PMID- 42941561 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20261027 LR - 20261028 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 15 IP - 20 DP - 2026 Oct 16 TI - Viscoelastic Hemostatic Testing as a Diagnostic Tool for Trauma-Induced Coagulopathy with a Focus on Arabian Gulf Countries: A Narrative Review. LID - 10.3390/jcm15208048 [doi] LID - 8048 AB - Trauma-induced coagulopathy (TIC) at admission to the emergency department is associated with severe bleeding, massive transfusion, increased morbidity, and mortality. There are significant regional variations in the accessibility and acceptance of point-of-care technology, such as viscoelastic hemostatic testing (VET), for coagulation monitoring and bleeding management in the Arabian Gulf council countries (GCC). Notable regional differences among these countries are mainly due to variation in the awareness of the benefits of VET-guided bleeding management using rotational thromboelastometry (ROTEM) or thromboelastography (TEG), compared with a transfusion ratio-based approach using shock packs, rather than for economic reasons. This review highlights the superiority of VET-guided bleeding management in severe trauma over conventional coagulation tests (CCTs) for early TIC detection and the importance of monitoring hemostatic disorders, whether hypocoagulability or hypercoagulability. VET consistently outperforms traditional coagulation tests in detecting early coagulation abnormalities and predicting massive transfusion and mortality in major trauma. Besides hyperfibrinolysis, fibrinogen deficiency often represents the first issue in TIC. Recent meta-analyses consistently demonstrated a reduction in mortality by implementing VET-guided bleeding management algorithms in severe trauma. Several studies demonstrated that VETs are valuable tools for massive transfusion and mortality prediction in bleeding patients with severe trauma. There is a notable variation in VET adoption and practice across trauma settings in the Arab Gulf. GCC-specific primary evidence is limited, with the Qatar cohort representing the largest directly identified regional study. FAU - Yassen, Khaled Ahmed AU - Yassen KA AUID- ORCID: 0000-0003-3483-0291 AD - Anesthesia Unit, Surgery Department, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Gorlinger, Klaus AU - Gorlinger K AUID- ORCID: 0000-0002-7315-9528 AD - Anesthesia Department, University of Duisburg, 45147 Essen, Germany. AD - Tem Innovations, 81829 Munich, Germany. FAU - Alzimami, Lama AU - Alzimami L AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alswilem, Noor Salman AU - Alswilem NS AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Almutairi, Amani AU - Almutairi A AUID- ORCID: 0009-0008-5159-3682 AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alsagheer, Mubarak AU - Alsagheer M AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alwayel, Hashim AU - Alwayel H AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alkhalaf, Ali Mousa AU - Alkhalaf AM AUID- ORCID: 0009-0000-8830-5607 AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Aljamaan, Nour Hassan AU - Aljamaan NH AUID- ORCID: 0009-0001-9621-2037 AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alqurqush, Noor AU - Alqurqush N AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alkhawajah, Amnah Ali AU - Alkhawajah AA AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Alhussain, Ridha AU - Alhussain R AUID- ORCID: 0009-0001-7082-5900 AD - College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Saleh, Sherif AU - Saleh S AUID- ORCID: 0000-0001-5586-1949 AD - Surgery Department, College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. FAU - Khan, Imtiyaz Ahmad AU - Khan IA AUID- ORCID: 0009-0004-5898-9250 AD - Surgery Department, College of Medicine, King Faisal University, Hofuf 31982, Alahsa, Saudi Arabia. LA - eng GR - Grant No. KFU 260/Deanship of Research, King Faisal University, AlAhsa Hofuf Saudi Arabia/ PT - Journal Article PT - Review DEP - 20261016 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC13706474 OTO - NOTNLM OT - fibrinolysis OT - hemostatic resuscitation OT - massive transfusion OT - rotational thromboelastometry OT - thromboelastography OT - trauma-induced coagulopathy OT - viscoelastic hemostatic testing COIS- Prof Klaus Gorlinger works as the Medical Director, Tem Innovations GmbH, 81829 Munich, Germany. The other authors declare no conflicts of interest. EDAT- 2026/10/27 11:32 MHDA- 2026/10/27 11:33 PMCR- 2026/10/16 CRDT- 2026/10/27 10:39 PHST- 2026/09/14 00:00 [received] PHST- 2026/10/02 00:00 [revised] PHST- 2026/10/06 00:00 [accepted] PHST- 2026/10/27 11:33 [medline] PHST- 2026/10/27 11:32 [pubmed] PHST- 2026/10/27 10:39 [entrez] PHST- 2026/10/16 00:00 [pmc-release] AID - jcm15208048 [pii] AID - jcm-15-08048 [pii] AID - 10.3390/jcm15208048 [doi] PST - epublish SO - J Clin Med. 2026 Oct 16;15(20):8048. doi: 10.3390/jcm15208048. PMID- 42932991 OWN - NLM STAT- Publisher LR - 20261026 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) DP - 2026 Oct 9 TI - Management of transfusion in traumatic hemorrhagic shock. LID - 10.1097/MCC.0000000000001437 [doi] AB - PURPOSE OF REVIEW: Traumatic hemorrhagic shock remains the leading preventable cause of early trauma death, with most deaths occurring within the first 24 h. This review summarizes recent advances in prediction tools, transfusion protocols, blood products and monitoring strategies for transfusion management. RECENT FINDINGS: Transfusion management relies on early activation of major hemorrhage protocols and rapid delivery of balanced blood components to limit coagulopathy and restore oxygen delivery. Prehospital transfusion appears most beneficial in the most severely injured patients, particularly with prolonged transport times, though its mortality benefit varies across trauma systems and patient phenotypes. Low-titer group O whole blood simplifies logistics and may improve early hemostasis, but randomized trials have not shown a clear survival advantage over component therapy. Viscoelastic testing complements empirical algorithms by enabling faster, targeted correction of fibrinogen and factor deficiency. Emerging data also highlight the prognostic impact of ionized calcium disturbances and the potential of machine-learning models for early risk stratification. SUMMARY: Current evidence supports a time-critical, system-based approach in which standardized transfusion bundles are triggered early and refined using viscoelastic guidance. Future work should prioritize prospective validation of decision-support tools, phenotype-specific strategies, clarification of whole blood's role, and rigorous evaluation of emerging blood products. CI - Copyright (c) 2026 Wolters Kluwer Health, LLC. All rights reserved. FAU - Werner, Marie AU - Werner M AD - Service d'Anesthesie Reanimation Chirurgicale, DMU 12 Anesthesie Reanimation Chirurgicale Medecine Peri-Operatoire et Douleur, Hopital Bicetre, AP-HP, Universite Paris-Saclay, Equipe DYNAMIC, Inserm UMR_S999, Le Kremlin-Bicetre, France. FAU - Bergis, Benjamin AU - Bergis B FAU - Harrois, Anatole AU - Harrois A LA - eng PT - Journal Article DEP - 20261009 PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM OTO - NOTNLM OT - blood transfusion OT - hemorrhage OT - severe trauma OT - shock OT - trauma-induced coagulopathy EDAT- 2026/10/26 23:27 MHDA- 2026/10/26 23:27 CRDT- 2026/10/26 17:43 PHST- 2026/10/26 23:27 [medline] PHST- 2026/10/26 23:27 [pubmed] PHST- 2026/10/26 17:43 [entrez] AID - 00075198-990000000-00395 [pii] AID - 10.1097/MCC.0000000000001437 [doi] PST - aheadofprint SO - Curr Opin Crit Care. 2026 Oct 9. doi: 10.1097/MCC.0000000000001437. PMID- 42920619 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20261024 LR - 20261025 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 13 DP - 2026 TI - Effects of rivaroxaban combined with clopidogrel on thrombotic risk and myocardial injury indicators in patients with coronary artery ectasia. PG - 1912975 LID - 10.3389/fcvm.2026.1912975 [doi] LID - 1912975 AB - OBJECTIVE: To investigate the association between rivaroxaban combined with clopidogrel therapy and thrombotic risk, platelet activation, myocardial injury biomarkers, and clinical outcomes in patients with coronary artery ectasia (CAE). METHODS: This single-center retrospective cohort study included 158 consecutive patients with CAE diagnosed by coronary angiography between June 2023 and June 2025. Patients receiving clopidogrel alone or rivaroxaban plus clopidogrel were compared. A 1:1 nearest-neighbor propensity score matching method was applied, generating 70 matched pairs. Thrombotic risk markers, including D-dimer (D-D), thrombin-antithrombin complex (TAT), and von Willebrand factor (vWF), platelet activation parameters [ADP-induced platelet aggregation rate (ADP-PAg) and CD62P], thromboelastography parameters [maximum amplitude (MA) and reaction time (R)], and myocardial injury-related biomarkers [high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB (CK-MB), heart-type fatty acid-binding protein (H-FABP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were evaluated at baseline and 6 months. Clinical outcomes, including thrombotic-related adverse cardiovascular events and bleeding events, were recorded during 12 months of follow-up. RESULTS: After propensity score matching, baseline characteristics were well balanced between groups. At 6 months, patients receiving rivaroxaban plus clopidogrel showed lower levels of D-D, TAT, vWF, ADP-PAg, CD62P, MA, hs-cTnT, CK-MB, H-FABP, and NT-proBNP, as well as prolonged R values, compared with those receiving clopidogrel alone (all P < 0.05). During follow-up, thrombotic-related adverse cardiovascular events occurred less frequently in the combination therapy group than in the clopidogrel group (7.14% vs. 20.00%, P = 0.027). Minor bleeding events were numerically higher in the combination therapy group (17.14% vs. 10.00%, P = 0.218), while no intracranial or fatal bleeding events occurred. CONCLUSION: Among patients with CAE, rivaroxaban combined with clopidogrel was associated with more favorable changes in coagulation activation, platelet activity, myocardial injury biomarkers, and thrombotic-related clinical outcomes compared with clopidogrel alone. These findings suggest that combined anticoagulant and antiplatelet therapy may represent a potential strategy for selected high-risk patients with CAE. Further multicenter prospective studies are required to confirm these observations. CI - (c) Geng, Feng, Wu, Xie, Xing, Wang, Liang, Liu and Gao. FAU - Geng, Tao AU - Geng T AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Feng, Mengwei AU - Feng M AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Wu, Yunjie AU - Wu Y AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Xie, Zhaoqing AU - Xie Z AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Xing, Jingxian AU - Xing J AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Wang, Deguang AU - Wang D AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Liang, Xue AU - Liang X AD - Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China. FAU - Liu, Juan AU - Liu J AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. FAU - Gao, Hui AU - Gao H AD - Department of Cardiology, Cangzhou Central Hospital of Hebei Medical University, Cangzhou City, Hebei Province, China. LA - eng PT - Journal Article DEP - 20261009 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC13690761 OTO - NOTNLM OT - antithrombotic therapy OT - clopidogrel OT - coronary artery ectasia OT - myocardial injury OT - platelet activation OT - rivaroxaban OT - thrombotic risk COIS- The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2026/10/24 05:35 MHDA- 2026/10/24 05:36 PMCR- 2026/10/09 CRDT- 2026/10/24 04:52 PHST- 2026/06/18 00:00 [received] PHST- 2026/07/25 00:00 [revised] PHST- 2026/08/03 00:00 [accepted] PHST- 2026/10/24 05:36 [medline] PHST- 2026/10/24 05:35 [pubmed] PHST- 2026/10/24 04:52 [entrez] PHST- 2026/10/09 00:00 [pmc-release] AID - 10.3389/fcvm.2026.1912975 [doi] PST - epublish SO - Front Cardiovasc Med. 2026 Oct 9;13:1912975. doi: 10.3389/fcvm.2026.1912975. eCollection 2026. PMID- 42902959 OWN - NLM STAT- MEDLINE DCOM- 20261022 LR - 20261023 IS - 1553-2712 (Electronic) IS - 1069-6563 (Print) IS - 1069-6563 (Linking) VI - 33 IP - 10 DP - 2026 Oct TI - Prognostic Value of Thromboelastography Parameters for Early Trauma-Induced Coagulopathy in Severely Injured Patients: A Retrospective Cohort Study. PG - e70423 LID - 10.1111/acem.70423 [doi] LID - e70423 AB - BACKGROUND AND IMPORTANCE: Early trauma-induced coagulopathy (eTIC) is a major contributor to hemorrhage-related mortality after severe trauma. Viscoelastic testing using thromboelastography (TEG) has been increasingly implemented in trauma resuscitation; however, its prognostic value compared with conventional coagulation testing remains uncertain. OBJECTIVES: We evaluated the ability of TEG parameters to detect eTIC, hypofibrinogenemia, and hyperfibrinolysis in severely injured trauma patients. In addition, we assessed their prognostic performance for transfusion requirements and mortality compared with conventional laboratory parameters. DESIGN: Retrospective single-center cohort study. SETTINGS AND PARTICIPANTS: Severely injured adult trauma patients admitted to the resuscitation room of a Level I trauma center, between January 2019 and October 2024 were screened. OUTCOME MEASURES AND ANALYSIS: Primary outcomes were detection of eTIC (INR > 1.2), severe coagulopathy (INR > 1.5), hypofibrinogenemia (< 200 mg/dL), and thrombocytopenia (< 100,000/muL). Secondary outcomes included the ability of coagulation parameters to predict the need for transfusion of >/= 5 units of packed red blood cells within the first 24 h after admission and in-hospital mortality. RESULTS: A total of 262 patients were included; median ISS was 29 (IQR 23-41), and in-hospital mortality was 22.8%. eTIC was present in 31.5% of patients. TEG parameters showed moderate discriminatory performance for coagulopathy detection. For eTIC, maximum amplitude achieved an AUC of 0.73, while R-time achieved an AUC of 0.65. Predictive performance improved for severe coagulopathy, with R-time reaching an AUC of 0.81. Hyperfibrinolysis (LY30 > 7%) was uncommon (6.9%). Conventional laboratory parameters, particularly INR, consistently outperformed TEG-derived parameters for prediction of transfusion requirements (AUC 0.85) and mortality (AUC 0.79). CONCLUSION: In severely injured trauma patients, conventional coagulation testing, particularly INR, demonstrated superior prognostic performance compared with individual TEG parameters. Viscoelastic testing may provide complementary information but did not replace standard laboratory testing for prediction of transfusion needs or mortality in this cohort. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07186712. CI - (c) 2026 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine. FAU - Honnef, Gabriel AU - Honnef G AUID- ORCID: 0000-0001-9006-075X AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Zoidl, Philipp AU - Zoidl P AUID- ORCID: 0000-0001-7643-3193 AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Hallmann, Barbara AU - Hallmann B AUID- ORCID: 0000-0003-0230-9039 AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Missmann, Moritz AU - Missmann M AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Eichinger, Michael AU - Eichinger M AUID- ORCID: 0000-0001-8510-1123 AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Niederer, Maximilian AU - Niederer M AUID- ORCID: 0000-0001-5330-8138 AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Zajic, Paul AU - Zajic P AUID- ORCID: 0000-0003-3097-1994 AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. LA - eng SI - ClinicalTrials.gov/NCT07186712 PT - Journal Article PT - Observational Study PL - United States TA - Acad Emerg Med JT - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JID - 9418450 SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Blood Coagulation Disorders/etiology/diagnosis/mortality MH - Blood Transfusion/statistics & numerical data MH - Injury Severity Score MH - Prognosis MH - Retrospective Studies MH - *Thrombelastography/methods MH - Trauma Centers MH - *Wounds and Injuries/complications/mortality PMC - PMC13684053 COIS- The authors declare no conflicts of interest. EDAT- 2026/10/22 13:25 MHDA- 2026/10/22 13:26 PMCR- 2026/10/21 CRDT- 2026/10/22 08:58 PHST- 2026/09/01 00:00 [revised] PHST- 2026/06/08 00:00 [received] PHST- 2026/09/24 00:00 [accepted] PHST- 2026/10/22 13:26 [medline] PHST- 2026/10/22 13:25 [pubmed] PHST- 2026/10/22 08:58 [entrez] PHST- 2026/10/21 00:00 [pmc-release] AID - ACEM70423 [pii] AID - 10.1111/acem.70423 [doi] PST - ppublish SO - Acad Emerg Med. 2026 Oct;33(10):e70423. doi: 10.1111/acem.70423. PMID- 42858166 OWN - NLM STAT- MEDLINE DCOM- 20261010 LR - 20261010 IS - 1938-2723 (Electronic) IS - 1076-0296 (Linking) VI - 32 DP - 2026 Jan-Dec TI - Perioperative Myocardial Injury and Infarction: Thrombotic Mechanisms, Diagnostic Challenges, and Antithrombotic Management. PG - 10760296261497045 LID - 10.1177/10760296261497045 [doi] AB - BackgroundPerioperative myocardial injury (PMI) and perioperative myocardial infarction (PMIn) are common, often clinically silent complications after noncardiac surgery and are associated with substantial short- and long-term mortality. Surgical stress promotes a prothrombotic milieu through platelet activation, coagulation cascade amplification, impaired fibrinolysis, endothelial dysfunction, and plaque destabilization.PurposeThis narrative review synthesizes current evidence on the thrombotic mechanisms, diagnostic challenges, and antithrombotic management of PMI/PMIn, with emphasis on risk stratification using coronary computed tomography angiography (CCTA) and thrombogenicity biomarkers.MethodsMajor perioperative cohort studies, randomized trials, scientific statements, and international guidelines were reviewed, including VISION, MANAGE, POISE, PANDA, the 2021 American Heart Association scientific statement, the 2024 American College of Cardiology/American Heart Association (ACC/AHA) perioperative guideline, and the 2022 European Society of Cardiology guideline.ResultsMost perioperative ischemic injury is clinically silent and frequently reflects oxygen supply-demand mismatch, whereas atherothrombotic plaque rupture with coronary thrombosis represents an important minority. Serial high-sensitivity troponin surveillance is central to detection, but interpretation requires exclusion of nonischemic causes and integration with electrocardiography, echocardiography, clinical context, and coronary anatomy. CCTA identifies vulnerable coronary anatomy, whereas D-dimer and thromboelastography-derived platelet-fibrin clot strength characterize a complementary vulnerable-blood phenotype. Antithrombotic therapy should be individualized: antiplatelet therapy and invasive evaluation are appropriate for Type 1 PMIn when bleeding risk permits, whereas dabigatran reduced major vascular complications in selected patients with myocardial injury after noncardiac surgery (MINS) in MANAGE.ConclusionsA multimodal strategy integrating clinical risk, coronary anatomy, postoperative troponin surveillance, and thrombogenicity assessment may improve perioperative risk discrimination and guide individualized prevention and treatment. FAU - Jang, Jeong Yoon AU - Jang JY AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Bae, Jae Seok AU - Bae JS AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Cho, Yun-Ho AU - Cho YH AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Shin, Yujin AU - Shin Y AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Choi, Han Ra AU - Choi HR AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Noh, Min Seok AU - Noh MS AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Lee, Hyeong Joo AU - Lee HJ AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 FAU - Kang, Min Gyu AU - Kang MG AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Kim, Yong-Lee AU - Kim YL AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Kim, Hye-Ree AU - Kim HR AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Lee, Hyo Jin AU - Lee HJ AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Kim, Kye-Hwan AU - Kim KH AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Hwang, Jin-Yong AU - Hwang JY AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Park, Sung-Eun AU - Park SE AD - Department of Radiology, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. FAU - Park, Jeong Rang AU - Park JR AD - Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. FAU - Ahn, Jong-Hwa AU - Ahn JH AUID- ORCID: 0000-0002-5446-0446 AD - Division of Cardiology, Department of Internal Medicine, Gyeongsang National UniversitySchool of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. RINGGOLD: 553954 LA - eng PT - Journal Article PT - Review DEP - 20261010 PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 RN - 0 (Fibrinolytic Agents) SB - IM MH - Humans MH - *Myocardial Infarction/diagnosis/drug therapy/etiology MH - *Fibrinolytic Agents/therapeutic use MH - *Thrombosis/drug therapy/diagnosis OTO - NOTNLM OT - antithrombotic therapy OT - coronary computed tomography angiography OT - dabigatran OT - myocardial injury after noncardiac surgery OT - perioperative myocardial infarction OT - perioperative myocardial injury OT - thromboelastography OT - thrombosis COIS- Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2026/10/11 04:08 MHDA- 2026/10/11 04:09 CRDT- 2026/10/10 18:38 PHST- 2026/10/11 04:09 [medline] PHST- 2026/10/11 04:08 [pubmed] PHST- 2026/10/10 18:38 [entrez] AID - 10.1177/10760296261497045 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2026 Jan-Dec;32:10760296261497045. doi: 10.1177/10760296261497045. Epub 2026 Oct 10. PMID- 42853261 OWN - NLM STAT- Publisher LR - 20261009 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) DP - 2026 Oct 9 TI - Survival benefit of prehospital TXA in fibrinolytic shutdown: Insights from two prospective trauma trials. LID - 10.1097/TA.0000000000005092 [doi] AB - BACKGROUND: Fibrinolytic phenotypes have been implicated in postinjury pathophysiology and outcomes. While prehospital tranexamic acid (TXA) administration has demonstrated survival benefits, the interaction between TXA administration and distinct fibrinolytic profiles remains poorly defined. METHODS: We analyzed data from a harmonized dataset combining 2 prospective trials evaluating prehospital TXA use in trauma (Prehospital Tranexamic Acid Use for Traumatic Brain Injury and the Study of Tranexamic Acid During Air and Ground Medical Prehospital Transport Trial). Patients were stratified by initial thromboelastographic (TEG) LY30 into fibrinolytic shutdown (<0.9%), hyperfibrinolysis (>3%), and physiological fibrinolysis (0.9-3%). The primary outcome was 30-day mortality. Secondary outcomes included 24-hour mortality and adverse events. Multivariable regression adjusted for TXA administration, fibrinolysis phenotypes, age, mechanism of injury, injury severity score, and shock index on presentation to the hospital. RESULTS: Among 1,249 patients, 30-day mortality was 14.5% in the fibrinolytic shutdown group, 6.7% in the hyperfibrinolysis group, and 6.5% in the physiological fibrinolysis group. After multivariable regression, hyperfibrinolysis was associated with increased risk of death (HR 2.87; 95% CI: 1.10-7.53; p 0.03). Patients with fibrinolytic shutdown who were randomized to TXA had decreased risk of death (HR 0.32; 95% CI: 0.11-0.91; p=0.03). CONCLUSIONS: This multitrial analysis revealed greater statistically significant differences between fibrinolytic phenotypes than analysis of each trial alone. Fibrinolytic phenotypes were independently associated with mortality. Fibrinolytic shutdown in patients randomized to receive TXA was associated with lower risk of death. These findings support the relevance of fibrinolysis profiling during early trauma care and underscore the need for larger studies to further elucidate the prognostic and therapeutic implications in trauma. LEVEL OF EVIDENCE: II (Subanalysis of Randomized Controlled Trials). CI - Copyright (c) 2026 Wolters Kluwer Health, LLC. All rights reserved. FAU - Kenny, James E AU - Kenny JE AUID- ORCID: 0000-0002-1274-2138 AD - Department of Surgery, Regions Hospital, Saint Paul, MN (J.E.K., N.L., E.C.); Department of Surgery, Oregon Health and Science University, Portland, OR (J.E.K., A.M.P.B.); Department of Surgery, The Queen's Medical Center, Honolulu HI (A.M.P.B.); Department of Surgery, University of Minnesota, Minneapolis, MN (M.B.C.); Emergency Services-Alfred Health, Melbourne, VIC, Australia (B.M.); Monash University School of Public Health and Preventive Medicine, Melbourne VIC, Australia (B.M., S.B.); Department of Surgery, University of Pittsburgh, Pittsburgh, PA (M.D.N., J.L.S.); College of Health and Medicine, Australian National University, Canberra, ACT, Australia (R.G.); Department of Surgery, University of Nebraska Medical Center, Omaha, NE (C.D.B.); Molecular Neurotrauma and Hemostasis Group, Monash University, Melbourne, VIC, Australia (R.M.); Department of Surgery, University of Chicago, Chicago, IL (S.R.); Uniformed Services University of the Health Sciences, Bethesda, MD (M.A.S.). FAU - Brito, Alexandra Mp AU - Brito AM FAU - Benchiba-Charron, Myriam AU - Benchiba-Charron M FAU - Larson, Nicholas AU - Larson N FAU - Chrenka, Ella AU - Chrenka E FAU - Mitra, Biswadev AU - Mitra B FAU - Neal, Matthew D AU - Neal MD FAU - Gruen, Russell AU - Gruen R FAU - Barrett, Christopher D AU - Barrett CD FAU - Bernard, Stephen AU - Bernard S FAU - Medcalf, Robert AU - Medcalf R FAU - Rowell, Susan AU - Rowell S FAU - Sperry, Jason L AU - Sperry JL FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Journal Article DEP - 20261009 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM OTO - NOTNLM OT - Tranexamic acid OT - fibrinolysis OT - traumatic brain injury OT - traumatic hemorrhage EDAT- 2026/10/09 17:34 MHDA- 2026/10/09 17:34 CRDT- 2026/10/09 11:04 PHST- 2025/12/01 00:00 [received] PHST- 2026/05/15 00:00 [accepted] PHST- 2026/10/09 17:34 [medline] PHST- 2026/10/09 17:34 [pubmed] PHST- 2026/10/09 11:04 [entrez] AID - 01586154-990000000-01526 [pii] AID - 10.1097/TA.0000000000005092 [doi] PST - aheadofprint SO - J Trauma Acute Care Surg. 2026 Oct 9. doi: 10.1097/TA.0000000000005092. PMID- 42815292 OWN - NLM STAT- MEDLINE DCOM- 20261026 LR - 20261026 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 327 DP - 2026 Nov TI - Defining Rotational Thromboelastometry Thresholds for Fibrinolysis Phenotyping and Massive Transfusion Prediction in Trauma. PG - 343-351 LID - S0022-4804(26)00566-4 [pii] LID - 10.1016/j.jss.2026.08.056 [doi] AB - INTRODUCTION: Fibrinolysis, or clot breakdown, is a major contributor to death in severely injured patients. Thromboelastography (TEG) has established cutoffs for fibrinolysis phenotypes, hyperfibrinolysis, physiologic fibrinolysis, and fibrinolytic shutdown, but analogous thresholds for rotational thromboelastometry (ROTEM) remain limited. This study aimed to characterize fibrinolysis phenotypes using ROTEM and identify predictors of massive transfusion (MT) in trauma patients. METHODS: Among 2474 trauma patients who underwent ROTEM testing at an adult level I trauma center from 2018 to 2024, 2257 had an available EXTEM maximum lysis (ML) value and were included in the fibrinolysis phenotype analysis. Patients were categorized by EXTEM ML: shutdown (ML < 3%), physiologic (ML 3-15%), or hyperfibrinolysis (ML > 15%). The primary outcome was MT within 4 h; secondary outcomes included 24-h transfusion requirements, length of stay, and mortality. RESULTS: The median age was 46 y; 70.9% were male, and the median Injury Severity Score was 24.3. Hyperfibrinolysis occurred in 5.3% (n = 119), physiologic fibrinolysis in 64.6% (n = 1458), and shutdown in 30.1% (n = 680). Mortality was highest in hyperfibrinolysis (58.0%; 95% confidence interval [CI]: 49.0-66.5%) versus physiologic (10.6%; 95% CI: 9.2-12.3%) and shutdown (20.4%; 95% CI: 17.6-23.6%) (P < 0.001). MT within 4 h was 37.0% (95% CI: 28.8-45.9%) in hyperfibrinolysis versus 6.9% (95% CI: 5.7-8.3%) and 11.3% (95% CI: 9.2-13.9%), respectively. CONCLUSIONS: This study externally validates previously described ROTEM-specific EXTEM ML thresholds for fibrinolysis phenotyping in an independent trauma cohort. Hyperfibrinolysis strongly predicted MT and was associated with high mortality, whereas shutdown identified a distinct high-risk group. These findings support integration of ROTEM-specific fibrinolysis criteria into trauma protocols and prospective evaluation of phenotype-directed resuscitation strategies. CI - Copyright (c) 2026 Elsevier Inc. All rights reserved. FAU - Meade, Rodrigo AU - Meade R AD - College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Bowman, Stephen M AU - Bowman SM AD - Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Jensen, Hanna K AU - Jensen HK AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Kalkwarf, Kyle J AU - Kalkwarf KJ AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: kjkalkwarf@uams.edu. LA - eng PT - Journal Article DEP - 20260930 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Humans MH - *Thrombelastography/standards/methods MH - *Fibrinolysis MH - Male MH - *Blood Transfusion/statistics & numerical data MH - *Wounds and Injuries/blood/therapy/mortality/complications/diagnosis MH - Female MH - Middle Aged MH - Adult MH - Phenotype MH - Injury Severity Score MH - Retrospective Studies MH - Predictive Value of Tests MH - Trauma Centers/statistics & numerical data OTO - NOTNLM OT - Fibrinolysis OT - Massive transfusion OT - Maximum lysis OT - ROTEM (Rotational Thromboelastometry) OT - Viscoelastic testing EDAT- 2026/09/30 23:30 MHDA- 2026/10/26 23:26 CRDT- 2026/09/30 18:13 PHST- 2026/03/18 00:00 [received] PHST- 2026/08/25 00:00 [revised] PHST- 2026/08/27 00:00 [accepted] PHST- 2026/10/26 23:26 [medline] PHST- 2026/09/30 23:30 [pubmed] PHST- 2026/09/30 18:13 [entrez] AID - S0022-4804(26)00566-4 [pii] AID - 10.1016/j.jss.2026.08.056 [doi] PST - ppublish SO - J Surg Res. 2026 Nov;327:343-351. doi: 10.1016/j.jss.2026.08.056. Epub 2026 Sep 30. PMID- 42801447 OWN - NLM STAT- Publisher LR - 20260927 IS - 1573-742X (Electronic) IS - 0929-5305 (Linking) DP - 2026 Sep 27 TI - Methodological Approaches in the Evaluation of Platelet Structure and Function: An Instrumental Perspective. LID - 10.1007/s11239-026-03401-5 [doi] AB - Platelets are anucleate yet metabolically active cells that play essential roles in hemostasis, thrombosis, and inflammation by rapidly responding to vascular injury and maintaining vascular integrity. Alteration of platelets can lead to bleeding disorders or thrombotic complications. Therefore, studying their structural and functional properties is essential for understanding their roles in both physiological and pathological processes. Recent advances in experimental techniques have revolutionized platelet research. It has allowed high-resolution structural visualization, precise functional assessment, and detailed mapping of interplatelet interactions. Recently, platelet count and structure have been assessed using specialized techniques. For example, automated hematology analyzers provide accurate platelet counts, while light and electron microscopy reveal platelet morphology and ultrastructure. Flow cytometry evaluates platelet size, granularity, and surface markers. In addition, the platelet function is assessed through different instruments and assays. For example, adhesion is studied using microscopy-based assays, aggregation by light transmission aggregometry. Similarly, activation, and secretion are measured by fluorescence microscopy or flow cytometry. The clot retraction is evaluated using Sonoclot or thromboelastography. Although, several studies have described techniques for assessing the platelet count, structure and function, a single comprehensive narrative review is lacking. Therefore, in this review, we summarize current techniques for assessing platelet structure and function. We also cover both classical and newly developed methods. We highlight recent technical advances and analytical challenges. In addition, we discuss innovations such as artificial intelligence-assisted data analysis. This review aims to help researchers select appropriate methods for studying platelet biology and its role in health and disease. CI - (c) 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Beura, Samir Kumar AU - Beura SK AUID- ORCID: 0000-0003-2463-190X AD - Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, 151401, Punjab, India. FAU - Kulkarni, Paresh P AU - Kulkarni PP AUID- ORCID: 0000-0002-9108-0485 AD - Department of Heart, Blood and Kidney Research, Cleveland Clinic Research, Cleveland, OH, 44195, USA. FAU - Singh, Sunil Kumar AU - Singh SK AUID- ORCID: 0000-0001-6603-6282 AD - Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, 151401, Punjab, India. sunil.singh@cup.edu.in. LA - eng PT - Journal Article PT - Review DEP - 20260927 PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 SB - IM OTO - NOTNLM OT - Anatomical structure OT - Blood platelets OT - Functional parameters OT - Technical methods COIS- Declarations. Competing interests: The authors declare no competing interests. Ethical Consent: Not applicable. EDAT- 2026/09/27 17:31 MHDA- 2026/09/27 17:31 CRDT- 2026/09/27 11:08 PHST- 2026/07/13 00:00 [received] PHST- 2026/09/15 00:00 [accepted] PHST- 2026/09/27 17:31 [medline] PHST- 2026/09/27 17:31 [pubmed] PHST- 2026/09/27 11:08 [entrez] AID - 10.1007/s11239-026-03401-5 [pii] AID - 10.1007/s11239-026-03401-5 [doi] PST - aheadofprint SO - J Thromb Thrombolysis. 2026 Sep 27. doi: 10.1007/s11239-026-03401-5. PMID- 42786382 OWN - NLM STAT- Publisher LR - 20260925 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) DP - 2026 Sep 24 TI - Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine. LID - 10.1007/s12028-026-02601-4 [doi] AB - BACKGROUND: Antithrombotic-associated intracranial hemorrhage (ICH) is a life-threatening condition, and rapid treatment in the setting of antithrombotic agents may limit hematoma expansion and improve outcomes. This focused update evaluated the available evidence after publication of the 2016 guidelines. METHODS: The Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, generated five questions to guide a systematic review and meta-analysis. Three of these questions update prior recommendations, while two are newly introduced. Each question followed a Population, Intervention, Comparator, Outcome (PICO) framework and focused on the management of acute ICH including spontaneous intraparenchymal hemorrhage (IPH) and traumatic ICH. The topics addressed were: (1) andexanet alfa versus 4-factor prothrombin complex concentrate (4F-PCC) for treatment of oral factor Xa inhibitor effects; (2) platelet transfusion versus no transfusion for treatment in the setting of antiplatelet agent use; (3) desmopressin versus no desmopressin for treatment in the setting of antiplatelet agent use; (4) treatment of anticoagulant effects versus no treatment in the setting of small IPH; and (5) use of viscoelastic hemostatic assays (VHAs) to treat coagulopathy in traumatic ICH. Recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS: The panel generated eight recommendations. For patients with acute ICH, the panel issued the following conditional recommendations: use 4F-PCC rather than andexanet alfa for the treatment of the anticoagulant effects of factor Xa inhibitors, avoid platelet transfusion in non-neurosurgical patients with spontaneous IPH on antiplatelet agents, administer platelet transfusion in patients with spontaneous IPH on aspirin who are undergoing surgery, and use VHAs to guide treatment of coagulopathy in traumatic ICH. The panel was unable to issue recommendations regarding platelet transfusion for treatment of antiplatelet effects in traumatic ICH, use of desmopressin for treatment of antiplatelet effects, or treatment of anticoagulant effects in small IPH. CONCLUSIONS: The guideline writing panel provided new conditional recommendations for the treatment of antithrombotic-associated acute ICH. These recommendations are intended for consideration along with the patient's clinical status and patient-specific factors. CI - (c) 2026. The Author(s). FAU - Vallejo, Meghan Caylor AU - Vallejo MC AUID- ORCID: 0000-0002-8164-8145 AD - Department of Pharmacy, Temple University Hospital, Philadelphia, PA, USA. mmcaylor@gmail.com. FAU - Kennedy, Lori S AU - Kennedy LS AD - Center for Nursing Science, UC Davis Health, Sacramento, CA, USA. AD - Betty Irene Moore School of Nursing at UC Davis, Davis, CA, USA. FAU - Dengler, Bradley AU - Dengler B AD - Military Traumatic Brain Injury Initiative, Uniformed Services University, Bethesda, MD, USA. FAU - Barthol, Colleen AU - Barthol C AD - Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA. FAU - Belley-Cote, Emilie P AU - Belley-Cote EP AD - Department of Medicine, Divisions of Cardiology and Critical Care, McMaster University, Hamilton, ON, Canada. AD - Population Health Research Institute, Hamilton, ON, Canada. FAU - Burns, Joseph D AU - Burns JD AD - Division of Neurology, Section of Neurocritical Care, Lahey Hospital and Medical Center, Burlington, MA, USA. AD - Department of Neurology, UMass Chan Medical School, Worcester, MA, USA. FAU - Chau, Veda K AU - Chau VK AD - Stanford Health Care, Neurocritical Care, Palo Alto, CA, USA. FAU - Cordonnier, Charlotte AU - Cordonnier C AD - University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France. FAU - Cuker, Adam AU - Cuker A AD - Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. FAU - Honarmand, Kimia AU - Honarmand K AD - Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, Canada. FAU - Mahmoud, Sherif Hanafy AU - Mahmoud SH AD - Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada. FAU - Wilcox, M Elizabeth AU - Wilcox ME AD - Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. AD - Neurosciences and Mental Health Institute, University of Alberta, Edmonton, AB, Canada. FAU - Kumar, Monisha A AU - Kumar MA AD - Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA, USA. LA - eng PT - Journal Article DEP - 20260924 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM CIN - Neurocrit Care. 2026 Sep 24. doi: 10.1007/s12028-026-02639-4. PMID: 42786384 OTO - NOTNLM OT - Anticoagulant OT - Antidote OT - Antiplatelet OT - Antithrombotic OT - Apixaban OT - Aspirin OT - Blood products OT - Clopidogrel OT - DDAVP OT - Desmopressin OT - Evidence-based medicine OT - Factor Xa inhibitor OT - GRADE criteria, guidelines OT - Grading of Recommendations Assessment, Development, and Evaluation criteria OT - ICH OT - Intracerebral hemorrhage OT - Intracranial hemorrhage OT - Intraparenchymal hemorrhage OT - PCC OT - Platelets OT - Prothrombin complex concentrates OT - Reversal OT - Rivaroxaban OT - SAH OT - SDH OT - Subarachnoid hemorrhage OT - Subdural hematoma OT - Thromboelastography OT - Traumatic brain injury OT - Viscoelastic hemostatic assays COIS- Conflicts of Interest: Charlotte Cordonnier discloses the following: (i) Financial: Honoraria from Bayer (modest, $500-50,000) for her role on a Steering Committee for a phase 3 trial for Factor XI inhibitors (ii) Intellectual: TIPITCH project Coordinator-Funded by the France 2030-aims at transforming the prognosis of intracerebral hemorrhage with a special focus on bleeding associated with oral anticoagulants. Member of the writing committees for ESO ICH guidelines 2025 and AHA/ASA ICH guidelines (2022). Adam Cuker discloses the following: (i) Financial: Honorarium from Pfizer (modest, $500-50,000) for his role as a consultant. Authorship royalties (modest, $500-50,000) from UpToDate for his role as an author. Emilie Belley-Cote discloses the following: (i) Financial: Research grant from Abbott (significant: > $50,000) for her role as a researcher to fund a trial assessing different INR targets for mechanical valves. Joseph Burns discloses the following: (i) Intellectual: serves as a member of the editorial board for Neurology and Neurocritical Care. Ethical Approval: No IRB approval was necessary for writing this guideline. Artificial Intelligence: Artificial intelligence was not used in the development or writing of this manuscript. EDAT- 2026/09/25 05:32 MHDA- 2026/09/25 05:32 CRDT- 2026/09/24 23:47 PHST- 2026/02/25 00:00 [received] PHST- 2026/07/02 00:00 [accepted] PHST- 2026/09/25 05:32 [pubmed] PHST- 2026/09/25 05:32 [medline] PHST- 2026/09/24 23:47 [entrez] AID - 10.1007/s12028-026-02601-4 [pii] AID - 10.1007/s12028-026-02601-4 [doi] PST - aheadofprint SO - Neurocrit Care. 2026 Sep 24. doi: 10.1007/s12028-026-02601-4. PMID- 42778196 OWN - NLM STAT- Publisher LR - 20260923 IS - 1423-0410 (Electronic) IS - 0042-9007 (Linking) DP - 2026 Sep 23 TI - Rotational thromboelastometry-guided transfusion in acute trauma: Less plasma, greater precision. LID - 10.1111/vox.70378 [doi] AB - BACKGROUND AND OBJECTIVES: Effective transfusion management is essential in trauma patients with active bleeding. In this study, we aimed to evaluate the association between point-of-care rotational thromboelastometry (ROTEM)-guided management, blood-component utilization, and clinical outcomes. MATERIALS AND METHODS: We conducted a retrospective comparative cohort study of 200 trauma patients with active bleeding admitted between October 2023 and March 2025. One-hundred patients received ROTEM-guided management and 100 were managed using conventional coagulation tests. Blood-component utilization during the first 24 h and clinical outcomes were analyzed using multivariable models adjusted for relevant baseline variables. RESULTS: ROTEM-guided management was associated with lower fresh frozen plasma utilization (adjusted incidence rate ratio [aIRR] 0.36, 95% confidence interval [CI]: 0.24-0.55), higher cryoprecipitate utilization (aIRR 1.92, 95% CI: 1.40-2.66), and shorter intensive care unit (ICU) stay. Adjusted red blood cell (RBC) and platelet utilization did not differ between groups. Maximum clot firmness in the fibrin-based thromboelastometry assay correlated strongly with fibrinogen concentration, and clot formation time in the extrinsically activated thromboelastometry assay correlated inversely with platelet count. Differences in transfusion-related complications and in-hospital mortality were not statistically significant. CONCLUSION: ROTEM-guided management was associated with lower plasma utilization, higher cryoprecipitate utilization, and shorter ICU stay. Given the retrospective, non-randomized design and low RBC exposure, these findings should not be interpreted as evidence that ROTEM reduced bleeding severity or RBC requirements, particularly in massive-transfusion populations. Prospective studies in trauma patients with massive hemorrhage are required to evaluate the utility of ROTEM in guiding specific hemostatic blood-product transfusions. CI - (c) 2026 International Society of Blood Transfusion. FAU - Dinic, Radovan AU - Dinic R AD - Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia. FAU - Sabani, Almira AU - Sabani A AD - Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia. FAU - Zivotic, Biljana AU - Zivotic B AD - Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia. FAU - Horvacki, Neda AU - Horvacki N AD - Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia. FAU - Mladenovic, Nenad AU - Mladenovic N AD - Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center, University Clinical Center of Serbia, Belgrade, Serbia. FAU - Grujic, Jasmina AU - Grujic J AUID- ORCID: 0000-0003-3092-4768 AD - Department of Transfusiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. AD - Department of Laboratory Diagnostics, Blood Transfusion Institute of Vojvodina, Novi Sad, Serbia. LA - eng PT - Journal Article DEP - 20260923 PL - England TA - Vox Sang JT - Vox sanguinis JID - 0413606 SB - IM OTO - NOTNLM OT - ROTEM OT - hemostatic resuscitation OT - point-of-care diagnostics OT - transfusion management OT - trauma-induced coagulopathy OT - viscoelastic testing EDAT- 2026/09/23 23:56 MHDA- 2026/09/23 23:56 CRDT- 2026/09/23 20:23 PHST- 2026/08/19 00:00 [revised] PHST- 2025/10/31 00:00 [received] PHST- 2026/09/09 00:00 [accepted] PHST- 2026/09/23 23:56 [medline] PHST- 2026/09/23 23:56 [pubmed] PHST- 2026/09/23 20:23 [entrez] AID - 10.1111/vox.70378 [doi] PST - aheadofprint SO - Vox Sang. 2026 Sep 23. doi: 10.1111/vox.70378. PMID- 42762956 OWN - NLM STAT- Publisher LR - 20261002 IS - 1095-9319 (Electronic) IS - 0026-2862 (Linking) VI - 169 DP - 2026 Sep 19 TI - Viscoelastic hemostatic assays in trauma-induced coagulopathy: Precision transfusion, fibrinolytic phenotyping, and future directions. PG - 105023 LID - S0026-2862(26)00123-8 [pii] LID - 10.1016/j.mvr.2026.105023 [doi] AB - Trauma-induced coagulopathy (TIC) is a rapidly evolving hemostatic disorder that develops early after severe injury and remains a major determinant of hemorrhagic mortality and thrombotic complications. Conventional coagulation tests provide limited information on the dynamic interactions among coagulation factors, platelets, fibrinogen, and fibrinolysis, often delaying targeted intervention. Viscoelastic hemostatic assays (VHAs), thromboelastography and rotational thromboelastometry, offer real-time whole-blood assessment of clot initiation, propagation, strength, and lysis. This narrative review synthesizes evidence on TIC pathophysiology, emphasizing shock-induced endotheliopathy, activated protein C signaling, platelet dysfunction, and the fibrinolytic spectrum. VHA-guided transfusion is examined against fixed-ratio protocols and low-titer group O whole blood. Equal attention is given to the boundaries of these assays. Because VHAs are static, low-shear tests performed without a vascular surface, they do not interrogate platelet adhesion and cannot detect the receptor shedding characteristic of exhausted platelet syndrome; a normal clot strength with an adequate platelet count may therefore coexist with impaired platelet plug formation. Initiation parameters are sensitive to acidosis, hypothermia, and endogenous heparinoids independently of factor concentration, and conventional assays cannot distinguish pathologic fibrinolytic shutdown from hypo-fibrinolysis. Two constraints limit generalizability of published thresholds. Parameters are not interchangeable between manufacturers or between device generations, so thresholds cannot be transferred, a limitation that also constrains meta-analysis. Reference values differ systematically by sex and age, and current trauma thresholds derive from predominantly male cohorts. Emerging approaches include provocative tissue plasminogen activator-challenged testing, dielectric coagulometry, and flow-based microfluidic assays that interrogate adhesion under shear. CI - Copyright (c) 2026. Published by Elsevier Inc. FAU - Wu, Lingyan AU - Wu L AD - Longyou County People's Hospital Laboratory Department, Longyou, Zhejiang, 324400, China. Electronic address: 15605709177@163.com. FAU - Ben, Jianhua AU - Ben J AD - Longyou County People's Hospital Laboratory Department, Longyou, Zhejiang, 324400, China. Electronic address: jianhua.ben1200@atomicmail.io. FAU - Lu, Jun AU - Lu J AD - Department of Laboratory Medicine, Longyou County People's Hospital, Longyou, Zhejiang Province, 324400, China. Electronic address: 13656700603@139.com. LA - eng PT - Journal Article PT - Review DEP - 20260919 PL - United States TA - Microvasc Res JT - Microvascular research JID - 0165035 SB - IM OTO - NOTNLM OT - Artificial intelligence OT - Fibrinolytic phenotyping OT - Microfluidic coagulation assays OT - Platelet dysfunction OT - Transfusion strategies OT - Trauma-induced coagulopathy OT - Viscoelastic hemostatic assays COIS- Declaration of competing interest The authors declare that they have no competing interests. EDAT- 2026/09/19 23:52 MHDA- 2026/09/19 23:52 CRDT- 2026/09/19 19:15 PHST- 2026/07/11 00:00 [received] PHST- 2026/09/02 00:00 [revised] PHST- 2026/09/16 00:00 [accepted] PHST- 2026/09/19 23:52 [pubmed] PHST- 2026/09/19 23:52 [medline] PHST- 2026/09/19 19:15 [entrez] AID - S0026-2862(26)00123-8 [pii] AID - 10.1016/j.mvr.2026.105023 [doi] PST - aheadofprint SO - Microvasc Res. 2026 Sep 19;169:105023. doi: 10.1016/j.mvr.2026.105023. PMID- 42759550 OWN - NLM STAT- Publisher LR - 20260918 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) DP - 2026 Sep 18 TI - Evaluation of Platelet Contribution to Clot Strength in Neonates with Perinatal Hypoxia Using Rotational Thromboelastometry. LID - 10.1055/a-2949-4349 [doi] AB - The hemostatic derangement of neonates with perinatal hypoxia is of multifactorial origin and may be attributed to ischemic tissue injury, acute blood loss, or disseminated intravascular coagulation. However, the pathophysiological mechanisms of thrombocytopenia, a common hematological finding in neonates with perinatal hypoxia, remain unclear. The aim of the present study was to evaluate the contribution of platelets to clot formation and clot strength in neonates with perinatal hypoxia using rotational thromboelastometry (ROTEM). This prospective cohort study included 139 neonates with perinatal hypoxia and 106 healthy neonates. Demographics and clinical findings were recorded, while hematological and biochemical tests, along with ROTEM, extrinsically activated test (EXTEM), and fibrin clot obtained by platelet inhibition with cytochalasin D (FIBTEM) assays, were performed in all study neonates. ROTEM parameters differed significantly between the two study groups; prolonged clotting time and clot formation time, lower clot amplitude at 10 minutes (A10) and maximum clot firmness (MCF) values, as well as lower PLTEM MCF (the difference between EXTEM MCF and FIBTEM MCF) and PLTEM MCE (the difference between EXTEM MCE and FIBTEM MCE) values were recorded in hypoxic neonates. Neonates with perinatal hypoxia demonstrate a hypocoagulable profile, with decelerated coagulation activation, reduced clot formation and stability, impaired fibrinolysis, and significantly reduced platelet contribution to clot dynamics. CI - Thieme. All rights reserved. FAU - Konstantinidi, Aikaterini AU - Konstantinidi A AUID- ORCID: 0000-0003-4966-6826 AD - "Agios Panteleimon" General Hospital of Nikaia, Neonatal Intensive Care Unit, Greece, Piraeus. FAU - Sokou, Rozeta AU - Sokou R AUID- ORCID: 0000-0002-9972-8901 AD - Aretaieion Hospital, National and Kapodistrian University of Athens, Neonatal Department, Greece, Athens. FAU - Tsantes, Andreas G AU - Tsantes AG AUID- ORCID: 0000-0002-3695-0759 AD - "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Laboratory of Haematology and Blood Bank Unit, Greece, Athens. FAU - Lampridou, Maria AU - Lampridou M AD - "Agios Panteleimon" General Hospital of Nikaia, Neonatal Intensive Care Unit, Greece, Piraeus. FAU - Ioakeimidis, Georgios AU - Ioakeimidis G AD - "Agios Panteleimon" General Hospital of Nikaia, Neonatal Intensive Care Unit, Greece, Piraeus. FAU - Tavoulari, Evangelia-Filothei AU - Tavoulari EF AD - "Agios Panteleimon" General Hospital of Nikaia, Neonatal Intensive Care Unit, Greece, Piraeus. FAU - Mougiou, Vasiliki AU - Mougiou V AD - Aretaieion Hospital, National and Kapodistrian University of Athens, Neonatal Department, Greece, Athens. FAU - Iliodromiti, Zoi AU - Iliodromiti Z AD - Aretaieion Hospital, National and Kapodistrian University of Athens, Neonatal Department, Greece, Athens. FAU - Tsantes, Argirios E AU - Tsantes AE AD - "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Laboratory of Haematology and Blood Bank Unit, Greece, Athens. FAU - Iacovidou, Nicoletta AU - Iacovidou N AD - Aretaieion Hospital, National and Kapodistrian University of Athens, Neonatal Department, Greece, Athens. LA - eng PT - Journal Article DEP - 20260918 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM COIS- The authors declare that they have no conflict of interest. EDAT- 2026/09/18 23:36 MHDA- 2026/09/18 23:36 CRDT- 2026/09/18 19:07 PHST- 2026/09/18 23:36 [medline] PHST- 2026/09/18 23:36 [pubmed] PHST- 2026/09/18 19:07 [entrez] AID - 10.1055/a-2949-4349 [doi] PST - aheadofprint SO - Semin Thromb Hemost. 2026 Sep 18. doi: 10.1055/a-2949-4349. PMID- 42758066 OWN - NLM STAT- Publisher LR - 20260918 IS - 1527-2966 (Electronic) IS - 0099-1767 (Linking) DP - 2026 Sep 17 TI - Challenges, Advances, and Contemporary Developments in Trauma Care in Emergency Departments: A Scoping Review. LID - S0099-1767(26)00307-7 [pii] LID - 10.1016/j.jen.2026.08.011 [doi] AB - INTRODUCTION: Trauma is a leading cause of death worldwide, with emergency departments playing a pivotal role in the period from injury to emergency stabilization and treatment. Despite advances in trauma care, emergency department trauma management continues to face clinical, operational, and psychosocial challenges. This scoping review synthesizes evidence on challenges, innovations, and outcomes in emergency department-based trauma care, covering prehospital, in-hospital, system-level, and psychosocial aspects. METHODS: We conducted a literature search PubMed, Scopus, and Web of Science (2020-May 2025) using MeSH and free-text terms. Eligible studies included original research and syntheses on emergency department trauma interventions, systems, and outcomes. Twelve studies were ultimately included. RESULTS: Persistent challenges include communication failures during handover, delayed airway or hemorrhage control, trauma-induced coagulopathy, under-triage of elderly or high-risk patients, and clinician burnout. Concurrent innovations include damage-control resuscitation, resuscitative endovascular balloon occlusion of the aorta, viscoelastic testing, hybrid emergency department models, early tranexamic acid administration, and enhanced triage. Trauma-informed and palliative care approaches may enhance patient-centeredness, while artificial intelligence, predictive analytics, and remote monitoring show promise for future applications. Despite these advances, implementation barriers and evidence gaps remain. DISCUSSION: Although emergency department trauma care has improved in efficiency and precision, gaps persist in communication, early stabilization, geriatric care, and provider well-being. Future research should prioritize multicenter trials, long-term functional outcomes, cost-effectiveness, and the equitable implementation of scalable models to strengthen global trauma systems. CI - Copyright (c) 2026 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. FAU - Shahcheragh, Seyyed Hossein AU - Shahcheragh SH FAU - Moonesan, Mohammad Reza AU - Moonesan MR FAU - Babamohamadi, Hassan AU - Babamohamadi H LA - eng PT - Journal Article DEP - 20260917 PL - United States TA - J Emerg Nurs JT - Journal of emergency nursing JID - 7605913 SB - IM OTO - NOTNLM OT - Prehospital to ED transition OT - Resuscitation advances OT - Technological advances in trauma care OT - Trauma care emergency department OT - Trauma care innovation OT - Trauma management challenges OT - Trauma-informed care EDAT- 2026/09/18 12:26 MHDA- 2026/09/18 12:26 CRDT- 2026/09/18 10:29 PHST- 2026/06/28 00:00 [received] PHST- 2026/08/14 00:00 [revised] PHST- 2026/08/17 00:00 [accepted] PHST- 2026/09/18 12:26 [medline] PHST- 2026/09/18 12:26 [pubmed] PHST- 2026/09/18 10:29 [entrez] AID - S0099-1767(26)00307-7 [pii] AID - 10.1016/j.jen.2026.08.011 [doi] PST - aheadofprint SO - J Emerg Nurs. 2026 Sep 17:S0099-1767(26)00307-7. doi: 10.1016/j.jen.2026.08.011. PMID- 42756045 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260918 LR - 20260919 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 13 DP - 2026 TI - A refined phenomenological model of viscoelastic clot formation and lysis in trauma-induced coagulopathy. PG - 1816085 LID - 10.3389/fcvm.2026.1816085 [doi] LID - 1816085 AB - BACKGROUND: Hyperfibrinolysis is strongly associated with early post-injury mortality, but the condition is preventable with timely detection and targeted interventions. Unfortunately, current hyperfibrinolysis diagnostic assays such as thromboelastography (TEG) are time-consuming, making them infeasible for use in real-time treatment strategies to guide adjustable, precise, and personalized interventions. Computational models offer a fast alternative to current practice for ascertaining patient hemostatic state from quickly-measurable protein concentrations. However, few models exist to predict clot strength. Our prior biologically-interpretable, phenomenological, dynamical system TEG model does not often satisfactorily capture hyperfibrinolysis because this feature was missing from training data. Here, we present model improvements that are experimentally-driven and theoretically-grounded to better facilitate the replacement of slow patient viscoelastic clotting measurements, with and without hyperfibrinolysis, by rapid and accurate predictions of TEG parameters in silico. METHODS: We created a tPATXA dataset to enable model refinements, and we validated TEG parameter predictions using the published Activation of Coagulation and Inflammation in Trauma (ACIT) dataset, which was excluded from model training. Our tPATXA dataset consists of 310 citrated native (CN) TEG assay profiles that were generated from healthy human donor whole blood samples spiked with tissue plasminogen activator (tPA) and tranexamic acid (TXA) at varying concentrations to provide added phenomenological information about fibrinolysis behavior. We then used ACIT clinical data from 93 trauma patients containing 254 citrated kaolin (CK) and 122 citrated kaolin with heparinase (CKH) TEG assays for model validation. We characterized model performance by: the coefficient of determination R2 ; percent-error predictions of TEG parameters R-time, K-time, alpha angle, maximum amplitude, and time to maximum amplitude; and absolute errors of TEG parameters Ly30 and Ly60. RESULTS: Our key model update is to make a previously-constant parameter a time-varying function. Our updated model substantially outperforms the prior model in both datasets. On the tPATXA dataset that both models were trained on and then subsequently predicted to verify competency, the model updates improved R2 from 0.9726 to 0.9983. On the ACIT validation dataset that was not used for training, the model updates improved R2 from 0.9848 to 0.9993, and reduced TEG parameter prediction variance by over 99%. In addition, the updated model had low prediction errors of 1%-13% for R-time, K-time, alpha angle, maximum amplitude, and time to maximum amplitude, and 0.7%-2.2% for Ly30 and Ly60. A mechanistic interpretation of the new parameter is its capture of the formation and breakdown of a fibrin clot mesh over time. CONCLUSIONS: Our refined model offers higher accuracy, consistency, and biological interpretability than previously available. Our updated model's modular design supports future integration with literature phenomenological models that predict thrombin dynamics, as well as with externally-added controllers for automation. Thus, this work captures broad clinical coagulation insights and also lays the groundwork for real-time, personalized trauma care via control-theoretic tools. CI - (c) 2026 Liu, Shick, Shamash, Cook, Molina, Cohen and Menezes. FAU - Liu, Guanyun AU - Liu G AD - Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States. FAU - Shick, Amanda E AU - Shick AE AD - Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States. FAU - Shamash, Maya AU - Shamash M AD - Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States. FAU - Cook, Caroline M AU - Cook CM AD - Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States. FAU - Molina, Mario L AU - Molina ML AD - Department of Agricultural and Biological Engineering, University of Florida, Gainesville, FL, United States. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States. FAU - Menezes, Amor A AU - Menezes AA AD - Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States. AD - Department of Agricultural and Biological Engineering, University of Florida, Gainesville, FL, United States. AD - J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States. AD - Genetics Institute, University of Florida, Gainesville, FL, United States. AD - Department of Chemical Engineering, University of Florida, Gainesville, FL, United States. LA - eng PT - Journal Article DEP - 20260903 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC13582509 OTO - NOTNLM OT - blood coagulation OT - cybermedicine OT - dynamical system model OT - hyperfibrinolysis OT - thromboelastography (TEG) OT - tissue plasminogen activator (tPA) OT - tranexamic acid (TXA) OT - trauma-induced coagulopathy (TIC) COIS- The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2026/09/18 12:25 MHDA- 2026/09/18 12:26 PMCR- 2026/09/03 CRDT- 2026/09/18 06:34 PHST- 2026/02/23 00:00 [received] PHST- 2026/06/28 00:00 [revised] PHST- 2026/06/30 00:00 [accepted] PHST- 2026/09/18 12:26 [medline] PHST- 2026/09/18 12:25 [pubmed] PHST- 2026/09/18 06:34 [entrez] PHST- 2026/09/03 00:00 [pmc-release] AID - 10.3389/fcvm.2026.1816085 [doi] PST - epublish SO - Front Cardiovasc Med. 2026 Sep 3;13:1816085. doi: 10.3389/fcvm.2026.1816085. eCollection 2026. PMID- 42750072 OWN - NLM STAT- MEDLINE DCOM- 20260917 LR - 20260918 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 34 IP - 1 DP - 2026 Sep 14 TI - Gelatin 4% and hydroxyethyl starch (130/0.42) impair clot formation in a human ex vivo whole-blood resuscitation model. LID - 10.1186/s13049-026-01690-6 [doi] LID - 151 AB - BACKGROUND: Colloid solutions provide effective intravascular volume expansion but can impair hemostasis, which is particularly critical after trauma-associated hemorrhagic shock. The differential effects of specific colloids on plasmatic coagulation, platelet function and complement activation, especially when used alongside crystalloids, are still underexplored. We therefore examined graded hemodilution with gelatin or hydroxyethyl starch, alone and in combination with a balanced crystalloid, in an ex vivo human whole-blood model over time. METHODS: We used a citrate- and heparin-free human ex vivo whole-blood model to assess the effects of volume dilution with a balanced crystalloid (Jonosteril), gelatin solution (Gelafundin 4%) and hydroxyethyl starch (HES 130/0.42, 6%; Tetraspan). Whole-blood was diluted at increasing ratios up to 4:6 (diluent:blood), incubated for 30 minutes at 37 degrees C and analyzed for blood gases, standard coagulation tests, platelet activation (CD62P), von Willebrand factor (vWF), thrombin-antithrombin complexes, complement activation and viscoelastic parameters by ROTEM (EXTEM, INTEM, FIBTEM). RESULTS: At high dilution ratios, colloid-diluted samples exhibited more frequent macroscopic clotting and significantly lower pH with more pronounced base deficit than Jonosteril. Gelafundin, but not Jonosteril or Tetraspan, increased vWF levels over time, while CD62P expression, thrombin-antithrombin complexes and complement markers remained unchanged. ROTEM revealed a clearly hypocoagulable profile after dilution with Gelafundin or Tetraspan, most pronounced with HES, with prolonged clotting time and clot formation time, reduced a-angle and maximum clot firmness. When combining Jonosteril with increasing colloid fractions at fixed dilution, these changes followed a non-linear, ratio-dependent pattern. CONCLUSION: Balanced colloids, particularly HES 130/0.42, exert intrinsic, ratio-dependent adverse effects on clot formation beyond simple dilution, suggesting that hemostatic safety may depend not only on fluid type but also on the tolerated proportion of colloid within resuscitation strategies. CI - (c) 2026. The Author(s). FAU - Mannes, Marco AU - Mannes M AD - Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany. FAU - Spiegelburg, Doreen Tabea AU - Spiegelburg DT AD - Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany. FAU - Datzmann, Thomas AU - Datzmann T AD - Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany. FAU - Schultze, Anke AU - Schultze A AD - Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany. FAU - Bauer, Andreas AU - Bauer A AD - Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Ulm, Germany. FAU - Achatz, Gerhard AU - Achatz G AD - Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Ulm, Germany. FAU - Huber-Lang, Markus AU - Huber-Lang M AD - Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany. FAU - Braun, Christian Karl AU - Braun CK AD - Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany. christian.braun@uni-ulm.de. AD - German Center for Child and Adolescent Health (DZKJ), Partner Site Ulm, Ulm, Germany. christian.braun@uni-ulm.de. LA - eng PT - Journal Article DEP - 20260914 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Hydroxyethyl Starch Derivatives) RN - 9000-70-8 (Gelatin) RN - 0 (Plasma Substitutes) RN - 0 (Crystalloid Solutions) SB - IM MH - Humans MH - *Hydroxyethyl Starch Derivatives/pharmacology MH - *Blood Coagulation/drug effects MH - *Gelatin/pharmacology MH - Hemodilution/methods MH - Plasma Substitutes/pharmacology MH - *Shock, Hemorrhagic/therapy/blood MH - *Resuscitation/methods MH - Crystalloid Solutions/pharmacology PMC - PMC13579869 OTO - NOTNLM OT - Coagulation OT - Colloids OT - Crystalloids OT - Fluid resuscitation OT - Gelatin OT - Hydroxyethyl starch COIS- Declarations. Ethical approval: The study was approved by the independent ethics committee of the University of Ulm (for experiments with human donor blood; No. 103/20) and by the local animal care committee and federal authorities (for the animal experiments; Reg.-No./Approval: 1409) and complied with the NIH Guide for the Care and Use of Laboratory Animals (2011). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. EDAT- 2026/09/17 05:35 MHDA- 2026/09/17 05:36 PMCR- 2026/09/14 CRDT- 2026/09/17 00:05 PHST- 2025/12/22 00:00 [received] PHST- 2026/08/31 00:00 [accepted] PHST- 2026/09/17 05:36 [medline] PHST- 2026/09/17 05:35 [pubmed] PHST- 2026/09/17 00:05 [entrez] PHST- 2026/09/14 00:00 [pmc-release] AID - 10.1186/s13049-026-01690-6 [pii] AID - 1690 [pii] AID - 10.1186/s13049-026-01690-6 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2026 Sep 14;34(1):151. doi: 10.1186/s13049-026-01690-6. PMID- 42748774 OWN - NLM STAT- Publisher LR - 20260916 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 57 IP - 11 DP - 2026 Sep 9 TI - Persistent postoperative hypercoagulability and venous thromboembolism risk following pelvic and acetabular fractures: A prospective pilot study. PG - 113695 LID - S0020-1383(26)00682-0 [pii] LID - 10.1016/j.injury.2026.113695 [doi] AB - BACKGROUND: Pelvic and acetabular (PA) fractures are severe orthopaedic injuries associated with high risk of venous thromboembolism (VTE), a potentially life-threatening complication, despite current thromboprophylaxis strategies. The duration of postoperative hypercoagulability and associated VTE risk following surgical fixation remain unknown. Thromboelastography (TEG) analysis can assess the entire clotting process and can be used to quantify hypercoagulability and increased VTE risk through maximal amplitude (MA) and coagulation index (CI) parameters. PURPOSE: To characterize the extent and duration of postoperative hypercoagulability and VTE risk following PA fractures using serial TEG analysis. METHODS: Adults undergoing surgical management of PA fractures were prospectively enrolled. Serial TEG analysis was performed from admission to 3 months postoperatively. Standardized thromboprophylaxis consisted of low-molecular-weight heparin for 28 days postoperatively. Screening compression ultrasound was performed to detect asymptomatic proximal deep vein thrombosis (DVT) on postoperative day 3 (POD3). Mobility was measured using Timed Up and Go (TUG) test. One-sample t-tests compared mean MA and CI values at each time point with predefined hypercoagulable thresholds (MA >/=65 mm, CI >3). RESULTS: Thirty patients were enrolled, including 22 men (median age: 52.5 years). Most were hypercoagulable by POD3 and MA peaked on POD7. Hypercoagulability persisted in 75.0% and 38.5% of patients at four and six weeks, respectively. At three months, 28.6% remained hypercoagulable. 23.3% developed VTE (five pulmonary emboli, two proximal DVTs). Patients with acetabular fractures had consistently higher MA values. CONCLUSION: Despite standard thromboprophylaxis, patients with PA fractures demonstrated persistent hypercoagulability and a substantial VTE rate. These findings suggest that thrombosis risk may persist beyond current thromboprophylaxis durations and support further investigation of individualized strategies, particularly following acetabular fractures. CI - Copyright (c) 2026. Published by Elsevier Ltd. FAU - Clarke, Ashley AU - Clarke A AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. FAU - Tera, Yousra AU - Tera Y AD - Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada. FAU - Skeith, Leslie AU - Skeith L AD - Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. FAU - Othman, Maha AU - Othman M AD - Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada. FAU - Dodd, Andrew AU - Dodd A AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. FAU - Duffy, Paul AU - Duffy P AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. FAU - Korley, Robert AU - Korley R AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. FAU - Martin, C Ryan AU - Martin CR AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. FAU - Schneider, Prism AU - Schneider P AD - Department of Surgery, Division of Orthopaedic Trauma Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. Electronic address: prism.schneider@albertahealthservices.ca. LA - eng PT - Journal Article PT - Review DEP - 20260909 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM OTO - NOTNLM OT - Acetabular fractures OT - Blood coagulation OT - Pelvic fractures OT - Thromboelastography OT - Trauma OT - Venous thromboembolism COIS- Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prism Schneider reports financial support was provided by Johnson & Johnson MedTech. Prism Schneider reports financial support was provided by Stryker. Andrew Dodd reports a relationship with Arthrex Inc that includes: speaking and lecture fees. Paul Duffy and C Ryan Martin reports a relationship with Tactile Orthopaedics that includes: consulting or advisory. Robert Korley reports a relationship with AO Asia Pacific Limited that includes: speaking and lecture fees. Andrew Dodd reports a relationship with Bioventus Canada ULC that includes: speaking and lecture fees. Andrew Dodd reports a relationship with Cerapedics Inc that includes: speaking and lecture fees. Robert Korley reports a relationship with Johnson & Johnson MedTech that includes: speaking and lecture fees. C Ryan Martin reports a relationship with Smith & Nephew Inc that includes: speaking and lecture fees. Prism Schneider reports a relationship with Stryker Orthopaedics that includes: speaking and lecture fees. Prism Schneider reports a relationship with Osteoporosis Canada that includes: board membership. Prism Schneider reports a relationship with Canadian Journal of Surgery that includes: board membership. Co-author: C Ryan Martin, reports educational speaking engagements with Ossur. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/09/16 23:34 MHDA- 2026/09/16 23:34 CRDT- 2026/09/16 18:14 PHST- 2026/08/09 00:00 [received] PHST- 2026/09/05 00:00 [accepted] PHST- 2026/09/16 23:34 [medline] PHST- 2026/09/16 23:34 [pubmed] PHST- 2026/09/16 18:14 [entrez] AID - S0020-1383(26)00682-0 [pii] AID - 10.1016/j.injury.2026.113695 [doi] PST - aheadofprint SO - Injury. 2026 Sep 9;57(11):113695. doi: 10.1016/j.injury.2026.113695. PMID- 42697363 OWN - NLM STAT- Publisher LR - 20260914 IS - 1532-2971 (Electronic) IS - 1090-0233 (Linking) VI - 320 DP - 2026 Sep 4 TI - Quantitative assessment of viscoelastic skin properties in a porcine model: Implications for regenerative therapies. PG - 106872 LID - S1090-0233(26)00329-1 [pii] LID - 10.1016/j.tvjl.2026.106872 [doi] AB - Severe cutaneous and soft-tissue injuries remain a major clinical and socioeconomic challenge. Advances in resuscitation and intensive care have improved survival, but long-term outcomes depend on restoration of mechanically competent skin. Pigs are widely used as translational models for dermal regeneration, yet in vivo viscoelastic mapping of porcine skin is lacking. This study aimed to characterize regional and weight-dependent differences in porcine skin mechanics using cutometer-based suction measurements and to identify potentially useful conditions for preclinical testing of biomaterials and wound therapies. A total of 10 female domestic pigs (30-180 kg) contributed measurements across six weight categories. Cutometric parameters (R0, R5, R7, R8) were recorded at six standardized dorsal regions under general anesthesia, with repeated curves averaged for analysis. Given the limited sample size and irregular repeated-measures structure, basic descriptive statistics (medians, interquartile ranges) were used in this exploratory pilot study to assess relationships between body weight, anatomical region, laterality and viscoelastic behavior. Across all regions, the 70 kg group showed descriptively higher skin distensibility (R0) and recovery-related values (R8), while heavier pigs (100-120 kg) tended to exhibit higher elasticity- and resilience-related values (R5, R7). When the dorsum was divided into head, middle and rear sections, the head generally demonstrated greater distensibility and elasticity, whereas the rear showed better recovery. Left-right differences were modest, with a slight tendency towards higher distensibility and elasticity on the left side at lower weights. Overall, the 70-120 kg range and specific dorsal regions (particularly 1, 3, and 6) showed consistent descriptive viscoelastic patterns. These findings provide the first cutometric map of porcine skin and may serve as a biomechanical reference for informing experimental design and outcome assessment in regenerative and wound-healing research, while acknowledging the exploratory nature and limited sample size of the study. CI - Copyright (c) 2026. Published by Elsevier Ltd. FAU - Vana, V AU - Vana V AD - Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, Brno 625 00, Czech Republic. FAU - Koudelkova, N AU - Koudelkova N AD - Brno-Reckovice High School, Terezy Novakove 2, Brno 621 00, Czech Republic. FAU - Lipovy, B AU - Lipovy B AD - Department of Burns Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Srobarova 1150/50, Prague 100 34, Czech Republic. FAU - Knoz, M AU - Knoz M AD - Clinic of plastic and esthetic surgery, St Anne's University Hospital, Pekarska 664/53, Brno 602 00, Czech Republic. FAU - Matyskova, D AU - Matyskova D AD - Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, Brno 625 00, Czech Republic. FAU - Jeklova, E AU - Jeklova E AD - Veterinary Research Institute, Hudcova 296/70, Brno 621 00, Czech Republic. FAU - Skotakova, M AU - Skotakova M AD - Department of Biostatistics, St. Anne's University Hospital Brno, Pekarska 664/53, Brno 602 00, Czech Republic. FAU - Holoubek, J AU - Holoubek J AD - Department of Traumatology, Trauma Hospital Brno, Faculty of Medicine, Masaryk University, Ponavka 139/6, Brno 602 00, Czech Republic. Electronic address: j.holoubek@unbr.cz. LA - eng PT - Journal Article DEP - 20260904 PL - England TA - Vet J JT - Veterinary journal (London, England : 1997) JID - 9706281 SB - IM OTO - NOTNLM OT - Cutometer OT - Porcine model OT - Skin regeneration OT - Viscoelastic parameters OT - Wound healing COIS- Declaration of Competing Interest The authors declare that they have no known competing financial or personal interests that could have appeared to influence the work reported in this paper. EDAT- 2026/09/04 23:36 MHDA- 2026/09/04 23:36 CRDT- 2026/09/04 19:13 PHST- 2025/12/15 00:00 [received] PHST- 2026/07/10 00:00 [revised] PHST- 2026/09/03 00:00 [accepted] PHST- 2026/09/04 23:36 [pubmed] PHST- 2026/09/04 23:36 [medline] PHST- 2026/09/04 19:13 [entrez] AID - S1090-0233(26)00329-1 [pii] AID - 10.1016/j.tvjl.2026.106872 [doi] PST - aheadofprint SO - Vet J. 2026 Sep 4;320:106872. doi: 10.1016/j.tvjl.2026.106872. PMID- 42680516 OWN - NLM STAT- Publisher LR - 20260930 IS - 1600-0609 (Electronic) IS - 0902-4441 (Print) IS - 0902-4441 (Linking) DP - 2026 Sep 1 TI - Trauma-Induced Coagulopathy: From Endotheliopathy and Fibrinolysis Phenotypes to Viscoelastic-Guided Resuscitation. LID - 10.1111/ejh.70315 [doi] AB - Trauma-induced coagulopathy is a maladaptive, multifactorial response to severe injury that affects approximately one quarter of severely injured patients and substantially increases mortality. It arises from combined tissue injury and shock and is characterized by endothelial dysfunction, platelet abnormalities, fibrinogen depletion, and dysregulated fibrinolysis, with thrombin generation typically preserved early and reduced only later, evolving through early hypocoagulable, balanced, and later hypercoagulable phases. Recognition of trauma endotheliopathy, including glycocalyx shedding and the von Willebrand factor-ADAMTS-13 axis, has broadened understanding beyond simple consumption and dilution. Viscoelastic hemostatic assays, thromboelastography and rotational thromboelastometry, characterize clot initiation, propagation, strength, and lysis in near-real time and can detect fibrinolysis, fibrinogen deficiency, and platelet dysfunction that conventional tests miss; early clot amplitude parameters enable rapid, goal-directed decisions, although the largest randomized trial to date did not demonstrate a mortality benefit over conventional testing, and most thresholds remain expert-derived and platform-specific. Contemporary therapy focuses on damage-control resuscitation with permissive hypotension, balanced ratio-based transfusion, early tranexamic acid, calcium replacement, and targeted rather than empiric fibrinogen replacement, with recombinant activated factor VII reserved for rescue. Preinjury antithrombotic therapy and liver disease call for agent-specific adjustments, summarized in an accompanying reference table. This review synthesizes the mechanisms, viscoelastic diagnosis, and goal-directed treatment of trauma-induced coagulopathy and highlights persistent knowledge gaps, including the significance of fibrinolysis shutdown, endotheliopathy-directed therapy, and the optimal timing of venous thromboembolism prophylaxis and resumption of antithrombotic therapy. CI - (c) 2026 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. FAU - Meister, Riley AU - Meister R AUID- ORCID: 0009-0005-1414-1829 AD - Legacy Emanuel Internal Medicine Residency, Portland, Oregon, USA. FAU - Kim, Youjin AU - Kim Y AUID- ORCID: 0009-0007-0889-4669 AD - Legacy Salmon Creek Internal Medicine Residency, Vancouver, Washington, USA. FAU - Landry, Thomas C AU - Landry TC AUID- ORCID: 0009-0009-1802-9673 AD - Legacy Salmon Creek Internal Medicine Residency, Vancouver, Washington, USA. FAU - LaVasseur, Corinne AU - LaVasseur C AUID- ORCID: 0000-0001-7038-8889 AD - Division of Hematology and Oncology, Oregon Health & Science University, Portland, Oregon, USA. FAU - Shatzel, Joseph AU - Shatzel J AUID- ORCID: 0000-0001-9396-5976 AD - Division of Hematology and Oncology, Oregon Health & Science University, Portland, Oregon, USA. FAU - Deloughery, Thomas AU - Deloughery T AUID- ORCID: 0000-0002-5790-4700 AD - Division of Hematology and Oncology, Oregon Health & Science University, Portland, Oregon, USA. LA - eng GR - R01 HL151367/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review DEP - 20260901 PL - England TA - Eur J Haematol JT - European journal of haematology JID - 8703985 SB - IM PMC - PMC13618966 MID - NIHMS2211979 OTO - NOTNLM OT - anticoagulant reversal OT - damage-control resuscitation OT - endotheliopathy OT - fibrinolysis OT - hemorrhagic shock OT - massive transfusion OT - thromboelastography OT - thromboelastometry OT - trauma-induced coagulopathy OT - viscoelastic hemostatic assay COIS- Conflicts of Interest The authors declare no conflicts of interest. EDAT- 2026/09/01 23:34 MHDA- 2026/09/01 23:34 PMCR- 2026/09/28 CRDT- 2026/09/01 21:04 PHST- 2026/08/25 00:00 [revised] PHST- 2026/07/03 00:00 [received] PHST- 2026/08/26 00:00 [accepted] PHST- 2026/09/01 23:34 [medline] PHST- 2026/09/01 23:34 [pubmed] PHST- 2026/09/01 21:04 [entrez] PHST- 2026/09/28 00:00 [pmc-release] AID - 10.1111/ejh.70315 [doi] PST - aheadofprint SO - Eur J Haematol. 2026 Sep 1:10.1111/ejh.70315. doi: 10.1111/ejh.70315. PMID- 42678754 OWN - NLM STAT- Publisher LR - 20260901 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) DP - 2026 Sep 1 TI - Aging at the Cellular Level: An Exploratory Analysis of the Effect of Age on Platelet Dynamics in Injured Patients. LID - 10.1097/SHK.0000000000002934 [doi] AB - INTRODUCTION: Increasing chronological age drives dynamic changes in platelet functionality, bringing unique biologic challenges to the injured older adult. While platelets play an indispensable role in injury response, the impact of age on platelet dynamics after injury remains elusive. We examine the associations of age and platelet dynamics for injured patients not on antiplatelet therapy, hypothesizing that aging is associated with decreases in platelet count and function in injured patients. METHODS: We performed a secondary analysis of injured patients from a prospective observational study of coagulation and inflammation (2010-2024). Patients taking anticoagulants, antiplatelets, and/or with isolated traumatic brain injury were excluded. Univariable and multivariable associations of age and platelet count and function profiles (impedance aggregometry and viscoelastic testing) at presentation and up to seven days post-injury were analyzed. Platelet profiles, thromboembolic events, and mortality relationships were analyzed by stratifying age to <55 and >/=55 years. RESULTS: 716 patients were examined. Median age was 36 years (range 15-97 years). On multivariable analyses platelet count and functional profiles demonstrated independent associations with increasing age at all time points measured - reduced platelet count, aggregation responses, and hypercoagulable clotting dynamics. In patients >/=55 years low platelet count and reduced aggregation responses on presentation were suggestive of increased mortality (all p<0.05). CONCLUSION: Following injury, increasing chronological age is independently associated with altered platelet profiles - reduced platelet count and aggregation responses with concurrent hypercoagulable clotting dynamics. These age-related cellular changes may portend worse outcomes, including mortality, and should be considered for intervenable biologic targets in future study. CI - Copyright (c) 2026 by the Shock Society. FAU - Beattie, Genna AU - Beattie G AD - Department of Surgery, Highland Hospital, University of California, San Francisco East Bay, San Francisco, California. FAU - Joseph, Bellal A AU - Joseph BA AD - Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona. FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Chak, Suzanna AU - Chak S AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Chou, Celine AU - Chou C AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Arango, Isabel AU - Arango I AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Elmankabadi, Seif AU - Elmankabadi S AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Zoghbi, Karl AU - Zoghbi K AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Bardillon, Kim AU - Bardillon K AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Conte, Michelle AU - Conte M AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Bainton, Cedric M V AU - Bainton CMV AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Cuschieri, Joseph AU - Cuschieri J AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. AD - Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado, Denver, Colorado. FAU - Callcut, Rachael A AU - Callcut RA AD - Department of Surgery, University of California, Davis, Sacramento, California. FAU - Fields, Alexander T AU - Fields AT AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California. AD - Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California. LA - eng PT - Journal Article DEP - 20260901 PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM OTO - NOTNLM OT - Aging OT - coagulopathy OT - platelet aggregation OT - platelet function OT - traumatic injury COIS- Conflicts of Interest: The authors have no conflicts of interest to declare. EDAT- 2026/09/01 17:39 MHDA- 2026/09/01 17:39 CRDT- 2026/09/01 12:23 PHST- 2026/09/01 17:39 [medline] PHST- 2026/09/01 17:39 [pubmed] PHST- 2026/09/01 12:23 [entrez] AID - 00024382-990000000-00940 [pii] AID - 10.1097/SHK.0000000000002934 [doi] PST - aheadofprint SO - Shock. 2026 Sep 1. doi: 10.1097/SHK.0000000000002934. PMID- 42661399 OWN - NLM STAT- Publisher LR - 20260828 IS - 1301-5680 (Print) IS - 1301-5680 (Linking) DP - 2026 Aug 27 TI - Evaluation of changes in coagulation profile by thromboelastography in patients undergoing lobectomy for malignancy. LID - 10.4274/tjtcs.2026.2026-5-16 [doi] AB - BACKGROUND: Thromboelastography (TEG) provides a global assessment of coagulation and fibrinolytic activity. This study aimed to evaluate postoperative coagulation changes in patients undergoing lobectomy for lung malignancy using TEG. METHODS: In this prospective observational study, sixteen patients undergoing lobectomy for lung malignancy were included. TEG analyses were performed preoperatively, on postoperative day 0 (POD0) before low-molecular-weight heparin (LMWH) initiation, and on postoperative day 3 (POD3) after initiation of routine LMWH thromboprophylaxis. r time (clot initiation), k time (clot kinetics), alpha-angle (rate of clot strengthening), maximum amplitude (MA; maximum clot strength), Ly30 (fibrinolytic activity), and coagulation index (CI; overall coagulability) were evaluated. Temporal changes were analyzed using linear mixed models with Bonferroni-adjusted pairwise comparisons (Clinical trial registration: ClinicalTrials.gov identifier: NCT06484231). RESULTS: No significant temporal change was observed in r time (p=0.293). Significant changes were detected in k time, alpha-angle, MA, Ly30, and CI (all p<0.001). On POD0, k time was prolonged and MA decreased compared with preoperative values, whereas alpha-angle increased and Ly30 showed a decreasing tendency, indicating heterogeneous postoperative coagulation responses. On POD3, alpha-angle significantly decreased compared with POD0, while Ly30 significantly increased compared with both preoperative values and POD0, suggesting evolving coagulation dynamics under ongoing thromboprophylaxis. CI progressively increased throughout the postoperative period, indicating a shift toward a more hypercoagulable profile. CONCLUSION: TEG revealed a dynamic, multidimensional postoperative coagulation profile rather than a uniform hypercoagulable shift. Early (POD0) changes-prolonged k time and reduced MA with an increased alpha-angle-likely reflected surgical trauma and perioperative hemodilution, whereas POD3 findings appeared to combine physiological recovery with thromboprophylaxis. The progressive rise in CI indicated an evolving shift toward hypercoagulability, while alpha-angle and Ly30 emerged as the most responsive parameters and may be useful for monitoring perioperative coagulation. Because postoperative recovery and LMWH effects could not be disentangled in this design, these findings are hypothesis-generating and warrant confirmation in larger controlled studies. FAU - Kececi Ozgur, Gizem AU - Kececi Ozgur G AUID- ORCID: 0000-0002-9434-4941 AD - Clinic of Thoracic Surgery, Yuksekova Public Hospital, Hakkari, Turkiye. FAU - Mammadov, Rza AU - Mammadov R AUID- ORCID: 0000-0003-3845-6858 AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Akpunar, Esranur AU - Akpunar E AUID- ORCID: 0000-0003-1904-2617 AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Akcam, Tevfik Ilker AU - Akcam TI AUID- ORCID: 0000-0001-7108-9469 AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Ozdil, Ali AU - Ozdil A AUID- ORCID: 0000-0001-8182-1764 AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Ergonul, Ayse Gul AU - Ergonul AG AUID- ORCID: 0000-0001-8854-953X AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Cagirici, Ufuk AU - Cagirici U AUID- ORCID: 0000-0001-7827-793X AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. FAU - Cakan, Alpaslan AU - Cakan A AUID- ORCID: 0000-0002-4958-0996 AD - Department of Thoracic Surgery, Ege University Faculty of Medicine, Izmir, Turkiye. LA - eng SI - ClinicalTrials.gov/NCT06484231 PT - Journal Article DEP - 20260827 PL - Turkey TA - Turk Gogus Kalp Damar Cerrahisi Derg JT - Turk gogus kalp damar cerrahisi dergisi JID - 100887967 OTO - NOTNLM OT - Thromboelastography OT - low-molecular-weight-heparin OT - lung cancer surgery COIS- No conflict of interest was declared by the authors. EDAT- 2026/08/28 11:46 MHDA- 2026/08/28 11:46 CRDT- 2026/08/28 01:56 PHST- 2026/08/28 11:46 [medline] PHST- 2026/08/28 11:46 [pubmed] PHST- 2026/08/28 01:56 [entrez] AID - 10.4274/tjtcs.2026.2026-5-16 [doi] PST - aheadofprint SO - Turk Gogus Kalp Damar Cerrahisi Derg. 2026 Aug 27. doi: 10.4274/tjtcs.2026.2026-5-16. PMID- 42652719 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260827 LR - 20260829 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 15 IP - 16 DP - 2026 Aug 15 TI - Early Rotem Evaluation Abnormalities May Be Associated with Hemorragic but Not Thromboembolic Complications in Patients with Major Trauma Referred to Hospital Within the First Hour. LID - 10.3390/jcm15166315 [doi] LID - 6315 AB - Background: Trauma-induced coagulopathy is associated with a high rate of hemorrhagic complications and with increased mortality after major trauma. Viscoelastic techniques have been demonstrated to be useful for early diagnosis and appropriate management in these patients. Methods: This prospective observational study included patients who underwent major trauma (ISS (injury severity score) > 15) and were referred to hospital within the first hour. All underwent early ROTEM evaluation. Results: The study included 100 patients (80 males, 20 females, mean age 52.41 years). Twenty-three had bleeding, requiring transfusion (mean age of 57.3 years and ISS 21.7). According to accepted criteria of hypocoagulability, 10/23 (43.5%) had at least one abnormality in one of the ROTEM parameters. EXTEM CT was significantly longer in transfused patients. Four had symptomatic VTE (venous thromboembolism), and Doppler examination showed DVT (deep venous thrombosis) in 14 (14%) of the population. Sepsis, pneumonia, and acute renal failure were statistically more frequent in patients with thrombosis, while no relation was found with ROTEM. Finally, 3 out of 5 patients who died showed a severe hypocoagulable condition at initial ROTEM evaluation. Conclusions: In patients with major trauma referred to hospital within the first hour, early qualitative ROTEM examination at admission may be useful in identifying patients at bleeding risk. Sepsis, pneumonia, and acute renal failure, but not ROTEM parameters, were associated with the risk of thromboembolic events. FAU - Rostagno, Carlo AU - Rostagno C AUID- ORCID: 0000-0002-7764-8919 AD - Dipartimento Medicina Sperimentale e Clinica, Universita di Firenze, 50121 Firenze, Italy. FAU - Marchetti, Celeste AU - Marchetti C AD - Dipartimento Medicina Sperimentale e Clinica, Universita di Firenze, 50121 Firenze, Italy. FAU - Nencioni, Andrea AU - Nencioni A AUID- ORCID: 0009-0001-3219-0879 AD - Medicina e Chirurgia d'Urgenza e Accettazione, AOU Careggi, 50134 Firenze, Italy. FAU - Coppa, Alessandro AU - Coppa A AUID- ORCID: 0000-0002-8548-9903 AD - Medicina e Chirurgia d'Urgenza e Accettazione, AOU Careggi, 50134 Firenze, Italy. FAU - Guerra, Federica AU - Guerra F AD - Medicina e Chirurgia d'Urgenza e Accettazione, AOU Careggi, 50134 Firenze, Italy. FAU - Gianesello, Lara AU - Gianesello L AD - Anestesia e Rianimazione per Ortopedia, AOU Careggi, 50134 Firenze, Italy. FAU - Vanni, Simone AU - Vanni S AUID- ORCID: 0000-0002-1201-5715 AD - Dipartimento Medicina Sperimentale e Clinica, Universita di Firenze, 50121 Firenze, Italy. LA - eng PT - Journal Article DEP - 20260815 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC13513890 OTO - NOTNLM OT - bleeding OT - hemostasis OT - trauma OT - venous thromboembolism COIS- The authors declare no conflicts of interest. EDAT- 2026/08/27 05:35 MHDA- 2026/08/27 05:36 PMCR- 2026/08/15 CRDT- 2026/08/27 01:06 PHST- 2026/07/03 00:00 [received] PHST- 2026/08/10 00:00 [revised] PHST- 2026/08/13 00:00 [accepted] PHST- 2026/08/27 05:36 [medline] PHST- 2026/08/27 05:35 [pubmed] PHST- 2026/08/27 01:06 [entrez] PHST- 2026/08/15 00:00 [pmc-release] AID - jcm15166315 [pii] AID - jcm-15-06315 [pii] AID - 10.3390/jcm15166315 [doi] PST - epublish SO - J Clin Med. 2026 Aug 15;15(16):6315. doi: 10.3390/jcm15166315. PMID- 42652061 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260827 LR - 20260829 IS - 2227-9059 (Print) IS - 2227-9059 (Electronic) IS - 2227-9059 (Linking) VI - 14 IP - 8 DP - 2026 Jul 26 TI - Cellular and Molecular Mechanisms of Hemorrhagic Shock: Biological Rationale for Individualized Fluid Resuscitation Strategies and Multimodal Monitoring. LID - 10.3390/biomedicines14081678 [doi] LID - 1678 AB - Hemorrhagic shock is a leading cause of preventable death following multiple trauma, driven by a cascade of interacting cellular and molecular disturbances that extend well beyond simple volume loss. Acute blood loss initiates tissue hypoperfusion and cellular hypoxia, setting in motion the lethal triad of hypothermia, acidosis, and coagulopathy through several converging pathways: complement activation with excessive C3a and C5a production; neutrophil-mediated tissue injury; NADPH-oxidase-driven reactive oxygen species (ROS) overproduction that overwhelms superoxide dismutase defenses; mitochondrial respiratory chain impairment; dysregulation of the pro-inflammatory cytokine network; and endothelial apoptosis with degradation of the endothelial glycocalyx and disruption of interendothelial junctions, with consequent vascular hyperpermeability. These mechanisms provide the biological rationale for the resuscitation strategy. Each class of fluid acts on these pathways in a distinct way: crystalloids modulate acid-base homeostasis, chloride-mediated renal vasoconstriction, and coagulation factor activity; colloids influence oncotic pressure, endothelial integrity, and microvascular perfusion; and blood products, particularly plasma and whole blood, actively modulate mitochondrial metabolism, endothelial permeability, and pro-apoptotic signaling beyond their volume-expanding role. Translating this biology to the bedside requires a multimodal monitoring framework that converts molecular endpoints into real-time therapeutic targets, integrating lactate and base excess as markers of cellular oxygen debt, dynamic preload indices such as pulse pressure and stroke volume variation, advanced hemodynamic platforms, point-of-care ultrasonography, viscoelastic coagulation testing, and near-infrared spectroscopy of tissue oxygenation. This review synthesizes the biological basis of hemorrhagic shock and its translation into an individualized, goal-directed resuscitation strategy for the critically ill polytrauma patient. FAU - Ritiu, Stelian Adrian AU - Ritiu SA AUID- ORCID: 0000-0002-8751-6813 AD - Doctoral School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Popovici, Sonia Elena AU - Popovici SE AUID- ORCID: 0000-0001-5195-3993 AD - Doctoral School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic for Anaesthesia and Intensive Care, Clinical Municipal Emergency Hospital, 300041 Timisoara, Romania. FAU - Papurica, Marius AU - Papurica M AUID- ORCID: 0000-0002-4065-3650 AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. FAU - Sandesc, Dorel AU - Sandesc D AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. FAU - Baloi, Adelina AU - Baloi A AD - Doctoral School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. FAU - Toma, Daiana AU - Toma D AUID- ORCID: 0009-0007-1034-923X AD - Doctoral School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. FAU - Wellmann, Norbert AU - Wellmann N AUID- ORCID: 0009-0004-0749-8232 AD - Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology Dr. Victor Babes, 300310 Timisoara, Romania. AD - Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Bucuras, Petru AU - Bucuras P AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Barsac, Claudiu Rafael AU - Barsac CR AUID- ORCID: 0000-0001-7591-7241 AD - Doctoral School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. FAU - Bedreag, Ovidiu AU - Bedreag O AUID- ORCID: 0000-0002-3432-9168 AD - Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Anaesthesia and Intensive Care Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania. AD - Clinic of Anaesthesia and Intensive Care, Emergency County Hospital Pius Brinzeu, 300723 Timisoara, Romania. LA - eng PT - Journal Article PT - Review DEP - 20260726 PL - Switzerland TA - Biomedicines JT - Biomedicines JID - 101691304 PMC - PMC13509298 OTO - NOTNLM OT - cellular mechanisms OT - fluid resuscitation OT - glycocalyx OT - hemorrhagic shock OT - multimodal monitoring OT - oxidative stress OT - trauma OT - trauma-induced coagulopathy COIS- The authors declare no conflict of interest. EDAT- 2026/08/27 05:35 MHDA- 2026/08/27 05:36 PMCR- 2026/07/26 CRDT- 2026/08/27 01:05 PHST- 2026/06/12 00:00 [received] PHST- 2026/07/23 00:00 [revised] PHST- 2026/07/25 00:00 [accepted] PHST- 2026/08/27 05:36 [medline] PHST- 2026/08/27 05:35 [pubmed] PHST- 2026/08/27 01:05 [entrez] PHST- 2026/07/26 00:00 [pmc-release] AID - biomedicines14081678 [pii] AID - biomedicines-14-01678 [pii] AID - 10.3390/biomedicines14081678 [doi] PST - epublish SO - Biomedicines. 2026 Jul 26;14(8):1678. doi: 10.3390/biomedicines14081678. PMID- 42625973 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260821 LR - 20260921 IS - 2222-0682 (Print) IS - 2222-0682 (Electronic) IS - 2222-0682 (Linking) VI - 16 IP - 3 DP - 2026 Sep 20 TI - Strengthening trauma care in low- and middle-income countries through guideline adaptation and scalable system reforms. PG - 113355 LID - 10.5662/wjm.v16.i3.113355 [doi] LID - 113355 AB - Trauma is a leading global cause of death and disability, with nearly 90% of fatalities occurring in low- and middle-income countries (LMICs), where prehospital care, infrastructure, and trained personnel are limited. This narrative review synthesizes literature (2019-2025) on the initial management of adult polytrauma, and explores strategies to adapt global guidelines in resource-constrained settings. Contemporary frameworks such as advanced trauma life support (ATLS) and World Health Organization essential trauma care emphasize context-sensitive sequencing, permissive hypotension, balanced transfusion, damage-control surgery, and integration of point-of-care ultrasound. Adjuncts including tranexamic acid, viscoelastic-guided transfusion, prehospital whole blood, and selective aortic balloon occlusion offer incremental survival benefits. However, widespread barriers-training deficits, blood bank shortages, lack of imaging, and absent trauma registries-impede implementation. Emerging models demonstrate that scalable solutions such as primary trauma care courses, phased ATLS rollouts, hybrid emergency rooms, and tablet-based registries can reduce mortality and referral delays without requiring wholesale adoption of high-income systems. Meaningful progress requires adapting evidence-based guidelines to local realities, supported by investments in education, diagnostics, transfusion logistics, and national surveillance. Future work should quantify cost-effectiveness and refine context-specific frameworks to close the outcome gap in LMICs. CI - (c)Author(s) 2026. FAU - Le, Kim-Long AU - Le KL AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. FAU - Pham, Tri-Nhan AU - Pham TN AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. FAU - Tran, Minh-Quang AU - Tran MQ AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. AD - Department of Gastroenterology Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. FAU - Trinh, My-Tran AU - Trinh MT AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. AD - Department of Gastroenterology Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. FAU - Pham, Phu-Cuong AU - Pham PC AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. FAU - Duong-Ngoc, Quynh-Nhu AU - Duong-Ngoc QN AD - Department of Surgery, Khanh Hoi Hospital, Ho Chi Minh 07000, Viet Nam. FAU - Thai, Khanh-Phat AU - Thai KP AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. FAU - Le, Nguyen-Khoi AU - Le NK AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. AD - Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam. tg_lenguyenkhoi@pnt.edu.vn. FAU - Mai-Phan, Tuong-Anh AU - Mai-Phan TA AD - Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. FAU - Luong-Toan, Hoang-Long AU - Luong-Toan HL AD - Department of Anesthesiology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam. LA - eng PT - Journal Article PT - Review DEP - 20260920 PL - United States TA - World J Methodol JT - World journal of methodology JID - 101628739 PMC - PMC13491171 OTO - NOTNLM OT - Damage-control surgery OT - Guideline implementation barriers OT - Low- and middle-income countries OT - Massive transfusion protocol OT - Polytrauma resuscitation OT - Primary trauma care OT - Trauma systems COIS- Conflict-of-interest statement: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2026/08/21 11:39 MHDA- 2026/08/21 11:40 PMCR- 2026/09/20 CRDT- 2026/08/21 05:41 PHST- 2025/08/25 00:00 [received] PHST- 2025/09/21 00:00 [revised] PHST- 2025/12/18 00:00 [accepted] PHST- 2026/08/21 11:40 [medline] PHST- 2026/08/21 11:39 [pubmed] PHST- 2026/08/21 05:41 [entrez] PHST- 2026/09/20 00:00 [pmc-release] AID - 10.5662/wjm.v16.i3.113355 [doi] PST - epublish SO - World J Methodol. 2026 Sep 20;16(3):113355. doi: 10.5662/wjm.v16.i3.113355. eCollection 2026 Sep 20. PMID- 42601747 OWN - NLM STAT- MEDLINE DCOM- 20260815 LR - 20260923 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 105 IP - 33 DP - 2026 Aug 14 TI - Thrombus molecular markers and thromboelastogram as early predictors of venous thromboembolism after total knee arthroplasty in perioperative elderly patients: A prospective study. PG - e50228 LID - 10.1097/MD.0000000000050228 [doi] LID - e50228 AB - Elderly patients undergoing total knee arthroplasty have a higher incidence of venous thromboembolism (VTE) owing to age, surgical trauma, and other factors. Numerous studies have employed the Caprini scale and d-dimer levels to evaluate perioperative coagulation function and predict the occurrence of postoperative VTE. However, relatively few studies have assessed the risk of VTE by analyzing perioperative thrombus molecular markers and thromboelastography (TEG) findings in these patients. This prospective cohort study enrolled patients aged >60 years who underwent artificial knee replacement surgery between March 2024 and September 2024 at the Department of Arthroplasty of the Third Hospital of Hebei Medical University. The levels of thrombus molecular markers, including thrombin-antithrombin complex (TAT), plasmin-alpha2-plasmininhibitor complex, thrombomodulin, tissue plasminogen activator-inhibitor complex, and TEG, which included reaction time (R), clot kinetics (K), angle alpha, maximum amplitude, and clotting index (CI), were measured preoperatively and at postoperative hours 2 (poh2), day 1 (pod1), and day 3 (pod3). The patients were categorized into VTE and non-VTE groups based on color Doppler ultrasonography screening on postoperative day 4. We examined the disparities in general information indicators between the 2 groups, and logistic regression was used to analyze deep vein thrombosis risk factors in these patients. The diagnostic effectiveness of markers was determined using the receiver operating characteristic curve. TAT and TEG partial parameters are capable of reflecting the postoperative hypercoagulable state of the body with sensitivity; the combination of these parameters is anticipated to offer a strong predictive value in elderly patients. The median age in the VTE group was 71 (60-82), higher than 66 (60-83) in the non‑VTE group, and significant differences were found between the 2 groups (P = .025). Significant differences in R (P = .007), angle alpha (P = .029), and TAT (P = .047) on pod1 and clotting index (P = .027), TAT (P = .017), and TAT/plasmin inhibitor complex (P = .004) on pod3 were observed between the 2 groups. Binary logistic regression revealed that age, R value, angle alpha, TAT, and age were significant risk factors for deep vein thrombosis. Our research indicates that the area under the curve, sensitivity, and specificity of multi-index detection are superior to single-index detection. CI - Copyright (c) 2026 the Author(s). Published by Wolters Kluwer Health, LLC. FAU - Zhang, Bei AU - Zhang B AD - Department of Laboratory Medicine, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People's Republic of China. FAU - Zhao, Huan AU - Zhao H AD - Department of Laboratory Medicine, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People's Republic of China. FAU - Lu, Jie AU - Lu J AD - Department of Laboratory Medicine, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People's Republic of China. FAU - Zhang, Song AU - Zhang S AD - Department of Laboratory Medicine, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People's Republic of China. FAU - Chang, Li AU - Chang L AUID- ORCID: 0009-0006-9044-604 AD - Department of Rehabilitation, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People's Republic of China. LA - eng PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Biomarkers) RN - 0 (antithrombin III-protease complex) RN - 0 (alpha-2-Antiplasmin) RN - 9000-94-6 (Antithrombin III) RN - EC 3.4.- (Peptide Hydrolases) SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Arthroplasty, Replacement, Knee/adverse effects MH - Prospective Studies MH - Female MH - Biomarkers/blood MH - *Venous Thromboembolism/diagnosis/etiology/blood MH - Aged MH - Male MH - *Postoperative Complications/diagnosis/blood MH - Middle Aged MH - Risk Factors MH - Aged, 80 and over MH - alpha-2-Antiplasmin MH - Perioperative Period MH - Antithrombin III MH - Peptide Hydrolases PMC - PMC13480757 OTO - NOTNLM OT - ROC OT - logistic regression OT - thromboelastography OT - thrombus molecular biomarkers OT - total knee arthroplasty COIS- The authors have no conflicts of interest to declare. EDAT- 2026/08/15 05:36 MHDA- 2026/08/15 05:37 PMCR- 2026/08/14 CRDT- 2026/08/15 01:00 PHST- 2026/01/09 00:00 [received] PHST- 2026/07/30 00:00 [accepted] PHST- 2026/08/15 05:37 [medline] PHST- 2026/08/15 05:36 [pubmed] PHST- 2026/08/15 01:00 [entrez] PHST- 2026/08/14 00:00 [pmc-release] AID - 00005792-202608140-00075 [pii] AID - MD-D-26-00223 [pii] AID - 10.1097/MD.0000000000050228 [doi] PST - ppublish SO - Medicine (Baltimore). 2026 Aug 14;105(33):e50228. doi: 10.1097/MD.0000000000050228. PMID- 42589593 OWN - NLM STAT- MEDLINE DCOM- 20260813 LR - 20260815 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 27 IP - 15 DP - 2026 Aug 2 TI - Assessment of Hypercoagulability After Orthopedic Trauma Surgery Using Coagulation Biomarkers and TEG/ROTEM. LID - 10.3390/ijms27156939 [doi] LID - 6939 AB - Orthopedic trauma surgery is associated with an increased risk of postoperative hypercoagulability, predisposing patients to potentially life-threatening thromboembolic complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Conventional coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), have limited sensitivity in detecting the complex hemostatic alterations that occur following orthopedic trauma procedures. In recent years, viscoelastic hemostatic assays-thromboelastography (TEG) and rotational thromboelastometry (ROTEM)-alongside specific coagulation biomarkers, such as D-dimer, fibrinogen, thrombin-antithrombin (TAT) complexes, and prothrombin fragments F1+2, have emerged as promising tools for a more comprehensive assessment of coagulation status in the perioperative setting. This narrative review, conducted using a structured literature search strategy with systematic elements, aims to synthesize the current evidence regarding the use of TEG/ROTEM and coagulation biomarkers in evaluating hypercoagulability following orthopedic trauma surgery, identify patterns of hemostatic dysregulation across different surgical procedures and patient populations, and highlight existing gaps in the literature. A structured search was conducted across major electronic databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. The findings of this review provide clinicians with a clearer framework for perioperative coagulation monitoring and inform future research aimed at optimizing individualized thromboprophylaxis strategies in orthopedic trauma patients. FAU - Huzum, Bogdan AU - Huzum B AD - Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania. AD - Orthopedic Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania. FAU - Cionca, Dan Viorel AU - Cionca DV AD - Orthopedic Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania. FAU - Ciupilan, Daniel AU - Ciupilan D AD - Orthopedic Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania. FAU - Tesoi, Dragos-Florin AU - Tesoi DF AD - Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania. AD - Emergency Clinical Hospital for Children "Sfanta Maria", 700309 Iasi, Romania. FAU - Mircea, Cornelia AU - Mircea C AUID- ORCID: 0000-0002-1981-8246 AD - Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania. FAU - Badulescu, Oana-Viola AU - Badulescu OV AD - Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania. AD - Hematology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania. LA - eng GR - 351058/The Health Program/ PT - Journal Article PT - Review DEP - 20260802 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Biomarkers/blood MH - *Thrombophilia/etiology/diagnosis/blood MH - *Orthopedic Procedures/adverse effects MH - Blood Coagulation MH - Blood Coagulation Tests/methods MH - *Postoperative Complications/blood/diagnosis/etiology PMC - PMC13466603 OTO - NOTNLM OT - D-dimer OT - fibrinogen OT - rotational thromboelastometry OT - thrombin-antithrombin complexes OT - thromboelastography OT - total hip arthroplasty OT - total knee arthroplasty COIS- The authors declare no conflicts of interest. EDAT- 2026/08/13 05:35 MHDA- 2026/08/13 05:36 PMCR- 2026/08/02 CRDT- 2026/08/13 01:05 PHST- 2026/06/28 00:00 [received] PHST- 2026/07/26 00:00 [revised] PHST- 2026/07/31 00:00 [accepted] PHST- 2026/08/13 05:36 [medline] PHST- 2026/08/13 05:35 [pubmed] PHST- 2026/08/13 01:05 [entrez] PHST- 2026/08/02 00:00 [pmc-release] AID - ijms27156939 [pii] AID - ijms-27-06939 [pii] AID - 10.3390/ijms27156939 [doi] PST - epublish SO - Int J Mol Sci. 2026 Aug 2;27(15):6939. doi: 10.3390/ijms27156939. PMID- 42576283 OWN - NLM STAT- Publisher LR - 20260811 IS - 1477-111X (Electronic) IS - 0267-6591 (Linking) DP - 2026 Aug 10 TI - ECMO as salvage therapy for severe ARDS complicating Crotalus atrox envenomation. PG - 2676591261476521 LID - 10.1177/02676591261476521 [doi] AB - BackgroundSnakebite envenomation is a global health problem, though rarely encountered in Europe outside captive settings. The Western diamondback rattlesnake (Crotalus atrox) is one of the most medically important North American pit vipers, with venom capable of provoking profound coagulation disorders and systemic toxicity. Respiratory complications are exceedingly rare, and the role of extracorporeal membrane oxygenation (ECMO) in this context has not been previously described.Case presentationWe report the case of a 36-year-old man who sustained a facial bite from a captive Crotalus atrox. On arrival, he presented with rapidly progressive facial and pharyngeal edema requiring emergent intubation. Laboratory investigations revealed disseminated intravascular coagulation (DIC), characterized by thrombocytopenia, hypofibrinogenemia, prolonged INR and aPTT, markedly elevated D-dimers, and ROTEM evidence of impaired clot formation. High-dose antivenom and targeted factor replacement were administered. Within hours, the patient developed pulmonary hemorrhage and acute respiratory distress syndrome (ARDS), unresponsive to maximal conventional therapy. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated as rescue support, resulting in rapid stabilization of gas exchange. The subsequent ICU course was complicated by acute kidney injury and seizures during sedation tapering, all managed successfully. ECMO was explanted on the 4th postcannulation day, tracheostomy was performed on the 6th postcannulation day, and the patient was decannulated on the 16th postcannulation day. He was discharged home on the 22nd postcannulation day in good general condition, without residual organ dysfunction.ConclusionThis case highlights the potential for Crotalus atrox envenomation to cause fulminant systemic complications including DIC and ARDS. It also demonstrates that V-V ECMO can be safely and effectively applied as salvage therapy in venom-induced ARDS, provided it is initiated promptly within specialized centers. FAU - Papatriantafyllou, Athanasios AU - Papatriantafyllou A AUID- ORCID: 0009-0004-6189-6493 AD - Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany. FAU - Leivaditis, Vasileios AU - Leivaditis V AD - Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany. FAU - Prepelita, Daniela AU - Prepelita D AD - Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany. FAU - Steinbach, Florian AU - Steinbach F AD - Poison Control Center, Johannes Gutenberg University of Mainz, Mainz, Germany. FAU - Dahm, Manfred AU - Dahm M AD - Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany. LA - eng PT - Journal Article DEP - 20260810 PL - England TA - Perfusion JT - Perfusion JID - 8700166 SB - IM OTO - NOTNLM OT - Crotalus atrox OT - acute respiratory distress syndrome OT - disseminated intravascular coagulation OT - extracorporeal membrane oxygenation OT - rattlesnake envenomation OT - toxicology emergencies OT - veno-venous ECMO EDAT- 2026/08/11 06:35 MHDA- 2026/08/11 06:35 CRDT- 2026/08/11 00:33 PHST- 2026/08/11 06:35 [medline] PHST- 2026/08/11 06:35 [pubmed] PHST- 2026/08/11 00:33 [entrez] AID - 10.1177/02676591261476521 [doi] PST - aheadofprint SO - Perfusion. 2026 Aug 10:2676591261476521. doi: 10.1177/02676591261476521. PMID- 42552026 OWN - NLM STAT- MEDLINE DCOM- 20260804 LR - 20260804 IS - 1878-1608 (Electronic) IS - 1753-3740 (Linking) VI - 40 IP - 1 DP - 2026 Mar TI - Transfusion management in critically ill patients. PG - 87-99 LID - S1753-3740(26)00014-6 [pii] LID - 10.1016/j.bpa.2026.07.004 [doi] AB - Blood component transfusion remains a common intervention in critically ill patients and is primarily used to support oxygen delivery and correct coagulopathy. Over the past two decades, evidence from randomized trials and systematic reviews have supported the adoption of restrictive transfusion strategies in most critically ill populations. However, transfusion decisions should be individualized in patients with conditions involving ischemia-sensitive organs, including acute myocardial infarction and acute neurologic injury, where higher thresholds may be appropriate. Management of bleeding and coagulopathy in critical illness also involves platelet transfusion, coagulation factor replacement, and antifibrinolytic therapy. Increasingly, viscoelastic assays are used to guide targeted hemostatic therapy. Although transfusion can be lifesaving, it carries potential risks including transfusion reactions, circulatory overload, and transfusion-related lung injury. Optimal transfusion practice therefore requires balancing physiologic need with transfusion-related risks while applying evidence-based thresholds within the clinical context of critical illness. CI - Copyright (c) 2026. Published by Elsevier Ltd. FAU - Stein, Samantha J AU - Stein SJ AD - Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ-440, Boston, MA, 02116, United States. Electronic address: Samanthast529@gmail.com. FAU - Lam, LeAnn AU - Lam L AD - Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ-440, Boston, MA, 02114, United States. Electronic address: llam@mgh.harvard.edu. FAU - Tameze, Yasmine AU - Tameze Y AD - Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ-440, Boston, MA, 02114, United States. Electronic address: ytameze@mgh.harvard.edu. FAU - Barragan-Bradford, Diana AU - Barragan-Bradford D AD - Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ-440, Boston, MA, 02114, United States. Electronic address: dbarraganbradford@mgh.harvard.edu. LA - eng PT - Journal Article PT - Review DEP - 20260717 PL - Netherlands TA - Best Pract Res Clin Anaesthesiol JT - Best practice & research. Clinical anaesthesiology JID - 101121446 SB - IM MH - Humans MH - *Critical Illness/therapy MH - *Blood Transfusion/methods MH - *Disease Management MH - Hemorrhage/therapy MH - *Critical Care/methods OTO - NOTNLM OT - Coagulopathy OT - Critical illness OT - Plasma transfusion OT - Platelet transfusion OT - Red blood cell transfusion OT - Thromboelastography OT - Tranexamic acid COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/08/09 15:21 MHDA- 2026/08/09 15:22 CRDT- 2026/08/04 20:53 PHST- 2026/03/15 00:00 [received] PHST- 2026/07/15 00:00 [revised] PHST- 2026/07/16 00:00 [accepted] PHST- 2026/08/09 15:22 [medline] PHST- 2026/08/09 15:21 [pubmed] PHST- 2026/08/04 20:53 [entrez] AID - S1753-3740(26)00014-6 [pii] AID - 10.1016/j.bpa.2026.07.004 [doi] PST - ppublish SO - Best Pract Res Clin Anaesthesiol. 2026 Mar;40(1):87-99. doi: 10.1016/j.bpa.2026.07.004. Epub 2026 Jul 17. PMID- 42560240 OWN - NLM STAT- MEDLINE DCOM- 20260806 LR - 20260808 IS - 1930-613X (Electronic) IS - 0026-4075 (Print) IS - 0026-4075 (Linking) VI - 191 IP - Supplement_1 DP - 2026 Aug 1 TI - Novel In-line Filter Reduces ABO Circulating Antibodies in Whole Blood. PG - 293-301 LID - 10.1093/milmed/usag076 [doi] AB - INTRODUCTION: Low titer O whole blood (LTOWB) is the preferred blood product for resuscitation after hemorrhage in civilian and military trauma. The low titer requirement minimizes the risk of hemolytic transfusion reactions caused by donor ABO antibodies. However, up to 25% of otherwise eligible donors are excluded because of high antibody titers. A novel in-line filter has been developed to bind and remove donor antibodies from whole blood during infusion. We evaluated the efficacy of this filter across multiple infusion methods and assessed its effects on whole blood composition and coagulation potential. MATERIALS AND METHODS: This study was reviewed and approved as non-human research by the Institutional Review Board. Low-titer O whole blood (LTOWB) units were obtained from our regional blood bank. In the first experimental series, LTOWB units were split into unmodified native whole blood (n = 5) and spiked whole blood (n = 5) to which murine anti-human anti-A and -B antibodies were added to achieve elevated titers before simulated infusion using 3 commercially available methods (gravity, rapid manual, and automated rapid normothermic) and samples were collected after infusion both with and without the in-line filter. In a second series, unmodified native whole blood units were evaluated by cell count, flow cytometry, viscoelastic thromboelastometry, and platelet (PLT) aggregometry with and without in-line filtration. Comparisons were made using Mann-Whitney and paired t-tests. RESULTS: Use of the in-line filter significantly reduced anti-A and anti-B titers across all infusion methods, with the greatest reduction seen after gravity infusion. Gravity filtration was also associated with the most pronounced changes in whole blood characteristics, including reductions in white blood cell count, PLT count, hematocrit, and hemoglobin. Viscoelastic testing revealed modest alterations in maximum clot firmness, alpha angle, and PLT contribution to clot. Multiplate aggregometry demonstrated reductions in area under the curve on both arachidonic acid and adenosine diphosphate agonist assays. CONCLUSIONS: The novel in-line filter effectively reduces circulating anti-A and -B antibody titers in whole blood, though the extent of reduction varies by infusion method. Filtration induces mild changes in hematologic and coagulation parameters, but overall, filtered whole blood maintains the critical attributes for hemostatic resuscitation. Further studies are warranted to optimize filtration rates for maximal antibody clearance and to assess the impact of filtration rates for maximal antibody clearance. This approach may expand the LTOWB donor pool by enabling safe use of high-titer anti-A/anti-B donors. CI - (c) The Association of Military Surgeons of the United States 2026. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. FAU - Wetmore, Gregory C AU - Wetmore GC AUID- ORCID: 0009-0004-9559-5883 AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Chae, Ryan C AU - Chae RC AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Wattley, Lindsey J AU - Wattley LJ AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Schuster, Rebecca AU - Schuster R AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Joseph, Bernadin AU - Joseph B AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. FAU - Cancelas, Jose A AU - Cancelas JA AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. AD - Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH 45219, United States. AD - Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, United States. FAU - Gruda, Maryann AU - Gruda M AD - CytoSorbents Corporation, Princeton, NJ 08540, United States. FAU - Pritts, Timothy A AU - Pritts TA AUID- ORCID: 0000-0003-2495-3255 AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, United States. LA - eng GR - FA8650-23-2-6K10/U.S. Air Force/ GR - NH/NIH HHS/United States GR - T32 GM008478-32/Ruth L. Kirschstein National Research Service Award Institutional Training/ PT - Journal Article PL - England TA - Mil Med JT - Military medicine JID - 2984771R RN - 0 (ABO Blood-Group System) RN - 0 (Antibodies) SB - IM MH - Humans MH - *ABO Blood-Group System/blood/immunology MH - *Filtration/instrumentation/methods MH - *Antibodies/blood PMC - PMC13445614 COIS- Maryann Gruda, PhD, is employed by CytoSorbents Corporation. EDAT- 2026/08/06 12:37 MHDA- 2026/08/06 12:38 PMCR- 2027/08/06 CRDT- 2026/08/06 10:03 PHST- 2026/08/06 12:38 [medline] PHST- 2026/08/06 12:37 [pubmed] PHST- 2026/08/06 10:03 [entrez] PHST- 2027/08/06 00:00 [pmc-release] AID - 8752013 [pii] AID - usag076 [pii] AID - 10.1093/milmed/usag076 [doi] PST - ppublish SO - Mil Med. 2026 Aug 1;191(Supplement_1):293-301. doi: 10.1093/milmed/usag076. PMID- 42543528 OWN - NLM STAT- MEDLINE DCOM- 20260826 LR - 20260926 IS - 2192-2659 (Electronic) IS - 2192-2640 (Print) IS - 2192-2640 (Linking) VI - 15 IP - 32 DP - 2026 Aug TI - Encapsulation and Controlled Release of Human Spinal Cord Organoid-Derived Extracellular Vesicles for Tissue Patterning in Viscoelastic Hyaluronic Acid Hydrogels. PG - e71472 LID - 10.1002/adhm.71472 [doi] LID - e71472 AB - Human induced pluripotent stem cells (hiPSCs) can differentiate into various types of central nervous system organoids which are valuable for applications in tissue engineering and injury repair. The secreted extracellular vesicles (EVs) of organoids, in particular the small-sized EV subset referred as exosomes (30-200 nm), have emerged as novel therapeutics in regenerative medicine. This study investigated the encapsulation and controlled release of human spinal cord organoid (hSCO)-derived EVs in viscoelastic hyaluronic acid (HA) hydrogels and assessed their impact on organoid patterning. A series of pH-responsive hydrogels were fabricated, leading to sustained EV release regulated by viscoelastic properties. The pH of these hydrogels decreased from 9 to 7 during incubation, which altered hydrogel viscoelasticity, thereby modulating EV release kinetics. In addition, EV-loaded hydrogels regulated key hSCO patterning markers such as DBX1 and ISL1. Furthermore, these EVs in hydrogels can cross a modeled blood-spinal cord barrier and provide cross-barrier capability for delivery. Taken together, the organoid-secreted EVs in viscoelastic HA hydrogels can be released at a controlled rate and have potential to regulate spinal cord organoid patterning. This study advances our knowledge of regulating intercellular communication and developing EV-based therapies for treating neurological disorders such as spinal cord injury. CI - (c) 2026 Wiley-VCH GmbH. FAU - Chen, Xingchi AU - Chen X AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. AD - Department of Industrial and Manufacture Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. AD - High Performance Materials Institute, Florida State University, Tallahassee, Florida, USA. FAU - Liu, Chang AU - Liu C AUID- ORCID: 0000-0002-2749-7542 AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. AD - Department of pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, USA. FAU - McDaniel, Garrett AU - McDaniel G AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. FAU - Joshi, Sailesti AU - Joshi S AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. FAU - Ma, Shaoxuan AU - Ma S AUID- ORCID: 0009-0000-5692-2846 AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. FAU - Sen, Jennifer Berg AU - Sen JB AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. FAU - Driscoll, Tristan AU - Driscoll T AUID- ORCID: 0000-0002-2426-5551 AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. FAU - Zeng, Changchun AU - Zeng C AUID- ORCID: 0000-0003-0855-3497 AD - Department of Industrial and Manufacture Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. AD - High Performance Materials Institute, Florida State University, Tallahassee, Florida, USA. FAU - Li, Yan AU - Li Y AUID- ORCID: 0000-0002-5938-8519 AD - Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, USA. LA - eng GR - R01 NS125016/NS/NINDS NIH HHS/United States GR - CBET-1917618/National Science Foundation/ GR - 2425703/National Science Foundation/ GR - R01NS125016/NH/NIH HHS/United States GR - R01NS125016/NH/NIH HHS/United States PT - Journal Article DEP - 20260802 PL - Germany TA - Adv Healthc Mater JT - Advanced healthcare materials JID - 101581613 RN - 9004-61-9 (Hyaluronic Acid) RN - 0 (Hydrogels) SB - IM MH - Humans MH - *Hyaluronic Acid/chemistry MH - *Hydrogels/chemistry MH - *Spinal Cord/cytology/metabolism MH - *Extracellular Vesicles/metabolism/chemistry MH - *Organoids/metabolism/cytology MH - Induced Pluripotent Stem Cells/metabolism/cytology PMC - PMC13507618 OTO - NOTNLM OT - extracellular vesicles OT - human pluripotent stem cells OT - hyaluronic acid hydrogels OT - spinal cord organoids OT - viscoelastic properties COIS- The authors declare no conflicts of interest. EDAT- 2026/08/03 06:36 MHDA- 2026/08/26 05:36 PMCR- 2026/08/26 CRDT- 2026/08/03 00:23 PHST- 2026/06/20 00:00 [revised] PHST- 2026/02/22 00:00 [received] PHST- 2026/06/24 00:00 [accepted] PHST- 2026/08/26 05:36 [medline] PHST- 2026/08/03 06:36 [pubmed] PHST- 2026/08/03 00:23 [entrez] PHST- 2026/08/26 00:00 [pmc-release] AID - ADHM71472 [pii] AID - 10.1002/adhm.71472 [doi] PST - ppublish SO - Adv Healthc Mater. 2026 Aug;15(32):e71472. doi: 10.1002/adhm.71472. Epub 2026 Aug 2. PMID- 42534936 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260731 LR - 20260813 IS - 2296-858X (Print) IS - 2296-858X (Electronic) IS - 2296-858X (Linking) VI - 13 DP - 2026 TI - VHA-guided resuscitation and post-24-hour survival in traumatic hemorrhage: a propensity- matched retrospective cohort study from China. PG - 1865755 LID - 10.3389/fmed.2026.1865755 [doi] LID - 1865755 AB - OBJECTIVE: Traumatic hemorrhage is the predominant preventable cause of mortality in severe trauma cases. Timely and efficacious hemostatic resuscitation is crucial for the management of severe traumatic hemorrhages. This study aimed to evaluate the association between implementation of viscoelastic hemostatic assay (VHA)/TEG-guided hemostatic resuscitation and clinical outcomes among transfused traumatic hemorrhage patients who survived at least 24 h after emergency department arrival in China. METHODS: We conducted a retrospective, single-center before-after cohort study of trauma patients admitted to the emergency department of a tertiary trauma center from January 2012 to December 2021. Patients admitted from 2012 to 2016 were managed using a conventional coagulation assay (CCA)-guided strategy, whereas patients admitted from 2017 to 2021 were managed using a VHA/TEG-guided strategy. Because the analysis required complete 24-h coagulation and transfusion-response data, the primary cohort was defined as transfused traumatic hemorrhage patients who survived at least 24 h after emergency department arrival. Propensity score matching was used to reduce baseline imbalance. The primary outcome was post-24-h in-hospital mortality. RESULTS: A total of 154 patients who survived at least 24 h were included after propensity score matching, with 77 patients in each group. Post-24-h in-hospital death occurred in 21 of 77 patients in the CCA-guided group and 9 of 77 patients in the VHA-guided group. Kaplan-Meier analysis showed improved post-24-h in-hospital survival in the VHA-guided group (log-rank P = 0.015). In multivariable Cox regression adjusting for age, ISS, APACHE II score, admission shock index, and baseline PT, VHA-guided resuscitation was associated with a lower hazard of post-24-h in-hospital death (adjusted HR 0.37, 95% CI 0.16-0.84, P = 0.018). The VHA-guided group exhibited reduced plasma utilization and greater fibrinogen-directed replacement compared with the CCA-guided group. CONCLUSION: Among transfused traumatic hemorrhage patients who survived at least 24 h, VHA-guided hemostatic resuscitation was associated with improved post-24-h in-hospital survival, reduced plasma exposure, greater fibrinogen-directed replacement, and improved PT correction. This study cannot determine whether VHA-guided resuscitation improves survival during the initial 24 h, when early hemorrhagic mortality is highest. Because of the retrospective before-after design, survivorship bias, and residual confounding, these findings should be interpreted as hypothesis-generating. CI - Copyright (c) 2026 Zhong, Lin, Song, Zeng, He and Song. FAU - Zhong, Lincui AU - Zhong L AD - Intensive Care Unit, The 908th Hospital of Chinese PLA Logistic Support Force, Nanchang, China. AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. FAU - Lin, Qingwei AU - Lin Q AD - Intensive Care Unit, The 908th Hospital of Chinese PLA Logistic Support Force, Nanchang, China. AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. FAU - Song, Xiaomin AU - Song X AD - Intensive Care Unit, The 908th Hospital of Chinese PLA Logistic Support Force, Nanchang, China. AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. FAU - Zeng, Qingbo AU - Zeng Q AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. AD - Intensive Care Unit, Nanchang Hongdou Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi, China. FAU - He, Longping AU - He L AD - Intensive Care Unit, The 908th Hospital of Chinese PLA Logistic Support Force, Nanchang, China. AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. FAU - Song, Jingchun AU - Song J AD - Intensive Care Unit, The 908th Hospital of Chinese PLA Logistic Support Force, Nanchang, China. AD - Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang, China. LA - eng PT - Journal Article DEP - 20260716 PL - Switzerland TA - Front Med (Lausanne) JT - Frontiers in medicine JID - 101648047 PMC - PMC13422429 OTO - NOTNLM OT - hemorrhage OT - hemostatic resuscitation OT - severe trauma OT - thromboelastography OT - transfusion COIS- The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2026/07/31 12:39 MHDA- 2026/07/31 12:40 PMCR- 2026/07/16 CRDT- 2026/07/31 06:19 PHST- 2026/04/26 00:00 [received] PHST- 2026/06/24 00:00 [revised] PHST- 2026/07/01 00:00 [accepted] PHST- 2026/07/31 12:40 [medline] PHST- 2026/07/31 12:39 [pubmed] PHST- 2026/07/31 06:19 [entrez] PHST- 2026/07/16 00:00 [pmc-release] AID - 10.3389/fmed.2026.1865755 [doi] PST - epublish SO - Front Med (Lausanne). 2026 Jul 16;13:1865755. doi: 10.3389/fmed.2026.1865755. eCollection 2026. PMID- 42512805 OWN - NLM STAT- MEDLINE DCOM- 20260729 LR - 20260813 IS - 1648-9144 (Electronic) IS - 1010-660X (Print) IS - 1010-660X (Linking) VI - 62 IP - 7 DP - 2026 Jun 30 TI - Hemostatic Resuscitation in Trauma-Induced Coagulopathy: A Comprehensive Narrative Review. LID - 10.3390/medicina62071263 [doi] LID - 1263 AB - Background and Objectives: Traumatic hemorrhage remains the leading cause of preventable death following major injury, with most hemorrhage-related fatalities occurring within the first hours after trauma. During this early phase, trauma-induced coagulopathy (TIC) frequently develops as an independent pathophysiological response, affecting up to one-third of severely injured patients and being strongly associated with increased morbidity and mortality. Over the past two decades, TIC has been recognized as a complex endogenous process rather than a simple consequence of dilution, hypothermia, or acidosis, prompting a paradigm shift in early trauma resuscitation. Materials and Methods: This narrative review analyzes the current literature on the pathophysiology of TIC and the evolution of hemostatic resuscitation strategies. Key topics include the mechanisms underlying early coagulopathy, its clinical impact, and the evidence supporting contemporary therapeutic approaches. Published data on balanced transfusion strategies, whole blood transfusion, fibrinogen replacement, cryoprecipitate, prothrombin complex concentrates, tranexamic acid and viscoelastic-guided resuscitation were reviewed, along with relevant international guidelines. Results: Emerging evidence supports early, balanced, and targeted hemostatic resuscitation to mitigate the effects of TIC and improve outcomes in bleeding trauma patients. Balanced transfusion ratios, prompt correction of fibrinogen deficiency, early antifibrinolytic therapy and selective use of coagulation factor concentrates have been associated with reduced transfusion requirements and improved survival. Viscoelastic testing enables rapid, individualized assessment of coagulation abnormalities, although its availability and implementation remain inconsistent across trauma systems. Conclusions: Early recognition and aggressive, structured management of trauma-induced coagulopathy are essential to reduce preventable deaths from traumatic hemorrhage. While advances in hemostatic resuscitation have improved outcomes, significant challenges remain in standardizing treatment protocols and expanding access to viscoelastic diagnostics. Ongoing research and system-level optimization are needed to further refine and disseminate evidence-based strategies for the management of TIC. FAU - Matteucci, Matteo AU - Matteucci M AUID- ORCID: 0000-0002-8724-2859 AD - Department of General Surgery, University of Milan, 20122 Milan, Italy. FAU - Cirillo, Bruno AU - Cirillo B AUID- ORCID: 0000-0003-1889-2644 AD - Department of Surgery, Sapienza University, 00161 Rome, Italy. FAU - Brucchi, Francesco AU - Brucchi F AD - Department of General Surgery, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20145 Milan, Italy. FAU - Suadoni, Fabio AU - Suadoni F AD - Section of Legal Medicine, University of Perugia, 06123 Perugia, Italy. FAU - Pesce, Antonio AU - Pesce A AUID- ORCID: 0000-0002-7560-551X AD - Department of Surgery, Azienda Unita Sanitaria Locale (AUSL) Ferrara, 44121 Ferrara, Italy. FAU - Giuliani, Daniele AU - Giuliani D AD - Department of Colorectal and General Surgery, Azienda Ospedaliera di Terni, 05100 Terni, Italy. FAU - Spizzirri, Alessandro AU - Spizzirri A AD - Department of Colorectal and General Surgery, Azienda Ospedaliera di Terni, 05100 Terni, Italy. FAU - Napolitano, Vincenzo AU - Napolitano V AD - Department of Colorectal and General Surgery, Azienda Ospedaliera di Terni, 05100 Terni, Italy. FAU - Micheli, Marta AU - Micheli M AD - Department of Immunohaematology and Trasfusion, Azienda Ospedaliera di Terni, 05100 Terni, Italy. FAU - Dionigi, Gianlorenzo AU - Dionigi G AUID- ORCID: 0000-0003-0864-6087 AD - Department of General Surgery, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20145 Milan, Italy. FAU - Cirocchi, Roberto AU - Cirocchi R AUID- ORCID: 0000-0002-2457-0636 AD - Department of General Surgery, University of Perugia, 06123 Perugia, Italy. LA - eng PT - Journal Article PT - Review DEP - 20260630 PL - Switzerland TA - Medicina (Kaunas) JT - Medicina (Kaunas, Lithuania) JID - 9425208 SB - IM MH - Humans MH - *Blood Coagulation Disorders/etiology/therapy/physiopathology MH - *Resuscitation/methods/standards MH - *Wounds and Injuries/complications/physiopathology MH - Hemorrhage/therapy/etiology MH - Blood Transfusion/methods MH - Hemostasis/physiology PMC - PMC13413692 OTO - NOTNLM OT - TIC OT - acute traumatic coagulopathy OT - damage control resuscitation OT - hemostatic resuscitation OT - thromboelastometry OT - trauma guidelines for major bleeding OT - trauma-induced coagulopathy OT - viscoelastic testing COIS- The authors declare no conflicts of interest. EDAT- 2026/07/28 06:37 MHDA- 2026/07/29 18:38 PMCR- 2026/06/30 CRDT- 2026/07/28 01:12 PHST- 2026/04/21 00:00 [received] PHST- 2026/06/16 00:00 [revised] PHST- 2026/06/22 00:00 [accepted] PHST- 2026/07/29 18:38 [medline] PHST- 2026/07/28 06:37 [pubmed] PHST- 2026/07/28 01:12 [entrez] PHST- 2026/06/30 00:00 [pmc-release] AID - medicina62071263 [pii] AID - medicina-62-01263 [pii] AID - 10.3390/medicina62071263 [doi] PST - epublish SO - Medicina (Kaunas). 2026 Jun 30;62(7):1263. doi: 10.3390/medicina62071263. PMID- 42498325 OWN - NLM STAT- Publisher LR - 20260804 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) DP - 2026 Aug 4 TI - Rotem Platelet Component (A5 Platelet) as a Rapid Marker of Thrombocytopenia after Severe Trauma. LID - 10.1055/a-2922-8113 [doi] AB - Thrombocytopenia contributes to trauma-induced coagulopathy and may require platelet transfusion. Viscoelastic assays can provide rapid surrogates of platelet count, but thresholds may be influenced by physiological derangements. We compared ROTEM-derived parameters for diagnosing thrombocytopenia and tested their robustness across selected conditions.We performed a retrospective registry-based cohort study in a level 1 trauma center (2011-2021). Severely injured adults were included if they had at least one paired ROTEM and platelet count measurement within 24 hours of admission; patients receiving anticoagulants were excluded. Thrombocytopenia was defined as platelets <100 G/L. Associations between platelet count and ROTEM parameters were assessed with Spearman correlation. Diagnostic accuracy was evaluated using ROC and precision-recall (PR) analyses; optimal thresholds were chosen by maximal F1-score. For the best parameter, performance was explored across hemoglobin level, acidosis, and hypocalcemia.Of 4,395 admissions, 865 patients were included with 1,395 paired measurements; thrombocytopenia occurred in 213 samples (15.3%) and was present at admission in 35 (4%). Platelet count correlated with clot amplitude/elasticity (p < 0.001). The platelet component of clot amplitude at 5 minutes (A5 PLAT) had the best discrimination (AUC 0.929; AUPRC 0.627). The optimal PR-based threshold was A5 PLAT /=II complications within 30 days postoperatively. All clinically relevant candidate variables were entered into a least absolute shrinkage and selection operator (LASSO) regression model for feature selection. Variables retained by LASSO were further evaluated before inclusion in the multivariable model. Two multivariable logistic regression models were subsequently constructed: a baseline clinical model (Model 1) and an extended biomarker model (Model 2), which additionally incorporated C-reactive protein (CRP), thrombomodulin (TM), and thromboelastography maximum amplitude (MA). Model discrimination, reclassification, calibration, and potential clinical utility were assessed, and Shapley Additive exPlanations (SHAP) were applied as a supplementary interpretability analysis. RESULTS: A total of 195 patients were included, of whom 56 (28.72%) developed postoperative complications. The final model retained seven predictors: albumin, prothrombin time, portal hypertension, surgical approach, CRP, TM, and MA. Model 2 demonstrated superior discriminative performance compared with Model 1 in the training cohort (area under the curve (AUC) 0.88 vs. 0.74, p = 0.006); a similar advantage was observed in the validation cohort (AUC 0.84 vs. 0.67, p = 0.001). Model 2 also achieved higher net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values in both cohorts. Incremental value analysis indicated that the performance gain of Model 2 was primarily attributable to MA, while CRP and TM provided only limited additional predictive value. Calibration and decision curve analyses further supported the overall performance and potential clinical utility of Model 2. CONCLUSIONS: The extended preoperative prediction model demonstrated superior overall predictive performance compared with the model based solely on conventional clinical indicators. This improvement was driven primarily by MA, while CRP and TM, included as exploratory biomarkers within the extended framework, contributed only modest incremental value. These findings should be considered preliminary and require confirmation in larger multicenter studies with external validation before broader clinical implementation. CI - (c) Copyright: (c) 2026 The Author(s). FAU - Hu, Yiling AU - Hu Y AD - Department of Laboratory Medicine, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, 314000 Jiaxing, Zhejiang, China. FAU - Shen, Weifeng AU - Shen W AD - Department of Laboratory Medicine, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, 314000 Jiaxing, Zhejiang, China. FAU - Zhou, Hui AU - Zhou H AD - Department of Laboratory Medicine, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, 314000 Jiaxing, Zhejiang, China. FAU - Tang, Dongmei AU - Tang D AD - Department of Laboratory Medicine, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, 314000 Jiaxing, Zhejiang, China. LA - eng PT - Journal Article PL - Italy TA - Ann Ital Chir JT - Annali italiani di chirurgia JID - 0372343 RN - 0 (Thrombomodulin) RN - 9007-41-4 (C-Reactive Protein) RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Thrombelastography MH - *Thrombomodulin/blood MH - *Hepatectomy/adverse effects MH - Female MH - *C-Reactive Protein/analysis MH - *Postoperative Complications/blood/diagnosis/etiology/epidemiology MH - Retrospective Studies MH - Male MH - *Liver Neoplasms/surgery/blood MH - Predictive Value of Tests MH - Middle Aged MH - *Carcinoma, Hepatocellular/surgery/blood MH - Biomarkers/blood MH - Aged MH - Cohort Studies MH - Preoperative Care OTO - NOTNLM OT - C-reactive protein OT - hepatectomy OT - postoperative complications OT - prediction model OT - thromboelastography OT - thrombomodulin COIS- The authors declare no conflict of interest. EDAT- 2026/07/17 06:44 MHDA- 2026/07/17 19:17 CRDT- 2026/07/17 05:16 PHST- 2026/02/24 00:00 [received] PHST- 2026/03/26 00:00 [revised] PHST- 2026/05/29 00:00 [accepted] PHST- 2026/07/17 19:17 [medline] PHST- 2026/07/17 06:44 [pubmed] PHST- 2026/07/17 05:16 [entrez] AID - S0003-469X(26)00130-0 [pii] AID - 10.62713/aic.4609 [doi] PST - ppublish SO - Ann Ital Chir. 2026 Jul 14;97(7):1218-1231. doi: 10.62713/aic.4609. PMID- 42441910 OWN - NLM STAT- MEDLINE DCOM- 20261023 LR - 20261026 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 101 IP - 5 DP - 2026 Nov 1 TI - Tranexamic acid in patients with traumatic brain injury: Is there benefit in patients with fibrinolytic shutdown? PG - 790-796 LID - 10.1097/TA.0000000000005066 [doi] AB - BACKGROUND: Tranexamic acid (TXA) is widely used in patients with traumatic brain injury (TBI). However, its pharmacology suggests differences in effectiveness should exist based on fibrinolytic phenotype, particularly fibrinolytic shutdown. This study examined whether fibrinolytic shutdown is associated with increased mortality in TBI and whether TXA retains its benefit in this subgroup. METHODS: This retrospective cohort study included TBI patients who had thromboelastography (TEG) upon presentation at three affiliated trauma centers. Patients were excluded if they received TXA before TEG, had TXA >3 hours postadmission, Glasgow Coma Score (GCS)=3 and a nonreactive pupil or a nonsurvivable injury. The primary endpoint was all-cause mortality, either in-hospital or in-hospice, up to 28 days. Patients were stratified by fibrinolytic phenotype: shutdown (LY30<0.5%), physiologic (0.5-7.7%), or hyperfibrinolytic (>7.7%) and TXA receipt. Univariate and multivariate analyses were performed. RESULTS: Of 394 patients (mean age 64+/-21 y; 56% ground-level falls; 74% mild TBI), fibrinolytic shutdown predominated [72% (n=285)], followed by physiologic [27% (n=107)], and hyperfibrinolysis [0.5% (n=2)]. Unadjusted mortality was 16% with shutdown versus 9.2% without ( p =0.090). After controlling for age, ISS, GCS, multicompartmental head injury, neurosurgical intervention, and TXA, there was no association between shutdown phenotype and mortality [OR (95% CI) =1.37 (0.62-3.05)]. In patients with fibrinolytic shutdown, unadjusted mortality was lower in patients who received TXA [12% (24/196) vs. 24% (21/89), p =0.015]. After controlling for age, ISS, GCS, multicompartmental head injury, and neurosurgical intervention, mortality remained lower [OR (95% CI)=0.36 (0.16-0.77)]. In patients without fibrinolytic shutdown, no difference in mortality was noted [TXA, 9.6% (7/73) vs. no TXA, 8.3% (3/36), p =1.00]. These results did not change after controlling for the above confounders [OR (95% CI)=0.96 (0.16-5.78)]. CONCLUSIONS: TXA remained associated with lower mortality in TBI patients with fibrinolytic shutdown, despite pharmacologic expectations. Fibrinolytic shutdown was not independently associated with higher mortality. These findings support early TXA administration without delaying treatment for TEG interpretation. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV. CI - Copyright (c) 2026 Wolters Kluwer Health, LLC. All rights reserved. FAU - Barletta, Jeffrey F AU - Barletta JF AUID- ORCID: 0000-0002-9054-8218 AD - Department of Pharmacy Practice, College of Pharmacy-Glendale Campus, Midwestern University, Glendale (J.F.B.); Department of Trauma Services, HonorHealth, John C. Lincoln Medical Center, Phoenix (H.L., J.F.S., A.J.M., J.K.D.); Arizona College of Osteopathic Medicine, Midwestern University, Glendale; A.T. Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ (V.Z.). FAU - Lim, Hoang AU - Lim H FAU - Sucher, Joseph F AU - Sucher JF FAU - Mangram, Alicia J AU - Mangram AJ FAU - Dzandu, James K AU - Dzandu JK FAU - Zach, Victor AU - Zach V LA - eng PT - Journal Article PT - Multicenter Study DEP - 20260713 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 6T84R30KC1 (Tranexamic Acid) RN - 0 (Antifibrinolytic Agents) SB - IM MH - Humans MH - *Tranexamic Acid/therapeutic use MH - *Brain Injuries, Traumatic/mortality/drug therapy/blood MH - Female MH - Male MH - Retrospective Studies MH - *Antifibrinolytic Agents/therapeutic use MH - Middle Aged MH - Thrombelastography MH - *Fibrinolysis/drug effects MH - Adult MH - Treatment Outcome MH - Aged MH - Glasgow Coma Scale OTO - NOTNLM OT - Tranexamic acid OT - fibrinolytic shutdown OT - thromboelastography OT - traumatic brain injury EDAT- 2026/07/13 22:44 MHDA- 2026/10/23 18:30 CRDT- 2026/07/13 15:32 PHST- 2026/01/14 00:00 [received] PHST- 2026/04/19 00:00 [accepted] PHST- 2026/10/23 18:30 [medline] PHST- 2026/07/13 22:44 [pubmed] PHST- 2026/07/13 15:32 [entrez] AID - 01586154-990000000-01444 [pii] AID - 10.1097/TA.0000000000005066 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Nov 1;101(5):790-796. doi: 10.1097/TA.0000000000005066. Epub 2026 Jul 13. PMID- 42416367 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260708 LR - 20260726 IS - 2637-3726 (Electronic) IS - 2637-3726 (Linking) VI - 14 IP - 2 DP - 2026 Jul-Dec TI - Delayed and recurrent thoracic epidural haematoma after spinal anaesthesia in a patient with factor XIII deficiency. PG - e70083 LID - 10.1002/anr3.70083 [doi] LID - e70083 AB - Spinal epidural haematoma after spinal anaesthesia is rare but may cause severe neurological injury. We report the case of an 85-year-old man who developed a delayed thoracic spinal epidural haematoma following uncomplicated single-shot spinal anaesthesia for elective endovascular aortic repair. Low-dose intravenous unfractionated heparin was administered 73 minutes after the spinal puncture. Seventy-two hours after surgery, the patient developed acute bilateral lower-limb weakness, back pain, loss of perineal sensation and urinary retention. Magnetic resonance imaging revealed a posterior thoracic epidural haematoma from T7 to T12; urgent T8-T12 hemilaminectomy was then performed. Despite partial neurological recovery, seven days later, the patient developed sudden back pain and complete paraplegia. Repeat imaging showed recurrent epidural haematoma from T6 to T12, requiring repeat decompression. Standard coagulation tests and rotational thromboelastometry remained within normal limits throughout admission. Subsequent extended coagulation testing identified reduced factor XIII activity (38%). The patient remained paraplegic with persistent urinary retention after 60 days of rehabilitation. This case illustrates that delayed and recurrent spinal epidural haematoma may occur after atraumatic spinal anaesthesia despite guideline-compliant timing of unfractionated heparin and normal routine coagulation testing. In patients with unexplained delayed or recurrent neuraxial bleeding, occult disorders of clot stability should be considered. CI - (c) 2026 Association of Anaesthetists. FAU - Fioccola, A AU - Fioccola A AUID- ORCID: 0000-0003-4443-1905 AD - Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital Milan Italy. AD - Department of Health Sciences University of Milan Milan Italy. FAU - Pitimada, M AU - Pitimada M AD - Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital Milan Italy. AD - Department of Health Sciences University of Milan Milan Italy. FAU - Cannavo, A AU - Cannavo A AD - Complex Operating Unit, Rehabilitation Unit 2 The Milanese Institutes of Martinitt, Stelline and Pio Albergo Trivulzio Milan Italy. FAU - Cabiddu, M AU - Cabiddu M AD - Complex Operating Unit, Rehabilitation Unit 2 The Milanese Institutes of Martinitt, Stelline and Pio Albergo Trivulzio Milan Italy. FAU - Filardo, C AU - Filardo C AD - Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital Milan Italy. FAU - Chiumello, D AU - Chiumello D AD - Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital Milan Italy. AD - Department of Health Sciences University of Milan Milan Italy. AD - Coordinated Research Center on Respiratory Failure University of Milan Milan Italy. LA - eng PT - Journal Article DEP - 20260707 PL - England TA - Anaesth Rep JT - Anaesthesia reports JID - 101759073 PMC - PMC13339921 OTO - NOTNLM OT - anaesthesia, spinal OT - aortic aneurysm, abdominal OT - endovascular procedures OT - factor XIII deficiency OT - haematoma, epidural EDAT- 2026/07/08 06:51 MHDA- 2026/07/08 06:52 PMCR- 2027/07/07 CRDT- 2026/07/08 04:41 PHST- 2026/06/22 00:00 [accepted] PHST- 2026/07/08 06:52 [medline] PHST- 2026/07/08 06:51 [pubmed] PHST- 2026/07/08 04:41 [entrez] PHST- 2027/07/07 00:00 [pmc-release] AID - ANR370083 [pii] AID - 10.1002/anr3.70083 [doi] PST - epublish SO - Anaesth Rep. 2026 Jul 7;14(2):e70083. doi: 10.1002/anr3.70083. eCollection 2026 Jul-Dec. PMID- 42405400 OWN - NLM STAT- Publisher LR - 20260706 IS - 1873-4286 (Electronic) IS - 1381-6128 (Linking) DP - 2026 Jul 2 TI - The Use of Hemostatic Agents in Traumatic Bleeding: One Size Does Not Fit All. LID - 10.2174/0113816128465344260615113947 [doi] AB - INTRODUCTION: Hemostatic agents (bleeding-stopping agents) are pharmacological or biological substances used to induce hemostasis in cases of trauma, surgical interventions, or spontaneous bleeding. These agents act at various steps of primary and secondary hemostasis, promoting clot formation, reducing blood loss, and improving patient outcomes. This narrative review examines the current status of hemostatic agents and highlights major developments and gaps in the field. METHODS: A systematic literature search was used to identify relevant articles. Consecutive trials in English between 2005 and 2025 investigating the indications and use of hemostatic agents were abstracted with a search in Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE registries. Case reports, editorials, and expert opinions were excluded from the analysis. RESULTS: The use of tranexamic acid has recently been reintroduced, especially in trauma patients. It should be used in exsanguinating victims of trauma and resultant hemorrhagic shock. Prothrombin Complex Concentrates (PCC) have emerged as a favorable choice over Fresh Frozen Plasma (FFP) in bleeding due to vitamin K antagonists and other anticoagulants, and their use is increasing with studies. On the other hand, FFP is recommended when alternative treatment options are unavailable or in conjunction with first-choice agents, in narrowed indications due to possible complications. DISCUSSION: The evidence underscores that no single hemostatic agent is universally superior; optimal management requires individualized selection based on the mechanism of bleeding, underlying coagulopathy, and patient-specific factors. TXA has demonstrated consistent survival benefits in traumatic hemorrhage when administered early, yet its efficacy diminishes beyond the 3-hour window, emphasizing time-sensitivity in clinical decision-making. PCC offers practical advantages over FFP in anticoagulant reversal, including faster INR normalization, lower volume load, and no compatibility requirements, but its role in massive transfusion remains limited by the absence of factor V. FFP retains utility as an adjunct in complex coagulopathies and resource-limited settings. The integration of point-of-care viscoelastic testing (TEG/ROTEM) represents a significant advancement in guiding goal-directed hemostatic therapy and reducing unnecessary transfusions. Emerging agents and antidotes for DOAC reversal further expand the therapeutic landscape, though cost and availability remain barriers. CONCLUSION: Treatment with hemostatic agents can be lifesaving, especially after being adjusted for individual risks and benefits. Therefore, the selection of agents should be tailored on a case-by-case basis. CI - Copyright(c) Bentham Science Publishers; For any queries, please email at epub@benthamscience.net. FAU - Akman, Canan AU - Akman C AD - Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkiye. FAU - Erdem, Busra AU - Erdem B AD - Department of Emergency Medicine, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkiye. FAU - Sorgun, Omay AU - Sorgun O AD - Department of Emergency Medicine, Izmir City Hospital, Izmir, Turkiye. FAU - Ucar, Asli Bahar AU - Ucar AB AD - Department of Emergency Medicine, Marmara University School of Medicine, Pendik, Istanbul, Turkiye. FAU - Erdem, Asim Bedri AU - Erdem AB AD - Department of Emergency Medicine, University of Health Sciences, Gaziosmanpasa Education and Research Hospital, Istanbul, Turkiye. FAU - Ersan, Eylem AU - Ersan E AD - Department of Emergency Medicine, Faculty of Medicine, Balikesir Univ. Balikesir, Turkiye. FAU - Karcioglu, Ozgur AU - Karcioglu O AD - Department of Emergency Medicine, University of Health Sciences, Istanbul Education and Research Hospital, Istanbul, Turkiye. LA - eng PT - Journal Article DEP - 20260702 PL - United Arab Emirates TA - Curr Pharm Des JT - Current pharmaceutical design JID - 9602487 SB - IM OTO - NOTNLM OT - Hemostatic agents OT - bleeding OT - fresh frozen plasma OT - hemorrhage OT - tranexamic acid OT - trauma EDAT- 2026/07/06 06:32 MHDA- 2026/07/06 06:32 CRDT- 2026/07/06 05:45 PHST- 2025/12/17 00:00 [received] PHST- 2026/04/02 00:00 [revised] PHST- 2026/04/08 00:00 [accepted] PHST- 2026/07/06 06:32 [medline] PHST- 2026/07/06 06:32 [pubmed] PHST- 2026/07/06 05:45 [entrez] AID - CPD-EPUB-156788 [pii] AID - 10.2174/0113816128465344260615113947 [doi] PST - aheadofprint SO - Curr Pharm Des. 2026 Jul 2. doi: 10.2174/0113816128465344260615113947. PMID- 42384992 OWN - NLM STAT- MEDLINE DCOM- 20260701 LR - 20260813 IS - 1678-2674 (Electronic) IS - 0102-8650 (Print) IS - 0102-8650 (Linking) VI - 41 DP - 2026 TI - Damage control resuscitation in resource-diverse settings: a survey-based comparison of trauma care practices worldwide. PG - e412826 LID - S0102-86502026000102204 [pii] LID - 10.1590/acb412826 [doi] LID - e412826 AB - PURPOSE: Trauma is a major global cause of death, with uncontrolled hemorrhage as its leading preventable cause. Damage control resuscitation (DCR) is a cornerstone strategy for hemorrhagic shock, yet implementation varies by resource availability. This study compared DCR practices between high-income countries (HICs) and low- and middle-income countries (LMICs), predominantly represented by institutions from Latin America, particularly Brazil. METHODS: A cross-sectional survey of trauma care providers was conducted between 2024 and 2025, assessing DCR practices, resuscitation strategies, and adjunctive therapies. Data from a Brazilian national survey were incorporated into the LMIC cohort. Countries were classified using World Bank 2024 income criteria, and comparisons were analyzed using hierarchical logistic regression with adjustment for multiple comparisons. RESULTS: Massive transfusion protocol availability result was significantly lower in LMICs than in HICs (47.4 vs. 89.1%; OR = 0.11, 95%CI 0.02-0.62; p(BH) < 0.001). LMICs also had reduced availability of fresh frozen plasma (OR = 0.04; p(BH) = 0.035), balanced crystalloids (OR = 0.21; p(BH) < 0.001), viscoelastic coagulation monitoring (TEG/ROTEM; OR = 0.04; p(BH) 0.001), prothrombin complex concentrate (OR = 0.01; p(BH) < 0.001), fibrinogen concentrate (OR = 0.10; p(BH) < 0.001), rapid infusers (OR = 0.04; p(BH) < 0.001), invasive temperature monitoring (OR = 0.02; p(BH) < 0.001), calcium replacement (OR = 0.17; p(BH) = 0.002), and active rewarming systems (OR = 0.21; p(BH) = 0.035). Whole blood use was lower in LMICs (5.8 vs. 17.4%) but did not reach statistical significance in the primary model (OR = 0.55, 95%CI 0.12-2.45). Tranexamic acid availability was nearly universal and did not differ between settings (96.1 vs. 97.8%). CONCLUSION: Although DCR principles are widely recognized, substantial disparities persist in access to critical resuscitation resources across income settings. FAU - Pacheco, Leticia Stefani AU - Pacheco LS AUID- ORCID: 0009-0007-5965-2117 AD - Pontificia Universidade Catolica de Sao Paulo - Health Sciences and Medical School of Sorocaba - Department of Surgery - Sorocaba (SP) - Brazil. FAU - Possiedi, Rafael Dib AU - Possiedi RD AUID- ORCID: 0000-0002-3678-7920 AD - University of Maryland - School of Medicine - Department of Surgery - Baltimore (MD) - United States. AD - Doctors Without Borders - Department of Surgery - Brussels - Belgium. AD - UK-MED - Department of Surgery - Manchester - United Kingdom. FAU - Scalea, Thomas Michael AU - Scalea TM AUID- ORCID: 0000-0001-8794-4108 AD - University of Maryland - School of Medicine - Department of Surgery - Baltimore (MD) - United States. FAU - Ribeiro Junior, Marcelo Augusto Fontenelle AU - Ribeiro Junior MAF AUID- ORCID: 0000-0001-9826-4722 AD - Pontificia Universidade Catolica de Sao Paulo - Health Sciences and Medical School of Sorocaba - Department of Surgery - Sorocaba (SP) - Brazil. AD - University of Maryland - School of Medicine - Department of Surgery - Baltimore (MD) - United States. LA - eng PT - Comparative Study PT - Journal Article DEP - 20260629 PL - Brazil TA - Acta Cir Bras JT - Acta cirurgica brasileira JID - 9103983 RN - 0 (Crystalloid Solutions) SB - IM MH - Humans MH - *Resuscitation/methods/statistics & numerical data MH - Cross-Sectional Studies MH - Resource-Limited Settings MH - Developing Countries/statistics & numerical data MH - *Shock, Hemorrhagic/therapy MH - Brazil MH - Blood Transfusion/statistics & numerical data MH - Developed Countries/statistics & numerical data MH - *Wounds and Injuries/therapy MH - Crystalloid Solutions PMC - PMC13316842 COIS- Conflict of interest: Nothing to declare. EDAT- 2026/07/01 18:33 MHDA- 2026/07/01 18:34 PMCR- 2026/06/29 CRDT- 2026/07/01 15:43 PHST- 2026/01/20 00:00 [received] PHST- 2026/04/02 00:00 [accepted] PHST- 2026/07/01 18:34 [medline] PHST- 2026/07/01 18:33 [pubmed] PHST- 2026/07/01 15:43 [entrez] PHST- 2026/06/29 00:00 [pmc-release] AID - S0102-86502026000102204 [pii] AID - 10.1590/acb412826 [doi] PST - epublish SO - Acta Cir Bras. 2026 Jun 29;41:e412826. doi: 10.1590/acb412826. eCollection 2026. PMID- 42356540 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260626 LR - 20260813 IS - 1424-8247 (Print) IS - 1424-8247 (Electronic) IS - 1424-8247 (Linking) VI - 19 IP - 6 DP - 2026 Jun 11 TI - Precipitation-Based Encapsulation of Fibrinogen in Calcium Carbonate for Non-Compressible Hemorrhage Control. LID - 10.3390/ph19060923 [doi] LID - 923 AB - Background: Uncontrolled hemorrhage, especially at non-compressible sites, remains a major cause of preventable trauma deaths. This study reports the development of fibrinogen-loaded calcium carbonate (CaCO(3)) microparticles that combine hemostatic activity with self-propelling capability for targeted delivery against blood flow, with a focus on understanding formulation-dependent trade-offs among particle yield, protein loading, clotting performance, and transport behavior. Methods: Microparticles were synthesized via a precipitation method using different carbonate sources and characterized for yield, morphology, size, and fibrinogen encapsulation. Hemostatic function was assessed using rotational thromboelastometry (ROTEM) in fibrinogen-deficient plasma. Propulsion behavior was evaluated following exposure to protonated tranexamic acid (TXA(+)), which triggers CO(2) generation. Particle size and encapsulation were examined by microscopy and fluorescence imaging. Results: The precipitation method produced spherical micrometer-sized particles, with fibrinogen inclusion reducing yield and particle size relative to unload controls. Fluorescence microscopy confirmed successful encapsulation. Encapsulation efficiency varied with formulation, with sodium carbonate-based particles showing higher relative fibrinogen loading. ROTEM analysis demonstrated that fibrinogen-loaded particles significantly improved clot formation, increasing maximum clot firmness compared to fibrinogen-free particles, although performance remained formulation-dependent. TXA(+)-triggered propulsion achieved maximum speeds up to 4.221 cm/s. Fibrinogen-loaded particles exhibited longer activation lag times than unloaded particles, indicating a trade-off between hemostatic functionality and propulsion kinetics. Conclusions: Fibrinogen-loaded CaCO(3) microparticles exhibit both hemostatic activity and chemically triggered motion in vitro. The study identifies key formulation-dependent trade-offs between particle yield, fibrinogen loading, clotting performance, and propulsion behavior. While these findings support the feasibility of combining localization and clot stabilization mechanisms, further studies under physiologically relevant flow conditions and in vivo models are required to evaluate their potential for active delivery in non-compressible hemorrhage. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Bonnici, Tristan AU - Bonnici T AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Tenn, Catherine AU - Tenn C AD - Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB T1A 8K6, Canada. FAU - Kastrup, Christian J AU - Kastrup CJ AUID- ORCID: 0000-0003-3644-0019 AD - Versiti Blood Research Institute, Milwaukee, WI 53226, USA. AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA. AD - Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI 53226, USA. AD - Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA. AD - Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. AD - Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada. FAU - Beckett, Andrew AU - Beckett A AD - St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada. AD - Royal Canadian Medical Services, Ottawa, ON K1A 0K2, Canada. LA - eng GR - Program Activity People_017/Defence Research and Development Canada/ PT - Journal Article DEP - 20260611 PL - Switzerland TA - Pharmaceuticals (Basel) JT - Pharmaceuticals (Basel, Switzerland) JID - 101238453 PMC - PMC13304839 OTO - NOTNLM OT - calcium carbonate OT - fibrinogen encapsulation OT - hemostatic particles OT - non-compressible hemorrhage OT - self-propulsion OT - tranexamic acid COIS- The authors declare no conflicts of interest. EDAT- 2026/06/26 16:10 MHDA- 2026/06/26 16:11 PMCR- 2026/06/11 CRDT- 2026/06/26 01:18 PHST- 2026/04/22 00:00 [received] PHST- 2026/05/31 00:00 [revised] PHST- 2026/06/04 00:00 [accepted] PHST- 2026/06/26 16:11 [medline] PHST- 2026/06/26 16:10 [pubmed] PHST- 2026/06/26 01:18 [entrez] PHST- 2026/06/11 00:00 [pmc-release] AID - ph19060923 [pii] AID - pharmaceuticals-19-00923 [pii] AID - 10.3390/ph19060923 [doi] PST - epublish SO - Pharmaceuticals (Basel). 2026 Jun 11;19(6):923. doi: 10.3390/ph19060923. PMID- 42344540 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260625 LR - 20260813 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 11 IP - 2 DP - 2026 TI - Role of thromboelastography in risk stratifying patients with traumatic brain injury on prehospital antiplatelet agents. PG - e002013 LID - 10.1136/tsaco-2025-002013 [doi] LID - e002013 AB - INTRODUCTION: The Brain Injury Guidelines (BIG) offer valuable criteria for identifying trauma patients requiring observation without immediate intervention. One variable evaluated in BIG is prehospital aspirin (ASA) or clopidogrel use. These patients are classified as BIG3 requiring repeat head CT and neurosurgery consultation. This study aims to investigate the rate of hemorrhage progression and neurosurgery intervention (NSI) in patients fulfilling all BIG1 criteria except prehospital ASA or clopidogrel use and how thromboelastography (TEG) with platelet mapping (PM) could be used to identify patients whose platelets remain uninhibited by prehospital antiplatelet therapy, suggesting safe BIG 1 management. METHODS: Retrospective review of data at a Level I trauma center between 2017 and 2022 focused on patients with traumatic brain injury (TBI) who reported prehospital ASA or clopidogrel use. Patients were categorized BIG 1, 2, or 3 based on initial CT, Glasgow Coma Scale admission, intoxication, skull fracture type, and presence/size of intracranial hemorrhages. Impact of antiplatelet agents on platelet function was analyzed using TEG with PM. RESULTS: We identified 236 blunt TBIs on prehospital ASA or clopidogrel. BIG scores, excluding antiplatelet medications, resulted in BIG1 (24.6%), BIG2 (19.5%), and BIG3 (55.9%) classifications. 32% of patients on prehospital clopidogrel showed ADP inhibition greater than 60%, whereas 61% of those on prehospital ASA had arachidonic acid inhibition greater than 60%. Of the 58 cases fulfilling BIG1 criteria in all parameters except prehospital ASA or clopidogrel use, all but one patient demonstrated a stable repeat head CT, and no NSI was required. DISCUSSION: Prehospital ASA or clopidogrel use did not impact hemorrhage progression or need for NSI in patients with blunt TBI otherwise meeting BIG1 criteria. TEG with PM provided valuable insights into platelet inhibition. Findings indicate the benefits of tailoring management strategies for trauma patients on antiplatelet therapy to optimize resource allocation and improve care. LEVEL OF EVIDENCE: IV therapeutic/care management. CI - Copyright (c) Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. FAU - Okonya, Tracy AU - Okonya T AD - The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA. FAU - Gulati, Snigdha AU - Gulati S AD - St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. FAU - Reeson, Emily A AU - Reeson EA AD - Creighton University School of Medicine - Phoenix Health Sciences Campus, Phoenix, Arizona, USA. FAU - Mailolo, John K AU - Mailolo JK AD - Creighton University School of Medicine - Phoenix Health Sciences Campus, Phoenix, Arizona, USA. FAU - Rahaman, Clay A AU - Rahaman CA AD - Creighton University School of Medicine - Phoenix Health Sciences Campus, Phoenix, Arizona, USA. FAU - Warrington, Nicole V AU - Warrington NV AD - St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. FAU - Matthees, Nicholas G AU - Matthees NG AD - St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. FAU - Low, Trevor M AU - Low TM AD - St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. FAU - Kupanoff, Kristina M AU - Kupanoff KM AUID- ORCID: 0000-0001-5045-3524 AD - The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA. FAU - Weinberg, Jordan A AU - Weinberg JA AD - Department of Trauma Surgery, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. FAU - Bogert, James N AU - Bogert JN AD - Department of Trauma Surgery, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. LA - eng PT - Journal Article DEP - 20260616 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC13289316 OTO - NOTNLM OT - Anticoagulants OT - Brain Injuries, Traumatic OT - practice guideline OT - thrombelastography COIS- None declared. EDAT- 2026/06/25 06:37 MHDA- 2026/06/25 06:38 PMCR- 2026/06/16 CRDT- 2026/06/25 04:40 PHST- 2025/07/23 00:00 [received] PHST- 2026/05/29 00:00 [accepted] PHST- 2026/06/25 06:38 [medline] PHST- 2026/06/25 06:37 [pubmed] PHST- 2026/06/25 04:40 [entrez] PHST- 2026/06/16 00:00 [pmc-release] AID - tsaco-2025-002013 [pii] AID - 10.1136/tsaco-2025-002013 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2026 Jun 16;11(2):e002013. doi: 10.1136/tsaco-2025-002013. eCollection 2026. PMID- 42313188 OWN - NLM STAT- MEDLINE DCOM- 20260618 LR - 20260813 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 52 IP - 1 DP - 2026 Jun 18 TI - From single to dual platelet inhibition FIBTEM assay: fibrinogen replacement thresholds for critical bleeding after trauma. LID - 10.1007/s00068-026-03250-0 [doi] LID - 200 AB - PURPOSE: The FIBTEM assay in Rotational Thromboelastometry (ROTEM((R))) measures fibrin-based clot formation. The reagent transitioned from single to dual-platelet inhibition with addition of tirofiban to cytochalasin D, offering more complete platelet suppression. The aim of this study was to assess the impact of this change on transfusion thresholds in trauma. METHODS: In this retrospective cohort study, we included adult patients with major trauma across Queensland who presented between 2022 and 2025 and had results available for paired ROTEM and conventional coagulation tests on arrival. Patients were sub-grouped into single and dual-platelet inhibition assay groups. Correlations between FIBTEM-A5 and Clauss fibrinogen were analysed, comparing correlation strength and diagnostic accuracy for fibrinogen levels of < 2.0 g/L. RESULTS: The relationship between FIBTEM-A5 and Clauss fibrinogen was similar using single platelet inhibition assays (R(2) 0.61;95%CI: 0.51-0.70) and dual-platelet inhibition assays (R(2) 0.70;95%CI: 0.62-0.77; p = 0.94). Predicted FIBTEM-A5 amplitudes at 2 g/L fibrinogen were 7.83 mm (95%CI: 7.42-8.23) and 7.54 mm (95%CI: 7.22-7.87). Diagnostic performance for detecting fibrinogen < 2.0 g/L was comparable between assays, for both FIBTEM-A5 0.05). For the dual-platelet inhibition assay, sensitivity and specificity were 97.8% and 48.1% at 0.05). However, diabetes prevalence, intraoperative transfusion rate, hip versus tibiofibular fracture distribution, injury severity score (ISS) score >/= 25, hemoglobin, hematocrit, fibrinogen (FIB), and D-Dimer (D-D) levels differed significantly (all p < 0.05). Thromboelastography (TEG) revealed significantly higher maximum amplitude (MA) and alpha-angle, but lower clot formation time (K) value in the DVT group (all p < 0.001). Multivariable analysis identified hip fracture, ISS >/= 25, elevated FIB, elevated D-D, increased MA, and decreased K as independent risk factors (all p < 0.05). The nomogram demonstrated excellent predictive performance (area under the curve = 0.89, 95% confidence interval: 0.77 - 1.00), good calibration (Hosmer-Lemeshow test p > 0.05), and clinical utility on DCA. CONCLUSIONS: The TEG-based nomogram incorporating clinical features effectively predicts postoperative DVT risk in traumatic fracture patients, facilitating early identification of high-risk individuals and personalized pro-phylaxis to mitigate DVT incidence and improve outcomes. FAU - Liu, Zhen AU - Liu Z FAU - Long, Hao AU - Long H LA - eng PT - Journal Article PL - Germany TA - Clin Lab JT - Clinical laboratory JID - 9705611 SB - IM MH - Humans MH - *Nomograms MH - Female MH - *Venous Thrombosis/etiology/diagnosis/blood MH - Male MH - Risk Factors MH - Middle Aged MH - *Lower Extremity/blood supply MH - *Postoperative Complications/diagnosis/etiology MH - *Fractures, Bone/surgery/complications MH - Risk Assessment MH - Adult MH - Ultrasonography, Doppler, Color MH - ROC Curve MH - Aged MH - Predictive Value of Tests EDAT- 2026/06/15 12:54 MHDA- 2026/06/15 12:55 CRDT- 2026/06/15 11:08 PHST- 2026/06/15 12:55 [medline] PHST- 2026/06/15 12:54 [pubmed] PHST- 2026/06/15 11:08 [entrez] AID - 10.7754/Clin.Lab.2025.250643 [doi] PST - ppublish SO - Clin Lab. 2026 Jun 1;72(6). doi: 10.7754/Clin.Lab.2025.250643. PMID- 42288399 OWN - NLM STAT- MEDLINE DCOM- 20260720 LR - 20261004 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 40 IP - 8 DP - 2026 Aug TI - Pro: Point-of-care Viscoelastic Testing Should Be Routinely Used in All Cardiac Surgery Patients. PG - 2608-2612 LID - S1053-0770(26)00443-X [pii] LID - 10.1053/j.jvca.2026.05.044 [doi] AB - This "Pro" argument supports the routine incorporation of point-of-care viscoelastic testing (VET) into perioperative bleeding management algorithms for all cardiac surgery patients. This group of patients remains among the highest consumers of allogeneic blood products, and transfusion is independently associated with increased morbidity, mortality, and cost. Standard laboratory tests have significant limitations in diagnosing coagulopathy and are not designed to guide intraoperative bleeding management. VET enables rapid identification of specific coagulation abnormalities and supports targeted hemostatic therapy. Current evidence demonstrates reductions in transfusion requirements, postoperative bleeding, acute kidney injury, and healthcare costs when VET is integrated into structured transfusion algorithms. Although limitations exist, the available evidence and contemporary guidelines support the routine implementation of VET in cardiac surgical programs. CI - Copyright (c) 2026 Elsevier Inc. All rights reserved. FAU - Galhardo, Carlos Jr, AU - Galhardo C Jr, AD - Department of Anesthesia, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada. Electronic address: galhardc@mcmaster.ca. FAU - Sheriffdeen, Raiyah AU - Sheriffdeen R AD - Department of Anesthesiology, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC. LA - eng PT - Journal Article PT - Review DEP - 20260522 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 SB - IM MH - Humans MH - *Cardiac Surgical Procedures/methods/adverse effects MH - *Thrombelastography/methods/standards MH - *Point-of-Care Testing/standards MH - *Point-of-Care Systems/standards MH - Blood Coagulation Tests/methods MH - Blood Transfusion/methods MH - *Blood Loss, Surgical/prevention & control OTO - NOTNLM OT - blood coagulation tests OT - point-of-care testing OT - thromboelastography OT - thromboelastometry OT - viscoelastic testing COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/06/15 11:30 MHDA- 2026/07/21 00:35 CRDT- 2026/06/13 21:55 PHST- 2026/01/22 00:00 [received] PHST- 2026/05/06 00:00 [revised] PHST- 2026/05/18 00:00 [accepted] PHST- 2026/07/21 00:35 [medline] PHST- 2026/06/15 11:30 [pubmed] PHST- 2026/06/13 21:55 [entrez] AID - S1053-0770(26)00443-X [pii] AID - 10.1053/j.jvca.2026.05.044 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2026 Aug;40(8):2608-2612. doi: 10.1053/j.jvca.2026.05.044. Epub 2026 May 22. PMID- 42288391 OWN - NLM STAT- Publisher LR - 20260613 IS - 2173-5727 (Electronic) IS - 2173-5727 (Linking) DP - 2026 Jun 13 TI - Viscoelastic energy index and pulmonary resilience in mechanically ventilated patients: a Bayesian longitudinal multicentre study. PG - 502548 LID - S2173-5727(26)00156-6 [pii] LID - 10.1016/j.medine.2026.502548 [doi] AB - OBJECTIVE: The cyclical energy load imposed by the mechanical ventilator can influence mechanical efficiency and may be associated with an increased risk of lung injury. This study proposes the Viscoelastic Energy Index (VEI) and relative resilience, which incorporate biophysical, mathematical and geometric principles, to analyse the association between VEI and relative resilience with ARDS severity and ICU mortality. DESIGN: International, multicentre, retrospective study; quantitative analysis of pressure-volume curves to estimate energy delivered, dissipated, and recovered per ventilatory cycle. Bayesian modelling used to assess associations and perform subgroup analyses. SETTING: 4 intensive care units across 4 Latin American countries PATIENTS: Adults who received invasive mechanical ventilation in volume-controlled mode, with (mild and moderate/severe ARDS) and without ARDS. MAIN VARIABLES OF INTEREST: VEI and relative resilience, ARDS severity, ICU mortality. RESULTS: High respiratory rate, elevated driving pressure and flow, lower compliance and reduced functional residual capacity were associated with lower VEI. In patients with moderate-severe ARDS, a higher VEI was associated with lower ICU mortality (posterior probability 89.6%). As VEI increased, dissipated energy rose marginally while relative resilience increased from 0.93 to 0.97, indicating improved initial mechanical efficiency. Hysteresis decreased progressively and the relative proportion of elastic and resistive components remained stable, suggesting energetic tolerance without structural overload. CONCLUSIONS: A higher VEI is associated with greater resilience and lower mortality in patients with ARDS. Prospective studies are needed to confirm these findings. CI - Copyright (c) 2026 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved. FAU - Fajardo-Campoverdi, Aurio AU - Fajardo-Campoverdi A AD - University of La Frontera, Chile. Electronic address: drauriopiotr@gmail.com. FAU - Gallardo, Adrian AU - Gallardo A AD - Kinesiology and Respiratory Care Service, Sanatorio Clinica Modelo de Moron, Buenos Aires, Argentina. FAU - Baptistella, Antuani AU - Baptistella A AD - Postgraduate Programme in Biosciences and Health, University of Western Santa Catarina, Unoesc, Joacaba, SC, Brazil. FAU - Perez, Victor AU - Perez V AD - Respiratory Therapy Unit, Dos de Mayo National Hospital (HNDM), Lima, Peru. FAU - Almanza, Amilkar AU - Almanza A AD - Coordinator of the Critical Care Pulmonology Committee, AMCI, Colombia. FAU - Vivanco, Paulina AU - Vivanco P AD - Critical Care Unit, Physical Medicine and Rehabilitation Service, Clinica Alemana, Santiago, Chile. CN - International Mechanical Ventilation Group (WeVent) LA - eng PT - Journal Article DEP - 20260613 PL - Spain TA - Med Intensiva (Engl Ed) JT - Medicina intensiva JID - 101717568 SB - IM OTO - NOTNLM OT - ARDS OT - Driving pressure OT - Mecanotransduccion OT - Mechanical power OT - Mechanotransduction OT - Presion de conduccion OT - Resiliencia OT - SDRA OT - VALI OT - Viscoelastic energy index OT - Indice de energia viscoelastica COIS- Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest. EDAT- 2026/06/15 11:29 MHDA- 2026/06/15 11:29 CRDT- 2026/06/13 21:55 PHST- 2026/06/15 11:29 [medline] PHST- 2026/06/15 11:29 [pubmed] PHST- 2026/06/13 21:55 [entrez] AID - S2173-5727(26)00156-6 [pii] AID - 10.1016/j.medine.2026.502548 [doi] PST - aheadofprint SO - Med Intensiva (Engl Ed). 2026 Jun 13:502548. doi: 10.1016/j.medine.2026.502548. PMID- 42243989 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260605 LR - 20260813 IS - 2332-8886 (Electronic) IS - 2332-8886 (Linking) VI - 12 IP - 1 DP - 2026 Jun 5 TI - Effects of transcutaneous auricular vagus nerve stimulation or combined vagal and trigeminal nerve stimulation on platelet function and laboratory hemostasis parameters in healthy human subjects. LID - 10.1186/s42234-026-00208-w [doi] LID - 14 AB - BACKGROUND: Traumatic or surgical hemorrhage causes substantial morbidity and mortality. Electrical vagus nerve stimulation (VNS) reduces traumatic hemorrhage in animal models. VNS targets acetylcholine-producing T lymphocytes in the spleen to increase intracellular calcium within circulating platelets via alpha7 nicotinic acetylcholine receptors. Elevated calcium levels facilitate platelet activation (priming) after tissue injury to accelerate and increase clot formation that improves hemostasis. Trigeminal nerve stimulation (TNS) also decreases traumatic hemorrhage in mice, but the mechanism remains unknown. Recently, we showed that transcutaneous auricular neurostimulation (tAN; combined auricular VNS and TNS) reduces blood loss and days of menstruation in women with idiopathic or von Willebrand disease related heavy menstrual bleeding. The ability of tAN or transcutaneous auricular VNS (taVNS) to improve platelet function or laboratory hemostasis remains unknown. METHODS: Here we performed a prospective, randomized, double-blind, sham-controlled, single-center, first-in-human exploratory trial to determine the safety and efficacy of taVNS or tAN to prime platelets and augment clot formation. Healthy adult subjects received sham stimulation before taVNS or tAN, followed by serial measurements of platelet and hemostasis markers, including platelet functional analysis, thrombin generation, blood counts, coagulation assays, and thromboelastography. Repeated measures one-way ANOVA followed by Bonferroni's test was used for comparisons between three or more time points. Two-tailed paired T-test was used for comparisons between two time points. RESULTS: Administration of taVNS or tAN was well tolerated without observable adverse events during the study period. taVNS or tAN primed platelets via collagen- or ADP-mediated signaling pathways, respectively. taVNS accelerated clot initiation, propagation, and stabilization as measured by thromboelastography. There were no differences in systemic or local thrombin generation, circulating white or red blood cell counts, platelet counts, prothrombin time, partial thromboplastin time, or INR assays after administration of taVNS or tAN. CONCLUSIONS: These results provide evidence that taVNS or tAN primes human platelets and taVNS accelerates clotting kinetics as quantified by thromboelastography. taVNS and tAN warrant additional clinical study as therapies for traumatic or surgical hemorrhage and congenital or acquired coagulopathies. TRIAL REGISTRATION: This study is registered with the ClinicalTrials.gov database ( http://clinicaltrials.gov ). The registration number is NCT05977946. The study start is 10-31-2023. CI - (c) 2026. The Author(s). FAU - Huston, Jared M AU - Huston JM AD - Department of Surgery, Northwell Health, 2000 Marcus Avenue, New Hyde Park, NY, 11042, USA. jhuston@northwell.edu. AD - Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA. jhuston@northwell.edu. AD - Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. jhuston@northwell.edu. AD - Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. jhuston@northwell.edu. FAU - Bravo-Iniguez, Carlos E AU - Bravo-Iniguez CE AD - Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. FAU - Papoin, Julien AU - Papoin J AD - Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. AD - Institute of Molecular Medicine, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, 11030, USA. AD - Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA. FAU - Ahmad, Maaryj AU - Ahmad M AD - Institute of Molecular Medicine, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, 11030, USA. FAU - Le, Brooke AU - Le B AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Mirro, Isabella AU - Mirro I AD - Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. FAU - McWade, Melanie AU - McWade M AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Benner, Caroline AU - Benner C AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Covalin, Alejandro AU - Covalin A AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Czura, Christopher J AU - Czura CJ AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Khodaparast, Navid AU - Khodaparast N AD - Spark Biomedical Inc., Dallas, TX, 75252, USA. FAU - Blanc, Lionel AU - Blanc L AD - Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. AD - Institute of Molecular Medicine, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, 11030, USA. AD - Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA. LA - eng SI - ClinicalTrials.gov/NCT05977946 PT - Journal Article DEP - 20260605 PL - England TA - Bioelectron Med JT - Bioelectronic medicine JID - 101660849 PMC - PMC13237925 OTO - NOTNLM OT - Bleeding OT - Hemorrhage OT - Hemostasis OT - Neuromodulation OT - Platelets OT - Spleen OT - Surgery OT - Trauma OT - Trigeminal nerve stimulation OT - Vagus nerve stimulation COIS- Declarations. Ethics approval and consent to participate: The study was reviewed and approved by the WCG institutional review board (20226632). The participant provided written informed consent to participate in the study. Consent for publication: The participant provided written informed consent to publish data obtained in the study. Competing interests: JMH- intellectual property rights and consultant to Spark Biomedical Inc. CBI- no competing financial interests JP- no competing financial interests MA- no competing financial interests IM- no competing financial interests MM- employee at Spark Biomedical Inc. CB- employee at Spark Biomedical Inc. AC- employee at Spark Biomedical Inc. CJC- intellectual property rights and employee at Spark Biomedical Inc. NK- employee at Spark Biomedical Inc. LB- no competing financial interests. EDAT- 2026/06/05 06:35 MHDA- 2026/06/05 06:36 PMCR- 2026/06/05 CRDT- 2026/06/05 00:08 PHST- 2026/03/01 00:00 [received] PHST- 2026/05/17 00:00 [accepted] PHST- 2026/06/05 06:36 [medline] PHST- 2026/06/05 06:35 [pubmed] PHST- 2026/06/05 00:08 [entrez] PHST- 2026/06/05 00:00 [pmc-release] AID - 10.1186/s42234-026-00208-w [pii] AID - 208 [pii] AID - 10.1186/s42234-026-00208-w [doi] PST - epublish SO - Bioelectron Med. 2026 Jun 5;12(1):14. doi: 10.1186/s42234-026-00208-w. PMID- 42233229 OWN - NLM STAT- In-Process LR - 20260813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 66 IP - 8 DP - 2026 Aug TI - Management of trauma-induced coagulopathy in the perioperative setting: What is the role of anesthesia? PG - 1657-1666 LID - 10.1111/trf.70290 [doi] FAU - Mitchell, Angela M AU - Mitchell AM AUID- ORCID: 0009-0001-1358-7184 AD - University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA. FAU - O'Connell, Brennah C AU - O'Connell BC AD - University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA. FAU - Sams, Valerie G AU - Sams VG AD - University of Cincinnati Medical Center, Cincinnati, Ohio, USA. LA - eng PT - Journal Article PT - Review DEP - 20260603 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM PMC - PMC13452595 OTO - NOTNLM OT - TIC OT - anesthesia OT - anesthesiologist OT - anesthesiology OT - anesthetist OT - coagulopathy OT - damage-control anesthesia OT - guidelines OT - management OT - monitoring OT - perioperative OT - trauma OT - trauma surgery OT - trauma-induced coagulopathy OT - viscoelastic COIS- The authors have disclosed no conflicts of interest. EDAT- 2026/06/03 06:34 MHDA- 2026/06/03 06:34 PMCR- 2026/08/08 CRDT- 2026/06/03 05:22 PHST- 2026/05/21 00:00 [revised] PHST- 2026/03/03 00:00 [received] PHST- 2026/05/27 00:00 [accepted] PHST- 2026/06/03 06:34 [pubmed] PHST- 2026/06/03 06:34 [medline] PHST- 2026/06/03 05:22 [entrez] PHST- 2026/08/08 00:00 [pmc-release] AID - TRF70290 [pii] AID - 10.1111/trf.70290 [doi] PST - ppublish SO - Transfusion. 2026 Aug;66(8):1657-1666. doi: 10.1111/trf.70290. Epub 2026 Jun 3. PMID- 42229249 OWN - NLM STAT- MEDLINE DCOM- 20260613 LR - 20260613 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 262 DP - 2026 Jun TI - Defining a fibrinogen-to-factor XIII replacement ratio in an in-vitro model of dilutional coagulopathy. PG - 109729 LID - S0049-3848(26)00148-9 [pii] LID - 10.1016/j.thromres.2026.109729 [doi] AB - BACKGROUND: Massive blood loss during surgery or trauma leads to dilutional coagulopathy. While fibrinogen is typically the first factor to reach critical levels, factor XIII (FXIII) also decreases proportionally, further impairing clot stability. Routine coagulation tests are insensitive to FXIII, leading to unrecognised deficiency during acute bleeding. This study aimed to define an optimal fibrinogen-to-FXIII replacement ratio to empirically restore adequate haemostasis. METHODS: In an in-vitro haemodilution model using blood from 20 healthy volunteers, we simulated a 70% loss of circulating blood volume. Five incremental combinations of fibrinogen (0-200 mg/kg) and FXIII (0-50 IU/kg) were tested. Coagulation status was analyzed via standard laboratory parameters, viscoelastic testing and confocal microscopy. RESULTS: Haemodilution reduced fibrinogen from a median of 294 to 73 mg/dL and FXIII activity from a median of 130 to 31%. Fibrinogen monotherapy at 50 mg/kg restored fibrinogen target levels (>/= 150 mg/dL) but failed to reach FXIII targets (>60%). The lowest combination of fibrinogen and FXIII to achieve both therapeutic goals was 50 mg/kg and 25 IU/kg, respectively. FXIII demonstrated a strong synergistic effect on clot firmness (FIBtest MCF); when combined with 25 IU/kg FXIII, half the fibrinogen dose was needed to reach functional thresholds. Confocal imaging showed best interconnected fibrin networks with combined therapy. CONCLUSION: Our data indicate that a fibrinogen-to-FXIII replacement ratio of approximately 2:1 (mg/kg to IU/kg) effectively restores clot stability in dilutional coagulopathy. This ratio may provide a practical framework for empirical therapy when rapid FXIII assessment is unavailable. CI - Copyright (c) 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Alomar-Dominguez, Cristina AU - Alomar-Dominguez C AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria. FAU - Bauer, Marie Therese AU - Bauer MT AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria. FAU - Fries, Dietmar AU - Fries D AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria. FAU - Deinhart, Ludwig AU - Deinhart L AD - Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. FAU - Gebetsberger, Jennifer AU - Gebetsberger J AD - Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. FAU - Bachler, Mirjam AU - Bachler M AD - Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. FAU - Bosch, Johannes AU - Bosch J AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria.. Electronic address: johannes.boesch@i-med.ac.at. FAU - Schobersberger, Wolfgang AU - Schobersberger W AD - Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. FAU - Hermann, Martin AU - Hermann M AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria. FAU - Irsara, Christian AU - Irsara C AD - Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria. FAU - Brunelli, Luca AU - Brunelli L AD - Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria. FAU - Tobiasch, Anna Katharina AU - Tobiasch AK AD - Medical University Innsbruck, Department of Anaesthesia and Intensive Care, Innsbruck, Austria. LA - eng PT - Journal Article DEP - 20260530 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 RN - 9013-56-3 (Factor XIII) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Factor XIII/therapeutic use/analysis MH - *Fibrinogen/therapeutic use/analysis/pharmacology MH - Hemodilution/methods MH - *Blood Coagulation Disorders/drug therapy/blood MH - Adult MH - Male MH - Blood Coagulation/drug effects MH - Female MH - Blood Coagulation Tests/methods OTO - NOTNLM OT - Clot stability OT - Coagulopathy OT - Factor XIII OT - Fibrinogen OT - Haemodilution OT - Thrombelastometry OT - Viscoelastic testing COIS- Declaration of competing interest DF declares following COIs: Grants/support/lecture fee from Astra Zeneca, Baxter, Braun, Cytosorb, CSL Behring, IL-Werfen, LFB-France, Mitsubishi Pharma, Octapharma. JB declares following COIs: Lecture fee from Octapharma. The remaining authors declare no financial interests/personal relationships which may be considered as potential competing interests. EDAT- 2026/06/03 00:41 MHDA- 2026/06/13 06:38 CRDT- 2026/06/02 18:10 PHST- 2026/03/14 00:00 [received] PHST- 2026/05/13 00:00 [revised] PHST- 2026/05/29 00:00 [accepted] PHST- 2026/06/13 06:38 [medline] PHST- 2026/06/03 00:41 [pubmed] PHST- 2026/06/02 18:10 [entrez] AID - S0049-3848(26)00148-9 [pii] AID - 10.1016/j.thromres.2026.109729 [doi] PST - ppublish SO - Thromb Res. 2026 Jun;262:109729. doi: 10.1016/j.thromres.2026.109729. Epub 2026 May 30. PMID- 42206924 OWN - NLM STAT- MEDLINE DCOM- 20260908 LR - 20260916 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 54 IP - 9 DP - 2026 Sep 1 TI - Traumatic Inflammatory-Coagulation Coactivation Occurs Early After Injury and Impacts Mortality. PG - 2313-2321 LID - 10.1097/CCM.0000000000007224 [doi] AB - OBJECTIVES: Acute traumatic coagulopathy is known to occur early following severe injury. However, the role and impact of both pro- and anti-inflammatory cytokines are unknown. We aimed to investigate the inflammatory (pro- and anti-inflammatory cytokines) and coagulation pathways following injury and their relation to 30-day mortality. DESIGN: Patients included in this analysis had complete data available for a panel of 48 coagulation and inflammatory biomarkers obtained from initial emergency department blood draws. Principal component analysis (PCA), a dimensionality-reduction machine learning method, was used to identify biomarker phenotypes present. Principal components with variance (eigenvalues) greater than 1 were selected for inclusion in the analysis. Least Absolute Shrinkage and Selection Operator regression was performed to identify independent predictors of 30-day mortality. The critical administration threshold (CAT, > 3 units of RBCs in 1 hr) was used to quantify bleeding. SETTING: This is a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) study. PATIENTS: The PROPPR study was a pragmatic, phase 3, multisite, randomized clinical trial that included 680 severely injured patients at 12 level 1 trauma centers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Inflammatory and coagulation marker phenotypes were associated with 30-day mortality. Among 286 patients included, 30-day mortality was 24.4% ( n = 70). PCA found 14 phenotypes that collectively explained 83% of pathophysiologic variability. The top six principal components contributing to the early pathophysiology changes were a coagulopathy phenotype, followed by two distinct mixed inflammatory phenotypes, a platelet phenotype representing platelet activation integrins, von Willebrand Factor (vWF), and a thromboelastography phenotype representing clot strength and thrombin generation. Controlling for age, sex, injury mechanism, and bleeding (CAT+), mortality was predominantly driven by the coagulopathy phenotype 1 ( p = 0.0002) and mixed inflammatory phenotype 3 ( p = 0.0684). CONCLUSIONS: These findings demonstrate that coagulation and inflammation are coactivated early after severe injury and are associated with poor outcomes. The activation of these pathways is both complex and integrated, involving inflammatory cytokines, chemokines, growth factors, coagulation factors, platelet activated integrins, vWF, and thrombin. This study uses the largest comprehensive array of coagulation and inflammatory biomarkers to date and identifies key biologic phenotypes linked to mortality after severe trauma. CI - Copyright (c) 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, LLC. FAU - Riccardi, Julia AU - Riccardi J AUID- ORCID: 0009-0003-4672-440 AD - Department of Surgery, University of California Davis, Sacramento, CA. FAU - Robles, Anamaria J AU - Robles AJ AD - Department of Surgery, University of California Davis, Sacramento, CA. FAU - Ross, James T AU - Ross JT AD - Department of Surgery, Case Western Reserve, Cleveland, OH. AD - The Blood, Heart, Lung, and Immunology Research Center at Case Western Reserve University and University Hospitals Cleveland, Cleveland, OH. FAU - Lewis, Carrie AU - Lewis C AD - Department of Surgery, University of California Davis, Sacramento, CA. FAU - Bellini, Alyssa R AU - Bellini AR AD - Department of Surgery, University of California Davis, Sacramento, CA. FAU - Mell, Matthew AU - Mell M AD - Department of Surgery, University of California Davis, Sacramento, CA. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL. FAU - Callcut, Rachael A AU - Callcut RA AD - Department of Surgery, University of California Davis, Sacramento, CA. LA - eng GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - U01 HL077863/HL/NHLBI NIH HHS/United States GR - UL1 TR001860/TR/NCATS NIH HHS/United States PT - Clinical Trial, Phase III PT - Journal Article PT - Multicenter Study PT - Pragmatic Clinical Trial DEP - 20260528 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 RN - 0 (Biomarkers) RN - 0 (Cytokines) SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Biomarkers/blood MH - Blood Coagulation/physiology MH - *Blood Coagulation Disorders/etiology/mortality MH - Cytokines/blood MH - *Inflammation/blood MH - Principal Component Analysis MH - *Wounds and Injuries/mortality/complications/blood PMC - PMC13533472 OTO - NOTNLM OT - coagulation OT - inflammation OT - inflammatory reaction OT - injury OT - trauma COIS- Dr. Riccardi's institution received funding from the National Heart, Lung, and Blood Institute (NHLBI; RO1 HL149670; UO1 HL077863). Drs. Riccardi, Robles, Lewis, Mell, and Callcut received support for article research from the National Institutes of Health (NIH). Dr. Bellini's institution received funding from the National Center for Advancing Translational Sciences (UL1 TR001860). Dr. Holcomb received funding from Aspen Medical, Infrascan, Geneva, QinFlow Chair, Zibrio, Hemostatics, MiNK Therapeutics, Obvius Robotics, and UT Health; he disclosed that he is co-inventor of the Junctional Emergency Tourniquet Tool. Dr. Callcut's institution received funding from the NHLBI, the NIH, GE Healthcare, CSL Bearing, and Humacyte; she received funding from BeeKeeperAI. Dr. Ross has disclosed that he does not have any potential conflicts of interest. EDAT- 2026/05/28 12:34 MHDA- 2026/09/08 17:36 PMCR- 2026/09/01 CRDT- 2026/05/28 09:33 PHST- 2026/09/08 17:36 [medline] PHST- 2026/05/28 12:34 [pubmed] PHST- 2026/05/28 09:33 [entrez] PHST- 2026/09/01 00:00 [pmc-release] AID - 00003246-990000000-00854 [pii] AID - CCMED-D-25-01348 [pii] AID - 10.1097/CCM.0000000000007224 [doi] PST - ppublish SO - Crit Care Med. 2026 Sep 1;54(9):2313-2321. doi: 10.1097/CCM.0000000000007224. Epub 2026 May 28. PMID- 42200676 OWN - NLM STAT- Publisher LR - 20261006 IS - 1525-1489 (Electronic) IS - 0885-0666 (Linking) DP - 2026 May 27 TI - Subclinical Hypercoagulable Viscoelastic Characteristics Associated with Post-Acute Sequelae of SARS-CoV2 Physical Symptoms in COVID-19 ALI/ARDS Survivors. PG - 8850666261453886 LID - 10.1177/08850666261453886 [doi] AB - BackgroundEvidence suggests that thrombo-inflammation underlies post-acute sequelae of SARS CoV-2 (PASC). Rotational Thromboelastometry (ROTEM) identifies hypercoagulability related to thrombo-inflammation in hospitalized patients. We sought to determine whether COVID-19 acute lung injury/acute respiratory distress syndrome (ALI/ARDS) survivors with PASC have evidence of hypercoagulability identifiable on ROTEM at 15 months after discharge.MethodsWe conducted a single-center prospective cohort study of 93 adults hospitalized for COVID-19 ALI/ARDS in 2020. At 15-month follow-up, participants not receiving dual antiplatelet therapy or anticoagulation and without genetic coagulation disorders underwent ROTEM testing and completed symptom questionnaires. Cross-sectional associations between ROTEM parameters and PASC using the 12 symptoms and scoring from the RECOVER definition were tested using generalized additive models with propensity score adjustment for demographics, comorbidities, and aspirin use. Sensitivity analyses evaluated associations with specific PASC symptom phenotypes: patient-reported moderate or greater post-exertional malaise (PEM), fatigue, or brain fog.ResultsParticipants had a mean age of 55 years (SD, 11); 40% were women; 54% required mechanical ventilation, 18% received non-rebreather mask or non-invasive ventilation only, and 28% received nasal cannula oxygen only. At 15-month follow-up, 24% had PASC, 43% had PEM, 27% had fatigue, and 20% had brain fog. In adjusted analyses, increased fibrinogen contribution to clot strength (FIBTEM maximum clot firmness [MCF]), showed direct, linear associations with PASC risk. FIBTEM MCF values above reference ranges were more common in those with PASC (13 [59%] vs 20 [28%], p < 0.01). Similar associations were observed for PEM and fatigue, but not brain fog.ConclusionsAmong survivors of COVID-19 ALI/ARDS, at 15 months after hospitalization, PASC, PEM, and fatigue, but not brain fog, are associated with subclinical hypercoagulable clotting characteristics identified on ROTEM that are driven by fibrinogen dysregulation. Further work is needed to evaluate the role of long-term coagulation abnormalities in persistent post-COVID physical symptoms and to explore potential therapeutic approaches. FAU - Jones, Ansley E AU - Jones AE AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Mira-Sanchez, Margarita AU - Mira-Sanchez M AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Khan, Zain AU - Khan Z AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. RINGGOLD: 33638 FAU - McGroder, Claire F AU - McGroder CF AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Depender, Christopher AU - Depender C AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Ogunlusi, Charity O AU - Ogunlusi CO AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Murphy, Scarlett O AU - Murphy SO AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Wei, Ying AU - Wei Y AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. RINGGOLD: 33638 FAU - Garcia, Christine K AU - Garcia CK AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 FAU - Roh, David J AU - Roh DJ AUID- ORCID: 0000-0003-1927-7686 AD - Department of Neurology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 25065 FAU - Baldwin, Matthew R AU - Baldwin MR AUID- ORCID: 0000-0003-4670-3433 AD - Division of Pulmonary, Allergy, and Critical Care, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA. RINGGOLD: 21611 LA - eng PT - Journal Article DEP - 20260527 PL - United States TA - J Intensive Care Med JT - Journal of intensive care medicine JID - 8610344 SB - IM OTO - NOTNLM OT - acute lung injury OT - acute respiratory distress syndrome OT - fatigue OT - post-acute sequalae of COVID-19 OT - post-exertional malaise OT - rotational thromboelastometry OT - survivor EDAT- 2026/05/27 12:35 MHDA- 2026/05/27 12:35 CRDT- 2026/05/27 09:04 PHST- 2026/05/27 12:35 [medline] PHST- 2026/05/27 12:35 [pubmed] PHST- 2026/05/27 09:04 [entrez] AID - 10.1177/08850666261453886 [doi] PST - aheadofprint SO - J Intensive Care Med. 2026 May 27:8850666261453886. doi: 10.1177/08850666261453886. PMID- 42196838 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260527 LR - 20260813 IS - 2075-4418 (Print) IS - 2075-4418 (Electronic) IS - 2075-4418 (Linking) VI - 16 IP - 10 DP - 2026 May 12 TI - Is "Physiological Lysis" in Viscoelastometry a Plasmin-Mediated Process? LID - 10.3390/diagnostics16101472 [doi] LID - 1472 AB - Viscoelastic testing (VET) is widely used to guide hemostatic therapy in patients with coagulopathy. One important application is the detection of fibrinolysis, defined as a reduction in clot amplitude after maximum clot firmness (MCF), quantified as maximum lysis (ML). Low ML values have recently been associated with adverse outcomes in trauma and sepsis. However, the biological basis of low ML remains unclear. Objective: To determine whether low ML values reflect reduced plasmin-mediated fibrinolysis in tissue factor (TF) activated viscoelastic assays (EX-assay). Methods: A total of 120 healthy adults (52.5% female; mean age 38.2 +/- 14.1 years) were studied. EX-assay without fibrinolysis inhibition were compared with assays containing the antifibrinolytic agent tranexamic acid (AP-assay). VET parameters obtained with and without fibrinolysis inhibition were compared using paired analyses, Pearson correlation, and Bland-Altman methods. Results: Clot firmness at 10 min (CA10) was similar with or without fibrinolysis inhibition; although MCF differed statistically, the difference was clinically negligible. ML ranged from 1% to 13% in both assays, with nearly identical mean values (5.9 +/- 2.6% vs. 6.0 +/- 2.6%). Correlation analysis demonstrated strong agreement for CA10, MCF, and ML between assays, and Bland-Altman analysis confirmed minimal bias for ML. Conclusions: Low ML values in TF-triggered viscoelastic assays were unaffected by tranexamic acid, suggesting that they are unlikely to reflect plasmin-mediated fibrinolysis. These findings support the contribution of alternative mechanisms, such as platelet-mediated clot retraction. FAU - Smudla, Aniko AU - Smudla A AD - Department of Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. FAU - Schochl, Herbert AU - Schochl H AUID- ORCID: 0000-0001-6028-1551 AD - Ludwig-Boltzmann-Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria. FAU - Calatzis, Andreas AU - Calatzis A AD - Institute for Cardiovascular Prevention, LMU Munich University Hospital, 80336 Munich, Germany. FAU - Gergely, Csikos Richard AU - Gergely CR AUID- ORCID: 0000-0002-3161-1272 AD - Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary. FAU - Fazakas, Janos AU - Fazakas J AD - Department of Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. LA - eng PT - Journal Article DEP - 20260512 PL - Switzerland TA - Diagnostics (Basel) JT - Diagnostics (Basel, Switzerland) JID - 101658402 PMC - PMC13205181 OTO - NOTNLM OT - clot retraction OT - maximum lysis OT - physiologic lysis OT - tranexamic acid OT - viscoelastometry COIS- AC and HS are consultants of Apiro, the manufacturer of the applied assays. HS received honoraria for participation in advisory board meetings for Bayer Healthcare, Bohringer Ingelheim, and Octapharma and study grants from CSL Behring and Enicor. EDAT- 2026/05/27 06:42 MHDA- 2026/05/27 06:43 PMCR- 2026/05/12 CRDT- 2026/05/27 01:18 PHST- 2026/04/09 00:00 [received] PHST- 2026/05/07 00:00 [revised] PHST- 2026/05/11 00:00 [accepted] PHST- 2026/05/27 06:43 [medline] PHST- 2026/05/27 06:42 [pubmed] PHST- 2026/05/27 01:18 [entrez] PHST- 2026/05/12 00:00 [pmc-release] AID - diagnostics16101472 [pii] AID - diagnostics-16-01472 [pii] AID - 10.3390/diagnostics16101472 [doi] PST - epublish SO - Diagnostics (Basel). 2026 May 12;16(10):1472. doi: 10.3390/diagnostics16101472. PMID- 42181487 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260525 LR - 20260813 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 18 IP - 4 DP - 2026 Apr TI - Recurrent Laryngeal Nerve Identification in Thyroidectomy: Limitations of Anatomical Landmarks and the Gamboa-Hoil Principle. PG - e107506 LID - 10.7759/cureus.107506 [doi] LID - e107506 AB - Recurrent laryngeal nerve (RLN) injury remains one of the most clinically significant complications of thyroidectomy, with potential consequences for voice, airway protection, and overall quality of life. Despite advances in surgical technique, the reliable identification and preservation of the RLN remain challenging because of its anatomical variability. This narrative review analyzes the anatomical course of the RLN and its relationship with commonly used surgical landmarks, including Berry's ligament (BL), the Zuckerkandl tubercle (ZT), the tracheoesophageal groove (TEG), and the inferior thyroid artery (ITA). The limitations of these landmarks are examined, alongside variations in nerve branching patterns, mechanisms of injury, and factors related to patient characteristics and surgical experience. In addition, differences between proximal and distal approaches for nerve identification are discussed. Current strategies rely primarily on direct visualization and, in selected cases, intraoperative nerve monitoring (IONM). However, these approaches are influenced by anatomical variability and do not consistently prevent RLN injury. Available evidence suggests that no single anatomical landmark provides a universally reliable method for nerve identification. Based on these findings, we propose a surgical concept focused on identifying the RLN at its point of entry into the larynx, where the nerve typically follows a posteromedial course relative to the thyroid lobe and maintains a consistent relationship with the lateral aspect of the trachea, a region that appears more anatomically consistent and less affected by extralaryngeal variability. This approach, termed the Gamboa-Hoil principle, incorporates standard nerve identification, followed by a deliberate pause at the distal extralaryngeal segment, particularly within the final 2 cm before entry into the larynx, where the division of Berry's ligament is deferred until the exact site of nerve entry is confirmed. This concept may provide a more consistent and reproducible framework for RLN identification. Further prospective and comparative studies are required to validate its clinical applicability and impact on surgical outcomes. CI - Copyright (c) 2026, Gamboa-Hoil et al. FAU - Gamboa-Hoil, Sergio Isidro AU - Gamboa-Hoil SI AD - Surgical Oncology, Mexican Social Security Institute, Merida, MEX. LA - eng PT - Journal Article PT - Review DEP - 20260421 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC13195054 OTO - NOTNLM OT - anatomical variability OT - gamboa-hoil principle OT - nerve injury OT - recurrent laryngeal nerve OT - thyroidectomy COIS- Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2026/05/25 12:34 MHDA- 2026/05/25 12:35 PMCR- 2026/04/21 CRDT- 2026/05/25 08:01 PHST- 2026/04/21 00:00 [accepted] PHST- 2026/05/25 12:35 [medline] PHST- 2026/05/25 12:34 [pubmed] PHST- 2026/05/25 08:01 [entrez] PHST- 2026/04/21 00:00 [pmc-release] AID - 10.7759/cureus.107506 [doi] PST - epublish SO - Cureus. 2026 Apr 21;18(4):e107506. doi: 10.7759/cureus.107506. eCollection 2026 Apr. PMID- 42164837 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260521 LR - 20260813 IS - 2667-114X (Electronic) IS - 2667-114X (Linking) VI - 9 DP - 2026 TI - Increased metallopeptidase activity, compromised endothelial integrity and impaired pathogen recognition revealed by transcriptomics in Angiostrongylus vasorum-infected dogs with hypocoagulability and vascular dysfunction. PG - 100378 LID - 10.1016/j.crpvbd.2026.100378 [doi] LID - 100378 AB - Dogs infected with the cardiopulmonary nematode Angiostrongylus vasorum are at high risk to die because of the associated bleeding pathologies, which remain poorly understood. Given their central role in immune surveillance and signaling, we analyzed transcriptomic profiles from (i) A. vasorum-infected dogs presenting with hypocoagulability (Inf(hypo); n = 5), (ii) infected dogs with normal coagulation values (Inf(norm); n = 5), and (iii) uninfected controls (UC; n = 12). Alongside classical hematology and coagulation parameters, including rotational thromboelastometry (ROTEM), we generated a global transcriptomic profile of circulating blood cells, enabling the identification of differentially expressed genes following infection. Fibrinogen levels were significantly lower in Inf(hypo) than in Inf(norm) dogs. All Inf(hypo) dogs showed out-of-range prothrombin times. Matrix metalloprotease transcripts were strongly upregulated among infected dogs, regardless of their coagulation status, which might amplify vascular disruption and inflammation. Analysis of downregulated transcripts in infected dogs compared to UC indicated a loss of endothelial integrity, especially at the level of the lungs, and of inflammatory processes contributing to fibrinolysis and coagulopathies. Endothelial injury is a known trigger of disseminated intravascular coagulation (DIC) and consumption of coagulation factors, which could explain the observed coagulation disorders induced by A. vasorum infection. The multifaceted alterations observed in hematologic and coagulation parameters, ROTEM, and transcriptomic profiles of A. vasorum-infected dogs point to a dynamic and evolving disruption of hemostatic balance. While some animals show signs of early compensatory hypercoagulability, others seem to progress toward a state consistent with DIC, marked by factor consumption, endothelial dysfunction, and impaired fibrinogen-dependent clotting. CI - (c) 2026 The Authors. FAU - Tritten, Lucienne AU - Tritten L AD - Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, Zurich, 8057, Switzerland. FAU - Tayyrov, Annageldi AU - Tayyrov A AD - Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, Zurich, 8057, Switzerland. FAU - Opitz, Lennart AU - Opitz L AD - Functional Genomics Center Zurich, ETH Zurich/University of Zurich, Winterthurerstrasse 190, Zurich, 8057, Switzerland. FAU - Kutter, Annette P N AU - Kutter APN AD - Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, Zurich, 8057, Switzerland. FAU - Sigrist, Nadja E AU - Sigrist NE AD - Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, Zurich, 8057, Switzerland. FAU - Hofer-Inteeworn, Natalie AU - Hofer-Inteeworn N AD - Clinic for Small Animal Internal Medicine, Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland. FAU - Kummerle-Fraune, Claudia AU - Kummerle-Fraune C AD - Clinic for Small Animal Internal Medicine, Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland. FAU - Schnyder, Manuela AU - Schnyder M AD - Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, Zurich, 8057, Switzerland. LA - eng PT - Journal Article DEP - 20260412 PL - Netherlands TA - Curr Res Parasitol Vector Borne Dis JT - Current research in parasitology & vector-borne diseases JID - 9918226380706676 PMC - PMC13185918 OTO - NOTNLM OT - Angiostrongylus vasorum OT - Consumptive coagulopathy OT - Dog OT - Impaired fibrinogen-dependent clotting OT - Inflammation OT - Transcriptome OT - Vascular endothelium disfunction COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/05/21 06:32 MHDA- 2026/05/21 06:33 PMCR- 2026/04/12 CRDT- 2026/05/21 04:45 PHST- 2026/01/18 00:00 [received] PHST- 2026/04/09 00:00 [revised] PHST- 2026/04/10 00:00 [accepted] PHST- 2026/05/21 06:33 [medline] PHST- 2026/05/21 06:32 [pubmed] PHST- 2026/05/21 04:45 [entrez] PHST- 2026/04/12 00:00 [pmc-release] AID - S2667-114X(26)00034-8 [pii] AID - 100378 [pii] AID - 10.1016/j.crpvbd.2026.100378 [doi] PST - epublish SO - Curr Res Parasitol Vector Borne Dis. 2026 Apr 12;9:100378. doi: 10.1016/j.crpvbd.2026.100378. eCollection 2026. PMID- 42155694 OWN - NLM STAT- MEDLINE DCOM- 20260804 LR - 20260807 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 24 IP - 8 DP - 2026 Aug TI - Traumatic disseminated intravascular coagulation: a narrative review of modern concepts in pathophysiology, diagnosis, and management. PG - 2699-2712 LID - S1538-7836(26)00326-0 [pii] LID - 10.1016/j.jtha.2026.04.038 [doi] AB - Traumatic disseminated intravascular coagulation is a catastrophic complication in severely injured patients, profoundly impacting morbidity and mortality. This condition manifests as a dynamic, heterogeneous spectrum: an initial hyperfibrinolytic phenotype followed by a thrombotic phenotype characterized by microvascular thrombosis and organ dysfunction. Recent advances frame traumatic disseminated intravascular coagulation as a failure of immunothrombosis, driven by damage-associated molecular patterns, neutrophil extracellular traps, and catastrophic endotheliopathy. This narrative review synthesized modern pathophysiological concepts (eg, shock-induced endotheliopathy, antithrombin leakage, and traumatic brain injury-specific triggers) with evolving clinical strategies. We compared diagnostic scoring systems (eg, Japanese Association for Acute Medicine) and highlighted the pivotal role of viscoelastic testing in guiding resuscitation. Management principles are detailed as a phased approach: (1) early, viscoelastic testing-guided damage control resuscitation and tranexamic acid for hemorrhage and (2) late-phase viscoelastic testing prophylaxis and targeted, albeit controversial, anticoagulant use to manage thrombosis. The aim was to provide clinicians with an evidence-based framework for the early recognition and effective management of this complex syndrome. CI - Copyright (c) 2026 The Author(s). Published by Elsevier Inc. All rights reserved. FAU - Omori, Kazuhiko AU - Omori K AD - Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan. Electronic address: koomori@juntendo.ac.jp. FAU - Wada, Takeshi AU - Wada T AD - Department of Anesthesiology and Critical Care Medicine, Division of Acute and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan. LA - eng PT - Journal Article PT - Review DEP - 20260520 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Anticoagulants) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Humans MH - *Disseminated Intravascular Coagulation/diagnosis/physiopathology/therapy/blood/etiology MH - *Blood Coagulation/drug effects MH - Anticoagulants/therapeutic use MH - *Wounds and Injuries/complications/blood/therapy/diagnosis/physiopathology MH - Predictive Value of Tests MH - Thrombosis/blood/diagnosis/therapy MH - Resuscitation MH - Tranexamic Acid/therapeutic use MH - Hemorrhage/blood/diagnosis MH - Animals MH - Thrombelastography MH - Risk Factors OTO - NOTNLM OT - disseminated intravascular coagulation OT - endotheliopathy OT - hemostasis OT - immunothrombosis OT - thrombosis OT - wounds and injuries COIS- Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/05/20 00:35 MHDA- 2026/08/07 18:36 CRDT- 2026/05/19 19:36 PHST- 2025/10/05 00:00 [received] PHST- 2026/04/28 00:00 [revised] PHST- 2026/04/30 00:00 [accepted] PHST- 2026/08/07 18:36 [medline] PHST- 2026/05/20 00:35 [pubmed] PHST- 2026/05/19 19:36 [entrez] AID - S1538-7836(26)00326-0 [pii] AID - 10.1016/j.jtha.2026.04.038 [doi] PST - ppublish SO - J Thromb Haemost. 2026 Aug;24(8):2699-2712. doi: 10.1016/j.jtha.2026.04.038. Epub 2026 May 20. PMID- 42149310 OWN - NLM STAT- MEDLINE DCOM- 20260806 LR - 20260828 IS - 1573-742X (Electronic) IS - 0929-5305 (Print) IS - 0929-5305 (Linking) VI - 59 IP - 6 DP - 2026 Aug TI - Association of thrombogenicity indices with perioperative cardiovascular events after non-cardiac surgery: a prespecified analysis of the PANDA study. PG - 1349-1361 LID - 10.1007/s11239-026-03299-z [doi] AB - Traditional clinical risk models, such as Revised Cardiac Risk Index (RCRI), have limited predictive value for estimating postoperative cardiovascular complications following non-cardiac surgery. This analysis aimed to evaluate prognostic value of thrombogenicity profiles and coronary anatomy for cardiovascular events in patients undergoing non-cardiac surgery. In a prospective cohort of 120 patients who underwent intermediate-to-high risk surgery, thrombogenicity profiles were assessed using thromboelastography (TEG(R)) and conventional hemostatic measurements before surgery. Coronary artery disease (CAD) was preoperatively defined as presence of significant stenosis (>/= 50% luminal narrowing) on coronary computed tomography angiography (CCTA). Postoperative cardiovascular events were defined as cardiovascular death, non-fatal myocardial infarction, myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30 days after surgery. Sixteen patients (13.3%) experienced cardiovascular events. In multivariable analysis, presence of CAD (odds ratio [OR]: 5.11; 95% confidence interval [CI]: 1.49-17.53; P = 0.009), D-dimer (per 1-mug/mL increase: OR: 1.22; 95% CI: 1.02-1.47; P = 0.030), and platelet-fibrin clot strength (PFCS) measured by TEG(R) (per 1-mm increase: OR: 1.10; 95% CI: 1.01-1.20; P = 0.027) were independently associated with cardiovascular events. Discrimination of cardiovascular event risk improved progressively with the sequential addition of the following risk stratification models: RCRI alone, RCRI + CCTA, and RCRI + CCTA + thrombogenicity profiles (C-index: 0.660 vs. 0.731 vs. 0.803). Cardiovascular event rates increased with greater risk burden, ranging from 4.2% in patients with no risk components to 77.8% in those with all components present. Integrating thrombogenicity assessment and CCTA with traditional clinical risk models may improve perioperative risk stratification and help guide tailored preventive strategies for patients undergoing non-cardiac surgery.Clinical trial registration. URL: http://www.clinicaltrials.gov . Unique identifier: NCT02250963. CI - (c) 2026. The Author(s). FAU - Hendrianus, Hendrianus AU - Hendrianus H AD - Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea. AD - Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. AD - Division of Cardiology, Natuna General Hospital, Natuna, Indonesia. FAU - Ahn, Jong-Hwa AU - Ahn JH AD - Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea. AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. FAU - Kang, Min-Gyu AU - Kang MG AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. AD - Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea. FAU - Kim, Kye-Hwan AU - Kim KH AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. AD - Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea. FAU - Koh, Jin-Sin AU - Koh JS AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. AD - Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea. FAU - Kim, Sang-Wook AU - Kim SW AD - Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea. AD - Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. FAU - Hwang, Jin-Yong AU - Hwang JY AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. AD - Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea. FAU - Tantry, Udaya S AU - Tantry US AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Maryland, USA. FAU - Gurbel, Paul A AU - Gurbel PA AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Maryland, USA. FAU - Park, Jeong-Rang AU - Park JR AD - Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea. AD - Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea. FAU - Jeong, Young-Hoon AU - Jeong YH AUID- ORCID: 0009-0009-9479-2822 AD - Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. goodoctor@naver.com. AD - CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea. goodoctor@naver.com. LA - eng SI - ClinicalTrials.gov/NCT02250963 PT - Journal Article PT - Observational Study DEP - 20260518 PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 SB - IM MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Cardiovascular Diseases/etiology MH - Coronary Artery Disease/complications MH - *Postoperative Complications/etiology MH - Prognosis MH - Prospective Studies MH - Risk Assessment MH - Risk Factors MH - *Surgical Procedures, Operative/adverse effects MH - Thrombelastography MH - *Thrombosis/etiology PMC - PMC13447407 OTO - NOTNLM OT - Cardiovascular events OT - Coronary artery disease OT - Perioperative risk OT - Revised Cardiac Risk Index OT - Surgery OT - Thrombogenicity COIS- Declarations. Competing interest: Dr Gurbel has received grants and personal fees from Dr. Gurbel has received consulting fees and/or honoraria from Baron and Budd, Cleveland Clinic foundation, Medtronic, Wolters Kluwer Pharma; grants from Abcentra LLC, Accriva Diagnostics, Alnylam Pharmaceuticals, Covance, Eli Lilly, Haemonetics, Hikari Dx, Idorisa, Instrumentation labs, Medtronic, Novartis, Prolocor, Recor Medical; and has patents 'Detection of Restenosis Risk in Patients Issued' and 'Assessment of Cardiac Health and Thrombotic Risk in a Patient'. Dr Jeong has received honoraria for lectures from Daiichi Sankyo, Sanofi-Aventis, Han-mi Pharmaceuticals, and Daewoong Pharmaceuticals and research grants or support from Samjin Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, Biotronik Korea, and U and I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2026/05/18 12:43 MHDA- 2026/08/06 12:37 PMCR- 2026/05/18 CRDT- 2026/05/18 11:16 PHST- 2026/02/16 00:00 [received] PHST- 2026/04/19 00:00 [accepted] PHST- 2026/08/06 12:37 [medline] PHST- 2026/05/18 12:43 [pubmed] PHST- 2026/05/18 11:16 [entrez] PHST- 2026/05/18 00:00 [pmc-release] AID - 10.1007/s11239-026-03299-z [pii] AID - 3299 [pii] AID - 10.1007/s11239-026-03299-z [doi] PST - ppublish SO - J Thromb Thrombolysis. 2026 Aug;59(6):1349-1361. doi: 10.1007/s11239-026-03299-z. Epub 2026 May 18. PMID- 42145275 OWN - NLM STAT- MEDLINE DCOM- 20260716 LR - 20260819 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 5 IP - 5 DP - 2026 May 18 TI - Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. PG - CD007871 LID - 10.1002/14651858.CD007871.pub4 [doi] LID - CD007871 AB - BACKGROUND: Severe bleeding and coagulopathy are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy, but their roles remain disputed. This is an update of a review that was first published in 2011 and updated in January 2016. OBJECTIVES: The objective was to evaluate the benefits and harms of TEG-/ROTEM-guided transfusion strategies for bleeding in adults and children by comparing TEG-ROTEM-guided transfusion with standard treatment. SEARCH METHODS: In this updated review, we identified randomised controlled trials (RCTs) from the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE(R) ALL; Embase; Web of Science Core Collection and Biosis Previews via Clarivate; CINAHL EBSCO; and the WHO Global Index Medicus incl. LILACS (from 2015 up to 5 January 2025). We searched for ongoing clinical trials and unpublished studies in the following registries during the aforementioned period: ISRCTN, ClinicalTrials.gov, CentreWatch, and UMIN-CTR. We contacted trial authors, authors of previous reviews, and manufacturers in the field. The original searches were run in October 2010 and January 2016. SELECTION CRITERIA: We included all RCTs, irrespective of blinding or language, that compared transfusion guided by TEG or ROTEM to transfusion guided by clinical judgement, guided by standard laboratory tests, or a combination. We also included interventional algorithms including both TEG and ROTEM in combination with standard laboratory tests or other devices. The primary analysis included trials on TEG or ROTEM versus any comparator. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data; we resolved any disagreements by discussion. We presented pooled estimates of the intervention effects on dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). Due to skewed data, meta-analysis was not provided for continuous outcome data. Our primary outcome measure was all-cause mortality. We performed subgroup and sensitivity analyses to assess the effect of a TEG- or ROTEM-guided algorithm in adults and children on various clinical and physiological outcomes. We evaluated potential bias by examining trial methodological components using the Cochrane Risk of Bias 1 and assessed the risk of random error through Trial Sequential Analysis (TSA). MAIN RESULTS: This systematic review included 35 randomised trials (n = 3096), with most involving patients undergoing elective cardiac surgery. Hence, 18 trials and 1603 participants were added since the previous update of this review. TEG-/ROTEM-guided transfusion algorithms may be associated with a reduction in mortality (RR 0.76, 95% CI 0.63 to 0.92; 19 trials; 1865 participants, I(2)= 0%; random-effects model; very low-certainty evidence), but the evidence is very uncertain. This aligns with results from a previous update of this review. Additionally, TEG-/ROTEM-guided transfusion algorithms may reduce bleeding volume (standardised mean difference -0.31, 95% CI -0.51 to -0.11; 19 trials; 1523 participants, I(2) = 72%, random-effects model; very low-certainty evidence), but the evidence is very uncertain. No effects on the need for packed red blood cells were seen; RR 0.94 (95% CI 0.87 to 1.01; 21 trials, 2003 participants; I(2) = 91%; random-effects model; very low-certainty evidence), but the evidence is very uncertain. Furthermore, reductions may be observed in the use of fresh frozen plasma (RR 0.52, 95% CI 0.35 to 0.76; 18 trials; 1536 participants; I(2) = 94%, random-effects model; very low-certainty evidence), platelet transfusions (RR 0.69, 95% CI: 0.55 to 0.87; 20 trials; 1607 participants; I(2) = 60%; random-effects model; very low-certainty evidence), and in the risk of surgical re-intervention (RR 0.63, 95% CI 0.45 to 0.88; 13 trials; 1204 participants; I(2) = 0%; fixed-effect model; very low-certainty evidence), but the evidence is very uncertain. Using the GRADE framework, the certainty of the evidence was judged to be very low across all outcomes. TSA for mortality indicated that 64% of the required information size had been reached, with the monitoring boundary for benefit crossed. AUTHORS' CONCLUSIONS: TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma, platelets, and surgical re-intervention, but the evidence is very uncertain. Furthermore, the results were primarily based on the adult population undergoing elective cardiac surgery. Hence, the conclusion remains unchanged from the previous update of this review. There is a need for large, low risk of bias randomised controlled trials evaluating TEG/ROTEM across diverse clinical settings, including paediatric and neonatal populations, sepsis, trauma, obstetrics, and high-risk surgical and critically ill cohorts requiring major transfusion. Future studies should be adequately powered and prioritise patient-centred outcomes such as long-term survival, adverse events, cost-effectiveness, and the role of TEG/ROTEM in coagulopathy and severe haemorrhage. CI - Copyright (c) 2026 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Kvisselgaard, Ask Daffy AU - Kvisselgaard AD AUID- ORCID: 0000-0002-4147-0987 AD - Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark. AD - Danish Aneasthesia Allergy Centre, Allergy Clinic 1, Copenhagen University Hospital Gentofte, Copenhagen, Denmark. FAU - Wolthers, Signe Amalie AU - Wolthers SA AUID- ORCID: 0000-0001-6325-2449 AD - Prehospital Centre Zealand, Naestved, Denmark. AD - Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. FAU - Wikkelso, Anne J AU - Wikkelso AJ AUID- ORCID: 0000-0001-6848-8143 AD - Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. AD - Department of Anaesthesiology and Intensive Care Medicine, Roskilde Hospital, Roskilde, Denmark. FAU - Holst, Lars Brokso AU - Holst LB AUID- ORCID: 0000-0001-8951-9252 AD - Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Drivenes, Bergitte AU - Drivenes B AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Afshari, Arash AU - Afshari A AUID- ORCID: 0000-0001-5117-9715 AD - Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. AD - Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. LA - eng SI - ClinicalTrials.gov/NCT01402739 SI - ClinicalTrials.gov/NCT02311985 PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20260518 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - Cochrane Database Syst Rev. 2016 Aug 22;(8):CD007871. doi: 10.1002/14651858.CD007871.pub3. PMID: 27552162 MH - Humans MH - *Thrombelastography/methods MH - Randomized Controlled Trials as Topic MH - Child MH - Adult MH - *Hemorrhage/therapy/mortality MH - *Blood Transfusion/methods PMC - PMC13181841 COIS- Ask Daffy Kvisselgaard: None Signe Amilie Wolthers: None Anne Wikkelso: None Lars Brokso Holst: None Bergitte Drivenes: None Arash Afshari: None. Cochrane editor, but was not involved in the editorial process of this review. EDAT- 2026/05/18 12:42 MHDA- 2026/05/18 12:43 PMCR- 2027/05/18 CRDT- 2026/05/18 06:33 PHST- 2026/05/18 12:43 [medline] PHST- 2026/05/18 12:42 [pubmed] PHST- 2026/05/18 06:33 [entrez] PHST- 2027/05/18 00:00 [pmc-release] AID - CD007871.pub4 [pii] AID - 10.1002/14651858.CD007871.pub4 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2026 May 18;5(5):CD007871. doi: 10.1002/14651858.CD007871.pub4. PMID- 42140689 OWN - NLM STAT- MEDLINE DCOM- 20260716 LR - 20260803 IS - 1557-9832 (Electronic) IS - 0272-2712 (Linking) VI - 46 IP - 2 DP - 2026 Jun TI - Viscoelastic Testing for the Laboratorian: Recent Advances and Practical Advice. PG - 351-373 LID - S0272-2712(26)00009-0 [pii] LID - 10.1016/j.cll.2026.02.009 [doi] AB - Viscoelastic testing is increasingly recognized as a standard-of-care tool for goal-directed transfusion management, with expanding endorsement from national and international guidelines. Its clinical utility is well established across several high-acuity settings, including cardiothoracic surgery, trauma, liver transplantation, and obstetric hemorrhage. These next-generation systems use alternative detection technologies and generate distinct numerical outputs for comparable TEG 5000 and ROTEM delta parameters, making institution-specific validation of transfusion thresholds essential. This article provides an overview of recent advances in viscoelastic testing and offers practical guidance for laboratorians involved in incorporating these emerging technologies into clinical workflows. CI - Copyright (c) 2026 Elsevier Inc. All rights reserved. FAU - Volod, Oksana AU - Volod O AD - Coagulation and Consultative Services, Department of Pathology and Laboratory Medicine, Cedars Sinai, Los Angeles, CA 90048, USA. Electronic address: Oksana.Volod@csmc.edu. LA - eng PT - Journal Article PT - Review DEP - 20260311 PL - United States TA - Clin Lab Med JT - Clinics in laboratory medicine JID - 8100174 SB - IM MH - Humans MH - *Thrombelastography/methods OTO - NOTNLM OT - Guidelines OT - Hemostasis OT - Laboratory practice OT - Quantra OT - ROTEM sigma OT - TEG 6s COIS- Disclosures O. Volod is a consultant for Quantra and served on the Clinical Care Improvement Steering Committee for Diagnostica Stago, Inc., and received honoraria for consultancy outside the submitted work. EDAT- 2026/05/16 00:37 MHDA- 2026/05/16 00:38 CRDT- 2026/05/15 20:52 PHST- 2026/05/16 00:38 [medline] PHST- 2026/05/16 00:37 [pubmed] PHST- 2026/05/15 20:52 [entrez] AID - S0272-2712(26)00009-0 [pii] AID - 10.1016/j.cll.2026.02.009 [doi] PST - ppublish SO - Clin Lab Med. 2026 Jun;46(2):351-373. doi: 10.1016/j.cll.2026.02.009. Epub 2026 Mar 11. PMID- 42138510 OWN - NLM STAT- MEDLINE DCOM- 20260923 LR - 20260929 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 101 IP - 2 DP - 2026 Aug 1 TI - Characterization of the binding of skeletal muscle myosin to fibrin in trauma. PG - 281-290 LID - 10.1097/TA.0000000000004946 [doi] AB - BACKGROUND: The procoagulant phenotype of skeletal muscle myosin (SkM) includes the promotion of thrombin generation to form fibrin, and subsequent increased resistance of fibrin clots to fibrinolysis. The release of SkM into circulation following localized tissue injury is hypothesized to promote systemic hypercoagulation. Yet, in trauma patients and in animal models of tissue injury, an unexplained decrease in SkM levels has been observed. METHODS: Plasma samples were collected from orthopedic trauma patients at admission and 6 weeks later and from pigs subjected to experimentally extensive muscle injury. Plasma SkM and myoglobin levels were measured. The binding of SkM to fibrin was quantified in vitro using fluorescence imaging assays. Fibrinolysis was measured using turbidimetric assays and thromboelastography. RESULTS: SkM plasma levels in trauma patients were lower at admission compared to 6 weeks later, while plasma myoglobin levels were higher at admission than at 6 weeks. In the pig injury model, plasma SkM levels at 24 hours after injury were decreased, while myoglobin levels were increased. In vitro, SkM bound to fibrin, but not fibrinogen, with an apparent Kd of 0.18 muM and was associated with a decrease in the level of SkM in solution. Fluorescence imaging of the fibrin clots confirmed the presence of SkM within fibrin clots, which increased the resistance of the fibrin clot to fibrinolysis. CONCLUSIONS: Direct binding of SkM to fibrin may explain the reduced circulating SkM levels observed after trauma and may help identify potential roles for SkM in trauma-associated coagulopathy. ( J Trauma Acute Care Surg . 2026;101: 281-290. Copyright (c) 2026 Wolters Kluwer Health, Inc. All rights reserved.). CI - Copyright (c) 2026 Wolters Kluwer Health, Inc. All rights reserved. FAU - Yang, Chih Jen AU - Yang CJ AUID- ORCID: 0000-0003-4902-8867 AD - Department of Biomedical Engineering (C.J.Y., A.A.R., E.C.K., A.L.L., J.P., H.H.V., J.J.S., C.P., J.E.A., O.J.T.M), Oregon Health & Science University, Portland, Oregon; Department of Emergency Medicine (C.J.Y.), Tri-Service General Hospital, National Defensive Medical Center, Taipei, Taiwan; Critical Care and Acute Care Surgery (J.P.G.), Oregon Health & Science University, Portland, Oregon; Department of Molecular Medicine (H.D., J.H.G.), The Scripps Research Institute, La Jolla, California; Department of Orthopaedics & Rehabilitation (D.F.P., N.S.M., C.E.H., T.T., Z.M.W.), Oregon Health & Science University, Portland, Oregon; Division of Hematology and Medical Oncology (J.J.S.), Oregon Health and Science University, Portland, Oregon; Department of Surgery (M.A.S.), Uniformed Services University, Bethesda, Maryland; Department of Anesthesiology & Perioperative Medicine (M.P.H.), Oregon Health & Science University, Portland, Oregon; Operative Care Division (M.P.H.), Portland Veterans Administration Medical Center, Portland, Oregon. FAU - Rodolf, Amelia A AU - Rodolf AA FAU - Garay, Joseph P AU - Garay JP FAU - Kelmser, Ethan C AU - Kelmser EC FAU - Lira, Andre L AU - Lira AL FAU - Pang, Jiaqing AU - Pang J FAU - Vu, Helen H AU - Vu HH FAU - Deguchi, Hiroshi AU - Deguchi H FAU - Peterson, Danielle F AU - Peterson DF FAU - McKibben, Natasha S AU - McKibben NS FAU - Hutchison, Catherine E AU - Hutchison CE FAU - Trapalis, Talia AU - Trapalis T FAU - Shatzel, Joseph J AU - Shatzel JJ FAU - Puy, Cristina AU - Puy C FAU - Aslan, Joseph E AU - Aslan JE FAU - Working, Zachary M AU - Working ZM FAU - Schreiber, Martin A AU - Schreiber MA FAU - Hutchens, Michael P AU - Hutchens MP FAU - Griffin, John H AU - Griffin JH FAU - McCarty, Owen J T AU - McCarty OJT CN - Portland, Oregon LA - eng GR - R01 HL101972/HL/NHLBI NIH HHS/United States GR - R01 HL142975/HL/NHLBI NIH HHS/United States GR - R01 HL151367/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20260518 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-31-4 (Fibrin) RN - EC 3.6.1.- (Skeletal Muscle Myosins) RN - 0 (Myoglobin) SB - IM MH - Animals MH - *Fibrin/metabolism MH - Swine MH - Humans MH - Female MH - Fibrinolysis/physiology MH - *Wounds and Injuries/blood MH - *Skeletal Muscle Myosins/blood/metabolism MH - Myoglobin/blood MH - Disease Models, Animal MH - Thrombelastography MH - Male MH - Blood Coagulation PMC - PMC13616134 MID - NIHMS2211973 OTO - NOTNLM OT - Skeletal muscle myosin OT - coagulation OT - fibrin OT - fibrinolysis OT - pig OT - trauma COIS- DISCLOSURE JTACS COI Disclosure forms for all authors have been supplied and are provided as Supplemental Digital Content 1, http://links.lww.com/TA/F201. EDAT- 2026/05/15 17:37 MHDA- 2026/09/23 11:49 PMCR- 2026/09/27 CRDT- 2026/05/15 09:33 PHST- 2025/11/06 00:00 [received] PHST- 2026/01/22 00:00 [accepted] PHST- 2026/09/23 11:49 [medline] PHST- 2026/05/15 17:37 [pubmed] PHST- 2026/05/15 09:33 [entrez] PHST- 2026/09/27 00:00 [pmc-release] AID - 01586154-990000000-01372 [pii] AID - 10.1097/TA.0000000000004946 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Aug 1;101(2):281-290. doi: 10.1097/TA.0000000000004946. Epub 2026 May 18. PMID- 42120237 OWN - NLM STAT- Publisher LR - 20260512 IS - 1008-1275 (Print) IS - 1008-1275 (Linking) DP - 2026 Apr 23 TI - The lethal triad: Past, present, and future. LID - S1008-1275(26)00095-7 [pii] LID - 10.1016/j.cjtee.2026.04.001 [doi] AB - The post-traumatic "lethal triad" is a cornerstone theory in modern trauma care, and its evolution mirrors the paradigm shift in trauma medicine from empirical treatment to evidence-based precision medicine. This review traces the development of this theory, from the "bloody vicious cycle" first described in 1982, to the reconceptualization of acute traumatic coagulopathy in 2003, the establishment of damage control resuscitation strategies in 2007, and the revision of diagnostic criteria in 2016 to focus on fibrinolysis. Current clinical controversies primarily center on 3 aspects: (1) confusion regarding defining and differentiating between post-traumatic coagulation disorders, trauma-induced coagulopathy, and disseminated intravascular coagulation; (2) the predictive value of including hypocalcemia as a 4th element in a "lethal diamond" lacks evidence-based support; and (3) the lack of unified standards for intervention thresholds and correction strategies for hypothermia and acidosis. Furthermore, clinical practice issues, such as the superiority of whole blood versus component therapy, individualized viscoelastic hemostatic assay-guided treatment, and the role of life-support technologies such as extracorporeal membrane oxygenation, remain to be clarified. Future directions currently focus on 3 trends: (1) molecular phenotyping using metabolomic biomarkers and artificial intelligence algorithms for ultra-early identification and targeted hemostasis, (2) establishing a "lactate + base deficit" dual monitoring and real-time decision-making system integrating multi-source data, and (3) developing dynamic risk prediction models through multi-omics technologies to drive the transition from "reactive management" to "proactive prevention and treatment", all for advancing lethal triad-centered trauma care from reactive management to proactive prevention and treatment. CI - Copyright (c) 2026 Chinese Medical Association. Published by Elsevier B.V. All rights reserved. FAU - Xiao, Lifeng AU - Xiao L AD - Department of Emergency, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong province, 515000, China. FAU - Zhang, Lianyang AU - Zhang L AD - Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China. Electronic address: hpzhangly@163.com. LA - eng PT - Journal Article PT - Review DEP - 20260423 PL - China TA - Chin J Traumatol JT - Chinese journal of traumatology = Zhonghua chuang shang za zhi JID - 100886162 SB - IM OTO - NOTNLM OT - Damage control resuscitation OT - Lethal triad OT - Precision medicine OT - Trauma-induced coagulopathy COIS- Declaration of competing interest The authors declare no conflict of interest. EDAT- 2026/05/13 00:29 MHDA- 2026/05/13 00:29 CRDT- 2026/05/12 21:52 PHST- 2026/03/19 00:00 [received] PHST- 2026/04/07 00:00 [accepted] PHST- 2026/05/13 00:29 [medline] PHST- 2026/05/13 00:29 [pubmed] PHST- 2026/05/12 21:52 [entrez] AID - S1008-1275(26)00095-7 [pii] AID - 10.1016/j.cjtee.2026.04.001 [doi] PST - aheadofprint SO - Chin J Traumatol. 2026 Apr 23:S1008-1275(26)00095-7. doi: 10.1016/j.cjtee.2026.04.001. PMID- 42109853 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260511 LR - 20260813 IS - 2589-0042 (Electronic) IS - 2589-0042 (Linking) VI - 29 IP - 6 DP - 2026 Jun 19 TI - Longitudinal changes in coagulation-fibrinolysis in patients with traumatic brain injury within seven days after injury. PG - 115443 LID - 10.1016/j.isci.2026.115443 [doi] LID - 115443 AB - Traumatic brain injury (TBI)-induced coagulopathy is associated with poor outcomes of patients, but its progression remains poorly understood. We longitudinally collected peripheral venous blood samples from patients with TBI 24 h, 3 days, and 7 days after injury, and analyzed the samples for conventional blood and conventional coagulation tests, thromboelastography, coagulation factor activity, platelet activity, and levels of extracellular vesicles through laboratory tests. By detecting longitudinal changes in the coagulation-fibrinolysis, we found that TBI patients were in a state of hyperfibrinolysis within 24 h after injury, but transitioned to a hypercoagulable state on the 7(th) day after injury. And, the concentrations of extracellular vesicles continued to increase from 24 h to 7 days after injury. We identified the early changes in TBI-induced coagulopathy, namely that TBI patients undergo a transition from a hyperfibrinolytic state to a hypercoagulable state within 24 h to 7 days post-injury. CI - (c) 2026 Published by Elsevier Inc. FAU - Dong, Xinlong AU - Dong X AD - Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. AD - Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. FAU - Yao, Nanyu AU - Yao N AD - Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Zhang, Limin AU - Zhang L AD - Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Zheng, Guanghui AU - Zheng G AD - Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Zhao, Yutong AU - Zhao Y AD - Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. FAU - Liu, Weiming AU - Liu W AD - Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. LA - eng PT - Journal Article DEP - 20260324 PL - United States TA - iScience JT - iScience JID - 101724038 PMC - PMC13156692 OTO - NOTNLM OT - cardiovascular medicine OT - health sciences OT - medical specialty OT - medicine COIS- The authors declare no competing interests. EDAT- 2026/05/11 13:00 MHDA- 2026/05/11 13:01 PMCR- 2026/03/24 CRDT- 2026/05/11 06:39 PHST- 2025/08/10 00:00 [received] PHST- 2025/11/25 00:00 [revised] PHST- 2026/03/19 00:00 [accepted] PHST- 2026/05/11 13:01 [medline] PHST- 2026/05/11 13:00 [pubmed] PHST- 2026/05/11 06:39 [entrez] PHST- 2026/03/24 00:00 [pmc-release] AID - S2589-0042(26)00818-7 [pii] AID - 115443 [pii] AID - 10.1016/j.isci.2026.115443 [doi] PST - epublish SO - iScience. 2026 Mar 24;29(6):115443. doi: 10.1016/j.isci.2026.115443. eCollection 2026 Jun 19. PMID- 42094753 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260507 LR - 20260813 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 11 IP - Suppl 1 DP - 2026 TI - Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma. PG - e002241 LID - 10.1136/tsaco-2026-002241 [doi] LID - e002241 AB - Viscoelastic testing is an old but evolving technology that is commonly used in the management of trauma patients. Unlike conventional coagulation studies that provide information on specific parts of the clotting process, viscoelastic testing gives a more global view of clotting. The two currently used forms of viscoelastic testing are rotational thromboelastometry (ROTEM) and thromboelastography (TEG). This review will outline the history, technical aspects, and clinical data for ROTEM and TEG in the context of managing traumatic injury. CI - Copyright (c) Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. FAU - Brito, Alexandra M P AU - Brito AMP AUID- ORCID: 0000-0002-2137-1834 AD - Surgical Critical Care, Oregon Health & Science University, Portland, Oregon, USA. FAU - Schreiber, Martin A AU - Schreiber MA AUID- ORCID: 0000-0002-4430-6779 AD - Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. LA - eng PT - Journal Article PT - Review DEP - 20260430 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC13141058 OTO - NOTNLM OT - Blood coagulation OT - blood coagulation tests OT - blood transfusion COIS- MS is a consultant for Haemonetics and has received institutional grant funding to support research. MS has also been a consultant for CSL Behring and has received institutional grant funding from CSL Behring. In addition, MS serves as a consultant for Tricol and has previously served as a consultant for Octapharma. EDAT- 2026/05/07 06:38 MHDA- 2026/05/07 06:39 PMCR- 2026/04/30 CRDT- 2026/05/07 05:16 PHST- 2026/01/03 00:00 [received] PHST- 2026/02/21 00:00 [accepted] PHST- 2026/05/07 06:39 [medline] PHST- 2026/05/07 06:38 [pubmed] PHST- 2026/05/07 05:16 [entrez] PHST- 2026/04/30 00:00 [pmc-release] AID - tsaco-2026-002241 [pii] AID - 10.1136/tsaco-2026-002241 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2026 Apr 30;11(Suppl 1):e002241. doi: 10.1136/tsaco-2026-002241. eCollection 2026. PMID- 42088733 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260506 LR - 20260813 IS - 2949-9070 (Electronic) IS - 2949-9070 (Linking) VI - 4 IP - 2 DP - 2026 Jun TI - Viscous drag-induced self-regeneration of laser-dissected actin stress fibers: A potential mechanism for mechanical memory. PG - 100191 LID - 10.1016/j.mbm.2026.100191 [doi] LID - 100191 AB - Biological tissues are constantly subjected to physiological mechanical stresses that can induce microdamage to cellular components, a process linked to cellular aging and carcinogenesis. Actin stress fibers (SFs) are central to maintaining structural integrity and transducing mechanical cues to intracellular organelles. While SF mechanical properties and disassembly have been extensively studied, the regenerative dynamics following acute physical trauma, specifically complete transection, remain poorly understood. Using a short-pulsed laser nanoscissor system to investigate porcine aortic smooth muscle cells, this study reveals a self-repairing capacity in individual SFs that we characterize as a form of "mechanical memory". Following precise ablation, SFs exhibited immediate viscoelastic contraction, which was well-characterized by a first-order viscoelastic model. The results revealed a significant spatial dependency in repair capabilities: peripheral SFs demonstrated a markedly higher regeneration rate ( approximately 80%) compared to central SFs ( approximately 30%). This difference was closely correlated with the contraction time constant (tau); SFs with a higher tau (indicating prolonged contraction against high viscous resistance) were less conducive to repair. The author propose a mechanochemical repair model where the localized high-strain field generated by viscous friction at the severed ends of SFs serves as a cue for the recruitment of crosslinking proteins. Excessive surrounding resistance dampens the contraction velocity, preventing the formation of a sufficiently intense dynamic strain field. This attenuated mechanical signal appears insufficient to trigger the mechanosensitive recruitment of crosslinking proteins. These findings suggest that SF regeneration is governed by a delicate balance between contractile dynamics, intracellular location, and the surrounding mechanical environment, providing new insights into the biomechanical pathways underlying cellular homeostasis. CI - (c) 2026 The Author. FAU - Nagayama, Kazuaki AU - Nagayama K AD - Micro-Nano Biomechanics Laboratory, Department of Mechanical Systems Engineering, Ibaraki University, Nakanarusawa-cho, Hitachi, 316-8511, Japan. LA - eng PT - Journal Article DEP - 20260415 PL - Netherlands TA - Mechanobiol Med JT - Mechanobiology in medicine JID - 9918804283006676 PMC - PMC13137181 OTO - NOTNLM OT - Actin stress fibers OT - Cell biomechanics OT - Laser nanodissection OT - Mechanotransduction OT - Self-repair mechanism OT - Viscoelastic contraction COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2026/05/06 06:38 MHDA- 2026/05/06 06:39 PMCR- 2026/04/15 CRDT- 2026/05/06 05:04 PHST- 2026/02/17 00:00 [received] PHST- 2026/04/01 00:00 [revised] PHST- 2026/04/13 00:00 [accepted] PHST- 2026/05/06 06:39 [medline] PHST- 2026/05/06 06:38 [pubmed] PHST- 2026/05/06 05:04 [entrez] PHST- 2026/04/15 00:00 [pmc-release] AID - S2949-9070(26)00018-5 [pii] AID - 100191 [pii] AID - 10.1016/j.mbm.2026.100191 [doi] PST - epublish SO - Mechanobiol Med. 2026 Apr 15;4(2):100191. doi: 10.1016/j.mbm.2026.100191. eCollection 2026 Jun. PMID- 42088147 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260506 LR - 20260813 IS - 2110-5820 (Print) IS - 2110-5820 (Electronic) IS - 2110-5820 (Linking) VI - 16 DP - 2026 TI - Regional citrate anticoagulation for renal replacement therapy during venovenous ECMO: A randomized crossover pilot study. PG - 100072 LID - 10.1016/j.aicoj.2026.100072 [doi] LID - 100072 AB - BACKGROUND: Regional citrate anticoagulation (RCA) is suggested as the preferred anticoagulation strategy during continuous renal replacement therapy (CRRT), as it prolongs circuit lifespan while minimizing bleeding complications. However, evidence on its use in CRRT circuits during extracorporeal membrane oxygenation (ECMO) is limited. In patients receiving ECMO, systemic anticoagulation with unfractionated heparin (UFH) is routinely administered to maintain circuit patency and is often relied upon to anticoagulate the CRRT circuit, limiting the use of regional citrate anticoagulation. The aim of this study is to evaluate whether adding regional citrate anticoagulation (RCA) to systemic unfractionated heparin (UFH) reduces CRRT circuits clotting in patients undergoing venovenous extracorporeal membrane oxygenation (VV ECMO). RESULTS: Patients were randomized to receive alternating CRRT circuits anticoagulated with either systemic UFH alone or regional citrate anticoagulation added to systemic UFH (RCA + UFH), according to a predefined crossover sequence. Each circuit was maintained for up to 72 h or until clotting occurred. Coagulation parameters, CRRT pressures, and thromboelastography (TEG) data were collected.A total of 66 CRRT circuits from 18 patients were analyzed (33 RCA + UFH; 33 UFH). No clotting events occurred in the RCA + UFH circuits, whereas 6 events were observed with UFH alone (0% vs 19%; p < 0.001). Cox proportional hazards analysis showed significantly longer circuit survival with RCA + UFH compared to UFH alone (p = 0.029). Platelet counts increased during RCA + UFH but declined during UFH alone (median change +6 vs -7 x10(3)/muL; p < 0.001), with a significantly more favorable overall trend under RCA + UFH (effect estimate +13 x 10(3)/muL, 95% CI 8-19). D-dimer levels increased significantly during UFH alone, whereas a lower increase was observed with RCA + UFH (effect estimate -782 mug/L, 95% CI -1525 to -39).Thromboelastography performed at the circuit level showed significantly prolonged R-times with RCA + UFH compared with UFH alone (median R-time 90 vs. 30 min; p < 0.001). No clinically relevant RCA-related metabolic complications were observed, including no episodes of severe hypernatremia, metabolic alkalosis, or citrate accumulation. CONCLUSIONS: In patients undergoing VV ECMO, adding regional citrate anticoagulation to systemic unfractionated heparin reduced CRRT circuit clotting, prevented platelet consumption. This technique was feasible, safe, and may improve CRRT efficiency in this high-risk population. CLINICAL TRIAL: ClinicalTrials.gov Identifier NCT05148026. CI - (c) 2026 The Author(s). FAU - Giani, Marco AU - Giani M AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. FAU - Frazzei, Marta AU - Frazzei M AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. FAU - Rona, Roberto AU - Rona R AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. FAU - Langer, Thomas AU - Langer T AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Lombardy, Italy. FAU - Pozzi, Matteo AU - Pozzi M AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. FAU - Foti, Giuseppe AU - Foti G AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. FAU - Rezoagli, Emanuele AU - Rezoagli E AD - Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardy, Italy. AD - Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Lombardy, Italy. CN - CRRT ECMO Study Group LA - eng SI - ClinicalTrials.gov/NCT05148026 PT - Journal Article DEP - 20260427 PL - France TA - Ann Intensive Care JT - Annals of intensive care JID - 101562873 PMC - PMC13137002 OTO - NOTNLM OT - Acute kidney injury OT - CRRT OT - ECMO OT - Regional citrate anticoagulation COIS- The authors declare no conflicts of interest related to this work. EDAT- 2026/05/06 06:38 MHDA- 2026/05/06 06:39 PMCR- 2026/04/27 CRDT- 2026/05/06 04:57 PHST- 2026/02/01 00:00 [received] PHST- 2026/03/25 00:00 [revised] PHST- 2026/04/20 00:00 [accepted] PHST- 2026/05/06 06:39 [medline] PHST- 2026/05/06 06:38 [pubmed] PHST- 2026/05/06 04:57 [entrez] PHST- 2026/04/27 00:00 [pmc-release] AID - S2110-5820(26)00107-X [pii] AID - 100072 [pii] AID - 10.1016/j.aicoj.2026.100072 [doi] PST - epublish SO - Ann Intensive Care. 2026 Apr 27;16:100072. doi: 10.1016/j.aicoj.2026.100072. eCollection 2026. PMID- 42083375 OWN - NLM STAT- MEDLINE DCOM- 20260703 LR - 20260703 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 37 IP - 5 DP - 2026 Jul 1 TI - Fibrin degradation products enhance plasmin activity and contribute to fibrinolysis during simulated trauma-induced coagulopathy. PG - 184-189 LID - 10.1097/MBC.0000000000001430 [doi] AB - OBJECTIVE: Fibrinolysis is an important component of trauma-induced coagulopathy (TIC) that is strongly associated with early mortality after injury. Yet, the mechanisms driving excessive fibrinolysis remain incompletely understood. We hypothesized that fibrin degradation products (FDPs) known to become elevated in the blood after trauma can actively contribute to TIC by promoting disordered clot formation and enhanced plasmin activity. METHODS: Purified FDPs, fragments X, D, E, and D-dimer, were titrated into normal human plasma in vitro at physiologically relevant concentrations under normal and simulated TIC conditions. Rotational thromboelastometry (ROTEM) was used to assess their effects on clot initiation, formation, firmness, and lysis. Thrombin generation assays (TGA) and plasmin generation assays (PGA) were performed to measure enzymatic activity in the presence of each FDP. Key parameters included clotting time (CT), alpha-angle, maximum clot firmness (MCF), lysis index at 45 minutes (LI-45), maximum lysis (ML), time to peak plasmin activity, PGA slope and peak plasmin concentration. RESULTS: Fragments D, X, and D-dimer increased clot lysis by ROTEM under TIC-like conditions. D-dimer and D fragments significantly accelerated plasmin generation judged by shortening PGA peak time, and increasing PGA slope and concentration, whereas thrombin generation was not different across all groups. CONCLUSIONS: Individual FDPs, including fragments D, X, and D-dimer, can contribute to TIC by increasing plasmin activity. Further studies in whole blood and trauma patient samples are warranted. CI - Copyright (c) 2026 Wolters Kluwer Health, Inc. All rights reserved. FAU - Han, Chang Yeop AU - Han CY AD - Department of Emergency Medicine. AD - Resuscitation Engineering Science Unit (RESCU), University of Washington, Seattle, Washington, USA. FAU - Dow, Nathan AU - Dow N AD - Department of Emergency Medicine. FAU - White, Nathan J AU - White NJ AD - Department of Emergency Medicine. AD - Resuscitation Engineering Science Unit (RESCU), University of Washington, Seattle, Washington, USA. LA - eng PT - Journal Article DEP - 20260504 PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - EC 3.4.21.7 (Fibrinolysin) RN - 0 (Fibrin Fibrinogen Degradation Products) SB - IM MH - Humans MH - *Fibrinolysis MH - *Fibrinolysin/metabolism MH - *Fibrin Fibrinogen Degradation Products/metabolism MH - *Wounds and Injuries/complications/blood MH - *Blood Coagulation Disorders/etiology/blood MH - Thrombelastography OTO - NOTNLM OT - coagulopathy OT - fibrin degradation products OT - fibrinogen OT - fibrinolysis OT - plasmin OT - trauma EDAT- 2026/05/05 06:33 MHDA- 2026/07/03 06:30 CRDT- 2026/05/05 02:12 PHST- 2025/12/30 00:00 [received] PHST- 2026/04/03 00:00 [accepted] PHST- 2026/07/03 06:30 [medline] PHST- 2026/05/05 06:33 [pubmed] PHST- 2026/05/05 02:12 [entrez] AID - 00001721-990000000-00254 [pii] AID - 10.1097/MBC.0000000000001430 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2026 Jul 1;37(5):184-189. doi: 10.1097/MBC.0000000000001430. Epub 2026 May 4. PMID- 42075592 OWN - NLM STAT- MEDLINE DCOM- 20260716 LR - 20260813 IS - 1648-9144 (Electronic) IS - 1010-660X (Print) IS - 1010-660X (Linking) VI - 62 IP - 4 DP - 2026 Apr 9 TI - Mechanical Signatures of Tibiofemoral Cartilage Degeneration Identified by Unconfined Compression Testing: Implications for Early Osteoarthritis Risk in Athletes. LID - 10.3390/medicina62040720 [doi] LID - 720 AB - Background and objectives: Articular cartilage provides low-friction articulation across joint surfaces, distributes loads, and absorbs stress, all of which are crucial mechanical functions of joints. Changes in the mechanical characteristics of cartilage are among the first signs of degenerative joint disease, and they are especially important for athletes who are subjected to high-impact, high-magnitude loading on a regular basis. The objective of this study was to: (i) compare the mechanical characteristics of tibiofemoral cartilage in healthy and osteoarthritic conditions across medial and lateral anatomical compartments; and (ii) use nonlinear phenomenological viscoelastic modeling in conjunction with unconfined compression testing to characterize compartment-specific viscoelastic behavior. Materials and Methods: Forty-six human tibiofemoral cartilage samples were collected during knee surgeries and classified as healthy (n = 17) or osteoarthritic (n = 29) and as medial (n = 26) or lateral (n = 20). Quasi-static unconfined compression tests were performed at 1 mm/min to obtain stress-strain responses, Young's modulus, maximum compressive stress, and energy absorption. Viscoelastic behavior was analyzed using a nonlinear phenomenological viscoelastic model. Appropriate parametric or non-parametric statistical tests and effect size measures were applied. Results: Osteoarthritic cartilage's stiffness and energy absorption were significantly higher than those of healthy tissue (p < 0.05). Medial cartilage exhibited significantly greater stiffness and stress than lateral cartilage (p < 0.001). The nonlinear phenomenological viscoelastic model provided an excellent fit (R(2) > 0.999). Conclusions: The mechanical profile of osteoarthritic tibiofemoral cartilage is characterized by pathological mechanical remodeling and increased stiffness. Greater mechanical susceptibility in the medial compartment supports the significance of cartilage biomechanical properties as sensitive indicators of early degeneration and osteoarthritis risk in athletic populations. FAU - Benhmida, Saida AU - Benhmida S AD - Laboratory of Biophysics and Medical Technologies, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 9 Street, Doctor Zouheir Safi, Tunis 1006, Tunisia. FAU - Dergaa, Ismail AU - Dergaa I AUID- ORCID: 0000-0001-8091-1856 AD - High Institute of Sport and Physical Education of Ksar Said, University of Manouba, Manouba 2010, Tunisia. AD - Physical Activity Research Unit, Sport and Health (UR18JS01), National Observatory of Sports, Tunis 1003, Tunisia. AD - High Institute of Sport and Physical Education of El Kef, University of Jendouba, Jendouba 7100, Tunisia. FAU - Ceylan, Halil Ibrahim AU - Ceylan HI AUID- ORCID: 0009-0005-2214-4667 AD - Physical Education and Sports Teaching Department, Faculty of Sports Sciences, Ataturk University, Erzurum 25240, Turkey. FAU - Bragazzi, Nicola Luigi AU - Bragazzi NL AUID- ORCID: 0000-0001-8409-868X AD - Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada. FAU - de Giorgio, Andrea AU - de Giorgio A AUID- ORCID: 0000-0001-6064-5634 AD - Artificial Engineering s.r.l, 80121 Naples, Italy. FAU - Boussi, Hanene AU - Boussi H AD - Laboratory of Biophysics and Medical Technologies, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 9 Street, Doctor Zouheir Safi, Tunis 1006, Tunisia. FAU - Trabelsi, Hedi AU - Trabelsi H AD - Laboratory of Biophysics and Medical Technologies, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 9 Street, Doctor Zouheir Safi, Tunis 1006, Tunisia. LA - eng PT - Journal Article DEP - 20260409 PL - Switzerland TA - Medicina (Kaunas) JT - Medicina (Kaunas, Lithuania) JID - 9425208 SB - IM MH - Humans MH - Tibiofemoral Joint/physiopathology MH - Female MH - *Cartilage, Articular/physiopathology MH - Male MH - Athletes/statistics & numerical data MH - Adult MH - Biomechanical Phenomena/physiology MH - Middle Aged MH - *Osteoarthritis/physiopathology MH - *Osteoarthritis, Knee/physiopathology PMC - PMC13117947 OTO - NOTNLM OT - Young's modulus OT - articular cartilage OT - biomechanical properties OT - energy absorption OT - nonlinear phenomenological viscoelastic model OT - osteoarthritis OT - sports injuries OT - tibiofemoral joint OT - unconfined compression OT - viscoelastic modeling COIS- Author Dr. Andrea de Giorgio was employed by the company Artificial Engineering. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interes. EDAT- 2026/05/04 06:33 MHDA- 2026/05/04 06:34 PMCR- 2026/04/09 CRDT- 2026/05/04 01:18 PHST- 2026/01/06 00:00 [received] PHST- 2026/03/27 00:00 [revised] PHST- 2026/04/03 00:00 [accepted] PHST- 2026/05/04 06:34 [medline] PHST- 2026/05/04 06:33 [pubmed] PHST- 2026/05/04 01:18 [entrez] PHST- 2026/04/09 00:00 [pmc-release] AID - medicina62040720 [pii] AID - medicina-62-00720 [pii] AID - 10.3390/medicina62040720 [doi] PST - epublish SO - Medicina (Kaunas). 2026 Apr 9;62(4):720. doi: 10.3390/medicina62040720. PMID- 42074737 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260504 LR - 20260813 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 15 IP - 8 DP - 2026 Apr 12 TI - Biomechanical and Viscoelastic Properties of the Ankle Muscles in Relation to Muscle Force in Patients with Operated Tibial Pilon Fractures. LID - 10.3390/jcm15082934 [doi] LID - 2934 AB - Background: Tibial pilon fractures are complex injuries frequently associated with persistent functional impairment, even after successful surgical fixation. While previous studies have reported deficits in muscle strength and balance, little is known about the side-to-side variations in intrinsic biomechanical and viscoelastic muscle properties following surgery. Objectives: This study aimed to compare the biomechanical and viscoelastic properties of ankle periarticular muscles between the affected and non-affected limbs in patients with surgically treated unilateral tibial pilon fractures. A secondary objective was to evaluate the relationship between intrinsic muscle properties and isometric muscle force. Methods: A total of 39 subjects with unilateral surgically treated tibial pilon fractures were evaluated after fracture healing. Myotonometric assessment was performed to evaluate muscle mechanical parameters, including tone (frequency), stiffness, and elasticity (decrement), as well as viscoelastic properties, including relaxation time and creep, in the tibialis anterior, peroneus longus, medial gastrocnemius, and lateral gastrocnemius muscles. Isometric muscle force of ankle dorsiflexors and plantar flexors was measured using a handheld dynamometer. Side-to-side comparisons and Pearson correlation analyses were performed. Results: The affected limb showed significantly reduced ankle range of motion in all planes and significantly lower isometric muscle force in both the dorsiflexors (p = 0.0002) and the plantar flexors (p = 0.0066). Stiffness was significantly higher in the medial (p = 0.038) and lateral gastrocnemius (p = 0.045) muscles on the affected side. Decrement was significantly increased (indicating reduced elasticity) in the peroneus longus (p = 0.021). No significant differences were observed for tone, relaxation time, or creep. Conclusions: Myotonometry revealed increased stiffness in the gastrocnemius muscles and reduced elasticity in the peroneus longus on the operated side compared with the non-affected limb. Tone and viscoelastic properties did not differ significantly between sides. However, tone, stiffness, and elasticity were significantly correlated with muscle force, indicating a relationship between intrinsic muscle mechanical properties and force production after tibial pilon fracture surgery. FAU - Bolovan, Andrei-Daniel AU - Bolovan AD AD - Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. AD - Research Center for Assessment of Human Motion, Functionality and Disability, Department of Rehabilitation, Physical Medicine and Rheumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Onofrei, Roxana-Ramona AU - Onofrei RR AUID- ORCID: 0000-0003-2896-7523 AD - Research Center for Assessment of Human Motion, Functionality and Disability, Department of Rehabilitation, Physical Medicine and Rheumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Hogea, Gheorghe-Bogdan AU - Hogea GB AUID- ORCID: 0000-0003-4924-7832 AD - Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. AD - "Pius Brinzeu" Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania. AD - Research Center Teodor Sora, Department of Orthopedics II, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania. FAU - Abu-Awwad, Ahmed AU - Abu-Awwad A AUID- ORCID: 0000-0002-6185-0960 AD - Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. AD - "Pius Brinzeu" Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania. AD - Research Center Teodor Sora, Department of Orthopedics II, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania. FAU - Patrascu, Jenel-Marian Jr AU - Patrascu JM Jr AD - Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. AD - "Pius Brinzeu" Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania. AD - Research Center Teodor Sora, Department of Orthopedics II, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania. FAU - Tapardea, Alexandra-Roxana AU - Tapardea AR AD - Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Crisan, Alexandru-Florian AU - Crisan AF AUID- ORCID: 0009-0002-6020-4593 AD - Research Center for Assessment of Human Motion, Functionality and Disability, Department of Rehabilitation, Physical Medicine and Rheumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. AD - Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, "Victor Babes", 300310 Timisoara, Romania. FAU - Amaricai, Elena-Constanta AU - Amaricai EC AUID- ORCID: 0000-0002-0706-7449 AD - Research Center for Assessment of Human Motion, Functionality and Disability, Department of Rehabilitation, Physical Medicine and Rheumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. LA - eng PT - Journal Article DEP - 20260412 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC13116270 OTO - NOTNLM OT - ankle biomechanics OT - isometric muscle strength OT - muscle stiffness OT - muscle-force relationship OT - stress relaxation time OT - tibial pilon fracture OT - viscoelastic muscle properties COIS- The authors declare that they have no conflicts of interest. The funders had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. EDAT- 2026/05/04 06:33 MHDA- 2026/05/04 06:34 PMCR- 2026/04/12 CRDT- 2026/05/04 01:15 PHST- 2026/03/11 00:00 [received] PHST- 2026/04/05 00:00 [revised] PHST- 2026/04/09 00:00 [accepted] PHST- 2026/05/04 06:34 [medline] PHST- 2026/05/04 06:33 [pubmed] PHST- 2026/05/04 01:15 [entrez] PHST- 2026/04/12 00:00 [pmc-release] AID - jcm15082934 [pii] AID - jcm-15-02934 [pii] AID - 10.3390/jcm15082934 [doi] PST - epublish SO - J Clin Med. 2026 Apr 12;15(8):2934. doi: 10.3390/jcm15082934. PMID- 42057448 OWN - NLM STAT- MEDLINE DCOM- 20261007 LR - 20261007 IS - 1943-3654 (Electronic) IS - 0020-1324 (Linking) VI - 71 IP - 10 DP - 2026 Oct TI - Correlation Between Mechanical Power and the Viscoelastic Properties of the Lung. PG - 1102-1107 LID - 10.1177/19433654261433946 [doi] AB - BACKGROUND: Lung protective ventilation strategy, aiming to decrease ventilation-induced lung injury, is based on 2 major principles: (1) ventilation at a narrow range of volume, with low plateau and driving pressures, while (2) keeping the lung open, to avoid tidal alveolar recruitment/de-recruitment. Mechanical power (MP) was developed as a single value describing energy transfer to the lungs. Energy transfer to the lung parenchyma during ventilation is associated with the viscoelastic properties of the lung. This study aimed to describe the correlation between MP and the viscoelastic properties of the lung. METHODS: An exploratory prospective study in an 18-bed mixed ICU of a university-affiliated tertiary hospital. Immediately after percutaneous tracheostomy was performed, 2 inspiratory holds were performed, with 2 different constant flows. Based on the ventilator settings, inspiratory hold measurements [including peak pressure, plateau pressure (P(plat)), tidal volume], and resistive elements, viscoelastic properties of the lungs (viscoelastic resistance, R(2); viscoelastic compliance, C(2); and viscoelastic time constant, tau(2)) and MP were calculated for each inspiratory hold. Those measurements were compared. MP was correlated with the viscoelastic properties of the lung. RESULTS: Nine subjects were included in the study. No differences were noted in the viscoelastic properties of the lung between the 2 inspiratory hold measurements. The MP increased in the higher flow inspiratory hold. No correlation was found between either R(2) or C(2) and MP. A moderate negative correlation was found between tau(2) and MP. CONCLUSIONS: MP was found to be negatively correlated with tau(2), but not with R(2) or C(2). The clinical implication of this finding has yet to be defined. FAU - Statlender, Liran AU - Statlender L AUID- ORCID: 0000-0001-8980-7860 AD - Drs. Statlender, Robinson, and Kagan are affiliated with the Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel. AD - Drs. Statlender, Robinson, and Kagan are affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Robinson, Eyal AU - Robinson E AD - Drs. Statlender, Robinson, and Kagan are affiliated with the Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel. AD - Drs. Statlender, Robinson, and Kagan are affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Kagan, Ilya AU - Kagan I AD - Drs. Statlender, Robinson, and Kagan are affiliated with the Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel. AD - Drs. Statlender, Robinson, and Kagan are affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - Dr. Kagan is affiliated with the Institute for Nutrition Research, Felsenstein Medical Research Centre, Petah Tikva, Israel. LA - eng PT - Journal Article DEP - 20260429 PL - United States TA - Respir Care JT - Respiratory care JID - 7510357 SB - IM MH - Humans MH - *Elasticity MH - Prospective Studies MH - *Lung/physiopathology/physiology MH - Viscosity MH - Tidal Volume MH - *Respiration, Artificial/methods MH - Male MH - Female MH - *Ventilator-Induced Lung Injury/prevention & control MH - *Energy Transfer/physiology OTO - NOTNLM OT - mechanical power OT - viscoelastic properties of the lung COIS- Author Disclosure StatementThe authors declare that they have no competing interests. EDAT- 2026/04/30 06:34 MHDA- 2026/10/07 17:33 CRDT- 2026/04/30 01:53 PHST- 2026/10/07 17:33 [medline] PHST- 2026/04/30 06:34 [pubmed] PHST- 2026/04/30 01:53 [entrez] AID - 10.1177/19433654261433946 [doi] PST - ppublish SO - Respir Care. 2026 Oct;71(10):1102-1107. doi: 10.1177/19433654261433946. Epub 2026 Apr 29. PMID- 42052858 OWN - NLM STAT- MEDLINE DCOM- 20260518 LR - 20260518 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 39 IP - 3 DP - 2026 Jun 1 TI - Recognition of intrapartum uterine rupture, anesthetic management, and maternal-fetal outcomes: strategies for rapid response. PG - 245-251 LID - 10.1097/ACO.0000000000001656 [doi] AB - PURPOSE OF THE REVIEW: Uterine rupture is a rare but life-threatening obstetric condition that can lead to catastrophic outcomes for pregnant patients and their offspring. As the trial of labor after cesarean births rises and other uterine procedures become more common, the observed rates of this complication have increased. We aim to provide guidance on risk stratification, timely recognition, anesthetic considerations, hemorrhage management, and associated outcomes. RECENT FINDINGS: The risk of uterine rupture varies by scar type, with the highest rates after classical cesarean incisions. Third-trimester assessment of lower uterine segment thickness can further refine risk. Intrapartum rupture frequently presents with nonspecific maternal symptoms but is most consistently associated with fetal heart rate abnormalities. Although epidural analgesia alters pain perception, it typically does not entirely eliminate clinical signs of rupture; increasing bolus requirements can signal evolving pathology. Contemporary anesthetic management emphasizes rapid team activation, early massive transfusion protocol initiation, and goal-directed resuscitation supported by point-of-care viscoelastic testing. Maternal outcomes are worse in unscarred uteri and with delayed diagnosis. SUMMARY: Effective management of uterine rupture involves appropriate risk assessment, vigilant intrapartum monitoring, and structured rapid-response strategies. The integration of hemorrhage protocols and preparedness strategies on labor and delivery units is fundamental to improving outcomes. CI - Copyright (c) 2026 Wolters Kluwer Health, Inc. All rights reserved. FAU - Opipari, AnneMarie AU - Opipari A AD - Department of Obstetrics and Gynecology. FAU - Singh, Shubhangi AU - Singh S AD - Department of Anesthesia, University of Michigan, Ann Arbor, Michigan. FAU - Taylor, Michael AU - Taylor M AD - Department of Anesthesia, University of Michigan, Ann Arbor, Michigan. FAU - Cardillo, Nicholas AU - Cardillo N AD - Department of Anesthesia, University of Michigan, Ann Arbor, Michigan. FAU - Delgado, Carlos AU - Delgado C AD - Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA. LA - eng PT - Journal Article PT - Review DEP - 20260427 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Humans MH - Female MH - Pregnancy MH - *Uterine Rupture/diagnosis/epidemiology/etiology/therapy MH - *Anesthesia, Obstetrical/adverse effects/methods MH - *Vaginal Birth after Cesarean/adverse effects MH - Risk Assessment MH - Resuscitation/methods MH - *Uterine Hemorrhage/diagnosis/epidemiology/etiology/therapy MH - Blood Transfusion/methods MH - Postpartum Period MH - Apgar Score MH - Pregnancy Outcome MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - maternal resuscitation OT - obstetric emergency OT - rapid response OT - uterine rupture EDAT- 2026/04/29 06:35 MHDA- 2026/04/29 12:42 CRDT- 2026/04/29 05:43 PHST- 2026/04/29 12:42 [medline] PHST- 2026/04/29 06:35 [pubmed] PHST- 2026/04/29 05:43 [entrez] AID - 00001503-202606000-00006 [pii] AID - 10.1097/ACO.0000000000001656 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2026 Jun 1;39(3):245-251. doi: 10.1097/ACO.0000000000001656. Epub 2026 Apr 27. PMID- 42030009 OWN - NLM STAT- MEDLINE DCOM- 20260627 LR - 20260813 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 52 IP - 1 DP - 2026 Apr 24 TI - Incidence of ROTEM((R))-defined coagulopathy at hospital arrival among polytrauma patients receiving fibrinogen concentrate in prehospital setting: a prospective observational study. LID - 10.1007/s00068-026-03183-8 [doi] LID - 144 AB - PURPOSE: Trauma-induced coagulopathy affects approximately one-quarter of polytrauma patients and is associated with increased mortality. Given the central role of fibrinogen and its early depletion after injury, supplementation is recommended after hospital admission in the presence of hypofibrinogenaemia or suspected major haemorrhage. As coagulopathy develops within minutes of trauma, prehospital fibrinogen administration may help mitigate its progression before hospital arrival. This study evaluated the incidence of coagulopathy at hospital admission, assessed using ROTEM(R), among polytrauma patients receiving fibrinogen concentrate in the prehospital setting. METHODS: In this single-centre, prospective observational study, adult patients with polytrauma (Injury Severity Score >/= 16) were enrolled after prehospital administration of fibrinogen concentrate. The primary outcome was the presence of coagulopathy at hospital arrival, defined according to predefined ROTEM(R) Delta thresholds (FIBTEM MCF /= 80 s and/or EXTEM MCF 30 mug/mL of APAC. In APAC pulldown and in vitro complement activation tests, APAC specifically interacted with necrotic cells and recruited C1q and factor H (FH) onto the cell surfaces. Importantly, APAC promoted early complement activation at the C3 level on cell surfaces, without proportional terminal pathway (C5b-9) activation. APAC interacts with several complement components without adversely affecting systemic complement activity within the expected therapeutic range. APAC may regulate complement activation on cell surfaces even at subinhibitory concentrations, promoting early complement activation via C1q but limiting it to the level of C3 by recruiting FH. CI - (c) 2026 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. FAU - Kotimaa, Juha AU - Kotimaa J AD - VTT Technical Research Centre of Finland, Immunotechnology, Espoo, Finland. AD - Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland. FAU - Rezola, Mikel Artero AU - Rezola MA AD - Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland. FAU - Jouppila, Annukka AU - Jouppila A AD - Clinical Research Institute, Helsinki University Central Hospital, Helsinki, Finland. FAU - Lassila, Riitta AU - Lassila R AD - Clinical Research Institute, Helsinki University Central Hospital, Helsinki, Finland. AD - Coagulation Disorders Unit, Departments of Hematology and Clinical Chemistry, University of Helsinki, Helsinki, Finland. FAU - Meri, Seppo AU - Meri S AD - Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland. AD - Diagnostic Center, Helsinki University Hospital, Helsinki, Finland. LA - eng PT - Journal Article DEP - 20260216 PL - United States TA - Blood Vessel Thromb Hemost JT - Blood vessels, thrombosis & hemostasis JID - 9918957761606676 PMC - PMC13091194 COIS- Conflict-of-interest disclosure: R.L. is the chief scientific officer and chief medical officer for Aplagon Ltd. The Clinical Research Institute (Helsinki University Central Hospital) received research funding from Aplagon Ltd to support A.J.'s employment. The remaining authors declare no competing financial interests. EDAT- 2026/04/20 13:10 MHDA- 2026/04/20 13:11 PMCR- 2026/02/16 CRDT- 2026/04/20 07:26 PHST- 2025/07/11 00:00 [received] PHST- 2026/01/20 00:00 [accepted] PHST- 2026/04/20 13:11 [medline] PHST- 2026/04/20 13:10 [pubmed] PHST- 2026/04/20 07:26 [entrez] PHST- 2026/02/16 00:00 [pmc-release] AID - S2950-3272(26)00015-X [pii] AID - 100150 [pii] AID - 10.1016/j.bvth.2026.100150 [doi] PST - epublish SO - Blood Vessel Thromb Hemost. 2026 Feb 16;3(2):100150. doi: 10.1016/j.bvth.2026.100150. eCollection 2026 May. PMID- 41987276 OWN - NLM STAT- MEDLINE DCOM- 20260715 LR - 20260813 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 34 IP - 1 DP - 2026 Apr 15 TI - Sonorheometry to detect traumatic induced coagulopathy during initial management of trauma patients: an observational, multi-center study. LID - 10.1186/s13049-026-01610-8 [doi] LID - 91 AB - BACKGROUND: In severe trauma 30% of the patients develop a trauma-induced coagulopathy (TIC), which is associated with higher mortality, massive transfusion and prolonged intensive care stay. Conventional coagulation assays present limitations to detect TIC, primarily due to delayed turnaround time. To enhance early management of TIC viscoelastic tests have been included into guidelines as a standard of care. The Quantra device, based on sonorheometry analysis, offers a rapid bedside assessment of coagulation but lacks validation in a trauma population. The aim of this study was to validate Quantra to detect TIC compared with standard blood coagulation test in severe trauma patients. METHODS: We performed a multicenter analysis of prospectively collected data (January 1, 2022-December 31, 2024) across four level-1 trauma centers. Trauma patients > 16 years underwent simultaneous Quantra and standard laboratory testing at hospital admission. Diagnostic performance for prespecified thresholds-activated partial thromboplastin time (aPTT) ratio > 1.5, prothrombin time ratio (PTr) > 1.5, fibrinogen 1.5 with a best cutoff of 144.5s; 0.82 [0.75-0.90] for clot stiffness to predict a PTr > 1.5 (best cutoff 15.4hPa); 0.87 [0.81-0.93] for fibrinogen contribution to clot stiffness to predict a fibrinogen concentration < 1.5g/L (best cutoff 1.1hPa); 0.90 [0.84-0.95] for platelet contribution to clot stiffness to predict a platelets count /= 3 were excluded. TEG 6s parameters were classified using published thresholds. Multivariable logistic and linear regression analyses evaluated associations with in-hospital mortality and RBC transfusion volumes at 4 and 24 h. RESULTS: Among 194 patients, 54.1% had abnormal TEG 6s results. These patients received higher RBC transfusion volumes at 4 and 24 h, and had higher in-hospital mortality. Abnormal TEG 6s findings were associated with higher in-hospital mortality in the multivariable analysis (adjusted OR 3.505, p = 0.050) and increased transfusion volume at 4 h (B = 1.686, p = 0.023) and 24 h (B = 2.313, p = 0.042). CONCLUSION: Initial TEG 6s abnormalities were associated with in-hospital mortality and early RBC transfusion in trauma patients undergoing massive transfusion. In massively transfused patients without severe traumatic brain injury, these findings suggest that arrival TEG 6s parameters may aid early risk stratification for hemorrhage-related outcomes. FAU - Seo, Dongmin AU - Seo D AUID- ORCID: 0009-0009-6716-3959 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea. FAU - Kwon, Junsik AU - Kwon J AUID- ORCID: 0000-0003-3164-4995 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea. FAU - Heo, Inhae AU - Heo I AUID- ORCID: 0000-0001-8046-8604 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea. FAU - Jung, Kyoungwon AU - Jung K AUID- ORCID: 0000-0001-7895-0362 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea. jake98@daum.net. AD - Ajou University Hospital Gyeonggi-do South Regional Trauma Center, Suwon, Republic of Korea. jake98@daum.net. LA - eng GR - HI22C1806/Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea/ PT - Journal Article DEP - 20260309 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - Female MH - Male MH - Retrospective Studies MH - Hospital Mortality MH - *Thrombelastography/methods MH - Risk Assessment MH - Middle Aged MH - Adult MH - *Blood Transfusion MH - *Hemorrhage/therapy/mortality/etiology MH - *Wounds and Injuries/therapy/mortality/complications MH - Republic of Korea/epidemiology MH - Trauma Centers MH - Injury Severity Score MH - Erythrocyte Transfusion MH - Prognosis PMC - PMC12971739 OTO - NOTNLM OT - Massive transfusion OT - Mortality OT - Severe trauma OT - TEG 6s OT - Transfusion volume COIS- Declarations. Competing interests: The authors declare no competing interests. EDAT- 2026/03/09 19:00 MHDA- 2026/06/28 00:39 PMCR- 2026/03/09 CRDT- 2026/03/09 12:14 PHST- 2025/06/30 00:00 [received] PHST- 2026/01/20 00:00 [accepted] PHST- 2026/06/28 00:39 [medline] PHST- 2026/03/09 19:00 [pubmed] PHST- 2026/03/09 12:14 [entrez] PHST- 2026/03/09 00:00 [pmc-release] AID - 10.1007/s00068-026-03107-6 [pii] AID - 3107 [pii] AID - 10.1007/s00068-026-03107-6 [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2026 Mar 9;52(1):89. doi: 10.1007/s00068-026-03107-6. PMID- 41770246 OWN - NLM STAT- MEDLINE DCOM- 20260709 LR - 20261017 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 52 IP - 1 DP - 2026 Mar 2 TI - Multicenter survey on viscoelastic assays access and use in trauma in Swiss emergency departments. LID - 10.1007/s00068-026-03092-w [doi] LID - 76 AB - PURPOSE: Trauma is a global cause of morbidity and mortality, with early deaths frequently resulting from hemorrhage and traumatic brain injury. Prompt assessment and targeted management of bleeding and trauma-induced coagulopathy are essential in this context. Viscoelastic tests (VETs), such as TEG and ROTEM, offer advantages over conventional coagulation. Therefore, we wanted to evaluate their availability and use in Swiss emergency departments (EDs). METHODS: A 16-item online survey assessing access, use, and training related to VET, as well as the use of massive hemorrhage protocols, was distributed to 52 EDs recognized by the Swiss Society of Emergency and Rescue Medicine. Twelve were level-1 trauma centers, five of which were university hospitals. RESULTS: The response rate was 86.5% (45/52). Access to VET was reported by 44.4% of centers, while routine use in major trauma was noted in 26.7%. Most users were trauma centers. Devices were predominantly located outside the ED (e.g., laboratories or operating rooms). Over half of the centers with access to VET reported no formal training. Additionally, 51.1% of respondents indicated the absence of a dedicated massive hemorrhage protocol. Among those with protocols, most used conventional coagulation tests, and fewer included VET. CONCLUSION: The use of VET in Swiss EDs is limited, mainly to trauma centers, with restricted point-of-care access and heterogeneous training. Massive hemorrhage protocols are inconsistently implemented and often lack integration of VET. Key areas for improvement include expanding access beyond specialized centers, standardizing protocols and interpretation algorithms, optimizing device placement, and introducing structured training programs. CI - (c) 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. FAU - Lyon, Matthieu AU - Lyon M AUID- ORCID: 0000-0002-6507-0865 AD - Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva 14, CH-1211, Switzerland. Matthieu.lyon@hug.ch. FAU - De Valence, Timothe AU - De Valence T AUID- ORCID: 0000-0001-9621-2638 AD - Division of Anesthesiology, Department of Acute Care Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva 14, CH-1211, Switzerland. FAU - Fehlmann, Christophe A AU - Fehlmann CA AUID- ORCID: 0000-0002-4163-0338 AD - Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva 14, CH-1211, Switzerland. AD - Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, Geneva 14, CH-1211, Switzerland. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20260302 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - Switzerland MH - *Emergency Service, Hospital/statistics & numerical data MH - *Wounds and Injuries/complications/blood MH - *Hemorrhage/diagnosis/etiology MH - *Thrombelastography/statistics & numerical data MH - Surveys and Questionnaires MH - Trauma Centers MH - *Blood Coagulation Disorders/diagnosis/etiology PMC - PMC13668999 OTO - NOTNLM OT - Coagulopathy OT - ROTEM OT - TEG OT - Trauma OT - Viscoelastic assays OT - Viscoelastic testing COIS- Declarations. Ethics approval: Not applicable. Consent to participate and to publish: Not applicable Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests. EDAT- 2026/03/02 13:17 MHDA- 2026/03/06 19:43 PMCR- 2026/03/02 CRDT- 2026/03/02 11:04 PHST- 2025/07/17 00:00 [received] PHST- 2026/01/10 00:00 [accepted] PHST- 2026/03/06 19:43 [medline] PHST- 2026/03/02 13:17 [pubmed] PHST- 2026/03/02 11:04 [entrez] PHST- 2026/03/02 00:00 [pmc-release] AID - 10.1007/s00068-026-03092-w [pii] AID - 3092 [pii] AID - 10.1007/s00068-026-03092-w [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2026 Mar 2;52(1):76. doi: 10.1007/s00068-026-03092-w. PMID- 41738607 OWN - NLM STAT- Publisher LR - 20260225 IS - 1743-9159 (Electronic) IS - 1743-9159 (Linking) DP - 2026 Feb 25 TI - Ischemia-free liver transplantation protects coagulation function via the HNF4alpha-coagulation factor axis: a post hoc analysis from the IFLT-DBD randomized controlled trial. LID - 10.1097/JS9.0000000000004987 [doi] AB - BACKGROUND: The liver is essential for coagulation-anticoagulation balance. Ischemia-free liver transplantation (IFLT) has been proven to prevent ischemia-reperfusion injury (IRI) and improve postoperative recovery. In this study, we explored protective effects of IFLT on the coagulation system. MATERIALS AND METHODS: Sixty-five liver transplant patients were enrolled in this post hoc analysis of the IFLT-DBD (ischemia-free transplantation of livers from donors after brain death) trial. Data of blood loss, blood product transfusion, intraoperative conventional coagulation tests, and rapid thromboelastography were evaluated. Transcriptome analysis was performed, and liver tissue specimens were collected for experimental validation. RESULTS: Total blood loss was significantly lower in the IFLT group than in the conventional liver transplantation (CLT) group [1765.0 (565.0-2965.0) vs 2600.0 (595.0-4605.0) mL, P<0.001]. The IFLT group had fewer red blood cells (RBC), fresh frozen plasma (FFP), and platelet (PLT) transfusions than the CLT group [RBC: 4 (2-6) vs 7.25 (2.25-8) units, P = 0.026; FFP: 600 (0-600) vs 600 (400-987.5) ml, P = 0.031; PLT: 6(18.8%) vs 13(39.4%), P = 0.026]. Bulk transcriptome analysis showed that hepatocyte nuclear factor 4 alpha (HNF4alpha) expression was higher in the IFLT group. Real-time PCR revealed higher mRNA expression of HNF4alpha, factor II, and V in the IFLT group. Western blotting showed higher HNF4alpha protein expression in the IFLT group. CONCLUSION: Adopting IFLT significantly decreased intraoperative hemorrhage and blood product transfusion. IFLT facilitates the restoration of intraoperative coagulation homeostasis by preserving the HNF4alpha-mediated regulation of hepatic coagulation factor synthesis. CI - Copyright (c) 2026 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Dong, Yuqi AU - Dong Y AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Chen, Xiaoxiang AU - Chen X AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Xiong, Wei AU - Xiong W AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Zhang, Tao AU - Zhang T AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Shen, Yuekun AU - Shen Y AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Yang, Bing AU - Yang B AD - Operating Room and Anesthesia Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. FAU - Chen, Maogen AU - Chen M AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - Zhao, Qiang AU - Zhao Q AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - Ju, Weiqiang AU - Ju W AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - Hu, Anbin AU - Hu A AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - Wang, Dongping AU - Wang D AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - Yang, Lu AU - Yang L AD - Department of anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. FAU - Guo, Zhiyong AU - Guo Z AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. FAU - He, Xiaoshun AU - He X AD - Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China. AD - Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China. AD - Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China. LA - eng PT - Journal Article DEP - 20260225 PL - United States TA - Int J Surg JT - International journal of surgery (London, England) JID - 101228232 SB - IM OTO - NOTNLM OT - HNF4alpha OT - anesthesia OT - coagulation OT - ischemia-free liver transplantation EDAT- 2026/02/25 13:36 MHDA- 2026/02/25 13:36 CRDT- 2026/02/25 08:23 PHST- 2025/08/20 00:00 [received] PHST- 2026/01/21 00:00 [accepted] PHST- 2026/02/25 13:36 [medline] PHST- 2026/02/25 13:36 [pubmed] PHST- 2026/02/25 08:23 [entrez] AID - 01279778-990000000-04698 [pii] AID - 10.1097/JS9.0000000000004987 [doi] PST - aheadofprint SO - Int J Surg. 2026 Feb 25. doi: 10.1097/JS9.0000000000004987. PMID- 41737428 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260225 LR - 20260813 IS - 2398-8835 (Electronic) IS - 2398-8835 (Linking) VI - 9 IP - 2 DP - 2026 Feb TI - Viscoelastic Testing for Coagulation Management in Vascular Surgery-A Narrative Review. PG - e71836 LID - 10.1002/hsr2.71836 [doi] LID - e71836 AB - BACKGROUND: Viscoelastic testing (VET) has been increasingly used in cardiac, trauma, and hepatic surgery where it helps tackle the development of complex coagulopathies. Despite this, data on using VETs in vascular surgery remains limited to small and non-randomised control studies. Although the improvement in vascular techniques has decreased the rate of massive haemorrhages, there remain situations where they are a serious risk, and the associated coagulopathies pose a challenge to manage. AIMS: The aim of this paper is to review the current approved uses of VET and its potential translational benefit in vascular surgery. METHODS: An initial PUBMED search provided the foundation for chain sampling to identify relevant papers. RESULTS: With VET, clinicians can rapidly assess a patient's global haemostatic function thus allowing the timely, or pre-emptive, correction of coagulopathies. Using the platelet analysis functions pre-operatively helps guide anaesthetic technique as well as temporary discontinuation of anti-platelet therapy, an almost ubiquitous drug among vascular patients. Intra-operatively, the use of this point-of-care test, along with goal-directed algorithms, reduces the volumes of platelets, fibrinogen, and plasma that are transfused. During recovery, using VET can help distinguish a coagulopathic bleed from one requiring surgical re-exploration. Besides reducing the well-established adverse effects of transfusions, from electrolyte disturbances to the more rare but severe graft-vs-host disease, there is a significant cost-reducing effect. CONCLUSIONS: Although there is limited evidence of VET in vascular surgery, there seems to be a clear benefit from its use warranting further large randomised controlled trials from which standardised guidelines can be produced. CI - (c) 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. FAU - Munteanu, Alexandru AU - Munteanu A AUID- ORCID: 0000-0003-1549-1247 AD - Anaesthetic Core Trainee, Royal United Hospital Bath NHS Foundation Trust Bath UK. FAU - Bax, Elena AU - Bax E AD - Internal Medical Trainee, University Hospitals Sussex NHS Foundation Trust Brighton UK. LA - eng PT - Journal Article DEP - 20260222 PL - United States TA - Health Sci Rep JT - Health science reports JID - 101728855 PMC - PMC12928011 OTO - NOTNLM OT - ROTEM OT - TEG OT - point-of-care devices OT - vascular surgery OT - viscoelastic testing COIS- The authors declare no conflicts of interest. EDAT- 2026/02/25 10:22 MHDA- 2026/02/25 10:23 PMCR- 2026/02/22 CRDT- 2026/02/25 04:50 PHST- 2024/04/10 00:00 [received] PHST- 2025/11/03 00:00 [revised] PHST- 2025/11/19 00:00 [accepted] PHST- 2026/02/25 10:23 [medline] PHST- 2026/02/25 10:22 [pubmed] PHST- 2026/02/25 04:50 [entrez] PHST- 2026/02/22 00:00 [pmc-release] AID - HSR271836 [pii] AID - 10.1002/hsr2.71836 [doi] PST - epublish SO - Health Sci Rep. 2026 Feb 22;9(2):e71836. doi: 10.1002/hsr2.71836. eCollection 2026 Feb. PMID- 41719226 OWN - NLM STAT- MEDLINE DCOM- 20260708 LR - 20260813 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 21 IP - 2 DP - 2026 TI - The potential value of thromboelastography and conventional coagulation detection in guiding the management of venous thrombosis after traumatic brain injury. PG - e0343043 LID - 10.1371/journal.pone.0343043 [doi] LID - e0343043 AB - BACKGROUND: Coagulation disorders are serious complications of traumatic brain injury (TBI), yet the predictive value of thromboelastography (TEG) for deep vein thrombosis (DVT) in this population remains unclear. This study aimed to assess the TEG profiles and four conventional coagulation parameters in patients with isolated TBI at multiple time points to predict the risk of early DVT. METHODS: In this retrospective study, 71 patients with isolated TBI were enrolled and categorized into thrombosis (n = 30) and non-thrombosis (n = 41) groups based on Doppler ultrasound and pulmonary angiography findings. Conventional coagulation parameters (PT, APTT, FIB, D-Dimer, TT, PLT) and TEG parameters (R, alpha-angle, MA) were systematically measured at 24, 72, and 168 hours post-injury. Statistical analyses included group comparisons and binary logistic regression to identify independent predictors of thrombosis. RESULTS: Patients who developed thrombosis had significantly lower Glasgow Coma Scale (GCS) scores (p < 0.001). Coagulation profiles evolved dynamically: D-dimer and TEG-MA were elevated at 24 hours; PT, fibrinogen, and D-dimer were higher at 72 hours; PT, D-dimer, and TEG alpha-angle remained elevated at 168 hours. Multivariate analysis identified lower 24-hour GCS score (OR=0.595, p < 0.001) and elevated PT at 72 and 168 hours as independent predictors of DVT. D-dimer was predictive at 72 hours (OR=1.244, p = 0.023). TEG parameters, despite showing hypercoagulability, did not independently predict thrombosis. CONCLUSIONS: In isolated TBI, coagulation abnormalities evolved dynamically during the first week after injury. Conventional coagulation parameters, particularly prothrombin time and D-dimer, were more informative for venous thrombosis risk assessment, whereas TEG reflected global hypercoagulability without providing independent predictive value. CI - Copyright: (c) 2026 Zhou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. FAU - Zhou, Jingchao AU - Zhou J AUID- ORCID: 0009-0002-4713-4500 AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. AD - The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Wang, Zhenghao AU - Wang Z AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. AD - The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Pan, Rui AU - Pan R AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. AD - The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Zhang, Pengcheng AU - Zhang P AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. AD - The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Xia, Hechun AU - Xia H AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Wang, Wei AU - Wang W AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. FAU - Niu, Zhanfeng AU - Niu Z AUID- ORCID: 0000-0003-3297-1429 AD - Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. AD - The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China. LA - eng PT - Journal Article DEP - 20260220 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (fibrin fragment D) SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Venous Thrombosis/diagnosis/etiology/blood MH - *Brain Injuries, Traumatic/complications/blood MH - Male MH - Female MH - Middle Aged MH - Retrospective Studies MH - Adult MH - Fibrin Fibrinogen Degradation Products/metabolism MH - *Blood Coagulation MH - Blood Coagulation Tests MH - Glasgow Coma Scale PMC - PMC12923022 COIS- The authors have declared that no competing interests exist. EDAT- 2026/02/20 21:28 MHDA- 2026/02/20 21:29 PMCR- 2026/02/20 CRDT- 2026/02/20 13:24 PHST- 2025/12/11 00:00 [received] PHST- 2026/01/31 00:00 [accepted] PHST- 2026/02/20 21:29 [medline] PHST- 2026/02/20 21:28 [pubmed] PHST- 2026/02/20 13:24 [entrez] PHST- 2026/02/20 00:00 [pmc-release] AID - PONE-D-25-62755 [pii] AID - 10.1371/journal.pone.0343043 [doi] PST - epublish SO - PLoS One. 2026 Feb 20;21(2):e0343043. doi: 10.1371/journal.pone.0343043. eCollection 2026. PMID- 41709069 OWN - NLM STAT- MEDLINE DCOM- 20260708 LR - 20260813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 66 Suppl 1 IP - Suppl 1 DP - 2026 May TI - The impact of rapid infusers on the hemostatic potential of cryoprecipitate products. PG - S178-S186 LID - 10.1111/trf.70132 [doi] AB - BACKGROUND: In cases of massive transfusion, intravenous access can be limited. Additionally, delivering different products through separate lines and infusion methods adds unnecessary steps. RBC, plasma, and whole blood (WB) are delivered via rapid infusers; cryoprecipitate (CRYO) is infused through separate access and is not approved with these devices. STUDY DESIGN AND METHODS: We examined the impact of different transfusion methods on hemostatic performance and factor activity using two available CRYO products. Ten bags of CRYO, ten bags pathogen-reduced CRYO (Intercept(R) Fibrinogen Complex, IFC), and 20 units of WB were obtained. Each CRYO bag was infused with one unit of WB by three techniques: (1) gravity infusion with filter, (2) rapid infuser at 70 mL/min, and (3) pressure bag and filter. Hemostatic potential was measured by thrombelastography (TEG), thrombin generation (CAT), and factor levels (ACLTOP). Post-each infusion, disposable tubing and infusion parts were inspected for evidence of clumping or clogging. RESULTS: Both standard CRYO and IFC demonstrated maintained or improved TEG, CAT, and factor levels when subjected to a rapid infuser device and pressure bag. When compared with gravity infusion, a rapid infuser device and pressure bag demonstrated maintained or improved values by TEG, CAT, and factor activity. No evidence of clumping or clogging of tubing was encountered in the 20 runs performed. No evidence of system dysfunction with use of CRYO through these devices was found either. DISCUSSION: Restriction of CRYO infusion through rapid infuser devices or with pressure bags should be reconsidered. Future clinical trials are warranted. CI - Published 2026. This article is a U.S. Government work and is in the public domain in the USA. Transfusion published by Wiley Periodicals LLC on behalf of AABB. FAU - Purvis, Connor D AU - Purvis CD AUID- ORCID: 0009-0005-5030-8446 AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Redden, Samantha AU - Redden S AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Jacobson, Andrew AU - Jacobson A AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. AD - Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas, USA. FAU - Wang, Yao-Wei AU - Wang YW AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Campbell, Julie AU - Campbell J AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Cardenas, Jessica AU - Cardenas J AD - Department of Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Van Gent, Jan-Michael AU - Van Gent JM AUID- ORCID: 0000-0002-4655-2527 AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. AD - Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas, USA. FAU - Cotton, Bryan A AU - Cotton BA AUID- ORCID: 0000-0003-4184-6742 AD - Department of Surgery, The McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. LA - eng GR - AGT011786/Cerus Corporation/ PT - Journal Article DEP - 20260218 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 9001-32-5 (Fibrinogen) RN - 9001-27-8 (Factor VIII) RN - 0 (cryoprecipitate coagulum) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Humans MH - *Fibrinogen/administration & dosage/pharmacology MH - *Factor VIII/administration & dosage MH - *Hemostasis MH - *Blood Transfusion/methods/instrumentation MH - Thrombelastography MH - Thrombin PMC - PMC13184421 OTO - NOTNLM OT - coagulopathy OT - cryoprecipitate OT - rapid infuser OT - trauma COIS- This study was funded by a grant from the Cerus Corporation (Concord, CA). Dr. Cotton serves on the scientific advisory board and is a consultant for Cerus. Dr. Cotton is also the principal investigator on a study funded by Grifols (antithrombin III) and is a paid consultant and advisory board member for Grifols, Teleflex, Cerus, and Haemonetics. The views and information presented are those of the authors and do not represent the official positions of the U.S. Army Medical Center for Excellence, the U.S. Army Training and Doctrine Command, or the Departments of Army, Department of Defense, or U.S. Government. I, Connor D Purvis, attest on behalf of all authors that we had full access to the data of the study, conducted all data analyses independently from the funding entity, and take complete responsibility for the integrity and accuracy of the data reported in the manuscript. EDAT- 2026/02/19 01:35 MHDA- 2026/05/19 06:30 PMCR- 2026/05/19 CRDT- 2026/02/18 23:45 PHST- 2026/01/25 00:00 [revised] PHST- 2025/11/29 00:00 [received] PHST- 2026/02/06 00:00 [accepted] PHST- 2026/05/19 06:30 [medline] PHST- 2026/02/19 01:35 [pubmed] PHST- 2026/02/18 23:45 [entrez] PHST- 2026/05/19 00:00 [pmc-release] AID - TRF70132 [pii] AID - 10.1111/trf.70132 [doi] PST - ppublish SO - Transfusion. 2026 May;66 Suppl 1(Suppl 1):S178-S186. doi: 10.1111/trf.70132. Epub 2026 Feb 18. PMID- 41698179 OWN - NLM STAT- Publisher LR - 20260304 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) DP - 2026 Feb 12 TI - Pro-Con Debate: Formulaic Approach Using Fixed Ratios of Blood Components Versus Targeted Therapy Approach Guided By Viscoelastic Hemostatic Assays for Resuscitation in Traumatic Major Hemorrhage. LID - 10.1213/ANE.0000000000007972 [doi] AB - There are two different approaches to hemostatic resuscitation used in major hemorrhage protocols for critically bleeding trauma patients: A formulaic approach using fixed ratios of blood components and a targeted therapy approach guided by viscoelastic hemostatic assays. There is ongoing debate with differing opinions on what constitutes the most appropriate approach. There is also widespread variation in management approaches and options used. The aim of a major hemorrhage protocol is to guide a multidisciplinary multiple strategy approach to identify the source and cause of bleeding and control it expeditiously, correct coagulopathy, and normalize physiological derangement. Proponents of a fixed-ratio blood component approach to hemostatic resuscitation in traumatic hemorrhage argue that it provides the necessary blood components, reduces cognitive load on the trauma team and standardizes clinical practice. They also argue that the alternative of target-driven therapy is currently a utopian concept, delays care, and, if instituted, may result in harm to patients, carers, and the health system. Proponents of targeted therapy hold that a formulaic fixed-ratio approach does not treat specific deficits and may result in over-transfusion of components, exposing patients to the inherent risks of blood component transfusions. They propose that a targeted approach using viscoelastic hemostatic assays reduces exposure to blood components and reduces mortality. Both proposed strategies assume ready access to blood components and/or products, investigational tools, appropriately trained multidisciplinary staff and as such are targeted toward resuscitation of critical bleeding in advanced trauma systems. CI - Copyright (c) 2026 International Anesthesia Research Society. FAU - Mitra, Biswadev AU - Mitra B AUID- ORCID: 0000-0002-0508-2450 AD - From the School of Public Health & Preventive Medicine, Monash University. AD - Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. FAU - Keegan, Anastazia AU - Keegan A AUID- ORCID: 0000-0002-0795-7521 AD - PathWest Laboratory Medicine, Department of Haematology, King Edward Memorial Hospital, Perth, Western Australia, Australia. FAU - Spahn, Donat R AU - Spahn DR AD - University of Zurich, Zurich, Switzerland. FAU - Gorlinger, Klaus AU - Gorlinger K AD - Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany. LA - eng PT - Journal Article DEP - 20260212 PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM COIS- Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article. EDAT- 2026/02/16 18:33 MHDA- 2026/02/16 18:33 CRDT- 2026/02/16 16:32 PHST- 2026/02/16 18:33 [pubmed] PHST- 2026/02/16 18:33 [medline] PHST- 2026/02/16 16:32 [entrez] AID - 00000539-990000000-01663 [pii] AID - 10.1213/ANE.0000000000007972 [doi] PST - aheadofprint SO - Anesth Analg. 2026 Feb 12. doi: 10.1213/ANE.0000000000007972. PMID- 41697303 OWN - NLM STAT- MEDLINE DCOM- 20260708 LR - 20260920 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 52 IP - 1 DP - 2026 Feb 16 TI - The thrombelastometry parameter CT(EXTEM) as an independent risk factor for mortality in bleeding patients. PG - 47 LID - 10.1007/s00068-025-03079-z [doi] LID - 47 AB - PURPOSE: Pathologic thromboelastometric results may indicate a coagulation disorder. During bleeding, the prolongation of CTEXTEM (Clotting Time) measured by rotational thromboelastometry (ROTEM) can detect alterations in the extrinsic pathway. However, the significance of a prolonged CTEXTEM for risk stratification in patients with bleeding remains unclear. METHODS: A total of 2035 consecutive patients were retrospectively examined between 2014 and 2020 from a bleeding database at Saarland University Hospital. The database includes patients tested with ROTEM during bleeding. The study population was split into three groups: Cardiothoracic surgery with cardiopulmonary bypass (CPB, n = 753), trauma (n = 206) and medical bleeding (n = 1076). The impact of CTEXTEM on 30-day mortality was assessed using C-statistic. Threshold values for CTEXTEM reaching a specificity > 90% for 30-day mortality were selected. Adjusted hazard ratios (adjHR [95% confidence interval]) were calculated with multivariable Cox models. RESULTS: The C-statistic showed that CTEXTEM (C-statistic for groups 1-3: 0.62, threshold >/= 110 s (CPB); 0.65, threshold >/= 98 s (trauma); 0.63, threshold >/= 99 s (medical bleeding)) had a predictive power for 30-day mortality in all groups. The determined threshold value of CTEXTEM reaching a specificity > 90% remained an independent risk predictor for 30-day mortality even after adjustment for confounding factors (CPB: adjHR 2.5 [1.5-4.2], p < 0.001; trauma: adjHR 3.9 [1.8-8.7], p = 0.001; medical bleeding: adjHR 1.8 [1.4-2.5], p < 0.001). The 30-day mortality rate was significantly increased (CPB: CTEXTEM >/= 110 s, 26% versus 9%, p < 0.001; trauma: CTEXTEM >/= 98 s, 41% versus 11%, p < 0.001; medical bleeding: CTEXTEM >/= 99 s, 41% versus 22%, p < 0.001). CONCLUSION: Our results indicate that CTEXTEM-detected alterations in the extrinsic pathway may be an independent predictor of 30-day mortality in patients with bleeding. CI - (c) 2026. The Author(s). FAU - Bomberg, Hagen AU - Bomberg H AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University, University Medical Centre, Forchstrasse 370, Homburg/Saar, Germany. hagen.bomberg@balgrist.ch. AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Balgrist University Hospital, Zurich, Switzerland. hagen.bomberg@balgrist.ch. AD - Outcomes Research Consortium, Houston, TX, USA. hagen.bomberg@balgrist.ch. FAU - Gorlinger, Klaus AU - Gorlinger K AD - Medical Director, Tem Innovations GmbH, Munich, Germany. FAU - Wagenpfeil, Stefan AU - Wagenpfeil S AD - Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Centre, Homburg/Saar, Germany. FAU - Volk, Thomas AU - Volk T AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University, University Medical Centre, Forchstrasse 370, Homburg/Saar, Germany. AD - Outcomes Research Consortium, Houston, TX, USA. FAU - Schneider, Sven Oliver AU - Schneider SO AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University, University Medical Centre, Forchstrasse 370, Homburg/Saar, Germany. LA - eng PT - Journal Article DEP - 20260216 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - *Thrombelastography MH - Female MH - Retrospective Studies MH - *Hemorrhage/mortality/blood MH - Male MH - Risk Factors MH - Middle Aged MH - Aged MH - Risk Assessment MH - Wounds and Injuries/complications/mortality PMC - PMC12909406 OTO - NOTNLM OT - Bleeding OT - Mortality OT - Risk factor OT - Rotational thromboelastometry COIS- Declarations. KG works as the Medical Director of Tem Innovations GmbH, Munich, Germany. The other authors do not report any potential conflict of interest. Competing interests: The authors declare no competing interests. EDAT- 2026/02/16 12:31 MHDA- 2026/02/16 12:32 PMCR- 2026/02/16 CRDT- 2026/02/16 11:13 PHST- 2025/11/10 00:00 [received] PHST- 2025/12/28 00:00 [accepted] PHST- 2026/02/16 12:32 [medline] PHST- 2026/02/16 12:31 [pubmed] PHST- 2026/02/16 11:13 [entrez] PHST- 2026/02/16 00:00 [pmc-release] AID - 10.1007/s00068-025-03079-z [pii] AID - 3079 [pii] AID - 10.1007/s00068-025-03079-z [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2026 Feb 16;52(1):47. doi: 10.1007/s00068-025-03079-z. PMID- 41668681 OWN - NLM STAT- MEDLINE DCOM- 20260707 LR - 20260813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 66 Suppl 1 IP - Suppl 1 DP - 2026 May TI - An assessment of green plasma: The in vitro hemostatic superiority of a currently discarded blood product. PG - S172-S177 LID - 10.1111/trf.70115 [doi] AB - INTRODUCTION: Recent studies have linked trauma patient outcomes to the plasma donor's sex, with premenopausal females associated with improved survival and lower organ failure. Currently, green-colored plasma (due to oral contraceptive use) is removed from the donor pool. We set out to evaluate the hemostatic potential of green plasma. STUDY DESIGN & METHODS: We obtained 90 units of plasma from our regional blood center: 30 units of visible green plasma and 60 units of standard-color plasma divided between male and female donors. We collected clinical data such as age, sex, ethnicity, and number of pregnancies. We then assessed the hemostatic potential through thrombelastography (TEG), calibrated automated thrombography (CAT), and clotting factor levels. RESULTS: Green plasma unit donors were younger than standard-color female and male donor units (median age 27 vs. 58 vs. 54) and had fewer pregnancies than their non-green female counterparts (median 0 vs. 2); (both p < 0.001). All TEG values, as well as CAT lag time, thrombin potential, and peak thrombin were more hypercoagulable in the green plasma group compared to standard-color female and male donor units; all p < 0.05. In addition, the majority of factor levels (including II, VII, IX, X, and fibrinogen) were higher in green donor plasma; all p < 0.05. DISCUSSION: Based on our data, green plasma has superior hemostatic potential without any other aberrant characteristics, possibly justifying the use of green plasma in transfusion medicine. Reintroducing this product will help to expand on the plasma donor pool. CI - (c) 2026 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB. FAU - Redden, Samantha C AU - Redden SC AD - The Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - The Department of Surgery, McGovern Medical School, Houston, Texas, USA. FAU - Sun, David J AU - Sun DJ AD - The Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Wang, Yao-Wei W AU - Wang YW AD - The Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - The Department of Surgery, McGovern Medical School, Houston, Texas, USA. FAU - Hartwell, Elizabeth AU - Hartwell E AUID- ORCID: 0000-0002-9895-7921 AD - Gulf Coast Regional Blood Center, Houston, Texas, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Olson, Scott D AU - Olson SD AD - The Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - The Department of Surgery, McGovern Medical School, Houston, Texas, USA. FAU - Cotton, Bryan A AU - Cotton BA AUID- ORCID: 0000-0003-4184-6742 AD - The Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - The Department of Surgery, McGovern Medical School, Houston, Texas, USA. LA - eng GR - 175145/Trauma Research and Combat Casualty Care Collaborative/ PT - Journal Article DEP - 20260211 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Blood Coagulation Factors) SB - IM MH - Humans MH - Female MH - Male MH - *Plasma/chemistry MH - Adult MH - Middle Aged MH - *Hemostasis MH - Thrombelastography MH - *Blood Donors MH - Blood Coagulation Factors/analysis MH - Blood Donation MH - Color PMC - PMC13184430 COIS- Support for this work was provided by the Trauma Research and Combat Casualty Care Collaborative (TRC4). Dr. Cotton has financial relationship(s) with Haemonetics (Scientific Advisory Committee), Cerus (Research funding/Scientific Advisory Board), Teleflex (Consulting, Medical Advisory Board), and Grifols (Research funding, Consulting, Scientific Advisory Board). The remaining authors declare no conflicts of interest. EDAT- 2026/02/11 06:31 MHDA- 2026/05/19 06:31 PMCR- 2026/05/19 CRDT- 2026/02/11 04:23 PHST- 2026/01/25 00:00 [revised] PHST- 2025/11/30 00:00 [received] PHST- 2026/01/25 00:00 [accepted] PHST- 2026/05/19 06:31 [medline] PHST- 2026/02/11 06:31 [pubmed] PHST- 2026/02/11 04:23 [entrez] PHST- 2026/05/19 00:00 [pmc-release] AID - TRF70115 [pii] AID - 10.1111/trf.70115 [doi] PST - ppublish SO - Transfusion. 2026 May;66 Suppl 1(Suppl 1):S172-S177. doi: 10.1111/trf.70115. Epub 2026 Feb 11. PMID- 41660374 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260209 LR - 20260920 IS - 2472-7245 (Electronic) IS - 2472-7245 (Linking) VI - 11 IP - 1 DP - 2026 Jan-Mar TI - Thrombelastography as a Predictive Tool for Thromboembolic Events After Extremity Trauma: A Secondary Analysis of PREVENT-CLOT. LID - 10.2106/JBJS.OA.25.00352 [doi] LID - e25.00352 AB - BACKGROUND: Venous thromboembolism (VTE) poses significant risk of morbidity and mortality in orthopaedic trauma patients. Thromboelastography (TEG) analysis has been demonstrated to provide value in demonstrating hypercoagulability and predicting the risk of post-injury VTE. The primary aim was to investigate if TEG analysis at the time of admission following severe extremity trauma predicts thromboembolic events. We hypothesized that previously described elevations in maximal amplitude (MA) on initial TEG would correlate with an increased risk of VTE. METHODS: This was a secondary study of PREVENT CLOT, a multicenter, randomized trial that enrolled adult patients with an extremity fracture (from hip to midfoot or shoulder to wrist) treated operatively or any pelvic or acetabular fracture. TEG at admission was performed according to local protocols. The primary outcome of this analysis was postoperative VTE. We assessed the association between admission TEG values and VTE using bivariate and multivariable regression analyses. Statistical significance was set at p < 0.05. RESULTS: Thousand one hundred eighty-three patients enrolled participants in the PREVENTion of CLots in Orthopedic Trauma (PREVENT CLOT) trial had TEG analysis performed on initial presentation. Of these patients, 47 (3.97%) had a symptomatic postoperative VTE at a median of 9 days (interquartile range, 4-18 days). There were no differences in VTE rates when examining MA of >/=65, >/=69, or >/=72 (p = 0.12, 0.21, and 0.19, respectively). However, on admission TEG, reaction time (R-time) was significantly higher among those who experienced a postoperative deep venous thrombosis (2.45 vs. 1.79, p < 0.01). After controlling for confounders, R-time of >/=2.0 was associated with a 2.1-fold increased odds of VTE (OR 2.13, 95% confidence interval 1.06-4.28, p < 0.001). CONCLUSION: In contrast to previous smaller retrospective studies, elevated admission-TEG MA values were not predictive of VTE following operative orthopaedic extremity trauma in this secondary analysis of a large multicenter prospective study. Our findings suggest that an increased R-time on the admission TEG, which is thought to be indicative of a longer time to form a clot, may be paradoxically associated with an increased VTE risk in orthopedic trauma patients. LEVEL OF EVIDENCE: Level II. See Instructions for Authors for a complete description of levels of evidence. CI - Copyright (c) 2026 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. FAU - Mayfield, Cory K AU - Mayfield CK AUID- ORCID: 0000-0001-5268-3817 AD - Keck School of Medicine of the University of Southern California, Los Angeles, California. FAU - O'Hara, Nathan N AU - O'Hara NN AUID- ORCID: 0000-0003-0537-3474 AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Schneider, Prism S AU - Schneider PS AUID- ORCID: 0000-0002-2653-6503 AD - University of Calgary, Calgary, Alberta. FAU - Castillo, Renan C AU - Castillo RC AD - METRC Coordinating Center at Johns Hopkins School of Public Health, Baltimore, Maryland. FAU - O'Toole, Robert V AU - O'Toole RV AUID- ORCID: 0000-0002-5628-6584 AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Frey, Katherine P AU - Frey KP AUID- ORCID: 0000-0001-5305-1774 AD - METRC Coordinating Center at Johns Hopkins School of Public Health, Baltimore, Maryland. FAU - Obremskey, William AU - Obremskey W AD - Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Stein, Deborah M AU - Stein DM AUID- ORCID: 0000-0003-3683-3963 AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Firoozabadi, Reza AU - Firoozabadi R AUID- ORCID: 0000-0002-0221-2408 AD - University of Washington Harborview Medical Center, Seattle, Washington. FAU - Warner, Stephen J AU - Warner SJ AUID- ORCID: 0000-0001-7093-8836 AD - McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas. FAU - Karunakar, Madhav A AU - Karunakar MA AUID- ORCID: 0000-0002-5694-4524 AD - Carolinas Medical Center Atrium Health Musculoskeletal Institute, Charlotte, North Carolina. FAU - Gary, Joshua L AU - Gary JL AUID- ORCID: 0000-0002-6326-2468 AD - Keck School of Medicine of the University of Southern California, Los Angeles, California. LA - eng PT - Journal Article DEP - 20260211 PL - United States TA - JB JS Open Access JT - JB & JS open access JID - 101726219 PMC - PMC12879966 COIS- The authors have no actual or potential conflicts of interest to disclose. Work on the original PREVENT CLOT study was supported by funding from the Patient-Centered Outcomes Research Institute (PCS-1511-32745). No funds, grants, or other support was received for this secondary analysis. The original sponsors had no role in the design or conduct of the trial; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript for submission. The publication of this work was supported by The Gatti Family Research Innovation Fund. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/B102). EDAT- 2026/02/09 12:53 MHDA- 2026/02/09 12:54 PMCR- 2026/02/11 CRDT- 2026/02/09 07:00 PHST- 2026/02/09 12:54 [medline] PHST- 2026/02/09 12:53 [pubmed] PHST- 2026/02/09 07:00 [entrez] PHST- 2026/02/11 00:00 [pmc-release] AID - JBJSOA-D-25-00352 [pii] AID - 10.2106/JBJS.OA.25.00352 [doi] PST - epublish SO - JB JS Open Access. 2026 Feb 11;11(1):e25.00352. doi: 10.2106/JBJS.OA.25.00352. eCollection 2026 Jan-Mar. PMID- 41638579 OWN - NLM STAT- MEDLINE DCOM- 20260706 LR - 20260805 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 24 IP - 4 DP - 2026 Apr TI - Thrombelastography-estimated functional fibrinogen in healthy volunteers, end-stage renal disease, and trauma: inaccurate when most needed. PG - 1327-1338 LID - S1538-7836(26)00062-0 [pii] LID - 10.1016/j.jtha.2025.12.036 [doi] AB - BACKGROUND: Depletion of fibrinogen is an early event in trauma-induced coagulopathy (TIC), while hyperfibrinogenemia increases thrombotic risk in end-stage renal disease (ESRD). Viscoelastic tests aim to provide rapid fibrinogen estimates, yet their accuracy to define abnormal fibrinogenemia remains debated. OBJECTIVES: We assessed the accuracy of thrombelastography (TEG)-TEG 5000 and TEG 6s-in measuring normal and abnormal fibrinogen levels across healthy volunteers, patients with ESRD, and trauma patients at risk for TIC. METHODS: We compared the von Clauss functional fibrinogen (gold standard) with TEG 5000 functional fibrinogen level (FLEV) in 118 healthy volunteers, 52 patients with ESRD who underwent arteriovenous fistula surgery, and 265 severely injured patients. We compared Clauss fibrinogen with TEG 6s citrated functional fibrinogen (CFF) in 140 trauma patients at high risk for TIC. Pearson correlation was used. RESULTS: Clauss fibrinogen correlated moderately with TEG 5000-FLEV in healthy volunteers (r = 0.52; P < .0001) and patients with ESRD overall (r = 0.62; P < .0001). Correlation, however, deteriorated and became nonsignificant in patients with ESRD with fibrinogen of > 500 mg/dL. Trauma patients showed moderate overall correlation (r = 0.58; P < .0001), but the correlation decreased substantially with fibrinogen of <150 mg/dL (r = 0.20; P = .29). TEG 6s-CFF had better overall correlation (r = 0.66; P < .0001), though decreased at fibrinogen<200 mg/dL (r = 0.39; P = .04). CONCLUSION: Both TEG 5000-FLEV and TEG 6s-CFF correlated moderately with Clauss fibrinogen but decreased in correlation in both hyperfibrinogenemia and hypofibrinogenemia. Thus, we caution relying on TEG 5000 or TEG 6s to be the only laboratory measurement to guide fibrinogen replacement when resuscitating trauma patients at risk for TIC and TEG 5000-FLEV for assessing fibrinogen in patients with ESRD at risk for thrombotic events. CI - Copyright (c) 2026 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved. FAU - Vanderheyden, Dallas AU - Vanderheyden D AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA; Department of Surgery, School of Medicine, University of Colorado-Denver, Aurora, Colorado, USA. Electronic address: Ernest.Moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - Transplant Division, AdventHealth Transplant Institution, Porter Hospital, Denver, Colorado, USA. FAU - Chandler, James AU - Chandler J AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Khakoo, Anika AU - Khakoo A AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Sauaia, Angela AU - Sauaia A AD - Sauaia Statistical Solutions LLC, Denver, Colorado, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20260203 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 9001-32-5 (Fibrinogen) RN - 0 (Biomarkers) RN - 0 (FGG protein, human) SB - IM MH - Humans MH - *Thrombelastography MH - *Kidney Failure, Chronic/blood/diagnosis/complications MH - Female MH - Male MH - *Fibrinogen/analysis/metabolism MH - Adult MH - Middle Aged MH - *Wounds and Injuries/blood/complications/diagnosis MH - Predictive Value of Tests MH - *Blood Coagulation MH - Aged MH - Case-Control Studies MH - *Afibrinogenemia/blood/diagnosis MH - Risk Factors MH - Healthy Volunteers MH - Biomarkers/blood MH - Reproducibility of Results MH - Young Adult OTO - NOTNLM OT - coagulopathy OT - fibrinogen OT - hemorrhage OT - resuscitation OT - thrombelastography COIS- Declaration of competing interests E.E.M. received research support from Prytime, Humacyte, Haemonetics, and Hemosonics. None of the other authors have conflicts of interest or funding to report. EDAT- 2026/02/05 00:30 MHDA- 2026/03/27 01:10 CRDT- 2026/02/04 19:14 PHST- 2025/05/13 00:00 [received] PHST- 2025/11/12 00:00 [revised] PHST- 2025/12/14 00:00 [accepted] PHST- 2026/03/27 01:10 [medline] PHST- 2026/02/05 00:30 [pubmed] PHST- 2026/02/04 19:14 [entrez] AID - S1538-7836(26)00062-0 [pii] AID - 10.1016/j.jtha.2025.12.036 [doi] PST - ppublish SO - J Thromb Haemost. 2026 Apr;24(4):1327-1338. doi: 10.1016/j.jtha.2025.12.036. Epub 2026 Feb 3. PMID- 41626227 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260202 LR - 20260204 IS - 2296-858X (Print) IS - 2296-858X (Electronic) IS - 2296-858X (Linking) VI - 13 DP - 2026 TI - Application of a portable sealed positive pressure infusion device in a porcine model of hemorrhagic shock. PG - 1738724 LID - 10.3389/fmed.2026.1738724 [doi] LID - 1738724 AB - BACKGROUND: Hemorrhagic shock is a leading cause of trauma-related mortality in military and disaster settings, necessitating prompt fluid resuscitation. Conventional infusion methods, which rely on elevating fluid containers to generate hydrostatic pressure, risk secondary injury and are less efficient during prehospital transport. We developed a wearable, portable, sealed positive-pressure infusion device to optimize fluid administration in austere environments. METHODS: Ten male Bama miniature pigs underwent controlled hemorrhagic shock (mean arterial pressure [MAP] < 60 mmHg, induced by blood withdrawal until approximately 40-45% of estimated total blood volume [70 mL/kg body weight] and maintained for 30 min). Animals were randomized to receive resuscitation with 6% hydroxyethyl starch 130/0.4 in saline at 10 mL/min using either the novel device or conventional manual pressure infusion. Vital signs and blood parameters (e.g., activated partial thromboplastin time [APTT]) were measured at baseline, shock phase, 1 h post-resuscitation, and upon completion of resuscitation. Resuscitation time, fluid volume, and maximum infusion line pressure were recorded. RESULTS: All animals achieved successful resuscitation (100% immediate survival). During a 7-day follow-up, one animal in each group died (20%, p > 0.05). The device group exhibited a significantly shorter resuscitation time (103.0 +/- 16.97 [95% CI: 81.93, 124.07] vs. 122.4 +/- 8.02 [95% CI: 112.44, 132.36] minutes, p = 0.0496) and a higher infusion rate (9.29 +/- 0.50 [95% CI: 8.67, 9.91] vs. 7.68 +/- 0.40 [95% CI: 7.18, 8.18] mL/min, p < 0.001) compared with the control group. Both groups exhibited reduced APTT post-resuscitation; these descriptive findings may be associated with the colloid used but require further investigation with comprehensive coagulation assays (e.g., viscoelastic testing) and do not imply clinical benefit or harm. CONCLUSION: The portable sealed positive-pressure infusion device provided stable pressure, improved infusion performance, and maintained safety. It represents a feasible solution for managing hemorrhagic shock in prehospital austere settings. CI - Copyright (c) 2026 Tao, Lai, Fu, Lin, Zhang, Huang, Huang, Tian, Wu and Lin. FAU - Tao, Jinsong AU - Tao J AD - Department of General Surgery, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou, Fujian, China. FAU - Lai, Yuandan AU - Lai Y AD - Department of General Surgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. FAU - Fu, Caiyuan AU - Fu C AD - Department of General Surgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. FAU - Lin, Yiru AU - Lin Y AD - Department of General Surgery, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou, Fujian, China. FAU - Zhang, Yuemin AU - Zhang Y AD - Department of General Surgery, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou, Fujian, China. FAU - Huang, Wenting AU - Huang W AD - Department of General Surgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. FAU - Huang, Zhicheng AU - Huang Z AD - Department of General Surgery, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou, Fujian, China. FAU - Tian, Chunlan AU - Tian C AD - Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China. FAU - Wu, Weihang AU - Wu W AD - Department of General Surgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. AD - Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. FAU - Lin, Meijiao AU - Lin M AD - Department of General Surgery, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou, Fujian, China. AD - Department of General Surgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China. LA - eng PT - Journal Article DEP - 20260115 PL - Switzerland TA - Front Med (Lausanne) JT - Frontiers in medicine JID - 101648047 PMC - PMC12852321 OTO - NOTNLM OT - fluid resuscitation OT - hemorrhagic shock OT - porcine model OT - portable infusion device OT - prehospital care COIS- The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2026/02/02 18:13 MHDA- 2026/02/02 18:14 PMCR- 2026/01/15 CRDT- 2026/02/02 07:00 PHST- 2025/11/03 00:00 [received] PHST- 2026/01/01 00:00 [revised] PHST- 2026/01/05 00:00 [accepted] PHST- 2026/02/02 18:14 [medline] PHST- 2026/02/02 18:13 [pubmed] PHST- 2026/02/02 07:00 [entrez] PHST- 2026/01/15 00:00 [pmc-release] AID - 10.3389/fmed.2026.1738724 [doi] PST - epublish SO - Front Med (Lausanne). 2026 Jan 15;13:1738724. doi: 10.3389/fmed.2026.1738724. eCollection 2026. PMID- 41604765 OWN - NLM STAT- MEDLINE DCOM- 20260701 LR - 20260701 IS - 1748-605X (Electronic) IS - 1748-6041 (Linking) VI - 21 IP - 2 DP - 2026 Feb 12 TI - Solvent exchange in electrohydrodynamically atomized starch particles, and subsequent lyophilization to improve blood clotting performance. LID - 10.1088/1748-605X/ae3eec [doi] AB - Electrohydrodynamic discretized starch suspension after contacting with a crosslinker solution was subjected to solvent exchange in phased and optimal manner prior to lyophilization. The resulting nucleation and growth of new solvent crystals in the gelled droplet could provide a porous structure with internal surface area to the extent of 13.4 m(2)g(-1), and water absorption reaching 3.26 times the dry weight of particles. These properties promoted rapid plasma uptake, and aggregation of platelets, while the tranexamic acid loadeda prioriin the precursor suspension stabilized the blood clot against fibrinolysis.In vitroclotting time was reduced from 155 s to 64 s due to presence of microparticles (MPs). The clot strength and formation kinetics from the thromboelastography data supports this observation. The experiments with rat injury models reveal a significant reduction in clotting time (to less than a minute), and cumulative blood loss in reference to those observed for a commercially available hemostat. The antimicrobial activity of these MPs againstStaphylococcus aureusandEscherichia coliwas found superior than commercially available hemostat. These uniform MPs of equivalent diameter on the order of 100 microm provided uniform coverage on hard to reach places of wound site, and were found to degrade to 90% of its initial weight within 6 d of exposure to phosphate buffer saline at 37 degrees C which conforms to the time scale of skin regeneration process. CI - (c) 2026 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved. FAU - Sasmal, Pradyumna Kumar AU - Sasmal PK AD - Department of Chemical Engineering Indian Institute of Technology, Kharagpur 721302, India. FAU - Ganguly, Somenath AU - Ganguly S AUID- ORCID: 0000-0003-4651-5109 AD - Department of Chemical Engineering Indian Institute of Technology, Kharagpur 721302, India. LA - eng PT - Journal Article DEP - 20260212 PL - England TA - Biomed Mater JT - Biomedical materials (Bristol, England) JID - 101285195 RN - 9005-25-8 (Starch) RN - 0 (Solvents) RN - 0 (Hemostatics) SB - IM MH - Animals MH - Freeze Drying MH - *Blood Coagulation/drug effects MH - Rats MH - *Starch/chemistry/pharmacology MH - *Solvents/chemistry MH - Hemostatics/chemistry/pharmacology MH - Thrombelastography MH - Staphylococcus aureus/drug effects MH - Porosity MH - Escherichia coli/drug effects MH - Particle Size MH - Humans OTO - NOTNLM OT - biopolymer OT - electrospray OT - in vivo analysis OT - procoagulant OT - thromboelastography EDAT- 2026/01/29 01:48 MHDA- 2026/02/12 06:54 CRDT- 2026/01/28 18:04 PHST- 2025/08/15 00:00 [received] PHST- 2026/01/28 00:00 [accepted] PHST- 2026/02/12 06:54 [medline] PHST- 2026/01/29 01:48 [pubmed] PHST- 2026/01/28 18:04 [entrez] AID - 10.1088/1748-605X/ae3eec [doi] PST - epublish SO - Biomed Mater. 2026 Feb 12;21(2). doi: 10.1088/1748-605X/ae3eec. PMID- 41595788 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260128 LR - 20260131 IS - 2227-9059 (Print) IS - 2227-9059 (Electronic) IS - 2227-9059 (Linking) VI - 14 IP - 1 DP - 2026 Jan 22 TI - Exploratory Analysis of Coagulation and Fibrinolysis Trajectories After IL-6 Antagonist Therapy in COVID-19: A Case Series. LID - 10.3390/biomedicines14010254 [doi] LID - 254 AB - Background/Objectives: Severe COVID-19 is marked by IL-6-driven inflammation, endothelial injury, and dysregulated coagulation. Although IL-6 antagonists improve clinical outcomes, their effects on the temporal evolution of coagulation and fibrinolysis remain insufficiently defined. This study characterizes inflammatory, endothelial, coagulation, and fibrinolytic trajectories following IL-6 receptor blockade in critically ill COVID-19 patients. Methods: In this prospective, exploratory multicenter case series (ClinicalTrials.gov NCT05218369), 15 ICU patients with PCR- or antigen-confirmed COVID-19 received tocilizumab per protocol. Serial sampling at five timepoints (T0-T4) included routine laboratories, comprehensive viscoelastic hemostatic assays (ClotPro((R))), and ELISA-based endothelial and fibrinolytic biomarkers. Analyses were primarily descriptive, emphasizing temporal patterns through boxplots; paired Wilcoxon tests with FDR correction contextualized within-patient changes. Results: Patients exhibited marked inflammation, hyperfibrinogenemia, endothelial activation, and delayed fibrinolysis at baseline. IL-6 blockade induced rapid suppression of CRP and PCT, progressive declines in fibrinogen, and modest platelet increases. In contrast, vWF antigen and activity further increased, indicating persistent endothelial dysfunction. Viscoelastic testing showed preserved thrombin generation and sustained high clot firmness, while biochemical markers (rising PAI-1, modest PAP increase, and progressively increasing D-dimer) and VHA indices suggested ongoing antifibrinolytic activity despite resolution of systemic inflammation. Conclusions: IL-6 antagonism was associated with rapid attenuation of systemic inflammation but was not accompanied by normalization of endothelial activation or fibrinolytic resistance. The observed hemostatic profile was consistent with attenuation of inflammation-associated coagulation features, while endothelial and prothrombotic alterations appeared to persist during follow-up, warranting further investigation in larger controlled studies. FAU - Kovacs, Emoke Henrietta AU - Kovacs EH AD - Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary. FAU - Rottler, Mate AU - Rottler M AD - Department of Anaesthesiology and Intensive Therapy, Szent Gyorgy University Teaching Hospital of Fejer County, 8000 Szekesfehervar, Hungary. AD - Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary. FAU - Ruszkai, Zoltan AU - Ruszkai Z AUID- ORCID: 0000-0002-2469-7936 AD - Department of Anaesthesiology and Intensive Therapy, Flor Ferenc County Hospital, 2143 Kistarcsa, Hungary. FAU - Gered, Csanad AU - Gered C AD - Department of Anaesthesiology and Intensive Therapy, Flor Ferenc County Hospital, 2143 Kistarcsa, Hungary. FAU - Kiss, Tamas AU - Kiss T AD - Department of Anaesthesiology and Intensive Therapy, University of Pecs, 7624 Pecs, Hungary. FAU - Csata, Margit AU - Csata M AD - Department of Anaesthesiology and Intensive Therapy, University of Pecs, 7624 Pecs, Hungary. FAU - Reger, Barbara AU - Reger B AD - Department of Laboratory Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary. FAU - Jakabfi-Csepregi, Rita AU - Jakabfi-Csepregi R AD - Department of Laboratory Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary. FAU - Papp, Istvan AU - Papp I AD - Department of Laboratory Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary. FAU - Turan, Caner AU - Turan C AUID- ORCID: 0000-0002-8200-7569 AD - Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary. AD - Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. FAU - Hegyi, Peter AU - Hegyi P AD - Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary. AD - Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, 7624 Pecs, Hungary. AD - Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary. FAU - Fazakas, Janos AU - Fazakas J AD - Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. FAU - Molnar, Zsolt AU - Molnar Z AUID- ORCID: 0000-0002-1468-4058 AD - Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary. AD - Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. AD - Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 60-806 Poznan, Poland. FAU - Tanczos, Krisztian AU - Tanczos K AUID- ORCID: 0000-0002-6863-075X AD - Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary. LA - eng SI - ClinicalTrials.gov/NCT05218369 GR - K138816/Hungarian National Research, Development and Innovation Office/ PT - Journal Article DEP - 20260122 PL - Switzerland TA - Biomedicines JT - Biomedicines JID - 101691304 PMC - PMC12838625 OTO - NOTNLM OT - COVID-19 OT - coagulation OT - endothelial dysfunction OT - fibrinolysis OT - interleukin-6 antagonist OT - thromboinflammation OT - viscoelastic hemostatic assay COIS- The authors declare no conflicts of interest. EDAT- 2026/01/28 07:48 MHDA- 2026/01/28 07:49 PMCR- 2026/01/22 CRDT- 2026/01/28 01:07 PHST- 2025/12/02 00:00 [received] PHST- 2026/01/11 00:00 [revised] PHST- 2026/01/16 00:00 [accepted] PHST- 2026/01/28 07:49 [medline] PHST- 2026/01/28 07:48 [pubmed] PHST- 2026/01/28 01:07 [entrez] PHST- 2026/01/22 00:00 [pmc-release] AID - biomedicines14010254 [pii] AID - biomedicines-14-00254 [pii] AID - 10.3390/biomedicines14010254 [doi] PST - epublish SO - Biomedicines. 2026 Jan 22;14(1):254. doi: 10.3390/biomedicines14010254. PMID- 41589733 OWN - NLM STAT- MEDLINE DCOM- 20260701 LR - 20260701 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 100 IP - 2 DP - 2026 Feb 1 TI - Geriatric trauma coagulation profiles: Impact of sex on clot formation. PG - 227-232 LID - 10.1097/TA.0000000000004841 [doi] AB - INTRODUCTION: Limited data exist on the role of sex in coagulation among geriatric trauma patients. This study aimed to assess gender-based differences in thromboelastography (TEG) and conventional coagulation profiles in this population. We hypothesized that older females exhibit faster clot formation and greater clot strength following trauma. METHODS: We conducted a 5-year (2018-2023) retrospective review at an American College of Surgeons Level I trauma center. Included were geriatric trauma patients (65 years or older) with Level I activation and a rapid TEG obtained on arrival. Patients with bleeding disorders, on anticoagulants or antiplatelets, or who received blood products or antifibrinolytics prior to TEG were excluded. Patients were stratified by sex. Thromboelastography variables included activated clotting time (ACT), alpha angle, maximum amplitude (MA), and percent fibrinolysis at 30 minutes (LY30). Conventional profiles (prothrombin time and international normalized ratio [INR]) were also compared. RESULTS: A total of 349 patients met the inclusion criteria (63.3% male, 36.7% female). The median Injury Severity Score was 14 (interquartile range, 4-26), and 92% sustained blunt injuries. No significant sex differences were observed in shock index, Glasgow Coma Scale, Injury Severity Score, or time to TEG. Females had significantly shorter ACT (105 vs. 113 seconds, p = 0.037), higher alpha angle (77 vs. 75 degrees, p < 0.001), and greater MA (68 vs. 65 mm, p < 0.001). Prothrombin time and INR were also lower in females. No differences were found in LY30. After adjusting for confounders, male sex was independently associated with lower alpha angle (beta = -2.08, p = 0.031) and MA (beta = -3.28, p = 0.003), but not ACT, LY30, prothrombin time, or INR. CONCLUSION: In this single-center study of geriatric trauma patients, females demonstrated faster clot formation and greater clot strength compared with males on TEG. These findings indicate that sex-based hypercoagulability may persist despite age-related hormonal decline. Future prospective, multicenter studies will be essential to validate and expand upon these results and to better define the influence of other factors on the sex-specific differences observed. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV. CI - Copyright (c) 2025 American Association for the Surgery of Trauma. FAU - Castillo-Diaz, Francisco AU - Castillo-Diaz F AD - From the Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona. FAU - Al Ma'ani, Mohammad AU - Al Ma'ani M FAU - Magnotti, Louis J AU - Magnotti LJ FAU - Joseph, Bellal AU - Joseph B AUID- ORCID: 0000-0002-2205-3061 LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Humans MH - Female MH - Male MH - Thrombelastography MH - Retrospective Studies MH - Aged MH - *Wounds and Injuries/blood/complications MH - Sex Factors MH - *Blood Coagulation/physiology MH - Injury Severity Score MH - Aged, 80 and over MH - Trauma Centers MH - Blood Coagulation Tests MH - International Normalized Ratio OTO - NOTNLM OT - Thromboelastography OT - coagulopathy OT - geriatrics OT - resuscitation EDAT- 2026/01/27 12:59 MHDA- 2026/01/27 13:00 CRDT- 2026/01/27 08:14 PHST- 2025/08/01 00:00 [received] PHST- 2025/10/17 00:00 [accepted] PHST- 2026/01/27 13:00 [medline] PHST- 2026/01/27 12:59 [pubmed] PHST- 2026/01/27 08:14 [entrez] AID - 01586154-202602000-00010 [pii] AID - 10.1097/TA.0000000000004841 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Feb 1;100(2):227-232. doi: 10.1097/TA.0000000000004841. PMID- 41575197 OWN - NLM STAT- MEDLINE DCOM- 20260630 LR - 20261002 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 100 IP - 4 DP - 2026 Apr 1 TI - Platelet function assays fail to detect differences between transfusion of cold or room temperature platelets in traumatic brain injury patients. PG - 555-561 LID - 10.1097/TA.0000000000004894 [doi] AB - BACKGROUND: Traumatic brain injury (TBI) patients on antiplatelet medications lack definitive treatment for reversal of platelet inhibition and restoration of injury-induced platelet dysfunction. The use of platelet transfusions in this patient population remains controversial. Cold-stored platelets (CSPs) may be hemostatically superior to their room temperature platelet (RTP) counterparts for hemostatic resuscitation, but their impact on post-transfusion platelet function has yet to be assessed clinically. We aimed to evaluate the effect of CSP or RTP on post-transfusion platelet function in TBI patients on antiplatelet medications. We hypothesized that CSP would better restore platelet function based on the extensive in vitro data suggesting hemostatic superiority. METHODS: We performed a post hoc analysis of a randomized controlled trial comparing CSP and RTP in TBI patients on antiplatelet medications. Platelet hemostatic function was determined pretransfusion and posttransfusion using VerifyNow or thromboelastography with platelet mapping (TEG-PM). Clinical outcomes included 30-day mortality, need for neurosurgical intervention, and follow-up Rotterdam scores. RESULTS: Of the 94 patients with available data, 49 received CSP and 45 received RTP. Baseline characteristics and pre-transfusion assay measurements were similar between groups. Cold-stored platelet recipients had fewer neurosurgical procedures compared with RTP recipients (4.1% vs. 20.0%, p = 0.016). Room temperature platelet recipients showed a greater increase in TEG-PM kaolin maximum amplitude after transfusion compared with CSP recipients (2.4 mm vs. 0.6 mm, p = 0.004). No other differences were observed between RTP and CSP transfusions. CONCLUSION: Despite a reduction in neurosurgical events, CSP did not significantly improve observed platelet function in TBI patients on antiplatelet medications. Our findings highlight the disconnect between platelet function assays and clinical results and suggest transfusion of CSP versus RTP has minimal effect on platelet hemostatic function. A definitive trial is needed to assess the efficacy of differentially stored products in the bleeding patient, with consideration placed on how platelet hemostatic function is assessed. LEVEL OF EVIDENCE: Prognostic/epidemiologic; Level III. CI - Copyright (c) 2026 American Association for the Surgery of Trauma. FAU - Killinger, Jack R AU - Killinger JR AD - From the Department of Bioengineering (J.R.K., S.M.S.), Department of Surgery (J.R.K., N.A., A.A., A.A., D.M.D., L.H., R.K., P.A.L., E.P.M., S.M.S., P.C.S., A.J.S., L.E.V., R.Y., J.L.S., M.D.N.), University of Pittsburgh; Trauma and Transfusion Medicine Research Center (J.R.K., N.A., A.A., A.A., D.M.D., L.H., R.K., E.P.M., S.M.S., P.C.S., A.J.S., R.Y., M.D.N.); School of Public Health (J.F.L., S.R.W.), Department of Neurosurgery (A.G.A., A.F., T.H., P.M., A.M.P., O.R., D.O.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Emergency Medicine (B.A.F., N.M.M.), University of Iowa, Iowa City, Iowa; Department of Emergency Medicine (F.X.G.), and Department of Pathology (A.K.), University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Alsaadi, Nijmeh AU - Alsaadi N FAU - Luther, James F AU - Luther JF FAU - Abdullah, Abiha AU - Abdullah A FAU - Agnone, Allison G AU - Agnone AG FAU - Arivudainambi, Aishwarrya AU - Arivudainambi A FAU - Dishong, Devin M AU - Dishong DM FAU - Faine, Brett A AU - Faine BA FAU - Filicky, Amanda AU - Filicky A FAU - Guyette, Francis X AU - Guyette FX FAU - Hahner, Thomas AU - Hahner T FAU - Hoteit, Lara AU - Hoteit L FAU - Kaplan, Alesia AU - Kaplan A FAU - Kar, Ronit AU - Kar R FAU - Loughran, Patricia A AU - Loughran PA FAU - McIntyre, Peyton AU - McIntyre P FAU - Mihalko, Emily P AU - Mihalko EP FAU - Mohr, Nicholas M AU - Mohr NM FAU - Puccio, Ava M AU - Puccio AM FAU - Raymond, Olivia AU - Raymond O FAU - Shea, Susan M AU - Shea SM FAU - Spinella, Philip C AU - Spinella PC FAU - Srinivasan, Amudan J AU - Srinivasan AJ FAU - Vincent, Laura E AU - Vincent LE FAU - Younes, Reem AU - Younes R FAU - Wisniewski, Stephen R AU - Wisniewski SR FAU - Okonkwo, David AU - Okonkwo D FAU - Sperry, Jason L AU - Sperry JL FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 LA - eng GR - K25 HL161401/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial DEP - 20260121 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - *Platelet Transfusion/methods MH - *Brain Injuries, Traumatic/therapy/blood/complications/mortality MH - Female MH - *Platelet Function Tests MH - Male MH - Adult MH - Middle Aged MH - Platelet Aggregation Inhibitors/therapeutic use MH - Blood Platelets/physiology MH - Thrombelastography MH - *Blood Preservation/methods MH - Cold Temperature OTO - NOTNLM OT - Platelet function assays OT - TBI OT - antiplatelet medications OT - cold-stored platelets OT - platelet transfusions EDAT- 2026/01/23 13:05 MHDA- 2026/03/24 12:37 CRDT- 2026/01/23 09:02 PHST- 2025/08/08 00:00 [received] PHST- 2025/11/23 00:00 [accepted] PHST- 2026/03/24 12:37 [medline] PHST- 2026/01/23 13:05 [pubmed] PHST- 2026/01/23 09:02 [entrez] AID - 01586154-202604000-00005 [pii] AID - 10.1097/TA.0000000000004894 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Apr 1;100(4):555-561. doi: 10.1097/TA.0000000000004894. Epub 2026 Jan 21. PMID- 41529228 OWN - NLM STAT- MEDLINE DCOM- 20260626 LR - 20261020 IS - 2473-9537 (Electronic) IS - 2473-9529 (Print) IS - 2473-9529 (Linking) VI - 10 IP - 6 DP - 2026 Mar 24 TI - Impact of antiplatelet therapy on the hemostatic efficacy of platelet-targeted FVIII gene therapy in hemophilia A mice. PG - 1883-1896 LID - 10.1182/bloodadvances.2025017921 [doi] AB - Platelet-targeted factor VIII (FVIII) (2bF8) gene therapy offers promising hemostatic correction in hemophilia A (HA), even in the presence of FVIII inhibitors. Because platelet-derived FVIII is released from platelet alpha-granules upon activation at injury sites, it is essential to evaluate whether antiplatelet agents would compromise its therapeutic efficacy. Here, we investigated the effect of antiplatelet agents on the efficacy of platelet-FVIII in HA mice. 2bF8Tg mice express FVIII in platelets controlled by the alphaIIb promoter and were treated with aspirin, clopidogrel, or the alphaIIbbeta3-blocking antibody Leo.H4. Hemostatic function was evaluated through tail-bleeding models and in vitro assays. We found that all antiplatelet agents impaired platelet-FVIII-mediated hemostasis in vivo. Leo.H4 treatment caused severe bleeding in both the tail tip and tail vein transection injury models, consistent with its inhibition of platelet aggregation. Clopidogrel-treated 2bF8Tg mice exhibited 10 to 14 times more blood loss than controls, with extended bleeding; however, they still showed improvement compared to FVIIInull controls. Notably, platelet-FVIII retained superior efficacy compared to plasma-derived FVIII in clopidogrel-treated mice, despite having only 24% of normal FVIII activity. Aspirin also impaired hemostasis but to a lesser extent. In vitro rotational thromboelastometry and whole-blood thrombin generation assays showed no significant differences between aspirin- or clopidogrel-treated and control mice, suggesting that these assays may not fully capture platelet-FVIII dynamics. Our results indicate that platelet aggregation is crucial for the efficacy of platelet-FVIII. Although antiplatelet agents hinder its function, platelet-FVIII remains preferable to plasma-FVIII, highlighting its clinical potential and the importance of considering concomitant therapies in future applications. CI - (c) 2026 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. FAU - Yu, Hongyin AU - Yu H AUID- ORCID: 0000-0003-3903-7305 AD - Departments of Pediatrics, Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI. AD - Thrombosis and Hemostasis Program, Versiti Blood Research Institute, Milwaukee, WI. FAU - Schroeder, Jocelyn A AU - Schroeder JA AUID- ORCID: 0000-0001-8953-5201 AD - Departments of Pediatrics, Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI. AD - Thrombosis and Hemostasis Program, Versiti Blood Research Institute, Milwaukee, WI. AD - Children's Research Institute, Children's Wisconsin, Milwaukee, WI. AD - Midwest Athletes Against Childhood Cancer Fund Research Center, Milwaukee, WI. FAU - Mattson, Jeremy G AU - Mattson JG AD - Thrombosis and Hemostasis Program, Versiti Blood Research Institute, Milwaukee, WI. FAU - Gao, Chunyan AU - Gao C AD - Thrombosis and Hemostasis Program, Versiti Blood Research Institute, Milwaukee, WI. AD - Institute of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China. FAU - Shi, Qizhen AU - Shi Q AUID- ORCID: 0000-0003-1548-0708 AD - Departments of Pediatrics, Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI. AD - Thrombosis and Hemostasis Program, Versiti Blood Research Institute, Milwaukee, WI. AD - Children's Research Institute, Children's Wisconsin, Milwaukee, WI. AD - Midwest Athletes Against Childhood Cancer Fund Research Center, Milwaukee, WI. LA - eng GR - R01 HL102035/HL/NHLBI NIH HHS/United States PT - Journal Article PL - United States TA - Blood Adv JT - Blood advances JID - 101698425 RN - 9001-27-8 (Factor VIII) RN - 0 (Platelet Aggregation Inhibitors) RN - A74586SNO7 (Clopidogrel) SB - IM EIN - Blood Adv. 2026 Oct 13;10(19):6729. doi: 10.1182/bloodadvances.2026022295. PMID: 42814505 MH - Animals MH - *Hemophilia A/therapy/genetics MH - *Factor VIII/genetics/metabolism MH - Mice MH - *Platelet Aggregation Inhibitors/pharmacology/therapeutic use MH - *Blood Platelets/metabolism/drug effects MH - *Genetic Therapy/methods MH - *Hemostasis/drug effects MH - Disease Models, Animal MH - Mice, Transgenic MH - Clopidogrel MH - Humans MH - Gene Therapy Agents PMC - PMC12993903 COIS- Conflict-of-interest disclosure: The authors declare no competing financial interests. EDAT- 2026/01/13 19:39 MHDA- 2026/03/13 12:40 PMCR- 2026/01/16 CRDT- 2026/01/13 16:03 PHST- 2025/12/13 00:00 [accepted] PHST- 2025/07/29 00:00 [received] PHST- 2026/03/13 12:40 [medline] PHST- 2026/01/13 19:39 [pubmed] PHST- 2026/01/13 16:03 [entrez] PHST- 2026/01/16 00:00 [pmc-release] AID - 565991 [pii] AID - 10.1182/bloodadvances.2025017921 [doi] PST - ppublish SO - Blood Adv. 2026 Mar 24;10(6):1883-1896. doi: 10.1182/bloodadvances.2025017921. PMID- 41517266 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260110 LR - 20260113 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 15 IP - 1 DP - 2025 Dec 19 TI - Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update. LID - 10.3390/jcm15010012 [doi] LID - 12 AB - The recognition of trauma-induced coagulopathy (TIC) as an endogenous response to traumatic injuries rather than a consequence of therapeutic interventions has shifted the clinical approach toward an early and physiologically based hemostatic resuscitation. Prompt identification and correction of fibrinolysis and fibrinogen level derangements, dysregulated thrombin generation, and platelet dysfunction represent the cornerstones of the treatment strategies. Currently available viscoelastic hemostatic assays (VHAs) are point-of-care devices able to rapidly assess the phases of clot initiation, propagation, stabilization, and degradation, as well as isolate the contribution of specific elements-e.g., fibrinogen-to the coagulation process in fully automated analyses by multi-channel single-use cartridges. As a result, in the last decade, VHAs have been widely investigated as tools to implement individualized protocols of hemostatic resuscitation. Current guidelines support their use to optimize transfusion load in a goal-directed strategy. Nevertheless, contrasting evidence has emerged regarding the improvement in main clinical outcomes induced by the VHA-based algorithm of hemostatic resuscitation compared with those guided by conventional coagulation tests, and their place in the management of this peculiar population is still a matter of debate. We propose a narrative review ranging from TIC physiopathology as a proper substrate for viscoelastic diagnostic technique, through the strengths and weaknesses of VHAs, to their application in clinical practice. FAU - Natalini, Daniele AU - Natalini D AUID- ORCID: 0000-0003-1548-7627 AD - Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy. AD - Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universita Cattolica del Sacro Cuore, 00168 Rome, Italy. FAU - Xhemalaj, Rikardo AU - Xhemalaj R AUID- ORCID: 0000-0001-8957-9335 AD - Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy. AD - Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universita Cattolica del Sacro Cuore, 00168 Rome, Italy. FAU - Carelli, Simone AU - Carelli S AUID- ORCID: 0000-0002-0666-8955 AD - Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy. AD - Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universita Cattolica del Sacro Cuore, 00168 Rome, Italy. LA - eng PT - Journal Article PT - Review DEP - 20251219 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC12786857 OTO - NOTNLM OT - damage control resuscitation OT - hemostatic resuscitation OT - trauma-induced coagulopathy OT - viscoelastic hemostatic assays COIS- The authors declare no conflict of interest. EDAT- 2026/01/10 06:31 MHDA- 2026/01/10 06:32 PMCR- 2025/12/19 CRDT- 2026/01/10 01:15 PHST- 2025/11/11 00:00 [received] PHST- 2025/12/10 00:00 [revised] PHST- 2025/12/13 00:00 [accepted] PHST- 2026/01/10 06:32 [medline] PHST- 2026/01/10 06:31 [pubmed] PHST- 2026/01/10 01:15 [entrez] PHST- 2025/12/19 00:00 [pmc-release] AID - jcm15010012 [pii] AID - jcm-15-00012 [pii] AID - 10.3390/jcm15010012 [doi] PST - epublish SO - J Clin Med. 2025 Dec 19;15(1):12. doi: 10.3390/jcm15010012. PMID- 41504542 OWN - NLM STAT- MEDLINE DCOM- 20260625 LR - 20261013 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 54 IP - 3 DP - 2026 Mar 1 TI - Unique Pattern of Coagulopathy Among Patients With Severe Traumatic Brain Injury: A Principal Component Analysis of Hemorrhagic Shock Trials. PG - 464-473 LID - 10.1097/CCM.0000000000007005 [doi] AB - OBJECTIVES: Trauma-induced coagulopathy biomarkers may be influenced by injury mechanism. We sought to identify differences in patterns of coagulopathy with and without severe traumatic brain injury (TBI). DESIGN: Retrospective cohort study. SETTING: Harmonized database composed of six major hemorrhagic shock trials: Control of Major Bleeding After Trauma (COMBAT), Cold-stored Platelet Early Intervention in Hemorrhagic Shock (CriSP-HS), Prehospital Air Medical Plasma (PAMPer), Prehospital Whole Blood in Emergency Resuscitation (PPOWER), Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR), and Study of Tranexamic Acid During Air Medical and Ground Prehospital Transport (STAAMP). PATIENTS: All subjects randomized to placebo or standard-of-care groups with complete data for international normalized ratio (INR), thromboelastography values (alpha angle [AA], K time, maximum amplitude [MA], and lysis in 30 min), and Abbreviated Injury Scores (AISs). Subjects from COMBAT and CriSP-HS were screened and ultimately excluded from the final analysis as they did not meet eligibility criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Stratified principal component (PC) analysis was performed for INR and thromboelastography values. Strata were defined based on AIS scores as: 1) isolated severe TBI (iTBI); 2) severe polytrauma (POLY), those with both major head injury and torso/extremity trauma; and 3) isolated severe torso/extremity trauma (iTRUNK). We identified 506 subjects with complete data: 51 iTBI, 115 POLY, and 340 iTRUNK. For each stratum, two PCs were identified that accounted for more than 65% of the variance. Associations between PC scores and outcomes, including need for blood product transfusion within 24 hours as a surrogate marker for early coagulopathy and bleeding, were examined with logistic regression. For both iTBI and POLY, PC1 included INR, AA, K time, and MA, and was associated with greater odds of early transfusion (odds ratio [OR], 3.57; 95% CI, 1.50-8.45; p = 0.004 for iTBI and OR, 2.29; 95% CI, 1.11-4.75; p = 0.026 for POLY). For iTRUNK, PC1 included INR, AA, and MA and was protective with reduced odds of early transfusion (OR, 0.51; 95% CI, 0.37-0.70; p < 0.001). CONCLUSIONS: PC analysis demonstrated a unique pattern of coagulation biomarkers common to patients with severe TBI, irrespective of other injuries. CI - Copyright (c) 2026 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. FAU - Furman, Leah M AU - Furman LM AUID- ORCID: 0000-0002-4105-4043 AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Bizri, Nazih AU - Bizri N AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Feeney, Erin V AU - Feeney EV AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Gaines, Barbara A AU - Gaines BA AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. FAU - Guyette, Francis X AU - Guyette FX AD - Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, University of Alabama Birmingham, Birmingham, AL. FAU - Sperry, Jason L AU - Sperry JL AD - Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Leeper, Christine M AU - Leeper CM AD - Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. LA - eng GR - T32 GM008516/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20260108 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Brain Injuries, Traumatic/complications MH - *Shock, Hemorrhagic/therapy/complications MH - *Blood Coagulation Disorders/etiology MH - Female MH - Retrospective Studies MH - Male MH - Adult MH - Principal Component Analysis MH - Thrombelastography MH - Biomarkers MH - Middle Aged MH - International Normalized Ratio PMC - PMC12875202 MID - NIHMS2135929 OTO - NOTNLM OT - blood OT - brain injuries OT - coagulation disorders OT - multiple trauma OT - principal component analysis OT - shock COIS- Dr. Furman's institution received funding from the National Institutes of Health (NIH; T32 GM008516). Drs. Furman and Feeney received support for article research from the NIH. Dr. Gaines' institution received funding from the University of Pittsburgh; she received funding from the University of Chicago, Vanderbilt University, and the American Academy of Pediatrics. Dr. Guyette's institution received funding from the Department of Defense (DoD); he received support for article research from the DoD. Dr. Moore received research support from Humacyte, Prytime, and Haemonetics. Dr. Holcomb received funding from Zibrio, QinFlow, Hemostatics, Wake Forest Institute for Regenerative Medicine, Aspen Medical, Geneva Foundation, Infrascan, and University of Texas Health; he disclosed that he is co-inventor of the Junctional Emergency Tourniquet Tool; he received research grant support from the DoD and NIH; and he focused on hemorrhage control and resuscitation. Dr. Leeper received current funding support from DoD and the Biomedical Advanced Research and Development Authority, and prior honorarium from Haemonetics for participation in an expert panel. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2026/01/08 17:52 MHDA- 2026/03/08 06:38 PMCR- 2026/02/06 CRDT- 2026/01/08 09:36 PHST- 2026/03/08 06:38 [medline] PHST- 2026/01/08 17:52 [pubmed] PHST- 2026/01/08 09:36 [entrez] PHST- 2026/02/06 00:00 [pmc-release] AID - 00003246-202603000-00006 [pii] AID - 10.1097/CCM.0000000000007005 [doi] PST - ppublish SO - Crit Care Med. 2026 Mar 1;54(3):464-473. doi: 10.1097/CCM.0000000000007005. Epub 2026 Jan 8. PMID- 41492610 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260106 LR - 20260108 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 17 IP - 12 DP - 2025 Dec TI - In Vitro Evaluation of Whole Blood Hemostatic Function at a Level 1 Trauma Center. PG - e98468 LID - 10.7759/cureus.98468 [doi] LID - e98468 AB - BACKGROUND: Cold-stored whole blood (CSWB) is increasingly used in civilian trauma care, but concerns remain regarding its hemostatic efficacy, particularly platelet function. This study aimed to evaluate the thromboelastogram (TEG) profiles of emergency-release whole blood units available in the blood bank of our Level 1 trauma center. We hypothesized that CSWB would show a storage age-dependent decline in platelet function and that its hemostatic profile would resemble that of reconstituted whole blood (RWB). METHODS: TEG 6S analyses were performed on samples from 10 CSWB and 10 RWB units. Parameters assessed included reaction time (R time), functional fibrinogen (FF), and maximum amplitude (MA). Results were compared between groups and analyzed relative to storage age. RESULTS: R times were within normal limits for all samples. For FF, 2/10 CSWB samples were below normal compared to none of the RWB samples (P = 0.474). For MA, 7/10 CSWB samples were below normal compared to none of the RWB samples (P = 0.003). All RWB MA values exceeded those of CSWB. No correlation was found between CSWB MA values and storage age. CONCLUSION: In vitro platelet function, as assessed by TEG 6S, was below normal in most CSWB units but normal in all RWB samples. These findings suggest that transfusing hemostatically deficient CSWB may be suboptimal in managing trauma-related coagulopathy. CI - Copyright (c) 2025, Czarkowski et al. FAU - Czarkowski, Brian R AU - Czarkowski BR AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Hall, Rigel AU - Hall R AD - Department of Trauma/Acute and General Surgery, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Vazquez-Loreto, Andrea C AU - Vazquez-Loreto AC AD - Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA. FAU - Handschug, Jody L AU - Handschug JL AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Kupanoff, Kristina M AU - Kupanoff KM AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Huang, Dih-Dih AU - Huang DD AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Jones, Michael D AU - Jones MD AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Soe-Lin, Hahn AU - Soe-Lin H AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Bogert, James N AU - Bogert JN AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. FAU - Weinberg, Jordan A AU - Weinberg JA AD - Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA. LA - eng PT - Journal Article DEP - 20251204 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC12765506 OTO - NOTNLM OT - cold-stored whole blood OT - fresh frozen plasma transfusion OT - hemostasis OT - platelet transfusion OT - reconstituted whole blood OT - thromboelastography (teg) COIS- Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2026/01/06 13:05 MHDA- 2026/01/06 13:06 PMCR- 2025/12/04 CRDT- 2026/01/06 11:58 PHST- 2025/11/08 00:00 [accepted] PHST- 2026/01/06 13:06 [medline] PHST- 2026/01/06 13:05 [pubmed] PHST- 2026/01/06 11:58 [entrez] PHST- 2025/12/04 00:00 [pmc-release] AID - 10.7759/cureus.98468 [doi] PST - epublish SO - Cureus. 2025 Dec 4;17(12):e98468. doi: 10.7759/cureus.98468. eCollection 2025 Dec. PMID- 41489548 OWN - NLM STAT- MEDLINE DCOM- 20260223 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 100 IP - 3 DP - 2026 Mar 1 TI - Thromboinflammatory mediators produced by hyperfibrinolysis following injury. PG - 460-468 LID - 10.1097/TA.0000000000004792 [doi] AB - BACKGROUND: Fibrinolysis phenotypes are integral in the pathogenesis of trauma-induced coagulopathy and its sequelae. Of the various phenotypes of dysregulated fibrinolysis, hyperfibrinolysis (HF) is most associated with the highest mortality and has been implicated directly in death due to bleeding. While the dominant regulators of fibrinolysis are well established, additional yet crucial candidate biomediators of HF are less known. Thus, our hypothesis is that the early proteomic signature of HF would expand our comprehension of this dysregulated pathway after severe trauma. METHODS: Mass spectrometry-based proteomics methods were leveraged to characterize plasma samples from trauma patients enrolled in the Control of Major Bleeding After Trauma randomized control trial. In this post hoc analysis, the plasma fraction of samples collected at the emergency department from highly injured, hypotensive patients in HF was subjected to proteomics workflows. Projection to latent structures and principal component analyses were performed using rapid thromboelastogram-based percent decrease in clot strength 30 minutes after it reaches its maximum amplitude to identify statistically significant proteins. RESULTS: Fibrinogen gamma' (odds ratio [OR], 21.85; p = 0.001) and Golgi casein kinase (FAM20C) (OR, 4.25; p = 0.025) were among the top proteins most associated with HF. Other significant proteins included phospholipid transfer protein (OR, 2.39; p = 0.025) and 3-hydroxy-3-methylglutaryl coenzyme A synthase (OR, 217.36; p = 0.003). Proteins least associated with decreased HF included complement proteins, coagulation factors, and other procoagulant proteins such as thrombin-activatable fibrinolysis inhibitor (OR, 0.394; p = 0.011) and actin beta (OR, 0.732; p = 0.027). CONCLUSION: Cutting-edge proteomic analyses have uncovered potential biomediators of HF, a novel yet crucial next step in understanding these maladaptive syndromes. This provides a platform to characterize numerous additional proteins associated with HF from where we can start investigating potential therapeutic targets as the next step in treating HF and thus trauma-induced coagulopathy. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Thielen, Otto AU - Thielen O AUID- ORCID: 0000-0001-7703-1751 AD - From the Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery (O.T., C.E., B.S., T.R.S., L.T.G., K.D., B.R., S.S., K.H., E.M.), University of Colorado, Aurora, CO; and Department of Surgery (E.M.), Denver Health Medical Center, Ernest E Moore Shock Trauma Center, Denver Health, Aurora, CO. FAU - Erickson, Christopher AU - Erickson C FAU - Stocker, Benjamin AU - Stocker B FAU - Schaid, Terry R AU - Schaid TR FAU - Gallagher, Lauren T AU - Gallagher LT FAU - Dickinson, Kaitlyn AU - Dickinson K FAU - Ramser, Benjamin AU - Ramser B FAU - Sen, Sanchayita AU - Sen S FAU - Hansen, Kirk AU - Hansen K FAU - Moore, Ernest AU - Moore E LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - R01 HL142975/HL/NHLBI NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20250919 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Inflammation Mediators) RN - 9001-32-5 (Fibrinogen) RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Fibrinolysis/physiology MH - *Wounds and Injuries/complications/blood MH - Proteomics/methods MH - Male MH - Female MH - Thrombelastography MH - Adult MH - Middle Aged MH - *Inflammation Mediators/blood MH - *Blood Coagulation Disorders/etiology/blood MH - Fibrinogen/metabolism MH - Biomarkers/blood MH - *Thromboinflammation/blood/etiology OTO - NOTNLM OT - Fibrinogen gamma prime OT - hyperfibrinolysis OT - thromboinflammation OT - trauma EDAT- 2026/01/05 12:48 MHDA- 2026/02/23 13:06 CRDT- 2026/01/05 10:15 PHST- 2024/07/22 00:00 [received] PHST- 2025/08/08 00:00 [accepted] PHST- 2026/02/23 13:06 [medline] PHST- 2026/01/05 12:48 [pubmed] PHST- 2026/01/05 10:15 [entrez] AID - 01586154-202603000-00016 [pii] AID - 10.1097/TA.0000000000004792 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Mar 1;100(3):460-468. doi: 10.1097/TA.0000000000004792. Epub 2025 Sep 19. PMID- 41485823 OWN - NLM STAT- MEDLINE DCOM- 20260104 LR - 20260104 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 233 IP - 6S DP - 2026 Jan TI - Hemostatic resuscitation: blood product replacement during cesarean delivery. PG - S289-S309.e1 LID - S0002-9378(25)00467-3 [pii] LID - 10.1016/j.ajog.2025.07.007 [doi] AB - Despite efforts to improve accurate prediction, early detection, and optimal medical and surgical treatments, obstetrical hemorrhage remains the leading cause of maternal mortality worldwide. The development and application of clinical bundles incorporating risk assessment tools focused on earlier detection and prompt intervention have demonstrated improved clinical outcomes. Many clinical bundles and obstetrical hemorrhage institutional protocols have incorporated different methods attempting to quantify intraoperative blood loss during cesarean. The addition of blood loss quantification, when incorporated into structured bundles, appears to improve outcomes. Although evidence specific to obstetrics is limited, the practice of hemostatic resuscitation and the use of massive transfusion protocols have been adapted from the trauma literature. Following identification of excessive hemorrhage, resuscitation with excessive crystalloid or colloid solutions should be avoided as it increases morbidity and mortality. Instead, hemostatic resuscitation including early administration of blood products should be instituted without delays. Early blood product and clotting factor administration, when indicated, with avoidance of hypothermia, excessive crystalloid or colloid solutions, hypocalcemia, and acidemia are key to achieve rapid hemostasis and avoid dilutional coagulopathy. At the same time, faster hemostasis results in decreased end-organ hypoperfusion/damage leading to inflammation-induced disseminated intravascular coagulation. Together with classical blood products (red blood cells, plasma, platelets, and cryoprecipitate), different adjuvants have been used to achieve faster hemostasis including tranexamic acid, fibrinogen concentrates, activated factor VII, and prothrombin complex concentrates. The efficacy of group O low titer whole blood is currently being studied in civilian trauma victims with hemorrhagic shock; its role in obstetrical hemorrhage is promising but will require validation in clinical trials. Point-of-care viscoelastic testing enables the identification of specific clotting anomalies, potentially reducing unnecessary transfusions through an individualized approach to transfusion. Viscoelastic testing may be used to guide transfusions after the acute phase of resuscitation when severe intraoperative active bleeding has been controlled. Persistence of nonsurgical bleeding following cesarean delivery may require the use of topical hemostatic agents or, in extreme cases, damage control surgery with abdominal packing and temporary abdominal closure followed by medical stabilization in the intensive care unit. Patients who receive large amounts of blood products should be followed closely for the development of abdominal compartment syndrome, a rare but potentially deadly complication. Abdominal compartment syndrome should be suspected in patients who received large-volume resuscitation with persistent hypotension and oliguria not responsive to further fluid administration together with ventilatory compromise secondary to decreased respiratory compliance. Diagnosis requires measurement of intravesical pressure. Immediate treatment includes surgical abdominal decompression. CI - Copyright (c) 2025 Elsevier Inc. All rights reserved. FAU - Pacheco, Luis D AU - Pacheco LD AD - Divisions of Maternal Fetal Medicine and Surgical Critical Care, Departments of Obstetrics, Gynecology, and Anesthesiology, University of Texas Medical Branch, Galveston, TX. Electronic address: ldpachec@utmb.edu. FAU - Farber, Michaela K AU - Farber MK AD - Division of Obstetric Anesthesiology, Brigham and Women's Hospital, Associate Professor of Anesthesia, Harvard Medical School, Boston, MA. FAU - Martins, Juliana Gevaerd AU - Martins JG AD - Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at ODU, Norfolk, VA. FAU - Omere, Chasey I AU - Omere CI AD - Division of Maternal Fetal Medicine, Department of Ob-Gyn, University of Texas Medical Branch, Galveston, TX. FAU - Shamshirsaz, Amir A AU - Shamshirsaz AA AD - Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, Department of Medicine/Division of Pulmonary Critical Care, Texas Children's Hospital/Pavilion for Women, Baylor St Lukes Medical Center, Baylor College of Medicine, Houston, TX. FAU - Yates, Sean G AU - Yates SG AD - Department of Pathology, Division of Transfusion Medicine, and Hemostasis, UT Southwestern Medical Center, Dallas, TX. LA - eng PT - Journal Article PT - Review PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - IM MH - Humans MH - Female MH - Pregnancy MH - *Cesarean Section/adverse effects MH - *Resuscitation/methods MH - *Blood Loss, Surgical/prevention & control MH - *Postpartum Hemorrhage/therapy MH - Blood Transfusion MH - *Blood Component Transfusion OTO - NOTNLM OT - abdominal compartment syndrome OT - blood products OT - cesarean delivery OT - coagulation cascade OT - damage control surgery OT - disseminated intravascular coagulation OT - fibrin sealants OT - gelatin OT - hemostatic matrix OT - hemostatic resuscitation OT - intensive care unit OT - massive transfusion protocols OT - microfibrillar collagen OT - obstetrical hemorrhage OT - oxidized regenerated cellulose OT - thrombin hemostatic agent OT - topical hemostatic agents OT - transfusion OT - viscoelastic testing EDAT- 2026/01/05 00:49 MHDA- 2026/01/05 00:50 CRDT- 2026/01/04 20:54 PHST- 2024/11/26 00:00 [received] PHST- 2025/07/01 00:00 [revised] PHST- 2025/07/02 00:00 [accepted] PHST- 2026/01/05 00:50 [medline] PHST- 2026/01/05 00:49 [pubmed] PHST- 2026/01/04 20:54 [entrez] AID - S0002-9378(25)00467-3 [pii] AID - 10.1016/j.ajog.2025.07.007 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2026 Jan;233(6S):S289-S309.e1. doi: 10.1016/j.ajog.2025.07.007. PMID- 41481926 OWN - NLM STAT- MEDLINE DCOM- 20260102 LR - 20260430 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 100 IP - 1 DP - 2026 Jan 1 TI - Low FIBTEM amplitude in neurotrauma: True plasma fibrinogen depletion or functional fibrin activity reduction? PG - 147-151 LID - 10.1097/TA.0000000000004787 [doi] AB - BACKGROUND: FIBTEM, a component of rotational thromboelastometry, assesses the functional contribution of fibrin to clot formation. Notably, impaired fibrin function using FIBTEM may be observed despite normal plasma fibrinogen levels measured by the Clauss assay. The clinical implications of such isolated functional deficits are poorly understood in traumatic intracranial hemorrhage (TICH) and are the focus of this brief report. METHODS: From February 2022 to July 2023, we conducted a single-center retrospective study of patients with TICH and Glasgow Coma Scale score of 10 mm, (2) FIBTEM-A5 2 g/L (isolated fibrin dysfunction), and (3) FIBTEM-A5 10 mm, and 6 of 25 (24%) with isolated fibrin dysfunction. Progressive hemorrhagic injury occurred in 6 of 9 TD patients (66%), 2 of 26 (8%) with FIBTEM-A5 >10 mm, and 9 of 23 (39%) with isolated fibrin dysfunction. In multivariate analysis, TD was associated with a 4.5-fold increase in the log odds of progressive hemorrhagic injury (95% confidence interval, 1.5-7.4), while isolated fibrin dysfunction was associated with a 3.2-fold increase (95% confidence interval, 1.0-5.4). No significant associations with mortality were observed. CONCLUSION: In TICH, low FIBTEM-A5 may reflect either fibrinogen deficiency or impaired fibrin function. Progressive hemorrhagic injury is increased in both of these phenotypes. Further research is needed to validate these findings and to guide the optimal clinical response to low FIBTEM-A5 in neurotrauma. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Hiwase, Abhiram D AU - Hiwase AD AD - From the Department of Neurosurgery (A.D.H., C.D.O., L.M.K., A.J.W.), Department of Intensive Care Medicine (B.R.), and Department of Trauma (N.F., A.J.W., D.Y.E.), Royal Adelaide Hospital; and Adelaide Medical School, Faculty of Health & Medical Sciences (A.D.H., L.R.H., J.H., B.R., A.J.W., D.Y.E.), University of Adelaide, Adelaide, Australia. FAU - Hains, Lewis R AU - Hains LR AUID- ORCID: 0009-0003-0577-9105 FAU - Henkel, Justin AU - Henkel J FAU - Reddi, Benjamin AU - Reddi B FAU - Ovenden, Christopher D AU - Ovenden CD FAU - Kaukas, Lola M AU - Kaukas LM FAU - Foo, Ngee AU - Foo N FAU - Wells, Adam J AU - Wells AJ FAU - Ellis, Daniel Y AU - Ellis DY LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20250919 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-32-5 (Fibrinogen) RN - 9001-31-4 (Fibrin) SB - IM MH - Humans MH - Female MH - Male MH - Retrospective Studies MH - *Fibrinogen/analysis/metabolism MH - *Thrombelastography/methods MH - Adult MH - Middle Aged MH - *Fibrin/metabolism MH - Glasgow Coma Scale MH - *Intracranial Hemorrhage, Traumatic/blood/mortality MH - *Afibrinogenemia/blood/diagnosis OTO - NOTNLM OT - Traumatic brain injury OT - coagulation OT - thromboelastometry EDAT- 2026/01/02 19:38 MHDA- 2026/01/02 19:39 CRDT- 2026/01/02 17:03 PHST- 2025/04/03 00:00 [received] PHST- 2025/07/31 00:00 [accepted] PHST- 2026/01/02 19:39 [medline] PHST- 2026/01/02 19:38 [pubmed] PHST- 2026/01/02 17:03 [entrez] AID - 01586154-202601000-00020 [pii] AID - 10.1097/TA.0000000000004787 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Jan 1;100(1):147-151. doi: 10.1097/TA.0000000000004787. Epub 2025 Sep 19. PMID- 41477481 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260101 LR - 20260103 IS - 2364-3420 (Electronic) IS - 2364-3439 (Print) IS - 2364-3439 (Linking) VI - 11 IP - 6 DP - 2025 Dec 31 TI - Multiscale analysis of mechanical stress in muscle under static and dynamic loading. PG - 408-422 LID - 10.52601/bpr.2025.250019 [doi] AB - Deep tissue injury (DTI) is a serious condition primarily triggered by prolonged mechanical loading rather than short-term excessive force. Cyclic force stimulation has been shown to enhance cellular protection; however, the biomechanical mechanisms underlying tissue and cellular responses to such stimulation remain poorly understood. This study investigates the biomechanical effects of cyclic force transmission from viscoelastic muscle tissue to muscle fibers using a multiscale finite element model with varying cyclic force parameters. Finite element analysis was used to examine the impact of different frequencies and amplitudes of force stimulation, considering the viscoelastic properties of tissues and cells. Results indicated that, on each one of the three model scales, the average maximal Von Mises stress during stress relaxation increased with cyclic force amplitude at a constant frequency. At a fixed amplitude, frequency variations did not influence the average maximal Von Mises stress in the macroscopic and mesoscopic models. However, in the microscopic model, higher frequencies resulted in lower average maximal Von Mises stress at low amplitudes and higher average maximal Von Mises stress at high amplitudes. Notably, a high-frequency, low-amplitude cyclic force mode reduced the average maximal minimum principal stress by 3.6% in the first four seconds and 5.8% in the last 16 seconds of the 20-second stress relaxation period. These findings suggested that such a cyclic force mode may mitigate or delay mechanical damage caused by prolonged mechanical loading, offering insights into potential strategies for preventing DTI. CI - (c) The Author(s) 2025. FAU - Ke, Xue AU - Ke X AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China. AD - College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China. FAU - Lu, Yansong AU - Lu Y AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China. FAU - Peng, Linjing AU - Peng L AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China. FAU - Yu, Lu AU - Yu L AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China. FAU - Yao, Yifei AU - Yao Y AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China. LA - eng PT - Journal Article PL - China TA - Biophys Rep JT - Biophysics reports JID - 101676603 PMC - PMC12749125 OTO - NOTNLM OT - Cyclic force stimulation OT - Deep tissue injury OT - Finite element analysis OT - Multiscale muscle hyper-viscoelastic models OT - Stress relaxation COIS- Xue Ke, Yansong Lu, Linjing Peng, Lu Yu and Yifei Yao declare that they have no conflict of interest. EDAT- 2026/01/01 07:38 MHDA- 2026/01/01 07:39 PMCR- 2025/12/31 CRDT- 2026/01/01 04:51 PHST- 2025/03/03 00:00 [received] PHST- 2025/05/07 00:00 [accepted] PHST- 2026/01/01 07:39 [medline] PHST- 2026/01/01 07:38 [pubmed] PHST- 2026/01/01 04:51 [entrez] PHST- 2025/12/31 00:00 [pmc-release] AID - br-11-6-408 [pii] AID - 10.52601/bpr.2025.250019 [doi] PST - ppublish SO - Biophys Rep. 2025 Dec 31;11(6):408-422. doi: 10.52601/bpr.2025.250019. PMID- 41462858 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251230 LR - 20260102 IS - 2227-9059 (Print) IS - 2227-9059 (Electronic) IS - 2227-9059 (Linking) VI - 13 IP - 12 DP - 2025 Nov 21 TI - PCSK9 Promotes Platelet Activation and NET Formation, Aggravating Pulmonary Microthrombosis in Sepsis-Induced Lung Injury. LID - 10.3390/biomedicines13122843 [doi] LID - 2843 AB - Background: Sepsis-induced lung injury is a major clinical challenge, frequently complicated by pulmonary microthrombosis, which exacerbates disease severity and worsens prognosis. Recent studies suggest that proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in inflammatory and thrombotic processes. However, the contribution of PCSK9 to pulmonary microthrombosis in sepsis remains unclear. Methods: Adult male C57BL/6J mice were subjected to cecal ligation and puncture (CLP) to induce sepsis. Twelve hours post-CLP, mice received either recombinant PCSK9 (1 mug, i.p.) or the PCSK9 inhibitor evolocumab (10 mg/kg, i.p.). Platelet activation and pulmonary microthrombosis were assessed using hematoxylin-eosin staining, immunofluorescence, and thromboelastography. Results: Administration of PCSK9 significantly enhanced platelet activation and increased neutrophil extracellular trap (NET) formation, promoting pulmonary microthrombosis in septic mice. In contrast, administration of evolocumab effectively attenuated platelet activation, reduced NET formation, and alleviated pulmonary microthrombosis. Conclusions: PCSK9 exacerbates sepsis-induced pulmonary microthrombosis by promoting platelet activation and NET formation. Targeting PCSK9 may represent a novel therapeutic strategy for preventing thrombotic complications in sepsis-induced lung injury. FAU - Lv, Xin AU - Lv X AD - Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. FAU - Xiong, Wanxia AU - Xiong W AD - Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. FAU - Jiang, Linghui AU - Jiang L AUID- ORCID: 0009-0003-2562-1129 AD - Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. LA - eng GR - 2022ZSQN22/Zhongshan Hospital, Fudan University/ PT - Journal Article DEP - 20251121 PL - Switzerland TA - Biomedicines JT - Biomedicines JID - 101691304 PMC - PMC12731091 OTO - NOTNLM OT - PCSK9 OT - neutrophil extracellular traps OT - platelet activation OT - pulmonary microthrombosis OT - sepsis COIS- The authors have no conflicts of interest to declare. EDAT- 2025/12/30 07:40 MHDA- 2025/12/30 07:41 PMCR- 2025/11/21 CRDT- 2025/12/30 01:40 PHST- 2025/08/20 00:00 [received] PHST- 2025/11/12 00:00 [revised] PHST- 2025/11/18 00:00 [accepted] PHST- 2025/12/30 07:41 [medline] PHST- 2025/12/30 07:40 [pubmed] PHST- 2025/12/30 01:40 [entrez] PHST- 2025/11/21 00:00 [pmc-release] AID - biomedicines13122843 [pii] AID - biomedicines-13-02843 [pii] AID - 10.3390/biomedicines13122843 [doi] PST - epublish SO - Biomedicines. 2025 Nov 21;13(12):2843. doi: 10.3390/biomedicines13122843. PMID- 41461750 OWN - NLM STAT- MEDLINE DCOM- 20251230 LR - 20260919 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 15 IP - 1 DP - 2025 Dec 29 TI - Anatomical variations of the recurrent laryngeal nerve and postoperative outcomes in thyroid surgeries conducted at a teaching hospital in Ethiopia. PG - 44872 LID - 10.1038/s41598-025-28768-y [doi] LID - 44872 AB - Thyroid surgery requires a thorough knowledge of the neck anatomy and its anatomical variations. This is of utmost importance since it is well known that variations of the recurrent laryngeal nerve are prone to iatrogenic injuries. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Surgeons must comprehensively understand the anatomy of the recurrent laryngeal nerve during thyroid operation. To assess the anatomical variations of recurrent laryngeal nerves, with inferior approach using inferior thyroid artery as a consistent anatomical landmark, and outcomes in patients who had undergone thyroid surgery in Tibebe Ghion Specialised Hospital, Bahir Dar, Ethiopia. An institutional-based prospective observational study of 102 consecutive patients was conducted from June 2021 to August 2022 at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Data were collected prospectively using a standardized intraoperative checklist and intraoperative photographs. The study included 102 patients (92 female, 10 male). Age distribution was 18-39 years: 53.9%; 40-60 years: 42.2%; 61-80 years: 3.9%. A total of 156 RLNs were dissected: 87 right and 69 left. Right-side branching was observed in 24.1% of nerves (single trunk 75.9%; bifurcation 18.4%; trifurcation 5.7%); left-side branching occurred in 10.2% (single trunk 89.8%; bifurcation 10.2%). In relation to the ITA, right RLNs were posterior in 68.9%, anterior in 27.7%, and interdigitating among arterial branches in 3.4%; left RLNs were posterior in 91.3%, anterior in 7.3%, and interdigitating in 1.4%. Using the operative landmark of the tracheoesophageal groove (TEG - defined here as the space between the trachea and esophagus at the level of dissection), 93.1% of right RLNs were identified within or adjacent to the TEG and 6.9% were lateral to the tracheal surface; 100% left RLNs were identified within or adjacent to the TEG. Early postoperative course was uneventful in 92.2%; transient hoarseness occurred in 2.0%. Anatomical consideration of the variations in the course, branching pattern, and relation of recurrent laryngeal nerve with inferior thyroid artery and tracheoesophageal groove is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy. CI - (c) 2025. The Author(s). FAU - Wubie, Abel Gashaw AU - Wubie AG AD - Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. abigash@gmail.com. FAU - Biadgelign, Melesse G AU - Biadgelign MG AD - Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Fentahun, Netsanet AU - Fentahun N AD - School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Bugis, Samuel Philip AU - Bugis SP AD - Department of Surgery, Faculty of Medicine, Branch for Global Surgical Care, The University of British Columbia, Vancouver, Canada. FAU - Mengistie, Chernet T AU - Mengistie CT AD - School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia. FAU - Mengistie, Biruk T AU - Mengistie BT AD - School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia. FAU - Negussie, Michael A AU - Negussie MA AD - School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia. FAU - Amsalu, Bedemariam Tadesse AU - Amsalu BT AD - School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Woldehana, Nathnael Abera AU - Woldehana NA AD - Department of Surgery, Johns Hopkins School of Medicine, The Johns Hopkins University, Maryland, USA. FAU - Tsegaye, Yonatan Abie AU - Tsegaye YA AD - Department of Surgery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. FAU - Andargie, Dereje G AU - Andargie DG AD - Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. LA - eng PT - Journal Article PT - Observational Study DEP - 20251229 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 SB - IM MH - Humans MH - Female MH - Male MH - Adult MH - Ethiopia MH - Middle Aged MH - *Recurrent Laryngeal Nerve/anatomy & histology/surgery MH - Adolescent MH - Hospitals, Teaching MH - Aged MH - *Thyroidectomy/adverse effects/methods MH - *Thyroid Gland/surgery/innervation MH - Young Adult MH - Prospective Studies MH - Aged, 80 and over MH - *Recurrent Laryngeal Nerve Injuries/etiology/prevention & control MH - Postoperative Complications MH - *Anatomic Variation MH - Treatment Outcome PMC - PMC12748805 OTO - NOTNLM OT - Recurrent laryngeal nerve OT - Thyroidectomy COIS- Declarations. Ethics approval and consent to participate: We confirm that all study protocols were approved by the Institutional Review Board of Bahir Dar University, College of Medicine and Health Sciences, on March 7, 2021 (No. 202167400). We confirm that all methods were carried out in accordance with relevant guidelines and regulations. Upon receiving approval from the Institutional Review Board, permission was obtained from Tibebe Ghion Specialized Hospital to conduct data collection. Written informed consent was obtained from all patients before the procedure, and our research adhered to the Declaration of Helsinki. Competing interests: The authors declare no competing interests. EDAT- 2025/12/30 00:30 MHDA- 2025/12/30 07:41 PMCR- 2025/12/29 CRDT- 2025/12/29 23:46 PHST- 2025/04/08 00:00 [received] PHST- 2025/11/12 00:00 [accepted] PHST- 2025/12/30 07:41 [medline] PHST- 2025/12/30 00:30 [pubmed] PHST- 2025/12/29 23:46 [entrez] PHST- 2025/12/29 00:00 [pmc-release] AID - 10.1038/s41598-025-28768-y [pii] AID - 28768 [pii] AID - 10.1038/s41598-025-28768-y [doi] PST - epublish SO - Sci Rep. 2025 Dec 29;15(1):44872. doi: 10.1038/s41598-025-28768-y. PMID- 41448542 OWN - NLM STAT- MEDLINE DCOM- 20260610 LR - 20260807 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 24 IP - 6 DP - 2026 Jun TI - Hyperfibrinolysis in trauma-induced coagulopathy: exploring the role of inflammatory cytokines. PG - 2235-2242 LID - S1538-7836(25)00908-0 [pii] LID - 10.1016/j.jtha.2025.11.026 [doi] AB - BACKGROUND: Hyperfibrinolysis is the excessive fibrinolytic activity observed in severely injured patients with trauma-induced coagulopathy (TIC). Previous studies suggest that inflammatory cytokines initiate inflammatory responses triggered by trauma and could impact on the coagulation cascade; however, the association between inflammatory cytokines and the development of hyperfibrinolysis has not been fully evaluated. OBJECTIVES: The aim of this study was to identify the characteristics of the inflammatory cytokines dynamics in TIC, particularly hyperfibrinolysis. METHODS: This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Study patients were stratified into the hyperfibrinolysis and nonhyperfibrinolysis groups using thromboelastography LY30 values and plasmin-antiplasmin complex. Serial values of inflammatory cytokine level (0-24 hours postadmission) were compared between the hyperfibrinolysis and nonhyperfibrinolysis groups. Subgroup analysis investigated the cytokines comparing patients with traumatic brain injury with hyperfibrinolysis and those without hyperfibrinolysis. RESULTS: A total of 477 patients were included (hyperfibrinolysis, 45; nonhyperfibrinolysis, 432). The levels of interleukin (IL)-6, interleukin 1 receptor antagonist (IL-1Ra), and major vault protein (MVP)-1 were significantly higher in the hyperfibrinolysis group than those in the nonhyperfibrinolysis group across the time points within 24 hours after presentation. The level of platelet-derived growth factor subunit B (PDGF-B) upon arrival was significantly higher in the hyperfibrinolysis group. The IL-6, IL-1Ra, and MVP-1 levels peaked at 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter. CONCLUSION: The current study revealed that IL-6, IL-1Ra, and MVP-1 levels trended upward for 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter in severely injured patients with hyperfibrinolysis. CI - Copyright (c) 2025 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved. FAU - Takahashi, Kyosuke AU - Takahashi K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. Electronic address: kyosk497113@emerg-med.co. FAU - Yamakawa, Kazuma AU - Yamakawa K AD - Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan. FAU - Siletz, Anaar E AU - Siletz AE AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Katsura, Morihiro AU - Katsura M AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Holcomb, John B AU - Holcomb JB AD - Division of Trauma and Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Cotton, Bryan A AU - Cotton BA AD - Division of Acute Care Surgery, and the Center for Translational Injury Research, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas, USA. FAU - Wade, Charles E AU - Wade CE AD - Division of Acute Care Surgery, and the Center for Translational Injury Research, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Department of Surgery, The University of Colorado, Denver-Anschutz Medical Campus, Denver, Colorado, USA. FAU - Martin, Matthew AU - Martin M AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Inaba, Kenji AU - Inaba K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Matsushima, Kazuhide AU - Matsushima K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20251223 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Biomarkers) RN - 0 (Cytokines) RN - 0 (Inflammation Mediators) RN - 0 (Interleukin-6) SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Middle Aged MH - Biomarkers/blood MH - *Blood Coagulation MH - *Blood Coagulation Disorders/blood/etiology/diagnosis MH - *Cytokines/blood MH - *Fibrinolysis MH - *Inflammation Mediators/blood MH - Interleukin-6/blood MH - Thrombelastography MH - Time Factors MH - *Wounds and Injuries/blood/complications/diagnosis MH - Secondary Data Analysis OTO - NOTNLM OT - inflammatory cytokine OT - trauma-induced coagulopathy COIS- Declaration of competing interests J.B.H. is on the board of directors of Decisio Health, CCJ Medical Devices, QinFlow, Hemostatics, Zibrio, and Oxyband; receives research grant support from the DoD, DARPA, NIH, and CSL focused on hemorrhage control and resuscitation; consults with WFIRM and Aspen Medical; is the co-inventor of the Junctional Emergency Tourniquet Tool; and receives royalties from UT Health. All other authors deny any potential conflicts of interest. EDAT- 2025/12/26 00:32 MHDA- 2026/06/11 05:39 CRDT- 2025/12/25 19:33 PHST- 2024/10/31 00:00 [received] PHST- 2025/11/05 00:00 [revised] PHST- 2025/11/13 00:00 [accepted] PHST- 2026/06/11 05:39 [medline] PHST- 2025/12/26 00:32 [pubmed] PHST- 2025/12/25 19:33 [entrez] AID - S1538-7836(25)00908-0 [pii] AID - 10.1016/j.jtha.2025.11.026 [doi] PST - ppublish SO - J Thromb Haemost. 2026 Jun;24(6):2235-2242. doi: 10.1016/j.jtha.2025.11.026. Epub 2025 Dec 23. PMID- 41419706 OWN - NLM STAT- MEDLINE DCOM- 20260129 LR - 20260403 IS - 1496-8975 (Electronic) IS - 0832-610X (Linking) VI - 72 IP - 11 DP - 2025 Nov TI - The association of point-of-care coagulation testing with bleeding symptoms in patients with Ehlers-Danlos syndrome: an exploratory cross-sectional study. PG - 1661-1668 LID - 10.1007/s12630-025-03048-5 [doi] AB - PURPOSE: Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders associated with an increased risk of bleeding. We examined the association between point-of-care (POC) testing parameters with bleeding history in a cohort cared for at the GoodHope EDS Clinic at Toronto General Hospital. METHODS: We conducted an exploratory cross-sectional study at the Toronto General Hospital GoodHope EDS Clinic, recruiting adult patients with a diagnosis of EDS from 27 April 2022 to 7 October 2024. Patients provided samples for rotational thromboelastometry (ROTEM) and functional platelet testing (PlateletWorks), and were administered the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT) to calculate the Bleeding Severity Score (BSS). The association between the BSS and POC parameters was examined using descriptive statistics and Spearman correlation analysis. RESULTS: We recruited 17 patients (hypermobile subtype, n = 10; classical subtype, n = 7). Clinically significant bleeding (BSS >/= 4 in males; >/= 6 in females) was reported in the majority (classical group, 86%; hypermobile group, 90%). Nine (53%) patients had major surgery or trauma at a median age of 23 (range, 8-39) yr. There were no significant abnormalities detected using ROTEM. Lower functional platelet percentages were observed in the hypermobile subgroup, with no association with BSS. CONCLUSIONS: Point-of-care functional platelet testing using aggregation in response to an exogenous collagen agonist may detect inherent platelet dysfunction in patients with hypermobile subtype. We did not detect any ROTEM parameter abnormalities that were associated with elevated BSS scores. This supports a multifactorial etiology of bleeding in this patient population. CI - (c) 2025. Canadian Anesthesiologists' Society. FAU - Lam, Austin L AU - Lam AL AD - Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. FAU - Mittal, Nimish AU - Mittal N AD - Temerty Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada. AD - Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Women's College Hospital, Sinai Health, Toronto, ON, Canada. AD - Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada. FAU - Vinod, Michelle AU - Vinod M AD - Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada. FAU - Karkouti, Keyvan AU - Karkouti K AD - Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Women's College Hospital, Sinai Health, Toronto, ON, Canada. AD - Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada. FAU - Clarke, Hance AU - Clarke H AD - Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Women's College Hospital, Sinai Health, Toronto, ON, Canada. AD - Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada. FAU - Bartoszko, Justyna AU - Bartoszko J AUID- ORCID: 0000-0002-0738-0451 AD - Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Women's College Hospital, Sinai Health, Toronto, ON, Canada. justyna.bartoszko@uhn.ca. AD - Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada. justyna.bartoszko@uhn.ca. LA - eng GR - Non-US Government Research Support/ PT - Journal Article TT - Association entre les tests de coagulation au point de service et les symptomes hemorragiques chez des personnes atteintes du syndrome d'Ehlers-Danlos : une etude transversale exploratoire. DEP - 20251219 PL - United States TA - Can J Anaesth JT - Canadian journal of anaesthesia = Journal canadien d'anesthesie JID - 8701709 SB - IM MH - Humans MH - Cross-Sectional Studies MH - Male MH - Female MH - *Ehlers-Danlos Syndrome/complications MH - Adult MH - *Hemorrhage/etiology/diagnosis MH - *Point-of-Care Testing MH - Thrombelastography/methods MH - Blood Coagulation Tests/methods MH - Young Adult MH - Severity of Illness Index MH - Middle Aged OTO - NOTNLM OT - Ehlers-Danlos syndrome OT - bleeding OT - hemorrhage OT - perioperative period EDAT- 2025/12/20 00:40 MHDA- 2026/01/29 19:10 CRDT- 2025/12/19 23:37 PHST- 2024/11/08 00:00 [received] PHST- 2025/05/22 00:00 [accepted] PHST- 2025/05/11 00:00 [revised] PHST- 2026/01/29 19:10 [medline] PHST- 2025/12/20 00:40 [pubmed] PHST- 2025/12/19 23:37 [entrez] AID - 10.1007/s12630-025-03048-5 [pii] AID - 10.1007/s12630-025-03048-5 [doi] PST - ppublish SO - Can J Anaesth. 2025 Nov;72(11):1661-1668. doi: 10.1007/s12630-025-03048-5. Epub 2025 Dec 19. PMID- 41405435 OWN - NLM STAT- MEDLINE DCOM- 20260324 LR - 20260813 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 100 IP - 4 DP - 2026 Apr 1 TI - Whole blood becomes increasingly susceptible to tPA-mediated fibrinolysis with storage. PG - 549-554 LID - 10.1097/TA.0000000000004870 [doi] AB - BACKGROUND: Whole blood transfusion is increasingly used in trauma resuscitation, but its hemostatic effectiveness over time remains unclear. Separately, hyperfibrinolysis is a known pathologic result of major trauma that contributes to death by exsanguination. Emerging data suggest the functional integrity of whole blood components, particularly fibrinogen, may deteriorate during WB storage, but no studies on how whole blood storage impacts sensitivity to tPA have been performed to date. This study set out to investigate how whole blood storage affects susceptibility to tissue plasminogen activator (tPA)-mediated fibrinolysis and explore potential mechanisms contributing to any observed changes. METHODS: Whole blood was obtained (n = 34) from a local urban blood bank and stored at 4C. Thromboelastography with 75 ng/mL tPA was performed at three storage intervals: Days 1-3, Days 7-11, and Day 21. Fibrinogen function was evaluated using alpha angle and platelet function via maximum amplitude metrics. Plasminogen activator inhibitor type 1 activity was quantified in plasma from stored whole blood via a commercially available activity assay, and hemolysis was measured using Harboe method. ANOVA and Spearman correlations were performed with significance set at p < 0.05. RESULTS: Sensitivity to tPA-induced fibrinolysis increased significantly with storage duration, with LY30 values rising nearly threefold by expiration ( p < 0.0001). Alpha angle and MA declined over time, and MA had a strong inverse correlation with tPA sensitivity. Hemolysis rose with storage ( p < 0.0001) but was not significantly correlated with tPA sensitivity ( r = 0.231, p < 0.073). Plasminogen activator inhibitor type 1 levels paradoxically increased with time, suggesting it does not drive the observed increase in tPA sensitivity. CONCLUSION: Stored whole blood becomes increasingly vulnerable to tPA-mediated fibrinolysis, potentially due to a combination of declining fibrinogen and platelet function. These findings raise considerations for clinical use of older whole blood units and support the potential role of adjunctive therapies during trauma resuscitation. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Maginot, Elizabeth R AU - Maginot ER AUID- ORCID: 0009-0008-3697-3185 AD - From the Division of Acute Care Surgery, Department of Surgery (E.R.M., E.K.B., F.I.G., C.M.W., D.C.H., K.S.S., A.A.C., T.B.M., G.E.V., R.H., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Department of Surgery (E.E.M.), University of Colorado Anschutz Medical Campus, Aurora; Department of Surgery (H.M.B.), AdventHealth Porter, Denver, Colorado; Department of Pathology (N.G., O.B.), and Department of Cellular and Integrative Physiology (C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska. FAU - Barmettler, Nicolle K AU - Barmettler NK FAU - Moore, Ernest E AU - Moore EE FAU - Moore, Hunter B AU - Moore HB FAU - Gawargi, Flobater I AU - Gawargi FI FAU - White, Collin M AU - White CM FAU - Hiser, Dylan C AU - Hiser DC FAU - Sextro, Kyle S AU - Sextro KS FAU - Clegg, Ashley A AU - Clegg AA FAU - Moody, Trace B AU - Moody TB FAU - Volk, Grace E AU - Volk GE FAU - Goodman, Natasha AU - Goodman N FAU - Bobr, Aleh AU - Bobr A FAU - Henry, Reynold AU - Henry R FAU - Barrett, Christopher D AU - Barrett CD AUID- ORCID: 0000-0001-9720-8155 LA - eng GR - K08 HL171936/HL/NHLBI NIH HHS/United States GR - P20 GM152326/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20251217 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 9001-32-5 (Fibrinogen) RN - 0 (Fibrinolytic Agents) SB - IM MH - Humans MH - *Tissue Plasminogen Activator/pharmacology MH - *Fibrinolysis/drug effects MH - Thrombelastography MH - *Blood Preservation/methods MH - Male MH - Female MH - Fibrinogen/metabolism MH - Adult MH - Time Factors MH - Middle Aged MH - *Fibrinolytic Agents/pharmacology MH - Hemolysis PMC - PMC13367527 MID - NIHMS2188562 OTO - NOTNLM OT - Whole Blood Storage OT - fibrinogen function OT - fibrinolysis OT - hemolysis OT - tPA sensitivity EDAT- 2025/12/17 13:02 MHDA- 2026/03/24 12:36 PMCR- 2026/07/14 CRDT- 2025/12/17 09:53 PHST- 2025/08/07 00:00 [received] PHST- 2025/11/03 00:00 [accepted] PHST- 2026/03/24 12:36 [medline] PHST- 2025/12/17 13:02 [pubmed] PHST- 2025/12/17 09:53 [entrez] PHST- 2026/07/14 00:00 [pmc-release] AID - 01586154-202604000-00004 [pii] AID - 10.1097/TA.0000000000004870 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Apr 1;100(4):549-554. doi: 10.1097/TA.0000000000004870. Epub 2025 Dec 17. PMID- 41394236 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251215 LR - 20251217 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 17 IP - 12 DP - 2025 Dec TI - Quantra(R) Viscoelastic Testing in Pediatric Trauma: A Review of Emerging Evidence and Clinical Integration. PG - e99134 LID - 10.7759/cureus.99134 [doi] LID - e99134 AB - Early recognition and correction of trauma-induced coagulopathy (TIC) are critical determinants of survival in pediatric trauma. Traditional laboratory evaluations, such as prothrombin time (PT)/international normalised ratio (INR) and fibrinogen, provide a delayed and incomplete assessment of real-time clotting behavior. The Quantra(R) System (HemoSonics, Charlottesville, VA, USA), a type of viscoelastic hemostatic assay (VHAs), utilizes soundwave technology to provide a more rapid and comprehensive assessment of coagulation. This review summarizes current evidence regarding Quantra use in pediatric trauma, compares it with conventional viscoelastic tools (TEG(R) (Haemonetics, Boston, MA, USA) and ROTEM(R) (Werfen, Bedford, MA, USA)), and discusses emerging experience in perioperative monitoring and trauma resuscitation pathways. Though preliminary data suggests Quantra is well-correlated with conventional VHAs and offers rapid, simple, and standardized assessment in pediatric trauma resuscitation, large-scale pediatric validation studies are needed to define thresholds, optimize transfusion algorithms, and assess outcomes. CI - Copyright (c) 2025, Deskins et al. FAU - Deskins, Chris AU - Deskins C AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Smith, Samantha AU - Smith S AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Bonasso, Patrick C AU - Bonasso PC AD - Pediatric Surgery, West Virginia University, Morgantown, USA. FAU - Jones, William S AU - Jones WS AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Bower, Ryan I AU - Bower RI AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Bowers, Marcus AU - Bowers M AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Kochy, Zachary AU - Kochy Z AD - Trauma, WVU Medicine, Morgantown, USA. FAU - Seifarth, Alice AU - Seifarth A AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Olness, Erik AU - Olness E AD - Anesthesiology, West Virginia University, Morgantown, USA. FAU - Ellison, Pavithra R AU - Ellison PR AD - Anesthesiology, West Virginia University, Morgantown, USA. LA - eng PT - Journal Article PT - Review DEP - 20251213 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC12701736 OTO - NOTNLM OT - bleeding OT - injury OT - pediatric trauma OT - quantra(R) viscoelastic testing OT - trauma-induced coagulopathy COIS- Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2025/12/15 13:10 MHDA- 2025/12/15 13:11 PMCR- 2025/12/13 CRDT- 2025/12/15 06:16 PHST- 2025/12/12 00:00 [accepted] PHST- 2025/12/15 13:11 [medline] PHST- 2025/12/15 13:10 [pubmed] PHST- 2025/12/15 06:16 [entrez] PHST- 2025/12/13 00:00 [pmc-release] AID - 10.7759/cureus.99134 [doi] PST - epublish SO - Cureus. 2025 Dec 13;17(12):e99134. doi: 10.7759/cureus.99134. eCollection 2025 Dec. PMID- 41384770 OWN - NLM STAT- MEDLINE DCOM- 20251224 LR - 20260213 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 39 IP - 1 DP - 2026 Feb 1 TI - Anticoagulation and hemostasis in the extracorporeal membrane oxygenation patient. PG - 39-45 LID - 10.1097/ACO.0000000000001603 [doi] AB - PURPOSE OF REVIEW: To provide an updated overview of hemostatic disturbances and anticoagulation management during extracorporeal membrane oxygenation (ECMO), emphasizing the mechanisms underlying the dual risk of bleeding and thrombosis, current therapeutic strategies, and future perspectives. RECENT FINDINGS: Bleeding and thrombotic events remain the most frequent and life-threatening complications of ECMO, occurring in up to 50% of patients. Advances in mechanistic understanding have highlighted the roles of platelet activation and dysfunction, acquired von Willebrand syndrome, fibrinolytic imbalance, and hemolysis-induced endothelial injury. While unfractionated heparin remains the mainstay of anticoagulation, direct thrombin inhibitors such as bivalirudin have emerged as potential alternatives with comparable safety and efficacy. Viscoelastic testing, platelet function assays, and anti-Xa monitoring are increasingly integrated into clinical practice to refine anticoagulation titration. SUMMARY: Hemostatic disturbances during ECMO reflect a complex interplay between patient severity, circuit-related shear stress, and systemic anticoagulation. Understanding these mechanisms is key to preventing both bleeding and thrombosis. Standardization of monitoring and the development of personalized, physiology-based anticoagulation protocols, supported by emerging technologies and more biocompatible circuits, represent the next step toward improving outcomes in ECMO-supported patients. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Saura, Ouriel AU - Saura O AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN. AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, Sorbonne Universite, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France. FAU - Levy, David AU - Levy D AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN. AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, Sorbonne Universite, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France. FAU - Schmidt, Matthieu AU - Schmidt M AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN. AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, Sorbonne Universite, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France. LA - eng PT - Journal Article PT - Review DEP - 20251203 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Anticoagulants) SB - IM MH - Humans MH - *Extracorporeal Membrane Oxygenation/adverse effects/methods MH - *Anticoagulants/therapeutic use/adverse effects/administration & dosage MH - *Thrombosis/prevention & control/etiology MH - *Hemostasis/drug effects/physiology MH - *Hemorrhage/prevention & control/etiology MH - Blood Coagulation/drug effects OTO - NOTNLM OT - anticoagulation OT - bleeding OT - extracorporeal membrane oxygenation OT - hemostasis OT - thrombosis EDAT- 2025/12/12 17:54 MHDA- 2025/12/24 07:43 CRDT- 2025/12/12 09:14 PHST- 2025/12/24 07:43 [medline] PHST- 2025/12/12 17:54 [pubmed] PHST- 2025/12/12 09:14 [entrez] AID - 00001503-202602000-00007 [pii] AID - 10.1097/ACO.0000000000001603 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2026 Feb 1;39(1):39-45. doi: 10.1097/ACO.0000000000001603. Epub 2025 Dec 3. PMID- 41384757 OWN - NLM STAT- MEDLINE DCOM- 20251224 LR - 20260213 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 39 IP - 1 DP - 2026 Feb 1 TI - Future directions in viscoelastic hemostatic assay usage in bleeding patients. PG - 17-25 LID - 10.1097/ACO.0000000000001609 [doi] AB - PURPOSE OF REVIEW: Severe bleeding and coagulopathy remain major challenges in perioperative care, particularly in cardiac surgery, trauma, and obstetrics. Viscoelastic hemostatic assays (VHAs) have emerged as rapid, point-of-care tools to assess coagulation, but their evidence base and clinical integration remain inconsistent. This review summarizes current evidence, highlights assay limitations, and outlines opportunities for refinement. RECENT FINDINGS: VHAs outperform conventional plasma-based tests in turnaround time and functional assessment of coagulation. International guidelines increasingly recommend their use in patient blood management, yet two multicenter randomized trials have been conducted, yielding contrasting results in cardiac surgery and trauma. Major challenges include heterogeneity in platforms, assay design, activation methods, and output parameters, as well as variability in algorithm adherence and subjective interpretation. Device discontinuations further threaten evidence transferability. Two assay parameters - fibrinogen contribution to clot strength and extrinsically activated clotting time - are particularly relevant, but both require refinement to improve diagnostic precision and therapeutic guidance. SUMMARY: VHAs are valuable tools for bleeding management but remain limited by platform heterogeneity, incomplete assay specificity, and modest predictive accuracy. Future research should focus on assay standardization, dual platelet inhibition in fibrinogen assays, and improved discrimination of coagulation factor deficiencies to enable reliable, widely applicable clinical algorithms. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Erdoes, Gabor AU - Erdoes G AD - Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. FAU - Mazzeffi, Michael AU - Mazzeffi M AD - Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia, USA. FAU - Koster, Andreas AU - Koster A AD - Clinic for Anesthesiology and Interdisciplinary Intensive Care Medicine, Sana Heart Center Cottbus, Germany, Ruhr-University Bochum, Bochum, Germany. LA - eng PT - Journal Article PT - Review DEP - 20251209 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Humans MH - *Blood Coagulation Disorders/diagnosis/blood MH - Blood Coagulation Tests/methods/trends MH - *Hemorrhage/diagnosis/blood/therapy MH - Hemostasis MH - *Thrombelastography/methods/trends MH - *Perioperative Care/methods MH - Blood Coagulation MH - Cardiac Surgical Procedures/adverse effects MH - Point-of-Care Systems OTO - NOTNLM OT - bleeding management OT - cardiac surgery OT - fibrinogen OT - trauma OT - viscoelastic hemostatic assays EDAT- 2025/12/12 17:55 MHDA- 2025/12/24 07:43 CRDT- 2025/12/12 09:13 PHST- 2025/12/24 07:43 [medline] PHST- 2025/12/12 17:55 [pubmed] PHST- 2025/12/12 09:13 [entrez] AID - 00001503-202602000-00004 [pii] AID - 10.1097/ACO.0000000000001609 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2026 Feb 1;39(1):17-25. doi: 10.1097/ACO.0000000000001609. Epub 2025 Dec 9. PMID- 41325092 OWN - NLM STAT- MEDLINE DCOM- 20251201 LR - 20260501 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 99 IP - 6 DP - 2025 Dec 1 TI - The observed incidence of hypocalcemia in traumatically injured patients is lower than previously reported. PG - 920-927 LID - 10.1097/TA.0000000000004756 [doi] AB - BACKGROUND: Incidence of hypocalcemia in trauma patients has been reported as 23% to 56% in small studies with strict inclusion criteria. We aim to describe the incidence of hypocalcemia in a larger set of patients with an ionized calcium level drawn in the trauma bay. We also aim to corroborate the association of calcium levels with mortality, blood product administration, emergent procedural intervention, and coagulopathy by thromboelastography (TEG). METHODS: We performed a retrospective review of patients 15 years or older who presented as a trauma activation over 1 year. We describe the incidence of hypocalcemia and compare normal (ionized calcium, >4.0 mg/dL) versus low (3.0-4.0 mg/dL) versus very low (<3.0 mg/dL) cohorts with regard to mortality, number of emergent procedures performed, blood product transfusion, overall incidence, and type of TEG derangements. RESULTS: Of 2,275 included trauma activations, 57 patients presented with hypocalcemia (2.5%; 95% confidence interval, 1.9-3.1), and 2,272 patients (97.4%) were normocalcemic. Forty-eight patients (2.1%) had moderate hypocalcemia, and nine (0.4%) had severe hypocalcemia. Hypocalcemic patients had decreased maximum amplitude both as citrated functional fibrinogen measures and citrated RapidTEG. Clot lysis at 30 minutes was significantly prolonged in severely hypocalcemic patients, but reaction time was not different in hypocalcemic patients. Mortality was significantly higher for the hypocalcemic group and differed significantly between each subgroup of calcium levels. Hypocalcemic patients received significantly more of all components of blood product transfusions and higher number of emergent procedures. CONCLUSION: In a large, inclusive population, the incidence of presenting hypocalcemia is almost 20-fold lower than previous reports. Hypocalcemia was associated with increased mortality, blood product transfusions, and emergent procedures. Hypocalcemia was associated with TEG derangements in maximal amplitude and clot lysis, but not reaction time. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Hill, Joshua H AU - Hill JH AUID- ORCID: 0000-0001-7729-0681 AD - From the Department of Trauma/Surgical Critical Care/Acute Care Surgery (J.H.H., M.K., B.S., E.R., M.L., J.L., K.L., T.K.), OhioHealth Grant Medical Center, Columbus; and Ohio University Heritage College of Medicine (K.W.), Dublin, Ohio. FAU - Shah, Bhairav AU - Shah B FAU - Rady, Emily AU - Rady E FAU - Lieber, Michael AU - Lieber M FAU - Lauria, Julia AU - Lauria J FAU - Lee, Katarina AU - Lee K FAU - Wierzbicki, Katrina AU - Wierzbicki K FAU - Kashikar, Tanisha AU - Kashikar T FAU - Kincaid, Michelle AU - Kincaid M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20251119 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - SY7Q814VUP (Calcium) SB - IM MH - Humans MH - *Hypocalcemia/epidemiology/etiology/blood MH - Incidence MH - Retrospective Studies MH - Male MH - Female MH - *Wounds and Injuries/complications/mortality/blood MH - Adult MH - Thrombelastography MH - Middle Aged MH - Calcium/blood MH - Blood Transfusion/statistics & numerical data MH - Young Adult OTO - NOTNLM OT - Hypocalcemia OT - coagulopathy OT - thromboelastography EDAT- 2025/12/01 18:51 MHDA- 2025/12/01 18:52 CRDT- 2025/12/01 12:25 PHST- 2025/01/12 00:00 [received] PHST- 2025/06/26 00:00 [accepted] PHST- 2025/12/01 18:52 [medline] PHST- 2025/12/01 18:51 [pubmed] PHST- 2025/12/01 12:25 [entrez] AID - 01586154-202512000-00013 [pii] AID - 10.1097/TA.0000000000004756 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Dec 1;99(6):920-927. doi: 10.1097/TA.0000000000004756. Epub 2025 Nov 19. PMID- 41269788 OWN - NLM STAT- MEDLINE DCOM- 20260213 LR - 20260813 IS - 2473-9537 (Electronic) IS - 2473-9529 (Print) IS - 2473-9529 (Linking) VI - 10 IP - 4 DP - 2026 Feb 24 TI - Next-generation FVIIIa-mimetic bispecific antibody NXT007: evaluation in preclinical models of hemostasis and thrombosis. PG - 1058-1067 LID - 10.1182/bloodadvances.2025018215 [doi] AB - NXT007 is a next-generation factor VIIIa (FVIIIa)-mimetic bispecific antibody currently in phase 1/2 trials. It was developed by optimizing the framework of emicizumab to achieve hemostatic normalization in people with hemophilia A (PwHA). Here, we provide a direct comparison of NXT007 with emicizumab, using a wide range of in vitro and in vivo preclinical models of hemostasis and thrombosis. Both NXT007 and emicizumab increased tissue factor (TF)-triggered peak height thrombin generation when spiked into HA-like (FVIII-neutralized) plasma, with NXT007 being more potent than emicizumab, achieving peak at lower concentrations and producing a higher maximum effect. NXT007 and emicizumab delayed fibrinolysis in a dose-dependent manner, with NXT007 having approximately 20-fold more potent antifibrinolytic effect. Both bispecific antibodies corrected clotting times and kinetics of HA-like blood, measured by rotational thromboelastometry, with NXT007 being approximately 23-fold more potent. In collagen/TF-coated flow chambers perfused with HA-like blood at arterial shear rates, NXT007 and emicizumab increased fibrin deposition without increasing platelet adherence; the maximum effect of NXT007 was greater than that of emicizumab and was achieved at lower concentration. Following tail vein transection in HA mice, NXT007 was more potent than emicizumab in controlling bleeding. In a ferric chloride carotid injury model, the administration of NXT007 and emicizumab at plasma concentrations of approximately 20 to 200 mug/mL had no effect on maximum blood flow reduction, indicating that they do not present a prothrombotic profile in this model. Overall, our data support the ongoing clinical evaluation of NXT007 and suggest that it can substantially improve therapeutic efficacy for PwHA. CI - (c) 2026 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. FAU - Locke, Matthew AU - Locke M AUID- ORCID: 0000-0001-9239-5027 AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Albiez, Jamie AU - Albiez J AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Receveur, Nicolas AU - Receveur N AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Marbach, Sandra AU - Marbach S AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Frey, Nina AU - Frey N AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Girotra, Mukul AU - Girotra M AUID- ORCID: 0000-0003-0937-3674 AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Wyssenbach, Mariella AU - Wyssenbach M AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - Bektic, Lejla AU - Bektic L AUID- ORCID: 0000-0003-1590-0653 AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. FAU - David, Tovo AU - David T AUID- ORCID: 0000-0003-2828-9945 AD - F. Hoffmann-La Roche Ltd, Basel, Switzerland. LA - eng PT - Journal Article PL - United States TA - Blood Adv JT - Blood advances JID - 101698425 RN - 0 (Antibodies, Bispecific) RN - 7NL2E3F6K3 (emicizumab) RN - 72175-66-7 (Factor VIIIa) RN - 0 (Antibodies, Monoclonal, Humanized) SB - IM MH - *Antibodies, Bispecific/pharmacology/therapeutic use MH - *Thrombosis/drug therapy/etiology MH - Animals MH - *Hemostasis/drug effects MH - Humans MH - Mice MH - Disease Models, Animal MH - Hemophilia A/drug therapy MH - *Factor VIIIa MH - Antibodies, Monoclonal, Humanized/pharmacology/therapeutic use MH - Blood Coagulation/drug effects PMC - PMC12915180 COIS- Conflict-of-interest disclosure: M.L., J.A., N.R., S.M., N.F., M.G., and T.D. are employees of F. Hoffmann-La Roche Ltd. M.L., J.A., N.F., M.G., and T.D. hold stock in F. Hoffmann-La Roche Ltd. M.W. and L.B. were employees of F. Hoffmann-La Roche Ltd at the time the work was conducted. The current affiliation for M.W. is Zentral-Apotheke Zollikofen AG, Zollikofen, Switzerland. EDAT- 2025/11/21 18:25 MHDA- 2026/02/13 12:49 PMCR- 2025/11/25 CRDT- 2025/11/21 12:23 PHST- 2025/10/30 00:00 [accepted] PHST- 2025/08/27 00:00 [received] PHST- 2026/02/13 12:49 [medline] PHST- 2025/11/21 18:25 [pubmed] PHST- 2025/11/21 12:23 [entrez] PHST- 2025/11/25 00:00 [pmc-release] AID - 548337 [pii] AID - 10.1182/bloodadvances.2025018215 [doi] PST - ppublish SO - Blood Adv. 2026 Feb 24;10(4):1058-1067. doi: 10.1182/bloodadvances.2025018215. PMID- 41246541 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251117 LR - 20251120 IS - 1920-8642 (Print) IS - 1920-8642 (Linking) VI - 16 IP - 6 DP - 2025 Nov 1 TI - The cAMP-PKA signaling pathway induces apoptosis and promotes hypothermic liver injury. PG - 543-551 LID - 10.5847/wjem.j.1920-8642.2025.114 [doi] AB - BACKGROUND: The mechanisms underlying hypothermic liver injury necessitate investigation for the development of effective diagnostic and therapeutic approaches. We aim to establish a model of hypothermic liver injury to explore the hepatic alterations, thereby facilitating the prevention and treatment of the liver injury associated with hypothermia. METHODS: The mice were placed in a -20 degrees C environment, to establish a hypothermic injury model. The liver function, metabolites, and proteins expression were measured by thromboelastography, histopathology, metabolomics and western blotting, respectively. Furthermore, apoptosis and pathway changes in the liver cells conducted with target metabolites were examined and verified. RESULTS: According to the prolonged righting reflex recovery time and death occurrence, the mice with the anal temperature (AT) dropping to 20 degrees C or 15 degrees C were used to establish a model of hypothermia. The model mice showed changes in alanine aminotransferase (ALT), aspartate transaminase (AST), and coagulation indicators. HE staining results indicated that liver tissue in the AT 20 degrees C mice had large hemorrhagic patches, while the AT 15 degrees C mice displayed significant congestion, along with extensive infiltration of inflammatory cells around the central vein. Metabolomic and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of target metabolites revealed a significant increase in 3-hydroxybutyric acid and changes in the cyclic adenosine monophosphate (cAMP) signaling pathway in the liver tissue of hypothermic mice. The hypothermic mice showed decreases in levels of cAMP, protein kinase A C-alpha (PKA C-alpha), and phosphorylated BCL-2/BCL-XL-associated death promoter (p-Bad) and an increase in BCL-2/BCL-XL-associated death promoter (Bad) level in the liver. These protein changes and apoptosis were intensified by 3-hydroxybutyric acid in liver cells. CONCLUSION: Hypothermia may induce apoptosis in the liver cell which may be related to the changes of the cAMP-PKA pathway proteins expression. These findings provide a basis for the treatment of hypothermic injury. CI - (c) 2025 World Journal of Emergency Medicine. FAU - Liu, Ying AU - Liu Y AD - 1Emergency Medicine Department, General Hospital of Northern Theater Command, Laboratory of Rescue Center of Severe Wound and Trauma PLA, Shenyang 110016, China. FAU - Cheng, Feng AU - Cheng F AD - 1Emergency Medicine Department, General Hospital of Northern Theater Command, Laboratory of Rescue Center of Severe Wound and Trauma PLA, Shenyang 110016, China. FAU - Wang, Zewei AU - Wang Z AD - 1Emergency Medicine Department, General Hospital of Northern Theater Command, Laboratory of Rescue Center of Severe Wound and Trauma PLA, Shenyang 110016, China. FAU - Juan, Du AU - Juan D AD - 2Research and Transformation Laboratory of Acute Critical Care, Jilin Province People's Hospital, Changchun 130021, China. FAU - Yuan, Zhixin AU - Yuan Z AD - 3Department of Emergency, Jilin Province People's Hospital, Changchun 130021, China. FAU - Tian, Xiaoye AU - Tian X AD - 4Emergency and Critical Care Department, Puyang People's Hospital, Puyang 457004, China. FAU - Ma, Ruihang AU - Ma R AD - 1Emergency Medicine Department, General Hospital of Northern Theater Command, Laboratory of Rescue Center of Severe Wound and Trauma PLA, Shenyang 110016, China. FAU - Jin, Hongxu AU - Jin H AD - 1Emergency Medicine Department, General Hospital of Northern Theater Command, Laboratory of Rescue Center of Severe Wound and Trauma PLA, Shenyang 110016, China. LA - eng PT - Journal Article PL - China TA - World J Emerg Med JT - World journal of emergency medicine JID - 101549691 PMC - PMC12616304 OTO - NOTNLM OT - 3-hydroxybutyric acid OT - Apoptosis OT - Hypothermia OT - Liver OT - Metabolomics EDAT- 2025/11/17 17:29 MHDA- 2025/11/17 17:30 PMCR- 2025/11/01 CRDT- 2025/11/17 06:29 PHST- 2024/08/06 00:00 [received] PHST- 2025/01/21 00:00 [accepted] PHST- 2025/11/17 17:30 [medline] PHST- 2025/11/17 17:29 [pubmed] PHST- 2025/11/17 06:29 [entrez] PHST- 2025/11/01 00:00 [pmc-release] AID - 1920-8642-16-6-543 [pii] AID - 10.5847/wjem.j.1920-8642.2025.114 [doi] PST - ppublish SO - World J Emerg Med. 2025 Nov 1;16(6):543-551. doi: 10.5847/wjem.j.1920-8642.2025.114. PMID- 41243346 OWN - NLM STAT- MEDLINE DCOM- 20251117 LR - 20260415 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 37 IP - 6 DP - 2025 Dec TI - What the Sigma? Exploring the Change From Single to Dual Anti-Platelet ROTEM on the FIBTEM to Clauss Fibrinogen Relationship in Neurotrauma. PG - e70170 LID - 10.1111/1742-6723.70170 [doi] AB - OBJECTIVE: The Clauss fibrinogen (CF) assay is the clinical standard for detecting hypofibrinogenaemia in traumatic intracranial haemorrhage (TICH). This assay, however, is time-intensive limiting rapid coagulopathy management. FIBTEM, a module of the rotational thromboelastometry (ROTEM) Sigma device, alternatively provides a rapid point-of-care assessment of fibrin contribution to clot firmness. In many centres, FIBTEM is used as a surrogate for CF. Recently, the FIBTEM cartridge has been modified to include tirofiban in addition to cytochalasin, shifting from a single to dual anti-platelet formulation. The impact of this change on the established FIBTEM-CF relationship remains uncertain, and it is unclear if FIBTEM thresholds typically thought to corroborate with reduced CF remain valid. METHODS: We conducted a retrospective observational cohort study between February 2022 and 2025, evaluating the relationship between FIBTEM and CF before and after the cartridge modification at our institute. Eligible participants were patients with TICH and a Glasgow Coma Scale 1.2, fibrinogen concentration <150 mg dl(-1), and platelet count <50 and <100 G L(-1) were compared with ClotPro(R) parameters from the extrinsically activated thromboelastometric test (EX-Test) and extrinsically activated test plus cytochalasin and tirofiban (FIB-Test), including clotting time, clot amplitude at 5 and 10 min running time (CA5/CA10), maximum clot firmness, and platelet contribution to clot firmness. On the basis of these data, we developed an algorithm for the early treatment of trauma-induced coagulopathy. RESULTS: We included 375 patients (67.8% male) with a median injury severity score of 16 (interquartile range, 9-27). Receiver operating characteristic curve analysis for detecting an international normalised ratio >1.2 using EX-Test clotting time yielded an area under the receiver operating characteristic curve (AUC) of 0.71. Detection of fibrinogen <150 mg dl(-1) using FIB-Test CA5 showed an AUC of 0.96. Platelet counts <50 and <100 G L(-1) were detected by CA5-derived platelet contribution, with AUCs of 0.93 and 0.94, respectively. CONCLUSIONS: These ClotPro(R) cut-off values allow for early and reliable detection of hypofibrinogenaemia and thrombocytopenia. Only after correction of fibrinogen and platelet deficits should prolonged CT be considered a weak marker for the augmentation of coagulation factors. CI - Copyright (c) 2025 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Hofmann, Nikolaus AU - Hofmann N AD - Clinical Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria; The Research Centre in cooperation with AUVA, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AD - The Research Centre in cooperation with AUVA, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria. Electronic address: herbert.schoechl@medical-education.at. FAU - Oberladstatter, Daniel AU - Oberladstatter D AD - The Research Centre in cooperation with AUVA, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria; Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. FAU - Zipperle, Johannes AU - Zipperle J AD - The Research Centre in cooperation with AUVA, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria. FAU - Schmitt, Felix AU - Schmitt F AD - Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany. FAU - von der Forst, Maik AU - von der Forst M AD - Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany. FAU - Martin, Carlo AU - Martin C AD - Clinical Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria. FAU - Gratz, Johannes AU - Gratz J AD - Clinical Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria; Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charite-Universitatsmedizin Berlin, Berlin, Germany. LA - eng PT - Journal Article DEP - 20251107 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Humans MH - Male MH - *Algorithms MH - Female MH - *Wounds and Injuries/complications/blood MH - Retrospective Studies MH - Middle Aged MH - Adult MH - *Thrombelastography/methods MH - Blood Coagulation Tests/methods MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy/blood MH - *Hemorrhage/blood/therapy/etiology/diagnosis MH - Aged MH - Platelet Count OTO - NOTNLM OT - ClotPro(R) OT - blood coagulation testing OT - clinical protocols OT - multiple trauma OT - thrombelastometry OT - trauma-induced coagulopathy OT - viscoelastic testing COIS- Declarations of interest HS has received honoraria for participation in advisory board meetings for Alexion, Bayer Healthcare, Boehringer Ingelheim, TEM International, Haemonetics, and Vifor, and has received study grants from CSL Behring. FS has received consulting fees from CSL Behring, Roche Diabetes, and AstraZeneca. MvdF has received consulting fees from Roche Diabetes and scientific funding from Immunexpress Inc. and LFB. JG has received honoraria, research funding, and travel reimbursement from Alexion, Boehringer Ingelheim, CSL Behring, Johnson & Johnson, Instrumentation Laboratory, Mitsubishi Tanabe Pharma, Novo Nordisk, Octapharma, and Portola. The other authors declare that they have no conflicts of interest. EDAT- 2025/11/09 00:32 MHDA- 2026/01/05 00:49 CRDT- 2025/11/08 21:54 PHST- 2025/07/07 00:00 [received] PHST- 2025/09/04 00:00 [revised] PHST- 2025/09/05 00:00 [accepted] PHST- 2026/01/05 00:49 [medline] PHST- 2025/11/09 00:32 [pubmed] PHST- 2025/11/08 21:54 [entrez] AID - S0007-0912(25)00708-1 [pii] AID - 10.1016/j.bja.2025.09.040 [doi] PST - ppublish SO - Br J Anaesth. 2026 Jan;136(1):117-125. doi: 10.1016/j.bja.2025.09.040. Epub 2025 Nov 7. PMID- 41199476 OWN - NLM STAT- In-Process LR - 20260813 IS - 1553-2712 (Electronic) IS - 1069-6563 (Print) IS - 1069-6563 (Linking) VI - 33 IP - 3 DP - 2026 Mar TI - Needle of Death Thromboelastography Tracings in Severely Bleeding Trauma Patients: A Novel Predictor of Hemorrhagic Blood Failure and Futile Resuscitation? PG - e70192 LID - 10.1111/acem.70192 [doi] LID - e70192 FAU - Bunch, Connor M AU - Bunch CM AD - Departments of Emergency Medicine & Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA. FAU - Walsh, Mark M AU - Walsh MM AUID- ORCID: 0000-0002-5795-1144 AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Department of Emergency Medicine, Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Moore, Ernest E AU - Moore EE AD - Ernest E. Moore Shock Trauma Center, Denver Health, Denver, Colorado, USA. AD - Department of Surgery, University of Colorado Health Science Center, Aurora, Colorado, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Health Science Center, Aurora, Colorado, USA. FAU - Moore, Peter K AU - Moore PK AUID- ORCID: 0000-0001-6446-067X AD - Department of Pulmonary & Critical Care Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA. FAU - Johnson, Jeffrey L AU - Johnson JL AD - Department of Trauma & Acute Care Surgery, Henry Ford Hospital, Detroit, Michigan, USA. FAU - Thomas, Samuel J AU - Thomas SJ AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, Indiana, USA. FAU - Fox, Sarah S AU - Fox SS AD - Department of Trauma Services, Beacon Memorial Hospital, South Bend, Indiana, USA. FAU - Lewandowski, Daniel F AU - Lewandowski DF AD - Departments of Emergency Medicine & Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA. AD - Department of Pulmonary & Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA. FAU - Miller, Joseph B AU - Miller JB AUID- ORCID: 0000-0002-9451-1359 AD - Departments of Emergency Medicine & Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA. AD - Department of Emergency Medicine, Michigan State University Health Sciences, East Lansing, Michigan, USA. LA - eng PT - Journal Article DEP - 20251106 PL - United States TA - Acad Emerg Med JT - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JID - 9418450 SB - IM PMC - PMC12937038 COIS- E.E.M. and H.B.M. have received research grants from Haemonetics Corporation outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. EDAT- 2025/11/07 06:28 MHDA- 2025/11/07 06:28 PMCR- 2026/02/26 CRDT- 2025/11/07 00:23 PHST- 2025/10/22 00:00 [revised] PHST- 2025/10/10 00:00 [received] PHST- 2025/10/29 00:00 [accepted] PHST- 2025/11/07 06:28 [pubmed] PHST- 2025/11/07 06:28 [medline] PHST- 2025/11/07 00:23 [entrez] PHST- 2026/02/26 00:00 [pmc-release] AID - ACEM70192 [pii] AID - 10.1111/acem.70192 [doi] PST - ppublish SO - Acad Emerg Med. 2026 Mar;33(3):e70192. doi: 10.1111/acem.70192. Epub 2025 Nov 6. PMID- 41169412 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251031 LR - 20251102 IS - 2296-858X (Print) IS - 2296-858X (Electronic) IS - 2296-858X (Linking) VI - 12 DP - 2025 TI - Critical trigger thresholds for hemostatic management: a narrative review of viscoelastic hemostatic assay applications. PG - 1658845 LID - 10.3389/fmed.2025.1658845 [doi] LID - 1658845 AB - Viscoelastic haemostasis assays (VHA) are increasingly used in clinical practice. These bedside whole-blood tests, commonly implemented through thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are prized for their speed, accuracy, and accessibility, resulting in their increased usage in managing complex cases such as severe trauma, cardiac surgery, postpartum hemorrhage, and liver disease. Despite their widespread use, clear guidelines for regulating coagulation function in surgical patients through VHA remain undefined. This review searched the majority of the literature on VHA in the past decade and discussed the triggers and algorithms for hemostatic management guided by VHA in surgeries with a high risk of major bleeding. It also reviews the potential benefits of VHA over traditional coagulation tests (like prothrombin time and partial thromboplastin time) and clinical judgments, focusing on aspects such as reducing bleeding volume, decreasing use of allogeneic blood products, improving patient outcomes and mortality, and enhancing cost-effectiveness. CI - Copyright (c) 2025 Xu, Cao, Sun, Xiao, Yao, Luo, Wang, Gao, Zou, Tao and Yan. FAU - Xu, Zhi-Li AU - Xu ZL AD - School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong, China. AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Cao, Han AU - Cao H AD - School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong, China. AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Sun, Da-Wei AU - Sun DW AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Xiao, Jie AU - Xiao J AD - School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong, China. AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Yao, Yuan-Yuan AU - Yao YY AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Luo, Ge AU - Luo G AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Wang, Ting-Ting AU - Wang TT AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Gao, Qi AU - Gao Q AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Zou, Jing-Cheng AU - Zou JC AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Tao, Xin-Chen AU - Tao XC AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. FAU - Yan, Min AU - Yan M AD - Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. LA - eng PT - Journal Article PT - Review DEP - 20251015 PL - Switzerland TA - Front Med (Lausanne) JT - Frontiers in medicine JID - 101648047 PMC - PMC12568721 OTO - NOTNLM OT - coagulopathy OT - major bleeding OT - rotational thromboelastometry OT - thromboelastography OT - transfusion OT - viscoelastic hemostatic assay COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2025/10/31 06:27 MHDA- 2025/10/31 06:28 PMCR- 2025/10/15 CRDT- 2025/10/31 04:45 PHST- 2025/07/03 00:00 [received] PHST- 2025/09/29 00:00 [accepted] PHST- 2025/10/31 06:28 [medline] PHST- 2025/10/31 06:27 [pubmed] PHST- 2025/10/31 04:45 [entrez] PHST- 2025/10/15 00:00 [pmc-release] AID - 10.3389/fmed.2025.1658845 [doi] PST - epublish SO - Front Med (Lausanne). 2025 Oct 15;12:1658845. doi: 10.3389/fmed.2025.1658845. eCollection 2025. PMID- 41166985 OWN - NLM STAT- MEDLINE DCOM- 20260116 LR - 20260116 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 190 DP - 2026 Feb TI - Viscoelastic assay versus conventional coagulation-directed resuscitation for severely injured trauma patients undergoing massive transfusion. PG - 109814 LID - S0039-6060(25)00666-X [pii] LID - 10.1016/j.surg.2025.109814 [doi] AB - BACKGROUND: The evaluation of coagulopathy in trauma patients traditionally relies on conventional coagulation tests, which assess isolated components of the coagulation cascade. Viscoelastic assays, in contrast, provide whole-blood analysis. Prior studies have shown conflicting results regarding benefits of viscoelastic assay-guided massive transfusion in trauma. This study investigated the impact of viscoelastic assay resuscitation on mortality in severely injured trauma patients, hypothesizing that viscoelastic assay-guided massive transfusion leads to reduced mortality. METHODS: A single-center pre-post study (2018-2021) of severely injured (Injury Severity Score >15) adult (>18 years old) trauma patients receiving massive transfusion (>4 U within 4 hours or >10 U within 24 hours of packed red blood cells), before (PRE cohort) versus after (POST cohort) viscoelastic assay implementation. The primary outcome was in-hospital mortality. RESULTS: Of 186 patients, 95 were in the PRE cohort and 91 were in the POST cohort. All demographic details, vital signs, and injury profile including Injury Severity Score were similar between cohorts (all P > .05). Mortality was similar between POST and PRE cohorts (35.2% vs 41.1%, P = .41). However, the POST cohort received more fresh frozen plasma (6 U vs 4 U, P = .006) and total blood products (13 U vs 10 U, P = .006) within 4 hours of arrival and more platelets within 24 hours (2 U vs 1 U, P = .020). CONCLUSION: At a single level I trauma center, severely injured trauma patients undergoing viscoelastic assay-guided massive transfusion resuscitation received more fresh frozen plasma and overall blood products. However, viscoelastic assay-guided resuscitation had similar mortality and outcomes compared with resuscitation guided by conventional coagulation tests alone. This further supports a lack of benefit for viscoelastic assay-guided massive transfusion for trauma. LEVEL OF EVIDENCE: Level IV. CI - Copyright (c) 2025. Published by Elsevier Inc. FAU - Painter, Robert AU - Painter R AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. Electronic address: https://twitter.com/UCI_Trauma. FAU - Grigorian, Areg AU - Grigorian A AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. Electronic address: https://twitter.com/UCIrvineSurgery. FAU - Sargent, Brynn AU - Sargent B AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Liang, Tyler AU - Liang T AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Homo, Richelle AU - Homo R AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Conovaloff, Joseph AU - Conovaloff J AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Schubl, Sebastian AU - Schubl S AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Kirby, Katharine AU - Kirby K AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Jebbia, Mallory AU - Jebbia M AD - Division of Trauma, Department of Surgery, Desert Regional Medical Center, Palm Springs, CA. FAU - Swentek, Lourdes AU - Swentek L AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. FAU - Nahmias, Jeffry AU - Nahmias J AD - Burns and Surgical Critical Care, Division of Trauma, Department of Surgery, University of California, Irvine, Orange, CA. Electronic address: jnahmias@hs.uci.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20251029 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Humans MH - Female MH - Male MH - *Wounds and Injuries/mortality/therapy/complications/blood MH - *Resuscitation/methods MH - Adult MH - *Blood Transfusion/methods MH - Middle Aged MH - Injury Severity Score MH - Hospital Mortality MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy/blood MH - *Thrombelastography/methods MH - Blood Coagulation Tests/methods MH - Retrospective Studies COIS- Conflict of Interest/Disclosure The authors have no relevant financial disclosures. EDAT- 2025/10/31 00:29 MHDA- 2026/01/17 00:36 CRDT- 2025/10/30 19:05 PHST- 2024/05/02 00:00 [received] PHST- 2025/08/15 00:00 [revised] PHST- 2025/09/09 00:00 [accepted] PHST- 2026/01/17 00:36 [medline] PHST- 2025/10/31 00:29 [pubmed] PHST- 2025/10/30 19:05 [entrez] AID - S0039-6060(25)00666-X [pii] AID - 10.1016/j.surg.2025.109814 [doi] PST - ppublish SO - Surgery. 2026 Feb;190:109814. doi: 10.1016/j.surg.2025.109814. Epub 2025 Oct 29. PMID- 41139135 OWN - NLM STAT- MEDLINE DCOM- 20260612 LR - 20261010 IS - 1573-742X (Electronic) IS - 0929-5305 (Linking) VI - 59 IP - 3 DP - 2026 Mar TI - Optimizing hemorrhage management in trauma: integrative roles of tranexamic acid and tissue plasminogen activator-augmented viscoelastic testing. PG - 653-663 LID - 10.1007/s11239-025-03194-z [doi] AB - Trauma-induced coagulopathy (TIC) is a dynamic process that contributes to early mortality following injury, with dysregulated fibrinolysis playing a central role in its pathophysiology. Tranexamic acid (TXA), a potent antifibrinolytic agent, is widely used in trauma and surgical settings for hemorrhage management. Its effectiveness is dependent on appropriate timing and patient selection, as indiscriminate use may increase the risk of thromboembolic events. As a result, real-time monitoring of coagulation status is essential to guide TXA therapy. Conventional coagulation tests (CCTs), such as the International Normalized Ratio (INR) and Activated Partial Thromboplastin Time (aPTT), are inadequate in trauma care, as they provide static snapshots of coagulation status. By contrast, viscoelastic testing (VET) platforms, including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), allow for real-time assessments of coagulation status. More recently, tissue plasminogen activator-augmented VET (tPA-VET) has been developed to more effectively distinguish between fibrinolysis phenotypes. This review explores the pathophysiology of TIC, current approaches to hemorrhage management including the use of TXA, the role of VET in guiding TXA therapy, the diagnostic value of tPA-VET, and future directions in implementing VET-guided trauma resuscitation protocols. CI - (c) 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Pandya, Aarjav P AU - Pandya AP AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Gonzalez, Ibzan J AU - Gonzalez IJ AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Khan, Maaz S AU - Khan MS AD - Department of General Surgery, Albert Einstein/Montefiore Medical Center, New York City, NY, USA. FAU - Kazmi, Syeda A B AU - Kazmi SAB AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Taylor, Hanson C AU - Taylor HC AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Allababidi, Ola AU - Allababidi O AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Rahmany, Sehra G AU - Rahmany SG AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. FAU - Chaudhry, Rabail A AU - Chaudhry RA AD - Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine, Tucson, AZ, USA. rchaudhry@arizona.edu. LA - eng PT - Journal Article PT - Review DEP - 20251025 PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 0 (Antifibrinolytic Agents) SB - IM MH - Humans MH - *Tranexamic Acid/therapeutic use MH - *Wounds and Injuries/complications/blood MH - *Thrombelastography/methods MH - *Tissue Plasminogen Activator/therapeutic use MH - *Antifibrinolytic Agents/therapeutic use MH - *Hemorrhage/drug therapy/etiology/blood/therapy MH - Fibrinolysis/drug effects OTO - NOTNLM OT - Rotational thromboelastometry OT - Thromboelastography OT - Tissue plasminogen activator OT - Tranexamic acid OT - Trauma OT - Viscoelastic testing COIS- Declarations. Competing interests: The authors declare no competing interests. EDAT- 2025/10/26 06:33 MHDA- 2026/06/12 06:37 CRDT- 2025/10/26 00:12 PHST- 2025/08/22 00:00 [received] PHST- 2025/10/05 00:00 [accepted] PHST- 2026/06/12 06:37 [medline] PHST- 2025/10/26 06:33 [pubmed] PHST- 2025/10/26 00:12 [entrez] AID - 10.1007/s11239-025-03194-z [pii] AID - 10.1007/s11239-025-03194-z [doi] PST - ppublish SO - J Thromb Thrombolysis. 2026 Mar;59(3):653-663. doi: 10.1007/s11239-025-03194-z. Epub 2025 Oct 25. PMID- 41136013 OWN - NLM STAT- MEDLINE DCOM- 20251024 LR - 20251024 IS - 2214-5532 (Electronic) IS - 2214-5524 (Linking) VI - 47 DP - 2025 Nov TI - Exploring microgravity-induced changes to the coagulation system using thrombelastograph - a topical review. PG - 134-139 LID - S2214-5524(25)00077-X [pii] LID - 10.1016/j.lssr.2025.06.008 [doi] AB - An internal jugular venous thrombus in an astronaut was first identified in 2020 following a two-month microgravity exposure. This raised concerns about thromboembolic events (TE) during spaceflights. Studies have suggested that microgravity can induce changes in blood composition, venous flow and endothelial dysfunction, which might all contribute to a hypercoagulable state. However, whether these proposed mechanisms translate into a clinically significant increase in TE risk remains unclear since, even though humans have spent >200 person-years in space, no studies of blood coagulation in microgravity have been carried out. Additionally, the specific risks and implications of microgravity-induced coagulation changes in diverse populations, including future spacefarers with varying health conditions and ages, remain unclear. The precise risks and effects of microgravity-induced coagulation, especially as they relate to diverse groups such as future space travellers with different health conditions and age ranges, remain ambiguous and require further exploration. Thrombelastography (TEG), often used in trauma, surgery and anesthesiology, offers a comprehensive assessment of whole blood coagulation dynamics, providing a more holistic view compared to traditional coagulation assays. In particular, TEG has the ability to predict the hypercoagulable state associated with TE. A previous study of coagulation disorders in a 60-day bedrest setting has provided valuable insights into blood coagulation dynamics, although TEG did not differ in this specific study. However, the transferability of these findings to true microgravity environments remains to be elucidated. Understanding the effects of microgravity on the coagulation process is crucial for ensuring the health and safety of astronauts during space missions. By leveraging thrombelastography to study the end-result of the coagulation cascade, we can obtain valuable insights into the impact of microgravity on the coagulation system and comprehensively evaluate the risk of TE. Furthermore, this knowledge could inform preventive strategies and enhance the safety of future long-duration missions and diverse populations participating in future low-cost spaceflight ventures. CI - Copyright (c) 2025 The Authors. Published by Elsevier B.V. All rights reserved. FAU - Mayor, Ivy AU - Mayor I AD - Department of Cellular and Molecular Biology, Karolinska Institute, Sweden. Electronic address: i.mayor.email@gmail.com. FAU - Lindgaard, Karsten AU - Lindgaard K AD - Center for Aerospace Medicine, Danish Defence Medical Command, Sodalsparken 20, DK-8220, Brabrand, Denmark. Electronic address: FSK-I-SYD02@mil.dk. FAU - Harandi, Bijan AU - Harandi B AD - Department of Chemistry, Tufts University, 62 Talbot Avenue, Medford, MA, 02155, USA. Electronic address: bijan.harandi@outlook.com. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of anesthesia, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark; Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen E, Denmark. Electronic address: jakob.stensballe@regionh.dk. FAU - Molgaard, Jesper AU - Molgaard J AD - Center for cancer and organ dysfunction, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark. Electronic address: jesper.moelgaard@regionh.dk. LA - eng PT - Journal Article PT - Review DEP - 20250619 PL - Netherlands TA - Life Sci Space Res (Amst) JT - Life sciences in space research JID - 101632373 SB - IM MH - Humans MH - *Weightlessness/adverse effects MH - *Blood Coagulation/physiology MH - *Thrombelastography/methods MH - Space Flight MH - Thromboembolism/etiology OTO - NOTNLM OT - Coagulation OT - Human spaceflight OT - Hypercoagulability OT - Microgravity OT - Thromboembolism COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2025/10/25 00:30 MHDA- 2025/10/25 00:31 CRDT- 2025/10/24 20:54 PHST- 2025/01/22 00:00 [received] PHST- 2025/05/23 00:00 [revised] PHST- 2025/06/16 00:00 [accepted] PHST- 2025/10/25 00:31 [medline] PHST- 2025/10/25 00:30 [pubmed] PHST- 2025/10/24 20:54 [entrez] AID - S2214-5524(25)00077-X [pii] AID - 10.1016/j.lssr.2025.06.008 [doi] PST - ppublish SO - Life Sci Space Res (Amst). 2025 Nov;47:134-139. doi: 10.1016/j.lssr.2025.06.008. Epub 2025 Jun 19. PMID- 41124248 OWN - NLM STAT- MEDLINE DCOM- 20251022 LR - 20260822 IS - 2375-2548 (Electronic) IS - 2375-2548 (Linking) VI - 11 IP - 43 DP - 2025 Oct 24 TI - Visualizing the chronicle of multiple cell fates using a near-IR dual-RNA/DNA-targeting probe. PG - eadz6633 LID - 10.1126/sciadv.adz6633 [doi] LID - eadz6633 AB - Early detection and late-stage cell fate assessment are key factors to develop therapeutic strategies, although current methods cannot capture early responses or distinguish multiple injury states, especially in ultraviolet-visible (UV-vis)-sensitive cells. Here, we introduce a method to simultaneously detect variations in RNA and DNA under near-infrared photoexcitation. Using a pyrazinacene-based probe (TEG(8)-N14), we unexpectedly achieved discrimination of multiple cell states, including apoptosis, necrosis, necroptosis, and senescence, based on RNA/DNA changes. Specifically, TEG(8)-N14 selectively stains necrotic cells in live samples, while after fixation, it allows detection of ultraearly senescence in UV-vis-sensitive cells, providing approximately twofold greater informational content than existing RNA or DNA fluorophores. These findings break current imaging barriers by enabling comprehensive visualization of single-cell fate histories without being affected by UV-vis or genetic manipulation. FAU - Sutrisno, Linawati AU - Sutrisno L AUID- ORCID: 0000-0003-3085-9660 AD - International Center for Young Scientists (ICYS), National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. FAU - Richards, Gary J AU - Richards GJ AUID- ORCID: 0000-0002-5262-2587 AD - Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. FAU - Evans, Jack D AU - Evans JD AUID- ORCID: 0000-0001-9521-2601 AD - School of Physics, Chemistry and Earth Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia. FAU - Matsumoto, Michio AU - Matsumoto M AUID- ORCID: 0000-0002-6037-0228 AD - Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. FAU - Li, Xianglan AU - Li X AUID- ORCID: 0000-0003-0992-1722 AD - Bioanalysis Unit, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047, Japan. FAU - Uto, Koichiro AU - Uto K AUID- ORCID: 0000-0001-7091-0585 AD - Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. FAU - Hill, Jonathan P AU - Hill JP AUID- ORCID: 0000-0002-4229-5842 AD - Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. FAU - Taki, Masayasu AU - Taki M AUID- ORCID: 0000-0003-2185-4593 AD - Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan. AD - Institute for Glyco-core Research (iGCORE), Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1193, Japan. FAU - Yamaguchi, Shigehiro AU - Yamaguchi S AUID- ORCID: 0000-0003-0072-8969 AD - Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan. FAU - Ariga, Katsuhiko AU - Ariga K AUID- ORCID: 0000-0002-2445-2955 AD - Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan. AD - Department of Advanced Material Science, Graduate School of Frontier Science, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8561, Japan. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20251022 PL - United States TA - Sci Adv JT - Science advances JID - 101653440 RN - 9007-49-2 (DNA) RN - 63231-63-0 (RNA) RN - 0 (Fluorescent Dyes) SB - IM MH - Humans MH - *DNA/genetics/metabolism MH - *RNA/genetics/metabolism MH - Apoptosis MH - Fluorescent Dyes/chemistry MH - Cellular Senescence MH - Single-Cell Analysis PMC - PMC12542947 EDAT- 2025/10/22 18:26 MHDA- 2025/10/22 18:27 PMCR- 2025/10/22 CRDT- 2025/10/22 14:04 PHST- 2025/10/22 18:27 [medline] PHST- 2025/10/22 18:26 [pubmed] PHST- 2025/10/22 14:04 [entrez] PHST- 2025/10/22 00:00 [pmc-release] AID - adz6633 [pii] AID - 10.1126/sciadv.adz6633 [doi] PST - ppublish SO - Sci Adv. 2025 Oct 24;11(43):eadz6633. doi: 10.1126/sciadv.adz6633. Epub 2025 Oct 22. PMID- 41117907 OWN - NLM STAT- MEDLINE DCOM- 20251021 LR - 20260917 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 51 IP - 1 DP - 2025 Oct 21 TI - Prognostic value of admission ROTEM in trauma: enhancing 30-day all-cause mortality prediction using machine learning. PG - 301 LID - 10.1007/s00068-025-02959-8 [doi] LID - 301 AB - BACKGROUND: Haemorrhage is a leading cause of trauma death, yet early coagulation markers are rarely used to predict long-term outcomes. This study assessed whether a single admission rotational thromboelastometry (ROTEM) test could independently predict 30-day all-cause mortality and improve existing trauma scores. METHODS: We conducted a retrospective cohort study of 1,498 adult trauma patients admitted to a Level 1 trauma centre, with ROTEM (EXTEM, INTEM, FIBTEM) acquired on admission. Machine learning models were developed to predict 30-day mortality using ROTEM alone, using conventional trauma scores (RTS, NISS, GAP, MGAP, TRISS), and their combination. Model performance was assessed through cross validation using AUROC, AUPRC, and specificity at 90% sensitivity. SHAP was used for explainability. RESULTS: ROTEM alone predicted 30-day mortality with an AUROC of 0.80, comparable to RTS and NISS (both 0.79), and superior to PT-INR (0.63) and base excess (0.58). When combined with ROTEM, specificity significantly improved across all trauma scores, with the greatest gains observed in RTS (0.23 to 0.62) and NISS (0.36 to 0.69) (all p < 0.001). Key predictive ROTEM variables included clotting time, clot firmness time, and fibrinolysis indices. Model performance was notably lower in female patients. CONCLUSIONS: A single admission ROTEM test predicted 30-day all-cause mortality with accuracy comparable to traditional trauma scores and outperformed conventional coagulation markers. Integrating ROTEM into established scores significantly enhanced predictive performance. Viscoelastic data appears to hold prognostic information capable of improving long-term trauma outcome assessments. CI - (c) 2025. The Author(s). FAU - Kildal, Villiam V AU - Kildal VV AUID- ORCID: 0000-0002-9767-134X AD - Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden. villiam.vejbrink.kildal@ki.se. AD - Department of Perioperative Care and Intensive Care, Sodersjukhuset, Stockholm, Sweden. villiam.vejbrink.kildal@ki.se. FAU - Dahlberg, Martin AU - Dahlberg M AD - Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden. AD - Department of Surgery, Sodersjukhuset, Stockholm, Sweden. FAU - Ek, Carl Henrik AU - Ek CH AD - Department of Computer Science and Technology, University of Cambridge, Cambridge, UK. FAU - Oldner, Anders AU - Oldner A AD - Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden. AD - Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. FAU - Wikman, Agneta AU - Wikman A AD - Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden. AD - Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden. FAU - Wahlgren, Carl Magnus AU - Wahlgren CM AD - Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. AD - Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden. FAU - Gunther, Mattias AU - Gunther M AD - Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden. AD - Department of Perioperative Care and Intensive Care, Sodersjukhuset, Stockholm, Sweden. AD - Department of Neuroscience, Section of Experimental Traumatology, Karolinska Institutet, Stockholm, Sweden. LA - eng PT - Journal Article DEP - 20251021 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - Female MH - *Machine Learning MH - *Thrombelastography/methods MH - Male MH - Retrospective Studies MH - Prognosis MH - *Wounds and Injuries/mortality/blood MH - Middle Aged MH - Adult MH - Predictive Value of Tests MH - Aged MH - *Hemorrhage/mortality/blood MH - Trauma Centers MH - Injury Severity Score PMC - PMC12540630 OTO - NOTNLM OT - Artificial intelligence OT - Coagulation OT - Intensive care OT - Machine learning OT - Mortality OT - Outcome OT - Prediction OT - Thromboelastographynull OT - Thromboelastometry OT - Trauma OT - Viscoelastic hemostatic assays COIS- Declarations. Ethics approval and consent to participate: The study was approved by the Swedish Ethical Review Authority (Dnr 2020 - 01474). Consent to participate was waived due to the retrospective nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. EDAT- 2025/10/21 12:35 MHDA- 2025/10/21 12:36 PMCR- 2025/10/21 CRDT- 2025/10/21 11:13 PHST- 2025/05/21 00:00 [received] PHST- 2025/08/04 00:00 [accepted] PHST- 2025/10/21 12:36 [medline] PHST- 2025/10/21 12:35 [pubmed] PHST- 2025/10/21 11:13 [entrez] PHST- 2025/10/21 00:00 [pmc-release] AID - 10.1007/s00068-025-02959-8 [pii] AID - 2959 [pii] AID - 10.1007/s00068-025-02959-8 [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2025 Oct 21;51(1):301. doi: 10.1007/s00068-025-02959-8. PMID- 41096763 OWN - NLM STAT- MEDLINE DCOM- 20251016 LR - 20251019 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 26 IP - 19 DP - 2025 Sep 28 TI - Procoagulant Effects of Bothrops diporus Venom: Kinetic Modeling and Role of Serine Protease Activity. LID - 10.3390/ijms26199496 [doi] LID - 9496 AB - Bothrops species are responsible for the majority of envenomations in Argentina. In particular, Bothrops diporus is among the main species responsible for the majority of envenomations in Argentina and causes significant injury and coagulopathy. Given the significance of this venom, the authors sought to define the toxin responsible for coagulopathy with specialized spectrophotometric and thromboelastographic methods. Utilizing clotting time, spectrophotometry, and thromboelastography, it was determined that B. diporus venom has potent, procoagulant activity in human plasma and buffer milieu. Calcium-dependent and -independent activities consistent with serine protease activity were identified. The activity included both thrombin-generating and thrombin-like enzymatic activity. The venom cleaved the serine protease-specific chromogenic substrate beta-Ala-Gly-Arg-p-nitroanilide diacetate, and its activity was inhibited in plasma by antithrombin after addition of heparin. Further, venom exposed in isolation to RuCl(3), a known inhibitor of serine protease-containing venoms, demonstrated decreased activity in human plasma. In conclusion, the present study contributes to a better understanding of B. diporus venom and may have implications for the rational design of inhibitors, antivenom formulations, or preclinical models to study venom-induced coagulopathies. FAU - Lopez, Gisela L AU - Lopez GL AD - Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Instituto de Quimica Basica y Aplicada del Nordeste Argentino (IQUIBA-NEA), Corrientes CP3400, Argentina. FAU - Nielsen, Sarah A AU - Nielsen SA AD - Department of Ecology and Evolutionary Biology, College of Science, University of Arizona, Tucson, AZ 85724, USA. FAU - Nielsen, Vance G AU - Nielsen VG AUID- ORCID: 0000-0002-8072-9883 AD - Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ 85750, USA. FAU - Fusco, Luciano S AU - Fusco LS AUID- ORCID: 0000-0002-7784-6237 AD - Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Instituto de Quimica Basica y Aplicada del Nordeste Argentino (IQUIBA-NEA), Corrientes CP3400, Argentina. AD - Facultad de Ciencias Exactas Naturales y Agrimensura, Universidad Nacional del Nordeste, Corrientes CP3400, Argentina. LA - eng GR - Grant number PI: 21V001/Secretaria General de Ciencia y Tecnica, Universidad Nacional del Nordeste, Argentina/ PT - Journal Article DEP - 20250928 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - EC 3.4.- (Serine Proteases) RN - 0 (Crotalid Venoms) RN - 0 (Coagulants) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - *Bothrops/metabolism MH - *Serine Proteases/metabolism MH - Animals MH - *Crotalid Venoms/pharmacology/chemistry MH - Humans MH - *Blood Coagulation/drug effects MH - Kinetics MH - Thrombelastography MH - *Coagulants/pharmacology MH - Thrombin/metabolism PMC - PMC12525055 OTO - NOTNLM OT - Bothrops species OT - antithrombin OT - calcium dependent activity OT - coagulation kinetics OT - coagulation time OT - ruthenium antivenom OT - serine protease OT - spectrophotometry OT - thromboelastography OT - venom COIS- One author (V.G.N.) is the inventor of the use of CORM-2 as a remedy for venom-induced coagulopathy, with USPTO patents (#10,314,860 and #10,828,326) owned by the University of Arizona Board of Regents. The author is also the owner of a company, Trinity Antivenoms, LLC, which is inactive and possesses no assets. These conflicts of interest are overseen by the University of Arizona's Office of Conflict of Interest, which has in place a plan for mitigation of conflicts, including periodic reporting by this author and oversight by a colleague that is not involved with this project or any relevant patents to provide assurance of scientific integrity. EDAT- 2025/10/16 06:30 MHDA- 2025/10/16 06:31 PMCR- 2025/09/28 CRDT- 2025/10/16 01:12 PHST- 2025/08/20 00:00 [received] PHST- 2025/09/24 00:00 [revised] PHST- 2025/09/26 00:00 [accepted] PHST- 2025/10/16 06:31 [medline] PHST- 2025/10/16 06:30 [pubmed] PHST- 2025/10/16 01:12 [entrez] PHST- 2025/09/28 00:00 [pmc-release] AID - ijms26199496 [pii] AID - ijms-26-09496 [pii] AID - 10.3390/ijms26199496 [doi] PST - epublish SO - Int J Mol Sci. 2025 Sep 28;26(19):9496. doi: 10.3390/ijms26199496. PMID- 41069610 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251010 LR - 20260307 IS - 2475-0379 (Electronic) IS - 2475-0379 (Linking) VI - 9 IP - 6 DP - 2025 Aug TI - Beyond the count: platelet dysfunction profile in pediatric trauma patients. PG - 103160 LID - 10.1016/j.rpth.2025.103160 [doi] LID - 103160 AB - BACKGROUND: Existing clinical coagulation assays are inadequate to evaluate posttraumatic platelet dysfunction in children. OBJECTIVES: To elucidate changes in flow-dependent platelet function after injury in children using a microfluidic assay. METHODS: We enrolled 18 children who presented with highest-acuity trauma activation and 10 healthy children at an academic pediatric center. For the control cohort, outpatient blood samples were collected, and for the trauma cohort, blood was collected in the trauma bay for conventional coagulation tests, thromboelastography, von Willebrand factor A1 domain activity, and a microfluidic assay using a stenotic channel (shear rate = 3500 s(-1)). RESULTS: The trauma cohort characteristics were 67% male, median (IQR) age 6 years (4-12), median (IQR) injury severity score 17 (9-26), and 78% blunt mechanism. In total, 50% required blood transfusion and 11% (2/18) died. While thromboelastography maximum amplitude (59.9 +/- 6.1 mm) and platelet counts (306.3 +/- 111.1 x 10(3) cells/muL) were within normal limits, the microfluidic assay revealed significantly lower platelet deposition in the trauma cohort versus the control cohort (1.18 +/- 0.25 vs 3.06 +/- 0.82 mean fluorescence intensity fold change; P < .0001). Lower levels of platelet deposition correlated with receipt of blood transfusion within 6 hours of arrival (r = -0.44, P = .048). von Willebrand factor A1 domain activity was not different between groups and was not correlated with platelet deposition based on mean fluorescence intensity fold change (R (2) < 0.0001). CONCLUSION: Posttraumatic platelet dysfunction was observed by utilizing a microfluidic assay in a pediatric trauma cohort. Further study is needed to understand the underlying mechanisms and significance of posttraumatic platelet dysfunction in children. CI - (c) 2025 The Authors. FAU - Kar, Ronit AU - Kar R AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Feeney, Erin V AU - Feeney EV AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Killinger, Jack R AU - Killinger JR AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Morgan, Katrina M AU - Morgan KM AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA. FAU - Dishong, Devin M AU - Dishong DM AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Rahn, Katelin C AU - Rahn KC AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Rassam, Rassam M G AU - Rassam RMG AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Ballentine, Grace A AU - Ballentine GA AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Spinella, Philip C AU - Spinella PC AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Neal, Matthew D AU - Neal MD AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Gaines, Barbara A AU - Gaines BA AD - Department of Surgery, UT Southwestern, Dallas, Texas, USA. FAU - Shea, Susan M AU - Shea SM AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Leeper, Christine M AU - Leeper CM AD - Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. AD - Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA. LA - eng GR - K25 HL161401/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20250826 PL - United States TA - Res Pract Thromb Haemost JT - Research and practice in thrombosis and haemostasis JID - 101703775 PMC - PMC12506559 OTO - NOTNLM OT - Hemostasis OT - microfluidics OT - pediatrics OT - platelets OT - trauma-induced coagulopathy EDAT- 2025/10/10 06:29 MHDA- 2025/10/10 06:30 PMCR- 2025/08/26 CRDT- 2025/10/10 04:48 PHST- 2025/01/09 00:00 [received] PHST- 2025/07/16 00:00 [revised] PHST- 2025/08/20 00:00 [accepted] PHST- 2025/10/10 06:30 [medline] PHST- 2025/10/10 06:29 [pubmed] PHST- 2025/10/10 04:48 [entrez] PHST- 2025/08/26 00:00 [pmc-release] AID - S2475-0379(25)00484-4 [pii] AID - 103160 [pii] AID - 10.1016/j.rpth.2025.103160 [doi] PST - epublish SO - Res Pract Thromb Haemost. 2025 Aug 26;9(6):103160. doi: 10.1016/j.rpth.2025.103160. eCollection 2025 Aug. PMID- 41058374 OWN - NLM STAT- MEDLINE DCOM- 20260104 LR - 20260912 IS - 1471-6771 (Electronic) IS - 0007-0912 (Print) IS - 0007-0912 (Linking) VI - 136 IP - 1 DP - 2026 Jan TI - A novel role for ADAMTS13 in hyperfibrinolysis after trauma-induced shock(☆). PG - 107-116 LID - S0007-0912(25)00582-3 [pii] LID - 10.1016/j.bja.2025.07.092 [doi] AB - BACKGROUND: Trauma-induced coagulopathy with hyperfibrinolysis is associated with high mortality. The protease ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motifs 13) is cleaved after tissue injury. We analysed the underlying mechanism of ADAMTS13 proteolytic cleavage and the effect of ADAMTS13 on trauma-induced hyperfibrinolysis. METHODS: Thirty-nine trauma patients with shock were stratified based on ADAMTS13 conformation. Mechanisms of ADAMTS13 cleavage were explored in vitro using blood from healthy volunteers. The role of ADAMTS13 in hyperfibrinolysis was examined using rotational thromboelastometry (ROTEM) and a fibrin formation assay. RESULTS: ADAMTS13 circulated in a truncated and hyperactive form in 23% of trauma patients in shock. Truncated ADAMTS13 was associated with a significant increase in hyperfibrinolysis (ROTEM FIBTEM maximum lysis 85 [62-100] vs 1 [0-7]%, P=0.002) and mortality (44% vs 3%, P=0.007) compared with patients with a closed ADAMTS13 conformation. In vitro, ADAMTS13 was cleaved at its distal self-regulating domains in the presence of tissue plasminogen activator and plasmin, which concentration-dependently increased ADAMTS13 activity. This activation was prevented by tranexamic acid. Hyperactivated ADAMTS13 was associated with hyperfibrinolysis by both ROTEM and fibrin formation assays compared with conditions where ADAMTS13 was inactivated. CONCLUSIONS: During trauma-induced shock, ADAMTS13 can circulate in a truncated and hyperactivated conformation, which is associated with hyperfibrinolysis and mortality. In vitro, tissue plasminogen activator and plasmin can truncate ADAMTS13, increasing its activity. Additionally, ADAMTS13 directly contributes to hyperfibrinolysis, and tranexamic acid can prevent ADAMTS13 degradation. INSTITUTIONAL ETHICAL REVIEW BOARD APPROVAL NUMBERS: NL58766.018.16, NL74188.018.20. CI - Copyright (c) 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Sloos, Pieter H AU - Sloos PH AD - Department of Intensive Care Medicine, location University of Amsterdam, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands. FAU - Vermeersch, Lisa AU - Vermeersch L AD - Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium. FAU - Roozendaal, Daphne S AU - Roozendaal DS AD - Department of Intensive Care Medicine, location University of Amsterdam, Amsterdam, The Netherlands. FAU - Delmote, Anne-Sophie AU - Delmote AS AD - Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium. FAU - Veer, Cornelis van 't AU - Veer CV' AD - Center for Experimental and Molecular Medicine, location University of Amsterdam, Amsterdam, The Netherlands. FAU - Momanyi, Thomas O AU - Momanyi TO AD - Oklahoma State University Center for Health Sciences, Department of Biochemistry and Microbiology, Tulsa, OK, USA. FAU - Miranda, Frida Z AU - Miranda FZ AD - Oklahoma State University Center for Health Sciences, Department of Biochemistry and Microbiology, Tulsa, OK, USA. FAU - Muia, Joshua AU - Muia J AD - Oklahoma State University Center for Health Sciences, Department of Biochemistry and Microbiology, Tulsa, OK, USA; Versiti Blood Research Institute, Milwaukee, WI, USA. FAU - Tersteeg, Claudia AU - Tersteeg C AD - Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium. FAU - Vanhoorelbeke, Karen AU - Vanhoorelbeke K AD - Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, location University of Amsterdam, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus MC, Rotterdam, The Netherlands. FAU - Kleinveld, Derek J B AU - Kleinveld DJB AD - Department of Intensive Care Medicine, location University of Amsterdam, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands. Electronic address: d.kleinveld@erasmusmc.nl. LA - eng GR - R35 GM142926/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20251006 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - EC 3.4.24.87 (ADAMTS13 Protein) RN - EC 3.4.24.87 (ADAMTS13 protein, human) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Humans MH - *ADAMTS13 Protein/blood/physiology/metabolism MH - Male MH - *Fibrinolysis/physiology MH - Female MH - Middle Aged MH - Adult MH - Thrombelastography/methods MH - *Shock, Traumatic/blood MH - Aged MH - *Blood Coagulation Disorders/etiology/blood MH - *Wounds and Injuries/complications MH - Tranexamic Acid/pharmacology MH - Young Adult PMC - PMC13269631 OTO - NOTNLM OT - ADAMTS13 OT - coagulopathy OT - hyperfibrinolysis OT - trauma OT - trauma-induced coagulopathy COIS- Declaration of interests JM holds the patent 'Fluorogenic substrate for ADAMTS13' (US 8663912), issued to Washington University. All other authors declare that they have no conflicts of interest. EDAT- 2025/10/08 06:29 MHDA- 2026/01/05 00:49 PMCR- 2025/10/06 CRDT- 2025/10/08 03:37 PHST- 2024/11/03 00:00 [received] PHST- 2025/06/13 00:00 [revised] PHST- 2025/07/12 00:00 [accepted] PHST- 2026/01/05 00:49 [medline] PHST- 2025/10/08 06:29 [pubmed] PHST- 2025/10/08 03:37 [entrez] PHST- 2025/10/06 00:00 [pmc-release] AID - S0007-0912(25)00582-3 [pii] AID - 10.1016/j.bja.2025.07.092 [doi] PST - ppublish SO - Br J Anaesth. 2026 Jan;136(1):107-116. doi: 10.1016/j.bja.2025.07.092. Epub 2025 Oct 6. PMID- 41048523 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251006 LR - 20251008 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 12 DP - 2025 TI - Thromboelastography in ruptured abdominal aortic aneurysm management: lessons from vascular, cardiac, and trauma surgery. PG - 1668165 LID - 10.3389/fcvm.2025.1668165 [doi] LID - 1668165 AB - Ruptured abdominal aortic aneurysm (rAAA) is a critical surgical emergency. Thromboelastography (TEG) is a viscoelastic, point-of-care test that provides a comprehensive real-time assessment of coagulation and fibrinolysis. Although TEG has been successfully adopted in trauma and cardiac surgery for individualised transfusion guidance, its role in rAAA has not been sufficiently explored. We conducted a review of studies published between 2009 and 2024 to assess the utility of TEG or rotational thromboelastometry (ROTEM) in rAAA management. Evidence from vascular surgery suggests reduced blood-product transfusions and postoperative bleeding. Additional data from cardiac surgery and emergency/trauma demonstrated improved survival, fewer reoperations and cost efficiency. Although there are few direct studies on the utility of TEG in rAAA and these are mostly descriptive, the results presented in this review suggest its potential role in vascular emergencies. To confirm this, well-designed prospective studies are essential to determine when and how TEG should guide decision-making in this critical setting. CI - (c) 2025 Gniedziejko, Halman, Kimilu, Folwarski and Sieminski. FAU - Gniedziejko, Michal AU - Gniedziejko M AD - Emergency Department, University Clinical Centre, Gdansk, Poland. AD - Student Scientific Circle of Neurotraumatology, Medical University of Gdansk, Gdansk, Poland. FAU - Halman, Joanna AU - Halman J AD - Student Scientific Circle of Neurotraumatology, Medical University of Gdansk, Gdansk, Poland. AD - Department of Vascular Surgery, University Clinical Centre, Gdansk, Poland. FAU - Kimilu, Nina AU - Kimilu N AD - Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Gdansk, Poland. FAU - Folwarski, Marcin AU - Folwarski M AD - Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Gdansk, Poland. AD - Home Enteral and Parenteral Nutrition Unit, Nicolaus Copernicus Hospital, Gdansk, Poland. FAU - Sieminski, Mariusz AU - Sieminski M AD - Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland. LA - eng PT - Journal Article PT - Review DEP - 20250919 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC12491231 OTO - NOTNLM OT - ROTEM OT - TEG OT - abdominal aortic aneurysm OT - cardiac surgery OT - rAAA OT - thromboelastography OT - vascular surgery OT - viscoelastic testing COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2025/10/06 12:31 MHDA- 2025/10/06 12:32 PMCR- 2025/09/19 CRDT- 2025/10/06 07:09 PHST- 2025/07/17 00:00 [received] PHST- 2025/09/02 00:00 [accepted] PHST- 2025/10/06 12:32 [medline] PHST- 2025/10/06 12:31 [pubmed] PHST- 2025/10/06 07:09 [entrez] PHST- 2025/09/19 00:00 [pmc-release] AID - 10.3389/fcvm.2025.1668165 [doi] PST - epublish SO - Front Cardiovasc Med. 2025 Sep 19;12:1668165. doi: 10.3389/fcvm.2025.1668165. eCollection 2025. PMID- 41045051 OWN - NLM STAT- MEDLINE DCOM- 20251112 LR - 20260528 IS - 1096-8652 (Electronic) IS - 0361-8609 (Linking) VI - 100 IP - 12 DP - 2025 Dec TI - TEG and ROTEM: Technology and Clinical Applications, 2026 Update. PG - 2357-2370 LID - 10.1002/ajh.70074 [doi] AB - Viscoelastic testing (VET) has evolved significantly since its inception in the mid-20th century, when it was first developed to guide transfusion strategies in trauma and surgical patients. Initially, VET technologies such as TEG and ROTEM assessed clot formation by measuring the mechanical resistance of a pin or piston within a blood sample. Recent advances have introduced automated, cartridge-based systems and novel detection methods-including resonance frequency and ultrasound-based sonorheometry-these new systems allow for more precise, rapid, and user-friendly assessment of clot dynamics at the point of care. VET is now indicated for a wide range of clinical scenarios where complex coagulopathy is anticipated, including trauma, cardiac surgery, liver transplantation, obstetric hemorrhage, and hematologic disorders such as DIC. Its use is expanding into new populations, including pediatric cardiac surgery, patients with inflammatory bowel disease, and those with COVID-19. However, VET remains limited in its ability to reliably detect therapeutic anticoagulants and certain congenital bleeding disorders, such as von Willebrand disease and deficiencies of protein C, S, and antithrombin. Technical limitations, including potential discrepancies between in vitro and in vivo clot formation, and lack of FDA approval for pediatric use have imposed implementation barriers to centers interested in pediatric VET. Looking forward, the integration of VET data with electronic medical records, the development of predictive models, artificial intelligence, and continued innovation in platelet function assessment and detection technologies are poised to enhance the clinical utility of VET. As guidelines and evidence continue to evolve, VET is positioned to become an increasingly important tool for real-time, individualized management of coagulopathy in diverse patient populations. CI - (c) 2025 Wiley Periodicals LLC. FAU - Longacre, Mckenna M AU - Longacre MM AD - Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. FAU - Ibla, Juan C AU - Ibla JC AUID- ORCID: 0000-0003-2096-5363 AD - Division of Cardiac Anesthesiology, Department of Pediatric Anesthesiology, Ann &Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. LA - eng PT - Journal Article PT - Review DEP - 20251004 PL - United States TA - Am J Hematol JT - American journal of hematology JID - 7610369 SB - IM MH - Humans MH - *Thrombelastography/methods/instrumentation MH - COVID-19/blood MH - *Blood Coagulation Disorders/diagnosis/blood MH - SARS-CoV-2 OTO - NOTNLM OT - ROTEM OT - TEG OT - coagulation OT - hemostasis EDAT- 2025/10/04 06:30 MHDA- 2025/11/13 00:32 CRDT- 2025/10/04 04:42 PHST- 2025/08/26 00:00 [revised] PHST- 2025/05/22 00:00 [received] PHST- 2025/09/02 00:00 [accepted] PHST- 2025/11/13 00:32 [medline] PHST- 2025/10/04 06:30 [pubmed] PHST- 2025/10/04 04:42 [entrez] AID - 10.1002/ajh.70074 [doi] PST - ppublish SO - Am J Hematol. 2025 Dec;100(12):2357-2370. doi: 10.1002/ajh.70074. Epub 2025 Oct 4. PMID- 41020563 OWN - NLM STAT- MEDLINE DCOM- 20260824 LR - 20260904 IS - 1433-7347 (Electronic) IS - 0942-2056 (Print) IS - 0942-2056 (Linking) VI - 34 IP - 9 DP - 2026 Sep TI - Anticoagulant and anti-inflammatory effects of fondaparinux sodium during anterior cruciate ligament reconstruction in high risk VTE patients: A randomised controlled, triple blinded, prospective study. PG - 3257-3268 LID - 10.1002/ksa.70081 [doi] AB - PURPOSE: This study aimed to evaluate the anticoagulant and anti-inflammatory effects of fondaparinux sodium in patients at high risk of venous thromboembolism (VTE) undergoing anterior cruciate ligament (ACL) reconstruction. METHODS: A single-centre, triple-blinded, randomised, controlled study enroled high-risk VTE patients (Caprini score >/= 5) undergoing ACL reconstruction. Patients were randomised to receive either fondaparinux sodium (2.5 mg daily for 14 days) or enoxaparin sodium (4000 AxaIU daily for 14 days). Coagulation parameters, inflammatory markers, thromboelastography (TEG) and duplex ultrasound of the lower limbs were assessed at predefined time points. RESULTS: A total of 72 patients were included. Baseline demographic characteristics, including age, gender and preoperative health status, were similar between the two groups. No cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) were reported in either group. Group A showed significantly lower D-dimer levels on postoperative days 3, 7, and 13 and higher activated partial thromboplastin time (APTT) on Day 7 (p < 0.05). TEG showed that reaction time (R) was longer in Group A, and maximum amplitude (MA) increased postoperatively (p < 0.05). Inflammatory markers (ESR, CRP and IL-6) were significantly lower in Group A at multiple time points (p < 0.05). Knee circumference also decreased significantly in Group A on Days 3 and 7 (p < 0.05). No significant differences were found between the groups regarding pain, blood loss or postoperative complications (p > 0.05). CONCLUSION: In high-risk VTE patients undergoing ACL reconstruction, fondaparinux sodium exhibited superior anticoagulant and anti-inflammatory effects compared to enoxaparin sodium, with reduced knee swelling. No significant differences were observed in major postoperative VTE events or bleeding risks, suggesting fondaparinux sodium may be a preferable option for postoperative thromboprophylaxis. LEVEL OF EVIDENCE: Level I. CI - (c) 2025 European Society of Sports Traumatology, Knee Surgery and Arthroscopy. FAU - Zheng, Pai AU - Zheng P AUID- ORCID: 0009-0002-6711-1912 AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - Che, Guangwei AU - Che G AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - Zhang, Xueer AU - Zhang X AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - You, Haoming AU - You H AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - Peng, Jiayuan AU - Peng J AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - Huang, Yong AU - Huang Y AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. FAU - Shi, Lihan AU - Shi L AUID- ORCID: 0009-0001-5125-5543 AD - Chengdu University of Traditional Chinese Medicine, Chengdu, China. AD - Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China. LA - eng GR - 2021HR08/Scientific Research Special Funding of Sichuan Medical Association/ PT - Journal Article PT - Randomized Controlled Trial DEP - 20250929 PL - Germany TA - Knee Surg Sports Traumatol Arthrosc JT - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JID - 9314730 RN - J177FOW5JL (Fondaparinux) RN - 0 (Polysaccharides) RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) RN - 0 (fibrin fragment D) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (Anti-Inflammatory Agents) RN - 9007-41-4 (C-Reactive Protein) SB - IM MH - Humans MH - Female MH - Male MH - Fondaparinux MH - *Polysaccharides/therapeutic use MH - Prospective Studies MH - *Venous Thromboembolism/prevention & control/etiology MH - *Anterior Cruciate Ligament Reconstruction MH - *Anticoagulants/therapeutic use MH - Enoxaparin/therapeutic use MH - Adult MH - Fibrin Fibrinogen Degradation Products/metabolism MH - *Anti-Inflammatory Agents/therapeutic use MH - Young Adult MH - Thrombelastography MH - C-Reactive Protein/metabolism MH - Anterior Cruciate Ligament Injuries MH - Postoperative Complications/prevention & control MH - Adolescent PMC - PMC13502423 OTO - NOTNLM OT - anterior cruciate ligament reconstruction OT - fondaparinux sodium OT - postoperative anticoagulation OT - postoperative anti-inflammation OT - venous thromboembolism COIS- The authors declare no conflicts of interest. EDAT- 2025/09/29 13:19 MHDA- 2026/08/24 18:42 PMCR- 2026/08/24 CRDT- 2025/09/29 08:33 PHST- 2025/08/12 00:00 [revised] PHST- 2025/06/10 00:00 [received] PHST- 2025/08/20 00:00 [accepted] PHST- 2026/08/24 18:42 [medline] PHST- 2025/09/29 13:19 [pubmed] PHST- 2025/09/29 08:33 [entrez] PHST- 2026/08/24 00:00 [pmc-release] AID - KSA70081 [pii] AID - 10.1002/ksa.70081 [doi] PST - ppublish SO - Knee Surg Sports Traumatol Arthrosc. 2026 Sep;34(9):3257-3268. doi: 10.1002/ksa.70081. Epub 2025 Sep 29. PMID- 41004381 OWN - NLM STAT- MEDLINE DCOM- 20250926 LR - 20260502 IS - 1399-6576 (Electronic) IS - 0001-5172 (Linking) VI - 69 IP - 10 DP - 2025 Nov TI - Rapid Update and Revision of: Thromboelastography or Rotational Thromboelastometry Guided Algorithms in Bleeding Patients-An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. PG - e70127 LID - 10.1111/aas.70127 [doi] AB - BACKGROUND: Bleeding patients face significant morbidity and mortality due to impaired hemostasis. Hemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG/ROTEM versus standard of care in bleeding patients in an updated review. METHODS: This systematic review of randomized controlled trials with meta-analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA, and GRADE guidelines. A literature search was conducted in five major databases. Both pediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis-dependent renal injury. RESULTS: This systematic review included 35 randomized trials (n = 3096), primarily elective cardiac surgery. TEG-/ROTEM-guided algorithms led to a statistically significant reduction in mortality (RR = 0.76, 95% CI 0.63-0.92) I(2): 0%. Furthermore, a significant reduction in transfused fresh frozen plasma (RR = 0.52, 95% CI 0.35-0.76) I(2): 94%, platelets (RR = 0.69, 95% CI 0.55-0.87) I(2): 60%, the risk for surgical reintervention (RR = 0.63, 95% CI 0.45-0.88) I(2): 0%, and bleeding with a standard mean difference of -0.31 (95% CI, -0.51 to -0.11) I(2): 72% was found. According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 64% of the optimal information size was reached with a crossed alpha-boundary. CONCLUSIONS: TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma, platelets, and surgical reintervention, but the evidence is very uncertain. Furthermore, the results were primarily based on the adult population undergoing elective cardiac surgery. EDITORIAL COMMENT: This updated systematic review presents a synthesis of evidence for how thromboelastography or rotational thromboelastometry has been implemented in study conditions to guide tranfusion in bleeding patients. The certainty for the evidence is very limited. CI - (c) 2025 Acta Anaesthesiologica Scandinavica Foundation. FAU - Kvisselgaard, A D AU - Kvisselgaard AD AUID- ORCID: 0000-0002-4147-0987 AD - Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark. AD - Danish Anaesthesia Allergy Centre, Allergy Clinic 1, Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark. FAU - Wolthers, S A AU - Wolthers SA AUID- ORCID: 0000-0001-6325-2449 AD - Prehospital Centre Zealand, Naestved, Denmark. FAU - Wikkelso, A AU - Wikkelso A AUID- ORCID: 0000-0001-6848-8143 AD - Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark. FAU - Holst, L B AU - Holst LB AD - Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. FAU - Drivenes, B AU - Drivenes B AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Afshari, A AU - Afshari A AD - Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. AD - Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - England TA - Acta Anaesthesiol Scand JT - Acta anaesthesiologica Scandinavica JID - 0370270 SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Algorithms MH - *Hemorrhage/therapy/mortality MH - Blood Transfusion MH - Randomized Controlled Trials as Topic EDAT- 2025/09/26 18:29 MHDA- 2025/09/26 18:30 CRDT- 2025/09/26 12:53 PHST- 2025/08/21 00:00 [revised] PHST- 2025/06/16 00:00 [received] PHST- 2025/08/29 00:00 [accepted] PHST- 2025/09/26 18:30 [medline] PHST- 2025/09/26 18:29 [pubmed] PHST- 2025/09/26 12:53 [entrez] AID - 10.1111/aas.70127 [doi] PST - ppublish SO - Acta Anaesthesiol Scand. 2025 Nov;69(10):e70127. doi: 10.1111/aas.70127. PMID- 41001705 OWN - NLM STAT- MEDLINE DCOM- 20251105 LR - 20260715 IS - 2576-9456 (Print) IS - 2475-7241 (Linking) VI - 10 IP - 6 DP - 2025 Nov 4 TI - Blood Utilization and Waste Following Implementation of Thromboelastography. PG - 1466-1475 LID - 10.1093/jalm/jfaf139 [doi] AB - BACKGROUND: Thromboelastography (TEG) is a viscoelastic testing platform that monitors real-time coagulation. This study evaluated changes in blood use and waste following TEG implementation, as well as changes in massive transfusion protocol (MTP) blood utilization and returns following TEG implementation. METHODS: The study is a retrospective analysis of blood component transfusion in 3 services (cardiothoracic surgery, emergency department, and trauma surgery) and overall blood waste at a level II trauma center for 104 weeks before and after TEG implementation. Blood utilization and waste were compared by a paired t-test. Additionally, MTP blood utilization and returns were compared for 80 cases pre-TEG and 80 cases post-TEG implementation by an independent t-test. RESULTS: Changes in weekly mean utilization after implementation of TEG differed among component types. Red blood cell (RBC) transfusions increased by 15% (P < 0.01), while plasma transfusions decreased by 26% (P < 0.05). The mean RBC units wasted decreased (P < 0.01), but the mean plasma units wasted increased significantly between the pre- and post-TEG groups (P < 0.001). The weekly mean platelet and cryoprecipitate waste and utilization showed no significant difference between the pre- and post-TEG groups. MTP utilization and returns showed no significant difference between pre- and post-TEG implementation. CONCLUSIONS: In line with previous literature, plasma utilization decreased post-TEG implementation. Plasma waste unexpectedly increased, which may be due to an increase of orders for plasma that were not transfused. RBC utilization and waste showed significant changes, although the impact of blood availability during the COVID pandemic should be considered a confounding variable in this study. CI - (c) Association for Diagnostics & Laboratory Medicine 2025. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. FAU - Shelton, Kaitlyn M AU - Shelton KM AUID- ORCID: 0009-0000-7955-6199 AD - Medical Services, Bloodworks Northwest, Seattle, WA, United States. AD - Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, United States. FAU - Walker, LeeAnn P AU - Walker LP AD - Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, United States. FAU - Carman, Carol A AU - Carman CA AUID- ORCID: 0000-0001-8055-1512 AD - Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, United States. FAU - Gonzalez, Daniel AU - Gonzalez D AD - Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, United States. FAU - Burnett-Greenup, Sarah AU - Burnett-Greenup S AD - Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, United States. LA - eng PT - Journal Article PL - England TA - J Appl Lab Med JT - The journal of applied laboratory medicine JID - 101693884 SB - IM MH - *Thrombelastography/statistics & numerical data/methods MH - Humans MH - Retrospective Studies MH - *Blood Transfusion/statistics & numerical data MH - *COVID-19/epidemiology/virology MH - Trauma Centers/statistics & numerical data MH - *Blood Component Transfusion/statistics & numerical data MH - Emergency Service, Hospital/statistics & numerical data MH - Female MH - Male MH - SARS-CoV-2 EDAT- 2025/09/26 06:30 MHDA- 2025/11/05 06:29 CRDT- 2025/09/26 05:49 PHST- 2024/08/03 00:00 [received] PHST- 2025/08/11 00:00 [accepted] PHST- 2025/11/05 06:29 [medline] PHST- 2025/09/26 06:30 [pubmed] PHST- 2025/09/26 05:49 [entrez] AID - 8264417 [pii] AID - 10.1093/jalm/jfaf139 [doi] PST - ppublish SO - J Appl Lab Med. 2025 Nov 4;10(6):1466-1475. doi: 10.1093/jalm/jfaf139. PMID- 40991006 OWN - NLM STAT- MEDLINE DCOM- 20260202 LR - 20260202 IS - 1545-1534 (Electronic) IS - 1080-6032 (Linking) VI - 37 IP - 1 DP - 2026 Mar TI - Impact of Extreme Temperatures on Hemostatic Gauze Using Thromboelastography. PG - 32-37 LID - 10.1177/10806032251376307 [doi] AB - IntroductionHemorrhage control in austere environments is challenging, particularly for wounds that are not amenable to tourniquets. Hemostatic gauzes are crucial in such settings, but their efficacy may be compromised by suboptimal storage conditions, including extreme temperatures, where discoloration has been observed. This study evaluated the impact of extreme temperature exposure on the efficacy of hemostatic gauze using thromboelastography.MethodsBlood from 30 healthy adults was diluted by 30% with hetastarch to mimic trauma-induced coagulopathy. Kerlix and QuikClot Combat Gauze stored for 3 weeks in cold (-10 degrees C), hot (70 degrees C), and room-temperature (22 degrees C) environments were compared in the thromboelastography parameters of R (time to initiation of clot formation), K (clot amplification), alpha angle (clot formation rate), and MA (maximum amplitude of clot).ResultsCompared with whole blood, diluted blood had weaker clots with slower clot-formation kinetics (MA=58 vs 43 mm, P<0.0001; K=2.6 vs 4.0 min, P<0.0001; alpha angle=55 vs 47 degrees, P<0.0003) but faster clot initiation times (R=8.7 vs 7.1 min, P<0.0001). Addition of either gauze shortened clot initiation times (Kerlix: 7.1 vs 5.0 min, P<0.0001; QuikClot Combat Gauze: 7.1 vs 2.7 min, P<0.0001), with QuikClot Combat Gauze significantly shortening R compared with Kerlix. Reductions in R values were consistent across temperature extremes (P<0.05). The other parameters were consistently unaffected (P>0.05).ConclusionsThis in vitro laboratory study demonstrated that hemostatic gauze retained its ability to initiate clotting in vitro even after prolonged exposure to temperature extremes. FAU - Ockenfels, Brittany A AU - Ockenfels BA AD - Department of Emergency Medicine, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA. RINGGOLD: 680745 FAU - Jordan, Matthew R AU - Jordan MR AD - Department of Emergency Medicine, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA. RINGGOLD: 680745 FAU - DesRosiers, Taylor AU - DesRosiers T AD - Critical Care and Emergency Medicine, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA. RINGGOLD: 680745 FAU - Stuart, Sean AU - Stuart S AD - Department of Emergency Medicine, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA. RINGGOLD: 680745 LA - eng PT - Journal Article DEP - 20250924 PL - United States TA - Wilderness Environ Med JT - Wilderness & environmental medicine JID - 9505185 RN - 0 (Hemostatics) SB - IM MH - *Thrombelastography MH - Humans MH - *Bandages MH - Adult MH - Male MH - Female MH - Young Adult MH - *Hemostatics MH - *Hot Temperature MH - Temperature OTO - NOTNLM OT - coagulopathy OT - combat OT - hemorrhage OT - prehospital OT - trauma EDAT- 2025/09/24 13:00 MHDA- 2026/02/02 23:52 CRDT- 2025/09/24 11:13 PHST- 2026/02/02 23:52 [medline] PHST- 2025/09/24 13:00 [pubmed] PHST- 2025/09/24 11:13 [entrez] AID - 10.1177/10806032251376307 [doi] PST - ppublish SO - Wilderness Environ Med. 2026 Mar;37(1):32-37. doi: 10.1177/10806032251376307. Epub 2025 Sep 24. PMID- 40984108 OWN - NLM STAT- MEDLINE DCOM- 20250923 LR - 20250923 IS - 1930-613X (Electronic) IS - 0026-4075 (Linking) VI - 190 IP - Supplement_2 DP - 2025 Sep 1 TI - A Synthetic Short-Chain Polyphosphate Complexed With Silica Nanoparticle, Corrects Coagulopathy Under Hemodilute, Hypothermic, or Acidotic Conditions as Assessed by In Vitro Coagulation Assays. PG - 297-303 LID - 10.1093/milmed/usaf176 [doi] AB - INTRODUCTION: Noncompressible hemorrhage accounts for up to 90% of potentially survivable combat deaths. Hypothermia, acidosis, and resuscitative hemodilution ("the lethal triad") contribute significantly to coagulation dysfunction after trauma and are sequelae of trauma-induced coagulopathy. The polyphosphate (polyP)-silica nanoparticle (SNP) (polyP-SNP) complex is a synthetic biomimetic of platelet-length polyP. It is under development as a prohemostatic therapeutic for noncompressible hemorrhage. In this study, we assessed the polyP-SNP complex's ability to restore hemostasis under conditions mimicking the lethal triad in human-pooled normal plasma (hPNP). MATERIALS AND METHODS: Lethal triad conditions were simulated using hPNP by dilution with isotonic saline (hemodilution: 100-10% hPNP), chilling (hypothermia: 37-30 degrees C), or adding lactic acid (metabolic acidosis: 0-10 mM). Thrombin generation assay was performed in a 96-well fluorogenic assay format. The reaction was initiated by adding CaCl2/phospholipid to citrated hPNP with equal concentrations of the polyP-SNP complex or SNP (0.25 mg/mL). Thromboelastography (TEG) was performed using TEG5000 analyzer. The reactions were initiated by adding CaCl2 to hPNP with equal concentrations of the polyP-SNP complex or SNP. Lipidated tissue factor (0.5 ng/mL) was used as positive control for both assays. RESULTS: The polyP-SNP complex improved thrombin generation at all diluted hPNP levels with Time-to-Peak /=33% hPNP. Lipidated tissue factor -control failed to generate thrombin at 130 x 10(9)/L and hemoglobin > 90 g/L. CONCLUSIONS: RCA with calcium-containing dialysate significantly improves IRRT completion rates, filter longevity, and ultrafiltration efficiency without increasing metabolic risks, in a specific group of patients with platelet counts > 130 x 10(9)/L and hemoglobin > 90 g/L, positioning RCA as a safer and more effective anticoagulation strategy for critically ill populations. Prospective trials are needed to validate these findings and to optimize RCA protocols. CLINICAL TRIAL NUMBER: Not applicable. CI - (c) 2025. The Author(s). FAU - Zhao, Tao AU - Zhao T AD - Renal Division, Department of Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China. AD - Institute of Nephrology, Peking University, Beijing, China. AD - Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China. FAU - Yang, Jie AU - Yang J AD - Renal Division, Department of Medicine, Peking University First Hospital (Taiyuan Central Hospital of Shanxi Medical University), No. 256, Fendong Street, Xiaodian District, Taiyuan, Shanxi, 030009, P. R. China. FAU - Liu, Zhongyuan AU - Liu Z AD - Renal Division, Department of Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China. FAU - Jin, Qizhuang AU - Jin Q AD - Renal Division, Department of Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China. jinqizhuang@bjmu.edu.cn. AD - Institute of Nephrology, Peking University, Beijing, China. jinqizhuang@bjmu.edu.cn. AD - Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China. jinqizhuang@bjmu.edu.cn. FAU - Su, Tao AU - Su T AD - Renal Division, Department of Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China. tao.su@bjmu.edu.cn. AD - Institute of Nephrology, Peking University, Beijing, China. tao.su@bjmu.edu.cn. AD - Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China. tao.su@bjmu.edu.cn. LA - eng GR - 2022CR09/National High Level Hospital Clinical Research Funding (Interdepartmental Clinical Research Project of Peking University First Hospital)/ GR - 2017ZX09304028/National Science and Technology Major Projects for Major New Drugs Innovation and Development/ GR - 2019-I2M-5-046/CAMS Innovation Fund for Medical Science/ PT - Journal Article DEP - 20250822 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Anticoagulants) RN - 2968PHW8QP (Citric Acid) SB - IM MH - Humans MH - Retrospective Studies MH - *Anticoagulants/administration & dosage/adverse effects MH - Male MH - Female MH - *Critical Illness/therapy MH - Middle Aged MH - *Citric Acid/administration & dosage/adverse effects MH - Aged MH - Case-Control Studies MH - *Intermittent Renal Replacement Therapy/methods/adverse effects PMC - PMC12372272 OTO - NOTNLM OT - Acute kidney injury OT - Circuit clotting OT - Critically ill OT - Heparin-free OT - Intermittent renal replacement therapy OT - Regional citrate anticoagulation COIS- Declarations. Ethics approval: This retrospective study complied with the Declaration of Helsinki. The study protocol was reviewed and approved by the Human Ethics Committee of the Peking University First Hospital (MR-11-23-021020). The need for informed consent was waived by the Human Ethics Committee of the Peking University First Hospital due to the retrospective nature of the study and the use of anonymized patient data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. EDAT- 2025/08/26 04:46 MHDA- 2025/08/26 04:47 PMCR- 2025/08/22 CRDT- 2025/08/21 23:33 PHST- 2025/06/09 00:00 [received] PHST- 2025/08/14 00:00 [accepted] PHST- 2025/08/26 04:47 [medline] PHST- 2025/08/26 04:46 [pubmed] PHST- 2025/08/21 23:33 [entrez] PHST- 2025/08/22 00:00 [pmc-release] AID - 10.1186/s12882-025-04406-7 [pii] AID - 4406 [pii] AID - 10.1186/s12882-025-04406-7 [doi] PST - epublish SO - BMC Nephrol. 2025 Aug 22;26(1):480. doi: 10.1186/s12882-025-04406-7. PMID- 40848626 OWN - NLM STAT- MEDLINE DCOM- 20251106 LR - 20251106 IS - 1532-2653 (Electronic) IS - 0967-5868 (Linking) VI - 141 DP - 2025 Nov TI - The role of hypercoagulability in ischemic stroke associated with blunt cerebrovascular injury. PG - 111572 LID - S0967-5868(25)00545-4 [pii] LID - 10.1016/j.jocn.2025.111572 [doi] AB - BACKGROUND: Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing coagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via coagulation profile, including thromboelastography (TEG) and coagulation studies, on ischemic stroke incidence following BCVI. METHODS: This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 h of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI. Receiver operating curves (ROC) with area under the curve (AUC) were constructed for incident strokes. RESULTS: 38 patients met inclusion criteria with 22 (57.9 %) being male with a median age of 51 (20.25). The most common mechanism of injury was motor vehicle collision occurring in 17 (44.7 %) patients. Seven (18.4 %) suffered ischemic strokes in the distribution of BCVI. The stroke group were found to have significantly decreased R value (3.7 [2.45-4.15] vs. 4.3 [3.75-4.8], p = 0.040), fibrinogen (197.9 (62.7) vs. 282.1 (103.9), p = 0.049), and aPTT (23.5 [22.8-26.4] vs. 27.8 [26.2-35.0], p = 0.039). On ROC analysis, R value (AUC = 0.75), fibrinogen (AUC = 0.75), and PTT (AUC = 0.76) had high discriminatory value for incident stroke while the highest Biffl grade did not (AUC = 0.48). CONCLUSIONS: In this cohort of patients with blunt cerebrovascular injury, those with evidence of hypercoagulation experienced an increased incidence of BCVI-related ischemic stroke in the distribution of injury. While larger studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier initiation of anti-thrombotic prophylaxis. CI - Copyright (c) 2025 Elsevier Ltd. All rights reserved. FAU - Carlson, Dayna M AU - Carlson DM AD - School of Medicine, Oregon Health and Science University, United States. Electronic address: Carlsday@ohsu.edu. FAU - Mcintyre, Matthew K AU - Mcintyre MK AD - Department of Neurosurgery, Oregon Health and Science University, United States. Electronic address: mcintyma@ohsu.edu. FAU - Nugent, Joseph AU - Nugent J AD - Department of Neurosurgery, Oregon Health and Science University, United States. FAU - Regner, Justin L AU - Regner JL AD - Department of Critical Care and Acute Care Surgery, Oregon Health and Science University, United States. FAU - Sally, Mitchell B AU - Sally MB AD - Department of Critical Care and Acute Care Surgery, Oregon Health and Science University, United States. FAU - Barton, Cassie A AU - Barton CA AD - Department of Critical Care and Acute Care Surgery, Oregon Health and Science University, United States. FAU - Wright, James AU - Wright J AD - Department of Neurosurgery, Oregon Health and Science University, United States. Electronic address: wrighjam@ohsu.edu. LA - eng PT - Journal Article DEP - 20250824 PL - Scotland TA - J Clin Neurosci JT - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JID - 9433352 SB - IM MH - Humans MH - Male MH - Middle Aged MH - Female MH - *Ischemic Stroke/etiology/epidemiology/blood MH - Retrospective Studies MH - *Thrombophilia/complications/epidemiology/etiology MH - Adult MH - *Cerebrovascular Trauma/complications/epidemiology MH - Thrombelastography MH - Aged MH - *Wounds, Nonpenetrating/complications OTO - NOTNLM OT - Blunt cerebrovascular injury OT - Ischemic stroke OT - Thromboelastography COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2025/08/24 00:46 MHDA- 2025/11/07 00:27 CRDT- 2025/08/23 18:13 PHST- 2025/05/22 00:00 [received] PHST- 2025/08/04 00:00 [revised] PHST- 2025/08/16 00:00 [accepted] PHST- 2025/11/07 00:27 [medline] PHST- 2025/08/24 00:46 [pubmed] PHST- 2025/08/23 18:13 [entrez] AID - S0967-5868(25)00545-4 [pii] AID - 10.1016/j.jocn.2025.111572 [doi] PST - ppublish SO - J Clin Neurosci. 2025 Nov;141:111572. doi: 10.1016/j.jocn.2025.111572. Epub 2025 Aug 24. PMID- 40838005 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20250914 LR - 20250914 IS - 0973-6247 (Print) IS - 1998-3565 (Electronic) IS - 0973-6247 (Linking) VI - 19 IP - 1 DP - 2025 Jan-Jun TI - Rotational thromboelastometry and patient blood management: A narrative review. PG - 130-137 LID - 10.4103/ajts.ajts_18_23 [doi] AB - Limitation of standard coagulation tests in early detection of coagulopathy leads to empirical decision-making for the management of the coagulopathy, which in many cases is accompanied by improper transfusion. Some studies have investigated the role of rotational thromboelastometry (ROTEM) in reducing the need for blood products in different clinical conditions, which have been associated with different results. Whether ROTEM as a point of care test reduces the need for transfusion in all clinical settings is still a question. A brief introduction of methodology of ROTEM and its role in patient blood management (PBM) approach is explored in this review. Search was performed to find literature describing ROTEM applied for decrease in transfusion requirements. Specific search terms were "Thromboelastometry," "ROTEM," "Cardiac surgical procedures," "Trauma," "wounds and injuries" "Liver transplantation," "obstetric" "Transfusion," and "PBM." we reached to 75 publications for this review after application of our search strategy. The number of publications in the field of obstetric was insufficient for review and conclusion. The available evidence supports the helpfulness of ROTEM test in reducing the need for blood transfusions in surgery or trauma. However, it is need to further investigation to evaluate the benefit and efficacy of ROTEM in other medical conditions such as obstetric hemorrhage. CI - Copyright: (c) 2025 Asian Journal of Transfusion Science. FAU - Khalaf-Adeli, Elham AU - Khalaf-Adeli E AD - Department of Hematology, Faculty of Paramedical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. AD - Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. FAU - Tobeyani, Fatemeh AU - Tobeyani F AD - Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. LA - eng PT - Journal Article PT - Review DEP - 20250630 PL - India TA - Asian J Transfus Sci JT - Asian journal of transfusion science JID - 101306858 PMC - PMC12364062 OTO - NOTNLM OT - Blood transfusion OT - cardiac surgical procedures OT - liver transplantation OT - rotational thromboelastometry OT - trauma COIS- There are no conflicts of interest. EDAT- 2025/08/21 06:28 MHDA- 2025/08/21 06:29 PMCR- 2025/01/01 CRDT- 2025/08/21 05:23 PHST- 2023/01/24 00:00 [received] PHST- 2023/02/25 00:00 [revised] PHST- 2023/03/14 00:00 [accepted] PHST- 2025/08/21 06:29 [medline] PHST- 2025/08/21 06:28 [pubmed] PHST- 2025/08/21 05:23 [entrez] PHST- 2025/01/01 00:00 [pmc-release] AID - AJTS-19-130 [pii] AID - 10.4103/ajts.ajts_18_23 [doi] PST - ppublish SO - Asian J Transfus Sci. 2025 Jan-Jun;19(1):130-137. doi: 10.4103/ajts.ajts_18_23. Epub 2025 Jun 30. PMID- 40836257 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20250914 LR - 20250914 IS - 2047-0525 (Print) IS - 2047-0525 (Electronic) IS - 2047-0525 (Linking) VI - 14 IP - 1 DP - 2025 Aug 20 TI - Management of burn patients undergoing surgery while on extracorporeal membrane oxygenation (ECMO): clinical experience and a standardized perioperative protocol. PG - 89 LID - 10.1186/s13741-025-00572-2 [doi] LID - 89 AB - Severe burn injuries complicated by acute respiratory failure present unique challenges in critical care medicine. Although the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) can offer life-saving support for this patient cohort, the perioperative management of burn patients on ECMO remains poorly standardized, and evidence-based guidelines are lacking. This perspective outlines the experiences gained from managing burn patients undergoing surgery while on V-V ECMO at a major burn center. Over a 3-year period, 14 patients with an average burned total body surface area (TBSA) involvement of 41% were treated with ECMO support. Several key strategies contributed to the safe surgical management of these patients. Looking ahead, there is a clear need for multicenter registry data and collaborative efforts to establish standardized perioperative protocols for burn patients receiving ECMO. Individualized anticoagulation management using point-of-care techniques such as thromboelastography, and the evaluation of optimal surgical timing strategies, will be essential areas for future research. In conclusion, interdisciplinary teamwork and structured perioperative management protocols can enable safe surgical treatment of burn patients on ECMO. Broader collaboration and standardized data collection are crucial steps to improving outcomes and establishing best practices for this complex patient population. CI - (c) 2025. The Author(s). FAU - Schmidt, Sonja Verena AU - Schmidt SV AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. sonja.schmidt@rub.de. FAU - Macedo Santos, Elisabete AU - Macedo Santos E AD - Department of Anesthesiology, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Drysch, Marius AU - Drysch M AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Puscz, Flemming AU - Puscz F AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Reinkemeier, Felix AU - Reinkemeier F AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Buchwald, Dirk AU - Buchwald D AD - Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Zahn, Peter K AU - Zahn PK AD - Department of Anesthesiology, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Lehnhardt, Marcus AU - Lehnhardt M AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Hinzmann, Jannik AU - Hinzmann J AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. FAU - Wallner, Christoph AU - Wallner C AD - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44789, Bochum, Germany. LA - eng PT - Journal Article PT - Review DEP - 20250820 PL - England TA - Perioper Med (Lond) JT - Perioperative medicine (London, England) JID - 101609072 PMC - PMC12366222 OTO - NOTNLM OT - Anticoagulation OT - Burn surgery OT - ECMO OT - Intensive care OT - Perioperative medicine COIS- Declarations. Ethics approval and consent to participate: Not applicable as it is not a study but an observation of patients treated in the regular setting. This observation is based on a retrospective analysis of routine clinical data collected within our own department. In accordance with section sign 6 of the Health Data Protection Act of North Rhine-Westphalia (GDSG NRW) and section sign 15 (1) of the Professional Code of Conduct of the Medical Association of Westphalia-Lippe, no patient consent or formal ethics approval is required in this case, as the data were extracted exclusively from internal patient records by individuals directly involved in the patients' clinical care. The data were handled in compliance with data protection regulations and used solely in anonymized form for scientific analysis. According to these regulations, consultation of an ethics committee is not mandatory for such departmental, retrospective, and anonymized evaluations in publicly governed institutions. Consent for publication: Not applicable as data is pseudonymized and no personal information are included in the manuscript. Competing interests: The authors declare no competing interests. EDAT- 2025/08/21 06:28 MHDA- 2025/08/21 06:29 PMCR- 2025/08/20 CRDT- 2025/08/21 00:24 PHST- 2025/04/29 00:00 [received] PHST- 2025/08/02 00:00 [accepted] PHST- 2025/08/21 06:29 [medline] PHST- 2025/08/21 06:28 [pubmed] PHST- 2025/08/21 00:24 [entrez] PHST- 2025/08/20 00:00 [pmc-release] AID - 10.1186/s13741-025-00572-2 [pii] AID - 572 [pii] AID - 10.1186/s13741-025-00572-2 [doi] PST - epublish SO - Perioper Med (Lond). 2025 Aug 20;14(1):89. doi: 10.1186/s13741-025-00572-2. PMID- 40834486 OWN - NLM STAT- MEDLINE DCOM- 20251016 LR - 20260313 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 51 IP - 8 DP - 2025 Nov TI - Decoding the proteomic landscape of platelet extracellular vesicles: Implications for coagulation in burn patients. PG - 107651 LID - S0305-4179(25)00280-3 [pii] LID - 10.1016/j.burns.2025.107651 [doi] AB - BACKGROUND: To analyze the effects of platelet extracellular vesicles (PLT-EVs) on coagulation function in severe burns patients using in vitro coagulation assays, and to explore the proteins involved in coagulation reaction in PLT-EVs by proteomics technology, laying the foundation for the diagnosis and treatment of coagulation dysfunction in patients with severe burns. METHODS: Six healthy volunteers and six patients with severe burns were selected. The coagulation function was compared by thromboelastography and conventional coagulation tests, and the differentially expressed proteins of PLT-EVs in the control group and the burns group were analyzed by liquid chromatography-mass spectrometry. The differentially expressed proteins were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG); the top 10 proteins related to coagulation were screened. RESULTS: The in vitro coagulation results revealed that the severe burns patients were in a hypocoagulable state following shock, as evidenced by hyperfibrinolysis and decreased platelet function and quantity; PLT-EVs were found to promote coagulation in vitro. Quantitative analysis of the 853 proteins found in PLT-EVs indicated that 191 proteins were up-regulated and 77 proteins were down-regulated. The GO and KEGG analysis of the differentially expressed proteins showed their involvement in biological processes such as coagulation function, inflammatory response, immune response, and body repair and regulation. CONCLUSIONS: PLT-EVs play a role in reducing coagulation dysfunction after severe burns by regulating the quantity of coagulation-related proteins. CI - Copyright (c) 2025 Elsevier Ltd and International Society of Burns Injuries. All rights reserved. FAU - Li, Quan AU - Li Q AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. FAU - Gao, Lei AU - Gao L AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. FAU - Li, Fang AU - Li F AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. Electronic address: lifang19891010@163.com. FAU - Li, Junliang AU - Li J AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. FAU - Hou, Zhihui AU - Hou Z AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. FAU - Cao, Shengjun AU - Cao S AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. Electronic address: shengjunc@aliyun.com. FAU - Wang, Lingfeng AU - Wang L AD - Department of burn surgery, burn medical institute of Inner Mongolia, the third affiliated hospital of Inner Mongolia medical university, Baogang hospital, Baotou, China. Electronic address: wlf7413@vip.sina.com. LA - eng PT - Journal Article DEP - 20250805 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 SB - IM MH - Humans MH - *Burns/blood/metabolism/complications MH - *Extracellular Vesicles/metabolism MH - Male MH - *Blood Platelets/metabolism MH - Proteomics MH - Female MH - Adult MH - Thrombelastography MH - *Blood Coagulation/physiology MH - Middle Aged MH - Case-Control Studies MH - *Blood Coagulation Disorders/etiology/metabolism MH - Blood Coagulation Tests OTO - NOTNLM OT - Burns OT - Coagulation OT - Platelet extracellular vesicles, PLT-EVs OT - Proteomics COIS- Declaration of Competing Interest The authors declare no conflicts of interest. EDAT- 2025/08/20 18:31 MHDA- 2025/10/17 00:31 CRDT- 2025/08/20 18:01 PHST- 2024/10/02 00:00 [received] PHST- 2025/06/29 00:00 [revised] PHST- 2025/08/04 00:00 [accepted] PHST- 2025/10/17 00:31 [medline] PHST- 2025/08/20 18:31 [pubmed] PHST- 2025/08/20 18:01 [entrez] AID - S0305-4179(25)00280-3 [pii] AID - 10.1016/j.burns.2025.107651 [doi] PST - ppublish SO - Burns. 2025 Nov;51(8):107651. doi: 10.1016/j.burns.2025.107651. Epub 2025 Aug 5. PMID- 40831665 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250822 IS - 2640-1002 (Electronic) IS - 2640-1002 (Linking) VI - 8 IP - 3 DP - 2025 TI - Predicting bleeding risk in PAD patients on antiplatelets using TEG coagulation testing. PG - 335-341 LID - 10.26502/jsr.10020456 [doi] AB - INTRODUCTION: Bleeding is a major concern while using antithrombotic therapy. While Thromboelastography with Platelet Mapping (TEG-PM) predicts postoperative bleeding and platelet dysfunction in trauma, its utility in peripheral artery disease (PAD) remains unclear. Hence, this study aimed to evaluate whether platelet inhibition (PI) and maximum amplitude of adenosine diphosphate (MA ADP) can predict bleeding risk in PAD. METHODS: Patients with PAD undergoing lower extremity revascularization between 2021-2025 were prospectively evaluated and monitored for one year to identify bleeding events. Bleeding events were defined as clinically significant hemorrhages that required medical intervention or transfusion. Patients were stratified based on the occurrence of bleeding, and descriptive statistics characterized each group. The Mann-Whitney U test assessed differences in platelet function, while receiver operating characteristic (ROC) analysis determined the optimal TEG-PM cutoff values for predicting increased bleeding risk. RESULTS: A total of 234 patients were analyzed, of whom 14 (5%) experienced a bleeding event. The bleeding cohort exhibited higher platelet inhibition (94.5% vs. 24.1%; p<0.0001) and lower MA ADP (22.4 vs. 52; p<0.0001), suggesting reduced platelet aggregation and clot strength. ROC analysis revealed platelet inhibition >86.4% (AUC: 0.89, sensitivity: 71%, specificity: 92%) and MA ADP <31.9 (AUC: 0.85, sensitivity: 79%, specificity: 85%) as predictive thresholds for bleeding risk. CONCLUSION: High platelet inhibition (>86.4%) and low MA ADP (<31.9%) may serve as indicators of bleeding risk in PAD patients on antiplatelets, highlighting the potential utility of TEG-PM in guiding personalized antithrombotic management. FAU - Alvarez, Adriana A Rodriguez AU - Alvarez AAR AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA. FAU - Cieri, Isabella Ferlini AU - Cieri IF AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA. FAU - Boya, Mounika AU - Boya M AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA. FAU - Patel, Shiv AU - Patel S AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA. FAU - Dua, Anahita AU - Dua A AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA. LA - eng GR - R21 AG077310/AG/NIA NIH HHS/United States PT - Journal Article DEP - 20250722 PL - United States TA - J Surg Res (Houst) JT - Journal of surgery and research JID - 101768933 PMC - PMC12360087 MID - NIHMS2101261 OTO - NOTNLM OT - Antiplatelet therapy OT - Bleeding risk OT - Hemorrhage OT - Peripheral arterial disease OT - Platelet function testing OT - Revascularization OT - Thromboelastography COIS- Conflict of interest The authors declare no conflicts of interest. EDAT- 2025/08/20 06:30 MHDA- 2025/08/20 06:31 PMCR- 2025/08/19 CRDT- 2025/08/20 04:58 PHST- 2025/08/20 06:31 [medline] PHST- 2025/08/20 06:30 [pubmed] PHST- 2025/08/20 04:58 [entrez] PHST- 2025/08/19 00:00 [pmc-release] AID - 10.26502/jsr.10020456 [doi] PST - ppublish SO - J Surg Res (Houst). 2025;8(3):335-341. doi: 10.26502/jsr.10020456. Epub 2025 Jul 22. PMID- 40819888 OWN - NLM STAT- MEDLINE DCOM- 20251112 LR - 20251112 IS - 1423-0410 (Electronic) IS - 0042-9007 (Linking) VI - 120 IP - 11 DP - 2025 Nov TI - Impact of a rapid blood warmer on the quality and function of cold-stored platelets. PG - 1143-1152 LID - 10.1111/vox.70094 [doi] AB - BACKGROUND AND OBJECTIVES: Pre-hospital critical care faces challenges in carrying platelet concentrates (PC). Cold-stored platelets (CSP) may offer improved haemostatic function over room temperature platelets. Rapid warming of blood products is crucial for hypothermic trauma patients. This study evaluates whether the degrees M Warmer System ( degrees MEQU, Copenhagen), used for red cells and intravenous thrombin receptor activator peptide 6 fluids, affects CSP functionality compared to a standard giving set. MATERIALS AND METHODS: Buffy coat-derived platelets, in a platelet additive solution to plasma ratio of approximately 65:35, were stored at 4 +/- 2 degrees C without agitation for 6 days. A baseline measurement was taken on Day 2. On Day 6, a 'pre-sample' was taken; then CSP were either infused through the degrees MEQU or a standard transfusion-giving set. Platelet function was assessed by aggregation and thromboelastography (TEG). Platelet activation was assessed by CD62P expression, Annexin V binding, microparticle concentration and soluble CD62P concentration. Ten replicates were completed. RESULTS: Neither aggregation nor TEG showed significant differences between PC infused through the standard set or the rapid blood warmer. Soluble CD62P levels were significantly higher in both the standard giving set (26.7 +/- 6.4 ng/mL) and rapid blood warmer (25.9 +/- 5.1 ng/mL) compared to the pre-sample (18.8 +/- 4.8 ng/mL), with no significant difference between the groups. CONCLUSION: The degrees MEQU did not detrimentally affect platelet quality and functionality compared to a standard giving set, suggesting the feasibility for a CSP clinical trial in the pre-hospital environment. CI - (c) 2025 International Society of Blood Transfusion. FAU - Goatson, Sarah AU - Goatson S AD - Welsh Blood Service, Pontyclun, UK. FAU - Nash, Jamie AU - Nash J AUID- ORCID: 0000-0002-5984-6268 AD - Welsh Blood Service, Pontyclun, UK. FAU - Saunders, Christine AU - Saunders C AUID- ORCID: 0000-0002-7010-6068 AD - Welsh Blood Service, Pontyclun, UK. FAU - Pearce, Nicola AU - Pearce N AD - Welsh Blood Service, Pontyclun, UK. FAU - Sayers, Edward J AU - Sayers EJ AUID- ORCID: 0000-0002-2621-1119 AD - Welsh Blood Service, Pontyclun, UK. FAU - Rawlinson, David AU - Rawlinson D AUID- ORCID: 0000-0001-7106-1722 AD - Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK. FAU - Hingston, Christopher AU - Hingston C AD - Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK. FAU - Scorer, Thomas AU - Scorer T AD - Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK. FAU - George, Chloe E AU - George CE AD - Welsh Blood Service, Pontyclun, UK. LA - eng GR - University of the West of England/ GR - Welsh Blood Service/ PT - Journal Article DEP - 20250817 PL - England TA - Vox Sang JT - Vox sanguinis JID - 0413606 RN - 0 (P-Selectin) SB - IM MH - Humans MH - *Blood Platelets/metabolism/cytology MH - *Blood Preservation/methods/instrumentation MH - *Platelet Transfusion/methods MH - Cold Temperature MH - Platelet Activation MH - Male MH - Thrombelastography MH - Platelet Aggregation MH - Female MH - P-Selectin OTO - NOTNLM OT - cold-stored platelet OT - platelet concentrate OT - platelet transfusion OT - pre-hospital transfusion EDAT- 2025/08/18 00:26 MHDA- 2025/11/13 00:30 CRDT- 2025/08/17 21:02 PHST- 2025/07/22 00:00 [revised] PHST- 2025/05/01 00:00 [received] PHST- 2025/07/28 00:00 [accepted] PHST- 2025/11/13 00:30 [medline] PHST- 2025/08/18 00:26 [pubmed] PHST- 2025/08/17 21:02 [entrez] AID - 10.1111/vox.70094 [doi] PST - ppublish SO - Vox Sang. 2025 Nov;120(11):1143-1152. doi: 10.1111/vox.70094. Epub 2025 Aug 17. PMID- 40809622 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250816 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 17 IP - 7 DP - 2025 Jul TI - Comparative Assessment of Thromboelastography and Rotational Thromboelastometry in Trauma-Related Coagulopathy. PG - e87890 LID - 10.7759/cureus.87890 [doi] LID - e87890 AB - Background Trauma-induced coagulopathy (TIC) has a crucial impact on the outcome and death rate in people suffering from trauma. This study aimed to evaluate the speed, reliability, and treatment decisions of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) use in emergency trauma cases. Methods This prospective observational study was used to investigate 60 trauma patients with suspected coagulopathy. TEG and ROTEM measured clot initiation, its formation, strength, and lysis, along with the more common lab coagulation tests (prothrombin time, activated partial thromboplastin time, and platelet counts). All tests were performed to compare blood transfusion status, fibrinogen, antifibrinolytic use, and the timing of surgery. To assess the comparisons, Student's t-test and chi-square analysis were both carried out with a significant p-value of <0.05. Results Both TEG and ROTEM effectively assessed coagulopathy. ROTEM measured results faster, with a mean time of 24 minutes, compared to TEG with a mean time of 31 minutes (p<0.001). It was found that ROTEM resulted in quicker clotting time and clot formation (both p-values were 0.01 and 0.03). Patients under ROTEM treatment were treated and operated on sooner than those in the TEG group. However, there were no significant variations found in transfusion and fibrinogen use in TEG and ROTEM groups. Conclusion Both TEG and ROTEM can give reliable information about trauma patients' coagulopathy. With ROTEM, the results were obtained rapidly, and doctors were able to make clinical decisions faster in critical care cases. Even though clot test results were slightly different, both types of assays helped with better resuscitation for each patient. CI - Copyright (c) 2025, Sta Ines et al. FAU - Sta Ines, Mars Christian A AU - Sta Ines MCA AD - Medical Education and Emergency Medicine, University Hospital Coventry, Coventry, GBR. FAU - Khalid, Usman I AU - Khalid UI AD - Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR. FAU - Shah, Muhmmad H AU - Shah MH AD - Pathology, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK. LA - eng PT - Journal Article DEP - 20250714 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC12345383 OTO - NOTNLM OT - coagulopathy OT - hemostatic techniques OT - mechanical OT - thromboelastography OT - trauma OT - viscoelastic testing COIS- Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Federal PGMI and PU Lahore, including issued approval (Ref: 1433-22SBS). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2025/08/14 06:28 MHDA- 2025/08/14 06:29 PMCR- 2025/07/14 CRDT- 2025/08/14 05:26 PHST- 2025/07/12 00:00 [accepted] PHST- 2025/08/14 06:29 [medline] PHST- 2025/08/14 06:28 [pubmed] PHST- 2025/08/14 05:26 [entrez] PHST- 2025/07/14 00:00 [pmc-release] AID - 10.7759/cureus.87890 [doi] PST - epublish SO - Cureus. 2025 Jul 14;17(7):e87890. doi: 10.7759/cureus.87890. eCollection 2025 Jul. PMID- 40786332 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250813 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 17 IP - 7 DP - 2025 Jul TI - Rapid Thromboelastography Identifies Coagulopathy and Predicts Poor Outcomes in Severe Traumatic Brain Injury. PG - e87710 LID - 10.7759/cureus.87710 [doi] LID - e87710 AB - Introduction Traumatic brain injury (TBI) occurs when a force transmitted to the head or body results in neuropathologic damage and dysfunction. Approximately 25% of patients with TBI present with coagulopathy on admission, which is associated with increased mortality. Viscoelastic methods like rapid thromboelastography (r-TEG) and rotational thromboelastometry may be precise in identifying the coagulopathic changes in these patients. The objective of this study is to assess r-TEG in patients with severe TBI (sTBI). Methods This was a single-center cross-sectional study conducted in a 2059-bedded level 1 trauma center. Patients over 18 years of age who presented with sTBI [Glasgow Coma Scale (GCS), /=60% on TEG-PM. RESULTS: Between December 2019 and December 2021, 768 patients underwent TEG-PM. AA inhibition was more likely to occur in mBIG 3 patients (26.3%) compared to mBIG 1 or mBIG 2 patients (P = 0.08),. ADP and combined AA/ADP inhibition were similar between mBIG scores. Modified BIG 3 patients were more likely to experience bleed progression compared to mBIG 1 or 2 (46.4%; P < 0.001) and to require neurosurgical intervention (16.5%; p < 0.001). DISCUSSION: Our study suggests that the higher the mBIG scores, the more likely patients will have worse outcomes regardless of platelet inhibition. Patients with TBI who experience worse outcomes is multifactorial in nature. TEG-PM should be used in conjunction with clinical judgement for treatment guidance. FAU - Parmer, Hunter W AU - Parmer HW AUID- ORCID: 0000-0002-6897-1773 AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Miles, M Victoria P AU - Miles MVP AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Hicks, Chace AU - Hicks C AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Favors, Lauren E AU - Favors LE AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Rippy, Meredith AU - Rippy M AD - Erlanger Health System, Chattanooga, TN, USA. RINGGOLD: 2362 FAU - Wilson, Andrew AU - Wilson A AD - Department of Mathematics, University of Tennessee Chattanooga, TN, USA. FAU - Edwards, Abigail AU - Edwards A AD - University of Tennessee College of Medicine, Memphis, TN, USA. RINGGOLD: 12325 FAU - Stewart, Kathryn AU - Stewart K AD - Erlanger Health System, Chattanooga, TN, USA. RINGGOLD: 2362 FAU - Maxwell, Robert A AU - Maxwell RA AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, TN, USA. RINGGOLD: 70274 LA - eng PT - Journal Article DEP - 20250731 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Humans MH - *Brain Injuries, Traumatic/complications/blood MH - Male MH - Retrospective Studies MH - Female MH - Thrombelastography MH - Middle Aged MH - Adult MH - Aged MH - *Intracranial Hemorrhages/etiology/blood OTO - NOTNLM OT - acute care surgery OT - trauma OT - trauma acute care COIS- Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2025/07/31 18:28 MHDA- 2026/01/09 07:06 CRDT- 2025/07/31 15:32 PHST- 2026/01/09 07:06 [medline] PHST- 2025/07/31 18:28 [pubmed] PHST- 2025/07/31 15:32 [entrez] AID - 10.1177/00031348251363523 [doi] PST - ppublish SO - Am Surg. 2026 Feb;92(2):345-352. doi: 10.1177/00031348251363523. Epub 2025 Jul 31. PMID- 40739783 OWN - NLM STAT- MEDLINE DCOM- 20250916 LR - 20250916 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 65 IP - 9 DP - 2025 Sep TI - Adherence to local rotational thromboelastometry recommendations in the care of trauma patients: A retrospective cohort study. PG - 1716-1727 LID - 10.1111/trf.18349 [doi] AB - BACKGROUND: Rotational thromboelastometry (ROTEM) is a blood test that measures hemostatic parameters to guide hemostatic therapy. ROTEM outputs can be cognitively challenging to interpret, which may limit adherence in trauma care. Our objective was to assess hemostatic therapy administration adherence to local ROTEM recommendations. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of trauma patients receiving ROTEM testing at a level 1 trauma center between January 1st 2017, and December 31st 2021. Adherence to local ROTEM best practices was determined by comparing the blood products patients received after a patient's first ROTEM test to those that should have been administered based on their ROTEM results. Multivariable logistic regression models were used to determine the association between clinical and patient covariates with ROTEM adherence and between ROTEM adherence and in-hospital mortality. RESULTS: Only 46.6% (n = 208/446) of patients had complete adherence to ROTEM recommendations. Product-specific adherence was lower when product initiation was recommended (vs. not) by ROTEM. A greater number of ROTEM abnormalities (odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.05-0.19) and a higher injury severity score (OR: 0.96, 95% CI: 0.94-0.98) reduced adherence. Adherence to ROTEM did not reduce in-hospital mortality (OR: 0.71, 95% CI: 0.35-1.41). The number of ROTEM abnormalities was associated with in-hospital mortality (OR: 3.07, 95% CI: 2.01-4.77). DISCUSSION: We found moderate adherence to admission ROTEM recommendations with lower adherence for more severely injured patients. The number of ROTEM abnormalities increased the odds of in-hospital mortality. Quantifying adherence is valuable for understanding ROTEM implementations in trauma care. CI - (c) 2025 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB. FAU - Harish, Vinyas AU - Harish V AUID- ORCID: 0000-0001-6364-2439 AD - Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. AD - Institute for Health Policy, Evaluation, and Management, University of Toronto, Toronto, Canada. FAU - Postill, Gemma AU - Postill G AUID- ORCID: 0000-0001-6185-995X AD - Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. AD - Institute for Health Policy, Evaluation, and Management, University of Toronto, Toronto, Canada. FAU - Al-Haimus, Fayad AU - Al-Haimus F AD - Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. AD - Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - McGowan, Melissa AU - McGowan M AD - Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. FAU - Pavenski, Katerina AU - Pavenski K AUID- ORCID: 0000-0001-6700-5197 AD - Department of Laboratory Medicine, Unity Health Toronto, Toronto, Ontario, Canada. AD - Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada. FAU - Beckett, Andrew AU - Beckett A AUID- ORCID: 0000-0002-4943-9415 AD - Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada. AD - Division of General Surgery, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. FAU - Sholzberg, Michelle AU - Sholzberg M AD - Department of Laboratory Medicine, Unity Health Toronto, Toronto, Ontario, Canada. AD - Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada. FAU - Nolan, Brodie AU - Nolan B AUID- ORCID: 0000-0003-2872-0643 AD - Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. AD - Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article DEP - 20250730 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Retrospective Studies MH - Female MH - Male MH - *Wounds and Injuries/therapy/blood/mortality MH - Middle Aged MH - Adult MH - *Guideline Adherence MH - Trauma Centers MH - Hospital Mortality MH - Aged PMC - PMC12432809 COIS- The authors have no relevant conflicts of interest to disclose. EDAT- 2025/07/31 06:27 MHDA- 2025/09/16 18:32 PMCR- 2025/09/13 CRDT- 2025/07/31 01:53 PHST- 2025/07/02 00:00 [revised] PHST- 2024/10/14 00:00 [received] PHST- 2025/07/03 00:00 [accepted] PHST- 2025/09/16 18:32 [medline] PHST- 2025/07/31 06:27 [pubmed] PHST- 2025/07/31 01:53 [entrez] PHST- 2025/09/13 00:00 [pmc-release] AID - TRF18349 [pii] AID - 10.1111/trf.18349 [doi] PST - ppublish SO - Transfusion. 2025 Sep;65(9):1716-1727. doi: 10.1111/trf.18349. Epub 2025 Jul 30. PMID- 40728979 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250802 IS - 1467-3045 (Electronic) IS - 1467-3037 (Print) IS - 1467-3037 (Linking) VI - 47 IP - 7 DP - 2025 Jul 2 TI - CD63 Immunological Activation Versus Hemostatic Function: Platelet Alterations After Polytrauma. LID - 10.3390/cimb47070510 [doi] LID - 510 AB - Platelets are attributed an increasing role in the post-traumatic immune response. The exact mechanisms, particularly the link between immune response and hemostasis, have not been conclusively established. This study aimed to investigate the activity marker CD63 on platelets after polytrauma and its significance for hemostasis. A non-interventional, prospective clinical study was conducted, in which the blood of 20 polytraumatized patients was analyzed at nine time points within 10 days following trauma. Peripheral blood platelets were analyzed using flow cytometry to determine CD63 expression and rotational thromboelastometry (ROTEM((R))) for hemostatic platelet function. Additionally, the clinical parameters of age, gender, and injury severity were correlated to the experimental outcomes. During the observation period, an increase in platelet count and CD63 expression was observed. Simultaneously, a hemostasiological dysfunction with reduced platelet maximum clot firmness (MCF) was observed. The factors of age, gender, and injury severity showed no significant influence on immunological activation or coagulation function. These results suggest that polytrauma induces a platelet response and CD63 activation while simultaneously impairing hemostasis. This reveals a novel perspective on post-traumatic coagulation disorders, indicating that immunologically active platelets may lose their ability to contribute effectively to blood clotting. Consequently, these findings emphasize the critical role of platelet immunology in hemostatic regulation. FAU - Roemmermann, Gregor AU - Roemmermann G AUID- ORCID: 0009-0009-0572-3068 AD - Department of Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Bohe, Olivia AU - Bohe O AUID- ORCID: 0000-0003-0227-4016 AD - Department of Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Heimann, Laura AU - Heimann L AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Wirth, Franziska AU - Wirth F AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Drumm, Franziska AU - Drumm F AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Biberthaler, Peter AU - Biberthaler P AD - Department of Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Moog, Philipp AU - Moog P AD - Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Schwenk, Christina AU - Schwenk C AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Muehlhaupt, Nadja AU - Muehlhaupt N AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Wan, Li AU - Wan L AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. FAU - Hanschen, Marc AU - Hanschen M AUID- ORCID: 0000-0002-2683-9870 AD - Department of Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, TUM University Hospital, School of Medicine, Technical University of Munich, 81675 Munich, Germany. LA - eng PT - Journal Article DEP - 20250702 PL - Switzerland TA - Curr Issues Mol Biol JT - Current issues in molecular biology JID - 100931761 PMC - PMC12294029 OTO - NOTNLM OT - CD63 OT - hemostasis OT - immune response OT - platelet activation OT - platelet function OT - polytrauma OT - post-traumatic coagulation disorders COIS- The authors declare no conflicts of interest. EDAT- 2025/07/29 18:31 MHDA- 2025/07/29 18:32 PMCR- 2025/07/02 CRDT- 2025/07/29 12:54 PHST- 2025/05/26 00:00 [received] PHST- 2025/06/21 00:00 [revised] PHST- 2025/06/26 00:00 [accepted] PHST- 2025/07/29 18:32 [medline] PHST- 2025/07/29 18:31 [pubmed] PHST- 2025/07/29 12:54 [entrez] PHST- 2025/07/02 00:00 [pmc-release] AID - cimb47070510 [pii] AID - cimb-47-00510 [pii] AID - 10.3390/cimb47070510 [doi] PST - epublish SO - Curr Issues Mol Biol. 2025 Jul 2;47(7):510. doi: 10.3390/cimb47070510. PMID- 40720740 OWN - NLM STAT- MEDLINE DCOM- 20251112 LR - 20260715 IS - 1559-0488 (Electronic) IS - 1559-047X (Linking) VI - 46 IP - 6 DP - 2025 Nov 5 TI - American Burn Association Clinical Practice Guideline on Blood Product Transfusion in Burn Care. PG - 1155-1170 LID - 10.1093/jbcr/iraf021 [doi] AB - This Clinical Practice Guideline addresses blood product transfusion among hospitalized acutely burned adults. The Investigator Panel, consisting of the authors of this paper, developed clinically relevant questions in PICO format (Population, Intervention, Comparator, Outcome). These questions informed a systematic literature search which returned 1947 titles, of which 10 articles met the criteria for inclusion and critical review. We strongly recommend the use of a restrictive red blood cell (RBC) transfusion threshold (hemoglobin level >/= 7 g/dL), to reduce the number of blood transfusions administered to adults with burns >/= 20% total burn surface area (TBSA). We also recommend a restrictive RBC transfusion threshold because the outcomes of infection, length of stay, and mortality are no worse than with liberal RBC transfusion thresholds (hemoglobin level >/= 10 g/dL), while transfusing less blood. We make a weak recommendation to not use recombinant human erythropoietin to reduce the number of RBC transfusions. We make a weak conditional recommendation to consider the use of intraoperative intravenous tranexamic acid during major burn wound excision, to reduce the number of perioperative blood transfusions, preferably in conjunction with performing dynamic viscoelastic testing in this setting. We recommend that in the perioperative period during major burn debridement, thromboelastography and rotation thromboelastometry be used to guide blood product transfusion, to reduce the overall amount of blood product transfusion. No recommendation could be made on the use of a 1:1:1 RBC to fresh frozen plasma to platelet transfusion strategy to decrease the number of RBC transfusions or mortality in adult burn patients undergoing surgical burn wound excision. CI - (c) The Author(s) 2025. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. FAU - Wallace, David AU - Wallace D AUID- ORCID: 0000-0002-1564-9027 AD - Ross Tilley Burn Centre and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Lavrentieva, Athina AU - Lavrentieva A AUID- ORCID: 0000-0002-6605-287X AD - Papanikolaou Hospital, A-ICU & Burn ICU, Thessaloniki, Greece. FAU - Romanowski, Kathleen S AU - Romanowski KS AUID- ORCID: 0000-0002-4431-2423 AD - University of California Davis, Department of Surgery and Shriners Hospitals for Children Northern California, Sacramento, CA, United States. FAU - Shupp, Jeffrey W AU - Shupp JW AUID- ORCID: 0000-0002-4394-6416 AD - MedStar Washington Hospital Center Burn Center and Department of Surgery, Georgetown University, Washington, DC, United States. FAU - Cartotto, Robert AU - Cartotto R AUID- ORCID: 0000-0002-1357-6397 AD - Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Main, Emilia AU - Main E AD - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. FAU - Palmieri, Tina L AU - Palmieri TL AUID- ORCID: 0000-0001-6340-1715 AD - University of California Davis, Department of Surgery and Shriners Hospitals for Children Northern California, Sacramento, CA, United States. LA - eng PT - Journal Article PT - Practice Guideline PL - England TA - J Burn Care Res JT - Journal of burn care & research : official publication of the American Burn Association JID - 101262774 SB - IM MH - Humans MH - *Burns/therapy MH - *Blood Transfusion/standards MH - Erythrocyte Transfusion MH - United States MH - Adult MH - *Blood Component Transfusion OTO - NOTNLM OT - blood OT - blood products OT - burn OT - erythropoietin OT - tranexamic acid OT - transfusion EDAT- 2025/07/28 19:03 MHDA- 2025/11/12 23:29 CRDT- 2025/07/28 16:05 PHST- 2025/01/03 00:00 [received] PHST- 2025/02/19 00:00 [revised] PHST- 2025/11/12 23:29 [medline] PHST- 2025/07/28 19:03 [pubmed] PHST- 2025/07/28 16:05 [entrez] AID - 8213810 [pii] AID - 10.1093/jbcr/iraf021 [doi] PST - ppublish SO - J Burn Care Res. 2025 Nov 5;46(6):1155-1170. doi: 10.1093/jbcr/iraf021. PMID- 40712062 OWN - NLM STAT- MEDLINE DCOM- 20260127 LR - 20261023 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 100 IP - 2 DP - 2026 Feb 1 TI - Coagulation factor XIII: An unrecognized regulator of fibrinolytic phenotypes in trauma-A potential link to cysteine cathepsin degradation of plasminogen. PG - 271-280 LID - 10.1097/TA.0000000000004706 [doi] AB - BACKGROUND: Trauma-induced coagulopathy (TIC) has distinct fibrinolytic phenotypes based on viscoelastic testing. The underlying mechanisms behind differences in fibrinolytic responses to trauma are unclear. We hypothesized that plasma proteins crosslinked into fibrin clots by the transglutaminase activity of factor XIII (FXIII) may explain tissue-type plasminogen activator (tPA) responsiveness observed in fibrinolysis shutdown. METHODS: Plasma samples from trauma patients were categorized into four fibrinolytic phenotypes (hyperfibrinolysis, hypofibrinolysis, fibrinolysis shutdown, and physiologic fibrinolysis) based on rapid thromboelastography and tPA-enhanced thromboelastography. Plasma underwent liquid chromatography-mass spectrometry proteomics for substrates of FXIII, evaluation for FXIII concentration/activity, and Western blotting to confirm proteomic findings. In vitro studies assessed cysteine cathepsin-mediated proteolysis of fibrinolytic and clot-related proteins. RESULTS: Plasma proteomic analysis identified differences in levels of four proteins known to be crosslinked into fibrin in fibrinolysis shutdown patients. Patients with shutdown exhibited significantly higher plasma FXIII activity compared with other phenotypes. Because FXIII crosslinks protease inhibitors to fibrin, we studied inflammatory cysteine cathepsins' ability to degrade fibrinolytic proteins. Cysteine cathepsins degraded coagulation and fibrinolytic proteins in vitro, including plasminogen, tPA, and fibrinogen. Cathepsin L exposure completely disrupted ex vivo fibrin clot formation and impaired fibrinolytic enzyme function, highlighting its potential multifaceted role in TIC pathophysiology. CONCLUSION: Elevated FXIII activity and protease inhibitor incorporation into fibrin clots may regulate fibrinolysis shutdown in trauma patients with fibrinolysis shutdown by inhibiting cysteine cathepsin activity. These findings identify FXIII and cysteine cathepsins as possible contributors to TIC that should be studied further. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Moore, Peter K AU - Moore PK AUID- ORCID: 0000-0001-6446-067 AD - From the Department of Medicine (P.K.M.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Surgery (E.E.M., A.S., J.C.), Denver Health Medical Center, Denver, Colorado; Department of Medicine (R.G., W.J.J.), National Jewish Health, Denver, Colorado; Department of Structural Biology and Biochemistry (K.H.), University of Colorado Anschutz Medical Center, Aurora, Colorado; Department of Surgery (C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; and Department of Surgery (H.B.M.), Advent Health, Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Garner, Raleigh AU - Garner R FAU - Hansen, Kirk AU - Hansen K FAU - Barrett, Christopher D AU - Barrett CD FAU - Sauaia, Angela AU - Sauaia A FAU - Chandler, James AU - Chandler J FAU - Janssen, William J AU - Janssen WJ FAU - Moore, Hunter B AU - Moore HB LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20250725 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9013-56-3 (Factor XIII) RN - 9001-91-6 (Plasminogen) RN - EC 3.4.- (Cathepsins) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - K848JZ4886 (Cysteine) SB - IM MH - Humans MH - *Factor XIII/metabolism/physiology MH - *Fibrinolysis/physiology MH - *Wounds and Injuries/blood/complications MH - Thrombelastography MH - Male MH - Phenotype MH - Proteomics MH - Female MH - *Plasminogen/metabolism MH - Adult MH - *Blood Coagulation Disorders/etiology/blood MH - Middle Aged MH - *Cathepsins/metabolism MH - Tissue Plasminogen Activator/metabolism MH - Cysteine/metabolism OTO - NOTNLM OT - MENT protein OT - Trauma-induced coagulopathy OT - cysteine proteases OT - factor XIII OT - fibrinolysis shutdown EDAT- 2025/07/25 18:27 MHDA- 2026/01/27 12:59 CRDT- 2025/07/25 14:23 PHST- 2025/01/21 00:00 [received] PHST- 2025/05/12 00:00 [accepted] PHST- 2026/01/27 12:59 [medline] PHST- 2025/07/25 18:27 [pubmed] PHST- 2025/07/25 14:23 [entrez] AID - 01586154-202602000-00016 [pii] AID - 10.1097/TA.0000000000004706 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2026 Feb 1;100(2):271-280. doi: 10.1097/TA.0000000000004706. Epub 2025 Jul 25. PMID- 40700333 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250926 IS - 2673-1991 (Electronic) IS - 2673-1991 (Linking) VI - 6 IP - 3 DP - 2025 Jun 24 TI - It Is Written in the Clot: Coagulation Assessment in Severe Burn Injury. LID - 10.3390/ebj6030037 [doi] LID - 37 AB - BACKGROUND: Coagulopathy in severe burn injury is associated with complications and mortality. METHODS: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. RESULTS: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. CONCLUSIONS: CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality. FAU - Nikolaidou, Eirini AU - Nikolaidou E AUID- ORCID: 0000-0003-2367-1248 AD - Department of Plastic, Reconstructive and Hand Surgery & Burns ICU, "George Papanikolaou" General Hospital, 57010 Thessaloniki, Greece. FAU - Lazaridou, Andriana AU - Lazaridou A AUID- ORCID: 0000-0001-6261-3708 AD - Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, "George Papanikolaou" General Hospital, 57010 Thessaloniki, Greece. FAU - Iasonidou, Christina AU - Iasonidou C AD - 2nd Department of Intensive Care Medicine, "George Papanikolaou" General Hospital, 57010 Thessaloniki, Greece. FAU - Tsaroucha, Alexandra AU - Tsaroucha A AD - Second Department of Surgery, Laboratory of Experimental Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece. FAU - Papadopoulou, Sophia AU - Papadopoulou S AUID- ORCID: 0000-0001-9151-6413 AD - Department of Plastic, Reconstructive and Hand Surgery & Burns ICU, "George Papanikolaou" General Hospital, 57010 Thessaloniki, Greece. FAU - Kaldoudi, Eleni AU - Kaldoudi E AUID- ORCID: 0000-0002-6054-4961 AD - Medical Physics and Medical Informatics, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece. FAU - Sovatzidis, Apostolos AU - Sovatzidis A AUID- ORCID: 0000-0002-2859-0845 AD - Department of Surgery, General Hospital of Giannitsa, 58100 Pella, Greece. FAU - Kakagia, Despoina AU - Kakagia D AUID- ORCID: 0000-0003-2107-6170 AD - Department of Plastic and Reconstructive Surgery, Democritus University Hospital, 68100 Alexandroupolis, Greece. LA - eng PT - Journal Article DEP - 20250624 PL - Switzerland TA - Eur Burn J JT - European burn journal JID - 9918609778106676 PMC - PMC12285928 OTO - NOTNLM OT - blood coagulation disorders OT - blood coagulation factors OT - blood coagulation tests OT - burns COIS- The authors declare no conflict of interest. EDAT- 2025/07/23 18:28 MHDA- 2025/07/23 18:29 PMCR- 2025/06/24 CRDT- 2025/07/23 13:05 PHST- 2025/04/08 00:00 [received] PHST- 2025/06/08 00:00 [revised] PHST- 2025/06/17 00:00 [accepted] PHST- 2025/07/23 18:29 [medline] PHST- 2025/07/23 18:28 [pubmed] PHST- 2025/07/23 13:05 [entrez] PHST- 2025/06/24 00:00 [pmc-release] AID - ebj6030037 [pii] AID - ebj-06-00037 [pii] AID - 10.3390/ebj6030037 [doi] PST - epublish SO - Eur Burn J. 2025 Jun 24;6(3):37. doi: 10.3390/ebj6030037. PMID- 40691642 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20260925 IS - 2047-0525 (Print) IS - 2047-0525 (Electronic) IS - 2047-0525 (Linking) VI - 14 IP - 1 DP - 2025 Jul 21 TI - The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study with historical control. PG - 75 LID - 10.1186/s13741-025-00562-4 [doi] LID - 75 AB - BACKGROUND: Despite advances in treatment, hemorrhage remains one of the leading causes of early death in trauma. Rapid, personalized treatment of coagulopathy in this population should therefore be a priority. The introduction of viscoelastic hemostatic assays may improve transfusion strategies. METHODS: This prospective observational study aimed to compare the efficacy of a ROTEM-guided hemostatic treatment protocol for trauma patients with a historical control group who had received conventional coagulation testing. The study included adults with multiple trauma requiring transfusion (>/= 1 unit of RBC within 12 h). The aim was to compare transfusion requirements in the operating room, on the 1st and 2nd ICU days, the rate of massive transfusion, and the overall outcome. The data obtained were stored in a database and analyzed using Statistica 13.3 (Stat Soft Polska). A p-value < 0.05 was considered significant. Study was registered retrospectively at researchregistry.com (RR10995). RESULTS: A total of 78 patients were compared. The number of RBC units transfused in the OR and on the 1st ICU day decreased significantly after implementation of the ROTEM treatment protocol (p = 0.01, p = 0.04). Fewer patients in the study group required RBC transfusion on the 1st and 2nd ICU days (p = 0.01, p = 0.003), as well as the number of patients requiring FFP transfusion in all examined periods of time (p = 0.02, p = 0.006, p = 0.01). While FFP use per patient in the OR and on the 1st ICU day was lower, it was not statistically significant. Fibrinogen substitution in the OR remained similar, but more patients from the study group received it on the 1st ICU day (13 vs. 5, p = 0.04). The need for other blood products and coagulation factors remained unchanged. MT incidence decreased significantly in the first 24 h (p = 0.02), while 30-day mortality remained unchanged. CONCLUSIONS: The introduction of the ROTEM- guided hemostatic treatment protocol in trauma resulted in a changes in transfusion requirements and a reduction in the incidence of MT. ROTEM can be a useful clinical tool in the rapid and targeted management of bleeding trauma patients. TRIAL REGISTRATION: Researchregistry.com (RR10995). CI - (c) 2025. The Author(s). FAU - Kozera, Natalia AU - Kozera N AD - Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland. natalia.kozera@umw.edu.pl. FAU - Welna, Marek AU - Welna M AD - Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland. FAU - Gozdzik, Waldemar AU - Gozdzik W AD - Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland. LA - eng PT - Journal Article DEP - 20250721 PL - England TA - Perioper Med (Lond) JT - Perioperative medicine (London, England) JID - 101609072 PMC - PMC12281821 OTO - NOTNLM OT - Hemorrhage OT - Major trauma OT - ROTEM OT - Rotational thromboelastometry COIS- Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Bioethics Committee at Wroclaw Medical University (approval number KB-610/2016 dated 14.12.2016, extension approval number KB-685/2017 dated 02.11.2017). During the course of the study, the ROTEM guided hemostatic treatment protocol was implemented as the local standard of care. Patient consent was waived due to the observational character of the study. Nevertheless, as soon as their general condition became stable, patients in the study group were informed about the study and asked to provide written informed consent. In case of death, next of kin were contacted. Consent for publication: Not applicable. Competing interests: Natalia Kozera received lecture fees from Octapharma AG company. Marek Welna and Waldemar Gozdzik declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. EDAT- 2025/07/22 00:25 MHDA- 2025/07/22 00:26 PMCR- 2025/07/21 CRDT- 2025/07/21 23:37 PHST- 2025/02/06 00:00 [received] PHST- 2025/07/09 00:00 [accepted] PHST- 2025/07/22 00:26 [medline] PHST- 2025/07/22 00:25 [pubmed] PHST- 2025/07/21 23:37 [entrez] PHST- 2025/07/21 00:00 [pmc-release] AID - 10.1186/s13741-025-00562-4 [pii] AID - 562 [pii] AID - 10.1186/s13741-025-00562-4 [doi] PST - epublish SO - Perioper Med (Lond). 2025 Jul 21;14(1):75. doi: 10.1186/s13741-025-00562-4. PMID- 40690085 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250724 IS - 2191-219X (Print) IS - 2191-219X (Electronic) IS - 2191-219X (Linking) VI - 15 IP - 1 DP - 2025 Jul 21 TI - Evaluation of myocardial fibrosis and wall motion abnormality with (68)Ga-FAPI PET/MR in coronary heart disease. PG - 89 LID - 10.1186/s13550-025-01246-2 [doi] LID - 89 AB - BACKGROUND: To explore the characteristics of cardiac fibroblast activation protein inhibitor (FAPI) PET/MR in coronary heart disease (CHD) and its association with abnormal wall motion. RESULTS: In this prospective study, participants with CHD after PCI (Percutaneous Coronary Intervention) underwent gallium 68 ((68) Ga)-labeled FAPI PET/MR imaging. FAP signal was quantified using standardized uptake values. Cardiac MRI yielded functional parameters and area of injury (MRI non-viable). Abnormal wall motion identified by myocardial strain analysis was evaluated using integrated analysis of late gadolinium enhancement (LGE) and FAP signal. The correlations between FAP signal and clinical parameters were explored. Forty-two participants were included and FAP signal was higher in left ventricle regional myocardium compared with remote normal areas (SUVmax, 5.0 +/- 1.8 vs 1.2 +/- 0.4; p < .001). In total, 432 segments (432/714, 60.50%) displayed impaired wall motion. In integrated analysis, the highest wall motion abnormality score was observed in the FAPI active/MRI non-viable group (11.0 +/- 5.2). FAP signal was positively correlated with K time (SUVpeak: R = 0.48; p = .046; SUVmean: R = 0.57; p = .014) and negatively correlated with Angle (SUVpeak: R = - 0.52; p = .026; SUVmean: R = - 0.56; p = .026) in thromboelastography. Immunohistochemical analysis revealed FAP-positive fibroblasts in the infarct and border zone, and robust expression of alpha-smooth muscle actin and vimentin. CONCLUSIONS: Simultaneous (68) Ga- FAPI PET/MR offers novel insights into the regional pattern of fibroblast activation in CHD, and the fibroblast activation protein signal is associated with abnormal wall motion. Trial registration ClinicalTrials: ClinicalTrials.gov ID: NCT05867589. Registered 01 May 2023, https://clinicaltrials.gov/study/NCT05867589. CI - (c) 2025. The Author(s). FAU - Luo, Rui AU - Luo R AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Zhao, Zhenyu AU - Zhao Z AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Zhang, Chuan AU - Zhang C AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Li, Ru-Shuai AU - Li RS AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Wang, Yanrong AU - Wang Y AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Meng, Qingle AU - Meng Q AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Ni, Yudan AU - Ni Y AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Wang, Bolin AU - Wang B AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Li, Lanhua AU - Li L AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Feng, Luan AU - Feng L AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Yang, Rui AU - Yang R AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Xie, Lin AU - Xie L AD - Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan. FAU - Chen, Xin AU - Chen X AD - Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. FAU - Zhang, Ming-Rong AU - Zhang MR AD - Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan. zhang.ming-rong@qst.go.jp. FAU - Wang, Feng AU - Wang F AUID- ORCID: 0000-0003-1089-3095 AD - Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China. fengwangcn@hotmail.com. LA - eng SI - ClinicalTrials.gov/NCT05867589 GR - JSDW202247/Jiangsu Provincial Medical Key Discipline Cultivation Unit/ GR - BE2017612/Jiangsu Provincial Key Research and Development Special Fund/ GR - 201911042/Nanjing Medical and Health International Joint Research and Development Project/ GR - NMUB2019154/General Project of Science and Technology Development Fund of Nanjing Medical University/ GR - 82003532/National Natural Science Foundation of China/ GR - 2021HYX009/Nuclear Medicine Laboratory Open Project/ PT - Journal Article DEP - 20250721 PL - Germany TA - EJNMMI Res JT - EJNMMI research JID - 101560946 PMC - PMC12279661 OTO - NOTNLM OT - Fibroblast activation protein (FAP) OT - Late gadolinium enhancement (LGE) OT - PET/MR COIS- Declarations. Ethics approval and consent to participate: This prospective study was approved by the institutional Ethics Committee of Nanjing First Hospital (identification no. KY20230428-02) and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. EDAT- 2025/07/21 12:40 MHDA- 2025/07/21 12:41 PMCR- 2025/07/21 CRDT- 2025/07/21 11:19 PHST- 2024/10/02 00:00 [received] PHST- 2025/04/25 00:00 [accepted] PHST- 2025/07/21 12:41 [medline] PHST- 2025/07/21 12:40 [pubmed] PHST- 2025/07/21 11:19 [entrez] PHST- 2025/07/21 00:00 [pmc-release] AID - 10.1186/s13550-025-01246-2 [pii] AID - 1246 [pii] AID - 10.1186/s13550-025-01246-2 [doi] PST - epublish SO - EJNMMI Res. 2025 Jul 21;15(1):89. doi: 10.1186/s13550-025-01246-2. PMID- 40683811 OWN - NLM STAT- MEDLINE DCOM- 20260824 LR - 20260824 IS - 0929-6646 (Print) IS - 0929-6646 (Linking) VI - 125 IP - 9 DP - 2026 Sep TI - Current controversies and advances in massive transfusion: Balancing evidence and practice. PG - 1066-1073 LID - S0929-6646(25)00383-3 [pii] LID - 10.1016/j.jfma.2025.07.016 [doi] AB - Massive transfusion protocols (MTPs) are essential frameworks for rapidly managing severe hemorrhage, particularly in trauma scenarios. This review addresses ongoing controversies and advancements in MTPs, including optimal blood product ratios, the role of viscoelastic hemostatic assays (VHAs), renewed interest in whole blood transfusions, and distinctions between civilian and military practices. Current evidence supports balanced transfusion strategies (approximately 1:1:1 ratios of plasma:platelets: red blood cells), significantly improving early hemorrhage control, though individual patient variability remains under investigation. Viscoelastic tests like TEG and ROTEM offer real-time clot assessment, allowing individualized treatment. However, evidence from randomized trials, such as ITACTIC, reveals mixed outcomes, limiting consensus on widespread implementation. Whole blood transfusions, previously eclipsed by component therapy, are gaining traction due to demonstrated survival benefits, logistical simplicity, and fewer transfusions needed. Military experiences significantly influence civilian practices, demonstrating survival improvements with early and aggressive blood product use. Despite general agreement on balanced transfusion as the cornerstone of massive hemorrhage management, ongoing studies emphasize refining protocols, optimizing implementation speed, and tailoring strategies to patient-specific conditions. Future directions will likely integrate precision medicine approaches and advanced diagnostics to enhance patient outcomes in massive hemorrhage scenarios. CI - Copyright (c) 2026 Formosan Medical Association. Published by Elsevier B.V. All rights reserved. FAU - Lin, Ting-Lung AU - Lin TL AD - Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan. Electronic address: u301018@ms28.hinet.net. FAU - Liu, Hang-Tsung AU - Liu HT AD - Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan. Electronic address: htl1688@yahoo.com.tw. FAU - Hsieh, Ching-Hua AU - Hsieh CH AD - Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan. Electronic address: m93chinghua@gmail.com. LA - eng PT - Journal Article PT - Review DEP - 20250718 PL - Singapore TA - J Formos Med Assoc JT - Journal of the Formosan Medical Association = Taiwan yi zhi JID - 9214933 SB - IM MH - Humans MH - *Blood Transfusion/methods MH - *Hemorrhage/therapy MH - *Wounds and Injuries/complications/therapy MH - Hemostasis OTO - NOTNLM OT - Hemorrhage control OT - Massive transfusion OT - Trauma OT - Viscoelastic assay OT - Whole blood COIS- Conflicts of interest The authors affirm that they do not have any competing interests. EDAT- 2025/07/20 04:03 MHDA- 2026/08/24 23:34 CRDT- 2025/07/19 21:58 PHST- 2025/05/15 00:00 [received] PHST- 2025/06/29 00:00 [revised] PHST- 2025/07/16 00:00 [accepted] PHST- 2026/08/24 23:34 [medline] PHST- 2025/07/20 04:03 [pubmed] PHST- 2025/07/19 21:58 [entrez] AID - S0929-6646(25)00383-3 [pii] AID - 10.1016/j.jfma.2025.07.016 [doi] PST - ppublish SO - J Formos Med Assoc. 2026 Sep;125(9):1066-1073. doi: 10.1016/j.jfma.2025.07.016. Epub 2025 Jul 18. PMID- 40629245 OWN - NLM STAT- MEDLINE DCOM- 20251009 LR - 20251011 IS - 1936-0541 (Electronic) IS - 1936-0533 (Print) IS - 1936-0533 (Linking) VI - 19 IP - 5 DP - 2025 Oct TI - Advances in the prevention and management of procedural bleeding in patients with cirrhosis. PG - 1035-1050 LID - 10.1007/s12072-025-10834-2 [doi] AB - INTRODUCTION: Patients with cirrhosis frequently require procedures and are at risk of bleeding related to interventions. Procedural bleeding adversely impacts patients with cirrhosis and is associated with mortality. Assessment of bleeding risk in these patients is complex due to changes in hemostasis, portal hypertension, elevated thrombosis risk, and comorbid infection and renal disease. This clinical review will discuss current data regarding risk assessment, prevention, and management of procedural bleeding in patients with cirrhosis. DISCUSSION: Risk of procedural bleeding in patients with cirrhosis involves patient-related and procedure-related factors. Conventional hemostasis parameters such as prothrombin time and platelet count are not predictive of bleeding in cirrhosis and may lead providers to overestimate bleeding risk. Hepatic decompensation, kidney injury, metabolic syndrome, alcohol use, and infections are all associated with increased bleeding risk. Procedure type, urgency, and operator experience also influence procedural bleeding risk. Historically pre-procedural transfusion support has been used in attempt to mitigate procedural bleeding risk. However, mounting data argues against this approach. Patient optimization, procedure conditions, and procedure technique can minimize bleeding risk. Viscoelastic testing may be useful to reduce the use of prophylactic transfusion and reassure proceduralists. CONCLUSION: Historically, the risk of procedural bleeding has been overestimated in patients with cirrhosis due to abnormal conventional coagulation testing including prolonged prothrombin time and thrombocytopenia. Prophylactic transfusion has not been consistently demonstrated to reduce bleeding risk and carries some risks. Performing only necessary procedures under optimal conditions with safe technique and preparation for rescue transfusion can minimize procedural-associated bleeding and its consequences. CI - (c) 2025. The Author(s). FAU - Davis, Jessica P E AU - Davis JPE AD - Division of Gastroenterology and Hepatology, DC Veterans Affairs Medical Center, Washington, DC, USA. FAU - Farias, Alberto Q AU - Farias AQ AD - Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. FAU - Intagliata, Nicolas M AU - Intagliata NM AD - Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA. nmi4d@uvahealth.org. LA - eng PT - Journal Article PT - Review DEP - 20250708 PL - United States TA - Hepatol Int JT - Hepatology international JID - 101304009 SB - IM MH - Humans MH - *Liver Cirrhosis/complications MH - *Hemorrhage/prevention & control/etiology/therapy MH - Risk Assessment MH - Blood Transfusion/methods MH - Risk Factors MH - *Blood Loss, Surgical/prevention & control PMC - PMC12507928 OTO - NOTNLM OT - Bleeding OT - Hemostasis OT - Procedure OT - Thrombosis COIS- Declarations. Conflict of interest: Jessica P. E. Davis, Alberto Q. Farias, and Nicolas M. Intagliata have no conflict of interest to disclose. EDAT- 2025/07/09 00:27 MHDA- 2025/10/09 06:28 PMCR- 2025/07/08 CRDT- 2025/07/08 23:50 PHST- 2025/01/30 00:00 [received] PHST- 2025/04/20 00:00 [accepted] PHST- 2025/10/09 06:28 [medline] PHST- 2025/07/09 00:27 [pubmed] PHST- 2025/07/08 23:50 [entrez] PHST- 2025/07/08 00:00 [pmc-release] AID - 10.1007/s12072-025-10834-2 [pii] AID - 10834 [pii] AID - 10.1007/s12072-025-10834-2 [doi] PST - ppublish SO - Hepatol Int. 2025 Oct;19(5):1035-1050. doi: 10.1007/s12072-025-10834-2. Epub 2025 Jul 8. PMID- 40580496 OWN - NLM STAT- MEDLINE DCOM- 20251205 LR - 20260513 IS - 1535-2900 (Electronic) IS - 1079-2082 (Linking) VI - 82 IP - 24 DP - 2025 Dec 5 TI - Resuscitating massive transfusion knowledge: An update for the pharmacist. PG - 1314-1327 LID - 10.1093/ajhp/zxaf164 [doi] AB - PURPOSE: To review the indications, components, complications, and adjunctive medications associated with massive transfusion and implications for the clinical pharmacist. SUMMARY: Massive transfusion is a medical emergency and comprises the administration of various blood products in specific ratios to the acutely hemorrhaging patient. Definitions of massive transfusion vary, with the most common being the administration of 10 or more units of red blood cells within 24 hours. Complications associated with massive transfusion include electrolyte abnormalities and cardiopulmonary reactions. Adjunctive medications may be used during massive transfusion, including supplementation with intravenous calcium and administration of tranexamic acid, when indicated. Emergency medicine and critical care pharmacists must be well versed in the art of massive transfusion as they are an active participant during bedside resuscitation. CONCLUSION: Hemorrhage is a common complication due to traumatic injury, with patients receiving blood products for resuscitation. Massive transfusion protocols may be initiated in this patient population. Pharmacists participating in the management of resuscitation must be knowledgeable about managing complications of massive transfusion and on the use of adjunctive pharmacotherapy. CI - (c) American Society of Health-System Pharmacists 2025. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. FAU - Santiago, Ruben AU - Santiago R AD - Jackson Memorial Hospital, Miami, FL, USA. FAU - Slocum, Giles AU - Slocum G AD - Rush University Medical Center, Chicago, IL, USA. FAU - Riggi, Gina AU - Riggi G AD - Jackson Memorial Hospital, Miami, FL, USA. LA - eng PT - Journal Article PT - Review PL - England TA - Am J Health Syst Pharm JT - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JID - 9503023 SB - IM MH - Humans MH - *Pharmacists MH - *Resuscitation/methods MH - *Blood Transfusion/methods MH - *Hemorrhage/therapy/etiology MH - Professional Role MH - *Pharmacy Service, Hospital OTO - NOTNLM OT - hemorrhagic shock OT - massive transfusion OT - resuscitation OT - thromboelastography OT - tranexamic acid OT - trauma EDAT- 2025/07/01 04:46 MHDA- 2025/12/05 06:26 CRDT- 2025/06/28 14:02 PHST- 2025/12/05 06:26 [medline] PHST- 2025/07/01 04:46 [pubmed] PHST- 2025/06/28 14:02 [entrez] AID - 8177208 [pii] AID - 10.1093/ajhp/zxaf164 [doi] PST - ppublish SO - Am J Health Syst Pharm. 2025 Dec 5;82(24):1314-1327. doi: 10.1093/ajhp/zxaf164. PMID- 40577503 OWN - NLM STAT- MEDLINE DCOM- 20250721 LR - 20250721 IS - 2651-5032 (Electronic) IS - 1019-5149 (Linking) VI - 35 IP - 4 DP - 2025 TI - Thromboelastography in Patients with Chronic Subdural Hematoma: A Prospective Pilot Study. PG - 644-651 LID - 10.5137/1019-5149.JTN.47482-24.2 [doi] AB - AIM: To evaluate association between chronic subdural hematoma (CSDH) and thromboelastography (TEG). MATERIAL AND METHODS: A prospective pilot study was conducted on 52 patients with CSDH. The primary outcomes were CSDH severity, recurrence rate, and outcome. The secondary outcome was the association between TEG parameters and the risk factors of CSDH. RESULTS: The association between the preoperative TEG parameters and the primary outcomes was compared. Results revealed no statistically significant association between the primary outcomes and admission modified Rankin scale score and follow-up GOS score. The R values significantly differed between patients with recurrence and those without (p=0.045). Further subgroup analysis of TEG parameters revealed that patients with R values ≥ 5 had a significantly high incidence of recurrence (1.231, 95% confidence interval [CI]: 0.973-1.557], p=0.025). However, further logistic regression analysis did not reveal significant results (1.198, 95% CI: 0.855-1.680, p=0.293). Moreover, the association between the preoperative TEG parameters and the secondary outcomes was compared. Results revealed a statistically significant association between the secondary outcomes and hematoma thickness and LY30 values (p=0.039), midline shift and Angle (p=0.043), and multiplicity of the hematoma cavity and MA (p=0.022). Further, the secondary outcomes were also significantly associated with postoperative TEG parameters such as multiplicity of the hematoma cavity and LY 30 value (p=0.011) and residual hematoma at follow-up (MA, p=0.001). CONCLUSION: Due to the small sample size, the efficacy of TEG parameters in predicting CSDH recurrence is unclear. However, TEG parameters are associated with the imaging characteristics of CSDH, and they can also be used to predict the absorption of hematoma. Nevertheless, large-scale prospective cohort studies should be performed to further validate the findings of this study. FAU - DU, Xiaolin AU - DU X AD - The Jinyang Hospital Affiliated to Guizhou Medical University, Department of Neurosurgery, 550084, Guiyang, Guizhou Province, China. FAU - Wang, Cheng AU - Wang C FAU - Jiao, Rukai AU - Jiao R FAU - Deng, Xiaopeng AU - Deng X FAU - Chen, Junquan AU - Chen J FAU - Zhou, Chengming AU - Zhou C FAU - Zhou, Kun AU - Zhou K LA - eng PT - Journal Article PL - Turkey TA - Turk Neurosurg JT - Turkish neurosurgery JID - 9423821 SB - IM MH - Humans MH - *Hematoma, Subdural, Chronic/surgery/diagnostic imaging/diagnosis MH - Pilot Projects MH - Male MH - Female MH - Prospective Studies MH - *Thrombelastography/methods MH - Aged MH - Middle Aged MH - Recurrence MH - Aged, 80 and over MH - Risk Factors MH - Adult EDAT- 2025/06/27 18:28 MHDA- 2025/07/21 12:39 CRDT- 2025/06/27 14:13 PHST- 2025/07/21 12:39 [medline] PHST- 2025/06/27 18:28 [pubmed] PHST- 2025/06/27 14:13 [entrez] AID - 10.5137/1019-5149.JTN.47482-24.2 [doi] PST - ppublish SO - Turk Neurosurg. 2025;35(4):644-651. doi: 10.5137/1019-5149.JTN.47482-24.2. PMID- 40576680 OWN - NLM STAT- MEDLINE DCOM- 20250627 LR - 20260210 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 51 IP - 1 DP - 2025 Jun 27 TI - Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update. PG - 240 LID - 10.1007/s00068-025-02919-2 [doi] LID - 240 AB - PURPOSE: Our aim was to update the evidence-based and consensus-based recommendations for inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries on the basis of current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. METHODS: MEDLINE and Embase were systematically searched to May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for the prevention of acidaemia, hypocalcaemia and hypothermia, for coagulation management, fluid replacement therapy, blood product transfusions, viscoelastic assays, or central venous access in patients with multiple and/or severe injuries in the hospital setting. We considered patient-relevant clinical outcomes, such as mortality and bleeding control, or coagulation parameters as surrogate outcomes. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. RESULTS: Fifty-nine new studies were identified. Interventions covered were blood products (n = 19 studies), coagulation management (n = 14), viscoelastic assays (n = 12), temperature management (n = 5), fluid replacement therapy (n = 4), base excess/lactate (n = 3), calcium (n = 1), and intravenous access (n = 1). Twelve recommendations were modified, and seven additional recommendations were developed. All achieved strong consensus. CONCLUSION: The key recommendations are summarised as follows. Trauma-induced coagulopathy (TIC) is a distinct clinical entity requiring early diagnostic and therapeutic interventions. Perform viscoelastic assays in order to aid in the diagnosis and treatment of TIC in severely bleeding trauma patients. Since only approximately 20% of trauma patients are hyperfibrinolytic and tranexamic acid is not beneficial in the absence of hyperfibrinolysis, TXA should not be indiscriminately used in all patients in the emergency department. Coagulation factor concentrates as well as TXA are indicated in patients with life-threatening haemorrhage and/or haemorrhagic shock. CI - (c) 2025. The Author(s). FAU - Lier, Heiko AU - Lier H AUID- ORCID: 0000-0001-7374-4324 AD - Anaesthesiology and Pain Therapy, Mediapark Klinik, Cologne, Germany. FAU - Goossen, Kathe AU - Goossen K AUID- ORCID: 0000-0002-1436-1144 AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. kaethe.goossen@uni-wh.de. FAU - Kugler, Charlotte M AU - Kugler CM AUID- ORCID: 0000-0003-4170-3290 AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. FAU - Strasser, Erwin AU - Strasser E AUID- ORCID: 0000-0002-8113-0522 AD - Department of Transfusion Medicine, Cellular Therapeutics and Haemostaseology, LMU Munich University Hospital, Munich, Germany. FAU - Hussmann, Bjorn AU - Hussmann B AUID- ORCID: 0000-0001-8333-6367 AD - Department of Trauma Surgery, Hochsauerland Hospital, Arnsberg, Germany. FAU - Maegele, Marc AU - Maegele M AUID- ORCID: 0000-0002-0634-4723 AD - Department of Orthopaedics, Trauma Surgery, and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. FAU - Hilbert-Carius, Peter AU - Hilbert-Carius P AUID- ORCID: 0000-0002-4704-2377 AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Bergmannstrost Hospital, Halle, Germany. LA - eng PT - Journal Article PT - Systematic Review DEP - 20250627 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - *Fluid Therapy/methods/standards MH - *Multiple Trauma/therapy/complications MH - Practice Guidelines as Topic MH - Blood Transfusion MH - *Blood Coagulation Disorders/therapy/etiology MH - *Hemorrhage/therapy/etiology PMC - PMC12204895 OTO - NOTNLM OT - Coagulation management OT - Fluid replacement therapy OT - Outcome OT - Polytrauma guideline OT - Transfusion COIS- Declarations. Ethics statement: Ethical approval was not required, because the study used publicly accessible documents as evidence. Competing interests: Heiko Lier declares that he has received honoraria for lectures and travel fees from AstraZeneca, Bayer Vital, DRK-Blutspendedienst West, CSL Behring, Ferring, Mitsubishi Pharma, NovoNordisk, Organon, and Werfen. Marc Maegele declares that he has received honoraria for lectures, participation in expert/advisory board committees and financial support for participation in congresses and scientific projects from Abbott, Astra Zeneca, Baxter, Bayer, Biotest, CSL Behring, IL-Werfen/TEM-International, LFB, Biomedicaments France, Portola, and Octapharma. Kathe Goossen, Charlotte M. Kugler, Erwin Strasser, Bjoern Hussmann, and Peter Hilbert-Carius declare no competing interests. EDAT- 2025/06/27 12:30 MHDA- 2025/06/27 12:31 PMCR- 2025/06/27 CRDT- 2025/06/27 11:03 PHST- 2025/03/31 00:00 [received] PHST- 2025/06/10 00:00 [accepted] PHST- 2025/06/27 12:31 [medline] PHST- 2025/06/27 12:30 [pubmed] PHST- 2025/06/27 11:03 [entrez] PHST- 2025/06/27 00:00 [pmc-release] AID - 10.1007/s00068-025-02919-2 [pii] AID - 2919 [pii] AID - 10.1007/s00068-025-02919-2 [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2025 Jun 27;51(1):240. doi: 10.1007/s00068-025-02919-2. PMID- 40557349 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250626 IS - 2691-3593 (Electronic) IS - 2691-3593 (Linking) VI - 6 IP - 2 DP - 2025 Jun TI - Is Mechanism a Biological Variable?: A Secondary Analysis of the PROPPR Trial. PG - e572 LID - 10.1097/AS9.0000000000000572 [doi] AB - OBJECTIVE: The purpose of this study was to evaluate for differences in the baseline mortality rates of patients injured by different mechanisms, in the Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial, and compare their responses to 2 resuscitation paradigms. Our hypothesis was there are differences between the blunt and penetrating trauma patients, with regard to baseline and effect size. BACKGROUND: Previous research including clinical trials and basic science research suggests differences in mortality among patients injured by blunt or penetrating mechanisms, although differences between these 2 mechanisms-both baseline and effect size-are rarely considered explicitly. The objective of this analysis was to compare mortality and other clinical outcomes of trauma patients stratified specifically by injury mechanism and resuscitation strategy. METHODS: We performed a retrospective review of the PROPPR trial to assess for differences in mortality outcomes in patients with blunt or penetrating injuries who received a 1:1:1 or 1:1:2 resuscitation strategy. Our primary outcome was 24-hour mortality with additional endpoints at proximate (ie, 1 hour, 3 hours, and 6 hours) times post-arrival. A logistic regression model utilizing general estimating equations and adjusted for age, Injury Severity Score (ISS), and first documented pulse and Glasgow Coma Scale (GCS) score were used to assess the interaction of mortality outcomes by resuscitation type and injury mechanism. Secondary outcomes evaluated include acute kidney injury, ventilator-associated pneumonia, cardiac arrest, symptomatic and asymptomatic pulmonary embolism, deep vein thrombosis, acute respiratory distress syndrome, and stroke. Additional nonmortality outcomes of interest included total hospital and ventilator- and ICU-free days, time to hemostasis, time to exsanguination, and time to death. RESULTS: The original trial enrolled 680 patients, 338 (49.7%) received 1:1:1 and 342 (50.3%) 1:1:2 resuscitation. 8 patients had combined blunt and penetrating injuries and were excluded from this analysis, leaving 672 patients with blunt (350, 52.1%) and penetrating (322, 47.9%) injuries. Compared to penetrating injuries, patients with blunt injuries were older, more likely to be white, had a higher rate of air transfers, longer transport time and longer time to hemostasis, lower GCS Score, and higher ISS and R time on thromboelastography (P < 0.001). Overall mortality between blunt and penetrating injuries was similar at 1 hour (2.6% vs 4.0%, P = 0.286) and 3 hours (7.4% and 8.1%, P = 0.754). However, mortality in both groups steadily increased overtime, and more markedly at 24 hours for patients with blunt compared to penetrating injuries (16.9% and 11.8%, P = 0.063). When comparing resuscitation strategies, receipt of a 1:1:1 resuscitation significantly decreased the odds of mortality among blunt-injured patients who received a 1:1:1 transfusion (relative to blunt-injured patients receiving a 1:1:2 transfusion) at 3 hours (odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.10-0.66, P = 0.005) and 6 hours (OR: 0.38, 95% CI: 0.19-0.77, P = 0.0007). We observed no statistically significant differences in patients with penetrating injuries or at any time other points. CONCLUSIONS: We found a significant difference in adjusted mortality at 3 hours in patients with blunt injuries when comparing resuscitation strategies, which was consistent with previous studies. Responses to resuscitation may differ depending on the mechanism of injury, and some interventions may be more beneficial depending on injury type. CI - Copyright (c) 2025 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Baird, Emily W AU - Baird EW AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. FAU - Lammers, Daniel T AU - Lammers DT AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. FAU - Griffin, Russell L AU - Griffin RL AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. FAU - Stephens, Shannon W AU - Stephens SW AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. FAU - Jansen, Jan O AU - Jansen JO AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. FAU - Holcomb, John B AU - Holcomb JB AD - From the Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL. LA - eng PT - Journal Article DEP - 20250506 PL - United States TA - Ann Surg Open JT - Annals of surgery open : perspectives of surgical history, education, and clinical approaches JID - 101769928 PMC - PMC12185091 OTO - NOTNLM OT - resuscitation OT - trauma COIS- J.B.H. is on the board of directors of Decisio Health, CCJ Medical Devices, QinFlow, Hemostatics, and Zibrio. He receives research grant support from the DoD, DARPA, NIH, and CSL focused on hemorrhage control and resuscitation. He consults with WFIRM and Aspen Medical, is the co-inventor of the Junctional Emergency Tourniquet Tool, and receives royalties from UT Health. J.O.J. has received personal fees from CSL Behring, Cellphire, Octapharma, and Infrascan; and grants from CSL Behring, Infrascan, and RevMedX. The remaining authors declare that they have nothing to disclose. EDAT- 2025/06/25 06:25 MHDA- 2025/06/25 06:26 PMCR- 2025/05/06 CRDT- 2025/06/25 04:34 PHST- 2024/08/18 00:00 [received] PHST- 2025/04/05 00:00 [accepted] PHST- 2025/06/25 06:26 [medline] PHST- 2025/06/25 06:25 [pubmed] PHST- 2025/06/25 04:34 [entrez] PHST- 2025/05/06 00:00 [pmc-release] AID - AOSO-D-24-00182 [pii] AID - 10.1097/AS9.0000000000000572 [doi] PST - epublish SO - Ann Surg Open. 2025 May 6;6(2):e572. doi: 10.1097/AS9.0000000000000572. eCollection 2025 Jun. PMID- 40543946 OWN - NLM STAT- MEDLINE DCOM- 20250624 LR - 20250728 IS - 1558-1349 (Electronic) IS - 1042-3680 (Linking) VI - 36 IP - 3 DP - 2025 Jul TI - Thrombosis and Coagulopathy. PG - 375-385 LID - S1042-3680(25)00019-1 [pii] LID - 10.1016/j.nec.2025.03.006 [doi] AB - Effective anticoagulation management is crucial for balancing thromboembolism and hemorrhage risks in patients with traumatic brain injury (TBI) and spinal cord injury (SCI). A systematic review from January 1984 to August 2024 highlights a growing preference for prothrombin complex concentrate (PCC) as the primary reversal agent, with limited evidence on idarucizumab for dabigatran. Most studies show that 4F-PCC improves mortality and hemostatic efficacy, facilitating faster surgical interventions. The lack of large clinical trials remains a significant gap, limiting the development of standardized protocols. Increasing use of viscoelastic assays for assessing residual anticoagulant activity offers potential for more personalized treatment strategies. CI - Copyright (c) 2025 Elsevier Inc. All rights reserved. FAU - Savi, Marzia AU - Savi M AD - Department of Intensive Care, Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK. FAU - Hawryluk, Gregory AU - Hawryluk G AD - Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ghawryluk@braintrauma.org. LA - eng PT - Journal Article PT - Systematic Review DEP - 20250429 PL - United States TA - Neurosurg Clin N Am JT - Neurosurgery clinics of North America JID - 9008004 RN - 0 (Anticoagulants) RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) SB - IM MH - Humans MH - *Blood Coagulation Disorders/drug therapy/etiology MH - *Thrombosis/drug therapy/etiology MH - Brain Injuries, Traumatic/complications MH - Anticoagulants/therapeutic use MH - Spinal Cord Injuries/complications MH - Blood Coagulation Factors/therapeutic use OTO - NOTNLM OT - Anticoagulant OT - Antiplatelet OT - Hemorrhage OT - Spinal cord injury OT - Thromboembolism OT - Traumatic brain injury COIS- Disclosure The authors have nothing to disclose. EDAT- 2025/06/22 06:10 MHDA- 2025/06/24 13:14 CRDT- 2025/06/21 20:54 PHST- 2025/06/24 13:14 [medline] PHST- 2025/06/22 06:10 [pubmed] PHST- 2025/06/21 20:54 [entrez] AID - S1042-3680(25)00019-1 [pii] AID - 10.1016/j.nec.2025.03.006 [doi] PST - ppublish SO - Neurosurg Clin N Am. 2025 Jul;36(3):375-385. doi: 10.1016/j.nec.2025.03.006. Epub 2025 Apr 29. PMID- 40517530 OWN - NLM STAT- MEDLINE DCOM- 20251112 LR - 20260813 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 250 DP - 2025 Dec TI - Change in novel plasmin activated clotting time assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma in under 3 minutes. PG - 116476 LID - S0002-9610(25)00299-5 [pii] LID - 10.1016/j.amjsurg.2025.116476 [doi] AB - BACKGROUND: Hyperfibrinolysis after trauma increases mortality, yet rapid identification remains a challenge. Prior work demonstrates liver transplantation is an idealized model of fibrinolysis. Early resource mobilization and antifibrinolytic therapy improves outcomes in trauma, but efficacy is lost with delays in care. We set out to develop a novel plasmin-activated clotting time (PACT) assay to rapidly diagnose hyperfibrinolysis. METHODS: Whole blood from adult liver transplant(n ​= ​40) and trauma patients(n ​= ​32) underwent PACT assay alongside traditional and tPA-challenged thromboelastography(TEG). Primary outcomes of massive transfusion and early mortality were assessed. RESULTS: PACT accurately identified hyperfibrinolysis within 3 ​min during the anhepatic phase of liver transplant (35 ​% prevalence; p ​< ​0.001). In trauma, a PACT threshold (DeltaACT >18.5 ​s) predicted massive transfusion or death (AUC ​= ​0.857, p ​< ​0.001), outperforming conventional TEG metrics (AUC<0.625). CONCLUSION: The PACT assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma patients in 3 ​min, offering potential for rapid resource triage and early targeted therapeutic administration. CI - Published by Elsevier Inc. FAU - Maginot, Elizabeth R AU - Maginot ER AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, AdventHealth Porter, Denver, CO, USA. FAU - Moore, Ernest E AU - Moore EE AD - Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, Denver, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. FAU - Barmettler, Nicolle K AU - Barmettler NK AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Moody, Trace B AU - Moody TB AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Volk, Grace E AU - Volk GE AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Sextro, Kyle S AU - Sextro KS AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Hiser, Dylan C AU - Hiser DC AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Clegg, Ashley A AU - Clegg AA AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Gawargi, Flobater I AU - Gawargi FI AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - White, Collin M AU - White CM AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Henry, Reynold AU - Henry R AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. FAU - Chandler, James G AU - Chandler JG AD - Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, Denver, CO, USA. FAU - Yaffe, Michael B AU - Yaffe MB AD - Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Departments of Biological Engineering and Biology, Massachusetts Institute of Technology, Cambridge, MA, USA. FAU - Nydam, Trevor L AU - Nydam TL AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. FAU - Barrett, Christopher D AU - Barrett CD AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: cbarrett@unmc.edu. LA - eng GR - K08 HL171936/HL/NHLBI NIH HHS/United States GR - P20 GM152326/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20250610 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Humans MH - Female MH - Male MH - *Wounds and Injuries/mortality/blood/complications/therapy MH - Middle Aged MH - *Blood Transfusion/statistics & numerical data MH - Adult MH - *Fibrinolysis MH - Thrombelastography MH - *Fibrinolysin MH - *Blood Coagulation Disorders/diagnosis/etiology/blood MH - Predictive Value of Tests MH - Time Factors MH - Aged PMC - PMC13367528 MID - NIHMS2188543 COIS- Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christopher D. Barrett reports financial support was provided by NIHNational Institute of General Medical Sciences. Christopher D. Barrett reports financial support was provided by National Heart Lung and Blood Institute. Christopher D. Barrett reports a relationship with Genentech Inc that includes: funding grants. Hunter B. Moore reports a relationship with Genentech Inc that includes: funding grants. Ernest E. Moore reports a relationship with Genentech Inc that includes: funding grants. Michael B. Yaffe reports a relationship with Genentech Inc that includes: funding grants. Christopher D. Barrett reports a relationship with Werfen that includes: funding grants. Christopher D. Barrett reports a relationship with Atheneum Partners that includes: consulting or advisory. Christopher D. Barrett reports a relationship with Grifols Inc that includes: consulting or advisory. Hunter B. Moore reports a relationship with Haemonetics Corporation that includes: funding grants. Ernest E. Moore reports a relationship with Haemonetics Corporation that includes: funding grants. Ernest E. Moore reports a relationship with HemoSonicsLLC that includes: funding grants. Hunter B. Moore reports a relationship with HemoSonicsLLC that includes: funding grants. Hunter B. Moore reports a relationship with Diagnostica Stago Inc that includes: funding grants. Ernest E. Moore reports a relationship with Diagnostica Stago Inc that includes: funding grants. Michael B. Yaffe reports a relationship with Merrimack Pharmaceuticals Inc that includes: equity or stocks. Christopher D. Barrett has patent pending to Genetech Inc. Hunter B. Moore has patent pending to Genetech Inc. Ernest E. Moore has patent pending to Genetech Inc. Michael B. Yaffe has patent pending to Genetech Inc. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2025/06/16 00:26 MHDA- 2025/11/12 23:30 PMCR- 2026/07/14 CRDT- 2025/06/15 18:03 PHST- 2025/03/21 00:00 [received] PHST- 2025/05/16 00:00 [revised] PHST- 2025/06/10 00:00 [accepted] PHST- 2025/11/12 23:30 [medline] PHST- 2025/06/16 00:26 [pubmed] PHST- 2025/06/15 18:03 [entrez] PHST- 2026/07/14 00:00 [pmc-release] AID - S0002-9610(25)00299-5 [pii] AID - 10.1016/j.amjsurg.2025.116476 [doi] PST - ppublish SO - Am J Surg. 2025 Dec;250:116476. doi: 10.1016/j.amjsurg.2025.116476. Epub 2025 Jun 10. PMID- 40511630 OWN - NLM STAT- MEDLINE DCOM- 20250709 LR - 20250819 IS - 1473-6500 (Electronic) IS - 0952-7907 (Print) IS - 0952-7907 (Linking) VI - 38 IP - 4 DP - 2025 Aug 1 TI - 'Fulminant hepatic failure' anesthesiologic considerations. PG - 503-512 LID - 10.1097/ACO.0000000000001530 [doi] AB - PURPOSE OF REVIEW: The aim is to summarize perioperative management of patients with acute liver failure (ALF). RECENT FINDINGS: The risk of mortality has decreased due to advancements in supportive care and the admission of ALF patients to the ICU. Noninvasive intracranial pressure monitoring is now preferred over invasive methods. Alternatives like transcranial Doppler have emerged, and treatments such as hypertonic saline and mannitol have proven effective in reducing intracranial hypertension (ICH), a common cause of death in these cases. In contrast, invasive hemodynamic monitoring may be necessary to optimize fluid management and the use of vasopressors or inotropes. Norepinephrine should be the first-choice vasopressor for hemodynamic support. Acute kidney injury frequently occurs in patients with ALF and often necessitates the early initiation of renal replacement therapy (RRT). RRT also helps clear hyperammonemia, which can enhance ICH control. Furthermore, coagulation management should rely on point-of-care viscoelastic tests rather than traditional lab tests, as this provides a more accurate assessment of thrombotic or hemorrhagic risks during ALF. SUMMARY: Multiorgan failure associated with ALF requires rapid and aggressive treatment to mitigate the risk of fatal outcomes. Key issues that must be effectively managed include encephalopathy, brain edema, severe coagulopathy, hemodynamic instability, and acute kidney injury. CI - Copyright (c) 2025 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Vetrugno, Luigi AU - Vetrugno L AD - Department of Emergency, Health Integrated Agency of Friuli Centrale, Tolmezzo. AD - Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti. FAU - Alessandri, Francesco AU - Alessandri F AD - Department of General and Specialistic Surgery, 'Sapienza' University of Rome, Rome. FAU - Toscano, Antonio AU - Toscano A AD - Anesthesia, Intensive Care and Emergency, 'Citta della Salute e della Scienza' Hospital, Torino. FAU - Voza, Antonio AU - Voza A AD - Department of Emergency Medicine, IRCCS Humanitas Research Hospital, Rozzano. AD - Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan. FAU - Deana, Cristian AU - Deana C AD - Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy. LA - eng PT - Journal Article PT - Review DEP - 20250526 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Vasoconstrictor Agents) SB - IM MH - Humans MH - *Liver Failure, Acute/complications/therapy/physiopathology MH - Acute Kidney Injury/therapy/etiology MH - Intracranial Hypertension/etiology/prevention & control/therapy MH - *Perioperative Care/methods MH - Multiple Organ Failure/therapy/etiology MH - Renal Replacement Therapy/methods MH - Vasoconstrictor Agents/therapeutic use MH - *Anesthesia/methods PMC - PMC12188796 OTO - NOTNLM OT - acute liver failure OT - coagulopathy OT - encephalopathy OT - hemodynamic monitoring OT - renal replacement therapy COIS- There are no conflicts of interest. EDAT- 2025/06/13 12:31 MHDA- 2025/07/09 12:29 PMCR- 2025/06/25 CRDT- 2025/06/13 06:33 PHST- 2025/07/09 12:29 [medline] PHST- 2025/06/13 12:31 [pubmed] PHST- 2025/06/13 06:33 [entrez] PHST- 2025/06/25 00:00 [pmc-release] AID - 00001503-202508000-00029 [pii] AID - ACO380422 [pii] AID - 10.1097/ACO.0000000000001530 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2025 Aug 1;38(4):503-512. doi: 10.1097/ACO.0000000000001530. Epub 2025 May 26. PMID- 40507614 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250615 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 14 IP - 11 DP - 2025 May 30 TI - Perioperative Blood Management. LID - 10.3390/jcm14113847 [doi] LID - 3847 AB - Perioperative blood management strategies include evidence-based guidelines to efficiently manage blood products and transfusions while minimizing blood loss and improving patient outcomes. Perioperative Medicine has made evident that anemia is often under-recognized and not appropriately addressed prior to surgery. Early recognition and correction of anemia is imperative for better surgical optimization, fewer transfusions perioperatively, and improved outcomes. Patient blood management utilize evidence-based guidelines for the establishment of a framework to promote treatment of the causes of anemia, reduce blood loss and coagulopathy as well as to improve patient safety and outcomes by efficiently managing blood products, decrease complications associated with blood transfusions and reduce overall costs. Both liberal and restrictive strategies for blood transfusions established thresholds for hemoglobin: restrictive transfusion threshold of hemoglobin 7-8 g/dL in stable patients, and a higher transfusion threshold of hemoglobin > 8 g/dL may be considered in patients with cardiac disease. Intraoperatively, tests such as viscoelastic testing, including rotational thromboelastometry and thrombelastography, offer real-time analysis of a patient's clotting ability, allowing for targeted transfusions of fresh frozen plasma, platelets, cryoprecipitate or antifibrinolytic drugs. Complications associated with blood transfusions include allergic reactions, delayed hemolytic reactions, transfusion related acute lung injury, transfusion-associated circulatory overload, and the transmission of infectious diseases such as Hepatitis B, Hepatitis C, and Human-immunodeficiency virus. This review will discuss the management of blood products for surgical patients in the entire perioperative setting, with specific considerations for the peri-, intra- and post-operative stages. FAU - Parikh, Shruti AU - Parikh S AUID- ORCID: 0009-0007-2224-3782 AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. FAU - Bentz, Taylor AU - Bentz T AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. FAU - Crowley, Samuel AU - Crowley S AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. FAU - Greenspan, Seth AU - Greenspan S AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. FAU - Costa, Ana AU - Costa A AUID- ORCID: 0000-0002-1816-6194 AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. FAU - Bergese, Sergio AU - Bergese S AUID- ORCID: 0000-0001-5641-5908 AD - Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA. LA - eng PT - Journal Article PT - Review DEP - 20250530 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC12155826 OTO - NOTNLM OT - TACO OT - TRALI OT - blood management OT - blood products OT - enhanced recovery OT - massive transfusion protocol OT - perioperative guidelines OT - perioperative outcomes OT - preoperative evaluation OT - preoperative optimization OT - surgical optimization COIS- The authors declare no conflicts of interest. EDAT- 2025/06/13 06:34 MHDA- 2025/06/13 06:35 PMCR- 2025/05/30 CRDT- 2025/06/13 01:04 PHST- 2025/05/01 00:00 [received] PHST- 2025/05/16 00:00 [revised] PHST- 2025/05/21 00:00 [accepted] PHST- 2025/06/13 06:35 [medline] PHST- 2025/06/13 06:34 [pubmed] PHST- 2025/06/13 01:04 [entrez] PHST- 2025/05/30 00:00 [pmc-release] AID - jcm14113847 [pii] AID - jcm-14-03847 [pii] AID - 10.3390/jcm14113847 [doi] PST - epublish SO - J Clin Med. 2025 May 30;14(11):3847. doi: 10.3390/jcm14113847. PMID- 40496846 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250612 IS - 2475-0379 (Electronic) IS - 2475-0379 (Linking) VI - 9 IP - 4 DP - 2025 May TI - The role of factor V in trauma-induced coagulopathy: an observational and experimental study. PG - 102857 LID - 10.1016/j.rpth.2025.102857 [doi] LID - 102857 AB - BACKGROUND: In bleeding patients with trauma-induced coagulopathy (TIC), factor (F)V becomes depleted, which may not be corrected with existing treatment strategies. It is currently unknown whether supplementing FV or FVa improves TIC. OBJECTIVES: To explore the relationship between FV activity and mortality in trauma patients, and to investigate the effect of FV(a) supplementation in addition to other treatment strategies in an in vitro model of TIC. METHODS: The association between FV activity and mortality was studied using an international prospective cohort study of trauma patients. In an in vitro whole blood and plasma model of TIC, the effect of FV(a) on rotational thromboelastometry and fibrin formation was studied. Effects of FV(a) were evaluated either as a standalone therapy or as adjunctive therapy in combination with tranexamic acid, fibrinogen concentrate, and/or prothrombin complex concentrate. RESULTS: A total of 1285 patients were included, with a median injury severity score of 16 (interquartile range: 8-26). Decreased FV activity was associated with increased mortality. In the whole blood TIC model, FVa increased maximum clot firmness and reduced fibrinolysis, both as a single and combination therapy. In the plasma TIC model, with lower tissue factor concentrations than in the whole blood model, FV(a) prolonged clotting times, both as a single treatment and in combination with other treatments. CONCLUSION: FV depletion after trauma is associated with increased mortality. In an in vitro model of TIC, FV(a) results in procoagulant, antifibrinolytic, and anticoagulant effects. Further research is highly warranted. CI - (c) 2025 The Authors. FAU - Sloos, Pieter H AU - Sloos PH AD - Department of Intensive Care Medicine, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Amsterdam Institute for Infection and Immunity, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. FAU - Dujardin, Romein W G AU - Dujardin RWG AD - Department of Intensive Care Medicine, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Department of Anesthesiology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. FAU - Meijers, Joost C M AU - Meijers JCM AD - Department of Experimental Vascular Medicine, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Davenport, Ross AU - Davenport R AD - Department of Trauma Surgery, Barts and the London School of Medicine and Dentistry, London, United Kingdom. FAU - Stanworth, Simon AU - Stanworth S AD - National Health Service Blood and Transplant/Oxford University Hospital NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Johansson, Par I AU - Johansson PI AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, Section for Transfusion Medicine, Copenhagen University Hospital Rigshospitalet, Capital Region Blood Bank, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, Section for Transfusion Medicine, Copenhagen University Hospital Rigshospitalet, Capital Region Blood Bank, Copenhagen, Denmark. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Amsterdam Institute for Infection and Immunity, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. FAU - Kleinveld, Derek J B AU - Kleinveld DJB AD - Department of Intensive Care Medicine, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Amsterdam Institute for Infection and Immunity, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, the Netherlands. AD - Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands. LA - eng PT - Journal Article DEP - 20250417 PL - United States TA - Res Pract Thromb Haemost JT - Research and practice in thrombosis and haemostasis JID - 101703775 PMC - PMC12150085 OTO - NOTNLM OT - blood coagulation factors OT - factor V OT - hemorrhage OT - hemostasis OT - wounds and Injuries EDAT- 2025/06/11 11:29 MHDA- 2025/06/11 11:30 PMCR- 2025/04/17 CRDT- 2025/06/11 05:27 PHST- 2024/07/15 00:00 [received] PHST- 2025/04/06 00:00 [revised] PHST- 2025/04/10 00:00 [accepted] PHST- 2025/06/11 11:30 [medline] PHST- 2025/06/11 11:29 [pubmed] PHST- 2025/06/11 05:27 [entrez] PHST- 2025/04/17 00:00 [pmc-release] AID - S2475-0379(25)00181-5 [pii] AID - 102857 [pii] AID - 10.1016/j.rpth.2025.102857 [doi] PST - epublish SO - Res Pract Thromb Haemost. 2025 Apr 17;9(4):102857. doi: 10.1016/j.rpth.2025.102857. eCollection 2025 May. PMID- 40491626 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250611 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 17 IP - 5 DP - 2025 May TI - Evaluation of Trauma-Induced Coagulopathy by Systematic Insights Into Pathophysiology and Advances in Emergency Resuscitation. PG - e83839 LID - 10.7759/cureus.83839 [doi] LID - e83839 AB - Trauma-induced coagulopathy (TIC) exists as a fatal complication that develops from severe injuries and substantially increases patient mortality. Effective knowledge of TIC pathophysiology, together with optimized resuscitation strategies, is fundamental for enhancing patient outcomes. This review system examined TIC mechanisms through an analysis of present-day intervention methods. This systematic research with meta-analysis covered PubMed, Scopus, and Web of Science, together with Google Scholar databases, to review TIC pathophysiology and resuscitation practices. The inclusion of observational and experimental designs occurred by using predetermined selection criteria. Two independent researchers collected data from studies that received quality assessments through the Newcastle-Ottawa Scale (version 2011), along with the Cochrane Risk of Bias Tool (version 2) evaluation. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach served as the method for evaluating evidence certainty. The analyzed studies amounted to 11 after meeting the established criteria. Three major mechanisms led to TIC development, including disrupted fibrinolysis function, impaired platelet functioning, and damaged vessel walls. Six studies submitted for meta-analysis demonstrated that coagulation abnormalities, including hypofibrinogenemia and elevated activated protein C, result in adverse outcomes with a pooled HR of 6.3 (95% CI: 3.04-13.05, p < 0.05). The compound variation (I(2) = 69%) across data points appeared from differences between measurements and experimental conditions used in the studies. This review presents fibrinogen together with thrombin and activated protein C as diagnostic markers for TIC while supporting the use of protocol-based resuscitation. Future research requires several hospitals to participate in trials to establish new treatment protocols and establish uniform biomarker testing procedures in clinical settings. CI - Copyright (c) 2025, Rashid et al. FAU - Rashid, Noor Ul Ain AU - Rashid NUA AD - General Surgery, Akhtar Saeed Trust Hospital, Lahore, PAK. FAU - Nasir, Ahmad Abdullah AU - Nasir AA AD - General Surgery, General Medicine, Anesthesiology and Psychiatry, Akhtar Saeed Medical and Dental College, Lahore, PAK. FAU - Fattani, Bilal AU - Fattani B AD - Medicine, Jinnah Medical and Dental College, Karachi, PAK. FAU - Minhas, Madeeha AU - Minhas M AD - Health Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU. FAU - Tanvir, Seemi AU - Tanvir S AD - Pathology, Margalla Institute of Health Sciences, Rawalpindi, PAK. FAU - Pathan, Soobia AU - Pathan S AD - Pharmacology and Therapeutics, Liaquat Institute of Medical and Health Sciences, Thatta, PAK. FAU - Barkha, Fnu AU - Barkha F AD - Medicine and Surgery, Chandka Medical College, Larkana, PAK. FAU - Nangdev, Pirya AU - Nangdev P AD - Anatomy, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, PAK. FAU - Khalid, Aneesa AU - Khalid A AD - Pathology, University of Health Sciences, Lahore, PAK. AD - Biomedical Sciences, COMSATS (Commission on Science and Technology for Sustainable Development in the South) University Islamabad, Islamabad, PAK. AD - Molecular Pathology and Genetics, University of the Punjab, Lahore, PAK. LA - eng PT - Journal Article PT - Review DEP - 20250510 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC12147678 OTO - NOTNLM OT - fibrinolysis OT - hemostasis OT - meta-analysis OT - resuscitation OT - trauma-induced coagulopathy OT - viscoelastic testing COIS- Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2025/06/10 11:29 MHDA- 2025/06/10 11:30 PMCR- 2025/05/10 CRDT- 2025/06/10 04:36 PHST- 2025/05/10 00:00 [accepted] PHST- 2025/06/10 11:30 [medline] PHST- 2025/06/10 11:29 [pubmed] PHST- 2025/06/10 04:36 [entrez] PHST- 2025/05/10 00:00 [pmc-release] AID - 10.7759/cureus.83839 [doi] PST - epublish SO - Cureus. 2025 May 10;17(5):e83839. doi: 10.7759/cureus.83839. eCollection 2025 May. PMID- 40486089 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250613 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 10 IP - 2 DP - 2025 TI - Multicenter evaluation of the Quantra with the QStat Cartridge in adult trauma patients. PG - e001672 LID - 10.1136/tsaco-2024-001672 [doi] LID - e001672 AB - BACKGROUND: Trauma-induced coagulopathy (TIC) occurs in a quarter of trauma patients and is associated with death due to uncontrolled bleeding. Current guidelines recommend viscoelastic testing (VET) to assess coagulopathy and guide transfusions. The Quantra with the QStat Cartridge is a point-of-care (POC) VET device that measures changes in clot stiffness (CS) during coagulation and fibrinolysis using ultrasound detection of resonance. This study aimed to evaluate the performance of the QStat Cartridge in trauma patients compared with rotational thromboelastometry (ROTEM) delta and thromboelastography (TEG) 6s VET devices. METHODS: A multicenter prospective observational study was conducted in adult patients meeting criteria for a full trauma team response at eight US level 1 trauma centers. Citrated blood samples drawn on arrival at the hospital or after blood transfusions were analyzed in parallel on QStat, ROTEM or TEG. Correlation between QStat and equivalent VET measurements was assessed by linear regression. Concordance was assessed by agreement of results relative to device-specific normal reference ranges. RESULTS: 259 severely injured patients were enrolled, yielding 271 samples for analysis. Moderate to strong correlations between QStat and corresponding ROTEM and TEG measurements were observed (r=0.64-0.88). The concordance between CS results was 84.5% for QStat CS and EXTEM A10 and 83.3% for CS and citrated rapid TEG maximum amplitude. For fibrinogen-related results, concordance was 81.5% for QStat fibrinogen contribution to clot stiffness (FCS) and FIBTEM A10 and 93.8% for FCS and citrated functional fibrinogen maximum amplitude. For fibrinolysis measurements, the overall agreement between QStat clot stability to lysis and EXTEM ML or CK-LY30 was 97.5% and 92.9%, respectively. CONCLUSION: QStat provides comparable information to the ROTEM delta and TEG 6s in trauma patients and can be useful for diagnosing TIC and guiding treatment. The Quantra's simplicity of use, ability to deploy at the POC, and rapid availability of results may provide clinicians with a faster, more convenient means to assess and manage TIC. LEVEL OF EVIDENCE: Diagnostic test, level II. TRIAL REGISTRATION NUMBER: NCT04312958. CI - Copyright (c) Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. FAU - Moore, Ernest E AU - Moore EE AUID- ORCID: 0000-0002-0419-4848 AD - Ernest E Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA. FAU - Michelson, Edward A AU - Michelson EA AUID- ORCID: 0000-0003-4468-8962 AD - Emergency Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA. FAU - Gabriel-Ramos, Katrina AU - Gabriel-Ramos K AUID- ORCID: 0009-0009-5378-4949 AD - Anesthesiology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA. FAU - Cripps, Michael W AU - Cripps MW AUID- ORCID: 0000-0002-1263-1876 AD - Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Flores, Antolin AU - Flores A AUID- ORCID: 0000-0001-9823-5307 AD - Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. FAU - Vandyck, Kofi AU - Vandyck K AUID- ORCID: 0000-0001-5631-949X AD - Anesthesiology, The University of Oklahoma Health Sciences College of Medicine, Oklahoma City, Oklahoma, USA. FAU - Thurston, Brian AU - Thurston B AD - Surgery, Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA. FAU - Brennan, Meghan AU - Brennan M AUID- ORCID: 0009-0006-2598-5485 AD - Anesthesiology, University of Florida Health, Gainesville, Florida, USA. FAU - Viola, Francesco AU - Viola F AUID- ORCID: 0000-0002-4258-4900 AD - HemoSonics, LLC, Durham, North Carolina, USA. FAU - Winegar, Deborah A AU - Winegar DA AUID- ORCID: 0000-0002-4277-400X AD - HemoSonics, LLC, Durham, North Carolina, USA. LA - eng SI - ClinicalTrials.gov/NCT04312958 PT - Journal Article DEP - 20250603 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 CIN - Trauma Surg Acute Care Open. 2025 Jun 08;10(2):e001919. doi: 10.1136/tsaco-2025-001919. PMID: 40510862 PMC - PMC12142034 OTO - NOTNLM OT - blood coagulation tests OT - fibrinolysis OT - hemorrhage COIS- All institutions received research support from HemoSonics, LLC, for conduct of the study. In addition, EEM receives research support from Haemonetics, Humacyte and Prytime, and serves on a DSMB for Kcentra. EAM received an honorarium for a lecture from HemoSonics, LLC. MWC receives institutional support from Octapharma, serves on an advisory board for Grifols, and receives stock options from TraumaCare.AI, Inc. AF is a paid consultant for Werfen. KV receives research funding from Timewell Medical Co., Octapharma, and CELLPHIRE, and grant funding from SCA. FV and DAW are full-time employees of HemoSonics, LLC. EDAT- 2025/06/09 12:30 MHDA- 2025/06/09 12:31 PMCR- 2025/06/03 CRDT- 2025/06/09 06:39 PHST- 2024/10/23 00:00 [received] PHST- 2025/05/04 00:00 [accepted] PHST- 2025/06/09 12:31 [medline] PHST- 2025/06/09 12:30 [pubmed] PHST- 2025/06/09 06:39 [entrez] PHST- 2025/06/03 00:00 [pmc-release] AID - tsaco-2024-001672 [pii] AID - 10.1136/tsaco-2024-001672 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2025 Jun 3;10(2):e001672. doi: 10.1136/tsaco-2024-001672. eCollection 2025. PMID- 40479939 OWN - NLM STAT- MEDLINE DCOM- 20250803 LR - 20250805 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 56 IP - 8 DP - 2025 Aug TI - Platelet dysfunction in trauma: a sub study of the FEISTY pilot trial analysing whole blood aggregometry data. PG - 112468 LID - S0020-1383(25)00329-8 [pii] LID - 10.1016/j.injury.2025.112468 [doi] AB - OBJECTIVE: To identify platelet hypofunction and its associations in severely injured trauma patients presenting with haemorrhage. DESIGN: Planned sub-study of data collected from the FEISTY trial; an Australian multicentre, randomised controlled pilot trial investigating early fibrinogen replacement in severely injured trauma patients. SETTING: Four major trauma centres in Queensland, Australia. PARTICIPANTS: Adult trauma patients (age >/=18 years) presenting with clinically significant haemorrhage or potential for significant transfusion requirements. MAIN OUTCOME MEASURES: Platelet function parameters arachidonic acid (ASPI), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) assessed via Multiplate(R) analysis, rotational thromboelastometry (ROTEM(R)) parameters EXTEM, FIBTEM, and PLTEM (EXTEM - FIBTEM), transfusion requirements, and clinical outcomes. RESULTS: Significant platelet hypofunction was detected in this cohort of severely injured trauma patients at time of presentation, with 70 % of patients having hypofunction in at least one Multiplate(R) channel. The median ASPI area under the curve and 95 % confidence interval were below the lower reference range, indicating this population had reduced platelet function. In patients with deranged platelet function, significantly lower platelet count (p /= 16) were associated with a higher shock index, positive troponin T levels, standard coagulation abnormalities, hypofibrinogenemia, and abnormal ROTEM parameters (p < 0.05). These patients also had higher rates of massive transfusions and in-hospital mortality (p = 0.001). Coagulation alterations were significantly associated with higher injury severity score (ISS), shock index, head abbreviated injury score (AIS), hypofibrinogenemia, transfusion need, and mortality (p < 0.05). Hypofibrinogenemic patients were younger, sustained severe injuries, had higher shock indices and coagulation marker levels, required more intensive treatments, had longer hospital stays, and had higher mortality (p < 0.05). A significant positive correlation was found between plasma fibrinogen concentration and FIBTEM-MCF (r = 0.294; p = 0.001). Conclusions: Approximately one-fourth of the patients had early traumatic coagulopathy, as assessed by ROTEM. The FIBTEM A10/MCF may serves as a surrogate marker for plasma fibrinogen concentration. While prior studies have established the link between ROTEM and injury severity, our findings reinforce its relevance across varying trauma severity levels. However, prospective studies are warranted to validate its role within diverse trauma systems and evolving resuscitation protocols. FAU - Asim, Mohammad AU - Asim M AUID- ORCID: 0000-0001-9947-8730 AD - Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - El-Menyar, Ayman AU - El-Menyar A AUID- ORCID: 0000-0003-2584-953X AD - Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. AD - Clinical Medicine, Weill Cornell Medical College, Doha P.O. Box 3050, Qatar. FAU - Peralta, Ruben AU - Peralta R AUID- ORCID: 0000-0003-2817-0194 AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. AD - Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo P.O. Box 1423, Dominican Republic. FAU - Arumugam, Suresh AU - Arumugam S AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Wahlen, Bianca AU - Wahlen B AD - Department of Anesthesiology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Ahmed, Khalid AU - Ahmed K AUID- ORCID: 0000-0003-3576-0555 AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Khan, Naushad Ahmad AU - Khan NA AD - Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Alansari, Amani N AU - Alansari AN AD - Department of Pediatric Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Mollazehi, Monira AU - Mollazehi M AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Ibnas, Muhamed AU - Ibnas M AUID- ORCID: 0000-0002-3603-2755 AD - Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Al-Hassani, Ammar AU - Al-Hassani A AUID- ORCID: 0000-0002-2907-9248 AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Parchani, Ashok AU - Parchani A AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Chughtai, Talat AU - Chughtai T AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Galwankar, Sagar AU - Galwankar S AUID- ORCID: 0009-0007-4530-9107 AD - Emergency Medicine Residency Program, College of Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, FL 34243, USA. FAU - Al-Thani, Hassan AU - Al-Thani H AD - Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. FAU - Rizoli, Sandro AU - Rizoli S AUID- ORCID: 0000-0001-8250-7355 AD - Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar. LA - eng PT - Journal Article DEP - 20250430 PL - Switzerland TA - Diagnostics (Basel) JT - Diagnostics (Basel, Switzerland) JID - 101658402 PMC - PMC12071595 OTO - NOTNLM OT - ROTEM OT - coagulation abnormalities OT - outcomes OT - polytrauma OT - severity of injury COIS- The authors declare no conflicts of interest. EDAT- 2025/05/14 11:41 MHDA- 2025/05/14 11:42 PMCR- 2025/04/30 CRDT- 2025/05/14 01:07 PHST- 2025/03/05 00:00 [received] PHST- 2025/04/18 00:00 [revised] PHST- 2025/04/27 00:00 [accepted] PHST- 2025/05/14 11:42 [medline] PHST- 2025/05/14 11:41 [pubmed] PHST- 2025/05/14 01:07 [entrez] PHST- 2025/04/30 00:00 [pmc-release] AID - diagnostics15091148 [pii] AID - diagnostics-15-01148 [pii] AID - 10.3390/diagnostics15091148 [doi] PST - epublish SO - Diagnostics (Basel). 2025 Apr 30;15(9):1148. doi: 10.3390/diagnostics15091148. PMID- 40350576 OWN - NLM STAT- MEDLINE DCOM- 20250825 LR - 20261014 IS - 1362-301X (Electronic) IS - 0269-9052 (Linking) VI - 39 IP - 11 DP - 2025 Aug TI - A prediction model of adenosine diphosphate inhibition among traumatic brain injury patients. PG - 963-969 LID - 10.1080/02699052.2025.2502425 [doi] AB - INTRODUCTION: Coagulopathy in the setting of traumatic brain injury (TBI) increases the risk of poor outcomes. Thromboelastography with platelet mapping (TEG-PM) provides a dynamic assessment of clotting parameters including adenosine diphosphate (ADP) inhibition and can guide antiplatelet reversal. METHODS: A cross-sectional study of a single Level I Trauma Center traumatic brain injury database from February 2015 to March 2024 was conducted to develop a prediction model of ADP inhibition. Included patients had evidence of traumatic intracranial hemorrhage on CT at the time of presentation and underwent TEG-PM testing. Patients with a history of antiplatelet or anticoagulant use were excluded. Significant ADP inhibition was defined as >/= 60%. RESULTS: 485 patients were included. Patients with significant ADP inhibition were younger and more likely to have a severe head injury (Glasgow Coma Scale 3-8). In a multivariate logistic regression model including age and head injury severity as independent variables, severe head injury significantly increased the likelihood of ADP inhibition (odds ratio 2.14, 95% confidence interval 1.28-3.58). CONCLUSION: The observation that severe head injury was significantly associated with ADP inhibition could help identify patients at risk for platelet dysfunction in settings without TEG-PM. FAU - Smith, Caitlyn J AU - Smith CJ AUID- ORCID: 0009-0008-9670-8738 AD - Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Howard, Susanna D AU - Howard SD AUID- ORCID: 0000-0003-3639-8877 AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Arena, John D AU - Arena JD AUID- ORCID: 0000-0002-4322-4472 AD - Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Ghenbot, Yohannes G AU - Ghenbot YG AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Ali, Zarina S AU - Ali ZS AUID- ORCID: 0000-0002-9048-0487 AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Petrov, Dmitry AU - Petrov D AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Kumar, Monisha A AU - Kumar MA AD - Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Schuster, James M AU - Schuster JM AD - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. LA - eng PT - Journal Article DEP - 20250511 PL - England TA - Brain Inj JT - Brain injury JID - 8710358 RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Humans MH - Male MH - *Brain Injuries, Traumatic/complications/blood MH - Female MH - Middle Aged MH - Adult MH - Cross-Sectional Studies MH - *Adenosine Diphosphate MH - Thrombelastography/methods MH - Aged MH - Glasgow Coma Scale MH - Young Adult OTO - NOTNLM OT - Traumatic brain injury OT - adenosine diphosphate inhibition OT - platelet dysfunction OT - predictive modeling OT - thromboelastography EDAT- 2025/05/12 06:32 MHDA- 2025/08/31 19:57 CRDT- 2025/05/12 00:22 PHST- 2025/08/31 19:57 [medline] PHST- 2025/05/12 06:32 [pubmed] PHST- 2025/05/12 00:22 [entrez] AID - 10.1080/02699052.2025.2502425 [doi] PST - ppublish SO - Brain Inj. 2025 Aug;39(11):963-969. doi: 10.1080/02699052.2025.2502425. Epub 2025 May 11. PMID- 40337621 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250509 IS - 2475-0379 (Electronic) IS - 2475-0379 (Linking) VI - 9 IP - 3 DP - 2025 Mar TI - Comparison of 2 thromboelastography methods using patient and control samples. PG - 102843 LID - 10.1016/j.rpth.2025.102843 [doi] LID - 102843 AB - BACKGROUND: Viscoelastic testing at point-of-care is associated with reduced blood loss and blood product transfusions. The ROTEM (Werfen) sigma is a cartridge-based system that may facilitate point-of-care use, but limited studies exist comparing the sigma with the predicated ROTEM delta. OBJECTIVES: We compared the performance of the ROTEM delta with that of the sigma. METHODS: Citrated blood was collected from 20 healthy donors and patients during liver transplants (n = 17), obstetrics (n = 15), cardiovascular (n = 9), and trauma surgeries (n = 10). A method comparison was performed using the delta as the predicate. Imprecision was assessed at 2 levels for each assay. Manufacturer reference intervals were verified using 20 healthy donors. An algorithm used for cardiovascular surgery with the delta was compared with the sigma. RESULTS: The coefficient of variation was <10% for all assays/parameters except for the thromboelastometry with extrinsic activation (EXTEM) clotting time (10.3%) and EXTEM amplitude (A)5 (10.2%). Reference intervals for the delta and sigma were comparable to manufacturer claims. The Pearson r comparing the delta and sigma exceeded .85 for all parameters/assays except for thromboelastometry with cytochalasin D-mediated platelet inhibition (FIBTEM) A10 (.77; 95% CI, .66-.86), FIBTEM A20 (.78; 95% CI, .65-.87), and thromboelastometry with heparinase clotting time (.77; 95% CI, .61-.87). No difference was observed in extrapolated thresholds from the delta-guided algorithm. However, extrapolated sigma A5 parameters for EXTEM were 5 mm lower, and for FIBTEM were 1 mm lower than delta A10 parameters. CONCLUSION: The ROTEM delta and sigma devices had comparable performance. A negative bias was observed in the FIBTEM assay with lower extrapolated clinical decision points for a delta-guided treatment algorithm for the FIBTEM and EXTEM A5. CI - (c) 2025 The Author(s). FAU - Frick, Robert AU - Frick R AD - Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA. FAU - Washburn, Brittany AU - Washburn B AD - Department of Laboratories, Barnes Jewish Hospital, St. Louis, Missouri, USA. FAU - Plocher, Dennis AU - Plocher D AD - Department of Laboratories, Barnes Jewish Hospital, St. Louis, Missouri, USA. FAU - Zoller, Jonathan K AU - Zoller JK AD - Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA. FAU - Gillihan, Jason AU - Gillihan J AD - Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA. FAU - Dombrowski, Michael AU - Dombrowski M AD - Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA. AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA. FAU - Eby, Charles AU - Eby C AD - Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA. FAU - Farnsworth, Christopher W AU - Farnsworth CW AD - Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA. LA - eng PT - Journal Article DEP - 20250330 PL - United States TA - Res Pract Thromb Haemost JT - Research and practice in thrombosis and haemostasis JID - 101703775 PMC - PMC12056965 OTO - NOTNLM OT - blood product utilization OT - coagulation OT - method comparison OT - thromboelastometry OT - transfusion EDAT- 2025/05/08 11:13 MHDA- 2025/05/08 11:14 PMCR- 2025/03/30 CRDT- 2025/05/08 05:18 PHST- 2024/09/24 00:00 [received] PHST- 2025/03/05 00:00 [revised] PHST- 2025/03/20 00:00 [accepted] PHST- 2025/05/08 11:14 [medline] PHST- 2025/05/08 11:13 [pubmed] PHST- 2025/05/08 05:18 [entrez] PHST- 2025/03/30 00:00 [pmc-release] AID - S2475-0379(25)00167-0 [pii] AID - 102843 [pii] AID - 10.1016/j.rpth.2025.102843 [doi] PST - epublish SO - Res Pract Thromb Haemost. 2025 Mar 30;9(3):102843. doi: 10.1016/j.rpth.2025.102843. eCollection 2025 Mar. PMID- 40306503 OWN - NLM STAT- MEDLINE DCOM- 20250525 LR - 20250525 IS - 1879-0003 (Electronic) IS - 0141-8130 (Linking) VI - 311 IP - Pt 1 DP - 2025 Jun TI - Sodium alginate hydrogel platelet rich plasma exosome loaded for synergistic hemostasis. PG - 143447 LID - S0141-8130(25)03999-6 [pii] LID - 10.1016/j.ijbiomac.2025.143447 [doi] AB - Uncontrollable traumatic bleeding caused by surgery or traffic accidents is an important factor leading to high mortality rates. Therefore, there is an urgent hemostatic materials with fast, effective, and safe to achieve rapid hemostasis. Traditional hemostatic materials have limited effect in deep irregular tissues or massive bleeding scenes, while exocrine hydrogel can break through limitations by quickly stopping bleeding and reducing secondary injury. The gelatin time of an injectable 10 % oxidized sodium alginate-10 % gelatin (OSA-G) hydrogel was 8 s. Platelet-rich plasma exosomes (PRP-Exo) from the autologous biological macromolecule play a crucial role in blood coagulation and hemostasis. The OSA-G hydrogel loaded with PRP-Exo exhibited superior effects on proliferation and angiogenesis in vitro. The APTT and thromboelastography of the OSA-G-EXO group were significantly reduced, indicating the occurrence of intrinsic coagulation pathways and the blood was in a hypercoagulable state and promoting hemostasis. Meanwhile, it has been confirmed in the rat tail-cutting model and the liver bleeding model that the hemostasis time is approximately 30 s, promoting skin healing in the skin wound model. By providing a controlled environment for coagulopathy or anticoagulant-treated patients, it shows a good clinical application prospect. CI - Copyright (c) 2025. Published by Elsevier B.V. FAU - Sun, Di AU - Sun D AD - Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China. Electronic address: sundi@mail.ipc.ac.cn. FAU - Yu, Haichao AU - Yu H AD - Nankai University, Tianjin 300071, PR China; PLA General Hospital, Beijing 100048, PR China. FAU - Shen, Hechen AU - Shen H AD - Tianjin Third Central Hospital, Tianjin 300170, PR China. FAU - Wang, Yiran AU - Wang Y AD - Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China. FAU - Su, Tianqi AU - Su T AD - PLA General Hospital, Beijing 100048, PR China. FAU - Guo, Hongbo AU - Guo H AD - National Center for Nanoscience and Technology of China, Beijing 100190, PR China. FAU - Xing, Xiong AU - Xing X AD - PLA General Hospital, Beijing 100048, PR China. FAU - Wang, Weikang AU - Wang W AD - Peking University People's Hospital, Beijing 100044, PR China. FAU - Wei, Li AU - Wei L AD - Beijing Children's Hospital, Beijing 100045, PR China. FAU - Gao, Wenqing AU - Gao W AD - Tianjin Third Central Hospital, Tianjin 300170, PR China. FAU - Yao, Yi AU - Yao Y AD - PLA General Hospital, Beijing 100048, PR China. FAU - Xiu, Bingyu AU - Xiu B AD - Beijing Children's Hospital, Beijing 100045, PR China. FAU - Wang, Jianing AU - Wang J AD - Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China. FAU - Zhang, Xuesong AU - Zhang X AD - Nankai University, Tianjin 300071, PR China; PLA General Hospital, Beijing 100048, PR China. Electronic address: zhangxuesong301@126.com. FAU - Guo, Yanchuan AU - Guo Y AD - Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China. Electronic address: yanchuanguo@mail.ipc.ac.cn. LA - eng PT - Journal Article DEP - 20250428 PL - Netherlands TA - Int J Biol Macromol JT - International journal of biological macromolecules JID - 7909578 RN - 0 (Alginates) RN - 0 (Hydrogels) RN - 0 (Hemostatics) SB - IM MH - *Alginates/chemistry/pharmacology MH - Animals MH - *Hemostasis/drug effects MH - *Platelet-Rich Plasma/chemistry/metabolism MH - *Hydrogels/chemistry/pharmacology MH - *Exosomes/chemistry/metabolism MH - Rats MH - Humans MH - Blood Coagulation/drug effects MH - Wound Healing/drug effects MH - Male MH - *Hemostatics/pharmacology/chemistry MH - Human Umbilical Vein Endothelial Cells MH - Rats, Sprague-Dawley MH - Hemorrhage MH - Neovascularization, Physiologic/drug effects OTO - NOTNLM OT - Hemostatic OT - Platelet rich plasma exosome OT - Sodium alginate hydrogel COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2025/05/01 00:27 MHDA- 2025/05/26 00:29 CRDT- 2025/04/30 19:33 PHST- 2024/12/07 00:00 [received] PHST- 2025/04/15 00:00 [revised] PHST- 2025/04/22 00:00 [accepted] PHST- 2025/05/26 00:29 [medline] PHST- 2025/05/01 00:27 [pubmed] PHST- 2025/04/30 19:33 [entrez] AID - S0141-8130(25)03999-6 [pii] AID - 10.1016/j.ijbiomac.2025.143447 [doi] PST - ppublish SO - Int J Biol Macromol. 2025 Jun;311(Pt 1):143447. doi: 10.1016/j.ijbiomac.2025.143447. Epub 2025 Apr 28. PMID- 40290364 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250429 IS - 0974-2700 (Print) IS - 0974-519X (Electronic) IS - 0974-2700 (Linking) VI - 18 IP - 1 DP - 2025 Jan-Mar TI - A Nomogram Prediction Model for Clinical Outcome of Trauma-induced Coagulopathy Patients with Severe Multiple Trauma. PG - 3-9 LID - 10.4103/jets.jets_124_24 [doi] AB - INTRODUCTION: The objective of this study was to investigate the predictive value of thromboelastography (TEG) combined with conventional coagulation test parameters for the clinical outcome of patients with trauma-induced coagulopathy (TIC) and establish and evaluate a clinical nomogram for predicting the prognosis of TIC patients. METHODS: Clinical data of severe multiple trauma patients who underwent emergency treatment in the hospital from November 2018 to August 2021 were enrolled retrospectively. The prognosis was evaluated according to the length of hospital stay and the 30-day survival rate. Multivariable logistic regression model was used to evaluate the correlation between TEG parameters and clinical outcomes. A nomogram model was constructed and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value. RESULTS: Univariate analysis indicated that there were significant differences in age, hypertension, temperature fluctuation (>3 degrees C), transfusion, kinetics time (K), angle (alpha) value, maximal amplitude (MA), and international normalized ratio between the good and poor outcome group (P < 0.05). Multivariate logistic regression analysis showed that age, Glasgow Coma Scale scores, temperature fluctuation (>3 degrees C), and MA parameters were independent risk factors for poor outcome, and we established the nomogram prediction model. According to ROC curve analysis, the area under the curve for MA parameter was 0.689 (95% confidence interval [CI]: 0.610-0.760), and the corresponding sensitivity and specificity were 44.12% and 91.87%, respectively. The area under the curve for temperature fluctuation (>3 degrees C) was 0.697 (95% CI: 0.618-0.768), and the corresponding sensitivity and specificity were 60.00% and 79.67%, respectively. CONCLUSION: TEG parameters combined with relevant clinical indicators can be used to evaluate the prognosis of TIC patients with severe multiple trauma. The establishment of correlation nomogram model was guiding significance for clinical evaluation of long-term prognosis of trauma patients. CI - Copyright: (c) 2025 Journal of Emergencies, Trauma, and Shock. FAU - Shen, Jun AU - Shen J AD - Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. FAU - Xu, Feng AU - Xu F AD - Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. LA - eng PT - Journal Article DEP - 20250227 PL - India TA - J Emerg Trauma Shock JT - Journal of emergencies, trauma, and shock JID - 101493921 PMC - PMC12020931 OTO - NOTNLM OT - Clinical outcome OT - multiple trauma OT - nomogram model OT - parameters OT - thromboelastography OT - trauma-induced coagulopathy COIS- There are no conflicts of interest. EDAT- 2025/04/28 17:03 MHDA- 2025/04/28 17:04 PMCR- 2025/01/01 CRDT- 2025/04/28 06:19 PHST- 2024/09/06 00:00 [received] PHST- 2024/11/19 00:00 [revised] PHST- 2025/01/07 00:00 [accepted] PHST- 2025/04/28 17:04 [medline] PHST- 2025/04/28 17:03 [pubmed] PHST- 2025/04/28 06:19 [entrez] PHST- 2025/01/01 00:00 [pmc-release] AID - JETS-18-3 [pii] AID - 10.4103/jets.jets_124_24 [doi] PST - ppublish SO - J Emerg Trauma Shock. 2025 Jan-Mar;18(1):3-9. doi: 10.4103/jets.jets_124_24. Epub 2025 Feb 27. PMID- 40288410 OWN - NLM STAT- MEDLINE DCOM- 20250825 LR - 20250827 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) VI - 45 IP - 4 DP - 2025 Aug TI - Fibrinogen Replacement: A Questionable Dogma. PG - 320-323 LID - 10.1055/a-2535-8910 [doi] AB - Management of hemostasis in the perioperative setting, in trauma or in acute care, has considerably changed over the last two decades. Viscoelastic testing and single-factor replacement therapies have become cornerstones of the respective clinical approaches. Here, we illuminate the basic theories for these approaches as well as the important evidence available. Both viscoelastic assays and single-factor replacements are important improvements; their use must be based on the strongest scientific evidence available. CI - Thieme. All rights reserved. FAU - Duque, Patricia AU - Duque P AD - Department of Anesthesiology and Intensive Care, Gregorio Maranon Hospital, Madrid, Spain. FAU - Korte, Wolfgang AU - Korte W AD - Haemostasis and Haemophilia Center, St. Gallen, Switzerland. LA - eng PT - Journal Article PT - Review DEP - 20250427 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Fibrinogen/therapeutic use/administration & dosage MH - Evidence-Based Medicine COIS- Potential conflicts of interests for this manuscript in the last two years exist with Takeda, Sobi and Sysmex. EDAT- 2025/04/28 00:27 MHDA- 2025/09/08 07:56 CRDT- 2025/04/27 18:53 PHST- 2025/09/08 07:56 [medline] PHST- 2025/04/28 00:27 [pubmed] PHST- 2025/04/27 18:53 [entrez] AID - 10.1055/a-2535-8910 [doi] PST - ppublish SO - Hamostaseologie. 2025 Aug;45(4):320-323. doi: 10.1055/a-2535-8910. Epub 2025 Apr 27. PMID- 40278683 OWN - NLM STAT- MEDLINE DCOM- 20250425 LR - 20250427 IS - 2072-6651 (Electronic) IS - 2072-6651 (Linking) VI - 17 IP - 4 DP - 2025 Apr 7 TI - Bite First, Bleed Later: How Philippine Trimeresurus Pit Viper Venoms Hijack Blood Clotting. LID - 10.3390/toxins17040185 [doi] LID - 185 AB - The Philippines has a high diversity of venomous snake species, but there is minimal information on their envenomation effects. This is evidenced by the small number of case reports, the poor reporting of envenomation cases, and the absence of specific antivenoms apart from one against the Philippine cobra (Naja philippinensis). This study sought to profile the action of selected Philippine pit viper venoms on blood coagulation and to investigate whether commercially available non-specific antivenoms can provide adequate protection against these venoms. Venom from the pit vipers Trimeresurus flavomaculatus and Trimeresurus mcgregori were subjected to coagulation assays, antivenom cross-neutralization tests, and thromboelastography. Venoms from both species were able to clot human plasma and isolated human fibrinogen. Consistent with pseudo-procoagulant/thrombin-like activity, the resulting fibrin clots were weak and transient, thereby contributing to net anticoagulation through the depletion of fibrinogen levels. Clotting factors fIXa and fXa were also inhibited by the venoms, further contributing to the net anticoagulant activity. Monovalent and polyvalent antivenoms from the Thai Red Cross Society were effective against both venoms, indicating cross-neutralization of venom toxins; the polyvalent antivenom was able to rescue fibrinogen clotting to a greater degree than the monovalent antivenom. Our findings highlight the coagulopathic effects of these pit viper venoms and suggest the utility of procuring the non-specific antivenoms for areas in the Philippines with a high risk for pit viper envenomation. FAU - Castillo, Daniel Albert E AU - Castillo DAE AUID- ORCID: 0009-0002-6226-1655 AD - The Graduate School, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines. AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia. AD - Department of Biological Sciences, College of Science, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines. AD - Avilon Wildlife Conservation Foundation and School of Practical Veterinary Management, Inc., 9003 GP Sitio Gulod, Barangay San Isidro, Rodriguez 1860, Rizal, Philippines. FAU - Seneci, Lorenzo AU - Seneci L AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia. FAU - Chowdhury, Abhinandan AU - Chowdhury A AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia. FAU - Rimando, Marilyn G AU - Rimando MG AD - The Graduate School, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines. AD - Department of Biological Sciences, College of Science, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines. AD - Research Center for the Natural and Applied Sciences, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines. FAU - Fry, Bryan G AU - Fry BG AUID- ORCID: 0000-0001-6661-1283 AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia. LA - eng GR - DP190100304/Australian Research Council/ PT - Journal Article DEP - 20250407 PL - Switzerland TA - Toxins (Basel) JT - Toxins JID - 101530765 RN - 0 (Antivenins) RN - 0 (Crotalid Venoms) RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation/drug effects MH - Animals MH - Antivenins/pharmacology MH - Humans MH - *Trimeresurus MH - Philippines MH - *Snake Bites/blood MH - *Crotalid Venoms/toxicity/antagonists & inhibitors MH - Thrombelastography MH - Fibrinogen/metabolism PMC - PMC12031257 OTO - NOTNLM OT - Trimeresurus OT - antivenom OT - coagulotoxicity OT - fibrinogen OT - pseudo-procoagulant COIS- D.A.E.C. is a lecturer of the Avilon Wildlife Conservation Foundation and School of Practical Veterinary Management, Inc. The institution provided snakes for venom collection, but it had no input in experimental design or reviewing of results before publication. The other authors declare no conflicts of interest. EDAT- 2025/04/25 13:46 MHDA- 2025/04/25 13:47 PMCR- 2025/04/07 CRDT- 2025/04/25 10:24 PHST- 2025/02/18 00:00 [received] PHST- 2025/03/13 00:00 [revised] PHST- 2025/04/04 00:00 [accepted] PHST- 2025/04/25 13:47 [medline] PHST- 2025/04/25 13:46 [pubmed] PHST- 2025/04/25 10:24 [entrez] PHST- 2025/04/07 00:00 [pmc-release] AID - toxins17040185 [pii] AID - toxins-17-00185 [pii] AID - 10.3390/toxins17040185 [doi] PST - epublish SO - Toxins (Basel). 2025 Apr 7;17(4):185. doi: 10.3390/toxins17040185. PMID- 40275305 OWN - NLM STAT- MEDLINE DCOM- 20250425 LR - 20260406 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 33 IP - 1 DP - 2025 Apr 24 TI - Utility of point of care viscoelastic haemostatic assays for trauma patients in the emergency department. PG - 68 LID - 10.1186/s13049-025-01388-1 [doi] LID - 68 AB - BACKGROUND AND OBJECTIVES: Traumatic haemorrhage often requires initiation of a massive haemorrhage protocol (MHP). The primary aim of this exploratory Emergency Department (ED) study was to examine the utility of point of care Viscoelastic Haemostatic Assays (VHA) in terms of accuracy. The primary outcome was prediction of the need for massive transfusion (MT) at 24-hours. METHODS: Prospective observational study of consecutive trauma patients investigated with reported using STARD guidelines. Patients in an Australian ED setting < 1-hour from triage enrolled in a three-year window. The point-of-care device used was a TEG6s (Haemonetics, Braintree, MA, USA). The primary outcome was accuracy VHA testing for predicting MT delivery at 24-hours (an internationally recognised of massive transfusion was used). Other trauma outcomes such as product transfusion, injury severity score (ISS) and demographics were recorded. For analysis of accuracy the cohort was divided into VHA-normal (n = 44) and VHA-abnormal (n = 70) binary groups. Secondary outcomes included utility of TEG6s individual components and accuracy of VHA when combined with validated MHP decision scores. RESULTS: Among eligible cases (n = 114) in-patient mortality was 7.0% with 91.2% receiving transfusion. Presence of (any) abnormal VHA result provided a 73.6% (95%CI 59.7-84.7) sensitivity and 49.3% (95%CI 36.1-62.3) specificity for predicting MT. Citrated Functional Fibrinogen (CFF) component had a higher performance for MT "rule-in" specificity (86.9%). When VHA was combined with validated MHP decision scores performance was increased. For example, normal VHA with Trauma Associated Severe Haemorrhage score < 8.5 was observed to yield a sensitivity of 96.2% for MT requirement rule-out. Further studies should examine if VHA test parameters can be added or (replace INR) in the existing clinical scores used to make decisions about transfusion in ED patients. CONCLUSION: The standalone performance of early VHA testing in the ED setting was insufficient to reliably for predict a need for massive transfusion. CI - (c) 2025. The Author(s). FAU - Coggins, Andrew Richard AU - Coggins AR AUID- ORCID: 0000-0002-5652-6920 AD - Department of Emergency Medicine, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia. andrew.coggins@health.nsw.gov.au. FAU - Nguyen, Vinh Dat David AU - Nguyen VDD AD - Western Sydney Local Health DistrictWestmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia. FAU - Pasalic, Leonardo AU - Pasalic L AUID- ORCID: 0000-0002-8237-6743 AD - Department of Haematology, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia. FAU - Ramesh, Murari AU - Ramesh M AUID- ORCID: 0000-0002-3049-6786 AD - Western Sydney Local Health DistrictWestmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia. FAU - Wangoo, Kush AU - Wangoo K AD - Western Sydney Local Health DistrictWestmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia. LA - eng PT - Journal Article PT - Observational Study DEP - 20250424 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Adult MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - Australia MH - Blood Transfusion MH - *Emergency Service, Hospital MH - *Hemorrhage/therapy/etiology/diagnosis/blood MH - Injury Severity Score MH - *Point-of-Care Systems MH - Prospective Studies MH - *Thrombelastography/methods MH - Triage MH - *Wounds and Injuries/complications/therapy/blood PMC - PMC12023681 OTO - NOTNLM OT - Accident & emergency medicine OT - Blood bank & transfusion medicine OT - Trauma management COIS- Declarations. Consent for publication: N/A. Competing interests: The authors declare no competing interests. EDAT- 2025/04/25 01:21 MHDA- 2025/04/25 13:45 PMCR- 2025/04/24 CRDT- 2025/04/24 23:49 PHST- 2025/02/21 00:00 [received] PHST- 2025/04/10 00:00 [accepted] PHST- 2025/04/25 13:45 [medline] PHST- 2025/04/25 01:21 [pubmed] PHST- 2025/04/24 23:49 [entrez] PHST- 2025/04/24 00:00 [pmc-release] AID - 10.1186/s13049-025-01388-1 [pii] AID - 1388 [pii] AID - 10.1186/s13049-025-01388-1 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2025 Apr 24;33(1):68. doi: 10.1186/s13049-025-01388-1. PMID- 40271704 OWN - NLM STAT- MEDLINE DCOM- 20250424 LR - 20260813 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 4 IP - 4 DP - 2025 Apr 24 TI - Blood transfusion strategies for major bleeding in trauma. PG - CD012635 LID - 10.1002/14651858.CD012635.pub2 [doi] LID - CD012635 AB - BACKGROUND: Trauma is a leading cause of morbidity and mortality worldwide. Research shows that haemorrhage and trauma-induced coagulopathy are reversible components of traumatic injury, if identified and treated early. Lack of consensus on definitions and transfusion strategies hinders the translation of this evidence into clinical practice. OBJECTIVES: To assess the beneficial and harmful effects of transfusion strategies started within 24 hours of traumatic injury in adults (aged 16 years and over) with major bleeding. SEARCH METHODS: CENTRAL, MEDLINE, Embase, five other databases, and three trial registers were searched on 20 November 2023. We also checked reference lists of included studies to identify any additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adults (aged 16 years and over) receiving blood products for the management of bleeding within 24 hours of traumatic injury. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology to perform the review and assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 18 RCTs with 5041 participants. Comparison 1: Prehospital transfusion strategies Five studies compared use of plasma (fresh frozen plasma (FFP) or lyophilised plasma) versus 'standard of care'. We are uncertain of the effect of plasma on all-cause mortality at 24 hours (risk ratio (RR) 1.05, 95% confidence interval (CI), 0.48 to 2.30; 3 studies, 279 participants; very low certainty evidence). There is probably no difference between plasma and standard of care in all-cause mortality at 30 days (RR 0.95, 95% CI 0.78 to 1.17; 3 studies, 664 participants; moderate-certainty evidence). However, the results of one cluster-RCT that could not be included in our meta-analysis suggested that plasma may be associated with a lower risk of death at 30 days (RR 0.54, 95% CI 0.42 to 0.70; 1 study, 481 participants; low-certainty evidence). There may be no difference between plasma and standard of care in the total number of thromboembolic events in 30 days (RR 1.23, 95% CI 0.67 to.2.27; 4 studies, 586 participants; low-certainty evidence). Comparison 2: In-hospital transfusion strategies Ten studies evaluated this comparison, seven providing usable data. The studies evaluated cryoprecitate (three studies); fixed-ratio blood component transfusion (three studies); fresh frozen plasma (FFP) (one study); lyophilised plasma (one study); leucoreduced red blood cells (one study); and a restrictive transfusion strategy (one study). All-cause mortality at 24 hours For all-cause mortality at 24 hours, there is probably no difference between: * cryoprecipitate plus a major haemorrhage protocol (MHP) versus MHP alone (RR 0.92, 95% CI 0.70 to 1.21; 1 study, 1577 participants; moderate-certainty evidence); and * blood products (plasma:platelets:red blood cells (RBCs)) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 0.75, 95% CI 0.52 to 1.08; 1 study, 680 participants; moderate-certainty evidence). We are uncertain of the effect on all-cause mortality at 24 hours for: * blood products (RBCs:FFP) transfused in 1:1 ratio versus transfusion according to coagulation and full blood count results (Peto odds ratio (POR) 0.45, 0.17 to 1.22; 1 study, 434 participants; very low certainty evidence); and * lyophilised (FlyP) plasma versus FFP (POR 1.04, 95% CI 0.06 to 17.23; 1 study, 47 participants; very low certainty evidence); All-cause mortality at 30 days For all-cause mortality at 30 days, there is probably no difference between blood products (plasma:platelets:RBCs) transfused in a 1:1:1 ratio versus a 1:1:2 ratio (RR 0.85, 95% CI 0.65 to 1.11; 1 study, 680 participants; moderate-certainty evidence). There may be little to no difference between the following interventions in all-cause mortality at 30 days: * cryoprecipitate plus MHP versus MHP alone (RR 0.77, 95% CI 0.33 to 1.78; 2 studies, 1572 participants; low-certainty evidence); and *leucoreduced RBCs versus standard RBCs (RR 1.20, 95% CI 0.74 to 1.95; 1 study,55 participants; low certainty evidence). We are uncertain of the effect on all-cause mortality at 30 days for: *lyophilised plasma versus FFP (RR 0.75, 95% CI 0.28 to 2.02; 1 study, 47 participants; very low certainty evidence); and * blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (RR 2.25, 95% CI 0.90 to 5.62; 1 study, 69 participants; very low certainty evidence). Total number of thromboembolic events at 30 days There may be little to no difference between the following interventions for total thromboembolic events at 30 days: * cryoprecipitate plus MHP versus MHP alone (RR 0.55, 95% CI 0.08 to 3.72; 2 studies, 1645 participants; low-certainty evidence); and * blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus 1:1:2 ratio (RR 1.03, 95% CI 0.75 to 1.42; 1 study, 680 participants; low-certainty evidence). We are uncertain of the effect on the total number of thromboembolic events at 30 days for: *blood products (plasma:platelets:RBCs) transfused in 1:1:1 ratio versus standard MHP (POR 6.83, 95% CI 0.68 to 68.35; 1 study, 69 participants; very low certainty evidence). Comparison 3: Whole blood versus individual blood products We are uncertain of the effect of modified (leucoreduced) whole blood versus blood products (RBCs:plasma) transfused in a 1:1 ratio on all-cause mortality at 24 hours (RR 1.13, 95% CI 0.37 to 3.49) or 30 days (RR 1.62, 95% CI 0.69 to 3.80) (1 study, 107 participants; very low certainty evidence). Comparison 4: Goal-directed blood transfusion strategy of viscoelastic haemostatic assay (VHA) versus conventional laboratory coagulation tests (CCT) to guide haemostatic therapy There may be little or no difference in all-cause mortality at 24 hours between VHA and CCT (RR 0.85, 95% CI 0.54 to 1.35; 1 study, 396 participants; low-certainty evidence). We are uncertain of the effects on all-cause mortality at 30 days (RR 0.75, 95% CI 0.48 to 1.17; 2 studies, 506 participants; very low certainty evidence). There is probably no difference between VHA and CCT in total thromboembolic events at 30 days (RR 0.65, 95% CI 0.35 to 1.18; 1 study 396 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Overall, there was little to no evidence of a difference between blood transfusion strategies for mortality or thromboembolic events. The studies covered a wide range of interventions, and the comparators and standard of care practice varied between trials, thereby limiting the pooling of data. Further research is needed. CI - Copyright (c) 2025 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Brunskill, Susan J AU - Brunskill SJ AD - Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK. AD - Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK. FAU - Disegna, Arthur AU - Disegna A AD - National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK. FAU - Wong, Henna AU - Wong H AD - Department of Haematology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK. FAU - Fabes, Jeremy AU - Fabes J AD - Faculty of Health, University of Plymouth, Plymouth, UK. AD - Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK. AD - NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK. FAU - Desborough, Michael Jr AU - Desborough MJ AD - Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. AD - Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Doree, Carolyn AU - Doree C AD - Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK. AD - Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK. FAU - Davenport, Ross AU - Davenport R AD - Centre for Trauma Sciences - Blizard Institute, Queen Mary University of London, London, UK. FAU - Curry, Nicola AU - Curry N AD - Radcliffe Department of Medicine, University of Oxford, Oxford, UK. AD - Oxford Haemophilia & Thrombosis Centre, Churchill Hospital, Oxford, UK. FAU - Stanworth, Simon J AU - Stanworth SJ AD - Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. AD - Radcliffe Department of Medicine, University of Oxford, Oxford, UK. LA - eng SI - ClinicalTrials.gov/NCT02736812 SI - ClinicalTrials.gov/NCT02416817 SI - ClinicalTrials.gov/NCT04431999 SI - ClinicalTrials.gov/NCT04684719 SI - ClinicalTrials.gov/NCT04726410 PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20250424 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - doi: 10.1002/14651858.CD012635 MH - Humans MH - Randomized Controlled Trials as Topic MH - *Hemorrhage/therapy/mortality/etiology MH - *Blood Transfusion/methods/mortality MH - Plasma MH - *Wounds and Injuries/complications/mortality MH - Adult MH - Bias MH - Time Factors MH - Blood Component Transfusion/methods/mortality PMC - PMC12019925 COIS- SJB: none
AD: none
HW: none
JF: none
MJRD: none
CD: none
RD was involved in two of the included studies (Baksaas-Aasen 2021; Curry 2015). In Baksaas-Aasen 2021, RD contributed to the study design, development, and set up, site set up, participantt enrolment, data collection, and research governance. In Curry 2015, RD revised the manuscript. RD was not involved in the data extraction of Baksaas-Aasen 2021 or Curry 2015 for this review. RD is a co-investigator of an ongoing study (Davenport 2023). 
NC was involved in two of the included studies (Baksaas-Aasen 2021; Curry 2015). In Baksaas-Aasen 2021, NC contributed to the study design, development, and set up, site set up, participant enrolment, data collection, and research governance. In Curry 2015, NC contributed to the study design, patient recruitment, study conduct, data collection, data analysis, and writing the paper. NC was not involved in the data extraction of Baksaas-Aasen 2021 or Curry 2015 for this review. NC is a co-investigator of an ongoing study (Davenport 2023). 
SJS was involved in two of the included studies (Baksaas-Aasen 2021; Curry 2015). In Baksaas-Aasen 2021, SJS contributed to the study design, development, and set up, site set up, participant enrolment, data collection, and research governance. In Curry 2015, SJS contributed to the study design, conduct, and oversight, data analysis, and critical review of the paper. SJS was not involved in the data extraction or analysis of any data in this review. SJS is the chief investigator of an ongoing study (Davenport 2023). EDAT- 2025/04/24 12:28 MHDA- 2025/04/24 12:29 PMCR- 2026/04/24 CRDT- 2025/04/24 06:54 PHST- 2025/04/24 12:29 [medline] PHST- 2025/04/24 12:28 [pubmed] PHST- 2025/04/24 06:54 [entrez] PHST- 2026/04/24 00:00 [pmc-release] AID - CD012635.pub2 [pii] AID - 10.1002/14651858.CD012635.pub2 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2025 Apr 24;4(4):CD012635. doi: 10.1002/14651858.CD012635.pub2. PMID- 40252700 OWN - NLM STAT- MEDLINE DCOM- 20250731 LR - 20260430 IS - 2352-5568 (Electronic) IS - 2352-5568 (Linking) VI - 44 IP - 4 DP - 2025 Aug TI - Peri-partum reference range for the point-of-care viscoelastic testing device Quantra(R) QStat in healthy pregnancy and non-haemorrhagic post-partum - A short communication. PG - 101521 LID - S2352-5568(25)00053-0 [pii] LID - 10.1016/j.accpm.2025.101521 [doi] AB - INTRODUCTION: The Quantra(R) QStat is a novel point-of-care viscoelastometric test based on sonorheometry technology. Reference ranges in obstetric settings have not yet been established. The QStat measures five parameters: clotting time (CT, seconds (s)), clotting stiffness (CS, hectopascals (hPA)), fibrinogen (FCS, hPA) and platelet contribution to clot stiffness (PCS, hPA), and clot stability to lysis (CSL, percentage (%)). METHODS: A prospective observational study was conducted in two French academic hospitals to determine the reference range in full-term healthy pregnant women. The QStat measurements were performed upon admission to the delivery room and thirty to sixty minutes after uncomplicated vaginal or caesarean delivery. The primary analysis involved defining reference intervals, expressed as the means, standard deviations, distributions, and dispersions. The secondary analysis compared values between pregnant and nonpregnant patients, between the prepartum and postpartum periods, and between vaginal and caesarean delivery methods. RESULTS: Over one year, in 84 patients, the QStat parameter ranges were established for the end of pregnancy and immediate postpartum periods. The CT and FCS values differed between pregnant and nonpregnant women. No significant difference was found between the prepartum and postpartum values or between vaginal and caesarean delivery groups. DISCUSSION AND CONCLUSION: The QStat is a promising point-of-care viscoelastometric testing device that is now desirable for managing postpartum haemorrhage to enable haemostasic goal-oriented therapies. Similar to viscoelastometric testing in trauma and cardiac surgery, the QStat provides reliable measurements. Further research is needed to establish pathological reference values specific to the obstetric bleeding scenario. REGISTRATION: ClinicalTrial.gov: NCT04753671. CI - Copyright (c) 2025. Published by Elsevier Masson SAS. FAU - Lukowiak, Oliver AU - Lukowiak O AD - Departement d'Anesthesie obstetricale, hopital Jeanne-De-Flandre, Centre Hospitalier Universitaire de Lille, France. Electronic address: oliver.lukowiak@chu-lille.fr. FAU - Le Gouez, Agnes AU - Le Gouez A AD - Departement d'Anesthesie, hopital Antoine Beclere, APHP, Universite Paris-Saclay, Clamart, France. Electronic address: agnes.le-gouez@aphp.fr. FAU - Djebbour, Maxime AU - Djebbour M AD - Departement d'Anesthesie, hopital Antoine Beclere, APHP, Universite Paris-Saclay, Clamart, France. Electronic address: maxime.djebbour@aphp.fr. FAU - Mercier, Frederic J AU - Mercier FJ AD - Departement d'Anesthesie, hopital Antoine Beclere, APHP, Universite Paris-Saclay, Clamart, France. Electronic address: frederic.mercier@aphp.fr. FAU - Bouthors, Anne-Sophie AU - Bouthors AS AD - ULR 7365 - Equipe de recherche GRITA, Universite de Lille, France. Electronic address: anne-sophie.bouthors@chu-lille.fr. LA - eng SI - ClinicalTrials.gov/NCT04753671 PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20250417 PL - France TA - Anaesth Crit Care Pain Med JT - Anaesthesia, critical care & pain medicine JID - 101652401 SB - IM MH - Humans MH - Female MH - Pregnancy MH - Prospective Studies MH - Adult MH - *Thrombelastography/instrumentation/methods MH - Reference Values MH - *Postpartum Period/blood MH - *Point-of-Care Testing MH - *Point-of-Care Systems MH - Young Adult MH - Blood Coagulation MH - Cesarean Section OTO - NOTNLM OT - Fibrinogen OT - Haemostasis OT - Postpartum OT - Pregnancy OT - Quantra OT - Viscoelastometric test COIS- Declaration of competing interest The authors declare the present research was supported by Stago BioCare. The company provided the devices and the consumable supplies in the 2 hospitals for the time of the research program and provided statistical analysis support. EDAT- 2025/04/20 00:44 MHDA- 2025/08/01 00:29 CRDT- 2025/04/19 19:34 PHST- 2024/12/12 00:00 [received] PHST- 2025/01/03 00:00 [revised] PHST- 2025/02/01 00:00 [accepted] PHST- 2025/08/01 00:29 [medline] PHST- 2025/04/20 00:44 [pubmed] PHST- 2025/04/19 19:34 [entrez] AID - S2352-5568(25)00053-0 [pii] AID - 10.1016/j.accpm.2025.101521 [doi] PST - ppublish SO - Anaesth Crit Care Pain Med. 2025 Aug;44(4):101521. doi: 10.1016/j.accpm.2025.101521. Epub 2025 Apr 17. PMID- 40252546 OWN - NLM STAT- MEDLINE DCOM- 20250518 LR - 20260505 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 250 DP - 2025 Jun TI - Antiplatelet-anticoagulant, APAC, a mimic of endogenous heparin, is an antithrombotic with von Willebrand factor-mediated characteristics. PG - 109318 LID - S0049-3848(25)00067-2 [pii] LID - 10.1016/j.thromres.2025.109318 [doi] AB - BACKGROUND: We have conjugated selected number of unfractionated heparin (UFH) chains to human albumin core to mimic mast-cell heparin proteoglycans (HEP-PG). Indeed, APAC, dual antiplatelet and anticoagulant, as HEP-PG, has inhibited collagen- (CIPA) and thrombin-induced platelet aggregation, being simultaneously an anticoagulant. In several animal models of arterial thrombosis, APAC has provided vascular-injury-associated local antithrombotic properties mediated by von Willebrand factor (VWF). AIMS: We compared the structure-function effects of APAC with those of UFH in vitro, and when supplemented in blood studied platelet and VWF-dependency and anticoagulation. METHODS: We assessed the total thrombosis formation analysis system (T-TAS) and coagulation (rotational thromboelastometry, ROTEM) in blood, and thrombin generation and aggregation in platelet-rich plasma. We studied aggregation responses of APAC to collagen, ristocetin, ADP, and potential synergism with cangrelor, P2Y12 receptor antagonist. Finally, heparin-neutralizing role of platelet factor 4 (PF4) on antiplatelet and anticoagulant functions of APAC was investigated. RESULTS: APAC concentration-dependently exceeded the anticoagulant and antithrombotic action of UFH in ROTEM, and platelet thrombus formation under arterial blood flow over collagen/tissue factor. APAC uniquely inhibited CIPA. While ADP- and ristocetin-induced aggregation were unaffected by APAC, we detected synergism with cangrelor for CIPA. Disruption of the tertiary structure of APAC reverted its mode of action to anticoagulation only, alike UFH. PF4 neutralized antithrombotic actions of APAC. CONCLUSION: The structure-function of APAC conveys dual and unique antiplatelet and anticoagulant actions in flowing blood over collagen and beyond. Our studies confirmed the inhibitory role of APAC on VWF functions and fibrin formation. CI - Copyright (c) 2025 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Jouppila, Annukka AU - Jouppila A AD - Clinical Research institute HUCH, Helsinki, Finland; Research Program Unit in Systems Oncology, Medical Faculty, University of Helsinki, Helsinki, Finland. Electronic address: Annukka.Jouppila@hus.fi. FAU - Nevola, Ilja AU - Nevola I AD - Research Program Unit in Systems Oncology, Medical Faculty, University of Helsinki, Helsinki, Finland. FAU - Lemponen, Marja AU - Lemponen M AD - HUS Diagnostic Center, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Mattila, Tomi AU - Mattila T AD - Research Program Unit in Systems Oncology, Medical Faculty, University of Helsinki, Helsinki, Finland. FAU - Lassila, Riitta AU - Lassila R AD - Research Program Unit in Systems Oncology, Medical Faculty, University of Helsinki, Helsinki, Finland; Coagulation Disorders Unit, Departments of Hematology and Clinical Chemistry (HUSLAB Laboratory Services), Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland; Aplagon Ltd., Helsinki, Finland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20250412 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 RN - 9005-49-6 (Heparin) RN - 0 (von Willebrand Factor) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Anticoagulants) RN - 0 (Fibrinolytic Agents) SB - IM MH - Humans MH - *Heparin/pharmacology MH - *von Willebrand Factor/metabolism MH - *Platelet Aggregation Inhibitors/pharmacology/therapeutic use MH - *Anticoagulants/pharmacology/therapeutic use MH - Platelet Aggregation/drug effects MH - *Fibrinolytic Agents/pharmacology MH - Thrombosis/drug therapy MH - Blood Platelets/drug effects/metabolism OTO - NOTNLM OT - APAC OT - Antithrombotic OT - Platelet OT - Unfractionated heparin OT - von Willebrand factor COIS- Declaration of competing interest RL is the CMO and CSO for Aplagon Ltd., Helsinki, Finland. AJ received research funding via Clinical Research Institute HUCH from Aplagon Ltd. IL, ML and TM have no conflicts of interest to declare for this study. EDAT- 2025/04/20 00:44 MHDA- 2025/05/19 00:36 CRDT- 2025/04/19 18:10 PHST- 2024/12/04 00:00 [received] PHST- 2025/04/04 00:00 [revised] PHST- 2025/04/07 00:00 [accepted] PHST- 2025/05/19 00:36 [medline] PHST- 2025/04/20 00:44 [pubmed] PHST- 2025/04/19 18:10 [entrez] AID - S0049-3848(25)00067-2 [pii] AID - 10.1016/j.thromres.2025.109318 [doi] PST - ppublish SO - Thromb Res. 2025 Jun;250:109318. doi: 10.1016/j.thromres.2025.109318. Epub 2025 Apr 12. PMID- 40249632 OWN - NLM STAT- MEDLINE DCOM- 20250624 LR - 20260430 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 99 IP - 1 DP - 2025 Jul 1 TI - Where does cryoprecipitate fit into balanced resuscitation? An evaluation of 2,117 hemorrhaging patients using viscoelastic-based resuscitation. PG - 73-78 LID - 10.1097/TA.0000000000004643 [doi] AB - BACKGROUND: Empiric cryoprecipitate administration has recently failed to show survival benefit in hemorrhaging trauma patients. However, a recent Trauma Quality Improvement Program query suggested a survival benefit in massive transfusions when administering 1 U of cryoprecipitate to every 7 to 8 U of red blood cells (RBCs). We describe transfusion ratios when cryoprecipitate was indicated by viscoelastic testing (VET) and evaluated whole blood (WB)'s impact on this ratio. METHODS: Adult trauma patients admitted from July 2017 to December 2021 who received emergency-release blood products prehospital or in the emergency department were included. Patients who died within 60 minutes were excluded. Massive transfusion patients received arrival VET, which was repeated serially while on massive transfusion protocol. Cryoprecipitate transfusion was based on VET results. Blood product ratios were calculated for RBC, plasma, platelets, and cryoprecipitate in the first four and 24 hours of resuscitation. Each WB unit was counted as 1 RBC, 1 plasma, and 0.17 U of platelets. Outcomes were evaluated based on blood component ratios. Patients receiving WB were compared with patients who only received blood components. RESULTS: A total of 2,117 patients were included. Overall, the median age was 37 (25, 55) years, 74% were male, 37% were white, and 67% sustained blunt trauma. Overall survival was 77%. The median 4-hour RBC/plasma/platelet/cryoprecipitate ratio was 9:9.5:1.3:1. Patients who received WB did not require cryoprecipitate until later in their resuscitation when compared with blood components (10:9.5:1.7:1 vs. 7:6:1:1, p = 0.008). CONCLUSION: When using routine VET to guide resuscitation for hemorrhage, cryoprecipitate transfusion occurred later in patients receiving WB incorporated resuscitations compared with the component only strategy. For centers that do not use VET and use algorithmic resuscitation protocols, cryoprecipitate transfusion should be considered after 7 U of RBCs/plasma and after 10 U of a WB incorporated resuscitation. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Van Gent, Jan-Michael AU - Van Gent JM AUID- ORCID: 0000-0002-4655-2527 AD - From the Department of Surgery (J.-M.V.G., T.W.C., B.A.C.), McGovern Medical School, University of Texas Health Science Center, Houston; and Joint Trauma System (J.-M.V.G., J.M.G.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas. FAU - Clements, Thomas W AU - Clements TW FAU - Gurney, Jennifer M AU - Gurney JM FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article DEP - 20250417 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-32-5 (Fibrinogen) RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) SB - IM MH - Humans MH - Male MH - *Resuscitation/methods MH - Female MH - Adult MH - *Fibrinogen/administration & dosage/therapeutic use MH - *Factor VIII/administration & dosage/therapeutic use MH - Middle Aged MH - *Hemorrhage/therapy/etiology/mortality MH - *Wounds and Injuries/complications/therapy MH - *Blood Transfusion/methods MH - Retrospective Studies OTO - NOTNLM OT - Trauma OT - cryoprecipitate OT - massive transfusion EDAT- 2025/04/18 12:30 MHDA- 2025/06/24 11:11 CRDT- 2025/04/18 11:33 PHST- 2025/06/24 11:11 [medline] PHST- 2025/04/18 12:30 [pubmed] PHST- 2025/04/18 11:33 [entrez] AID - 01586154-990000000-00971 [pii] AID - 10.1097/TA.0000000000004643 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Jul 1;99(1):73-78. doi: 10.1097/TA.0000000000004643. Epub 2025 Apr 17. PMID- 40236264 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250417 IS - 2688-1152 (Electronic) IS - 2688-1152 (Linking) VI - 6 IP - 2 DP - 2025 Apr TI - Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort. PG - 100042 LID - 10.1016/j.acepjo.2024.100042 [doi] LID - 100042 AB - OBJECTIVES: Trauma-induced coagulopathy (TIC) carries significant risks, including increased mortality. Traditional TIC definitions rely on laboratories that result slowly and do not highlight therapeutic targets. We hypothesized that a TIC score, based on thromboelastography (TEG) and rotational thromboelastometry (ROTEM), collectively termed viscoelastic hemostatic assays, is associated with in-hospital mortality and packed red blood cell (pRBC) transfusion. METHODS: This retrospective cohort study used a database of adult patients undergoing institutional massive transfusion at seven level 1 trauma centers (2013-2018). A "TIC score" was developed, with 1 point assigned for abnormal TEG R-time (>/= 9 min) or ROTEM clot time (>/= 80 sec), a-angle (< 65(o)), or maximum amplitude (< 55 mm). TIC+ patients (TIC score 1-3) were compared with TIC- patients (TIC score 0). TIC Score composition and abnormal cutoff values were adjusted to investigate optimal weighting and thresholds. Multiple logistic and negative binomial regression was used to control confounders while evaluating the association between abnormal TIC values, in-hospital mortality, and 24-hour pRBC transfusion. RESULTS: Of 1499 patients in the final analysis, 591 (39.4%) were TIC+. Each 1-point increase in TIC score was associated with a 53% increase in the odds of mortality (odds ratio [OR], 1.53, 95% CI, 1.33-1.76, P < .001) and a 25% increase in pRBC transfusion volumes (incidence rate ratio, 1.25, 95% CI, 1.16-1.34, P < .001). Abnormal maximum amplitude was associated with both mortality (OR 1.50, 95% CI, 1.03-2.19, P = .034) and pRBC transfusion volumes (P < .001), whereas abnormal a-angle was associated with mortality (OR, 1.59, 95% CI, 1.09-2.32, P = .015). The unequal weighting of TIC score components and adjustments to normal/abnormal cutoff thresholds were maintained but did not improve the model's predictive power. CONCLUSION: A viscoelastic hemostatic assay-based TIC score is independently associated with mortality and pRBC transfusion volumes. This association persists with unequal weighting and adjustment of normal/abnormal cutoff thresholds of TEG components. CI - (c) 2024 The Authors. FAU - Murali, Shyam AU - Murali S AD - Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. AD - Division of Trauma and Surgical Critical Care, Grand View Health, Sellersville, Pennsylvania, USA. FAU - Winter, Eric AU - Winter E AD - Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Chanes, Nicolas M AU - Chanes NM AD - Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA. FAU - Hynes, Allyson M AU - Hynes AM AD - Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA. AD - Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA. FAU - Subramanian, Madhu AU - Subramanian M AD - Division of Acute Care Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. FAU - Smith, Alison A AU - Smith AA AD - Department of Surgery, Louisiana State University Health Sciences Center, University Medical Center New Orleans, New Orleans, Louisiana, USA. FAU - Seamon, Mark J AU - Seamon MJ AD - Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Cannon, Jeremy W AU - Cannon JW AD - Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. LA - eng PT - Journal Article DEP - 20250124 PL - United States TA - J Am Coll Emerg Physicians Open JT - Journal of the American College of Emergency Physicians open JID - 101764779 PMC - PMC11997675 OTO - NOTNLM OT - AcoTS OT - ROTEM OT - TEG OT - acute coagulopathy of trauma shock OT - coagulopathy OT - thromboelastography OT - trauma-induced coagulopathy COIS- Conflicts of Interest are documented in an attached supplement. EDAT- 2025/04/16 11:01 MHDA- 2025/04/16 11:02 PMCR- 2025/01/24 CRDT- 2025/04/16 05:23 PHST- 2024/08/04 00:00 [received] PHST- 2024/12/10 00:00 [revised] PHST- 2024/12/19 00:00 [accepted] PHST- 2025/04/16 11:02 [medline] PHST- 2025/04/16 11:01 [pubmed] PHST- 2025/04/16 05:23 [entrez] PHST- 2025/01/24 00:00 [pmc-release] AID - S2688-1152(24)01356-0 [pii] AID - 100042 [pii] AID - 10.1016/j.acepjo.2024.100042 [doi] PST - epublish SO - J Am Coll Emerg Physicians Open. 2025 Jan 24;6(2):100042. doi: 10.1016/j.acepjo.2024.100042. eCollection 2025 Apr. PMID- 40207569 OWN - NLM STAT- MEDLINE DCOM- 20250619 LR - 20250619 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 38 IP - 3 DP - 2025 Jun 1 TI - Updates in perioperative hemostasis in the pediatric surgical patient. PG - 222-229 LID - 10.1097/ACO.0000000000001499 [doi] AB - PURPOSE OF REVIEW: Maintaining hemostasis in pediatric patients undergoing major surgery presents unique challenges for the anesthesiologist. This review presents the most recent updates on pediatric perioperative bleeding and hemostasis management. RECENT FINDINGS: Patient blood management (PBM) programs remain scarcely implemented, but recent evidence for restrictive transfusion thresholds and reduction in allogeneic blood products in the pediatric population is growing. Notable updates include support for pediatric PBM programs, restrictive transfusion thresholds, increased use of viscoelastic testing, safety and efficacy of whole blood, and management of coagulopathy in trauma. SUMMARY: PBM programs and their key components have gained traction in the pediatric population in recent years: treating preoperative anemia, optimizing coagulation, and tolerating physiologic anemia through restrictive transfusion thresholds. Further evidence in the pediatric population is needed to guide the anesthesiologist. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Greenberg, Michael Richard AU - Greenberg MR AD - Division of Pediatric Anesthesiology, Duke University, Durham, North Carolina, USA. FAU - Jooste, Edmund AU - Jooste E FAU - Diaz-Rodriguez, Natalia AU - Diaz-Rodriguez N LA - eng PT - Journal Article PT - Review DEP - 20250410 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Humans MH - Child MH - *Perioperative Care/methods MH - Blood Transfusion/methods/standards MH - *Hemostasis MH - *Blood Loss, Surgical/prevention & control MH - Blood Coagulation Disorders/therapy MH - Anemia/therapy OTO - NOTNLM OT - coagulation OT - patient blood management OT - pediatric surgery OT - trauma OT - viscoelastic testing EDAT- 2025/04/10 12:34 MHDA- 2025/06/19 12:26 CRDT- 2025/04/10 06:33 PHST- 2025/06/19 12:26 [medline] PHST- 2025/04/10 12:34 [pubmed] PHST- 2025/04/10 06:33 [entrez] AID - 00001503-990000000-00286 [pii] AID - 10.1097/ACO.0000000000001499 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2025 Jun 1;38(3):222-229. doi: 10.1097/ACO.0000000000001499. Epub 2025 Apr 10. PMID- 40170216 OWN - NLM STAT- In-Process LR - 20250911 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 98 IP - 6 DP - 2025 Jun 1 TI - Goal-directed transfusion algorithm for trauma patients with severe hemorrhage using TEG 6S: Results of a Delphi consensus survey and expert panel recommendations. PG - 984-991 LID - 10.1097/TA.0000000000004606 [doi] FAU - Sarani, Babak AU - Sarani B AUID- ORCID: 0000-0001-6247-3004 AD - From the Department of Surgery (B.S.), Center for Trauma and Critical Care, George Washington University, Washington, DC; Department of Pathology and Molecular Medicine (J.C.), Kingston Health Sciences Centre, Queen's University, Kingston; Sunnybrook Research Institute (J.C.), Toronto, Canada; Department of Surgery (M.D.N., P.C.S., C.L.), Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania; DeWitt Daughtry Family Department of Surgery (J.P.M.), University of Miami Miller School of Medicine; Jackson Memorial Hospital (J.P.M.), Ryder Trauma Center, Miami, Florida; Department of Surgery (N.S.), Boston Medical Center, Boston, Massachusetts; Department of Trauma and Acute Care Surgery (B.T.), Spartanburg Medical Center, Spartanburg Regional Healthcare System, Spartanburg, South Carolina; Ernest E Moore Shock Trauma Center (E.E.M.), Denver Health, University of Colorado, Denver, Colorado; Department of Surgery (R.W.), University of Kansas, Kansas City, Kansas; Emergency Surgery (A.B.), Nottingham University NHS Trust, Nottingham, United Kingdom; Department of Surgery (L.Z.K.), University of California, San Francisco; and Departments of Surgery University of California, San Francisco and Zuckerberg San Francisco General Hospital (L.Z.K.). FAU - Callum, Jeannie AU - Callum J FAU - Neal, Matthew D AU - Neal MD FAU - Meizoso, Jonathan P AU - Meizoso JP FAU - Spinella, Philip C AU - Spinella PC FAU - Leeper, Christine AU - Leeper C FAU - Saillant, Noelle AU - Saillant N FAU - Thurston, Brian AU - Thurston B FAU - Moore, Ernest E AU - Moore EE FAU - Winfield, Robert AU - Winfield R FAU - Brooks, Adam AU - Brooks A FAU - Kornblith, Lucy Z AU - Kornblith LZ LA - eng PT - Journal Article DEP - 20250402 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM PMC - PMC12105950 OTO - NOTNLM OT - Algorithm OT - TEG OT - massive transfusion OT - thromboelastography EDAT- 2025/04/02 06:26 MHDA- 2025/04/02 06:26 PMCR- 2025/05/27 CRDT- 2025/04/02 00:03 PHST- 2025/04/02 06:26 [pubmed] PHST- 2025/04/02 06:26 [medline] PHST- 2025/04/02 00:03 [entrez] PHST- 2025/05/27 00:00 [pmc-release] AID - 01586154-202506000-00021 [pii] AID - JT-D-24-00956 [pii] AID - 10.1097/TA.0000000000004606 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Jun 1;98(6):984-991. doi: 10.1097/TA.0000000000004606. Epub 2025 Apr 2. PMID- 40137365 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250328 IS - 2079-4983 (Print) IS - 2079-4983 (Electronic) IS - 2079-4983 (Linking) VI - 16 IP - 3 DP - 2025 Mar 3 TI - Emulsion-Based Encapsulation of Fibrinogen with Calcium Carbonate for Hemorrhage Control. LID - 10.3390/jfb16030086 [doi] LID - 86 AB - Hemorrhage, particularly non-compressible torso bleeding, remains the leading cause of preventable death in trauma. Self-propelling hemostats composed of thrombin-calcium carbonate (CaCO(3)) particles and protonated tranexamic acid (TXA(+)) have been shown to reduce blood loss and mortality in severe bleeding animal models. To further enhance both hemostatic and self-propelling properties, this study was to investigate fibrinogen-CaCO(3) particles prepared via a water-oil-water (W/O/W) emulsion method. The particles were characterized using light and fluorescence microscopy, gel electrophoresis, rotational thromboelastometry (ROTEM), and video motion tracking. The method produced spherical micrometer-sized particles with various yields and fibrinogen content, depending on the preparation conditions. The highest yield was achieved with sodium carbonate (SC), followed by ammonium carbonate (AC) and sodium bicarbonate (SBC). AC and paraffin generated smaller particles compared to SC and heptane, which were used as the carbonate source and oil phase, respectively. Fibrinogen incorporation led to an increase in particle size, indicating a correlation between fibrinogen content and particle size. Fluorescence microscopy confirmed successful fibrinogen encapsulation, with various amounts and hemostatic effects as assessed by gel electrophoresis and ROTEM. Combining fibrinogen-CaCO(3) particles with TXA(+) and thrombin-CaCO(3) particles showed synergistic hemostatic effects. All fibrinogen-encapsulated particles exhibited self-propulsion when mixed with TXA(+) and exposed to water, regardless of fibrinogen content. This study advances current hemostatic particle technology by demonstrating enhanced self-propulsion and fibrinogen incorporation via the W/O/W emulsion method. Further optimization of the encapsulation method could enhance the effectiveness of fibrinogen-CaCO(3) particles for hemorrhage control. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Bonnici, Tristan AU - Bonnici T AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Chen, Yanyu AU - Chen Y AUID- ORCID: 0009-0006-1306-9228 AD - Department of Nanotechnology Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada. FAU - Kastrup, Christian AU - Kastrup C AD - Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada. AD - Versiti Blood Research Institute, Milwaukee, WI 53226, USA. FAU - Beckett, Andrew AU - Beckett A AD - St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada. AD - Royal Canadian Medical Services, Ottawa, ON K1A 0K2, Canada. LA - eng GR - PAct People_017/Defence Research and Development Canada/ PT - Journal Article DEP - 20250303 PL - Switzerland TA - J Funct Biomater JT - Journal of functional biomaterials JID - 101570734 PMC - PMC11942888 OTO - NOTNLM OT - calcium carbonate OT - fibrinogen OT - hemorrhage control OT - hemostatic particle OT - self-propulsion OT - tranexamic acid OT - trauma COIS- The authors declare no conflicts of interest. EDAT- 2025/03/26 12:30 MHDA- 2025/03/26 12:31 PMCR- 2025/03/03 CRDT- 2025/03/26 11:55 PHST- 2024/11/05 00:00 [received] PHST- 2024/12/06 00:00 [revised] PHST- 2025/02/27 00:00 [accepted] PHST- 2025/03/26 12:31 [medline] PHST- 2025/03/26 12:30 [pubmed] PHST- 2025/03/26 11:55 [entrez] PHST- 2025/03/03 00:00 [pmc-release] AID - jfb16030086 [pii] AID - jfb-16-00086 [pii] AID - 10.3390/jfb16030086 [doi] PST - epublish SO - J Funct Biomater. 2025 Mar 3;16(3):86. doi: 10.3390/jfb16030086. PMID- 40132980 OWN - NLM STAT- MEDLINE DCOM- 20260130 LR - 20260829 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 126 IP - 2 DP - 2026 Feb TI - Hyperfibrinolysis is Associated with Complement Activation Following Trauma. PG - 126-135 LID - 10.1055/a-2565-2449 [doi] AB - Complement is activated after trauma, but the activation mechanism is unknown. Plasmin can directly activate C3 and C5, and four distinct fibrinolytic phenotypes have now been recognized after injury-hyperfibrinolysis, fibrinolysis shutdown, hypofibrinolysis, and nonpathologic/physiologic.We set out to investigate whether a relationship between complement activation and fibrinolysis was present in adult trauma patients (n = 56).Rapid and tPA-challenged thromboelastography (TEG) was performed in the emergency department with IRB approval, and plasma obtained for C3a, C4a, C5a, Ba, sC5b-9, Factor I, Factor H, active PAI-1, alpha-2 antiplasmin (A2AP), plasmin-antiplasmin complex (PAP), and tPA activity measurement via multiplex, ELISA and activity assays. Data were analyzed using ANOVA and Spearman's correlations. Significance was set at p < 0.05.C3a and sC5b-9 were significantly higher in patients with hyperfibrinolysis than with physiologic or hypofibrinolysis (p < 0.05). Elevations in C3a, C4a, and SC5b9, along with depletion of Factors H and I, were significantly associated with massive transfusion within 6 hours and postinjury death. There were significant positive correlations between multiple markers of fibrinolysis and complement activation markers and significant negative correlations with Factors H and I. Significant negative correlations between fibrinolytic inhibitors and complement activation were also observed.Our findings suggest that fibrinolysis may play a direct role in complement activation in trauma through plasmin-mediated cleavage of C3 and C5. CI - Thieme. All rights reserved. FAU - Barrett, Christopher D AU - Barrett CD AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. AD - Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Maginot, Elizabeth R AU - Maginot ER AUID- ORCID: 0009-0008-3697-3185 AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States. AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. FAU - White, Collin M AU - White CM AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Advent Health Porter, Denver, Colorado, United States. FAU - Bernhardt, Isabella M AU - Bernhardt IM AD - Hunter College, New York, New York, United States. FAU - Moody, Trace B AU - Moody TB AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Chandler, James G AU - Chandler JG AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States. FAU - Gawargi, Flobater I AU - Gawargi FI AD - Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Henry, Reynold AU - Henry R AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Draxler, Dominik F AU - Draxler DF AD - Department of Cardiology and Bern Center for Precision Medicine, University Hospital of Bern, Bern, Switzerland. FAU - Schreiber, Martin A AU - Schreiber MA AD - Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, United States. FAU - Medcalf, Robert L AU - Medcalf RL AD - Molecular Neurotrauma and Haemostasis Laboratory, Australian Centre of Blood Diseases, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Sauaia, Angela AU - Sauaia A AD - Sauaia Statistical Solutions, L.L.C., Denver, Colorado, United States. LA - eng GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - K08-HL171936/HL/NHLBI NIH HHS/United States GR - P20-GM152326/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20250325 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - EC 3.4.21.7 (Fibrinolysin) RN - 0 (Complement Membrane Attack Complex) RN - 0 (alpha-2-Antiplasmin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 80295-42-7 (Complement C3a) RN - 0 (SC5b-9 protein complex) RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Fibrinolysis MH - *Complement Activation MH - Male MH - *Wounds and Injuries/blood/immunology MH - Female MH - Thrombelastography MH - Middle Aged MH - Adult MH - Fibrinolysin/metabolism MH - Complement Membrane Attack Complex/metabolism MH - Aged MH - alpha-2-Antiplasmin/metabolism MH - Tissue Plasminogen Activator/blood MH - Complement C3a/metabolism MH - Young Adult MH - Biomarkers/blood COIS- C.D.B., E.E.M., and H.B.M. have patents issued or pending related to coagulation/fibrinolysis diagnostics, and H.B.M. and E.E.M. are an inventor on US11137409B2 that pertains to the tPA-challenged thrombelastogram used in this study. C.D.B., E.E.M., and HBM have previously received grant support from Genentech, Inc. and Werfen. C.D.B. has received consulting fees from Atheneum Partners. E.E.M. and H.B.M. have received grant support from Haemonetics, Hemosonics, Stago Diagnostica. E.E.M. has received grant support from Prytime. M.A.S. has received consulting fees and grant support from Haemonetics and CSL Behring, and consulting fees from Octapharma. EDAT- 2025/03/26 13:06 MHDA- 2026/01/31 00:29 CRDT- 2025/03/25 21:33 PHST- 2026/01/31 00:29 [medline] PHST- 2025/03/26 13:06 [pubmed] PHST- 2025/03/25 21:33 [entrez] AID - 10.1055/a-2565-2449 [doi] PST - ppublish SO - Thromb Haemost. 2026 Feb;126(2):126-135. doi: 10.1055/a-2565-2449. Epub 2025 Mar 25. PMID- 40115320 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250322 IS - 2296-2360 (Print) IS - 2296-2360 (Electronic) IS - 2296-2360 (Linking) VI - 13 DP - 2025 TI - Utilization of ECMO with fiberoptic bronchoscopy for pediatric patients with lethal pulmonary hemorrhage unresponsive to conventional mechanical ventilation. PG - 1547579 LID - 10.3389/fped.2025.1547579 [doi] LID - 1547579 AB - OBJECTIVE: To evaluate the safety and efficacy of extracorporeal membrane oxygenation (ECMO) combined with fiberoptic bronchoscopy in children with life-threatening pulmonary hemorrhage that does not respond to conventional mechanical ventilation. METHODS: From October 2019 to June 2022, four pediatric patients with life-threatening pulmonary hemorrhage requiring ECMO support were admitted to our hospital. Based on their weight and vascular conditions, either venoarterial (VA)-ECMO or venovenous (VV)-ECMO was selected. The anticoagulation strategy was tailored, and fiberoptic bronchoscopy was performed to assess airway bleeding and remove blood clots. RESULTS: The study involved four patients. Case 1 sustained injuries from a traffic accident, Case 2 experienced combined injuries from a high fall, Case 3 had pulmonary vascular malformation, and Case 4 presented with anti-neutrophil cytoplasmic antibody-associated vasculitis. Case 1 underwent VA-ECMO with carotid artery and vein cannulation, whereas the other patients received VV-ECMO with jugular-femoral vein cannulation. During cannulation, heparin was administered at 0.5 mg/kg. Protamine was subsequently used to neutralize heparin based on the bleeding situation. Anticoagulation was initiated 24 h after ECMO commencement in Cases 1, 2, and 4, maintaining an activated clotting time (ACT) of 160-180 s. In Case 3, active bleeding was observed in the tracheal tube post-ECMO initiation. Protamine was administered to reverse the effects of heparin, and anticoagulation was withheld for the first 72 h. After a second interventional embolization of the vascular malformations, the active bleeding ceased. Two fiberoptic bronchoscopies revealed no further bleeding, and anticoagulation was initiated at 5 U/kg/h to maintain an ACT of 160 s. Coagulation parameters, including ACT, blood analysis, and thromboelastography, were closely monitored, and heparin dosages were adjusted accordingly. Heparin was paused 1 h before each fiberoptic bronchoscopy and resumed afterward. During ECMO, all patients successfully underwent fiberoptic bronchoscopy. Cases 2 and 3 required three and six procedures, respectively. Substantial thrombi were removed from the airways of Cases 2 and 3. All patients survived, and they were discharged without complications related to ECMO or fiberoptic bronchoscopy. CONCLUSION: For children with life-threatening pulmonary hemorrhage that did not respond to conventional mechanical ventilation, the combination of ECMO and fiberoptic bronchoscopy represents a promising therapeutic option. ECMO rapidly corrects hypoxemia and provides respiratory support, whereas fiberoptic bronchoscopy effectively clears blood clots and facilitates lung re-expansion. Under an individualized anticoagulation strategy, this combined approach is both safe and effective, significantly improving clinical outcomes in pediatric patients with life-threatening pulmonary hemorrhage. CI - (c) 2025 Lu, Sun, Chen, Fu, Li and Liu. FAU - Lu, Siwei AU - Lu S AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. FAU - Sun, Yuelin AU - Sun Y AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. FAU - Chen, Yingfu AU - Chen Y AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. FAU - Fu, Yueqiang AU - Fu Y AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. FAU - Li, Jing AU - Li J AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. FAU - Liu, Chengjun AU - Liu C AD - Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. LA - eng PT - Journal Article DEP - 20250306 PL - Switzerland TA - Front Pediatr JT - Frontiers in pediatrics JID - 101615492 PMC - PMC11922937 OTO - NOTNLM OT - VA-ECMO OT - VV-ECMO OT - children OT - extracorporeal membrane oxygenation (ECMO) OT - fiberoptic bronchoscopy OT - pulmonary hemorrhage COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2025/03/21 11:17 MHDA- 2025/03/21 11:18 PMCR- 2025/03/06 CRDT- 2025/03/21 05:01 PHST- 2024/12/18 00:00 [received] PHST- 2025/02/17 00:00 [accepted] PHST- 2025/03/21 11:18 [medline] PHST- 2025/03/21 11:17 [pubmed] PHST- 2025/03/21 05:01 [entrez] PHST- 2025/03/06 00:00 [pmc-release] AID - 10.3389/fped.2025.1547579 [doi] PST - epublish SO - Front Pediatr. 2025 Mar 6;13:1547579. doi: 10.3389/fped.2025.1547579. eCollection 2025. PMID- 40107968 OWN - NLM STAT- MEDLINE DCOM- 20250522 LR - 20260602 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 98 IP - 6 DP - 2025 Jun 1 TI - Platelet flux in trauma-associated venous thromboembolism: A secondary analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) studies. PG - 957-965 LID - 10.1097/TA.0000000000004592 [doi] AB - BACKGROUND: Venous thromboembolism (VTE) after traumatic injury is morbid. Evaluating changes in platelets in injured patients who develop VTE could identify platelet-based strategies for management of thrombotic complications after injury. METHODS: In a prospectively designed secondary analysis of a multicenter cohort study conducted by the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT1) study group, injured patients aged 18 to 40 years admitted for a minimum of 48 hours with at least one risk factor for VTE were evaluated. A subset of CLOTT1 patients had platelet aggregometry and thromboelastography performed to examine platelet function (CLOTT2). Patients who developed VTE were compared with those who did not. RESULTS: Of 7,805 patients from CLOTT1 (mean [SD] age, 29.1 [6.4] years; 1,987 [25.5%] female), 425 (5.4%) developed VTE. Platelet count was lower at each time point for patients with VTE (admission: 242 [234-251] vs. 254 [252-256], p < 0.01; hospital day 1: 157 [150-164] vs. 197 [195-198], p < 0.01; all counts x10 9 /L). An initial 10-point reduction in platelet count was associated with development of VTE (odds ratio, 1.32 [1.13-1.53]; p < 0.01) controlling for shock, injury severity, coagulopathy, sex, and product transfusion. When evaluating 129 CLOTT2 patients, velocity of platelet aggregation was higher on admission in the VTE group (18.5 vs. 12.8 aggregation units/min; p < 0.01) in response to adenosine diphosphate stimulation. In response to thrombin stimulation, velocity of platelet aggregation was higher at 48 hours (34.4 vs. 12.3 aggregation units/min; p < 0.01), and overall aggregation was higher in the VTE group at 72 hours (area under the curve, 173.2 vs. 129.6; p < 0.01). Thromboelastography results were not different between groups. CONCLUSION: This study identified an association of early reduction in platelet count with the development of VTE in injured patients at risk for VTE. P2Y 1/2 and protease-activated receptor 1 receptor stimulation changes in platelet aggregation responses are altered in VTE patients. Interrogating platelet count and functional responses may be beneficial in evaluating thrombotic complications after injury. LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Andraska, Elizabeth AU - Andraska E AUID- ORCID: 0000-0001-6536-070 AD - From the University of Pittsburgh, Pittsburgh Trauma and Transfusion Medicine Research Center (E.A., M.D.N.), University of California, San Francisco and Zuckerberg San Francisco General Hospital (B.N.-G., A.F., M.M.K, L.K.), Ernest E Moore Shock Trauma Center at Denver Health (E.M.), University of Texas Health Sciences Center, Houston (C.E.W.). FAU - Fields, Alexander AU - Fields A FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B FAU - Moore, Ernest AU - Moore E FAU - Wade, Charles E AU - Wade CE FAU - Knudson, M Margaret AU - Knudson MM FAU - Neal, Matthew D AU - Neal MD FAU - Kornblith, Lucy AU - Kornblith L CN - CLOTT (Consortium of Leaders in the Study of Traumatic Thromboembolism) Study Group LA - eng GR - R35 GM119526/GM/NIGMS NIH HHS/United States GR - R35 GM150656/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20250320 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Adult MH - Female MH - Humans MH - Male MH - Young Adult MH - *Blood Platelets/physiology MH - Platelet Aggregation MH - Platelet Count MH - Platelet Function Tests MH - Prospective Studies MH - Risk Factors MH - Thrombelastography MH - *Venous Thromboembolism/blood/diagnosis/etiology MH - *Wounds and Injuries/complications/blood PMC - PMC12097933 MID - NIHMS2067737 OTO - NOTNLM OT - Venous thromboembolism OT - platelet function OT - thromboelastography COIS- Conflicts of Interest: Author Disclosure forms have been supplied and are provided as Supplemental Digital Content (http://links.lww.com/TA/E355). I, Elizabeth Andraska, attest on behalf of all authors that we had full access to the data of the study, conducted all data analyses independently from the funding entity, and take complete responsibility for the integrity and accuracy of the data reported in the manuscript. FIR - Brakenridge, Scott IR - Brakenridge S FIR - Sixta, Sherry L IR - Sixta SL FIR - Bruns, Brandon R IR - Bruns BR FIR - Scalea, Thomas M IR - Scalea TM FIR - Costantini, Todd W IR - Costantini TW FIR - Crookes, Bruce A IR - Crookes BA FIR - Haut, Elliott R IR - Haut ER FIR - Velmahos, George C IR - Velmahos GC FIR - Kerwin, Andrew IR - Kerwin A FIR - Mohr, Alicia IR - Mohr A FIR - Kiraly, Lazio N IR - Kiraly LN FIR - Spain, David A IR - Spain DA FIR - Knowlton, Lisa M IR - Knowlton LM FIR - Martin, Matthew J IR - Martin MJ FIR - Milia, David J IR - Milia DJ FIR - Nirula, Ram IR - Nirula R FIR - Rogers, Frederick B IR - Rogers FB FIR - Wade, Charles E IR - Wade CE FIR - McNutt, Michelle K IR - McNutt MK FIR - Cipolle, Mark D IR - Cipolle MD EDAT- 2025/03/20 06:24 MHDA- 2025/05/22 06:28 PMCR- 2026/06/01 CRDT- 2025/03/20 00:03 PHST- 2025/05/22 06:28 [medline] PHST- 2025/03/20 06:24 [pubmed] PHST- 2025/03/20 00:03 [entrez] PHST- 2026/06/01 00:00 [pmc-release] AID - 01586154-202506000-00018 [pii] AID - 10.1097/TA.0000000000004592 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Jun 1;98(6):957-965. doi: 10.1097/TA.0000000000004592. Epub 2025 Mar 20. PMID- 40087116 OWN - NLM STAT- MEDLINE DCOM- 20250916 LR - 20251005 IS - 1008-1275 (Print) IS - 1008-1275 (Electronic) IS - 1008-1275 (Linking) VI - 28 IP - 5 DP - 2025 Sep TI - Construction and preliminary trial test of a decision-making app for pre-hospital damage control resuscitation. PG - 313-318 LID - S1008-1275(25)00009-4 [pii] LID - 10.1016/j.cjtee.2024.11.001 [doi] AB - PURPOSE: To construct a decision-making app for pre-hospital damage control resuscitation (PHDCR) for severely injured patients, and to make a preliminary trial test on the effectiveness and usability aspects of the constructed app. METHODS: Decision-making algorithms were first established by a thorough literature review, and were then used to be learned by computer with 3 kinds of text segmentation algorithms, i.e., dictionary-based segmentation, machine learning algorithms based on labeling, and deep learning algorithms based on understanding. B/S architecture mode and Spring Boot were used as a framework to construct the app. A total of 16 Grade-5 medical students were recruited to test the effectiveness and usability aspects of the app by using an animal model-based test on simulated PHDCR. Twelve adult Bama miniature pigs were subjected to penetrating abdominal injuries and were randomly assigned to the 16 students, who were randomly divided into 2 groups (n = 8 each): group A (decided on PHDCR by themselves) and group B (decided on PHDCR with the aid of the app). The students were asked to complete the PHDCR within 1 h, and then blood samples were taken and thromboelastography, routine coagulation test, blood cell count, and blood gas analysis were examined. The lab examination results along with the value of mean arterial pressure were used to compare the resuscitation effects between the 2 groups. Furthermore, a 4-statement-based post-test survey on a 5-point Likert scale was performed in group B students to test the usability aspects of the constructed app. RESULTS: With the above 3 kinds of text segmentation algorithm, B/S architecture mode, and Spring Boot as the development framework, the decision-making app for PHDCR was successfully constructed. The time to decide PHDCR was (28.8 +/- 3.41) sec in group B, much shorter than that in group A (87.5 +/- 8.53) sec (p < 0.001). The outcomes of animals treated by group B students were much better than that by group A students as indicated by higher mean arterial pressure, oxygen saturation and fibrinogen concentration and maximum amplitude, and lower R values in group B than those in group A. The post-test survey revealed that group B students gave a mean score of no less than 4 for all 4 statements. CONCLUSION: A decision-making app for PHDCR was constructed in the present study and the preliminary trial test revealed that it could help to improve the resuscitation effect in animal models of penetrating abdominal injury. CI - Copyright (c) 2025. Published by Elsevier B.V. FAU - Yang, Haoyang AU - Yang H AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Du, Wenqiong AU - Du W AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Zong, Zhaowen AU - Zong Z AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. Electronic address: zongzhaowen@163.com. FAU - Zhong, Xin AU - Zhong X AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Jia, Yijun AU - Jia Y AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Jiang, Renqing AU - Jiang R AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Dai, Chenglin AU - Dai C AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. FAU - Ye, Zhao AU - Ye Z AD - State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Army Medical University, Chongqing, 400038, China. LA - eng PT - Journal Article DEP - 20250218 PL - China TA - Chin J Traumatol JT - Chinese journal of traumatology = Zhonghua chuang shang za zhi JID - 100886162 SB - IM MH - Animals MH - Swine MH - *Resuscitation/methods MH - *Mobile Applications MH - Humans MH - Algorithms MH - *Emergency Medical Services/methods MH - Male MH - *Decision Making MH - Female PMC - PMC12489481 OTO - NOTNLM OT - App OT - Decision-making OT - Pre-hospital damage control resuscitation OT - Severely injured patients OT - Trauma COIS- Declaration of competing interest The authors declare no conflicts of interest. EDAT- 2025/03/15 00:38 MHDA- 2025/09/17 00:31 PMCR- 2025/02/18 CRDT- 2025/03/14 22:56 PHST- 2024/02/07 00:00 [received] PHST- 2024/11/06 00:00 [revised] PHST- 2024/11/12 00:00 [accepted] PHST- 2025/09/17 00:31 [medline] PHST- 2025/03/15 00:38 [pubmed] PHST- 2025/03/14 22:56 [entrez] PHST- 2025/02/18 00:00 [pmc-release] AID - S1008-1275(25)00009-4 [pii] AID - 10.1016/j.cjtee.2024.11.001 [doi] PST - ppublish SO - Chin J Traumatol. 2025 Sep;28(5):313-318. doi: 10.1016/j.cjtee.2024.11.001. Epub 2025 Feb 18. PMID- 40079301 OWN - NLM STAT- MEDLINE DCOM- 20260802 LR - 20260802 IS - 1476-8259 (Electronic) IS - 1025-5842 (Linking) VI - 29 IP - 10 DP - 2026 Aug TI - Finite element analysis of various fixation patterns in mandible bone fracture. PG - 2303-2318 LID - 10.1080/10255842.2025.2476187 [doi] AB - Mandibular fractures are among the most serious injuries to the maxillofacial region, with controversy surrounding their diagnosis, classification, and management Fixation mini-plate systems are commonly used for treatment of mandibular fractures. Previous studies have examined plate configurations with various locking systems. However, the impact of plate thickness on the performance of unlocking screw mechanisms has not been investigated in the literature. Also, there exist conflicting findings concerning the impact of the locking and unlocking screw mechanisms on the concentration of stress within the screws. This study investigates the effect of plate thickness and plate-screw locking mechanisms on the performance of the fixation system using the finite element analysis. The complex relation between jawbone thickness and occurred cracks or fractions made us build a precised model for investigating the fixation patterns. Results showed that the locking screw mechanism reduced the von Miss stress in the buccal and lingual regions of the bone. Increasing the plate thickness also decreased the von Miss stress and maximum pressure in the bone. The unlocking screws application resulted in lower values of stress and displacement in the plate and screws compared to the locking screws. Moreover, while using a plate with a higher thickness resulted in a pronounced decrease in plate von Mises stress, it led to a higher stress on the screws. The study investigated crack propagation by analyzing bone density, which was directly related to age and an individual's lifestyle. This method enables a more precise use of the viscoelastic characteristics of mandibular bones tailored to everyone. The outcomes of this study indicated that the locking screw mechanism demonstrated enhanced features in light of the reduced stress on the bone. Nevertheless, the screws and plate experienced an elevated stress level using this mechanism. FAU - Tazh, Tayebeh AU - Tazh T AUID- ORCID: 0009-0000-1950-1778 AD - Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran. FAU - Khorramymehr, Siamak AU - Khorramymehr S AUID- ORCID: 0000-0002-3293-8090 AD - Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran. FAU - Hassani, Kamran AU - Hassani K AUID- ORCID: 0000-0003-0430-9606 AD - Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran. AD - School of Mechanical, Industrial and Aeronautical Engineering, University of the Witwatersrand, Johannesburg, South Africa. FAU - Nikkhoo, Mohammad AU - Nikkhoo M AUID- ORCID: 0000-0002-8386-9021 AD - School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan. AD - Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. LA - eng PT - Journal Article DEP - 20250313 PL - England TA - Comput Methods Biomech Biomed Engin JT - Computer methods in biomechanics and biomedical engineering JID - 9802899 SB - IM MH - *Finite Element Analysis MH - Humans MH - *Mandibular Fractures/surgery/physiopathology MH - Bone Plates MH - Bone Screws MH - Stress, Mechanical MH - *Fracture Fixation, Internal/methods MH - Biomechanical Phenomena OTO - NOTNLM OT - 3D scanning OT - Finite element OT - fixation plates OT - mandibular bones OT - viscoelastic EDAT- 2025/03/13 14:07 MHDA- 2026/08/02 13:45 CRDT- 2025/03/13 06:33 PHST- 2026/08/02 13:45 [medline] PHST- 2025/03/13 14:07 [pubmed] PHST- 2025/03/13 06:33 [entrez] AID - 10.1080/10255842.2025.2476187 [doi] PST - ppublish SO - Comput Methods Biomech Biomed Engin. 2026 Aug;29(10):2303-2318. doi: 10.1080/10255842.2025.2476187. Epub 2025 Mar 13. PMID- 40074918 OWN - NLM STAT- MEDLINE DCOM- 20250313 LR - 20261008 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 51 IP - 1 DP - 2025 Mar 12 TI - Conventional Coagulation Tests are a better predictor of mortality than Viscoelastic Haemostatic Assays in trauma patients with shock: a prospective observational study. PG - 131 LID - 10.1007/s00068-025-02808-8 [doi] AB - PURPOSE: Conventional Coagulation Tests (CCTs) and Viscoelastic Haemostatic Assays (VHAs) are currently used in guiding trauma resuscitation. However, the role of these tests in predicting mortality is less known. This study aims to analyze both CCTs and VHAs in predicting mortality. METHODS: A prospective observational study was conducted on adult trauma patients who presented in shock. They underwent VHA using rotational thromboelastometry (ROTEM ((R)) delta viscoelastic system by Werfen) and CCTs. Univariable and multivariable regression analysis was done to compare the predictive power of mortality between CCTs and VHAs. RESULTS: Out of 8,765 trauma patients screened, 106 were included. Descriptive statistics showed a majority of blunt injuries with road traffic incidents as the predominant mechanism. The median Injury Severity Score (ISS) was 24 (IQR 14-34). Mortality rate at 24 h was 9.4% and overall 30-day mortality was 26% (n = 28). Univariable analysis showed that reduced clotting time had better survival (p = 0.005) while prolonged INR, reduced fibrinogen and elevated d-dimer levels were associated with mortality. In multivariable analysis, prolonged INR > 1.66 (AUC 0.74, OR 9.4, 95% CI 2.6-34.1) and prolonged clotting time > 384 s (AUC 0.67, OR 7.4, 95% CI 1.1-51.9) had best prediction of mortality. Overall, CCTs were better at predicting mortality than VHA. CONCLUSION: CCTs, especially INR proved to be a more reliable predictor of mortality compared to VHAs in trauma patients. These findings suggest that CCTs offer better prognostic value, although integrating both testing modalities could potentially enhance overall assessment and management strategies in trauma care. CI - (c) 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. FAU - Jonish, Anten P AU - Jonish AP AUID- ORCID: 0009-0004-5319-5603 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. FAU - James, Joses Dany AU - James JD AUID- ORCID: 0000-0001-9162-6452 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. FAU - Titus, D K AU - Titus DK AD - Department of General Surgery - Unit IV, Christian Medical College, Vellore, Tamil Nadu, India. FAU - Sharma, Srujan Lam AU - Sharma SL AUID- ORCID: 0000-0002-7721-1098 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. FAU - Purushothaman, Vijayan AU - Purushothaman V AUID- ORCID: 0000-0002-9589-4961 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. FAU - Dave, Rutvi Gautam AU - Dave RG AUID- ORCID: 0000-0002-1294-7061 AD - Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India. FAU - Nair, Sukesh Chandran AU - Nair SC AD - Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India. FAU - Chase, Suchita AU - Chase S AD - Department of General Surgery - Unit IV, Christian Medical College, Vellore, Tamil Nadu, India. FAU - Nayak, Sukria AU - Nayak S AUID- ORCID: 0000-0001-5474-4257 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. FAU - Kumar, Vignesh AU - Kumar V AUID- ORCID: 0000-0003-3697-8601 AD - Department of Trauma Surgery, Christian Medical College Vellore, Ranipet Campus, Vellore, Tamil Nadu, India. vickycoumar@gmail.com. LA - eng PT - Journal Article PT - Observational Study DEP - 20250312 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - Prospective Studies MH - Male MH - Female MH - *Thrombelastography MH - Middle Aged MH - Adult MH - Blood Coagulation Tests/methods MH - Injury Severity Score MH - *Wounds and Injuries/mortality/blood/complications MH - Predictive Value of Tests MH - *Shock/mortality/blood/etiology MH - Prognosis OTO - NOTNLM OT - Conventional Coagulation Tests (CCTs) OT - Mortality in trauma OT - ROTEM OT - Viscoelastic Haemostatic Assays (VHAs) COIS- Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of Christian Medical College Vellore (IRB Min No. 13545 [OBSERVE] dated 3rd November 2020). Consent to participate: Informed consent for participation and publication was obtained from all individual participants or their legal guardians included in the study. Financial interest: The authors have no relevant financial or non-financial interests to disclose. Competing interests: The authors declare no competing interests. EDAT- 2025/03/13 06:27 MHDA- 2025/03/13 06:28 CRDT- 2025/03/13 00:21 PHST- 2024/11/21 00:00 [received] PHST- 2025/03/01 00:00 [accepted] PHST- 2025/03/13 06:28 [medline] PHST- 2025/03/13 06:27 [pubmed] PHST- 2025/03/13 00:21 [entrez] AID - 10.1007/s00068-025-02808-8 [pii] AID - 10.1007/s00068-025-02808-8 [doi] PST - epublish SO - Eur J Trauma Emerg Surg. 2025 Mar 12;51(1):131. doi: 10.1007/s00068-025-02808-8. PMID- 40050454 OWN - NLM STAT- MEDLINE DCOM- 20250825 LR - 20261010 IS - 1432-1084 (Electronic) IS - 0938-7994 (Linking) VI - 35 IP - 9 DP - 2025 Sep TI - Recurrent laryngeal nerve thermal injury in radiofrequency ablation for papillary thyroid carcinoma and related risk factors: a prospective large cohort study. PG - 5804-5816 LID - 10.1007/s00330-025-11448-w [doi] AB - OBJECTIVE: To establish a prediction model for recurrent laryngeal nerve thermal injury (RLNTI) in radiofrequency ablation (RFA) of papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: This prospective study was conducted at a single center from July 2016 to September 2022. Patients diagnosed with PTC and received US-RFA by different interventional therapy groups were enrolled, and classified as derivation cohort and validation cohort based on therapy groups. The logistic regression analysis was used in derivation cohort to develop the model and internal and external validation was performed in derivation and validation cohort respectively. RESULTS: The derivation cohort included 1632 patients (mean age, 40 years, +/-11 (standard deviation), 1300 female), and the validation cohort comprised 755 patients (mean age, 38 years, +/-11 (standard deviation), 584 female). Three variables were independently associated with RLNTI: the minimum distance from tumor to tracheoesophageal groove (TEG-D) 0.695 kcal (odds ratio, 4.537; p < 0.0001). The area under the receiver operating characteristic curve (AUC) of the model in the derivation cohort, validation cohort, and total group were 0.877 (95% CI: 0.845, 0.910), 0.901 (95% CI: 0.835, 0.967) and 0.886 (95% CI: 0.85, 0.915) respectively. The calibration plot and Hosmer-Lemeshow test demonstrated a good fit (chi(2) = 3.49, p = 0.321). CONCLUSION: The prediction model of RLNTI was derived based on TEG-D, tumor posterior location, and ablation energy and exhibited good discrimination and calibration abilities. KEY POINTS: Question Recurrent laryngeal nerve thermal injury (RLNTI) is a major complication of radiofrequency ablation (RFA) for papillary thyroid carcinoma (PTC), while related risk factors are unclear. Findings The minimum distance from tumor to tracheoesophageal groove 0.695 kcal are factors independently associated with RLNTI. Clinical relevance This study developed a simple prediction model with good discrimination and calibration abilities, which provided interventional radiologists an evidence-based method to predict RLNTI and thereby reduce the incidence of RLNTI in RFA of PTC. CI - (c) 2025. The Author(s), under exclusive licence to European Society of Radiology. FAU - Hua, Qing AU - Hua Q AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. AD - College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. FAU - Song, YanYan AU - Song Y AD - Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. FAU - Zhou, Wei AU - Zhou W AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Liu, ZhenHua AU - Liu Z AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Zhang, Lu AU - Zhang L AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Zhu, Ying AU - Zhu Y AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Lai, LiMei AU - Lai L AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Yeung, Yat Hin AU - Yeung YH AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. FAU - Li, Ning AU - Li N AD - Department of Ultrasound, Anning First People's Hospital, No.2 Ganghenan Road, 650330, Kunming, Yunnan Province, China. FAU - Zhan, WeiWei AU - Zhan W AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. AD - College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. FAU - Dong, YiJie AU - Dong Y AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. dongyiyin@126.com. AD - College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. dongyiyin@126.com. FAU - Xia, ShuJun AU - Xia S AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. xiashu_jun@126.com. AD - College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. xiashu_jun@126.com. FAU - Zhou, JianQiao AU - Zhou J AUID- ORCID: 0000-0002-0964-8407 AD - Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. zhousu30@126.com. AD - College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, 200025, Shanghai, China. zhousu30@126.com. CN - Chinese Ablation Alliance for Thyroid and Cervical Lymph Nodes LA - eng GR - 82071928/National Natural Science Foundation of China/ GR - 23XD1401300/Program of Shanghai Academic/Technology Research Leader/ PT - Journal Article DEP - 20250306 PL - Germany TA - Eur Radiol JT - European radiology JID - 9114774 SB - IM MH - Humans MH - Female MH - Adult MH - Male MH - *Thyroid Cancer, Papillary/surgery MH - Prospective Studies MH - *Radiofrequency Ablation/adverse effects MH - Risk Factors MH - *Thyroid Neoplasms/surgery MH - *Recurrent Laryngeal Nerve Injuries/etiology MH - Middle Aged MH - Cohort Studies OTO - NOTNLM OT - Papillary thyroid carcinoma OT - Radiofrequency ablation OT - Recurrent laryngeal nerve thermal injury OT - Ultrasound COIS- Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is JianQiao Zhou. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors, statistician YanYan Song has significant statistical expertise. Informed consent: Written informed consent was obtained from all patients in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: The study subjects or cohorts have not been previously reported. Methodology: Prospective Observational study Performed at one institution FIR - Xiang, Xie IR - Xiang X FIR - Jinping, Wang IR - Jinping W FIR - Yongchao, Chen IR - Yongchao C FIR - Nian'an, He IR - Nian'an H FIR - Lianhe, Lin IR - Lianhe L FIR - Rongxi, Liang IR - Rongxi L FIR - Zuobing, Zhang IR - Zuobing Z FIR - Huining, Wu IR - Huining W FIR - Jian, Zheng IR - Jian Z FIR - Shidi, Hu IR - Shidi H FIR - Shunlan, Wang IR - Shunlan W FIR - Fugao, Huang IR - Fugao H FIR - Geng, Cen IR - Geng C FIR - Zongbao, Niu IR - Zongbao N FIR - Wenjuan, Mei IR - Wenjuan M FIR - Song, Wang IR - Song W FIR - Xiandong, Fu IR - Xiandong F FIR - Zhiyuan, Wang IR - Zhiyuan W FIR - Zhongqian, Hu IR - Zhongqian H FIR - Baoding, Chen IR - Baoding C FIR - Xinhua, Ye IR - Xinhua Y FIR - Chun, Li IR - Chun L FIR - Chunquan, Zhang IR - Chunquan Z FIR - Liang, Sang IR - Liang S FIR - Yingxia, Zhang IR - Yingxia Z FIR - Jingping, Liu IR - Jingping L FIR - Ruibin, Yan IR - Ruibin Y FIR - Wenxiao, Zhang IR - Wenxiao Z FIR - Yong, Lu IR - Yong L FIR - Yunzhen, Shi IR - Yunzhen S FIR - Huiping, Niu IR - Huiping N FIR - Baoyan, Bai IR - Baoyan B FIR - Fan, Wu IR - Fan W FIR - Dong, Xu IR - Dong X FIR - Yingchao, Chen IR - Yingchao C FIR - Xinliang, Xu IR - Xinliang X FIR - Qinglin, Hu IR - Qinglin H FIR - De, Lv IR - De L FIR - Ting, Ma IR - Ting M FIR - Jing, Wang IR - Jing W FIR - Xiaomao, Luo IR - Xiaomao L FIR - Lingbin, Qi IR - Lingbin Q FIR - Ruhai, Zhou IR - Ruhai Z FIR - Jinduo, Shou IR - Jinduo S FIR - Han, Wang IR - Han W FIR - Xinglan, Liu IR - Xinglan L FIR - Wei, Zhang IR - Wei Z FIR - Xia, ShuJun IR - Xia S FIR - Zhou, Wei IR - Zhou W FIR - Hua, Qing IR - Hua Q FIR - Dong, YiJie IR - Dong Y FIR - Zhou, JianQiao IR - Zhou J FIR - Liu, Zhenhua IR - Liu Z FIR - Zhang, Lu IR - Zhang L FIR - Li, Ning IR - Li N EDAT- 2025/03/07 00:21 MHDA- 2025/08/31 19:51 CRDT- 2025/03/06 23:24 PHST- 2024/07/08 00:00 [received] PHST- 2025/01/22 00:00 [accepted] PHST- 2024/12/30 00:00 [revised] PHST- 2025/08/31 19:51 [medline] PHST- 2025/03/07 00:21 [pubmed] PHST- 2025/03/06 23:24 [entrez] AID - 10.1007/s00330-025-11448-w [pii] AID - 10.1007/s00330-025-11448-w [doi] PST - ppublish SO - Eur Radiol. 2025 Sep;35(9):5804-5816. doi: 10.1007/s00330-025-11448-w. Epub 2025 Mar 6. PMID- 40004568 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250228 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 14 IP - 4 DP - 2025 Feb 7 TI - Comment on Baetu et al. Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry. J. Clin. Med. 2024, 13, 4219. LID - 10.3390/jcm14041037 [doi] LID - 1037 AB - With great interest, we read the recent study by Baetu et al [...]. FAU - Schochl, Herbert AU - Schochl H AUID- ORCID: 0000-0001-6028-1551 AD - Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Department of Translational Anesthesiology and Pain Medicine, 1200 Vienna, Austria. AD - Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Hofmann, Nikolaus AU - Hofmann N AD - Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria. FAU - Zipperle, Johannes AU - Zipperle J AUID- ORCID: 0000-0002-8222-3413 AD - Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Department of Translational Anesthesiology and Pain Medicine, 1200 Vienna, Austria. LA - eng PT - Journal Article DEP - 20250207 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 CON - J Clin Med. 13:4219. PMC - PMC11855955 COIS- H.S. has received honoraria for participating in advisory board meetings with Bayer Healthcare, Boehringer Ingelheim, Alexion and Octapharm. He has also received speaker fees from CSL Behring, Haemonetics, Bristol-Myers Squibb, Stago and Vifor. N.H. and J.Z. report no conflicts of interest. EDAT- 2025/02/26 06:28 MHDA- 2025/02/26 06:29 PMCR- 2025/02/07 CRDT- 2025/02/26 01:18 PHST- 2024/08/05 00:00 [received] PHST- 2025/02/03 00:00 [accepted] PHST- 2025/02/26 06:29 [medline] PHST- 2025/02/26 06:28 [pubmed] PHST- 2025/02/26 01:18 [entrez] PHST- 2025/02/07 00:00 [pmc-release] AID - jcm14041037 [pii] AID - jcm-14-01037 [pii] AID - 10.3390/jcm14041037 [doi] PST - epublish SO - J Clin Med. 2025 Feb 7;14(4):1037. doi: 10.3390/jcm14041037. PMID- 39998505 OWN - NLM STAT- MEDLINE DCOM- 20250509 LR - 20251231 IS - 1434-3916 (Electronic) IS - 0936-8051 (Linking) VI - 145 IP - 1 DP - 2025 Feb 25 TI - ROTEM's utility in guiding resuscitation of traumatic lower extremity fracture patients. PG - 170 LID - 10.1007/s00402-025-05773-4 [doi] AB - INTRODUCTION: Rotational thromboelastometry (ROTEM) is a method for real-time detection of clotting derangements allowing for targeted blood product resuscitation. We sought to determine if coagulopathy profiles differed based on fracture location (comparing pelvic versus tibia and femur fractures), if ROTEM profiles correlated between both total hospital and intensive care unit length of stay (LOS), and if ROTEM profiles correlated with patients undergoing an immediate definitive fixation versus an early damage control approach to care. MATERIALS AND METHODS: A retrospective cohort study was performed using data from a level 1 trauma registry database. ICD codes were used to isolate operative lower extremity fractures that had a ROTEM on admission. Two cohorts were created: (1) stratification by fracture location including pelvis, femur, and tibia (n = 498) and (2) stratification by fixation method including external fixation versus early definitive fixation (n = 154). The fracture location cohort assessed length of stay parameters while the fixation cohort assessed fixation approaches with ROTEM profiles. RESULTS: The majority of fracture location patients with ROTEM APTEM and ROTEM EXTEM profiles were physiologically coagulable with all three fracture locations. Most patients with ROTEM INTEM profiles showed hypocoagulable derangements with femur (75.2%), tibia (68.1%), and pelvic fractures (68.8%). Fractures classified as ROTEM APTEM hypocoagulable indicated a longer hospital LOS (r = 0.282) and ICU LOS (r = 0.510). No correlation was found between coagulopathy profiles and fixation approaches. CONCLUSIONS: ROTEM studies on fracture types showed little consensus on ROTEM profiles correlating to a specific fracture location. ROTEM profiles collected showed limited predictive ability of a patient's hospital and ICU LOS. Early definitive fixation versus external fixation did not correlate between specific ROTEM profiles. Overall, there did not appear to be utility in routine use of ROTEM in fracture patients and this should be limited to those with severe multisystem injuries. CI - (c) 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Mize, Brandi M AU - Mize BM AD - College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Reif, Rebecca J AU - Reif RJ AD - Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA. FAU - Spears, Garrett L AU - Spears GL AD - College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Kalkwarf, Kyle J AU - Kalkwarf KJ AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Jensen, Hanna K AU - Jensen HK AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Cherney, Steven M AU - Cherney SM AUID- ORCID: 0000-0001-9576-7439 AD - Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA. SCherney@mcw.edu. FAU - Mears, Simon C AU - Mears SC AD - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. LA - eng PT - Journal Article DEP - 20250225 PL - Germany TA - Arch Orthop Trauma Surg JT - Archives of orthopaedic and trauma surgery JID - 9011043 SB - IM MH - Humans MH - Retrospective Studies MH - Male MH - Female MH - *Thrombelastography MH - *Femoral Fractures/complications/therapy/surgery/blood MH - Middle Aged MH - *Resuscitation/methods MH - Adult MH - *Tibial Fractures/complications/therapy/surgery/blood MH - Length of Stay MH - Fracture Fixation/methods MH - Pelvic Bones/injuries MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Aged OTO - NOTNLM OT - Coagulopathy OT - Orthopedic trauma OT - Rotational thromboelastometry (ROTEM) COIS- Declarations. Ethical approval: was provided through IRB #228,114 at the University of Arkansas for Medical Sciences. There are no financial or conflict of interest with any author involved with this study. Data used in the formation of this study belongs to the Arkansas Clinical Data Repository (AR-CDR) maintained by the Department of Biomedical Informatics in the UAMS College of Medicine. AR-CDR data is anonymized and collected through UAMS electronic medical records, tumor registry, billing, and cancer genomic databases which include encounters since January 5, 2014. The AR-CDR has been approved to function as a data bank to support research across UAMS. Conflict of interest: None of the authors report any personal or financial conflict of interest. No funding was received for conducting this study. EDAT- 2025/02/25 12:25 MHDA- 2025/02/25 12:26 CRDT- 2025/02/25 11:03 PHST- 2024/03/23 00:00 [received] PHST- 2025/01/18 00:00 [accepted] PHST- 2025/02/25 12:26 [medline] PHST- 2025/02/25 12:25 [pubmed] PHST- 2025/02/25 11:03 [entrez] AID - 10.1007/s00402-025-05773-4 [pii] AID - 10.1007/s00402-025-05773-4 [doi] PST - epublish SO - Arch Orthop Trauma Surg. 2025 Feb 25;145(1):170. doi: 10.1007/s00402-025-05773-4. PMID- 39998104 OWN - NLM STAT- MEDLINE DCOM- 20250510 LR - 20250606 IS - 2072-6651 (Electronic) IS - 2072-6651 (Linking) VI - 17 IP - 2 DP - 2025 Feb 13 TI - Rattlesnake Roundup: Point-of-Care Thrombelastographic Methods Define the Molecular Impacts on Coagulation of Crotalus Venom Toxins In Vitro and In Vivo. LID - 10.3390/toxins17020087 [doi] LID - 87 AB - A malalignment between rattlesnake-envenomed patients' degree of compromised coagulation and the data generated by standard hematological determinations generated with blood samples anticoagulated with calcium (Ca) chelating agents is almost certain. Many rattlesnake venom toxins are Ca-independent toxins that likely continue to damage plasmatic and cellular components of coagulation in blood samples (anticoagulated with Ca chelation) during transportation from the emergency department to the clinical laboratory. The most straightforward approach to abrogate this patient-laboratory malalignment is to reduce "needle to activation time"-the time from blood collection to commencement of laboratory analysis-with utilization of point-of-care (POC) technology such as thrombelastography. The workflow and history of standard and POC approaches to hematological assessment is reviewed. Further, using a preclinical model of envenomation with four different rattlesnake venoms, the remarkably diverse damage to coagulation revealed with POC thrombelastography is presented. It is anticipated that future investigation and potential changes in clinical monitoring practices with POC methods of hematological assessment will improve the management of envenomed patients and assist in precision care. FAU - Nielsen, Vance G AU - Nielsen VG AUID- ORCID: 0000-0002-8072-9883 AD - Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ 85750, USA. LA - eng GR - 22-06454/Flinn Foundation/ PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20250213 PL - Switzerland TA - Toxins (Basel) JT - Toxins JID - 101530765 RN - 0 (Crotalid Venoms) SB - IM MH - *Thrombelastography/methods MH - Animals MH - *Crotalid Venoms/toxicity MH - *Blood Coagulation/drug effects MH - *Crotalus MH - Humans MH - *Point-of-Care Systems MH - *Snake Bites/blood/diagnosis PMC - PMC11860698 OTO - NOTNLM OT - fibrinogen concentration OT - metalloproteinase OT - platelet count OT - point-of-care methods OT - rabbit model OT - rattlesnake venom OT - serine protease OT - thrombelastography COIS- The author is the inventor of the use of CORM-2 as a remedy for venom induced coagulopathy, with USPTO patents (#10,314,860 and #10,828,326) owned by the University of Arizona Board of Regents. Another patent involving the combination of RuCl3 with CORM-2 as a treatment for hemotoxic envenomation has been filed with the USPTO, also owned by the University of Arizona Board of Regents, with the author as inventor. The author is also the owner of a company, Trinity Antivenoms, LLC, that is inactive and that possesses no assets. These conflicts of interest are overseen by the University of Arizona's Office of Conflict of Interest, which has in place a plan for mitigation of conflicts that includes periodic reporting by the author and oversight by a colleague that is not involved with this project or any relevant patents to provide assurance of scientific integrity. Lastly, the funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. EDAT- 2025/02/25 12:24 MHDA- 2025/02/25 12:25 PMCR- 2025/02/13 CRDT- 2025/02/25 08:44 PHST- 2024/12/17 00:00 [received] PHST- 2025/02/11 00:00 [revised] PHST- 2025/02/12 00:00 [accepted] PHST- 2025/02/25 12:25 [medline] PHST- 2025/02/25 12:24 [pubmed] PHST- 2025/02/25 08:44 [entrez] PHST- 2025/02/13 00:00 [pmc-release] AID - toxins17020087 [pii] AID - toxins-17-00087 [pii] AID - 10.3390/toxins17020087 [doi] PST - epublish SO - Toxins (Basel). 2025 Feb 13;17(2):87. doi: 10.3390/toxins17020087. PMID- 39981790 OWN - NLM STAT- MEDLINE DCOM- 20250509 LR - 20250509 IS - 2295-3337 (Electronic) IS - 1784-3286 (Linking) VI - 79 IP - 6 DP - 2024 Dec TI - Unravelling the coagulation paradox in liver cirrhosis: challenges and insights. PG - 451-461 LID - 10.1080/17843286.2025.2469906 [doi] AB - Patients with liver disease experience complex haemostatic changes leading to a state of 'rebalanced haemostasis' that may shift towards bleeding or thrombosis due to complications like kidney dysfunction, bacterial infection, or acute-on-chronic liver failure. Traditional coagulation tests inadequately capture haemostasis in cirrhosis, whereas advanced assays like thrombin generation assay and viscoelastic testing offer better insights but remain limited in clinical outcome prediction or guiding pre-procedural prophylaxis.Contrary to the traditional view of cirrhosis as a bleeding disorder, recent evidence highlights a paradox of higher venous thromboembolism incidence in hospitalised cirrhotic patients. Misconceptions about 'auto-anticoagulation' and concerns about anticoagulation safety hinder consistent thromboprophylaxis. Emerging data suggest that low molecular weight heparin is safe and effective in cirrhotic patients, supporting more evidence-based thromboprophylaxis. For thrombotic events or conditions like atrial fibrillation, therapeutic anticoagulation is recommended, and may offer additional benefits, such as attenuating liver fibrosis and portal hypertension. However, anticoagulation is not established as a core therapy in cirrhosis, given safety concerns in advanced disease.Bleeding remains a significant challenge in cirrhosis, with management focusing on specific aetiologies, including portal hypertension or procedural injuries. In pre-procedural planning, there is a trend of unnecessary blood product use, often based on an assumed bleeding risk. Rational pre-procedural planning should minimize unnecessary transfusions, optimise modifiable risks, and include a plan for managing potential bleeding.This review aims to clarify the 'coagulation paradox' in cirrhosis, promoting a nuanced, individualized approach to managing bleeding and thrombosis in chronic liver disease. FAU - Ferdinande, K AU - Ferdinande K AUID- ORCID: 0009-0004-1554-1739 AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. AD - Department of Gastroenterology and Hepatology, AZ Delta Roeselare, Belgium. FAU - Raevens, S AU - Raevens S AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. FAU - Decaestecker, J AU - Decaestecker J AD - Department of Gastroenterology and Hepatology, AZ Delta Roeselare, Belgium. FAU - De Vloo, C AU - De Vloo C AD - Department of Gastroenterology and Hepatology, AZ Delta Roeselare, Belgium. FAU - Seynhaeve, L AU - Seynhaeve L AD - Department of Gastroenterology and Hepatology, AZ Delta Roeselare, Belgium. FAU - Hoof, L AU - Hoof L AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. FAU - Verhelst, X AU - Verhelst X AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. FAU - Geerts, A AU - Geerts A AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. FAU - Devreese, K M J AU - Devreese KMJ AD - Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium. AD - Department of Diagnostic Sciences, Ghent University, Belgium. FAU - Degroote, H AU - Degroote H AUID- ORCID: 0000-0003-1891-0582 AD - Department of Gastroenterology and Hepatology, University Hospital Brussels, Belgium. FAU - Van Vlierberghe, H AU - Van Vlierberghe H AD - Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. LA - eng PT - Journal Article PT - Review DEP - 20250221 PL - England TA - Acta Clin Belg JT - Acta clinica Belgica JID - 0370306 RN - 0 (Anticoagulants) SB - IM MH - Humans MH - *Liver Cirrhosis/complications/blood/physiopathology MH - Anticoagulants/therapeutic use MH - *Hemorrhage/etiology/prevention & control MH - *Venous Thromboembolism/prevention & control/etiology MH - *Blood Coagulation MH - Blood Coagulation Tests OAB - 1) Dynamic haemostasis in cirrhosisHaemostatic balance in cirrhotic patients can fluctuate, influenced by factors such as renal impairment, bacterial infections, and the progression of liver disease. Haemostatic management must therefore be highly personalised.2) Limitations of traditional coagulation tests and role of global haemostatic assaysConventional coagulation tests poorly reflect the haemostatic capacity in cirrhosis. Advanced tools like rotational thromboelastometry (ROTEM) and thrombin generation assays (TGAs) offer a more accurate, global assessment, despite certain limitations.3) Prothrombotic risks in cirrhosisContrary to earlier beliefs, cirrhotic patients are not 'auto-anticoagulated', and thromboprophylaxis should be carefully considered for those hospitalised.4) Complexities of anticoagulation in cirrhosisDespite promising evidence suggesting a role in disease progression, anticoagulation has not yet become standard in cirrhosis management, mainly due to uncertainties around pharmacokinetics and pharmacodynamics in this population.5) Pre-procedural planning to minimise bleeding riskTailored pre-procedural planning is crucial for cirrhotic patients, focusing on minimising unnecessary transfusions, optimising modifiable risk factors, and having a clear strategy for managing potential bleeding complications.6) Tailored bleeding management in cirrhosisEffective bleeding management in cirrhosis requires a personalised approach, prioritising the underlying cause, whether portal hypertension, procedural injury, or spontaneous mucosal bleeding, with targeted strategies such as prompt intervention in procedural injury or individualised transfusion protocols in cases of spontaneous mucosal bleeding or marked coagulopathy contributing to ongoing bleeding. OABL- eng OTO - NOTNLM OT - Coagulation OT - bleeding OT - cirrhosis OT - dynamic haemostatic status OT - thrombosis EDAT- 2025/02/21 12:22 MHDA- 2025/03/31 20:04 CRDT- 2025/02/21 07:13 PHST- 2025/03/31 20:04 [medline] PHST- 2025/02/21 12:22 [pubmed] PHST- 2025/02/21 07:13 [entrez] AID - 10.1080/17843286.2025.2469906 [doi] PST - ppublish SO - Acta Clin Belg. 2024 Dec;79(6):451-461. doi: 10.1080/17843286.2025.2469906. Epub 2025 Feb 21. PMID- 39962975 OWN - NLM STAT- MEDLINE DCOM- 20250508 LR - 20250508 IS - 2287-285X (Electronic) IS - 2287-2728 (Print) IS - 2287-2728 (Linking) VI - 31 IP - Suppl DP - 2025 Feb TI - Prediction and prevention of post-procedural bleedings in patients with cirrhosis. PG - S205-S227 LID - 10.3350/cmh.2024.0928 [doi] AB - Although post-procedural bleedings are infrequent in patients with cirrhosis, they are associated with significant morbidity and mortality. Therefore, predicting and preventing such bleedings is important. Established predictors of post-procedural bleeding include high-bleeding risk procedure, severe cirrhosis and high body mass index; prognostic value of anemia, acute kidney injury and bacterial infection is more uncertain. While prothrombin time and international normalized ratio do not predict post-procedural bleeding, some evidence suggests that platelet count, whole blood thrombin generation assay and viscoelastic tests may be helpful in this context. Prevention of postprocedural bleeding involves careful management of antithrombotic drugs during the periprocedural period. Patients with cirrhosis present unique challenges due to altered pharmacokinetics and pharmacodynamics of antithrombotic drugs, but there is a lack of dedicated studies specifically focused on this patient population. Guidelines for periprocedural management of antithrombotic drugs developed for patients without liver disease are thus applied to those with cirrhosis. Some technical aspects may decrease the risk of post-procedural bleeding, namely ultrasoundguidance, opting for transjugular route rather than percutaneous route, and the level of expertise of the operator. The effectiveness of platelet transfusions or thrombopoietin-receptor agonists remains uncertain. Transfusion of fresh-frozen plasma, of fibrinogen, and administration of tranexamic acid are not recommended for reducing post-procedural bleeding in patients with cirrhosis. In conclusion, prediction of post-procedural requires a global approach taking into account the patients characteristics, the risk of the procedure, and the platelet count. There is little data to support prophylactic correction of hemostasis, and dedicated studies are needed. FAU - Riescher-Tuczkiewicz, Alix AU - Riescher-Tuczkiewicz A AD - Paris City University, Inserm, Inflammatory Research Center, UMR 1149, Paris, France. FAU - Rautou, Pierre-Emmanuel AU - Rautou PE AD - Paris City University, Inserm, Inflammatory Research Center, UMR 1149, Paris, France. AD - AP-HP, Beaujon Hospital, Hepatology Department, DMU DIGEST, Reference Center for Vascular Diseases of the Liver, FILFOIE, ERN RARE-LIVER, Clichy, France. LA - eng PT - Journal Article PT - Review DEP - 20250218 PL - Korea (South) TA - Clin Mol Hepatol JT - Clinical and molecular hepatology JID - 101586730 RN - 0 (Fibrinolytic Agents) SB - IM MH - Humans MH - *Liver Cirrhosis/complications MH - *Hemorrhage/prevention & control/etiology/diagnosis MH - Fibrinolytic Agents/therapeutic use MH - Risk Factors MH - Platelet Count MH - Platelet Transfusion PMC - PMC11925446 OTO - NOTNLM OT - Anticoagulants OT - Antiplatelet OT - Blood coagulation OT - Hemostasis OT - Liver diseases COIS- Conflicts of Interest The authors have no conflicts to disclose. EDAT- 2025/02/18 06:21 MHDA- 2025/03/19 06:22 PMCR- 2025/02/01 CRDT- 2025/02/18 03:01 PHST- 2024/10/19 00:00 [received] PHST- 2025/02/17 00:00 [accepted] PHST- 2025/03/19 06:22 [medline] PHST- 2025/02/18 06:21 [pubmed] PHST- 2025/02/18 03:01 [entrez] PHST- 2025/02/01 00:00 [pmc-release] AID - cmh.2024.0928 [pii] AID - cmh-2024-0928 [pii] AID - 10.3350/cmh.2024.0928 [doi] PST - ppublish SO - Clin Mol Hepatol. 2025 Feb;31(Suppl):S205-S227. doi: 10.3350/cmh.2024.0928. Epub 2025 Feb 18. PMID- 39956975 OWN - NLM STAT- MEDLINE DCOM- 20250324 LR - 20260501 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 98 IP - 4 DP - 2025 Apr 1 TI - Predictive value of platelet function assays in traumatic brain injury patients on antiplatelet therapy. PG - 550-556 LID - 10.1097/TA.0000000000004557 [doi] AB - INTRODUCTION: Traumatic brain injury (TBI) patients on antiplatelet therapy face higher mortality because of impaired platelet function, which may be treated by platelet transfusion. The value of testing platelet function in this cohort remains controversial. We aimed to evaluate the relationship between platelet function assays and outcomes in TBI patients on antiplatelet therapy receiving platelet transfusions. We hypothesized that the magnitude of change in platelet assay performance following a transfusion would predict meaningful clinical outcomes. METHODS: A cohort of patients, aged 18 to 89 years, with a history of preinjury antiplatelet therapy or who required platelet transfusion, and who were deemed at risk for neurosurgical intervention, was selected from a prospective randomized controlled trial of platelet transfusion for TBI. Pre- and posttransfusion blood samples were drawn. Platelet hemostatic function assays (PHFAs) included thromboelastography with platelet mapping (TEG-PM) and VerifyNow. Logistic regression models assessed the association of temporal assay results with 30-day all-cause mortality, need for craniotomy, and initial and follow-up Rotterdam scores. RESULTS: Data from 94 TBI patients (43% female) with a median age of 76 years were analyzed. The 30-day mortality rate was 14%. VerifyNow aspirin assay was able to capture increases in platelet function following a platelet transfusion in patients on aspirin (significant positive Delta = 65 aspirin response units, p < 0.001). Thromboelastography with platelet mapping parameters detected improved platelet function following transfusion, although the absolute value of changes was minimal. Thromboelastography with platelet mapping parameters predicted important clinical outcomes on logistic regression, although no significant associations with clinical outcomes were identified by the change in PHFA after transfusion or after adjusting for multiple comparisons. CONCLUSION: Higher absolute pre- and posttransfusion values of TEG-PM were associated with decreased mortality, decreased need for neurosurgical intervention, and decreased risk of progression of hemorrhage in TBI patients taking antiplatelet agents, although neither the change in TEG-PM after transfusion nor any other PHFA value predicted outcomes. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level II. CI - Copyright (c) 2025 American Association for the Surgery of Trauma. FAU - Alsaadi, Nijmeh AU - Alsaadi N AUID- ORCID: 0000-0002-4290-0539 AD - From the Trauma and Transfusion Medicine Research Center (N.A., R.Y., J.R.K., L.H., A.S., M.Z., D.M.D., A. Abdullah, A. Arivudainambi, R.K., E.P.M., P.L., P.C.S., J.L.S., S.M.S., M.D.N.); and Department of Surgery (N.A., R.Y., J.R.K., L.H., L.E.V., A.S., M.Z., D.M.D., A. Abdullah, E.P.M., P.L., J.L.S., S.M.S., M.D.N.), Department of Neurosurgery (A.M.P., P.M., O.R., A.F., T.H., A.G.A., D.O.), School of Public Health (S.R.W., J.F.L.), Department of Emergency Medicine (F.X.G.), and Department of Bioengineering (S.M.S.), University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Younes, Reem AU - Younes R FAU - Killinger, Jack R AU - Killinger JR FAU - Hoteit, Lara AU - Hoteit L FAU - Puccio, Ava M AU - Puccio AM FAU - McIntyre, Peyton AU - McIntyre P FAU - Raymond, Olivia AU - Raymond O FAU - Filicky, Amanda AU - Filicky A FAU - Hahner, Thomas AU - Hahner T FAU - Agnone, Allison G AU - Agnone AG FAU - Vincent, Laura E AU - Vincent LE FAU - Srinivasan, Amudan AU - Srinivasan A FAU - Zarisfi, Mohammadreza AU - Zarisfi M FAU - Dishong, Devin M AU - Dishong DM FAU - Abdullah, Abiha AU - Abdullah A FAU - Arivudainambi, Aishwarrya AU - Arivudainambi A FAU - Kar, Ronit AU - Kar R FAU - Mihalko, Emily P AU - Mihalko EP FAU - Loughran, Patricia AU - Loughran P FAU - Wisniewski, Stephen R AU - Wisniewski SR FAU - Luther, James F AU - Luther JF FAU - Spinella, Philip C AU - Spinella PC FAU - Okonkwo, David AU - Okonkwo D FAU - Guyette, Francis X AU - Guyette FX FAU - Sperry, Jason L AU - Sperry JL FAU - Shea, Susan M AU - Shea SM FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 LA - eng GR - K25 HL161401/HL/NHLBI NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20250217 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - Female MH - Male MH - Aged MH - *Brain Injuries, Traumatic/mortality/blood/therapy MH - Middle Aged MH - *Platelet Aggregation Inhibitors/therapeutic use MH - *Platelet Function Tests/methods MH - *Platelet Transfusion/methods MH - Adult MH - Aged, 80 and over MH - Prospective Studies MH - Predictive Value of Tests MH - Adolescent MH - Young Adult MH - Thrombelastography MH - Blood Platelets/physiology PMC - PMC12142354 MID - NIHMS2072454 COIS- Conflicts of Interest: JTACS COI Disclosure forms for all authors have been supplied and are provided as supplemental digital content. EDAT- 2025/02/17 11:03 MHDA- 2025/03/24 06:30 PMCR- 2026/04/01 CRDT- 2025/02/17 00:03 PHST- 2025/03/24 06:30 [medline] PHST- 2025/02/17 11:03 [pubmed] PHST- 2025/02/17 00:03 [entrez] PHST- 2026/04/01 00:00 [pmc-release] AID - 01586154-990000000-00919 [pii] AID - 10.1097/TA.0000000000004557 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Apr 1;98(4):550-556. doi: 10.1097/TA.0000000000004557. Epub 2025 Feb 17. PMID- 39937615 OWN - NLM STAT- MEDLINE DCOM- 20250225 LR - 20250506 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 38 IP - 2 DP - 2025 Apr 1 TI - Individualized and targeted coagulation management in bleeding trauma patients. PG - 114-119 LID - 10.1097/ACO.0000000000001467 [doi] AB - PURPOSE OF REVIEW: This review aims to summarize current evidence on hemostatic management of bleeding trauma patients, with a focus on resuscitation strategies using either coagulation factor concentrates or fixed-ratio transfusion concepts. It discusses the potential benefits and limitations of both approaches. RECENT FINDINGS: Recent studies have shown that coagulopathy caused by massive traumatic hemorrhage often cannot be reversed by empiric treatment. During initial resuscitation, a fixed-ratio transfusion approach uses the allogeneic blood products red blood cells, plasma, and platelets to mimic 'reconstituted whole blood'. However, this one-size-fits-all strategy risks both overtransfusion and undertransfusion in trauma patients.Many European trauma centers have shifted toward individualized hemostatic therapy based on point-of-care diagnostics, particularly using viscoelastic tests. These tests provide rapid insight into the patient's hemostatic deficiencies, enabling a more targeted and personalized treatment approach. SUMMARY: Individualized, goal-directed hemostatic management offers several advantages over fixed-ratio transfusion therapy for trauma patients. However, there is a paucity of data regarding the direct comparison of these two approaches. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Hofmann, Nikolaus AU - Hofmann N AD - Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna. AD - Department of Translational Anesthesiology and Pain Medicine, Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AD - Department of Translational Anesthesiology and Pain Medicine, Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Vienna, Austria. FAU - Gratz, Johannes AU - Gratz J AD - Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna. LA - eng PT - Journal Article PT - Review DEP - 20250213 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) SB - IM MH - Humans MH - *Hemorrhage/therapy/etiology/blood MH - *Wounds and Injuries/complications/therapy/blood MH - *Precision Medicine/methods MH - *Blood Transfusion/methods MH - *Resuscitation/methods MH - *Blood Coagulation Disorders/therapy/etiology MH - Blood Coagulation Factors/therapeutic use EDAT- 2025/02/12 18:47 MHDA- 2025/02/25 12:25 CRDT- 2025/02/12 12:12 PHST- 2025/02/25 12:25 [medline] PHST- 2025/02/12 18:47 [pubmed] PHST- 2025/02/12 12:12 [entrez] AID - 00001503-202504000-00006 [pii] AID - 10.1097/ACO.0000000000001467 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2025 Apr 1;38(2):114-119. doi: 10.1097/ACO.0000000000001467. Epub 2025 Feb 13. PMID- 39918902 OWN - NLM STAT- MEDLINE DCOM- 20250506 LR - 20250506 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 36 IP - 2 DP - 2025 Mar 1 TI - Massive transfusion protocol prediction decision aids in an Australian trauma setting. PG - 58-61 LID - 10.1097/MBC.0000000000001338 [doi] AB - BACKGROUND: Trauma patients may require activation of an emergent massive transfusion protocol (MTP). Several decision aids are designed to predict massive transfusion requirements but have not been widely studied in the Australasian setting. METHODS: Commonly used MTP decision aids were assessed for accuracy in injured patients at an urban Level 1 trauma centre. Consecutive cases were prospectively enrolled to a complete registry of thromboelastogram assays in trauma patients. Analysis was undertaken using receiver operating characteristic (ROC) curves, sensitivity and specificity. RESULTS: A total of 114 patients met inclusion criteria (56 received MTP). More detailed and military derived scores including McLaughlin and Larson demonstrated >90% specificity. Area under ROC curve results were similar to prior reports, but the ABC score performed less accurately than expected. CONCLUSION: In the setting of traumatic haemorrhage, the available MTP prediction decision aids should be applied cautiously and used only in combination with on-going clinical judgement. CI - Copyright (c) 2025 Wolters Kluwer Health, Inc. All rights reserved. FAU - Wangoo, Kush AU - Wangoo K AD - Emergency Department, Westmead Hospital. FAU - Nguyen, Vinh Dat David AU - Nguyen VDD AD - The University of Sydney, Western Clinical School, Sydney, Australia. FAU - Byth, Karen AU - Byth K AD - The University of Sydney, Western Clinical School, Sydney, Australia. FAU - Malik, Rajesh AU - Malik R AD - Emergency Department, Westmead Hospital. AD - The University of Sydney, Western Clinical School, Sydney, Australia. FAU - Coggins, Andrew AU - Coggins A AD - Emergency Department, Westmead Hospital. AD - The University of Sydney, Western Clinical School, Sydney, Australia. LA - eng PT - Journal Article DEP - 20250102 PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 SB - IM MH - Humans MH - Male MH - *Blood Transfusion/methods MH - Female MH - Australia MH - *Decision Support Techniques MH - Adult MH - *Wounds and Injuries/therapy MH - Middle Aged MH - Prospective Studies MH - Trauma Centers MH - Thrombelastography MH - *Hemorrhage/therapy MH - ROC Curve EDAT- 2025/02/07 18:20 MHDA- 2025/02/07 18:21 CRDT- 2025/02/07 12:23 PHST- 2023/03/21 00:00 [received] PHST- 2024/12/18 00:00 [accepted] PHST- 2025/02/07 18:21 [medline] PHST- 2025/02/07 18:20 [pubmed] PHST- 2025/02/07 12:23 [entrez] AID - 00001721-202503000-00004 [pii] AID - 10.1097/MBC.0000000000001338 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2025 Mar 1;36(2):58-61. doi: 10.1097/MBC.0000000000001338. Epub 2025 Jan 2. PMID- 39915759 OWN - NLM STAT- MEDLINE DCOM- 20250506 LR - 20250526 IS - 1749-799X (Electronic) IS - 1749-799X (Linking) VI - 20 IP - 1 DP - 2025 Feb 6 TI - Plastic deformation of anterior cruciate ligament: listen to the patient, do not just rely on imaging. PG - 144 LID - 10.1186/s13018-025-05527-3 [doi] LID - 144 AB - PURPOSE: Diagnosing plastic deformation of the anterior cruciate ligament (ACL) is challenging: patients may not report knee instability, and MRI may not confirm the lesion, delaying adequate treatment. This study analyzed clinical findings and complaints in patients with a confirmed diagnosis of plastic deformation of the ACL. METHODS: Data on complaints, physical, imaging and arthroscopic assessment, and subjective evaluation of 15 patients with undiagnosed or delayed ACL insufficiency from plastic deformation of the ACL (Group 1) and 30 patients who underwent an ACL reconstruction following complete tear of the ACL diagnosed clinically and at imaging (Group 2) were compared and analyzed. RESULTS: A knee effusion was reported in both study groups, occurring within the first 4 h after the index knee injury, and it was statistically more significant in the complete ACL tear group. All patients reported low values (zero, one, and two) on a scale from zero to 10 in their confidence in performing high-intensity pivoting sports and physical activities. All patients reported that they did not feel comfortable in performing changing direction pivoting on their injured knee. CONCLUSION: Plastic deformation of the ACL may not be clearly manifest clinically and on MRI, and physical exam may present subtle findings that do not allow to fully assess the function of the injured ligament. Therefore, surgeons should listen to the patient, not just rely on imaging, taking into account the patient's report of how the knee is working and their complaints as they remain the leading guide for decision-making. LEVEL OF EVIDENCE IV: Diagnostic studies - Investigating a diagnostic test. CI - (c) 2025. The Author(s). FAU - Piedade, Sergio Rocha AU - Piedade SR AD - Exercise and Sports Medicine, Department of Orthopaedic, Rheumatology, and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil. FAU - Ferreira, Daniel Miranda AU - Ferreira DM AD - Exercise and Sports Medicine, Department of Orthopaedic, Rheumatology, and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil. AD - Department of Radiology, University of Campinas-UNICAMP, Campinas, SP, Brazil. AD - Faculty of Medicine, Sao Leopoldo Mandic, Campinas, SP, Brazil. FAU - Gorios, Carlos AU - Gorios C AD - Centro Universitario Sao Camilo, Ipiranga, Sao Paulo, Brazil. FAU - Maffulli, Nicola AU - Maffulli N AD - Department of Trauma and Orthopaedic Surgery, School Medicine and Psychology, Sapienza University, Rome, Italy. n.maffulli@qmul.ac.uk. AD - Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK. n.maffulli@qmul.ac.uk. AD - School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke On Trent, England. n.maffulli@qmul.ac.uk. LA - eng PT - Journal Article DEP - 20250206 PL - England TA - J Orthop Surg Res JT - Journal of orthopaedic surgery and research JID - 101265112 SB - IM MH - Humans MH - *Anterior Cruciate Ligament Injuries/diagnostic imaging/surgery MH - Male MH - Female MH - Adult MH - Magnetic Resonance Imaging/methods MH - Anterior Cruciate Ligament Reconstruction/methods MH - Young Adult MH - *Anterior Cruciate Ligament/diagnostic imaging/surgery MH - Adolescent MH - Middle Aged MH - Physical Examination MH - Arthroscopy PMC - PMC11803950 OTO - NOTNLM OT - Anterior cruciate ligament injuries OT - Biomechanical phenomena OT - Clinical diagnosis OT - Physical examination OT - Radiology OT - Sprains and strains OT - Surveys and questionnaires OT - Viscoelastic substances COIS- Declarations. Competing interests: Prof Nicola Maffulli is the Editor in Chief of the Journal of Orthopaedic Surgery and Research. EDAT- 2025/02/07 00:20 MHDA- 2025/02/07 11:12 PMCR- 2025/02/06 CRDT- 2025/02/06 23:37 PHST- 2024/11/10 00:00 [received] PHST- 2025/01/20 00:00 [accepted] PHST- 2025/02/07 11:12 [medline] PHST- 2025/02/07 00:20 [pubmed] PHST- 2025/02/06 23:37 [entrez] PHST- 2025/02/06 00:00 [pmc-release] AID - 10.1186/s13018-025-05527-3 [pii] AID - 5527 [pii] AID - 10.1186/s13018-025-05527-3 [doi] PST - epublish SO - J Orthop Surg Res. 2025 Feb 6;20(1):144. doi: 10.1186/s13018-025-05527-3. PMID- 39908221 OWN - NLM STAT- MEDLINE DCOM- 20250320 LR - 20250526 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 65 IP - 3 DP - 2025 Mar TI - Comparison of whole blood versus red blood cells and plasma to correct trauma-induced coagulopathy ex vivo. PG - 624-636 LID - 10.1111/trf.18143 [doi] AB - BACKGROUND: Early resuscitation is based on platelet-poor components such as red blood cells and plasma (RBC + P), contributing to platelet dilution and worsening of trauma-induced coagulopathy (TIC). We aimed to compare the ability of cold-stored whole blood (WB) versus RBC + P as a single component to correct TIC. STUDY DESIGN AND METHODS: Blood samples were collected on admission from trauma patients who required activation of the major hemorrhage protocol at a single UK major trauma center in 2021/2022. Samples were spiked ex vivo with volumes equivalent to two, four, or eight units of WB or RBC + P stored for a maximum of 2 weeks. Thromboelastometry, platelet counting, and multiple electrode aggregometry (MEA) were performed. RESULTS: Samples from 20 adult trauma patients were analyzed. Median age was 32 years (27-42), 89% were male, 70% had platelet dysfunction (tissue factor-activated ROTEM [EXTEM]-tissue factor-activated ROTEM with cytochalasin D [FIBTEM] clot amplitude at 5 min [A5] 100 s, EXTEM ML30 >10%, FIBTEM A10 <10 mm; and (2) CCT-based INR >/=1.8, PTT >/=1.5 times of upper normal limit, platelets <50 x 10(9)/L, and Clauss Fibrinogen <1.5 g/L, was assessed for its correlation with mortality. Modified Poisson regression was used to model 28-day mortality. RESULTS: Twenty-two of sixty-eight patients (32%) had abnormal ROTEM but normal CCTs. TIC defined by CCTs was associated with increased mortality [24 h: 5/13 (38%) vs. 5/55 (9%), p = 0.025; 28d: 8/13 (62%) vs. 11/55 (20%), p = 0.002]; compared to ROTEM, which was not [24 h: 7/35 (20%) vs. 3/33 (9%), p = 0.307; 28d: 11/35 (31%) vs. 9/33 (27%), p = 0.594], despite requiring significantly higher blood component transfusion within the first 4 and 24 h of MHP (p-values<0.05). CONCLUSIONS: ROTEM is more sensitive in identifying TIC. Patients with abnormal CCTs had a higher death rate, and those with abnormal ROTEM had no significantly increased mortality. A prospective study is required to assess the effects of ROTEM further. CI - (c) 2025 The Author(s). Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society. FAU - Hutspardol, Sakara AU - Hutspardol S AUID- ORCID: 0000-0002-7730-6791 AD - Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Borja, Tyrone AU - Borja T AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Kroeker, Jenna AU - Kroeker J AD - Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada. AD - Department of General Surgery, Maimonides Health, New York, USA. FAU - Wang, Xiu Qing AU - Wang XQ AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Mi, Jian AU - Mi J AD - Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. FAU - Zamar, David AU - Zamar D AD - Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. FAU - Chan, Geoffrey AU - Chan G AD - Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. FAU - Smith, Tyler AU - Smith T AD - Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Hawes, Harvey AU - Hawes H AD - Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada. FAU - Shih, Andrew W AU - Shih AW AUID- ORCID: 0000-0001-7107-2595 AD - Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. AD - Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada. LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study DEP - 20250125 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Male MH - Female MH - Retrospective Studies MH - Middle Aged MH - *Wounds and Injuries/blood/complications/mortality/therapy MH - *Hemorrhage/blood/therapy/mortality/etiology MH - *Blood Coagulation Disorders/etiology/blood/diagnosis/mortality/therapy MH - Adult MH - Blood Coagulation Tests/methods MH - Aged PMC - PMC12174763 OTO - NOTNLM OT - ROTEM OT - conventional coagulation test OT - fibrinogen OT - massive haemorrhage OT - transfusion COIS- The authors have no competing interests. EDAT- 2025/01/27 00:20 MHDA- 2025/06/18 06:25 PMCR- 2025/06/18 CRDT- 2025/01/26 23:30 PHST- 2024/11/08 00:00 [revised] PHST- 2024/07/04 00:00 [received] PHST- 2025/01/19 00:00 [accepted] PHST- 2025/06/18 06:25 [medline] PHST- 2025/01/27 00:20 [pubmed] PHST- 2025/01/26 23:30 [entrez] PHST- 2025/06/18 00:00 [pmc-release] AID - TME13128 [pii] AID - 10.1111/tme.13128 [doi] PST - ppublish SO - Transfus Med. 2025 Jun;35(3):266-274. doi: 10.1111/tme.13128. Epub 2025 Jan 25. PMID- 39852956 OWN - NLM STAT- MEDLINE DCOM- 20250503 LR - 20250606 IS - 2072-6651 (Electronic) IS - 2072-6651 (Linking) VI - 17 IP - 1 DP - 2024 Dec 24 TI - Viscoelastic Study of Hemostasis Disorders Associated with Echis ocellatus Envenoming in North Benin Using a Quantra Analyzer. LID - 10.3390/toxins17010003 [doi] LID - 3 AB - Echis ocellatus envenomings are a public health problem in West Africa, leading to bleeding and hypocoagulability. The aim of this study was to assess the hemostasis disorders associated with E. ocellatus envenoming. Envenomed patients with an abnormal whole blood clotting test (WBCT) were prospectively included at Tanguieta, Benin. A WBCT with a sequential reading (i.e., at 20, 30, and 60 min), viscoelastic analysis (VA) using the Quantra analyzer, and blood count were performed on admission. VA and the WBCT were also assessed at 4, 8, 12, 24, 48, and 72 h after antivenom administration. Nineteen patients were included. On admission, the main results were an absence of a clot on VA and a slight decrease in platelets. Clot time gradually decreased over time while clot stiffness, fibrinogen, and platelet contributions to stiffness increased. Sequential reading improved the sensitivity of the WBCT. At H48, all patients with recurrence bleeding after antivenom administration had an abnormal WBCT while patients with a normal WBCT never had bleeding during their follow-up. VA allows the identification of various hemostasis disorders. Hypofibrinogenemia was the main disorder that persisted for several days after treatment. A WBCT with a sequential reading is an effective alternative for monitoring hypocoagulability in the absence of a laboratory. FAU - Larreche, Sebastien AU - Larreche S AUID- ORCID: 0000-0002-8961-7132 AD - Department of Medical Biology, Begin National Military Teaching Hospital, F-94160 Saint-Mande, France. AD - Inserm UMRS-1144, Universite Paris Cite, F-75006 Paris, France. FAU - Chacha, Roland Benes AU - Chacha RB AD - Benin Clinical Research Institute, Abomey-Calavi, Benin. FAU - Sodjinou, Noe AU - Sodjinou N AD - Benin Clinical Research Institute, Abomey-Calavi, Benin. FAU - Ouorou, Seidou Alassane AU - Ouorou SA AD - Emergency Department, Saint-Jean de Dieu Hospital, Tanguieta, Benin. FAU - Ganhouingnon, Eric AU - Ganhouingnon E AD - Medical Biology Laboratory, Saint-Jean de Dieu Hospital, Tanguieta, Benin. FAU - Layo, Edith Aloukoutou AU - Layo EA AD - Benin Clinical Research Institute, Abomey-Calavi, Benin. FAU - Megarbane, Bruno AU - Megarbane B AUID- ORCID: 0000-0002-2522-2764 AD - Inserm UMRS-1144, Universite Paris Cite, F-75006 Paris, France. AD - Department of Medical and Toxicological Critical Care, Assistance Publique-Hopitaux de Paris, Lariboisiere Hospital, Federation of toxicology, F-75010 Paris, France. FAU - Massougbodji, Achille AU - Massougbodji A AD - Benin Clinical Research Institute, Abomey-Calavi, Benin. FAU - Chippaux, Jean-Philippe AU - Chippaux JP AUID- ORCID: 0000-0002-1976-8568 AD - French National Research Institute for Development, Mother and Child in Tropical Environment: Pathogens, Health System and Epidemiological Transition, Universite Paris Cite, F-75006 Paris, France. LA - eng PT - Journal Article DEP - 20241224 PL - Switzerland TA - Toxins (Basel) JT - Toxins JID - 101530765 RN - 0 (Antivenins) RN - 0 (Viper Venoms) SB - IM MH - Humans MH - Male MH - Benin MH - Female MH - Animals MH - Adult MH - Middle Aged MH - *Snake Bites/blood/drug therapy/complications MH - Antivenins/therapeutic use MH - *Viper Venoms/toxicity MH - *Viperidae MH - Young Adult MH - Blood Coagulation Tests MH - Hemostasis MH - Blood Coagulation/drug effects MH - *Blood Coagulation Disorders/blood MH - Prospective Studies MH - Hemorrhage/blood MH - Adolescent MH - Aged MH - Echis PMC - PMC11769018 OTO - NOTNLM OT - Quantra OT - antivenom OT - coagulation OT - fibrinogen OT - fibrinolysis OT - platelets OT - viscoelastic assay OT - whole blood clotting test COIS- The authors declare no conflicts of interest. EDAT- 2025/01/24 17:38 MHDA- 2025/01/24 17:39 PMCR- 2024/12/24 CRDT- 2025/01/24 08:45 PHST- 2024/11/19 00:00 [received] PHST- 2024/12/09 00:00 [revised] PHST- 2024/12/21 00:00 [accepted] PHST- 2025/01/24 17:39 [medline] PHST- 2025/01/24 17:38 [pubmed] PHST- 2025/01/24 08:45 [entrez] PHST- 2024/12/24 00:00 [pmc-release] AID - toxins17010003 [pii] AID - toxins-17-00003 [pii] AID - 10.3390/toxins17010003 [doi] PST - epublish SO - Toxins (Basel). 2024 Dec 24;17(1):3. doi: 10.3390/toxins17010003. PMID- 39837554 OWN - NLM STAT- MEDLINE DCOM- 20251127 LR - 20260813 IS - 2567-689X (Electronic) IS - 0340-6245 (Print) IS - 0340-6245 (Linking) VI - 125 IP - 12 DP - 2025 Dec TI - A Novel Fibrinolysis Resistance Capacity Assay can Detect Fibrinolytic Phenotypes in Trauma Patients. PG - 1205-1215 LID - 10.1055/a-2508-3424 [doi] AB - To evaluate residual fibrinolysis resistance activity (FRA) in plasma, a detergent-modified plasma clot lysis assay time (dPCLT) was established in which alpha2-antiplasmin (A2AP) and plasminogen activator inhibitor type 1 (PAI-1) are inactivated without impacting protease activity. We applied this novel assay to severely injured trauma patients' plasma.Tissue-type plasminogen activator (tPA)-induced plasma clot lysis assays were conducted after detergents- (dPCLT) or vehicle- (sPCLT) treatment, and time to 50% clot lysis was measured ("transition midpoint", T (m)). Residual FRA was then calculated as ([sPCLT T (m)] - [dPCLT T (m)]/[sPCLT T (m)]) x100% = Delta T(m) PCLT (%). Assay results were compared to rapid thromboelastography (TEG) LY30, tPA TEG LY30, and plasma fibrinolysis biomarkers in polytrauma patients' plasma (N=43).Delta T(m) PCLT(%) in normal plasma (N=5) was 63.0 +/- 8.3 whereas in A2AP-depleted plasma was -19.1 +/- 1.3%, Plasmin-antiplasmin (PAP) complex increased after complete lysis of sPCLT, whereas that in dPCLT was negligible in normal plasma. In trauma plasma, significant correlations between Delta T(m) PCLT and active PAI-1 (r = 0.85, p<0.0001), PAP complex (r = -0.85, p<0.0001), free A2AP (r = 0.66, p<0.0001), total A2AP levels (r = 0.52, p=0.001) and tPA TEG LY30 (r = -0.85, p<0.0001) were found. dPCLT in hyperfibrinolysis patients diagnosed by tPA TEG was significantly shorter than those with low fibrinolysis [10.2 +/- 6.4 minutes versus 20.2 +/- 2.1 minutes, p=0.0006].Hyperfibrinolysis after trauma is significantly related to exhaustion of FRA, and our novel assay appears to quickly assess this state and may be a useful clinical diagnostic after additional validation. . We established a new clot lysis assay to measure residual fibrinolysis resistance activity after inactivating PAI-1 and A2AP by detergents without impacting protease function.. . This novel clot lysis assay unmasked the mechanism of hyperfibrinolysis after trauma as exhaustion of fibrinolysis resistance activity, and appeared useful in quickly identifying these patients.. CI - Thieme. All rights reserved. FAU - Barrett, Christopher D AU - Barrett CD AUID- ORCID: 0000-0001-9720-8155 AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. AD - Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Suzuki, Yuko AU - Suzuki Y AUID- ORCID: 0000-0003-4833-8580 AD - Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States. AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. FAU - Moore, Hunter B AU - Moore HB AUID- ORCID: 0000-0002-5939-3828 AD - Division of Solid Organ Transplantation, Department of Surgery, AdventHealth Porter, Denver, Colorado, United States. FAU - Maginot, Elizabeth R AU - Maginot ER AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - White, Collin M AU - White CM AD - Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Siddiqui, Halima AU - Siddiqui H AD - Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Gawargi, Flobater I AU - Gawargi FI AD - Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States. FAU - Chandler, James G AU - Chandler JG AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. FAU - Sauaia, Angela AU - Sauaia A AD - Sauaia Statistical Solutions, LLC, Denver, Colorado, United States. FAU - Urano, Tetsumei AU - Urano T AUID- ORCID: 0000-0002-7398-9732 AD - Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan. AD - Department of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan. LA - eng GR - K08 HL171936/HL/NHLBI NIH HHS/United States GR - 22H03172/JSPS KAKENHI/ GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - K08-HL171936/National Heart Lung and Blood Institute/ GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - 22K08153/JSPS KAKENHI/ GR - 21ek0210154h0002/Japan Agency for Medical Research and Development/ GR - P20 GM152326/GM/NIGMS NIH HHS/United States GR - P20-GM152326/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20250121 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (alpha-2-Antiplasmin) RN - 0 (Plasminogen Activator Inhibitor 1) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 0 (Biomarkers) RN - 0 (SERPINE1 protein, human) SB - IM MH - Humans MH - *Fibrinolysis MH - alpha-2-Antiplasmin/metabolism MH - Male MH - Plasminogen Activator Inhibitor 1/blood MH - Female MH - Tissue Plasminogen Activator MH - Thrombelastography MH - Middle Aged MH - Adult MH - Biomarkers/blood MH - *Fibrin Clot Lysis Time/methods MH - Phenotype MH - *Wounds and Injuries/blood/diagnosis MH - *Multiple Trauma/blood/diagnosis MH - Young Adult MH - Aged MH - Predictive Value of Tests PMC - PMC13433134 MID - NIHMS2188546 COIS- T.U. and Y.S. have an international pending patent related to this detergent-based clot lysis assay method (PCT/JP2022/ 40448, WO 2023/074864 A1). C.D.B., E.E.M. and H.B.M. have patents issued or pending related to coagulation/fibrinolysis diagnostics, and H.B.M. and E.E.M. are an inventor on US11137409B2 that pertains to the tPA-challenged thrombelastogram used in this study. C.D.B., E.E.M. and H.B.M. have previously received grant support from Genentech, Inc and Werfen. C.D.B. has received consulting fees from Atheneum Partners. E.E.M. and H.B.M. have received grant support from Haemonetics, Hemosonics, Stago Diagnostica. E.E.M. has received grant support from Prytime. All other authors have nothing to disclose. EDAT- 2025/01/22 05:33 MHDA- 2025/11/28 00:26 PMCR- 2026/08/04 CRDT- 2025/01/21 19:32 PHST- 2025/11/28 00:26 [medline] PHST- 2025/01/22 05:33 [pubmed] PHST- 2025/01/21 19:32 [entrez] PHST- 2026/08/04 00:00 [pmc-release] AID - 10.1055/a-2508-3424 [doi] PST - ppublish SO - Thromb Haemost. 2025 Dec;125(12):1205-1215. doi: 10.1055/a-2508-3424. Epub 2025 Jan 21. PMID- 39836091 OWN - NLM STAT- MEDLINE DCOM- 20250502 LR - 20260815 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 98 IP - 4 DP - 2025 Apr 1 TI - The tissue-plasminogen activator-challenged thromboelastography provides a comprehensive assessment of fibrinolysis in the severely injured. PG - 578-586 LID - 10.1097/TA.0000000000004526 [doi] AB - BACKGROUND: Tissue-plasminogen activator-challenged thromboelastography (tPA-TEG) predicts massive transfusion and mortality better than conventional rapid thromboelastography (rTEG), with little concordance between their lysis values (LY30). We hypothesized that the main fibrinolytic inhibitors plasminogen activator inhibitor-1 (PAI-1) and alpha-2 antiplasmin (A2AP), as well as markers of fibrinolytic activation (plasmin-antiplasmin [PAP], tPA-PAI-1 complex, tPA activity), would correlate more strongly with tPA-TEG versus rTEG LY30 and may explain the recent findings of four distinct fibrinolytic phenotypes in trauma based on these two TEG methodologies. METHODS: Adult trauma patients (n = 56) had tPA-TEG, rTEG, and plasma obtained on arrival to the emergency department with institutional review board approval. Plasminogen activator inhibitor-1 activity, A2AP, PAP, and tPA-PAI-1 complex as well as tPA activity were measured. Data were analyzed using Spearman's correlations and analysis of variance. RESULTS: The median age was 34 years, 75% were male, and the New Injury Severity Score was 14. Mortality was 25%, and 23% required a massive transfusion. There was a significant negative correlation between PAI-1 activity and A2AP with tPA-TEG LY30 ( r = -0.77, p < 0.0001 and r = -0.62, p < 0.0001). There was a significant positive correlation between PAP complex and tPA-TEG LY30 ( r = 0.74, p < 0.0001). There was no correlation between any fibrinolytic analyte and rTEG LY30. When stratified by phenotype, patients with hypofibrinolysis and nonpathologic fibrinolysis had higher active PAI-1 ( p < 0.05) and A2AP levels ( p < 0.05), lower PAP ( p < 0.05), and tPA-PAI-1 complex ( p < 0.05). Tissue-plasminogen activator activity was higher in hyperfibrinolysis relative to the other three groups ( p < 0.05). CONCLUSION: Tissue-plasminogen activator-TEG LY30 more accurately reflects fibrinolysis phenotypes in trauma patients than conventional TEG methods. This provides an explanation for tPA-TEG's superior performance over rTEG in predicting clinical outcomes. LEVEL OF EVIDENCE: Diagnostic Tests/Criteria; Level III. CI - Copyright (c) 2025 American Association for the Surgery of Trauma. FAU - Maginot, Elizabeth R AU - Maginot ER AUID- ORCID: 0009-0008-3697-3185 AD - From the Division of Acute Care Surgery, Department of Surgery (E.R.M., T.B.M., C.M.W., H.S., R.H., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (H.B.M.), AdventHealth Porter; Department of Surgery (E.E.M., J.G.C.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Department of Surgery (E.E.M.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Hunter College (I.M.B.), New York, New York; Sauaia Statistical Solutions, LLC (A.S.), Denver, Colorado; and Department of Cellular and Integrative Physiology (F.I.G., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska. FAU - Moore, Hunter B AU - Moore HB FAU - Moore, Ernest E AU - Moore EE FAU - Bernhardt, Isabella M AU - Bernhardt IM FAU - Moody, Trace B AU - Moody TB FAU - White, Collin M AU - White CM FAU - Siddiqui, Halima AU - Siddiqui H FAU - Gawargi, Flobater I AU - Gawargi FI FAU - Henry, Reynold AU - Henry R FAU - Chandler, James G AU - Chandler JG FAU - Sauaia, Angela AU - Sauaia A FAU - Barrett, Christopher D AU - Barrett CD AUID- ORCID: 0000-0001-9720-8155 LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P20 GM152326/GM/NIGMS NIH HHS/United States GR - K08 HL171936/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20250117 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 0 (Plasminogen Activator Inhibitor 1) RN - 0 (alpha-2-Antiplasmin) RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Fibrinolysis/physiology MH - Male MH - *Tissue Plasminogen Activator/blood MH - Female MH - Adult MH - *Wounds and Injuries/blood/mortality/diagnosis MH - Plasminogen Activator Inhibitor 1/blood MH - alpha-2-Antiplasmin/metabolism/analysis MH - Middle Aged MH - Injury Severity Score MH - Biomarkers/blood PMC - PMC13475717 MID - NIHMS2192732 COIS- DISCLOSURE Conflicts of Interest: Author Disclosure forms have been supplied and are provided as Supplemental Digital Content (http://links.lww.com/TA/E216). EDAT- 2025/01/21 12:26 MHDA- 2025/03/24 06:30 PMCR- 2026/08/14 CRDT- 2025/01/21 10:43 PHST- 2025/03/24 06:30 [medline] PHST- 2025/01/21 12:26 [pubmed] PHST- 2025/01/21 10:43 [entrez] PHST- 2026/08/14 00:00 [pmc-release] AID - 01586154-990000000-00888 [pii] AID - 10.1097/TA.0000000000004526 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Apr 1;98(4):578-586. doi: 10.1097/TA.0000000000004526. Epub 2025 Jan 17. PMID- 39832780 OWN - NLM STAT- Publisher LR - 20250623 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) DP - 2025 Jan 20 TI - Does a Simple Blood Gas Analysis and the Clinical Impression Predict Trauma-Induced Coagulopathy? LID - 10.1055/a-2445-7163 [doi] AB - OBJECTIVES: Trauma-induced coagulopathy (TIC) is common in severely injured patients and is associated with significant morbidity and mortality. METHOD: The association of two parameters of blood gas analysis (hemoglobin [Hb], base excess [BE]) with standard coagulation tests (SCTs) and rotational thrombelastometry (ROTEM) using the database of the TraumaRegister DGU between 2015 and 2022 was studied. In a stepwise approach, the occurrence of a TIC, the correlations between Hb/BE levels and SCT, as well as ROTEM were calculated respectively. Then we aimed to detect relations between different Hb/BE levels and the occurrence of TIC, using standard clotting studies and/or ROTEM respectively. RESULTS: TIC occurred in 17.2% of the 68,996 primarily admitted adult patients with Injury Severity Score >/=9. A high correlation was found between Hb/BE and SCT. With a decrease in Hb and BE, the frequency of TIC increased and at an admission Hb <8 g/dL and BE < -6 mmol/L, >60% of patients presented with TIC. Clinical conditions associated with TIC were Glasgow Coma Scale 1,000 mL, serious injuries to the head and/or the thorax and/or the abdomen and/or the extremities. CONCLUSION: Almost one-sixth of patients present with a TIC at hospital admission. Blood gas analysis samples showed relevant correlations between Hb/BE levels and SCT. The combined closer inspection of Hb/BE and the clinical presentation of the patient is able to predict TIC in the majority of patients. CI - Thieme. All rights reserved. FAU - Hilbert-Carius, Peter AU - Hilbert-Carius P AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany. FAU - Lefering, Rolf AU - Lefering R AD - IFOM, Witten/Herdecke University, Koln, Nordrhein-Westfalen, Germany. FAU - Wrigge, Hermann AU - Wrigge H AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany. AD - Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany. FAU - Hofmann, Gunther O AU - Hofmann GO AD - Department of Trauma Surgery, Jena University Hospital, Jena, Thueringen, Germany. FAU - Davis, Jesse AU - Davis J AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany. FAU - Koch, Rene AU - Koch R AD - Department of Anaesthesiology and Intensive Care Medicine, Husum Hospital, Husum, Schleswig-Holstein, Germany. LA - eng PT - Journal Article DEP - 20250120 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 SB - IM COIS- The authors declare that they have no conflict of interest. EDAT- 2025/01/21 09:01 MHDA- 2025/01/21 09:01 CRDT- 2025/01/20 19:43 PHST- 2025/01/21 09:01 [pubmed] PHST- 2025/01/21 09:01 [medline] PHST- 2025/01/20 19:43 [entrez] AID - 10.1055/a-2445-7163 [doi] PST - aheadofprint SO - Hamostaseologie. 2025 Jan 20. doi: 10.1055/a-2445-7163. PMID- 39829054 OWN - NLM STAT- MEDLINE DCOM- 20250501 LR - 20260429 IS - 1399-6576 (Electronic) IS - 0001-5172 (Print) IS - 0001-5172 (Linking) VI - 69 IP - 2 DP - 2025 Feb TI - Coagulation and platelet function in cold-stored whole blood on missions in a helicopter emergency service. PG - e14568 LID - 10.1111/aas.14568 [doi] LID - e14568 AB - BACKGROUND: Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions. METHODS: Twenty units of low-titre group O RhD negative whole blood were collected from healthy volunteers and analysed before, during and after transport in a helicopter. Coagulation and platelet function, as measured by thromboelastography, and blood samples for pH, electrolytes, glucose and lactate were assessed at baseline and 24, 72 and 168 h after storage in the helicopter. Plasma concentrations of coagulation factors and haemoglobin and blood counts were measured at baseline and after 168 h. RESULTS: Plasma concentrations of coagulation factors and haemoglobin did not change during storage and transport. Platelet counts decreased from a baseline mean of 172 +/- 29 x 10(9)/L to a mean of 120 +/- 28 x 10(9)/L after 168 h, and platelet function worsened slightly but significantly by 8%-9% during storage and transport. pH and glucose decreased while potassium and lactate levels increased after 168 h compared with baseline. CONCLUSION: Storage and transport of whole-blood units in a rescue helicopter, for up to 168 h, had a slight impact on the blood quality. Storage of whole blood on board of the helicopter holds up to European standard, measured as temperature and haemolysis. CI - (c) 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. FAU - Sato Folatre, Jose-Gabriel AU - Sato Folatre JG AUID- ORCID: 0000-0002-8710-9142 AD - Helicopter Emergency Medical Service, Region Vastra Gotaland, Kungalv, Sweden. AD - Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. FAU - Wikman, Agneta AU - Wikman A AUID- ORCID: 0000-0002-8810-7974 AD - Centre for Haematology and Regenerative Medicine (HERM), Karolinska University Hospital, Stockholm, Sweden. AD - Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. FAU - Radulovic, Vladimir AU - Radulovic V AD - Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden. FAU - Sandstrom, Goran AU - Sandstrom G AUID- ORCID: 0000-0001-7352-4356 AD - Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. AD - Department of War Studies, Swedish Defence University, Stockholm, Sweden. FAU - Skallsjo, Gabriel AU - Skallsjo G AD - Helicopter Emergency Medical Service, Region Vastra Gotaland, Kungalv, Sweden. AD - Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. FAU - Arnell, Per AU - Arnell P AD - Helicopter Emergency Medical Service, Region Vastra Gotaland, Kungalv, Sweden. FAU - Ricksten, Sven-Erik AU - Ricksten SE AUID- ORCID: 0000-0002-1445-7525 AD - Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. FAU - Romlin, Birgitta AU - Romlin B AUID- ORCID: 0000-0002-8187-9760 AD - Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. AD - Department of Paediatric Anaesthesia and Intensive Care, Queen Silvia Children's Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. LA - eng GR - Helicopter Emergency Medical Service, Region Vastra Gotaland/ GR - The Swedish Armed Forces Science & Technology Fund/ GR - The Centre for Disaster Medicine, Gothenburg University/ GR - The Department of Haematology and Coagulation Disorders/ GR - The Local Research and Development Council Fyrbodal/ GR - AT9221011/The Swedish Society for Military Medical Officers/ PT - Journal Article PL - England TA - Acta Anaesthesiol Scand JT - Acta anaesthesiologica Scandinavica JID - 0370270 RN - 0 (Blood Glucose) RN - 33X04XA5AT (Lactic Acid) RN - 0 (Hemoglobins) RN - 0 (Blood Coagulation Factors) RN - 0 (Electrolytes) SB - IM MH - Humans MH - *Air Ambulances MH - *Blood Coagulation/physiology MH - *Blood Preservation/methods MH - *Blood Platelets/physiology MH - Thrombelastography MH - Male MH - Adult MH - *Emergency Medical Services MH - Platelet Function Tests MH - Female MH - Platelet Count MH - Cold Temperature MH - Blood Glucose/analysis MH - Lactic Acid/blood MH - Hemoglobins/analysis MH - Hydrogen-Ion Concentration MH - Blood Coagulation Factors/analysis MH - Electrolytes/blood MH - Aircraft PMC - PMC11744058 OTO - NOTNLM OT - coagulation OT - critical emergency medicine OT - helicopter emergency medical service OT - platelet function OT - prehospital emergency services OT - thromboelastography OT - whole blood COIS- The authors declare that they have no conflicts of interest. EDAT- 2025/01/20 22:54 MHDA- 2025/01/20 22:55 PMCR- 2025/01/20 CRDT- 2025/01/20 01:53 PHST- 2024/12/03 00:00 [revised] PHST- 2024/07/03 00:00 [received] PHST- 2024/12/09 00:00 [accepted] PHST- 2025/01/20 22:55 [medline] PHST- 2025/01/20 22:54 [pubmed] PHST- 2025/01/20 01:53 [entrez] PHST- 2025/01/20 00:00 [pmc-release] AID - AAS14568 [pii] AID - 10.1111/aas.14568 [doi] PST - ppublish SO - Acta Anaesthesiol Scand. 2025 Feb;69(2):e14568. doi: 10.1111/aas.14568. PMID- 39823697 OWN - NLM STAT- MEDLINE DCOM- 20250501 LR - 20260202 IS - 1879-1271 (Electronic) IS - 0268-0033 (Print) IS - 0268-0033 (Linking) VI - 122 DP - 2025 Feb TI - Two minutes is sufficient to characterize the viscoelastic properties of the human lower birth canal during the first stage of labor. PG - 106430 LID - S0268-0033(25)00002-6 [pii] LID - 10.1016/j.clinbiomech.2025.106430 [doi] AB - BACKGROUND: The lower birth canal is the final constriction through which a fetal head must pass for delivery. Unfortunately, injuries to the lower birth canal tissues occur in up to 19 % of first-time vaginal deliveries due to the 300 % stretch required. METHODS: This is a secondary analysis of data from 56 healthy nullipara recorded by a lower birth canal dilator during the first stage of labor. A four parameter Fractional Zener rheological Model was used to characterize the canal viscoelastic properties during the first stage of labor. We tested the (null) hypothesis that the Model constants identified during the initial 20 s ramp-and-5-min-hold dilation from 40 to 55 mm will not accurately predict the final hoop tension after 60 min of slower dilation. FINDINGS: The null hypothesis was rejected in that when the four Model parameters were calculated for all nullipara from the 20-s-ramp-and-5-min-hold data, the relative fit error was 8 +/- 4 %, and the relative prediction error after 60 min of dilation was 10 +/- 5 %. Furthermore, when the Model constants were instead calculated from the 20 s ramp and only the initial 90 s of the 5-min-hold, the error was still acceptable: 13 +/- 4 % for relative fit and 13 +/- 18 % for relative prediction. INTERPRETATION: Two minutes is sufficient to characterize canal viscoelastic properties during the first stage of labor and identify those with stiffer tissues at higher risk for a pelvic floor injury during delivery. This could form the basis for a clinical test predicting injury. CI - Copyright (c) 2025 Elsevier Ltd. All rights reserved. FAU - Masteling, Mariana AU - Masteling M AD - Department of Mechanical Engineering, University of Michigan, 2350 Hayward St, Ann Arbor, MI 48109, United States; Department of Biomedical Engineering, University of Michigan, 200 Bonisteel Blvd, Ann Arbor, MI 48109, United States. Electronic address: mastelin@umich.edu. FAU - DeLancey, John O L AU - DeLancey JOL AD - Department of Obstetrics and Gynecology, University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI 48109, United States. Electronic address: delancey@umich.edu. FAU - Ashton-Miller, James A AU - Ashton-Miller JA AD - Department of Mechanical Engineering, University of Michigan, 2350 Hayward St, Ann Arbor, MI 48109, United States; Department of Biomedical Engineering, University of Michigan, 200 Bonisteel Blvd, Ann Arbor, MI 48109, United States. Electronic address: jaam@umich.edu. LA - eng GR - R44 HD096987/HD/NICHD NIH HHS/United States GR - RC2 DK122379/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20250111 PL - England TA - Clin Biomech (Bristol) JT - Clinical biomechanics (Bristol, Avon) JID - 8611877 SB - IM MH - Humans MH - Female MH - Viscosity MH - Pregnancy MH - Elasticity MH - Adult MH - *Labor Stage, First/physiology MH - Time Factors MH - Rheology MH - Biomechanical Phenomena MH - Models, Biological PMC - PMC11822253 MID - NIHMS2049987 OTO - NOTNLM OT - Childbirth OT - Fractional Zener viscoelastic model OT - Injury prevention OT - Labor OT - Pelvic floor OT - Viscoelastic properties COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2025/01/18 15:10 MHDA- 2025/02/10 00:19 PMCR- 2026/02/01 CRDT- 2025/01/17 18:02 PHST- 2024/09/30 00:00 [received] PHST- 2024/12/13 00:00 [revised] PHST- 2025/01/09 00:00 [accepted] PHST- 2025/02/10 00:19 [medline] PHST- 2025/01/18 15:10 [pubmed] PHST- 2025/01/17 18:02 [entrez] PHST- 2026/02/01 00:00 [pmc-release] AID - S0268-0033(25)00002-6 [pii] AID - 10.1016/j.clinbiomech.2025.106430 [doi] PST - ppublish SO - Clin Biomech (Bristol). 2025 Feb;122:106430. doi: 10.1016/j.clinbiomech.2025.106430. Epub 2025 Jan 11. PMID- 39813417 OWN - NLM STAT- MEDLINE DCOM- 20250501 LR - 20250522 IS - 1809-4546 (Electronic) IS - 0100-6991 (Print) IS - 0100-6991 (Linking) VI - 51 DP - 2025 TI - Damage control resuscitation: how it's done and where we can improve. A view of the Brazilian reality according to trauma professionals. PG - e20243785 LID - S0100-69912024000100227 [pii] LID - 10.1590/0100-6991e-20243785-en [doi] LID - e20243785 AB - INTRODUCTION: Hemorrhage is the leading cause of preventable deaths in trauma patients, resulting in 1.5 million deaths annually worldwide. Traditional trauma assessment follows the ABC (airway, breathing, circulation) sequence; evidence suggests the CAB (circulation, airway, breathing) approach to maintain perfusion and prevent hypotension. Damage Control Resuscitation (DCR), derived from military protocols, focuses on early hemorrhage control and volume replacement to combat the "diamond of death" (hypothermia, hypocalcemia, acidosis, coagulopathy). This study evaluates the implementation of DCR protocols in Brazilian trauma centers, hypothesizing sub-optimal resuscitation due to high costs of necessary materials and equipment. METHODS: In 2024, an electronic survey was conducted among Brazilian Trauma Society members to assess DCR practices. The survey, completed by 121 participants, included demographic data and expertise in DCR. RESULTS: All 27 Brazilian states were represented in the study. Of the respondents, 47.9% reported the availability of Massive Transfusion Protocol (MTP) at their hospitals, and only 18.2% utilized whole blood. Permissive hypotension was practiced by 84.3%, except in traumatic brain injury cases. The use of tranexamic acid was high (96.7%), but TEG/ROTEM was used by only 5%. For hemorrhage control, tourniquets and resuscitative thoracotomy were commonly available, but REBOA was rarely accessible (0.8%). CONCLUSION: Among the centers represented herein, the results highlight several inconsistencies in DCR and MTP implementation across Brazilian trauma centers, primarily due to resource constraints. The findings suggest a need for improved infrastructure and adherence to updated protocols to enhance trauma care and patient outcomes. FAU - Ribeiro Junior, Marcelo Augusto Fontenelle AU - Ribeiro Junior MAF AUID- ORCID: 0000-0001-9826-4722 AD - - University of Maryland, R Adams Cowley Shock Trauma Center - Baltimore - MD - Estados Unidos. AD - - Pontifical Catholic University of Sao Paulo - Campus Sorocaba, Discipline of Trauma Surgery - Sorocaba - SP - Brasil. FAU - Pacheco, Leticia Stefani AU - Pacheco LS AUID- ORCID: 0009-0007-5965-2117 AD - - Pontifical Catholic University of Sao Paulo - Campus Sorocaba, Discipline of Trauma Surgery - Sorocaba - SP - Brasil. FAU - Duchesne, Juan Carlos AU - Duchesne JC AUID- ORCID: 0000-0002-1490-1585 AD - - Tulane University School of Medicine, Division Trauma, Acute Care & Critical Care Surgery - New Orleans - LA - Estados Unidos. FAU - Parreira, Jose Gustavo AU - Parreira JG AUID- ORCID: 0000-0001-5883-9296 AD - - Santa Casa School of Medical Sciences, Department of Surgery - Sao Paulo - SP - Brasil. FAU - Mohseni, Shahin AU - Mohseni S AUID- ORCID: 0000-0001-7097-487X AD - - School of Medical Sciences Orebro university, Department of Surgery - Orebro - OR - Suecia. LA - eng LA - por PT - Journal Article DEP - 20250113 PL - Brazil TA - Rev Col Bras Cir JT - Revista do Colegio Brasileiro de Cirurgioes JID - 7809515 SB - IM MH - Humans MH - Brazil MH - *Resuscitation/methods/standards MH - *Wounds and Injuries/therapy/complications MH - *Hemorrhage/therapy MH - Trauma Centers MH - Female MH - Male PMC - PMC11665334 COIS- Conflict of interest: no. EDAT- 2025/01/15 18:20 MHDA- 2025/01/15 18:21 PMCR- 2024/12/02 CRDT- 2025/01/15 15:22 PHST- 2024/06/15 00:00 [received] PHST- 2024/10/17 00:00 [accepted] PHST- 2025/01/15 18:21 [medline] PHST- 2025/01/15 18:20 [pubmed] PHST- 2025/01/15 15:22 [entrez] PHST- 2024/12/02 00:00 [pmc-release] AID - S0100-69912024000100227 [pii] AID - 10.1590/0100-6991e-20243785-en [doi] PST - epublish SO - Rev Col Bras Cir. 2025 Jan 13;51:e20243785. doi: 10.1590/0100-6991e-20243785-en. eCollection 2025. PMID- 39809164 OWN - NLM STAT- MEDLINE DCOM- 20250501 LR - 20250602 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 103 IP - 47 DP - 2024 Nov 22 TI - Analysis of factors related to venous thrombosis after ankle fracture combined with type 2 diabetes mellitus applying tourniquet surgery. PG - e40296 LID - 10.1097/MD.0000000000040296 [doi] LID - e40296 AB - The objective was to study the risk factors of venous thrombosis after ankle fracture with type 2 diabetes mellitus surgery using a tourniquet and to assess the effect of ischemic preconditioning and metformin combination therapy in preventing thrombosis. One hundred eighty patients with ankle fractures combined with type 2 diabetes mellitus treated with lower extremity tourniquet surgery between January 2020 and December 2023 were analyzed. Based on postoperative color Doppler ultrasound of both lower extremities, the patients were divided into thrombus-positive and negative groups. Multifactorial logistic regression analysis was utilized to determine the high-risk factors for venous thrombosis and construct a prediction model. There were 64 cases in the positive group and 116 cases in the negative group. The differences between the 2 groups in gender, age, fracture site, preoperative glycosylated hemoglobin, thromboelastography parameters, duration of surgery, D-dimer level at 1-week postoperatively, and thromboelastography K, alpha, and MA values were not statistically significant (P > .05); however, there was no statistically significant difference in the preoperative D-dimer level, tourniquet duration, bleeding volume, thromboelastography R-value at 1-week postoperatively, and ischemic preconditioning in combination with metformin treatment patient There was a significant difference in the proportion (P < .05). Multifactorial logistic regression analysis showed that preoperative high D-dimer, prolonged tourniquet application, massive bleeding, and increased thromboelastography R-value at 1-week postoperatively were independent risk factors, and ischemic preconditioning combined with metformin was a protective factor. Preoperative high D-dimer, prolonged tourniquet application, massive bleeding, and increased thromboelastography R-value at 1-week postoperatively were independent risk factors for postoperative venous thrombosis in patients with ankle fracture with type 2 diabetes mellitus and ischemic preconditioning combined with metformin treatment was a protective measure, and the prediction model is valuable in guiding clinical thrombosis risk assessment. CI - Copyright (c) 2024 the Author(s). Published by Wolters Kluwer Health, Inc. FAU - Wang, Cheng-Gui AU - Wang CG AUID- ORCID: 0009-0007-1430-2818 AD - Ya'an Hospital of Traditional Chinese Medicine, Ya'an, China. LA - eng PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (Hypoglycemic Agents) RN - 9100L32L2N (Metformin) SB - IM MH - Adult MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Ankle Fractures/surgery/complications MH - *Diabetes Mellitus, Type 2/complications/drug therapy MH - Fibrin Fibrinogen Degradation Products/analysis MH - Hypoglycemic Agents/therapeutic use MH - Metformin/therapeutic use MH - *Postoperative Complications/etiology/prevention & control/epidemiology MH - Retrospective Studies MH - Risk Factors MH - Thrombelastography MH - *Tourniquets/adverse effects MH - Ultrasonography, Doppler, Color MH - *Venous Thrombosis/etiology/prevention & control/epidemiology PMC - PMC11596340 COIS- The authors have no funding and conflicts of interest to disclose. EDAT- 2025/01/15 00:20 MHDA- 2025/01/15 00:21 PMCR- 2024/11/22 CRDT- 2025/01/14 18:15 PHST- 2025/01/15 00:21 [medline] PHST- 2025/01/15 00:20 [pubmed] PHST- 2025/01/14 18:15 [entrez] PHST- 2024/11/22 00:00 [pmc-release] AID - 00005792-202411220-00025 [pii] AID - MD-D-24-11104 [pii] AID - 10.1097/MD.0000000000040296 [doi] PST - ppublish SO - Medicine (Baltimore). 2024 Nov 22;103(47):e40296. doi: 10.1097/MD.0000000000040296. PMID- 39793720 OWN - NLM STAT- MEDLINE DCOM- 20250430 LR - 20250714 IS - 1532-8511 (Electronic) IS - 1052-3057 (Print) IS - 1052-3057 (Linking) VI - 34 IP - 3 DP - 2025 Mar TI - Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage. PG - 108228 LID - S1052-3057(25)00006-0 [pii] LID - 10.1016/j.jstrokecerebrovasdis.2025.108228 [doi] AB - BACKGROUND: Intracranial hemorrhage (ICH) is a complication of oral anticoagulation and is associated with significant morbidity and mortality. Clinical need exists for biomarkers to measure anticoagulation in patients with factor Xa inhibitor-associated ICH to assess the hemostatic effect of reversal agents. This study explored the utility of thromboelastography (TEG) to assess anticoagulation in emergency department (ED) patients who received activated prothrombin complex concentrate (aPCC) reversal for factor Xa-inhibitor-associated ICH. METHODS: This was a prospective, single-center, cohort study in a convenient sample of adult patients presenting to the ED with acute factor Xa-associated ICH. Exclusion criteria included pregnancy, incarceration, polytrauma, hepatic failure, or other known coagulopathic conditions. TEG samples were collected prior to anticoagulation reversal, as well as at 30-minutes, 12-hours, and 24-hours post-reversal. Only patients who received aPCC reversal were included in the final analysis. RESULTS: Pre-reversal TEG was collected on 10 participants prior to aPCC administration. A significant decrease in TEG R-time was observed at 30 minutes post-aPCC reversal (Beta = -0.91, p = 0.035). R-time increased at 12- and 24-hours post-aPCC reversal to baseline levels. Significant changes were not observed in K-time, clot strength, maximum amplitude, or coagulation index. CONCLUSIONS: TEG R-time decreases acutely after anticoagulation reversal with aPCC and rebounds at 12- and 24-hours post-reversal. TEG R-time may serve as a potential sensitive biomarker of the residual anticoagulation activity of factor Xa inhibitors in patients with ICH that undergo anticoagulation reversal with aPCCs. CI - Copyright (c) 2025. Published by Elsevier Inc. FAU - Zepeski, A AU - Zepeski A AD - Department of Emergency Medicine, University of Iowa College of Medicine, United States; University of Iowa College of Pharmacy, United States. Electronic address: anne-zepeski@uiowa.edu. FAU - Faine, B A AU - Faine BA AD - Department of Emergency Medicine, University of Iowa College of Medicine, United States; University of Iowa College of Pharmacy, United States. FAU - Ghannam, M AU - Ghannam M AD - Department of Neurology, University of Iowa College of Medicine, United States. FAU - Olalde, H M AU - Olalde HM AD - Department of Neurology, University of Iowa College of Medicine, United States. FAU - Wendt, L AU - Wendt L AD - Institute for Clinical and Translational Sciences, University of Iowa, United States. FAU - Naidech, A AU - Naidech A AD - Department of Neurology, Northwestern Medicine Feinberg School of Medicine, United States. FAU - Mohr, N M AU - Mohr NM AD - Department of Emergency Medicine, University of Iowa College of Medicine, United States; Department of Anesthesia, University of Iowa College of Medicine, United States; Department of Epidemiology, University of Iowa College of Public Health, United States. FAU - Leira, E C AU - Leira EC AD - Department of Neurology, University of Iowa College of Medicine, United States; Department of Epidemiology, University of Iowa College of Public Health, United States; Department of Neurosurgery, University of Iowa College of Medicine, United States. LA - eng GR - R01 NS110779/NS/NINDS NIH HHS/United States GR - U24 NS107247/NS/NINDS NIH HHS/United States PT - Journal Article DEP - 20250108 PL - United States TA - J Stroke Cerebrovasc Dis JT - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JID - 9111633 RN - 0 (Factor Xa Inhibitors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 0 (Blood Coagulation Factors) RN - 0 (Anticoagulants) SB - IM UOF - medRxiv. 2024 Aug 08:2024.08.07.24311652. doi: 10.1101/2024.08.07.24311652. PMID: 39211886 MH - Humans MH - *Thrombelastography MH - Female MH - Prospective Studies MH - Male MH - *Factor Xa Inhibitors/adverse effects/administration & dosage MH - *Intracranial Hemorrhages/chemically induced/blood/diagnosis/drug therapy MH - Middle Aged MH - *Blood Coagulation/drug effects MH - *Blood Coagulation Factors/therapeutic use/adverse effects/administration & dosage MH - Predictive Value of Tests MH - Aged MH - Time Factors MH - Treatment Outcome MH - Adult MH - Emergency Service, Hospital MH - *Drug Monitoring/methods MH - *Anticoagulants/adverse effects MH - Aged, 80 and over PMC - PMC12247156 MID - NIHMS2083504 OTO - NOTNLM OT - Anticoagulation OT - Anticoagulation reversal OT - Hematologic studies OT - Intracranial hemorrhage COIS- Declaration of competing interest EL: Salary support from NIH-NINDS; AZ, BF, MG, HO, LW, AN, NM: report no relevant disclosures or conflicts of interest. EDAT- 2025/01/11 14:02 MHDA- 2025/02/07 00:20 PMCR- 2025/07/11 CRDT- 2025/01/10 19:15 PHST- 2024/10/23 00:00 [received] PHST- 2025/01/02 00:00 [revised] PHST- 2025/01/06 00:00 [accepted] PHST- 2025/02/07 00:20 [medline] PHST- 2025/01/11 14:02 [pubmed] PHST- 2025/01/10 19:15 [entrez] PHST- 2025/07/11 00:00 [pmc-release] AID - S1052-3057(25)00006-0 [pii] AID - 10.1016/j.jstrokecerebrovasdis.2025.108228 [doi] PST - ppublish SO - J Stroke Cerebrovasc Dis. 2025 Mar;34(3):108228. doi: 10.1016/j.jstrokecerebrovasdis.2025.108228. Epub 2025 Jan 8. PMID- 39758560 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250107 IS - 1179-2736 (Print) IS - 1179-2736 (Electronic) IS - 1179-2736 (Linking) VI - 15 DP - 2024 TI - Subcutaneous Hematoma Elevates Plasma Levels of FDP and D-Dimer; an Analysis by Animal Model Experiments. PG - 557-564 LID - 10.2147/JBM.S479126 [doi] AB - PURPOSE: Trauma-associated coagulopathy has been considered to develop as a result of increased fibrinolysis due to massive bleeding, tissue damage and hypoperfusion. However, it has not been investigated whether hematoma may cause trauma-associated coagulopathy. Using experimental animal model, we analyzed the effects of hematoma formation on coagulation and fibrinolysis parameters. MATERIALS: Male Wistar rats were used for the studies. METHODS: We made an animal model of subcutaneous hematoma without tissue injuries. This model can be categorised as a kind of trauma models. We created experimentally subcutaneous hematomas in test animals using blood collected from other animals. We performed blood sampling to measure blood cell counts and coagulation parameters from test animals at 1, 6, 24, 48 and 96 hours after hematoma generation. Blood samples were collected and immediately sent for measurement of CBC, Prothrombin, FDP, D-dimer, Fibrinogen, Antithrombin, AST and ALT. Furthermore, after 1, 24 and 48 hours, we performed dynamic evaluation of coagulation/fibrinolysis function using thromboelastometry method. RESULTS: After the hematoma were created, FDP and D-dimer increased over time, and reached a plateau after 48 hours. During the period, there was no decrease in Fibrinogen and Antithrombin, and no thrombocytopenia occurred. Moreover, no obvious changes in coagulation/fibrinolysis function were observed employing thromboelastometry. DISCUSSION: Elevated FDP and D-dimer after hematoma creation are assumed to be synthesized in the hematoma, not in the streaming blood. Thromboelastometry also shows that elevated levels of FDP and D-dimer are not caused by intravascular coagulation and subsequent fibrinolysis. CONCLUSION: The study showed that subcutaneous hematomas caused increases in FDP and D-dimer levels, without activating the blood coagulation/fibrinolysis system. CI - (c) 2024 Nakao et al. FAU - Nakao, Takami AU - Nakao T AUID- ORCID: 0000-0001-8533-7398 AD - Critical Care Medical Center, Kindai University Nara Hospital, Ikoma-city, Nara, Japan. FAU - Kitazawa, Yasuhide AU - Kitazawa Y AUID- ORCID: 0000-0001-9744-2355 AD - Department of Emergency Medicine, Izumi City General Medical Center, Izumi-city, Osaka, Japan. FAU - Masuda, Shiori AU - Masuda S AD - Department of Clinical Laboratory, Kindai University Nara Hospital, Ikoma-city, Nara, Japan. FAU - Hashimoto, Naoki AU - Hashimoto N AUID- ORCID: 0000-0002-4411-9201 AD - Department of Emergency Medicine, Sanda City Hospital, Sanda-city, Hyogo, Japan. LA - eng PT - Journal Article DEP - 20241230 PL - New Zealand TA - J Blood Med JT - Journal of blood medicine JID - 101550884 PMC - PMC11697687 OTO - NOTNLM OT - coagulopathy OT - fibrinolysis OT - intravascular coagulation OT - trauma COIS- There is no conflict of interest in this manuscript, including financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest. EDAT- 2025/01/06 10:08 MHDA- 2025/01/06 10:09 PMCR- 2024/12/30 CRDT- 2025/01/06 05:22 PHST- 2024/07/12 00:00 [received] PHST- 2024/12/11 00:00 [accepted] PHST- 2025/01/06 10:09 [medline] PHST- 2025/01/06 10:08 [pubmed] PHST- 2025/01/06 05:22 [entrez] PHST- 2024/12/30 00:00 [pmc-release] AID - 479126 [pii] AID - 10.2147/JBM.S479126 [doi] PST - epublish SO - J Blood Med. 2024 Dec 30;15:557-564. doi: 10.2147/JBM.S479126. eCollection 2024. PMID- 39755516 OWN - NLM STAT- MEDLINE DCOM- 20250423 LR - 20250531 IS - 1471-6771 (Electronic) IS - 0007-0912 (Print) IS - 0007-0912 (Linking) VI - 134 IP - 5 DP - 2025 May TI - Altered thrombin generation with prothrombin complex concentrate is not detected by viscoelastic testing: an in vitro study. PG - 1392-1401 LID - S0007-0912(24)00711-6 [pii] LID - 10.1016/j.bja.2024.10.047 [doi] AB - BACKGROUND: Bleeding guidelines currently recommend use of viscoelastic testing (VET) to direct haemostatic resuscitation in severe haemorrhage. However, VET-derived parameters of clot initiation, such as clotting time (CT) and activated clotting time (ACT), might not adequately reflect a clinically relevant interaction of procoagulant and anticoagulant activity, as revealed by thrombin generation assays. The aim of this study was to evaluate the ability of CT and ACT to indicate thrombin generation activity. METHODS: Citrated whole blood obtained from 13 healthy volunteers underwent a 50% crystalloid dilution (DL-50%), followed by spiking with four-factor prothrombin complex concentrate (DL-50% + 4F-PCC). Changes in thrombin generation activity were compared with the VET parameters CT and ACT derived from four commercially available viscoelastic devices (ROTEM(R) Delta, ClotPro(R), TEG(R)6s, and Quantra(R)) and standard coagulation tests. RESULTS: Dilution of whole blood resulted in a marked increase in velocity index, peak height, and endogenous thrombin potential (all P<0.01), with a further substantial increase after spiking with 4F-PCC (all P<0.001). In contrast, CT and ACT were significantly prolonged in response to DL-50% on all devices (all P<0.05). Subsequent spiking of diluted blood with 4F-PCC had no impact on CT and ACT derived from VET analysers, but it restored standard coagulation tests without reaching baseline values (all P<0.01). CONCLUSIONS: Upregulated thrombin generation parameters after PCC spiking were not displayed by CT, ACT, or standard tests. Our results do not support treatment algorithms using prolonged CT or ACT as a trigger for administration of PCC to augment thrombin generation. CI - Copyright (c) 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Hofmann, Nikolaus AU - Hofmann N AD - Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria; Department of Anesthesiology and Intensive Care Medicine AUVA Trauma Center Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. FAU - Zipperle, Johannes AU - Zipperle J AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria. FAU - Gratz, Johannes AU - Gratz J AD - Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria. Electronic address: johannes.gratz@meduniwien.ac.at. FAU - Schmitt, Felix C F AU - Schmitt FCF AD - Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany. FAU - Oberladstatter, Daniel AU - Oberladstatter D AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria; Department of Anesthesiology and Intensive Care Medicine AUVA Trauma Center Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. LA - eng PT - Journal Article DEP - 20250104 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - EC 3.4.21.5 (Thrombin) RN - 37224-63-8 (prothrombin complex concentrates) RN - 0 (Blood Coagulation Factors) SB - IM MH - Humans MH - *Thrombin/biosynthesis/metabolism MH - *Blood Coagulation Factors/pharmacology MH - Male MH - Adult MH - Female MH - Blood Coagulation Tests/methods MH - *Thrombelastography/methods MH - Blood Coagulation/drug effects MH - Young Adult MH - Middle Aged MH - Healthy Volunteers MH - Whole Blood Coagulation Time PMC - PMC12106903 OTO - NOTNLM OT - point-of-care coagulation testing OT - prothrombin complex concentrate OT - thrombin generation OT - trauma-induced coagulopathy OT - viscoelastic testing COIS- Declaration of interests HS received honoraria for participation in advisory board meetings for Bayer Healthcare, Bohringer Ingelheim, and TEM international and study grants from CSL Behring. JG has received honoraria, research funding, and travel reimbursement from Alexion, AstraZeneca, Boehringer Ingelheim, CSL Behring, Instrumentation Laboratory, Johnson & Johnson, Mitsubishi Tanabe Pharma, Octapharma, Portola, and Takeda. FS has received consulting fees from CSL Behring, Roche Diabetes and payment or honoraria for lectures, travel expenses, and scientific support from AstraZeneca, CSL Behring, enicor, and LFB. The other authors declare no conflict of interest. EDAT- 2025/01/05 06:12 MHDA- 2025/04/23 06:26 PMCR- 2025/01/04 CRDT- 2025/01/04 21:56 PHST- 2024/07/25 00:00 [received] PHST- 2024/09/09 00:00 [revised] PHST- 2024/10/01 00:00 [accepted] PHST- 2025/04/23 06:26 [medline] PHST- 2025/01/05 06:12 [pubmed] PHST- 2025/01/04 21:56 [entrez] PHST- 2025/01/04 00:00 [pmc-release] AID - S0007-0912(24)00711-6 [pii] AID - 10.1016/j.bja.2024.10.047 [doi] PST - ppublish SO - Br J Anaesth. 2025 May;134(5):1392-1401. doi: 10.1016/j.bja.2024.10.047. Epub 2025 Jan 4. PMID- 39749491 OWN - NLM STAT- MEDLINE DCOM- 20250307 LR - 20260609 IS - 1878-3503 (Electronic) IS - 0035-9203 (Linking) VI - 119 IP - 3 DP - 2025 Mar 7 TI - Haemotoxicity of snakes: a review of pathogenesis, clinical manifestations, novel diagnostics and challenges in management. PG - 283-303 LID - 10.1093/trstmh/trae058 [doi] AB - Haemotoxicity is the most common complication of systemic envenoming following snakebite, leading to diverse clinical syndromes ranging from haemorrhagic to prothrombotic manifestations. Key haematological abnormalities include platelet dysfunction, venom-induced consumption coagulopathy, anticoagulant coagulopathy and organ-threatening thrombotic microangiopathy. Diagnostic methods include the bedside whole blood clotting test, laboratory coagulation screening and other advanced methods such as thromboelastogram and clot strength analysis. The primary management strategies are venom neutralisation with antivenom and correction of coagulopathy with blood component transfusions, while options such as plasma exchange are utilised in certain cases. Recent advancements in understanding the pathogenesis of haemotoxicity have facilitated the development of new diagnostic and treatment modalities. This review summarises current knowledge on the pathogenesis, diagnosis, clinical and laboratory manifestations and treatment of the haematological effects of snake envenoming. Furthermore, it highlights important challenges concerning diagnosis and management. Addressing these challenges is crucial for achieving the WHO's goal of reducing deaths and disabilities caused by snakebites by 2030. CI - (c) The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. FAU - Alvitigala, Bhawani Yasassri AU - Alvitigala BY AUID- ORCID: 0000-0002-6166-122X AD - Department of Pathology, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka. FAU - Dissanayake, Harsha A AU - Dissanayake HA AD - Department of Clinical Medicine, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka. FAU - Weeratunga, Praveen N AU - Weeratunga PN AD - Department of Clinical Medicine, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka. FAU - Padmaperuma, P A Chanya D AU - Padmaperuma PACD AD - Colombo North Teaching Hospital, Ragama, Western Province, Sri Lanka. FAU - Gooneratne, Lallindra Viranjan AU - Gooneratne LV AD - Department of Pathology, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka. FAU - Gnanathasan, Christeine Ariaranee AU - Gnanathasan CA AD - Department of Clinical Medicine, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - England TA - Trans R Soc Trop Med Hyg JT - Transactions of the Royal Society of Tropical Medicine and Hygiene JID - 7506129 RN - 0 (Antivenins) RN - 0 (Snake Venoms) SB - IM EIN - Trans R Soc Trop Med Hyg. 2025 Aug 8;119(8):982-984. doi: 10.1093/trstmh/traf021. PMID: 40037365 EIN - Trans R Soc Trop Med Hyg. 2026 Apr 1;120(4):423. doi: 10.1093/trstmh/traf142. PMID: 41383112 MH - *Snake Bites/complications/therapy/diagnosis MH - Humans MH - Animals MH - *Antivenins/therapeutic use MH - *Blood Coagulation Disorders/therapy/etiology/diagnosis MH - *Snake Venoms/toxicity MH - Snakes OTO - NOTNLM OT - consumption coagulopathy OT - haemotoxicity OT - snakebite OT - systemic envenoming OT - thrombocytopenia OT - thrombotic microangiopathy EDAT- 2025/01/03 06:21 MHDA- 2025/03/07 18:22 CRDT- 2025/01/03 05:04 PHST- 2024/04/05 00:00 [received] PHST- 2024/06/29 00:00 [revised] PHST- 2024/08/29 00:00 [accepted] PHST- 2025/03/07 18:22 [medline] PHST- 2025/01/03 06:21 [pubmed] PHST- 2025/01/03 05:04 [entrez] AID - 7931928 [pii] AID - 10.1093/trstmh/trae058 [doi] PST - ppublish SO - Trans R Soc Trop Med Hyg. 2025 Mar 7;119(3):283-303. doi: 10.1093/trstmh/trae058. PMID- 39727766 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250104 IS - 2313-7673 (Electronic) IS - 2313-7673 (Linking) VI - 9 IP - 12 DP - 2024 Dec 15 TI - Quasi-Static Mechanical Biomimetics Evaluation of Car Crash Dummy Skin. LID - 10.3390/biomimetics9120762 [doi] LID - 762 AB - Accurate replication of soft tissue properties is essential for the development of car crash test dummy skin to ensure the precision of biomechanical injury data. However, the intricacy of multi-layer soft tissue poses challenges in standardizing the development and testing of dummy skin materials to emulate soft tissue properties. This study presents a comprehensive testing and analysis of the compressive mechanical properties of both single and multi-layered soft tissues and car crash dummy skin materials, aiming to enhance the biofidelity of dummy skin. We presented one-term Ogden hyperelastic models and generalized Maxwell viscoelastic models for single-layer and multi-layer soft tissues, as well as dummy skin materials. The comparative analysis results indicate that the existing dummy skin material fails to fully consider the strain-rate-dependent characteristic of soft tissue. Furthermore, dummy skin materials exhibited ~3 times shorter relaxation times and ~2-3 times lower stress decay rates compared to soft tissues, suggesting a less viscous nature. This study provides an accurate representation of the mechanics of soft tissue and dummy skin under quasi-static compressive loading. The findings are instrumental for the development of novel bionic skin materials or structures to more precisely replicate the biomechanical properties of soft tissues, thereby enhancing the accuracy and reliability of car crash test dummies. FAU - Li, Yurun AU - Li Y AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Liu, Zhixin AU - Liu Z AUID- ORCID: 0000-0002-1571-6728 AD - China Automotive Technology and Research Center, Tianjin 300300, China. FAU - Sun, Cuiru AU - Sun C AUID- ORCID: 0000-0001-9253-3733 AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Zheng, Xiaoya AU - Zheng X AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Du, Guorui AU - Du G AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Wang, Xiaoshuang AU - Wang X AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Wang, Songchen AU - Wang S AUID- ORCID: 0009-0000-7581-4226 AD - Department of Mechanical Engineering, Tianjin University, No. 135 Yaguan Road, Tianjin 300354, China. FAU - Liu, Weidong AU - Liu W AD - China Automotive Technology and Research Center, Tianjin 300300, China. LA - eng GR - 12021002/National Natural Science Foundation of China/ GR - 82241208/National Natural Science Foundation of China/ GR - 12272262/National Natural Science Foundation of China/ GR - 22JCYBJC01420/TIANJIN SCIENCE AND TECHNOLOGY PLANNING PROJECT/ PT - Journal Article DEP - 20241215 PL - Switzerland TA - Biomimetics (Basel) JT - Biomimetics (Basel, Switzerland) JID - 101719189 PMC - PMC11673420 OTO - NOTNLM OT - Ogden model OT - car crush dummy skin OT - soft tissue mechanics OT - viscoelastic properties COIS- The authors declare no conflicts of interest. EDAT- 2024/12/27 12:20 MHDA- 2024/12/27 12:21 PMCR- 2024/12/15 CRDT- 2024/12/27 09:15 PHST- 2024/11/06 00:00 [received] PHST- 2024/12/06 00:00 [revised] PHST- 2024/12/13 00:00 [accepted] PHST- 2024/12/27 12:21 [medline] PHST- 2024/12/27 12:20 [pubmed] PHST- 2024/12/27 09:15 [entrez] PHST- 2024/12/15 00:00 [pmc-release] AID - biomimetics9120762 [pii] AID - biomimetics-09-00762 [pii] AID - 10.3390/biomimetics9120762 [doi] PST - epublish SO - Biomimetics (Basel). 2024 Dec 15;9(12):762. doi: 10.3390/biomimetics9120762. PMID- 39719587 OWN - NLM STAT- MEDLINE DCOM- 20241224 LR - 20250104 IS - 1749-799X (Electronic) IS - 1749-799X (Linking) VI - 19 IP - 1 DP - 2024 Dec 24 TI - Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures : TEG coupled with standard coagulation indices for predicting thrombosis in hip fractures. PG - 870 LID - 10.1186/s13018-024-05386-4 [doi] LID - 870 AB - BACKGROUND: Deep venous thrombosis of the lower extremity is a common and fatal complication of hip fracture in the elderly. However, there is a lack of targeted laboratory diagnostic methods. Although traditional laboratory indicators can provide some reference, the diagnostic efficiency is relatively limited This study aimed to investigate the diagnostic accuracies of thromboelastography (TEG) combined with traditional coagulation parameters for early diagnosis of newly occurring lower extremity deep vein thrombosis (DVT) in elderly patients with hip fractures. METHODS: We conducted a retrospective cohort study including seventy-four elderly patients with hip fractures without lower extremity DVT at admission between 2022 and 2023. Disease history, laboratory tests including blood routine, six coagulation parameters at admission, and TEG on the day after the operation were collected using validated methods. Color Doppler ultrasonography of lower extremity venous was performed at admission and discharge to confirm the diagnosis of perioperative new thrombosis. A logistic regression model was used to construct joint diagnostic indexes using traditional parameters, including coagulation parameters and patient histories, combined with TEG indicators, and the receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of each single TEG indicator and joint diagnostic indicators for newly occurring thrombosis in elderly patients with hip fracture. RESULTS: The incidence of lower extremity DVT was 33.78%. The average age was 82.0 years, and 7.0% were male. The TEG R values at discharge were 5.8 min and 6.3 min for the DVT and without VTE groups, respectively, showing a significant difference (p = 0.035). D-dimer levels in the DVT group were significantly higher than in the non-VTE group (4.3 vs. 2.9 mg/L, p = 0.029). The multivariate-adjusted model showed significant correlations between newly occurring DVT and TEG indicators, including R values, D-dimer, and BMI, with odd ratio values of 0.43, 1.43, and 1.25, respectively (all p value < 0.05). Among each traditional coagulation parameter and TEG indicators, D-dimer and R-value had the highest diagnostic accuracy (ROC area under the curve, AUC for D-dimer: 67.7%; AUC for R: 67.6%), respectively. For joint indicators, the combination of R + CI + alphaangle + D-dimer had the highest AUC (0.7475), followed by R + CI + alphaangle + BMI (0.7123). R + CI + alphaangle + gender had the lowest AUC (0.5920). CONCLUSION: TEG demonstrates diagnostic value for newly occurring lower extremity DVT in elderly hip fracture patients. When combined with traditional coagulation parameters and patient histories, its diagnostic value is further enhanced, providing robust support for the establishment of a more comprehensive diagnostic and predictive scoring system for DVT in elderly hip fracture patients. CI - (c) 2024. The Author(s). FAU - Yang, Huan AU - Yang H AD - Department of Orthopaedic Trauma, China-Japan Friendship Hospital, Yinghua East Street, Chaoyang District, Beijing, China. FAU - Yuan, Yusong AU - Yuan Y AD - Department of Orthopaedic Trauma, China-Japan Friendship Hospital, Yinghua East Street, Chaoyang District, Beijing, China. FAU - Shi, Lei AU - Shi L AD - Department of Orthopaedic Trauma, China-Japan Friendship Hospital, Yinghua East Street, Chaoyang District, Beijing, China. FAU - Yang, Yurun AU - Yang Y AD - Department of Orthopaedic Trauma, China-Japan Friendship Hospital, Yinghua East Street, Chaoyang District, Beijing, China. FAU - Zhu, Yidan AU - Zhu Y AD - Department of Clinical Research Institute, Peking University, Yiheyuan Road, Haidian District, Beijing, China. yidanzhu@bjmu.edu.cn. FAU - Chen, Ying AU - Chen Y AD - Department of Orthopaedic Trauma, China-Japan Friendship Hospital, Yinghua East Street, Chaoyang District, Beijing, China. cyzryh@163.com. LA - eng GR - 2023-HX-46/China-Japan Friendship Hospital Self-selected Project/ GR - ZRJY2023-QM29/Elite Medical Professionals Project of China-Japan Friendship Hospital/ GR - 2023-NHLHCRF-YYPPLC-ZR-12/National High Level Hospital Clinical Research Funding/ PT - Journal Article DEP - 20241224 PL - England TA - J Orthop Surg Res JT - Journal of orthopaedic surgery and research JID - 101265112 SB - IM MH - Humans MH - *Hip Fractures/surgery/blood/complications MH - Male MH - Female MH - Retrospective Studies MH - Aged, 80 and over MH - *Thrombelastography/methods MH - Aged MH - *Venous Thrombosis/etiology/diagnosis/blood/diagnostic imaging MH - *Predictive Value of Tests MH - Blood Coagulation Tests/methods MH - Cohort Studies MH - Blood Coagulation/physiology MH - Postoperative Complications/diagnosis/blood/etiology PMC - PMC11667881 OTO - NOTNLM OT - Combination OT - DVT OT - Elderly patients OT - Hip fracture OT - TEG COIS- Declarations. Ethics approval and consent to participate: The study complied with all the relevant national regulations and institutional policies and was by the tenets of the Helsinki Declaration. It was approved by the ethical committee of China-Japan Friendship Hospital (ref. number: 2023-KY-145), and although the study was considered to have a minimal risk for patients since the blood samples for the TEG analysis were collected as part of routinely performed blood draws and no additional blood draws were performed, written consent was obtained from every patient. Competing interests: The authors declare no competing interests. EDAT- 2024/12/25 00:20 MHDA- 2024/12/25 00:21 PMCR- 2024/12/24 CRDT- 2024/12/24 23:25 PHST- 2024/10/03 00:00 [received] PHST- 2024/12/18 00:00 [accepted] PHST- 2024/12/25 00:21 [medline] PHST- 2024/12/25 00:20 [pubmed] PHST- 2024/12/24 23:25 [entrez] PHST- 2024/12/24 00:00 [pmc-release] AID - 10.1186/s13018-024-05386-4 [pii] AID - 5386 [pii] AID - 10.1186/s13018-024-05386-4 [doi] PST - epublish SO - J Orthop Surg Res. 2024 Dec 24;19(1):870. doi: 10.1186/s13018-024-05386-4. PMID- 39696493 OWN - NLM STAT- MEDLINE DCOM- 20241219 LR - 20250104 IS - 2047-783X (Electronic) IS - 0949-2321 (Print) IS - 0949-2321 (Linking) VI - 29 IP - 1 DP - 2024 Dec 18 TI - Diagnostic value of thromboelastogram and thrombus molecular markers in early detection of deep vein thrombosis in patients with lower extremity fracture. PG - 592 LID - 10.1186/s40001-024-02190-y [doi] LID - 592 AB - BACKGROUND: Deep vein thrombosis (DVT) is an obstructive disease with a hindering venous reflux mechanism. The aim of this study was to identify independent risk factors for deep vein thrombosis (DVT) in patients with traumatic lower extremity fractures and assess the diagnostic value of thromboelastogram (TEG) and thrombus molecular markers. METHODS: Reviewed patients with lower extremity fractures were admitted from October 2022 to September 2023. DVT was screened using color Doppler ultrasonography postoperation. Patients were categorized into two groups: those with DVT (n = 61) and those without (n = 191). Logistic regression was utilized to analyze DVT risk factors in these patients, and the diagnostic effectiveness of each marker was determined using the receiver operating characteristic curve (ROC curve). RESULTS: Significant differences were found in the incidence of hip (44.8%), and tibia (16.4%) fractures in the DVT groups (P < 0.001). Elevated levels of tPAIC, PIC, sTM, TAT, APTT, and TEG parameters (angle, MA, and CI) were observed in the DVT group (P < 0.05). Multivariate logistic regression revealed that PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture were significant risk factors for DVT. CONCLUSIONS: Patients with hip fractures showed a higher incidence of perioperative DVT. Factors such as PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture significantly contributed to the risk of DVT in traumatic lower limb fractures. Both thromboelastogram and thrombus molecular markers demonstrated strong diagnostic capabilities in the early detection of DVT, with comparable diagnostic efficiency. CI - (c) 2024. The Author(s). FAU - Jianfei, E AU - Jianfei E AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. FAU - Zheng, Mao AU - Zheng M AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. FAU - Wei, Wei AU - Wei W AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. FAU - He, Shaoping AU - He S AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. FAU - Yuan, Chengliang AU - Yuan C AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. FAU - Chen, Zongyao AU - Chen Z AD - Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China. chenzyao@yeah.net. AD - Pathogenic Microbiology and Clinical Immunology Key Laboratory of Deyang City, Deyang, China. chenzyao@yeah.net. LA - eng PT - Journal Article DEP - 20241218 PL - England TA - Eur J Med Res JT - European journal of medical research JID - 9517857 RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Venous Thrombosis/diagnosis/etiology/blood MH - *Thrombelastography/methods MH - Male MH - Female MH - Middle Aged MH - *Lower Extremity/blood supply MH - *Biomarkers/blood MH - Risk Factors MH - Aged MH - Adult MH - Early Diagnosis MH - Fractures, Bone/blood/complications/diagnosis MH - ROC Curve MH - Retrospective Studies PMC - PMC11657810 OTO - NOTNLM OT - Comparative study OT - Deep vein thrombosis OT - Thromboelastogram OT - Thrombus molecular markers OT - Traumatic fracture COIS- Declarations. Ethics approval and consent to participate: This study was in accordance with the institutional Ethics Committee of People's Hospital of Deyang City (Approval No. 2023-06-013-K01). Competing interests: The authors declare no competing interests. EDAT- 2024/12/19 06:23 MHDA- 2024/12/19 06:24 PMCR- 2024/12/18 CRDT- 2024/12/19 00:48 PHST- 2024/07/31 00:00 [received] PHST- 2024/12/01 00:00 [accepted] PHST- 2024/12/19 06:24 [medline] PHST- 2024/12/19 06:23 [pubmed] PHST- 2024/12/19 00:48 [entrez] PHST- 2024/12/18 00:00 [pmc-release] AID - 10.1186/s40001-024-02190-y [pii] AID - 2190 [pii] AID - 10.1186/s40001-024-02190-y [doi] PST - epublish SO - Eur J Med Res. 2024 Dec 18;29(1):592. doi: 10.1186/s40001-024-02190-y. PMID- 39692453 OWN - NLM STAT- MEDLINE DCOM- 20250428 LR - 20250519 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 91 IP - 4 DP - 2025 Apr TI - What, When, and Why: Viscoelastic Hemostatic Assays and Their Uses in Trauma Resuscitation. PG - 626-632 LID - 10.1177/00031348241309563 [doi] AB - Viscoelastic hemostatic assays (VHAs) have become a valuable tool in guiding transfusion therapy, particularly in trauma care. While various forms of VHA exist, all provide a quantitative assessment of clot kinetics, strength, and dissolution. Studies have demonstrated that VHA can reduce both mortality and utilization of blood products in the general population. Interpreting VHA results requires consideration of specific patient factors, such as age and altered physiological properties as in pregnancy and the process of aging. Further research is needed to establish accurate reference ranges for these specific populations. This review article provides a comprehensive overview of the technical aspects of VHA as well as their clinical uses in trauma resuscitation. FAU - Burkhart, Jennaye G AU - Burkhart JG AD - Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA. RINGGOLD: 21638 FAU - Smith, Ross P AU - Smith RP AUID- ORCID: 0009-0007-1067-3603 AD - University of Kansas School of Medicine, Wichita, KS, USA. RINGGOLD: 8586 FAU - Hill, Terra M AU - Hill TM AUID- ORCID: 0009-0006-9490-6912 AD - Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA. RINGGOLD: 21638 FAU - Winfield, Robert D AU - Winfield RD AD - Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA. RINGGOLD: 21638 LA - eng PT - Journal Article PT - Review DEP - 20241218 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Humans MH - *Resuscitation/methods MH - *Wounds and Injuries/therapy/complications/blood MH - *Thrombelastography/methods MH - *Hemostasis MH - Blood Transfusion MH - Blood Coagulation Tests/methods OTO - NOTNLM OT - critical care OT - general surgery OT - surgical education OT - trauma COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2024/12/18 12:24 MHDA- 2025/03/31 21:17 CRDT- 2024/12/18 08:53 PHST- 2025/03/31 21:17 [medline] PHST- 2024/12/18 12:24 [pubmed] PHST- 2024/12/18 08:53 [entrez] AID - 10.1177/00031348241309563 [doi] PST - ppublish SO - Am Surg. 2025 Apr;91(4):626-632. doi: 10.1177/00031348241309563. Epub 2024 Dec 18. PMID- 39692085 OWN - NLM STAT- MEDLINE DCOM- 20250428 LR - 20250519 IS - 1550-9613 (Electronic) IS - 0278-4297 (Print) IS - 0278-4297 (Linking) VI - 44 IP - 4 DP - 2025 Apr TI - The Median Nerve Displays Adaptive Characteristics When Exposed to Repeated Pinch Grip Efforts of Varying Rates of Force Development: An Ultrasonic Investigation. PG - 727-738 LID - 10.1002/jum.16634 [doi] AB - OBJECTIVES: Repeated gripping with high grip forces and high rates of grip force development are risk factors for carpal tunnel syndrome. As the nerve's adaptive ability is crucial to prevent disease progression, we investigated how these risk factors influence median nerve deformation and displacement over the time course of a repeated pinch grip task. METHODS: Seventeen healthy participants performed a repeated grip task against a load cell while their carpal tunnel was scanned with ultrasound. The grip task involved pulp-pinching three consecutive times from 0 to 40% maximal voluntary exertion (MVE), performed at three different rates of force development (RFD): 40% MVE/1 second; 2 seconds; and 5 seconds. Ultrasound images were analyzed at 10% MVE intervals. Nerve circularity, width, height, and cross-sectional area were measured to assess deformation. Median nerve displacement was assessed by its change in position relative to the flexor digitorum superficialis tendon of the third digit (FD) in both radioulnar and palmodorsal axes. RESULTS: Linear mixed modeling indicated that median nerve deformation increased, becoming more circular, with each repeated pulp-pinch (P < .01) and with grip force magnitude (P < .01). However, a faster RFD decreased nerve deformation (P < .01). Furthermore, the nerve displaced ulnarly during pulp-pinching, with greater displacement during the fastest (ie, 40% MVE/1 second) RFD (P < .01). CONCLUSIONS: The median nerve deformed and displaced in response to pulp-pinching; however, faster rates of force development hindered this adaptive response. This likely reflects the viscoelastic properties of the healthy nerve and subsynovial connective tissue, highlighting the importance of tissue compliance in preventing nerve compression. CI - (c) 2024 The Author(s). Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine. FAU - Balogh, Denise AU - Balogh D AUID- ORCID: 0009-0005-8812-5792 AD - Canadian Center for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. FAU - Kociolek, Aaron M AU - Kociolek AM AUID- ORCID: 0000-0003-3032-6610 AD - School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada. LA - eng GR - 2017-04097/Natural Sciences and Engineering Research Council of Canada, Discovery Grant/ PT - Journal Article DEP - 20241218 PL - England TA - J Ultrasound Med JT - Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine JID - 8211547 SB - IM MH - Humans MH - Ultrasonography/methods MH - Male MH - *Median Nerve/physiology/diagnostic imaging MH - Female MH - *Hand Strength/physiology MH - Adult MH - *Adaptation, Physiological/physiology MH - Carpal Tunnel Syndrome/physiopathology MH - Young Adult PMC - PMC11892086 OTO - NOTNLM OT - carpal tunnel OT - connective tissue OT - ultrasound OT - viscoelastic substances EDAT- 2024/12/18 11:32 MHDA- 2025/03/10 12:32 PMCR- 2025/03/10 CRDT- 2024/12/18 05:53 PHST- 2024/11/14 00:00 [revised] PHST- 2024/10/03 00:00 [received] PHST- 2024/12/03 00:00 [accepted] PHST- 2025/03/10 12:32 [medline] PHST- 2024/12/18 11:32 [pubmed] PHST- 2024/12/18 05:53 [entrez] PHST- 2025/03/10 00:00 [pmc-release] AID - JUM16634 [pii] AID - 10.1002/jum.16634 [doi] PST - ppublish SO - J Ultrasound Med. 2025 Apr;44(4):727-738. doi: 10.1002/jum.16634. Epub 2024 Dec 18. PMID- 39690462 OWN - NLM STAT- MEDLINE DCOM- 20241218 LR - 20260430 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 98 IP - 1 DP - 2025 Jan 1 TI - Patterns of trauma-induced coagulopathy in injured children: A principal component analysis investigating endothelial, coagulation, and platelet biomarkers. PG - 36-41 LID - 10.1097/TA.0000000000004501 [doi] AB - BACKGROUND: Trauma-induced coagulopathy is common and associated with poor outcomes in injured children. Our aim was to identify patterns of coagulopathy after injury using endothelial, platelet, and coagulation biomarkers, and associate these phenotypes with relevant patient factors and clinical outcomes in a pediatric trauma cohort. METHODS: Principal component (PC) analysis was performed on data from injured children between 2018 and 2022. Laboratories included endothelial markers (syndecan-1, thrombomodulin, tissue factor, and vascular endothelial growth factor), international normalized ratio, platelet count, rapid thromboelastography maximum amplitude, and base deficit. Variables were reduced to PCs; PC scores were generated for each subject and used in logistic regression with outcomes including mortality, blood transfusion, shock (pediatric-adjusted shock index), and patient characteristics including age, sex, injury mechanism, and traumatic brain injury. RESULTS: In total, 59 children had complete data for analysis. Median (interquartile range) age was 10 (4-14) years, 31% female, 21% penetrating mechanism, and median (interquartile range) injury severity score of 16 (9-21). Principal component analysis identified two significant PCs accounting for 67% of overall variance. PC1 included syndecan-1, thrombomodulin, vascular endothelial growth factor, international normalized ratio, and base deficit; PC1 scores were associated with mortality, blood transfusion, and shock (all p < 0.001). PC2 included tissue factor, platelet count, and rapid thromboelastography maximum amplitude; PC2 scores were associated with age (rho = -0.42, p = 0.001) but no studied clinical outcome. Neither PC was significantly associated with sex, injury mechanism, or traumatic brain injury. CONCLUSION: Principal component analysis detected two distinct biomarker patterns in injured children involving the domains of the endothelium, coagulation, and platelets. The first phenotype was associated with poor clinical outcomes, while the second was associated with age. This supports the concept that pediatric trauma-induced coagulopathy elicits a heterogeneous response, and suggests that there may be a prognostic value to these phenotypes that warrants further investigation. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV. CI - Copyright (c) 2024 American Association for the Surgery of Trauma. FAU - Morgan, Katrina M AU - Morgan KM AUID- ORCID: 0000-0002-0307-0472 AD - From the Department of Surgery (K.M.M.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.V.F.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery and Critical Care Medicine (P.C.S., C.M.L.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Department of Surgery (B.A.G.), University of Texas Southwestern, Dallas, Texas. FAU - Feeney, Erin V AU - Feeney EV FAU - Spinella, Philip C AU - Spinella PC FAU - Gaines, Barbara A AU - Gaines BA FAU - Leeper, Christine M AU - Leeper CM LA - eng PT - Journal Article DEP - 20241120 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) RN - 0 (Thrombomodulin) RN - 0 (Vascular Endothelial Growth Factor A) RN - 0 (THBD protein, human) RN - 9035-58-9 (Thromboplastin) SB - IM MH - Humans MH - Female MH - Male MH - Child MH - *Blood Coagulation Disorders/etiology/blood/diagnosis MH - Child, Preschool MH - *Biomarkers/blood MH - *Principal Component Analysis MH - Adolescent MH - *Thrombelastography MH - *Thrombomodulin/blood MH - *Wounds and Injuries/complications/blood MH - Injury Severity Score MH - Platelet Count MH - Blood Platelets/metabolism MH - Vascular Endothelial Growth Factor A/blood MH - Thromboplastin/metabolism/analysis EDAT- 2024/12/18 11:32 MHDA- 2024/12/18 11:33 CRDT- 2024/12/18 00:13 PHST- 2024/12/18 11:33 [medline] PHST- 2024/12/18 11:32 [pubmed] PHST- 2024/12/18 00:13 [entrez] AID - 01586154-202501000-00005 [pii] AID - 10.1097/TA.0000000000004501 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2025 Jan 1;98(1):36-41. doi: 10.1097/TA.0000000000004501. Epub 2024 Nov 20. PMID- 39639247 OWN - NLM STAT- MEDLINE DCOM- 20241206 LR - 20250305 IS - 1471-2474 (Electronic) IS - 1471-2474 (Linking) VI - 25 IP - 1 DP - 2024 Dec 6 TI - Association of thromboelastogram hypercoagulability with postoperative deep venous thrombosis of the lower extremity in patients with femur and pelvic fractures: a cohort study. PG - 1005 LID - 10.1186/s12891-024-08135-0 [doi] LID - 1005 AB - BACKGROUND: The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation. METHODS: Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (alpha) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors. RESULTS: Compared to the non-DVT group, the DVT group had decreased R and K values, while the alpha, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389-2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 - 2.709). CONCLUSIONS: The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Register ( https://www.chictr.org.cn/bin/home ) on April 16, 2024, with registration number ChiCTR2400083135. CI - (c) 2024. The Author(s). FAU - Cheng, Peiyao AU - Cheng P AD - Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. FAU - Cheng, Bo AU - Cheng B AD - Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 7300703@qq.com. FAU - Wu, Linqin AU - Wu L AD - Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. FAU - Zhang, Hui AU - Zhang H AD - Department of Anaesthesiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China. FAU - Yang, Yitong AU - Yang Y AD - Department of Anaesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. LA - eng PT - Journal Article DEP - 20241206 PL - England TA - BMC Musculoskelet Disord JT - BMC musculoskeletal disorders JID - 100968565 SB - IM EIN - BMC Musculoskelet Disord. 2025 Mar 5;26(1):223. doi: 10.1186/s12891-025-08436-y. PMID: 40045275 MH - Humans MH - Male MH - Female MH - *Thrombelastography MH - *Venous Thrombosis/etiology/blood/epidemiology/diagnosis MH - Middle Aged MH - *Thrombophilia/blood/diagnosis/etiology MH - Retrospective Studies MH - *Pelvic Bones/injuries MH - Adult MH - *Postoperative Complications/blood/etiology/epidemiology/diagnosis MH - *Fractures, Bone/surgery/blood/complications MH - Aged MH - Femoral Fractures/surgery/blood/complications MH - Lower Extremity/blood supply/surgery MH - China/epidemiology PMC - PMC11622452 OTO - NOTNLM OT - Deep vein thrombosis OT - Fracture OT - Propensity score matching OT - Thromboelastography COIS- Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital at Chongqing Medical University (K2023-526) on October 12, 2023, which waived the need for written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. EDAT- 2024/12/06 05:30 MHDA- 2024/12/06 06:23 PMCR- 2024/12/06 CRDT- 2024/12/05 23:50 PHST- 2024/10/16 00:00 [received] PHST- 2024/12/02 00:00 [accepted] PHST- 2024/12/06 06:23 [medline] PHST- 2024/12/06 05:30 [pubmed] PHST- 2024/12/05 23:50 [entrez] PHST- 2024/12/06 00:00 [pmc-release] AID - 10.1186/s12891-024-08135-0 [pii] AID - 8135 [pii] AID - 10.1186/s12891-024-08135-0 [doi] PST - epublish SO - BMC Musculoskelet Disord. 2024 Dec 6;25(1):1005. doi: 10.1186/s12891-024-08135-0. PMID- 39623709 OWN - NLM STAT- MEDLINE DCOM- 20241203 LR - 20260429 IS - 1399-6576 (Electronic) IS - 0001-5172 (Linking) VI - 69 IP - 1 DP - 2025 Jan TI - Thromboelastography or rotational thromboelastometry guided algorithms in bleeding patients: An updated systematic review with meta-analysis and trial sequential analysis. PG - e14558 LID - 10.1111/aas.14558 [doi] AB - BACKGROUND: Bleeding patients face significant morbidity and mortality due to impaired haemostasis. Haemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG/ROTEM versus standard of care in bleeding patients in an updated review. METHODS: This systematic review of randomised controlled trials with meta-analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA and GRADE guidelines. A literature search was conducted in five major databases. Both paediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis-dependent renal injury. RESULTS: This systematic review included 31 randomised trials (n = 2756), with most patients undergoing elective cardiac surgery. TEG-/ROTEM-guided algorithms reduced the amount of transfused fresh frozen plasma (RR 0.5, 95% CI 0.32-0.72, I(2): 94%), platelets (RR 0.7, 95% CI 0.55-0.91, I(2): 57%), the risk for surgical reintervention (RR 0.65, 95% CI 0.47-0.94, I(2): 0%), and bleeding with a standard mean difference of -0.31 (95% CI -0.55 to -0.08, I(2): 75%). No statistically significant difference was demonstrated for mortality (RR 0.76, 95% CI 0.57-1.00, I(2): 5%). According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 54% of the optimal information size was reached with an alpha-boundary RR of 0.81 (95% CI 0.63-1.03). CONCLUSIONS: TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma and platelets, but the evidence is very uncertain. Further, the results were primarily based on the adult population undergoing elective cardiac surgery. CI - (c) 2024 Acta Anaesthesiologica Scandinavica Foundation. FAU - Kvisselgaard, A D AU - Kvisselgaard AD AUID- ORCID: 0000-0002-4147-0987 AD - Department of Anesthesia and Intensive Care, Copenhagen University Hospital-Herlev, Copenhagen, Denmark. FAU - Wolthers, S A AU - Wolthers SA AUID- ORCID: 0000-0001-6325-2449 AD - Prehospital Centre Zealand, Naestved, Denmark. FAU - Wikkelso, A AU - Wikkelso A AUID- ORCID: 0000-0001-6848-8143 AD - Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital-Roskilde, Roskilde, Denmark. FAU - Holst, L B AU - Holst LB AUID- ORCID: 0000-0001-8951-9252 AD - Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Drivenes, B AU - Drivenes B AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Afshari, A AU - Afshari A AD - Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. AD - Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - England TA - Acta Anaesthesiol Scand JT - Acta anaesthesiologica Scandinavica JID - 0370270 SB - IM MH - Humans MH - *Thrombelastography/methods MH - *Algorithms MH - *Hemorrhage/therapy MH - *Blood Transfusion/methods/statistics & numerical data MH - Randomized Controlled Trials as Topic OTO - NOTNLM OT - ROTEM OT - TEG OT - bleeding patients OT - haemostatic resuscitation OT - meta-analysis with trial sequential analysis OT - rotational thromboelastometry OT - systematic review OT - thromboelastography OT - transfusion algorithms EDAT- 2024/12/03 06:24 MHDA- 2024/12/03 06:25 CRDT- 2024/12/03 01:23 PHST- 2024/11/11 00:00 [revised] PHST- 2024/07/05 00:00 [received] PHST- 2024/11/13 00:00 [accepted] PHST- 2024/12/03 06:25 [medline] PHST- 2024/12/03 06:24 [pubmed] PHST- 2024/12/03 01:23 [entrez] AID - 10.1111/aas.14558 [doi] PST - ppublish SO - Acta Anaesthesiol Scand. 2025 Jan;69(1):e14558. doi: 10.1111/aas.14558. PMID- 39622047 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241207 IS - 2694-1902 (Electronic) IS - 2694-1902 (Linking) VI - 8 IP - 23 DP - 2024 Dec 2 TI - Management of severe traumatic brain injury in a rivaroxaban overdose: illustrative case. LID - CASE24475 [pii] LID - 10.3171/CASE24475 [doi] AB - BACKGROUND: The management of rivaroxaban overdose in severe traumatic brain injury (sTBI) is undocumented. Reversal with andexanet alfa (AA) and prothrombin complex concentrates (PCCs) in cases of supratherapeutic doses remains unproven. Management is further complicated by the absence of real-time serum rivaroxaban concentration assays and drug-specific coagulation assays. This report details the use of plasma exchange (PLEX) in combination with PCC and AA to manage rivaroxaban overdose in sTBI. OBSERVATIONS: A 36-year-old female presented with sTBI. Her admission international normalized ratio was 4.8 and thromboelastography reaction time was 85 seconds. Chromogenic low-molecular-weight heparin anti-Xa (AXA) concentration was < 0.1 units/mL. PCC and vitamin K were administered but failed to improve coagulopathy. Further history revealed a possible rivaroxaban overdose, and AA was administered. The second AXA prior to AA was > 1.8 units/mL. AXA remained > 1.8 units/mL 3 hours after AA. PLEX was urgently initiated prior to surgery for drug removal. Serum rivaroxaban concentrations pre- and post-PLEX were 534.6 and 256.8 ng/mL, respectively. A hemicraniectomy was performed without intraoperative or postoperative bleeding complications. LESSONS: Routine reversal strategies may be insufficient in achieving hemostasis in rivaroxaban overdose. PLEX reduced serum rivaroxaban concentration by 52%. PLEX can be an important adjunct to consider for medical and perioperative management of rivaroxaban overdose. https://thejns.org/doi/10.3171/CASE24475. FAU - Foertsch, Madeline J AU - Foertsch MJ AD - Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, Ohio. FAU - Beckett, Henry T AU - Beckett HT AD - University of Cincinnati College of Medicine, Cincinnati, Ohio. FAU - Dehne, Lauren M AU - Dehne LM AD - Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, Ohio. FAU - Janusz, Stephanie AU - Janusz S AD - Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, Ohio. FAU - Ferioli, Simona AU - Ferioli S AD - Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. FAU - Ngwenya, Laura B AU - Ngwenya LB AD - Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. FAU - Droege, Molly E AU - Droege ME AD - Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, Ohio. LA - eng PT - Journal Article DEP - 20241202 PL - United States TA - J Neurosurg Case Lessons JT - Journal of neurosurgery. Case lessons JID - 9918227275606676 PMC - PMC11616141 OTO - NOTNLM OT - direct-acting oral anticoagulants OT - overdose OT - plasma exchange OT - rivaroxaban OT - traumatic brain injury EDAT- 2024/12/02 18:27 MHDA- 2024/12/02 18:28 PMCR- 2024/12/02 CRDT- 2024/12/02 16:54 PHST- 2024/07/22 00:00 [received] PHST- 2024/09/12 00:00 [accepted] PHST- 2024/12/02 18:28 [medline] PHST- 2024/12/02 18:27 [pubmed] PHST- 2024/12/02 16:54 [entrez] PHST- 2024/12/02 00:00 [pmc-release] AID - CASE24475 [pii] AID - 10.3171/CASE24475 [doi] PST - epublish SO - J Neurosurg Case Lessons. 2024 Dec 2;8(23):CASE24475. doi: 10.3171/CASE24475. Print 2024 Dec 2. PMID- 39612673 OWN - NLM STAT- MEDLINE DCOM- 20241217 LR - 20260705 IS - 1557-8615 (Electronic) IS - 0883-9441 (Linking) VI - 85 DP - 2025 Feb TI - Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study. PG - 154982 LID - S0883-9441(24)00469-6 [pii] LID - 10.1016/j.jcrc.2024.154982 [doi] AB - PURPOSE: Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke. MATERIALS AND METHODS: We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score >/= 4 points based on the Japanese Association of Acute Medicine score. RESULTS: A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 x 10(4)/muL, (interquartile range [IQR]: 12.6-25.0 x 10(4)/muL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8-37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (R = -0.63, p < 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72-0.99]). CONCLUSIONS: These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke. CI - Copyright (c) 2024 The Author(s). Published by Elsevier Inc. All rights reserved. FAU - Endo, Yuri AU - Endo Y AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Inokuchi, Ryota AU - Inokuchi R AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan. FAU - Yamamoto, Miyuki AU - Yamamoto M AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Horie, Ryohei AU - Horie R AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Asada, Toshifumi AU - Asada T AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Kashiwa, Koichi AU - Kashiwa K AD - Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Fujishiro, Kazuki AU - Fujishiro K AD - Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. FAU - Iwagami, Masao AU - Iwagami M AD - Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. FAU - Doi, Kent AU - Doi K AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: kentdoi@m.u-tokyo.ac.jp. LA - eng PT - Journal Article PT - Observational Study DEP - 20241128 PL - United States TA - J Crit Care JT - Journal of critical care JID - 8610642 SB - IM MH - Humans MH - Retrospective Studies MH - *Heat Stroke/complications/physiopathology/blood MH - Male MH - Female MH - Middle Aged MH - *Thrombelastography MH - *Disseminated Intravascular Coagulation/blood/physiopathology/etiology/diagnosis MH - Aged MH - Platelet Count MH - Intensive Care Units MH - Platelet Function Tests MH - Severity of Illness Index MH - Emergency Service, Hospital OTO - NOTNLM OT - Disseminated intravascular coagulation OT - Heatstroke OT - Platelet dysfunction OT - Thromboelastography COIS- Declaration of competing interest The authors declare that they have no competing interests. EDAT- 2024/11/30 11:18 MHDA- 2024/12/18 00:22 CRDT- 2024/11/29 18:07 PHST- 2024/08/20 00:00 [received] PHST- 2024/11/15 00:00 [revised] PHST- 2024/11/18 00:00 [accepted] PHST- 2024/12/18 00:22 [medline] PHST- 2024/11/30 11:18 [pubmed] PHST- 2024/11/29 18:07 [entrez] AID - S0883-9441(24)00469-6 [pii] AID - 10.1016/j.jcrc.2024.154982 [doi] PST - ppublish SO - J Crit Care. 2025 Feb;85:154982. doi: 10.1016/j.jcrc.2024.154982. Epub 2024 Nov 28. PMID- 39558712 OWN - NLM STAT- MEDLINE DCOM- 20250425 LR - 20250621 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 65 IP - 1 DP - 2025 Jan TI - Hemostatic function, immunomodulatory capacity, and effects of lipemia in cold-stored whole blood. PG - 171-184 LID - 10.1111/trf.18065 [doi] AB - BACKGROUND: Whole blood (WB) is increasingly being used for resuscitation of trauma patients. Although platelet-, red blood cell (RBC)- and plasma-specific parameters in cold-stored WB are well characterized, there has been limited investigation of biological response modifiers (BRMs), which may induce adverse reactions in recipients. The aim of this study was to evaluate the quality and function of RBC, platelets, plasma proteins, and BRMs in cold-stored WB during storage. METHODS: WB (n = 24) was collected into collected into citrate-phosphate-dextrose (CPD) anticoagulant, held overnight, processed through a platelet-sparing filter, and stored at 2-6 degrees C for 21 days. RBC, platelet, coagulation factor quality and function, and BRM concentrations were measured throughout the duration of storage. RESULTS: WB was effectively leukoreduced, with 99.98% reduction in leukocyte count and 81% platelet count recovery following filtration. Five WB units were significantly lipemic, with a visible lipid layer appearing after being cold storage overnight. These were more turbid with higher hemolysis compared to non-lipemic units (p = .023). Despite a decrease in platelet count during storage (p < .001), hemostatic function as measured by thromboelastography was maintained for at least 21 days (R time and maximum amplitude; both p < .001). There was a significant increase in PF4, CD62P, and RANTES during cold storage (all p < .001). DISCUSSION: WB retains hemostatic potential for at least 21 days of cold storage, and with further development, may be suitable for transfusion in Australia. Before implementation in Australia, quality control measures for lipemia and hemolysis would need to be defined as part of our manufacturing processes. CI - (c) 2024 AABB. FAU - Tan, Joanne C G AU - Tan JCG AUID- ORCID: 0000-0002-8700-6776 AD - Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia. AD - Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia. FAU - Aung, Htet Htet AU - Aung HH AD - Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia. FAU - Marks, Denese C AU - Marks DC AUID- ORCID: 0000-0002-3674-6934 AD - Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia. AD - Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia. LA - eng PT - Journal Article DEP - 20241118 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM EIN - Transfusion. 2025 Sep;65(9):1764. doi: 10.1111/trf.18237. PMID: 40542501 MH - Humans MH - *Blood Preservation/methods MH - *Hemostasis MH - Thrombelastography MH - Blood Platelets MH - Erythrocytes MH - Hemolysis MH - Female MH - Male OTO - NOTNLM OT - WB in vitro quality OT - hemostasis OT - lipemia OT - soluble mediators OT - whole blood EDAT- 2024/11/19 09:26 MHDA- 2025/01/21 09:02 CRDT- 2024/11/19 03:03 PHST- 2024/10/31 00:00 [revised] PHST- 2024/02/22 00:00 [received] PHST- 2024/10/31 00:00 [accepted] PHST- 2025/01/21 09:02 [medline] PHST- 2024/11/19 09:26 [pubmed] PHST- 2024/11/19 03:03 [entrez] AID - 10.1111/trf.18065 [doi] PST - ppublish SO - Transfusion. 2025 Jan;65(1):171-184. doi: 10.1111/trf.18065. Epub 2024 Nov 18. PMID- 39539833 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20251022 LR - 20251022 IS - 2474-1272 (Electronic) IS - 2474-1264 (Print) IS - 2474-1264 (Linking) VI - 9 IP - 1 DP - 2025 Jan-Feb TI - Use of Cohesive Viscoelastic Agents to Facilitate Safe Removal of Posterior Segment Intraocular Foreign Bodies. PG - 50-53 LID - 10.1177/24741264241287612 [doi] AB - Purpose: To assess the ability of viscoelastic agents and perfluoro-N-octane (PFO) to safely remove an intraocular foreign body (IOFB). Methods: A 23-gauge pars plana vitrectomy and lensectomy were performed in a porcine eye. A 5.0 mm metallic IOFB was inserted through a corneal paracentesis and dropped into the vitreous cavity. The posterior segment was filled completely with a balanced salt solution, cohesive viscoelastic, or dispersive viscoelastic or was partially filled with PFO under a balanced salt solution. The IOFB was then brought anteriorly and released. Each test was repeated multiple times and videorecorded. Results: The IOFB fell with high velocity through the balanced salt solution-filled vitreous cavity. When the eye was filled with either of the 2 viscoelastic agents, the IOFB did not move or moved posteriorly extremely slowly. A vitreous cavity filled partially with PFO led to deflection of the object's path, with the peripheral retina being struck, or the IOFB dropping straight down and striking the macula. PFO and the cohesive viscoelastic were easily removed from the eye with the vitrectomy instrument. The dispersive viscoelastic could not be completely removed and repeatedly clogged the vitreous cutter. Conclusions: Filling the posterior segment with a cohesive viscoelastic agent may significantly increase the safety and ease of IOFB removal. CI - (c) The Author(s) 2024. FAU - Budoff, Greg AU - Budoff G AD - Retina Division, Department of Ophthamology, UCLA Stein Eye Institute, Los Angeles, CA, USA. AD - Retina Consultants, PC, Hartford, CT, USA. FAU - McCannel, Colin A AU - McCannel CA AD - Retina Division, Department of Ophthamology, UCLA Stein Eye Institute, Los Angeles, CA, USA. AD - Retinal Disorders and Ophthalmic Genetics, Department of Ophthalmology, UCLA Stein Eye Institute, Los Angeles, CA, USA. LA - eng PT - Journal Article DEP - 20241022 PL - United States TA - J Vitreoretin Dis JT - Journal of vitreoretinal diseases JID - 101700301 PMC - PMC11556294 OTO - NOTNLM OT - IOFB OT - open globe OT - penetrating injury OT - perfluorocarbon liquid OT - trauma OT - viscoelastic COIS- The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article. EDAT- 2024/11/14 17:38 MHDA- 2024/11/14 17:39 PMCR- 2025/10/22 CRDT- 2024/11/14 04:24 PHST- 2024/11/14 17:39 [medline] PHST- 2024/11/14 17:38 [pubmed] PHST- 2024/11/14 04:24 [entrez] PHST- 2025/10/22 00:00 [pmc-release] AID - 10.1177_24741264241287612 [pii] AID - 10.1177/24741264241287612 [doi] PST - epublish SO - J Vitreoretin Dis. 2024 Oct 22;9(1):50-53. doi: 10.1177/24741264241287612. eCollection 2025 Jan-Feb. PMID- 39524069 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20260923 IS - 1751-1437 (Print) IS - 2057-360X (Electronic) IS - 1751-1437 (Linking) VI - 25 IP - 4 DP - 2024 Nov TI - Should viscoelastic testing be a standard point-of-care test on all intensive care units? PG - 432-439 LID - 10.1177/17511437241290154 [doi] AB - Viscoelastic tests (VETs) have transformed assessment of haemostasis and transfusion practices in trauma, cardiac and liver transplantation centres. Impaired haemostasis is a common problem on the general intensive care unit (ICU), but routine use of VETs is rare. We have accordingly reviewed the evidence to determine whether there is evidence to support the use of VETs as a standard point of care test on all ICUs in assessing and managing patients. The benefits of using VETs in the management of major haemorrhage, namely faster identification of a coagulopathy, in particular early detection of fibrinolysis, and reduced transfusion requirements for blood products have been seen in the general ICU. Validation of treatments algorithms is now required to standardise practice. There is also emerging evidence to support the use of VETs to guide urgent treatment decisions in patients with a coagulopathy or in patients taking anti-coagulants or anti-platelet therapies. We recommend that departments independently review the feasibility of setting up a viscoelastic point of care service which considers the applicability to their patient cohort, the financial cost and the personnel required. CI - (c) The Intensive Care Society 2024. FAU - Natasha Passi, Neha AU - Natasha Passi N AUID- ORCID: 0000-0003-4465-7832 AD - Whipps Cross University Hospital, Barts Health NHS Trust, London, UK. FAU - Parker, Thomas AU - Parker T AD - Whipps Cross University Hospital, Barts Health NHS Trust, London, UK. LA - eng PT - Journal Article PT - Review DEP - 20241015 PL - England TA - J Intensive Care Soc JT - Journal of the Intensive Care Society JID - 101538668 PMC - PMC11549721 OTO - NOTNLM OT - thromboelastography OT - thromboelastometry OT - viscoelastic test COIS- The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2024/11/13 13:56 MHDA- 2024/11/13 13:57 PMCR- 2024/10/15 CRDT- 2024/11/11 05:24 PHST- 2024/11/13 13:57 [medline] PHST- 2024/11/13 13:56 [pubmed] PHST- 2024/11/11 05:24 [entrez] PHST- 2024/10/15 00:00 [pmc-release] AID - 10.1177_17511437241290154 [pii] AID - 10.1177/17511437241290154 [doi] PST - epublish SO - J Intensive Care Soc. 2024 Oct 15;25(4):432-439. doi: 10.1177/17511437241290154. eCollection 2024 Nov. PMID- 39513391 OWN - NLM STAT- MEDLINE DCOM- 20241218 LR - 20241219 IS - 1365-3148 (Electronic) IS - 0958-7578 (Linking) VI - 34 IP - 6 DP - 2024 Dec TI - Resuscitation of adult shocked trauma patients using major haemorrhage protocol guided by viscoelastic haemostatic assays versus formulaic approach. PG - 514-519 LID - 10.1111/tme.13109 [doi] AB - BACKGROUND: The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients. METHODS: This was a registry-based cohort study including shocked trauma patients from two trauma centres-one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA-guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death. RESULTS: Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4-1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in-hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7-8.0, p = 0.17). CONCLUSIONS: Given the cost and potential adverse effects of blood component transfusions, VHA-guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated. CI - (c) 2024 British Blood Transfusion Society. FAU - Mitra, Biswadev AU - Mitra B AUID- ORCID: 0000-0002-0508-2450 AD - Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. AD - School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Wake, Elizabeth AU - Wake E AUID- ORCID: 0000-0003-2460-0150 AD - Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia. AD - Griffith University, Gold Coast, Queensland, Australia. FAU - Talarico, Carly AU - Talarico C AUID- ORCID: 0009-0007-0248-0916 AD - Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. FAU - Czuchwicki, Sarah AU - Czuchwicki S AUID- ORCID: 0000-0002-7627-6869 AD - Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia. FAU - Koolstra, Christine AU - Koolstra C AD - Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. FAU - Campbell, Don AU - Campbell D AUID- ORCID: 0000-0003-0679-7455 AD - Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia. AD - Griffith University, Gold Coast, Queensland, Australia. FAU - Hendel, Simon AU - Hendel S AUID- ORCID: 0000-0003-0336-462X AD - Trauma Service, Alfred Health, Melbourne, Victoria, Australia. AD - National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia. FAU - Winearls, James AU - Winearls J AUID- ORCID: 0000-0002-0665-0034 AD - Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia. LA - eng GR - 1189490/Blood Synergy program, established under the Australian National Health and Medical Research Council's Synergy Grants/ PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20241108 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Humans MH - Male MH - Female MH - *Resuscitation/methods MH - Adult MH - Middle Aged MH - *Registries MH - Wounds and Injuries/therapy/blood/mortality MH - Blood Component Transfusion MH - Hemorrhage/therapy/blood/mortality MH - Aged MH - Blood Transfusion OTO - NOTNLM OT - blood OT - emergency medicine OT - transfusion OT - viscoelastic haemostatic assay OT - wounds and injuries EDAT- 2024/11/13 13:54 MHDA- 2024/12/18 11:32 CRDT- 2024/11/08 06:22 PHST- 2024/09/27 00:00 [revised] PHST- 2024/04/27 00:00 [received] PHST- 2024/10/24 00:00 [accepted] PHST- 2024/12/18 11:32 [medline] PHST- 2024/11/13 13:54 [pubmed] PHST- 2024/11/08 06:22 [entrez] AID - 10.1111/tme.13109 [doi] PST - ppublish SO - Transfus Med. 2024 Dec;34(6):514-519. doi: 10.1111/tme.13109. Epub 2024 Nov 8. PMID- 39485330 OWN - NLM STAT- MEDLINE DCOM- 20241101 LR - 20250110 IS - 1813-9175 (Electronic) IS - 1813-9175 (Linking) VI - 2024 DP - 2024 Nov 1 TI - Cerebrospinal fluid drain placement and comprehensive strategies for spinal cord protection in open thoracoabdominal aortic aneurysm repair. LID - 10.1510/mmcts.2024.100 [doi] AB - Ischaemic spinal cord injury remains a significant challenge in thoracoabdominal aortic repairs. Modern techniques have reduced spinal cord injury rates yet managing patients during and after thoracoabdominal aortic repairs remains complex. This article outlines our comprehensive approach to the prevention of spinal cord injuries in open thoracoabdominal aortic repair operations, focusing on the placement of cerebrospinal fluid drain and intraoperative strategies to enhance spinal cord protection. Preoperative planning involves thorough patient assessment, prehabilitation and nutritional support, detailed imaging review, thorough operative planning and patient blood management. Intraoperative measures include the use of neuromonitoring techniques like near-infrared spectroscopy and motor evoked potentials, as well as cerebrospinal fluid drainage together with blood pressure management to optimize spinal cord perfusion. Postoperative management focuses on maintaining haemodynamic stability with high mean arterial pressure, along with close monitoring and management of the cerebrospinal fluid drain to improve spinal cord perfusion. Additionally, thromboelastography-guided strategies are crucial for optimizing coagulation and addressing postoperative bleeding complications. The goal of this multifaceted approach is to minimize the risk of spinal cord injury, thereby improving patient outcomes and reducing the incidence of postoperative paraplegia. Our video tutorial shows some of our preoperative and intraoperative techniques for spinal cord protection in thoracoabdominal aortic repairs. CI - (c) The Author 2024. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Pruna-Guillen, Robert AU - Pruna-Guillen R AD - Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clinic, 170th Villarroel St., 08036 Barcelona, Spain. FAU - Corredor, Carlos AU - Corredor C AD - Department of Perioperative Medicine, St Bartholomew's Hospital, London, UK. FAU - Rojanthagoon, Thanakorn AU - Rojanthagoon T AD - School of Medicine, University of Nottingham, Nottingham, UK. FAU - Lopez-Marco, Ana AU - Lopez-Marco A AD - Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK. FAU - Adams, Benjamin AU - Adams B AD - Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE UK. FAU - Ye Oo, Aung AU - Ye Oo A AD - Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK. LA - eng PT - Journal Article PT - Video-Audio Media DEP - 20241101 PL - England TA - Multimed Man Cardiothorac Surg JT - Multimedia manual of cardiothoracic surgery : MMCTS JID - 101495626 SB - IM MH - Humans MH - *Aortic Aneurysm, Thoracic/surgery MH - *Drainage/methods MH - *Spinal Cord Ischemia/prevention & control/etiology MH - Postoperative Complications/prevention & control MH - Spinal Cord Injuries/prevention & control MH - Aortic Aneurysm, Thoracoabdominal OTO - NOTNLM OT - Aortic aneurysm OT - Cerebrospinal fluid drainage OT - Neuroprotection techniques OT - Open repair OT - Paraplegia OT - Spinal cord protection OT - Thoracoabdominal aortic aneurysm EDAT- 2024/11/01 12:26 MHDA- 2024/11/01 12:27 CRDT- 2024/11/01 11:23 PHST- 2024/11/01 12:27 [medline] PHST- 2024/11/01 12:26 [pubmed] PHST- 2024/11/01 11:23 [entrez] AID - 10.1510/mmcts.2024.100 [doi] PST - epublish SO - Multimed Man Cardiothorac Surg. 2024 Nov 1;2024. doi: 10.1510/mmcts.2024.100. PMID- 39435530 OWN - NLM STAT- MEDLINE DCOM- 20250501 LR - 20250502 IS - 1478-7083 (Electronic) IS - 0035-8843 (Print) IS - 0035-8843 (Linking) VI - 107 IP - 5 DP - 2025 May TI - Improving communication during damage control surgery: a survey of adult major trauma centres in England. PG - 318-325 LID - 10.1308/rcsann.2024.0087 [doi] AB - INTRODUCTION: Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. METHODS: An online survey was devised and distributed via the national programme of care for trauma in November 2020. RESULTS: Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. CONCLUSIONS: We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools. FAU - Patton, E N AU - Patton EN AD - Manchester University NHS Foundation Trust, UK. FAU - Lisagors, I AU - Lisagors I AD - Manchester University NHS Foundation Trust, UK. FAU - Tyrrell-Marsh, I AU - Tyrrell-Marsh I AD - Manchester University NHS Foundation Trust, UK. FAU - Agarwal, S AU - Agarwal S AD - Manchester University NHS Foundation Trust, UK. FAU - Wee, L V AU - Wee LV AD - Manchester University NHS Foundation Trust, UK. FAU - Darwish, A AU - Darwish A AD - Manchester University NHS Foundation Trust, UK. FAU - Smith, S R AU - Smith SR AD - Manchester University NHS Foundation Trust, UK. LA - eng PT - Journal Article PT - Review DEP - 20241022 PL - England TA - Ann R Coll Surg Engl JT - Annals of the Royal College of Surgeons of England JID - 7506860 SB - IM MH - Humans MH - *Trauma Centers/organization & administration/statistics & numerical data/standards MH - England MH - *Checklist/statistics & numerical data MH - Adult MH - *Communication MH - *Wounds and Injuries/surgery MH - *Patient Care Team/organization & administration MH - Surveys and Questionnaires MH - Quality Improvement PMC - PMC12043366 OTO - NOTNLM OT - adult OT - checklist OT - surveys and questionnaires OT - trauma centres EDAT- 2024/10/22 06:27 MHDA- 2025/05/01 06:27 PMCR- 2025/05/01 CRDT- 2024/10/22 04:53 PHST- 2025/05/01 06:27 [medline] PHST- 2024/10/22 06:27 [pubmed] PHST- 2024/10/22 04:53 [entrez] PHST- 2025/05/01 00:00 [pmc-release] AID - rcsann.2024.0087 [pii] AID - 10.1308/rcsann.2024.0087 [doi] PST - ppublish SO - Ann R Coll Surg Engl. 2025 May;107(5):318-325. doi: 10.1308/rcsann.2024.0087. Epub 2024 Oct 22. PMID- 39430866 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241023 IS - 2475-0379 (Electronic) IS - 2475-0379 (Linking) VI - 8 IP - 7 DP - 2024 Oct TI - Hyperfibrinolysis: a crucial phenotypic abnormality of posttraumatic fibrinolytic dysfunction. PG - 102568 LID - 10.1016/j.rpth.2024.102568 [doi] LID - 102568 AB - BACKGROUND: Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated. OBJECTIVES: To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications. METHODS: This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Patients were stratified according to the degree of fibrinolysis upon arrival using TEG LY30 values: low LY30, <0.8%; normal LY30, 0.81% to 0.9%; and high LY30, >/=3%. Serial values of molecular markers (0-72 hours after admission) and clinical outcomes were compared between fibrinolysis groups. RESULTS: A total of 547 patients were included (low LY30, 320; normal LY30, 108; high LY30, 119). The high LY30 group had higher tissue plasminogen activator and plasmin-antiplasmin values upon hospital arrival than the low LY30 or normal LY30 groups (P < .001, respectively). There was no significant difference in levels of tissue plasminogen activator, plasmin-antiplasmin, and plasminogen activator inhibitor 1 between the low LY30 and normal LY30 groups. The high LY30 group was associated with an increased risk of 24-hour and 30-day mortality, while there was no significant difference in mortality between the low LY30 and normal LY30 groups. CONCLUSION: Our results suggest that hyperfibrinolysis is the most common form of traumatic fibrinolytic dysfunction and is associated with worse outcome. CI - (c) 2024 The Authors. FAU - Takahashi, Kyosuke AU - Takahashi K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Yamakawa, Kazuma AU - Yamakawa K AD - Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan. FAU - Siletz, Anaar E AU - Siletz AE AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Katsura, Morihiro AU - Katsura M AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Holcomb, John B AU - Holcomb JB AD - Division of Trauma and Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Wade, Charles E AU - Wade CE AD - Division of Acute Care Surgery, and the Center for Translational Injury Research, the University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Department of Surgery, the University of Colorado, Denver - Anschutz Medical Campus, Denver, Colorado, USA. FAU - Fox, Erin E AU - Fox EE AD - Division of Acute Care Surgery, and the Center for Translational Injury Research, the University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas, USA. FAU - Schellenberg, Morgan AU - Schellenberg M AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Martin, Matthew AU - Martin M AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Inaba, Kenji AU - Inaba K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. FAU - Matsushima, Kazuhide AU - Matsushima K AD - Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. LA - eng PT - Journal Article DEP - 20240911 PL - United States TA - Res Pract Thromb Haemost JT - Research and practice in thrombosis and haemostasis JID - 101703775 PMC - PMC11488401 OTO - NOTNLM OT - blood transfusion OT - hyperfibrinolysis OT - outcome OT - thromboelastography OT - trauma-induced coagulopathy EDAT- 2024/10/21 10:51 MHDA- 2024/10/21 10:52 PMCR- 2024/09/11 CRDT- 2024/10/21 05:58 PHST- 2024/04/16 00:00 [received] PHST- 2024/06/04 00:00 [revised] PHST- 2024/09/05 00:00 [accepted] PHST- 2024/10/21 10:52 [medline] PHST- 2024/10/21 10:51 [pubmed] PHST- 2024/10/21 05:58 [entrez] PHST- 2024/09/11 00:00 [pmc-release] AID - S2475-0379(24)00263-2 [pii] AID - 102568 [pii] AID - 10.1016/j.rpth.2024.102568 [doi] PST - epublish SO - Res Pract Thromb Haemost. 2024 Sep 11;8(7):102568. doi: 10.1016/j.rpth.2024.102568. eCollection 2024 Oct. PMID- 39380617 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241010 IS - 2287-1683 (Electronic) IS - 2799-4317 (Print) VI - 37 IP - 2 DP - 2024 Jun TI - Predictors of massive transfusion protocols activation in patients with trauma in Korea: a systematic review. PG - 97-105 LID - 10.20408/jti.2024.0015 [doi] AB - PURPOSE: Massive transfusion protocols (MTPs) implementation improves clinical outcomes of the patient's resuscitation with hemorrhagic trauma. Various predictive scoring system have been used and studied worldwide to improve clinical decision. However, such research has not yet been studied in Korea. This systematic review aimed to assess the predictors of MTPs activation in patients with trauma in Korea. METHODS: The PubMed, Embase, Cochrane Library, Research Information Sharing Service databases, KoreaMed, and KMbase were searched from November 2022. All studies conducted in Korea that utilized predictors of MTPs activation in adult patients with trauma were included. RESULTS: Ten articles were eligible for analysis, and the predictors were assessed. Clinical assessments such as systolic and diastolic blood pressure, shock index (SI), prehospital modified SI, modified early warning system (MEWS) and reverse SI multiplied by the Glasgow Coma Scale (rSIG) were used. Laboratory values such as lactate level, fibrinogen degradation product/fibrinogen ratio, and rotational thromboelastometry (ROTEM) were used. Imaging examinations such as pelvic bleeding score were used as predictors of MTPs activation. CONCLUSIONS: Our systematic review identified predictors of MTPs activation in patients with trauma in Korea; predictions were performed using tools that requires clinical assessments, laboratory values or imaging examinations only. Among them, ROTEM, rSIG, MEWS, SI, and lactate level showed good effects for predictions of MTPs activation. The application of predictors for MTP's activation should be individualized based on hospital resource and skill set, also should be performed as a clinical decision supporting tools. CI - (c) 2024 The Korean Society of Traumatology. FAU - Seo, Dongmin AU - Seo D AUID- ORCID: 0009-0009-6716-3959 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. FAU - Heo, Inhae AU - Heo I AUID- ORCID: 0000-0001-8046-8604 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. FAU - Park, Juhong AU - Park J AUID- ORCID: 0000-0003-4574-2203 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. FAU - Kwon, Junsik AU - Kwon J AUID- ORCID: 0000-0003-3164-4995 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. FAU - Sohn, Hye-Min AU - Sohn HM AUID- ORCID: 0000-0003-3545-3248 AD - Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. FAU - Jung, Kyoungwon AU - Jung K AUID- ORCID: 0000-0001-7895-0362 AD - Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. LA - eng PT - Journal Article DEP - 20240614 PL - Korea (South) TA - J Trauma Inj JT - Journal of trauma and injury JID - 101647847 PMC - PMC11309178 OTO - NOTNLM OT - Blood transfusion OT - Korea OT - Predictors OT - Systematic review OT - Wounds and injuries COIS- Conflicts of interest Junsik Kwon is an Editorial Board member of the Journal of Trauma and Injury, but was not involved in the peer reviewer selection, evaluation, or decision process of this article. The authors have no other conflicts of interest to declare. EDAT- 2024/10/09 07:29 MHDA- 2024/10/09 07:30 PMCR- 2024/06/01 CRDT- 2024/10/09 04:35 PHST- 2024/03/05 00:00 [received] PHST- 2024/04/16 00:00 [revised] PHST- 2024/04/24 00:00 [accepted] PHST- 2024/10/09 07:30 [medline] PHST- 2024/10/09 07:29 [pubmed] PHST- 2024/10/09 04:35 [entrez] PHST- 2024/06/01 00:00 [pmc-release] AID - jti-2024-0015 [pii] AID - 10.20408/jti.2024.0015 [doi] PST - ppublish SO - J Trauma Inj. 2024 Jun;37(2):97-105. doi: 10.20408/jti.2024.0015. Epub 2024 Jun 14. PMID- 39378792 OWN - NLM STAT- MEDLINE DCOM- 20241127 LR - 20260417 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 303 DP - 2024 Nov TI - Plasma Inclusive Resuscitation Is Not Associated With Coagulation Profile Changes in Burn Patients. PG - 233-240 LID - S0022-4804(24)00557-2 [pii] LID - 10.1016/j.jss.2024.09.013 [doi] AB - INTRODUCTION: Dynamically titrated crystalloids are the standard of care for burn shock resuscitation. There are theoretical concerns that the adjunctive use of allogeneic plasma may perturb the patient's coagulation and inflammation status deleteriously. It was hypothesized that plasma-inclusive resuscitation (PIR) would not be associated with prothrombotic changes relative to baseline after thermal injury. METHODS: Patients admitted to a regional burn center who were treated with PIR as part of their burn resuscitation were enrolled. Whole blood samples were analyzed prospectively via rapid thromboelastography and rotational thromboelastometry to assess for coagulopathy at four time points throughout their acute burn resuscitation. The mixed-effect model for repeated measures followed by Tukey's post hoc test for comparisons was used to examine group differences. RESULTS: There were 35 patients in the analysis. Most were male (74.3%) with a median age of 43 y (32-55), concomitant inhalation injury of 28.6%, total body surface area burn size of 34% (27%-48.5%), and the overall mortality of the cohort was 28.6%. There were no transfusion reactions or thrombotic events. There were no differences in thromboelastography or rotational thromboelastometry parameters overall or when stratified by mortality, total body surface area burn, and inhalation injury. There were no significant differences between the fibrinolytic phenotypes over time. CONCLUSIONS: Data suggest that PIR was not associated with prothrombotic or lytic changes in burn patients relative to baseline. Further research is needed to confirm these findings and evaluate efficacy of PIR in acute burn resuscitation. CI - Published by Elsevier Inc. FAU - Mathew, Shane K AU - Mathew SK AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia. FAU - Le, Tuan D AU - Le TD AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia. FAU - Pusateri, Anthony E AU - Pusateri AE AD - Naval Medical Research Unit San Antonio, San Antonio, Texas. FAU - Pinto, Desiree N AU - Pinto DN AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia. FAU - Carney, Bonnie C AU - Carney BC AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia. FAU - McLawhorn, Melissa M AU - McLawhorn MM AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia. FAU - Tejiram, Shawn AU - Tejiram S AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia. FAU - Travis, Taryn E AU - Travis TE AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia. FAU - Moffatt, Lauren T AU - Moffatt LT AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia. FAU - Shupp, Jeffrey W AU - Shupp JW AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia. Electronic address: jeffrey.w.shupp@medstar.net. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20241007 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Humans MH - *Burns/therapy/blood/mortality/complications MH - Male MH - Female MH - Adult MH - Middle Aged MH - *Resuscitation/methods MH - *Thrombelastography MH - Prospective Studies MH - Plasma MH - Blood Coagulation/physiology OTO - NOTNLM OT - Burn induced coagulopathy OT - Fresh frozen plasma OT - Plasma inclusive resuscitation OT - Viscoelastic assays EDAT- 2024/10/09 00:23 MHDA- 2024/11/27 06:20 CRDT- 2024/10/08 18:09 PHST- 2024/03/01 00:00 [received] PHST- 2024/08/01 00:00 [revised] PHST- 2024/09/02 00:00 [accepted] PHST- 2024/11/27 06:20 [medline] PHST- 2024/10/09 00:23 [pubmed] PHST- 2024/10/08 18:09 [entrez] AID - S0022-4804(24)00557-2 [pii] AID - 10.1016/j.jss.2024.09.013 [doi] PST - ppublish SO - J Surg Res. 2024 Nov;303:233-240. doi: 10.1016/j.jss.2024.09.013. Epub 2024 Oct 7. PMID- 39376894 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241009 IS - 2772-6096 (Electronic) IS - 2772-6096 (Linking) VI - 12 DP - 2024 Dec TI - Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy. PG - 100310 LID - 10.1016/j.bjao.2024.100310 [doi] LID - 100310 AB - Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the in vitro closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate). Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available. CI - (c) 2024 The Author(s). FAU - Erdoes, Gabor AU - Erdoes G AD - Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. FAU - Goobie, Susan M AU - Goobie SM AD - Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Haas, Thorsten AU - Haas T AD - Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA. FAU - Koster, Andreas AU - Koster A AD - Institute of Anaesthesiology and Pain Therapy, Heart and Diabetes Centre NRW, Ruhr University Bochum, Bad Oeynhausen, Germany. FAU - Levy, Jerrold H AU - Levy JH AD - Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA. FAU - Steiner, Marie E AU - Steiner ME AD - Divisions of Critical Care and Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. LA - eng PT - Journal Article PT - Review DEP - 20240923 PL - England TA - BJA Open JT - BJA open JID - 9918419157906676 PMC - PMC11456917 OTO - NOTNLM OT - bleeding OT - bleeding disorders OT - haemostasis OT - surgery OT - tranexamic acid OT - transfusion OT - trauma OT - viscoelastic testing EDAT- 2024/10/08 10:55 MHDA- 2024/10/08 10:56 PMCR- 2024/09/23 CRDT- 2024/10/08 04:44 PHST- 2024/04/27 00:00 [received] PHST- 2024/08/18 00:00 [accepted] PHST- 2024/10/08 10:56 [medline] PHST- 2024/10/08 10:55 [pubmed] PHST- 2024/10/08 04:44 [entrez] PHST- 2024/09/23 00:00 [pmc-release] AID - S2772-6096(24)00054-6 [pii] AID - 100310 [pii] AID - 10.1016/j.bjao.2024.100310 [doi] PST - epublish SO - BJA Open. 2024 Sep 23;12:100310. doi: 10.1016/j.bjao.2024.100310. eCollection 2024 Dec. PMID- 39325049 OWN - NLM STAT- MEDLINE DCOM- 20240926 LR - 20260829 IS - 1531-2291 (Electronic) IS - 0890-5339 (Linking) VI - 38 IP - 10 DP - 2024 Oct 1 TI - Heritable Thrombophilia and Increased Risk for Venous Thromboembolism Despite Thromboprophylaxis After Pelvis or Acetabulum Fracture. PG - 521-526 LID - 10.1097/BOT.0000000000002865 [doi] AB - OBJECTIVES: Individuals with pelvic and acetabular fractures are at high risk of venous thromboembolism (VTE). The purpose of this study was to determine whether serum markers for thrombophilia and rapid thromboelastography (r-TEG) values correlate with increased VTE risk among patients with pelvic and acetabular fractures. DESIGN: Prospective observational study. SETTING: Two urban academic level 1 trauma centers. PATIENT SELECTION CRITERIA: Adult patients with isolated pelvis and/or acetabulum fractures (OTA/AO 61 and 62) treated surgically placed on a standardized VTE chemoprophylaxis regimen with enoxaparin over a 5-year period were included. OUTCOME MEASURES AND COMPARISONS: Serum r-TEG, coagulation laboratory values, and markers for heritable thrombophilia were drawn postoperatively and after completion of a 6-week course of enoxaparin. The primary outcome was VTE event (either deep venous thrombosis or pulmonary embolism) diagnosed using a Duplex ultrasound, chest computed tomography angiogram, or lung ventilation-perfusion ordered based on clinical suspicion of a VTE event. Laboratory markers and values were then compared between patients who went on to have a VTE event and those who did not and patients with and without markers of thrombophilia. RESULTS: One hundred thirty-three adult patients with isolated operative pelvic and/or acetabular fractures were enrolled in this study. The average age of patients at time of injury was 48.3 years (range 18-91). Sixty-seven percent of patients in the study were (n = 90) males. Sixty-three percent of patients (n = 84) completed both clinical and laboratory follow-up. Forty-one percent of patients (n = 54) had 1 or more markers of heritable thrombophilia. Twelve percent (n = 10) of patients who completed follow-up were diagnosed with VTE. Age, sex, and smoking status were not associated with VTE. Patients who developed VTE had a higher body mass index (P = 0.04). Having more than 1 marker of heritable thrombophilia (P = 0.004) and an r-TEG mean amplitude greater than 72 mm postoperatively was positively associated with VTE (P = 0.02). CONCLUSIONS: Among patients treated surgically for isolated pelvic and acetabular fractures who received enoxaparin prophylaxis, the presence of more than 1 marker of heritable thrombophilia or r-TEG mean amplitude value greater than 72 mm postoperatively was associated with an increased risk of VTE. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. CI - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved. FAU - Shah, Nihar S AU - Shah NS AUID- ORCID: 0000-0003-0419-5733 AD - Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH; and. FAU - Pierrie, Sarah N AU - Pierrie SN AUID- ORCID: 0000-0001-9237-1551 AD - Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH; and. FAU - Agel, Julie AU - Agel J AD - Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA. FAU - Firoozabadi, Reza AU - Firoozabadi R AD - Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA. FAU - Sagi, H Claude AU - Sagi HC AD - Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH; and. LA - eng GR - Foundation for Orthopaedic Trauma/ PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - J Orthop Trauma JT - Journal of orthopaedic trauma JID - 8807705 RN - 0 (Enoxaparin) RN - 0 (Anticoagulants) RN - Thrombophilia, hereditary SB - IM MH - Humans MH - Male MH - *Acetabulum/injuries MH - Female MH - *Thrombophilia/complications/blood MH - *Venous Thromboembolism/prevention & control/etiology MH - *Fractures, Bone/complications/surgery MH - Adult MH - Middle Aged MH - *Pelvic Bones/injuries MH - Prospective Studies MH - Enoxaparin/therapeutic use MH - Anticoagulants/therapeutic use MH - Risk Factors MH - Aged MH - Young Adult MH - Comorbidity MH - Risk Assessment MH - Treatment Outcome COIS- The authors report no conflict of interest. EDAT- 2024/09/26 12:42 MHDA- 2024/09/26 12:43 CRDT- 2024/09/26 10:53 PHST- 2024/06/18 00:00 [accepted] PHST- 2024/09/26 12:43 [medline] PHST- 2024/09/26 12:42 [pubmed] PHST- 2024/09/26 10:53 [entrez] AID - 00005131-202410000-00002 [pii] AID - 10.1097/BOT.0000000000002865 [doi] PST - ppublish SO - J Orthop Trauma. 2024 Oct 1;38(10):521-526. doi: 10.1097/BOT.0000000000002865. PMID- 39300624 OWN - NLM STAT- MEDLINE DCOM- 20240920 LR - 20240920 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 55 Suppl 3 DP - 2024 Sep TI - Mitochondrial dysfunction in platelets from severe trauma patients - A prospective case-control study. PG - 111481 LID - S0020-1383(24)00168-2 [pii] LID - 10.1016/j.injury.2024.111481 [doi] AB - INTRODUCTION: Trauma-induced coagulopathy (TIC) refers to an abnormal coagulation process, an imbalance between coagulation and fibrinolysis due to several pathological factors, such as haemorrhage and tissue injury. Platelet activation and subsequent clot formation are associated with mitochondrial activity, suggesting a possible role for mitochondria in TIC. Comprehensive studies of mitochondrial dysfunction in platelets from severe trauma patients have not yet been performed. METHODS: In this prospective case-control study, patients with severe trauma (ISS>/=16) had venous blood samples taken at arrival to the Emergency Unit of a Level 1 Trauma Centre. Mitochondrial functional measurements (Oxygraph-2k, Oroboros) were performed to determine oxygen consumption in different respiratory states, the H(2)O(2) production and extramitochondrial Ca(2+) movements. In addition, standard laboratory and coagulation tests, viscoelastometry (ClotPro) and aggregometry (Multiplate) were performed. Measurements data were compared with age and sex matched healthy control patients. RESULTS: Severe trauma patients (n = 113) with a median age of 38 years (IQR, 20-51), a median ISS of 28 (IQR, 20-48) met our inclusion criteria. Oxidative phosphorylation in platelet mitochondria from severe trauma patients significantly decreased compared to controls (34.7 +/- 8.8 pmol/s/mL vs. 48.0 +/- 19.7 pmol/s/mL). The mitochondrial H(2)O(2) production significantly increased and greater endogenous Ca(2+) release was found in the polytrauma group. Consistent with these results, clotting time (CT) increased while maximum clot firmness (MCF) decreased with the EX-test and FIB-test in severe trauma samples. Multiplate aggregometry showed significantly decreased ADP-test (38 +/- 12 AUC vs. 112 +/- 14 AUC) and ASPI test (78 +/- 22 AUC vs. 84 +/- 28 AUC) also tended to decrease in mitochondria of polytrauma patients as compared with controls. Significant strong correlation has been demonstrated between mitochondrial OxPhos and MCF while it was negatively correlated with ISS (R(2)=0.448, P<0.05), INR, CT and lactate level of patients. CONCLUSIONS: The present study revealed that severe trauma is associated with platelet mitochondrial dysfunction resulting in reduced ATP synthesis and impaired extramitochondrial Ca(2+) movement. These factors are required for platelet activation, recruitment and clot stability likely thus, platelet mitochondrial dysfunction contributes to the development of TIC. CI - Copyright (c) 2024. Published by Elsevier Ltd. FAU - Sandor, Lilla AU - Sandor L AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Donka, Tibor AU - Donka T AD - National Academy of Scientist Education, Pacsirta str 31., Szeged, 6724, Hungary. FAU - Barath, Balint AU - Barath B AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Javor, Peter AU - Javor P AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Jasz, David Kurszan AU - Jasz DK AD - National Academy of Scientist Education, Pacsirta str 31., Szeged, 6724, Hungary. FAU - Perenyi, Domonkos AU - Perenyi D AD - National Academy of Scientist Education, Pacsirta str 31., Szeged, 6724, Hungary. FAU - Babik, Barna AU - Babik B AD - Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Varga, Endre AU - Varga E AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Torok, Laszlo AU - Torok L AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary; Department of Sports Medicine, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. FAU - Hartmann, Petra AU - Hartmann P AD - Department of Traumatology, University of Szeged, Semmelweis str 6., Szeged, 6725, Hungary. Electronic address: hartmann.petra@med.u-szeged.hu. LA - eng PT - Journal Article DEP - 20240917 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - SY7Q814VUP (Calcium) RN - BBX060AN9V (Hydrogen Peroxide) SB - IM MH - Humans MH - Prospective Studies MH - Male MH - Case-Control Studies MH - Female MH - Adult MH - *Blood Platelets/metabolism MH - *Wounds and Injuries/complications/blood MH - *Mitochondria/metabolism MH - Middle Aged MH - *Blood Coagulation Disorders/etiology/blood MH - Oxidative Phosphorylation MH - Blood Coagulation/physiology MH - Young Adult MH - Platelet Activation/physiology MH - Calcium/metabolism/blood MH - Hydrogen Peroxide/metabolism/blood OTO - NOTNLM OT - Clinical trial OT - High-resolution respirometry OT - Mitochondrial dysfunction OT - Platelet activation OT - Trauma-induced coagulopathy (TIC) COIS- Declaration of competing interest No conflict of interest exists. EDAT- 2024/09/21 13:19 MHDA- 2024/09/21 13:20 CRDT- 2024/09/20 00:07 PHST- 2023/12/13 00:00 [received] PHST- 2024/02/13 00:00 [revised] PHST- 2024/02/25 00:00 [accepted] PHST- 2024/09/21 13:20 [medline] PHST- 2024/09/21 13:19 [pubmed] PHST- 2024/09/20 00:07 [entrez] AID - S0020-1383(24)00168-2 [pii] AID - 10.1016/j.injury.2024.111481 [doi] PST - ppublish SO - Injury. 2024 Sep;55 Suppl 3:111481. doi: 10.1016/j.injury.2024.111481. Epub 2024 Sep 17. PMID- 39296135 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240920 IS - 2405-8440 (Print) IS - 2405-8440 (Electronic) IS - 2405-8440 (Linking) VI - 10 IP - 17 DP - 2024 Sep 15 TI - Combined effect of intermittent hemostasis and a modified external hemorrhage control device in a lethal swine model. PG - e37017 LID - 10.1016/j.heliyon.2024.e37017 [doi] LID - e37017 AB - BACKGROUND: Non-compressible torso hemorrhage (NCTH) presents the ultimate challenge in pre-hospital care. While external hemorrhage control devices (EHCDs) such as the Abdominal Aortic and Junctional Tourniquet (AAJT) and SAM Junctional Tourniquet (SJT) have been invented, the current design and application strategy requires further improvement. Therefore, researchers devised a novel apparatus named Modified EHCD (M-EHCD) and implemented intermittent hemostasis (IH) as a preventive measure against ischemia-reperfusion injury. The objective of this study was to ascertain the combined effect of M-EHCD and IH on the hemostatic effect of NCTH. METHODS: Eighteen swine were randomized to M-EHCD, AAJT or SJT. The NCTH model was established by inducing Class Ⅲ hemorrhagic shock and performing a hemi-transection of common femoral artery (CFA). EHCDs were rapidly fastened since the onset of free bleeding (T(0min)). The IH strategy was implemented by fully releasing M-EHCD at T(40min), T(70min) and T(100min), respectively, whereas AAJT and SJT maintained continuous hemostasis (CH) until T(120min). All groups underwent CFA bridging at T(110min), and EHCDs were removed at T(120min). Reperfusion lasted for 60 min, after which euthanasia was performed. Hemodynamics, intra-vesical pressure (IVP), and blood samples were collected periodically. Histological examinations were also conducted. RESULTS: M-EHCD demonstrated the fastest application time (M-EHCD: 26.38 +/- 6.32s vs. SJT: 30.84 +/- 5.62s vs. AAJT: 54.28 +/- 5.45s, P < 0.001) and reduced free blood loss (M-EHCD: 17.77 +/- 9.85g vs. SJT: 51.80 +/- 33.70g vs. AAJT: 115.20 +/- 61.36g, P = 0.011) compared to SJT and AAJT. M-EHCD exhibited inhibitory effects on heart rate (M-EHCD: 91.83 +/- 31.61bpm vs. AAJT: 129.00 +/- 32.32bpm vs. SJT: 135.17 +/- 21.24bpm, P = 0.041) and shock index. The device's external pressure was lowest in M-EHCD and highest in SJT (P = 0.001). The resultant increase in IVP were still the lowest in M-EHCD (M-EHCD: -0.07 +/- 0.45 mmHg vs. AAJT: 27.04 +/- 5.03 mmHg vs. SJT: 5.58 +/- 2.55 mmHg, P < 0.001). Furthermore, M-EHCD caused the least colonic injury (M-EHCD: 1.17 +/- 0.41 vs. AAJT: 2.17 +/- 0.41 vs. SJT: 2.17 +/- 0.41, P = 0.001). The removal of M-EHCD showed the slightest impact on pH (P < 0.001), while AAJT group was more susceptible to the lethal triad based on the arterial lactate and thrombelastogram results. CONCLUSIONS: M-EHCD + IH protected the organs and reduced the risk of the lethal triad by decreasing disruptions to IVP, hemodynamics, acid-base equilibrium and coagulation. M-EHCD + IH was superior to the hemostatic safety and efficacy of AAJT/SJT + CH. CI - (c) 2024 The Authors. FAU - Zhang, Hua-Yu AU - Zhang HY AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. FAU - Guo, Yong AU - Guo Y AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. AD - Emergency and Critical Care Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China. FAU - Zhao, Dong-Chu AU - Zhao DC AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. FAU - Huang, Xiao-Ying AU - Huang XY AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. FAU - Li, Yang AU - Li Y AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. FAU - Zhang, Lian-Yang AU - Zhang LY AD - Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. LA - eng PT - Journal Article DEP - 20240830 PL - England TA - Heliyon JT - Heliyon JID - 101672560 PMC - PMC11408843 OTO - NOTNLM OT - External hemostasis OT - Ischemia-reperfusion injury OT - Non-compressible torso hemorrhage OT - Pre-hospital care OT - Swine model COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/09/19 06:43 MHDA- 2024/09/19 06:44 PMCR- 2024/08/30 CRDT- 2024/09/19 04:51 PHST- 2024/05/05 00:00 [received] PHST- 2024/08/26 00:00 [revised] PHST- 2024/08/26 00:00 [accepted] PHST- 2024/09/19 06:44 [medline] PHST- 2024/09/19 06:43 [pubmed] PHST- 2024/09/19 04:51 [entrez] PHST- 2024/08/30 00:00 [pmc-release] AID - S2405-8440(24)13048-4 [pii] AID - e37017 [pii] AID - 10.1016/j.heliyon.2024.e37017 [doi] PST - epublish SO - Heliyon. 2024 Aug 30;10(17):e37017. doi: 10.1016/j.heliyon.2024.e37017. eCollection 2024 Sep 15. PMID- 39293062 OWN - NLM STAT- MEDLINE DCOM- 20241213 LR - 20261018 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 63 IP - 1 DP - 2025 Jan 1 TI - FIBRINOLYTIC DYSFUNCTION AND ENDOTHELIOPATHY AFTER MAJOR THERMAL INJURY: CONSIDERATIONS NEEDED FOR NEW APPROACHES TO BURN SHOCK RESUSCITATION. PG - 11-18 LID - 10.1097/SHK.0000000000002473 [doi] AB - In recent years, it has become apparent that fibrinolytic dysfunction and endotheliopathy develop in up to 40% of patients during the first hours following thermal injury and are associated with poor outcomes and increased resuscitation requirements. Rapidly following burn injury, the fibrinolytic system is activated, with activation generally greater with increased severity of injury. Very high plasma concentrations of plasmin-antiplasmin complex (marker of activation) have been associated with mortality. Patients display hyperfibrinolytic, physiologic/normal, or hypofibrinolytic/fibrinolytic shutdown phenotypes, as assessed by viscoelastic assay. Phenotypes change in over 50% of patients during the acute burn resuscitation period, with some patterns (maladaptive) associated with increased mortality risk and others (adaptive, trending toward the physiologic phenotype) associated with survival. Endotheliopathy, as reflected in elevated plasma concentrations of syndecan-1 has also been associated with increased mortality. Here we review the incidence and effects of these responses after burn injury and explore mechanisms and potential interactions with the early inflammatory response. Available data from burn and nonburn trauma suggest that the fibrinolytic, endothelial, and inflammatory systems interact extensively and that dysregulation in one may exacerbate dysregulation in the others. This raises the possibility that successful treatment of one may favorably impact the others. CI - Copyright (c) 2024 by the Shock Society. FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Moffatt, Lauren T AU - Moffatt LT FAU - Ho, Dao H AU - Ho DH AD - Cellular and Immune-based Adjuncts for Casualty Care, Naval Medical Research Unit San Antonio, Joint Base San Antonio-Fort Sam Houston, Texas. FAU - Neidert, Leslie E AU - Neidert LE AD - Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Joint Base San Antonio-Fort Sam Houston, Texas. FAU - Morgan, Clifford G AU - Morgan CG AD - Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Joint Base San Antonio-Fort Sam Houston, Texas. FAU - Tejiram, Shawn AU - Tejiram S AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC. FAU - Cardin, Sylvain AU - Cardin S AD - Naval Medical Research Unit San Antonio, Joint Base San Antonio-Fort Sam Houston, Texas. FAU - Shupp, Jeffrey W AU - Shupp JW LA - eng PT - Journal Article PT - Review DEP - 20240916 PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM MH - Humans MH - *Burns/blood/therapy MH - *Fibrinolysis MH - *Resuscitation/methods MH - Shock/therapy/blood MH - Animals MH - Endothelium, Vascular/metabolism COIS- The authors report no conflicts of interest. EDAT- 2024/09/18 18:45 MHDA- 2024/12/13 20:06 CRDT- 2024/09/18 17:02 PHST- 2024/12/13 20:06 [medline] PHST- 2024/09/18 18:45 [pubmed] PHST- 2024/09/18 17:02 [entrez] AID - 00024382-202501000-00003 [pii] AID - 10.1097/SHK.0000000000002473 [doi] PST - ppublish SO - Shock. 2025 Jan 1;63(1):11-18. doi: 10.1097/SHK.0000000000002473. Epub 2024 Sep 16. PMID- 39251251 OWN - NLM STAT- MEDLINE DCOM- 20241113 LR - 20241113 IS - 1423-0410 (Electronic) IS - 0042-9007 (Linking) VI - 119 IP - 11 DP - 2024 Nov TI - A comprehensive approach to continuous quality improvement of massive transfusion by developing key performance indicators. PG - 1183-1190 LID - 10.1111/vox.13732 [doi] AB - BACKGROUND AND OBJECTIVES: To develop key performance indicators (KPI) for use in quality assessment of our institutional goal-directed massive transfusion (GDMT). MATERIALS AND METHODS: A team comprising our transfusion and emergency medicine departments carried out a cross-sectional data analysis of GDMT in adult patients from January 2021 to December 2022. The study was rooted in the Define, Measure, Analyse, Improve, Control (DMAIC) approach. Features of KPIs were (a) importance, (b) scientific soundness and (c) feasibility. Study parameters were defined and analysed using measures of central tendencies and benchmark comparison. RESULTS: Ninety-two massive transfusion events occurred and 1405 blood components were used. Trauma was the leading cause, followed by postpartum haemorrhage and upper gastrointestinal bleeding. Appropriate GDMT activation was observed only in 43.47% of events. The turnaround time (TAT) was within the benchmark in 85.8% of events with an average of 16 +/- 10 min. The average utilization of blood components was 20.5 (interquartile range [IQR] = 11.3) in the appropriate group and 5.5 (IQR = 4.25) in the inappropriate group with a wastage rate of 3.5%. Duration of activation was 6.19 +/- 4.59 h, and the adherence to thromboelastography was 66.3%. Overall mortality was 45.65%, and the average duration of hospital stay was 6.1 +/- 5.9 days. CONCLUSION: The KPIs developed were easy to capture, and the analysis provided a comprehensive approach to the quality improvement of the GDMT protocol. CI - (c) 2024 The Author(s). Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion. FAU - Ninan, Ancy AU - Ninan A AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Krishnan, Vimal AU - Krishnan V AUID- ORCID: 0000-0002-0100-2396 AD - Department of Emergency Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Shastry, Shamee AU - Shastry S AUID- ORCID: 0000-0001-9796-2326 AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Mohan, Ganesh AU - Mohan G AUID- ORCID: 0000-0002-8728-9307 AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. AD - Manipal Centre for Benign Haematological Disorders, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Chenna, Deepika AU - Chenna D AUID- ORCID: 0000-0003-1461-5498 AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Madkaiker, Deep AU - Madkaiker D AUID- ORCID: 0009-0009-8774-7599 AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. FAU - Balakrishnan, Jayaraj Mymbilly AU - Balakrishnan JM AUID- ORCID: 0000-0001-6437-8756 AD - Department of Emergency Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. LA - eng PT - Journal Article DEP - 20240909 PL - England TA - Vox Sang JT - Vox sanguinis JID - 0413606 SB - IM MH - Humans MH - Female MH - *Quality Improvement MH - *Blood Transfusion/methods/standards MH - Cross-Sectional Studies MH - Male MH - Adult MH - Middle Aged MH - Quality Indicators, Health Care MH - Postpartum Hemorrhage/therapy OTO - NOTNLM OT - blood transfusion OT - key performance indicators OT - major haemorrhage protocol OT - massive transfusion protocol OT - process improvement OT - quality indicators EDAT- 2024/09/10 00:43 MHDA- 2024/11/14 03:57 CRDT- 2024/09/09 20:43 PHST- 2024/07/30 00:00 [revised] PHST- 2024/04/01 00:00 [received] PHST- 2024/08/14 00:00 [accepted] PHST- 2024/11/14 03:57 [medline] PHST- 2024/09/10 00:43 [pubmed] PHST- 2024/09/09 20:43 [entrez] AID - 10.1111/vox.13732 [doi] PST - ppublish SO - Vox Sang. 2024 Nov;119(11):1183-1190. doi: 10.1111/vox.13732. Epub 2024 Sep 9. PMID- 39245887 OWN - NLM STAT- MEDLINE DCOM- 20241021 LR - 20250617 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 64 IP - 10 DP - 2024 Oct TI - Survey of pediatric massive transfusion protocol practice at United States level I trauma centers: An AABB Pediatric Transfusion Medicine Subsection study. PG - 1860-1869 LID - 10.1111/trf.17997 [doi] AB - BACKGROUND: Trauma remains the leading cause of pediatric mortality in the United States. Although use of massive transfusion protocols (MTPs) in this population is widespread, optimal pediatric resuscitation is not well established. We sought to assess contemporary pediatric MTP practice in the United States. STUDY DESIGN AND METHODS: A web-based survey was designed by the Association for the Advancement of Blood & Biotherapies (AABB) Pediatric Transfusion Medicine Subsection and distributed to select American College of Surgeons (ACS) Level I Verified pediatric trauma centers. The survey assessed current MTP policy, implementation, and recent changes in practice. RESULTS: Response rate was 55% (22/40). Almost half of the respondents were from the South. The median RBC:plasma ratio was 1 (interquartile range 1-1.5). Protocolized fibrinogen supplementation was common while integration of antifibrinolytic therapy into MTPs was infrequent. Viscoelastic testing (VET) was available at most sites, 71% (15/21, one site did not respond), and was generally utilized on an ad-hoc basis. Roughly, a third of sites had changed their MTP in the past 3 years due to blood supply issues, and about a third reported having group O Whole Blood on-site. CONCLUSION: MTP practice is similar throughout the United States. Though fibrinogen supplementation is common-other emerging interventions such as antifibrinolytic therapy or utilization of routine viscoelastic testing-are not widespread. Pediatric transfusion medicine experts must continue to follow practice change, as contemporary large trials begin to characterize new supportive modalities to optimize resuscitation in pediatric trauma patients. CI - (c) 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB. FAU - Adkins, Brian D AU - Adkins BD AUID- ORCID: 0000-0002-9480-2762 AD - Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. AD - Children's Health System, Dallas, Texas, USA. FAU - Noland, Daniel K AU - Noland DK AD - Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. AD - Children's Health System, Dallas, Texas, USA. FAU - Jacobs, Jeremy W AU - Jacobs JW AD - Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. FAU - Booth, Garrett S AU - Booth GS AUID- ORCID: 0000-0002-8422-9480 AD - Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Malicki, Denise AU - Malicki D AD - Department of Pathology, Rady Children's Hospital San Diego, San Diego, California, USA. FAU - Helander, Louise AU - Helander L AUID- ORCID: 0000-0002-7836-0132 AD - Department of Medicine, University of Colorado, Aurora, Colorado, USA. FAU - Jacquot, Cyril AU - Jacquot C AUID- ORCID: 0000-0003-1281-0644 AD - Department of Pathology, Children's National Hospital, Washington, DC, USA. FAU - Buscema, Gina AU - Buscema G AD - Transfusion Services, Inova Fairfax Medical Campus, Falls Church, Virginia, USA. FAU - Goel, Ruchika AU - Goel R AD - Department of Internal Medicine, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois, USA. AD - Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA. AD - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. FAU - Andrews, Jennifer AU - Andrews J AUID- ORCID: 0000-0002-3801-4198 AD - Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. FAU - Lieberman, Lani AU - Lieberman L AUID- ORCID: 0000-0002-3633-0728 AD - Laboratory Medicine Program, University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article DEP - 20240908 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 9001-32-5 (Fibrinogen) RN - 0 (Antifibrinolytic Agents) SB - IM MH - Humans MH - *Blood Transfusion/methods MH - *Trauma Centers MH - United States MH - Child MH - Transfusion Medicine/methods MH - Wounds and Injuries/therapy/blood MH - Resuscitation/methods MH - Clinical Protocols MH - Surveys and Questionnaires MH - Fibrinogen/analysis/therapeutic use MH - Female MH - Practice Patterns, Physicians'/statistics & numerical data MH - Antifibrinolytic Agents/therapeutic use OTO - NOTNLM OT - massive transfusion protocol OT - pediatric OT - transfusion medicine OT - trauma resuscitation EDAT- 2024/09/09 06:41 MHDA- 2024/10/21 10:51 CRDT- 2024/09/09 01:02 PHST- 2024/06/28 00:00 [revised] PHST- 2024/05/17 00:00 [received] PHST- 2024/08/11 00:00 [accepted] PHST- 2024/10/21 10:51 [medline] PHST- 2024/09/09 06:41 [pubmed] PHST- 2024/09/09 01:02 [entrez] AID - 10.1111/trf.17997 [doi] PST - ppublish SO - Transfusion. 2024 Oct;64(10):1860-1869. doi: 10.1111/trf.17997. Epub 2024 Sep 8. PMID- 39226704 OWN - NLM STAT- MEDLINE DCOM- 20241019 LR - 20260415 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 302 DP - 2024 Oct TI - Intravenous Versus Intraosseous Use of Tranexamic Acid in Patients With Traumatic Brain Injury. PG - 798-804 LID - S0022-4804(24)00508-0 [pii] LID - 10.1016/j.jss.2024.08.003 [doi] AB - INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic drug that has been demonstrated to reduce head injury-related mortality when given within 2 h of injury in patients with traumatic brain injury and intracranial hemorrhage. It is usually administered via intravenous (IV) access, which can be difficult to obtain in prehospital and austere settings. Intraosseous (IO) access is fast and offers an alternative when IV access proves challenging; however, TXA administration via IO access has never been studied in humans. We sought to determine if the total drug exposure of TXA given in the prehospital setting in patients with moderate or severe brain injury differs based on route of administration. METHODS: We performed a retrospective analysis of prospectively collected data from the prehospital TXA for traumatic brain injury trial (NCT01990768). Participants who received TXA via IO administration were compared to those who received TXA via IV administration and stratified by renal function category based on the Kidney Disease Improving Global Outcomes criteria. The area under the plasma drug concentration-time curve (AUC) was calculated using the trapezoidal rule (Phoenix WinNonlin 8.3, Certara, Princeton NJ) to obtain total drug exposure. The inverse variance method was used to combine observations within strata and calculate mean differences. RESULTS: Of the 966 participants enrolled in the trial, 345 participants received a 2-g TXA prehospital bolus (11 IO, 334 IV); 312 participants received a 1-g TXA prehospital bolus followed by a 1-g TXA infusion in-hospital over 8 h (13 IO, 299 IV). After exclusion because of missing data and extreme estimated AUC, 233 IV and eight IO participants in the 2-g bolus arm and 152 IV and eight IO participants in the 1-g bolus 1-g infusion arm remained. Participants did not differ by age, sex, race, ethnicity, body mass index, serum creatinine, estimated glomerular filtration rate, or clot lysis at 30 min on thromboelastography. No difference in the mean AUCs were observed between IV and IO for either the 2-g bolus group (-2.6 mu g/mL/h [IO] compared to IV, 95% confidence interval: -28.4 to 23.3 mu g/mL/h) or the 1-g bolus/1-g infusion group (-13.0 mu g/mL/h [IO] compared to IV, 95% confidence interval: -236.2 to 210.3 mu g/mL/h). CONCLUSIONS: These preliminary data suggest that the administration of TXA via IO and IV routes may result in similar total drug exposure. Further studies incorporating larger numbers with clinical outcomes are needed to confirm this finding. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Newman, Zachary C AU - Newman ZC AD - The University of Chicago Pritzker School of Medicine, Chicago, Illinois. Electronic address: Zachary.Newman@bsd.uchicago.edu. FAU - Ogbeifun, Victoria O AU - Ogbeifun VO AD - Missouri State University, Springfield, Missouri. FAU - Barbosa, Claire E AU - Barbosa CE AD - The University of Chicago, Chicago, Illinois. FAU - McKinley, W Ian AU - McKinley WI AD - Department of Surgery, Section of Trauma and Acute Care Surgery, The University of Chicago, Chicago, Illinois. FAU - Benjamin, Andrew J AU - Benjamin AJ AD - Department of Surgery, Section of Trauma and Acute Care Surgery, The University of Chicago, Chicago, Illinois. FAU - Munar, Myrna Y AU - Munar MY AD - Oregon State University College of Pharmacy, Portland, Oregon. FAU - Pramuka, Pierce E AU - Pramuka PE AD - The University of Chicago, Chicago, Illinois. FAU - McGovern, Katie D AU - McGovern KD AD - The University of Illinois at Urbana-Champaign, Champaign, Illinois. FAU - Nordgren, Rachel K AU - Nordgren RK AD - Department of Public Health Sciences, The University of Chicago, Chicago, Illinois. FAU - Schreiber, Martin A AU - Schreiber MA AD - Donald D. Trunkey Center for Civilian and Combat Casualty Care, Oregon Health & Science University, Portland, Oregon. FAU - Rowell, Susan E AU - Rowell SE AD - The University of Chicago, Chicago, Illinois. LA - eng SI - ClinicalTrials.gov/NCT01990768 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20240902 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 6T84R30KC1 (Tranexamic Acid) RN - 0 (Antifibrinolytic Agents) SB - IM MH - Humans MH - *Tranexamic Acid/administration & dosage MH - *Antifibrinolytic Agents/administration & dosage MH - Male MH - Retrospective Studies MH - Female MH - *Brain Injuries, Traumatic/drug therapy MH - Adult MH - *Infusions, Intraosseous MH - Middle Aged MH - Infusions, Intravenous MH - Administration, Intravenous MH - Treatment Outcome MH - Young Adult MH - Emergency Medical Services/methods OTO - NOTNLM OT - Intraosseus OT - Pharmacokinetics OT - TBI OT - TXA OT - Trauma EDAT- 2024/09/04 01:01 MHDA- 2024/10/19 16:22 CRDT- 2024/09/03 18:03 PHST- 2023/12/05 00:00 [received] PHST- 2024/07/22 00:00 [revised] PHST- 2024/08/01 00:00 [accepted] PHST- 2024/10/19 16:22 [medline] PHST- 2024/09/04 01:01 [pubmed] PHST- 2024/09/03 18:03 [entrez] AID - S0022-4804(24)00508-0 [pii] AID - 10.1016/j.jss.2024.08.003 [doi] PST - ppublish SO - J Surg Res. 2024 Oct;302:798-804. doi: 10.1016/j.jss.2024.08.003. Epub 2024 Sep 2. PMID- 39216824 OWN - NLM STAT- MEDLINE DCOM- 20240928 LR - 20260331 IS - 1879-0887 (Electronic) IS - 0167-8140 (Linking) VI - 200 DP - 2024 Nov TI - Risk factors for recurrent laryngeal nerve injury in microwave ablation of thyroid nodules: A multicenter study. PG - 110516 LID - S0167-8140(24)03494-7 [pii] LID - 10.1016/j.radonc.2024.110516 [doi] AB - BACKGROUND AND PURPOSE: This study aimed to investigate the risk factors for recurrent laryngeal nerve (RLN) injury after microwave ablation (MWA) of thyroid nodules and to identify factors influencing the recovery time of post-procedure hoarseness. MATERIALS AND METHODS: We retrospectively analyzed data from patients who underwent MWA for thyroid nodules at five hospitals between November 2018 and July 2022. Patients were divided into malignant and benign nodule groups. Variables analyzed included nodule size and location, the shortest distance from nodules to the thyroid capsule and tracheoesophageal groove (TEG-D), and ablation parameters. Univariate and multivariate analyses were performed to identify risk factors. Kaplan-Meier and Cox analyses were used to evaluate the recovery time of hoarseness after MWA. RESULTS: The study included 1,216 patients (mean age 44 +/- 12 [SD] years; 901 women) with 602 malignant nodules and 614 benign nodules. The posterior capsule distance (PCD) and TEG-D were identified as independent influencing factors for hoarseness in all patients (P = 0.014, OR = 0.068; P < 0.001, OR = 0.005; AUC = 0.869). TEG-D was a significant risk factor for hoarseness, with safe thresholds identified at 4.9 mm for malignant nodules and 2.2 mm for benign nodules. Among patients who developed hoarseness, those in the close-distance group (TEG-D 5.065 mg/l, lower extremity < 3, duration of bedrest, and MA value of TEG are independent risk factors for postoperative DVT in SCI patients, D-dimer having the highest diagnostic value. When the above risk factors occur, clinicians need to be vigilant and take appropriate prevention and treatment measures. FAU - Yang, Diao AU - Yang D AUID- ORCID: 0009-0004-0387-8131 AD - The First College of Clinical Medical Science, China Three Gorges University. Department of Spinal Surgery, Yichang Central People's Hospital, Yichang, PR China. FAU - Chen, Shiwen AU - Chen S AD - The First College of Clinical Medical Science, China Three Gorges University. Department of Spinal Surgery, Yichang Central People's Hospital, Yichang, PR China. FAU - Zhuo, Can AU - Zhuo C AD - The First College of Clinical Medical Science, China Three Gorges University. Department of Spinal Surgery, Yichang Central People's Hospital, Yichang, PR China. FAU - Chen, Haidan AU - Chen H AD - The First College of Clinical Medical Science, China Three Gorges University. Department of Spinal Surgery, Yichang Central People's Hospital, Yichang, PR China. LA - eng PT - Journal Article PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 RN - 0 (fibrin fragment D) RN - 0 (Fibrin Fibrinogen Degradation Products) SB - IM MH - Humans MH - *Venous Thrombosis/etiology/blood MH - Risk Factors MH - Male MH - Female MH - *Spinal Cord Injuries/complications MH - Middle Aged MH - *Spinal Fractures/surgery/blood MH - *Postoperative Complications/etiology/blood MH - Adult MH - Retrospective Studies MH - Fibrin Fibrinogen Degradation Products/analysis/metabolism MH - Aged PMC - PMC11322941 OTO - NOTNLM OT - D-dimer OT - TEG OT - deep vein thrombosis OT - risk factor OT - spinal cord injury OT - spinal fracture COIS- Ethical ApprovalThe Ethics Committee of Yichang Central People's Hospital approved this study. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2024/08/13 06:42 MHDA- 2024/08/13 06:43 PMCR- 2024/08/12 CRDT- 2024/08/13 02:52 PHST- 2024/08/13 06:43 [medline] PHST- 2024/08/13 06:42 [pubmed] PHST- 2024/08/13 02:52 [entrez] PHST- 2024/08/12 00:00 [pmc-release] AID - 10.1177_10760296241271331 [pii] AID - 10.1177/10760296241271331 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241271331. doi: 10.1177/10760296241271331. PMID- 39115454 OWN - NLM STAT- MEDLINE DCOM- 20241008 LR - 20241015 IS - 1528-1175 (Electronic) IS - 0003-3022 (Print) IS - 0003-3022 (Linking) VI - 141 IP - 5 DP - 2024 Nov 1 TI - Correction of Trauma-induced Coagulopathy by Goal-directed Therapy: A Secondary Analysis of the ITACTIC Trial. PG - 904-912 LID - 10.1097/ALN.0000000000005183 [doi] AB - BACKGROUND: Trauma hemorrhage induces a coagulopathy with a high associated mortality rate. The Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (ITACTIC) randomized trial tested two goal-directed treatment algorithms for coagulation management: one guided by conventional coagulation tests and one by viscoelastic hemostatic assays (viscoelastic). The lack of a difference in 28-day mortality led the authors to hypothesize that coagulopathic patients received insufficient treatment to correct coagulopathy. METHODS: During ITACTIC, two sites were coenrolling patients into an ongoing prospective observational study, which included serial blood sampling at the same intervals as in ITACTIC. The subgroup in both studies had conventional and viscoelastic test results for each patient available for analysis. A goal-directed treatment was defined as one triggered by an ITACTIC algorithm. Coagulopathy was defined as rotational thromboelastometry EXTEM A5 less than 40 mm. The primary outcome was correction of coagulopathy by the 12th unit of erythrocyte transfusion during resuscitation. RESULTS: Full viscoelastic and conventional coagulation test results were available for 133 patients. Of these patients, 71% were coagulopathic on admission, and 16% developed a coagulopathy during resuscitation. ITACTIC viscoelastic hemostatic assay group patients were more likely to receive goal-directed treatment than the standard group (76% vs. 47%; odds ratio, 3.73; 95% CI, 1.64 to 8.49; P = 0.002). However, only 54% of patients received goal-directed treatment, and only 20% corrected their coagulopathy (vs. 0% with empiric treatment alone; not significant). Median time to first goal-directed treatment was 68 (53 to 88) min for viscoelastic and 110 (77 to 123) min for standard (P = 0.005). CONCLUSIONS: In ITACTIC, many bleeding trauma patients did not receive an indicated goal-directed treatment. Interventions arrived late during resuscitation and were only partially effective at correcting coagulopathy. CI - Copyright (c) 2024 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists. FAU - Lindsay, Charlotte AU - Lindsay C AUID- ORCID: 0000-0002-7283-857X AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, London, United Kingdom. FAU - Davenport, Ross AU - Davenport R AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, London, United Kingdom. FAU - Baksaas-Aasen, Kjersti AU - Baksaas-Aasen K AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Kolstadbraten, Knut Magne AU - Kolstadbraten KM AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Naess, Pal Aksel AU - Naess PA AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Curry, Nicola AU - Curry N AD - Oxford University Hospital National Health Service Trust, Oxford, United Kingdom. FAU - Maegele, Marc AU - Maegele M AD - Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Juffermans, Nicole AU - Juffermans N AD - Erasmus University, Rotterdam, The Netherlands. FAU - Stanworth, Simon AU - Stanworth S AD - Oxford University Hospital National Health Service Trust, Oxford, United Kingdom. FAU - Stensballe, Jakob AU - Stensballe J AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Johansson, Per Ingemar AU - Johansson PI AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Gaarder, Christine AU - Gaarder C AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Brohi, Karim AU - Brohi K AUID- ORCID: 0000-0003-0643-8866 AD - Oslo University Hospital and University of Oslo, Oslo, Norway. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Randomized Controlled Trial PL - United States TA - Anesthesiology JT - Anesthesiology JID - 1300217 SB - IM CIN - Anesthesiology. 141:10.1097/ALN.0000000000005189. MH - Adult MH - Female MH - Humans MH - Male MH - Middle Aged MH - Algorithms MH - *Blood Coagulation Disorders/etiology/therapy MH - Blood Coagulation Tests/methods MH - *Early Goal-Directed Therapy/methods MH - Hemorrhage/therapy/etiology MH - Prospective Studies MH - Resuscitation/methods MH - Thrombelastography/methods MH - Treatment Outcome MH - *Wounds and Injuries/complications/therapy/blood PMC - PMC11462890 COIS- Dr. Curry has received research grants from CSL Behring (King of Prussia, Pennsylvania) and Sobi (Stockholm, Sweden) and has served on advisory boards for LFB Biomedicaments (Les Ulis, France), Octapharma (Lachen, Swittzerland), and Sobi. Dr. Maegele has received honoraria for lectures and speakers' bureaus, congress travel support, and financial support for research projects from Astra Zeneca (Cambridge, United Kingdom), Bayer (Leverkusen, Germany), CSL Behring, Werfen (Barcelona, Spain), LFB Biomedicaments, Octapharma, and Portola Inc. (South San Francisco, California). Dr. Johansson has received unrestricted research grants from Haemonetics Corp. (Boston, Massachusetts) and Octapharma. Dr. Gaarder has received honoraria for lectures from Octapharma, has received research grant support from Haemonetics (Boston, Massachusetts) and Werfen in the form of device and reagent support, and also has previously served on the advisory board for Nycomed (Zurich, Switzerland). Dr. Brohi and Dr. Davenport have received research grant support from Werfen and Haemosonics (Boston, Massachusetts) in the form of device and reagent support and have served on external advisory panels for Octapharma, Astra Zeneca, and Werfen. Dr. Brohi has previously served on external advisory panels for Haemonetics Corp, Werfen, CSL Behring, Bayer, and Astra Zeneca. The other authors declare no competing interests. EDAT- 2024/08/08 12:42 MHDA- 2024/10/08 12:25 PMCR- 2024/10/09 CRDT- 2024/08/08 10:24 PHST- 2024/10/08 12:25 [medline] PHST- 2024/08/08 12:42 [pubmed] PHST- 2024/08/08 10:24 [entrez] PHST- 2024/10/09 00:00 [pmc-release] AID - 141881 [pii] AID - ALN-D-24-00017 [pii] AID - 10.1097/ALN.0000000000005183 [doi] PST - ppublish SO - Anesthesiology. 2024 Nov 1;141(5):904-912. doi: 10.1097/ALN.0000000000005183. PMID- 39069123 OWN - NLM STAT- MEDLINE DCOM- 20241030 LR - 20251202 IS - 1615-5947 (Electronic) IS - 0890-5096 (Print) IS - 0890-5096 (Linking) VI - 109 DP - 2024 Dec TI - The Use of Clot Strength as a Predictor of Thrombosis in Peripheral Artery Disease. PG - 273-283 LID - S0890-5096(24)00481-3 [pii] LID - 10.1016/j.avsg.2024.06.041 [doi] AB - BACKGROUND: Graft/stent thrombosis is the leading cause of amputation in patients over 60, and while dual antiplatelet therapy is the standard of care, there is a significant variability in platelet response and limited guidance on measuring effectiveness. Thromboelastography with platelet mapping (TEG-PM) can objectively detail an individual's coagulation profile, namely the strength of the clot and its response to antiplatelet medication. Although TEG-PM has been used for predicting postoperative bleeding and assessing platelet dysfunction in traumatic brain injury, its application in thrombosis diseases such as peripheral artery disease remains unexplored. The aim of this observational study was to determine if objective measures of clot strength could predict a high clinical risk of thrombosis. METHODS: Patients >60 years with peripheral artery disease undergoing revascularization were prospectively evaluated from 2021 to 2023. They were clinically followed for 1 year to detect any thrombotic events. TEG-PM was used to objectively evaluate coagulation profiles in patients at 1, 3, 6, and 9 months. These follow-up periods were chosen based on studies showing that 1-3 month intervals in the first year after lower extremity revascularization optimize therapy and risk control. The TEG-PM data preceding a thrombotic/stenotic event in patients with thrombosis was compared to the last known well TEG-PM event in those without a thrombotic/stenotic event. We stratified the groups based on the occurrence of thrombosis/stenotic events. Descriptive statistics were applied to characterize each group and a chi-square test was conducted to assess the variance between both groups. An unpaired t-test was run to identify differences in platelet function. Receiver operating characteristic analysis was performed to determine the optimal TEG-PM cutoff for predicting a higher risk of thrombosis. RESULTS: One hundred and fifty-eight patients were analyzed, from whom 28 (17.7%) experienced a thrombotic event. The thrombosis cohort exhibited significantly greater MA(ADP), MA(Fibrin,) and MA(Thrombin) [50.2 vs. 40.0, P < 0.05], [18.19 vs. 14.64, P < 0.05], and [63.8 vs. 58.5, P < 0.05], respectively, indicative of greater clot strength. By receiver operating characteristic analysis, the optimal predictor cut-off for MA(ADP), indicating a higher risk of thrombosis, was >42 mm [P < 0.05] with 82% sensitivity and 50% specificity. CONCLUSIONS: An increase in clot strength was found to be predictive of thrombosis/stenosis within 30 days. Using a MA(ADP) cut-off greater than 42 mm might serve as an alternative approach to tailor the use of antiplatelet medication, potentially reducing the risk of thrombosis. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Suarez Ferreira, Sasha AU - Suarez Ferreira S AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA; Division Department of Surgery, Northwestern Medicine, Chicago, IL. FAU - Agrawal, Aniket AU - Agrawal A AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Lee, Ivy AU - Lee I AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Rodriguez, Adriana AU - Rodriguez A AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Cieri, Isabella AU - Cieri I AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Young, Elizabeth AU - Young E AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Patel, Shiv AU - Patel S AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Ghandour, Samir AU - Ghandour S AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Morena, Leela AU - Morena L AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Hagos, Fanah AU - Hagos F AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Grobman, Benjamin AU - Grobman B AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. FAU - Machlus, Kellie AU - Machlus K AD - Vascular Biology Program, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Boston, MA. FAU - Roy, Trisha AU - Roy T AD - Department of Cardiovascular Surgery, Houston Methodist, Weill Cornell Medical College, Houston, TX. FAU - Dua, Anahita AU - Dua A AD - Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: adua1@mgh.harvard.edu. LA - eng GR - R01 DK139341/DK/NIDDK NIH HHS/United States GR - R01 HL151494/HL/NHLBI NIH HHS/United States GR - R21 AG077310/AG/NIA NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20240726 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - Male MH - *Peripheral Arterial Disease/diagnosis/blood/therapy MH - Female MH - Aged MH - *Thrombelastography MH - *Thrombosis/blood/etiology/diagnosis MH - *Predictive Value of Tests MH - Prospective Studies MH - *Blood Coagulation/drug effects MH - Time Factors MH - Risk Factors MH - Middle Aged MH - Risk Assessment MH - Platelet Aggregation Inhibitors/therapeutic use/adverse effects MH - Treatment Outcome MH - Graft Occlusion, Vascular/etiology/blood MH - Aged, 80 and over MH - Endovascular Procedures/adverse effects MH - Platelet Function Tests PMC - PMC11524772 MID - NIHMS2014400 COIS- Conflicts of Interest: none EDAT- 2024/07/29 00:42 MHDA- 2024/10/31 04:54 PMCR- 2025/12/01 CRDT- 2024/07/28 19:14 PHST- 2024/05/01 00:00 [received] PHST- 2024/06/18 00:00 [revised] PHST- 2024/06/20 00:00 [accepted] PHST- 2024/10/31 04:54 [medline] PHST- 2024/07/29 00:42 [pubmed] PHST- 2024/07/28 19:14 [entrez] PHST- 2025/12/01 00:00 [pmc-release] AID - S0890-5096(24)00481-3 [pii] AID - 10.1016/j.avsg.2024.06.041 [doi] PST - ppublish SO - Ann Vasc Surg. 2024 Dec;109:273-283. doi: 10.1016/j.avsg.2024.06.041. Epub 2024 Jul 26. PMID- 39064259 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240729 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 14 DP - 2024 Jul 19 TI - Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry. LID - 10.3390/jcm13144219 [doi] LID - 4219 AB - Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result of the unique interactions between the patient, trauma, and resuscitation-related causes. The main objective of trauma resuscitation is to create the optimal milieu for both the development of immediate reparatory mechanisms and the prevention of further secondary injuries. Endotheliopathy represents one of the hallmarks of trauma-induced coagulopathy, and comprises endothelial dysfunction, abnormal coagulation, and inflammation, all of which arise after severe trauma and hemorrhagic shock. Methods: We retrospectively and descriptively evaluated 217 patients admitted to the Bucharest Clinical Emergency Hospital who met the Berlin criteria for the diagnosis of multiple trauma. Patients with high suspicion of auto-heparinization were identified according to the dynamic clinical and para-clinical evolution and subsequently tested using rotational thromboelastometry (ROTEM). The ratio between the clot formation time (CT) was used, obtained on the two channels of interest (INTEM/HEPTEM). Results: Among the 217 patients with a mean age of 43.43 +/- 15.45 years and a mean injury severity score (ISS) of 36.98 +/- 1.875, 42 patients had a reasonable clinical and para-clinical suspicion of auto-heparinization, which was later confirmed by the INTEM/HEPTEM clotting time ratio in 28 cases (12.9% from the entire study population). A multiple linear regression analysis highlighted that serum lactate (estimated 0.02, p = 0.0098) and noradrenaline requirement (estimated 0.03, p = 0.0053) influenced the CT (INTEM/HEPTEM) ratio. Conclusions: There is a subset of multiple trauma patients in which the CT (INTEM/HEPTEM) ratio was influenced only by serum lactate levels and patients' need for vasopressor use, reinforcing the relationship between shock, hypoperfusion, and clotting derangements. This emphasizes the unique response that each patient has to trauma. FAU - Baetu, Alexandru Emil AU - Baetu AE AUID- ORCID: 0009-0005-4194-087X AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Grigore Alexandrescu Clinical Emergency Hospital for Children, 011743 Bucharest, Romania. FAU - Mirea, Liliana AU - Mirea L AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. FAU - Cobilinschi, Cristian AU - Cobilinschi C AUID- ORCID: 0000-0002-1142-7427 AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. FAU - Grintescu, Ioana Cristina AU - Grintescu IC AD - Department of Anesthesiology and Intensive Care, Zetta Clinic, 020311 Bucharest, Romania. FAU - Grintescu, Ioana Marina AU - Grintescu IM AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. LA - eng PT - Journal Article DEP - 20240719 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC11278177 OTO - NOTNLM OT - auto-heparinization OT - critical care OT - multiple trauma OT - thromboelastometry OT - trauma-induced coagulopathy COIS- The authors declare no conflicts of interest. EDAT- 2024/07/27 10:47 MHDA- 2024/07/27 10:48 PMCR- 2024/07/19 CRDT- 2024/07/27 01:20 PHST- 2024/06/02 00:00 [received] PHST- 2024/07/13 00:00 [revised] PHST- 2024/07/17 00:00 [accepted] PHST- 2024/07/27 10:48 [medline] PHST- 2024/07/27 10:47 [pubmed] PHST- 2024/07/27 01:20 [entrez] PHST- 2024/07/19 00:00 [pmc-release] AID - jcm13144219 [pii] AID - jcm-13-04219 [pii] AID - 10.3390/jcm13144219 [doi] PST - epublish SO - J Clin Med. 2024 Jul 19;13(14):4219. doi: 10.3390/jcm13144219. PMID- 39064098 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240729 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 14 DP - 2024 Jul 11 TI - Early Point-of-Care Thromboelastometry Reduces Mortality in Patients with Severe Trauma and Risk of Transfusion: An Analysis Based on the TraumaRegister DGU((R)). LID - 10.3390/jcm13144059 [doi] LID - 4059 AB - Background: Thromboelastometry like ROTEM((R)) is a point-of-care method used to assess the coagulation status of patients in a rapid manner being particularly useful in critical care settings, such as trauma, where quick and accurate assessment of coagulation can guide timely and appropriate treatment. Currently, this method is not yet comprehensively available with sparse data on its effectiveness in resuscitation rooms. The aim of this study was to assess the effect of early thromboelastometry on the probability of mass transfusions and mortality of severely injured patients. Methods: The TraumaRegister DGU((R)) was retrospectively analyzed for severely injured patients (2011 until 2020) with information available regarding blood transfusions and Trauma-Associated Severe Hemorrhage (TASH) score components. Patients with an estimated risk of mass transfusion >2% were included in a matched-pair analysis. Cases with and without use of ROTEM((R)) diagnostic were matched based on risk categories for mass transfusion. A total of 1722 patients with ROTEM((R)) diagnostics could be matched with a non-ROTEM((R)) patient with an identical risk category. Adult patients (>/=16) admitted to a trauma center in Germany, Austria, or Switzerland with Maximum Abbreviated Injury Scale severity >/=3 were included. Results: A total of 83,798 trauma victims were identified after applying the inclusion and exclusion criteria. For 7740 of these patients, the use of ROTEM((R)) was documented. The mean Injury Severity Score (ISS) in patients with ROTEM((R)) was 24.3 compared to 19.7 in the non-ROTEM((R)) group. The number of mass transfusions showed no significant difference (14.9% ROTEM((R)) group vs. 13.4% non-ROTEM((R)) group, p = 0.45). Coagulation management agents were given significantly more often in the ROTEM((R)) subgroup. Mortality in the ROTEM((R)) group was 4.1% less than expected (estimated mortality based on RISC II 34.6% vs. observed mortality 30.5% (n = 525)). In the non-ROTEM((R)) group, observed mortality was 1.6% less than expected. Therefore, by using ROTEM((R)) analysis, the expected mortality could be reduced by 2.5% (number needed to treat (NNT) 40; SMR of ROTEM((R)) group: 1:0.88; SMR of non-ROTEM((R)) group: 1:0.96; p = 0.081). Conclusions: Hemorrhage is still one of the leading causes of death of severely injured patients in the first hours after trauma. Early thromboelastometry can lead to a more targeted coagulation management, but is not yet widely available. This study demonstrated that ROTEM((R)) was used for the more severely injured patients and that its use was associated with a less than expected mortality as well as a higher utilization of hemostatic products. FAU - Beyersdorf, Christoph AU - Beyersdorf C AUID- ORCID: 0000-0003-3975-6764 AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - Bieler, Dan AU - Bieler D AUID- ORCID: 0000-0002-0708-1259 AD - Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, 56072 Koblenz, Germany. FAU - Lefering, Rolf AU - Lefering R AD - Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 58455 Cologne, Germany. FAU - Imach, Sebastian AU - Imach S AD - Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 58455 Cologne, Germany. FAU - Hackenberg, Lisa AU - Hackenberg L AD - Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, 56072 Koblenz, Germany. FAU - Schiffner, Erik AU - Schiffner E AUID- ORCID: 0000-0002-3897-0964 AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - Thelen, Simon AU - Thelen S AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - Lakomek, Felix AU - Lakomek F AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - Windolf, Joachim AU - Windolf J AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - Jaekel, Carina AU - Jaekel C AUID- ORCID: 0000-0003-2188-3861 AD - Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany. FAU - TraumaRegister Dgu AU - TraumaRegister Dgu AD - Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU(R)), 10623 Berlin, Germany. LA - eng PT - Journal Article DEP - 20240711 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC11277494 OTO - NOTNLM OT - ROTEM(R), thromboelastometry OT - bleeding OT - coagulopathy OT - massive transfusion OT - point-of-care OT - trauma COIS- The authors declare no conflicts of interest. EDAT- 2024/07/27 10:47 MHDA- 2024/07/27 10:48 PMCR- 2024/07/11 CRDT- 2024/07/27 01:19 PHST- 2024/04/20 00:00 [received] PHST- 2024/07/01 00:00 [revised] PHST- 2024/07/06 00:00 [accepted] PHST- 2024/07/27 10:48 [medline] PHST- 2024/07/27 10:47 [pubmed] PHST- 2024/07/27 01:19 [entrez] PHST- 2024/07/11 00:00 [pmc-release] AID - jcm13144059 [pii] AID - jcm-13-04059 [pii] AID - 10.3390/jcm13144059 [doi] PST - epublish SO - J Clin Med. 2024 Jul 11;13(14):4059. doi: 10.3390/jcm13144059. PMID- 39063005 OWN - NLM STAT- MEDLINE DCOM- 20240727 LR - 20240729 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 25 IP - 14 DP - 2024 Jul 16 TI - Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury. LID - 10.3390/ijms25147763 [doi] LID - 7763 AB - Coagulopathy and traumatic brain injury (TBI) are complexly intertwined. In isolated TBI, coagulopathy may contribute to hemorrhagic lesion development, progression, or recurrence, as it may lead to a particular pattern of coagulopathy called TBI-induced coagulopathy (TBI-IC). We performed a retrospective and descriptive evaluation of 63 patients admitted to the Emergency Clinical Hospital Bucharest with the diagnosis of moderate/severe brain injury. In addition to demographic data, all included patients had a complete paraclinical evaluation that included rotational thromboelastometric (ROTEM) blood-clot analysis. The platelet component (PLTEM) and the endotheliopathy activation and stress index score (EASIX) were calculated. These parameters were presented comparatively according to survival at 30 days and helped define the two study groups: survivors and non-survivors at 30 days. The contribution of platelets to clot strength is derived from maximum clot elasticity (MCE) and maximum clot firmness (MCF). MCE is defined as (MCF x 100)/(100 - MCF), and PLTEM is defined as EXTEM MCE-FIBTEM MCE. EASIX is a novel biomarker recently studied in TBI patients, calculated according to the following formula: lactate dehydrogenase (U/L) x creatinine (mg/dL)/platelets (10(9) cells/L). Regarding the demographic data, there were no significant differences between the survivors and non-survivors. All ROTEM parameters related to clot amplitude (A5, A10, A20, MCF in EXTEM and FIBTEM channels) were higher in the group of patients who survived. Also, PLTEM was decreased in the group of deceased patients (89.71 +/- 22.86 vs. 132.3 +/- 16.56 p < 0.0001). The cut-off point determined with the ROC curve is 114.10, with a sensitivity of 94.74% and a specificity of 93.18%, for the detection of the negative prognosis (death at 30 days). The EASIX score was significantly higher in the patients who survived the traumatic event, with a median difference value of 1.15 (p < 0.0001). The ROC analysis of this biomarker highlights a cut-off point of 2.12, with a sensitivity of 88.64% and a specificity of 94.74% (AUC = 0.95, p < 0.0001), for the prediction of mortality. The comparative analysis of the two studied markers was performed using the Cox proportional hazard ratio and highlighted the greater influence that PLTEM has on survival time (b value = -0.05, p < 0.0001) compared to EASIX (b value = 0.49, p = 0.0026). The present retrospective study indicates the potential of the TBI-IC reflecting parameters PLTEM and EASIX as markers of mortality prognosis. Larger prospective studies are needed to confirm their combined prognostic value and use in decision-making and reduction in the burden of disease by adequate allocation of resources in a personalized and timely manner. FAU - Baetu, Alexandru Emil AU - Baetu AE AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Grigore Alexandrescu Clinical Emergency Hospital for Children, 011743 Bucharest, Romania. FAU - Mirea, Liliana Elena AU - Mirea LE AUID- ORCID: 0000-0002-1136-6150 AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. FAU - Cobilinschi, Cristian AU - Cobilinschi C AUID- ORCID: 0000-0002-1142-7427 AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. FAU - Grintescu, Ioana Cristina AU - Grintescu IC AD - Department of Anesthesiology and Intensive Care, Zetta Clinic, 020311 Bucharest, Romania. FAU - Grintescu, Ioana Marina AU - Grintescu IM AD - Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania. AD - Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania. LA - eng PT - Journal Article DEP - 20240716 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Biomarkers) SB - IM MH - Humans MH - *Brain Injuries, Traumatic/mortality/blood/complications/physiopathology MH - Male MH - Female MH - Middle Aged MH - Adult MH - *Blood Platelets/metabolism MH - Retrospective Studies MH - Thrombelastography MH - Aged MH - Prognosis MH - Biomarkers/blood MH - Blood Coagulation Disorders/etiology/mortality/blood PMC - PMC11276696 OTO - NOTNLM OT - EASIX OT - PLTEM OT - ROTEM OT - TBI-induced coagulopathy OT - clot elasticity OT - trauma-induced coagulopathy OT - traumatic brain injury COIS- The authors declare no conflicts of interest. EDAT- 2024/07/27 10:47 MHDA- 2024/07/28 14:51 PMCR- 2024/07/16 CRDT- 2024/07/27 01:13 PHST- 2024/06/08 00:00 [received] PHST- 2024/07/09 00:00 [revised] PHST- 2024/07/14 00:00 [accepted] PHST- 2024/07/28 14:51 [medline] PHST- 2024/07/27 10:47 [pubmed] PHST- 2024/07/27 01:13 [entrez] PHST- 2024/07/16 00:00 [pmc-release] AID - ijms25147763 [pii] AID - ijms-25-07763 [pii] AID - 10.3390/ijms25147763 [doi] PST - epublish SO - Int J Mol Sci. 2024 Jul 16;25(14):7763. doi: 10.3390/ijms25147763. PMID- 39036674 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240723 IS - 0973-6247 (Print) IS - 1998-3565 (Electronic) IS - 0973-6247 (Linking) VI - 18 IP - 1 DP - 2024 Jan-Jun TI - Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes. PG - 7-15 LID - 10.4103/ajts.ajts_56_23 [doi] AB - BACKGROUND AND OBJECTIVE: We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock. MATERIALS AND METHODS: This was a retro-prospective case-control study conducted over a period of 2 years among the patients who received MT using a 1:1:1 fixed ratio protocol (controls, Group A) and goal-based protocol (cases, Group B) guided through TEG. Patients were matched for the type and severity of the clinical conditions. Utilization of blood components, clinical outcomes, transfusion-related complications, and total mortality rates were compared between the groups. RESULTS: There were 113 patients in the formula-based group and 109 patients in the goal-based transfusion group who were matched for injury severity scores. The total blood components utilized were 1867 and 1560, respectively, with a 17.7% reduction associated with the use of TEG. Patients were divided into normal, hypo, and hypercoagulable based on TEG, and a higher transfusion rate was associated with hypocoagulable TEG (942 vs. 610). The prothrombin time, activated partial thromboplastin time, R time, and K time had a significant positive correlation with the need to transfuse more than 20 blood components, whereas platelet count, base excess, alpha angle, MA, and CI had a negative correlation (r = 0.268, P < 0.001). At the end of goal-directed transfusion, 75% of the patients were free of transfusion support (vs. 65.4%) and only 6.9% of the patients had coagulopathy (vs. 31.8%) compared to formula-based resuscitation with a 10% reduction in mortality. CONCLUSION: TEG-guided goal-based approach helped to reduce blood component utilization with a reduced incidence of coagulopathy at the end of the MT while improving patient survival. CI - Copyright: (c) 2024 Asian Journal of Transfusion Science. FAU - Prethika, P A AU - Prethika PA AD - Department of Immunohematology and Blood Transfusion, Apollo Hospitals, Chennai, Tamil Nadu, India. AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India. FAU - Mohan, Ganesh AU - Mohan G AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India. FAU - Shastry, Shamee AU - Shastry S AD - Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India. FAU - Balakrishnan, Jayaraj Mymbilly AU - Balakrishnan JM AD - Department of Emergency Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India. LA - eng PT - Journal Article DEP - 20240621 PL - India TA - Asian J Transfus Sci JT - Asian journal of transfusion science JID - 101306858 PMC - PMC11259345 OTO - NOTNLM OT - Blood utilization OT - goal-directed massive transfusion OT - hemorrhagic shock OT - massive transfusion OT - thromboelastogram COIS- There are no conflicts of interest. EDAT- 2024/07/22 06:43 MHDA- 2024/07/22 06:44 PMCR- 2024/01/01 CRDT- 2024/07/22 05:36 PHST- 2023/03/15 00:00 [received] PHST- 2023/09/05 00:00 [revised] PHST- 2024/02/04 00:00 [accepted] PHST- 2024/07/22 06:44 [medline] PHST- 2024/07/22 06:43 [pubmed] PHST- 2024/07/22 05:36 [entrez] PHST- 2024/01/01 00:00 [pmc-release] AID - AJTS-18-7 [pii] AID - 10.4103/ajts.ajts_56_23 [doi] PST - ppublish SO - Asian J Transfus Sci. 2024 Jan-Jun;18(1):7-15. doi: 10.4103/ajts.ajts_56_23. Epub 2024 Jun 21. PMID- 39024728 OWN - NLM STAT- MEDLINE DCOM- 20241123 LR - 20241202 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 238 DP - 2024 Dec TI - Multicenter analysis of massive transfusion practices demonstrates variabilities across trauma centers in the Southwestern Surgical Congress. PG - 115819 LID - S0002-9610(24)00371-4 [pii] LID - 10.1016/j.amjsurg.2024.115819 [doi] AB - BACKGROUND: This study's purpose is to investigate emergent blood (EB) usage, massive transfusion protocols (MTP), and the use of pharmacologic adjuncts to resuscitation across trauma centers in the Southwestern Surgical Congress (SWSC). METHODS: Anonymous, voluntary 26-question survey conducted by the SWSC multicenter trials group. Descriptive statistical analysis was performed. RESULTS: 36 institutions across 14 states responded. EB is immediately available at 27 institutions. 53 ​% have LTOWB available. LTOWB is incorporated into MTP at 39 ​% of institutions and is the primary MTP product used at 4 centers. 65 ​% of institutions use thromboelastography to guide resuscitation. 70 ​% of institutions reported using TXA and 11 ​% used fibrinogen concentrate. 36 ​% of responding institutions routinely draw ionized calcium values. Four institutions have a calcium replacement protocol. Only 6 centers report redosing antibiotics during MTP. CONCLUSION: EB availability and MTP practices are evolving with variability across the SWSC. Pharmacologic therapies remain poorly incorporated into the MTP. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Hall, Chad AU - Hall C AD - Baylor Scott & White Memorial Hospital, Temple, TX, USA. Electronic address: Chad.hall@bswhealth.org. FAU - Shaver, Courtney AU - Shaver C AD - Baylor Scott & White Memorial Hospital, Temple, TX, USA. FAU - Regner, Justin AU - Regner J AD - Baylor Scott & White Memorial Hospital, Temple, TX, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20240711 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Humans MH - *Trauma Centers MH - *Blood Transfusion/statistics & numerical data MH - Resuscitation/methods MH - Surveys and Questionnaires MH - United States MH - Wounds and Injuries/therapy/surgery MH - Practice Patterns, Physicians'/statistics & numerical data MH - Congresses as Topic MH - Hemorrhage/therapy MH - Thrombelastography COIS- Declaration of competing Competing interest The authors have no relevant financial conflicts of interest to declare. No external funding was received for completion of this work. EDAT- 2024/07/19 00:42 MHDA- 2024/11/24 00:44 CRDT- 2024/07/18 18:18 PHST- 2024/04/15 00:00 [received] PHST- 2024/06/18 00:00 [revised] PHST- 2024/07/01 00:00 [accepted] PHST- 2024/11/24 00:44 [medline] PHST- 2024/07/19 00:42 [pubmed] PHST- 2024/07/18 18:18 [entrez] AID - S0002-9610(24)00371-4 [pii] AID - 10.1016/j.amjsurg.2024.115819 [doi] PST - ppublish SO - Am J Surg. 2024 Dec;238:115819. doi: 10.1016/j.amjsurg.2024.115819. Epub 2024 Jul 11. PMID- 39003092 OWN - NLM STAT- MEDLINE DCOM- 20241123 LR - 20241123 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 238 DP - 2024 Dec TI - Marijuana may lead to increased platelet activity in trauma patients. PG - 115822 LID - S0002-9610(24)00374-X [pii] LID - 10.1016/j.amjsurg.2024.115822 [doi] AB - INTRODUCTION: Delta-9-tetraydrocannabinol (THC) usage is associated with venous thromboembolic events (VTE) in trauma patients. We hypothesized that THC ​+ ​trauma patients would have less platelet inhibition than THC - patients using thromboelastography with platelet mapping (TEG-PM). METHODS: Results from initial TEG- PM assays and patient's UDS were reviewed between 2019 and 2023. Mean levels of arachidonic acid (AA) and adenosine diphosphate (ADP) percent inhibition were compared by THC status. RESULTS: 793 patients had TEG-PM and UDS data. Mean levels of arachidonic acid (AA) percentage inhibition were 32.6 ​+/- ​34.2. AA inhibition was lower for THC ​+ ​vs THC- patients (THC+ 23.9 ​+/- ​27.0 vs THC- 34.3 ​+/- ​35.3, P ​< ​0.001). There was no association between THC status and ADP inhibition (THC+ 32.5 ​+/- ​27.1 vs THC- 30.8 ​+/- ​28.4, P ​= ​0.536). DISCUSSION: To our knowledge, our data are the first to suggest a clinically measurable increase in platelet reactivity in THC ​+ ​trauma patients. More work is needed to determine if addition of aspirin to the chemoprophylaxis strategy for THC ​+ ​patients would mitigate the known association of THC with VTE. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Tanner, Danielle F AU - Tanner DF AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: DanielleTanner@Creighton.edu. FAU - Eastes, Joel G AU - Eastes JG AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: JoelEastes@Creighton.edu. FAU - Reeson, Emily A AU - Reeson EA AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: emilyreeson@creighton.edu. FAU - Lam, Eric W AU - Lam EW AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: ericlam@creighton.edu. FAU - Rahaman, Clay A AU - Rahaman CA AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: clayrahaman@creighton.edu. FAU - O'Toole, Devin M AU - O'Toole DM AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: devinotoole@creighton.edu. FAU - Tolan, Grace C AU - Tolan GC AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: gracetolan@creighton.edu. FAU - Babarinde, Oluwatosin A AU - Babarinde OA AD - Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA, USA. Electronic address: oluwatosinbabarinde@creighton.edu. FAU - Kupanoff, Kristina M AU - Kupanoff KM AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Kristina.Kupanoff@commonspirit.org. FAU - Huang, Dih-Dih AU - Huang DD AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Dih-Dih.Huang900@commonspirit.org. FAU - Jones, Michael D AU - Jones MD AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Michael.Jones900@commonspirit.org. FAU - Czarkowski, Brian R AU - Czarkowski BR AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Brian.Czarkowski@Commonspirit.org. FAU - Weinberg, Jordan A AU - Weinberg JA AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Jordan.Weinberg@Commonspirit.org. FAU - Bogert, James N AU - Bogert JN AD - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: James.Bogert@Commonspirit.org. LA - eng PT - Journal Article DEP - 20240702 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - 7J8897W37S (Dronabinol) RN - 27YG812J1I (Arachidonic Acid) SB - IM MH - Humans MH - Female MH - Male MH - *Wounds and Injuries/complications/blood MH - Adult MH - *Dronabinol/pharmacology MH - Middle Aged MH - *Thrombelastography MH - Platelet Activation/drug effects MH - Retrospective Studies MH - Venous Thromboembolism/prevention & control/etiology/blood MH - Arachidonic Acid/blood OTO - NOTNLM OT - Delta-9-tetraydrocannabinol (THC) OT - Platelet activation OT - Platelet mapping OT - Thromboelastography (TEG) OT - Venous thromboembolism (VTE) COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/07/14 02:43 MHDA- 2024/11/24 00:44 CRDT- 2024/07/13 21:56 PHST- 2024/04/08 00:00 [received] PHST- 2024/06/13 00:00 [revised] PHST- 2024/07/01 00:00 [accepted] PHST- 2024/11/24 00:44 [medline] PHST- 2024/07/14 02:43 [pubmed] PHST- 2024/07/13 21:56 [entrez] AID - S0002-9610(24)00374-X [pii] AID - 10.1016/j.amjsurg.2024.115822 [doi] PST - ppublish SO - Am J Surg. 2024 Dec;238:115822. doi: 10.1016/j.amjsurg.2024.115822. Epub 2024 Jul 2. PMID- 38974221 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240709 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 9 IP - 1 DP - 2024 TI - Using microfluidic shear to assess transfusion requirements in trauma patients. PG - e001403 LID - 10.1136/tsaco-2024-001403 [doi] LID - e001403 AB - BACKGROUND: Viscoelastic assays have widely been used for evaluating coagulopathies but lack the addition of shear stress important to in vivo clot formation. Stasys technology subjects whole blood to shear forces over factor-coated surfaces. Microclot formation is analyzed to determine clot area (CA) and platelet contractile forces (PCFs). We hypothesize the CA and PCF from this novel assay will provide information that correlates with trauma-induced coagulopathy and transfusion requirements. METHODS: Blood samples were collected on adult trauma patients from a single-institution prospective cohort study of high-level activations. Patient and injury characteristics, transfusion data, and outcomes were collected. Thromboelastography, coagulation studies, and Stasys assays were run on paired samples collected at admission. Stasys CA and PCFs were quantified as area under the curve calculations and maximum values. Normal ranges for Stasys assays were determined using healthy donors. Data were compared using Kruskal-Wallis tests and simple linear regression. RESULTS: From March 2021 to January 2023, 108 samples were obtained. Median age was 37.5 (IQR 27.5-52) years; patients were 77% male. 71% suffered blunt trauma, 26% had an Injury Severity Score of >/=25. An elevated international normalized ratio significantly correlated with decreased cumulative PCF (p=0.05), maximum PCF (p=0.05) and CA (p=0.02). Lower cumulative PCF significantly correlated with transfusion of any products at 6 and 24 hours (p=0.04 and p=0.05) as well as packed red blood cells (pRBCs) at 6 and 24 hours (p=0.04 and p=0.03). A decreased maximum PCF showed significant correlation with receiving any transfusion at 6 (p=0.04) and 24 hours (p=0.02) as well as transfusion of pRBCs, fresh frozen plasma, and platelets in the first 6 hours (p=0.03, p=0.03, p=0.03, respectively). CONCLUSIONS: Assessing coagulopathy in real time remains challenging in trauma patients. In this pilot study, we demonstrated that microfluidic approaches incorporating shear stress could predict transfusion requirements at time of admission as well as requirements in the first 24 hours. LEVEL OF EVIDENCE: Level II. CI - (c) Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Vuoncino, Leslie H AU - Vuoncino LH AUID- ORCID: 0009-0002-4522-8853 AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Robles, Anamaria J AU - Robles AJ AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Barnes, Ashli C AU - Barnes AC AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Ross, James T AU - Ross JT AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Graeff, Leonardo W AU - Graeff LW AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Anway, Taylor L AU - Anway TL AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Vincent, Nico T AU - Vincent NT AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Tippireddy, Nithya AU - Tippireddy N AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Tanaka, Kimi M AU - Tanaka KM AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Mays, Randi J AU - Mays RJ AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Callcut, Rachael A AU - Callcut RA AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. LA - eng GR - R01 HL149670/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20240705 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC11227844 OTO - NOTNLM OT - Blood coagulation OT - Inflammation OT - blood coagulation tests OT - blood transfusion COIS- Competing interests: None declared. EDAT- 2024/07/08 12:43 MHDA- 2024/07/08 12:44 PMCR- 2024/07/05 CRDT- 2024/07/08 07:29 PHST- 2024/01/31 00:00 [received] PHST- 2024/05/31 00:00 [accepted] PHST- 2024/07/08 12:44 [medline] PHST- 2024/07/08 12:43 [pubmed] PHST- 2024/07/08 07:29 [entrez] PHST- 2024/07/05 00:00 [pmc-release] AID - tsaco-2024-001403 [pii] AID - 10.1136/tsaco-2024-001403 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2024 Jul 5;9(1):e001403. doi: 10.1136/tsaco-2024-001403. eCollection 2024. PMID- 38930139 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240629 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 12 DP - 2024 Jun 20 TI - The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays? LID - 10.3390/jcm13123612 [doi] LID - 3612 AB - Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well as providing a concise narrative review of the published evidence to guide its use in various clinical settings. Notably, there is increasing evidence of the potential utility of viscoelastic testing for assessment of direct oral anticoagulants, and bleeding associated with chronic liver disease, orthotopic liver transplantation, cardiac surgery, trauma, obstetrics and pediatrics. FAU - Reardon, Benjamin AU - Reardon B AUID- ORCID: 0000-0002-5767-508X AD - School of Medicine and Public Health, Joint Medical Program, University of Newcastle, Callaghan, NSW 2145, Australia. AD - Haematology Department, Calvary Mater Hospital Newcastle, Waratah, NSW 2298, Australia. FAU - Pasalic, Leonardo AU - Pasalic L AD - Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia. AD - Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia. AD - Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW 2145, Australia. FAU - Favaloro, Emmanuel J AU - Favaloro EJ AUID- ORCID: 0000-0002-2103-1661 AD - Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia. AD - Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW 2145, Australia. AD - School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW 2650, Australia. AD - School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia. LA - eng PT - Journal Article PT - Review DEP - 20240620 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC11205135 OTO - NOTNLM OT - coagulation OT - hemostasis OT - transfusion OT - viscoelastic testing COIS- E.J.F. is a Section Board Member for the Journal of Clinical Medicine. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2024/06/27 06:42 MHDA- 2024/06/27 06:43 PMCR- 2024/06/20 CRDT- 2024/06/27 01:16 PHST- 2024/05/01 00:00 [received] PHST- 2024/06/18 00:00 [revised] PHST- 2024/06/18 00:00 [accepted] PHST- 2024/06/27 06:43 [medline] PHST- 2024/06/27 06:42 [pubmed] PHST- 2024/06/27 01:16 [entrez] PHST- 2024/06/20 00:00 [pmc-release] AID - jcm13123612 [pii] AID - jcm-13-03612 [pii] AID - 10.3390/jcm13123612 [doi] PST - epublish SO - J Clin Med. 2024 Jun 20;13(12):3612. doi: 10.3390/jcm13123612. PMID- 38922177 OWN - NLM STAT- MEDLINE DCOM- 20240626 LR - 20250424 IS - 2072-6651 (Electronic) IS - 2072-6651 (Linking) VI - 16 IP - 6 DP - 2024 Jun 20 TI - The Clot Thickens: Differential Coagulotoxic and Cardiotoxic Activities of Anguimorpha Lizard Venoms. LID - 10.3390/toxins16060283 [doi] LID - 283 AB - Despite their evolutionary novelty, lizard venoms are much less studied in comparison to the intense research on snake venoms. While the venoms of helodermatid lizards have long been assumed to be for defensive purposes, there is increasing evidence of toxic activities more useful for predation than defence (such as paralytic neurotoxicity). This study aimed to ascertain the effects of Heloderma, Lanthanotus, and Varanus lizard venoms on the coagulation and cardiovascular systems. Anticoagulant toxicity was demonstrated for the Varanus species studied, with the venoms prolonging clotting times in human and bird plasma due to the destructive cleavage of fibrinogen. In contrast, thromboelastographic analyses on human and bird plasmas in this study demonstrated a procoagulant bioactivity for Heloderma venoms. A previous study on Heloderma venom using factor-depleted plasmas as a proxy model suggested a procoagulant factor was present that activated either Factor XI or Factor XII, but could not ascertain the precise target. Our activation studies using purified zymogens confirmed FXII activation. Comparisons of neonate and adult H. exasperatum, revealed the neonates to be more potent in the ability to activate FXII, being more similar to the venom of the smaller species H. suspectum than the adult H. exasperatum. This suggests potent FXII activation a basal trait in the genus, present in the small bodied last common ancestor. This also indicates an ontogenetic difference in prey preferences in the larger Heloderma species paralleing the change in venom biochemistry. In addition, as birds lack Factor XII, the ability to clot avian plasma suggested an additional procoagulant site of action, which was revealed to be the activation of Factor VII, with H. horridum being the most potent. This study also examined the effects upon the cardiovascular system, including the liberation of kinins from kininogen, which contributes to hypotension induction. This form of toxicity was previously described for Heloderma venoms, and was revealed in this study was to also be a pathophysiological effect of Lanthanotus and Varanus venoms. This suggests that this toxic activity was present in the venom of the last common ancestor of the anguimorph lizards, which is consistent with kallikrein enzymes being a shared toxin trait. This study therefore uncovered novel actions of anguimorph lizard venoms, not only contributing to the evolutionary biology body of knowledge but also revealing novel activities to mine for drug design lead compounds. FAU - Dobson, James AU - Dobson J AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD 4072, Australia. FAU - Chowdhury, Abhinandan AU - Chowdhury A AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD 4072, Australia. FAU - Tai-A-Pin, Jeremie AU - Tai-A-Pin J AD - Venomenal Volunteers, The Netherlands. FAU - van der Ploeg, Harold AU - van der Ploeg H AD - Working Group Adder Research Netherlands, RAVON, 6525 ED Nijmegen, The Netherlands. FAU - Gillett, Amber AU - Gillett A AD - FaunaVet Wildlife Consultancy, Glass House Mountains, QLD 4518, Australia. FAU - Fry, Bryan G AU - Fry BG AUID- ORCID: 0000-0001-6661-1283 AD - Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD 4072, Australia. LA - eng GR - DP190100304/Australian Research Council/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20240620 PL - Switzerland TA - Toxins (Basel) JT - Toxins JID - 101530765 RN - 0 (Anticoagulants) RN - 0 (Venoms) RN - 0 (Cardiotoxins) SB - IM MH - Animals MH - *Lizards/physiology MH - *Blood Coagulation/drug effects MH - Humans MH - Anticoagulants/toxicity MH - Birds MH - Venoms/toxicity MH - Cardiotoxins/toxicity MH - Thrombelastography MH - Cardiotoxicity PMC - PMC11209219 OTO - NOTNLM OT - Heloderma OT - Varanus OT - coagulation OT - evolution OT - lizard OT - venom COIS- The authors declare no conflicts of interest. EDAT- 2024/06/26 12:42 MHDA- 2024/06/26 12:43 PMCR- 2024/06/20 CRDT- 2024/06/26 10:04 PHST- 2024/05/29 00:00 [received] PHST- 2024/06/11 00:00 [revised] PHST- 2024/06/17 00:00 [accepted] PHST- 2024/06/26 12:43 [medline] PHST- 2024/06/26 12:42 [pubmed] PHST- 2024/06/26 10:04 [entrez] PHST- 2024/06/20 00:00 [pmc-release] AID - toxins16060283 [pii] AID - toxins-16-00283 [pii] AID - 10.3390/toxins16060283 [doi] PST - epublish SO - Toxins (Basel). 2024 Jun 20;16(6):283. doi: 10.3390/toxins16060283. PMID- 38902134 OWN - NLM STAT- MEDLINE DCOM- 20240828 LR - 20250411 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 50 IP - 7 DP - 2024 Sep TI - Factor XIII in major burns coagulation. PG - 1769-1778 LID - S0305-4179(24)00143-8 [pii] LID - 10.1016/j.burns.2024.05.002 [doi] AB - BACKGROUND: In the days following a burn injury, major burn patients (MBP) present a multifactorial coagulation disorder known as acute burn-induced coagulopathy. Several studies have investigated coagulation in MBPs; however, Factor XIII (FXIII), which converts fibrin monomers into a stable clot and promotes wound healing, has not yet been studied. OBJECTIVE: To determine the kinetics of FXIII and other coagulation factors and cofactors in MBPs in order to clarify coagulopathy in these patients and its potential relationship with surgical bleeding. METHODS: Prospective observational pilot study of the kinetics of FXIII and other coagulation factors and cofactors in MBPs during the first 30 days of burn injury. RESULTS: FXIII levels show a significant decline of 75.10% in the interval between the burn injury and surgery, and a decline of 87.70% in the 24 h following surgery. Patients undergo surgery with a median antigenic FXIII of 32%. Plasma levels of most factors decrease significantly 24 h after the burn injury. CONCLUSION: MBPs experience a significant decrease in plasma levels of FXIII from the time of admission up to 24 h after surgery. Abnormally low levels were observed at the time of surgery that could not be detected by other coagulation tests. The decrease in most factors at 24 h seems to be associated with dilution due to intensive fluid resuscitation. CI - Copyright (c) 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved. FAU - Guilabert, Patricia AU - Guilabert P AD - Anesthesia and Critical Care Department. University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: patricia.guilabert@gmail.com. FAU - Abarca, Luis AU - Abarca L AD - Anesthesia and Critical Care Department. University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: labarcavilchez@gmail.com. FAU - Usua, Gemma AU - Usua G AD - Anesthesia and Critical Care Department. University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: gemmausua@gmail.com. FAU - Martin, Nuria AU - Martin N AD - Anesthesia and Critical Care Department. Hospital Clinic Barcelona, Spain. Electronic address: nmartinmarata@gmail.com. FAU - Alonso, Maria AU - Alonso M AD - Anesthesia and Critical Care Department. University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: mrlns.07@gmail.com. FAU - Barret, Joan P AU - Barret JP AD - Plastic Surgery Department and Burn Centre. University Hospital Vall d'Hebron. Autonomous University of Barcelona, Barcelona, Spain. Electronic address: jpbarret@vhebron.net. FAU - Colomina, Maria J AU - Colomina MJ AD - Anesthesia and Critical Care Department, University Bellvitge Hospital, University of Barcelona, Barcelona, Spain. Electronic address: mjcolomina@bellvitgehospital.cat. LA - eng PT - Journal Article PT - Observational Study DEP - 20240510 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - 9013-56-3 (Factor XIII) SB - IM MH - *Burns/blood/metabolism/complications MH - Humans MH - Male MH - Adult MH - Female MH - Middle Aged MH - *Factor XIII/metabolism MH - Prospective Studies MH - Pilot Projects MH - *Blood Coagulation Disorders/etiology/blood MH - Aged MH - Young Adult MH - Blood Coagulation/physiology OTO - NOTNLM OT - Blood coagulation OT - Blood coagulation disorders OT - Blood coagulation test OT - Burns OT - Factor XIII OT - Thrombelastography COIS- Declaration of Competing Interest The authors declare not having any conflict of interest related to this manuscript. EDAT- 2024/06/21 00:42 MHDA- 2024/08/31 09:45 CRDT- 2024/06/20 21:57 PHST- 2023/08/22 00:00 [received] PHST- 2024/04/25 00:00 [revised] PHST- 2024/05/02 00:00 [accepted] PHST- 2024/08/31 09:45 [medline] PHST- 2024/06/21 00:42 [pubmed] PHST- 2024/06/20 21:57 [entrez] AID - S0305-4179(24)00143-8 [pii] AID - 10.1016/j.burns.2024.05.002 [doi] PST - ppublish SO - Burns. 2024 Sep;50(7):1769-1778. doi: 10.1016/j.burns.2024.05.002. Epub 2024 May 10. PMID- 38899908 OWN - NLM STAT- MEDLINE DCOM- 20241229 LR - 20261018 IS - 1524-4040 (Electronic) IS - 0148-396X (Linking) VI - 95 IP - 5 DP - 2024 Nov 1 TI - Coagulopathy in Penetrating Ballistic Cranial Trauma: A 7-Year Experience. PG - 1186-1190 LID - 10.1227/neu.0000000000002995 [doi] AB - BACKGROUND AND OBJECTIVES: Penetrating ballistic cranial trauma (PBCT) carries significant mortality when compared with blunt trauma. The development of coagulopathy in PBCT is a strong predictor of mortality. The goal of the study was to describe the incidence and risk factors of coagulopathy in PBCT and to report the value of tranexamic acid administration in PBCT. METHODS: We retrospectively analyzed 270 patients who presented with PBCT to a single, Level 1 trauma center between 2016 and 2023. RESULTS: A total of 47% (127/270) of patients with PBCT developed coagulopathy at presentation. Fifty-seven patients received tranexamic acid at presentation, which did not affect the development of coagulopathy. Coagulopathic patients were more likely to have more serious injury patterns (bihemispheric [adjusted odds ratio, aOR: 2.6 CI: 1.4-4.9, P = .004] or transventricular trajectories [aOR: 4.9 CI: 1.9-19.6, P = .03]). In addition, they presented with a larger base deficit (aOR: 0.9 CI: 1.002-1.2 per mEq/L, P = .006) which negatively correlated with the international normalized ratio (rho: -0.46, P < .0001, Spearman correlation). Using thromboelastography helped to identify an additional 20% of patients who presented with normal coagulation on conventional testing. CONCLUSION: Coagulopathy is prevalent in approximately 50% of patients with PBCT and is persistent despite treatment in a substantial subset of patients. The addition of thromboelastography with its increased coagulopathy sensitivity can potentially guide treatment more efficiently than traditional coagulopathy laboratory tests and fibrinogen alone. Patients with a significant base deficit on arterial blood gas are at higher risk for coagulopathy. CI - Copyright (c) Congress of Neurological Surgeons 2024. All rights reserved. FAU - Alhourani, Ahmad AU - Alhourani A AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. FAU - Stephenson, Tyler L AU - Stephenson TL AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. FAU - Bridwell, Elizabeth M AU - Bridwell EM AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. FAU - Danehower, Sarah E AU - Danehower SE AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. FAU - Walek, Konrad W AU - Walek KW AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. FAU - Smith, Jason W AU - Smith JW AD - Department of General Surgery, University of Louisville, Louisville , Kentucky , USA. FAU - Sieg, Emily AU - Sieg E AUID- ORCID: 0000-0002-6354-9880 AD - Department of Neurosurgery, University of Louisville, Louisville , Kentucky , USA. LA - eng PT - Journal Article DEP - 20240620 PL - United States TA - Neurosurgery JT - Neurosurgery JID - 7802914 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Humans MH - *Blood Coagulation Disorders/etiology/epidemiology MH - Male MH - Female MH - Adult MH - Retrospective Studies MH - *Head Injuries, Penetrating/complications/diagnostic imaging MH - Middle Aged MH - Wounds, Gunshot/complications MH - Antifibrinolytic Agents/therapeutic use MH - Tranexamic Acid/therapeutic use MH - Young Adult MH - Risk Factors EDAT- 2024/06/20 12:43 MHDA- 2024/12/29 18:16 CRDT- 2024/06/20 09:04 PHST- 2023/11/16 00:00 [received] PHST- 2024/03/25 00:00 [accepted] PHST- 2024/12/29 18:16 [medline] PHST- 2024/06/20 12:43 [pubmed] PHST- 2024/06/20 09:04 [entrez] AID - 00006123-202411000-00025 [pii] AID - 10.1227/neu.0000000000002995 [doi] PST - ppublish SO - Neurosurgery. 2024 Nov 1;95(5):1186-1190. doi: 10.1227/neu.0000000000002995. Epub 2024 Jun 20. PMID- 38837523 OWN - NLM STAT- MEDLINE DCOM- 20240812 LR - 20240812 IS - 1095-8355 (Electronic) IS - 1065-6995 (Linking) VI - 48 IP - 9 DP - 2024 Sep TI - Lysophosphatidylcholine induces oxidative stress and calcium-mediated cell death in human blood platelets. PG - 1266-1284 LID - 10.1002/cbin.12192 [doi] AB - Platelets are essential component of circulation that plays a major role in hemostasis and thrombosis. During activation and its demise, platelets release platelet-derived microvesicles, with lysophosphatidylcholine (LPC) being a prominent component in their lipid composition. LPC, an oxidized low-density lipoprotein, is involved in cellular metabolism, but its higher level is implicated in pathologies like atherosclerosis, diabetes, and inflammatory disorders. Despite this, its impact on platelet function remains relatively unexplored. To address this, we studied LPC's effects on washed human platelets. A multimode plate reader was employed to measure reactive oxygen species and intracellular calcium using H(2)DCF-DA and Fluo-4-AM, respectively. Flow cytometry was utilized to measure phosphatidylserine expression, mitochondrial membrane potential (DeltaPsim), and mitochondrial permeability transition pore (mPTP) formation using FITC-Annexin V, JC-1, and CoCl(2)/calcein-AM, respectively. Additionally, platelet morphology and its ultrastructure were observed via phase contrast and electron microscopy. Sonoclot and light transmission aggregometry were employed to examine fibrin formation and platelet aggregation, respectively. The findings demonstrate that LPC induced oxidative stress and increased intracellular calcium in platelets, resulting in increased phosphatidylserine expression and reduced DeltaPsim. LPC triggered caspase-independent platelet death and mPTP opening via cytosolic and mitochondrial calcium, along with microvesiculation and reduced platelet counts. LPC increased the platelet's size, adopting a balloon-shaped morphology, causing membrane fragmentation and releasing its cellular contents, while inducing a pro-coagulant phenotype with increased fibrin formation and reduced integrin alphaIIbbeta3 activation. Conclusively, this study reveals LPC-induced oxidative stress and calcium-mediated platelet death, necrotic in nature with pro-coagulant properties, potentially impacting inflammation and repair mechanisms during vascular injury. CI - (c) 2024 International Federation for Cell Biology. FAU - Yadav, Pooja AU - Yadav P AD - Department of Zoology, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. FAU - Beura, Samir K AU - Beura SK AD - Department of Zoology, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. FAU - Panigrahi, Abhishek R AU - Panigrahi AR AD - Department of Zoology, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. FAU - Kulkarni, Paresh P AU - Kulkarni PP AD - Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. FAU - Yadav, Mithlesh K AU - Yadav MK AD - Department of Zoology, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. FAU - Munshi, Anjana AU - Munshi A AUID- ORCID: 0000-0002-7657-8592 AD - Department of Human Genetics and Molecular Medicine, Central University of Punjab, Ghudda, Bathinda, India. FAU - Singh, Sunil K AU - Singh SK AUID- ORCID: 0000-0001-6603-6282 AD - Department of Zoology, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. AD - Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Ghudda, Bathinda, India. LA - eng PT - Journal Article DEP - 20240604 PL - England TA - Cell Biol Int JT - Cell biology international JID - 9307129 RN - 0 (Lysophosphatidylcholines) RN - SY7Q814VUP (Calcium) RN - 0 (Reactive Oxygen Species) RN - 0 (Mitochondrial Permeability Transition Pore) SB - IM MH - Humans MH - *Oxidative Stress/drug effects MH - *Lysophosphatidylcholines/pharmacology/metabolism MH - *Calcium/metabolism MH - *Blood Platelets/metabolism/drug effects MH - *Reactive Oxygen Species/metabolism MH - *Cell Death/drug effects MH - Membrane Potential, Mitochondrial/drug effects MH - Mitochondria/metabolism/drug effects MH - Platelet Aggregation/drug effects MH - Mitochondrial Permeability Transition Pore/metabolism OTO - NOTNLM OT - cell death OT - intracellular calcium OT - lysophosphatidylcholine (LPC) OT - mitochondrial dysfunction OT - oxidative stress OT - platelet EDAT- 2024/06/05 19:12 MHDA- 2024/08/12 06:43 CRDT- 2024/06/05 12:25 PHST- 2024/05/06 00:00 [revised] PHST- 2023/12/15 00:00 [received] PHST- 2024/05/11 00:00 [accepted] PHST- 2024/08/12 06:43 [medline] PHST- 2024/06/05 19:12 [pubmed] PHST- 2024/06/05 12:25 [entrez] AID - 10.1002/cbin.12192 [doi] PST - ppublish SO - Cell Biol Int. 2024 Sep;48(9):1266-1284. doi: 10.1002/cbin.12192. Epub 2024 Jun 4. PMID- 38768918 OWN - NLM STAT- MEDLINE DCOM- 20240604 LR - 20240604 IS - 1879-0003 (Electronic) IS - 0141-8130 (Linking) VI - 270 IP - Pt 2 DP - 2024 Jun TI - Injectable ChitHCl-DDA tissue adhesive with high adhesive strength and biocompatibility for torn meniscus repair and regeneration. PG - 132409 LID - S0141-8130(24)03214-8 [pii] LID - 10.1016/j.ijbiomac.2024.132409 [doi] AB - Suture pull-through is a clinical problem in meniscus repair surgery due to the sharp leading edge of sutures. Several tissue adhesives have been developed as an alternative to traditional suturing; however, there is still no suitable tissue adhesive specific for meniscus repair treatment due to unsatisfactory biosafety, biodegradable, sterilizable, and tissue-bonding characteristics. In this study, we used a tissue adhesive composed of chitosan hydrochloride reacted with oxidative periodate-oxidized dextran (ChitHCl-DDA) combined with a chitosan-based hydrogel and oxidative dextran to attach to the meniscus. We conducted viscoelastic tests, viscosity tests, lap shear stress tests, Fourier transform infrared (FTIR) spectroscopy, swelling ratio tests, and degradation behavior tests to characterize these materials. An MTT assay, alcian blue staining, migration assay, cell behavior observations, and protein expression tests were used to understand cell viability and responses. Moreover, ex vivo and in vivo tests were used to analyze tissue regeneration and biocompatibility of the ChitHCl-DDA tissue adhesive. Our results revealed that the ChitHCl-DDA tissue adhesive provided excellent tissue adhesive strength, cell viability, and cell responses. This tissue adhesive has great potential for torn meniscus tissue repair and regeneration. CI - Copyright (c) 2024 Elsevier B.V. All rights reserved. FAU - Wong, Pei-Chun AU - Wong PC AD - Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan. FAU - Chen, Kuan-Hao AU - Chen KH AD - Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. FAU - Wang, Wei-Ru AU - Wang WR AD - Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan. FAU - Chen, Chieh-Ying AU - Chen CY AD - School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan. FAU - Wang, Yu-Tzu AU - Wang YT AD - Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan. FAU - Lee, Yu-Bin AU - Lee YB AD - Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Republic of Korea. FAU - Wu, Jia-Lin AU - Wu JL AD - Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Orthopedics Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. Electronic address: wu.jialin@tmu.edu.tw. LA - eng PT - Journal Article DEP - 20240518 PL - Netherlands TA - Int J Biol Macromol JT - International journal of biological macromolecules JID - 7909578 RN - 0 (Tissue Adhesives) RN - 0 (Biocompatible Materials) RN - 9012-76-4 (Chitosan) RN - 0 (Dextrans) RN - 0 (Hydrogels) SB - IM MH - *Tissue Adhesives/chemistry/pharmacology MH - Animals MH - *Regeneration/drug effects MH - *Biocompatible Materials/chemistry/pharmacology MH - *Chitosan/chemistry/pharmacology MH - Materials Testing MH - Meniscus/drug effects MH - Dextrans/chemistry MH - Cell Survival/drug effects MH - Hydrogels/chemistry/pharmacology MH - Rabbits MH - Tibial Meniscus Injuries/surgery MH - Humans MH - Injections OTO - NOTNLM OT - Suture pull-through OT - Tissue adhesive OT - Tissue regeneration OT - meniscus COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/05/21 00:42 MHDA- 2024/06/04 06:42 CRDT- 2024/05/20 19:30 PHST- 2024/03/16 00:00 [received] PHST- 2024/05/09 00:00 [revised] PHST- 2024/05/13 00:00 [accepted] PHST- 2024/06/04 06:42 [medline] PHST- 2024/05/21 00:42 [pubmed] PHST- 2024/05/20 19:30 [entrez] AID - S0141-8130(24)03214-8 [pii] AID - 10.1016/j.ijbiomac.2024.132409 [doi] PST - ppublish SO - Int J Biol Macromol. 2024 Jun;270(Pt 2):132409. doi: 10.1016/j.ijbiomac.2024.132409. Epub 2024 May 18. PMID- 38725162 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20260922 IS - 2383-7977 (Electronic) IS - 1975-5171 (Print) IS - 1975-5171 (Linking) VI - 19 IP - 2 DP - 2024 Apr TI - Revolutionizing trauma care: advancing coagulation management and damage control anesthesia. PG - 73-84 LID - 10.17085/apm.24038 [doi] AB - Despite advances in emergency transfer systems and trauma medicine, the incidence of preventable deaths due to massive hemorrhage remains high. Recent immunological research has elucidated key mechanisms underlying trauma-induced coagulopathy in the early stages of trauma, including sympathoadrenal stimulation, shedding of the glycocalyx, and endotheliopathy. Consequently, the condition progresses to fibrinogen depletion, hyperfibrinolysis, and platelet dysfunction. Coexisting factors such as uncorrected acidosis, hypothermia, excessive crystalloid administration, and a history of anticoagulant use exacerbate coagulopathy. This study introduces damage-control anesthetic management based on recent insights into damage-control resuscitation, emphasizing the importance of rapid transport, timely bleeding control, early administration of antifibrinolytics and fibrinogen concentrates, and maintenance of calcium levels and body temperature. Additionally, this study discusses brain-protective strategies for trauma patients with brain injuries and the utilization of cartridge-based viscoelastic assays for goal-directed coagulation management in trauma settings. This comprehensive approach may provide potential insights for anesthetic management in the fast-paced field of trauma medicine. FAU - Kwon, Min A AU - Kwon MA AD - Department of Anesthesiology and pain medicine, Dankook University Hospital, Cheonan, Korea. FAU - Ji, Sung Mi AU - Ji SM AD - Department of Anesthesiology and pain medicine, Dankook University Hospital, Cheonan, Korea. LA - eng PT - Journal Article PT - Review DEP - 20240430 PL - Korea (South) TA - Anesth Pain Med (Seoul) JT - Anesthesia and pain medicine JID - 101517708 EIN - Anesth Pain Med (Seoul). 2025 Jul;20(3):288. doi: 10.17085/apm.24038.e1. PMID: 40792376 PMC - PMC11089294 OTO - NOTNLM OT - Anesthesia OT - Blood coagulation OT - Blood transfusion OT - Endothelium OT - Fibrinogen OT - Fibrinolysis OT - Glycocalyx COIS- CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported. EDAT- 2024/05/10 06:42 MHDA- 2024/05/10 06:43 PMCR- 2024/04/30 CRDT- 2024/05/10 00:56 PHST- 2024/03/20 00:00 [received] PHST- 2024/04/29 00:00 [accepted] PHST- 2024/05/10 06:43 [medline] PHST- 2024/05/10 06:42 [pubmed] PHST- 2024/05/10 00:56 [entrez] PHST- 2024/04/30 00:00 [pmc-release] AID - apm.24038 [pii] AID - apm-24038 [pii] AID - 10.17085/apm.24038 [doi] PST - ppublish SO - Anesth Pain Med (Seoul). 2024 Apr;19(2):73-84. doi: 10.17085/apm.24038. Epub 2024 Apr 30. PMID- 38687916 OWN - NLM STAT- MEDLINE DCOM- 20240820 LR - 20240820 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 90 IP - 9 DP - 2024 Sep TI - The Impact of ADP Inhibition on Traumatic Brain Injury Outcomes. PG - 2200-2205 LID - 10.1177/00031348241248814 [doi] AB - Platelet inhibition correlates with severity of traumatic brain injury and may be associated with mortality. Adenosine diphosphate participates in platelet aggregation via the activation of the ADP receptors, P2Y1 and P2Y12. Prior work suggests this ADP pathway is significant in managing patients with head injuries. This study aimed to measure the influence of ADP inhibition on outcomes after a traumatic brain injury (TBI), as measured by thromboelastography with platelet mapping (TEG-PM). Outcomes were defined as (a) hospital length of stay; (b) ICU length of stay, (c) mortality, and (d) progression of hemorrhage on CT. The resulting cohort was split into quartiles to compare the effect of increasingly inhibited ADP values on the identified outcomes. Comparisons of 2 groups of patients were also conducted, one defined by ADP inhibition less than or equal to 60% and the other group by ADP inhibition of greater than 60%. 98 patients were included in final analysis, with 72.4% having ADP inhibition less than 60%. These patients were significantly older and had lower global injury severity scores (ISSs), although their head-specific ISS was equivalent. Compared to the group with ADP inhibition over 60%, there was no significant difference in mortality, hospital or ICU length of stay, or progression of lesion on CT. Patients with ADP less than 60% inhibited had smaller ISS and higher GCS, indicating they were less injured than those with greater ADP inhibition, consistent with prior literature. The equivalent ICU and hospital length of stay and mortality suggests that ADP inhibition plays a smaller role in outcomes. Additional study with a larger sample size and guideline-based assessments is necessary to further define the impact of ADP inhibition and to determine the role of platelet transfusion in this population. FAU - Nielsen, Dana AU - Nielsen D AUID- ORCID: 0000-0001-9586-5530 AD - General Surgery Residency Program, University of North Dakota, Fargo, ND, USA. RINGGOLD: 3579 FAU - Mathies, Amanda AU - Mathies A AD - University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA. RINGGOLD: 12281 FAU - Cao, Li AU - Cao L AD - Research Design and Biostatistics Core, Sanford Health, Fargo, ND, USA. RINGGOLD: 23506 FAU - Sang, Tyler AU - Sang T AD - Research Design and Biostatistics Core, Sanford Health, Fargo, ND, USA. RINGGOLD: 23506 FAU - Howe, Chase AU - Howe C AD - University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA. RINGGOLD: 12281 FAU - Briggs, Steven AU - Briggs S AD - Department of Trauma and Acute Care Surgery, Sanford Health, Fargo, ND, USA. RINGGOLD: 23506 LA - eng PT - Journal Article DEP - 20240430 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Humans MH - Male MH - *Brain Injuries, Traumatic/mortality MH - Female MH - *Adenosine Diphosphate MH - Middle Aged MH - *Length of Stay/statistics & numerical data MH - *Thrombelastography MH - Adult MH - Injury Severity Score MH - Aged MH - Retrospective Studies OTO - NOTNLM OT - critical care OT - other OT - trauma OT - trauma acute care COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2024/04/30 18:50 MHDA- 2024/08/20 06:42 CRDT- 2024/04/30 16:03 PHST- 2024/08/20 06:42 [medline] PHST- 2024/04/30 18:50 [pubmed] PHST- 2024/04/30 16:03 [entrez] AID - 10.1177/00031348241248814 [doi] PST - ppublish SO - Am Surg. 2024 Sep;90(9):2200-2205. doi: 10.1177/00031348241248814. Epub 2024 Apr 30. PMID- 38670141 OWN - NLM STAT- MEDLINE DCOM- 20240529 LR - 20260812 IS - 1361-6560 (Electronic) IS - 0031-9155 (Print) IS - 0031-9155 (Linking) VI - 69 IP - 11 DP - 2024 May 29 TI - Brain elastography in aging relates to fluid/solid trendlines. LID - 10.1088/1361-6560/ad4446 [doi] LID - 115037 AB - The relatively new tools of brain elastography have established a general trendline for healthy, aging adult humans, whereby the brain's viscoelastic properties 'soften' over many decades. Earlier studies of the aging brain have demonstrated a wide spectrum of changes in morphology and composition towards the later decades of lifespan. This leads to a major question of causal mechanisms: of the many changes documented in structure and composition of the aging brain, which ones drive the long term trendline for viscoelastic properties of grey matter and white matter? The issue is important for illuminating which factors brain elastography is sensitive to, defining its unique role for study of the brain and clinical diagnoses of neurological disease and injury. We address these issues by examining trendlines in aging from our elastography data, also utilizing data from an earlier landmark study of brain composition, and from a biophysics model that captures the multiscale biphasic (fluid/solid) structure of the brain. Taken together, these imply that long term changes in extracellular water in the glymphatic system of the brain along with a decline in the extracellular matrix have a profound effect on the measured viscoelastic properties. Specifically, the trendlines indicate that water tends to replace solid fraction as a function of age, then grey matter stiffness decreases inversely as water fraction squared, whereas white matter stiffness declines inversely as water fraction to the 2/3 power, a behavior consistent with the cylindrical shape of the axons. These unique behaviors point to elastography of the brain as an important macroscopic measure of underlying microscopic structural change, with direct implications for clinical studies of aging, disease, and injury. CI - Creative Commons Attribution license. FAU - Parker, Kevin J AU - Parker KJ AUID- ORCID: 0000-0002-6313-6605 AD - Department of Electrical and Computer Engineering, University of Rochester, 724 Computer Studies Building, Box 270231, Rochester, NY 14627, United States of America. AD - Department of Biomedical Engineering, University of Rochester, 204 Goergen Hall, Box 270168, Rochester, NY 14627, United States of America. AD - Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, United States of America. FAU - Kabir, Irteza Enan AU - Kabir IE AUID- ORCID: 0000-0002-6061-0340 AD - Department of Electrical and Computer Engineering, University of Rochester, 724 Computer Studies Building, Box 270231, Rochester, NY 14627, United States of America. FAU - Doyley, Marvin M AU - Doyley MM AUID- ORCID: 0000-0002-5154-6711 AD - Department of Electrical and Computer Engineering, University of Rochester, 724 Computer Studies Building, Box 270231, Rochester, NY 14627, United States of America. AD - Department of Biomedical Engineering, University of Rochester, 204 Goergen Hall, Box 270168, Rochester, NY 14627, United States of America. AD - Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, United States of America. FAU - Faiyaz, Abrar AU - Faiyaz A AUID- ORCID: 0000-0003-0666-3051 AD - Department of Electrical and Computer Engineering, University of Rochester, 724 Computer Studies Building, Box 270231, Rochester, NY 14627, United States of America. FAU - Uddin, Md Nasir AU - Uddin MN AUID- ORCID: 0000-0002-5887-1322 AD - Department of Biomedical Engineering, University of Rochester, 204 Goergen Hall, Box 270168, Rochester, NY 14627, United States of America. AD - Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY 14642, United States of America. FAU - Flores, Gilmer AU - Flores G AD - Department of Biomedical Engineering, University of Rochester, 204 Goergen Hall, Box 270168, Rochester, NY 14627, United States of America. FAU - Schifitto, Giovanni AU - Schifitto G AUID- ORCID: 0000-0002-2115-4143 AD - Department of Electrical and Computer Engineering, University of Rochester, 724 Computer Studies Building, Box 270231, Rochester, NY 14627, United States of America. AD - Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, United States of America. AD - Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY 14642, United States of America. LA - eng GR - R01 AG054328/AG/NIA NIH HHS/United States GR - R01 EB032337/EB/NIBIB NIH HHS/United States GR - R21 EB033122/EB/NIBIB NIH HHS/United States GR - R21 NS113674/NS/NINDS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20240529 PL - England TA - Phys Med Biol JT - Physics in medicine and biology JID - 0401220 SB - IM MH - Humans MH - *Aging/physiology MH - *Elasticity Imaging Techniques MH - *Brain/diagnostic imaging MH - Aged MH - Middle Aged MH - Adult MH - Elasticity MH - Male MH - Viscosity MH - Female MH - Aged, 80 and over MH - White Matter/diagnostic imaging MH - Young Adult PMC - PMC12135900 OTO - NOTNLM OT - MRI OT - aging OT - biphasic models OT - brain OT - elastography OT - viscoelastic models EDAT- 2024/04/27 09:47 MHDA- 2024/05/29 12:45 PMCR- 2025/06/04 CRDT- 2024/04/26 18:53 PHST- 2024/01/23 00:00 [received] PHST- 2024/04/26 00:00 [accepted] PHST- 2024/05/29 12:45 [medline] PHST- 2024/04/27 09:47 [pubmed] PHST- 2024/04/26 18:53 [entrez] PHST- 2025/06/04 00:00 [pmc-release] AID - pmbad4446 [pii] AID - 10.1088/1361-6560/ad4446 [doi] PST - epublish SO - Phys Med Biol. 2024 May 29;69(11):115037. doi: 10.1088/1361-6560/ad4446. PMID- 38638953 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240425 IS - 2405-8440 (Print) IS - 2405-8440 (Electronic) IS - 2405-8440 (Linking) VI - 10 IP - 8 DP - 2024 Apr 30 TI - Revealing the role of material properties in impact-related injuries: Investigating the influence of brain and skull density variations on head injury severity. PG - e29427 LID - 10.1016/j.heliyon.2024.e29427 [doi] LID - e29427 AB - Traumatic brain injuries (TBI) resulting from head impacts are a major public health concern, which prompted our research to investigate the complex relationship between the material properties of brain tissue and the severity of TBI. The goal of this research is to investigate how variations in brain and skull density influence the vulnerability of brain tissue to traumatic injury, thereby enhancing our understanding of injury mechanism. To achieve this goal, we employed a well-validated finite element head model (FEHM). The current investigation was divided into two phases: in the first one, three distinct brain viscoelastic materials that had been utilized in prior studies were analyzed. The review of the properties of these three materials has been meticulous, encompassing both the spectrum of mechanical properties and the behaviors that are relevant to the way in which brain tissue reacts to traumatic loading conditions. In the second phase, the material properties of both the brain and skull tissue, alongside the impact conditions, were held constant. After this step, the focus was directed towards the variation of density in the brain and skull, which was consistent with the results obtained from previous experimental investigations, in order to determine the precise impact of these variations in density. This approach allowed a more profound comprehension of the impacts that density had on the simulation results. In the first phase, Material No. 2 exhibited the highest maximum first principal strain value in the frontal region (epsilonmax = 15.41%), indicating lower stiffness to instantaneous deformation. This characteristic suggests that Material No. 2 may deform more extensively upon impact, potentially increasing the risk of injury due to its viscoelastic behavior. In contrast, Material No. 1, with a lower maximum first principal strain in the frontal region (epsilonmax = 7.87%), displayed greater stiffness to instantaneous deformation, potentially reducing the risk of brain injury upon head impact. The second phase provided quantitative findings revealing a proportional relationship between brain tissue density and the pressures experienced by the brain. A 2 % increase in brain tissue density corresponded to approximately a 1 % increase in pressure on the brain tissue. Similarly, changes in skull density exhibited a similar quantitative relationship, with a 6 % increase in skull density leading to a 2.5 % increase in brain pressure. This preliminary approximate ratio of 2 to 1 between brain and skull density variations provides an initial quantitative framework for assessing the impact of density changes on brain vulnerability. These findings have several implications for the development of protective measures and injury prevention strategies, particularly in contexts where head trauma is a major issue. CI - (c) 2024 The Author(s). FAU - Abdi, Hamed AU - Abdi H AD - Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. FAU - Sanchez-Molina, David AU - Sanchez-Molina D AD - Universitat Politecnica de Catalunya, GIES, Av. Eduard Maristany, 16, 08019 Barcelona, Spain. FAU - Garcia-Vilana, Silvia AU - Garcia-Vilana S AD - Universitat Politecnica de Catalunya, GIES, Av. Eduard Maristany, 16, 08019 Barcelona, Spain. FAU - Rahimi-Movaghar, Vafa AU - Rahimi-Movaghar V AD - Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. LA - eng PT - Journal Article DEP - 20240409 PL - England TA - Heliyon JT - Heliyon JID - 101672560 PMC - PMC11024611 OTO - NOTNLM OT - Density OT - Finite element model (FEM) OT - Head impact OT - Head injury criterion (HIC) OT - Injury prevention OT - Traumatic brain injuries (TBI) OT - Viscoelastic materials COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/04/19 06:43 MHDA- 2024/04/19 06:44 PMCR- 2024/04/09 CRDT- 2024/04/19 03:48 PHST- 2023/11/13 00:00 [received] PHST- 2024/04/05 00:00 [revised] PHST- 2024/04/08 00:00 [accepted] PHST- 2024/04/19 06:44 [medline] PHST- 2024/04/19 06:43 [pubmed] PHST- 2024/04/19 03:48 [entrez] PHST- 2024/04/09 00:00 [pmc-release] AID - S2405-8440(24)05458-6 [pii] AID - e29427 [pii] AID - 10.1016/j.heliyon.2024.e29427 [doi] PST - epublish SO - Heliyon. 2024 Apr 9;10(8):e29427. doi: 10.1016/j.heliyon.2024.e29427. eCollection 2024 Apr 30. PMID- 38596569 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240411 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 9 IP - 1 DP - 2024 TI - Does an early, balanced resuscitation strategy reduce the incidence of hypofibrinogenemia in hemorrhagic shock? PG - e001193 LID - 10.1136/tsaco-2023-001193 [doi] LID - e001193 AB - OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported. METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography angle <60. Univariate and multivariable analyses assessed risk factors for HYPOFIB. Inverse probability of treatment weighting analyses assessed the relationship between cryoprecipitate administration and outcomes. RESULTS: Of 29 782 patients, 6618 level 1 activations, and 1948 patients receiving emergency release blood, <1%, 2%, and 7% were HYPOFIB. HYPOFIB patients were younger, had higher head Abbreviated Injury Scale value, and had worse coagulopathy and shock. HYPOFIB had lower survival (48% vs 82%, p<0.001), shorter time to death (median 28 (7, 50) vs 36 (14, 140) hours, p=0.012), and were more likely to die from head injury (72% vs 51%, p<0.001). Risk factors for HYPOFIB included increased age (OR (95% CI) 0.98 (0.96 to 0.99), p=0.03), head injury severity (OR 1.24 (1.06 to 1.46), p=0.009), lower arrival pH (OR 0.01 (0.001 to 0.20), p=0.002), and elevated prehospital red blood cell to platelet ratio (OR 1.20 (1.02 to 1.41), p=0.03). Among HYPOFIB patients, there was no difference in survival for those that received early cryoprecipitate (within 2 hours; 40 vs 47%; p=0.630). On inverse probability of treatment weighted analysis, early cryoprecipitate did not benefit the full cohort (OR 0.52 (0.43 to 0.65), p<0.001), nor the HYPOFIB subgroup (0.28 (0.20 to 0.39), p<0.001). CONCLUSIONS: Low rates of hypofibrinogenemia were found in our center which treats hemorrhage with early, balanced resuscitation. Previously reported higher rates may be partially due to unbalanced resuscitation and/or delay in resuscitation initiation. Routine empiric inclusion of concentrated fibrinogen replacement in MTPs is not supported by the currently available data. LEVEL OF EVIDENCE: Level III. CI - (c) Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Lubkin, David T AU - Lubkin DT AUID- ORCID: 0000-0001-9209-3192 AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Mueck, Krislynn M AU - Mueck KM AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Hatton, Gabrielle E AU - Hatton GE AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Brill, Jason B AU - Brill JB AUID- ORCID: 0000-0002-4734-3161 AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Sandoval, Mariela AU - Sandoval M AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Wade, Charles E AU - Wade CE AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cotton, Bryan A AU - Cotton BA AUID- ORCID: 0000-0003-4184-6742 AD - Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. LA - eng PT - Journal Article DEP - 20240403 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 CIN - doi: 10.1136/tsaco-2023-001354 PMC - PMC11002398 OTO - NOTNLM OT - Shock, Hemorrhagic OT - fibrinogen OT - resuscitation OT - wounds and injuries COIS- Competing interests: None declared. EDAT- 2024/04/10 06:42 MHDA- 2024/04/10 06:43 PMCR- 2024/04/03 CRDT- 2024/04/10 04:11 PHST- 2023/06/10 00:00 [received] PHST- 2024/03/20 00:00 [accepted] PHST- 2024/04/10 06:43 [medline] PHST- 2024/04/10 06:42 [pubmed] PHST- 2024/04/10 04:11 [entrez] PHST- 2024/04/03 00:00 [pmc-release] AID - tsaco-2023-001193 [pii] AID - 10.1136/tsaco-2023-001193 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2024 Apr 3;9(1):e001193. doi: 10.1136/tsaco-2023-001193. eCollection 2024. PMID- 38596567 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241123 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 9 IP - 1 DP - 2024 TI - Prehospital balanced resuscitation may mitigate hypofibrinogenemia in traumatic hemorrhagic shock. PG - e001354 LID - 10.1136/tsaco-2023-001354 [doi] LID - e001354 FAU - Starr, Nichole AU - Starr N AUID- ORCID: 0000-0003-0714-5512 AD - Surgery, University of California San Francisco, San Francisco, California, USA. AD - Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA. FAU - Kornblith, Lucy AU - Kornblith L AUID- ORCID: 0000-0002-1861-9691 AD - Surgery, University of California San Francisco, San Francisco, California, USA. AD - Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA. LA - eng PT - Journal Article DEP - 20240403 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 CIN - doi: 10.1136/tsaco-2023-001193 PMC - PMC11002369 OTO - NOTNLM OT - Blood Coagulation Factors OT - Multiple Trauma OT - resuscitation OT - thrombelastography COIS- Competing interests: LK-consulting for University of Maryland/BARDA, Scientific Advisory Board of Cerus, Consulting for Gamma Diagnostics, Consulting for Coagulant Therapeutics, Consulting for Haemonetics and husband is founder of CaptureDx. EDAT- 2024/04/10 06:43 MHDA- 2024/04/10 06:44 PMCR- 2024/04/03 CRDT- 2024/04/10 04:11 PHST- 2024/04/10 06:44 [medline] PHST- 2024/04/10 06:43 [pubmed] PHST- 2024/04/10 04:11 [entrez] PHST- 2024/04/03 00:00 [pmc-release] AID - tsaco-2023-001354 [pii] AID - 10.1136/tsaco-2023-001354 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2024 Apr 3;9(1):e001354. doi: 10.1136/tsaco-2023-001354. eCollection 2024. PMID- 38587897 OWN - NLM STAT- MEDLINE DCOM- 20240725 LR - 20260501 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 97 IP - 2S Suppl 1 DP - 2024 Aug 1 TI - Investigation and validation of the TEG6s during rotary wing aeromedical flight. PG - S113-S118 LID - 10.1097/TA.0000000000004335 [doi] AB - INTRODUCTION: To improve rural and austere trauma care, hospital-based testing performed at the point of injury may shorten the time lapsed from injury to intervention. This study aimed to evaluate the use of the TEG6s device (Haemonetics(R), Clinton, PA) in a rotary wing aircraft. Prior attempts suffered from limitation related to lack of vibration mitigation. METHODS: This was an investigator-initiated, industry-supported study. Haemonetics provided a TEG6s analyzer. The device underwent a standard validation. It was secured in place on the aircraft using shipping foam for vibration mitigation. Donors provided two tubes of sample blood in one sitting. Paired studies were performed on the aircraft during level flight and in the hospital, using the Global Hemostasis with Lysis Cartridge(Haemonetics (R), Clinton, PA). Both normal and presumed pathologic samples were tested in separate phases. Paired t tests were performed. RESULTS: For normal donors, the mean R for laboratory compared with the aircraft was 6.2 minutes versus 7.2 minutes ( p = 0.025). The mean +/- SD Citrated Rapid TEG Maximum Amplitude (CRT MA) was 59.3 +/- 5.6 mm and 55.9 +/- 7.3 mm ( p < 0.001) for laboratory and aircraft ( p < 0.001). Among normal donors, R was within normal range for 17 of 18 laboratory tests and 18 of 18 aircraft tests ( p > 0.99). During the testing of pathologic samples, the mean R time was 14.8 minutes for laboratory samples and 12.6 minutes for aircraft ( p = 0.02). Aircraft samples were classified as abnormal in 78% of samples; this was not significantly different than laboratory samples ( p = 0.5). CONCLUSION: The use of the TEG6s for inflight viscoelastic testing appears promising. While statistically significant differences are seen in some results, these values are not considered clinically significant. Classifying samples as normal or abnormal demonstrated a higher correlation. Future studies should focus on longer flight times to evaluate for LY30, takeoff, and landing effects. Overall, this study suggests that TEG6s can be used in a prehospital environment, and further study is warranted. LEVEL OF EVIDENCE: Diagnostic Tests or Criteria; Level III. CI - Copyright (c) 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma. FAU - Bardes, James AU - Bardes J AD - From the Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (J.B., D.G., A.W.), Department of Pathology, Anatomy, and Laboratory Medicine (A.S.), School of Medicine, and Department of Epidemiology (S.W.), School of Public Health, West Virginia University, Morgantown, West Virginia. FAU - Grabo, Daniel AU - Grabo D FAU - Shmookler, Aaron AU - Shmookler A FAU - Wen, Sijin AU - Wen S FAU - Wilson, Alison AU - Wilson A LA - eng GR - U54 GM104942/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Validation Study DEP - 20240408 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Humans MH - *Air Ambulances MH - Male MH - Adult MH - Female MH - Thrombelastography/methods MH - Middle Aged PMC - PMC11272443 MID - NIHMS1978876 COIS- Conflict of Interest: The authors have no additional conflicts of interest to report. All JTACS disclosure forms have been supplied and are provided as supplemental digital content. EDAT- 2024/04/08 12:43 MHDA- 2024/07/26 12:46 PMCR- 2025/08/01 CRDT- 2024/04/08 12:03 PHST- 2024/07/26 12:46 [medline] PHST- 2024/04/08 12:43 [pubmed] PHST- 2024/04/08 12:03 [entrez] PHST- 2025/08/01 00:00 [pmc-release] AID - 01586154-990000000-00689 [pii] AID - 10.1097/TA.0000000000004335 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2024 Aug 1;97(2S Suppl 1):S113-S118. doi: 10.1097/TA.0000000000004335. Epub 2024 Apr 8. PMID- 38579436 OWN - NLM STAT- MEDLINE DCOM- 20240630 LR - 20240630 IS - 1873-5800 (Electronic) IS - 0968-0160 (Linking) VI - 48 DP - 2024 Jun TI - Effect of loading direction and anatomical location on the ultimate tensile stress, fracture toughness, and failure patterns of knee meniscus. PG - 120-127 LID - S0968-0160(24)00040-1 [pii] LID - 10.1016/j.knee.2024.03.004 [doi] AB - BACKGROUND: Rupture of the knee menisci is a common injury that can have implications for other conditions, such as osteoarthritis. The fracture toughness of soft tissue (J(c)) is a mechanical property that characterizes its resistance to tear extension. To date, J(c) of the meniscus has not been quantified. METHODS: Cyclic tensile tests were conducted on meniscus samples to determine J(c) and explore its characteristics. Initially, the study investigated the impact of an initial notch on the ultimate tensile stress. This allowed for an understanding of how the presence of a notch affects its structural integrity. Subsequently, J(c) was measured in both the radial and circumferential directions to assess its loading direction dependency. Furthermore, the study assessed the effect of anatomical location by comparing samples collected from the femoral and tibial layers. RESULTS: Defect tolerance of the meniscus is influenced by the loading direction. In the circumferential direction, the presence of an initial notch did not affect the ultimate stress, and no crack expansion was observed. In radial samples with a notch length of 40% or more of the total width, crack propagation occurred, leading to a decrease in the ultimate stress (p< 0.01). Additionally, J(c) was found to be higher in the femoral layer compared to the tibial layer (p= 0.017). CONCLUSION: The study also examined the failure patterns of the meniscus to enhance our understanding of its pathology. These insights contribute to a better comprehension of meniscus injuries and can aid in the development of more effective treatment strategies. CI - Copyright (c) 2024 Elsevier B.V. All rights reserved. FAU - Sabouri, Pouya AU - Sabouri P AD - Biomechanical Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran 15875-4413, Iran. FAU - Hashemi, Ata AU - Hashemi A AD - Biomechanical Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran 15875-4413, Iran. Electronic address: a.hashemi@aut.ac.ir. LA - eng PT - Journal Article DEP - 20240404 PL - Netherlands TA - Knee JT - The Knee JID - 9430798 SB - IM MH - Humans MH - *Tensile Strength/physiology MH - *Menisci, Tibial/physiopathology/physiology MH - Weight-Bearing/physiology MH - Tibial Meniscus Injuries/physiopathology/surgery MH - Stress, Mechanical MH - Biomechanical Phenomena MH - Middle Aged MH - Male MH - Cadaver MH - Aged MH - Female OTO - NOTNLM OT - Crack propagation OT - Defect tolerance OT - Failure pattern OT - Fracture toughness OT - Meniscus OT - Viscoelastic COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2024/04/06 00:42 MHDA- 2024/07/01 00:42 CRDT- 2024/04/05 18:03 PHST- 2023/07/02 00:00 [received] PHST- 2024/01/05 00:00 [revised] PHST- 2024/03/18 00:00 [accepted] PHST- 2024/07/01 00:42 [medline] PHST- 2024/04/06 00:42 [pubmed] PHST- 2024/04/05 18:03 [entrez] AID - S0968-0160(24)00040-1 [pii] AID - 10.1016/j.knee.2024.03.004 [doi] PST - ppublish SO - Knee. 2024 Jun;48:120-127. doi: 10.1016/j.knee.2024.03.004. Epub 2024 Apr 4. PMID- 38576501 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240406 IS - 2234-8999 (Print) IS - 2288-2243 (Electronic) IS - 2234-8999 (Linking) VI - 20 IP - 1 DP - 2024 Mar TI - Thromboelastometry-Based Prophylaxis for Venous Thromboembolism in the Acute Period Following Isolated Severe Traumatic Brain Injury. PG - 45-51 LID - 10.13004/kjnt.2024.20.e10 [doi] AB - OBJECTIVE: Traumatic brain injury (TBI) is an independent risk factor for venous thromboembolism (VTE). This study aimed to determine the optimal timing for initiating pharmacological thromboprophylaxis for VTE in patients with isolated severe TBI using rotational thromboelastometry (ROTEM). METHODS: This single-center observational study enrolled 115 patients aged 18-59 years with isolated severe TBI within the first 48 hours after injury. RESULTS: Using ROTEM data, we identified hypercoagulation due to an increase in clot density (MCF EXTEM >72), which was attributed to fibrinogen (MCF FIBTEM >25). From day 4, hypercoagulation occurred in 14.8% of the patients. By day 7, these changes were observed in 85.2% of patients. According to brain computed tomography findings, patients who received early VTE chemoprophylaxis on days 3-4 after severe TBI did not experience progression of hemorrhagic foci. CONCLUSION: Our results emphasize the clinical significance of thromboelastometry in patients with isolated severe traumatic TBI. Anticoagulant prophylaxis started on 3-4 days after severe TBI was relatively safe, and most patients did not experience hemorrhagic foci progression. The data acquired in this study may enable the optimization of VTE chemoprophylactic approaches, thereby reducing the associated risks to patients. CI - Copyright (c) 2024 Korean Neurotraumatology Society. FAU - Baranich, Anastasia I AU - Baranich AI AUID- ORCID: 0000-0002-1167-0742 AD - Neurocritical Care Department, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. FAU - Sychev, Aleksandr A AU - Sychev AA AUID- ORCID: 0000-0002-0038-1005 AD - Neurocritical Care Department, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. FAU - Savin, Ivan A AU - Savin IA AUID- ORCID: 0000-0003-3874-4147 AD - Neurocritical Care Department, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. FAU - Danilov, Gleb V AU - Danilov GV AUID- ORCID: 0000-0003-1442-5993 AD - Laboratory of Biomedical Informatics and Artificial Intelligence, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. FAU - Strunina, Yulia V AU - Strunina YV AUID- ORCID: 0000-0001-5010-6661 AD - Laboratory of Biomedical Informatics and Artificial Intelligence, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. LA - eng PT - Journal Article DEP - 20240314 PL - Korea (South) TA - Korean J Neurotrauma JT - Korean journal of neurotrauma JID - 101584658 PMC - PMC10990693 OTO - NOTNLM OT - Thrombelastography OT - Traumatic brain injury OT - Venous thromboembolism COIS- Conflict of Interest: The authors have no financial conflicts of interest. EDAT- 2024/04/05 06:44 MHDA- 2024/04/05 06:45 PMCR- 2024/03/01 CRDT- 2024/04/05 03:55 PHST- 2023/12/21 00:00 [received] PHST- 2024/01/22 00:00 [revised] PHST- 2024/03/06 00:00 [accepted] PHST- 2024/04/05 06:45 [medline] PHST- 2024/04/05 06:44 [pubmed] PHST- 2024/04/05 03:55 [entrez] PHST- 2024/03/01 00:00 [pmc-release] AID - 10.13004/kjnt.2024.20.e10 [doi] PST - epublish SO - Korean J Neurotrauma. 2024 Mar 14;20(1):45-51. doi: 10.13004/kjnt.2024.20.e10. eCollection 2024 Mar. PMID- 38555106 OWN - NLM STAT- MEDLINE DCOM- 20240401 LR - 20240403 IS - 2530-0180 (Electronic) IS - 2530-0180 (Linking) VI - 71 IP - 3 DP - 2024 Mar TI - An effective insulin infusion protocol for severe traumatic brain injury patients: A retrospective observational study. PG - 103-109 LID - S2530-0180(24)00031-3 [pii] LID - 10.1016/j.endien.2024.03.014 [doi] AB - PURPOSE: Severe traumatic brain injury (sTBI) patients often experience stress hyperglycaemia, which can lead to negative outcomes. This study aims to introduce an effective insulin infusion protocol specifically designed for sTBI patients. METHODS: Data was collected from all sTBI patients during two periods: 1 October 2019 to 30 April 2020, and 1 June 2020 to 31 December 2020. In May 2020, a new insulin infusion protocol was implemented. Blood glucose management, infection, coagulation, and prognosis were compared in these two periods. RESULT: 195 patients were included, with 106 using the new protocol. The proportion of hyperglycaemia decreased from 40.04% to 26.91% (P<0.05), and the proportion of on-target blood glucose levels increased from 35.69% to 38.98% (P<0.05). Average blood glucose levels decreased from 9.98+/-2.79mmol/L to 8.96+/-2.82mmol/L (P<0.05). There was no substantial increase in hypoglycaemia, which remained controlled below 1%. The new protocol positively influenced glucose concentration and dispersion trends. There were no significant differences in catheter-related infections, antibiotic use, mechanical ventilation (MV) duration, length of stay in ICU, Glasgow Outcome Scale (GOS), or mortality. However, the conventional protocol group had a higher coagulation tendency (R-value of thromboelastography 4.80+/-1.35min vs. 5.52+/-1.87min, P<0.05), with no difference in deep vein thrombosis (DVT) incidence. CONCLUSION: Our findings suggest that a customized insulin infusion process for sTBI patients can effectively manage blood glucose. While there is no significant improvement in infection control or prognosis, it may have a positive impact on coagulation without affecting the occurrence of DVT. CI - Copyright (c) 2024 The Author(s). Published by Elsevier Espana, S.L.U. All rights reserved. FAU - Chen, Jie AU - Chen J AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. FAU - Ye, Bingbing AU - Ye B AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. FAU - Lin, Feng AU - Lin F AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. FAU - Cai, Wenchao AU - Cai W AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. FAU - Chen, Rui AU - Chen R AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. Electronic address: woshichenrui2324@163.com. FAU - Ruan, Zhanwei AU - Ruan Z AD - Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang 325200, China. Electronic address: rzwryjzyxk@wmu.edu.cn. LA - eng PT - Journal Article PT - Observational Study PL - Spain TA - Endocrinol Diabetes Nutr (Engl Ed) JT - Endocrinologia, diabetes y nutricion JID - 101717565 RN - 0 (Blood Glucose) RN - 0 (Insulin) SB - IM MH - Humans MH - Blood Glucose MH - *Brain Injuries, Traumatic/complications/drug therapy MH - *Hyperglycemia/drug therapy/etiology MH - Insulin/therapeutic use MH - Observational Studies as Topic MH - Prognosis OTO - NOTNLM OT - Coagulacion OT - Coagulation OT - Hiperglucemia OT - Hyperglycaemia OT - Insulin infusion protocol OT - Lesion cerebral traumatica grave OT - Protocolo de infusion de insulina OT - Severe traumatic brain injury EDAT- 2024/03/31 00:42 MHDA- 2024/04/01 06:42 CRDT- 2024/03/30 22:07 PHST- 2023/10/25 00:00 [received] PHST- 2024/01/09 00:00 [accepted] PHST- 2024/04/01 06:42 [medline] PHST- 2024/03/31 00:42 [pubmed] PHST- 2024/03/30 22:07 [entrez] AID - S2530-0180(24)00031-3 [pii] AID - 10.1016/j.endien.2024.03.014 [doi] PST - ppublish SO - Endocrinol Diabetes Nutr (Engl Ed). 2024 Mar;71(3):103-109. doi: 10.1016/j.endien.2024.03.014. PMID- 38529277 OWN - NLM STAT- MEDLINE DCOM- 20240327 LR - 20240409 IS - 1664-3224 (Electronic) IS - 1664-3224 (Linking) VI - 15 DP - 2024 TI - Association between loss of hypercoagulable phenotype, clinical features and complement pathway consumption in COVID-19. PG - 1337070 LID - 10.3389/fimmu.2024.1337070 [doi] LID - 1337070 AB - BACKGROUND: Coronavirus disease 2019 (COVID-19) features a hypercoagulable state, but therapeutic anticoagulation effectiveness varies with disease severity. We aimed to evaluate the dynamics of the coagulation profile and its association with COVID-19 severity, outcomes, and biomarker trajectories. METHODS: This multicenter, prospective, observational study included patients with COVID-19 requiring respiratory support. Rotational thromboelastometry findings were evaluated for coagulation and fibrinolysis status. Hypercoagulable status was defined as supranormal range of maximum clot elasticity in an external pathway. Longitudinal laboratory parameters were collected to characterize the coagulation phenotype. RESULTS: Of 166 patients, 90 (54%) were severely ill at inclusion (invasive mechanical ventilation, 84; extracorporeal membrane oxygenation, 6). Higher maximum elasticity (P=0.02) and lower maximum lysis in the external pathway (P=0.03) were observed in severely ill patients compared with the corresponding values in patients on non-invasive oxygen supplementation. Hypercoagulability components correlated with platelet and fibrinogen levels. Hypercoagulable phenotype was associated with favorable outcomes in severely ill patients, while normocoagulable phenotype was not (median time to recovery, 15 days vs. 27 days, P=0.002), but no significant association was observed in moderately ill patients. In patients with severe COVID-19, lower initial C3, minimum C3, CH50, and greater changes in CH50 were associated with the normocoagulable phenotype. Changes in complement components correlated with dynamics of coagulation markers, hematocrit, and alveolar injury markers. CONCLUSIONS: While hypercoagulable states become more evident with increasing severity of respiratory disease in patients with COVID-19, normocoagulable phenotype is associated with triggered by alternative pathway activation and poor outcomes. CI - Copyright (c) 2024 Kasugai, Tanaka, Suzuki, Ito, Nishida, Ozaki, Kutsuna, Yokoyama, Kaneko, Ogata, Matsui, Goshima, Hamada, Ishii, Kodama, Jingushi, Ishikura, Kamidani, Tada, Okada, Yamamoto and Goto. FAU - Kasugai, Daisuke AU - Kasugai D AD - Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Tanaka, Taku AU - Tanaka T AD - Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Suzuki, Takako AU - Suzuki T AD - Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Ito, Yoshinori AU - Ito Y AD - Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Nishida, Kazuki AU - Nishida K AD - Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Ozaki, Masayuki AU - Ozaki M AD - Department of Critical Care Medicine, Komaki City Hospital, Komaki, Japan. FAU - Kutsuna, Takeo AU - Kutsuna T AD - Department of Respiratory Medicine, Daido Hospital, Nagoya, Japan. FAU - Yokoyama, Toshiki AU - Yokoyama T AD - Department of Emergency and Critical Care Medicine, Tosei General Hospital, Seto, Japan. FAU - Kaneko, Hitoshi AU - Kaneko H AD - Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan. FAU - Ogata, Ryo AU - Ogata R AD - Department of Respiratory Medicine, Meitetsu Hospital, Nagoya, Japan. FAU - Matsui, Ryohei AU - Matsui R AD - Department of Emergency and Critical Care Medicine, Nagoya City University Hospital, Nagoya, Japan. FAU - Goshima, Takahiro AU - Goshima T AD - Department of Emergency and General Internal Medicine, Fujita Health University, Toyoake, Japan. FAU - Hamada, Hiroshi AU - Hamada H AD - Department of Internal Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. FAU - Ishii, Azusa AU - Ishii A AD - Department of Respiratory Medicine, Chukyo Hospital, Nagoya, Japan. FAU - Kodama, Yusuke AU - Kodama Y AD - Department of Internal Medicine, Kyoritsu General Hospital, Nagoya, Japan. FAU - Jingushi, Naruhiro AU - Jingushi N AD - Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Ishikura, Ken AU - Ishikura K AD - Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan. FAU - Kamidani, Ryo AU - Kamidani R AD - Department of Emergency and Critical Care Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. FAU - Tada, Masashi AU - Tada M AD - Department of Internal Medicine, SaiShukan Hospital, Kitanagoya, Japan. FAU - Okada, Hideshi AU - Okada H AD - Department of Emergency and Critical Care Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. FAU - Yamamoto, Takanori AU - Yamamoto T AD - Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. FAU - Goto, Yukari AU - Goto Y AD - Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. AD - Department of Emergency Medicine, Nagoya EkiSaikai Hospital, Nagoya, Japan. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20240311 PL - Switzerland TA - Front Immunol JT - Frontiers in immunology JID - 101560960 SB - IM MH - Humans MH - *COVID-19 MH - Prospective Studies MH - *Thrombophilia/etiology MH - Blood Coagulation MH - Phenotype PMC - PMC10961343 OTO - NOTNLM OT - COVID-19 OT - alternative complement pathway OT - blood coagulation disorders OT - microthrombosis OT - rotational thromboelastometry COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2024/03/26 06:45 MHDA- 2024/03/27 06:43 PMCR- 2024/01/01 CRDT- 2024/03/26 03:42 PHST- 2023/11/12 00:00 [received] PHST- 2024/02/27 00:00 [accepted] PHST- 2024/03/27 06:43 [medline] PHST- 2024/03/26 06:45 [pubmed] PHST- 2024/03/26 03:42 [entrez] PHST- 2024/01/01 00:00 [pmc-release] AID - 10.3389/fimmu.2024.1337070 [doi] PST - epublish SO - Front Immunol. 2024 Mar 11;15:1337070. doi: 10.3389/fimmu.2024.1337070. eCollection 2024. PMID- 38520264 OWN - NLM STAT- MEDLINE DCOM- 20240605 LR - 20240605 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 90 IP - 7 DP - 2024 Jul TI - Use of Thromboelastography in Assessment of Snake Bite Coagulopathy. PG - 1940-1941 LID - 10.1177/00031348241241646 [doi] AB - Background: Monitoring for envenomation coagulopathy following snake bites has traditionally involved using serial coagulation studies.Purpose: Thromboelastography (TEG), with its real-time assessment, could offer an alternative to standard of care. This study aims to evaluate the use of TEG with traditional coagulation labs in the assessment of snake bite coagulopathy.Research Design: A retrospective review of patients who presented to a level 1 trauma center between 2014 and 2020 with snake bite envenomation was conducted, comparing traditional coagulation studies to TEG plus coagulation studies.Results: The 12 patients who had studies within the stipulations of our review were tracked and subsequently progressed well clinically with no adverse effects and ultimately discharged home with an average hospital stay of 2.2 days.Conclusions: Our data suggests that patients can be observed clinically without needing repeat coagulation studies if initial TEG and TCS are within normal limits. FAU - Hammond, Chandler AU - Hammond C AD - Mercer Univeristy School of Medicine, Macon, GA, USA. RINGGOLD: 12241 FAU - Ninad, Nehal AU - Ninad N AD - Atrium Health Navicent, Macon, GA, USA. RINGGOLD: 5223 FAU - Christie, Dudley B AU - Christie DB AD - Atrium Health Navicent, Macon, GA, USA. RINGGOLD: 5223 LA - eng PT - Journal Article DEP - 20240323 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - *Thrombelastography/methods MH - Humans MH - *Snake Bites/complications MH - Retrospective Studies MH - *Blood Coagulation Disorders/etiology/diagnosis MH - Male MH - Female MH - Adult MH - Middle Aged MH - Aged MH - Blood Coagulation Tests OTO - NOTNLM OT - trauma OT - trauma acute care COIS- Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2024/03/23 20:48 MHDA- 2024/06/05 13:12 CRDT- 2024/03/23 06:33 PHST- 2024/06/05 13:12 [medline] PHST- 2024/03/23 20:48 [pubmed] PHST- 2024/03/23 06:33 [entrez] AID - 10.1177/00031348241241646 [doi] PST - ppublish SO - Am Surg. 2024 Jul;90(7):1940-1941. doi: 10.1177/00031348241241646. Epub 2024 Mar 23. PMID- 38519359 OWN - NLM STAT- MEDLINE DCOM- 20241127 LR - 20260417 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 303 DP - 2024 Nov TI - Higher Doses of Calcium Associated With Survival in Trauma Patients. PG - 788-794 LID - S0022-4804(24)00094-5 [pii] LID - 10.1016/j.jss.2024.02.014 [doi] AB - INTRODUCTION: Calcium is required for coagulation, cardiac output, and peripheral vascular resistance. Between 85% and 94% of trauma patients treated with massive blood transfusion develop hypocalcemia.(1) The aim of this study is to evaluate the relationship between increased intravenous calcium administration during massive transfusion and improved survival of trauma patients. METHODS: We performed a retrospective analysis of trauma patients who received massive transfusion over a 2-y period. Doses of elemental calcium administered per unit of blood product transfused were calculated by calcium to blood product ratio (CBR). Chi-square test evaluated association between coagulopathy and 30-d mortality. Two-sample t-test evaluated association between CBR and coagulopathy. Bivariate regression analysis evaluated association between CBR and blood products transfused per patient. Multivariable logistic regression analysis, controlling for age, sex, coagulopathy, and Injury Severity Score evaluated the association between CBR and mortality. RESULTS: The study included 77 patients. Coagulopathy was associated with increased 30-d mortality (P < 0.05). Patients who survived had higher CBR than those who died (P < 0.05). CBR was associated with a significant reduction in total blood products transfused per patient (P < 0.05). CBR was not associated with coagulopathy (P = 0.24). Multivariable logistic regression analysis demonstrated that Injury Severity Score >/=16, coagulopathy and decreased CBR were significant predictors of mortality (P < 0.05). CBR above 50 mg was a predictor of survival (P < 0.05). CONCLUSIONS: Higher doses of calcium given per blood product transfused were associated with improved 30-d survival and decreased blood product transfusions. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Wade, Dillon J AU - Wade DJ AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Pilkington, Collin AU - Pilkington C AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Henson, J Curran AU - Henson JC AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Jensen, Hanna K AU - Jensen HK AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Kalkwarf, Kyle AU - Kalkwarf K AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Bhavaraju, Avi AU - Bhavaraju A AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Bruce, Nolan AU - Bruce N AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Bowman, Stephen AU - Bowman S AD - Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas. FAU - Margolick, Joseph AU - Margolick J AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: jmargolick@uams.edu. LA - eng PT - Journal Article DEP - 20240321 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - SY7Q814VUP (Calcium) SB - IM MH - Humans MH - Female MH - Male MH - Retrospective Studies MH - Middle Aged MH - Adult MH - *Wounds and Injuries/mortality/complications/therapy MH - *Calcium/blood MH - Blood Transfusion/statistics & numerical data MH - Aged MH - Hypocalcemia/etiology MH - Blood Coagulation Disorders/etiology/mortality/therapy OTO - NOTNLM OT - Coagulopathy OT - Hypocalcemia OT - Massive transfusion OT - Rotational thromboelastometry EDAT- 2024/03/23 05:42 MHDA- 2024/11/27 06:19 CRDT- 2024/03/22 23:04 PHST- 2023/02/28 00:00 [received] PHST- 2024/01/17 00:00 [revised] PHST- 2024/02/16 00:00 [accepted] PHST- 2024/11/27 06:19 [medline] PHST- 2024/03/23 05:42 [pubmed] PHST- 2024/03/22 23:04 [entrez] AID - S0022-4804(24)00094-5 [pii] AID - 10.1016/j.jss.2024.02.014 [doi] PST - ppublish SO - J Surg Res. 2024 Nov;303:788-794. doi: 10.1016/j.jss.2024.02.014. Epub 2024 Mar 21. PMID- 38516476 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240323 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 16 IP - 2 DP - 2024 Feb TI - Thromboelastometric Analysis of the Correlation Between Burn-Induced Coagulopathy and Severity of Burn Injury. PG - e54489 LID - 10.7759/cureus.54489 [doi] LID - e54489 AB - Background In this study, we aimed to analyze the association between the burn index (BI) and burn-induced coagulopathy. Methods Adult burn patients transported to our emergency department who underwent rotational thromboelastometry (ROTEM) between April 1, 2013, and December 31, 2021, were enrolled in this study. The patients were categorized into two groups based on burn severity. Severe burns were defined as BI scores of > 15. Patient demographics, clinical variables of burns, standard laboratory test data, ROTEM data, and clinical outcomes of both groups were evaluated. In addition, the correlation between severe burns and significant variables was evaluated using a univariate analysis. Results Seven patients were enrolled and categorized into the severe (n = 2) and control (n = 5) groups. The severe group had a significantly worse consciousness level and higher mortality rate and showed higher tendencies of burn severity and clinical severity scores. Disseminated intravascular coagulation was confirmed in one patient. All ROTEM variables in the severe group regarding clot firmness in the extrinsic coagulation cascade (EXTEM) and fibrinogen-specific coagulation cascade (FIBTEM) showed a decreasing tendency as compared to those in the control group. Moreover, correlation analyses revealed strong correlations between the BI and clot firmness (rho = -0.946 to -0.721). Conclusions Severe BI was strongly associated with decreased blood clot firmness in EXTEM, FIBTEM, and ROTEM. Future research using viscoelastic devices may provide new possibilities for the treatment of severe burns. CI - Copyright (c) 2024, Koami et al. FAU - Koami, Hiroyuki AU - Koami H AD - Department of Emergency and Critical Care Medicine, Saga University, Saga, JPN. FAU - Sakamoto, Yuichiro AU - Sakamoto Y AD - Department of Emergency and Critical Care Medicine, Saga University, Saga, JPN. FAU - Matsuoka, Ayaka AU - Matsuoka A AD - Department of Emergency and Critical Care Medicine, Saga University Hospital, Saga, JPN. FAU - Shinada, Kota AU - Shinada K AD - Department of Emergency and Critical Care Medicine, Saga University, Saga, JPN. LA - eng PT - Journal Article DEP - 20240219 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC10955108 OTO - NOTNLM OT - burn index OT - clot firmness OT - extrinsic coagulation cascade OT - fibrinogen OT - viscoelastic device COIS- The authors have declared that no competing interests exist. EDAT- 2024/03/22 06:44 MHDA- 2024/03/22 06:45 PMCR- 2024/02/19 CRDT- 2024/03/22 04:13 PHST- 2024/02/19 00:00 [accepted] PHST- 2024/03/22 06:45 [medline] PHST- 2024/03/22 06:44 [pubmed] PHST- 2024/03/22 04:13 [entrez] PHST- 2024/02/19 00:00 [pmc-release] AID - 10.7759/cureus.54489 [doi] PST - epublish SO - Cureus. 2024 Feb 19;16(2):e54489. doi: 10.7759/cureus.54489. eCollection 2024 Feb. PMID- 38511850 OWN - NLM STAT- MEDLINE DCOM- 20240411 LR - 20250616 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 64 IP - 4 DP - 2024 Apr TI - Evaluating the effects of hypoxic storage on platelet function and health using a novel storage system. PG - 693-704 LID - 10.1111/trf.17784 [doi] AB - BACKGROUND: Thousands of units of whole blood (WB) and blood components are transfused daily to treat trauma patients. Improved methods for blood storage are critical to support trauma-related care. The Hemanext ONE(R) system offers a unique method for hypoxic storage of WB, with successfully demonstrated storage of clinically viable RBCs. This work evaluated the system for the storage of WB, focusing on platelet health and function. STUDY DESIGN AND METHODS: WB was collected from healthy donors and processed through the Hemanext ONE(R) system. Hemoglobin oxygen saturation (HbSO(2)) levels of WB were depleted to 10%, 20%, or 30% of total HbSO(2) and then stored in PVC bags sealed in oxygen-impermeable bags (except for normoxic control) with samples collected on days 1, 7, and 14 post-processing. Flow cytometry assessed the activation and apoptosis of platelets. Clot dynamics were assessed based on aggregometry and thromboelastography assays, as well as thrombin generation using a calibrated-automated thrombogram method. RESULTS: Hypoxic storage conditions were maintained throughout the storage period. Hypoxia triggered increased lactate production, but pH changes were negligible compared to normoxic control. Storage at 10% HbSO(2) had a significant impact on platelet function, resulting in increased activation and reduced clot formation and aggregation. These effects were less significant at 20% and 30% HbSO(2). DISCUSSION: This study indicates that platelets are sensitive to hypoxic storage and suffer significant metabolic and functional deterioration when stored at or below 10% HbSO(2). CI - (c) 2024 AABB. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. FAU - Weaver, A J Jr AU - Weaver AJ Jr AUID- ORCID: 0000-0002-9266-0123 AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - McIntosh, C S AU - McIntosh CS AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Kelly, S G AU - Kelly SG AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Barrera, G D AU - Barrera GD AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Lizarraga, S AU - Lizarraga S AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Hildreth, K E AU - Hildreth KE AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Williams, C E AU - Williams CE AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Grantham, L AU - Grantham L AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Yoshida, T AU - Yoshida T AUID- ORCID: 0000-0002-3879-5668 AD - Hemanext Inc., Lexington, Massachusetts, USA. FAU - Omert, L AU - Omert L AD - Hemanext Inc., Lexington, Massachusetts, USA. FAU - Bynum, J A AU - Bynum JA FAU - Meledeo, M A AU - Meledeo MA AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. FAU - Reddoch-Cardenas, K M AU - Reddoch-Cardenas KM AUID- ORCID: 0000-0003-2626-9780 AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. LA - eng GR - B_026_2020/U.S. Army Medical Research and Development Command/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20240321 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Humans MH - *Blood Preservation/methods MH - *Blood Platelets/metabolism MH - Erythrocytes MH - Blood Coagulation Tests MH - Hypoxia OTO - NOTNLM OT - Hemanext ONE(R) OT - hypoxic storage OT - platelets OT - shelf-life OT - trauma OT - whole blood EDAT- 2024/03/21 12:43 MHDA- 2024/04/11 06:43 CRDT- 2024/03/21 08:33 PHST- 2024/01/14 00:00 [revised] PHST- 2023/09/16 00:00 [received] PHST- 2024/03/04 00:00 [accepted] PHST- 2024/04/11 06:43 [medline] PHST- 2024/03/21 12:43 [pubmed] PHST- 2024/03/21 08:33 [entrez] AID - 10.1111/trf.17784 [doi] PST - ppublish SO - Transfusion. 2024 Apr;64(4):693-704. doi: 10.1111/trf.17784. Epub 2024 Mar 21. PMID- 38485260 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20241013 IS - 2383-4625 (Print) IS - 2383-4625 (Electronic) IS - 2383-4625 (Linking) VI - 11 IP - 3 DP - 2024 Sep TI - Update on the pathophysiology and management of acute trauma hemorrhage and trauma-induced coagulopathy based upon viscoelastic testing. PG - 259-267 LID - 10.15441/ceem.24.202 [doi] AB - Uncontrolled hemorrhage and trauma-induced coagulopathy (TIC) are the two predominant causes of preventable death after trauma. Early control of bleeding sources and rapid detection, characterization and management of TIC have been associated with improved outcomes. However, recent surveys confirm vast heterogeneity in the clinical diagnosis and management of hemorrhage and TIC from acute trauma, even in advanced trauma centers. In addition, conventional coagulation assays, although still used frequently during the early assessment of bleeding trauma patients, have their limitations. This narrative review highlights the clinical value of rapid point-of-care viscoelastic testing for the early diagnosis and individualized goal-directed therapy in bleeding trauma patients with TIC. FAU - Maegele, Marc AU - Maegele M AD - Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. LA - eng PT - Journal Article DEP - 20240315 PL - Korea (South) TA - Clin Exp Emerg Med JT - Clinical and experimental emergency medicine JID - 101657493 PMC - PMC11467455 OTO - NOTNLM OT - Bleeding OT - Coagulopathy OT - Hemorrhage OT - Trauma OT - Viscoelastic testing COIS- Conflicts of interest The author has received honoraria for speaker's bureaus, participation in advisory boards, support for conference travels and research projects from Abbott, Astra Zeneca, Baxter, Bayer, CSL Behring, IL-Werfen, LFB Biomedicaments, Octapharma, Portotla Inc, and TEM International. The author has no other conflicts of interest to declare. EDAT- 2024/03/15 00:43 MHDA- 2024/03/15 00:44 PMCR- 2024/03/15 CRDT- 2024/03/14 21:38 PHST- 2024/02/07 00:00 [received] PHST- 2024/02/20 00:00 [accepted] PHST- 2024/03/15 00:44 [medline] PHST- 2024/03/15 00:43 [pubmed] PHST- 2024/03/14 21:38 [entrez] PHST- 2024/03/15 00:00 [pmc-release] AID - ceem.24.202 [pii] AID - ceem-24-202 [pii] AID - 10.15441/ceem.24.202 [doi] PST - ppublish SO - Clin Exp Emerg Med. 2024 Sep;11(3):259-267. doi: 10.15441/ceem.24.202. Epub 2024 Mar 15. PMID- 38462250 OWN - NLM STAT- MEDLINE DCOM- 20240312 LR - 20240814 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 230 IP - 3S DP - 2024 Mar TI - The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care. PG - S1089-S1106 LID - S0002-9378(22)00730-X [pii] LID - 10.1016/j.ajog.2022.09.008 [doi] AB - Viscoelastic hemostatic assays are point-of-care devices that assess coagulation and fibrinolysis in whole blood samples. These technologies provide numeric and visual information of clot initiation, clot strength, and clot lysis under low-shear conditions, and have been used in a variety of clinical settings and subpopulations, including trauma, cardiac surgery, and obstetrics. Emerging data indicate that these devices are useful for detecting important coagulation defects during major postpartum hemorrhage (especially low plasma fibrinogen concentration [hypofibrinogenemia]) and informing clinical decision-making for blood product use. Data from observational studies suggest that, compared with traditional formulaic approaches to transfusion management, targeted or goal-directed transfusion approaches using data from viscoelastic hemostatic assays are associated with reduced hemorrhage-related morbidity and lower blood product requirement. Viscoelastic hemostatic assays can also be used to identify and treat coagulation defects in patients with inherited or acquired coagulation disorders, such as factor XI deficiency or immune-mediated thrombocytopenia, and to assess hemostatic profiles of patients prescribed anticoagulant medications to mitigate the risk of epidural hematoma after neuraxial anesthesia and postpartum hemorrhage after delivery. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Katz, Daniel AU - Katz D AD - Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: daniel.katz@mountsinai.org. FAU - Farber, Michaela AU - Farber M AD - Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. FAU - Getrajdman, Chloe AU - Getrajdman C AD - Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. FAU - Hamburger, Joshua AU - Hamburger J AD - Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. FAU - Reale, Sharon AU - Reale S AD - Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. FAU - Butwick, Alexander AU - Butwick A AD - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA. LA - eng PT - Journal Article PT - Review DEP - 20230823 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 RN - 0 (Hemostatics) SB - IM MH - Pregnancy MH - Female MH - Humans MH - *Hemostatics/therapeutic use MH - *Postpartum Hemorrhage/diagnosis/therapy MH - Thrombelastography MH - Hemostasis MH - Blood Coagulation MH - *Blood Coagulation Disorders/diagnosis/therapy OTO - NOTNLM OT - anticoagulants OT - blood coagulation disorders OT - blood coagulation tests OT - blood transfusion OT - fibrinogen OT - hemorrhage OT - point-of-care systems OT - postpartum OT - thromboelastography OT - thromboelastometry EDAT- 2024/03/11 00:42 MHDA- 2024/03/12 06:43 CRDT- 2024/03/10 21:55 PHST- 2022/07/27 00:00 [received] PHST- 2022/09/06 00:00 [revised] PHST- 2022/09/06 00:00 [accepted] PHST- 2024/03/12 06:43 [medline] PHST- 2024/03/11 00:42 [pubmed] PHST- 2024/03/10 21:55 [entrez] AID - S0002-9378(22)00730-X [pii] AID - 10.1016/j.ajog.2022.09.008 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2024 Mar;230(3S):S1089-S1106. doi: 10.1016/j.ajog.2022.09.008. Epub 2023 Aug 23. PMID- 38460171 OWN - NLM STAT- MEDLINE DCOM- 20240515 LR - 20260127 IS - 2198-3844 (Electronic) IS - 2198-3844 (Linking) VI - 11 IP - 18 DP - 2024 May TI - Harnessing Mechanical Stress with Viscoelastic Biomaterials for Periodontal Ligament Regeneration. PG - e2309562 LID - 10.1002/advs.202309562 [doi] LID - 2309562 AB - The viscoelasticity of mechanically sensitive tissues such as periodontal ligaments (PDLs) is key in maintaining mechanical homeostasis. Unfortunately, PDLs easily lose viscoelasticity (e.g., stress relaxation) during periodontitis or dental trauma, which disrupt cell-extracellular matrix (ECM) interactions and accelerates tissue damage. Here, Pluronic F127 diacrylate (F127DA) hydrogels with PDL-matched stress relaxation rates and high elastic moduli are developed. The hydrogel viscoelasticity is modulated without chemical cross-linking by controlling precursor concentrations. Under cytomechanical loading, F127DA hydrogels with fast relaxation rates significantly improved the fibrogenic differentiation potential of PDL stem cells (PDLSCs), while cells cultured on F127DA hydrogels with various stress relaxation rates exhibited similar fibrogenic differentiation potentials with limited cell spreading and traction forces under static conditions. Mechanically, faster-relaxing F127DA hydrogels leveraged cytomechanical loading to activate PDLSC mechanotransduction by upregulating integrin-focal adhesion kinase pathway and thus cytoskeletal rearrangement, reinforcing cell-ECM interactions. In vivo experiments confirm that faster-relaxing F127DA hydrogels significantly promoted PDL repair and reduced abnormal healing (e.g., root resorption and ankyloses) in delayed replantation of avulsed teeth. This study firstly investigated how matrix nonlinear viscoelasticity influences the fibrogenesis of PDLSCs under mechanical stimuli, and it reveals the underlying mechanobiology, which suggests novel strategies for PDL regeneration. CI - (c) 2024 The Authors. Advanced Science published by Wiley-VCH GmbH. FAU - Zhang, Jiu-Jiu AU - Zhang JJ AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Li, Xuan AU - Li X AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Tian, Yi AU - Tian Y AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Zou, Jie-Kang AU - Zou JK AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Gan, Dian AU - Gan D AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Deng, Dao-Kun AU - Deng DK AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Jiao, Chen AU - Jiao C AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Yin, Yuan AU - Yin Y AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Tian, Bei-Min AU - Tian BM AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Wu, Rui-Xin AU - Wu RX AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - Chen, Fa-Ming AU - Chen FM AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. FAU - He, Xiao-Tao AU - He XT AUID- ORCID: 0000-0002-3767-4610 AD - State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China. LA - eng GR - 82130026/National Natural Science Foundation of China/ GR - 82371010/National Natural Science Foundation of China/ GR - 82301079/National Natural Science Foundation of China/ GR - 82001102/National Natural Science Foundation of China/ GR - 82170958/National Natural Science Foundation of China/ GR - 82101013/National Natural Science Foundation of China/ GR - 82370957/National Natural Science Foundation of China/ GR - 2021PYRC001/Young Elite Scientist Support Program/ GR - 2022QNRC001/Young Elite Scientist Sponsorship Program/ GR - 2022TQ0134/China Postdoctoral Science Foundation/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20240309 PL - Germany TA - Adv Sci (Weinh) JT - Advanced science (Weinheim, Baden-Wurttemberg, Germany) JID - 101664569 RN - 0 (Hydrogels) RN - 0 (Biocompatible Materials) RN - 106392-12-5 (Poloxamer) SB - IM MH - *Periodontal Ligament/cytology/physiology MH - *Regeneration/physiology MH - *Hydrogels/chemistry MH - *Biocompatible Materials/chemistry MH - Animals MH - *Stress, Mechanical MH - Humans MH - Cells, Cultured MH - Viscosity MH - Poloxamer/chemistry/pharmacology MH - Stem Cells/cytology MH - Elasticity MH - Cell Differentiation/physiology PMC - PMC11095218 OTO - NOTNLM OT - F127 hydrogels OT - mechanical regulation OT - periodontal ligaments OT - viscoelastic hydrogels OT - viscoelasticity COIS- The authors declare no conflict of interest. EDAT- 2024/03/09 20:43 MHDA- 2024/05/15 12:44 PMCR- 2024/03/09 CRDT- 2024/03/09 14:53 PHST- 2024/02/15 00:00 [revised] PHST- 2023/12/07 00:00 [received] PHST- 2024/05/15 12:44 [medline] PHST- 2024/03/09 20:43 [pubmed] PHST- 2024/03/09 14:53 [entrez] PHST- 2024/03/09 00:00 [pmc-release] AID - ADVS7703 [pii] AID - 10.1002/advs.202309562 [doi] PST - ppublish SO - Adv Sci (Weinh). 2024 May;11(18):e2309562. doi: 10.1002/advs.202309562. Epub 2024 Mar 9. PMID- 38453302 OWN - NLM STAT- MEDLINE DCOM- 20240311 LR - 20240311 IS - 1558-3171 (Electronic) IS - 0039-6109 (Linking) VI - 104 IP - 2 DP - 2024 Apr TI - Resuscitation and Care in the Trauma Bay. PG - 279-292 LID - S0039-6109(23)00160-3 [pii] LID - 10.1016/j.suc.2023.09.005 [doi] AB - Start balanced resuscitation early (pre-hospital if possible), either in the form of whole blood or 1:1:1 ratio. Minimize resuscitation with crystalloid to minimize patient morbidity and mortality. Trauma-induced coagulopathy can be largely avoided with the use of balanced resuscitation, permissive hypotension, and minimized time to hemostasis. Using protocolized "triggers" for massive and ultramassive transfusion will assist in minimizing delays in transfusion of products, achieving balanced ratios, and avoiding trauma induced coagulopathy. Once "audible" bleeding has been addressed, further blood product resuscitation and adjunct replacement should be guided by viscoelastic testing. Early transfusion of whole blood can reduce patient morbidity, mortality, decreases donor exposure, and reduces nursing logistics during transfusions. Adjuncts to resuscitation should be guided by laboratory testing and carefully developed, institution-specific guidelines. These include empiric calcium replacement, tranexamic acid (or other anti-fibrinolytics), and fibrinogen supplementation. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Van Gent, Jan-Michael AU - Van Gent JM AD - The Red Duke Trauma Institute, Memorial Hermann Hospital, Houston, TX, USA; McGovern Medical School, University of Texas Health Science Center-Houston, Houston, TX, USA. FAU - Clements, Thomas W AU - Clements TW AD - The Red Duke Trauma Institute, Memorial Hermann Hospital, Houston, TX, USA; McGovern Medical School, University of Texas Health Science Center-Houston, Houston, TX, USA. FAU - Cotton, Bryan A AU - Cotton BA AD - The Red Duke Trauma Institute, Memorial Hermann Hospital, Houston, TX, USA; McGovern Medical School, University of Texas Health Science Center-Houston, Houston, TX, USA; Center for Translational Injury Research, Houston, TX, USA. Electronic address: Bryan.A.Cotton@uth.tmc.edu. LA - eng PT - Journal Article PT - Review DEP - 20231020 PL - United States TA - Surg Clin North Am JT - The Surgical clinics of North America JID - 0074243 RN - 0 (Hemostatics) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Humans MH - Hemorrhage/etiology/therapy MH - Blood Transfusion MH - *Blood Coagulation Disorders/etiology/therapy MH - *Hemostatics MH - *Tranexamic Acid/therapeutic use MH - Resuscitation MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - Balanced resuscitation OT - Hemorrhagic shock OT - Trauma OT - Trauma-induced coagulopathy EDAT- 2024/03/08 00:43 MHDA- 2024/03/11 06:42 CRDT- 2024/03/07 21:00 PHST- 2024/03/11 06:42 [medline] PHST- 2024/03/08 00:43 [pubmed] PHST- 2024/03/07 21:00 [entrez] AID - S0039-6109(23)00160-3 [pii] AID - 10.1016/j.suc.2023.09.005 [doi] PST - ppublish SO - Surg Clin North Am. 2024 Apr;104(2):279-292. doi: 10.1016/j.suc.2023.09.005. Epub 2023 Oct 20. PMID- 38398681 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240227 IS - 2075-1729 (Print) IS - 2075-1729 (Electronic) IS - 2075-1729 (Linking) VI - 14 IP - 2 DP - 2024 Jan 24 TI - Post-Reconstitution Hemostatic Stability Profiles of Canadian and German Freeze-Dried Plasma. LID - 10.3390/life14020172 [doi] LID - 172 AB - Despite the importance of the hemostatic properties of reconstituted freeze-dried plasma (FDP) for trauma resuscitation, few studies have been conducted to determine its post-reconstitution hemostatic stability. This study aimed to assess the short- (/=168 h) hemostatic stabilities of Canadian and German freeze-dried plasma (CFDP and LyoPlas) after reconstitution and storage under different conditions. Post-reconstitution hemostatic profiles were determined using rotational thromboelastometry (ROTEM) and a Stago analyzer, as both are widely used as standard methods for assessing the quality of plasma. When compared to the initial reconstituted CFDP, there were no changes in ROTEM measurements for INTEM maximum clot firmness (MCF), EXTEM clotting time (CT) and MCF, and Stago measurements for prothrombin time (PT), partial thromboplastin time (PTT), D-dimer concentration, plasminogen, and protein C activities after storage at 4 degrees C for 24 h and room temperature (RT) (22-25 degrees C) for 4 h. However, an increase in INTEM CT and decreases in fibrinogen concentration, factors V and VIII, and protein S activities were observed after storage at 4 degrees C for 24 h, while an increase in factor V and decreases in antithrombin and protein S activities were seen after storage at RT for 4 h. Evaluation of the long-term stability of reconstituted LyoPlas showed decreased stability in both global and specific hemostatic profiles with increasing storage temperatures, particularly at 35 degrees C, where progressive changes in CT and MCF, PT, PTT, fibrinogen concentration, factor V, antithrombin, protein C, and protein S activities were seen even after storage for 4 h. We confirmed the short-term stability of CFDP in global hemostatic properties after reconstitution and storage at RT, consistent with the shelf life of reconstituted LyoPlas. The long-term stability analyses suggest that the post-reconstitution hemostatic stability of FDP products would decrease over time with increasing storage temperature, with a significant loss of hemostatic functions at 35 degrees C compared to 22 degrees C or below. Therefore, the shelf life of reconstituted FDP should be recommended according to the storage temperature. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Moes, Katherine AU - Moes K AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Singh, Kanwal AU - Singh K AUID- ORCID: 0000-0003-3303-5966 AD - St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada. FAU - Rhind, Shawn G AU - Rhind SG AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada. FAU - Pambrun, Chantale AU - Pambrun C AD - Centre for Innovation, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada. FAU - Jenkins, Craig AU - Jenkins C AD - Centre for Innovation, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada. FAU - da Luz, Luis AU - da Luz L AUID- ORCID: 0000-0003-0292-9676 AD - Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada. FAU - Beckett, Andrew AU - Beckett A AD - St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada. AD - Royal Canadian Medical Services, Ottawa, ON K1A 0K2, Canada. LA - eng GR - People_014/Canadian Forces Health Services, the CF Surgeon Generals Health Research Program, and Defence Research and Development Canada/ PT - Journal Article DEP - 20240124 PL - Switzerland TA - Life (Basel) JT - Life (Basel, Switzerland) JID - 101580444 PMC - PMC10890410 OTO - NOTNLM OT - coagulation OT - freeze-dried plasma OT - hemostatic resuscitation OT - prehospital transfusion OT - stability COIS- The authors declare no conflicts of interest. EDAT- 2024/02/24 11:43 MHDA- 2024/02/24 11:44 PMCR- 2024/01/24 CRDT- 2024/02/24 01:14 PHST- 2023/11/27 00:00 [received] PHST- 2023/12/31 00:00 [revised] PHST- 2024/01/03 00:00 [accepted] PHST- 2024/02/24 11:44 [medline] PHST- 2024/02/24 11:43 [pubmed] PHST- 2024/02/24 01:14 [entrez] PHST- 2024/01/24 00:00 [pmc-release] AID - life14020172 [pii] AID - life-14-00172 [pii] AID - 10.3390/life14020172 [doi] PST - epublish SO - Life (Basel). 2024 Jan 24;14(2):172. doi: 10.3390/life14020172. PMID- 38394296 OWN - NLM STAT- MEDLINE DCOM- 20240305 LR - 20250302 IS - 1557-8674 (Electronic) IS - 1096-2964 (Print) IS - 1096-2964 (Linking) VI - 25 IP - 2 DP - 2024 Mar TI - Fibrinolysis Resistance After Injury Is a Risk Factor for a Hospital-Acquired Pneumonia-Like Disease Pattern. PG - 87-94 LID - 10.1089/sur.2023.257 [doi] AB - Background: Pneumonia is associated with increased morbidity and costs in the intensive care unit (ICU). Its early identification is key for optimal outcomes, but early biomarkers are lacking. Studies suggest that fibrinolysis resistance (FR) after major abdominal surgery is linked to an increased risk of infection. Patients and Methods: Patients in a randomized controlled trial for hemorrhagic shock were evaluated for FR. Fibrinolysis resistance was quantified by thrombelastography with exogenous tissue plasminogen activator (tPA-TEG) at 24- and 48-hours post-injury and measuring LY30 (%). A receiver-operating characteristics (ROC) curve analysis was used to identify a cutoff for increased risk of pneumonia, which was then validated in ICU patients at risk for venous thromboembolism (VTE). Multivariable logistic regression was used to control for confounders. Results: Forty-nine patients in the hemorrhagic shock cohort had tPA-TEGs at 24- and 48-hours (median ISS, 27; 7% pneumonia). A composite tPA-TEG LY30 of less than 4% at 24 and 48 hours was found to be the optimal cutoff for increased risk of pneumonia. This cohort had a seven-fold increased rate of pneumonia (4% vs. 28%; p = 0.048). Eighty-eight patients in the VTE cohort had tPA-TEGs at 24 and 48 hours post-ICU admission (median ISS, 28; 6% pneumonia). The tPA-TEG LY30 of less than 4% was associated with a 10-fold increased rate of pneumonia (19% vs. 1.5%; p = 0.002). In patients with traumatic brain injury, the same association was found (33% vs. 3.2%; p = 0.006). Adjusting for confounders, the tPA-TEG persisted as a substantial risk factor for pneumonia (adjusted odds ratio [OR], 35.7; 95% confidence interval [CI], 1.9-682; p = 0.018). Conclusions: Fibrinolysis resistance quantified by tPA-TEG within 48 hours of ICU admission is associated with an increased risk of pneumonia in patients in hemorrhagic shock and those at risk for VTE. Prospective validation of the tPA-TEG LY30 optimal cutoff for pneumonia and further investigation into whether endogenous FR is a cause of an altered immunity is warranted. FAU - Rodriguez, Ivan E AU - Rodriguez IE AD - Colorado Center for Transplantation Care, Research, and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Saben, Jessica L AU - Saben JL AD - Colorado Center for Transplantation Care, Research, and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Department of Surgery, Ernest E. Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Knudson, M Margaret AU - Knudson MM AD - Department of Surgery, University of California San Francisco, San Francisco, California, USA. FAU - Moore, Peter K AU - Moore PK AD - University of Colorado Denver, Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA. FAU - Pieracci, Fredric AU - Pieracci F AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Department of Surgery, Ernest E. Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, Ernest E. Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Moore, Hunter B AU - Moore HB AD - Colorado Center for Transplantation Care, Research, and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - Transplant Institution at Porter, AdventHealth, Denver, Colorado, USA. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20240223 PL - United States TA - Surg Infect (Larchmt) JT - Surgical infections JID - 9815642 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Humans MH - Fibrinolysis MH - Tissue Plasminogen Activator MH - *Shock, Hemorrhagic MH - *Venous Thromboembolism/epidemiology/etiology MH - Risk Factors MH - Hospitals MH - *Wounds and Injuries PMC - PMC10924191 OTO - NOTNLM OT - fibrinolysis resistance OT - infections OT - pneumonia OT - trauma COIS- H.B.M. and E.E.M. have an issued patent for the tPA-TEG that is licensed through the University of Colorado. The remaining authors have no relevant conflicts to disclose. EDAT- 2024/02/23 18:42 MHDA- 2024/03/05 06:44 PMCR- 2025/03/01 CRDT- 2024/02/23 14:13 PHST- 2024/03/05 06:44 [medline] PHST- 2024/02/23 18:42 [pubmed] PHST- 2024/02/23 14:13 [entrez] PHST- 2025/03/01 00:00 [pmc-release] AID - 10.1089/sur.2023.257 [pii] AID - 10.1089/sur.2023.257 [doi] PST - ppublish SO - Surg Infect (Larchmt). 2024 Mar;25(2):87-94. doi: 10.1089/sur.2023.257. Epub 2024 Feb 23. PMID- 38390985 OWN - NLM STAT- MEDLINE DCOM- 20240306 LR - 20250601 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 37 IP - 2 DP - 2024 Apr 1 TI - Massive transfusion in trauma. PG - 117-124 LID - 10.1097/ACO.0000000000001347 [doi] AB - PURPOSE OF REVIEW: The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. RECENT FINDINGS: Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3-4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. SUMMARY: To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested. CI - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved. FAU - Lier, Heiko AU - Lier H AD - Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne. FAU - Hossfeld, Bjorn AU - Hossfeld B AD - Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Center of Emergency Medicine, HEMS 'Christoph 22', Armed Forces Hospital, Ulm, Germany. LA - eng PT - Journal Article PT - Review DEP - 20240119 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) SB - IM MH - Humans MH - Hemorrhage/diagnosis/etiology/therapy MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Coagulation Factors/therapeutic use MH - *Hemostatics/therapeutic use MH - Blood Transfusion/methods MH - *Wounds and Injuries/complications/therapy EDAT- 2024/02/23 12:42 MHDA- 2024/03/06 06:43 CRDT- 2024/02/23 08:02 PHST- 2024/03/06 06:43 [medline] PHST- 2024/02/23 12:42 [pubmed] PHST- 2024/02/23 08:02 [entrez] AID - 00001503-202404000-00005 [pii] AID - 10.1097/ACO.0000000000001347 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2024 Apr 1;37(2):117-124. doi: 10.1097/ACO.0000000000001347. Epub 2024 Jan 19. PMID- 38390904 OWN - NLM STAT- MEDLINE DCOM- 20240306 LR - 20250601 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 37 IP - 2 DP - 2024 Apr 1 TI - Guidelines in trauma-related bleeding and coagulopathy: an update. PG - 110-116 LID - 10.1097/ACO.0000000000001346 [doi] AB - PURPOSE OF REVIEW: The diagnosis and treatment of patients with severe traumatic bleeding and subsequent trauma-induced coagulopathy (TIC) is still inconsistent, although the implementation of standardized algorithms/treatment pathways was repeatedly linked to improved outcome. Various evidence-based guidelines for these patients now exist, three of which have recently been updated. RECENT FINDINGS: A synopsis of the three recently updated guidelines for diagnosis and treatment of seriously bleeding trauma patients with TIC is presented: (i) AWMF S3 guideline 'Polytrauma/Seriously Injured Patient Treatment' under the auspices of the German Society for Trauma Surgery; (ii) guideline of the European Society of Anesthesiology and Intensive Care (ESAIC) on the management of perioperative bleeding; and (iii) European guideline on the management of major bleeding and coagulopathy after trauma in its 6th edition (EU-Trauma). SUMMARY: Treatment of trauma-related bleeding begins at the scene with local compression, use of tourniquets and pelvic binders and rapid transport to a certified trauma centre. After arrival at the hospital, measures to record, monitor and support coagulation function should be initiated immediately. Surgical bleeding control is carried out according to 'damage control' principles. Modern coagulation management includes individualized treatment based on target values derived from point-of-care viscoelastic test procedures. CI - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved. FAU - Christoffel, Jannis AU - Christoffel J AD - Department for Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center (CMMC). FAU - Maegele, Marc AU - Maegele M AD - Department for Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center (CMMC). AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany. LA - eng PT - Journal Article PT - Review DEP - 20240122 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Humans MH - Hemorrhage/diagnosis/etiology/therapy MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Coagulation MH - *Wounds and Injuries/complications/therapy EDAT- 2024/02/23 12:43 MHDA- 2024/03/06 06:43 CRDT- 2024/02/23 08:00 PHST- 2024/03/06 06:43 [medline] PHST- 2024/02/23 12:43 [pubmed] PHST- 2024/02/23 08:00 [entrez] AID - 00001503-202404000-00004 [pii] AID - 10.1097/ACO.0000000000001346 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2024 Apr 1;37(2):110-116. doi: 10.1097/ACO.0000000000001346. Epub 2024 Jan 22. PMID- 38382192 OWN - NLM STAT- MEDLINE DCOM- 20240403 LR - 20240403 IS - 1943-5681 (Electronic) IS - 0002-9645 (Linking) VI - 85 IP - 4 DP - 2024 Apr 1 TI - Evaluation of viscoelastic coagulation monitoring parameters and fibrinogen concentrations in healthy dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy. LID - ajvr.23.11.0250 [pii] LID - 10.2460/ajvr.23.11.0250 [doi] AB - OBJECTIVE: Evaluation of viscoelastic parameters along with Hct percentages, platelet numbers, and fibrinogen concentrations in healthy dogs undergoing elective stifle arthroscopy and tibial plateau leveling osteotomy (TPLO). These results determine if dogs are in a normal, hypocoagulable, or hypercoagulable state at 4 different time points. ANIMALS: Prospective study of 37 client-owned dogs enrolled between February 2, 2022, and November 10, 2022. METHODS: All dogs received a standardized anesthetic protocol. Patients enrolled in the study underwent stifle arthroscopy using a 3-portal technique with a TPLO performed by board-certified surgeons. Viscoelastic testing, Hct percentage, fibrinogen concentration, and platelet numbers were measured preoperatively, immediately postoperatively, 24 hours postoperatively, and 14 days postoperatively. RESULTS: Stifle arthroscopy and TPLO surgery was not associated with significant effects on viscoelastic coagulation monitoring and fibrinogen concentrations in healthy dogs when comparing the time points. CLINICAL RELEVANCE: Humans have a high risk of thrombotic events when undergoing elective orthopedic surgery and are often placed on prophylactic antithrombotic medication prior to surgery. Viscoelastic coagulation monitoring in dogs undergoing similar orthopedic procedures has been evaluated in veterinary medicine, but the effects on platelets and fibrinogen concentrations from similar orthopedic procedures and uniform anesthesia protocols have not been documented. Cranial cruciate ligament insufficiency is the most common orthopedic injury in dogs. Treatment requires elective surgical correction for the best results and improved long-term prognosis. The findings of this study suggest that similar preoperative prophylactic antithrombotic intervention is not needed for canine patients. FAU - Grace, Mackenzie AU - Grace M AD - Gulf Coast Veterinary Specialists-Surgery, Houston, TX. FAU - Salazar, Rebecca AU - Salazar R AD - Gulf Coast Veterinary Specialists-Surgery, Houston, TX. FAU - Zayas, Jose AU - Zayas J AD - Southwest Veterinary Surgical Service-Surgery, Tucson, AZ. FAU - Allen, Philip AU - Allen P AD - Gulf Coast Veterinary Specialists-Surgery, Houston, TX. LA - eng PT - Journal Article DEP - 20240212 PL - United States TA - Am J Vet Res JT - American journal of veterinary research JID - 0375011 RN - 9001-32-5 (Fibrinogen) RN - 0 (Fibrinolytic Agents) SB - IM MH - Humans MH - Dogs MH - Animals MH - Stifle/surgery MH - *Anterior Cruciate Ligament Injuries/veterinary MH - Fibrinogen MH - Arthroscopy/veterinary MH - Prospective Studies MH - Fibrinolytic Agents MH - Tibia/surgery MH - Osteotomy/veterinary/methods MH - *Dog Diseases/surgery OTO - NOTNLM OT - fibrinogen OT - platelets OT - stifle arthroscopy OT - tibial plateau leveling osteotomy OT - viscoelastic coagulation monitoring EDAT- 2024/02/22 00:43 MHDA- 2024/04/03 06:44 CRDT- 2024/02/21 18:04 PHST- 2023/11/06 00:00 [received] PHST- 2024/01/18 00:00 [accepted] PHST- 2024/04/03 06:44 [medline] PHST- 2024/02/22 00:43 [pubmed] PHST- 2024/02/21 18:04 [entrez] AID - ajvr.23.11.0250 [pii] AID - 10.2460/ajvr.23.11.0250 [doi] PST - epublish SO - Am J Vet Res. 2024 Feb 12;85(4):ajvr.23.11.0250. doi: 10.2460/ajvr.23.11.0250. Print 2024 Apr 1. PMID- 38375027 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240404 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 9 IP - 1 DP - 2024 TI - Missingness matters: a secondary analysis of thromboelastography measurements from a recent prehospital randomized tranexamic acid clinical trial. PG - e001346 LID - 10.1136/tsaco-2023-001346 [doi] LID - e001346 AB - BACKGROUND: Tranexamic acid (TXA) has been hypothesized to mitigate coagulopathy in patients after traumatic injury. Despite previous prehospital clinical trials demonstrating a TXA survival benefit, none have demonstrated correlated changes in thromboelastography (TEG) parameters. We sought to analyze if missing TEG data contributed to this paucity of findings. METHODS: We performed a secondary analysis of the Study of Tranexamic Acid During Air Medical and Ground Prehospital Transport Trial. We compared patients that received TEG (YES-TEG) and patients unable to be sampled (NO-TEG) to analyze subgroups in which to investigate TEG differences. TEG parameter differences across TXA intervention arms were assessed within subgroups disproportionately present in the NO-TEG relative to the YES-TEG cohort. Generalized linear models controlling for potential confounders were applied to findings with p<0.10 on univariate analysis. RESULTS: NO-TEG patients had lower prehospital systolic blood pressure (SBP) (100 (78, 140) vs 125 (88, 147), p<0.01), lower prehospital Glascow Coma Score (14 (3, 15) vs 15 (12, 15), p<0.01), greater rates of prehospital intubation (39.4% vs 24.4%, p<0.01) and greater mortality at 30 days (36.4% vs 6.8%, p<0.01). NO-TEG patients had a greater international normalized ratio relative to the YES-TEG subgroup (1.2 (1.1, 1.5) vs 1.1 (1.0, 1.2), p=0.04). Within a severe prehospital shock cohort (SBP<70), TXA was associated with a significant decrease in clot lysis at 30 min on multivariate analysis (beta=-27.6, 95% CI (-51.3 to -3.9), p=0.02). CONCLUSIONS: Missing data, due to the logistical challenges of sampling certain severely injured patients, may be associated with a lack of TEG parameter changes on TXA administration in the primary analysis. Previous demonstration of TXA's survival benefit in patients with severe prehospital shock in tandem with the current findings supports the notion that TXA acts at least partially by improving clot integrity. LEVEL OF EVIDENCE: Level II. CI - (c) Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Donohue, Jack K AU - Donohue JK AUID- ORCID: 0000-0002-7975-570X AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Iyanna, Nidhi AU - Iyanna N AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Lorence, John M AU - Lorence JM AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Brown, Joshua B AU - Brown JB AUID- ORCID: 0000-0002-6936-035X AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Guyette, Frances X AU - Guyette FX AUID- ORCID: 0000-0002-9151-4896 AD - Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Eastridge, Brian J AU - Eastridge BJ AD - Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA. FAU - Nirula, Raminder AU - Nirula R AD - Department of Surgery, University of Utah, Salt Lake City, Utah, USA. FAU - Vercruysse, Gary A AU - Vercruysse GA AD - Department of Surgery, University of Arizona, Tucson, Arizona, USA. FAU - O'Keeffe, Terence AU - O'Keeffe T AD - Department of Surgery, University of Arizona, Tucson, Arizona, USA. FAU - Joseph, Bellal AU - Joseph B AD - Department of Surgery, University of Arizona, Tucson, Arizona, USA. FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Sperry, Jason L AU - Sperry JL AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. LA - eng GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20240217 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 CIN - Trauma Surg Acute Care Open. 2024 Mar 7;9(1):e001429. doi: 10.1136/tsaco-2024-001429. PMID: 38464550 CIN - Trauma Surg Acute Care Open. 2024 Apr 2;9(1):e001405. doi: 10.1136/tsaco-2024-001405. PMID: 38571726 PMC - PMC10875568 OTO - NOTNLM OT - Multiple Trauma OT - blood transfusion OT - thromboelastography OT - tranexamic acid COIS- Competing interests: None declared. EDAT- 2024/02/20 11:50 MHDA- 2024/02/20 11:51 PMCR- 2024/02/17 CRDT- 2024/02/20 03:38 PHST- 2023/12/20 00:00 [received] PHST- 2024/01/31 00:00 [accepted] PHST- 2024/02/20 11:51 [medline] PHST- 2024/02/20 11:50 [pubmed] PHST- 2024/02/20 03:38 [entrez] PHST- 2024/02/17 00:00 [pmc-release] AID - tsaco-2023-001346 [pii] AID - 10.1136/tsaco-2023-001346 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2024 Feb 17;9(1):e001346. doi: 10.1136/tsaco-2023-001346. eCollection 2024. PMID- 38365499 OWN - NLM STAT- MEDLINE DCOM- 20240503 LR - 20240520 IS - 1444-2892 (Electronic) IS - 1443-9506 (Linking) VI - 33 IP - 4 DP - 2024 Apr TI - Implementation of Patient Blood Management in Orthotopic Heart Transplants: A Single Centre Retrospective Observational Review. PG - 518-523 LID - S1443-9506(24)00040-4 [pii] LID - 10.1016/j.hlc.2024.01.010 [doi] AB - BACKGROUND: Blood transfusion in the perioperative cardiothoracic setting has accepted risks including deep sternal wound infection, increased intensive care unit length of stay, lung injury, and cost. It has an immunomodulatory effect which may cause allo-immunisation. This may influence long-term survival through immune-mediated factors. Targeting coagulation defects to reduce unnecessary or inappropriate transfusions may reduce these complications. METHODS: In 2012, an institution-wide patient blood management evidence-based algorithmic bleeding management protocol was implemented at The Prince Charles Hospital, Brisbane, Australia. The benefit of this has been previously reported in our lung transplant and cardiac surgery (excluding transplants) cohorts. This study aimed to investigate the effect of this on our orthotopic heart transplant recipients. RESULTS: After the implementation of the protocol, despite no difference in preoperative haemoglobin levels and higher risk patients (EuroSCORE 20 vs 26; p=0.013), the use of packed red blood cells (13.0 U vs 4.4 U; p=0.046) was significantly lower postoperatively and fresh frozen plasma was significantly lower both intra- and postoperatively (7.4 U vs 0.6 U; p<0.001, and 3.3 U vs 0.6 U; p=0.011 respectively). Concurrently, the use of prothrombin complex concentrate (33% vs 78%; p<0.001) and desmopressin (5% vs 22%; p=0.0028) was significantly higher in the post-protocol group, while there was less use of recombinant factor VIIa (15% vs 4%; p=0.058). Intraoperative units of cryoprecipitate also rose from 0.9 to 2.0 (p=0.006). CONCLUSIONS: We have demonstrated that a targeted patient blood management protocol with point-of-care testing for heart transplant recipients is correlated with fewer blood products used postoperatively, with some increase in haemostatic products and no evidence of increased adverse events. CI - Copyright (c) 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. FAU - Rapier, Jacob J AU - Rapier JJ AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. Electronic address: jjrapier@aol.com. FAU - Daley, Michael AU - Daley M AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Smith, Susan E AU - Smith SE AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Goh, Sean L AU - Goh SL AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Margale, Swaroop AU - Margale S AD - Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Smith, Ian AU - Smith I AD - Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Thomson, Bruce M AU - Thomson BM AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Tesar, Peter J AU - Tesar PJ AD - Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia. FAU - Pearse, Bronwyn L AU - Pearse BL AD - Department of Surgery and Critical Care, The Prince Charles Hospital, Brisbane, Qld, Australia. LA - eng PT - Journal Article PT - Observational Study DEP - 20240215 PL - Australia TA - Heart Lung Circ JT - Heart, lung & circulation JID - 100963739 RN - 0 (Blood Coagulation Factors) SB - IM MH - Humans MH - *Heart Transplantation/adverse effects MH - Retrospective Studies MH - Female MH - Male MH - Middle Aged MH - Blood Transfusion/statistics & numerical data/methods MH - Blood Coagulation Factors/therapeutic use MH - Aged MH - Adult OTO - NOTNLM OT - Bleeding OT - Blood management OT - Heart transplant OT - Patient outcomes OT - Point-of-care coagulation testing OT - Transfusion COIS- Conflicts of Interest There are no conflicts of interest to disclose. EDAT- 2024/02/17 10:42 MHDA- 2024/05/04 11:50 CRDT- 2024/02/16 21:53 PHST- 2023/10/06 00:00 [received] PHST- 2023/12/20 00:00 [revised] PHST- 2024/01/01 00:00 [accepted] PHST- 2024/05/04 11:50 [medline] PHST- 2024/02/17 10:42 [pubmed] PHST- 2024/02/16 21:53 [entrez] AID - S1443-9506(24)00040-4 [pii] AID - 10.1016/j.hlc.2024.01.010 [doi] PST - ppublish SO - Heart Lung Circ. 2024 Apr;33(4):518-523. doi: 10.1016/j.hlc.2024.01.010. Epub 2024 Feb 15. PMID- 38359679 OWN - NLM STAT- MEDLINE DCOM- 20240319 LR - 20260406 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 296 DP - 2024 Apr TI - Desmopressin, Misoprostol, nor Carboprost Affect Platelet Aggregability Following Traumatic Brain Injury and Aspirin. PG - 643-653 LID - S0022-4804(24)00048-9 [pii] LID - 10.1016/j.jss.2024.01.027 [doi] AB - INTRODUCTION: Desmopressin (DDAVP) has been utilized clinically in patients taking aspirin (ASA) to improve drug-induced platelet dysfunction. Misoprostol and carboprost, prostaglandin analogs commonly used for postpartum hemorrhage, may also induce platelet aggregation. The aim of this study was to determine the effects of DDAVP, misoprostol, and carboprost administration on platelet aggregability following traumatic brain injury (TBI) in mice treated with ASA. METHODS: Male C57BL/6 mice were randomized into seven groups (n = 5 each): untouched, ASA only, Saline/TBI, ASA/TBI, ASA/TBI/DDAVP 0.4 mug/kg, ASA/TBI/misoprostol 1 mg/kg, and ASA/TBI/carboprost 100 mug/kg. TBI was induced via a weight drop model 4-h after ASA (50 mg/kg) gavage. Mice were given an intraperitoneal injection of DDAVP, misoprostol, or carboprost 10 minutes after TBI. In vivo testing was completed utilizing tail vein bleed. Mice were sacrificed 30-min posttreatment and blood was collected via cardiac puncture. Whole blood was analyzed via Multiplate impedance aggregometry, rotational thromboelastometry, and TEG6s. RESULTS: Mice receiving misoprostol after ASA/TBI demonstrated decreased tail vein bleeding times compared to ASA only treated mice. However, mice treated with misoprostol following ASA and TBI demonstrated decreased platelet aggregability compared to untouched mice and TBI only mice within the arachidonic acid agonist pathway. By contrast, DDAVP and carboprost did not significantly change platelet aggregability via adenosine diphosphate or arachidonic acid following ASA and TBI. However, DDAVP did decrease the platelet contribution to clot via rotational thromboelastometry. CONCLUSIONS: Reversal of medication-induced platelet inhibition has become increasingly controversial after TBI. Based on these results, DDAVP, misoprostol, nor carboprost consistently improve platelet aggregability following TBI in those also treated with ASA. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Baucom, Matthew R AU - Baucom MR AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Price, Adam D AU - Price AD AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Weissman, Nicholas AU - Weissman N AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - England, Lisa AU - England L AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Schuster, Rebecca M AU - Schuster RM AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Pritts, Timothy A AU - Pritts TA AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: michael.goodman@ucmail.uc.edu. LA - eng GR - T32 GM008478/GM/NIGMS NIH HHS/United States GR - R01 GM124156/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20240214 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - R16CO5Y76E (Aspirin) RN - ENR1LLB0FP (Deamino Arginine Vasopressin) RN - 7B5032XT6O (Carboprost) RN - 0E43V0BB57 (Misoprostol) RN - 27YG812J1I (Arachidonic Acid) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - Female MH - Male MH - Mice MH - Animals MH - Aspirin/pharmacology/therapeutic use MH - Deamino Arginine Vasopressin/pharmacology/therapeutic use MH - *Carboprost/pharmacology MH - *Misoprostol/pharmacology/therapeutic use MH - Arachidonic Acid/pharmacology MH - Mice, Inbred C57BL MH - Platelet Aggregation/physiology MH - Platelet Aggregation Inhibitors/pharmacology/therapeutic use MH - *Brain Injuries, Traumatic/complications/drug therapy OTO - NOTNLM OT - Aspirin OT - Carboprost OT - Desmopressin OT - Misoprostol OT - Platelet OT - TBI EDAT- 2024/02/16 00:42 MHDA- 2024/03/19 06:43 CRDT- 2024/02/15 18:11 PHST- 2023/05/18 00:00 [received] PHST- 2023/12/26 00:00 [revised] PHST- 2024/01/16 00:00 [accepted] PHST- 2024/03/19 06:43 [medline] PHST- 2024/02/16 00:42 [pubmed] PHST- 2024/02/15 18:11 [entrez] AID - S0022-4804(24)00048-9 [pii] AID - 10.1016/j.jss.2024.01.027 [doi] PST - ppublish SO - J Surg Res. 2024 Apr;296:643-653. doi: 10.1016/j.jss.2024.01.027. Epub 2024 Feb 14. PMID- 38299935 OWN - NLM STAT- MEDLINE DCOM- 20240502 LR - 20250502 IS - 1529-7535 (Print) IS - 1529-7535 (Linking) VI - 25 IP - 5 DP - 2024 May 1 TI - Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand. PG - e221-e231 LID - 10.1097/PCC.0000000000003452 [doi] AB - OBJECTIVES: This study aimed to determine the test performances of rotational thromboelastometry (ROTEM) and activated partial thromboplastin time-based clot waveform analysis (aPTT-CWA) compared with the International Society on Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH-DIC) score for diagnosis of overt disseminated intravascular coagulation (ODIC) in critically ill children. Prognostic indicators of DIC complications were also evaluated. DESIGN: A prospective cross-sectional observational study was conducted. ROTEM and aPTT-CWA were assessed alongside standard parameters based on the ISTH-DIC score and natural anticoagulants. Both conventional and global hemostatic tests were repeated on days 3-5 for nonovert DIC. SETTING: PICU of the Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. SUBJECTS: Infants and children who were admitted to PICU with underlying diseases predisposed to DIC, such as sepsis, malignancy, major surgery, trauma, or severe illness, were included in the study between July 1, 2021, and November 30, 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-four children were enrolled in this study. The prevalence of ODIC was 20.3%. Regarding ROTEM parameters, using EXTEM clot formation time (CFT) cutoff of greater than 102 seconds provided sensitivity and specificity of 90.9% and 80.9%, respectively, for diagnosing ODIC, with the area under the curve (AUC) of 0.86. In the case of aPTT-CWA performance, no biphasic waveform was observed, whereas both maximum coagulation acceleration (Min2) of less than 0.35%/s 2 and maximum coagulation deceleration of less than 0.25%/s 2 demonstrated identical sensitivities of 76.9% and specificities of 79.6%. Combining two global hemostatic tests significantly improved the diagnostic performance (INTEM CFT + EXTEM CFT + Min2 AUC 0.92 [95% CI, 0.80-1.00] vs. EXTEM CFT AUC 0.86 [95% CI, 0.75-0.96], p = 0.034). Bleeding was the most common consequence. In multivariable logistic regression analysis, Min2 of less than 0.36%/s 2 was an independent risk factor for bleeding complications, with an adjusted odds ratio of 15.08 (95% CI, 1.08-211.15, p = 0.044). CONCLUSIONS: ROTEM and aPTT-CWA were valuable diagnostic tools in critically ill children who might require point-of-care tests. Min2 showed significant clinical implications for predicting bleeding events in this population. CI - Copyright (c) 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. FAU - Chanthong, Supapitch AU - Chanthong S AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Choed-Amphai, Chane AU - Choed-Amphai C AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Manowong, Suphara AU - Manowong S AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Tuntivate, Pakinee AU - Tuntivate P AD - Hematology Laboratory, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Tansriratanawong, Supakanya AU - Tansriratanawong S AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Makonkawkeyoon, Krit AU - Makonkawkeyoon K AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. FAU - Natesirinilkul, Rungrote AU - Natesirinilkul R AD - Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20240201 PL - United States TA - Pediatr Crit Care Med JT - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JID - 100954653 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Male MH - Prospective Studies MH - Female MH - Child, Preschool MH - Thailand/epidemiology MH - *Disseminated Intravascular Coagulation/diagnosis MH - *Critical Illness MH - Child MH - Infant MH - Cross-Sectional Studies MH - Partial Thromboplastin Time/methods MH - Intensive Care Units, Pediatric MH - Point-of-Care Testing MH - Sensitivity and Specificity MH - Adolescent MH - Point-of-Care Systems MH - Infant, Newborn COIS- Dr. Choed-Amphai received funding from Chiang Mai University (111/2565). Dr. Chanthong received support for article research from Chiang Mai University. Dr. Makonkawkeyoon disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2024/02/01 12:42 MHDA- 2024/05/02 12:59 CRDT- 2024/02/01 09:33 PHST- 2024/05/02 12:59 [medline] PHST- 2024/02/01 12:42 [pubmed] PHST- 2024/02/01 09:33 [entrez] AID - 00130478-202405000-00018 [pii] AID - 10.1097/PCC.0000000000003452 [doi] PST - ppublish SO - Pediatr Crit Care Med. 2024 May 1;25(5):e221-e231. doi: 10.1097/PCC.0000000000003452. Epub 2024 Feb 1. PMID- 38299576 OWN - NLM STAT- MEDLINE DCOM- 20240614 LR - 20240618 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 239 IP - 1 DP - 2024 Jul 1 TI - Differentiating Pathologic from Physiologic Fibrinolysis: Not as Simple as Conventional Thrombelastography. PG - 30-41 LID - 10.1097/XCS.0000000000001027 [doi] AB - BACKGROUND: Conventional rapid thrombelastography (rTEG) cannot differentiate fibrinolysis shutdown from hypofibrinolysis, as both of these patient populations have low fibrinolytic activity. Tissue plasminogen activator (tPA) TEG can identify depletion of fibrinolytic inhibitors, and its use in combination with rTEG has the potential to differentiate all 3 pathologic fibrinolytic phenotypes after trauma. We hypothesize tPA-TEG and rTEG in combination can further stratify fibrinolysis phenotypes postinjury to better stratify risk for mortality. STUDY DESIGN: Adult trauma patients (981) with both rTEG and tPA-TEG performed less than 2 hours postinjury were included. rTEG lysis at 30 minutes after maximum amplitude (LY30) was used to initially define fibrinolysis phenotypes (hyperfibrinolysis >3%, physiologic 0.9% to 3%, and shutdown <0.9%), with Youden Index then used to define pathologic extremes of tPA-TEG LY30 (tPA sensitive [depletion of fibrinolytic inhibitors] vs resistant) resulting in 9 groups that were assessed for risk of death. RESULTS: The median New Injury Severity Score was 22, 21% were female, 45% had penetrating injury, and overall mortality was 13%. The tPA-TEG LY30 inflection point for increased mortality was >35.5% (tPA sensitive, odds ratio mortality 9.2, p < 0.001) and <0.3% (tPA resistance, odds ratio mortality 6.3, p = 0.04). Of the 9 potential fibrinolytic phenotypes, 5 were associated with increased mortality. Overall, the 9 phenotypes provided a significantly better prediction of mortality than rTEG or tPA-TEG alone (areas under the operating characteristics curves = 0.80 vs 0.63 and 0.75, respectively, p < 0.0001). These could be condensed to 3 pathologic phenotypes (true hyperfibrinolysis, early fibrinolysis shutdown, and hypofibrinolysis). CONCLUSIONS: The combination of rTEG and tPA-TEG increases the ability to predict mortality and suggests patient-specific strategies for improved outcomes. CI - Copyright (c) 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Moore, Hunter B AU - Moore HB AD - From the Department of Surgery, Transplant Institution, AdventHealth at Porter Hospital, Denver, CO (HB Moore). FAU - Barrett, Christopher D AU - Barrett CD AD - Department of Surgery, University of Nebraska School of Medicine, Omaha, NE (Barrett). FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO (EE Moore, Pieracci). FAU - Pieracci, Fredric M AU - Pieracci FM AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO (EE Moore, Pieracci). FAU - Sauaia, Angela AU - Sauaia A AD - Department of Public Health, University of Colorado School of Public Health, Aurora, CO (Sauaia). LA - eng PT - Journal Article DEP - 20240201 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Humans MH - *Thrombelastography/methods MH - Female MH - *Fibrinolysis/physiology MH - Male MH - Adult MH - Middle Aged MH - *Tissue Plasminogen Activator MH - *Wounds and Injuries/blood/diagnosis/mortality MH - Injury Severity Score MH - Retrospective Studies MH - Phenotype MH - Aged EDAT- 2024/02/01 12:42 MHDA- 2024/06/14 12:44 CRDT- 2024/02/01 08:41 PHST- 2024/06/14 12:44 [medline] PHST- 2024/02/01 12:42 [pubmed] PHST- 2024/02/01 08:41 [entrez] AID - 00019464-202407000-00005 [pii] AID - 10.1097/XCS.0000000000001027 [doi] PST - ppublish SO - J Am Coll Surg. 2024 Jul 1;239(1):30-41. doi: 10.1097/XCS.0000000000001027. Epub 2024 Feb 1. PMID- 38238778 OWN - NLM STAT- MEDLINE DCOM- 20240122 LR - 20241029 IS - 1465-993X (Electronic) IS - 1465-9921 (Print) IS - 1465-9921 (Linking) VI - 25 IP - 1 DP - 2024 Jan 18 TI - Time-Controlled Adaptive Ventilation (TCAV): a personalized strategy for lung protection. PG - 37 LID - 10.1186/s12931-023-02615-y [doi] LID - 37 AB - Acute respiratory distress syndrome (ARDS) alters the dynamics of lung inflation during mechanical ventilation. Repetitive alveolar collapse and expansion (RACE) predisposes the lung to ventilator-induced lung injury (VILI). Two broad approaches are currently used to minimize VILI: (1) low tidal volume (LV(T)) with low-moderate positive end-expiratory pressure (PEEP); and (2) open lung approach (OLA). The LV(T) approach attempts to protect already open lung tissue from overdistension, while simultaneously resting collapsed tissue by excluding it from the cycle of mechanical ventilation. By contrast, the OLA attempts to reinflate potentially recruitable lung, usually over a period of seconds to minutes using higher PEEP used to prevent progressive loss of end-expiratory lung volume (EELV) and RACE. However, even with these protective strategies, clinical studies have shown that ARDS-related mortality remains unacceptably high with a scarcity of effective interventions over the last two decades. One of the main limitations these varied interventions demonstrate to benefit is the observed clinical and pathologic heterogeneity in ARDS. We have developed an alternative ventilation strategy known as the Time Controlled Adaptive Ventilation (TCAV) method of applying the Airway Pressure Release Ventilation (APRV) mode, which takes advantage of the heterogeneous time- and pressure-dependent collapse and reopening of lung units. The TCAV method is a closed-loop system where the expiratory duration personalizes V(T) and EELV. Personalization of TCAV is informed and tuned with changes in respiratory system compliance (C(RS)) measured by the slope of the expiratory flow curve during passive exhalation. Two potentially beneficial features of TCAV are: (i) the expiratory duration is personalized to a given patient's lung physiology, which promotes alveolar stabilization by halting the progressive collapse of alveoli, thereby minimizing the time for the reopened lung to collapse again in the next expiration, and (ii) an extended inspiratory phase at a fixed inflation pressure after alveolar stabilization gradually reopens a small amount of tissue with each breath. Subsequently, densely collapsed regions are slowly ratcheted open over a period of hours, or even days. Thus, TCAV has the potential to minimize VILI, reducing ARDS-related morbidity and mortality. CI - (c) 2024. The Author(s). FAU - Al-Khalisy, Hassan AU - Al-Khalisy H AD - East Carolina University, Greenville, NC, USA. FAU - Nieman, Gary F AU - Nieman GF AD - SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. FAU - Kollisch-Singule, Michaela AU - Kollisch-Singule M AD - SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. FAU - Andrews, Penny AU - Andrews P AD - R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA. FAU - Camporota, Luigi AU - Camporota L AD - Health Centre for Human and Applied Physiological Sciences, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Shiber, Joseph AU - Shiber J AD - University of Florida College of Medicine, Jacksonville, FL, USA. FAU - Manougian, Toni AU - Manougian T AD - Westchester Medical Center, Valhalla, NY, USA. FAU - Satalin, Joshua AU - Satalin J AD - SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. satalinj@upstate.edu. FAU - Blair, Sarah AU - Blair S AD - SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. FAU - Ghosh, Auyon AU - Ghosh A AD - SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. FAU - Herrmann, Jacob AU - Herrmann J AD - University of Iowa, Iowa City, IA, USA. FAU - Kaczka, David W AU - Kaczka DW AD - University of Iowa, Iowa City, IA, USA. FAU - Gaver, Donald P AU - Gaver DP AD - Tulane University, New Orleans, LA, USA. FAU - Bates, Jason H T AU - Bates JHT AD - University of Vermont, Burlington, VT, USA. FAU - Habashi, Nader M AU - Habashi NM AD - R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA. LA - eng GR - K08 HL168205/HL/NHLBI NIH HHS/United States GR - R01 HL142702/HL/NHLBI NIH HHS/United States GR - R01HL142702/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review DEP - 20240118 PL - England TA - Respir Res JT - Respiratory research JID - 101090633 SB - IM MH - Humans MH - Respiration, Artificial/methods MH - Lung/pathology MH - Pulmonary Alveoli/pathology MH - *Respiratory Distress Syndrome/diagnosis/therapy/pathology MH - Continuous Positive Airway Pressure/methods MH - Tidal Volume MH - *Ventilator-Induced Lung Injury/prevention & control/pathology PMC - PMC10797864 OTO - NOTNLM OT - APRV OT - ARDS OT - ARMA OT - Acute respiratory distress syndrome OT - Alveolar opening and collapse time constants OT - Driving pressure OT - Dynamic alveolar mechanics OT - Open lung approach OT - Regional alveolar instability OT - Stress-multipliers OT - TCAV OT - Tidal volume OT - VILI OT - Ventilator-induced lung injury OT - Viscoelastic COIS- MKS has received a Research Grant and GFN an Unrestricted Educational Grant from Drager Medical Systems, Inc. GFN, MKS have presented and received honoraria and/or travel reimbursement at event(s) sponsored by Drager Medical Systems, Inc., outside of the published work. GFN, MKS, have lectured for Intensive Care On-line Network, Inc. (ICON). NMH is the founder of ICON, of which PLA is an employee. NMH holds patents on a method of initiating, managing and/or weaning airway pressure release ventilation, as well as controlling a ventilator in accordance with the same. DWK and JH are co-founders and shareholders of OscillaVent, Inc., and are co-inventors on a patent involving multi-frequency oscillatory ventilation. DWK and JH also receive research support from ZOLL Medical Corporation, and DWK is a consultant for Lungpacer Medical, Inc. JHTB is a consultant to and shareholder of OscillaVent, Inc., and has two patents pending in the field of MV. The authors maintain that industry had no role in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; nor the preparation, review, or approval of the manuscript. EDAT- 2024/01/19 00:42 MHDA- 2024/01/22 06:42 PMCR- 2024/01/18 CRDT- 2024/01/18 23:39 PHST- 2023/05/11 00:00 [received] PHST- 2023/11/25 00:00 [accepted] PHST- 2024/01/22 06:42 [medline] PHST- 2024/01/19 00:42 [pubmed] PHST- 2024/01/18 23:39 [entrez] PHST- 2024/01/18 00:00 [pmc-release] AID - 10.1186/s12931-023-02615-y [pii] AID - 2615 [pii] AID - 10.1186/s12931-023-02615-y [doi] PST - epublish SO - Respir Res. 2024 Jan 18;25(1):37. doi: 10.1186/s12931-023-02615-y. PMID- 38196013 OWN - NLM STAT- MEDLINE DCOM- 20240519 LR - 20260412 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 36 IP - 3 DP - 2024 Jun TI - Fibrinogen levels in severe trauma: A preliminary comparison of Clauss Fibrinogen, ROTEM Sigma, ROTEM Delta and TEG 6s assays from the FEISTY pilot randomised clinical trial. PG - 363-370 LID - 10.1111/1742-6723.14356 [doi] AB - OBJECTIVE: To describe the relationships between different methods of measuring functional fibrinogen levels in severely injured, bleeding trauma patients across multiple timepoints during hospitalisation. METHODS: In 100 adult trauma patients enrolled in the FEISTY pilot randomised clinical trial at four tertiary trauma centres in Australia, blood samples were collected prospectively. Consistency of agreement was calculated, comparing functional fibrinogen levels measured by four methods - ROTEM(R) Delta and Sigma FIBTEM A5, TEG(R) 6s CFF MA, and gold-standard Clauss Fibrinogen. RESULTS: Comparing the ROTEM(R) Delta and new-generation ROTEM(R) Sigma machine, consistency of agreement for FIBTEM A5, measured by calculating intraclass correlation coefficients (ICCs), was >/=0.73 across all analysed timepoints, with mean differences (Sigma minus Delta) of 0.10-3.57 mm. Corresponding values comparing the ROTEM(R) Sigma FIBTEM A5 and TEG(R) 6s CFF MA were ICC = 0.55-0.82 and ICC = 4.69-7.97 (CFF MA minus A5). Comparing ROTEM(R) Sigma FIBTEM A5 and Clauss Fibrinogen Analysis (CFA), among statistically significant simple linear regression models, R(2) was 0.25-0.67, and comparing TEG(R) 6s CFF MA and CFA (CFA) 0.65-0.82, although not all differences were significant with the latter comparison. Relationships across all timepoints combined were Clauss Fibrinogen (CF) (g/L) = 0.21𝑥 + 0.004 (where 𝑥 = ROTEM(R) Sigma FIBTEM A5 in mm) and (g/L) = 0.16𝑥 - 0.06 (where 𝑥 = TEG(R) 6s CFF MA in mm). CONCLUSIONS: The present study revealed acceptable agreement between four different assays measuring functional fibrinogen, with current- and previous-generation ROTEM(R) machines (Sigma, Delta) performing similarly measuring functional fibrinogen via FIBTEM assay. This suggests that haemostatic resuscitation algorithms designed for the ROTEM(R) Delta can be applied to the ROTEM(R) Sigma to guide fibrinogen replacement. CI - (c) 2024 Australasian College for Emergency Medicine. FAU - Auty, Travis AU - Auty T AUID- ORCID: 0000-0001-7959-1736 AD - Intensive Care Unit, Rockhampton Hospital, Rockhampton, Queensland, Australia. FAU - McCullough, James AU - McCullough J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Griffith University, Gold Coast, Queensland, Australia. FAU - Hughes, Ian AU - Hughes I AUID- ORCID: 0000-0002-8126-1303 AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Office for Research Governance and Development, Gold Coast University Hospital, Brisbane, Queensland, Australia. AD - University of Queensland, Brisbane, Queensland, Australia. FAU - Fanning, Jonathon P AU - Fanning JP AUID- ORCID: 0000-0002-1675-0522 AD - University of Queensland, Brisbane, Queensland, Australia. AD - Intensive Care Unit, St Andrew's War Memorial Hospital, UnitingCare Health, Brisbane, Queensland, Australia. AD - Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia. FAU - Czuchwicki, Sarah AU - Czuchwicki S AUID- ORCID: 0000-0002-7627-6869 AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Winearls, James AU - Winearls J AUID- ORCID: 0000-0002-0665-0034 AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Griffith University, Gold Coast, Queensland, Australia. AD - University of Queensland, Brisbane, Queensland, Australia. AD - Intensive Care Unit, St Andrew's War Memorial Hospital, UnitingCare Health, Brisbane, Queensland, Australia. LA - eng PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial DEP - 20240109 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Fibrinogen/analysis MH - Male MH - Female MH - Pilot Projects MH - Adult MH - *Thrombelastography/methods MH - Middle Aged MH - Australia MH - *Wounds and Injuries/blood MH - Prospective Studies MH - Blood Coagulation Tests/methods/standards MH - Hemorrhage/blood OTO - NOTNLM OT - coagulopathy OT - fibrinogen OT - haemorrhage OT - rotational thromboelastometry OT - trauma EDAT- 2024/01/10 06:42 MHDA- 2024/05/20 00:42 CRDT- 2024/01/10 00:10 PHST- 2023/08/02 00:00 [received] PHST- 2023/11/19 00:00 [accepted] PHST- 2024/05/20 00:42 [medline] PHST- 2024/01/10 06:42 [pubmed] PHST- 2024/01/10 00:10 [entrez] AID - 10.1111/1742-6723.14356 [doi] PST - ppublish SO - Emerg Med Australas. 2024 Jun;36(3):363-370. doi: 10.1111/1742-6723.14356. Epub 2024 Jan 9. PMID- 38182562 OWN - NLM STAT- MEDLINE DCOM- 20240108 LR - 20250807 IS - 2041-1723 (Electronic) IS - 2041-1723 (Linking) VI - 15 IP - 1 DP - 2024 Jan 5 TI - Quick model-based viscoelastic clot strength predictions from blood protein concentrations for cybermedical coagulation control. PG - 314 LID - 10.1038/s41467-023-44231-w [doi] LID - 314 AB - Cybermedical systems that regulate patient clotting in real time with personalized blood product delivery will improve treatment outcomes. These systems will harness popular viscoelastic assays of clot strength such as thromboelastography (TEG), which help evaluate coagulation status in numerous conditions: major surgery (e.g., heart, vascular, hip fracture, and trauma); liver cirrhosis and transplants; COVID-19; ICU stays; sepsis; obstetrics; diabetes; and coagulopathies like hemophilia. But these measurements are time-consuming, and thus impractical for urgent care and automated coagulation control. Because protein concentrations in a blood sample can be measured in about five minutes, we develop personalized, phenomenological, quick, control-oriented models that predict TEG curve outputs from input blood protein concentrations, to facilitate treatment decisions based on TEG curves. Here, we accurately predict, experimentally validate, and mechanistically justify curves and parameters for common TEG assays (Functional Fibrinogen, Citrated Native, Platelet Mapping, and Rapid TEG), and verify results with trauma patient clotting data. CI - (c) 2024. The Author(s). FAU - Ghetmiri, Damon E AU - Ghetmiri DE AD - Department of Mechanical and Aerospace Engineering, University of Florida, 527 Gale Lemerand Drive, Gainesville, FL, 32611-6250, USA. AD - ASML, 17075 Thornmint Court, San Diego, CA, 92127-2413, USA. FAU - Venturi, Alessia J AU - Venturi AJ AUID- ORCID: 0000-0003-1809-3295 AD - Department of Mechanical and Aerospace Engineering, University of Florida, 527 Gale Lemerand Drive, Gainesville, FL, 32611-6250, USA. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado Denver, 12631 East 17th Avenue, Mailstop C305, Aurora, CO, 80045-2527, USA. AD - Center for Combat Medicine and Battlefield (COMBAT) Research, Department of Emergency Medicine, University of Colorado Denver, 12401 East 17th Avenue, Mailstop B215, Aurora, CO, 80045-2589, USA. FAU - Menezes, Amor A AU - Menezes AA AUID- ORCID: 0000-0003-3923-5766 AD - Department of Mechanical and Aerospace Engineering, University of Florida, 527 Gale Lemerand Drive, Gainesville, FL, 32611-6250, USA. amormenezes@ufl.edu. AD - J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611-6131, USA. amormenezes@ufl.edu. AD - Department of Agricultural and Biological Engineering, University of Florida, 1741 Museum Road, Gainesville, FL, 32611-0570, USA. amormenezes@ufl.edu. AD - Genetics Institute, University of Florida, 2033 Mowry Road, Gainesville, FL, 32610-3610, USA. amormenezes@ufl.edu. LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20240105 PL - England TA - Nat Commun JT - Nature communications JID - 101528555 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Female MH - Pregnancy MH - Humans MH - *Blood Coagulation MH - Blood Platelets MH - *Hemostatics MH - Biological Assay MH - Fibrinogen PMC - PMC10770315 COIS- The authors declare the following competing interests: a patent application has been filed that covers all material in this article. EDAT- 2024/01/06 10:42 MHDA- 2024/01/08 06:43 PMCR- 2024/01/05 CRDT- 2024/01/05 23:13 PHST- 2023/01/02 00:00 [received] PHST- 2023/12/05 00:00 [accepted] PHST- 2024/01/08 06:43 [medline] PHST- 2024/01/06 10:42 [pubmed] PHST- 2024/01/05 23:13 [entrez] PHST- 2024/01/05 00:00 [pmc-release] AID - 10.1038/s41467-023-44231-w [pii] AID - 44231 [pii] AID - 10.1038/s41467-023-44231-w [doi] PST - epublish SO - Nat Commun. 2024 Jan 5;15(1):314. doi: 10.1038/s41467-023-44231-w. PMID- 38146823 OWN - NLM STAT- MEDLINE DCOM- 20240318 LR - 20240326 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 238 IP - 4 DP - 2024 Apr 1 TI - Empiric Cryoprecipitate Transfusion in Patients with Severe Hemorrhage: Results from the US Experience in the International CRYOSTAT-2 Trial. PG - 636-643 LID - 10.1097/XCS.0000000000000938 [doi] AB - BACKGROUND: Hypofibrinogenemia has been shown to predict massive transfusion and is associated with higher mortality in severely injured patients. However, the role of empiric fibrinogen replacement in bleeding trauma patients remains controversial. We sought to determine the effect of empiric cryoprecipitate as an adjunct to a balanced transfusion strategy (1:1:1). STUDY DESIGN: This study is a subanalysis of patients treated at the single US trauma center in a multicenter randomized controlled trial. Trauma patients (more than 15 years) were eligible if they had evidence of active hemorrhage requiring emergent surgery or interventional radiology, massive transfusion protocol (MTP) activation, and received at least 1 unit of blood. Transfer patients, those with injuries incompatible with life, or those injured more than 3 hours earlier were excluded. Patients were randomized to standard MTP (STANDARD) or MTP plus 3 pools of cryoprecipitate (CRYO). Primary outcomes included all-cause mortality at 28 days. Secondary outcomes were transfusion requirements, intraoperative and postoperative coagulation laboratory values, and quality-of-life measures (Glasgow outcome score-extended). RESULTS: Forty-nine patients (23 in the CRYO group and 26 in the STANDARD group) were enrolled between May 2021 and October 2021. Time to randomization was similar between groups (14 vs 24 minutes, p = 0.676). Median time to cryoprecipitate was 41 minutes (interquartile range 37 to 48). There were no differences in demographics, arrival physiology, laboratory values, or injury severity. Intraoperative and ICU thrombelastography values, including functional fibrinogen, were similar between groups. There was no benefit to CRYO with respect to post-emergency department transfusions (intraoperative and ICU through 24 hours), complications, Glasgow outcome score, or mortality. CONCLUSIONS: In this study of severely injured, bleeding trauma patients, empiric cryoprecipitate did not improve survival or reduce transfusion requirements. Cryoprecipitate should continue as an "on-demand" addition to a balanced transfusion strategy, guided by laboratory values and should not be given empirically. CI - Copyright (c) 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Van Gent, Jan-Michael AU - Van Gent JM AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). FAU - Kaminski, Carter W AU - Kaminski CW AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). FAU - Praestholm, Caroline AU - Praestholm C AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). FAU - Pivalizza, Evan G AU - Pivalizza EG AD - Anesthesiology (Pivalizza), McGovern Medical School, Houston, TX. FAU - Clements, Thomas W AU - Clements TW AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). FAU - Kao, Lillian S AU - Kao LS AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). AD - The Center for Translational Injury Research, Houston, TX (Kao, Cotton). FAU - Stanworth, Simon AU - Stanworth S AD - Queen Mary University of London Barts, UK (Stanworth). FAU - Brohi, Karim AU - Brohi K AD - Department of Haematology, University of Oxford, UK (Brohi). FAU - Cotton, Bryan A AU - Cotton BA AD - From the Departments of Surgery (Van Gent, Kaminski, Praestholm, Clements, Kao, Cotton). AD - The Center for Translational Injury Research, Houston, TX (Kao, Cotton). LA - eng PT - Journal Article DEP - 20231226 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 9001-32-5 (Fibrinogen) RN - 0 (Hemostatics) SB - IM MH - Humans MH - Blood Coagulation MH - Blood Transfusion MH - Fibrinogen/therapeutic use MH - Hemorrhage/etiology/therapy MH - *Hemostatics MH - *Wounds and Injuries/complications/therapy MH - Multicenter Studies as Topic MH - Randomized Controlled Trials as Topic EDAT- 2023/12/26 12:42 MHDA- 2024/03/18 06:44 CRDT- 2023/12/26 07:43 PHST- 2024/03/18 06:44 [medline] PHST- 2023/12/26 12:42 [pubmed] PHST- 2023/12/26 07:43 [entrez] AID - 00019464-202404000-00046 [pii] AID - 10.1097/XCS.0000000000000938 [doi] PST - ppublish SO - J Am Coll Surg. 2024 Apr 1;238(4):636-643. doi: 10.1097/XCS.0000000000000938. Epub 2023 Dec 26. PMID- 38130737 OWN - NLM STAT- MEDLINE DCOM- 20231225 LR - 20231225 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 29 IP - 46 DP - 2023 Dec 14 TI - Paying attention to the value of thrombelastography and the impact of postreperfusion syndrome on outcomes of liver transplantation. PG - 6092-6094 LID - 10.3748/wjg.v29.i46.6092 [doi] AB - Only limited information is available about the connection between massive blood transfusion and postoperative survival rates in pediatric liver transplantation. The aim of Gordon's study was to examine the potential impact of perioperative transfusion on postoperative complications and death in young children receiving pediatric living-donor liver transplantation (PLDLT). The authors concluded that transfusion of a red blood cell volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT. However, viscoelastic coagulation monitoring was not utilized in the study; instead, only conventional coagulation monitoring was conducted. Overall, the choice of blood coagulation monitoring method during blood transfusion can have a significant impact on patient prognosis. Several studies have shown that the viscoelastic coagulation testing such as thrombelastography (TEG) is highly sensitive and accurate for diagnosing coagulation dysfunction. Indeed, a TEG-guided blood transfusion strategy can improve prognosis. Moreover, postreperfusion syndrome is one of the most common complications of liver transplantation and an important factor affecting the prognosis of patients and should also be included in regression analysis. CI - (c)The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. FAU - Wu, Yu-Li AU - Wu YL AD - Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China. FAU - Che, Lu AU - Che L AD - Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China. FAU - Weng, Yi-Qi AU - Weng YQ AD - Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China. wyq2023@nankai.edu.cn. LA - eng PT - Journal Article PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 SB - IM MH - Humans MH - Child MH - Child, Preschool MH - *Thrombelastography MH - *Liver Transplantation/adverse effects/methods MH - Living Donors MH - Blood Coagulation Tests MH - Blood Transfusion PMC - PMC10731155 OTO - NOTNLM OT - Blood transfusion OT - Child OT - Liver transplantation OT - Prognosis OT - Reperfusion Injury OT - Thrombelastography COIS- Conflict-of-interest statement: The authors declare no conflict of interest for this article. EDAT- 2023/12/22 06:42 MHDA- 2023/12/25 06:43 PMCR- 2023/12/14 CRDT- 2023/12/22 03:59 PHST- 2023/10/13 00:00 [received] PHST- 2023/11/08 00:00 [revised] PHST- 2023/11/17 00:00 [accepted] PHST- 2023/12/25 06:43 [medline] PHST- 2023/12/22 06:42 [pubmed] PHST- 2023/12/22 03:59 [entrez] PHST- 2023/12/14 00:00 [pmc-release] AID - 10.3748/wjg.v29.i46.6092 [doi] PST - ppublish SO - World J Gastroenterol. 2023 Dec 14;29(46):6092-6094. doi: 10.3748/wjg.v29.i46.6092. PMID- 38101576 OWN - NLM STAT- MEDLINE DCOM- 20240325 LR - 20260714 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 22 IP - 4 DP - 2024 Apr TI - Immature platelet dynamics are associated with clinical outcomes after major trauma. PG - 926-935 LID - S1538-7836(23)00865-6 [pii] LID - 10.1016/j.jtha.2023.12.002 [doi] AB - BACKGROUND: Major trauma results in dramatic changes in platelet behavior. Newly formed platelets are more reactive than older platelets, but their contributions to hemostasis and thrombosis after severe injury have not been previously evaluated. OBJECTIVES: To determine how immature platelet metrics and plasma thrombopoietin relate to clinical outcomes after major injury. METHODS: A prospective observational cohort study was performed in adult trauma patients. Platelet counts and the immature platelet fraction (IPF) were measured at admission and 24 hours, 72 hours, and 7 days after injury. Thromboelastometry was performed at admission. Plasma thrombopoietin, c-Mpl, and GPIbalpha were quantified in a separate cohort. The primary outcome was in-hospital mortality; secondary outcomes were venous thromboembolic events and multiple organ dysfunction syndrome (MODS). RESULTS: On admission, immature platelet counts (IPCs) were significantly lower in nonsurvivors (n = 40) than in survivors (n = 236; 7.3 x 10(9)/L vs 10.6 x 10(9)/L; P = .009), but IPF did not differ. Similarly, impaired platelet function on thromboelastometry was associated with lower admission IPC (9.1 x 10(9)/L vs 11.9 x 10(9)/L; P < .001). However, at later time points, we observed significantly higher IPF and IPC in patients who developed venous thromboembolism (21.0 x 10(9)/L vs 11.1 x 10(9)/L; P = .02) and prolonged MODS (20.9 x 10(9)/L vs 11 x 10(9)/L; P = .003) than in those who did not develop complications. Plasma thrombopoietin levels at admission were significantly lower in nonsurvivors (P < .001), in patients with MODS (P < .001), and in those who developed venous thromboembolism (P = .04). CONCLUSION: Lower levels of immature platelets in the acute phase after major injury are associated with increased mortality, whereas higher immature platelet levels at later time points may predispose to thrombosis and MODS. CI - Copyright (c) 2023 The Author(s). Published by Elsevier Inc. All rights reserved. FAU - Schofield, Henry AU - Schofield H AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Rossetto, Andrea AU - Rossetto A AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Armstrong, Paul C AU - Armstrong PC AD - Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK. FAU - Allan, Harriet E AU - Allan HE AD - Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK. FAU - Warner, Timothy D AU - Warner TD AD - Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Vulliamy, Paul AU - Vulliamy P AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. Electronic address: p.e.d.vulliamy@qmul.ac.uk. LA - eng GR - RG/19/8/34500/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Observational Study DEP - 20231213 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 9014-42-0 (Thrombopoietin) SB - IM MH - Adult MH - Humans MH - Prospective Studies MH - Thrombopoietin MH - *Venous Thromboembolism/diagnosis MH - Blood Platelets MH - *Thrombosis OTO - NOTNLM OT - multiple organ failure OT - platelets OT - thrombopoietin OT - trauma OT - venous thromboembolism COIS- Declaration of competing interests There are no competing interests to disclose. EDAT- 2023/12/16 11:43 MHDA- 2024/03/25 06:42 CRDT- 2023/12/15 19:28 PHST- 2023/08/25 00:00 [received] PHST- 2023/11/24 00:00 [revised] PHST- 2023/12/02 00:00 [accepted] PHST- 2024/03/25 06:42 [medline] PHST- 2023/12/16 11:43 [pubmed] PHST- 2023/12/15 19:28 [entrez] AID - S1538-7836(23)00865-6 [pii] AID - 10.1016/j.jtha.2023.12.002 [doi] PST - ppublish SO - J Thromb Haemost. 2024 Apr;22(4):926-935. doi: 10.1016/j.jtha.2023.12.002. Epub 2023 Dec 13. PMID- 38096775 OWN - NLM STAT- MEDLINE DCOM- 20240226 LR - 20250613 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 295 DP - 2024 Mar TI - Syndecan-1 as the Effect or Effector of the Endothelial Inflammatory Response? PG - 611-618 LID - S0022-4804(23)00543-7 [pii] LID - 10.1016/j.jss.2023.10.010 [doi] AB - INTRODUCTION: Syndecan-1 is a heparan sulfate proteoglycan found in the glycocalyx of vascular endothelial cells. Serum levels of syndecan-1 have repeatedly been demonstrated to increase following traumatic injury and shock, but it is unclear whether syndecan-1 plays an active role in the inflammatory response or is simply a biomarker of a state of hypoperfusion. The aim of this study was to identify the role of syndecan-1 role in the inflammatory process in the absence of trauma. METHODS: Male mice were randomized into five groups (n = 3). Four groups received increasing concentrations of syndecan-1 (1, 10, 100, and 1000pg/mL per blood volume) and a fifth group was given normal saline as a control via intravenous injection. These concentrations were selected based on previous syndecan-1 enzyme-linked immunosorbent assay data acquired following induced hemorrhagic shock in mice resulting in serum levels of 10-6000 pg/mL. Mice from each group were sacrificed at 1-, 4-, and 24-h time points for serum biomarker evaluation. A multiplex enzyme-linked immunosorbent assay was performed to analyze proinflammatory cytokines and chemokines including interleukin (IL)-1a, IL-1b, IL-2, IL-3, IL-4, IL-6, IL-10, IL-12, IL-17, monocyte chemoattractant protein-1, TNF-alpha, macrophage inflammatory protein-1alpha, granulocyte-macrophage colony-stimulating factor, and normal T cell expressed and presumably secreted levels. Whole blood was analyzed via rotational thromboelastometry in a separate group of mice dosed with syndecan-1 at 1000 pg/mL and compared to sham mice at 1 h. RESULTS: Tumor necrosis factor-alpha was significantly elevated in the 1000 pg/mL group compared to sham animals. There were no significant changes in IL-1a, IL-1b, IL-2, IL-3, IL-4, IL-6, IL-10, IL-12, monocyte chemoattractant protein--1, macrophage inflammatory protein-1alpha, granulocyte-macrophage colony-stimulating factor, or normal T cell expressed and presumably secretedat 1, 4, and 24 h for any group when compared to mice receiving saline alone. No significant differences were noted in coagulability between the 1000 pg/mL syndecan-1 group and shams at 1 h CONCLUSIONS: Inflammatory cytokine concentrations did not change with increasing dosage of syndecan-1 within mice at any timepoint, except for an acute change in tumor necrosis factor-alpha which was transient. Based on our results, syndecan-1 appears to be a biomarker for inflammation rather than an active participant in eliciting an inflammatory response. Further research will focus on the role of syndecan-1 following hemorrhagic shock. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Baucom, Matthew R AU - Baucom MR AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Weissman, Nicholas AU - Weissman N AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Price, Adam D AU - Price AD AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - England, Lisa AU - England L AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Schuster, Rebecca M AU - Schuster RM AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Pritts, Timothy A AU - Pritts TA AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: michael.goodman@ucmail.uc.edu. LA - eng GR - T32 GM008478/GM/NIGMS NIH HHS/United States GR - R01 GM124156/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20231213 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 83869-56-1 (Granulocyte-Macrophage Colony-Stimulating Factor) RN - 130068-27-8 (Interleukin-10) RN - 0 (Interleukin-6) RN - 0 (Tumor Necrosis Factor-alpha) RN - 0 (Syndecan-1) RN - 0 (Interleukin-2) RN - 0 (Interleukin-3) RN - 207137-56-2 (Interleukin-4) RN - 0 (Cytokines) RN - 187348-17-0 (Interleukin-12) RN - 0 (Biomarkers) RN - 0 (Macrophage Inflammatory Proteins) SB - IM MH - Humans MH - Male MH - Mice MH - Animals MH - *Granulocyte-Macrophage Colony-Stimulating Factor MH - Interleukin-10 MH - Interleukin-6 MH - Endothelial Cells MH - Tumor Necrosis Factor-alpha MH - *Shock, Hemorrhagic/complications MH - Syndecan-1 MH - Interleukin-2 MH - Interleukin-3 MH - Interleukin-4 MH - Cytokines MH - Interleukin-12 MH - Biomarkers MH - Macrophage Inflammatory Proteins OTO - NOTNLM OT - Endotheliopathy OT - Glycocalyx OT - Inflammation OT - Syndecan-1 EDAT- 2023/12/15 00:43 MHDA- 2024/02/26 06:44 CRDT- 2023/12/14 18:15 PHST- 2023/03/01 00:00 [received] PHST- 2023/09/11 00:00 [revised] PHST- 2023/10/27 00:00 [accepted] PHST- 2024/02/26 06:44 [medline] PHST- 2023/12/15 00:43 [pubmed] PHST- 2023/12/14 18:15 [entrez] AID - S0022-4804(23)00543-7 [pii] AID - 10.1016/j.jss.2023.10.010 [doi] PST - ppublish SO - J Surg Res. 2024 Mar;295:611-618. doi: 10.1016/j.jss.2023.10.010. Epub 2023 Dec 13. PMID- 38079234 OWN - NLM STAT- MEDLINE DCOM- 20240424 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 96 IP - 5 DP - 2024 May 1 TI - Older females have increased mortality after trauma as compared with younger females and males, associated with increased fibrinolysis. PG - 831-837 LID - 10.1097/TA.0000000000004235 [doi] AB - INTRODUCTION: Female sex may provide a survival benefit after trauma, possibly attributable to protective effects of estrogen. This study aimed to compare markers of coagulation between male and female trauma patients across different ages. METHODS: Secondary analysis of a prospective cohort study that was conducted at six trauma centers. Trauma patients presenting with full trauma team activation were eligible for inclusion. Patients with a penetrating trauma or traumatic brain injury were excluded. Upon hospital arrival, blood was drawn for measurement of endothelial and coagulation markers and for rotational thromboelastometry measurement. Trauma patients were divided into four categories: males younger than 45 years, males 45 years or older, females younger than 45 years, and females 45 years or older. In a sensitivity analysis, patients between 45 and 55 years old were excluded to control for menopausal transitioning. Groups were compared with a Kruskal-Wallis test with Bonferroni correction. A logistic regression was performed to assess whether the independent effect of sex and age on mortality. RESULTS: A total of 1,345 patients were available for analysis. Compared with the other groups, mortality was highest in females 45 years or older, albeit not independent from injury severity and shock. In the group of females 45 years or older, there was increased fibrinolysis, demonstrated by increased levels of plasmin-antiplasmin complexes with a concomitant decrease in alpha2-antiplasmin. Also, a modest decrease in coagulation factors II and X was observed. Fibrinogen levels were comparable between groups. The sensitivity analysis in 1,104 patients demonstrated an independent relationship between female sex, age 55 years or older, and mortality. Rotational thromboelastometry profiles did not reflect the changes in coagulation tests. CONCLUSION: Female trauma patients past their reproductive age have an increased risk of mortality compared with younger females and males, associated with augmented fibrinolysis and clotting factor consumption. Rotational thromboelastometry parameters did not reflect coagulation differences between groups. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Dujardin, Romein W G AU - Dujardin RWG AD - From the Laboratory of Experimental Intensive Care and Anesthesiology (R.W.G.D., D.J.B.K., C.E.v.d.B., E.B., N.P.J.), and Department of Intensive Care (R.W.G.D., C.E.v.d.B.), Amsterdam UMC, University of Amsterdam; OLVG Hospital, Department of Intensive Care Medicine (R.W.G.D., N.P.J.), Amsterdam; Erasmus MC, Department of Anesthesiology (D.J.B.K.), Rotterdam; Department of Anesthesiology (C.E.v.d.B., E.B.), Amsterdam UMC, Vrije Universiteit Amsterdam; Department of Surgery (L.M.G.G., E.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Traumatology (C.G.), Oslo University Hospital, Oslo, Norway; Trauma Sciences (K.B.), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; NHS Blood and Transplant/Oxford University Hospital NHS Trust (S.S.), John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine (S.S.), University of Oxford, United Kingdom; Department of Anesthesiology and Trauma Center (P.I.J., J.S.), Center for Head and Orthopedics, and Section for Transfusion Medicine (P.I.J., J.S.), Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; and Department of Traumatology and Orthopedic Surgery (M.M.), Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Kleinveld, Derek J B AU - Kleinveld DJB FAU - van den Brom, Charissa E AU - van den Brom CE FAU - Geeraedts, Leo M G Jr AU - Geeraedts LMG Jr FAU - Beijer, Elise AU - Beijer E FAU - Gaarder, Christine AU - Gaarder C FAU - Brohi, Karim AU - Brohi K FAU - Stanworth, Simon AU - Stanworth S FAU - Johansson, Par I AU - Johansson PI FAU - Stensballe, Jakob AU - Stensballe J FAU - Maegele, Marc AU - Maegele M FAU - Juffermans, Nicole P AU - Juffermans NP LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20231208 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - Age Factors MH - Biomarkers/blood MH - *Fibrinolysis/physiology MH - Injury Severity Score MH - Prospective Studies MH - Sex Factors MH - *Thrombelastography MH - Trauma Centers/statistics & numerical data MH - *Wounds and Injuries/mortality/blood/complications EDAT- 2023/12/11 18:42 MHDA- 2024/04/24 19:05 CRDT- 2023/12/11 12:12 PHST- 2024/04/24 19:05 [medline] PHST- 2023/12/11 18:42 [pubmed] PHST- 2023/12/11 12:12 [entrez] AID - 01586154-202405000-00020 [pii] AID - 10.1097/TA.0000000000004235 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2024 May 1;96(5):831-837. doi: 10.1097/TA.0000000000004235. Epub 2023 Dec 8. PMID- 38070741 OWN - NLM STAT- MEDLINE DCOM- 20240301 LR - 20260625 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 22 IP - 3 DP - 2024 Mar TI - Group B or not group B? An association between ABO, early mortality, and organ dysfunction in major trauma patients with shock. PG - 676-685 LID - S1538-7836(23)00856-5 [pii] LID - 10.1016/j.jtha.2023.11.018 [doi] AB - BACKGROUND: ABO blood group alters coagulation profiles in the general population and may influence outcomes after trauma. The relationship between trauma-induced coagulopathy, severe injury with hemorrhagic shock, and survival with respect to ABO group is unknown. OBJECTIVES: In severe hemorrhagic trauma, we aimed to characterize the association of ABO group with admission coagulation profiles, mortality, and immune-mediated complications. METHODS: Clinical and laboratory variables were examined from severely injured adult patients enrolled in a perpetual observational cohort study at a UK Major Trauma Center. Univariate and multivariate analyses were performed to determine differences in clinical outcomes (mortality, organ dysfunction, and critical care support). In a shock subgroup, we performed an exploratory analysis of rotational thromboelastometry parameters and coagulation biomarkers. RESULTS: In 1119 trauma patients, we found no difference in mortality between ABO groups. In patients with shock, 24-hour mortality was significantly lower in group B vs non-B groups (7% vs 16%, adjusted odds ratio [aOR], 0.19; P = .030), but there were increased rates of invasive ventilation (aOR, 3.34; P = .033), renal replacement therapy (aOR, 2.55; P = .037), and a trend for infection (aOR, 1.85; P = .067). Comparing patients with shock, group B vs non-B patients had 40% higher fibrinogen, 65% higher factor (F) VIII, 36% higher FIX, 20% higher FXIII, and 19% higher von Willebrand factor. CONCLUSION: In this observational study limited by single time-point sampling and subgroup analysis of trauma hemorrhage with shock, group B patients have enhanced hemostatic capability associated with early survival but with increased risk of immune-mediated complications. CI - Copyright (c) 2023 The Author(s). Published by Elsevier Inc. All rights reserved. FAU - Schofield, Henry AU - Schofield H AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. Electronic address: henry.schofield@nhs.net. FAU - Lindsay, Charlotte AU - Lindsay C AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. FAU - Davenport, Ross AU - Davenport R AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. LA - eng PT - Journal Article PT - Observational Study DEP - 20231207 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 SB - IM MH - Adult MH - Humans MH - Multiple Organ Failure/etiology MH - *Blood Coagulation Disorders MH - Hemorrhage/etiology MH - Blood Coagulation MH - *Shock, Hemorrhagic/complications MH - *Wounds and Injuries/complications/diagnosis OTO - NOTNLM OT - ABO blood group OT - coagulopathy OT - hemorrhage OT - organ failure OT - transfusion OT - trauma COIS- Declaration of competing interests The authors declare that they have no conflicts of interest. EDAT- 2023/12/10 06:42 MHDA- 2024/03/01 06:44 CRDT- 2023/12/09 19:27 PHST- 2023/08/28 00:00 [received] PHST- 2023/10/14 00:00 [revised] PHST- 2023/11/22 00:00 [accepted] PHST- 2024/03/01 06:44 [medline] PHST- 2023/12/10 06:42 [pubmed] PHST- 2023/12/09 19:27 [entrez] AID - S1538-7836(23)00856-5 [pii] AID - 10.1016/j.jtha.2023.11.018 [doi] PST - ppublish SO - J Thromb Haemost. 2024 Mar;22(3):676-685. doi: 10.1016/j.jtha.2023.11.018. Epub 2023 Dec 7. PMID- 38055340 OWN - NLM STAT- MEDLINE DCOM- 20240201 LR - 20240201 IS - 1476-4431 (Electronic) IS - 1476-4431 (Linking) VI - 34 IP - 1 DP - 2024 Jan-Feb TI - Prospective evaluation of platelet function and fibrinolysis in 20 dogs with trauma. PG - 40-48 LID - 10.1111/vec.13356 [doi] AB - OBJECTIVES: To determine platelet function and assess fibrinolysis in dogs following trauma using multiple electrical impedance aggregometry and a modified thromboelastographic (TEG) technique. To determine if the severity of trauma, as assessed by the Animal Trauma Triage (ATT) score and clinicopathological markers of shock, is associated with a greater degree of platelet dysfunction and fibrinolysis. SETTING: University teaching hospital. ANIMALS: Twenty client-owned dogs with trauma (occurring <24 h prior to admission and blood sampling) and ATT score of >4 were prospectively recruited. A control group of 10 healthy dogs was included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Platelet function was measured using multiple electrode platelet aggregometry (MEPA) utilizing arachidonic acid, ADP, and collagen agonists. Fibrinolysis was assessed in citrated whole blood with the addition of tissue plasminogen activator (tPA; 50 U/mL) using kaolin-activated TEG. Conventional statistical analysis was performed to compare coagulation parameters between the groups and assess linear correlations. Median (interquartile range) ATT score was 5 (5-7), and 65% (n = 13) of dogs suffered polytrauma. Mean (+/- SD) time from trauma to blood sampling was 9 hours (+/- 6). Median (interquartile range) shock index and plasma lactate concentration were 1.1 (0.7-2.0, n = 16) and 2.9 mmol/L (0.9-16.0, n = 18), respectively. Four dogs did not survive to discharge (20%). There were no differences between the trauma and control group coagulation variables. A moderate negative correlation between ATT score and area under the curve for ADP was found (P = 0.043, r(2) = -0.496). CONCLUSIONS: Preliminary evaluation of platelet function measured by MEPA, and fibrinolysis measured by tPA-modified TEG, is not significantly different in this population of dogs with traumatic injury compared to healthy dogs. CI - (c) 2023 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society. FAU - Birkbeck, Rachael AU - Birkbeck R AUID- ORCID: 0000-0002-1684-5978 AD - The Ralph Veterinary Referral Centre, Fourth Avenue Globe Business Park, Marlow, UK. FAU - Chan, Daniel L AU - Chan DL AUID- ORCID: 0000-0001-5213-0390 AD - Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK. FAU - McBride, Duana AU - McBride D AD - Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK. FAU - Cortellini, Stefano AU - Cortellini S AD - Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK. LA - eng GR - PetSavers/ PT - Journal Article DEP - 20231206 PL - United States TA - J Vet Emerg Crit Care (San Antonio) JT - Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) JID - 101152804 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Humans MH - Dogs MH - Animals MH - Fibrinolysis MH - Tissue Plasminogen Activator MH - Hemostasis MH - Thrombelastography/veterinary MH - Blood Coagulation MH - *Blood Coagulation Disorders/veterinary MH - *Dog Diseases OTO - NOTNLM OT - acute traumatic coagulopathy OT - hyperfibrinolysis OT - platelet aggregometry OT - platelet dysfunction OT - thromboelastography (TEG) EDAT- 2023/12/06 18:42 MHDA- 2024/02/01 06:43 CRDT- 2023/12/06 12:22 PHST- 2022/08/26 00:00 [revised] PHST- 2022/01/21 00:00 [received] PHST- 2022/09/24 00:00 [accepted] PHST- 2024/02/01 06:43 [medline] PHST- 2023/12/06 18:42 [pubmed] PHST- 2023/12/06 12:22 [entrez] AID - 10.1111/vec.13356 [doi] PST - ppublish SO - J Vet Emerg Crit Care (San Antonio). 2024 Jan-Feb;34(1):40-48. doi: 10.1111/vec.13356. Epub 2023 Dec 6. PMID- 38046391 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231205 IS - 1441-2772 (Print) IS - 2652-9335 (Electronic) IS - 1441-2772 (Linking) VI - 23 IP - 1 DP - 2021 Mar TI - Fibrinogen Early In Severe Trauma studY (FEISTY): results from an Australian multicentre randomised controlled pilot trial. PG - 32-46 LID - 10.51893/2021.1.OA3 [doi] AB - Background: Haemorrhage is a major cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage, and early replacement using fibrinogen concentrate (FC) or cryoprecipitate (Cryo) is recommended by several international trauma guidelines. Limited evidence supports one product over the other, with widespread geographic and institutional variation in practice. Two previous trials have investigated the feasibility of rapid FC administration in severely injured trauma patients, with conflicting results. Objective: To compare the time to fibrinogen replacement using FC or Cryo in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia. Design, setting, patients and interventions: A multicentre controlled pilot trial in which adult trauma patients with haemorrhage were randomly assigned (1:1) to receive FC or Cryo for fibrinogen replacement, guided by FIBTEM A5 (functional fibrinogen assessment at 5 minutes after clot formation, using rotational thromboelastometry). Main outcome measures: The primary outcome was time to commencement of fibrinogen replacement. Secondary outcomes included effects of the intervention on plasma fibrinogen levels and clinical outcomes including transfusion requirements and mortality. Results: Of the 100 randomly assigned patients, 62 were hypofibrinogenaemic and received the intervention (n = 37) or Cryo (n = 25). Median (interquartile range [IQR]) time to delivery of FC was 29 min (23-40 min) compared with 60 min (40-80 min) for Cryo (P = 0.0001). All 62 patients were hypofibrinogenaemic before receiving FC or Cryo (FC: median FIBTEM A5, 8 mm [IQR, 7-9 mm]; Cryo: median FIBTEM A5, 9 mm [IQR, 5-10 mm]). In the FC arm patients received a median of 3 g FC (IQR, 2-4 g), and in the Cryo arm patients received a median of 8 units of Cryo (IQR, 8-14 units). Restoration of fibrinogen levels was achieved in both arms after the intervention. Blood product transfusion, fluid resuscitation and thromboembolic complications were similar in both arms. Overall mortality was 15.3%, with more deaths in the FC arm. Conclusion: Fibrinogen replacement in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia was achieved substantially faster using FC compared with Cryo. Fibrinogen levels increased appropriately using either product. The optimal method for replacing fibrinogen in traumatic haemorrhage is controversial. Our results will inform the design of a larger trial powered to assess patient-centred outcomes. CI - (c) 2021 College of Intensive Care Medicine of Australia and New Zealand. FAU - Winearls, James AU - Winearls J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia. AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia. AD - St Andrews War Memorial Hospital Brisbane, QLD, Australia. FAU - Wullschleger, Martin AU - Wullschleger M AD - Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia. FAU - Wake, Elizabeth AU - Wake E AD - Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia. FAU - McQuilten, Zoe AU - McQuilten Z AD - Transfusion Research Unit, Monash University, Melbourne, VIC, Australia. AD - Monash Health, Melbourne, VIC, Australia. FAU - Reade, Michael AU - Reade M AD - Military Medicine and Surgery, Joint Health Command, Australian Defence Force. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. FAU - Hurn, Catherine AU - Hurn C AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. FAU - Ryan, Glenn AU - Ryan G AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Trout, Melita AU - Trout M AD - Townsville Hospital, Townsville, QLD, Australia. AD - Faculty of Medicine, James Cook University, Townsville, QLD, Australia. FAU - Walsham, James AU - Walsham J AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Holley, Anthony AU - Holley A AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. FAU - George, Shane AU - George S AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Emergency Department and Children's Critical Care Service, Gold Coast University Hospital, Gold Coast, QLD, Australia. AD - Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia. FAU - Dyer, Wayne AU - Dyer W AD - Australian Red Cross Lifeblood. FAU - McCullough, James AU - McCullough J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia. FAU - Keijzers, Gerben AU - Keijzers G AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia. AD - School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia. AD - Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia. FAU - Fraser, John AU - Fraser J AD - School of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Critical Care Research Group, Prince Charles Hospital, Brisbane, QLD, Australia. FAU - Presneill, Jeffrey AU - Presneill J AD - Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia. AD - University of Melbourne, Melbourne, VIC, Australia. FAU - Campbell, Don AU - Campbell D AD - Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia. LA - eng PT - Journal Article DEP - 20231018 PL - Netherlands TA - Crit Care Resusc JT - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JID - 100888170 PMC - PMC10692540 COIS- James Winearls has received educational, travel and research support from Werfen, Haemonetics and CSL Behring. Shane George has received research support for FEISTY Junior from Werfen, Haemonetics and CSL Behring. EDAT- 2023/12/04 06:42 MHDA- 2023/12/04 06:43 PMCR- 2021/03/01 CRDT- 2023/12/04 04:57 PHST- 2023/12/04 06:43 [medline] PHST- 2023/12/04 06:42 [pubmed] PHST- 2023/12/04 04:57 [entrez] PHST- 2021/03/01 00:00 [pmc-release] AID - S1441-2772(23)00287-9 [pii] AID - 10.51893/2021.1.OA3 [doi] PST - epublish SO - Crit Care Resusc. 2023 Oct 18;23(1):32-46. doi: 10.51893/2021.1.OA3. eCollection 2021 Mar. PMID- 38030560 OWN - NLM STAT- MEDLINE DCOM- 20240319 LR - 20240319 IS - 1365-3148 (Electronic) IS - 0958-7578 (Linking) VI - 34 IP - 1 DP - 2024 Feb TI - Utility of rotational thromboelastometry in the management of massive haemorrhage at a regional Australian hospital. PG - 54-60 LID - 10.1111/tme.13018 [doi] AB - BACKGROUND: Rotational thromboelastometry (ROTEM) allows targeted and individualised blood product replacement. OBJECTIVES: The study aimed to determine the impact of ROTEM-guided transfusion on the clinical course of patients with acute massive haemorrhage in a regional Australian hospital. METHODS/MATERIALS: A retrospective review of all patients with acute massive haemorrhage that compared the characteristics, blood product use, and clinical outcomes of patients with massive haemorrhage before and after the introduction of ROTEM-guided transfusion. RESULTS: In per-protocol analysis, the 31/97 (32%) with ROTEM-guided transfusion used less packed red blood cells (median [interquartile range]: 6 [6-8] vs. 8 [6-12] units, p = 0.03) than patients whose transfusion was not ROTEM-guided. They were also less likely to receive fresh frozen plasma (2/31 [6%] vs. 45/66 [68%], p < 0.0001) or platelets (2/31 [6%] vs. 31/66 [47%], p < 0.0001); they were, however, more likely to receive fibrinogen products (26/31 [84%] vs. 38/66 [58%], p = 0.01). Patients receiving ROTEM-guided transfusion had lower in-hospital mortality (6/31 [19%] vs. 20/66 [30%], odds ratio 0.55 [95% confidence interval]: 0.20-1.55, p = 0.26) although this did not achieve statistical significance in this small cohort. CONCLUSION: ROTEM-guided massive transfusion of patients with acute haemorrhage in this regional Australian hospital led to a reduction in packed red blood cell, fresh frozen plasma, and platelet utilisation and may also have reduced mortality. CI - (c) 2023 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society. FAU - Liu, Yu-Hsuan AU - Liu YH AUID- ORCID: 0009-0006-8557-2906 AD - Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia. AD - Department of Anaesthesia, Cairns Hospital, Cairns, Queensland, Australia. FAU - Sia, Jessica AU - Sia J AD - Department of Haematology, Cairns Hospital, Cairns, Queensland, Australia. FAU - Munas, Azhar AU - Munas A AD - Department of Haematology, Cairns Hospital, Cairns, Queensland, Australia. FAU - Tacon, Catherine AU - Tacon C AD - Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia. FAU - Salaveria, Kris AU - Salaveria K AD - Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia. FAU - Lutshaba, Harrison Langa AU - Lutshaba HL AUID- ORCID: 0000-0002-5803-1921 AD - Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia. FAU - Hanson, Josh AU - Hanson J AUID- ORCID: 0000-0002-1423-3839 AD - Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia. AD - The Kirby Institute, Sydney, New South Wales, Australia. LA - eng PT - Journal Article DEP - 20231129 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Australia MH - *Hemorrhage/therapy MH - Blood Transfusion/methods MH - Retrospective Studies OTO - NOTNLM OT - blood products OT - massive haemorrhage OT - massive transfusion OT - obstetrics OT - regional hospital OT - rotational thromboelastometry OT - surgery OT - trauma OT - viscoelastic haemostatic assays EDAT- 2023/11/30 00:42 MHDA- 2024/03/19 06:44 CRDT- 2023/11/29 22:07 PHST- 2023/09/14 00:00 [revised] PHST- 2023/05/16 00:00 [received] PHST- 2023/10/30 00:00 [accepted] PHST- 2024/03/19 06:44 [medline] PHST- 2023/11/30 00:42 [pubmed] PHST- 2023/11/29 22:07 [entrez] AID - 10.1111/tme.13018 [doi] PST - ppublish SO - Transfus Med. 2024 Feb;34(1):54-60. doi: 10.1111/tme.13018. Epub 2023 Nov 29. PMID- 38026458 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231201 IS - 1178-7090 (Print) IS - 1178-7090 (Electronic) IS - 1178-7090 (Linking) VI - 16 DP - 2023 TI - Safe and Effective Blood Preservation Through Acute Normovolemic Hemodilution and Low-Dose Tranexamic Acid in Open Partial Hepatectomy. PG - 3905-3916 LID - 10.2147/JPR.S426872 [doi] AB - OBJECTIVE: In this study, we evaluated the efficacy of tranexamic acid (TXA) and acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch (130/0.4) in minimizing blood loss during open partial liver resection. Coagulation function was assessed using thromboelastography (TEG) and hemostasis tests, while renal function changes were tracked through serum creatinine values post-surgery. METHODS: Thirty patients undergoing open partial liver resection were allocated to two groups: Group T received TXA + ANH, and Group A received ANH alone. Blood was drawn from the radial artery under general anesthesia. Both groups received peripheral vein injections of 6% hydroxyethyl starch 130/0.4. Group T additionally received intravenous TXA. Primary outcomes included blood loss and allogeneic blood transfusions. TEG assessed coagulation status and renal function was monitored. RESULTS: Group T demonstrated superior outcomes compared to Group A. Group T had significantly lower intraoperative blood loss (700 mL vs 1200 mL) and a lower bleeding rate per kilogram of body weight (13.3 mL/kg vs 20.4 mL/kg). Coagulation parameters favored Group T, with higher TEG maximum amplitude (55.91 mm vs 45.88 mm) and lower activated partial thromboplastin time (38.04 seconds vs 41.49 seconds). Neither group experienced acute renal injury or kidney function deficiency during hospitalization. CONCLUSION: TXA and ANH in a small dose during liver resection stabilize clotting, reduce blood loss by 6% compared to hydroxyethyl starch 130/0.4, and do not affect renal function. CI - (c) 2023 Yang et al. FAU - Yang, Jian AU - Yang J AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. FAU - Zhang, Jing AU - Zhang J AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. FAU - Luo, Jiayan AU - Luo J AD - Department of Anesthesiology, People's Hospital of Yanting, Sichuan, 621600, People's Republic of China. FAU - Ouyang, Jie AU - Ouyang J AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. FAU - Qu, Qicai AU - Qu Q AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. FAU - Wang, Qitao AU - Wang Q AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. FAU - Si, Yongyu AU - Si Y AD - Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China. LA - eng PT - Journal Article DEP - 20231115 PL - New Zealand TA - J Pain Res JT - Journal of pain research JID - 101540514 PMC - PMC10657755 OTO - NOTNLM OT - acute normovolemic hemodilution OT - coagulation function OT - liver resection OT - thromboelastography OT - tranexamic acid COIS- The authors declare that they have no competing interests. EDAT- 2023/11/29 18:41 MHDA- 2023/11/29 18:42 PMCR- 2023/11/15 CRDT- 2023/11/29 16:53 PHST- 2023/06/20 00:00 [received] PHST- 2023/10/21 00:00 [accepted] PHST- 2023/11/29 18:42 [medline] PHST- 2023/11/29 18:41 [pubmed] PHST- 2023/11/29 16:53 [entrez] PHST- 2023/11/15 00:00 [pmc-release] AID - 426872 [pii] AID - 10.2147/JPR.S426872 [doi] PST - epublish SO - J Pain Res. 2023 Nov 15;16:3905-3916. doi: 10.2147/JPR.S426872. eCollection 2023. PMID- 38020863 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231201 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 8 IP - 1 DP - 2023 TI - Hypofibrinogenemia following injury in 186 children and adolescents: identification of the phenotype, current outcomes, and potential for intervention. PG - e001108 LID - 10.1136/tsaco-2023-001108 [doi] LID - e001108 AB - OBJECTIVES: Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion. METHODS: All patients <18 years of age presenting to our trauma center 11/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography (r-TEG) angle <60 degrees. Our analysis sought to define risk factors for presenting with HYPOFIB, the impact on outcomes, and whether early replacement improved mortality. RESULTS: 4169 patients were entered into the trauma registry, with 926 level 1 trauma activations, of which 186 patients received emergency-release blood products during this time; 1%, 3%, and 10% were HYPOFIB, respectively. Of the 186 patients of interest, 18 were HYPOFIB and 168 were non-HYPOFIB. The HYPOFIB patients were significantly younger, had lower field and arrival Glasgow Coma Scale, had higher head Abbreviated Injury Scale, arrived with worse global coagulopathy, and died from brain injury. Non-HYPOFIB patients were more likely to have (+)focused assessment for the sonography of trauma on arrival, sustained severe abdominal injuries, and die from hemorrhage. 12% of patients who received early cryoprecipitate (0-2 hours) had higher mortality by univariate analysis (55% vs 31%, p=0.045), but no difference on multivariate analysis (OR 0.36, 95% CI 0.07 to 1.81, p=0.221). Those receiving early cryoprecipitate who survived after pediatric intensive care unit (PICU) admission had lower PICU fibrinogen and r-TEG alpha-angle values. CONCLUSION: In pediatric trauma, patients with hypofibrinogenemia on admission are most likely younger and to have sustained severe brain injury, with an associated mortality of over 80%. Given the absence of bleeding-related deaths in HYPOFIB patients, this study does not provide evidence for the empiric use of cryoprecipitate in the initial administration of a massive transfusion protocol. LEVEL OF EVIDENCE: Level III - Therapeutic/Care Management. CI - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Gerard, Justin AU - Gerard J AUID- ORCID: 0000-0003-3320-8484 AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Van Gent, Jan-Michael AU - Van Gent JM AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cardenas, Jessica AU - Cardenas J AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Gage, Christian AU - Gage C AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Meyer, David E AU - Meyer DE AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cox, Charles AU - Cox C AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Wade, Charles E AU - Wade CE AD - Surgery/Center for Injury Research, The University of Texas Health Science Center McGovern School of Medicine, Houston, Texas, USA. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. LA - eng PT - Journal Article DEP - 20231109 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC10649809 OTO - NOTNLM OT - fibrinolysis OT - hemorrhage OT - multiple trauma OT - pediatrics COIS- Competing interests: None declared. EDAT- 2023/11/29 18:42 MHDA- 2023/11/29 18:43 PMCR- 2023/11/09 CRDT- 2023/11/29 14:52 PHST- 2023/02/11 00:00 [received] PHST- 2023/10/06 00:00 [accepted] PHST- 2023/11/29 18:43 [medline] PHST- 2023/11/29 18:42 [pubmed] PHST- 2023/11/29 14:52 [entrez] PHST- 2023/11/09 00:00 [pmc-release] AID - tsaco-2023-001108 [pii] AID - 10.1136/tsaco-2023-001108 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2023 Nov 9;8(1):e001108. doi: 10.1136/tsaco-2023-001108. eCollection 2023. PMID- 37973317 OWN - NLM STAT- MEDLINE DCOM- 20231127 LR - 20231127 IS - 2162-9471 (Electronic) IS - 0065-2423 (Linking) VI - 117 DP - 2023 TI - Viscoelastic Testing Methods. PG - 1-52 LID - S0065-2423(23)00086-0 [pii] LID - 10.1016/bs.acc.2023.09.001 [doi] AB - Viscoelastic testing methods examine the real-time formation of a clot in a whole blood sample, and include thromboelastography (TEG), rotational thromboelastometry (ROTEM), and several other testing platforms. They allow for concurrent assessment of multiple aspects of clotting, including plasmatic coagulation factors, platelets, fibrinogen, and the fibrinolytic pathway. This testing is rapid and may be performed at the point-of-care, allowing for prompt identification of coagulopathies to guide focused and rational administration of blood products as well as the identification of anticoagulant effect. With recent industry progression towards user-friendly, cartridge-based, portable instruments, viscoelastic testing has emerged in the 21st century as a powerful tool to guide blood transfusions in the bleeding patient, and to identify and treat both bleeding and thrombotic conditions in many operative settings, including trauma surgery, liver transplant surgery, cardiac surgery, and obstetrics. In these settings, the use of transfusion algorithms guided by viscoelastic testing data has resulted in widespread improvements in patient blood management as well as modest improvements in select patient outcomes. To address the increasingly wide adoption of viscoelastic methods and the growing number of medical and laboratory personnel tasked with implementing, performing, and interpreting these methods, this chapter provides an overview of the history, physiology, and technology behind viscoelastic testing, as well as a practical review of its clinical utility and current evidence supporting its use. Also included is a review of testing limitations and the contextual role played by viscoelastic methods among all coagulation laboratory testing. CI - Copyright (c) 2023. Published by Elsevier Inc. FAU - Carll, Timothy AU - Carll T AD - Department of Pathology, University of Chicago, Chicago, IL, United States. Electronic address: imothy.Carll@bsd.uchicago.edu. LA - eng PT - Journal Article PT - Review DEP - 20231103 PL - United States TA - Adv Clin Chem JT - Advances in clinical chemistry JID - 2985173R SB - IM MH - Humans MH - *Blood Coagulation Disorders/diagnosis/therapy MH - Hemorrhage/therapy MH - Blood Coagulation Tests/methods MH - Thrombelastography/methods MH - Blood Transfusion MH - *Thrombosis/diagnosis OTO - NOTNLM OT - ClotPro OT - Coagulation OT - Hyperfibrinolysis OT - Point-of-care OT - Quantra OT - ROTEM OT - SonoClot OT - TEG OT - Transfusion OT - Viscoelastometry EDAT- 2023/11/17 15:23 MHDA- 2023/11/27 12:44 CRDT- 2023/11/16 20:59 PHST- 2023/11/27 12:44 [medline] PHST- 2023/11/17 15:23 [pubmed] PHST- 2023/11/16 20:59 [entrez] AID - S0065-2423(23)00086-0 [pii] AID - 10.1016/bs.acc.2023.09.001 [doi] PST - ppublish SO - Adv Clin Chem. 2023;117:1-52. doi: 10.1016/bs.acc.2023.09.001. Epub 2023 Nov 3. PMID- 37966339 OWN - NLM STAT- MEDLINE DCOM- 20240405 LR - 20260919 IS - 1529-7535 (Print) IS - 1529-7535 (Linking) VI - 25 IP - 4 DP - 2024 Apr 1 TI - Scenario Decision-Making About Plasma and Platelet Transfusion for Intracranial Monitor Placement: Cross-Sectional Survey of Pediatric Intensivists and Neurosurgeons. PG - e205-e213 LID - 10.1097/PCC.0000000000003414 [doi] AB - OBJECTIVES: To report pediatric intensivists' and pediatric neurosurgeons' responses to case-based scenarios about plasma and platelet transfusions before intracranial pressure (ICP) monitor placement in children with severe traumatic brain injury (TBI). DESIGN: Cross-sectional, electronic survey to evaluate reported plasma and platelet transfusion decisions in eight scenarios of TBI in which ICP monitor placement was indicated. SETTING: Survey administered through the Pediatric Acute Lung Injury and Sepsis Investigators and the American Association of Neurologic Surgeons. SUBJECTS: Pediatric intensivists and pediatric neurosurgeons. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 184 participants responded (85 identified as pediatric intensivists and 54 as pediatric neurosurgeons). In all eight scenarios, the majority of respondents reported that they would base their decision-making about plasma transfusion on international normalized ratio (INR) alone (60-69%), or platelet transfusion on platelet count alone (83-86%). Pediatric intensivists, as opposed to pediatric neurosurgeons, more frequently reported that they would have used viscoelastic testing in their consideration of plasma transfusion (32% vs. 7%, p < 0.001), as well as to guide platelet transfusions (29 vs. 8%, p < 0.001), for the case-based scenarios. For all relevant case-based scenarios, pediatric neurosurgeons in comparison with pediatric reported that they would use a lower median (interquartile range [IQR]) INR threshold for plasma transfusion (1.5 [IQR 1.4-1.7] vs. 2.0 [IQR 1.5-2.0], p < 0.001). Overall, in all respondents, the reported median platelet count threshold for platelet transfusion in the case-based scenario was 100 (IQR 50-100) x10 9 /L, with no difference between specialties. CONCLUSIONS: Despite little evidence showing efficacy, when we tested specialists' decision-making, we found that they reported using INR and platelet count in pediatric case-based scenarios of TBI undergoing ICP monitor placement. We also found that pediatric intensivists and pediatric neurosurgeons had differences in decision-making about the scenarios. CI - Copyright (c) 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. FAU - Nellis, Marianne E AU - Nellis ME AD - Division of Pediatric Critical Care, Department of Pediatrics, Weill Cornell Medicine, New York, NY. FAU - Karam, Oliver AU - Karam O AD - Pediatric Critical Care Medicine, Department of Pediatrics, Yale Medicine, New Haven, CT. FAU - Aldave, Guillermo AU - Aldave G AD - Division of Pediatric Neurosurgery, Baylor College of Medicine (Texas Children's Hospital), Houston, TX. FAU - Rocque, Brandon G AU - Rocque BG AD - Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL. FAU - Bauer, David F AU - Bauer DF AD - Division of Pediatric Neurosurgery, Baylor College of Medicine (Texas Children's Hospital), Houston, TX. CN - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network LA - eng GR - UL1 TR001873/TR/NCATS NIH HHS/United States GR - UL1 TR002384/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20231115 PL - United States TA - Pediatr Crit Care Med JT - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JID - 100954653 SB - IM MH - Humans MH - Child MH - *Platelet Transfusion MH - Neurosurgeons MH - Cross-Sectional Studies MH - Blood Component Transfusion MH - Plasma MH - *Brain Injuries, Traumatic/therapy PMC - PMC10994730 MID - NIHMS1941808 COIS- The authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2023/11/15 12:42 MHDA- 2024/04/05 06:44 PMCR- 2025/04/01 CRDT- 2023/11/15 09:34 PHST- 2024/04/05 06:44 [medline] PHST- 2023/11/15 12:42 [pubmed] PHST- 2023/11/15 09:34 [entrez] PHST- 2025/04/01 00:00 [pmc-release] AID - 00130478-202404000-00018 [pii] AID - 10.1097/PCC.0000000000003414 [doi] PST - ppublish SO - Pediatr Crit Care Med. 2024 Apr 1;25(4):e205-e213. doi: 10.1097/PCC.0000000000003414. Epub 2023 Nov 15. PMID- 37892040 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240927 IS - 2075-4418 (Print) IS - 2075-4418 (Electronic) IS - 2075-4418 (Linking) VI - 13 IP - 20 DP - 2023 Oct 16 TI - Basic Principles of Rotational Thromboelastometry (ROTEM((R))) and the Role of ROTEM-Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. LID - 10.3390/diagnostics13203219 [doi] LID - 3219 AB - Rotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate activation of particular parts of hemocoagulation in INTEM, EXTEM, and FIBTEM tests allows for a more comprehensive and faster evaluation of the missing component of hemostasis followed by targeted therapy. One of the most common cause of coagulopathy is trauma-induced coagulopathy. Fibrinogen replacement therapy by ROTEM allows for the use of a standard dosage of fibrinogen, which has been shown to be successful in preventing dilutional coagulopathy following colloid and crystalloid replacement and excessive amount of allogeneic blood transfusions. The best reflection of fibrinogen activity is observed in the FIBTEM assay, where fibrinogen replacement therapy is recommended at an MCF (maximum clot firmness) of FIBTEM < 10 mm and FIBTEM A10 < 7 mm. ROTEM also plays an important role in the diagnostic and management of inherited fibrinogen disorders. These can be manifested by bleeding complications, where changes in the MCF parameter are the most useful tool for assessing the effectiveness of fibrinogen replacement therapy. ROTEM-guided bleeding management algorithms effectively reduce the number of transfusions, healthcare costs, and complications, leading to the improvement of patient safety and overall health. FAU - Drotarova, Miroslava AU - Drotarova M AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Zolkova, Jana AU - Zolkova J AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Belakova, Kristina Maria AU - Belakova KM AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Brunclikova, Monika AU - Brunclikova M AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Skornova, Ingrid AU - Skornova I AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Stasko, Jan AU - Stasko J AUID- ORCID: 0000-0003-3305-0269 AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. FAU - Simurda, Tomas AU - Simurda T AUID- ORCID: 0000-0002-7626-9650 AD - National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia. LA - eng PT - Journal Article PT - Review DEP - 20231016 PL - Switzerland TA - Diagnostics (Basel) JT - Diagnostics (Basel, Switzerland) JID - 101658402 PMC - PMC10606358 OTO - NOTNLM OT - fibrinogen disorders OT - fibrinogen replacement therapy OT - management OT - rotational thromboelastometry COIS- The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. EDAT- 2023/10/28 11:48 MHDA- 2023/10/28 11:49 PMCR- 2023/10/16 CRDT- 2023/10/28 01:02 PHST- 2023/08/07 00:00 [received] PHST- 2023/09/28 00:00 [revised] PHST- 2023/10/04 00:00 [accepted] PHST- 2023/10/28 11:49 [medline] PHST- 2023/10/28 11:48 [pubmed] PHST- 2023/10/28 01:02 [entrez] PHST- 2023/10/16 00:00 [pmc-release] AID - diagnostics13203219 [pii] AID - diagnostics-13-03219 [pii] AID - 10.3390/diagnostics13203219 [doi] PST - epublish SO - Diagnostics (Basel). 2023 Oct 16;13(20):3219. doi: 10.3390/diagnostics13203219. PMID- 37876163 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231029 IS - 2667-677X (Print) IS - 2667-6370 (Electronic) IS - 2149-276X (Linking) VI - 51 IP - 5 DP - 2023 Oct 24 TI - Effects of Different Crystalloid Fluids on Renal Tissue in an Experimental Model of Hemorrhagic Shock. PG - 380-387 LID - 10.4274/TJAR.2023.231262 [doi] AB - OBJECTIVE: The type of fluid that should be used in uncontrollable hemorrhages remains an area of research. This study was designed to compare the effects of resuscitation with Ringer's lactate (RL) solution versus a normal saline (NS) solution on hemodynamics, renal tissue histopathology, coagulation, and apoptosis in a rat model of hemorrhagic shock. METHODS: The study employed groups designated as the control, hemorrhage, NS, and RL groups. Heart rate, mean arterial pressure, and respiratory rate were monitored. Annexin A5 values were assayed, rotational thromboelastometry analysis was performed, and excised kidney tissue samples were histopathologically analyzed. RESULTS: Blood pressure levels were found to be significantly higher in the control group than those measured in the other groups. While the clotting time (CT) and clot formation time (CFT) in the hemorrhage group were significantly longer than those in the control and RL groups, the CT and CFT measured in the control group were significantly shorter compared to the RL group. The mean Annexin A5 level was in the hemorrhage group, which was significantly higher compared to the other groups. In the renal histopathological evaluation, the scores of proximal tubular injury, distal renal tubular injury, and interstitial renal tubular injury were found to be significantly lower in the control group compared to the other groups. CONCLUSION: This study demonstrated that NS or RL can be used safely to improve the hemodynamic symptoms resulting from hemorrhagic shock as a means to reduce apoptosis, and to decrease findings in favor of coagulopathy in bedside coagulation tests during the early stages of hemorrhagic shock until the time of starting a blood transfusion. FAU - Saracoglu, Kemal Tolga AU - Saracoglu KT AUID- ORCID: 0000-0001-9470-7418 AD - Department of Anaesthesiology, ICU & Perioperative Medicine, Hazm Mebaireek General Hospital HMC, Doha, Qatar. AD - Qatar University College of Medicine, Doha, Qatar. FAU - Saracoglu, Ayten AU - Saracoglu A AUID- ORCID: 0000-0002-1186-0933 AD - Qatar University College of Medicine, Doha, Qatar. AD - Department of Anaesthesiology, ICU & Perioperative Medicine, Aisha Bint Hamad Al Attiyah Hospital HMC, Doha, Qatar. FAU - Yildirim, Mehmet AU - Yildirim M AUID- ORCID: 0000-0003-1798-5478 AD - Department of Physiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Istanbul, Turkey. FAU - Demirtas, Cumaali AU - Demirtas C AUID- ORCID: 0000-0001-5226-6730 AD - Department of Physiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Istanbul, Turkey. FAU - Akca, Metehan AU - Akca M AUID- ORCID: 0000-0003-0500-920X AD - Department of Physiology, Faculty of Medicine Tokat Gaziosmanpasa University, Tokat, Turkey. FAU - Serdogan, Ferda AU - Serdogan F AUID- ORCID: 0000-0002-9515-017X AD - Clinic of Anaesthesiology and Intensive Care, Turhal State Hospital, Tokat, Turkey. FAU - Ergun, Ilyas Samet AU - Ergun IS AUID- ORCID: 0000-0001-9308-3770 AD - Department of Medical Services and Techniques, Bezmialem Medical School, Istanbul, Turkey. FAU - Tetik, Sermin AU - Tetik S AUID- ORCID: 0000-0001-7157-9142 AD - European University of Lefke, Faculty of Pharmacy Lefke, Northern Cyprus TR-10 Mersin, Turkey. FAU - Pence, Sadrettin AU - Pence S AUID- ORCID: 0000-0001-9453-4166 AD - Department of Physilogy, Istanbul Medeniyet University, Istanbul, Turkey. LA - eng PT - Journal Article PL - Turkey TA - Turk J Anaesthesiol Reanim JT - Turkish journal of anaesthesiology and reanimation JID - 101680817 PMC - PMC10606732 OTO - NOTNLM OT - Annexin A5 OT - ROTEM OT - Ringer's lactate OT - hemorrhagic shock OT - normal saline COIS- Declaration of Interests: The authors have no conflict of interest to declare. EDAT- 2023/10/25 06:42 MHDA- 2023/10/25 06:43 PMCR- 2023/10/24 CRDT- 2023/10/25 02:08 PHST- 2023/10/25 06:43 [medline] PHST- 2023/10/25 06:42 [pubmed] PHST- 2023/10/25 02:08 [entrez] PHST- 2023/10/24 00:00 [pmc-release] AID - 62966 [pii] AID - 10.4274/TJAR.2023.231262 [doi] PST - ppublish SO - Turk J Anaesthesiol Reanim. 2023 Oct 24;51(5):380-387. doi: 10.4274/TJAR.2023.231262. PMID- 37872678 OWN - NLM STAT- MEDLINE DCOM- 20240126 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 96 IP - 2 DP - 2024 Feb 1 TI - A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage. PG - 216-224 LID - 10.1097/TA.0000000000004177 [doi] AB - INTRODUCTION: Tranexamic acid (TXA) is a life-saving treatment for traumatic hemorrhage, but the optimal dosing regimen remains unknown. Different doses and treatment strategies have been proposed, including single bolus, repeated bolus, or bolus plus infusion. The aim of this study was to determine the effect of different TXA dosing strategies on clinical outcomes in bleeding trauma patients. METHODS: Secondary analysis of a perpetual cohort study from a UK Level I trauma center. Adult patients who activated the local major hemorrhage protocol and received TXA were included. The primary outcome was 28-day mortality. Secondary outcomes were 24-hour mortality, multiple organ dysfunction syndrome, venous thromboembolism, and rotational thromboelastometry fibrinolysis. RESULTS: Over an 11-year period, 525 patients were included. Three dosing groups were identified: 1 g bolus only (n = 317), 1 g bolus +1 g infusion over 8 hours (n = 80), and 2 g bolus (n = 128). Demographics and admission physiology were similar, but there were differences in injury severity (median Injury Severity Score, 25, 29, and 25); and admission systolic blood pressure (median Systolic Blood Pressure, 99, 108, 99 mm Hg) across the 1-g, 1 g + 1 g, and 2-g groups. 28-day mortality was 21% in each treatment group. The incidence of multiple organ dysfunction syndrome was significantly higher in the bolus plus infusion group (84%) vs. 1 g bolus (64%) and 2 g bolus (62%) group, p = 0.002, but on multivariable analysis was nonsignificant. Venous thromboembolism rates were similar in the 1-g bolus (4%), 2 g bolus (8%) and bolus plus infusion groups (7%). There was no difference in rotational thromboelastometry maximum lysis at 24 hours: 5% in both the 1-g and 2-g bolus groups vs. 4% in bolus plus infusion group. CONCLUSION: Clinical outcomes and 24-hour fibrinolysis state were equivalent across three different dosing strategies of TXA. Single bolus administration is likely preferable to a bolus plus infusion regimen. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. CI - Copyright (c) 2023 American Association for the Surgery of Trauma. FAU - Gunn, Finn AU - Gunn F AD - From the Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry (F.G., R.S., A.A., A.R., P.V., K.B., R.D.), Queen Mary University of London; Barts Health National Health Service Trust (P.V., K.B., R.D.), London; Greater Glasgow and Clyde National Health Service Scotland (F.G.), Scotland; School of Medicine, Dentistry and Nursing (F.G.), University of Glasgow, Glasgow, United Kingdom; and Emergency Medical Services Department (A.A.), Faculty of Applied Medical Sciences, Jazan University, Kingdom of Saudi Arabia. FAU - Stevenson, Rheanna AU - Stevenson R FAU - Almuwallad, Ateeq AU - Almuwallad A FAU - Rossetto, Andrea AU - Rossetto A FAU - Vulliamy, Paul AU - Vulliamy P FAU - Brohi, Karim AU - Brohi K FAU - Davenport, Ross AU - Davenport R LA - eng SI - ISRCTN/ISRCTN12962642 PT - Journal Article DEP - 20231024 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 6T84R30KC1 (Tranexamic Acid) RN - 0 (Antifibrinolytic Agents) SB - IM MH - Adult MH - Humans MH - *Tranexamic Acid/therapeutic use MH - *Antifibrinolytic Agents/therapeutic use MH - *Venous Thromboembolism/chemically induced MH - Cohort Studies MH - Multiple Organ Failure MH - Hemorrhage/drug therapy/etiology EDAT- 2023/10/24 06:41 MHDA- 2024/01/26 06:43 CRDT- 2023/10/24 00:13 PHST- 2024/01/26 06:43 [medline] PHST- 2023/10/24 06:41 [pubmed] PHST- 2023/10/24 00:13 [entrez] AID - 01586154-202402000-00006 [pii] AID - 10.1097/TA.0000000000004177 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2024 Feb 1;96(2):216-224. doi: 10.1097/TA.0000000000004177. Epub 2023 Oct 24. PMID- 37861185 OWN - NLM STAT- MEDLINE DCOM- 20231102 LR - 20231120 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) VI - 29 IP - 6 DP - 2023 Dec 1 TI - Point-of-care, goal-directed management of bleeding in trauma patients. PG - 702-712 LID - 10.1097/MCC.0000000000001107 [doi] AB - PURPOSE OF REVIEW: The purpose of this review is to consider the clinical value of point-of-care (POC) testing in coagulopathic trauma patients with traumatic brain injury (TBI) and trauma-induced coagulopathy (TIC). RECENT FINDINGS: Patients suffering from severe TBI or TIC are at risk of developing pronounced haemostatic disorders. Standard coagulation tests (SCTs) are insufficient to reflect the complexity of these coagulopathies. Recent evidence has shown that viscoelastic tests (VETs) identify haemostatic disorders more rapidly and in more detail than SCTs. Moreover, VET results can guide coagulation therapy, allowing individualised treatment, which decreases transfusion requirements. However, the impact of VET on mortality remains uncertain. In contrast to VETs, the clinical impact of POC platelet function testing is still unproven. SUMMARY: POC SCTs are not able to characterise the complexity of trauma-associated coagulopathy. VETs provide a rapid estimation of underlying haemostatic disorders, thereby providing guidance for haemostatic therapy, which impacts allogenic blood transfusion requirements. The value of POC platelet function testing to identify platelet dysfunction and guide platelet transfusion is still uncertain. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Zipperle, Johannes AU - Zipperle J AD - Ludwig Boltzmann Institute for Traumatology, the Research Centre in Cooperation with AUVA, Vienna. FAU - Schmitt, Felix C F AU - Schmitt FCF AD - Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute for Traumatology, the Research Centre in Cooperation with AUVA, Vienna. AD - Paracelsus Medical University, Salzburg, Austria. LA - eng PT - Journal Article PT - Review DEP - 20231003 PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM MH - Humans MH - Point-of-Care Systems MH - Goals MH - Hemorrhage/etiology/therapy MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - *Hemostatic Disorders MH - *Wounds and Injuries/complications/therapy MH - Thrombelastography EDAT- 2023/10/20 12:44 MHDA- 2023/11/02 12:44 CRDT- 2023/10/20 07:43 PHST- 2023/11/02 12:44 [medline] PHST- 2023/10/20 12:44 [pubmed] PHST- 2023/10/20 07:43 [entrez] AID - 00075198-202312000-00027 [pii] AID - 10.1097/MCC.0000000000001107 [doi] PST - ppublish SO - Curr Opin Crit Care. 2023 Dec 1;29(6):702-712. doi: 10.1097/MCC.0000000000001107. Epub 2023 Oct 3. PMID- 37858445 OWN - NLM STAT- MEDLINE DCOM- 20231225 LR - 20240102 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 55 IP - 1 DP - 2024 Jan TI - The nature and timing of coagulation dysfunction in a cohort of trauma patients in the Australian pre-hospital setting. PG - 111124 LID - S0020-1383(23)00838-0 [pii] LID - 10.1016/j.injury.2023.111124 [doi] AB - BACKGROUND: Acute Traumatic Coagulopathy (ATC) is a complex pathological process that is associated with patient mortality and increased blood transfusion requirements. It is evident on hospital arrival, but there is a paucity of information about the nature of ATC and the characteristics of patients that develop ATC in the pre-hospital setting. The objective of this study was to describe the nature and timing of coagulation dysfunction in a cohort of injured patients and to report on patient and pre-hospital factors associated with the development of ATC in the field. METHODS: This was a prospective observational study of a convenience sample of trauma patients. Patients had blood taken during the pre-hospital phase of care and evaluated for derangements in Conventional Coagulation Assays (CCA) and Rotational Thromboelastometry (ROTEM). Associations between coagulation derangement and pre-hospital factors and patient outcomes were evaluated. RESULTS: A total of 216 patients who had either a complete CCA or ROTEM were included in the analysis. One hundred and eighty (83 %) of patients were male, with a median injury severity score of 17 [interquartile range (IQR) 10-27] and median age of 34 years [IQR = 25.0-52.0]. Hypofibrinogenemia was the predominant abnormality seen, (CCA Hypofibrinogenemia: 51/193, 26 %; ROTEM hypofibrinogenemia: 65/204, 32 %). Increased CCA derangement, the presence of ROTEM coagulopathy, worsening INR, worsening FibTEM and decreasing fibrinogen concentration, were all associated with both mortality and early massive transfusion. CONCLUSION: Clinically significant, multifaceted coagulopathy develops early in the clinical course, with hypofibrinogenemia being the predominant coagulopathy. In keeping with the ED literature, pre-hospital coagulation dysfunction was associated with mortality and early massive transfusion. Further work is required to identify strategies to identify and guide the pre-hospital management of the coagulation dysfunction seen in trauma. CI - Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Bodnar, Daniel AU - Bodnar D AD - Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Australia; Emergency Department, Queensland Children's Hospital, South Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia. Electronic address: daniel.bodnar@health.qld.gov.au. FAU - Bosley, Emma AU - Bosley E AD - Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia. FAU - Raven, Steven AU - Raven S AD - Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia. FAU - Williams, Sue AU - Williams S AD - Pathology Queensland Central Transfusion Laboratory, Royal Brisbane and Women's Hospital, Herston, Australia. FAU - Ryan, Glenn AU - Ryan G AD - School of Medicine, University of Queensland, Brisbane, Australia; Emergency Department, The Princess Alexandra Hospital, Woolloongabba, Australia. FAU - Wullschleger, Martin AU - Wullschleger M AD - School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Trauma Service, Gold Coast University Hospital, Gold Coast, Australia. FAU - Lam, Alfred K AU - Lam AK AD - School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Pathology Queensland, Gold Coast University Hospital, Gold Coast, Australia. LA - eng PT - Journal Article PT - Observational Study DEP - 20231014 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Humans MH - Male MH - Adult MH - Middle Aged MH - Female MH - *Afibrinogenemia MH - Australia/epidemiology MH - Blood Coagulation MH - *Blood Coagulation Disorders/etiology MH - Thrombelastography MH - Hospitals MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - Coagulopathy OT - Emergency medical system OT - Hypofibrinogenaemia OT - Pre-hospital OT - Trauma COIS- Declaration of Competing Interest The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Daniel Bodnar Emma Bosley Steven Raven Sue Williams Glenn Ryan Martin Wullschleger Alfred K. Lam EDAT- 2023/10/20 06:42 MHDA- 2023/12/25 06:42 CRDT- 2023/10/20 00:23 PHST- 2023/02/13 00:00 [received] PHST- 2023/09/11 00:00 [revised] PHST- 2023/10/12 00:00 [accepted] PHST- 2023/12/25 06:42 [medline] PHST- 2023/10/20 06:42 [pubmed] PHST- 2023/10/20 00:23 [entrez] AID - S0020-1383(23)00838-0 [pii] AID - 10.1016/j.injury.2023.111124 [doi] PST - ppublish SO - Injury. 2024 Jan;55(1):111124. doi: 10.1016/j.injury.2023.111124. Epub 2023 Oct 14. PMID- 37839099 OWN - NLM STAT- MEDLINE DCOM- 20231124 LR - 20231124 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 293 DP - 2024 Jan TI - Thromboembolic Complications Following Perioperative Tranexamic Acid Administration. PG - 676-684 LID - S0022-4804(23)00456-0 [pii] LID - 10.1016/j.jss.2023.08.048 [doi] AB - INTRODUCTION: The antifibrinolytic tranexamic acid (TXA) may reduce death in trauma; however, outcomes associated with TXA use in patients without proven hyperfibrinolysis remain unclear. We analyzed the associations of empirically administered TXA, hypothesizing that TXA use would correlate to lower transfusion totals but increased thromboembolic complications. METHODS: This retrospective cohort study compared trauma patients started on massive transfusion protocol at a Level I trauma center from 2016 to 2021 who either did or did not receive TXA. Our primary outcome was in-hospital mortality. Venous thromboembolism (VTE; pulmonary embolism or deep vein thrombosis), transfusion volumes, and coagulation measures were considered secondarily. Descriptive statistics, univariate analyses, and multivariable logistic regression were used to evaluate differences in outcomes. RESULTS: TXA patients presented with lower systolic blood pressure (100 versus 119.5 mmHg, P = 0.009), trended toward higher injury severity (ISS of 25 versus 20, P = 0.057), and were likelier to have undergone thoracotomy or laparotomy (89 versus 71%, P = 0.002). After adjusting for age, mechanism, presenting vitals, and operation, TXA was not significantly associated with mortality or VTE. TXA patients had larger volumes of packed red blood cells, platelets, and plasma transfused within 4- and 24-h (P /=40% TBSA) were associated with lower admission alpha-angle for rTEG (P = .03) and lower MA for rTEG (P = .02) and kTEG (P = .01). MA was lower in patients who died (nTEG, P = .04; kTEG, P = .02; rTEG, P = .003). Admission HF was associated with increased mortality (OR, 10.45; 95% CI, 2.54-43.31, P = .001) on rTEG only. Delayed SD was associated with mortality using rTEG and nTEG (OR 9.46; 95% CI, 1.96-45.73; P = .005 and OR, 6.91; 95% CI, 1.35-35.48; P = .02). Admission TEGs showed poor agreement on R-time (Rc, 0.00-0.56) and alpha-angle (0.40 to 0.55), and moderate agreement on MA (0.67-0.81) and LY30 (0.72-0.93). Interclass reliability was lowest for R-time (kappa, -0.07 to 0.01) and alpha-angle (-0.06 to 0.17) and highest for MA (0.22-0.51) and LY30 (0.29-0.49). Choice of TEG method may impact clinical decision-making. rTEG appeared most sensitive in parameter-specific associations with injury severity, abnormal fibrinolysis, and mortality. CI - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. FAU - Keyloun, John W AU - Keyloun JW AUID- ORCID: 0000-0002-9540-2664 AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA. FAU - Le, Tuan D AU - Le TD AUID- ORCID: 0000-0003-1539-6346 AD - Research Directorate, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA. AD - Department of Epidemiology and Biostatistics, University of Texas Tyler School of Medicine, Tyler, TX 75708, USA. FAU - Moffatt, Lauren T AU - Moffatt LT AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA. AD - Department of Biochemistry, Georgetown University, Washington, DC 20057, USA. FAU - Orfeo, Thomas AU - Orfeo T AD - Department of Biochemistry, College of Medicine, University of Vermont, Colchester, VT 05405, USA. FAU - McLawhorn, Melissa M AU - McLawhorn MM AUID- ORCID: 0000-0001-7400-2509 AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA. FAU - Bravo, Maria-Cristina AU - Bravo MC AD - Department of Biochemistry, College of Medicine, University of Vermont, Colchester, VT 05405, USA. FAU - Tejiram, Shawn AU - Tejiram S AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA. CN - SYSCOT Study Group FAU - Shupp, Jeffrey W AU - Shupp JW AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA. AD - Department of Surgery, Georgetown University, Washington, DC 20057, USA. FAU - Pusateri, Anthony E AU - Pusateri AE AUID- ORCID: 0000-0002-1324-4835 AD - Combat Casualty Care and Operational Medicine Directorate, Naval Medical Research Unit San Antonio, JBSA Fort Sam Houston, TX 78234, USA. AD - Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA. LA - eng GR - Systems Biology Coagulopathy of Trauma/ GR - W911NF-10-1-03761/Defense Health Program/ GR - U.S. Army Medical Research and Development Command/ PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - J Burn Care Res JT - Journal of burn care & research : official publication of the American Burn Association JID - 101262774 RN - 24H4NWX5CO (Kaolin) SB - IM MH - Humans MH - Male MH - Adult MH - Female MH - Thrombelastography/methods MH - Kaolin MH - *Burns/complications MH - Reproducibility of Results MH - *Blood Coagulation Disorders/etiology PMC - PMC10768763 OTO - NOTNLM OT - TEG OT - activated clotting time (ACT) OT - burns OT - coagulopathy OT - fibrinolysis OT - thromboelastography FIR - Bravo, Maria-Cristina IR - Bravo MC FIR - Brummel-Ziedins, Kathleen E IR - Brummel-Ziedins KE FIR - Callcut, Rachael A IR - Callcut RA FIR - Cohen, Mitchell J IR - Cohen MJ FIR - Freeman, Kalev IR - Freeman K FIR - Gautam, Aarti IR - Gautam A FIR - Hammamieh, Rasha IR - Hammamieh R FIR - Jett, Marti IR - Jett M FIR - McLawhorn, Melissa M IR - McLawhorn MM FIR - Moffatt, Lauren T IR - Moffatt LT FIR - Petzold, Linda R IR - Petzold LR FIR - Pusateri, Anthony E IR - Pusateri AE FIR - Shupp, Jeffrey W IR - Shupp JW FIR - Varner, Jeffrey D IR - Varner JD EDAT- 2023/10/15 05:45 MHDA- 2024/01/08 06:43 PMCR- 2023/10/14 CRDT- 2023/10/14 15:36 PHST- 2024/01/08 06:43 [medline] PHST- 2023/10/15 05:45 [pubmed] PHST- 2023/10/14 15:36 [entrez] PHST- 2023/10/14 00:00 [pmc-release] AID - 7317622 [pii] AID - irad152 [pii] AID - 10.1093/jbcr/irad152 [doi] PST - ppublish SO - J Burn Care Res. 2024 Jan 5;45(1):70-79. doi: 10.1093/jbcr/irad152. PMID- 37828662 OWN - NLM STAT- MEDLINE DCOM- 20240126 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 96 IP - 2 DP - 2024 Feb 1 TI - Trauma-induced coagulopathy: What you need to know. PG - 179-185 LID - 10.1097/TA.0000000000004170 [doi] AB - ABSTRACT: Trauma-induced coagulopathy (TIC) is a global inflammatory state accompanied by coagulation derangements, acidemia, and hypothermia, which occurs after traumatic injury. It occurs in approximately 25% of severely injured patients, and its incidence is directly related to injury severity. The mechanism of TIC is multifaceted; proposed contributing factors include dysregulation of activated protein C, increased tPA, systemic endothelial activation, decreased fibrinogen, clotting factor consumption, and platelet dysfunction. Effects of TIC include systemic inflammation, coagulation derangements, acidemia, and hypothermia. Trauma-induced coagulopathy may be diagnosed by conventional coagulation tests including platelet count, Clauss assay, international normalized ratio, thrombin time, prothrombin time, and activated partial thromboplastin time; viscoelastic hemostatic assays such as thrombelastography and rotational thrombelastography; or a clinical scoring system known as the Trauma Induced Coagulopathy Clinical Score. Preventing TIC begins in the prehospital phase with early hemorrhage control, blood product resuscitation, and tranexamic acid therapy. Early administration of prothrombin complex concentrate is also being studied in the prehospital environment. The mainstays of TIC treatment include hemorrhage control, blood and component transfusions, and correction of abnormalities such as hypocalcemia, acidosis, and hypothermia. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Buzzard, Lydia AU - Buzzard L AD - From the University of Wisconsin School of Medicine and Public Health (L.B.), Madison, Wisconsin; and Department of Surgery (L.B., M.S.), Oregon Health and Science University, Portland, Oregon. FAU - Schreiber, Martin AU - Schreiber M LA - eng PT - Journal Article DEP - 20231013 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Humans MH - *Hypothermia/complications MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Hemorrhage/etiology/therapy MH - Blood Coagulation Tests MH - Hemostasis MH - Thrombelastography/adverse effects MH - *Wounds and Injuries/complications EDAT- 2023/10/13 06:45 MHDA- 2024/01/26 06:43 CRDT- 2023/10/13 00:13 PHST- 2024/01/26 06:43 [medline] PHST- 2023/10/13 06:45 [pubmed] PHST- 2023/10/13 00:13 [entrez] AID - 01586154-202402000-00001 [pii] AID - 10.1097/TA.0000000000004170 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2024 Feb 1;96(2):179-185. doi: 10.1097/TA.0000000000004170. Epub 2023 Oct 13. PMID- 37813753 OWN - NLM STAT- MEDLINE DCOM- 20231206 LR - 20231217 IS - 1473-0502 (Print) IS - 1473-0502 (Linking) VI - 62 IP - 6 DP - 2023 Dec TI - Characteristics of blood clotting on thromboelastography in patients with early burns. PG - 103824 LID - S1473-0502(23)00238-0 [pii] LID - 10.1016/j.transci.2023.103824 [doi] AB - BACKGROUND: Thromboelastography (TEG) is a viscoelastic test that may be used to evaluate the hemostatic function of whole blood, and it may be useful for burn patients with multiple hemostatic defects. METHODS: We retrospectively recruited patients with burns between January 2019 and July 2021. Blood samples were drawn on admission and subjected to coagulation parameter assessment, including conventional coagulation tests and TEG assessment. Receiver operating characteristic (ROC) analysis was performed to predict the occurrence of complications in patients with early burns. RESULTS: Ninety-three patients with early burns met the inclusion criteria. Patients with minor, moderate, severe, and extremely severe burns accounted for 19.4 %, 36.6 %, 16.1 %, and 27.9 % of all patients, respectively. Compared with the healthy controls, patients with early burns showed significant reductions in the R and K values, and significant elevation in the maximum amplitude (MA), coagulation index (CI), and alpha angle. Compared with minor and moderate burn patients, patients with severe and extremely severe burns had lower K values and thrombin time and higher alpha angle, CI, prothrombin time, international normalized ratio, D-dimer, and fibrin degradation products. Patients with hypercoagulation had lower R and K values, longer MA, longer CI, and greater alpha angle. After ROC analysis, the areas under the ROC curve for acute lung injury, acute kidney injury, and bleeding were 0.789, 0.802, and 0.900, respectively. CONCLUSION: TEG provides insight into the hemostatic state of patients with early burns, and can predict complications in early burn patients when combined with conventional coagulation tests. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Jian, Fang AU - Jian F AD - Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. FAU - Lu, Chen AU - Lu C AD - Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. FAU - Jia, He AU - Jia H AD - Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. FAU - Na, Li AU - Na L AD - Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. FAU - Peng, Yang AU - Peng Y AD - Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. FAU - Maohong, Bian AU - Maohong B AD - Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. Electronic address: mhbian@126.com. FAU - Xulin, Chen AU - Xulin C AD - Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China. Electronic address: okcxl@126.com. LA - eng PT - Journal Article DEP - 20230929 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 RN - 0 (Hemostatics) MH - Humans MH - Thrombelastography MH - Retrospective Studies MH - Blood Coagulation MH - Blood Coagulation Tests MH - *Thrombosis MH - *Burns MH - *Hemostatics OTO - NOTNLM OT - Burn OT - Conventional coagulation parameters OT - Thromboelastography COIS- Declaration of Competing Interest The authors have no conflicts of interest to declare. EDAT- 2023/10/10 00:42 MHDA- 2023/12/06 06:42 CRDT- 2023/10/09 22:22 PHST- 2023/02/11 00:00 [received] PHST- 2023/09/12 00:00 [revised] PHST- 2023/09/22 00:00 [accepted] PHST- 2023/12/06 06:42 [medline] PHST- 2023/10/10 00:42 [pubmed] PHST- 2023/10/09 22:22 [entrez] AID - S1473-0502(23)00238-0 [pii] AID - 10.1016/j.transci.2023.103824 [doi] PST - ppublish SO - Transfus Apher Sci. 2023 Dec;62(6):103824. doi: 10.1016/j.transci.2023.103824. Epub 2023 Sep 29. PMID- 37802703 OWN - NLM STAT- MEDLINE DCOM- 20231216 LR - 20241108 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 227 DP - 2024 Jan TI - Analysis of fibrinolytic shutdown in trauma patients with traumatic brain injury. PG - 72-76 LID - S0002-9610(23)00490-7 [pii] LID - 10.1016/j.amjsurg.2023.09.034 [doi] AB - BACKGROUND: Coagulation profiles following major trauma vary depending on injury pattern and degree of shock. The physiologic mechanisms involved in coagulation function at any given time are varied and remain poorly understood. Thromboelastography (TEG) has been used evaluate coagulation profiles in the trauma population with some reports demonstrating a spectrum of fibrinolysis to fibrinolytic shutdown on initial presentation. The objective of this study was to evaluate the fibrinolytic profile of patients with TBI using thromboelastography (TEG). We hypothesized that patients with TBI would demonstrate low fibrinolytic activity. METHODS: All trauma activations at an ACS-verified level 1 trauma center received a TEG analysis upon arrival from December 2019 to June 2021. A retrospective review of the results and outcomes was conducted, and TBI patients were compared to patients without TBI. Linear regression was used to evaluate the effect of patient and injury factors on fibrinolysis. Hyperfibrinolysis was defined as LY30 ​> ​7.7%, physiologic fibrinolysis as LY30 0.6-7.7%, and fibrinolytic shutdown as LY30 ​< ​0.6%. RESULTS: A total of 1369 patients received an admission TEG analysis. Patients with TBI had a significantly higher median ISS (16 vs. 8, p ​< ​0.001), lower median admission Glasgow Coma Scale (14 vs. 15, p ​< ​0.001), longer intensive care unit length of stay (3 vs. 2 days, p ​< ​0.0001), increased ventilator days (216 vs. 183, p ​< ​0.001), higher mortality (14.6% vs. 5.1%, p ​< ​0.001), but lower shock index (0.6 vs. 0.7, p ​< ​0.0001) compared to those without TBI. Median LY30 was found to be decreased in the TBI group (0.1 vs. 0.2, p ​= ​0.0006). Patients with TBI were found to have a higher rate of fibrinolytic shutdown compared those without TBI (68.7% vs. 63.5%, p ​= ​0.054). ISS, sex, and shock index were found to be predictive of LY30 on linear regression, but TBI was not (Beta: 0.09, SE: 0.277, p ​= ​0.745). The rate of DVT/PE did not appear to be elevated in patients with TBI (0.8%) and without TBI (1.2%). CONCLUSIONS: Trauma patients with and without TBI were found to have high rates of fibrinolytic shutdown. Although there was a high incidence of fibrinolytic shutdown, it did not appear to have an impact on the rate of thrombotic complications. The clinical significance of these results is unclear and differs significantly from recent reports which demonstrated that TBI is associated with a 25% rate of fibrinolytic shutdown. Further investigation is needed to better define the fibrinolytic pathway in patients with trauma and TBI to develop optimal treatment algorithms. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Favors, L AU - Favors L AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. Electronic address: lauren.elizabeth.favors@gmail.com. FAU - Harrell, K AU - Harrell K AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. Electronic address: kevinharrell830@gmail.com. FAU - Miles, V AU - Miles V AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. Electronic address: mvpurvis@gmail.com. FAU - Hicks, R C AU - Hicks RC AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Rippy, M AU - Rippy M AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Parmer, H AU - Parmer H AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Edwards, A AU - Edwards A AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Brown, C AU - Brown C AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Stewart, K AU - Stewart K AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Day, L AU - Day L AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Wilson, A AU - Wilson A AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. FAU - Maxwell, R AU - Maxwell R AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA. Electronic address: robert.maxwell@universitysurgical.com. LA - eng PT - Journal Article DEP - 20230926 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Humans MH - *Brain Injuries, Traumatic MH - *Blood Coagulation Disorders/etiology/drug therapy MH - Fibrinolysis/physiology MH - Blood Coagulation Tests/adverse effects MH - Thrombelastography/adverse effects/methods MH - *Wounds and Injuries/complications OTO - NOTNLM OT - Coagulopathy OT - Hemorrhagic shock OT - Resuscitation OT - Sex profile OT - Thromboelastography OT - Trauma COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/10/07 00:41 MHDA- 2023/12/17 09:46 CRDT- 2023/10/06 22:00 PHST- 2023/06/30 00:00 [received] PHST- 2023/09/01 00:00 [revised] PHST- 2023/09/25 00:00 [accepted] PHST- 2023/12/17 09:46 [medline] PHST- 2023/10/07 00:41 [pubmed] PHST- 2023/10/06 22:00 [entrez] AID - S0002-9610(23)00490-7 [pii] AID - 10.1016/j.amjsurg.2023.09.034 [doi] PST - ppublish SO - Am J Surg. 2024 Jan;227:72-76. doi: 10.1016/j.amjsurg.2023.09.034. Epub 2023 Sep 26. PMID- 37767279 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20260310 LR - 20260310 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 50 IP - 4 DP - 2023 Aug TI - Detection of Acute Traumatic Coagulopathy by Viscoelastic Haemostatic Assays Compared to Standard Laboratory Tests: A Systematic Review. PG - 334-347 LID - 10.1159/000526217 [doi] AB - INTRODUCTION: The aim of this systematic review was to investigate whether viscoelastic haemostatic assays (VHAs) offer comparative diagnostic ability of acute traumatic coagulopathy (ATC) compared to the standard laboratory coagulation tests (SLCT). ATC is a complication of major trauma characterized by dysfunctional blood clotting, leading to an increased bleeding risk. Additionally, we aimed to analyse the association of VHA with blood product use and health outcomes. METHODS: The search protocol was pre-published and completed on December 2, 2020, assessing manuscripts from 2000 until the present. We searched MEDLINE, Embase, Cochrane Central, BIOSIS, Emcare, CINAHL, and additional online resources and referenced lists. Included were manuscripts that quantitatively reported the detection of ATC using VHAs and SLCTs. A meta-analysis was undertaken including observational studies that reported on patients with injuries to all body regions and results analysed using a random-effects model and reported using pooled odds ratio with 95% confidence intervals (CI). RESULTS: There were 14 observational studies and one randomized control trial involving 2,715 participants that satisfied inclusion criteria. We observed significant heterogeneity in the definitions of ATC, study design, setting, and patient population. Among observational studies that reported on patients with injuries to all body regions, VHAs were associated with higher odds of diagnosing ATC compared to SLCT (pooled OR 2.4; 95% CI: 1.4-4.1). There was inadequate evidence to suggest VHAs were associated with reduced blood product usage or lower mortality. CONCLUSION: VHAs detected more patients with ATC compared to SLCTs. However, the clinical significance and applicability of this finding remains unknown as translation to management was not adequately reported. CI - Copyright (c) 2022 by The Author(s). Published by S. Karger AG, Basel. FAU - Forster, Ellen K AU - Forster EK AD - Emergency & Trauma Centre, Alfred Health, Melbourne, Victoria, Australia. AD - School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. AD - National Trauma Research Institute, Monash University, Central Clinical School, Melbourne, Victoria, Australia. FAU - Hendel, Simon AU - Hendel S AD - National Trauma Research Institute, Monash University, Central Clinical School, Melbourne, Victoria, Australia. AD - Department of Anaesthesiology and Perioperative Medicine, Monash University and Alfred Health, Melbourne, Victoria, Australia. AD - Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia. FAU - Mitra, Biswadev AU - Mitra B AD - Emergency & Trauma Centre, Alfred Health, Melbourne, Victoria, Australia. AD - School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. AD - National Trauma Research Institute, Monash University, Central Clinical School, Melbourne, Victoria, Australia. LA - eng PT - Journal Article PT - Review DEP - 20221212 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC10521251 OTO - NOTNLM OT - Acute traumatic coagulopathy OT - Blood component transfusion OT - Thromboelastography OT - Viscoelastic assay OT - Wounds and injuries COIS- The authors have no conflicts of interest to declare. EDAT- 2023/09/28 06:42 MHDA- 2023/09/28 06:43 PMCR- 2022/12/12 CRDT- 2023/09/28 04:13 PHST- 2021/07/30 00:00 [received] PHST- 2022/07/24 00:00 [accepted] PHST- 2023/09/28 06:43 [medline] PHST- 2023/09/28 06:42 [pubmed] PHST- 2023/09/28 04:13 [entrez] PHST- 2022/12/12 00:00 [pmc-release] AID - tmh-0050-0334 [pii] AID - 10.1159/000526217 [doi] PST - epublish SO - Transfus Med Hemother. 2022 Dec 12;50(4):334-347. doi: 10.1159/000526217. eCollection 2023 Aug. PMID- 37729353 OWN - NLM STAT- MEDLINE DCOM- 20230922 LR - 20230923 IS - 2317-6385 (Electronic) IS - 1679-4508 (Print) IS - 1679-4508 (Linking) VI - 21 DP - 2023 TI - COVID-19-associated coagulopathy and acute kidney injury in critically ill patients. PG - eAO0119 LID - S1679-45082023000100229 [pii] LID - 10.31744/einstein_journal/2023AO0119 [doi] LID - eAO0119 AB - OBJECTIVE: The incidence of thrombotic events and acute kidney injury is high in critically ill patients with COVID-19. We aimed to evaluate and compare the coagulation profiles of patients with COVID-19 developing acute kidney injury versus those who did not, during their intensive care unit stay. METHODS: Conventional coagulation and platelet function tests, fibrinolysis, endogenous inhibitors of coagulation tests, and rotational thromboelastometry were conducted on days 0, 1, 3, 7, and 14 following intensive care unit admission. RESULTS: Out of 30 patients included, 13 (43.4%) met the criteria for acute kidney injury. Comparing both groups, patients with acute kidney injury were older: 73 (60-84) versus 54 (47-64) years, p=0.027, and had a lower baseline glomerular filtration rate: 70 (51-81) versus 93 (83-106) mL/min/1.73m2, p=0.004. On day 1, D-dimer and fibrinogen levels were elevated but similar between groups: 1780 (1319-5517) versus 1794 (726-2324) ng/mL, p=0.145 and 608 (550-700) versus 642 (469-722) g/dL, p=0.95, respectively. Rotational thromboelastometry data were also similar between groups. However, antithrombin activity and protein C levels were lower in patients who developed acute kidney injury: 82 (75-92) versus 98 (90-116), p=0.028 and 70 (52-82) versus 88 (78-101) micro/mL, p=0.038, respectively. Mean protein C levels were lower in the group with acute kidney injury across multiple time points during their stay in the intensive care unit. CONCLUSION: Critically ill patients experiencing acute kidney injury exhibited lower endogenous anticoagulant levels. Further studies are needed to understand the role of natural anticoagulants in the pathophysiology of acute kidney injury within this population. FAU - Silva, Bruno Caldin da AU - Silva BCD AUID- ORCID: 0000-0001-9568-0974 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Cordioli, Ricardo Luiz AU - Cordioli RL AUID- ORCID: 0000-0001-7521-399X AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Santos, Bento Fortunato Cardoso Dos AU - Santos BFCD AUID- ORCID: 0000-0002-4662-1959 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Guerra, Joao Carlos de Campos AU - Guerra JCC AUID- ORCID: 0000-0002-4156-529X AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Rodrigues, Roseny Dos Reis AU - Rodrigues RDR AUID- ORCID: 0000-0002-3796-5952 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Souza, Guilherme Martins de AU - Souza GM AUID- ORCID: 0000-0002-0643-2723 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Ashihara, Carolina AU - Ashihara C AUID- ORCID: 0000-0002-6961-8509 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Midega, Thais Dias AU - Midega TD AUID- ORCID: 0000-0002-1010-3711 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Campos, Niklas Soderberg AU - Campos NS AUID- ORCID: 0000-0002-4768-0299 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Carneiro, Barbara Vieira AU - Carneiro BV AUID- ORCID: 0000-0001-7858-9730 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Campos, Flavia Nunes Dias AU - Campos FND AUID- ORCID: 0000-0002-5406-2165 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Guimaraes, Helio Penna AU - Guimaraes HP AUID- ORCID: 0000-0001-5523-1015 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Matos, Gustavo Faissol Janot de AU - Matos GFJ AUID- ORCID: 0000-0001-9996-7040 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Aranda, Valdir Fernandes de AU - Aranda VF AUID- ORCID: 0000-0002-3246-4358 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Ferraz, Leonardo Jose Rolim AU - Ferraz LJR AUID- ORCID: 0000-0003-1822-1568 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. FAU - Correa, Thiago Domingos AU - Correa TD AUID- ORCID: 0000-0001-9546-3910 AD - Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. LA - eng PT - Journal Article DEP - 20230915 PL - Brazil TA - Einstein (Sao Paulo) JT - Einstein (Sao Paulo, Brazil) JID - 101281800 RN - 0 (Protein C) RN - 0 (Anticoagulants) SB - IM MH - Humans MH - Critical Illness MH - Protein C MH - *COVID-19/complications MH - *Blood Coagulation Disorders/etiology MH - *Acute Kidney Injury/etiology MH - Anticoagulants PMC - PMC10501765 COIS- Conflict of interest: none. EDAT- 2023/09/20 18:42 MHDA- 2023/09/22 06:42 PMCR- 2023/08/30 CRDT- 2023/09/20 13:46 PHST- 2022/09/03 00:00 [received] PHST- 2023/02/07 00:00 [accepted] PHST- 2023/09/22 06:42 [medline] PHST- 2023/09/20 18:42 [pubmed] PHST- 2023/09/20 13:46 [entrez] PHST- 2023/08/30 00:00 [pmc-release] AID - S1679-45082023000100229 [pii] AID - 10.31744/einstein_journal/2023AO0119 [doi] PST - epublish SO - Einstein (Sao Paulo). 2023 Sep 15;21:eAO0119. doi: 10.31744/einstein_journal/2023AO0119. eCollection 2023. PMID- 37665288 OWN - NLM STAT- MEDLINE DCOM- 20230905 LR - 20260127 IS - 2234-3814 (Electronic) IS - 2234-3806 (Print) IS - 2234-3806 (Linking) VI - 44 IP - 1 DP - 2024 Jan 1 TI - Prediction of Mid-term Platelet Transfusion in Stable Trauma Patients Using Rotational Thromboelastometry. PG - 74-81 LID - 10.3343/alm.2024.44.1.74 [doi] AB - BACKGROUND: Rotational thromboelastometry (ROTEM; TEM International GmbH, Munich, Germany) is a global coagulation test that guides evidence-based platelet transfusion in trauma patients. We evaluated ROTEM parameters for predicting mid-term (five days) platelet transfusion in trauma patients. METHODS: Maximum clot firmness and clot amplitudes after 5, 10, and 15 mins (A5, A10, and A15, respectively) of fibrin-specific ROTEM (FIBTEM) and extrinsically activated ROTEM (EXTEM) were retrospectively collected from 82 hospitalized, stable, non-bleeding trauma patients after successful initial resuscitation. Platelet-specific ROTEM (PLTEM) was calculated by subtracting FIBTEM from EXTEM. Platelet transfusions were reviewed for five days after ROTEM. RESULTS: The areas under the curve for FIBTEM, EXTEM, and PLTEM predicting platelet concentrate transfusion of >12 U at mid-term were 0.915-0.923, 0.878-0.896, and 0.551-0.735, respectively. FIBTEM and EXTEM parameters were comparable to those of fibrinogen, fibrin/fibrinogen degradation products, D-dimer, and antithrombin III. Strong correlations (r>0.7) were noted between platelet count and EXTEM (A5, A10, and A15) or PLTEM (A5), platelet function (per platelet count) and EXTEM (A10 and A15), and fibrinogen levels and all FIBTEM parameters. CONCLUSIONS: FIBTEM and EXTEM can reliably predict mid-term platelet transfusion in trauma patients. FIBTEM, EXTEM, and PLTEM parameters correlate with conventional coagulation tests (platelets and fibrinogen). FAU - Lim, Ha Jin AU - Lim HJ AUID- ORCID: 0000-0003-2436-5007 AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Jang, Hyunseok AU - Jang H AUID- ORCID: 0000-0002-0355-811X AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Lee, Naa AU - Lee N AUID- ORCID: 0000-0003-0288-7613 AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Jeong, Euisung AU - Jeong E AUID- ORCID: 0000-0003-4020-9311 AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Park, Yunchul AU - Park Y AUID- ORCID: 0000-0002-2163-1616 AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Jo, Younggoun AU - Jo Y AUID- ORCID: 0000-0002-4418-2729 AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Kim, Jungchul AU - Kim J AUID- ORCID: 0000-0002-6774-1861 AD - Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Lee, Young Eun AU - Lee YE AUID- ORCID: 0000-0003-2700-3087 AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea. FAU - Choi, Hyun-Jung AU - Choi HJ AUID- ORCID: 0000-0003-2901-5962 AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Kee, Seung-Jung AU - Kee SJ AUID- ORCID: 0000-0001-9708-5837 AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Shin, Jong Hee AU - Shin JH AUID- ORCID: 0000-0001-9593-476X AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea. FAU - Shin, Myung Geun AU - Shin MG AUID- ORCID: 0000-0002-0372-9185 AD - Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea. LA - eng PT - Journal Article DEP - 20230904 PL - Korea (South) TA - Ann Lab Med JT - Annals of laboratory medicine JID - 101571172 RN - 9001-32-5 (Fibrinogen) RN - 9001-31-4 (Fibrin) RN - 16VY3TM7ZO (antineoplaston A10) RN - 0 (Piperidones) RN - 0 (Benzeneacetamides) SB - IM MH - Humans MH - *Thrombelastography MH - *Platelet Transfusion MH - Retrospective Studies MH - Fibrinogen MH - Fibrin MH - Piperidones MH - Benzeneacetamides PMC - PMC10485857 OTO - NOTNLM OT - Fibrinogen OT - Platelet transfusion OT - Platelets OT - Rotational thromboelastometry OT - Trauma COIS- CONFLICTS OF INTEREST None declared. EDAT- 2023/09/04 12:42 MHDA- 2023/09/05 06:42 PMCR- 2023/09/04 CRDT- 2023/09/04 10:13 PHST- 2023/02/13 00:00 [received] PHST- 2023/05/05 00:00 [revised] PHST- 2023/08/04 00:00 [accepted] PHST- 2023/09/05 06:42 [medline] PHST- 2023/09/04 12:42 [pubmed] PHST- 2023/09/04 10:13 [entrez] PHST- 2023/09/04 00:00 [pmc-release] AID - alm.2024.44.1.74 [pii] AID - alm-44-1-74 [pii] AID - 10.3343/alm.2024.44.1.74 [doi] PST - ppublish SO - Ann Lab Med. 2024 Jan 1;44(1):74-81. doi: 10.3343/alm.2024.44.1.74. Epub 2023 Sep 4. PMID- 37633248 OWN - NLM STAT- MEDLINE DCOM- 20231102 LR - 20241202 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 292 DP - 2023 Dec TI - Adiposity and Coagulation: Predicting Postinjury Coagulation With Advanced Imaging Analysis. PG - 190-196 LID - S0022-4804(23)00356-6 [pii] LID - 10.1016/j.jss.2023.07.048 [doi] AB - INTRODUCTION: Anatomic distribution of adipose tissue has demonstrated variable associations with hypercoagulability. Utilizing a retrospective analysis of a previously enrolled prospective cohort, we assessed computed tomography (CT) scan-based anthropometric and volumetric measures of adiposity as predictors of postinjury hypercoagulability. METHODS: Segmentation analysis of arrival CT scans in significantly injured patients at a single level-I trauma center enrolled from December 2017 to August 2021 were analyzed for anthropometric indices of waist circumference (WC) and sagittal abdominal diameter (SAD), and volumetric parameters of visceral adipose tissue, superficial/deep subcutaneous adipose tissue, psoas/paravertebral muscle volume, and abdominal wall muscle volume. Associations with thromboelastography (TEG) were explored. RESULTS: Data from 91 patients showed strong correlations between body mass index and standard anthropometric measures of WC and SAD (P < 0.001); calculated volumes of subcutaneous adipose tissue and visceral adipose tissue (P < 0.001); and ratios of subcutaneous adipose:psoas muscle (SP ratio) and visceral adipose:psoas muscle ratio (both with P < 0.001, respectively). Correlation between TEG maximal amplitude (MA) and body mass index and SAD were not significant, with only weak correlation between TEG-MA and WC (r = 0.238, P = 0.041). Moderate but significant correlations existed between SP ratio and TEG-MA (r = 0.340, P = 0.005), but not visceral adipose:psoas muscle ratio (r = 0.159, P = 0.198). The relationship between TEG-MA and SP ratio remained significant when adjusted for injury severity score and lactate level (b = 0.302, P = 0.001). CONCLUSIONS: SP ratio is more strongly correlated with TEG-MA than standard obesity measures, and independently predicts increasing clot strength/stability after injury. Coagulation-relevant measures of sarcopenic obesity can be measured on CT scan, and may be used to optimize thromboprophylaxis strategies for obese injured patients. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Littlejohn, James B AU - Littlejohn JB AD - Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: jlittlejohn@umc.edu. FAU - Grenn, Emily E AU - Grenn EE AD - Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi. FAU - Carter, Kristen T AU - Carter KT AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Hazlewood, Rebekah AU - Hazlewood R AD - School of Medicine, University of Mississippi, Jackson, Mississippi. FAU - Sitta, Juliana AU - Sitta J AD - Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. FAU - Florez, Edward AU - Florez E AD - Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. FAU - Howard, Candace M AU - Howard CM AD - Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. FAU - Kutcher, Matthew E AU - Kutcher ME AD - Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi. LA - eng GR - K08 GM138812/GM/NIGMS NIH HHS/United States GR - T32 HL105324/HL/NHLBI NIH HHS/United States GR - U54 GM115428/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230824 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Anticoagulants) SB - IM MH - Humans MH - Adiposity MH - Retrospective Studies MH - Prospective Studies MH - Anticoagulants MH - *Venous Thromboembolism MH - Obesity/complications MH - Body Mass Index MH - Intra-Abdominal Fat/diagnostic imaging MH - *Thrombophilia PMC - PMC10658990 MID - NIHMS1942864 OTO - NOTNLM OT - Hypercoagulability OT - Obesity OT - Visceral adiposity EDAT- 2023/08/27 05:44 MHDA- 2023/11/02 12:43 PMCR- 2024/12/01 CRDT- 2023/08/26 18:12 PHST- 2023/03/02 00:00 [received] PHST- 2023/07/11 00:00 [revised] PHST- 2023/07/27 00:00 [accepted] PHST- 2023/11/02 12:43 [medline] PHST- 2023/08/27 05:44 [pubmed] PHST- 2023/08/26 18:12 [entrez] PHST- 2024/12/01 00:00 [pmc-release] AID - S0022-4804(23)00356-6 [pii] AID - 10.1016/j.jss.2023.07.048 [doi] PST - ppublish SO - J Surg Res. 2023 Dec;292:190-196. doi: 10.1016/j.jss.2023.07.048. Epub 2023 Aug 24. PMID- 37604188 OWN - NLM STAT- MEDLINE DCOM- 20240115 LR - 20240115 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 124 IP - 1 DP - 2024 Jan TI - Dose-Related Effectiveness of Andexanet Alfa for Reversal of Apixaban Anticoagulation in a Porcine Polytrauma Model. PG - 20-31 LID - 10.1055/s-0043-1772697 [doi] AB - BACKGROUND: Andexanet alfa (andexanet) is a reversal agent for use in patients with life-threatening or uncontrolled bleeding treated with oral factor Xa (FXa) inhibitors. There are limited data on the dose-response relationship of andexanet and FXa inhibitor-related bleeding. OBJECTIVE: The aim of this study was to assess the dose-related effectiveness of andexanet in reducing blood loss, improving survival, and reversing apixaban anticoagulation in a porcine polytrauma model. METHODS: Apixaban was given orally to 40 male pigs for 3 days at a dose of 20 mg/d. On day 3, following bilateral femur fractures and blunt liver injury, animals (n = 8/group) received andexanet (250-mg bolus, 250-mg bolus + 300-mg 2-hour infusion, 500-mg bolus, or 500-mg bolus + 600-mg 2-hour infusion) or vehicle (control). Total blood loss was the primary endpoint. Coagulation parameters were assessed for 300 minutes or until death. Data were analyzed with a mixed-model analysis of variance. RESULTS: Administration of 250-mg bolus + 300-mg infusion, andexanet 500-mg bolus, and 500-mg bolus + 600-mg infusion significantly decreased total blood loss by 37, 58, and 61%, respectively (all p < 0.0001), with 100% survival. Andexanet 250-mg bolus was ineffective in reducing total blood loss (6%) and mortality (63% survival) versus controls. Andexanet 500-mg bolus +/- infusion neutralized anti-FXa activity to less than 50 ng/mL. Andexanet neutralization of thrombin generation and thromboelastometry parameters was dose and infusion time dependent. CONCLUSION: In a porcine polytrauma model with major bleeding on apixaban, andexanet dose dependently decreased anti-FXa activity. Lower anti-FXa levels (<50 ng/mL) with andexanet 500-mg bolus +/- infusion were correlated with 60% less blood loss and 100% survival versus controls. CI - Thieme. All rights reserved. FAU - Rayatdoost, Farahnaz AU - Rayatdoost F AUID- ORCID: 0000-0003-0345-9442 AD - Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Braunschweig, Till AU - Braunschweig T AD - Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. FAU - Rossaint, Rolf AU - Rossaint R AD - Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Grottke, Oliver AU - Grottke O AD - Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany. LA - eng PT - Journal Article DEP - 20230821 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (PRT064445) RN - EC 3.4.21.6 (Factor Xa) RN - 3Z9Y7UWC1J (apixaban) RN - 0 (Factor Xa Inhibitors) RN - 0 (Recombinant Proteins) RN - 0 (Anticoagulants) RN - 0 (Pyrazoles) RN - 0 (Pyridones) SB - IM MH - Humans MH - Male MH - Animals MH - Swine MH - *Factor Xa/therapeutic use MH - Factor Xa Inhibitors/therapeutic use MH - Hemorrhage/chemically induced/drug therapy MH - *Multiple Trauma/complications/drug therapy/chemically induced MH - Recombinant Proteins/therapeutic use MH - Anticoagulants/therapeutic use MH - *Pyrazoles MH - *Pyridones COIS- F.R. and T.B. have no conflicts of interest to declare. H.S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim, and TEM International. He has also received speaker fees from Haemonetics and Vifor, and study grants from CSL Behring. R.R. has received honoraria for consulting or lecturing from CSL Behring, Boehringer Ingelheim and Fresenius. O.G. has received research funding from Abiomed, AstraZeneca, Alveron, Bayer Healthcare, Biotest, Boehringer Ingelheim, CSL Behring, Ferring, Octapharma, Novo Nordisk, Nycomed, and Portola. He has also received honoraria for lectures and consultancy support from Abiomed, AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, CSL Behring, Octapharma, Sanofi, Shire, Takeda, Pfizer, and Portola. EDAT- 2023/08/22 00:41 MHDA- 2024/01/15 12:43 CRDT- 2023/08/21 19:03 PHST- 2024/01/15 12:43 [medline] PHST- 2023/08/22 00:41 [pubmed] PHST- 2023/08/21 19:03 [entrez] AID - 10.1055/s-0043-1772697 [doi] PST - ppublish SO - Thromb Haemost. 2024 Jan;124(1):20-31. doi: 10.1055/s-0043-1772697. Epub 2023 Aug 21. PMID- 37599420 OWN - NLM STAT- MEDLINE DCOM- 20240329 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 96 IP - 4 DP - 2024 Apr 1 TI - Principal component analysis of a swine injury model identifies multiple phenotypes in trauma. PG - 634-640 LID - 10.1097/TA.0000000000004098 [doi] AB - BACKGROUND: Trauma is the third leading cause of death in the United States and the primary cause of death for people between the ages of 1 year and 44 years. In addition to tissue damage, trauma may also activate an inflammatory state known as trauma-induced coagulopathy (TIC) that is associated with clotting malfunctions, acidemia, and end-organ dysfunction. Prior work has also demonstrated benefit to acknowledging the type and severity of endothelial injury, coagulation derangements, and systemic inflammation in the management of trauma patients. This study builds upon prior work by combining laboratory, metabolic, and clinical metrics into an analysis of trauma phenotypes, evolution of phenotypes over time after trauma, and significance of trauma phenotype on mortality. METHODS: Seventy 3-month-old female Yorkshire crossbred swine were randomized to injury and resuscitation groups. Principal component analysis (PCA) of longitudinal swine TEG data (Reaction time, Alpha-Angle, Maximum Amplitude, and Clot Lysis at 30 minutes), pH, lactate, and MAP was completed in R at baseline, 1 hour postinjury, 3 hours postinjury, 6 hours postinjury, and 12 hours postinjury. Subjects were compared by principal component factor scores to assess differences in survival, injury severity, and treatment group. RESULTS: Among injured animals, three phenotypes were observed at each time point. Five phenotypes were associated with differences in survival, and of these, four were associated with differences in injury severity. Phenotype alignment was not significantly different by treatment group. CONCLUSION: This application of PCA to a set of coagulation, hemodynamic, and organ perfusion variables has identified multiple evolving phenotypes after trauma. Some of these phenotypes may correlate with injury severity and may have implications for survival. Next steps include validating these findings over greater numbers of subjects and exploring other machine-learning techniques for phenotype identification. LEVEL OF EVIDENCE: Level IV, Therapeutic/Care Management. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Buzzard, Lydia AU - Buzzard L AD - From the Department of Surgery (L.B., J.K., M.A., E.R., B.M., A.G., J.M., B.M., A.K., M.S.), Oregon Health and Science University, Portland, Oregon; University of Wisconsin Madison School of Medicine and Public Health (L.M.B.), Madison, Wisconsin; Department of Surgery (S.M.), University of California-Davis, Davis, CA; Department of Surgery (A.D.), Harborview Medical Center, Seattle, Washington; Department of Surgery (S.S.), Texas Tech University Health Sciences Center, Lubbock, Texas; Department of Surgery (B.B.), University of New Mexico, Albuquerque, New Mexico; and Department of Pathology and Laboratory Medicine (A.T., S.P.), University of California-San Francisco, San Francisco, California. FAU - Smith, Sawyer AU - Smith S FAU - Dixon, Alexandra AU - Dixon A FAU - Kenny, James AU - Kenny J FAU - Appleman, Ma AU - Appleman M FAU - Subramanian, Sarayu AU - Subramanian S FAU - Behrens, Brandon AU - Behrens B FAU - Rick, Elizabeth AU - Rick E FAU - Madtson, Brianne AU - Madtson B FAU - Goodman, Andrew AU - Goodman A FAU - Murphy, James AU - Murphy J FAU - McCully, Belinda AU - McCully B FAU - Kanlerd, Amonpon AU - Kanlerd A FAU - Trivedi, Alpa AU - Trivedi A FAU - Pati, Shibani AU - Pati S FAU - Schreiber, Martin AU - Schreiber M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20230821 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Animals MH - Female MH - Humans MH - Infant MH - *Blood Coagulation Disorders/etiology MH - Phenotype MH - Principal Component Analysis MH - Resuscitation/methods MH - Swine MH - Thrombelastography/methods MH - *Wounds and Injuries/complications EDAT- 2023/08/21 06:42 MHDA- 2024/03/29 06:46 CRDT- 2023/08/21 00:43 PHST- 2024/03/29 06:46 [medline] PHST- 2023/08/21 06:42 [pubmed] PHST- 2023/08/21 00:43 [entrez] AID - 01586154-202404000-00016 [pii] AID - 10.1097/TA.0000000000004098 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2024 Apr 1;96(4):634-640. doi: 10.1097/TA.0000000000004098. Epub 2023 Aug 21. PMID- 37595483 OWN - NLM STAT- MEDLINE DCOM- 20230918 LR - 20230918 IS - 1878-0180 (Electronic) IS - 1878-0180 (Linking) VI - 146 DP - 2023 Oct TI - Mechanical response of composite materials prepared with polyurethane elastomers and polyvinyl chloride films. PG - 106006 LID - S1751-6161(23)00359-4 [pii] LID - 10.1016/j.jmbbm.2023.106006 [doi] AB - This study describes a new method for the preparation of composite materials using polyvinyl chloride (PVC) films and polyurethane (PU) foam elastomers. This new preparation method was applied to composite materials used for sound and thermal insulation in the automotive and aerospace industries, and it was found to be effective in reducing debonding and fracture defects. This feature was achieved via the formation of through-holes in the surface material and the substrate prior to lamination, which led to the increase in the flow of air and adhesive and allowed for better compatibility between the material layers. The composite material shows a tensile strength of up to 37.6 Kg⋅cm(-2) and can achieve a tensile fracture strength of up to 281.3 N, if woven or biomaterials are used. This can be useful in solving challenges in the aerospace and automotive industries and may also act as a potential coating material for other applications in the future. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Liu, Xian-Ming AU - Liu XM AD - Key Laboratory of Mechanics on Disaster and Environment in Western China, College of Civil Engineering and Mechanics, Lanzhou University, Lanzhou, Gansu, 730000, PR China; School Shenzhen Polytechnic, Guangdong, 518055, PR China. Electronic address: liuxm17@lzu.edu.cn. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230731 PL - Netherlands TA - J Mech Behav Biomed Mater JT - Journal of the mechanical behavior of biomedical materials JID - 101322406 RN - 0 (Elastomers) RN - 9002-86-2 (Polyvinyl Chloride) RN - 9009-54-5 (polyurethane foam) RN - 0 (Polyurethanes) RN - 0 (Biocompatible Materials) SB - IM MH - Humans MH - *Elastomers MH - Polyvinyl Chloride MH - Polyurethanes MH - Biocompatible Materials MH - *Fractures, Bone OTO - NOTNLM OT - Boundary bond thickness OT - Film and polyurethane composite preparation process OT - Fracture mechanism of viscoelastic materials OT - Generalized Maxwell's creep instantonal equations OT - Peeling stress COIS- Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: the author represents that the Work is the author's original work. If the Work was prepared jointly, the author agrees to inform the co-authors of the terms of this Agreement and to obtain their permission to sign on their behalf. The Work is submitted only to this, and has not been published before. (If excerpts from copyrighted works are included, the author will obtain written permission from the copyright owners and show credit to the sources in the Work.) The author also represents that, to the best of his or her knowledge, the Work contains no libelous or unlawful statements, does not infringe on the rights of others, or contain material or instructions that might cause harm or injury. EDAT- 2023/08/19 11:42 MHDA- 2023/09/18 12:44 CRDT- 2023/08/18 18:07 PHST- 2023/05/02 00:00 [received] PHST- 2023/06/29 00:00 [revised] PHST- 2023/07/03 00:00 [accepted] PHST- 2023/09/18 12:44 [medline] PHST- 2023/08/19 11:42 [pubmed] PHST- 2023/08/18 18:07 [entrez] AID - S1751-6161(23)00359-4 [pii] AID - 10.1016/j.jmbbm.2023.106006 [doi] PST - ppublish SO - J Mech Behav Biomed Mater. 2023 Oct;146:106006. doi: 10.1016/j.jmbbm.2023.106006. Epub 2023 Jul 31. PMID- 37577193 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230815 IS - 0972-8988 (Print) IS - 2231-0916 (Electronic) IS - 0972-8988 (Linking) VI - 16 IP - 6 DP - 2023 Jun TI - Hemostatic and thromboelastographic parameters in dogs with renal azotemia. PG - 1214-1221 LID - 10.14202/vetworld.2023.1214-1221 [doi] AB - BACKGROUND AND AIM: Humans and dogs with azotemia can develop coagulation disorders. Therefore, this study aimed to evaluate the coagulation profiles and thromboelastographic parameters in dogs with acute kidney injury (AKI) and chronic kidney disease (CKD). MATERIALS AND METHODS: In this prospective study, 31 client-owned dogs with renal azotemia (creatinine >220 mumol/L) were enrolled. Clinical signs of hemostatic disorders, complete blood count, coagulation profile, D-dimers, thromboelastography, and 28-day survival data were obtained and analyzed using the t-test, Mann-Whitney U test, and Chi-square test. Statistical significance was set at p < 0.05. RESULTS: Seventeen dogs with AKI, 10 with CKD, and four with acute-on-chronic kidney injury (AoC) were enrolled. Ten dogs (AKI, 8/17; CKD, 2/10) had thrombocytopenia. Prothrombin time was prolonged in four dogs with AKI and longer in dogs with AKI than in dogs with CKD (p = 0.004). The activated partial thromboplastin time was prolonged in 23 dogs (AKI, 14/17; CKD, 7/10; AoC, 3/4) and was longer in azotemic dogs than in healthy control dogs (p = 0.003). Thromboelastographic tracings were hypocoagulable in three dogs with AKI and hypercoagulable in 16 dogs (AKI 4/17, CKD 9/10, AoC 3/4). The thromboelastographic values for maximum amplitude (p < 0.001) and global clot strength (p < 0.001) were lower in dogs with AKI than in those with CKD. CONCLUSION: Hypercoagulable thromboelastographic tracings were observed in dogs with CKD, whereas coagulation times were prolonged in dogs with AKI. However these findings should be validated by further studies. CI - Copyright: (c) Fischer, et al. FAU - Fischer, Hendryk AU - Fischer H AD - LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany. FAU - Geisen, Vera AU - Geisen V AD - LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany. FAU - Dorsch, Roswitha AU - Dorsch R AD - LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany. FAU - Hartmann, Katrin AU - Hartmann K AD - LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany. FAU - Dorfelt, Rene AU - Dorfelt R AD - LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany. LA - eng PT - Journal Article DEP - 20230605 PL - New Zealand TA - Vet World JT - Veterinary world JID - 101504872 PMC - PMC10421550 OTO - NOTNLM OT - acute kidney injury OT - canine OT - chronic kidney disease OT - coagulation OT - platelet function OT - viscoelastic test COIS- The authors declare that they have no competing interests. EDAT- 2023/08/14 06:41 MHDA- 2023/08/14 06:42 PMCR- 2023/06/01 CRDT- 2023/08/14 04:55 PHST- 2023/02/13 00:00 [received] PHST- 2023/05/02 00:00 [accepted] PHST- 2023/08/14 06:42 [medline] PHST- 2023/08/14 06:41 [pubmed] PHST- 2023/08/14 04:55 [entrez] PHST- 2023/06/01 00:00 [pmc-release] AID - Vetworld-16-1214 [pii] AID - 10.14202/vetworld.2023.1214-1221 [doi] PST - ppublish SO - Vet World. 2023 Jun;16(6):1214-1221. doi: 10.14202/vetworld.2023.1214-1221. Epub 2023 Jun 5. PMID- 37568228 OWN - NLM STAT- MEDLINE DCOM- 20230814 LR - 20231120 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 24 IP - 1 DP - 2023 Aug 11 TI - Rotational ThromboElastometry-guided blood component administration versus standard of care in patients with Cirrhosis and coagulopathy undergoing Invasive ProcEdures (RECIPE): study protocol for a randomised controlled trial. PG - 516 LID - 10.1186/s13063-023-07552-1 [doi] LID - 516 AB - BACKGROUND: Patients with cirrhosis often undergo invasive procedures both for management of complications of their advanced liver disease, including treatment for hepatocellular carcinoma, as well as underlying comorbidities. Despite a current understanding that most patients with cirrhosis are in a rebalanced haemostatic state (despite abnormalities in conventional coagulation tests, namely INR and platelet count), patients with cirrhosis are still often given prophylactic blood components based on these conventional parameters, in an effort to reduce procedure-related bleeding. Viscoelastic tests such as Rotational Thromboelastometry (ROTEM) provide a global measurement of haemostasis and have been shown to predict bleeding risk more accurately than conventional coagulation tests, and better guide blood product transfusion in a number of surgical and trauma-related settings. The aim of this study is to assess the utility of a ROTEM-based algorithm to guide prophylactic blood component delivery in patients with cirrhosis undergoing invasive procedures. We hypothesise that ROTEM-based decision-making will lead to a reduction in pre-procedural blood component usage, particularly fresh frozen plasma (FFP), compared with standard of care, whilst maintaining optimal clinical outcomes. METHODS: This is a multi-centre randomised controlled trial comparing ROTEM-guided prophylactic blood component administration to standard of care in patients with cirrhosis and coagulopathy undergoing invasive procedures. The primary efficacy outcome of the trial is the proportion of procedures requiring prophylactic transfusion, with the primary safety outcome being procedure-related bleeding complications. Secondary outcomes include the amount of blood products (FFP, platelets, cryoprecipitate) transfused, transfusion-related side effects, procedure-related complications other than bleeding, hospital length of stay and survival. DISCUSSION: We anticipate that this project will lead to improved prognostication of patients with cirrhosis, in terms of their peri-procedural bleeding risk. We hope to show that a significant proportion of cirrhotic patients, deemed coagulopathic on the basis of standard coagulation tests such as INR and platelet count, are actually in a haemostatic balance and thus do not require prophylactic blood product, leading to decreased and more efficient blood component use. TRIAL REGISTRATION: RECIPE has been prospectively registered with the Australia and New Zealand Clinical Trials Registry on the 30th April 2019 ( ACTRN12619000644167 ). CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - Janko, Natasha AU - Janko N AUID- ORCID: 0009-0000-5693-0248 AD - Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia. n.janko@alfred.org.au. AD - Central Clinical School, Monash University, Melbourne, VIC, Australia. n.janko@alfred.org.au. FAU - Majeed, Ammar AU - Majeed A AD - Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia. AD - Central Clinical School, Monash University, Melbourne, VIC, Australia. FAU - Kemp, William AU - Kemp W AD - Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia. AD - Central Clinical School, Monash University, Melbourne, VIC, Australia. FAU - Hogan, Chris AU - Hogan C AD - Department of Laboratory Haematology, Austin Health, Melbourne, VIC, Australia. FAU - Nandurkar, Harshal AU - Nandurkar H AD - Department of Haematology, Alfred Health, Melbourne, VIC, Australia. AD - Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia. FAU - Roberts, Stuart K AU - Roberts SK AD - Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia. AD - Central Clinical School, Monash University, Melbourne, VIC, Australia. LA - eng GR - ID 403/National Blood Authority/ PT - Clinical Trial Protocol PT - Journal Article DEP - 20230811 PL - England TA - Trials JT - Trials JID - 101263253 RN - 0 (Hemostatics) SB - IM MH - Humans MH - *Blood Coagulation Disorders/diagnosis/therapy/complications MH - Hemorrhage/etiology/prevention & control MH - *Hemostatics MH - Liver Cirrhosis/complications/diagnosis MH - Multicenter Studies as Topic MH - Randomized Controlled Trials as Topic MH - Standard of Care MH - Thrombelastography/methods PMC - PMC10422802 OTO - NOTNLM OT - Chronic liver disease OT - Cirrhosis OT - Coagulopathy OT - Fresh frozen plasma OT - Platelets OT - Rotational Thromboelastometry (ROTEM) OT - Surgery OT - Transfusion OT - Viscoelastic tests (VETs) COIS- The authors declare that they have no competing interests. EDAT- 2023/08/12 10:42 MHDA- 2023/08/14 06:42 PMCR- 2023/08/11 CRDT- 2023/08/11 23:39 PHST- 2023/06/01 00:00 [received] PHST- 2023/07/28 00:00 [accepted] PHST- 2023/08/14 06:42 [medline] PHST- 2023/08/12 10:42 [pubmed] PHST- 2023/08/11 23:39 [entrez] PHST- 2023/08/11 00:00 [pmc-release] AID - 10.1186/s13063-023-07552-1 [pii] AID - 7552 [pii] AID - 10.1186/s13063-023-07552-1 [doi] PST - epublish SO - Trials. 2023 Aug 11;24(1):516. doi: 10.1186/s13063-023-07552-1. PMID- 37559473 OWN - NLM STAT- MEDLINE DCOM- 20230912 LR - 20230912 IS - 1751-553X (Electronic) IS - 1751-5521 (Linking) VI - 45 IP - 5 DP - 2023 Oct TI - Viscoelastic testing: Critical appraisal of new methodologies and current literature. PG - 643-658 LID - 10.1111/ijlh.14144 [doi] AB - United States Food and Drug Administration (FDA)-approved viscoelastic testing (VET) methodologies have significantly changed in the last 10 years, with the availability of cartridge-based VET. Some of these cartridge-based methodologies use harmonic resonance-based clot detection. While VET has always allowed for the evaluation of real-time clot formation, cartridge-based VET provides increased ease of use as well as greater portability and robustness of results in out-of-laboratory environments. Here we review the use of VET in a variety of clinical contexts, including cardiac surgery, trauma, liver transplant, obstetrics, and hypercoagulable states such as COVID-19. As of now, high quality randomized trial evidence for new generation VET (TEG 6s, HemoSonics Quantra, ROTEM sigma) is limited. Nevertheless, the use of VET-guided transfusion algorithms appears to result in reduced blood usage without worsening of patient outcomes. Future work comparing the new generation VET instruments and continuing to validate clinically important cut-offs will help move the field of point-of-care coagulation monitoring forward and increase the quality of transfusion management in bleeding patients. CI - (c) 2023 The Authors. International Journal of Laboratory Hematology published by John Wiley & Sons Ltd. FAU - Wool, Geoffrey D AU - Wool GD AUID- ORCID: 0000-0002-3335-2905 AD - Department of Pathology, University of Chicago, Chicago, Illinois, USA. FAU - Carll, Timothy AU - Carll T AD - Department of Pathology, University of Chicago, Chicago, Illinois, USA. LA - eng PT - Journal Article PT - Review DEP - 20230809 PL - England TA - Int J Lab Hematol JT - International journal of laboratory hematology JID - 101300213 SB - IM MH - Humans MH - Thrombelastography/methods MH - *COVID-19 MH - Blood Coagulation MH - Blood Coagulation Tests MH - Hemorrhage MH - *Blood Coagulation Disorders OTO - NOTNLM OT - blood transfusion OT - fibrinogen OT - fibrinolysis OT - hemostasis OT - laboratory practice OT - platelets EDAT- 2023/08/10 06:43 MHDA- 2023/09/12 06:41 CRDT- 2023/08/10 02:43 PHST- 2023/03/14 00:00 [received] PHST- 2023/07/25 00:00 [accepted] PHST- 2023/09/12 06:41 [medline] PHST- 2023/08/10 06:43 [pubmed] PHST- 2023/08/10 02:43 [entrez] AID - 10.1111/ijlh.14144 [doi] PST - ppublish SO - Int J Lab Hematol. 2023 Oct;45(5):643-658. doi: 10.1111/ijlh.14144. Epub 2023 Aug 9. PMID- 37549450 OWN - NLM STAT- MEDLINE DCOM- 20230911 LR - 20240902 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 291 DP - 2023 Nov TI - Design and Development of a Clot Burst Pressure Device to Investigate Resuscitation Strategies. PG - 646-652 LID - S0022-4804(23)00318-9 [pii] LID - 10.1016/j.jss.2023.07.016 [doi] AB - INTRODUCTION: A reduction in clot strength is a hallmark feature of trauma-induced coagulopathy. A better understanding of clot integrity can optimize resuscitation strategies. We designed a device to gauge clot strength by pressurizing fluids over a formed clot and measuring the pressure needed to dislodge the clot. We hypothesized that this device could distinguish between clots formed in hypocoagulable and hypercoagulable states by observing differences in the clot burst pressure. METHODS: Whole blood from healthy volunteers was collected into sodium citrate tubes and was treated with heparin or fibrinogen to generate clots in a hypocoagulable or hypercoagulable state, respectively. Small bore holes were drilled into polystyrene plates, and recalcified blood was pipetted into the holes. Plates were incubated at 37 degrees C for 30 min to form clots. A pressure cap with an inlet for fluid from a syringe pump and an outlet leading to a measurement column was secured in the wells with a watertight seal. RESULTS: Clot burst pressure was normalized to individual baseline values to account for inherent differences in clot strength. The 1.0 g/L and 2.0 g/L fibrinogen groups were 1.65 +/- 0.07 (P = 0.0078) and 2.26 +/- 0.16 (P = 0.0078) times as strong as baseline, respectively. The 0.10, 0.15, or 0.20 USP units/mL groups were 0.388 +/- 0.07 (P = 0.125), 0.31 +/- 0.07 (P = 0.125), 0.21 +/- 0.07 (P = 0.125) times as strong as baseline, respectively. Data were analyzed using Wilcoxon matched pairs signed rank testing. CONCLUSIONS: This device tests clot strength using burst pressure, an easily interpreted clinical parameter not measured in existing devices. Future work can test blood from trauma patients to better understand trauma pathophysiology. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Mankame, Atharwa R AU - Mankame AR AD - Center for Translational Injury Research and Department of Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. Electronic address: atharwa.mankame@uth.tmc.edu. FAU - Schriner, Jacob B AU - Schriner JB AD - Center for Translational Injury Research and Department of Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. FAU - Skibber, Max A AU - Skibber MA AD - Center for Translational Injury Research and Department of Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. FAU - George, Mitchell J AU - George MJ AD - Department of Cardiovascular Surgery, McGovern Medical School at UTHealth, Houston, Texas. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research and Department of Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. FAU - Cox, Charles S Jr AU - Cox CS Jr AD - Center for Translational Injury Research and Department of Pediatric Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. FAU - Gill, Brijesh S AU - Gill BS AD - Center for Translational Injury Research and Department of Surgery, McGovern Medical School at UTHealth Science Center at Houston, Houston, Texas. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230806 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Thrombosis/diagnosis/etiology MH - *Blood Coagulation Disorders MH - Blood Coagulation/physiology MH - *Hemostatics MH - Fibrinogen MH - Thrombelastography MH - Resuscitation PMC - PMC10626576 MID - NIHMS1936438 OTO - NOTNLM OT - Clotting OT - Coagulation OT - Hemorrhage OT - Medical device OT - Trauma EDAT- 2023/08/08 00:42 MHDA- 2023/09/11 06:42 PMCR- 2024/09/01 CRDT- 2023/08/07 18:01 PHST- 2023/02/28 00:00 [received] PHST- 2023/07/04 00:00 [revised] PHST- 2023/07/06 00:00 [accepted] PHST- 2023/09/11 06:42 [medline] PHST- 2023/08/08 00:42 [pubmed] PHST- 2023/08/07 18:01 [entrez] PHST- 2024/09/01 00:00 [pmc-release] AID - S0022-4804(23)00318-9 [pii] AID - 10.1016/j.jss.2023.07.016 [doi] PST - ppublish SO - J Surg Res. 2023 Nov;291:646-652. doi: 10.1016/j.jss.2023.07.016. Epub 2023 Aug 6. PMID- 37546051 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230808 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 15 IP - 7 DP - 2023 Jul TI - Viscoelastometry to Manage Bleeding in Liver Disease. PG - e41401 LID - 10.7759/cureus.41401 [doi] LID - e41401 AB - A state of "re-balanced haemostasis" describes complex coagulation changes that arise in patients with liver disease. Changes include alterations in procoagulant and anticoagulant proteins, platelets and von Willebrand factor, as well as the fibrinolytic system. Various circumstances including infection, trauma, or surgery may disrupt this balance and predispose an individual to bleeding or thrombosis. The prothrombin time, international normalised ratio, and activated partial thromboplastin time are conventional coagulation screening tests that are routinely employed by clinicians to investigate unexplained bleeding, monitor anticoagulation, and inform preoperative assessments of bleeding risk. These standard coagulation tests assess quantitative defects in procoagulant clotting factors and are insensitive to levels of natural anticoagulants, which together with procoagulant factors, are often perturbed in liver disease. Therefore, the prolongation of clotting times measured by these tests often does not reflect the multifaceted alterations of haemostasis in these patients. Viscoelastic testing (VET) provides a more encompassing assessment of clotting function by recording real-time viscoelastic changes in whole blood and includes parameters that provide information on coagulation factor function, platelet contribution to clot formation, as well as fibrinolysis. To date, VET has been employed to predict and inform transfusion support in obstetric, trauma, and cardiac surgical fields, and its use in patients undergoing liver transplantation is well established. The ability of VET to accurately predict bleeding risk and precisely guide transfusion algorithms for patients with liver disease undergoing other invasive procedures or experiencing bleeding complications has been the topic of research over the last decade. This review is a critical summary of this data and provides a detailed snapshot of the position of VET as a clinical tool in patients with liver disease. CI - Copyright (c) 2023, Wilson et al. FAU - Wilson, Samantha AU - Wilson S AD - Gastroenterology and Hepatology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS. FAU - Joseph, Joanne AU - Joseph J AD - Hematology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS. AD - Hematology, St. Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, AUS. FAU - Danta, Mark AU - Danta M AD - Gastroenterology and Hepatology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS. AD - Gastroenterology and Hepatology, St. Vincent's Hospital, Sydney, AUS. FAU - Rabbolini, David J AU - Rabbolini DJ AD - Faculty of Medicine and Health, University of Sydney, Sydney, AUS. AD - Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR. LA - eng PT - Journal Article PT - Review DEP - 20230705 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC10402654 OTO - NOTNLM OT - bleeding OT - cirrhosis OT - liver disease OT - thrombosis OT - viscoelastometry COIS- The authors have declared that no competing interests exist. EDAT- 2023/08/07 06:41 MHDA- 2023/08/07 06:42 PMCR- 2023/07/05 CRDT- 2023/08/07 04:32 PHST- 2023/07/05 00:00 [accepted] PHST- 2023/08/07 06:42 [medline] PHST- 2023/08/07 06:41 [pubmed] PHST- 2023/08/07 04:32 [entrez] PHST- 2023/07/05 00:00 [pmc-release] AID - 10.7759/cureus.41401 [doi] PST - epublish SO - Cureus. 2023 Jul 5;15(7):e41401. doi: 10.7759/cureus.41401. eCollection 2023 Jul. PMID- 37523842 OWN - NLM STAT- MEDLINE DCOM- 20230808 LR - 20230810 IS - 1878-0180 (Electronic) IS - 1878-0180 (Linking) VI - 145 DP - 2023 Sep TI - Time-dependent plastic behavior of bacteria leading to rupture. PG - 106048 LID - S1751-6161(23)00401-0 [pii] LID - 10.1016/j.jmbbm.2023.106048 [doi] AB - A study of the mechanical response of bacteria is essential in designing an antibacterial surface for implants and food packaging applications. This research evaluated the mechanical response of Escherichia coli under different loading conditions. Indentation and prolonged creep tests were performed to understand their viscoelastic-plastic response. The results indicate that varying loading rates from 1 mum/s to 5 mum/s show an increase in modulus of 182% and 90%, calculated in the loading and unloading cycles, respectively, and a decrease in adhesion force by 42%. However, on varying loads from 5 nN to 25 nN, nominal change is observed in both modulus and adhesion force. The rupture curve at 100 nN load shows elastic and a small plastic deformation accompanied by a sharp peak indicating the cell wall rupture. The rupture force at the peak was found to be 34.38 +/- 5.15 nN, irrespective of the loading rate, making it a failure criterion for bacteria rupture. The creep response of bacteria increases (for 6 s) and then remains constant (for 15 s) with time, indicating that a standard linear solid (SLS) model applies to this behavior. This work attempts to evaluate the mechanical properties of E. coli bacteria focusing on its rupture by contact killing mechanism. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Siddiquie, Reshma Y AU - Siddiquie RY AD - Department of Mechanical Engineering, Indian Institute of Technology, Bombay, India. FAU - Sharma, Kuldeep AU - Sharma K AD - Department of Biosciences and Bioengineering, Indian Institute of Technology, Bombay, India. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Biosciences and Bioengineering, Indian Institute of Technology, Bombay, India. FAU - Agrawal, Amit AU - Agrawal A AD - Department of Mechanical Engineering, Indian Institute of Technology, Bombay, India. FAU - Joshi, Suhas S AU - Joshi SS AD - Department of Mechanical Engineering, Indian Institute of Technology, Bombay, India; Department of Mechanical Engineering, Indian Institute of Technology, Indore, India. Electronic address: ssjoshi@iitb.ac.in. LA - eng PT - Journal Article DEP - 20230727 PL - Netherlands TA - J Mech Behav Biomed Mater JT - Journal of the mechanical behavior of biomedical materials JID - 101322406 SB - IM MH - Humans MH - *Escherichia coli MH - Stress, Mechanical MH - Rupture OTO - NOTNLM OT - Atomic force microscopy OT - Bacteria rupture criteria OT - Contact killing mechanism OT - Creep response OT - Viscoelastic COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/08/01 01:07 MHDA- 2023/08/08 06:42 CRDT- 2023/07/31 18:03 PHST- 2023/06/07 00:00 [received] PHST- 2023/07/25 00:00 [revised] PHST- 2023/07/26 00:00 [accepted] PHST- 2023/08/08 06:42 [medline] PHST- 2023/08/01 01:07 [pubmed] PHST- 2023/07/31 18:03 [entrez] AID - S1751-6161(23)00401-0 [pii] AID - 10.1016/j.jmbbm.2023.106048 [doi] PST - ppublish SO - J Mech Behav Biomed Mater. 2023 Sep;145:106048. doi: 10.1016/j.jmbbm.2023.106048. Epub 2023 Jul 27. PMID- 37517207 OWN - NLM STAT- MEDLINE DCOM- 20230904 LR - 20230926 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 229 DP - 2023 Sep TI - A retrospective validation of ROTEM algorithms for detecting hyperfibrinolysis demonstrates poor agreement for prediction of in-hospital mortality and transfusion requirement in a general, non-cardiac, surgical population. PG - 170-177 LID - S0049-3848(23)00221-9 [pii] LID - 10.1016/j.thromres.2023.07.009 [doi] AB - INTRODUCTION: Hyperfibrinolysis diagnosed on Rotational Thromboelastography (ROTEM) is associated with increased transfusion requirements and mortality in trauma. The diagnosis and significance of hyperfibrinolysis in a mixed, non-cardiac, general surgical population has not been investigated. We aimed to measure agreement between four ROTEM algorithms for diagnosing hyperfibrinolysis and transfusion requirements and mortality in general surgical patients. These algorithms mostly incorporate measures of early or late clot amplitude reduction on the Extrinsic Clotting Pathway Test with Tissue Factor (EXTEM) channel. METHOD: Four hospital administrative data sets were linked from 2019 to 2022. Adults >18 years were included if a ROTEM was performed during their surgery (intraoperative period) or within 24-h of the surgery completion (postoperative period). The four hyperfibrinolysis criteria were applied to the ROTEM data and assessed for their agreement, intraoperative and postoperative transfusion requirements and in-patient mortality. RESULTS: We linked 933 ROTEMs to 558 patient-procedures. One algorithm identified hyperfibrinolysis on only three patients so was excluded. Agreement between the remaining three was slight (Cohens Kappa 0.18 (p < 0.001)) with hyperfibrinolysis diagnosed between 22 and 69 % of the procedures. The association between hyperfibrinolysis diagnosis and intraoperative or postoperative transfusion requirement was inconsistent between the criteria. However, an algorithm put forward by Goerling et al. was more often associated with transfusion requirement and inpatient mortality. DISCUSSION: The poor agreement between criteria suggests that some ROTEM criteria may not transfer directly to general surgical patients. Future research should focus on optimising hyperfibrinolysis cut-off values to update algorithms for bleeding general surgical patients. CI - Crown Copyright (c) 2023. Published by Elsevier Ltd. All rights reserved. FAU - Rosebery, Leon AU - Rosebery L AD - Intensive Care Unit, St George Hospital, Gray St, Kogarah 2217, Australia. FAU - Miller, Matthew AU - Miller M AD - Department of Anaesthesia, St George Hospital, Gray St, Kogarah 2217, Australia; Conjoint Lecturer St George and Sutherland Clinical Campus, UNSW, Sydney, Australia. Electronic address: matthew.miller1@health.nsw.gov.au. FAU - Loizou, Peter AU - Loizou P AD - Blood Bank Department, StG Public Hospital, Kogarah, NSW 2217, Australia. FAU - Ho, Shir Jing AU - Ho SJ AD - Conjoint Lecturer St George and Sutherland Clinical Campus, UNSW, Sydney, Australia; Department of Haematology, St George Hospital, Kogarah, NSW 2217, Australia. FAU - Adkins, Keith J AU - Adkins KJ AD - Department of Perfusion, St George Hospital, Gray St, Kogarah, NSW 2217, Australia. FAU - Deshpande, Kush AU - Deshpande K AD - Intensive Care Unit, St George Hospital, Gray St, Kogarah 2217, Australia; Conjoint Lecturer St George and Sutherland Clinical Campus, UNSW, Sydney, Australia. LA - eng PT - Journal Article DEP - 20230719 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM MH - Adult MH - Humans MH - *Thrombelastography/methods MH - Hospital Mortality MH - Retrospective Studies MH - *Blood Coagulation Disorders/diagnosis MH - Hemorrhage OTO - NOTNLM OT - Hyperfibrinolysis OT - Inpatient mortality OT - ROTEM OT - Rotational Thromboelastography OT - Surgery OT - Transfusion COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/07/31 00:41 MHDA- 2023/09/04 06:42 CRDT- 2023/07/30 18:05 PHST- 2023/05/10 00:00 [received] PHST- 2023/07/02 00:00 [revised] PHST- 2023/07/17 00:00 [accepted] PHST- 2023/09/04 06:42 [medline] PHST- 2023/07/31 00:41 [pubmed] PHST- 2023/07/30 18:05 [entrez] AID - S0049-3848(23)00221-9 [pii] AID - 10.1016/j.thromres.2023.07.009 [doi] PST - ppublish SO - Thromb Res. 2023 Sep;229:170-177. doi: 10.1016/j.thromres.2023.07.009. Epub 2023 Jul 19. PMID- 37466356 OWN - NLM STAT- MEDLINE DCOM- 20230814 LR - 20250111 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 63 IP - 8 DP - 2023 Aug TI - Omics markers of platelet transfusion in trauma patients. PG - 1447-1462 LID - 10.1111/trf.17472 [doi] AB - BACKGROUND: Even in the era of the COVID-19 pandemic, trauma remains the global leading cause of mortality under the age of 49. Trauma-induced coagulopathy is a leading driver of early mortality in critically ill patients, and transfusion of platelet products is a life-saving intervention to restore hemostasis in the bleeding patient. However, despite extensive functional studies based on viscoelastic assays, limited information is available about the impact of platelet transfusion on the circulating molecular signatures in trauma patients receiving platelet transfusion. MATERIALS AND METHODS: To bridge this gap, we leveraged metabolomics and proteomics approaches to characterize longitudinal plasma samples (n = 118; up to 11 time points; total samples: 759) from trauma patients enrolled in the Control Of Major Bleeding After Trauma (COMBAT) study. Samples were collected in the field, in the emergency department (ED), and at intervals up to 168 h (7 days) post-hospitalization. Transfusion of platelet (PLT) products was performed (n = 30; total samples: 250) in the ED through 24 h post-hospitalization. Longitudinal plasma samples were subjected to mass spectrometry-based metabolomics and proteomics workflows. Multivariate analyses were performed to determine omics markers of transfusion of one, two, three, or more PLT transfusions. RESULTS: Higher levels of tranexamic acid (TXA), inflammatory proteins, carnitines, and polyamines were detected in patients requiring PLT transfusion. Correlation of PLT units with omics data suggested sicker patients required more units and partially overlap with the population requiring transfusion of packed red blood cell products. Furthermore, platelet activation was likely increased in the most severely injured patients. Fatty acid levels were significantly lower in PLT transfusion recipients (at time of maximal transfusion: Hour 4) compared with non-recipients, while carnitine levels were significantly higher. Fatty acid levels restore later in the time course (e.g., post-PLT transfusion). DISCUSSION: The present study provides the first multi-omics characterization of platelet transfusion efficacy in a clinically relevant cohort of trauma patients. Physiological alterations following transfusion were detected, highlighting the efficacy of mass spectrometry-based omics techniques to improve personalized transfusion medicine. More specialized clinical research studies focused on PLT transfusion, including organized pre and post transfusion sample collection and limitation to PLT products only, are required to fully understand subsequent metabolomic and proteomic alterations. CI - (c) 2023 AABB. FAU - LaCroix, Ian S AU - LaCroix IS AD - Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Cohen, Mitchell AU - Cohen M AD - Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA. AD - "Ernest E Moore" Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M AD - Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Silliman, Christopher C AU - Silliman CC AD - Vitalant Research Institute, Denver, Colorado, USA. AD - Department of Pediatrics, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Hansen, Kirk C AU - Hansen KC AD - Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA. FAU - D'Alessandro, Angelo AU - D'Alessandro A AUID- ORCID: 0000-0002-2258-6490 AD - Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA. LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - RM1GM131968/GM/NIGMS NIH HHS/United States GR - R01HL146442/HL/NHLBI NIH HHS/United States GR - R01HL149714/HL/NHLBI NIH HHS/United States GR - R01HL148151/HL/NHLBI NIH HHS/United States GR - R01HL161004/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230719 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Fatty Acids) SB - IM MH - Humans MH - *Platelet Transfusion/methods MH - Pandemics MH - Proteomics MH - *COVID-19 MH - Hemorrhage/therapy MH - Fatty Acids OTO - NOTNLM OT - apheresis OT - coagulopathy OT - hemorrhagic shock OT - platelets OT - trauma EDAT- 2023/07/19 13:06 MHDA- 2023/08/14 06:41 CRDT- 2023/07/19 09:32 PHST- 2023/04/26 00:00 [revised] PHST- 2023/02/21 00:00 [received] PHST- 2023/05/30 00:00 [accepted] PHST- 2023/08/14 06:41 [medline] PHST- 2023/07/19 13:06 [pubmed] PHST- 2023/07/19 09:32 [entrez] AID - 10.1111/trf.17472 [doi] PST - ppublish SO - Transfusion. 2023 Aug;63(8):1447-1462. doi: 10.1111/trf.17472. Epub 2023 Jul 19. PMID- 37427027 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230718 IS - 2353-9461 (Electronic) IS - 0860-7796 (Print) IS - 0860-7796 (Linking) VI - 104 IP - 2 DP - 2023 TI - Exploring the potential of Inula viscosa extracts for antioxidant, antiproliferative and apoptotic effects on human liver cancer cells and a molecular docking study. PG - 183-198 LID - 10.5114/bta.2023.127207 [doi] AB - In folk medicine, Inula viscosa (Asteraceae) has been traditionally utilized for treating various ailments, including diabetes, bronchitis, diarrhea, rheumatism, and injuries. In this study, we aimed to investigate the chemical composition, antioxidant, antiproliferative, and apoptotic properties of I. viscosa leaf extracts. Extraction was performed using solvents of varying polarities. Antioxidant activity was determined using Ferric reducing antioxidant power (FRAP) and 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays. The results revealed that aqueous ethanol (70%) and aqueous ethyl acetate (70%) extracts contained high levels of phenols (645.58 +/- 8.77 mg CE/g) and flavonoids (180.69 +/- 1.54 mg QE/g), respectively. Aqueous ethanol (70%) extract exhibited the highest antioxidant activity with IC50 of 572.74 mumol TE/g DW (mumol Trolox equivalent in 1g of dry extract) in the ABTS assay and 76862.06 muM TE/g DW in the FRAP test. All extracts showed a considerable dose-dependent cytotoxic effect on cancerous HepG2 cells (P < 0.05). The aqueous ethanol extract demonstrated the highest inhibitory effect (IC50 = 1.67 mg/ml). Treatment with aqueous ethanol (70%) and pure ethyl acetate extracts significantly increased the number of apoptotic cells to 8 and 6%, respectively, in HepG2 cells (P < 0.05). Additionally, the aqueous ethanol extract significantly elevatedreactive oxygen species (ROS) levels (53%) in HepG2 cells. The molecular docking study identified paxanthone and banaxanthone E as the compounds that exhibited the highest binding affinities with BCL-2. This study demonstrated the potent antioxidant, antiproliferation, and intracellular ROS production of I. viscosa leaf extracts. Further studies should be conducted to identify the active compounds involved. CI - (c) 2023 Institute of Bioorganic Chemistry, Polish Academy of Sciences. FAU - Kheyar-Kraouche, Naoual AU - Kheyar-Kraouche N AD - Laboratory of Plant Biotechnology and Ethnobotany, Faculty of Nature and Life Sciences, University of Bejaia, Bejaia, Algeria. FAU - Boucheffa, Saliha AU - Boucheffa S AD - Laboratory of Applied Biochemistry, Faculty of Natural and Life Sciences, University Ferhat Abass Setif, Setif, Algeria. FAU - Bellik, Yuva AU - Bellik Y AD - Faculty of Nature and Life Sciences, University of Bordj Bou Arreridj, Algeria. FAU - Farida, Kheyar AU - Farida K AD - Chemistry Laboratory, Food Technology Department, National School of Agronomy "ENSA", El-harrach, Algeria. FAU - Brahmi-Chendouh, Nabila AU - Brahmi-Chendouh N AD - 3BS laboratory, Faculty of Natural and Life Sciences, University of Bejaia, Bejaia, Algeria. LA - eng PT - Journal Article DEP - 20230626 PL - Poland TA - BioTechnologia (Pozn) JT - Biotechnologia JID - 9702407 PMC - PMC10323743 OTO - NOTNLM OT - HepG2 cells OT - Inula viscosaleaf extracts OT - ROS OT - antioxidant OT - cytotoxic effect OT - molecular docking COIS- The authors declare that they have no conflict of interest. EDAT- 2023/07/10 06:42 MHDA- 2023/07/10 06:43 PMCR- 2023/06/26 CRDT- 2023/07/10 05:19 PHST- 2022/09/19 00:00 [received] PHST- 2023/01/21 00:00 [revised] PHST- 2023/03/03 00:00 [accepted] PHST- 2023/07/10 06:43 [medline] PHST- 2023/07/10 06:42 [pubmed] PHST- 2023/07/10 05:19 [entrez] PHST- 2023/06/26 00:00 [pmc-release] AID - BTA-104-2-50644 [pii] AID - 10.5114/bta.2023.127207 [doi] PST - epublish SO - BioTechnologia (Pozn). 2023 Jun 26;104(2):183-198. doi: 10.5114/bta.2023.127207. eCollection 2023. PMID- 37423609 OWN - NLM STAT- MEDLINE DCOM- 20240214 LR - 20250917 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 35 IP - 6 DP - 2023 Dec TI - Rotational thromboelastometry values across age groups in all trauma patients presenting to a level 1 trauma centre: An observational study. PG - 976-982 LID - 10.1111/1742-6723.14277 [doi] AB - OBJECTIVES: To describe rotational thromboelastometry (ROTEM) values (FIBTEM A5, EXTEM A5 and EXTEM CT) across age groups and assess for a statistical trend; and to determine whether any trend in ROTEM values is affected by severity of injury and packed red blood cells (PRBC) requirement. METHODS: Retrospective observational study at a level 1 trauma centre in Queensland, Australia. A total of 1601 consecutive trauma patients presenting to the ED. ROTEM data described included FIBTEM A5, EXTEM A5 and EXTEM CT. These values are described by age group (75 years), Injury Severity Score (ISS) category (<12, >/=12, <25 and >/=25) and number of PRBCs transfused in the first 24 h of admission (0 units, 1-4 units, 5-9 units and >/=10 units). RESULTS: The median age of participants was 37 years (interquartile range [IQR] 25-54 years), with 48.2% of patients had severe trauma (ISS >12) and 13.2% receiving at least one unit of PRBC in the first 24 h of admission. Median (IQR) values for FIBTEM A5, EXTEM A5 and EXTEM CT were 13 mm (10-16 mm), 45 mm (40-49 mm) and 62 s (56-71 s), respectively. A test for trend over progressive age groups showed an increase in FIBTEM A5 (P < 0.001) and EXTEM A5 values (P < 0.001) and a decrease in EXTEM CT values (P < 0.001). CONCLUSION: The present study demonstrated a pattern of increasing coagulability, as defined by ROTEM, with increasing age group in trauma patients, even among the severely injured. Further investigation is required to determine the clinical impact of these findings on both the ROTEM-guided management and longitudinal outcomes of these patients and whether an age-specific approach is beneficial. CI - (c) 2023 Australasian College for Emergency Medicine. FAU - Simpson, Jack AU - Simpson J AUID- ORCID: 0000-0001-6179-2775 AD - Department of Intensive Care, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - McCullough, James AU - McCullough J AD - Department of Intensive Care, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Walters, Kerin AU - Walters K AD - Department of Trauma, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Wake, Elizabeth AU - Wake E AD - Department of Trauma, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Ho, Debbie AU - Ho D AD - Department of Trauma, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Chan, Erick AU - Chan E AD - Department of Trauma, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Campbell, Don AU - Campbell D AUID- ORCID: 0000-0003-0679-7455 AD - Department of Trauma, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. FAU - Winearls, James AU - Winearls J AD - Department of Intensive Care, Gold Coast University Hospital, Queensland Health, Gold Coast, Queensland, Australia. LA - eng PT - Journal Article PT - Observational Study DEP - 20230709 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - Humans MH - Adult MH - Middle Aged MH - *Thrombelastography MH - Trauma Centers MH - Retrospective Studies MH - Australia MH - Queensland MH - *Blood Coagulation Disorders OTO - NOTNLM OT - age OT - geriatric OT - thromboelastometry OT - trauma EDAT- 2023/07/10 00:42 MHDA- 2024/02/13 12:44 CRDT- 2023/07/09 20:13 PHST- 2023/04/04 00:00 [revised] PHST- 2023/02/04 00:00 [received] PHST- 2023/06/18 00:00 [accepted] PHST- 2024/02/13 12:44 [medline] PHST- 2023/07/10 00:42 [pubmed] PHST- 2023/07/09 20:13 [entrez] AID - 10.1111/1742-6723.14277 [doi] PST - ppublish SO - Emerg Med Australas. 2023 Dec;35(6):976-982. doi: 10.1111/1742-6723.14277. Epub 2023 Jul 9. PMID- 37415401 OWN - NLM STAT- MEDLINE DCOM- 20231108 LR - 20231114 IS - 1943-7722 (Electronic) IS - 0002-9173 (Linking) VI - 160 IP - 5 DP - 2023 Nov 2 TI - Sensitivity and specificity of thromboelastography for hyperfibrinolysis: Comparison of TEG 5000 and TEG 6S CK LY30 systems. PG - 455-465 LID - 10.1093/ajcp/aqad068 [doi] AB - OBJECTIVES: The sensitivity and specificity of clot lysis at 30 minutes after maximum clot strength (LY30), as measured by thromboelastography (TEG), for clinically significant hyperfibrinolysis have not been compared across the 2 US Food and Drug Administration-approved instruments (the TEG 5000 and TEG 6s [Haemonetics]). METHODS: We performed a retrospective, single-center analysis of these 2 instruments using the kaolin (CK) reagent. RESULTS: Local verification studies showed that the TEG 5000 and TEG 6s CK LY30 upper limits of normal (ULNs) were distinct (5.0% and 3.2%, respectively). Retrospective analysis of patient data showed that abnormal LY30 was 6 times more prevalent with the TEG 6s than with the TEG 5000 instrument. LY30 was a significant predictor of mortality with both instruments (TEG 6s: receiver operating characteristic [ROC] area under the curve [AUC] = 0.836, P /=10%), with likelihood ratios of 8.22 and 2.62 for the TEG 6s and TEG 5000, respectively. Patients with a TEG 6s CK LY30 of 10% or higher were significantly more likely to die, receive cryoprecipitate, receive transfusions, or receive massive transfusion than patients with a TEG 6s LY30 of 3.3% to 9.9% (all P < .01). Patients with a TEG 5000 LY30 of 17.1% or higher were significantly more likely to die or use cryoprecipitate (P < .05); transfusion and massive transfusion protocol were not significantly different. Whole blood spiking studies showed that 70 ng/mL tissue plasminogen activator (tPA) achieved an average LY30 of approximately 10% for both instruments. CONCLUSIONS: CK LY30 above the ULN is a sensitive but not specific cutoff for hyperfibrinolysis. At least moderately elevated CK LY30 carries more clinical portent on the TEG 6s instrument than on the TEG 5000. These TEG instruments are not sensitive to low concentrations of tPA. CI - (c) The Author(s) 2023. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Fuja, Christine AU - Fuja C AUID- ORCID: 0000-0001-8044-5314 AD - Department of Pathology, University of Chicago, Chicago, IL, US. FAU - Carll, Timothy C AU - Carll TC AUID- ORCID: 0000-0003-1509-2158 AD - Department of Pathology, University of Chicago, Chicago, IL, US. FAU - Mikrut, Krzysztof AU - Mikrut K AD - Clinical Laboratories, University of Chicago Medicine, Chicago, IL, US. FAU - Wool, Geoffrey D AU - Wool GD AD - Department of Pathology, University of Chicago, Chicago, IL, US. LA - eng PT - Journal Article PL - England TA - Am J Clin Pathol JT - American journal of clinical pathology JID - 0370470 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Humans MH - *Thrombelastography MH - Tissue Plasminogen Activator MH - Retrospective Studies MH - *Blood Coagulation Disorders MH - Sensitivity and Specificity OTO - NOTNLM OT - LY30 OT - hyperfibrinolysis OT - thromboelastography OT - tissue plasminogen activator OT - trauma OT - viscoelastic testing EDAT- 2023/07/07 06:42 MHDA- 2023/11/08 06:44 CRDT- 2023/07/07 02:22 PHST- 2023/01/22 00:00 [received] PHST- 2023/05/15 00:00 [accepted] PHST- 2023/11/08 06:44 [medline] PHST- 2023/07/07 06:42 [pubmed] PHST- 2023/07/07 02:22 [entrez] AID - 7220824 [pii] AID - 10.1093/ajcp/aqad068 [doi] PST - ppublish SO - Am J Clin Pathol. 2023 Nov 2;160(5):455-465. doi: 10.1093/ajcp/aqad068. PMID- 37405823 OWN - NLM STAT- MEDLINE DCOM- 20231127 LR - 20250806 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 95 IP - 6 DP - 2023 Dec 1 TI - A metabolomic and proteomic analysis of pathologic hypercoagulability in traumatic brain injury patients after dura violation. PG - 925-934 LID - 10.1097/TA.0000000000004019 [doi] AB - BACKGROUND: The coagulopathy of traumatic brain injury (TBI) remains poorly understood. Contradictory descriptions highlight the distinction between systemic and local coagulation, with descriptions of systemic hypercoagulability despite intracranial hypocoagulopathy. This perplexing coagulation profile has been hypothesized to be due to tissue factor release. The objective of this study was to assess the coagulation profile of TBI patients undergoing neurosurgical procedures. We hypothesize that dura violation is associated with higher tissue factor and conversion to a hypercoagulable profile and unique metabolomic and proteomic phenotype. METHODS: This is a prospective, observational cohort study of all adult TBI patients at an urban, Level I trauma center who underwent a neurosurgical procedure from 2019 to 2021. Whole blood samples were collected before and then 1 hour following dura violation. Citrated rapid and tissue plasminogen activator (tPA) thrombelastography (TEG) were performed, in addition to measurement of tissue factory activity, metabolomics, and proteomics. RESULTS: Overall, 57 patients were included. The majority (61%) were male, the median age was 52 years, 70% presented after blunt trauma, and the median Glasgow Coma Score was 7. Compared with pre-dura violation, post-dura violation blood demonstrated systemic hypercoagulability, with a significant increase in clot strength (maximum amplitude of 74.4 mm vs. 63.5 mm; p < 0.0001) and a significant decrease in fibrinolysis (LY30 on tPAchallenged TEG of 1.4% vs. 2.6%; p = 0.04). There were no statistically significant differences in tissue factor. Metabolomics revealed notable increases in metabolites involved in late glycolysis, cysteine, and one-carbon metabolites, and metabolites involved in endothelial dysfunction/arginine metabolism/responses to hypoxia. Proteomics revealed notable increase in proteins related to platelet activation and fibrinolysis inhibition. CONCLUSION: A systemic hypercoagulability is observed in TBI patients, characterized by increased clot strength and decreased fibrinolysis and a unique metabolomic and proteomics phenotype independent of tissue factor levels. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - From the Department of Surgery (J.R.C.), The Ohio State University, Columbus, Ohio; Department of Biochemistry and Molecular Genetics (A.D.'A., I.L.C. M.D., F.G., P.L., S.M., M.J.C.), University of Colorado, Aurora, Colorado; Department of Immunology and Microbiology (W.R.), Scripps Research, La Jolla, California; Vitalant Research Institute (C.C.S.), Denver; and Department of Pediatrics (C.C.S.), University of Colorado, Aurora, Colorado. FAU - D'Alessandro, Angelo AU - D'Alessandro A FAU - LaCroix, Ian AU - LaCroix I FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M FAU - Lutz, Patrick AU - Lutz P FAU - Mitra, Sanchayita AU - Mitra S FAU - Gamboni, Fabia AU - Gamboni F FAU - Ruf, Wolram AU - Ruf W FAU - Silliman, Christopher C AU - Silliman CC FAU - Cohen, Mitchell J AU - Cohen MJ LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20230705 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 9035-58-9 (Thromboplastin) SB - IM MH - Adult MH - Humans MH - Male MH - Female MH - Middle Aged MH - Tissue Plasminogen Activator MH - Cohort Studies MH - Proteomics MH - Thromboplastin MH - *Thrombophilia/diagnosis/etiology MH - *Blood Coagulation Disorders/diagnosis/etiology MH - *Brain Injuries, Traumatic/complications MH - Thrombelastography/methods PMC - PMC11250571 MID - NIHMS1912882 EDAT- 2023/07/05 13:05 MHDA- 2023/11/27 12:45 PMCR- 2024/12/01 CRDT- 2023/07/05 11:53 PHST- 2023/11/27 12:45 [medline] PHST- 2023/07/05 13:05 [pubmed] PHST- 2023/07/05 11:53 [entrez] PHST- 2024/12/01 00:00 [pmc-release] AID - 01586154-202312000-00016 [pii] AID - 10.1097/TA.0000000000004019 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Dec 1;95(6):925-934. doi: 10.1097/TA.0000000000004019. Epub 2023 Jul 5. PMID- 37399149 OWN - NLM STAT- MEDLINE DCOM- 20231009 LR - 20231010 IS - 1940-9990 (Electronic) IS - 1932-4545 (Linking) VI - 17 IP - 4 DP - 2023 Aug TI - A Multichannel Portable Platform With Embedded Thermal Management for Miniaturized Dielectric Blood Coagulometry. PG - 843-856 LID - 10.1109/TBCAS.2023.3291875 [doi] AB - This article presents a standalone, multichannel, miniaturized impedance analyzer (MIA) system for dielectric blood coagulometry measurements with a microfluidic sensor termed ClotChip. The system incorporates a front-end interface board for 4-channel impedance measurements at an excitation frequency of 1 MHz, an integrated resistive heater formed by a pair of printed-circuit board (PCB) traces to keep the blood sample near a physiologic temperature of 37 degrees C, a software-defined instrument module for signal generation and data acquisition, and a Raspberry Pi-based embedded computer with 7-inch touchscreen display for signal processing and user interface. When measuring fixed test impedances across all four channels, the MIA system exhibits an excellent agreement with a benchtop impedance analyzer, with rms errors of 10 RBC U/6H postinjury or death within 6H after >/=1 RBC unit. Area under the receiver operating characteristics curves were used to compare predictive performance. Youden index determined optimal cutoffs. RESULTS: tPA-challenge-TEG was the best predictor of MT in the early hypotension subgroup (N = 212) with positive (PPV) and negative predictive values (NPV) of 75.0%, and 77.6%, respectively. tPA-challenge-TEG was a better predictor of MT than all but TASH (PPV = 65.0%, NPV = 93.3%) in the delayed hypotension group (N = 125). CONCLUSIONS: The tPA-challenge-TEG is the most accurate predictor of MT in trauma patients arriving hypotensive and offers early recognition of MT in patients with delayed hypotension. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Jiang, Jessie G AU - Jiang JG AD - University of Colorado School of Medicine, CU Anschutz Fitzsimons Building, 13001 East 17th Place, C290, Aurora, CO, 80045, USA. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado Denver School of Medicine, Department of Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, C-318, Aurora, CO, 80045, USA. Electronic address: hunter.moore@cuanschutz.edu. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado Denver School of Medicine, Department of Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, C-318, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. FAU - Pieracci, Fredric AU - Pieracci F AD - University of Colorado Denver School of Medicine, Department of Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, C-318, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. FAU - Sauaia, Angela AU - Sauaia A AD - University of Colorado Denver School of Public Health, Department of Health Systems, Management and Policy, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA. LA - eng PT - Journal Article DEP - 20230602 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Humans MH - Thrombelastography MH - Tissue Plasminogen Activator MH - Blood Transfusion MH - *Blood Coagulation Disorders/diagnosis MH - *Hypotension/diagnosis/etiology MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - Coagulopathy OT - Hemorrhagic shock OT - Hypotension OT - Massive transfusion OT - Resuscitation OT - Thrombelastography COIS- Declaration of competing interest This study was supported in part by grants from the Department of Defense (W81XWH-12-2-2008) and the National Institutes of Health (TACTIC UM1-HL120877, 1RM1GM131968-01, T32 GM008315). E.E.M. currently receives research support from Haemonetics, Werfen, Stago, Hemosonics, Diapharma, Prytime, and Humacyte; he is a co-founder of ThromboTherapeutics; he is listed as inventor on the following patents relating to blood coagulation or fibrinolysis (including assays): WO-2016073668-A1 (assignee: The Regents Of The University Of Colorado; status: published); US-9354243-B2 (assignee: Haemonetics Corporation, The Regents Of The University Of Colorado, A Body Corporate; status: granted); WO-2019014595-A1 (assignee: Thrombo Therapeutics, Inc.; status: published); EP-3215634-A1 (assignee: The Regents of the University of Colorado; status: published); EP-3303943-A1 (assignee: The Regents of The University of Colorado, A Body Corporate; status: published); WO-2021158799-A1 (assignee: The Regents Of The University Of Colorado, A Body Corporate; status: published); US-2020208194-A1 (assignee: Massachusetts Institute Of Technology, University Of Colorado; status: published). H.B.M. receives research support from Haemonetics and Instrumentation Laboratory; he is a co-founder of ThromboTherapeutics; he is listed as inventor on the following patents relating to blood coagulation or fibrinolysis (including assays): WO-2016073668-A1 (assignee: The Regents Of The University Of Colorado; status: published); WO-2019014595-A1 (assignee: Thrombo Therapeutics, Inc.; status: published); EP-3215634-A1 (assignee: The Regents of the University of Colorado; status: published); US-2020208194-A1 (assignee: Massachusetts Institute Of Technology, University Of Colorado; status: published). All other authors declare no competing interests. EDAT- 2023/06/11 01:06 MHDA- 2023/11/27 12:42 CRDT- 2023/06/10 21:57 PHST- 2023/03/31 00:00 [received] PHST- 2023/05/22 00:00 [revised] PHST- 2023/05/25 00:00 [accepted] PHST- 2023/11/27 12:42 [medline] PHST- 2023/06/11 01:06 [pubmed] PHST- 2023/06/10 21:57 [entrez] AID - S0002-9610(23)00219-2 [pii] AID - 10.1016/j.amjsurg.2023.05.033 [doi] PST - ppublish SO - Am J Surg. 2023 Dec;226(6):778-783. doi: 10.1016/j.amjsurg.2023.05.033. Epub 2023 Jun 2. PMID- 37257875 OWN - NLM STAT- MEDLINE DCOM- 20230602 LR - 20230602 IS - 1940-8250 (Electronic) IS - 0279-5442 (Linking) VI - 43 IP - 3 DP - 2023 Jun 1 TI - A Review of Thromboelastography for Nurses. PG - 29-37 LID - 10.4037/ccn2023371 [doi] AB - BACKGROUND: Thromboelastography is a viscoelastic test with multiple potential advantages over conventional coagulation tests in various disease states. Thromboelastography rapidly provides qualitative and quantitative information related to a patient's coagulation status. OBJECTIVE: To describe recent studies of the use of thromboelastography in various clinical states and how thromboelastography is used in coagulation management. METHODS: A literature review using the MEDLINE and PubMed databases was conducted. The updated methodology for integrated reviews by Whittemore and Knafl was followed. Coauthors evaluated separate areas that were independently reviewed by other coauthors to ensure appropriateness for inclusion. RESULTS: The use of thromboelastography for various clinical conditions with challenging hemostatic profiles has increased. This integrative review covers the use of thromboelastography in patients with trauma, medication-induced coagulopathy, acute and chronic liver failure, and cardiothoracic surgery. Potential future directions are also discussed. DISCUSSION: Thromboelastography has numerous potential benefits over conventional coagulation tests for assessing coagulation status in patients in various clinical states. Nurses can support clinical decisions to use the most appropriate test for their patients. CONCLUSIONS: Each team member should be involved in assessing the usefulness of thromboelastography. Critical care nurses and the multidisciplinary team must identify patients in whom its use is warranted, interpret the results, and provide appropriate interventions in response to the results and clinical status of the patient. CI - (c)2023 American Association of Critical-Care Nurses. FAU - Vollmer, Nicholas J AU - Vollmer NJ AD - Nicholas J. Vollmer is an emergency medicine and intensive care unit clinical pharmacy specialist at Mayo Clinic, Rochester, Minnesota. FAU - Leshko, Nicole A AU - Leshko NA AD - Nicole A. Leshko is a critical care pharmacist at Northwestern Memorial Hospital, Chicago, Illinois. FAU - Wilson, Charles S AU - Wilson CS AD - Charles S. Wilson Jr is a postgraduate year 2 critical care pharmacy resident at Wesley Medical Center, Wichita, Kansas. FAU - Gilbert, Brian W AU - Gilbert BW AD - Brian W. Gilbert is an emergency medicine clinical pharmacy specialist and Residency Program Director for the Postgraduate Year 2 Critical Care Pharmacy program at Wesley Medical Center. LA - eng PT - Journal Article PT - Review PL - United States TA - Crit Care Nurse JT - Critical care nurse JID - 8207799 RN - 0 (Hemostatics) MH - Humans MH - Thrombelastography/methods MH - *Blood Coagulation Disorders/diagnosis MH - *Hemostatics MH - Critical Care MH - *Nurses EDAT- 2023/06/01 01:08 MHDA- 2023/06/02 06:43 CRDT- 2023/05/31 20:13 PHST- 2023/06/02 06:43 [medline] PHST- 2023/06/01 01:08 [pubmed] PHST- 2023/05/31 20:13 [entrez] AID - 32102 [pii] AID - 10.4037/ccn2023371 [doi] PST - ppublish SO - Crit Care Nurse. 2023 Jun 1;43(3):29-37. doi: 10.4037/ccn2023371. PMID- 37251493 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230531 IS - 2475-0379 (Electronic) IS - 2475-0379 (Linking) VI - 7 IP - 4 DP - 2023 May TI - Blood coagulation test abnormalities in trauma patients detected by sonorheometry: a retrospective cohort study. PG - 100163 LID - 10.1016/j.rpth.2023.100163 [doi] LID - 100163 AB - BACKGROUND: Traumatic hemorrhage guidelines include point-of-care viscoelastic tests as a standard of care. Quantra (Hemosonics) is a device based on sonic estimation of elasticity via resonance (SEER) sonorheometry to assess whole blood clot formation. OBJECTIVES: Our study aimed to assess the ability of an early SEER evaluation to detect blood coagulation test abnormalities in trauma patients. METHODS: We conducted an observational retrospective cohort study with data collected at hospital admission of consecutive multiple trauma patients from September 2020 to February 2022 at a regional level 1 trauma center. We performed a receiving operator characteristic curve analysis to determine the ability of the SEER device to detect blood coagulation test abnormalities. Four values on the SEER device were analyzed: clot formation time, clot stiffness (CS), platelet contribution to CS, and fibrinogen contribution to CS. RESULTS: A total of 156 trauma patients were analyzed. The clot formation time value predicted an activated partial thromboplastin time ratio of >1.5 with an area under the curve (AUC) of 0.93 (95% CI, 0.86-0.99). The AUC of the CS value in detecting an international normalized ratio of prothrombin time of >1.5 was 0.87 (95% CI, 0.79-0.95). The AUC of fibrinogen contribution to CS to detect a fibrinogen concentration of <1.5 g/L was 0.87 (95% CI, 0.80-0.94). The AUC of platelet contribution to CS to detect a platelet concentration of <50 G/L was 0.99 (95% CI, 0.99-1.00). CONCLUSION: Our results suggest that the SEER device may be useful for the detection of blood coagulation test abnormalities at trauma admission. CI - (c) 2023 The Author(s). FAU - Duclos, Gary AU - Duclos G AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Fleury, Marie AU - Fleury M AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Grosdidier, Charlotte AU - Grosdidier C AD - Service of Medical Biology, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Lakbar, Ines AU - Lakbar I AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Antonini, Francois AU - Antonini F AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Lassale, Bernard AU - Lassale B AD - French Establishment for Blood, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Arbelot, Charlotte AU - Arbelot C AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Albaladejo, Pierre AU - Albaladejo P AD - Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France. FAU - Zieleskiewicz, Laurent AU - Zieleskiewicz L AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. FAU - Leone, Marc AU - Leone M AD - Service of Anesthesia and Intensive Care, Hopital Nord, Aix-Marseille Universite, Marseille, France. LA - eng PT - Journal Article DEP - 20230424 PL - United States TA - Res Pract Thromb Haemost JT - Research and practice in thrombosis and haemostasis JID - 101703775 PMC - PMC10208882 OTO - NOTNLM OT - blood coagulation test OT - critical care OT - hemorrhage OT - multiple traumas OT - thromboelastography EDAT- 2023/05/30 13:07 MHDA- 2023/05/30 13:08 PMCR- 2023/04/24 CRDT- 2023/05/30 11:37 PHST- 2022/08/17 00:00 [received] PHST- 2023/03/17 00:00 [revised] PHST- 2023/04/03 00:00 [accepted] PHST- 2023/05/30 13:08 [medline] PHST- 2023/05/30 13:07 [pubmed] PHST- 2023/05/30 11:37 [entrez] PHST- 2023/04/24 00:00 [pmc-release] AID - S2475-0379(23)00136-X [pii] AID - 100163 [pii] AID - 10.1016/j.rpth.2023.100163 [doi] PST - epublish SO - Res Pract Thromb Haemost. 2023 Apr 24;7(4):100163. doi: 10.1016/j.rpth.2023.100163. eCollection 2023 May. PMID- 37207863 OWN - NLM STAT- MEDLINE DCOM- 20230925 LR - 20250530 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 21 IP - 10 DP - 2023 Oct TI - A new global fibrinolysis capacity assay for the sensitive detection of hyperfibrinolysis and hypofibrinogenemia in trauma patients. PG - 2759-2770 LID - S1538-7836(23)00417-8 [pii] LID - 10.1016/j.jtha.2023.05.005 [doi] AB - BACKGROUND: Conventional clotting tests are not expeditious enough to allow timely targeted interventions in trauma, and current point-of-care analyzers, such as rotational thromboelastometry (ROTEM), have limited sensitivity for hyperfibrinolysis and hypofibrinogenemia. OBJECTIVES: To evaluate the performance of a recently developed global fibrinolysis capacity (GFC) assay in identifying fibrinolysis and hypofibrinogenemia in trauma patients. METHODS: Exploratory analysis of a prospective cohort of adult trauma patients admitted to a single UK major trauma center and of commercially available healthy donor samples was performed. Lysis time (LT) was measured in plasma according to the GFC manufacturer's protocol, and a novel fibrinogen-related parameter (percentage reduction in GFC optical density from baseline at 1 minute) was derived from the GFC curve. Hyperfibrinolysis was defined as a tissue factor-activated ROTEM maximum lysis of >15% or LT of 50% of the patients with false negative results, leading to higher sensitivity (90% vs 77%). CONCLUSION: Severe trauma patients are characterized by a hyperfibrinolytic profile upon admission to the emergency department. The GFC assay is more sensitive than ROTEM in capturing hyperfibrinolysis and hypofibrinogenemia but requires further development and automation. CI - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Rossetto, Andrea AU - Rossetto A AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. Electronic address: andrea.rossetto@qmul.ac.uk. FAU - Torres, Tracy AU - Torres T AD - Barts Health National Health Service Trust, London, UK. FAU - Platton, Sean AU - Platton S AD - Barts Health National Health Service Trust, London, UK. FAU - Vulliamy, Paul AU - Vulliamy P AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. FAU - Curry, Nicola AU - Curry N AD - Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals Foundation Trust, Oxford, UK. FAU - Davenport, Ross AU - Davenport R AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. LA - eng GR - MR/T023961/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article DEP - 20230517 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 9035-58-9 (Thromboplastin) SB - IM CIN - J Thromb Haemost. 2023 Oct;21(10):2705-2707. doi: 10.1016/j.jtha.2023.06.004. PMID: 37739588 MH - Adult MH - Humans MH - Fibrinolysis MH - *Afibrinogenemia/diagnosis MH - Thromboplastin MH - Prospective Studies MH - *Blood Coagulation Disorders MH - Thrombelastography/methods MH - *Wounds and Injuries/complications/diagnosis OTO - NOTNLM OT - clot lysis time OT - fibrinogen OT - fibrinolysis OT - thrombelastography OT - trauma COIS- Declaration of competing interests There are no competing interests to disclose. EDAT- 2023/05/20 09:42 MHDA- 2023/09/25 06:42 CRDT- 2023/05/19 19:25 PHST- 2023/01/14 00:00 [received] PHST- 2023/04/14 00:00 [revised] PHST- 2023/05/05 00:00 [accepted] PHST- 2023/09/25 06:42 [medline] PHST- 2023/05/20 09:42 [pubmed] PHST- 2023/05/19 19:25 [entrez] AID - S1538-7836(23)00417-8 [pii] AID - 10.1016/j.jtha.2023.05.005 [doi] PST - ppublish SO - J Thromb Haemost. 2023 Oct;21(10):2759-2770. doi: 10.1016/j.jtha.2023.05.005. Epub 2023 May 17. PMID- 37204747 OWN - NLM STAT- MEDLINE DCOM- 20230522 LR - 20230523 IS - 1940-6029 (Electronic) IS - 1064-3745 (Linking) VI - 2663 DP - 2023 TI - Measurement of Blood Viscoelasticity Using Thromboelastography. PG - 709-724 LID - 10.1007/978-1-0716-3175-1_47 [doi] AB - Thromboelastography (TEG) was the first viscoelastic test (VET), invented in Germany in 1948 by Dr. Hartert, and which evaluates the hemostatic competence of whole blood. Thromboelastography was introduced before the activated partial thromboplastin time (aPTT), which was devised in 1953. TEG was not widely used until the introduction of a cell-based model of hemostasis (1994) showing the importance of platelets and tissue factor in hemostasis. Nowadays, VET has become an essential method for assessing hemostatic competence in cardiac surgery, liver transplantation, and trauma. TEG has undergone several modifications, but the concept on which the original TEG was based (cup and pin technology) remained in up to the TEG 5000 analyzer (Haemonetics, Braintree, MA). A new generation of thromboelastography, TEG 6s (Haemonetics, Boston, MA), that assesses blood viscoelastic properties by resonance technology has recently been developed. This newer methodology represents a cartridge-based, automated assay aimed to improve on historical TEG performance and precision. In the present chapter, we will review the advantages and limitations of TEG 5000 and TEG 6s systems as well as factors that affect TEG and which must be considered when interpreting TEG tracings. CI - (c) 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Volod, Oksana AU - Volod O AD - Cedars-Sinai Medical Center, Los Angeles, CA, USA. Oksana.Volod@cshs.org. FAU - Runge, Alice AU - Runge A AD - Cedars-Sinai Medical Center, Los Angeles, CA, USA. LA - eng PT - Journal Article PL - United States TA - Methods Mol Biol JT - Methods in molecular biology (Clifton, N.J.) JID - 9214969 RN - 0 (Hemostatics) SB - IM MH - Humans MH - Thrombelastography/methods MH - Hemostasis MH - *Blood Coagulation Disorders MH - *Hemostatics MH - Partial Thromboplastin Time OTO - NOTNLM OT - Cup and pin technology OT - Resonance technology OT - TEG OT - TEG 6s OT - Thromboelastography OT - Viscoelastic testing EDAT- 2023/05/19 13:05 MHDA- 2023/05/22 06:42 CRDT- 2023/05/19 11:16 PHST- 2023/05/22 06:42 [medline] PHST- 2023/05/19 13:05 [pubmed] PHST- 2023/05/19 11:16 [entrez] AID - 10.1007/978-1-0716-3175-1_47 [doi] PST - ppublish SO - Methods Mol Biol. 2023;2663:709-724. doi: 10.1007/978-1-0716-3175-1_47. PMID- 37183883 OWN - NLM STAT- MEDLINE DCOM- 20231004 LR - 20250824 IS - 1527-3350 (Electronic) IS - 0270-9139 (Print) IS - 0270-9139 (Linking) VI - 78 IP - 4 DP - 2023 Oct 1 TI - Future directions in acute liver failure. PG - 1266-1289 LID - 10.1097/HEP.0000000000000458 [doi] AB - Acute liver failure (ALF) describes a clinical syndrome of rapid hepatocyte injury leading to liver failure manifested by coagulopathy and encephalopathy in the absence of pre-existing cirrhosis. The hallmark diagnostic features are a prolonged prothrombin time (ie, an international normalized ratio of prothrombin time of >/=1.5) and any degree of mental status alteration (HE). As a rare, orphan disease, it seemed an obvious target for a multicenter network. The Acute Liver Failure Study Group (ALFSG) began in 1997 to more thoroughly study and understand the causes, natural history, and management of ALF. Over the course of 22 years, 3364 adult patients were enrolled in the study registry (2614 ALF and 857 acute liver injury-international normalized ratio 2.0 but no encephalopathy-ALI) and >150,000 biosamples collected, including serum, plasma, urine, DNA, and liver tissue. Within the Registry study sites, 4 prospective substudies were conducted and published, 2 interventional ( N -acetylcysteine and ornithine phenylacetate), 1 prognostic [ 13 C-methacetin breath test (MBT)], and 1 mechanistic (rotational thromboelastometry). To review ALFSG's accomplishments and consider next steps, a 2-day in-person conference was held at UT Southwestern Medical Center, Dallas, TX, entitled "Acute Liver Failure: Science and Practice," in May 2022. To summarize the important findings in the field, this review highlights the current state of understanding of ALF and, more importantly, asks what further studies are needed to improve our understanding of the pathogenesis, natural history, and management of this unique and dramatic condition. CI - Copyright (c) 2023 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Stravitz, R Todd AU - Stravitz RT AD - Virginia Commonwealth University, Richmond, Virginia, USA. FAU - Fontana, Robert J AU - Fontana RJ AD - University of Michigan, Ann Arbor, Michigan, USA. FAU - Karvellas, Constantine AU - Karvellas C AD - University of Alberta, Edmonton, Alberta, Canada. FAU - Durkalski, Valerie AU - Durkalski V AD - Medical University of South Carolina, Charleston, South Carolina, USA. FAU - McGuire, Brendan AU - McGuire B AD - University of Alabama, Birmingham, Alabama, USA. FAU - Rule, Jody A AU - Rule JA AD - University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. FAU - Tujios, Shannan AU - Tujios S AD - University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. FAU - Lee, William M AU - Lee WM AD - University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. CN - Acute Liver Failure Study Group LA - eng SI - ClinicalTrials.gov/NCT00518440 SI - ClinicalTrials.gov/NCT00004467 SI - ClinicalTrials.gov/NCT00896025 SI - ClinicalTrials.gov/NCT01548690 SI - ClinicalTrials.gov/NCT02786836 GR - R01 DK058369/DK/NIDDK NIH HHS/United States GR - U01 DK058369/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review DEP - 20230516 PL - United States TA - Hepatology JT - Hepatology (Baltimore, Md.) JID - 8302946 SB - IM MH - Adult MH - Humans MH - Prospective Studies MH - *Liver Failure, Acute/diagnosis/etiology/therapy MH - Prognosis MH - *Liver Transplantation/adverse effects MH - Multicenter Studies as Topic PMC - PMC10521792 MID - NIHMS1900390 COIS- William M. Lee consults for Forma, GlaxoSmithKline, Seal Rock, Seattle Genetics, and Veristat. He received grants from Alexion, Eiger, Gilead, Intercept, and Vivet. The remaining authors have no conflicts to report. EDAT- 2023/05/15 13:06 MHDA- 2023/10/04 06:44 PMCR- 2023/09/26 CRDT- 2023/05/15 06:33 PHST- 2023/02/10 00:00 [received] PHST- 2023/04/20 00:00 [accepted] PHST- 2023/10/04 06:44 [medline] PHST- 2023/05/15 13:06 [pubmed] PHST- 2023/05/15 06:33 [entrez] PHST- 2023/09/26 00:00 [pmc-release] AID - 01515467-202310000-00028 [pii] AID - HEP-23-0268 [pii] AID - 10.1097/HEP.0000000000000458 [doi] PST - ppublish SO - Hepatology. 2023 Oct 1;78(4):1266-1289. doi: 10.1097/HEP.0000000000000458. Epub 2023 May 16. PMID- 37164268 OWN - NLM STAT- MEDLINE DCOM- 20230728 LR - 20230728 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 21 IP - 8 DP - 2023 Aug TI - Sonorheometry versus rotational thromboelastometry in trauma: a comparison of diagnostic and prognostic performance. PG - 2114-2125 LID - S1538-7836(23)00391-4 [pii] LID - 10.1016/j.jtha.2023.04.031 [doi] AB - BACKGROUND: Rotational thromboelastometry (ROTEM) is used to rapidly identify trauma-induced coagulopathy (TIC) and direct targeted interventions in hemorrhaging trauma patients. A novel technology, Quantra System (HemoSonics), utilizes sonic estimation of elasticity via resonance sonorheometry, avoids mechanical clot interference, and may increase diagnostic accuracy, but there are limited data on bleeding in major trauma patients. OBJECTIVES: To compare the performance of Quantra with that of ROTEM for rapid diagnosis of TIC and prediction of transfusion requirements and mortality. METHODS: Samples were collected from adult trauma patients enrolled in a perpetual cohort study upon admission to a single level 1 trauma center between 2020 and 2021. Samples were analyzed using Quantra, ROTEM, multiple electrode aggregometry, and conventional coagulation assays. RESULTS: Samples from 209 patients were analyzed. Correlations were strong between Quantra and ROTEM parameters (for all, p < .001): clot stiffness (CS) and tissue factor-activated ROTEM (EXTEM) clot amplitude at 5 minutes (A5) (r = 0.90); fibrinogen contribution to CS and tissue factor-activated ROTEM with cytochalasin D (FIBTEM) A5 (r = 0.85); and platelet contribution to CS and EXTEM-FIBTEM A5 (r = 0.73). Although CS showed higher discrimination than EXTEM A5 in detecting TIC (international normalized ratio, >1.2; area under the receiver operating characteristic curve, 0.83 vs 0.79; p = .038), the ability of fibrinogen contribution to CS to detect hypofibrinogenemia (a fibrinogen level of <2g/L) was good but lower than that of FIBTEM A5 (area under the receiver operating characteristic curve, 0.79 vs 0.84; p = .027). There was no difference between Quantra and ROTEM in detecting a platelet count of <150 x 10(9)/L, predicting rapid transfusion or mortality at 6 hours. CONCLUSION: Quantra and ROTEM have similar diagnostic performances in evaluating TIC and predicting clinically relevant outcomes. Larger studies are required to determine the utility of Quantra for goal-directed treatment of TIC. CI - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Rossetto, Andrea AU - Rossetto A AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. Electronic address: andrea.rossetto@qmul.ac.uk. FAU - Wohlgemut, Jared M AU - Wohlgemut JM AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. FAU - Davenport, Ross AU - Davenport R AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230508 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 9001-32-5 (Fibrinogen) RN - 9035-58-9 (Thromboplastin) SB - IM MH - Adult MH - Humans MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Cohort Studies MH - Fibrinogen/analysis MH - Hemorrhage MH - Prognosis MH - *Thrombelastography MH - Thromboplastin OTO - NOTNLM OT - blood coagulation OT - fibrinogen OT - platelets OT - point-of-care systems OT - trauma COIS- Declaration of competing interests There are no competing interests to disclose. EDAT- 2023/05/11 00:42 MHDA- 2023/07/21 06:44 CRDT- 2023/05/10 19:27 PHST- 2023/03/10 00:00 [received] PHST- 2023/04/28 00:00 [revised] PHST- 2023/04/28 00:00 [accepted] PHST- 2023/07/21 06:44 [medline] PHST- 2023/05/11 00:42 [pubmed] PHST- 2023/05/10 19:27 [entrez] AID - S1538-7836(23)00391-4 [pii] AID - 10.1016/j.jtha.2023.04.031 [doi] PST - ppublish SO - J Thromb Haemost. 2023 Aug;21(8):2114-2125. doi: 10.1016/j.jtha.2023.04.031. Epub 2023 May 8. PMID- 37109145 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230501 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 12 IP - 8 DP - 2023 Apr 11 TI - Acute Haemostatic Depletion and Failure in Patients with Traumatic Brain Injury (TBI): Pathophysiological and Clinical Considerations. LID - 10.3390/jcm12082809 [doi] LID - 2809 AB - BACKGROUND: Because of the aging population, the number of low falls in elderly people with pre-existing anticoagulation is rising, often leading to traumatic brain injury (TBI) with a social and economic burden. Hemostatic disorders and disbalances seem to play a pivotal role in bleeding progression. Interrelationships between anticoagulatoric medication, coagulopathy, and bleeding progression seem to be a promising aim of therapy. METHODS: We conducted a selective search of the literature in databases like Medline (Pubmed), Cochrane Library and current European treatment recommendations using relevant terms or their combination. RESULTS: Patients with isolated TBI are at risk for developing coagulopathy in the clinical course. Pre-injury intake of anticoagulants is leading to a significant increase in coagulopathy, so every third patient with TBI in this population suffers from coagulopathy, leading to hemorrhagic progression and delayed traumatic intracranial hemorrhage. In an assessment of coagulopathy, viscoelastic tests such as TEG or ROTEM seem to be more beneficial than conventional coagulation assays alone, especially because of their timely and more specific gain of information about coagulopathy. Furthermore, results of point-of-care diagnostic make rapid "goal-directed therapy" possible with promising results in subgroups of patients with TBI. CONCLUSIONS: The use of innovative technologies such as viscoelastic tests in the assessment of hemostatic disorders and implementation of treatment algorithms seem to be beneficial in patients with TBI, but further studies are needed to evaluate their impact on secondary brain injury and mortality. FAU - Kockelmann, Fabian AU - Kockelmann F AD - Department of Surgery, Klinikum Dortmund, University Hospital of the University Witten/Herdecke, Beurhausstr. 40, D-44137 Dortmund, Germany. AD - Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimerstr. 200, D-51109 Koln, Germany. FAU - Maegele, Marc AU - Maegele M AD - Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimerstr. 200, D-51109 Koln, Germany. AD - Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimerstr. 200, D-51109 Koln, Germany. LA - eng PT - Journal Article PT - Review DEP - 20230411 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC10143480 OTO - NOTNLM OT - coagulopathy OT - diagnostics OT - mechanisms OT - traumatic brain injury OT - treatment COIS- The authors declare no conflict of interest. EDAT- 2023/04/28 06:42 MHDA- 2023/04/28 06:43 PMCR- 2023/04/11 CRDT- 2023/04/28 01:32 PHST- 2023/03/06 00:00 [received] PHST- 2023/03/30 00:00 [revised] PHST- 2023/04/07 00:00 [accepted] PHST- 2023/04/28 06:43 [medline] PHST- 2023/04/28 06:42 [pubmed] PHST- 2023/04/28 01:32 [entrez] PHST- 2023/04/11 00:00 [pmc-release] AID - jcm12082809 [pii] AID - jcm-12-02809 [pii] AID - 10.3390/jcm12082809 [doi] PST - epublish SO - J Clin Med. 2023 Apr 11;12(8):2809. doi: 10.3390/jcm12082809. PMID- 37108280 OWN - NLM STAT- MEDLINE DCOM- 20230501 LR - 20230501 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 24 IP - 8 DP - 2023 Apr 12 TI - Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness. LID - 10.3390/ijms24087118 [doi] LID - 7118 AB - Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies. FAU - Zanza, Christian AU - Zanza C AD - Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy. AD - Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA. FAU - Romenskaya, Tatsiana AU - Romenskaya T AD - Department of Physiology and Pharmacology, Sapienza University of Rome, P. le A. Moro 5, 00185 Rome, Italy. FAU - Racca, Fabrizio AU - Racca F AD - Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy. FAU - Rocca, Eduardo AU - Rocca E AUID- ORCID: 0000-0002-9297-5897 AD - Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy. FAU - Piccolella, Fabio AU - Piccolella F AD - Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy. FAU - Piccioni, Andrea AU - Piccioni A AUID- ORCID: 0000-0001-5703-8737 AD - Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy. FAU - Saviano, Angela AU - Saviano A AUID- ORCID: 0000-0002-2820-7180 AD - Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy. FAU - Formenti-Ujlaki, George AU - Formenti-Ujlaki G AD - Department of Surgery, San Carlo Hospital, ASST Santi Paolo and Carlo, 20142 Milan, Italy. FAU - Savioli, Gabriele AU - Savioli G AUID- ORCID: 0000-0002-8679-5435 AD - Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy. FAU - Franceschi, Francesco AU - Franceschi F AD - Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy. FAU - Longhitano, Yaroslava AU - Longhitano Y AUID- ORCID: 0000-0001-8831-1361 AD - Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA. LA - eng PT - Journal Article PT - Review DEP - 20230412 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Hemostatics) SB - IM MH - Adult MH - Humans MH - Critical Illness MH - *Blood Coagulation Disorders MH - Blood Coagulation MH - Fibrinolysis MH - *Hemostatics MH - *Wounds and Injuries/complications PMC - PMC10138568 OTO - NOTNLM OT - blood coagulation disorders OT - exsanguination OT - hemorrhagic shock OT - hemostasis OT - polytrauma physiology OT - trauma COIS- The authors declare no conflict of interest. EDAT- 2023/04/28 06:41 MHDA- 2023/05/01 06:42 PMCR- 2023/04/12 CRDT- 2023/04/28 01:26 PHST- 2023/02/24 00:00 [received] PHST- 2023/03/29 00:00 [revised] PHST- 2023/03/30 00:00 [accepted] PHST- 2023/05/01 06:42 [medline] PHST- 2023/04/28 06:41 [pubmed] PHST- 2023/04/28 01:26 [entrez] PHST- 2023/04/12 00:00 [pmc-release] AID - ijms24087118 [pii] AID - ijms-24-07118 [pii] AID - 10.3390/ijms24087118 [doi] PST - epublish SO - Int J Mol Sci. 2023 Apr 12;24(8):7118. doi: 10.3390/ijms24087118. PMID- 37071767 OWN - NLM STAT- MEDLINE DCOM- 20230518 LR - 20230624 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 63 Suppl 3 DP - 2023 May TI - Delayed Leukoreduction of whole blood with a platelet-sparing filter to increase low-titer group O whole blood production in the United States. PG - S177-S188 LID - 10.1111/trf.17372 [doi] AB - BACKGROUND: Demand for low-titer Group O whole blood (LTOWB) is increasing for trauma. The whole blood (WB) platelet-sparing (WB-SP) filter enables leukoreduction (LR) while retaining platelet quantity and function; however, in the United States WB must be filtered and placed in the cold within 8 h of collection. A longer processing window would facilitate improved logistics and supply of LR-WB to meet the growing medical need. This study evaluated the impact of increasing filtration timing from <8 h to <12 h on the quality of LR-WB. STUDY DESIGN AND METHODS: Thirty WB units were collected from healthy donors. Control units were filtered within 8 h and test units within 12 h of collection. WB was tested throughout 21 days of storage. Hemolysis, WBC content, component recovery, and 25 additional markers of WB quality were tested including hematologic and metabolic markers, RBC morphology, aggregometry, thromboelastography, and p-selectin. RESULTS: There were 0 failures for residual WBC content, hemolysis, or pH, and no differences in component recovery between arms. Few differences in metabolic parameters were observed, but the small effect size suggests these are not clinically significant. Trends throughout storage were similar and filtration timing did not impact hematological parameters, platelet activation and aggregation, or hemostatic capacity. CONCLUSION: Our studies showed that extending filtration timing from 8 to 12 h from the collection does not significantly impact the quality of LR-WB. Characterization of the platelets demonstrated that storage lesions were not exacerbated. Extending the time from collection to filtration will improve LTOWB inventory in the United States. CI - (c) 2023 AABB. FAU - Wellington, Michael AU - Wellington M AD - American Red Cross, Norfolk Clinical Research Laboratory, Norfolk, Virginia, USA. FAU - Feldman, Tamar Perla AU - Feldman TP AUID- ORCID: 0009-0000-3906-3111 AD - American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA. FAU - Cleeton, Stephanie AU - Cleeton S AD - American Red Cross, Norfolk Clinical Research Laboratory, Norfolk, Virginia, USA. FAU - Sawyer, Sherrie AU - Sawyer S AD - American Red Cross, Norfolk Clinical Research Laboratory, Norfolk, Virginia, USA. FAU - Brown, Bethany L AU - Brown BL AUID- ORCID: 0000-0001-8595-8856 AD - American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230420 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Humans MH - *Hemolysis MH - *Blood Preservation MH - Blood Platelets/metabolism MH - Platelet Activation MH - Leukocyte Reduction Procedures OTO - NOTNLM OT - LTOWB supply OT - Low titer group O whole blood OT - blood processing EDAT- 2023/04/19 06:00 MHDA- 2023/05/18 06:42 CRDT- 2023/04/18 14:34 PHST- 2023/03/20 00:00 [revised] PHST- 2022/12/31 00:00 [received] PHST- 2023/03/22 00:00 [accepted] PHST- 2023/05/18 06:42 [medline] PHST- 2023/04/19 06:00 [pubmed] PHST- 2023/04/18 14:34 [entrez] AID - 10.1111/trf.17372 [doi] PST - ppublish SO - Transfusion. 2023 May;63 Suppl 3:S177-S188. doi: 10.1111/trf.17372. Epub 2023 Apr 20. PMID- 37058725 OWN - NLM STAT- MEDLINE DCOM- 20231020 LR - 20231020 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 136 IP - 5 DP - 2023 May 1 TI - Factor VIII: A Dynamic Modulator of Hemostasis and Thrombosis in Trauma. PG - 894-904 LID - 10.1213/ANE.0000000000006356 [doi] AB - A trace amount of thrombin cleaves factor VIII (FVIII) into an active form (FVIIIa), which catalyzes FIXa-mediated activation of FX on the activated platelet surface. FVIII rapidly binds to von Willebrand factor (VWF) after secretion and becomes highly concentrated via VWF-platelet interaction at a site of endothelial inflammation or injury. Circulating levels of FVIII and VWF are influenced by age, blood type (nontype O > type O), and metabolic syndromes. In the latter, hypercoagulability is associated with chronic inflammation (known as thrombo-inflammation). In acute stress including trauma, releasable pools of FVIII/VWF are secreted from the Weibel-Palade bodies in the endothelium and then augment local platelet accumulation, thrombin generation, and leukocyte recruitment. Early systemic increases of FVIII/VWF (>200% of normal) levels in trauma result in a lower sensitivity of contact-activated clotting time (activated partial thromboplastin time [aPTT] or viscoelastic coagulation test [VCT]). However, in severely injured patients, multiple serine proteases (FXa plasmin and activated protein C [APC]) are locally activated and may be systemically released. Severity of traumatic injury correlates with prolonged aPTT and elevated activation markers of FXa, plasmin, and APC, culminating in a poor prognosis. In a subset of acute trauma patients, cryoprecipitate that contains fibrinogen, FVIII/VWF, and FXIII is theoretically advantageous over purified fibrinogen concentrate to promote stable clot formation, but comparative efficacy data are lacking. In chronic inflammation or subacute phase of trauma, elevated FVIII/VWF contributes to the pathogenesis of venous thrombosis by enhancing not only thrombin generation but also augmenting inflammatory functions. Future developments in coagulation monitoring specific to trauma patients, and targeted to enhancement or inhibition of FVIII/VWF, are likely to help clinicians gain better control of hemostasis and thromboprophylaxis. The main goal of this narrative is to review the physiological functions and regulations of FVIII and implications of FVIII in coagulation monitoring and thromboembolic complications in major trauma patients. CI - Copyright (c) 2023 International Anesthesia Research Society. FAU - Tanaka, Kenichi A AU - Tanaka KA AD - From the Department of Anesthesiology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma. FAU - Terada, Rui AU - Terada R AD - From the Department of Anesthesiology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma. FAU - Butt, Amir L AU - Butt AL AD - From the Department of Anesthesiology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma. FAU - Mazzeffi, Michael A AU - Mazzeffi MA AD - Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia. FAU - McNeil, John S AU - McNeil JS AD - Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia. LA - eng PT - Journal Article PT - Review DEP - 20230414 PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Anticoagulants) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.7 (Fibrinolysin) RN - 0 (Hemostatics) RN - EC 3.4.21.5 (Thrombin) RN - 0 (von Willebrand Factor) SB - IM MH - Humans MH - Anticoagulants MH - *Factor VIII/metabolism MH - Fibrinogen MH - Fibrinolysin MH - Hemostasis MH - *Hemostatics MH - Inflammation MH - Thrombin/metabolism MH - *Thrombosis/etiology MH - *Venous Thromboembolism MH - von Willebrand Factor/metabolism EDAT- 2023/04/15 06:00 MHDA- 2023/04/18 06:42 CRDT- 2023/04/14 17:32 PHST- 2023/04/18 06:42 [medline] PHST- 2023/04/14 17:32 [entrez] PHST- 2023/04/15 06:00 [pubmed] AID - 00000539-202305000-00010 [pii] AID - 10.1213/ANE.0000000000006356 [doi] PST - ppublish SO - Anesth Analg. 2023 May 1;136(5):894-904. doi: 10.1213/ANE.0000000000006356. Epub 2023 Apr 14. PMID- 37055832 OWN - NLM STAT- MEDLINE DCOM- 20230417 LR - 20230419 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 27 IP - 1 DP - 2023 Apr 13 TI - Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study. PG - 141 LID - 10.1186/s13054-023-04421-w [doi] LID - 141 AB - BACKGROUND: To accelerate the diagnosis and treatment of trauma-induced coagulopathy (TIC), viscoelastic haemostatic assays (VHA) are increasingly used worldwide, although their value is still debated, with a recent randomised trial showing no improvement in outcome. The objective of this retrospective study was to compare 2 cohorts of injured patients in which TIC was managed with either a VHA-based algorithm or a conventional coagulation test (CCT)-based algorithm. METHODS: Data were retrieved from 2 registries and patients were included in the study if they received at least 1 unit of red blood cell in the first 24 h after admission. A propensity score, including sex, age, blunt vs. penetrating, systolic blood pressure, GCS, ISS and head AIS, admission lactate and PT(ratio), tranexamic acid administration, was then constructed. Primary outcome was the proportion of subjects who were alive and free of massive transfusion (MT) at 24 h after injury. We also compared the cost for blood products and coagulation factors. RESULTS: From 2012 to 2019, 7250 patients were admitted in the 2 trauma centres, and among these 624 were included in the study (CCT group: 380; VHA group: 244). After propensity score matching, 215 patients remained in each study group without any significant difference in demographics, vital signs, injury severity, or laboratory analysis. At 24 h, more patients were alive and free of MT in the VHA group (162 patients, 75%) as compared to the CCT group (112 patients, 52%; p < 0.01) and fewer patients received MT (32 patients, 15% vs. 91 patients, 42%, p < 0.01). However, no significant difference was observed for mortality at 24 h (odds ratio 0.94, 95% CI 0.59-1.51) or survival at day 28 (odds ratio 0.87, 95% CI 0.58-1.29). Overall cost of blood products and coagulation factors was dramatically reduced in the VHA group as compared to the CCT group (median [interquartile range]: 2357 euros [1108-5020] vs. 4092 euros [2510-5916], p < 0.001). CONCLUSIONS: A VHA-based strategy was associated with an increase of the number of patients alive and free of MT at 24 h together with an important reduction of blood product use and associated costs. However, that did not translate into an improvement in mortality. CI - (c) 2023. The Author(s). FAU - David, Jean-Stephane AU - David JS AD - Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Benite Cedex, France. jean-stephane.david@univ-lyon1.fr. AD - Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France. jean-stephane.david@univ-lyon1.fr. FAU - James, Arthur AU - James A AD - GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France. FAU - Orion, Maxime AU - Orion M AD - Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Benite Cedex, France. FAU - Selves, Agathe AU - Selves A AD - GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France. FAU - Bonnet, Melody AU - Bonnet M AD - Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Benite Cedex, France. FAU - Glasman, Pauline AU - Glasman P AD - GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France. FAU - Vacheron, Charles-Herve AU - Vacheron CH AD - Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Benite Cedex, France. AD - Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, HCL, Villeurbanne, France. AD - Division of Public Health, Department of Biostatistics and Bioinformatics, Lyon, France. FAU - Raux, Mathieu AU - Raux M AD - INSERM, UMRS1158 Neurophysiologie Respiratoire Experimentale Et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Universite, Site Pitie-Salpetriere, Departement d'Anesthesie Reanimation, Sorbonne Universite, Paris, France. LA - eng PT - Journal Article DEP - 20230413 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Hemostatics) RN - 0 (Blood Coagulation Factors) SB - IM MH - Humans MH - Retrospective Studies MH - *Hemostatics MH - Thrombelastography MH - Propensity Score MH - *Blood Coagulation Disorders/etiology/therapy MH - Blood Coagulation Factors MH - Resuscitation MH - Injury Severity Score MH - *Wounds and Injuries/complications/therapy PMC - PMC10103518 OTO - NOTNLM OT - Blood products OT - Cost OT - Outcome OT - Thromboelastometry OT - Trauma COIS- JS David received lectures fees from LFB (Les Ullis, France), manufacturer of coagulation factors (fibrinogen, PCC). EDAT- 2023/04/14 06:00 MHDA- 2023/04/17 06:41 PMCR- 2023/04/13 CRDT- 2023/04/13 23:39 PHST- 2023/01/16 00:00 [received] PHST- 2023/03/30 00:00 [accepted] PHST- 2023/04/17 06:41 [medline] PHST- 2023/04/13 23:39 [entrez] PHST- 2023/04/14 06:00 [pubmed] PHST- 2023/04/13 00:00 [pmc-release] AID - 10.1186/s13054-023-04421-w [pii] AID - 4421 [pii] AID - 10.1186/s13054-023-04421-w [doi] PST - epublish SO - Crit Care. 2023 Apr 13;27(1):141. doi: 10.1186/s13054-023-04421-w. PMID- 37052275 OWN - NLM STAT- MEDLINE DCOM- 20230414 LR - 20230414 IS - 2078-5151 (Electronic) IS - 0038-2361 (Linking) VI - 61 IP - 1 DP - 2023 Mar TI - Spectrum of coagulation profiles in severely injured patients - a subgroup analysis from the fluids in resuscitation of severe trauma trial. PG - 21-26 AB - BACKGROUND: Trauma-induced coagulopathy (TIC) is a major contributing factor to worsening bleeding in trauma patients. The objective of this study is to describe the spectrum of coagulation profiles amongst severely injured patients. METHODS: This is a retrospective study of all patients with complete baseline TEG coagulation parameters collected prior to randomisation in the FIRST (fluids in resuscitation of severe trauma) trial between January 2007 and December 2009. Parameters recorded for this study included patient demographics, mechanism of injury, admission vital signs, lactate, base excess, coagulation studies prothrombin time (PT), international normalised ratio (INR), thromboelastography (TEG) parameters, volume, and type of fluids administered, volume of blood products administered, length of intensive care unit (ICU) stay and major outcomes. RESULTS: A total of 87 patients were included in this study, with a median injury severity score (ISS) of 20 and 57.5 had a penetrating injury mechanism. Coagulopathy was highly prevalent in this cohort, of which a majority (69%) was diagnosed with hypercoagulopathy and 24% had a hypocoagulopathy status on admission. There was no difference in age, gender and amount of pre-hospital fluids administered across the three groups. The median volume of blood products was higher in the hypocoagulopathy group, although not statistically significant. Overall, the 30-day mortality rate was 13%, with case fatalities occurring in only coagulopathic patients: hypercoagulopathy (15%) and hypocoagulopathy (10%). CONCLUSION: TIC is not an infrequent diagnosis in severely injured patients resulting in increased morbidity and mortality. Determining the coagulation profile using TEG at presentation in this group of patients may inform appropriate management guidelines in order to improve outcome. CI - Copyright(c) Authors. FAU - Nathire, M E H AU - Nathire MEH AD - Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa. FAU - James, M F M AU - James MFM AD - Department of Anaesthesia, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa. FAU - Sobnach, S AU - Sobnach S AD - Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa. FAU - Nicol, A AU - Nicol A AD - Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa. FAU - Navsaria, P H AU - Navsaria PH AD - Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa. LA - eng PT - Journal Article PL - South Africa TA - S Afr J Surg JT - South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie JID - 2984854R SB - IM MH - Humans MH - *Blood Coagulation Disorders/etiology/therapy/diagnosis MH - Injury Severity Score MH - Retrospective Studies MH - Thrombelastography MH - *Wounds and Injuries/complications/therapy MH - *Wounds, Penetrating MH - Randomized Controlled Trials as Topic EDAT- 2023/04/14 06:00 MHDA- 2023/04/14 06:42 CRDT- 2023/04/13 07:43 PHST- 2023/04/14 06:42 [medline] PHST- 2023/04/13 07:43 [entrez] PHST- 2023/04/14 06:00 [pubmed] PST - ppublish SO - S Afr J Surg. 2023 Mar;61(1):21-26. PMID- 37039300 OWN - NLM STAT- MEDLINE DCOM- 20230412 LR - 20230419 IS - 1652-7518 (Electronic) IS - 0023-7205 (Linking) VI - 120 DP - 2023 Apr 6 TI - Analysis with viscoelastic hemostatic assays - a guide. LID - 22153 [pii] AB - Viscoelastic hemostasis analyses (VHA) are a complement in the evaluation of hemostasis in patients with major bleeding. The analysis measures viscoelastic changes in whole blood and the results give an overview of several components of hemostasis. VHA can be used to optimize fibrinogen levels, platelet and plasma substitution. The main clinical evidence supporting this strategy is in trauma, obstetric bleeding, heart and liver surgery, where algorithms based on VHA results facilitate individualized therapy. VHA measurement is of limited value to exclude treatment with anticoagulants and platelet inhibitors. Quality control aspects are also more cumbersome since whole blood with limited sustainability is used. Newer, more automated versions of the instruments have increased the reproducibility. The main advantage of VHA is the fast turn-around time and their role in guiding treatment in an emergency situation with bleeding. FAU - Ulfsdotter Nilsson, Caroline AU - Ulfsdotter Nilsson C AD - med dr, specialistlakare, Intensiv- och perioperativ vard, Skanes universitetssjukhus Lund; Anestesiologi och intensivvard, Lunds universitet. FAU - Radulovic, Vladimir AU - Radulovic V AD - med dr, overlakare, Koagulationscentrum, sektionen for hematologi och koagulation, VO specialistmedicin, Sahlgrenska universitetssjukhuset, Goteborg. FAU - Jeppsson, Anders AU - Jeppsson A AD - professor, overlakare, avdelningen for molekylar och klinisk medi-cin, institutionen for medicin, Sahlgrenska akademin, Goteborgs universitet; VO torax, Sahlgrenska universitetssjukhuset, Goteborg. FAU - Strandberg, Karin AU - Strandberg K AD - docent, overlakare, klinisk kemi och farmakologi, Medicinsk service, Region Skane, Malmo. LA - eng LA - swe PT - English Abstract PT - Journal Article TT - En guide till koagulationsanalys med viskoelastiska instrument. DEP - 20230406 PL - Sweden TA - Lakartidningen JT - Lakartidningen JID - 0027707 RN - 0 (Hemostatics) SB - IM MH - Humans MH - *Hemostatics/therapeutic use MH - Reproducibility of Results MH - Thrombelastography/methods MH - Hemostasis MH - Blood Coagulation Tests MH - Hemorrhage/therapy MH - *Blood Coagulation Disorders EDAT- 2023/04/12 06:00 MHDA- 2023/04/12 06:42 CRDT- 2023/04/11 07:22 PHST- 2023/04/12 06:42 [medline] PHST- 2023/04/11 07:22 [entrez] PHST- 2023/04/12 06:00 [pubmed] AID - 22153 [pii] PST - epublish SO - Lakartidningen. 2023 Apr 6;120:22153. PMID- 30725746 STAT- Publisher CTDT- 20230410 PB - StatPearls Publishing DP - 2023 Jan TI - Thromboelastography. BTI - StatPearls AB - Maintaining blood in a liquid state is essential for homeostasis, as it ensures the delivery of sufficient oxygen and nutrients to tissues while removing carbon dioxide and other waste products. Conversely, the ability of blood to convert from a liquid to a solid state, that is, coagulate, underlies the mechanism that protects the body from life-threatening exsanguination. This process of thrombosis is normally a localized event at the site of vascular injury, while the remaining circulating blood remains liquid. Thrombosis is a dynamic process that includes associated thrombolysis to maintain or restore blood flow through vessels once an injury has been sealed. These unique properties of blood are largely determined by a complex, active balance among procoagulant factors, anticoagulants, and fibrinolysis. Two major pathological conditions are commonly associated with the disequilibrium of this intricate system: bleeding and vascular thrombosis. Major bleeding is a serious medical complication that may be caused by external trauma, surgery, invasive procedures, or an underlying medical condition such as aneurysm rupture or peptic ulcer disease. According to the World Health Organization, injuries are responsible for 5.8 million deaths per year worldwide, with the associated bleeding responsible for about 30% to 40% of these deaths. Several congenital disorders, such as Von Willebrand disease and hemophilia A or B, associated with coagulation factor deficiencies, may cause significant bleeding even from minor injuries. In addition, prescribed anticoagulants and antiplatelet agents can induce a coagulopathic state, potentially leading to excessive bleeding associated with trauma or medical procedures. Acute blood loss can lead to coagulopathy due to the depletion of coagulation factors. Predictably, trauma-related coagulopathy has been associated with significantly higher mortality. Patients with ongoing or expected major bleeding benefit from an accurate assessment of the functional state of the hemostatic system to optimize care and enable cost-effective replacement of only the necessary blood components. Venous thromboembolism is another common and serious condition associated with abnormal blood coagulation. In these cases, systemic hypercoagulability shifts the body's homeostatic mechanisms toward a prothrombotic state. However, in many cases, the cause of venous thromboembolism may be unclear. Routine coagulation testing has not been shown to predict such events, and even a detailed investigation of hypercoagulability fails to identify an underlying disorder. Many individuals regularly take anticoagulants and antiplatelet agents, which affects the accuracy of many laboratory coagulation studies. An accurate and cost-effective method to monitor antithrombotic activity could help maintain an acceptable risk-benefit ratio in such patients. Inadequate anticoagulation or antiplatelet therapy can lead to devastating thromboembolic conditions. Several commonly used blood tests assess blood coagulation. These tests include prothrombin time, international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, fibrinogen concentration, D-dimer levels, activated clotting time, and whole blood bleeding time. These tests are typically used to diagnose coagulopathy and a possible prothrombotic state, monitor anticoagulation therapy, and assist in treating bleeding episodes. More specific factor analyses, such as Factor V, proteins C and S, antithrombin III, anticardiolipin antibodies, and prothrombin gene mutation, are useful but not as readily available in emergency clinical situations. Despite their effectiveness for specific clinical applications, such as anticoagulation monitoring, traditional diagnostic tests have notable limitations. One of the primary drawbacks in the context of acute major bleeding is the prolonged turnaround time. Moreover, these tests fail to provide a comprehensive assessment of hemostasis because they do not evaluate certain factors, including factor XIII, platelet function, and fibrinolytic activity. Platelet concentration, easily measured as part of a complete blood count, does not necessarily reflect their function, especially in the presence of elements known to affect platelet reactivity, such as nonsteroidal anti-inflammatory drugs, antiplatelet agents, uremia, malignancy, or alcohol intake. Bleeding time has a low sensitivity and high inconsistency in detecting platelet disorders. Delayed or inadequate diagnosis of coagulopathy in a bleeding patient may lead to an excessive and improperly balanced transfusion of scarce blood components with increased morbidity, treatment costs, and mortality. Thromboelastography (TEG) is a promising diagnostic modality that offers several advantages compared to other tests mentioned above. TEG was developed in 1948 by Dr. Hellmut Hartert at the University of Heidelberg. The first reported clinical application of the test occurred during the Vietnam War in an attempt to guide transfusions of blood components in injured soldiers. In the 1980s, TEG was found to be beneficial in patients with liver transplants, and in the 1990s, it was demonstrated to be useful in cardiac surgery. Since then, TEG has become increasingly used as growing evidence supports its clinical efficacy. A PubMed search using the keywords TEG and thromboelastometry yields approximately 6000 publications, highlighting its expanding role in medical practice. This topic outlines the general principles of TEG, including its methodology, normal values, current evidence, clinical applications, limitations, and future research directions. CI - Copyright (c) 2023, StatPearls Publishing LLC. FAU - Shaydakov, Maxim E AU - Shaydakov ME AD - WellSpan York Hospital / Temple University FAU - Sigmon, David F AU - Sigmon DF AD - University of Pennsylvania FAU - Blebea, John AU - Blebea J AD - Central Michigan University LA - eng PT - Study Guide PT - Book Chapter PL - Treasure Island (FL) COIS- Disclosure: Maxim E Shaydakov declares no relevant financial relationships with ineligible companies. Disclosure: David F Sigmon declares no relevant financial relationships with ineligible companies. Disclosure: John Blebea declares no relevant financial relationships with ineligible companies. EDAT- 2023/04/10 00:00 CRDT- 2023/04/10 00:00 AID - NBK537061 [bookaccession] PMID- 37018954 OWN - NLM STAT- MEDLINE DCOM- 20230425 LR - 20230517 IS - 1879-1271 (Electronic) IS - 0268-0033 (Linking) VI - 104 DP - 2023 Apr TI - Characterizing the viscoelastic properties of the anterolateral ligament and grafts commonly used in its reconstruction. PG - 105949 LID - S0268-0033(23)00080-3 [pii] LID - 10.1016/j.clinbiomech.2023.105949 [doi] AB - BACKGROUND: Current anatomic anterolateral ligament reconstruction is typically performed using either a gracilis tendon or an iliotibial band graft based on their quasi-static behavior. However, there is limited knowledge about their viscoelastic behaviors. This study aimed to characterize the viscoelastic properties of the anterolateral ligament, distal iliotibial band, distal gracilis tendon and proximal gracilis tendon for graft material choice in anterolateral ligament reconstruction. METHODS: All the tissues were harvested from thirteen fresh-frozen cadaveric knees and subjected to preconditioning (3-6 MPa), sinusoidal cycle (1.2-12 MPa), dwell at constant load (12 MPa), and load to failure (3%/s). The quasi-static and viscoelastic properties of the soft tissues were computed and compared using a linear mixed model (p < 0.05). FINDINGS: The hysteresis of anterolateral ligament (mean:0.4 Nm) was comparable with gracilis halves (p > 0.85) but iliotibial band (6 Nm) was significantly higher (p < 0.001,ES = 6.5). In contrast, the dynamic creep of anterolateral ligament (0.5 mm) was similar to iliotibial band (0.7 mm, p > 0.82) whereas both gracilis halves were significantly lower (p < 0.007,ES > 1.4). The elastic modulus of anterolateral ligament (181.4 MPa, p < 0.001,ES > 2.1) was the lowest compared to the grafts materials (distal gracilis tendon:835 MPa, distal gracilis tendon:726 MPa, iliotibial band:910 MPa). Additionally, the failure load of the anterolateral ligament (124.5 N, p < 0.001,ES > 2.9) was also the lowest. INTERPRETATION: The mechanical properties of the gracilis halves and iliotibial band were significantly different from anterolateral ligament, except for hysteresis and dynamic creep, respectively. Our findings showed that the gracilis halves may be a more appropriate graft choice for anterolateral ligament reconstruction due to its low energy dissipation and permanent deformation under dynamic loads. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Taylan, Orcun AU - Taylan O AD - Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium. Electronic address: orcun.taylan@kuleuven.be. FAU - Slane, Josh AU - Slane J AD - Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium. FAU - van Beek, Nathalie AU - van Beek N AD - Department of Orthopaedic Surgery, AZ St Elisabeth, Herentals, Belgium. FAU - Dandois, Felix AU - Dandois F AD - Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium. FAU - Scheys, Lennart AU - Scheys L AD - Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium; Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium. FAU - Claes, Steven AU - Claes S AD - Department of Orthopaedic Surgery, AZ St Elisabeth, Herentals, Belgium. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230329 PL - England TA - Clin Biomech (Bristol) JT - Clinical biomechanics (Bristol, Avon) JID - 8611877 SB - IM MH - Humans MH - Biomechanical Phenomena MH - Cadaver MH - *Anterior Cruciate Ligament/surgery MH - Tendons/transplantation MH - Knee Joint/surgery MH - *Anterior Cruciate Ligament Injuries/surgery OTO - NOTNLM OT - Anterolateral ligament OT - Gracilis tendon OT - Graft OT - Iliotibial band OT - Viscoelastic properties COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/04/06 06:00 MHDA- 2023/04/25 06:42 CRDT- 2023/04/05 18:04 PHST- 2022/10/11 00:00 [received] PHST- 2023/03/07 00:00 [revised] PHST- 2023/03/27 00:00 [accepted] PHST- 2023/04/25 06:42 [medline] PHST- 2023/04/06 06:00 [pubmed] PHST- 2023/04/05 18:04 [entrez] AID - S0268-0033(23)00080-3 [pii] AID - 10.1016/j.clinbiomech.2023.105949 [doi] PST - ppublish SO - Clin Biomech (Bristol). 2023 Apr;104:105949. doi: 10.1016/j.clinbiomech.2023.105949. Epub 2023 Mar 29. PMID- 36994749 OWN - NLM STAT- MEDLINE DCOM- 20230501 LR - 20230826 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 36 IP - 3 DP - 2023 Jun 1 TI - Etiology and management of hypofibrinogenemia in trauma. PG - 382-387 LID - 10.1097/ACO.0000000000001265 [doi] AB - PURPOSE OF REVIEW: Fibrin polymerization is essential for stable clot formation in trauma, and hypofibrinogenemia reduces hemostasis in trauma. This review considers fibrinogen biology, the changes that fibrinogen undergoes after major trauma, and current evidence for lab testing and treatment. RECENT FINDINGS: Fibrinogen is a polypeptide that is converted to fibrin by the action of thrombin. During trauma, fibrinogen levels are consumed and reduce within the first few hours because of consumption, dilution, and fibrinolysis. Fibrinogen levels usually rebound within 48 hours of injury and can contribute to thrombotic events. The Clauss fibrinogen assay is the gold standard test for fibrinogen levels, although viscoelastic hemostatic assays are often used when a lab delay is anticipated. An evidence-based threshold for fibrinogen replacement is not well established in the literature, but expert opinion recommends maintaining a level above 150 mg/dl. SUMMARY: Hypofibrinogenemia is an important cause of nonanatomic bleeding in trauma. Despite multiple pathologic causes, the cornerstone of treatment remains fibrinogen replacement with cryoprecipitate or fibrinogen concentrates. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Nathwani, Rajen AU - Nathwani R AD - Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington. FAU - Proumen, Adrian AU - Proumen A AD - State University of New York (SUNY) Upstate University Hospital, Syracuse, New York. FAU - Blaine, Kevin P AU - Blaine KP AD - Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, UHN2, Portland, Orlando, USA. LA - eng PT - Journal Article PT - Review DEP - 20230306 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 9001-32-5 (Fibrinogen) RN - 0 (Hemostatics) RN - 9001-31-4 (Fibrin) SB - IM MH - Humans MH - *Afibrinogenemia/complications/diagnosis MH - Hemostasis MH - Fibrinogen/therapeutic use/analysis MH - Hemorrhage/etiology/therapy MH - *Hemostatics MH - Fibrin EDAT- 2023/03/31 06:00 MHDA- 2023/05/01 06:42 CRDT- 2023/03/30 05:13 PHST- 2023/05/01 06:42 [medline] PHST- 2023/03/31 06:00 [pubmed] PHST- 2023/03/30 05:13 [entrez] AID - 00001503-202306000-00022 [pii] AID - 10.1097/ACO.0000000000001265 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2023 Jun 1;36(3):382-387. doi: 10.1097/ACO.0000000000001265. Epub 2023 Mar 6. PMID- 36971054 OWN - NLM STAT- MEDLINE DCOM- 20230518 LR - 20230624 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 63 Suppl 3 DP - 2023 May TI - Hemostatics in patients with inhibited coagulation-A viscoelastic in-vitro analysis. PG - S159-S167 LID - 10.1111/trf.17333 [doi] AB - BACKGROUND: The military has used topical hemostatic agents to successfully treat life-threatening external bleeding for years. In contrast to the military environment, the general population are increasingly prescribed anticoagulants. There are only few comparative evaluations of topical hemostatic agents with anticoagulated human blood. It is important to understand the impact of these agents on those who take anticoagulants. STUDY DESIGN AND METHODS: Citrated blood of patients treated with enoxaparin, heparin, and acetylsalicylic acid, apixaban or phenprocoumon was incubated with different hemostatic agents (QuikClot Gauze, Celox Granules, Celox Gauze, Chito SAM 100, WoundClot Trauma Gauze, QuikClot Gauze Moulage Trainer and Kerlix) and rotational thromboelastometry was performed with non-activated thromboelastometry (NATEM reagent). RESULTS: All tested agents improved the onset of coagulation in all anticoagulants, mostly to a significant degree. Most significant improvements were produced by QuikClot Gauze and QuikClot Gauze Moulage Trainer, followed by the tested chitosans (Celox Granules, Celox Gauze, Chito SAM 100). Of the anticoagulant groups, the most significant improvements were seen in enoxaparin. This was followed in order by apixaban, heparin, and acetylsalicylic acid, and phenprocoumon. DISCUSSION: All the hemostatic agents tested were able to activate the clotting cascade earlier and initiate faster clot formation in anticoagulated blood. A definitive head-to-head comparison is not feasible, because of the limitations of an in-vitro analysis. However, the sometimes-presented hypothesis that kaolin-based hemostatic agents are ineffective in anticoagulated blood is inaccurate according to our data. Hemostasis with hemostatic agents appears most challenging with phenprocoumon. CI - (c) 2023 AABB. FAU - Lechner, Raimund AU - Lechner R AUID- ORCID: 0000-0002-5961-335X AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. FAU - Hanke, Katharina AU - Hanke K AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. FAU - Schmid, Anna AU - Schmid A AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. FAU - Mayer, Benjamin AU - Mayer B AUID- ORCID: 0000-0003-1042-9006 AD - Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. FAU - Helm, Matthias AU - Helm M AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. FAU - Kulla, Martin AU - Kulla M AUID- ORCID: 0000-0001-7454-0876 AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. FAU - Hossfeld, Bjorn AU - Hossfeld B AUID- ORCID: 0000-0002-5048-2533 AD - Bundeswehr Hospital Ulm, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Ulm, Germany. LA - eng PT - Journal Article DEP - 20230426 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Hemostatics) RN - Q08SIO485D (Phenprocoumon) RN - 0 (Enoxaparin) RN - 0 (Anticoagulants) RN - 9005-49-6 (Heparin) RN - R16CO5Y76E (Aspirin) SB - IM MH - Humans MH - *Hemostatics/pharmacology MH - Phenprocoumon MH - Enoxaparin/pharmacology MH - Anticoagulants/pharmacology/therapeutic use MH - Heparin/pharmacology MH - Aspirin/pharmacology/therapeutic use OTO - NOTNLM OT - NATEM reagent OT - anticoagulation OT - bleeding control OT - hemostatic agent OT - viscoelastic testing EDAT- 2023/03/28 06:00 MHDA- 2023/05/18 06:42 CRDT- 2023/03/27 05:15 PHST- 2023/02/16 00:00 [revised] PHST- 2022/11/17 00:00 [received] PHST- 2023/02/16 00:00 [accepted] PHST- 2023/05/18 06:42 [medline] PHST- 2023/03/28 06:00 [pubmed] PHST- 2023/03/27 05:15 [entrez] AID - 10.1111/trf.17333 [doi] PST - ppublish SO - Transfusion. 2023 May;63 Suppl 3:S159-S167. doi: 10.1111/trf.17333. Epub 2023 Apr 26. PMID- 36941236 OWN - NLM STAT- MEDLINE DCOM- 20230727 LR - 20240401 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 95 IP - 2 DP - 2023 Aug 1 TI - Advances in trauma care to save lives from traumatic injury: A narrative review. PG - 285-292 LID - 10.1097/TA.0000000000003960 [doi] AB - Recent advances on trauma management from the prehospital setting to in hospital care led to a better surviving severe trauma rate. Mortality from exsanguination remains the first preventable mortality. Damage-control resuscitation and surgery are evolving and thus some promising concepts are developing. Transfusion toolkit is brought on the prehospital scene while temporary bridge to hemostasis may be helpful. Panel transfusion products allow an individualized ratio assumed by fresh frozen or lyophilized plasma, fresh or cold-stored whole blood, fibrinogen, four-factor prothrombin complex concentrates. Growing interest is raising in whole blood transfusion, resuscitative endovascular balloon occlusion of the aorta use, hybrid emergency room, viscoelastic hemostatic assays to improve patient outcomes. Microcirculation, traumatic endotheliopathy, organ failures and secondary immunosuppression are point out since late deaths are increasing and may deserve specific treatment.As each trauma patient follows his own course over the following days after trauma, trauma management may be seen through successive, temporal, and individualized aims. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Schmitt, Johan AU - Schmitt J AD - From the Intensive Care Unit, Military Teaching Hospital Clermont Tonnerre (S.J., A.P., D.D.D.M.), Brest, France; US Army Institute of Surgical Research (G.J.), San Antonio, Texas; and Joint Trauma System, DoD Center of Excellence for Trauma (G.J.), San Antonio, Texas. FAU - Gurney, Jennifer AU - Gurney J FAU - Aries, Philippe AU - Aries P FAU - Danguy Des Deserts, Marc AU - Danguy Des Deserts M LA - eng PT - Journal Article PT - Review DEP - 20230321 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemostatics) SB - IM MH - Humans MH - Aorta MH - Blood Transfusion MH - Exsanguination/etiology/therapy MH - Hemostasis MH - *Hemostatics MH - Resuscitation MH - *Emergency Medical Services MH - *Balloon Occlusion EDAT- 2023/03/22 06:00 MHDA- 2023/07/27 06:43 CRDT- 2023/03/21 00:04 PHST- 2023/07/27 06:43 [medline] PHST- 2023/03/22 06:00 [pubmed] PHST- 2023/03/21 00:04 [entrez] AID - 01586154-202308000-00017 [pii] AID - 10.1097/TA.0000000000003960 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Aug 1;95(2):285-292. doi: 10.1097/TA.0000000000003960. Epub 2023 Mar 21. PMID- 36934845 OWN - NLM STAT- MEDLINE DCOM- 20230619 LR - 20231121 IS - 2341-1929 (Electronic) IS - 2341-1929 (Linking) VI - 70 IP - 5 DP - 2023 May TI - Use of viscoelastic tests in the principle bleeding scenarios in Spanish hospitals. PG - 284-296 LID - S2341-1929(23)00076-8 [pii] LID - 10.1016/j.redare.2022.05.004 [doi] AB - Viscoelastic tests are designed to study the dynamics of clot formation, identify coagulopathies in real time, arrive at a diagnosis, and guide patient-specific administration of haemostatics. They are mainly used to treat clinically significant bleeding in any setting, and are also used in other situations involving clinically relevant alterations in haemostasis, such as coagulopathy in critically ill patients. These tests are administered following evidence-based algorithms that vary depending on the clinical context. This review summarises the results of a survey conducted in several hospitals to determine the prevalence and standardisation of viscoelastic tests in cardiac surgery, liver transplantation, and multiple trauma patients in Spain. The results reveal divergent opinions on key aspects, ranging from the diagnostic capacity of these tests to the interpretation of the basic parameters. On the basis of these findings, we propose a number of potential areas in which further research will improve the performance of these tests. CI - Copyright (c) 2023 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Publicado por Elsevier Espana, S.L.U. All rights reserved. FAU - Barquero, M AU - Barquero M AD - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Electronic address: mjcolomina@bellvitgehospital.cat. FAU - Yanes, G J AU - Yanes GJ AD - Hospital Universitario Virgen del Rocio, Sevilla, Spain. FAU - Blasi, A AU - Blasi A AD - Hospital Clinic, Barcelona, Spain; Institut d'Investigacio Biomedica Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain. FAU - Colomina, M J AU - Colomina MJ AD - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clinicas, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain. CN - Grupo Hemostasia - Seccion Hemostasia, Medicina Transfusional y Fluidoterapia - SEDAR LA - eng PT - Journal Article PT - Review DEP - 20230318 PL - Spain TA - Rev Esp Anestesiol Reanim (Engl Ed) JT - Revista espanola de anestesiologia y reanimacion JID - 101778594 SB - IM MH - Humans MH - Hemorrhage/etiology/therapy MH - *Blood Coagulation Disorders/diagnosis MH - Hemostasis MH - Spain/epidemiology MH - *Multiple Trauma OTO - NOTNLM OT - Coagulopathy OT - Coagulopatia OT - Haemostasis monitoring OT - Hemorragia quirurgica OT - Monitorizacion hemostasia OT - Practica transfusional OT - Surgical bleeding OT - Test viscoelasticos OT - Transfusion OT - Transfusion practice OT - Transfusion OT - Viscoelastic testing EDAT- 2023/03/20 06:00 MHDA- 2023/06/19 13:08 CRDT- 2023/03/19 20:28 PHST- 2021/11/29 00:00 [received] PHST- 2022/05/17 00:00 [accepted] PHST- 2023/06/19 13:08 [medline] PHST- 2023/03/20 06:00 [pubmed] PHST- 2023/03/19 20:28 [entrez] AID - S2341-1929(23)00076-8 [pii] AID - 10.1016/j.redare.2022.05.004 [doi] PST - ppublish SO - Rev Esp Anestesiol Reanim (Engl Ed). 2023 May;70(5):284-296. doi: 10.1016/j.redare.2022.05.004. Epub 2023 Mar 18. PMID- 36923287 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230316 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 14 DP - 2023 TI - SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock. PG - 1094845 LID - 10.3389/fphys.2023.1094845 [doi] LID - 1094845 AB - Irrespective of the reason for hypoperfusion, hypocoagulable and/or hyperfibrinolytic hemostatic aberrancies afflict up to one-quarter of critically ill patients in shock. Intensivists and traumatologists have embraced the concept of SHock-INduced Endotheliopathy (SHINE) as a foundational derangement in progressive shock wherein sympatho-adrenal activation may cause systemic endothelial injury. The pro-thrombotic endothelium lends to micro-thrombosis, enacting a cycle of worsening perfusion and increasing catecholamines, endothelial injury, de-endothelialization, and multiple organ failure. The hypocoagulable/hyperfibrinolytic hemostatic phenotype is thought to be driven by endothelial release of anti-thrombogenic mediators to the bloodstream and perivascular sympathetic nerve release of tissue plasminogen activator directly into the microvasculature. In the shock state, this hemostatic phenotype may be a counterbalancing, yet maladaptive, attempt to restore blood flow against a systemically pro-thrombotic endothelium and increased blood viscosity. We therefore review endothelial physiology with emphasis on glycocalyx function, unique biomarkers, and coagulofibrinolytic mediators, setting the stage for understanding the pathophysiology and hemostatic phenotypes of SHINE in various etiologies of shock. We propose that the hyperfibrinolytic phenotype is exemplified in progressive shock whether related to trauma-induced coagulopathy, sepsis-induced coagulopathy, or post-cardiac arrest syndrome-associated coagulopathy. Regardless of the initial insult, SHINE appears to be a catecholamine-driven entity which early in the disease course may manifest as hyper- or hypocoagulopathic and hyper- or hypofibrinolytic hemostatic imbalance. Moreover, these hemostatic derangements may rapidly evolve along the thrombohemorrhagic spectrum depending on the etiology, timing, and methods of resuscitation. Given the intricate hemochemical makeup and changes during these shock states, macroscopic whole blood tests of coagulative kinetics and clot strength serve as clinically useful and simple means for hemostasis phenotyping. We suggest that viscoelastic hemostatic assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are currently the most applicable clinical tools for assaying global hemostatic function-including fibrinolysis-to enable dynamic resuscitation with blood products and hemostatic adjuncts for those patients with thrombotic and/or hemorrhagic complications in shock states. CI - Copyright (c) 2023 Bunch, Chang, Moore, Moore, Kwaan, Miller, Al-Fadhl, Thomas, Zackariya, Patel, Zackariya, Haidar, Patel, McCurdy, Thomas, Zimmer, Fulkerson, Kim, Walsh, Hake, Kedar, Aboukhaled and Walsh. FAU - Bunch, Connor M AU - Bunch CM AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States. AD - Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, United States. FAU - Chang, Eric AU - Chang E AD - Department of Medical Education, Indiana University School of Medicine, Notre Dame Campus, South Bend, IN, United States. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, United States. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, United States. AD - Department of Transplant Surgery, Denver Health and University of Colorado Health Sciences Center, Denver, CO, United States. FAU - Kwaan, Hau C AU - Kwaan HC AD - Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. FAU - Miller, Joseph B AU - Miller JB AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States. AD - Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, United States. FAU - Al-Fadhl, Mahmoud D AU - Al-Fadhl MD AD - Department of Medical Education, Indiana University School of Medicine, Notre Dame Campus, South Bend, IN, United States. FAU - Thomas, Anthony V AU - Thomas AV AD - Department of Medical Education, Indiana University School of Medicine, Notre Dame Campus, South Bend, IN, United States. FAU - Zackariya, Nuha AU - Zackariya N AD - Department of Medical Education, Indiana University School of Medicine, Notre Dame Campus, South Bend, IN, United States. FAU - Patel, Shivani S AU - Patel SS AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States. FAU - Zackariya, Sufyan AU - Zackariya S AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States. FAU - Haidar, Saadeddine AU - Haidar S AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States. FAU - Patel, Bhavesh AU - Patel B AD - Division of Critical Care, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, United States. FAU - McCurdy, Michael T AU - McCurdy MT AD - Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. FAU - Thomas, Scott G AU - Thomas SG AD - Department of Trauma Surgery, Memorial Leighton Trauma Center, South Bend, IN, United States. FAU - Zimmer, Donald AU - Zimmer D AD - Department of Trauma Surgery, Memorial Leighton Trauma Center, South Bend, IN, United States. FAU - Fulkerson, Daniel AU - Fulkerson D AD - Department of Trauma Surgery, Memorial Leighton Trauma Center, South Bend, IN, United States. FAU - Kim, Paul Y AU - Kim PY AD - Department of Medicine, McMaster University, Hamilton, ON, Canada. AD - Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada. FAU - Walsh, Matthew R AU - Walsh MR AD - Cardinal Flow Assurance LLC, Mishawaka, IN, United States. FAU - Hake, Daniel AU - Hake D AD - Departments of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States. FAU - Kedar, Archana AU - Kedar A AD - Departments of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States. FAU - Aboukhaled, Michael AU - Aboukhaled M AD - Departments of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States. FAU - Walsh, Mark M AU - Walsh MM AD - Department of Medical Education, Indiana University School of Medicine, Notre Dame Campus, South Bend, IN, United States. AD - Departments of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States. LA - eng PT - Journal Article PT - Review DEP - 20230227 PL - Switzerland TA - Front Physiol JT - Frontiers in physiology JID - 101549006 PMC - PMC10009294 OTO - NOTNLM OT - critical care OT - endothelium OT - glycocalyx OT - hemostasis OT - precision medicine OT - resuscitation OT - shock OT - thromboelastography COIS- EM and HM have received research grants from Haemonetics Corporation outside the submitted work. Author MrW is employed by the company Cardinal Flow Assurance LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer, AD, declared a shared parent affiliation with the author MM to the handling editor at the time of review. EDAT- 2023/03/17 06:00 MHDA- 2023/03/17 06:01 PMCR- 2023/02/27 CRDT- 2023/03/16 02:20 PHST- 2022/11/10 00:00 [received] PHST- 2023/02/07 00:00 [accepted] PHST- 2023/03/16 02:20 [entrez] PHST- 2023/03/17 06:00 [pubmed] PHST- 2023/03/17 06:01 [medline] PHST- 2023/02/27 00:00 [pmc-release] AID - 1094845 [pii] AID - 10.3389/fphys.2023.1094845 [doi] PST - epublish SO - Front Physiol. 2023 Feb 27;14:1094845. doi: 10.3389/fphys.2023.1094845. eCollection 2023. PMID- 36919936 OWN - NLM STAT- MEDLINE DCOM- 20230718 LR - 20250821 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 237 IP - 2 DP - 2023 Aug 1 TI - Admission Thromboelastography at the Intersection of Traumatic Coagulopathy and Inflammation: A Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Study Subanalysis. PG - 259-269 LID - 10.1097/XCS.0000000000000678 [doi] AB - BACKGROUND: Acute traumatic coagulopathy (ATC) has many phenotypes and varying morbidity and mortality. The MA-R ratio, calculated from the admission thromboelastogram, serves as a biomarker to identify 1 phenotype of ATC and has previously been associated with significant derangements in the inflammatory response. This study evaluates outcomes related to abnormal MA-R ratios, including inflammatory responses, in a heterogeneous patient population. STUDY DESIGN: Patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) dataset were included. The MA-R ratio was calculated from admission thromboelastography, with a CRITICAL ratio defined as 11 or less. Key inflammatory mediators were identified as a priori. Cytokine expression was assessed during 24 hours using multivariable logistic regression. RESULTS: Significant elevations in the proinflammatory cytokines IL-1b, IL-6, and IL-8, as well as in the chemokines eotaxin, IFN-gamma-induced protein 10, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1beta, persisted during the first 24 hours. CRITICAL patients had significantly lower survival at 1, 3, 6, 12, and 18 hours and demonstrated significantly increased ARDS (odds ratio [OR] 1.817, 95% CI 1.082 to 3.051, p = 0.0239). CRITICAL patients had fewer ICU-free days (CRITICAL, 10 days, interquartile range [IQR] 0 to 25; vs NORMAL, 22 days, IQR 4 to 26, p < 0.0001) and fewer ventilator-free days (CRITICAL, 15 days, IQR 0 to 28; vs NORMAL, 26 days, IQR 9 to 28, p < 0.0001). CRITICAL patients were protected against systemic inflammatory response (OR 0.521, 95% CI 0.322 to 0.816, p = 0.0044). CONCLUSIONS: The subtype of ATC identified by the low MA-R ratio is associated with significant elevations in multiple proinflammatory cytokines at admission. Early mortality remains elevated in the CRITICAL group, in part due to coagulopathy. The MA-R ratio at admission is associated with a particularly morbid type of coagulopathy, associated with significant alterations in the inflammatory response after severe injury in heterogeneous patient populations. CI - Copyright (c) 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Savage, Stephanie A AU - Savage SA AD - From the University of Wisconsin School of Medicine & Public Health, Madison, WI (Savage, Zarzaur, Carney, Do). FAU - Zarzaur, Ben L AU - Zarzaur BL AD - From the University of Wisconsin School of Medicine & Public Health, Madison, WI (Savage, Zarzaur, Carney, Do). FAU - Fox, Erin E AU - Fox EE AD - University of Texas Health Science Center at Houston, Houston, TX (Fox, Wade). FAU - Wade, Charles E AU - Wade CE AD - University of Texas Health Science Center at Houston, Houston, TX (Fox, Wade). FAU - Carney, Patrick R AU - Carney PR AD - From the University of Wisconsin School of Medicine & Public Health, Madison, WI (Savage, Zarzaur, Carney, Do). FAU - Do, Trieu V AU - Do TV AD - From the University of Wisconsin School of Medicine & Public Health, Madison, WI (Savage, Zarzaur, Carney, Do). FAU - Holcomb, John B AU - Holcomb JB AD - University of Alabama at Birmingham, Birmingham, AL (Holcomb). LA - eng GR - U01 HL077863/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20230315 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 0 (Cytokines) SB - IM MH - Humans MH - *Thrombelastography MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Platelets MH - Cytokines MH - Inflammation/etiology EDAT- 2023/03/16 06:00 MHDA- 2023/07/18 13:07 CRDT- 2023/03/15 08:04 PHST- 2023/07/18 13:07 [medline] PHST- 2023/03/16 06:00 [pubmed] PHST- 2023/03/15 08:04 [entrez] AID - 00019464-202308000-00015 [pii] AID - 10.1097/XCS.0000000000000678 [doi] PST - ppublish SO - J Am Coll Surg. 2023 Aug 1;237(2):259-269. doi: 10.1097/XCS.0000000000000678. Epub 2023 Mar 15. PMID- 36914441 OWN - NLM STAT- MEDLINE DCOM- 20231113 LR - 20231122 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 49 IP - 7 DP - 2023 Nov TI - Changes in coagulation and temperature management in burn patients - A survey of burn centers in Switzerland, Austria and Germany. PG - 1566-1573 LID - S0305-4179(23)00031-1 [pii] LID - 10.1016/j.burns.2023.02.010 [doi] AB - BACKGROUND: Severely burned patients suffer from both coagulopathy and hypothermia, with a lack of international consensus and appropriate treatment guidelines. This study examines recent developments and trends in coagulation and temperature management in European burn centers. METHODS: A survey was sent to burn centers in Switzerland, Austria and Germany in 2016 and again in 2021. The analysis was performed using descriptive statistics, with categorical data reported in absolute numbers (n) and percentages (%) and numerical data reported as mean and standard deviation. RESULTS: The rate of completed questionnaires was 84 % (16 of 19 questionnaires) in 2016 and 91 % (21 of 22 questionnaires) in 2021. The number of global coagulation tests performed has decreased over the observation period in favor of single factor determination and bed-side point-of-care coagulation tests. This has also led to increased administration of single factor concentrates in therapy. Although many centers had a defined treatment protocol for hypothermia in 2016, coverage increased such that in 2021 all centers surveyed had such a protocol. The body temperature was measured more consistently in 2021; thus, hypothermia was more actively sought, detected and treated. CONCLUSION: A point-of-care guided, factor-based coagulation management and the maintenance of normothermia have gained importance in the care of burn patients in recent years. CI - Copyright (c) 2023 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Roggan, Celine L M AU - Roggan CLM AD - Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. FAU - Akbas, Samira AU - Akbas S AD - Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. FAU - Arvanitakis, Michael AU - Arvanitakis M AD - University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland. FAU - Mannil, Lijo AU - Mannil L AD - University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland. FAU - Spahn, Donat R AU - Spahn DR AD - Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. FAU - Plock, Jan A AU - Plock JA AD - University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery; Cantonal Hospital Aarau; Aarau, Switzerland. FAU - Kaserer, Alexander AU - Kaserer A AD - Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: alexander.kaserer@usz.ch. LA - eng PT - Journal Article DEP - 20230224 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 SB - IM MH - Humans MH - Burn Units MH - *Hypothermia MH - Temperature MH - Austria MH - Switzerland MH - *Burns/therapy MH - Surveys and Questionnaires MH - Germany OTO - NOTNLM OT - Burns OT - Coagulation management OT - Point-of-care tests OT - Temperature management COIS- Conflicts of interests CR, SA, MA and LM have no conflicts of interests to report. Dr. Spahn's academic department is receiving grant support from the Swiss National Science Foundation, Berne, Switzerland, the Swiss Society of Anesthesiology and Perioperative Medicine (SSAPM), Berne, Switzerland, the Swiss Foundation for Anesthesia Research, Zurich, Switzerland, Vifor SA, Villars-sur-Glane, Switzerland and Vifor (International) AG, St. Gallen, Switzerland.Dr. Spahn is co-chair of the ABC-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biomedicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland.Dr. Spahn received honoraria / travel support for consulting or lecturing from:Danube University of Krems, Austria, European Society of Anesthesiology and Intensive Care, Brussels, BE, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anesthesiologists, Seoul, Korea, Network for the Advancement of Patient Blood Management, Hemostasis and Thrombosis, Paris, France, Alexion Pharmaceuticals Inc., Boston, MA, AstraZeneca AG, Baar, Switzerland, Bayer AG, Zurich, Switzerland, B. Braun Melsungen AG, Melsungen, Germany, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II Sarl, Couvet, Switzerland, Daiichi Sankyo AG, Thalwil, Switzerland, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biomedicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, Novo Nordisk Health Care AG, Zurich, Switzerland, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Pfizer AG, Zurich, Switzerland, Pierre Fabre Pharma, Alschwil, Switzerland, Portola Schweiz GmbH, Aarau, Switzerland, Roche Diagnostics International Ltd, Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and Numbrecht, Germany, Shire Switzerland GmbH, Zug, Switzerland, Takeda, Glattpark, Switzerland, Tem International GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Neuilly sur Seine, France and Villars-sur-Glane, Switzerland, Vifor (International) AG, St. Gallen, Switzerland, Zuellig Pharma Holdings, Singapore, Singapore. AK received honoraria for lecturing from Bayer AG, Zurich, Switzerland. JAP received grant support from the Swiss National Science Foundation. JAP received honoraria/travel support from Mediwound (Russelsheim, Germany), Integra Lifesciences (Saint Priest, France), Polymedics (Denkendorf, Germany), Nanomedic Technologies (Lod, Israel). EDAT- 2023/03/14 06:00 MHDA- 2023/11/13 06:42 CRDT- 2023/03/13 22:59 PHST- 2022/09/06 00:00 [received] PHST- 2023/01/13 00:00 [revised] PHST- 2023/02/19 00:00 [accepted] PHST- 2023/11/13 06:42 [medline] PHST- 2023/03/14 06:00 [pubmed] PHST- 2023/03/13 22:59 [entrez] AID - S0305-4179(23)00031-1 [pii] AID - 10.1016/j.burns.2023.02.010 [doi] PST - ppublish SO - Burns. 2023 Nov;49(7):1566-1573. doi: 10.1016/j.burns.2023.02.010. Epub 2023 Feb 24. PMID- 36911060 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230314 IS - 1920-8642 (Print) IS - 1920-8642 (Linking) VI - 14 IP - 2 DP - 2023 TI - Prediction of return of spontaneous circulation in out-of-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study. PG - 89-95 LID - 10.5847/wjem.j.1920-8642.2023.031 [doi] AB - BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation (ROSC) and its prognostic factors. Rotational thromboelastometry (ROTEM((R))), a point-of-care testing (POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompanying non-shockable rhythm. METHODS: This is a single-center, retrospective observational study. Complete blood count, blood gas, and ROTEM POCT measurements were used. This study included patients with non-traumatic OHCA aged 18 years or older who were transported to the emergency department and evaluated using POCT between January 2013 and December 2021. The patients were divided into the ROSC and non-ROSC groups. Prehospital information and POCT parameters were compared using receiver operating characteristic (ROC) curve analysis, and further logistic regression analysis was performed. RESULTS: Sixty-seven and 135 patients were in the ROSC and non-ROSC groups, respectively. The ROC curves showed a high area under the curve (AUC) for K(+) of 0.77 (95% confidence interval [CI]: 0.71-0.83) and EXTEM amplitude 5 min after clotting time (A5) of 0.70 (95%CI: 0.62-0.77). The odds ratios for ROSC were as follows: female sex 3.67 (95%CI: 1.67-8.04); K(+) 0.64 (95%CI: 0.48-0.84); and EXTEM A5 1.03 (95%CI: 1.01-1.06). CONCLUSION: In OHCA patients with non-shockable rhythm, K(+) level and the ROTEM parameter EXTEM A5 may be useful in predicting ROSC. CI - Copyright: (c) World Journal of Emergency Medicine. FAU - Shinada, Kota AU - Shinada K AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture 849-8501, Japan. FAU - Koami, Hiroyuki AU - Koami H AD - Division of Translational Research in Intensive Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture 849-8501, Japan. FAU - Matsuoka, Ayaka AU - Matsuoka A AD - Division of Translational Research in Intensive Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture 849-8501, Japan. FAU - Sakamoto, Yuichiro AU - Sakamoto Y AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture 849-8501, Japan. LA - eng PT - Journal Article PL - China TA - World J Emerg Med JT - World journal of emergency medicine JID - 101549691 PMC - PMC9999141 OTO - NOTNLM OT - Blood coagulation disorders OT - Extrinsic pathway OT - Potassium OT - Rotational thromboelastometry COIS- Conflicts of interest: The authors have no potential conflicts of interest to disclose. EDAT- 2023/03/14 06:00 MHDA- 2023/03/14 06:01 PMCR- 2023/01/01 CRDT- 2023/03/13 04:20 PHST- 2022/08/09 00:00 [received] PHST- 2022/11/10 00:00 [accepted] PHST- 2023/03/13 04:20 [entrez] PHST- 2023/03/14 06:00 [pubmed] PHST- 2023/03/14 06:01 [medline] PHST- 2023/01/01 00:00 [pmc-release] AID - WJEM-14-89 [pii] AID - 10.5847/wjem.j.1920-8642.2023.031 [doi] PST - ppublish SO - World J Emerg Med. 2023;14(2):89-95. doi: 10.5847/wjem.j.1920-8642.2023.031. PMID- 36908225 OWN - NLM STAT- MEDLINE DCOM- 20230808 LR - 20230808 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 89 IP - 8 DP - 2023 Aug TI - Hypofibrinogenemic Massive Transfusion Trauma Patients Experience Worse Outcomes. PG - 3423-3428 LID - 10.1177/00031348231162711 [doi] AB - INTRODUCTION: Uncontrolled hemorrhage accounts for up to 40% of trauma-related mortality. Previous reports demonstrate that decreased fibrinogen levels during traumatic hemorrhage are associated with worse outcomes. Cryoprecipitate is used to replace fibrinogen for patients in hemorrhagic shock undergoing massive transfusion (MT), though the optimal ratio of cryoprecipitate to fresh frozen plasma (FFP), packed red blood cells (PRBCs), and platelets remains undefined. The purpose of this study is to investigate the effect of admission fibrinogen level and the use of cryoprecipitate on outcomes in trauma patients undergoing MT. METHODS: A prospective practice management guideline was established to obtain fibrinogen levels on adult trauma patients undergoing MT at a level I trauma center from December 2019 to December 2021. Ten units of cryoprecipitate were administered every other round of MT. Thromboelastography (TEG) was also obtained at the initiation and completion of MT. Patient demographic, injury, transfusion, and outcome data were collected. Hypofibrinogenemic (<200 mg/dL) patients at initiation of MT were compared to patients with a level of 200 mg/dL or greater. RESULTS: A total of 96 out of 130 patients met criteria and underwent MT with a median admission fibrinogen of 170.5 mg/dL. Hypofibrinogenemia was associated with elevated INR (1.26 vs 1.13, P < .001) and abnormal TEG including decreased alpha angle (68.1 vs 73.3, P < .001), increased K time (1.7 vs 1.1, P < .001), and decreased max amplitude (58 vs 66, P < .001). Patients with hypofibrinogenemia received more PRBC (10 vs 7 U, P = .002), FFP (9 vs 6 U, P = .003), and platelets (2 vs 1 U, P = .004) during MT. Hypofibrinogenemic patients demonstrated greater mortality than patients with normal levels (50% vs 23.5%, P = .021). Older age, decreased GCS, and elevated injury severity score (ISS) were risk factors for mortality. Increased fibrinogen was associated with lower odds of mortality (P = .001). Age, ISS, and fibrinogen level remained significantly associated with mortality in a multivariable analysis. Overall, fibrinogen in post-MT survivors showed an increase in median level compared to admission (231 vs 177.5 mg/dL, P < .001). CONCLUSION: Trauma patients undergoing MT with decreased admission fibrinogen demonstrate increased mortality. Other mortality risk factors include older age, decreased GCS, and higher ISS. Patients with increased fibrinogen levels had lower odds of mortality in a multivariable model. Post-MT survivors demonstrated significantly higher fibrinogen levels than pre-MT patients. Hypofibrinogenemic patients also had worse TEG parameters and required more PRBCs, FFP, and platelets during MT. Further studies are needed to assess the optimal volume of fibrinogen replacement with cryoprecipitate during MT to improve trauma patient mortality. FAU - Parker, Mitchell J AU - Parker MJ AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Tennessee Health Science Center, Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Crowder, Elizabeth W AU - Crowder EW AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Tennessee Health Science Center, Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Miles, M Victoria P AU - Miles MVP AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Tennessee Health Science Center, Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Harrell, Kevin N AU - Harrell KN AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Tennessee Health Science Center, Chattanooga, TN, USA. RINGGOLD: 70274 FAU - Maxwell, Robert A AU - Maxwell RA AD - Department of Surgery, Division of Trauma and Acute Care Surgery, University of Tennessee Health Science Center, Chattanooga, TN, USA. RINGGOLD: 70274 LA - eng PT - Journal Article DEP - 20230312 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 9001-32-5 (Fibrinogen) RN - 0 (Hemostatics) SB - IM MH - Adult MH - Humans MH - *Afibrinogenemia/therapy/complications MH - Prospective Studies MH - Retrospective Studies MH - Hemorrhage/etiology/therapy MH - Fibrinogen MH - *Hemostatics MH - Trauma Centers MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - cryoprecipitate OT - hypofibrinogenemia OT - massive transfusion protocol OT - trauma resuscitation OT - traumatic hemorrhage EDAT- 2023/03/14 06:00 MHDA- 2023/08/08 06:42 CRDT- 2023/03/13 03:03 PHST- 2023/08/08 06:42 [medline] PHST- 2023/03/14 06:00 [pubmed] PHST- 2023/03/13 03:03 [entrez] AID - 10.1177/00031348231162711 [doi] PST - ppublish SO - Am Surg. 2023 Aug;89(8):3423-3428. doi: 10.1177/00031348231162711. Epub 2023 Mar 12. PMID- 36894877 OWN - NLM STAT- MEDLINE DCOM- 20230313 LR - 20230313 IS - 1471-2466 (Electronic) IS - 1471-2466 (Linking) VI - 23 IP - 1 DP - 2023 Mar 9 TI - Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial. PG - 80 LID - 10.1186/s12890-023-02372-0 [doi] LID - 80 AB - BACKGROUND: Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia-reperfusion injury after allograft implantation play an important role in subsequent PGD development. METHODS: We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. RESULTS: Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18-129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105-0.267). After dichotomization of PGD (0-1 vs 2-3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2-3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). CONCLUSIONS: Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov (NCT03598907). CI - (c) 2023. The Author(s). FAU - Vajter, Jaromir AU - Vajter J AD - Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. FAU - Vachtenheim, Jiri Jr AU - Vachtenheim J Jr AD - Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. jiri.vachtenheim@fnmotol.cz. FAU - Prikrylova, Zuzana AU - Prikrylova Z AD - Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. FAU - Berousek, Jan AU - Berousek J AD - Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. FAU - Vymazal, Tomas AU - Vymazal T AD - Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. FAU - Lischke, Robert AU - Lischke R AD - Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. FAU - Martin, Archer Kilbourne AU - Martin AK AD - Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA. FAU - Durila, Miroslav AU - Durila M AD - Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. LA - eng SI - ClinicalTrials.gov/NCT03598907 PT - Journal Article PT - Randomized Controlled Trial DEP - 20230309 PL - England TA - BMC Pulm Med JT - BMC pulmonary medicine JID - 100968563 SB - IM MH - Humans MH - *Primary Graft Dysfunction MH - *Lung Transplantation MH - Hemorrhage MH - *Reperfusion Injury MH - Allografts PMC - PMC9996868 OTO - NOTNLM OT - 5% albumin OT - Anesthetic management OT - Lung transplantation OT - Rotational thromboelastometry OT - Volume replacement therapy COIS- The authors declare that they have no competing interests. EDAT- 2023/03/10 06:00 MHDA- 2023/03/14 06:00 PMCR- 2023/03/09 CRDT- 2023/03/09 23:33 PHST- 2022/09/23 00:00 [received] PHST- 2023/02/27 00:00 [accepted] PHST- 2023/03/09 23:33 [entrez] PHST- 2023/03/10 06:00 [pubmed] PHST- 2023/03/14 06:00 [medline] PHST- 2023/03/09 00:00 [pmc-release] AID - 10.1186/s12890-023-02372-0 [pii] AID - 2372 [pii] AID - 10.1186/s12890-023-02372-0 [doi] PST - epublish SO - BMC Pulm Med. 2023 Mar 9;23(1):80. doi: 10.1186/s12890-023-02372-0. PMID- 36894466 OWN - NLM STAT- MEDLINE DCOM- 20230609 LR - 20230609 IS - 1473-0502 (Print) IS - 1473-0502 (Linking) VI - 62 IP - 3 DP - 2023 Jun TI - Reduction of anti-A and anti-B isoagglutinin titers of group O whole blood units employing an ABO antibody immune adsorption column. PG - 103686 LID - S1473-0502(23)00054-X [pii] LID - 10.1016/j.transci.2023.103686 [doi] AB - BACKGROUND: Massive hemorrhage is a leading cause of death from trauma. There is growing interest in group O whole blood transfusions to mitigate coagulopathy and hemorrhagic shock. Insufficient availability of low-titer group O whole blood is a barrier to routine use. We tested the efficacy of the Glycosorb(R) ABO immunoadsorption column to reduce anti-A/B titers in group O whole blood. METHODS: Six group O whole blood units were collected from healthy volunteers, and centrifuged to separate platelet poor plasma. Platelet-poor plasma was filtered through a Glycosorb(R) ABO antibody immunoabsorption column, then reconstituted to prepare post-filtration whole blood. Anti-A/B titers, CBC, free hemoglobin, and thromboelastography (TEG) assays were performed on pre-and post-filtration whole blood. RESULTS: Mean( +/- SEM) anti-A (224 +/- 65 pre vs 13 +/- 4 post) and anti-B (138 +/- 38 pre vs 11 +/- 4 post) titers were significantly reduced (p = 0.004) in post-filtration whole blood. No significant changes were detected in CBC, free hemoglobin, and TEG parameters on day 0. Free hemoglobin increased throughout storage (48 mg/dl +/- 24 Day 0 vs 73 +/- 35 Day 7 vs 96 +/- 44 Day 14; p = 0.14). CONCLUSIONS: The Glycosorb(R) ABO column can significantly reduce anti-A/B isoagglutinin titers of group O whole blood units. Glycosorb(R) ABO could be employed to provide whole blood with lower risk of hemolysis and other consequences of infusing ABO incompatible plasma. Preparation of group O whole blood with substantially reduced anti-A/B would also increase the supply of low-titer group O whole blood for transfusion. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Gupta, Gaurav K AU - Gupta GK AD - Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA. Electronic address: guptag2@mskcc.org. FAU - Henrichs, Kelly AU - Henrichs K AD - Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA. Electronic address: Kelly_Henrichs@URMC.Rochester.edu. FAU - Nilsson, Kurt AU - Nilsson K AD - Glycorex Transplantation AB, Section of Hematology, Lund, Sweden. Electronic address: jn@glycorex.se. FAU - Wagner, Stephen AU - Wagner S AD - American Red Cross Holland Laboratory, Rockville, MD, USA. Electronic address: wagstalbot@yahoo.com. FAU - Brown, Bethany AU - Brown B AD - American Red Cross Holland Laboratory, Rockville, MD, USA. Electronic address: bethany.brown2@redcross.org. FAU - Masel, Debra AU - Masel D AD - Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA. Electronic address: Debra_Masel@URMC.Rochester.edu. FAU - Gestring, Mark L AU - Gestring ML AD - Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA. Electronic address: Mark_Gestring@urmc.rochester.edu. FAU - Vella, Michael A AU - Vella MA AD - Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA. Electronic address: Michael_Vella@urmc.rochester.edu. FAU - Refaai, Majed A AU - Refaai MA AD - Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA. Electronic address: Majed_Refaai@URMC.Rochester.edu. FAU - Blumberg, Neil AU - Blumberg N AD - Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA. Electronic address: Neil_Blumberg@URMC.Rochester.edu. LA - eng PT - Journal Article DEP - 20230305 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 RN - 0 (Antibodies) RN - 0 (Hemagglutinins) RN - 0 (ABO Blood-Group System) MH - Humans MH - Adsorption MH - *Antibodies MH - *Hemagglutinins MH - ABO Blood-Group System MH - Blood Group Incompatibility OTO - NOTNLM OT - ABO blood group OT - Immunoadsorption OT - Massive transfusion OT - Whole blood COIS- Conflict of interest GG, KH, DM, SW, BB, MG, MV, MR, NB: None. KN: staff member at Glycorex. EDAT- 2023/03/10 06:00 MHDA- 2023/06/09 06:42 CRDT- 2023/03/09 22:10 PHST- 2022/11/10 00:00 [received] PHST- 2023/02/17 00:00 [revised] PHST- 2023/02/27 00:00 [accepted] PHST- 2023/06/09 06:42 [medline] PHST- 2023/03/10 06:00 [pubmed] PHST- 2023/03/09 22:10 [entrez] AID - S1473-0502(23)00054-X [pii] AID - 10.1016/j.transci.2023.103686 [doi] PST - ppublish SO - Transfus Apher Sci. 2023 Jun;62(3):103686. doi: 10.1016/j.transci.2023.103686. Epub 2023 Mar 5. PMID- 36880555 OWN - NLM STAT- MEDLINE DCOM- 20230308 LR - 20240402 IS - 1531-7072 (Electronic) IS - 1070-5295 (Print) IS - 1070-5295 (Linking) VI - 29 IP - 2 DP - 2023 Apr 1 TI - Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients. PG - 50-60 LID - 10.1097/MCC.0000000000001027 [doi] AB - PURPOSE OF REVIEW: Spontaneous intracerebral hemorrhage (ICH) is the deadliest stroke subtype. Acute treatments necessitate rapid hemorrhage control to minimize secondary brain injury. Here, we discuss the overlap of transfusion medicine and acute ICH care relating to diagnostic testing and therapies relevant for coagulopathy reversal and secondary brain injury prevention. RECENT FINDINGS: Hematoma expansion (HE) is the largest contributor to poor outcomes after ICH. Conventional coagulation assays to diagnose coagulopathy after ICH does not predict HE. Given the testing limitations, empiric pragmatic hemorrhage control therapies have been trialed but have not improved ICH outcomes, with some therapies even causing harm. It is still unknown whether faster administration of these therapies will improve outcomes. Alternative coagulation tests (e.g., viscoelastic hemostatic assays, amongst others) may identify coagulopathies relevant for HE, currently not diagnosed using conventional assays. This provides opportunities for rapid, targeted therapies. In parallel, ongoing work is investigating alternative treatments using transfusion-based or transfusion-sparing pharmacotherapies that can be implemented in hemorrhage control strategies after ICH. SUMMARY: Further work is needed to identify improved laboratory diagnostic approaches and transfusion medicine treatment strategies to prevent HE and optimize hemorrhage control in ICH patients, who appear particularly vulnerable to the impacts of transfusion medicine practices. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Stone, Elizabeth F AU - Stone EF AD - Department of Pathology & Cell Biology. FAU - Poyraz, Fernanda Carvalho AU - Poyraz FC AD - Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA. FAU - Roh, David J AU - Roh DJ AD - Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA. LA - eng GR - K23 HL151901/HL/NHLBI NIH HHS/United States GR - R01 HL148151/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM MH - Humans MH - *Transfusion Medicine MH - Cerebral Hemorrhage/therapy MH - *Stroke/therapy MH - *Brain Injuries MH - Critical Care PMC - PMC9996464 MID - NIHMS1870638 COIS- CONFLICTS OF INTEREST: None. EDAT- 2023/03/08 06:00 MHDA- 2023/03/09 06:00 PMCR- 2024/04/01 CRDT- 2023/03/07 07:02 PHST- 2023/03/07 07:02 [entrez] PHST- 2023/03/08 06:00 [pubmed] PHST- 2023/03/09 06:00 [medline] PHST- 2024/04/01 00:00 [pmc-release] AID - 00075198-202304000-00003 [pii] AID - 10.1097/MCC.0000000000001027 [doi] PST - ppublish SO - Curr Opin Crit Care. 2023 Apr 1;29(2):50-60. doi: 10.1097/MCC.0000000000001027. PMID- 36872005 OWN - NLM STAT- MEDLINE DCOM- 20230309 LR - 20231205 IS - 1932-2275 (Print) IS - 1932-2275 (Linking) VI - 41 IP - 1 DP - 2023 Mar TI - Massive Trauma and Resuscitation Strategies. PG - 283-301 LID - S1932-2275(22)00108-2 [pii] LID - 10.1016/j.anclin.2022.10.008 [doi] AB - Massive trauma remains the leading cause of mortality among people aged younger than 45 years. In this review, we discuss the initial care and diagnosis of trauma patients followed by a comparison of resuscitation strategies. We discuss various strategies including use of whole blood and component therapy, examine viscoelastic techniques for management of coagulopathy, and consider the benefits and limitations of the resuscitation strategies and consider a series of questions that will be important for researchers to answer to provide the best and most cost-effective therapy for severely injured patients. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Galbraith, Carter M AU - Galbraith CM AD - Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 845, Birmingham, AL 35249, USA. FAU - Wagener, Brant M AU - Wagener BM AD - Division of Critical Care Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA; Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA. FAU - Chalkias, Athanasios AU - Chalkias A AD - Department of Anesthesiology, University of Thessaly, Biopolis, Larisa 41500, Greece; Outcomes Research Consortium, Cleveland, OH 44195, USA. FAU - Siddiqui, Shahla AU - Siddiqui S AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: ssiddiq4@bidmc.harvard.edu. FAU - Douin, David J AU - Douin DJ AD - Department of Anesthesiology, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO 80045, USA. Electronic address: david.douin@cuanschutz.edu. LA - eng GR - R01 GM127584/GM/NIGMS NIH HHS/United States GR - T32 GM135169/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review PL - United States TA - Anesthesiol Clin JT - Anesthesiology clinics JID - 101273663 SB - IM MH - Humans MH - *Resuscitation MH - *Wounds and Injuries/mortality/therapy PMC - PMC10688568 MID - NIHMS1944107 OTO - NOTNLM OT - Coagulopathy OT - Component therapy OT - Resuscitation OT - Trauma OT - Viscoelastic technique OT - Whole blood COIS- Disclosure None of the authors has any conflicts to disclose. Funding for this article was provided by R01GM127584 to B.M. Wagener. EDAT- 2023/03/06 06:00 MHDA- 2023/03/08 06:00 PMCR- 2023/11/30 CRDT- 2023/03/05 20:58 PHST- 2023/03/05 20:58 [entrez] PHST- 2023/03/06 06:00 [pubmed] PHST- 2023/03/08 06:00 [medline] PHST- 2023/11/30 00:00 [pmc-release] AID - S1932-2275(22)00108-2 [pii] AID - 10.1016/j.anclin.2022.10.008 [doi] PST - ppublish SO - Anesthesiol Clin. 2023 Mar;41(1):283-301. doi: 10.1016/j.anclin.2022.10.008. PMID- 36867429 OWN - NLM STAT- MEDLINE DCOM- 20230808 LR - 20230808 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 89 IP - 8 DP - 2023 Aug TI - Patterns of Platelet Mapping Thromboelastography Abnormalities in Trauma. PG - 3372-3374 LID - 10.1177/00031348231161668 [doi] AB - OBJECTIVES: Platelet mapping thromboelastography (TEG-PM) to evaluate trauma induced coagulopathy has become more prevalent. The objective of this study was to evaluate associations between TEG-PM and outcomes in trauma patients, including patients with TBI. METHODS: A retrospective review was conducted utilizing the American College of Surgeons National Trauma Database. Chart review was conducted to obtain specific TEG-PM parameters. Patients were excluded if they were on anti-platelets, anticoagulation, or received blood products prior to arrival. TEG-PM values and their associations with outcomes were evaluated using generalized linear model and Cox cause-specific hazards model. Outcomes included in-hospital death, hospital and ICU length of stay (LOS). Relative risk (RR) and hazard ratio (HR) and their 95% confidence intervals (CIs) are provided. RESULTS: A total of 1066 patients were included, with 151 (14%) diagnosed with isolated TBI. ADP inhibition was associated with significant increase rate of hospital LOS and ICU LOS (RR per % increase = 1.002 and RR = 1.006 per % increase, respectively) while increased MA(AA) and MA(ADP) were significantly associated with decrease rate of hospital LOS and ICU LOS (RR = .993 per mm increase and RR = .989 per mm increase, respectively, and RR = .986 per mm increase and RR = .989 per mm increase). R (per minute increase) and LY30 (per % increase) were associated with increased risk of in-hospital mortality (HR = 1.567 and HR = 1.057, respectively). No TEG-PM values significantly correlated with ISS. CONCLUSION: Specific TEG-PM abnormalities are associated with worse outcomes in trauma patients, including TBI patients. These results require further investigation to understand associations between traumatic injury and coagulopathy. FAU - Quinn, Seth A AU - Quinn SA AUID- ORCID: 0000-0001-8486-9149 AD - Division of Trauma and Acute Care, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 FAU - Gregg, Stephen E AU - Gregg SE AD - Division of Trauma and Acute Care, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 FAU - Garcia, Nicole AU - Garcia N AUID- ORCID: 0000-0002-8579-9397 AD - Division of Trauma and Acute Care, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 FAU - Fu, Yuanyuan AU - Fu Y AD - Division of Surgical Research, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 FAU - Irish, William AU - Irish W AD - Division of Surgical Research, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 FAU - Toschlog, Eric A AU - Toschlog EA AD - Division of Trauma and Acute Care, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. RINGGOLD: 12278 LA - eng PT - Journal Article DEP - 20230303 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Hospital Mortality MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Coagulation MH - Blood Platelets MH - Retrospective Studies OTO - NOTNLM OT - critical care OT - trauma EDAT- 2023/03/04 06:00 MHDA- 2023/08/08 06:42 CRDT- 2023/03/03 11:42 PHST- 2023/08/08 06:42 [medline] PHST- 2023/03/04 06:00 [pubmed] PHST- 2023/03/03 11:42 [entrez] AID - 10.1177/00031348231161668 [doi] PST - ppublish SO - Am Surg. 2023 Aug;89(8):3372-3374. doi: 10.1177/00031348231161668. Epub 2023 Mar 3. PMID- 36844746 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230228 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 10 DP - 2023 TI - Risk factor prediction of severe postoperative acute kidney injury at stage 3 in patients with acute type A aortic dissection using thromboelastography. PG - 1109620 LID - 10.3389/fcvm.2023.1109620 [doi] LID - 1109620 AB - OBJECTIVE: Perioperative blood transfusions and postoperative drainage volume not only are the commonly recognized risk factors for acute kidney injury (AKI) but also are indirect indicators of coagulopathy in patients with acute type A aortic dissection (ATAAD). However, standard laboratory tests fail to accurately reflect and assess the overall coagulopathy profile in patients with ATAAD. Thus, this study aimed to explore the association between the hemostatic system and severe postoperative AKI (stage 3) in patients with ATAAD using thromboelastography (TEG). METHODS: We selected 106 consecutive patients with ATAAD who underwent emergency aortic surgery at Beijing Anzhen Hospital. All participants were categorized into the stage 3 and non-stage 3 groups. The hemostatic system was evaluated using routine laboratory tests and TEG preoperatively. We undertook univariate and multivariate stepwise logistic regression analyses to determine the potential risk factors for severe postoperative AKI (stage 3), with a special investigation on the association between hemostatic system biomarkers and severe postoperative AKI (stage 3). The receiver operating characteristic (ROC) curves were generated to assess the predictive ability of hemostatic system biomarkers for severe postoperative AKI (stage 3). RESULTS: A total of 25 (23.6%) patients developed severe postoperative AKI (stage 3), including 21 patients (19.8%) who required continuous renal replacement therapy (RRT). Multivariate logistic regression analysis demonstrated that the preoperative fibrinogen level (OR, 2.02; 95% CI, 1.03 to 3.00; p = 0.04), platelet function (MA level) (OR, 1.23; 95% CI, 1.09 to 1.39; p = 0.001), and cardiopulmonary bypass (CPB) time (OR, 1.01; 95% CI, 1.00 to 1.02; p = 0.02) were independently associated with severe postoperative AKI (stage 3). The cutoff values of preoperative fibrinogen and platelet function (MA level) for predicting severe postoperative AKI (stage 3) were determined to be 2.56 g/L and 60.7 mm in the ROC curve [area under the curve (AUC): 0.824 and 0.829; p < 0.001]. CONCLUSIONS: The preoperative fibrinogen level and platelet function (measured by the MA level) were identified as potential predictive factors for developing severe postoperative AKI (stage 3) in patients with ATAAD. Thromboelastography could be considered a potentially valuable tool for real-time monitoring and rapid assessment of the hemostatic system to improve postoperative outcomes in patients. CI - Copyright (c) 2023 Guan, Li, Li, Gong, Zhang and Wang. FAU - Guan, Xin-Liang AU - Guan XL AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. FAU - Li, Lei AU - Li L AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. FAU - Li, Hai-Yang AU - Li HY AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. FAU - Gong, Ming AU - Gong M AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. FAU - Zhang, Hong-Jia AU - Zhang HJ AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. FAU - Wang, Xiao-Long AU - Wang XL AD - Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China. LA - eng PT - Journal Article DEP - 20230209 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC9948628 OTO - NOTNLM OT - acute kidney injury OT - acute type A aortic dissection OT - continuous renal replacement therapy (CRRT) OT - risk factor OT - thromboelastography (TEG) COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/02/28 06:00 MHDA- 2023/02/28 06:01 PMCR- 2023/01/01 CRDT- 2023/02/27 04:35 PHST- 2022/11/28 00:00 [received] PHST- 2023/01/17 00:00 [accepted] PHST- 2023/02/27 04:35 [entrez] PHST- 2023/02/28 06:00 [pubmed] PHST- 2023/02/28 06:01 [medline] PHST- 2023/01/01 00:00 [pmc-release] AID - 10.3389/fcvm.2023.1109620 [doi] PST - epublish SO - Front Cardiovasc Med. 2023 Feb 9;10:1109620. doi: 10.3389/fcvm.2023.1109620. eCollection 2023. PMID- 36821365 OWN - NLM STAT- MEDLINE DCOM- 20230731 LR - 20230731 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 89 IP - 7 DP - 2023 Jul TI - Clotting Propensity in Trauma Patients According to Marijuana Use: A Descriptive Analysis. PG - 3263-3266 LID - 10.1177/00031348231157889 [doi] AB - Marijuana use has been reported to promote hypercoagulable states among trauma patients, particularly respecting venous thromboembolism (VTE), a major contributor to morbidity and mortality in patients sustaining traumatic injury. We sought to investigate this further through a retrospective, single institutional study performed from January 2018 through June 2021, utilizing data from patients presenting to a Level 1 Trauma Center as a trauma activation. We observed less frequent VTE development in the marijuana-positive group compared to the marijuana-negative group, with patient thromboelastography revealing a longer mean R-time in the marijuana-positive group. Overall occurrence of VTE was too low for definitive conclusions, but a trend toward reduction in VTE frequency among marijuana users compared to nonusers was noted. More studies with larger populations and more VTE occurrences are needed to confirm a potential correlation between marijuana use and VTE development. FAU - LoPolito, Andrew AU - LoPolito A AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 FAU - Mourabet, Tala AU - Mourabet T AD - Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA. RINGGOLD: 6556 FAU - Syed, Huda AU - Syed H AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 FAU - Brown, Catherine T AU - Brown CT AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 FAU - Saint-Fort, Launick AU - Saint-Fort L AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 FAU - Horst, Michael A AU - Horst MA AD - Business Intelligence, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 FAU - Perea, Lindsey L AU - Perea LL AD - Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA. RINGGOLD: 209639 LA - eng PT - Journal Article DEP - 20230223 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Humans MH - *Venous Thromboembolism/epidemiology/etiology MH - Retrospective Studies MH - *Marijuana Use MH - Thrombelastography MH - *Substance-Related Disorders OTO - NOTNLM OT - marijuana OT - thromboelastography OT - trauma OT - venous thromboembolism EDAT- 2023/02/24 06:00 MHDA- 2023/07/31 06:42 CRDT- 2023/02/23 12:04 PHST- 2023/07/31 06:42 [medline] PHST- 2023/02/24 06:00 [pubmed] PHST- 2023/02/23 12:04 [entrez] AID - 10.1177/00031348231157889 [doi] PST - ppublish SO - Am Surg. 2023 Jul;89(7):3263-3266. doi: 10.1177/00031348231157889. Epub 2023 Feb 23. PMID- 36818773 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230224 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 50 IP - 1 DP - 2023 Feb TI - Factor XIII in the Acute Care Setting and Its Relevance in Obstetric Bleeding. PG - 10-17 LID - 10.1159/000526489 [doi] AB - BACKGROUND: Major hemorrhage is one of the main causes of preventable mortality in either severe trauma, high-risk surgical patient, or the obstetric population. As underlined by the cell-based coagulation model, a resistant and stable clot is essential to prevent or to stop an ongoing bleeding. Coagulation factor XIII (FXIII) stabilizes the newly formed clot by cross-linking the fibrin monomers into a three-dimensional network and by impeding fibrinolysis. Thus, FXIII is an essential coagulation factor in the acutely bleeding patient. SUMMARY: Acquired FXIII deficiency is much more common than the inherited form. On the basis of acute tissue injury which leads to major bleeding, acquired FXIII deficiency is traditionally considered to be secondary to consumption. However, recent evidence in the field of obstetrics and high-risk surgery suggests that it might be an associated factor rather than a consequence of the bleeding, which would mean that early replacement of FXIII could potentially improve outcomes. However, FXIII measurement is not universally available. Assessing FXIII through viscoelastic assays seems feasible, though likely it is not yet accurate. Moreover, the target population at risk and the aimed FXIII level required to achieve hemostasis in each condition are yet to be defined. KEY MESSAGES: FXIII should be assessed and replaced if necessary in the acutely bleeding patient. We recommend FXIII to be included in an escalating scheme of hemostatic therapies in the acute care setting. CI - Copyright (c) 2022 by The Author(s). Published by S. Karger AG, Basel. FAU - Duque, Patricia AU - Duque P AD - Anesthesiology and Intensive Care Department, Gregorio Maranon Hospital, Madrid, Spain. FAU - Korte, Wolfgang AU - Korte W AD - Haemostasis and Haemophilia Center, St. Gallen, Switzerland. LA - eng PT - Journal Article PT - Review DEP - 20221124 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC9912001 OTO - NOTNLM OT - Emergency medicine OT - Factor XIII OT - Hemorrhage OT - Obstetrics COIS- The authors have no conflicts of interest to declare. EDAT- 2023/02/24 06:00 MHDA- 2023/02/24 06:01 PMCR- 2022/11/24 CRDT- 2023/02/23 09:56 PHST- 2022/05/04 00:00 [received] PHST- 2022/08/06 00:00 [accepted] PHST- 2023/02/23 09:56 [entrez] PHST- 2023/02/24 06:00 [pubmed] PHST- 2023/02/24 06:01 [medline] PHST- 2022/11/24 00:00 [pmc-release] AID - tmh-0050-0010 [pii] AID - 10.1159/000526489 [doi] PST - epublish SO - Transfus Med Hemother. 2022 Nov 24;50(1):10-17. doi: 10.1159/000526489. eCollection 2023 Feb. PMID- 36815533 OWN - NLM STAT- MEDLINE DCOM- 20230501 LR - 20230826 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 36 IP - 3 DP - 2023 Jun 1 TI - Coagulation management and transfusion in massive postpartum hemorrhage. PG - 281-287 LID - 10.1097/ACO.0000000000001258 [doi] AB - PURPOSE OF REVIEW: Excessive bleeding during and following childbirth remains one of the leading causes of maternal mortality. RECENT FINDINGS: Current guidelines differ in definitions and recommendations on managing transfusion and hemostasis in massive postpartum hemorrhage (PPH). Insights gained from trauma-induced coagulopathy are not directly transferable to the obstetric population due to gestational alterations and a differing pathophysiology. SUMMARY: Factor deficiency is uncommon at the beginning of most etiologies of PPH but will eventually develop from consumption and depletion in the absence of bleeding control. The sensitivity of point-of-care tests for fibrinolysis is too low and may delay treatment, therefore tranexamic acid should be started early at diagnosis even without signs for hyperfibrinolysis. Transfusion management may be initiated empirically, but is best to be guided by laboratory and viscoelastic assay results as soon as possible. Hypofibrinogenemia is well detected by point-of-care tests, thus substitution may be tailored to individual needs, while reliable thresholds for fresh frozen plasma (FFP) and specific components are yet to be defined. In case of factor deficiency, prothrombin complex concentrate or lyophilized plasma allow for a more rapid restoration of coagulation than FFP. If bleeding and hemostasis are under control, a timely anticoagulation may be necessary. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Massoth, Christina AU - Massoth C AD - Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Munster. FAU - Wenk, Manuel AU - Wenk M AD - Department of Anesthesiology and Intensive Care, Clemenshospital Munster, Munster. FAU - Meybohm, Patrick AU - Meybohm P AD - Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg, Wuerzburg, Germany. FAU - Kranke, Peter AU - Kranke P AD - Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg, Wuerzburg, Germany. LA - eng PT - Journal Article PT - Review DEP - 20230222 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Pregnancy MH - Female MH - Humans MH - *Postpartum Hemorrhage/diagnosis/etiology/therapy MH - Blood Transfusion/methods MH - Blood Coagulation MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Hemostasis EDAT- 2023/02/24 06:00 MHDA- 2023/05/01 06:42 CRDT- 2023/02/23 05:23 PHST- 2023/05/01 06:42 [medline] PHST- 2023/02/24 06:00 [pubmed] PHST- 2023/02/23 05:23 [entrez] AID - 00001503-202306000-00007 [pii] AID - 10.1097/ACO.0000000000001258 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2023 Jun 1;36(3):281-287. doi: 10.1097/ACO.0000000000001258. Epub 2023 Feb 22. PMID- 36805626 OWN - NLM STAT- MEDLINE DCOM- 20230524 LR - 20250530 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 6 DP - 2023 Jun 1 TI - A proposed clinical coagulation score for research in trauma-induced coagulopathy. PG - 798-802 LID - 10.1097/TA.0000000000003874 [doi] AB - BACKGROUND: Trauma-induced coagulopathy (TIC) has been the subject of intense study for greater than a century, and it is associated with high morbidity and mortality. The Trans-Agency Consortium for Trauma-Induced Coagulopathy, funded by the National Health Heart, Lung and Blood Institute, was tasked with developing a clinical TIC score, distinguishing between injury-induced bleeding from persistent bleeding due to TIC. We hypothesized that the Trans-Agency Consortium for Trauma-Induced Coagulopathy clinical TIC score would correlate with laboratory measures of coagulation, transfusion requirements, and mortality. METHODS: Trauma activation patients requiring a surgical procedure for hemostasis were scored in the operating room (OR) and in the first ICU day by the attending trauma surgeon. Conventional and viscoelastic (thrombelastography) coagulation assays, transfusion requirements, and mortality were correlated to the coagulation scores using the Cochran-Armitage trend test or linear regression for numerical variables. RESULTS: Increased OR TIC scores were significantly associated with abnormal conventional and viscoelastic measurements, including hyperfibrinolysis incidence, as well as with higher mortality and more frequent requirement for massive transfusion ( p < 0.0001 for all trends). Patients with OR TIC score greater than 3 were more than 31 times more likely to have an ICU TIC score greater than 3 (relative risk, 31.6; 95% confidence interval, 12.7-78.3; p < 0.0001). CONCLUSION: A clinically defined TIC score obtained in the OR reflected the requirement for massive transfusion and mortality in severely injured trauma patients and also correlated with abnormal coagulation assays. The OR TIC score should be validated in multicenter studies. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Eitel, Andrew P AU - Eitel AP AD - From the Department of Anesthesiology and Pain Medicine (A.P.E.), University of Washington Medicine, Seattle, Washington; Department of Surgery (E.E.M., M.R.K., N.G.V., M.G.B., J.B.H., C.C.B., K.B.P., H.B.M., M.J.C., C.C.S.), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora; Trauma Surgery (E.E.M., E.M.C., R.A.L., F.M.P.), Denver Health Medical Center, Denver; School of Public Health (A.S.), University of Colorado Anschutz Medical Campus, Aurora; Vitalant Research Institute (M.R.K., C.C.S.), Denver, Colorado; Department of Surgery (C.J.F.), School of Medicine, University of Maryland, Baltimore, Maryland; Department of Pediatrics (C.C.S.), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Sauaia, Angela AU - Sauaia A FAU - Kelher, Marguerite R AU - Kelher MR FAU - Vigneshwar, Navin G AU - Vigneshwar NG FAU - Bartley, Matthew G AU - Bartley MG FAU - Hadley, Jamie B AU - Hadley JB FAU - Burlew, Clay C AU - Burlew CC FAU - Campion, Eric M AU - Campion EM FAU - Fox, Charles J AU - Fox CJ FAU - Lawless, Ryan A AU - Lawless RA FAU - Pieracci, Frederic M AU - Pieracci FM FAU - Platnick, Kenneth B AU - Platnick KB FAU - Moore, Hunter B AU - Moore HB FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20230220 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM CIN - J Trauma Acute Care Surg. 2023 Sep 1;95(3):e16-e17. doi: 10.1097/TA.0000000000003959. PMID: 37125788 MH - Humans MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Coagulation MH - Hemorrhage/etiology MH - Hemostasis MH - Blood Coagulation Tests MH - Thrombelastography/methods MH - *Wounds and Injuries/complications PMC - PMC10205655 MID - NIHMS1873992 COIS- Conflicts of interest: Haemonetics((R)) provided reagents and devices to run viscoelastic assays but had no involvement with data analysis, interpretation or any contribution to this manuscript. EDAT- 2023/02/23 06:00 MHDA- 2023/05/24 06:42 PMCR- 2024/06/01 CRDT- 2023/02/22 09:50 PHST- 2023/05/24 06:42 [medline] PHST- 2023/02/23 06:00 [pubmed] PHST- 2023/02/22 09:50 [entrez] PHST- 2024/06/01 00:00 [pmc-release] AID - 01586154-202306000-00008 [pii] AID - 10.1097/TA.0000000000003874 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Jun 1;94(6):798-802. doi: 10.1097/TA.0000000000003874. Epub 2023 Feb 20. PMID- 36787438 OWN - NLM STAT- MEDLINE DCOM- 20230524 LR - 20260429 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 6 DP - 2023 Jun 1 TI - Elucidating the molecular mechanisms of fibrinolytic shutdown after severe injury: The role of thrombin-activatable fibrinolysis inhibitor. PG - 857-862 LID - 10.1097/TA.0000000000003911 [doi] AB - BACKGROUND: The mechanisms underlying trauma-induced coagulopathy remain elusive. Hyperfibrinolysis has been linked to increased plasminogen activation and antiprotease consumption; however, the mechanistic players in its counterpart, fibrinolysis shutdown, remain unclear. We hypothesize that thrombin-activatable fibrinolysis inhibitor (TAFI) plays a major role in fibrinolytic shutdown after injury. METHODS: As part of this observational cohort study, whole blood was collected from trauma activation patients at a single, level 1 trauma center. Citrated rapid thrombelastography and the following enzyme-linked immunosorbent assays were conducted: thrombin, antithrombin, thrombin-antithrombin complex, TAFI, plasminogen, antiplasmin, plasmin-antiplasmin (PAP), tissue plasminogen activator, plasminogen activator inhibitor 1, and tissue plasminogen activator-plasminogen activator inhibitor 1 complex. Univariate and cluster analysis were performed. RESULTS: Overall, 56 patients (median age, 33.5 years; 70% male) were included. The majority (57%) presented after blunt mechanism and with severe injury (median New Injury Severity Score, 27). Two clusters of patients were identified: Group 1 (normal fibrinolysis, n = 21) and Group 2 (fibrinolysis shutdown, n = 35). Group 2 had significantly lower fibrinolysis with a median LY30 of 1.1% (interquartile range [IQR], 0.1-1.9%) versus 2.1% (IQR, 0.5-2.8%) in Group 1; while the median LY30 was within physiologic range, 45% of patients in Group 2 were in shutdown (vs. 24% in Group 1, p = 0.09). Compared with Group 1, Group 2 had significantly higher PAP (median, 4.7 [IQR, 1.7-9.3] vs. 1.4 [1.0-2.1] mug/mL in Group 1; p = 0.002) and higher TAFI (median, 152.5% [IQR, 110.3-190.7%] vs. 121.9% [IQR, 93.2-155.6%]; p = 0.04). There was a strong correlation between PAP and TAFI ( R2 = 0.5, p = 0.0002). CONCLUSION: The presented data characterize fibrinolytic shutdown, indicating an initial plasmin burst followed by diminished fibrinolysis, which is distinct from hypofibrinolysis (inadequate plasmin burst and fibrinolysis). After an initial thrombin and plasmin burst (increased PAP), fibrinolysis is inhibited, mediated in part by increased TAFI. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - From the Department of Surgery (J.R.C., E.E.M., M.J.C., A.B., C.C.S.), University of Colorado-Denver, Aurora; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health; Department of Cell Biology (K.J.), University of Oklahoma; Vitalant Research Institute (M.R.K.); and Department of Pediatrics (C.C.S.), School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Kelher, Marguerite R AU - Kelher MR FAU - Jones, Kenneth AU - Jones K FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural DEP - 20230213 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - EC 3.4.21.7 (Fibrinolysin) RN - EC 3.4.17.20 (Carboxypeptidase B2) RN - 0 (Plasminogen Activator Inhibitor 1) RN - EC 3.4.21.5 (Thrombin) RN - 0 (Antifibrinolytic Agents) RN - 9001-91-6 (Plasminogen) SB - IM CIN - J Trauma Acute Care Surg. 2024 Jan 1;96(1):e5. doi: 10.1097/TA.0000000000004104. PMID: 37611080 MH - Humans MH - Male MH - Adult MH - Female MH - Tissue Plasminogen Activator MH - Fibrinolysin MH - *Carboxypeptidase B2/pharmacology MH - Plasminogen Activator Inhibitor 1 MH - Thrombin MH - *Antifibrinolytic Agents/pharmacology MH - Fibrinolysis MH - *Blood Coagulation Disorders/etiology MH - Plasminogen PMC - PMC10205661 MID - NIHMS1871611 COIS- This research was supported with materials from Haemonetics Inc., and other research conducted by this group is supported by Instrumentation Laboratory and Stago. Dr Silliman is a scientific advisory board member of Hemanext, and Dr. Moore is cofounder of ThromboTherapeutics Inc. EDAT- 2023/02/15 06:00 MHDA- 2023/05/24 06:42 PMCR- 2024/06/01 CRDT- 2023/02/14 14:53 PHST- 2023/05/24 06:42 [medline] PHST- 2023/02/15 06:00 [pubmed] PHST- 2023/02/14 14:53 [entrez] PHST- 2024/06/01 00:00 [pmc-release] AID - 01586154-202306000-00015 [pii] AID - 10.1097/TA.0000000000003911 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Jun 1;94(6):857-862. doi: 10.1097/TA.0000000000003911. Epub 2023 Feb 13. PMID- 36774266 OWN - NLM STAT- MEDLINE DCOM- 20230417 LR - 20230417 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 54 IP - 5 DP - 2023 May TI - Persistent fibrinolysis shutdown is associated with increased mortality in traumatic pancreatic injury. PG - 1265-1270 LID - S0020-1383(23)00111-0 [pii] LID - 10.1016/j.injury.2023.02.013 [doi] AB - PURPOSE: The features of fibrinolytic system modifications and their relationship with prognosis are still unknown in traumatic pancreatic injury. The object of this prospective cohort research was to identify fibrinolytic characteristics in patients with pancreatic trauma and to identify the correlation to mortality. METHOD: A prospective screening of traumatic pancreatic injury patients was done for five years. The fibrinolytic status of patients was determined by thromboelastography (TEG). The percentage reduction in clot strength 30 min (LY30) after the time of maximal clot strength was utilized to distinguish the fibrinolytic phenotype of individuals, including fibrinolytic shutdown (SD), physiologic fibrinolysis (PHYS) and hyperfibrinolysis (HF). Two cohorts, transient fibrinolytic shutdown (TSD) and persistent fibrinolytic shutdown (PSD), were divided according to whether fibrinolytic shutdown persisted within one week. Demographics, injury severity, characteristics of pancreatic injury, treatment, and outcomes were compared. RESULT: A total of 180 cases enrolled, aged 42(interquartile range 32-51) years, 88% males, 97% were blunt trauma. The median ISS was 19(IQR 10-25), and 76% were AAST grade III to V (high-grade). At admission, there were 159 cases of SD (88%), 15 cases of PHYS (8%) while 6 cases of HF (3%). Of these, the TSD cohort included 54 patients (34%), while the PSD cohort included 105 patients (66%). Compared with the TSD cohort, the PSD cohort had more severe injury (ISS 21[IQR 12-27] vs 16[IQR 9-22], p = 0.006) and a higher proportion of AAST high-grade (83% vs 67%, p = 0.035). Persistent fibrinolytic shutdown was associated with operative treatment (odds ratio [OR] 3.111; 95%CI 1.146-8.447; p = 0.026), associated intra-abdominal injury (OR 8.331; 95% CI 1.301-53.336; p = 0.025) and admission LY30 (OR 0.016; 95% CI 0.002 - 0.120; p < 0.001). It was an independent predictor of mortality (adjusted odds ratio [AOR] 4.674; 95% CI 1.03 to 21.14; p = 0.045). CONCLUSION: Fibrinolytic shutdown especially persistence of this phenotype is more common in traumatic pancreatic injury than PHYS and HF, which related with mortality. Risk factors including LY30 at admission, intra-abdominal injury and operative treatment were associated with the persistent fibrinolytic shutdown. Sheltered the patients from these risk factors seems to be beneficial, which need to be confirmed by further large-scale studies. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Liu, Baochen AU - Liu B AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. FAU - Yang, Chao AU - Yang C AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. FAU - Deng, Yunxuan AU - Deng Y AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. FAU - Duan, Zehua AU - Duan Z AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. FAU - Wang, Kai AU - Wang K AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. FAU - Li, Jieshou AU - Li J AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: njlijieshou@126.com. FAU - Ding, Weiwei AU - Ding W AD - Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: dingwei_nju@hotmail.com. LA - eng PT - Journal Article DEP - 20230207 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Male MH - Female MH - Humans MH - Fibrinolysis/physiology MH - Prospective Studies MH - Injury Severity Score MH - Prognosis MH - *Abdominal Injuries/complications MH - *Thoracic Injuries/complications MH - *Blood Coagulation Disorders/etiology MH - Thrombelastography/adverse effects MH - *Wounds and Injuries/complications OTO - NOTNLM OT - Fibrinolysis shutdown OT - Mortality OT - Non-operative treatment OT - Traumatic pancreatic injury COIS- Conflict of interest The authors have indicated that they have no conflict of interest regarding the content of this article. EDAT- 2023/02/12 06:00 MHDA- 2023/04/17 06:41 CRDT- 2023/02/11 22:01 PHST- 2022/07/03 00:00 [received] PHST- 2023/01/16 00:00 [revised] PHST- 2023/02/05 00:00 [accepted] PHST- 2023/04/17 06:41 [medline] PHST- 2023/02/12 06:00 [pubmed] PHST- 2023/02/11 22:01 [entrez] AID - S0020-1383(23)00111-0 [pii] AID - 10.1016/j.injury.2023.02.013 [doi] PST - ppublish SO - Injury. 2023 May;54(5):1265-1270. doi: 10.1016/j.injury.2023.02.013. Epub 2023 Feb 7. PMID- 36765421 OWN - NLM STAT- MEDLINE DCOM- 20230214 LR - 20260313 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 27 IP - 1 DP - 2023 Feb 10 TI - Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study. PG - 55 LID - 10.1186/s13054-023-04329-5 [doi] LID - 55 AB - BACKGROUND: Fibrinolysisis is essential for vascular blood flow maintenance and is triggered by endothelial and platelet release of tissue plasminogen activator (t-PA). In certain critical conditions, e.g. sepsis, acute respiratory failure (ARF) and trauma, the fibrinolytic response is reduced and may lead to widespread thrombosis and multi-organ failure. The mechanisms underpinning fibrinolysis resistance include reduced t-PA expression and/or release, reduced t-PA and/or plasmin effect due to elevated inhibitor levels, increased consumption and/or clearance. This study in critically ill patients with fibrinolysis resistance aimed to evaluate the ability of t-PA and plasminogen supplementation to restore fibrinolysis with assessment using point-of-care ClotPro viscoelastic testing (VET). METHODS: In prospective, observational studies, whole-blood ClotPro VET evaluation was carried out in 105 critically ill patients. In 32 of 58 patients identified as fibrinolysis-resistant (clot lysis time > 300 s on the TPA-test: tissue factor activated coagulation with t-PA accelerated fibrinolysis), consecutive experimental whole-blood VET was carried out with repeat TPA-tests spiked with additional t-PA and/or plasminogen and the effect on lysis time determined. In an interventional study in a patient with ARF and fibrinolysis resistance, the impact of a 24 h intravenous low-dose alteplase infusion on coagulation and fibrinolysis was prospectively monitored using standard ClotPro VET. RESULTS: Distinct response groups emerged in the ex vivo experimental VET, with increased fibrinolysis observed following supplementation with (i) t-PA only or (ii) plasminogen and t-PA. A baseline TPA-test lysis time of > 1000 s was associated with the latter group. In the interventional study, a gradual reduction (25%) in serial TPA-test lysis times was observed during the 24 h low-dose alteplase infusion. CONCLUSIONS: ClotPro viscoelastic testing, the associated TPA-test and the novel experimental assays may be utilised to (i) investigate the potential mechanisms of fibrinolysis resistance, (ii) guide corrective treatment and (iii) monitor in real-time the treatment effect. Such a precision medicine and personalised treatment approach to the management of fibrinolysis resistance has the potential to increase treatment benefit, while minimising adverse events in critically ill patients. TRIAL REGISTRATION: VETtiPAT-ARF, a clinical trial evaluating ClotPro-guided t-PA (alteplase) administration in fibrinolysis-resistant patients with ARF, is ongoing (ClinicalTrials.gov NCT05540834 ; retrospectively registered September 15th 2022). CI - (c) 2023. The Author(s). FAU - Coupland, Lucy A AU - Coupland LA AD - Intensive Care Unit, Liverpool Hospital, Liverpool, Australia. l.coupland@unsw.edu.au. AD - Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia. l.coupland@unsw.edu.au. FAU - Rabbolini, David J AU - Rabbolini DJ AD - Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. AD - Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Schoenecker, Jonathan G AU - Schoenecker JG AD - Department of Orthopaedics and Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Crispin, Philip J AU - Crispin PJ AD - Haematology Department, The Canberra Hospital, Canberra, Australia. AD - The Australian National University Medical School, Canberra, Australia. FAU - Miller, Jennene J AU - Miller JJ AD - Intensive Care Unit, Liverpool Hospital, Liverpool, Australia. FAU - Ghent, Tony AU - Ghent T AD - Intensive Care Unit, Gold Coast University Hospital, South Port, Australia. FAU - Medcalf, Robert L AU - Medcalf RL AD - Australian Centre for Blood Diseases, Monash University, Melbourne, Australia. FAU - Aneman, Anders E AU - Aneman AE AD - Intensive Care Unit, Liverpool Hospital, Liverpool, Australia. anders.aneman@health.nsw.gov.au. AD - Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia. anders.aneman@health.nsw.gov.au. LA - eng SI - ClinicalTrials.gov/NCT05540834 GR - R01 GM126062/GM/NIGMS NIH HHS/United States GR - R01GM126062-01A1/GF/NIH HHS/United States PT - Journal Article DEP - 20230210 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 9001-91-6 (Plasminogen) SB - IM MH - Humans MH - *Fibrinolysis MH - *Tissue Plasminogen Activator/pharmacology/therapeutic use MH - Fibrin Clot Lysis Time MH - Point-of-Care Systems MH - Prospective Studies MH - Feasibility Studies MH - Critical Illness/therapy MH - Plasminogen/pharmacology PMC - PMC9912243 OTO - NOTNLM OT - Alteplase OT - Fibrinolysis OT - Fibrinolysis resistance OT - Fibrinolytic shutdown OT - Personalised medicine OT - Plasminogen OT - Point-of-care testing OT - Tissue plasminogen activator OT - Viscoelastic testing COIS- T. Ghent acts as a scientific consultant for Haemoview Diagnostics, Australia. The remaining authors have no conflicts of interest to declare. EDAT- 2023/02/12 06:00 MHDA- 2023/02/15 06:00 PMCR- 2023/02/10 CRDT- 2023/02/11 00:08 PHST- 2022/10/31 00:00 [received] PHST- 2023/01/22 00:00 [accepted] PHST- 2023/02/11 00:08 [entrez] PHST- 2023/02/12 06:00 [pubmed] PHST- 2023/02/15 06:00 [medline] PHST- 2023/02/10 00:00 [pmc-release] AID - 10.1186/s13054-023-04329-5 [pii] AID - 4329 [pii] AID - 10.1186/s13054-023-04329-5 [doi] PST - epublish SO - Crit Care. 2023 Feb 10;27(1):55. doi: 10.1186/s13054-023-04329-5. PMID- 36729905 OWN - NLM STAT- MEDLINE DCOM- 20230224 LR - 20230826 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 36 IP - 2 DP - 2023 Apr 1 TI - Alternative blood products in trauma. PG - 153-158 LID - 10.1097/ACO.0000000000001217 [doi] AB - PURPOSE OF REVIEW: Hemorrhage and trauma-induced coagulopathy cause significant morbidity and mortality in trauma patients. Although blood products are the cornerstone of resuscitation, these resources are scarce, necessitating alternatives. This review examines the use of alternative blood products in trauma as well as the literature supporting their use. RECENT FINDINGS: There is no single true blood product alternative. In recent years, there has been great progress in understanding trauma-induced pathophysiology and blood component alternatives. Products such as tranexamic acid and prothrombin complex concentrate have become well established and are frequently utilized in trauma centers, and many more alternatives are still undergoing further research and development. SUMMARY: Stabilization of hemorrhage and resuscitation is priority in trauma-induced coagulopathy treatment. Alternative products such as tranexamic acid, recombinant factors, prothrombic complex concentrate, fibrinogen concentrates, and desmopressin may also be considered based on the clinical context. Viscoelastic hemostatic assays such as rotational thromboelastometry and thromboelastography can help guide these efforts. Following initial stabilization, additional interventions such as iron supplementation, erythropoietin stimulating agents, and vitamin D may help with chronic sequela. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Jan, Kathryn M AU - Jan KM AD - Department of Anesthesiology & Pain Management, UT Southwestern Medical Center, Dallas, Texas, USA. FAU - Mohapatra, Shweta AU - Mohapatra S FAU - Moon, Tiffany S AU - Moon TS LA - eng PT - Journal Article PT - Review DEP - 20221206 PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 6T84R30KC1 (Tranexamic Acid) RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Tranexamic Acid/therapeutic use MH - Hemorrhage/therapy MH - *Hemostatics/therapeutic use MH - Fibrinogen/therapeutic use MH - *Blood Coagulation Disorders/etiology MH - Thrombelastography/adverse effects MH - *Wounds and Injuries/complications EDAT- 2023/02/03 06:00 MHDA- 2023/02/25 06:00 CRDT- 2023/02/02 12:53 PHST- 2023/02/03 06:00 [pubmed] PHST- 2023/02/25 06:00 [medline] PHST- 2023/02/02 12:53 [entrez] AID - 00001503-202304000-00007 [pii] AID - 10.1097/ACO.0000000000001217 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2023 Apr 1;36(2):153-158. doi: 10.1097/ACO.0000000000001217. Epub 2022 Dec 6. PMID- 36729884 OWN - NLM STAT- MEDLINE DCOM- 20230307 LR - 20260120 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 3 DP - 2023 Mar 1 TI - Approaches for optimizing venous thromboembolism prevention in injured patients: Findings from the consensus conference to implement optimal venous thromboembolism prophylaxis in trauma. PG - 469-478 LID - 10.1097/TA.0000000000003854 [doi] AB - Venous thromboembolism (VTE) is a major issue in trauma patients. Without prophylaxis, the rate of deep venous thrombosis approaches 60% and even with chemoprophylaxis may be nearly 30%. Advances in VTE reduction are imperative to reduce the burden of this issue in the trauma population. Novel approaches in VTE prevention may include new medications, dosing regimens, and extending prophylaxis to the postdischarge phase of care. Standard dosing regimens of low-molecular-weight heparin are insufficient in trauma, shifting our focus toward alternative dosing strategies to improve prophylaxis. Mixed data suggest that anti-Xa-guided dosage, weight-based dosing, and thromboelastography are among these potential strategies. The concern for VTE in trauma does not end upon discharge, however. The risk for VTE in this population extends well beyond hospitalization. Variable extended thromboprophylaxis regimens using aspirin, low-molecular-weight heparin, and direct oral anticoagulants have been suggested to mitigate this prolonged VTE risk, but the ideal approach for outpatient VTE prevention is still unclear. As part of the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma, a multidisciplinary array of participants, including physicians from multiple specialties, pharmacists, nurses, advanced practice providers, and patients met to attack these issues. This paper aims to review the current literature on novel approaches for optimizing VTE prevention in injured patients and identify research gaps that should be investigated to improve VTE rates in trauma. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Teichman, Amanda L AU - Teichman AL AD - From the Division of Acute Care Surgery, Department of Surgery (A.L.T.), Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Division of Acute Care Surgery, Department of Surgery (B.A.C.), McGovern Medical School, Memorial Hermann Hospital, Houston, Texas; Division of Acute Care Surgery, Department of Surgery (J.B.), Johns Hopkins University School of Medicine; R Adams Cowley Shock Trauma Center (N.K.D.), University of Maryland, Baltimore, Maryland; Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery (A.E.B., T.C.), University of California San Diego School of Medicine, San Diego, California; The Coalition for National Trauma Research (M.A.P.), San Antonio, Texas; Department of Trauma and Acute Care Surgery (T.J.J.), Atrium Health Navicent, Macon, Georgia; Department of Surgery (E.J.L.), Cedars-Sinai Medical Center, Los Angeles, California; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), Johns Hopkins University School of Medicine; Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine (E.R.H.); and Department of Health Policy and Management (E.R.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. FAU - Cotton, Bryan A AU - Cotton BA FAU - Byrne, James AU - Byrne J FAU - Dhillon, Navpreet K AU - Dhillon NK FAU - Berndtson, Allison E AU - Berndtson AE FAU - Price, Michelle A AU - Price MA FAU - Johns, Tracy J AU - Johns TJ FAU - Ley, Eric J AU - Ley EJ FAU - Costantini, Todd AU - Costantini T FAU - Haut, Elliott R AU - Haut ER LA - eng GR - R13 HL158206/HL/NHLBI NIH HHS/United States PT - Consensus Statement PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review DEP - 20221206 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) SB - IM MH - Humans MH - Aftercare MH - *Anticoagulants/therapeutic use MH - Heparin, Low-Molecular-Weight/therapeutic use MH - Patient Discharge MH - *Venous Thromboembolism/prevention & control PMC - PMC9975027 MID - NIHMS1854390 COIS- Conflict of Interest: The authors have no conflicts of interest to report. EDAT- 2023/02/03 06:00 MHDA- 2023/02/25 06:00 PMCR- 2024/03/01 CRDT- 2023/02/02 12:45 PHST- 2023/02/03 06:00 [pubmed] PHST- 2023/02/25 06:00 [medline] PHST- 2023/02/02 12:45 [entrez] PHST- 2024/03/01 00:00 [pmc-release] AID - 01586154-202303000-00016 [pii] AID - 10.1097/TA.0000000000003854 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Mar 1;94(3):469-478. doi: 10.1097/TA.0000000000003854. Epub 2022 Dec 6. PMID- 36728345 OWN - NLM STAT- MEDLINE DCOM- 20230818 LR - 20250801 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 4 DP - 2023 Apr 1 TI - Platelet and cryoprecipitate transfusions from female donors improve coagulopathy in vitro. PG - 497-503 LID - 10.1097/TA.0000000000003857 [doi] AB - BACKGROUND: Females are relatively hypercoagulable compared with males, with increased platelet aggregation and improved clot dynamics. However, sex differences in coagulation have not yet been considered in transfusion guidelines. Therefore, our objective was to evaluate hemostatic differences in sex concordant and sex discordant cryoprecipitate and platelet transfusions. We hypothesized that transfusion of blood products from female donors results in improved coagulopathy compared with male blood products. METHODS: This was a cohort study evaluating sex dimorphisms in coagulation assays and clotting factors in healthy volunteer plasma and cryoprecipitate. Sex dimorphisms in transfusions were evaluated using an in vitro coagulopathy model. Female or male platelets or single-donor cryoprecipitate was added to "recipient" whole blood after dilution of recipient blood with citrated saline to provoke a coagulopathic profile. Citrated native thromboelastography was then performed. Liquid chromatography/mass spectroscopy was performed on single-donor cryoprecipitate to evaluate sex dimorphisms in the proteome of cryoprecipitate. RESULTS: Females have an increased proportion of functional fibrinogen. Transfusion of female-donor platelets and cryoprecipitate induces a larger decrease in R time and greater increase in angle than male-donor platelets or cryoprecipitate. Female-donor cryoprecipitate has increased factor V and factor XIII compared with male cryoprecipitate, and comprehensive proteomics revealed sex differences in several proteins with potential immunological significance. CONCLUSION: Platelets and cryoprecipitate from female donors improve coagulopathy more than male blood products in vitro. Increased factor V and factor XIII activity as well as increased fibrinogen activity in female donors appears to drive this disparity. Sex differences in the proteome of cryoprecipitate may influence how transfusions modulate the thromboinflammation of trauma. The differing hemostatic profiles of female and male blood products suggest the potential role of sex-specific transfusions guidelines in hemostatic resuscitation. CI - Copyright (c) 2023 American Association for the Surgery of Trauma. FAU - DeBot, Margot AU - DeBot M AD - From the Division of GI, Trauma, and Endocrine, Department of Surgery (M.D., M.K., T.R.S., E.E.M., A.S., A.C., M.J.C., C.C.S., J.C.), Trauma Research Center and Department of Biochemistry and Molecular Genetics (C.E., I.L., A.D., K.H.), School of Medicine, University of Colorado, Aurora, Colorado; Vitalent Mountain Division (M.K., C.C.S.), Vitalant Research Institute; Ernest E Moore Shock Trauma Center (E.E.M.), Denver Health Medical Center, Denver; Department of Health Systems (A.S.), School of Public Health, Management and Policy, University of Colorado, Aurora, Colorado. FAU - Erickson, Christopher AU - Erickson C FAU - Kelher, Marguerite AU - Kelher M FAU - Schaid, Terry R Jr AU - Schaid TR Jr FAU - Moore, Ernest E AU - Moore EE FAU - Sauaia, Angela AU - Sauaia A FAU - Cralley, Alexis AU - Cralley A FAU - LaCroix, Ian AU - LaCroix I FAU - D'Alessandro, Angelo AU - D'Alessandro A FAU - Hansen, Kirk AU - Hansen K FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Silliman, Christopher C AU - Silliman CC FAU - Coleman, Julia AU - Coleman J LA - eng GR - R01 HL148151/HL/NHLBI NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20230111 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-24-5 (Factor V) RN - 9013-56-3 (Factor XIII) RN - 9001-32-5 (Fibrinogen) RN - 0 (Hemostatics) RN - 0 (Proteome) SB - IM MH - Female MH - Humans MH - Male MH - *Blood Coagulation Disorders MH - Cohort Studies MH - Factor V MH - Factor XIII MH - Fibrinogen MH - *Hemostatics/blood MH - Inflammation MH - Proteome MH - *Thrombosis MH - Sex Factors MH - Blood Coagulation Tests PMC - PMC10038850 MID - NIHMS1859996 COIS- Conflict of Interest Statement The authors have no conflicts of interest to disclose. Conflict of Interest Statement We otherwise report no financial or other conflicts of interest. EDAT- 2023/02/03 06:00 MHDA- 2023/03/25 06:00 PMCR- 2024/04/01 CRDT- 2023/02/02 08:46 PHST- 2023/02/03 06:00 [pubmed] PHST- 2023/03/25 06:00 [medline] PHST- 2023/02/02 08:46 [entrez] PHST- 2024/04/01 00:00 [pmc-release] AID - 01586154-202304000-00001 [pii] AID - 10.1097/TA.0000000000003857 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Apr 1;94(4):497-503. doi: 10.1097/TA.0000000000003857. Epub 2023 Jan 11. PMID- 36719393 OWN - NLM STAT- MEDLINE DCOM- 20230202 LR - 20230930 IS - 1535-1815 (Electronic) IS - 0749-5161 (Linking) VI - 39 IP - 2 DP - 2023 Feb 1 TI - Thromboelastography and Its Use in Pediatric Trauma Patients. PG - e41-e47 LID - 10.1097/PEC.0000000000002642 [doi] AB - BACKGROUND/PURPOSE: Thromboelastography's (TEG's) use in pediatric trauma patients is not widely studied. Identifying clotting cascade defects can direct decision making regarding blood product transfusion. METHODS: We performed a single-center retrospective review of all level 1 pediatric trauma patients. Data collected included demographics, diagnoses, Injury Severity Score, intensive care unit length of stay (ICU LOS), mortality, TEG values, and blood products received. We identified TEG values associated with mortality, ICU LOS, and need for blood product transfusion. RESULTS: A total of 237 trauma 1 patients were identified. After exclusions, 148 patients were included for analysis. Most patients were below TEG transfusion cut points. Patients with elevated reaction time, K value, and fibrinolysis at 30 minutes had increased odds of mortality with odds ratios of 1.71 (95% confidence interval [CI], 1.22-2.40), 1.94 (95% CI, 1.23-3.05), and 1.15 (95% CI, 1.03-1.28), respectively. For ICU LOS, elevated reaction time, K value, and fibrinolysis at 30 minutes, alpha angle, and maximum amplitude demonstrated hazard ratios of 0.76 (95% CI, 0.65-0.88), 0.82 (95% CI, 0.64-1.0), 0.95 (95% CI, 0.88-0.99), 1.05 (95% CI, 1.02-1.08), and 1.04 (95% CI, 1.01-1.06), respectively. There was no association between TEG and blood product transfusion. CONCLUSIONS: Coagulopathic patients based on TEG had higher mortality. All TEG values, as they moved toward transfusion-trigger cut points, were associated with increased mortality. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Tanner, Thomas E AU - Tanner TE AD - From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX. FAU - Drapkin, Zachary AU - Drapkin Z FAU - Fino, Nora AU - Fino N AD - Department of Internal Medicine, University of Utah Health. FAU - Russell, Katie AU - Russell K AD - Department of Surgery, Division of Pediatric Surgery, University of Utah, Salt Lake City, UT. FAU - Chaulk, David AU - Chaulk D AD - Department of Pediatrics. FAU - Hewes, Hilary A AU - Hewes HA AD - Department of Pediatrics. LA - eng PT - Journal Article DEP - 20220127 PL - United States TA - Pediatr Emerg Care JT - Pediatric emergency care JID - 8507560 SB - IM MH - Humans MH - Child MH - Thrombelastography MH - *Blood Coagulation Disorders/etiology/diagnosis MH - Blood Transfusion MH - Injury Severity Score MH - Length of Stay MH - *Wounds and Injuries/therapy COIS- Disclosure: The authors declare no conflict of interest. EDAT- 2023/02/01 06:00 MHDA- 2023/02/03 06:00 CRDT- 2023/01/31 10:43 PHST- 2023/01/31 10:43 [entrez] PHST- 2023/02/01 06:00 [pubmed] PHST- 2023/02/03 06:00 [medline] AID - 00006565-202302000-00011 [pii] AID - 10.1097/PEC.0000000000002642 [doi] PST - ppublish SO - Pediatr Emerg Care. 2023 Feb 1;39(2):e41-e47. doi: 10.1097/PEC.0000000000002642. Epub 2022 Jan 27. PMID- 36700506 OWN - NLM STAT- MEDLINE DCOM- 20230214 LR - 20250530 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 21 IP - 2 DP - 2023 Feb TI - Traumatic coagulopathy in the older patient: analysis of coagulation profiles from the Activation of Coagulation and Inflammation in Trauma-2 (ACIT-2) observational, multicenter study. PG - 215-226 LID - S1538-7836(22)07619-X [pii] LID - 10.1016/j.jtha.2022.11.005 [doi] AB - BACKGROUND: Most studies describing traumatic coagulopathy have used data from patient cohorts with an average age of between 35 and 45 years. The last 10 years has seen a steep increase in the number of patients admitted with significant injury and bleeding who are older than the age of 65 years. Many coagulation protein levels alter significantly with normal aging, and it is possible that traumatic coagulopathy has a different signature with age. OBJECTIVES: The aim of this study was to report the coagulation profiles, including standard and extended laboratory, as well as viscoelastic hemostatic assays, stratified according to age to explore age-related differences in hemostatic capability. METHODS: In total, 1576 patients were analyzed from 6 European level 1 trauma centers. RESULTS: As age increased, there was evidence of higher fibrinogen, greater thrombin generation, greater clotting factor consumption, and greater activation of fibrinolysis. Despite this, shock and severe injury led to the same pattern of changes within age groups: lower procoagulant factors (including fibrinogen), increased fibrinolysis, and higher levels of activated protein C. Thromboelastography and rotational thromboelastometry tests detected traumatic coagulopathy with prolongation of R/clotting time and reductions in clot amplitudes in each age cohort. Advancing age strongly correlated with higher fibrinogen levels and greater fibrinolysis. CONCLUSION: Age-related coagulation changes are evident in injured patients. Broadly, similar patterns of coagulation abnormalities are seen across age groups following severe injury/shock, but thresholds for single clotting factors differ. Age-related differences may need to be considered when clinical treatments (eg, transfusion therapy) are indicated. CI - Copyright (c) 2022 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved. FAU - Curry, Nicola S AU - Curry NS AD - Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom. Electronic address: nicola.curry@ouh.nhs.uk. FAU - Davenport, Ross AU - Davenport R AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Wong, Henna AU - Wong H AD - Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Johansson, Par AU - Johansson P AD - Department of Anesthesiology and Trauma Center, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anesthesiology and Trauma Center, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Brohi, Karim AU - Brohi K AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Laffan, Mike AU - Laffan M AD - Imperial College and Hammersmith Hospital, London, United Kingdom. FAU - Stanworth, Simon J AU - Stanworth SJ AD - Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom; NHS Blood and Transplant, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. LA - eng GR - MR/T023961/1/MRC_/Medical Research Council/United Kingdom GR - RPPG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20221222 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) RN - 0 (Hemostatics) SB - IM MH - Humans MH - Adult MH - Middle Aged MH - Blood Coagulation MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Coagulation Factors MH - Thrombelastography MH - Fibrinogen/metabolism MH - Inflammation MH - *Hemostatics/pharmacology MH - *Wounds and Injuries/complications/diagnosis OTO - NOTNLM OT - bleeding OT - elderly OT - hemostasis OT - trauma OT - traumatic coagulopathy EDAT- 2023/01/27 06:00 MHDA- 2023/02/15 06:00 CRDT- 2023/01/26 06:51 PHST- 2022/09/02 00:00 [received] PHST- 2022/10/19 00:00 [revised] PHST- 2022/11/04 00:00 [accepted] PHST- 2023/01/27 06:00 [pubmed] PHST- 2023/02/15 06:00 [medline] PHST- 2023/01/26 06:51 [entrez] AID - S1538-7836(22)07619-X [pii] AID - 10.1016/j.jtha.2022.11.005 [doi] PST - ppublish SO - J Thromb Haemost. 2023 Feb;21(2):215-226. doi: 10.1016/j.jtha.2022.11.005. Epub 2022 Dec 22. PMID- 36694515 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230201 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 14 IP - 12 DP - 2022 Dec TI - The Role of Thromboelastography in Identifying Coagulopathy Among Geriatric Traumatic Brain Injury Patients. PG - e32818 LID - 10.7759/cureus.32818 [doi] LID - e32818 AB - Background The geriatric population has the highest incidence of head injury, and those who are anticoagulated have an increased risk of traumatic intracranial hemorrhage (ICH). The availability of viscoelastic coagulation studies has coincided with the development of many anticoagulation reversal agents. In this study, our objective was to assess whether the thromboelastography (TEG) assay affected clinical decision-making regarding reversal agent administration among geriatric patients with ICH caused by blunt head trauma. Methodology We prospectively screened adults aged 65 and older with head trauma presenting to the emergency departments of two level-one trauma centers. International Classification of Diseases, Tenth Revision codes S00-09 were used to identify the diagnosis of head injury. Patients with CT head imaging positive for acute ICH were included. Each patient was assessed for home use of antiplatelet or anticoagulant medications, as well as in-hospital use of any reversal agents. Reversal agent administration and mortality were compared between patients who received TEG and those who did not. Results A total of 680 patients had acute ICH on head CT, and 324 (48%) patients received TEG. More patients screened with TEG were transfused platelets (30.2% vs. 10.7%, p < 0.001). This remained significant for patients taking anticoagulants, antiplatelets, or neither. There were no differences in the administration of other reversal agents (prothrombin complex concentrate or fresh frozen plasma) or mortality whether or not TEG was performed. Conclusions Patients who had TEG performed were more likely to receive platelet reversal agents, regardless of antiplatelet medication usage. Among elderly adults with ICH, TEG is a rapid screening test that may help identify patients with platelet function abnormalities requiring reversal. CI - Copyright (c) 2022, Busko et al. FAU - Busko, Alexander M AU - Busko AM AD - Critical Care, University of Alabama at Birmingham, Birmingham, USA. FAU - Solano, Joshua J AU - Solano JJ AD - Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA. FAU - Clayton, Lisa M AU - Clayton LM AD - Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA. FAU - Hughes, Patrick G AU - Hughes PG AD - Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA. FAU - Paley, Richard J AU - Paley RJ AD - Emergency Department, St Mary's Medical Center, West Palm Beach, USA. FAU - Shih, Richard D AU - Shih RD AD - Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA. FAU - Alter, Scott M AU - Alter SM AD - Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA. LA - eng PT - Journal Article DEP - 20221222 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC9863733 OTO - NOTNLM OT - anti-coag OT - anticoagulation reversal OT - geriatric injuries OT - intracranial hemorrhage (ich) OT - thromboelastography COIS- The authors have declared that no competing interests exist. EDAT- 2023/01/26 06:00 MHDA- 2023/01/26 06:01 PMCR- 2022/12/22 CRDT- 2023/01/25 01:43 PHST- 2022/12/22 00:00 [accepted] PHST- 2023/01/25 01:43 [entrez] PHST- 2023/01/26 06:00 [pubmed] PHST- 2023/01/26 06:01 [medline] PHST- 2022/12/22 00:00 [pmc-release] AID - 10.7759/cureus.32818 [doi] PST - epublish SO - Cureus. 2022 Dec 22;14(12):e32818. doi: 10.7759/cureus.32818. eCollection 2022 Dec. PMID- 36694332 OWN - NLM STAT- MEDLINE DCOM- 20230126 LR - 20230221 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 94 IP - 2 DP - 2023 Feb 1 TI - Admission maximum amplitude-reaction time ratio: Association between thromboelastography values predicts poor outcome in injured children. PG - 212-219 LID - 10.1097/TA.0000000000003834 [doi] AB - INTRODUCTION: Thromboelastography (TEG)-derived maximum amplitude-reaction time (MA-R) ratio that accounts for both hypocoagulable and hypercoagulable changes in coagulation is associated with poor outcomes in adults. The relationship between these TEG values and outcomes has not been studied in children. METHODS: In a retrospective cohort study, a level I pediatric trauma center database was queried for children younger than 18 years who had a TEG assay on admission between 2016 and 2020. Demographics, injury characteristics, and admission TEG values were recorded. The MA-R ratio was calculated and divided into quartiles. Main outcomes included mortality, transfusion within 24 hours of admission, and thromboembolism. A logistic regression model was generated adjusting for age, Injury Severity Score, injury mechanism, admission shock, and Glasgow Coma Scale. RESULTS: In total, 657 children were included, of which 70% were male and 75% had blunt mechanism injury. The median (interquartile range) age was 11 (4-14) years, the median (interquartile range) Injury Severity Score was10 (5-22), and in-hospital mortality was 7% (n = 45). Of these patients, 17% (n = 112) required transfusion. Most R and MA values were within normal limits. On unadjusted analysis, the lowest MA-R ratio quartile was associated with increased mortality (15% vs. 4%, 5%, and 4%, respectively; p < 0.001) and increased transfusion need (26% vs. 12%, 16%, and 13%, respectively; p = 0.002) compared with higher quartiles. In the logistic regression models, a low MA-R ratio was independently associated with increased in-hospital mortality (odds ratio [95% confidence interval], 4.4 [1.9-10.2]) and increased need for transfusion within 24 hours of admission (odds ratio [95% confidence interval], 2.0 [1.2-3.4]) compared with higher MA-R ratio. There was no association between MA-R ratio and venous thromboembolic events (venous thromboembolic event rate by quartile: 4%, 2%, 1%, and 3%). CONCLUSION: Although individual admission TEG values are not commonly substantially deranged in injured children, the MA-R ratio is an independent predictor of poor outcome. Maximum amplitude-reaction time ratio may be a useful prognostic tool in pediatric trauma; validation is necessary. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. CI - Copyright (c) 2022 American Association for the Surgery of Trauma. FAU - Abou Khalil, Elissa AU - Abou Khalil E AD - From the Department of Surgery (E.A.K., K.M.M., C.M.L.), Division of Trauma and General Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine; and Department of Surgery (B.A.G.), Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Gaines, Barbara A AU - Gaines BA FAU - Morgan, Katrina M AU - Morgan KM FAU - Leeper, Christine M AU - Leeper CM LA - eng PT - Journal Article DEP - 20221115 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Humans MH - Male MH - Child MH - Adolescent MH - Female MH - Thrombelastography MH - Retrospective Studies MH - Reaction Time MH - *Thrombophilia/complications MH - *Venous Thromboembolism MH - Injury Severity Score MH - *Wounds and Injuries/complications/diagnosis/therapy MH - *Blood Coagulation Disorders/etiology/complications EDAT- 2023/01/26 06:00 MHDA- 2023/01/27 06:00 CRDT- 2023/01/25 00:13 PHST- 2023/01/25 00:13 [entrez] PHST- 2023/01/26 06:00 [pubmed] PHST- 2023/01/27 06:00 [medline] AID - 01586154-202302000-00005 [pii] AID - 10.1097/TA.0000000000003834 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Feb 1;94(2):212-219. doi: 10.1097/TA.0000000000003834. Epub 2022 Nov 15. PMID- 36694329 OWN - NLM STAT- MEDLINE DCOM- 20230126 LR - 20260307 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 2 DP - 2023 Feb 1 TI - Estradiol provokes hypercoagulability and affects fibrin biology: A mechanistic exploration of sex dimorphisms in coagulation. PG - 179-186 LID - 10.1097/TA.0000000000003822 [doi] AB - BACKGROUND: Sex dimorphisms in coagulation are well established, with female-specific hypercoagulability conferring a survival benefit in the setting of trauma-induced coagulopathy (TIC). The mechanism behind these phenomena remains to be elucidated. We hypothesize that estradiol provokes a hypercoagulable profile and alters clot proteomics and fibrin crosslinking. METHODS: Whole blood was collected from healthy adult volunteers (n = 30). A battery of thrombelastography (TEG) assays (native, kaolin, platelet-mapping, functional fibrinogen), whole blood thrombin generation, proteomics, and clot structure architecture (via analysis of fibrin crosslinks and fluorescent fibrinogen-visualized clots) were performed after pre-treatment of the blood with physiologic concentrations of beta-estradiol. In addition, a prospective study of coagulation through the menstrual cycle was conducted by collecting blood from women on peak and nadir estrogen days in the standard 28-day menstrual cycle. RESULTS: On TEG, in females, estradiol provoked a hypercoagulable phenotype, specifically a shorter time to clot formation and greater thrombin generation, greater rate of clot propagation and functional fibrinogen, higher clot strength, and diminished clot fibrinolysis. In both males and females, estradiol increased platelet hyperactivity. Similar changes were seen in time to clot formation and clot strength in vivo during peak estrus of the menstrual cycle. On proteomic analysis, in both males and females, estradiol was associated with increases in abundance of several procoagulant and antifibrinolytic proteins. Crosslinking mass spectrometry analysis showed addition of estradiol increased the abundance of several FXIII crosslinks within the FIBA alpha chain in both sexes. Fluorescent fibrinogen analysis revealed a trend toward increased fiber resolvability index after addition of estradiol. CONCLUSION: Estradiol provokes a hypercoagulable phenotype, affecting time to clot formation, clot propagation, clot strength, clot fibrinolysis, and clot structure. In sum, these data highlight the role of estradiol is driving female-specific hypercoagulability and highlights its potential role as a therapeutic adjunct in resuscitation of TIC. CI - Copyright (c) 2022 American Association for the Surgery of Trauma. FAU - Coleman, Julia R AU - Coleman JR AD - From the Department of Surgery (J.R.C.), Ohio State University, Columbus, Ohio; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Department of Biochemistry and Molecular Genetics (L.S., K.H.), University of Colorado, Aurora, Colorado; Department of Emergency Medicine (N.D., K.F.), University of Vermont, Burlington, Vermont; Department of Surgery (M.J.C.), University of Colorado, Aurora; Vitalant Research Institute (C.C.S.), Denver; and Department of Pediatrics (C.C.S.), University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Schmitt, Lauren AU - Schmitt L FAU - Hansen, Kirk AU - Hansen K FAU - Dow, Nathan AU - Dow N FAU - Freeman, Kalev AU - Freeman K FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - R35 GM144099/GM/NIGMS NIH HHS/United States GR - S10 OD025030/OD/NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20221020 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-31-4 (Fibrin) RN - 4TI98Z838E (Estradiol) RN - EC 3.4.21.5 (Thrombin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Male MH - Female MH - Humans MH - Fibrin MH - Estradiol MH - Thrombin MH - Sex Characteristics MH - Prospective Studies MH - Proteomics MH - *Blood Coagulation Disorders MH - Thrombelastography/methods MH - Fibrinogen/metabolism MH - *Thrombophilia/etiology MH - *Thrombosis PMC - PMC9881840 MID - NIHMS1843409 EDAT- 2023/01/26 06:00 MHDA- 2023/01/27 06:00 PMCR- 2024/02/01 CRDT- 2023/01/25 00:13 PHST- 2023/01/25 00:13 [entrez] PHST- 2023/01/26 06:00 [pubmed] PHST- 2023/01/27 06:00 [medline] PHST- 2024/02/01 00:00 [pmc-release] AID - 01586154-202302000-00001 [pii] AID - 10.1097/TA.0000000000003822 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Feb 1;94(2):179-186. doi: 10.1097/TA.0000000000003822. Epub 2022 Oct 20. PMID- 36691873 OWN - NLM STAT- MEDLINE DCOM- 20231023 LR - 20231025 IS - 1554-527X (Electronic) IS - 0736-0266 (Linking) VI - 41 IP - 8 DP - 2023 Aug TI - Relative motion between the flexor digitorum superficialis tendon and subsynovial connective tissue is time dependent. PG - 1661-1669 LID - 10.1002/jor.25524 [doi] AB - The subsynovial connective tissue is an integral component of flexor tendon gliding in the carpal tunnel, which is strained during longitudinal tendon displacement. We tested the effects of repetition frequency and finger load on flexor tendon function throughout active finger movement. Eleven participants performed metacarpophalangeal joint flexion/extension of the long finger cyclically at three repetition frequencies (0.75, 1.00, 1.25 Hz) and two finger loads (3.5, 7 N). Relative displacement between the flexor digitorum superficialis tendon and subsynovial connective tissue was assessed as the shear-strain index with color ultrasound throughout the entire time history of finger flexion and extension. In addition, long finger joint angles were measured with electrogoniometry while flexor digitorum superficialis and extensor digitorum muscle activities were measured with fine-wire electromyography to characterize the finger movements. The shear-strain index increased with greater finger flexion (p = 0.001), representing higher relative displacement between tendon and subsynovial connective tissue; however, no changes were observed throughout finger extension. The shear-strain index also increased with higher repetition frequencies (p = 0.013) and finger loads (p = 0.029), further modulating time-dependent effects during finger flexion versus extension. Using ultrasound, we characterized the time-dependent response of the shear-strain index, in vivo, providing valuable data on flexor tendon function during active finger movement. Our results infer greater subsynovial connective tissue strain and shear during repetitive and forceful finger movements. Future research characterizing time-dependent effects in carpal tunnel syndrome patients may further elucidate the relations between subsynovial connective tissue function, damage, and carpal tunnel syndrome. CI - (c) 2023 The Authors. Journal of Orthopaedic Research(R) published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society. FAU - Kociolek, Aaron M AU - Kociolek AM AUID- ORCID: 0000-0003-3032-6610 AD - School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada. FAU - Keir, Peter J AU - Keir PJ AUID- ORCID: 0000-0002-9811-1547 AD - Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230207 PL - United States TA - J Orthop Res JT - Journal of orthopaedic research : official publication of the Orthopaedic Research Society JID - 8404726 SB - IM MH - Humans MH - *Carpal Tunnel Syndrome/diagnostic imaging MH - Connective Tissue/diagnostic imaging/physiology MH - Tendons/physiology MH - Fingers MH - Hand OTO - NOTNLM OT - carpal tunnel OT - shear OT - strain OT - ultrasound OT - viscoelastic EDAT- 2023/01/25 06:00 MHDA- 2023/10/23 12:43 CRDT- 2023/01/24 04:43 PHST- 2023/01/10 00:00 [revised] PHST- 2022/10/26 00:00 [received] PHST- 2023/01/19 00:00 [accepted] PHST- 2023/10/23 12:43 [medline] PHST- 2023/01/25 06:00 [pubmed] PHST- 2023/01/24 04:43 [entrez] AID - 10.1002/jor.25524 [doi] PST - ppublish SO - J Orthop Res. 2023 Aug;41(8):1661-1669. doi: 10.1002/jor.25524. Epub 2023 Feb 7. PMID- 36675530 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230202 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 12 IP - 2 DP - 2023 Jan 11 TI - Coagulation Disorders in Sepsis and COVID-19-Two Sides of the Same Coin? A Review of Inflammation-Coagulation Crosstalk in Bacterial Sepsis and COVID-19. LID - 10.3390/jcm12020601 [doi] LID - 601 AB - Sepsis is a major cause of morbidity and mortality worldwide. Sepsis-associated coagulation disorders are involved in the pathogenesis of multiorgan failure and lead to a subsequently worsening prognosis. Alongside the global impact of the COVID-19 pandemic, a great number of research papers have focused on SARS-CoV-2 pathogenesis and treatment. Significant progress has been made in this regard and coagulation disturbances were once again found to underlie some of the most serious adverse outcomes of SARS-CoV-2 infection, such as acute lung injury and multiorgan dysfunction. In the attempt of untangling the mechanisms behind COVID-19-associated coagulopathy (CAC), a series of similarities with sepsis-induced coagulopathy (SIC) became apparent. Whether they are, in fact, the same disease has not been established yet. The clinical picture of CAC shows the unique feature of an initial phase of intravascular coagulation confined to the respiratory system. Only later on, patients can develop a clinically significant form of systemic coagulopathy, possibly with a consumptive pattern, but, unlike SIC, it is not a key feature. Deepening our understanding of CAC pathogenesis has to remain a major goal for the research community, in order to design and validate accurate definitions and classification criteria. FAU - Tuculeanu, Georgeana AU - Tuculeanu G AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. FAU - Barbu, Ecaterina Constanta AU - Barbu EC AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. FAU - Lazar, Mihai AU - Lazar M AUID- ORCID: 0000-0002-1169-3653 AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. AD - National Institute for Infectious Diseases Prof. Dr. Matei Bals, No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania. FAU - Chitu-Tisu, Cristina Emilia AU - Chitu-Tisu CE AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. FAU - Moisa, Emanuel AU - Moisa E AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. AD - Department of Anaesthesia and Intensive Care, Elias Emergency University Hospital, No. 17, Marasti Avenue, 011461 Bucharest, Romania. FAU - Negoita, Silvius Ioan AU - Negoita SI AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. AD - Department of Anaesthesia and Intensive Care, Elias Emergency University Hospital, No. 17, Marasti Avenue, 011461 Bucharest, Romania. FAU - Ion, Daniela Adriana AU - Ion DA AD - Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania. LA - eng PT - Journal Article PT - Review DEP - 20230111 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9866352 OTO - NOTNLM OT - COVID-19 OT - SARS-CoV-2 infection OT - coagulopathy OT - disseminated intravascular coagulopathy OT - immunothrombosis OT - sepsis OT - viscoelastic tests COIS- The authors declare no conflict of interest. EDAT- 2023/01/22 06:00 MHDA- 2023/01/22 06:01 PMCR- 2023/01/11 CRDT- 2023/01/21 01:31 PHST- 2022/11/22 00:00 [received] PHST- 2022/12/27 00:00 [revised] PHST- 2023/01/10 00:00 [accepted] PHST- 2023/01/21 01:31 [entrez] PHST- 2023/01/22 06:00 [pubmed] PHST- 2023/01/22 06:01 [medline] PHST- 2023/01/11 00:00 [pmc-release] AID - jcm12020601 [pii] AID - jcm-12-00601 [pii] AID - 10.3390/jcm12020601 [doi] PST - epublish SO - J Clin Med. 2023 Jan 11;12(2):601. doi: 10.3390/jcm12020601. PMID- 36675406 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230201 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 12 IP - 2 DP - 2023 Jan 6 TI - Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J. Clin. Med. 2022, 11, 860. LID - 10.3390/jcm12020477 [doi] LID - 477 AB - With the advent of new viscoelastometric hemostatic assay (VHA) devices, with ready-to-use cartridge reagents allowing for their use by people without special laboratory skills, the appreciation of the actual clinical value of VHAs in settings such as severe trauma, post-partum hemorrhage, cardiac surgery and liver transplantation still needs to be fully validated. While two of the newest versions remain based on a 'cup and pin' system (ROTEM((R)) sigma, ClotPro((R))), two other new devices (TEG((R)) 6s, Quantra((R))) rely on very different technologies: clotting blood is no longer in contact with the probe and challenged by oscillation of one of the components but explored with ultrasound exposure. A systematic literature search (including Sonoclot((R))) retrieved 20 observational studies (19 prospective). Most studies pointed to imperfect agreements, highlighting the non-interchangeability of devices. Only a few studies, often with a limited number of patients enrolled, used a clinical outcome. No study compared VHA results with conventional laboratory assays obtained through a rapid tests panel. Clinical evidence of the utility of the new VHAs largely remains to be proven through randomized clinical trials, with clinically relevant outcomes, and compared to rapid panel hemostasis testing. The availability of new, improved VHA devices provides an impetus and an opportunity to do so. FAU - Bareille, Marion AU - Bareille M AUID- ORCID: 0000-0002-3589-4804 AD - CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Universite Catholique de Louvain, 5530 Yvoir, Belgium. FAU - Lecompte, Thomas AU - Lecompte T AD - Pharmacy Department, University of Namur, 5000 Namur, Belgium. AD - Universite de Lorraine, 54000 Nancy, France. FAU - Mullier, Francois AU - Mullier F AUID- ORCID: 0000-0001-6947-6099 AD - CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Universite Catholique de Louvain, 5530 Yvoir, Belgium. FAU - Roullet, Stephanie AU - Roullet S AUID- ORCID: 0000-0002-1064-0621 AD - Laboratory for Hemostasis, Inflammation & Thrombosis (HITh), Unite Mixte de Recherche (UMR)-1176, Institut National de la Sante et de la Recherche Medicale (Inserm), Universite Paris-Saclay, 94270 Le Kremlin-Bicetre, France. LA - eng PT - Journal Article DEP - 20230106 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 CON - J Clin Med. 11:860. PMC - PMC9866463 OTO - NOTNLM OT - COVID-19 OT - cardiac surgery OT - coagulopathy OT - fibrinogen OT - liver transplantation OT - postpartum hemorrhage OT - rotational thromboelastometry OT - thromboelastography OT - trauma OT - viscoelastic testing OT - viscoelastometry COIS- The authors declare no conflict of interest. EDAT- 2023/01/22 06:00 MHDA- 2023/01/22 06:01 PMCR- 2023/01/06 CRDT- 2023/01/21 01:30 PHST- 2022/09/27 00:00 [received] PHST- 2022/11/17 00:00 [revised] PHST- 2022/12/29 00:00 [accepted] PHST- 2023/01/21 01:30 [entrez] PHST- 2023/01/22 06:00 [pubmed] PHST- 2023/01/22 06:01 [medline] PHST- 2023/01/06 00:00 [pmc-release] AID - jcm12020477 [pii] AID - jcm-12-00477 [pii] AID - 10.3390/jcm12020477 [doi] PST - epublish SO - J Clin Med. 2023 Jan 6;12(2):477. doi: 10.3390/jcm12020477. PMID- 36623279 OWN - NLM STAT- MEDLINE DCOM- 20230111 LR - 20230111 IS - 1477-0903 (Electronic) IS - 0960-3271 (Linking) VI - 42 DP - 2023 Jan-Dec TI - Wasp-stung rat model translationally expresses the coagulopathy manifestations of human wasp patients. PG - 9603271221149013 LID - 10.1177/09603271221149013 [doi] AB - Two over 80 wasp stings male victims appeared severe abnormal coagulation were consecutively examined by thromboelastography (TEG) guided with heparinase during hospitalization. However, the cause of coagulopathy remains unsolved. Rats were applied to establish a wasp-stung animal model highly resembled the manifestations of wasp-stung patients. According body surface area conversion, Sprague-Dawley rats were stung based on wasp sting numbers (0, 4, 8, 12 stings; n = 6 each) with various exposure times (0, 1, 3, 6 h) to determine the simulation of coagulopathy. The blood R, K values, and angle degree of wasp-stung rats were measured by TEG. The TEG profiles of stung rats were found to be concomitant with that of wasp-stung patients. Data showed that the endogenous heparinization of rats was time-dependent. Compared to the TEG profile of eight stings given rat, the coagulation time of 2 mm clot formation at 3 h (R value) was longer than that at 0 h. The coagulation time was prolonged with increasing sting numbers when compared to the various stings at 1, 3, and 6 h exposed. Interestingly, there was observed the peak coagulation at 3 h of eight stings. The Ck-standard and Ck-heparinase at 3 h after 8 stings given were R: 9.6-4.4 min; K: 3.8-1.8 min; angle degree: 49.8-68.0, respectively. The original data of R, K values and angle degree in two wasp-stung victims were 11.7-13.6 min, 4.3-5.5 min, and 41.2-32.8 degrees in CK-standard, respectively; whereas those of the CK-heparinase groups were 5.6-6.7 min, 2.4-2.5 min, and 59.5-58.8 degrees , correspondingly. Conclusively, this massive wasp-stung animal model can be applied to the investigations of pathogenesis and provides a clinical strategy or guideline for clinical intervention. FAU - Lai, Dong AU - Lai D AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Intensive Care Unit, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. FAU - Tian, Yan AU - Tian Y AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Intensive Care Unit, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. FAU - Ji, Chang-Fu AU - Ji CF AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Intensive Care Unit, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. FAU - Zang, Yuan AU - Zang Y AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Intensive Care Unit, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. FAU - Fu, Yaw-Syan AU - Fu YS AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Department of Physiology, School of Basic Medical Science, 519884Xiamen Medical College, Xiamen, China. FAU - Weng, Ching-Feng AU - Weng CF AUID- ORCID: 0000-0002-9747-8697 AD - Medical Research Center, 519884The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China. AD - Department of Physiology, School of Basic Medical Science, 519884Xiamen Medical College, Xiamen, China. LA - eng PT - Journal Article PL - England TA - Hum Exp Toxicol JT - Human & experimental toxicology JID - 9004560 RN - EC 4.2.2.7 (Heparin Lyase) SB - IM MH - Humans MH - Male MH - Rats MH - Animals MH - *Wasps MH - *Insect Bites and Stings MH - Heparin Lyase MH - Rats, Sprague-Dawley MH - Blood Coagulation MH - Thrombelastography OTO - NOTNLM OT - coagulopathy OT - heparinization OT - rat model OT - thromboelastography OT - wasp sting EDAT- 2023/01/10 06:00 MHDA- 2023/01/12 06:00 CRDT- 2023/01/09 17:05 PHST- 2023/01/09 17:05 [entrez] PHST- 2023/01/10 06:00 [pubmed] PHST- 2023/01/12 06:00 [medline] AID - 10.1177/09603271221149013 [doi] PST - ppublish SO - Hum Exp Toxicol. 2023 Jan-Dec;42:9603271221149013. doi: 10.1177/09603271221149013. PMID- 36590822 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230506 IS - 2572-7966 (Electronic) IS - 2572-7958 (Print) IS - 2572-7958 (Linking) VI - 6 IP - 1 DP - 2023 Feb 1 TI - Biaxial Tensile Prestress and Waveguide Effects on Estimates of the Complex Shear Modulus Using Optical-Based Dynamic Elastography in Plate-Like Soft Tissue Phantoms. PG - 011006 LID - 10.1115/1.4056103 [doi] LID - 011006 AB - Dynamic elastography attempts to reconstruct quantitative maps of the viscoelastic properties of biological tissue, properties altered by disease and injury, by noninvasively measuring mechanical wave motion in the tissue. Most reconstruction strategies that have been developed neglect boundary conditions, including quasi-static tensile or compressive loading resulting in a nonzero prestress. Significant prestress is inherent to the functional role of some biological tissues, such as skeletal and cardiac muscle, arterial walls, and the cornea. In the present article a novel configuration, inspired by corneal elastography but generalizable to other applications, is studied. A polymer phantom layer is statically elongated via an in-plane biaxial normal stress while the phantom's response to transverse vibratory excitation is measured. We examine the interplay between biaxial prestress and waveguide effects in this plate-like tissue phantom. Finite static deformations caused by prestressing coupled with waveguide effects lead to results that are predicted by a novel coordinate transformation approach previously used to simplify reconstruction of anisotropic properties. Here, the approach estimates material viscoelastic properties independent of the nonzero prestress conditions without requiring advanced knowledge of those stress conditions. CI - Copyright (c) 2023 by ASME. FAU - Dore, Marta AU - Dore M AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. FAU - Luna, Aime AU - Luna A AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. FAU - Royston, Thomas J AU - Royston TJ AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. LA - eng GR - R01 AR071162/AR/NIAMS NIH HHS/United States PT - Journal Article DEP - 20221123 PL - United States TA - J Eng Sci Med Diagn Ther JT - Journal of engineering and science in medical diagnostics and therapy JID - 101723801 PMC - PMC9793440 OTO - NOTNLM OT - acoustoelasticity OT - elastography OT - viscoelastic COIS- There is no conflict of interest. EDAT- 2023/01/03 06:00 MHDA- 2023/01/03 06:01 CRDT- 2023/01/02 04:36 PHST- 2022/08/12 00:00 [received] PHST- 2022/10/23 00:00 [revised] PHST- 2023/01/02 04:36 [entrez] PHST- 2023/01/03 06:00 [pubmed] PHST- 2023/01/03 06:01 [medline] AID - JESMDT-22-1029 [pii] AID - 10.1115/1.4056103 [doi] PST - ppublish SO - J Eng Sci Med Diagn Ther. 2023 Feb 1;6(1):011006. doi: 10.1115/1.4056103. Epub 2022 Nov 23. PMID- 36589925 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230103 IS - 2572-7966 (Electronic) IS - 2572-7958 (Print) IS - 2572-7958 (Linking) VI - 6 IP - 2 DP - 2023 May 1 TI - Decoupling Uniaxial Tensile Prestress and Waveguide Effects From Estimates of the Complex Shear Modulus in a Cylindrical Structure Using Transverse-Polarized Dynamic Elastography. PG - 021003 LID - 10.1115/1.4056411 [doi] LID - 021003 AB - Dynamic elastography, whether based on magnetic resonance, ultrasound, or optical modalities, attempts to reconstruct quantitative maps of the viscoelastic properties of biological tissue, properties altered by disease and injury, by noninvasively measuring mechanical wave motion in the tissue. Most reconstruction strategies that have been developed neglect boundary conditions, including quasi-static tensile or compressive loading resulting in a nonzero prestress. Significant prestress is inherent to the functional role of some biological tissues currently being studied using elastography, such as skeletal and cardiac muscle, arterial walls, and the cornea. In the present article a configuration, inspired by muscle elastography but generalizable to other applications, is analytically and experimentally studied. A hyperelastic polymer phantom cylinder is statically elongated in the axial direction while its response to transverse-polarized vibratory excitation is measured. We examine the interplay between uniaxial prestress and waveguide effects in this muscle-like tissue phantom using computational finite element simulations and magnetic resonance elastography measurements. Finite deformations caused by prestress coupled with waveguide effects lead to results that are predicted by a coordinate transformation approach that has been previously used to simplify reconstruction of anisotropic properties using elastography. Here, the approach estimates material viscoelastic properties that are independent of the nonhomogeneous prestress conditions without requiring advanced knowledge of those stress conditions. CI - Copyright (c) 2023 by ASME. FAU - Salehabadi, Melika AU - Salehabadi M AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. FAU - Crutison, Joseph AU - Crutison J AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. FAU - Klatt, Dieter AU - Klatt D AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. FAU - Royston, Thomas J AU - Royston TJ AD - Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, 851 South Morgan Street, MC 063, Chicago, IL 60607. LA - eng PT - Journal Article DEP - 20221223 PL - United States TA - J Eng Sci Med Diagn Ther JT - Journal of engineering and science in medical diagnostics and therapy JID - 101723801 PMC - PMC9793439 OTO - NOTNLM OT - acoustoelasticity OT - elastography OT - viscoelastic EDAT- 2023/01/03 06:00 MHDA- 2023/01/03 06:01 CRDT- 2023/01/02 04:11 PHST- 2022/09/04 00:00 [received] PHST- 2022/11/26 00:00 [revised] PHST- 2023/01/02 04:11 [entrez] PHST- 2023/01/03 06:00 [pubmed] PHST- 2023/01/03 06:01 [medline] AID - JESMDT-22-1030 [pii] AID - 10.1115/1.4056411 [doi] PST - ppublish SO - J Eng Sci Med Diagn Ther. 2023 May 1;6(2):021003. doi: 10.1115/1.4056411. Epub 2022 Dec 23. PMID- 36577625 OWN - NLM STAT- MEDLINE DCOM- 20230417 LR - 20230417 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 54 IP - 5 DP - 2023 May TI - Acquired Factor XIII Deficiency in Patients with Multiple Trauma. PG - 1257-1264 LID - S0020-1383(22)00954-8 [pii] LID - 10.1016/j.injury.2022.12.021 [doi] AB - INTRODUCTION: Fibrin stabilizing factor (FXIII) plays a crucial role in blood clotting, tissue repair, and immune defense. FXIII deficiency after trauma can lead to prolonged wound healing due to persistent infections or coagulation disorders. The aim of this study was to describe the prevalence of acquired FXIII deficiency after trauma and to provide a description of the time-course changes of important coagulation parameters in relation to FXIII activity. In this context, patient characteristics, laboratory data, and treatment modalities were examined with respect to their influence on FXIII activity. Furthermore, the effects of in vitro administration of FXIII on clot firmness and outcomes in patients with severe traumatic brain injury were investigated. PATIENTS AND METHODS: Two trauma cohorts (A and B) were examined prospectively in a two-center study, and another (cohort C) was examined retrospectively. In cohort A (trauma patients, n=880) routine laboratory tests were conducted, and FXIII activity was measured. In cohort B (polytrauma patients, n=26), additional clinical parameters were collected, and in-vitro FXIII administration and rotational thromboelastometry (ROTEM) analyses were performed. In cohort C (polytrauma patients with severe traumatic brain injury [sTBI], n=84), the impact of initially measured FXIII activity on clinical outcomes after sTBI was investigated using the modified Rankin Scale (mRS) at least 6 months after trauma. RESULTS: The prevalence of FXIII activity <70% in cohort A was 12.4%, with significant differences in age, Hb, fibrinogen, and Hct levels, platelet count, aPTT, and INR (vs. prevalence of FXIII activity >70%). Cohort B showed a decrease in FXIII activity from 85% to 58% after 7 days. FXIII deficiency correlated with time after trauma, aPTT, and fibrinogen level, lactate, and Hb levels. In-vitro administration of FXIII showed a positive influence on clot firmness due to improved maximum clot firmness (MCF in FIBTEM) and reduced maximum lysis (ML in EXTEM). Finally, a significant difference in FXIII activity between patients after sTBI with good and poor clinical outcomes was observed 6 months after trauma. CONCLUSION: We demonstrated that trauma-associated FXIII deficiency is a common coagulation disorder, with FXIII deficiency increasing further in the first 7 days after trauma, the period of early surgical care. In vitro administration of FXIII was able to demonstrate significant clot stabilizing effects. For trauma patients with sTBI, FXIII activity could serve as a prognostic parameter, as it differed significantly between patients with good and poor clinical outcomes. CI - Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Hetz, Michael AU - Hetz M AD - Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AoR, Liebigstr. 20, 04103 Leipzig, Germany. Electronic address: Michael.Hetz@medizin.uni-leipzig.de. FAU - Juratli, Tareq AU - Juratli T AD - Clinic and Polyclinic for Neurosurgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address: Tareq.Juratli@uniklinikum-dresden.de. FAU - Tiebel, Oliver AU - Tiebel O AD - Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address: Oliver.Tiebel@uniklinikum-dresden.de. FAU - Giesecke, Moritz Tobias AU - Giesecke MT AD - Department of Operative Orthopedics and Trauma Surgery, Vivantes Klinikum Spandau, Ringstrasse 101B, 12203 Berlin, Germany. Electronic address: moritz.giesecke@mailbox.org. FAU - Tsitsilonis, Serafeim AU - Tsitsilonis S AD - Center for Musculoskeletal Surgery (CMSC), Charite - University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: serafeim.tsitsilonis@charite.de. FAU - Held, Hanns-Christoph AU - Held HC AD - Clinic and Polyclinic for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address: Hanns-Christoph.Held@uniklinikum-dresden.de. FAU - Beyer, Franziska AU - Beyer F AD - UniversityCenter for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address: Franziska.Beyer@uniklinikum-dresden.de. FAU - Kleber, Christian AU - Kleber C AD - Head of Trauma Surgery, Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AoR, Germany. Electronic address: Christian.Kleber@medizin.uni-leipzig.de. LA - eng PT - Journal Article DEP - 20221222 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Factor XIII Deficiency/complications MH - Retrospective Studies MH - *Blood Coagulation Disorders MH - Fibrinogen/therapeutic use MH - Thrombelastography/methods MH - *Multiple Trauma/complications MH - *Brain Injuries, Traumatic OTO - NOTNLM OT - FXIII OT - Trauma OT - acquired deficiency OT - bleeding OT - coagulopathy OT - factor XIII OT - multiple traumas OT - polytrauma OT - severe traumatic brain injury COIS- Declaration of Competing Interest The Center for Musculoskeletal Surgery (CMSC) Charite - University Medicine Berlin, Germany was provided with TEG machines, TEG reagent and fibrogramin for in-vitro FXIII assays by CSL Behring Germany for the cohort B studies (cohort A/C no support). Christian Kleber has received honoraria from CSL Behring, Germany, which also supported the funding of the open access publication. The remaining authors have disclosed that they do not have any conflicts of interest. EDAT- 2022/12/29 06:00 MHDA- 2023/04/17 06:41 CRDT- 2022/12/28 21:56 PHST- 2022/04/09 00:00 [received] PHST- 2022/11/23 00:00 [revised] PHST- 2022/12/16 00:00 [accepted] PHST- 2023/04/17 06:41 [medline] PHST- 2022/12/29 06:00 [pubmed] PHST- 2022/12/28 21:56 [entrez] AID - S0020-1383(22)00954-8 [pii] AID - 10.1016/j.injury.2022.12.021 [doi] PST - ppublish SO - Injury. 2023 May;54(5):1257-1264. doi: 10.1016/j.injury.2022.12.021. Epub 2022 Dec 22. PMID- 36556013 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221226 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 24 DP - 2022 Dec 13 TI - Heightened Procoagulation after Post-Operative Thromboprophylaxis Completion in Patients with Metastatic Bone Disease from Primary Colorectal Cancer. LID - 10.3390/jcm11247397 [doi] LID - 7397 AB - BACKGROUND: Platelets play a role in venous thromboembolism (VTE) and in mediating colorectal cancer (CRC) progression. Still, platelets' role in hypercoagulability after surgical intervention for metastatic bone disease (MBD) is ill-defined. METHODS: In this quantitative observational study, we utilized a high-resolution imaging approach to temporally examine platelet procoagulant membrane dynamics (PMD) in four patients with MBD from primary CRC (CRC/MBD), before and after surgical intervention, over a 6-month period. We coupled this investigation with thrombelastography, quantitative plasma shotgun proteomics, and biochemical analysis. RESULTS: The plasma of CRC/MBD patients was enriched in ADAM1a, ADAMTS7, and physiological ligands for platelet glycoprotein-VI/spleen tyrosine kinase (GPVI/Syk) activation. Thromboprophylaxis attenuated procoagulation upon its initial prescription (post-operative day one, POD1); however, all patients experienced rebound procoagulation between POD3 and POD14, which was associated with Syk activation (Y525/Y526) in all patients, and a VTE event in two patients. Plasma levels of DNA-histone complexes increased steadily after surgery and remained elevated throughout the study period. Additionally, we increasingly sighted both homotypic and heterotypic platelet microaggregates after surgery in CRC/MBD patients, but not in healthy control participants' plasma. CONCLUSIONS: Our data elucidates the cell biology of a prothrombo-inflammatory state caused by disease and vascular injury, and recalcitrant to thromboprophylaxis. New mechanistic insights into hypercoagulability in CRC/MBD patients may identify novel drug targets for effective thromboprophylaxis type and duration after orthopaedic surgery. FAU - Yamaura, Lisa AU - Yamaura L AUID- ORCID: 0000-0002-5774-2414 AD - McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Young, Daniel AU - Young D AD - McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Skeith, Leslie AU - Skeith L AD - Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Medicine, Division of Hematology and Hematological Malignancies, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Monument, Michael J AU - Monument MJ AD - McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Jenne, Craig N AU - Jenne CN AD - Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Dufour, Antoine AU - Dufour A AUID- ORCID: 0000-0002-3429-4188 AD - Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Schneider, Prism AU - Schneider P AD - McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. FAU - Agbani, Ejaife O AU - Agbani EO AUID- ORCID: 0000-0002-0043-9115 AD - McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. AD - Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada. LA - eng GR - CDT142654/CAPMC/CIHR/Canada GR - Studentship award/CanVECTOR/ PT - Journal Article DEP - 20221213 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9784178 OTO - NOTNLM OT - colorectal cancer OT - metastatic bone disease OT - orthopaedic surgery OT - platelet procoagulant membrane dynamics (PMD) OT - venous thromboembolism COIS- The authors declare no conflict of interest. EDAT- 2022/12/24 06:00 MHDA- 2022/12/24 06:01 PMCR- 2022/12/13 CRDT- 2022/12/23 01:38 PHST- 2022/11/10 00:00 [received] PHST- 2022/12/08 00:00 [revised] PHST- 2022/12/12 00:00 [accepted] PHST- 2022/12/23 01:38 [entrez] PHST- 2022/12/24 06:00 [pubmed] PHST- 2022/12/24 06:01 [medline] PHST- 2022/12/13 00:00 [pmc-release] AID - jcm11247397 [pii] AID - jcm-11-07397 [pii] AID - 10.3390/jcm11247397 [doi] PST - epublish SO - J Clin Med. 2022 Dec 13;11(24):7397. doi: 10.3390/jcm11247397. PMID- 36555922 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20250530 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 24 DP - 2022 Dec 9 TI - Conventional and Pro-Inflammatory Pathways of Fibrinolytic Activation in Non-Traumatic Hyperfibrinolysis. LID - 10.3390/jcm11247305 [doi] LID - 7305 AB - Hyperfibrinolysis (HF) frequently occurs after severe systemic hypoperfusion during major trauma and out-of-hospital cardiac arrest (OHCA). In trauma-induced HF, hypoperfusion, the activation of protein C (APC), and the release of tissue plasminogen activator (t-PA) have been identified as the driving elements of premature clot breakdown. The APC pathway also plays a role in inflammatory responses such as neutrophil extracellular trap formation (NETosis), which might contribute to lysis through cleavage of fibrin by neutrophil elastases. We investigated whether the APC and the plasminogen pathway were general drivers of HF, even in the absence of a traumatic incident. Additionally, we were interested in inflammatory activation such as the presence of NETs as potential contributing factors to HF. A total of 41 patients with OHCA were assigned to a HF and a non-HF group based on maximum lysis (ML) in thromboelastometry. Thrombin-antithrombin (TAT)-complex, soluble thrombomodulin (sTM), APC-PC inhibitor complex, t-PA, PAI-1, t-PA-PAI-1 complex, plasmin-antiplasmin (PAP), d-dimers, neutrophil elastase, histonylated DNA (hDNA) fragments, and interleukin-6 were assessed via immunoassays in the HF group vs. non-HF. APC-PC inhibitor complex is significantly higher in HF patients. Antigen levels of t-PA and PAI-1 do not differ between groups. However, t-PA activity is significantly higher and t-PA-PAI-1 complex significantly lower in the HF group. Consistent with these results, PAP and d-dimers are significantly elevated in HF. HDNA fragments and neutrophil elastase are not elevated in HF patients, but show a high level of correlation, suggesting NETosis occurs in OHCA as part of inflammatory activation and cellular decay. Just as in trauma, hypoperfusion, the activation of protein C, and the initiation of the plasminogen pathway of fibrinolysis manifest themselves in the HF of cardiac arrest. Despite features of NETosis being detectable in OHCA patients, early pro-inflammatory responses do not appear be associated with HF in cardiac arrest. FAU - Zipperle, Johannes AU - Zipperle J AUID- ORCID: 0000-0002-8222-3413 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. FAU - Ziegler, Bernhard AU - Ziegler B AD - Department of Anaesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Schochl, Herbert AU - Schochl H AUID- ORCID: 0000-0001-6028-1551 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Voelckel, Wolfgang AU - Voelckel W AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Dungel, Peter AU - Dungel P AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. FAU - Cadamuro, Janne AU - Cadamuro J AUID- ORCID: 0000-0002-6200-9831 AD - Department of Laboratory Medicine, University Hospital SALK, 5020 Salzburg, Austria. FAU - Osuchowski, Marcin AU - Osuchowski M AUID- ORCID: 0000-0002-1321-9883 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. FAU - Schlimp, Christoph J AU - Schlimp CJ AUID- ORCID: 0000-0001-8124-9462 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - AUVA Trauma Centre Linz, Department of Anaesthesiology and Intensive Care Medicine, 4010 Linz, Austria. FAU - Oberladstatter, Daniel AU - Oberladstatter D AUID- ORCID: 0000-0002-1350-5564 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. LA - eng GR - P 35425/FWF_/Austrian Science Fund FWF/Austria PT - Journal Article DEP - 20221209 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9787796 OTO - NOTNLM OT - activated protein C OT - cardiac arrest OT - hyperfibrinolysis OT - inflammation OT - ischemia OT - neutrophil extracellular traps OT - reperfusion OT - thromboelastometry OT - viscoelastic tests COIS- B.Z. received speaker fees from CSL Behring. H.S received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim, and Tem International, Haemonetics, Vifor, and received study grants from CSL Behring. C.J.S. received honoraria for lectures or participation in advisory board meetings from CSL Behring, Boehringer Ingelheim, Portola, Shionogi, and Octa. J.Z., D.O., M.O., P.D. and W.V. declare no conflicts of interest. AUVA is an Austrian, semi-federal healthcare organization and employer of several authors of this article. None of the supporting entities had any influence on the content of this study. No other competing interests declared. EDAT- 2022/12/24 06:00 MHDA- 2022/12/24 06:01 PMCR- 2022/12/09 CRDT- 2022/12/23 01:37 PHST- 2022/11/10 00:00 [received] PHST- 2022/11/29 00:00 [revised] PHST- 2022/12/01 00:00 [accepted] PHST- 2022/12/23 01:37 [entrez] PHST- 2022/12/24 06:00 [pubmed] PHST- 2022/12/24 06:01 [medline] PHST- 2022/12/09 00:00 [pmc-release] AID - jcm11247305 [pii] AID - jcm-11-07305 [pii] AID - 10.3390/jcm11247305 [doi] PST - epublish SO - J Clin Med. 2022 Dec 9;11(24):7305. doi: 10.3390/jcm11247305. PMID- 36549292 OWN - NLM STAT- MEDLINE DCOM- 20221226 LR - 20221226 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) VI - 42 IP - 6 DP - 2022 Dec TI - Global Coagulation Testing in Acute Care Medicine: Back to Bedside? PG - 400-408 LID - 10.1055/a-1938-1984 [doi] AB - OBJECTIVES: Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. DESIGN: As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. CONCLUSION: The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management. CI - Thieme. All rights reserved. FAU - Caspers, Michael AU - Caspers M AD - Department of Medicine, The Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Cologne, Germany. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Holle, Johannes Fabian AU - Holle JF AD - Department of Neurology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Limper, Ulrich AU - Limper U AD - Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Frohlich, Matthias AU - Frohlich M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Bouillon, Bertil AU - Bouillon B AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. LA - eng PT - Journal Article DEP - 20221222 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 RN - 0 (Hemostatics) SB - IM MH - Humans MH - Blood Coagulation Tests/methods MH - Blood Coagulation MH - Hemostasis MH - Hemorrhage/diagnosis/therapy MH - *Blood Coagulation Disorders/diagnosis/therapy MH - *Hemostatics/therapeutic use MH - Thrombelastography/methods COIS- The authors declare that they have no conflict of interest. EDAT- 2022/12/23 06:00 MHDA- 2022/12/27 06:00 CRDT- 2022/12/22 18:32 PHST- 2022/12/22 18:32 [entrez] PHST- 2022/12/23 06:00 [pubmed] PHST- 2022/12/27 06:00 [medline] AID - 10.1055/a-1938-1984 [doi] PST - ppublish SO - Hamostaseologie. 2022 Dec;42(6):400-408. doi: 10.1055/a-1938-1984. Epub 2022 Dec 22. PMID- 36548640 OWN - NLM STAT- MEDLINE DCOM- 20230113 LR - 20231202 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 58 IP - 6 DP - 2022 Dec 1 TI - BLOOD TYPE O IS A RISK FACTOR FOR HYPERFIBRINOLYSIS AND MASSIVE TRANSFUSION AFTER SEVERE INJURY. PG - 492-497 LID - 10.1097/SHK.0000000000002013 [doi] AB - Background: Blood type O is the most common blood type and has lower von Willebrand factor (vWF) levels (25%-35% lower than non-O blood types). von Willebrand factor is important for initiating platelet attachment and binding factor VIII. We hypothesized that patients with type O blood are at an increased risk of trauma-induced coagulopathy and bleeding post injury. Study Design: Adult trauma activations with known blood type at a level I trauma center with field systolic blood pressure < 90 mm Hg were studied retrospectively. The relationships of blood group O versus non-O to coagulation assays, massive transfusion (MT), ventilator-free days, and mortality were adjusted for confounders. Hyperfibrinolysis (HF) was defined as thromboelastogram of percent lysis in 30 min > 3%, and fibrinolysis shutdown was defined as percent lysis in 30 min < 0.9%. von Willebrand factor activity was quantified on 212 injured patients using a STAGO apparatus. Results: Overall, 268 patients met criteria. Type O patients were more likely to develop HF than non-type O blood patients (43% vs. 29%, P = 0.06) and had significantly lower vWF activity (222% vs. 249%, P = 0.01). After adjustment for New Injury Severity Score and blunt mechanism, type O had higher odds of HF (odds ratio, 1.94, 95% confidence interval, 1.09-3.47) and increased odds of MT (odds ratio, 3.02; 95% confidence interval, 1.22-7.49). Other outcomes were not significantly affected. Conclusion: Type O patients with hypotension had increased HF and MT post injury, and these were associated with lower vWF activity. These findings have implications for the monitoring of HF in patients receiving type O whole-blood transfusions post injury. CI - Copyright (c) 2022 by the Shock Society. FAU - DeBot, Margot AU - DeBot M AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Eitel, Andrew P AU - Eitel AP AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Sauaia, Angela AU - Sauaia A FAU - Lutz, Patrick AU - Lutz P AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Schaid, Terry R Jr AU - Schaid TR Jr AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Hadley, Jamie B AU - Hadley JB AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Kissau, Daniel J AU - Kissau DJ AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery/Trauma Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado. FAU - Kelher, Marguerite R AU - Kelher MR FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20221021 PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (von Willebrand Factor) RN - 0 (ABO Blood-Group System) SB - IM MH - Adult MH - Humans MH - *Blood Coagulation Disorders/epidemiology MH - Blood Transfusion MH - *Fibrinolysis MH - *Hemorrhage/epidemiology/etiology MH - Injury Severity Score MH - Retrospective Studies MH - Risk Factors MH - von Willebrand Factor/analysis MH - *Wounds and Injuries/complications MH - *ABO Blood-Group System PMC - PMC9793952 MID - NIHMS1841607 COIS- The authors report no conflicts of interest. EDAT- 2022/12/23 06:00 MHDA- 2022/12/27 06:00 PMCR- 2023/12/01 CRDT- 2022/12/22 15:12 PHST- 2022/12/23 06:00 [pubmed] PHST- 2022/12/27 06:00 [medline] PHST- 2022/12/22 15:12 [entrez] PHST- 2023/12/01 00:00 [pmc-release] AID - 00024382-202212000-00004 [pii] AID - 10.1097/SHK.0000000000002013 [doi] PST - ppublish SO - Shock. 2022 Dec 1;58(6):492-497. doi: 10.1097/SHK.0000000000002013. Epub 2022 Oct 21. PMID- 36520095 OWN - NLM STAT- MEDLINE DCOM- 20240108 LR - 20240108 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 89 IP - 12 DP - 2023 Dec TI - The Use of Whole Blood in Rural Trauma Leads to Decreased Resource Utilization. PG - 5276-5281 LID - 10.1177/00031348221142584 [doi] AB - BACKGROUND: Nearly 40% of trauma deaths result from uncontrolled hemorrhage. Most of these deaths occur within 24 hours, highlighting the importance of early resuscitation. Balanced component resuscitation has been shown to improve outcomes in hemorrhagic shock. However, hemostatic properties may then be decreased, leading to inadequate coagulopathy treatment or higher transfusion requirements. Data comparing the efficacy of component vs. whole blood (WB) resuscitation in early trauma is poor, particularly in the rural population. This study investigates WB use and resource utilization at a rural Level 1 trauma center. METHODS: A prospective cohort study with historical controls (HC) was performed using patients over age 17 presenting as the highest priority trauma. Two units of WB were available to patients with signs of hemorrhagic shock, with subsequent transfusions via massive transfusion protocol or thromboelastography guidance. Component utilization, time to hemorrhage control, complications, and transfer times were examined. RESULTS: Forty patients received WB vs. 153 HC. WB patients had lower complication rates (35% vs. 55.6%; P = .02), and a significant reduction in pRBC utilization in the emergency department (0 vs. 2; P < .0001) and throughout admission (2.0 vs. 4.0; P = .0003). All patients had prolonged transport times given the rural setting (1.42 hours HC vs. 2.03 hours WB; P = .002). DISCUSSION: Unlike most urban WB studies, this study occurred in a rural area with extended transportation times, when WB is inaccessible for patients. Despite this delay, WB patients demonstrated lower component utilization and complication rates. Further research is needed to characterize the impact of early WB access. FAU - Niemann, Britney R AU - Niemann BR AUID- ORCID: 0000-0002-8129-5220 AD - Department of Surgery, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Grabo, Daniel J AU - Grabo DJ AD - Department of Surgery, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Mullens, Cody AU - Mullens C AD - School of Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Shmookler, Aaron D AU - Shmookler AD AD - Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Lopez, Santiago AU - Lopez S AUID- ORCID: 0000-0002-8627-3776 AD - School of Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Lander, Owen M AU - Lander OM AD - Emergency Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Griffin, Peter L AU - Griffin PL AD - Emergency Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 FAU - Bardes, James M AU - Bardes JM AD - Department of Surgery, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 AD - Emergency Medicine, West Virginia University, Morgantown, WV, USA. RINGGOLD: 12355 LA - eng PT - Journal Article DEP - 20221215 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Humans MH - Adolescent MH - *Shock, Hemorrhagic/etiology/therapy MH - Prospective Studies MH - Rural Population MH - Blood Transfusion/methods MH - Hemorrhage/etiology/therapy MH - Resuscitation/methods MH - *Wounds and Injuries/complications/therapy MH - Blood Component Transfusion/methods OTO - NOTNLM OT - rural OT - transfusion OT - trauma OT - whole blood COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2022/12/16 06:00 MHDA- 2024/01/08 06:43 CRDT- 2022/12/15 10:32 PHST- 2024/01/08 06:43 [medline] PHST- 2022/12/16 06:00 [pubmed] PHST- 2022/12/15 10:32 [entrez] AID - 10.1177/00031348221142584 [doi] PST - ppublish SO - Am Surg. 2023 Dec;89(12):5276-5281. doi: 10.1177/00031348221142584. Epub 2022 Dec 15. PMID- 36513794 OWN - NLM STAT- MEDLINE DCOM- 20230413 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 38 IP - 2 DP - 2023 Apr TI - Coagulopathy in Isolated Traumatic Brain Injury: Myth or Reality. PG - 429-438 LID - 10.1007/s12028-022-01647-4 [doi] AB - INTRODUCTION: Traumatic Brain Injury (TBI) has been shown to be associated with altered hemostasis and coagulopathy, that correlates with worsening secondary injury and clinical outcomes. Isolated Traumatic Brain Injury (iTBI), that is TBI without significant extracranial injuries, has also been shown to be associated with systemic coagulopathy and derangements in hemostasis. METHODS: Literature Review. RESULTS: Present your results in logical sequence in the text, tables, and figures, giving the main or most important findings first. Do not repeat all the data in the tables or figures in the text; emphasize or summarize only the most important observations. Provide data on all primary and secondary outcomes identified in the Methods section. Give numeric results not only as derivatives (e.g. percentages) but also as the absolute numbers from which the derivatives were calculated, and specify the statistical significance attached to them, if any. DISCUSSION: In this review, we provide an overview of the pathophysiology of the hemostatic disturbances caused by iTBI, review key clinical findings and discrepancies in the way this question has been approached, describe the use and role of global viscoelastic assays such as the thromboelastrogram, and detail principles for reversal of pre-injury blood thinners. CONCLUSIONS: iTBI is clearly associated with the development of coagulopathy, but the extent to which it occurs is confounded by the fact that many of the studies have included patients with moderate extracranial trauma into the iTBI category. The coagulopathy itself has been better studied in preclinical models, and the mechanisms driving it suggest a pattern consistent with disseminated intravascular coagulation with hyperfibrinolysis. We provide pragmatic clinical takeaways and suggestions for future research. CI - (c) 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. FAU - Mathur, Rohan AU - Mathur R AUID- ORCID: 0000-0001-5246-8543 AD - Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology, and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, USA. rmathur2@jhmi.edu. FAU - Suarez, Jose I AU - Suarez JI AD - Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology, and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, USA. LA - eng PT - Journal Article PT - Review DEP - 20221213 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Humans MH - *Blood Coagulation Disorders MH - *Brain Injuries, Traumatic/complications OTO - NOTNLM OT - Coagulopathy OT - Outcomes OT - Primary brain injury OT - Secondary brain injury OT - Traumatic brain injury EDAT- 2022/12/14 06:00 MHDA- 2023/04/13 06:42 CRDT- 2022/12/13 23:32 PHST- 2022/07/12 00:00 [received] PHST- 2022/11/09 00:00 [accepted] PHST- 2023/04/13 06:42 [medline] PHST- 2022/12/14 06:00 [pubmed] PHST- 2022/12/13 23:32 [entrez] AID - 10.1007/s12028-022-01647-4 [pii] AID - 10.1007/s12028-022-01647-4 [doi] PST - ppublish SO - Neurocrit Care. 2023 Apr;38(2):429-438. doi: 10.1007/s12028-022-01647-4. Epub 2022 Dec 13. PMID- 36471184 OWN - NLM STAT- MEDLINE DCOM- 20230607 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 38 IP - 3 DP - 2023 Jun TI - Dynamic Changes of Hemostasis in Patients with Traumatic Brain Injury Undergoing Craniotomy: Association with in-Hospital Mortality. PG - 714-725 LID - 10.1007/s12028-022-01639-4 [doi] AB - BACKGROUND: Traumatic brain injury (TBI) induces complex systemic hemostatic alterations associated with secondary brain damage and death. We specifically investigated perioperative changes of hemostasis in patients with isolated TBI undergoing major neurosurgery and searched for their influence on outcome. METHODS: Serial analysis (four time points, T0-T3) of conventional coagulation assay and rotational thromboelastometry data acquired during 72 h from admission of 68 patients who underwent craniotomy to remove hematoma and/or to decompress the brain was performed. The primary outcome was in-hospital mortality. Secondary outcomes were the prevalence of hypocoagulation and increased clotting activity, coagulation parameters between survivors and nonsurvivors, and cutoff values of coagulation parameters predictive of mortality. RESULTS: Overall mortality was 22%. The prevalence of hypocoagulation according to rotational thromboelastometry decreased from 35.8% (T0) to 15.9% (T3). Lower fibrinogen levels, hyperfibrinolysis and fibrinolysis shutdown in the early period (T0-T1) following TBI were associated with higher mortality. Optimal cutoff values were identified: fibrin polymerization thromboelastometry (FIBTEM) clot amplitude at 10 min after clotting time 4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39-22.39). CONCLUSION: Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Knudson, M Margaret AU - Knudson MM AD - From the Department of Surgery (M.M.K., L.Z.K.), University of California San Francisco, San Francisco California; Department of Surgery (H.B.M.), University of Colorado, Denver, Colorado; Department of Surgery (E.E.M.), EE Moore Shock Trauma Center at Denver Health Center, Denver, Colorado; Department of Surgery (L.N.K.), Oregon Health Science University, Portland, Oregon; Department of Surgery (M.K.M., C.E.W.), University of Texas Medical Center, Houston, Texas; Department of Surgery (B.R.B.), University of Texas Southwestern, Dallas, Texas; and School of Public Health (A.S.), University of Colorado, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB FAU - Moore, Ernest E AU - Moore EE FAU - Kornblith, Lucy Z AU - Kornblith LZ FAU - Kiraly, Lazlo N AU - Kiraly LN FAU - McNutt, Michelle K AU - McNutt MK FAU - Wade, Charles E AU - Wade CE FAU - Bruns, Brandon R AU - Bruns BR FAU - Sauaia, Angela AU - Sauaia A LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20220520 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - 24H4NWX5CO (Kaolin) SB - IM MH - Humans MH - Tissue Plasminogen Activator MH - *Venous Thromboembolism/etiology/diagnosis MH - Prospective Studies MH - Kaolin MH - Thrombelastography/methods MH - *Blood Coagulation Disorders/etiology EDAT- 2022/10/28 06:00 MHDA- 2022/11/01 06:00 CRDT- 2022/10/27 10:16 PHST- 2022/10/27 10:16 [entrez] PHST- 2022/10/28 06:00 [pubmed] PHST- 2022/11/01 06:00 [medline] AID - 01586154-202211000-00005 [pii] AID - 10.1097/TA.0000000000003625 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Nov 1;93(5):597-603. doi: 10.1097/TA.0000000000003625. Epub 2022 May 20. PMID- 36294471 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221030 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 20 DP - 2022 Oct 19 TI - Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?-A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU((R)). LID - 10.3390/jcm11206150 [doi] LID - 6150 AB - INTRODUCTION: Death from uncontrolled trauma haemorrhage and subsequent trauma-induced coagulopathy (TIC) is potentially preventable. Point-of-care devices such as rotational thromboelastometry (ROTEM((R))) are advocated to detect haemostatic derangements more rapidly than conventional laboratory diagnostics. Regarding reductions in RBC transfusion, the use of ROTEM has been described as being efficient and associated with positive outcomes in several studies. OBJECTIVE: The effect of ROTEM use was assessed on three different outcome variables: (i) administration of haemostatics, (ii) rate of RBC transfusions and (iii) mortality in severely injured patients. METHODS AND MATERIAL: A retrospective analysis of a large data set of severely injured patients collected into the TraumaRegister DGU((R)) between 2009 and 2016 was conducted. The data of 7461 patients corresponded to the inclusion criteria and were subdivided into ROTEM-using and ROTEM-non-using groups. Both groups were analysed regarding (i) administration of haemostatics, (ii) rate of RBC transfusions and (iii) mortality. RESULTS: A lower mortality rate in ROTEM-using groups was observed (p = 0.043). Furthermore, more patients received haemostatic medication when ROTEM was used. In ROTEM-using groups, there was a statistically relevant higher application of massive transfusion. CONCLUSIONS: In this retrospective study, the use of ROTEM was associated with reduced mortality and an increased application of haemostatics and RBC transfusions. Prospective evidence is needed for further evidence-based recommendations. FAU - Riehl, Katrin AU - Riehl K AUID- ORCID: 0000-0003-0860-5568 AD - Department of Orthopaedics, Traumatology and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. FAU - Lefering, Rolf AU - Lefering R AD - IFOM-Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimerstrasse 200, 51109 Cologne, Germany. FAU - Maegele, Marc AU - Maegele M AD - IFOM-Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimerstrasse 200, 51109 Cologne, Germany. AD - Department for Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne Merheim Medical (CMMC), Witten/Herdecke University, 51109 Cologne, Germany. FAU - Caspers, Michael AU - Caspers M AD - Department for Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne Merheim Medical (CMMC), Witten/Herdecke University, 51109 Cologne, Germany. FAU - Migliorini, Filippo AU - Migliorini F AUID- ORCID: 0000-0001-7220-1221 AD - Department of Orthopaedics, Traumatology and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. FAU - Schenker, Hanno AU - Schenker H AD - Department of Orthopaedics, Traumatology and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. FAU - Hildebrand, Frank AU - Hildebrand F AD - Department of Orthopaedics, Traumatology and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. FAU - Frohlich, Matthias AU - Frohlich M AUID- ORCID: 0000-0002-8444-632X AD - Department for Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne Merheim Medical (CMMC), Witten/Herdecke University, 51109 Cologne, Germany. FAU - Driessen, Arne AU - Driessen A AD - Department of Orthopaedics, Traumatology and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. AD - Department of Traumatology and Orthopaedics, Luisenhospital Aachen, Evangelischer Krankenhausverein zu Aachen von 1867, 52064 Aachen, Germany. LA - eng PT - Journal Article DEP - 20221019 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9605144 OTO - NOTNLM OT - ROTEM OT - blood transfusion OT - haemostatics OT - trauma haemorrhage OT - trauma induced coagulopathy COIS- The authors declare no conflict of interest. EDAT- 2022/10/28 06:00 MHDA- 2022/10/28 06:01 PMCR- 2022/10/19 CRDT- 2022/10/27 01:31 PHST- 2022/07/12 00:00 [received] PHST- 2022/10/08 00:00 [revised] PHST- 2022/10/14 00:00 [accepted] PHST- 2022/10/27 01:31 [entrez] PHST- 2022/10/28 06:00 [pubmed] PHST- 2022/10/28 06:01 [medline] PHST- 2022/10/19 00:00 [pmc-release] AID - jcm11206150 [pii] AID - jcm-11-06150 [pii] AID - 10.3390/jcm11206150 [doi] PST - epublish SO - J Clin Med. 2022 Oct 19;11(20):6150. doi: 10.3390/jcm11206150. PMID- 36287131 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221102 IS - 2058-5241 (Print) IS - 2058-5241 (Electronic) IS - 2058-5241 (Linking) VI - 7 IP - 10 DP - 2022 Oct 26 TI - Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019. PG - 710-726 LID - 10.1530/EOR-22-0054 [doi] AB - The European guideline on the management of trauma-induced major bleeding and coagulopathy summarises the most relevant recommendations for trauma coagulopathy management. The management of trauma-induced major bleeding should interdisciplinary follow algorithms which distinguish between life-threatening and non-life-threatening bleeding. Point-of-care viscoelastic methods (VEM) assist target-controlled haemostatic treatment. Neither conventional coagulation assays nor VEM should delay treatment in life-threatening trauma-induced bleeding. Adjustments may be rational due to local circumstances, including the availability of blood products, pharmaceuticals, and employees. FAU - Niemann, Marcel AU - Niemann M AUID- ORCID: 0000-0001-7264-3089 AD - Charite - Universitatsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. AD - Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Otto, Ellen AU - Otto E AD - Charite - Universitatsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. AD - Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Eder, Christian AU - Eder C AD - Charite - Universitatsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. FAU - Youssef, Yasmin AU - Youssef Y AD - Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany. FAU - Kaufner, Lutz AU - Kaufner L AD - Charite - Universitatsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. FAU - Mardian, Sven AU - Mardian S AD - Charite - Universitatsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. LA - eng PT - Journal Article PT - Review DEP - 20221026 PL - England TA - EFORT Open Rev JT - EFORT open reviews JID - 101695674 PMC - PMC9619392 OTO - NOTNLM OT - coagulation management OT - coagulopathy OT - multiple injury EDAT- 2022/10/27 06:00 MHDA- 2022/10/27 06:01 PMCR- 2022/10/26 CRDT- 2022/10/26 10:33 PHST- 2022/10/26 10:33 [entrez] PHST- 2022/10/27 06:00 [pubmed] PHST- 2022/10/27 06:01 [medline] PHST- 2022/10/26 00:00 [pmc-release] AID - EOR-22-0054 [pii] AID - 10.1530/EOR-22-0054 [doi] PST - epublish SO - EFORT Open Rev. 2022 Oct 26;7(10):710-726. doi: 10.1530/EOR-22-0054. PMID- 36285178 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240906 IS - 2090-2840 (Print) IS - 2090-2859 (Electronic) IS - 2090-2840 (Linking) VI - 2022 DP - 2022 TI - The Addition of ROTEM Parameter Did Not Significantly Improve the Massive Transfusion Prediction in Severe Trauma Patients. PG - 7219812 LID - 10.1155/2022/7219812 [doi] LID - 7219812 AB - BACKGROUND: Rotational thrombelastometry (ROTEM) has been used to evaluate the coagulation state, predict transfusion, and optimize hemostatic management in trauma patients. However, there were limited studies on whether the prediction value could be improved by adding the ROTEM parameter to the prediction model for in-hospital mortality and massive transfusion (MT) in trauma patients. OBJECTIVE: This study assessed whether ROTEM data could improve the MT prediction model. METHOD: This was a single-center, retrospective study. Patients who presented to the trauma center and underwent ROTEM between 2016 and 2020 were included. The primary and secondary outcomes were massive transfusions and in-hospital mortality, respectively. We constructed two models using multivariate logistic regression with backward conditional stepwise elimination (Model 1: without the ROTEM parameter and Model 2: with the ROTEM parameter). The area under the receiver operating characteristic curve (AUROC) was calculated to assess the predictive ability of the models. RESULT: In total, 969 patients were included; 196 (20.2%) received MT. The in-hospital mortality rate was 14.1%. For MT, the AUROC was 0.854 (95% confidence interval [CI], 0.825-0.883) and 0.860 (95% CI, 0.832-0.888) for Model 1 and 2, respectively. For in-hospital mortality, the AUROC was 0.886 (95% CI, 0.857-0.915) and 0.889 (95% CI, 0.861-0.918) for models 1 and 2, respectively. The AUROC values for models 1 and 2 were not statistically different for either MT or in-hospital mortality. CONCLUSION: We found that the addition of the ROTEM parameter did not significantly improve the predictive power of MT and in-hospital mortality in trauma patients. CI - Copyright (c) 2022 Dongyup Baik et al. FAU - Baik, Dongyup AU - Baik D AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Yeom, Seok-Ran AU - Yeom SR AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Park, Sung-Wook AU - Park SW AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Cho, Youngmo AU - Cho Y AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Yang, Wook Tae AU - Yang WT AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Kwon, Hoon AU - Kwon H AD - Department of Radiology, Biomedical Research Institute, Pusan National University Department of Radiology, Busan 49241, Republic of Korea. FAU - Lee, Jae Il AU - Lee JI AD - Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Ko, Jun-Kyeung AU - Ko JK AD - Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Choi, Hyuk Jin AU - Choi HJ AD - Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Huh, Up AU - Huh U AD - Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. FAU - Goh, Tae Sik AU - Goh TS AD - Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan 49241, Republic of Korea. FAU - Song, Chan-Hee AU - Song CH AUID- ORCID: 0000-0002-3826-3813 AD - Department of Biomedical Engineering, Graduate School, Pusan National University, Busan 49241, Republic of Korea. FAU - Hwangbo, Lee AU - Hwangbo L AUID- ORCID: 0000-0002-1323-4450 AD - Department of Radiology, Biomedical Research Institute, Pusan National University Department of Radiology, Busan 49241, Republic of Korea. FAU - Wang, Il Jae AU - Wang IJ AUID- ORCID: 0000-0003-2479-2359 AD - Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea. LA - eng PT - Journal Article DEP - 20221015 PL - United States TA - Emerg Med Int JT - Emergency medicine international JID - 101567070 PMC - PMC9588372 COIS- The authors declare that there are no conflicts of interest. EDAT- 2022/10/27 06:00 MHDA- 2022/10/27 06:01 PMCR- 2022/10/15 CRDT- 2022/10/26 02:13 PHST- 2022/09/13 00:00 [received] PHST- 2022/10/03 00:00 [accepted] PHST- 2022/10/26 02:13 [entrez] PHST- 2022/10/27 06:00 [pubmed] PHST- 2022/10/27 06:01 [medline] PHST- 2022/10/15 00:00 [pmc-release] AID - 10.1155/2022/7219812 [doi] PST - epublish SO - Emerg Med Int. 2022 Oct 15;2022:7219812. doi: 10.1155/2022/7219812. eCollection 2022. PMID- 36280503 OWN - NLM STAT- MEDLINE DCOM- 20230214 LR - 20230315 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 173 IP - 3 DP - 2023 Mar TI - Platelet dysfunction persists after trauma despite balanced blood product resuscitation. PG - 821-829 LID - S0039-6060(22)00743-7 [pii] LID - 10.1016/j.surg.2022.09.017 [doi] AB - BACKGROUND: Platelet activation and aggregation are critical to the initiation of hemostasis after trauma with hemorrhage. Platelet dysfunction is a well-recognized phenomenon contributing to trauma-induced coagulopathy. The goal of this study was to evaluate the timing and severity of platelet dysfunction in massively transfused, traumatically injured patients during the first 72 hours after injury and its association with 30-day survival. METHODS: A retrospective secondary cohort study of platelet count and function was performed using samples from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial. Platelet characteristics were measured at 8 timepoints during the first 72 hours of hospitalization and compared between 30-day survivors and nonsurvivors. Platelet counts were assessed via flow cytometry. Platelet function was analyzed with the use of serial thrombelastography and impedance aggregometry with agonists arachidonic acid, adenosine diphosphate, collagen, thrombin receptor activating peptide, and ristocetin. RESULTS: In total, 680 patients were included for analysis. Platelet counts were significantly lower from baseline to 72 hours after hospital admission with further 1.3 to 2-fold reductions noted in nonsurvivors compared to survivor patients. Platelet aggregation via adenosine diphosphate, arachidonic acid, collagen, thrombin receptor activating peptide, and ristocetin was significantly lower in nonsurvivors at all time points. The nadir of platelet aggregation was 2 to 6 hours after admission with significant improvements in viscoelastic maximum clot formation and agonist-induced aggregation by 12 hours without concomitant improvement in platelet count. CONCLUSION: Platelet aggregability recovers 12 hours after injury independent of worsening thrombocytopenia. Failure of platelet function to recover portends a poor prognosis. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Wallen, Taylor E AU - Wallen TE AD - Department of Surgery, University of Cincinnati, OH. Electronic address: https://twitter.com/taylorwallen2. FAU - Baucom, Matthew R AU - Baucom MR AD - Department of Surgery, University of Cincinnati, OH. FAU - Hanseman, Dennis AU - Hanseman D AD - Department of Surgery, University of Cincinnati, OH. FAU - Wang, Yao-Wei W AU - Wang YW AD - Department of Surgery, University of Texas Health Science Center at Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, University of Texas Health Science Center at Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, University of Alabama Birmingham, AL. FAU - Pritts, Timothy A AU - Pritts TA AD - Department of Surgery, University of Cincinnati, OH. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, OH. Electronic address: michael.goodman@uc.edu. LA - eng PT - Journal Article DEP - 20221022 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 1404-55-3 (Ristocetin) RN - 27YG812J1I (Arachidonic Acid) RN - 9007-34-5 (Collagen) RN - 61D2G4IYVH (Adenosine Diphosphate) RN - 0 (Receptors, Thrombin) SB - IM MH - Humans MH - *Ristocetin/pharmacology MH - Retrospective Studies MH - Arachidonic Acid/pharmacology MH - Cohort Studies MH - *Blood Platelets/physiology MH - Platelet Function Tests MH - Collagen MH - Adenosine Diphosphate/pharmacology MH - Receptors, Thrombin EDAT- 2022/10/25 06:00 MHDA- 2023/02/15 06:00 CRDT- 2022/10/24 22:14 PHST- 2022/03/31 00:00 [received] PHST- 2022/08/23 00:00 [revised] PHST- 2022/09/11 00:00 [accepted] PHST- 2022/10/25 06:00 [pubmed] PHST- 2023/02/15 06:00 [medline] PHST- 2022/10/24 22:14 [entrez] AID - S0039-6060(22)00743-7 [pii] AID - 10.1016/j.surg.2022.09.017 [doi] PST - ppublish SO - Surgery. 2023 Mar;173(3):821-829. doi: 10.1016/j.surg.2022.09.017. Epub 2022 Oct 22. PMID- 36252602 OWN - NLM STAT- MEDLINE DCOM- 20230206 LR - 20240911 IS - 1098-9064 (Electronic) IS - 0094-6176 (Print) IS - 0094-6176 (Linking) VI - 49 IP - 2 DP - 2023 Mar TI - Modified Thromboelastography for Peri-interventional Assessment of Platelet Function in Cardiology Patients: A Narrative Review. PG - 192-200 LID - 10.1055/s-0042-1757545 [doi] AB - Viscoelastic testing (VET), such as thromboelastography, can measure whole blood coagulation dynamics in real time and is used across a range of clinical settings, including cardiac surgery, liver transplant, and trauma. The use of modified thromboelastography with platelet function assessment (TEG(R) PlateletMapping(R) Assay) can provide an analysis of platelet contribution to hemostasis, including the contribution of the P2Y12 receptor and thromboxane pathway to platelet function. The TEG PlateletMapping Assay has shown high correlation with the current gold standard test of platelet function, light transmission aggregometry, to measure arachidonic acid and adenosine diphosphate agonist-induced platelet activation. Studies have also shown comparable results with other whole blood platelet function tests. In this review, we explore the clinical applications of modified thromboelastography with platelet function assessment. This includes guiding dual antiplatelet therapy in relation to cardiac procedures, such as percutaneous coronary interventions, transcatheter aortic valve replacement, and left atrial appendage closure. We also explore the developing use of thromboelastography in the emergency care setting of coronavirus disease 2019, which is commonly associated with a hypercoagulable and hypofibrinolytic state. Despite a general lack of high-quality, grade 1 evidence regarding the use of modified thromboelastography with platelet function assessment in these disease areas, the ability of the TEG PlateletMapping Assay to measure global hemostasis and platelet reactivity rapidly and to view and evaluate results at the point of care makes it a promising area for further study for managing patient treatment and optimizing hemostatic therapy. CI - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). FAU - Hartmann, Jan AU - Hartmann J AD - Haemonetics Corp., Boston, Massachusetts. FAU - Curzen, Nick AU - Curzen N AD - Faculty of Medicine, University of Southampton & Cardiothoracic Department, University Hospital Southampton, United Kingdom. LA - eng PT - Journal Article PT - Review DEP - 20221017 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Humans MH - Thrombelastography/methods MH - *COVID-19 MH - Hemostasis MH - Blood Platelets MH - *Cardiology PMC - PMC9894686 COIS- J.H is an employee of Haemonetics Corp. N.C has received unrestricted research grants and consultancy fees from Haemonetics Corp. EDAT- 2022/10/18 06:00 MHDA- 2023/02/07 06:00 PMCR- 2022/10/01 CRDT- 2022/10/17 19:12 PHST- 2022/10/18 06:00 [pubmed] PHST- 2023/02/07 06:00 [medline] PHST- 2022/10/17 19:12 [entrez] PHST- 2022/10/01 00:00 [pmc-release] AID - STH03055 [pii] AID - 10.1055/s-0042-1757545 [doi] PST - ppublish SO - Semin Thromb Hemost. 2023 Mar;49(2):192-200. doi: 10.1055/s-0042-1757545. Epub 2022 Oct 17. PMID- 36250747 OWN - NLM STAT- MEDLINE DCOM- 20221202 LR - 20221206 IS - 1943-7722 (Electronic) IS - 0002-9173 (Linking) VI - 158 IP - 6 DP - 2022 Dec 1 TI - Evaluation of a Newly Implemented Critical Thromboelastography (TEG) Value Callback System. PG - 667-671 LID - 10.1093/ajcp/aqac114 [doi] AB - OBJECTIVES: Thromboelastography (TEG) measures whole blood coagulation kinetics in real time and is useful in guiding blood product transfusion. At our institution, providers have immediate remote access to TEG results. However, some critical values are occasionally missed. Our patient blood management program implemented a critical TEG value callback system to improve patient management and blood product utilization. METHODS: This retrospective, observational study assessed the data of trauma and critical care patients preimplementation (n = 20) and postimplementation (n = 100) of the callback system. Provider responses to callbacks and changes in TEG parameters after subsequent testing were compared between the two groups. RESULTS: In response to callbacks, 42% provided appropriate management and 42% ordered a repeat TEG vs 28% and 33% in the historical group (P < .0001 and P = .0002, respectively). Following callback, 90% of the TEG parameters in the study group showed an improvement vs 57% in the control group (P = .011). CONCLUSIONS: The increase in appropriate management and the improvement in TEG parameters upon repeat testing in the study group compared to the control group demonstrate the efficacy of the TEG callback system. Further studies are needed to evaluate the callback system effect on patient outcome. CI - (c) The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Yang, Shanna AU - Yang S AD - Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA. FAU - McRae, Hannah L AU - McRae HL AD - Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA. FAU - Terry, Treyc AU - Terry T AD - Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA. FAU - Cahill, Christine M AU - Cahill CM AD - Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA. FAU - Refaai, Majed A AU - Refaai MA AD - Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA. LA - eng PT - Journal Article PT - Observational Study PL - England TA - Am J Clin Pathol JT - American journal of clinical pathology JID - 0370470 SB - IM MH - Humans MH - *Thrombelastography/methods MH - Retrospective Studies MH - *Blood Transfusion/methods MH - Blood Coagulation OTO - NOTNLM OT - Bleeding OT - Critical laboratory values OT - Thromboelastography OT - Transfusion OT - Trauma EDAT- 2022/10/18 06:00 MHDA- 2022/12/03 06:00 CRDT- 2022/10/17 09:33 PHST- 2022/05/11 00:00 [received] PHST- 2022/08/18 00:00 [accepted] PHST- 2022/10/18 06:00 [pubmed] PHST- 2022/12/03 06:00 [medline] PHST- 2022/10/17 09:33 [entrez] AID - 6762023 [pii] AID - 10.1093/ajcp/aqac114 [doi] PST - ppublish SO - Am J Clin Pathol. 2022 Dec 1;158(6):667-671. doi: 10.1093/ajcp/aqac114. PMID- 36245074 OWN - NLM STAT- MEDLINE DCOM- 20230103 LR - 20260612 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 1S Suppl 1 DP - 2023 Jan 1 TI - Pediatric traumatic hemorrhagic shock consensus conference recommendations. PG - S2-S10 LID - 10.1097/TA.0000000000003805 [doi] AB - Hemorrhagic shock in pediatric trauma patients remains a challenging yet preventable cause of death. There is little high-quality evidence available to guide specific aspects of hemorrhage control and specific resuscitation practices in this population. We sought to generate clinical recommendations, expert consensus, and good practice statements to aid providers in care for these difficult patients.The Pediatric Traumatic Hemorrhagic Shock Consensus Conference process included systematic reviews related to six subtopics and one consensus meeting. A panel of 16 consensus multidisciplinary committee members evaluated the literature related to 6 specific topics: (1) blood products and fluid resuscitation for hemostatic resuscitation, (2) utilization of prehospital blood products, (3) use of hemostatic adjuncts, (4) tourniquet use, (5) prehospital airway and blood pressure management, and (6) conventional coagulation tests or thromboelastography-guided resuscitation. A total of 21 recommendations are detailed in this article: 2 clinical recommendations, 14 expert consensus statements, and 5 good practice statements. The statement, the panel's voting outcome, and the rationale for each statement intend to give pediatric trauma providers the latest evidence and guidance to care for pediatric trauma patients experiencing hemorrhagic shock. With a broad multidisciplinary representation, the Pediatric Traumatic Hemorrhagic Shock Consensus Conference systematically evaluated the literature and developed clinical recommendations, expert consensus, and good practice statements concerning topics in traumatically injured pediatric patients with hemorrhagic shock. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Russell, Robert T AU - Russell RT AD - From the Division of Pediatric Surgery, Department of Surgery (R.T.R., J.R.E.), University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama; Division of Pediatric Surgery, Department of Surgery (M.A.B.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (P.J.A.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Anesthesiology and Critical Care Medicine (M.M.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics (M.A.B.), Brooke Army Medical Center, Uniformed Services University; Division of Trauma and Burn Surgery (R.S.B.), Children's National Hospital, Washington, DC; Department of Surgery (B.A.G.), University of Pittsburgh School of Medicine, UPMC Children's Hospital, Pittsburgh, Pennsylvania; Division of Pediatric Surgery (M.J.), Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon; Departments of Pathology and Laboratory Medicine (C.D.J.) and Pediatrics (C.D.J.), Emory University School of Medicine, Atlanta, Georgia; Department of Surgery (C.L.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics (J.C.L.), Division of Emergency Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; Division of Critical Care Medicine (J.A.M.), The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pathology and Laboratory Medicine (K.K.N.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Emergency Medicine (D.K.N.), Davis School of Medicine, University of California, Sacramento, California; Department of Anesthesiology and Critical Care (P.A.S.), The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Divisions of Pediatric Surgery (A.M.V.) and Critical Care (A.M.V.), Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pathology (T.E.W.), Division of Pediatric Hematology and Oncology, Oregon Health and Science University, Portland, Oregon; and Department of Surgery and Critical Care Medicine (P.C.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Esparaz, Joseph R AU - Esparaz JR FAU - Beckwith, Michael A AU - Beckwith MA FAU - Abraham, Peter J AU - Abraham PJ FAU - Bembea, Melania M AU - Bembea MM FAU - Borgman, Matthew A AU - Borgman MA FAU - Burd, Randall S AU - Burd RS FAU - Gaines, Barbara A AU - Gaines BA FAU - Jafri, Mubeen AU - Jafri M FAU - Josephson, Cassandra D AU - Josephson CD FAU - Leeper, Christine AU - Leeper C FAU - Leonard, Julie C AU - Leonard JC FAU - Muszynski, Jennifer A AU - Muszynski JA FAU - Nicol, Kathleen K AU - Nicol KK FAU - Nishijima, Daniel K AU - Nishijima DK FAU - Stricker, Paul A AU - Stricker PA FAU - Vogel, Adam M AU - Vogel AM FAU - Wong, Trisha E AU - Wong TE FAU - Spinella, Philip C AU - Spinella PC LA - eng GR - R13 HD102128/HD/NICHD NIH HHS/United States PT - Consensus Statement PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20221017 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemostatics) SB - IM MH - Child MH - Humans MH - *Shock, Hemorrhagic/therapy MH - Resuscitation MH - Shock, Traumatic MH - Fluid Therapy MH - *Hemostatics PMC - PMC9805499 MID - NIHMS1841015 EDAT- 2022/10/18 06:00 MHDA- 2023/01/04 06:00 PMCR- 2024/01/01 CRDT- 2022/10/17 00:02 PHST- 2022/10/18 06:00 [pubmed] PHST- 2023/01/04 06:00 [medline] PHST- 2022/10/17 00:02 [entrez] PHST- 2024/01/01 00:00 [pmc-release] AID - 01586154-202301001-00002 [pii] AID - 10.1097/TA.0000000000003805 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Jan 1;94(1S Suppl 1):S2-S10. doi: 10.1097/TA.0000000000003805. Epub 2022 Oct 17. PMID- 36245047 OWN - NLM STAT- MEDLINE DCOM- 20221114 LR - 20221116 IS - 1432-1041 (Electronic) IS - 0031-6970 (Print) IS - 0031-6970 (Linking) VI - 78 IP - 12 DP - 2022 Dec TI - Comparison of ticagrelor and clopidogrel on platelet function and prognosis in unstable angina. PG - 1949-1958 LID - 10.1007/s00228-022-03401-3 [doi] AB - PURPOSE: This study aims to compare the effects of ticagrelor and clopidogrel on platelet function, cardiovascular prognosis, and bleeding in patients with unstable angina pectoris. METHODS: Patients with unstable angina pectoris undergoing percutaneous coronary intervention (PCI) were enrolled (January 2018-December 2019). In total, 212 patients were treated with ticagrelor (90 mg twice daily) and 210 patients were treated with clopidogrel (75 mg once daily). Thromboelastography and light transmission aggregometry were used to measure the platelet aggregation rate (PAR). High-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (CRP), and heart-type fatty acid-binding protein (h-FABP) were measured to assess myocardial injury after PCI. Cardiovascular prognosis and bleeding events were evaluated in hospital and 12 months after discharge. RESULTS: The PAR was significantly slower with ticagrelor (P < 0.001). hs-TnT, NT-proBNP, CRP, and h-FABP increased after compared with before PCI in both groups (P < 0.05). hs-TnT (P < 0.001) and h-FABP (P < 0.001) increased more significantly with clopidogrel. The in-hospital and 12-month major adverse cardiovascular event (MACE) rates were not significantly different between the two groups. The in-hospital total bleeding event rate was higher with ticagrelor (P < 0.05). Minor bleeding and total bleeding were more frequent at the 12-month follow-up in the ticagrelor group (P < 0.05). CONCLUSION: Ticagrelor was more effective in suppressing the PAR than clopidogrel and reduced PCI-induced myocardial injury in patients with unstable angina pectoris. However, it increased in-hospital and 12-month bleeding events and had no benefit on in-hospital and 12-month MACEs. CI - (c) 2022. The Author(s). FAU - Li, Chun AU - Li C AD - Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China. FAU - Liu, Ming AU - Liu M AD - Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China. FAU - Chen, Weixiang AU - Chen W AD - Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China. FAU - Jiang, Tingbo AU - Jiang T AD - Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China. FAU - Ling, Lin AU - Ling L AD - Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China. joylinling@126.com. LA - eng PT - Journal Article DEP - 20221017 PL - Germany TA - Eur J Clin Pharmacol JT - European journal of clinical pharmacology JID - 1256165 RN - GLH0314RVC (Ticagrelor) RN - A74586SNO7 (Clopidogrel) RN - 0 (Fatty Acid Binding Protein 3) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - Ticagrelor MH - Clopidogrel MH - Fatty Acid Binding Protein 3 MH - *Percutaneous Coronary Intervention/adverse effects MH - Platelet Aggregation Inhibitors MH - Treatment Outcome MH - Prognosis MH - Hemorrhage/chemically induced MH - Angina, Unstable/drug therapy/chemically induced PMC - PMC9649465 OTO - NOTNLM OT - Bleeding OT - Cardiovascular prognosis OT - Platelet aggregation rate OT - Ticagrelor OT - Unstable angina pectoris COIS- The authors declare no competing interests. EDAT- 2022/10/17 06:00 MHDA- 2022/11/15 06:00 PMCR- 2022/10/17 CRDT- 2022/10/16 23:19 PHST- 2022/05/28 00:00 [received] PHST- 2022/10/06 00:00 [accepted] PHST- 2022/10/17 06:00 [pubmed] PHST- 2022/11/15 06:00 [medline] PHST- 2022/10/16 23:19 [entrez] PHST- 2022/10/17 00:00 [pmc-release] AID - 10.1007/s00228-022-03401-3 [pii] AID - 3401 [pii] AID - 10.1007/s00228-022-03401-3 [doi] PST - ppublish SO - Eur J Clin Pharmacol. 2022 Dec;78(12):1949-1958. doi: 10.1007/s00228-022-03401-3. Epub 2022 Oct 17. PMID- 36227354 OWN - NLM STAT- MEDLINE DCOM- 20240715 LR - 20240718 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 50 IP - 3 DP - 2024 Jun TI - Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section. PG - 671-678 LID - 10.1007/s00068-022-02126-3 [doi] AB - INTRODUCTION: Fixation of major fractures plays a pivotal role in the surgical treatment of polytrauma patients. In addition to ongoing discussions regarding the optimal timing in level I trauma centers, it appears that the respective trauma systems impact the implementation of both, damage control and safe definitive surgery strategies. This study aimed to assess current standards of polytrauma treatment in a Europe-wide survey. METHODS: A survey, developed by members of the polytrauma section of ESTES, was sent online via SurveyMonkey((R)), between July and November 2020, to 450 members of ESTES (European Society of Trauma and Emergency Surgery). Participation was voluntary and anonymity was granted. The questionnaire consisted of demographic data and included questions about the definition of "polytrauma" and the local standards for the timing of fracture fixation. RESULTS: In total, questionnaires of 87 participants (19.3% response rate) were included. The majority of participants were senior consultants (50.57%). The mean work experience was 19 years, and on average, 17 multiple-injured patients were treated monthly. Most of the participants stated that a polytrauma patient is defined by ISS >/= 16 (44.16%), followed by the "Berlin Definition" (25.97%). Systolic blood pressure < 90 mmHg, tachycardia or vasopressor administration (86.84%), pH deviation, base excess shift (48.68%), and lactate > 4 mmol (40.79%) or coagulopathy defined by ROTEM (40.79%) were the three most often stated indicators for shock. Local guidelines (33.77%) and the S-3 Guideline by the DGU(R) (23.38%) were mostly stated as a reference for the treatment of polytrauma patients. Normal coagulation (79.69%), missing administration of vasopressors (62.50%), and missing clinical signs of "SIRS" (67.19%) were stated as criteria for safe definite secondary surgery. CONCLUSION: Different definitions of polytrauma are used in the clinical setting. Indication for and the extent of secondary (definitive) surgery are mainly dependent on the polytrauma patient;s physiology. The <> plays a less important role in decision making. CI - (c) 2022. The Author(s). FAU - Scherer, Julian AU - Scherer J AUID- ORCID: 0000-0001-8943-5817 AD - Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland. julian.scherer@usz.ch. FAU - Coimbra, Raul AU - Coimbra R AD - Riverside University Health System and Loma Linda University, Riverside, CA, USA. FAU - Mariani, Diego AU - Mariani D AD - Department of Emergency General Surgery, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy. FAU - Leenen, Luke AU - Leenen L AD - Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. FAU - Komadina, Radko AU - Komadina R AD - Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, 3000, Celje, Slovenia. FAU - Peralta, Ruben AU - Peralta R AD - Surgical Department (Hamad General Hospital), Hamad Medical Corporation, HMC, Doha, Qatar. FAU - Fattori, Luka AU - Fattori L AD - Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy. FAU - Marzi, Ingo AU - Marzi I AD - Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany. FAU - Wendt, Klaus AU - Wendt K AD - Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital Ulleval, Kirkeveien 166, 0450, Oslo, Norway. FAU - Pape, Hans-Christoph AU - Pape HC AD - Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland. FAU - Pfeifer, Roman AU - Pfeifer R AD - Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland. LA - eng PT - Journal Article DEP - 20221013 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Humans MH - *Multiple Trauma/therapy MH - Europe MH - Surveys and Questionnaires MH - Fracture Fixation/standards MH - Trauma Centers/standards MH - Fractures, Bone/surgery MH - Injury Severity Score MH - Male PMC - PMC11249422 OTO - NOTNLM OT - Damage control orthopaedics OT - Fracture care OT - Major fractures OT - Polytrauma COIS- All authors certify that no conflict of interest exists that needs to be reported. EDAT- 2022/10/14 06:00 MHDA- 2024/07/15 12:44 PMCR- 2022/10/13 CRDT- 2022/10/13 11:16 PHST- 2022/02/25 00:00 [received] PHST- 2022/10/01 00:00 [accepted] PHST- 2024/07/15 12:44 [medline] PHST- 2022/10/14 06:00 [pubmed] PHST- 2022/10/13 11:16 [entrez] PHST- 2022/10/13 00:00 [pmc-release] AID - 10.1007/s00068-022-02126-3 [pii] AID - 2126 [pii] AID - 10.1007/s00068-022-02126-3 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2024 Jun;50(3):671-678. doi: 10.1007/s00068-022-02126-3. Epub 2022 Oct 13. PMID- 36210205 OWN - NLM STAT- MEDLINE DCOM- 20221128 LR - 20230410 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 53 IP - 12 DP - 2022 Dec TI - Clinical significance of R-TEG in severe burn patients with coagulation dysfunction. PG - 3993-3999 LID - S0020-1383(22)00729-X [pii] LID - 10.1016/j.injury.2022.09.061 [doi] AB - INTRODUCTION: The aim of this study was to retrospectively analyze Thrombelastography (TEG) data of severe burn patients to provide a clinical basis for timely diagnosis and treatment of coagulation dysfunction. METHODS: The present study comprised burn patients with full thickness TBSA >/= 60%. The patients included in the study were admitted to the Third Affiliated Hospital of Inner Mongolia Medical University between March 2019 and March 2022 and died within 10 days. Patient demographic and clinical data, including abbreviated burn severity index (ABSI) score, full thickness and overall total surface burn area (TBSA), injury cause, International Society on Thrombosis and Hemostasis (ISTH) score, were retrieved from the electronic medical record system. TEG data (including ACT, K, alpha, MA and LY30), platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) data were obtained from the records of included patients for analysis. RESULTS: A total of 9 patients were enrolled. The average burn area was 90.0% TBSA and the full-thickness TBSA was 72.0%. The results showed that alpha, MA and PLT count values were significantly lower relative to those at obtained throughout admission period (all p < 0.05). PDW and MPV were significantly higher compared with the values at admission (all p < 0.05). ACT time was significantly longer from day 2 after severe burn compared with the ACT time at admission (all p < 0.05). LY30 value from day 3 after severe burn was significantly higher compared with the value at admission (p < 0.05). One patient was diagnosed with diffuse intravascular coagulation (DIC) on admission, whereas eight patients were diagnosed with DIC on the day of death. CONCLUSION: Coagulation dysfunction after severe burn is mainly characterized by procoagulant disorders and hyperfibrinolysis, which can be timely detected by TEG. Coagulation after severe burn exhibits a gradual aggravation, and can lead to death of patients. CI - Copyright (c) 2022. Published by Elsevier Ltd. FAU - Li, Quan AU - Li Q AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. FAU - Zhang, Tiening AU - Zhang T AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. FAU - Wang, Lingfeng AU - Wang L AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. FAU - Li, Fang AU - Li F AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. FAU - Chen, Qiang AU - Chen Q AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. FAU - Cao, Shengjun AU - Cao S AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. Electronic address: shengjunc@aliyun.com. FAU - Ba, Te AU - Ba T AD - Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China. Electronic address: bgyybate@126.com. LA - eng PT - Journal Article DEP - 20221002 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Humans MH - Thrombelastography MH - Retrospective Studies MH - *Blood Coagulation Disorders/diagnosis/etiology MH - *Burns/complications OTO - NOTNLM OT - Burn OT - Coagulation dysfunction OT - DIC OT - Platelet OT - Thrombelastography COIS- Declaration of Competing Interest The authors declare no conflicts of interest. EDAT- 2022/10/10 06:00 MHDA- 2022/11/29 06:00 CRDT- 2022/10/09 22:03 PHST- 2022/05/10 00:00 [received] PHST- 2022/08/27 00:00 [revised] PHST- 2022/09/29 00:00 [accepted] PHST- 2022/10/10 06:00 [pubmed] PHST- 2022/11/29 06:00 [medline] PHST- 2022/10/09 22:03 [entrez] AID - S0020-1383(22)00729-X [pii] AID - 10.1016/j.injury.2022.09.061 [doi] PST - ppublish SO - Injury. 2022 Dec;53(12):3993-3999. doi: 10.1016/j.injury.2022.09.061. Epub 2022 Oct 2. PMID- 36204390 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221009 IS - 2689-288X (Electronic) IS - 2689-288X (Linking) VI - 3 IP - 1 DP - 2022 TI - Effects of Guideline-Based Correction of Platelet Inhibition on Outcomes in Moderate to Severe Isolated Blunt Traumatic Brain Injury. PG - 388-397 LID - 10.1089/neur.2022.0003 [doi] AB - Platelet dysfunction has been demonstrated after traumatic brain injury (TBI) regardless of the use of platelet inhibitors. The purpose of this study was to determine the efficacy of a platelet-mapping thromboelastography (PM-TEG) in predicting TBI patients who would benefit from platelet transfusion. We hypothesized that adenosine diphosphate (ADP) and arachadonic acid (AA) inhibition in patients with TBI is associated with increased mortality and can be corrected with platelet transfusion. This is a retrospective review of patients admitted to a level 1 trauma center from January 2016 through September 2017 with moderate to severe blunt TBI (msTBI), defined by an initial Glasgow Coma Scale (GCS) /=60%) received one unit of platelets followed by repeat PM-TEG, until inhibition <60% or three units of platelets. Cohorts were defined as patients initially without (NPI) and with (PI) inhibition and subdivided into those whose inhibition corrected (PI-C) versus those whose did not correct (PI-NC). From 69 patients with isolated blunt TBI, 40 (58%) presented with NPI, 29 (42%) with PI. Of those with PI, 16 (55%) were with PI-C and 13 (45%) with PI-NC. Platelet inhibition in msTBI patients undergoing guideline-based transfusion is associated with age and GCS and an increase in mortality. Platelet inhibition seems to have a more adverse effect on patients >55 years of age or with GCS <8. Correction of platelet inhibition normalized mortality to that of NPI. CI - (c) Andrew B. Sorah et al., 2022; Published by Mary Ann Liebert, Inc. FAU - Sorah, Andrew B AU - Sorah AB AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Cunningham, Kyle AU - Cunningham K AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Wang, Huaping AU - Wang H AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. AD - Information and Analytic Services, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Karvetski, Colleen AU - Karvetski C AD - Information and Analytic Services, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Ekaney, Michael AU - Ekaney M AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Brintzenhoff, Rita AU - Brintzenhoff R AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. FAU - Evans, Susan AU - Evans S AD - F.H. Sammy Ross Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA. LA - eng PT - Journal Article DEP - 20220922 PL - United States TA - Neurotrauma Rep JT - Neurotrauma reports JID - 101773091 PMC - PMC9531883 OTO - NOTNLM OT - platelet dysfunction OT - platelet transfusion OT - thromboelastography OT - traumatic brain injury COIS- No competing financial interests exist. EDAT- 2022/10/08 06:00 MHDA- 2022/10/08 06:01 PMCR- 2022/09/22 CRDT- 2022/10/07 02:52 PHST- 2022/10/07 02:52 [entrez] PHST- 2022/10/08 06:00 [pubmed] PHST- 2022/10/08 06:01 [medline] PHST- 2022/09/22 00:00 [pmc-release] AID - 10.1089/neur.2022.0003 [pii] AID - 10.1089/neur.2022.0003 [doi] PST - epublish SO - Neurotrauma Rep. 2022 Sep 22;3(1):388-397. doi: 10.1089/neur.2022.0003. eCollection 2022. PMID- 36177090 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20260307 IS - 2691-3593 (Electronic) IS - 2691-3593 (Linking) VI - 3 IP - 2 DP - 2022 Jun TI - Proteomics of Coagulopathy Following Injury Reveals Limitations of Using Laboratory Assessment to Define Trauma-Induced Coagulopathy to Predict Massive Transfusion. LID - e167 [pii] LID - 10.1097/as9.0000000000000167 [doi] AB - OBJECTIVE: Trauma-induced coagulopathy (TIC) is provoked by multiple mechanisms and is perceived to be one driver of massive transfusions (MT). Single laboratory values using prothrombin time (INR) or thrombelastography (TEG) are used to clinically define this complex process. We used a proteomics approach to test whether current definitions of TIC (INR, TEG, or clinical judgement) are sufficient to capture the majority of protein changes associated with MT. METHODS: Eight level-I trauma centers contributed blood samples from patients available early after injury. TIC was defined as INR >1.5 (INR-TIC), TEG maximum amplitude <50mm (TEG-TIC), or clinical judgement (Clin-TIC) by the trauma surgeon. MT was defined as > 10 units of red blood cells in 24 hours or > 4 units RBC/hour during the first 4 hr. SomaLogic proteomic analysis of 1,305 proteins was performed. Pathways associated with proteins dysregulated in patients with each TIC definition and MT were identified. RESULTS: Patients (n=211) had a mean injury severity score of 24, with a MT and mortality rate of 22% and 12%, respectively. We identified 578 SOMAscan analytes dysregulated among MT patients, of which INR-TIC, TEG-TIC, and Clin-TIC patients showed dysregulation only in 25%, 3%, and 4% of these, respectively. TIC definitions jointly failed to show changes in 73% of the protein levels associated with MT, and failed to identify 26% of patients that received a massive transfusion. INR-TIC and TEG-TIC patients showed dysregulation of proteins significantly associated with complement activity. Proteins dysregulated in Clin-TIC or massive transfusion patients were not significantly associated with any pathway. CONCLUSION: These data indicate there are unexplored opportunities to identify patients at risk for massive bleeding. Only a small subset of proteins that are dysregulated in patients receiving MT are statistically significantly dysregulated among patients whose TIC is defined based solely on laboratory measurements or clinical assessment. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado, Department of Surgery. FAU - Neal, Matthew D AU - Neal MD AD - University of Pittsburgh, Pittsburgh Trauma Research Center, Department of Surgery. FAU - Bertolet, Marnie AU - Bertolet M AD - University of Pittsburgh, Department of Epidemiology. FAU - Joughin, Brian A AU - Joughin BA AD - Massachusetts Institute of Technology, Department of Biological Engineering. AD - Koch Institute for Integrative Cancer Research at MIT. AD - Center for Precision Cancer Medicine. FAU - Yaffe, Michael B AU - Yaffe MB AD - Massachusetts Institute of Technology, Department of Biological Engineering. AD - Koch Institute for Integrative Cancer Research at MIT. AD - Center for Precision Cancer Medicine. AD - Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery. FAU - Barrett, Christopher D AU - Barrett CD AD - Massachusetts Institute of Technology, Department of Biological Engineering. AD - Koch Institute for Integrative Cancer Research at MIT. AD - Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery. FAU - Bird, Molly A AU - Bird MA AD - Massachusetts Institute of Technology, Department of Biological Engineering. AD - Koch Institute for Integrative Cancer Research at MIT. AD - Center for Precision Cancer Medicine. FAU - Tracy, Russell P AU - Tracy RP AD - University of Vermont Department of Biochemistry. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado, Department of Surgery. AD - Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery. FAU - Sperry, Jason L AU - Sperry JL AD - University of Pittsburgh, Pittsburgh Trauma Research Center, Department of Surgery. FAU - Zuckerbraun, Brian S AU - Zuckerbraun BS AD - University of Pittsburgh, Pittsburgh Trauma Research Center, Department of Surgery. FAU - Park, Myung S AU - Park MS AD - Mayo Clinic Rochester, Department of Surgery. FAU - Cohen, Mitchell J AU - Cohen MJ AD - University of Colorado, Department of Surgery. FAU - Wisniewski, Stephen R AU - Wisniewski SR AD - University of Pittsburgh, Department of Epidemiology. FAU - Morrissey, James H AU - Morrissey JH AD - University of Michigan Medical School, Departments of Biological Chemistry and Internal Medicine. CN - TACTIC Investigators LA - eng GR - R00 HL151887/HL/NHLBI NIH HHS/United States GR - R35 ES028374/ES/NIEHS NIH HHS/United States GR - F32 HL134244/HL/NHLBI NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States GR - R35 HL135823/HL/NHLBI NIH HHS/United States GR - K99 HL151887/HL/NHLBI NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20220525 PL - United States TA - Ann Surg Open JT - Annals of surgery open : perspectives of surgical history, education, and clinical approaches JID - 101769928 PMC - PMC9514137 MID - NIHMS1800361 EDAT- 2022/10/01 06:00 MHDA- 2022/10/01 06:01 PMCR- 2022/05/25 CRDT- 2022/09/30 02:41 PHST- 2022/09/30 02:41 [entrez] PHST- 2022/10/01 06:00 [pubmed] PHST- 2022/10/01 06:01 [medline] PHST- 2022/05/25 00:00 [pmc-release] AID - e167 [pii] AID - 10.1097/as9.0000000000000167 [doi] PST - ppublish SO - Ann Surg Open. 2022 Jun;3(2):e167. doi: 10.1097/as9.0000000000000167. Epub 2022 May 25. PMID- 36174609 OWN - NLM STAT- MEDLINE DCOM- 20221020 LR - 20221020 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 48 IP - 7 DP - 2022 Oct TI - Role of Viscoelastic and Conventional Coagulation Tests for Management of Blood Product Replacement in the Bleeding Patient. PG - 785-795 LID - 10.1055/s-0042-1756192 [doi] AB - An important aim of viscoelastic testing (VET) is to implement transfusion algorithms based on coagulation test results to help reduce transfusion rates and improve patient outcomes. Establishing a rapid diagnosis and providing timely treatment of coagulopathy is the cornerstone of management of severely bleeding patients in trauma, postpartum hemorrhage, and major surgery. As the nature of acute bleeding and trauma leads to an unstable and tenuous physiologic state, conventional coagulation tests (CCTs) are too slow to diagnose, manage, and also course correct any hemostatic abnormalities that accompany an acute critical illness. Viscoelastic point-of-care tests strongly correlate with results from standard laboratory tests but are designed to enable clinicians to make timely, informed bleeding management decisions when time to intervene is critical. These assays provide an individualized and goal-oriented approach to patient blood management and are increasingly becoming involved in transfusion algorithms. The scope of this review aims to evaluate the current literature on VETs and their impact on actionable outputs in clinical decision making and their relationship to CCT. CI - Thieme. All rights reserved. FAU - Matkovic, Eduard AU - Matkovic E AD - Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. FAU - Lindholm, Paul F AU - Lindholm PF AD - Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. LA - eng PT - Journal Article PT - Review DEP - 20220929 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Hemostatics) SB - IM MH - Female MH - Humans MH - Blood Coagulation Tests/methods MH - Hemorrhage/diagnosis/therapy MH - *Blood Coagulation Disorders/diagnosis/therapy MH - Blood Transfusion/methods MH - *Hemostatics MH - Thrombelastography/methods MH - *Wounds and Injuries COIS- None declared. EDAT- 2022/09/30 06:00 MHDA- 2022/10/21 06:00 CRDT- 2022/09/29 19:03 PHST- 2022/09/30 06:00 [pubmed] PHST- 2022/10/21 06:00 [medline] PHST- 2022/09/29 19:03 [entrez] AID - 10.1055/s-0042-1756192 [doi] PST - ppublish SO - Semin Thromb Hemost. 2022 Oct;48(7):785-795. doi: 10.1055/s-0042-1756192. Epub 2022 Sep 29. PMID- 36174601 OWN - NLM STAT- MEDLINE DCOM- 20221020 LR - 20221020 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 48 IP - 7 DP - 2022 Oct TI - The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either-or Proposition. PG - 769-784 LID - 10.1055/s-0042-1756302 [doi] AB - There has been a significant interest in the last decade in the use of viscoelastic tests (VETs) to determine the hemostatic competence of bleeding patients. Previously, common coagulation tests (CCTs) such as the prothrombin time (PT) and partial thromboplastin time (PTT) were used to assist in the guidance of blood component and hemostatic adjunctive therapy for these patients. However, the experience of decades of VET use in liver failure with transplantation, cardiac surgery, and trauma has now spread to obstetrical hemorrhage and congenital and acquired coagulopathies. Since CCTs measure only 5 to 10% of the lifespan of a clot, these assays have been found to be of limited use for acute surgical and medical conditions, whereby rapid results are required. However, there are medical indications for the PT/PTT that cannot be supplanted by VETs. Therefore, the choice of whether to use a CCT or a VET to guide blood component therapy or hemostatic adjunctive therapy may often require consideration of both methodologies. In this review, we provide examples of the relative indications for CCTs and VETs in monitoring hemostatic competence of bleeding patients. CI - Thieme. All rights reserved. FAU - Bunch, Connor M AU - Bunch CM AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan. FAU - Berquist, Margaret AU - Berquist M AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Ansari, Aida AU - Ansari A AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - McCoy, Max L AU - McCoy ML AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Langford, Jack H AU - Langford JH AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Brenner, Toby J AU - Brenner TJ AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Aboukhaled, Michael AU - Aboukhaled M AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Thomas, Samuel J AU - Thomas SJ AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Peck, Ethan AU - Peck E AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Patel, Shivani AU - Patel S AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Cancel, Emily AU - Cancel E AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Al-Fadhl, Mahmoud D AU - Al-Fadhl MD AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Zackariya, Nuha AU - Zackariya N AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Thomas, Anthony V AU - Thomas AV AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Aversa, John G AU - Aversa JG AD - Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Greene, Ryan B AU - Greene RB AD - Department of Interventional Radiology, St. Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Seder, Christopher W AU - Seder CW AD - Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois. FAU - Speybroeck, Jacob AU - Speybroeck J AD - Department of Orthopedic Surgery, Case Western Medical Center, Cleveland, Ohio. FAU - Miller, Joseph B AU - Miller JB AD - Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan. FAU - Kwaan, Hau C AU - Kwaan HC AD - Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. FAU - Walsh, Mark M AU - Walsh MM AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. LA - eng PT - Journal Article PT - Review DEP - 20220929 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Hemostatics) SB - IM MH - Humans MH - *Hemostatics MH - Thrombelastography/methods MH - Blood Coagulation Tests MH - Hemostasis MH - *Blood Coagulation Disorders/therapy MH - Hemorrhage/therapy COIS- M.M.W. has received honoraria from Alexion Pharmaceuticals Boston, MA. EDAT- 2022/09/30 06:00 MHDA- 2022/10/21 06:00 CRDT- 2022/09/29 19:03 PHST- 2022/09/30 06:00 [pubmed] PHST- 2022/10/21 06:00 [medline] PHST- 2022/09/29 19:03 [entrez] AID - 10.1055/s-0042-1756302 [doi] PST - ppublish SO - Semin Thromb Hemost. 2022 Oct;48(7):769-784. doi: 10.1055/s-0042-1756302. Epub 2022 Sep 29. PMID- 36174600 OWN - NLM STAT- MEDLINE DCOM- 20221020 LR - 20260127 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 48 IP - 7 DP - 2022 Oct TI - Application of Activators Ecarin and Factor Xa in Thrombelastography for Measurement of Anticoagulant Effect of Direct Oral Anticoagulants Using TEG 5000. PG - 808-813 LID - 10.1055/s-0042-1756699 [doi] AB - There are situations where monitoring direct oral anticoagulants (DOACs) would be useful, including bleedings and trauma. The thromboelastographic technique has proven useful in bleeding situations in trauma and heart surgery. The aim of this study was to examine the effect of DOACs on all currently commercially available conventional TEG(R)5000 assays as well as novel modified assay using Ecarin and human factor Xa (HFXa). Healthy male volunteers were given single dose of oral dabigatran 150 mg, rivaroxaban 20 mg, or apixaban 5 mg. Kaolin, RapidTEG, functional fibrinogen, PlateletMapping assay, and novel modified assays using Ecarin and HFXa were prepared. All TEG parameters were recorded. DOAC concentrations were correlated to the parameters with highest response to the DOAC effect. Sensitivity and negative predictive value of the parameter with highest response to DOAC concentration of 50 ng/mL was calculated. None of the conventional TEG assays demonstrated significant response to the effect on apixaban. Using Ecarin, reaction time R was strongly correlated with dabigatran concentrations. Using HFXa assay, R was strongly correlated with rivaroxaban and apixaban concentrations: r = 0.96, 0.84, and 0.86, respectively; p < 0.0001 for all. The R times obtained with the modified assays demonstrated strong sensitivity and negative predictive values for DOAC levels of >/=50 ng/mL. We have demonstrated that TEG(R)5000 can monitor the DOAC effect on hemostasis when the appropriate activator is used with significant correlation with DOAC concentrations. Larger clinical studies are warranted for correlation of TEG profile and clinical outcomes. CI - Thieme. All rights reserved. FAU - Artang, Ramin AU - Artang R AD - Essentia Health Heart and Vascular Center, Duluth, Minnesota, United States. AD - Department of Cardiology, Bispebjerg University of Copenhagen Hospital, Copenhagen, Denmark. FAU - Brod, Camille AU - Brod C AD - University of Minnesota School of Medicine, Duluth, Minnesota, United States. FAU - Nielsen, Jorn Dalsgaard AU - Nielsen JD AD - Department of Cardiology, Bispebjerg University of Copenhagen Hospital, Copenhagen, Denmark. LA - eng PT - Journal Article DEP - 20220929 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - I0VM4M70GC (Dabigatran) RN - 9NDF7JZ4M3 (Rivaroxaban) RN - EC 3.4.21.6 (Factor Xa) RN - 0 (Antithrombins) RN - 24H4NWX5CO (Kaolin) RN - 0 (Anticoagulants) RN - 0 (Pyridones) RN - 9001-32-5 (Fibrinogen) RN - 0 (Factor Xa Inhibitors) RN - EC 3.4.24.- (ecarin) RN - EC 3.4.- (Endopeptidases) SB - IM MH - Male MH - Humans MH - *Dabigatran MH - *Rivaroxaban/pharmacology/therapeutic use MH - Thrombelastography/methods MH - Factor Xa MH - Antithrombins/therapeutic use MH - Kaolin MH - Anticoagulants/pharmacology/therapeutic use MH - Pyridones/pharmacology/therapeutic use MH - Hemorrhage/drug therapy MH - Fibrinogen MH - Administration, Oral MH - Factor Xa Inhibitors/pharmacology/therapeutic use MH - Endopeptidases COIS- None declared. EDAT- 2022/09/30 06:00 MHDA- 2022/10/21 06:00 CRDT- 2022/09/29 19:03 PHST- 2022/09/30 06:00 [pubmed] PHST- 2022/10/21 06:00 [medline] PHST- 2022/09/29 19:03 [entrez] AID - 10.1055/s-0042-1756699 [doi] PST - ppublish SO - Semin Thromb Hemost. 2022 Oct;48(7):808-813. doi: 10.1055/s-0042-1756699. Epub 2022 Sep 29. PMID- 36164260 OWN - NLM STAT- MEDLINE DCOM- 20220928 LR - 20221022 IS - 2329-0358 (Electronic) IS - 1425-9524 (Print) IS - 1425-9524 (Linking) VI - 27 DP - 2022 Sep 27 TI - Using Postoperative Coagulation Parameters Within 24 h After Liver Transplantation to Predict Incidence of Stage 3 Acute Kidney Injury (AKI). PG - e937535 LID - 10.12659/AOT.937535 [doi] AB - BACKGROUND This study aimed to investigate the relationship between coagulation function and the incidence of acute kidney injury (AKI) stage 3 within 24 h after liver transplantation (LT) and explore the predictive value of coagulation parameters for post-LT stage 3 AKI. MATERIAL AND METHODS A retrospective study was conducted on 241 patients who underwent LT at the Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine between February 2021 and February 2022. The coagulation parameters within 24 h after LT and the incidence of post-LT AKI within 7 days were recorded. The correlation between post-LT coagulation function and post-LT stage 3 AKI was determined using binary logistic regression analysis. RESULTS Post-LT AKI occurred in 99 cases (41.1%), 28 (28.3%) of which developed AKI stage 3. In univariate logistic regression analysis, multiple coagulation indexes of the AKI stage 3 group were worse than in the AKI stage 0-2 group. In multivariate logistic regression analysis, lower post-LT ADP-induced PLT aggregation rate (cut-off: 15.75%), higher D-dimer level (cut-off: 3.52 ug/ml), and prolonged R-value (cut-off: 7.5 min) within 24 h were independent risk factors for post-LT AKI stage 3. The AUROC value for predicting the incidence of post-LT AKI stage 3 combining the 3 indices was 0.835 (sensitivity: 83.3%, specificity: 76.9%). The decision curve showed that combining D-dimer, R-value, and ADP-induced PLT aggregation rate yielded the highest net benefit for predicting the incidence of stage 3 AKI. CONCLUSIONS Post-LT coagulation function within 24 h correlated with the incidence of post-LT AKI stage 3. Lower ADP-induced PLT aggregation rate, higher D-dimer level, and prolonged R-value from the TEG were independent risk factors for the incidence of post-LT AKI stage 3. FAU - Chen, Chen AU - Chen C AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). FAU - Chen, Xiaolan AU - Chen X AD - Department of Emergency, Shanghai Pulmonary Hospital, Shanghai, China (mainland). FAU - Zhao, Xianyuan AU - Zhao X AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). FAU - Feng, Junqi AU - Feng J AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). FAU - Gao, Yuan AU - Gao Y AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). FAU - Deng, Yuxiao AU - Deng Y AUID- ORCID: 0000-0003-2401-1495 AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). FAU - Li, Zhe AU - Li Z AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China (mainland). LA - eng PT - Journal Article DEP - 20220927 PL - United States TA - Ann Transplant JT - Annals of transplantation JID - 9802544 RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - *Acute Kidney Injury/epidemiology/etiology MH - Adenosine Diphosphate MH - China MH - Humans MH - Incidence MH - *Liver Transplantation/adverse effects MH - Retrospective Studies MH - Risk Factors PMC - PMC9526365 COIS- Conflict of interest: None declared EDAT- 2022/09/28 06:00 MHDA- 2022/10/23 06:00 PMCR- 2022/09/27 CRDT- 2022/09/27 01:22 PHST- 2022/09/27 01:22 [entrez] PHST- 2022/09/28 06:00 [pubmed] PHST- 2022/10/23 06:00 [medline] PHST- 2022/09/27 00:00 [pmc-release] AID - 937535 [pii] AID - 10.12659/AOT.937535 [doi] PST - epublish SO - Ann Transplant. 2022 Sep 27;27:e937535. doi: 10.12659/AOT.937535. PMID- 36142962 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220928 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 18 DP - 2022 Sep 9 TI - Traumatic Brain Injury Induces a Differential Immune Response in Polytrauma Patients; Prospective Analysis of CD69 Expression on T Cells and Platelet Expansion. LID - 10.3390/jcm11185315 [doi] LID - 5315 AB - BACKGROUND: Accidents and injuries are the leading causes of mortality in young people. CD4+ regulatory T cells (CD4+ Tregs), Th17 cells and platelets could be identified as key players in post-traumatic immunological dysfunction, which is a common cause of late mortality in trauma patients. The mechanisms of activation of these cell types and their interaction remain mostly unclear. Since CD69 is not only a leukocyte marker but has also immunoregulatory functions, we postulate a role for CD69 after trauma. The present study investigates the expression of CD69 on CD4+ Tregs and Th17 cells, as well as the posttraumatic expansion of platelets and hemostatic function. Subgroup analysis was performed to assess the differences between polytrauma patients with and without severe traumatic brain injury (TBI). METHODS: In this non-interventional prospective clinical trial, we analyzed sequential blood samples over a period of 10 days from 30 patients after multiple traumas with an ISS >/= 16. Platelet function was assessed by rotational thromboelastometry (ROTEM analysis). CD4+ Tregs and Th17 cells were stained with surface markers and analyzed by flow cytometry. RESULTS: We were able to demonstrate a significantly increased expression of CD69 on CD4+ Tregs after trauma. Subgroup analysis revealed that the absence of severe TBI is associated with a significantly higher expression of CD69 on CD4+ Tregs and on Th17 cells. Platelets expanded and showed signs of dysfunction, while an overall tendency of posttraumatic hypercoagulation was detected. CONCLUSIONS: Our results support the concept of injury-specific immune responses and add to a further understanding of the complex pathophysiology of post-traumatic immune dysfunction. FAU - Ditsch, Alexander AU - Ditsch A AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Hunold, Lea AU - Hunold L AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Hefele, Friederike AU - Hefele F AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Greve, Frederik AU - Greve F AD - Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Mair, Olivia AU - Mair O AD - Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Biberthaler, Peter AU - Biberthaler P AD - Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Heimann, Laura AU - Heimann L AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. FAU - Hanschen, Marc AU - Hanschen M AUID- ORCID: 0000-0002-2683-9870 AD - Experimental Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. AD - Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. LA - eng PT - Journal Article DEP - 20220909 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9504194 OTO - NOTNLM OT - CD4+ regulatory T cells OT - CD69 OT - T helper 17 cells OT - hemostasis OT - neuro-immune interaction OT - trauma OT - traumatic brain injury COIS- The authors declare that they have no competing interests. The authors declare no competing financial interests. EDAT- 2022/09/24 06:00 MHDA- 2022/09/24 06:01 PMCR- 2022/09/09 CRDT- 2022/09/23 01:27 PHST- 2022/08/04 00:00 [received] PHST- 2022/09/04 00:00 [revised] PHST- 2022/09/07 00:00 [accepted] PHST- 2022/09/23 01:27 [entrez] PHST- 2022/09/24 06:00 [pubmed] PHST- 2022/09/24 06:01 [medline] PHST- 2022/09/09 00:00 [pmc-release] AID - jcm11185315 [pii] AID - jcm-11-05315 [pii] AID - 10.3390/jcm11185315 [doi] PST - epublish SO - J Clin Med. 2022 Sep 9;11(18):5315. doi: 10.3390/jcm11185315. PMID- 36137866 OWN - NLM STAT- MEDLINE DCOM- 20221025 LR - 20221025 IS - 1773-0597 (Electronic) IS - 0181-5512 (Linking) VI - 45 IP - 9 DP - 2022 Nov TI - Spiral capsulorhexis technique with anterior chamber maintainer under continuous fluid pressure in intumescent cataracts and its clinical outcomes. PG - 1024-1030 LID - S0181-5512(22)00264-9 [pii] LID - 10.1016/j.jfo.2022.04.013 [doi] AB - PURPOSE: To evaluate the efficacy of technique combining an anterior chamber maintainer (ACM) and spiral capsulorhexis under continuous fluid pressure in intumescent cataracts. METHODS: One hundred thirty-one eyes of 128 patients who underwent phacoemulsification and IOL implantation for intumescent white cataracts without a red reflex were included in the study. Group 1 consisted of 67 eyes of 65 patients who underwent spiral capsulorhexis with an ACM under continuous fluid pressure. Group 2 consisted of 64 eyes of 63 patients who underwent capsulorhexis after injection of viscoelastic material into the anterior chamber. Both groups were compared in terms of endothelial cell loss, intraoperative and postoperative complications. RESULTS: Progression to the periphery in the capsule not resulting in a radial tear was observed in 3 eyes in Group 1 and 11 eyes in Group 2 (P=0.019). While the type of radial tear known as the Argentinian flag sign was not observed in Group 1, it was observed in 8 eyes in Group 2 (P=0.003). Postoperative intraocular lens (IOL) decentration did not develop in any eye in group 1, but in 3 eyes in group 2 (P=0.11). CONCLUSION: The combination technique of an anterior chamber maintainer and spiral capsulorhexis provides a controlled and safe capsulorhexis and reduces intraoperative and postoperative complications in intumescent cataracts. CI - Copyright (c) 2022 Elsevier Masson SAS. All rights reserved. FAU - Ucar, F AU - Ucar F AD - Ophthalmology Department, Konyagoz Eye Hospital, Konya, Turkey. Electronic address: fikretucar@konyagoz.com. LA - eng PT - Journal Article DEP - 20220920 PL - France TA - J Fr Ophtalmol JT - Journal francais d'ophtalmologie JID - 7804128 SB - IM MH - Humans MH - Capsulorhexis/adverse effects/methods MH - Lens Implantation, Intraocular/adverse effects MH - *Cataract/complications MH - *Phacoemulsification/adverse effects/methods MH - Anterior Chamber/surgery MH - Postoperative Complications/epidemiology/etiology MH - Rupture OTO - NOTNLM OT - Anterior chamber maintainer OT - Argentinian flag sign OT - Capsulorhexis sans viscoelastique OT - Capsulorhexis without viscoelastic OT - Cataracte intumescente OT - Dechirure radiale OT - Intumescent cataract OT - Mainteneur de chambre anterieure OT - Radial tear OT - Signe drapeau argentin EDAT- 2022/09/23 06:00 MHDA- 2022/10/26 06:00 CRDT- 2022/09/22 22:05 PHST- 2021/09/29 00:00 [received] PHST- 2022/01/25 00:00 [revised] PHST- 2022/04/07 00:00 [accepted] PHST- 2022/09/23 06:00 [pubmed] PHST- 2022/10/26 06:00 [medline] PHST- 2022/09/22 22:05 [entrez] AID - S0181-5512(22)00264-9 [pii] AID - 10.1016/j.jfo.2022.04.013 [doi] PST - ppublish SO - J Fr Ophtalmol. 2022 Nov;45(9):1024-1030. doi: 10.1016/j.jfo.2022.04.013. Epub 2022 Sep 20. PMID- 36113505 OWN - NLM STAT- MEDLINE DCOM- 20221020 LR - 20221020 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 48 IP - 7 DP - 2022 Oct TI - Advances in the Management of Coagulopathy in Trauma: The Role of Viscoelastic Hemostatic Assays across All Phases of Trauma Care. PG - 796-807 LID - 10.1055/s-0042-1756305 [doi] AB - Uncontrolled bleeding is the leading cause of preventable death following injury. Trauma-induced coagulopathy can manifest as diverse phenotypes ranging from hypocoagulability to hypercoagulability, which can change quickly during the acute phase of trauma care. The major advances in understanding coagulation over the past 25 years have resulted from the cell-based concept, emphasizing the key role of platelets and their interaction with the damaged endothelium. Consequently, conventional plasma-based coagulation testing is not accurate in predicting bleeding and does not provide an assessment of which blood products are indicated. Viscoelastic hemostatic assays (VHA), conducted in whole blood, have emerged as a superior method to guide goal-directed transfusion. The major change in resuscitation has been the shift from unbridled crystalloid loading to judicious balanced blood product administration. Furthermore, the recognition of the rapid changes from hypocoagulability to hypercoagulability has underscored the importance of ongoing surveillance beyond emergent surgery. While the benefits of VHA testing are maximized when used as early as possible, current technology limits use in the pre-hospital setting and the time to results compromises its utility in the emergency department. Thus, most of the reported experience with VHA in trauma is in the operating room and intensive care unit, where there is compelling data to support its value. This overview will address the current and potential role of VHA in the seriously injured patient, throughout the continuum of trauma management. CI - Thieme. All rights reserved. FAU - Meizoso, Jonathan P AU - Meizoso JP AD - DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida. FAU - Barrett, Christopher D AU - Barrett CD AD - Center for Precision Cancer Medicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts. AD - Department of Surgery, Boston University Medical Center, Boston University School of Medicine, Boston, Massachusetts. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. LA - eng PT - Journal Article DEP - 20220916 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Hemostatics) RN - 0 (Crystalloid Solutions) SB - IM MH - Humans MH - *Hemostatics MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Hemorrhage/etiology/therapy MH - *Emergency Medical Services MH - *Thrombophilia/complications MH - Crystalloid Solutions MH - *Wounds and Injuries/complications/therapy COIS- J.P.M. has nothing to disclose. C.D.B. has patents pending in fibrinolysis diagnostics and has received research support from Genentech, Inc and Instrumentation Laboratories. E.E.M. has patents pending in fibrinolysis diagnostics and has received research support from Haemonetics, Instrumentation Laboratories, Hemosonics, Stago, Diapharma, Prytime, and Humacyte. H.B.M. has patents pending in fibrinolysis diagnostics and has received research support from Haemonetics and Instrumentation Laboratories. EDAT- 2022/09/17 06:00 MHDA- 2022/10/21 06:00 CRDT- 2022/09/16 19:03 PHST- 2022/09/17 06:00 [pubmed] PHST- 2022/10/21 06:00 [medline] PHST- 2022/09/16 19:03 [entrez] AID - 10.1055/s-0042-1756305 [doi] PST - ppublish SO - Semin Thromb Hemost. 2022 Oct;48(7):796-807. doi: 10.1055/s-0042-1756305. Epub 2022 Sep 16. PMID- 36112899 OWN - NLM STAT- MEDLINE DCOM- 20230306 LR - 20230306 IS - 1525-1489 (Electronic) IS - 0885-0666 (Linking) VI - 38 IP - 4 DP - 2023 Apr TI - Impact on Blood Product Utilization with Thromboelastography Guided Resuscitation for Gastrointestinal Hemorrhage. PG - 368-374 LID - 10.1177/08850666221126661 [doi] AB - BACKGROUND: Thromboelastography (TEG) can guide transfusion therapy in trauma and has been associated with decreased transfusion requirements. This population differs from the medical population where the most common bleeding source is gastrointestinal hemorrhage (GIB). The utility of TEG in patients with acute GIB is not well described. We sought to assess whether the use of TEG impacts blood product utilization in patients with medical GIB. METHODS: A retrospective study looking at all adult patients admitted with a primary diagnosis of GIB to the George Washington University Intensive Care Unit (ICU) between 01/01/2017 to 12/31/2019. The primary intervention was the use of TEG to guide blood product resuscitation in addition to standard of care (TEG arm) versus standard of care alone (non-TEG arm). RESULTS: The primary outcome was the total number of blood products utilized. Patients in the TEG arm used more blood products compared to the non-TEG arm (9.10 vs 3.60, p < 0.001). There was no difference in secondary endpoints except for an increased requirement for mechanical ventilation within the TEG arm (26.2% vs 13.4%, p = 0.018). CONCLUSIONS: The use of TEG to guide resuscitation in patients with acute GIB may be associated with increased blood product utilization without any clinical benefit to patient-centered outcomes. FAU - Rizvi, Ghazi AU - Rizvi G AUID- ORCID: 0000-0001-8936-6006 AD - Department of Anesthesiology and Critical Care, 43963George Washington University Hospital, Washington, DC, USA. AD - Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA. FAU - Marcinkowski, Bridget AU - Marcinkowski B AD - 43989School of Medicine and Health Sciences, George Washington University, Washington, DC, USA. FAU - Srinivasa, Nandan AU - Srinivasa N AD - 43989School of Medicine and Health Sciences, George Washington University, Washington, DC, USA. FAU - Jett, Alex AU - Jett A AD - 43989School of Medicine and Health Sciences, George Washington University, Washington, DC, USA. FAU - Benjenk, Ivy AU - Benjenk I AD - Department of Anesthesiology and Critical Care, 43963George Washington University Hospital, Washington, DC, USA. FAU - Davison, Danielle AU - Davison D AD - Department of Anesthesiology and Critical Care, 43963George Washington University Hospital, Washington, DC, USA. FAU - Yamane, David AU - Yamane D AD - Department of Anesthesiology and Critical Care, 43963George Washington University Hospital, Washington, DC, USA. LA - eng PT - Journal Article DEP - 20220915 PL - United States TA - J Intensive Care Med JT - Journal of intensive care medicine JID - 8610344 SB - IM MH - Adult MH - Humans MH - *Thrombelastography MH - Retrospective Studies MH - *Blood Transfusion MH - Gastrointestinal Hemorrhage/therapy MH - Resuscitation OTO - NOTNLM OT - bleeding OT - coagulation OT - resuscitation OT - shock EDAT- 2022/09/17 06:00 MHDA- 2023/03/07 06:00 CRDT- 2022/09/16 15:43 PHST- 2022/09/17 06:00 [pubmed] PHST- 2023/03/07 06:00 [medline] PHST- 2022/09/16 15:43 [entrez] AID - 10.1177/08850666221126661 [doi] PST - ppublish SO - J Intensive Care Med. 2023 Apr;38(4):368-374. doi: 10.1177/08850666221126661. Epub 2022 Sep 15. PMID- 36100918 OWN - NLM STAT- MEDLINE DCOM- 20220915 LR - 20220922 IS - 1749-7922 (Electronic) IS - 1749-7922 (Linking) VI - 17 IP - 1 DP - 2022 Sep 13 TI - Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review. PG - 48 LID - 10.1186/s13017-022-00454-8 [doi] LID - 48 AB - OBJECTIVE: Viscoelastic hemostatic assay (VHA) provides a graphical representation of a clot's lifespan and reflects the real time of coagulation. It has been used to guide trauma resuscitation; however, evidence of the effectiveness of VHAs is still limited. This systematic review aims to summarize the published evidence to evaluate the VHA-guided strategy in resuscitating trauma patients. METHODS: The PubMed, Embase, and Web of Science databases were searched from their inception to December 13, 2021. Randomized controlled trials (RCTs) or observational studies comparing VHA-guided transfusion to controls in resuscitating trauma patients were included in this systematic review. RESULTS: Of the 7743 records screened, ten studies, including two RCTs and eight observational studies, met the inclusion criteria. There was great heterogeneity concerning study design, enrollment criterion, VHA device, VHA-guided strategy, and control strategy. Thrombelastography (TEG) was used as a guiding tool for transfusion in eight studies, and rotational thromboelastometry (ROTEM), and TEG or ROTEM were used in the other two studies. The overall risk of bias assessment was severe or mild in RCTs and was severe or moderate in observational studies. The main outcomes reported from the included studies were blood transfusion (n = 10), mortality (n = 10), hospital length of stay (LOS) (n = 7), intensive care unit LOS (n = 7), and cost (n = 4). The effect of the VHA-guided strategy was not always superior to the control. Most of the studies did not find significant differences in the transfusion amount of red blood cells (n = 7), plasma (n = 5), platelet (n = 7), cryoprecipitate/fibrinogen (n = 7), and mortality (n = 8) between the VHA-guided group and control group. Notable, two RCTs showed that the VHA-guided strategy was superior or equal to the conventional coagulation test-guided strategy in reducing mortality, respectively. CONCLUSION: Although some studies demonstrated VHA-guided strategy probable benefit in reducing the need for blood transfusion and mortality when resuscitating trauma patients, the evidence is still not robust. The quality of evidence was primarily downgraded by the limited number of included studies and great heterogeneity and severe risk of bias in these. Further studies are strongly recommended. CI - (c) 2022. The Author(s). FAU - Zhu, Zhe AU - Zhu Z AD - Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, People's Republic of China. AD - Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, People's Republic of China. FAU - Yu, Yong AU - Yu Y AD - Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, People's Republic of China. AD - Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, People's Republic of China. FAU - Hong, Kairui AU - Hong K AD - Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, People's Republic of China. AD - Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, People's Republic of China. FAU - Luo, Mengqin AU - Luo M AD - Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, People's Republic of China. AD - Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, People's Republic of China. FAU - Ke, Yefang AU - Ke Y AD - Department of Clinical Laboratory, Ningbo Women and Children's Hospital, Liuting street 339, Ningbo, Zhejiang, People's Republic of China. keyefang@foxmail.com. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20220913 PL - England TA - World J Emerg Surg JT - World journal of emergency surgery : WJES JID - 101266603 RN - 0 (Hemostatics) SB - IM MH - *Blood Coagulation Disorders/therapy MH - Hemostasis MH - *Hemostatics MH - Humans MH - Randomized Controlled Trials as Topic MH - Resuscitation MH - Thrombelastography PMC - PMC9472418 OTO - NOTNLM OT - Blood transfusion OT - Hemostatic resuscitation OT - Rotational thromboelastometry OT - Thrombelastography OT - Trauma OT - Viscoelastic hemostatic assay COIS- The authors declare that they have no competing interests. EDAT- 2022/09/14 06:00 MHDA- 2022/09/16 06:00 PMCR- 2022/09/13 CRDT- 2022/09/13 23:38 PHST- 2022/05/02 00:00 [received] PHST- 2022/09/05 00:00 [accepted] PHST- 2022/09/13 23:38 [entrez] PHST- 2022/09/14 06:00 [pubmed] PHST- 2022/09/16 06:00 [medline] PHST- 2022/09/13 00:00 [pmc-release] AID - 10.1186/s13017-022-00454-8 [pii] AID - 454 [pii] AID - 10.1186/s13017-022-00454-8 [doi] PST - epublish SO - World J Emerg Surg. 2022 Sep 13;17(1):48. doi: 10.1186/s13017-022-00454-8. PMID- 36100233 OWN - NLM STAT- MEDLINE DCOM- 20221020 LR - 20221020 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 48 IP - 7 DP - 2022 Oct TI - Viscoelastic Testing in the Clinical Management of Subarachnoid Hemorrhage and Intracerebral Hemorrhage. PG - 828-841 LID - 10.1055/s-0042-1756191 [doi] AB - Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are both debilitating and life-threatening incidents calling for immediate action and treatment. This review focuses on the applicability of viscoelastic testing (rotational thromboelastometry or thromboelastography [TEG]) in the management of SAH and ICH. A systematic literature search was performed in PubMed and EMBASE. Studies including patients with SAH or ICH, in which viscoelastic testing was performed, were identified. In total, 24 studies were included for analysis, and further subdivided into studies on SAH patients investigated prior to stenting or coiling (n = 12), ICH patients (n = 8) and studies testing patients undergoing stenting or coiling, or ischemic stroke patients undergoing thrombolysis or thrombectomy and developing ICH as a complication (n = 5). SAH patients had increased clot firmness, and this was associated with a higher degree of early brain injury and higher Hunt-Hess score. SAH patients with delayed cerebral ischemia had higher clot firmness than patients not developing delayed cerebral ischemia. ICH patients showed accelerated clot formation and increased clot firmness in comparison to healthy controls. Patients with hematoma expansion had longer clot initiation and lower platelet aggregation than patients with no hematoma expansion. During stent procedures for SAH, adjustment of antiplatelet therapy according to TEG platelet mapping did not change prevalence of major bleeding, thromboembolic events, or functional outcome. Viscoelastic testing prior to thrombolysis showed conflicting results in predicting ICH as complication. In conclusion, viscoelastic testing suggests hypercoagulation following SAH and ICH. Further investigation of the predictive value of increased clot firmness in SAH seems relevant. In ICH, the prediction of hematoma expansion and ICH as a complication to thrombolysis might be clinically relevant. CI - Thieme. All rights reserved. FAU - Hvas, Christine Lodberg AU - Hvas CL AD - Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark. AD - Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. FAU - Hvas, Anne-Mette AU - Hvas AM AD - Faculty of Health, Aarhus University, Aarhus, Denmark. LA - eng PT - Journal Article PT - Review DEP - 20220913 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Humans MH - *Subarachnoid Hemorrhage/complications/therapy MH - Platelet Aggregation Inhibitors MH - Cerebral Hemorrhage MH - Hematoma MH - *Brain Ischemia/complications COIS- None declared. EDAT- 2022/09/14 06:00 MHDA- 2022/10/21 06:00 CRDT- 2022/09/13 20:02 PHST- 2022/09/14 06:00 [pubmed] PHST- 2022/10/21 06:00 [medline] PHST- 2022/09/13 20:02 [entrez] AID - 10.1055/s-0042-1756191 [doi] PST - ppublish SO - Semin Thromb Hemost. 2022 Oct;48(7):828-841. doi: 10.1055/s-0042-1756191. Epub 2022 Sep 13. PMID- 36096943 OWN - NLM STAT- MEDLINE DCOM- 20230103 LR - 20230111 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 130 IP - 1 DP - 2023 Jan TI - Advanced diagnostic and therapeutic techniques for anaesthetists in thoracic trauma: an evidence-based review. PG - e80-e91 LID - S0007-0912(22)00366-X [pii] LID - 10.1016/j.bja.2022.07.005 [doi] AB - Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. Commonly performed interventions may be complicated in this setting including airway management, damage control resuscitation, and acute pain management. Anaesthetists must consider additional factors including airway injuries, vascular injuries, and coagulopathy when treating this population. This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway. CI - Copyright (c) 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Pollock, Gabriel A AU - Pollock GA AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: gabriel.pollock@cshs.org. FAU - Lo, Jessie AU - Lo J AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Chou, Henry AU - Chou H AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Kissen, Michael S AU - Kissen MS AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Kim, Michelle AU - Kim M AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Zhang, Vida AU - Zhang V AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Betz, Alexander AU - Betz A AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. FAU - Perlman, Ryan AU - Perlman R AD - Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA. LA - eng PT - Journal Article PT - Review DEP - 20220826 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Humans MH - *Thoracic Injuries/diagnosis/therapy MH - *Anesthesia MH - Airway Management/methods MH - *Anesthesiology MH - Anesthetists OTO - NOTNLM OT - POCUS OT - lung isolation OT - point-of care ultrasound OT - regional anaesthesia OT - thoracic trauma OT - trauma anaesthesia OT - viscoelastic testing EDAT- 2022/09/13 06:00 MHDA- 2023/01/04 06:00 CRDT- 2022/09/12 23:47 PHST- 2022/03/01 00:00 [received] PHST- 2022/05/27 00:00 [revised] PHST- 2022/07/02 00:00 [accepted] PHST- 2022/09/13 06:00 [pubmed] PHST- 2023/01/04 06:00 [medline] PHST- 2022/09/12 23:47 [entrez] AID - S0007-0912(22)00366-X [pii] AID - 10.1016/j.bja.2022.07.005 [doi] PST - ppublish SO - Br J Anaesth. 2023 Jan;130(1):e80-e91. doi: 10.1016/j.bja.2022.07.005. Epub 2022 Aug 26. PMID- 36096020 OWN - NLM STAT- MEDLINE DCOM- 20221024 LR - 20221209 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 280 DP - 2022 Dec TI - Analysis of Admission Thromboelastogram Profiles in 1369 Male and Female Trauma Patients. PG - 551-556 LID - S0022-4804(22)00515-7 [pii] LID - 10.1016/j.jss.2022.07.048 [doi] AB - INTRODUCTION: Recent studies have demonstrated a hypercoagulable thromboelastrogram (TEG) in female trauma patients compared with males, conferring a possible survival advantage. We hypothesized that TEG profiles would reveal a relative hypercoagulable state in female compared with male trauma patients. METHODS: A prospective review was conducted on all adult trauma patients admitted to the trauma service at an American College of Surgeons-verified level I trauma center from December 2019 to June 2021 who, per our institutional protocol, received a thrombelastotgraphy on their initial arrival to the trauma center if classified as a level I or II trauma activation. The thromboelastography values of male and female trauma patients were compared as the primary outcome variables of interest. The secondary outcomes investigated were hospital length of stay, surgical interventions, and ventilatory requirement. RESULTS: A total of 1369 patients met inclusion criteria, with 878 (64.1%) male and 491 (35.9%) female. Female patients had a higher median alpha angle (74.8 versus 72.6 degrees , P < 0.001), maximum amplitude (69.3 versus 66.2 mm, P < 0.001), and shorter median K time (1.0 versus 1.2 s, P < 0.001). Female patients had a shorter hospital length of stay (4 versus 5 d, P < 0.001), had a lower rate of surgical intervention (14.6% versus 25.5%, P < 0.001), and had lower rates of mechanical ventilation (19.3% versus 39.5%, P < 0.001). CONCLUSIONS: Female trauma patients were found to have hypercoagulable indices on TEG at the time of initial trauma evaluation compared with males. Intrinsic differences in sex coagulation profiles should be further investigated to optimize modern resuscitation strategies. CI - Published by Elsevier Inc. FAU - Favors, Lauren E AU - Favors LE AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee. Electronic address: laurenfavors93@gmail.com. FAU - Harrell, Kevin N AU - Harrell KN AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee. FAU - Miles, M Victoria P AU - Miles MVP AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee. FAU - Everett, Hayley AU - Everett H AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee. FAU - Rippy, Meredith AU - Rippy M AD - University of Tennessee Chattanooga, Chattanooga, Tennessee. FAU - Maxwell, Robert AU - Maxwell R AD - Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee. LA - eng PT - Journal Article DEP - 20220909 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Humans MH - Adult MH - Male MH - Female MH - Prospective Studies MH - Thrombelastography/methods MH - Trauma Centers MH - Resuscitation/methods MH - *Thrombophilia/diagnosis/etiology MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - Coagulopathy OT - Hemorrhagic shock OT - Resuscitation OT - Sex profile OT - Thromboelastography OT - Trauma EDAT- 2022/09/13 06:00 MHDA- 2022/10/25 06:00 CRDT- 2022/09/12 18:25 PHST- 2022/03/01 00:00 [received] PHST- 2022/06/13 00:00 [revised] PHST- 2022/07/28 00:00 [accepted] PHST- 2022/09/13 06:00 [pubmed] PHST- 2022/10/25 06:00 [medline] PHST- 2022/09/12 18:25 [entrez] AID - S0022-4804(22)00515-7 [pii] AID - 10.1016/j.jss.2022.07.048 [doi] PST - ppublish SO - J Surg Res. 2022 Dec;280:551-556. doi: 10.1016/j.jss.2022.07.048. Epub 2022 Sep 9. PMID- 36073613 OWN - NLM STAT- MEDLINE DCOM- 20221004 LR - 20221013 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 82 IP - 6 DP - 2022 Oct TI - Thrombelastography (TEG((R)) 6s) early amplitudes predict maximum amplitude in severely injured trauma patients. PG - 508-512 LID - 10.1080/00365513.2022.2119599 [doi] AB - Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG((R))) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG((R)) 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG((R)) 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG((R)) 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as <55 mm for Kaolin TEG((R)) and RapidTEG((R)), and <17 mm for TEG((R)) functional fibrinogen (FF). One hundred eighty-seven patients were included. Median time to MA was 20 (Kaolin TEG((R))), 21 (RapidTEG((R))) and 12 (TEG((R)) FF) min. For Kaolin TEG((R)), the optimal Youden index (YI) was at A5 < 36 mm (100/93% sensitivity/specificity) and A10 < 47 mm (100/96% sensitivity/specificity). RapidTEG((R)) optimal YI was at A5 < 34 mm (98/92% sensitivity/specificity) and A10 < 45 mm (96/95% sensitivity/specificity). TEG((R)) FF optimal YI was at A5 < 12 mm (97/93% sensitivity/specificity) and A10 < 15 mm (97/99% sensitivity/specificity). In summary, we found that TEG((R)) 6s early amplitudes were sensitive and specific predictors of MA in severely injured trauma patients. Intervening on early amplitudes can save valuable time in hemostatic resuscitation. FAU - Vigstedt, Martin AU - Vigstedt M AUID- ORCID: 0000-0003-0896-1204 AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Baksaas-Aasen, Kjersti AU - Baksaas-Aasen K AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Henriksen, Hanne H AU - Henriksen HH AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Maegele, Marc AU - Maegele M AD - Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Stanworth, Simon AU - Stanworth S AD - Oxford University Hospital NHS Trust, Oxford, UK. AD - NHS Blood and Transplant, Bristol, UK. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands. FAU - Kolstadbraten, Knut M AU - Kolstadbraten KM AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Naess, Pal A AU - Naess PA AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Queen Mary University of London, London, UK. FAU - Gaarder, Christine AU - Gaarder C AD - Oslo University Hospital and University of Oslo, Oslo, Norway. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. AD - Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20220908 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 0 (Benzeneacetamides) RN - 0 (Hemostatics) RN - 0 (Piperidones) RN - 16VY3TM7ZO (antineoplaston A10) RN - 24H4NWX5CO (Kaolin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Benzeneacetamides MH - *Blood Coagulation Disorders MH - Fibrinogen MH - *Hemostatics MH - Humans MH - Kaolin MH - Piperidones MH - Thrombelastography OTO - NOTNLM OT - Blood coagulation OT - hemostasis OT - shock OT - thrombelastography OT - trauma EDAT- 2022/09/09 06:00 MHDA- 2022/10/05 06:00 CRDT- 2022/09/08 06:33 PHST- 2022/09/09 06:00 [pubmed] PHST- 2022/10/05 06:00 [medline] PHST- 2022/09/08 06:33 [entrez] AID - 10.1080/00365513.2022.2119599 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2022 Oct;82(6):508-512. doi: 10.1080/00365513.2022.2119599. Epub 2022 Sep 8. PMID- 36057168 OWN - NLM STAT- MEDLINE DCOM- 20221216 LR - 20221216 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 218 DP - 2022 Oct TI - Postoperative myocardial injury and platelet reactivity in patients undergoing vascular surgery: The platelet reactivity and postoperative myocardial injury after major vascular surgery (PROMISE) study. PG - 177-185 LID - S0049-3848(22)00365-6 [pii] LID - 10.1016/j.thromres.2022.08.023 [doi] AB - BACKGROUND: Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity. OBJECTIVE: To examine the relationship between platelet activation (P-selectin expression) and PMI in patients undergoing elective open abdominal aortic surgery. METHODS: This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0-100 %). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow(R) assay (aspirin cartridge), with the Multiplate(R) analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG(R) Hemostasis Analyzer System (global hemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time. RESULTS: Ten patients (30.3 %) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (beta = 1.39 (1.1-1.75), P = 0.0064). No association was found between P-selectin measured later after surgery (at 24 h or 48 h) and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release. CONCLUSION: Platelet reactivity, assessed by P-selectin expression measured directly after surgery is associated with PMI, assessed by elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery. CI - Copyright (c) 2022 Elsevier Ltd. All rights reserved. FAU - Zheng, K L AU - Zheng KL AD - Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Bor, W L AU - Bor WL AD - Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Vernooij, L M AU - Vernooij LM AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Medical Centre, Utrecht, the Netherlands. FAU - Breet, N C AU - Breet NC AD - Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Kelder, J C AU - Kelder JC AD - Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Hackeng, C M AU - Hackeng CM AD - Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Kropman, R H J AU - Kropman RHJ AD - Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. FAU - Ten Berg, J M AU - Ten Berg JM AD - Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; University Medical Centre Maastricht, Maastricht University, Maastricht, the Netherlands. FAU - Noordzij, P G AU - Noordzij PG AD - Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Medical Centre, Utrecht, the Netherlands. Electronic address: p.noordzij@antoniusziekenhuis.nl. LA - eng PT - Journal Article PT - Observational Study DEP - 20220828 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 RN - 61D2G4IYVH (Adenosine Diphosphate) RN - R16CO5Y76E (Aspirin) RN - 0 (Diterpenes) RN - 0 (P-Selectin) RN - 0 (Troponin) SB - IM MH - Humans MH - Adenosine Diphosphate MH - Aspirin MH - Cohort Studies MH - Diterpenes MH - *Heart Injuries MH - Myocardium MH - P-Selectin MH - *Platelet Activation MH - Postoperative Period MH - Prospective Studies MH - Troponin MH - *Vascular Surgical Procedures/adverse effects OTO - NOTNLM OT - Myocardial injury OT - Platelet activitytroponin OT - Platelet function OT - Vascular surgery EDAT- 2022/09/04 06:00 MHDA- 2022/09/21 06:00 CRDT- 2022/09/03 18:15 PHST- 2022/07/05 00:00 [received] PHST- 2022/08/17 00:00 [revised] PHST- 2022/08/22 00:00 [accepted] PHST- 2022/09/04 06:00 [pubmed] PHST- 2022/09/21 06:00 [medline] PHST- 2022/09/03 18:15 [entrez] AID - S0049-3848(22)00365-6 [pii] AID - 10.1016/j.thromres.2022.08.023 [doi] PST - ppublish SO - Thromb Res. 2022 Oct;218:177-185. doi: 10.1016/j.thromres.2022.08.023. Epub 2022 Aug 28. PMID- 36055269 OWN - NLM STAT- MEDLINE DCOM- 20230206 LR - 20230206 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 49 IP - 2 DP - 2023 Mar TI - Thrombosis Risk Assessment in Myeloproliferative Neoplasm-Is There a Role for Viscoelastic Testing? PG - 173-181 LID - 10.1055/s-0042-1753483 [doi] AB - Philadelphia chromosome-negative myeloproliferative neoplasms include polycythemia vera, essential thrombocythemia, and myelofibrosis. They are associated with increased thrombotic events, and the primary goal of therapy, in particular those with polycythemia vera and essential thrombocythemia, is the prevention of thrombotic complications typically with antiplatelet therapy and/or cytoreduction. While several patient-, disease-, and genomic-related factors have been identified to influence thrombotic risks, there are no routine laboratory investigations to date that are sufficiently accurate to assess the underlying procoagulant state and predict the thrombotic risks. Conventional coagulation testing only measures time to clot formation and cannot reliably predict bleeding and thrombotic risks. Global coagulation assays such as thromboelastography, thrombin, and fibrin generation may provide a more thorough assessment of hemostatic function. Thromboelastography and thromboelastometry are viscoelastic tests which measure the mechanical properties of the hemostatic process, including the global dynamics of clot formation, stabilization, and dissolution. While viscoelastic testing is gaining traction in the investigations of coagulopathies and goal-directed blood product replacement in trauma and massive transfusion settings, the role of these assays in thrombosis is less well defined. Here, we provide a review of the current evidence of the role of viscoelastic testing in myeloproliferative neoplasm, particularly in the thrombotic risk assessment. CI - Thieme. All rights reserved. FAU - Lim, Hui Yin AU - Lim HY AD - Department of Hematology, Northern Pathology Victoria, Northern Hospital, Epping VIC, Australia. AD - Australian Centre for Blood Diseases, Monash University, Melbourne VIC, Australia. AD - Department of Medicine, Northern Health, University of Melbourne, Heidelberg, VIC, Australia. FAU - Ho, Prahlad AU - Ho P AUID- ORCID: 0000-0002-1373-7437 AD - Department of Hematology, Northern Pathology Victoria, Northern Hospital, Epping VIC, Australia. AD - Australian Centre for Blood Diseases, Monash University, Melbourne VIC, Australia. AD - Department of Medicine, Northern Health, University of Melbourne, Heidelberg, VIC, Australia. LA - eng PT - Journal Article PT - Review DEP - 20220902 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Hemostatics) SB - IM MH - Humans MH - *Polycythemia Vera/complications MH - *Thrombocythemia, Essential MH - *Myeloproliferative Disorders/complications/diagnosis MH - *Thrombosis MH - Risk Assessment MH - *Hemostatics COIS- None declared. EDAT- 2022/09/03 06:00 MHDA- 2023/02/07 06:00 CRDT- 2022/09/02 18:52 PHST- 2022/09/03 06:00 [pubmed] PHST- 2023/02/07 06:00 [medline] PHST- 2022/09/02 18:52 [entrez] AID - 10.1055/s-0042-1753483 [doi] PST - ppublish SO - Semin Thromb Hemost. 2023 Mar;49(2):173-181. doi: 10.1055/s-0042-1753483. Epub 2022 Sep 2. PMID- 36042872 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220906 IS - 1179-1349 (Print) IS - 1179-1349 (Electronic) IS - 1179-1349 (Linking) VI - 14 DP - 2022 TI - Design for a Multicentre Prospective Cohort for the Assessment of Platelet Function in Patients with Hepatitis-B-Virus-Related Acute-on-Chronic Liver Failure. PG - 997-1011 LID - 10.2147/CLEP.S376068 [doi] AB - BACKGROUND: Acute-on-chronic liver failure (ACLF) has high short-term mortality and lacks sufficient medical therapy. Available algorithms are unable to precisely predict short-term outcomes or safely stratify patients with ACLF as emergent liver transplantation candidates. Therefore, a personalized prognostic tool is urgently needed. PURPOSE: Platelet function and its clinical significance in ACLF patients with chronic hepatitis B virus (HBV) infection have not been investigated. This study aimed to assess changes in platelet function using thromboelastography (TEG) and platelet mapping (TEG-PM) in HBV-related ACLF patients. METHODS: Chronic liver disease patients with acute decompensation or acute hepatic injury were recruited. The derivation cohort enrolled HBV-related patients at Nanfang Hospital. HBV-related and non-HBV-related patients were both enrolled in internal and external validation cohorts at seven university hospitals. TEG and TEG-PM were performed at baseline in the derivation cohort and baseline, day 7, and day 14 in the validation cohorts. The primary outcome was all-cause 28-day mortality. Status check and new-onset complications were recorded during the 3-month follow-up, but status check will extend to 5 years. CONCLUSION AND FUTURE PLANS: In this study, 586 participants were enrolled, including 100 in derivation cohort, 133 in internal validation cohort, and 353 in external validation cohort. Biomaterials, including plasma, serum, urine, and some explanted liver tissues, were collected from these patients. A 3-month follow-up with survival status was completed. The baseline characteristics indicated that 51% of the patients had adenosine diphosphate (ADP)-hyporesponsive circulating platelets. The prognostic potential of platelet function will be explored in the derivation cohort (HBV-related ACLF patients) and further substantiated in the validation cohorts (HBV-related and non-HBV-related ACLF patients). Biosamples are currently used to explore the underlying mechanisms related to ADP-hyporesponsive platelets. The ongoing proteomic and metabolic analyses will provide new insights into the pathogenesis of extrahepatic organ failures in ACLF patients. CI - (c) 2022 Jiang et al. FAU - Jiang, Xiuhua AU - Jiang X AUID- ORCID: 0000-0002-4646-6186 AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Chai, Shiqi AU - Chai S AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Huang, Yan AU - Huang Y AD - Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, People's Republic of China. FAU - Huang, Zuxiong AU - Huang Z AUID- ORCID: 0000-0003-0994-0384 AD - Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China. FAU - Tan, Wenting AU - Tan W AD - Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China. FAU - Gao, Yanhang AU - Gao Y AD - Department of Hepatology, the First Hospital of Jilin University, Changchun, People's Republic of China. FAU - Lu, Xiaobo AU - Lu X AD - Infectious Disease Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China. FAU - Meng, Zhongji AU - Meng Z AUID- ORCID: 0000-0003-0401-535X AD - Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China. FAU - Zhou, Huayou AU - Zhou H AD - Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Kong, Wenbing AU - Kong W AD - Department of Blood Transfusion, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Tang, Xiaoting AU - Tang X AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Tang, Yujun AU - Tang Y AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Qi, Tingting AU - Qi T AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. FAU - Liao, Chengjin AU - Liao C AD - Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, People's Republic of China. FAU - Gan, Qiaorong AU - Gan Q AD - Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China. FAU - Xiang, Xiaomei AU - Xiang X AD - Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China. FAU - Zhang, Yanan AU - Zhang Y AD - Department of Hepatology, the First Hospital of Jilin University, Changchun, People's Republic of China. FAU - Wang, Shuai AU - Wang S AD - Infectious Disease Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China. FAU - Chen, Yuanyuan AU - Chen Y AD - Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China. FAU - Chen, Jinjun AU - Chen J AUID- ORCID: 0000-0003-4275-9149 AD - Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. AD - Hepatology Unit, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. LA - eng PT - Journal Article DEP - 20220824 PL - New Zealand TA - Clin Epidemiol JT - Clinical epidemiology JID - 101531700 PMC - PMC9420418 OTO - NOTNLM OT - acute-on-chronic liver failure OT - coagulopathy failure OT - platelet function OT - prognosis OT - study design OT - thromboelastography COIS- The authors report no conflicts of interest in this work. EDAT- 2022/09/01 06:00 MHDA- 2022/09/01 06:01 PMCR- 2022/08/24 CRDT- 2022/08/31 01:56 PHST- 2022/06/04 00:00 [received] PHST- 2022/08/15 00:00 [accepted] PHST- 2022/08/31 01:56 [entrez] PHST- 2022/09/01 06:00 [pubmed] PHST- 2022/09/01 06:01 [medline] PHST- 2022/08/24 00:00 [pmc-release] AID - 376068 [pii] AID - 10.2147/CLEP.S376068 [doi] PST - epublish SO - Clin Epidemiol. 2022 Aug 24;14:997-1011. doi: 10.2147/CLEP.S376068. eCollection 2022. PMID- 36041978 OWN - NLM STAT- MEDLINE DCOM- 20230214 LR - 20230214 IS - 1473-0502 (Print) IS - 1473-0502 (Linking) VI - 62 IP - 1 DP - 2023 Feb TI - In vitro comparison of CPD whole blood with conventional blood components. PG - 103526 LID - S1473-0502(22)00210-5 [pii] LID - 10.1016/j.transci.2022.103526 [doi] AB - INTRODUCTION: Resuscitation of severely injured trauma patients is commonly performed using red blood cells in additive solution supplemented with plasma and platelet concentrates. There is an increasing interest in the use of low anti-A titer Group O whole blood (LTOWB) in the early management of the resuscitation. It is unclear whether clinical outcome is improved using this approach. METHODS: Expired units of CPD-LTOWB were studied on Day 22 and expired units of thawed plasma on Day 6 and Day 7. LTOWB was assessed for hemoglobin content, clotting factor levels and platelet numbers and function using thromboelastography (TEG) and impedance aggregation. Assays of fibrinogen and FV, FVIII, FVII and FX were performed on the expired plasma. The LTOWB hemoglobin was compared to red cells in additive solution (AS-RBCs) and the clotting factor levels to those of expired thawed plasma. Platelet function was compared to fresh whole blood samples from healthy subjects. RESULTS: LTOWB contained slightly more hemoglobin than the AS-RBCs (Medians, 66 v 59 G), and the plasma content of fibrinogen was similar. Other clotting factors were reduced by approximately 15% except for FVIII which was 30% less. Both TEG and impedance aggregometry showed evidence of residual platelet function despite the prolonged period of refrigerator storage. CONCLUSION: LTOWB contains higher hemoglobin and adequate clotting factors, and residual platelet function is demonstrated indicating that this product would be expected to be at least equivalent to a single unit of each of the conventional components commonly used in trauma resuscitation. CI - Copyright (c) 2022 Elsevier Ltd. All rights reserved. FAU - Santangini, Miranda R AU - Santangini MR AD - Department of Coagulation and Transfusion Medicine, Providence, RI, USA. FAU - Leuckel, Stephanie N AU - Leuckel SN AD - Division of Trauma and Surgical Critical Care, Providence, RI, USA; Lifespan Academic Medical Center and the Alpert Medical School of Brown University, Providence, RI, USA. FAU - King, Karen A AU - King KA AD - Department of Coagulation and Transfusion Medicine, Providence, RI, USA. FAU - Cheves, Tracey A AU - Cheves TA AD - Department of Coagulation and Transfusion Medicine, Providence, RI, USA. FAU - Sweeney, Joseph D AU - Sweeney JD AD - Department of Coagulation and Transfusion Medicine, Providence, RI, USA; Lifespan Academic Medical Center and the Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: jsweeney@lifespan.org. LA - eng PT - Journal Article DEP - 20220827 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) MH - Humans MH - *Blood Component Transfusion MH - Blood Transfusion MH - Blood Coagulation Factors MH - Thrombelastography MH - Fibrinogen MH - Resuscitation MH - *Wounds and Injuries/therapy OTO - NOTNLM OT - Whole blood...trauma resuscitation conventional components COIS- Conflicts of interest Miranda R. Santangini-none; Stephanie N. Lueckel-none, Karen A King-none; Tracey A. Cheves-none; Joseph D. Sweeney-none. EDAT- 2022/08/31 06:00 MHDA- 2023/02/15 06:00 CRDT- 2022/08/30 22:15 PHST- 2022/05/27 00:00 [received] PHST- 2022/08/04 00:00 [revised] PHST- 2022/08/23 00:00 [accepted] PHST- 2022/08/31 06:00 [pubmed] PHST- 2023/02/15 06:00 [medline] PHST- 2022/08/30 22:15 [entrez] AID - S1473-0502(22)00210-5 [pii] AID - 10.1016/j.transci.2022.103526 [doi] PST - ppublish SO - Transfus Apher Sci. 2023 Feb;62(1):103526. doi: 10.1016/j.transci.2022.103526. Epub 2022 Aug 27. PMID- 35984000 OWN - NLM STAT- MEDLINE DCOM- 20221025 LR - 20230203 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 135 IP - 5 DP - 2022 Nov 1 TI - Characterization of 2 Different Prothrombin Complex Concentrates by Different Hemostatic Assays in an In Vitro Hemodilution Model. PG - 1031-1040 LID - 10.1213/ANE.0000000000006174 [doi] AB - BACKGROUND: Viscoelastically guided coagulation factor concentrate-based algorithms for the treatment of trauma-induced coagulopathy include the administration of prothrombin complex concentrates (PCCs). However, the exact role of PCC preparations in this context is a matter of debate. Particularly, the ideal diagnostic trigger for their administration and potential differences between heparin-containing and heparin-free preparations remain unclear. We investigated the hypothesis that 2 different PCCs might have distinct influences on in vitro blood coagulation. METHODS: We conducted a direct comparison of 2 commercially available PCC preparations (the heparin-containing Beriplex P/N and the heparin-free Cofact) in an in vitro hemodilution model. Sole fibrinogen substitution served as the control group. To characterize the hemostatic changes, we utilized conventional coagulation tests, a thrombin generation assay (TGA), and 2 different viscoelastic hemostatic assays (VHAs; ROTEM delta and ClotPro). RESULTS: Irrespective of the diagnostic assay used, no significant differences between the 2 PCC groups were observed. Fibrinogen levels remained stable from the baseline throughout every dilution level. The control group already showed an increased endogenous thrombin potential (ETP; nM.L -1 .min -1 ) at all dilution levels compared to baseline (baseline, 2829.4 (432.8); 40% dilution, 4211.7 (391.6); 60% dilution, 4290.9 (300.8); 80% dilution, 3861.4 (303.5); all P < .001). Spiking with both PCC preparations led to a further-pronounced thrombin elevation in comparison to the control group (ETP at 40% dilution, PCC1: 4913.3 [370.2], PCC2: 4988.1 [265.7]; 60% dilution, PCC1: 5174.5 [234.7], PCC2: 5390.4 [334.9]; 80% dilution, PCC1: 5253.8 [357.9], PCC2: 5392.6 [313.4]; all P < .001). Conventional coagulation tests did not mirror the TGA results. Despite increased thrombin generation, prothrombin time was significantly prolonged at all dilution levels for the control group, and both PCC groups exhibited significant prolongations at the 60% and 80% dilution levels (all P < .001) compared to baseline. Similarly, VHA did not depict the thrombin elevation. Furthermore, descriptive analyses revealed relevant differences between the 2 VHA devices, particularly at baseline. CONCLUSIONS: Both PCC preparations (ie, irrespective of heparin content) induced significant elevation of thrombin generation, which was not depicted by conventional coagulation tests or VHA. Our in vitro results suggest that diagnostic assays routinely used to guide PCC administration might not adequately reflect thrombin generation in bleeding patients. CI - Copyright (c) 2022 International Anesthesia Research Society. FAU - Infanger, Lukas AU - Infanger L AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. FAU - Hirschmann, Jorg AU - Hirschmann J AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. FAU - Schaden, Eva AU - Schaden E AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. AD - Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria. FAU - Ulbing, Stefan AU - Ulbing S AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. FAU - Pesce, Marco-Valerio AU - Pesce MV AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. FAU - Scharner, Vincenz AU - Scharner V AD - Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria. FAU - Gratz, Johannes AU - Gratz J AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine. LA - eng PT - Journal Article DEP - 20220818 PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 37224-63-8 (prothrombin complex concentrates) RN - 0 (Hemostatics) RN - EC 3.4.21.5 (Thrombin) RN - 0 (Blood Coagulation Factors) RN - 9005-49-6 (Heparin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Humans MH - *Hemostatics/pharmacology MH - Thrombin MH - Hemodilution MH - Blood Coagulation Factors/pharmacology MH - Heparin/pharmacology MH - Fibrinogen COIS- Conflicts of Interest: See Disclosures at the end of the article. EDAT- 2022/08/20 06:00 MHDA- 2022/10/26 06:00 CRDT- 2022/08/19 08:03 PHST- 2022/08/20 06:00 [pubmed] PHST- 2022/10/26 06:00 [medline] PHST- 2022/08/19 08:03 [entrez] AID - 00000539-202211000-00018 [pii] AID - 10.1213/ANE.0000000000006174 [doi] PST - ppublish SO - Anesth Analg. 2022 Nov 1;135(5):1031-1040. doi: 10.1213/ANE.0000000000006174. Epub 2022 Aug 18. PMID- 35956519 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240902 IS - 2223-7747 (Print) IS - 2223-7747 (Electronic) IS - 2223-7747 (Linking) VI - 11 IP - 15 DP - 2022 Aug 4 TI - Hepatoprotective Effect of Opuntia robusta Fruit Biocomponents in a Rat Model of Thioacetamide-Induced Liver Fibrosis. LID - 10.3390/plants11152039 [doi] LID - 2039 AB - Liver fibrosis is a chronic disease associated with oxidative stress that has a great impact on the population mortality. Due to their antioxidant capacity, we evaluated the protective effect of Opuntia robusta fruit (Or) on liver fibrosis. A nutraceutical characterization of Or was performed and a model of fibrosis was induced with thioacetamide (TAA) in Wistar rats. Aminotransferases, reduced glutathione (GSH) and histopathology were evaluated. Or contained 436.5 +/- 57 mg of Betacyanins equivalents/L., 793 mg of catechin equivalents (CAE)/100 g for flavonoids, 1118 mg of gallic acid equivalents (GAE)/100 g for total phenols, 141.14 mg/100 g for vitamin C and 429.9 mug/100 g for vitamin E. The antioxidant capacity of Or was: 2.27 mmol of Trolox(R) equivalents (TE)/L (DPPH), 62.2 +/- 5.0 mumol TE/g (ABTS*+), 80.2 +/- 11.7 mumol TE/g (FRAP), 247.9 +/- 15.6 micromol TE/g (AAPH) and 15.0% of H2O2 elimination. An increase (p < 0.05) of aminotransferases and a decrease (p < 0.05) of hepatic GSH was observed in the TAA group compared to the control and the concomitant groups. Histopathology showed changes in the normal architecture of the liver treated with TAA compared to the concomitant treatments. Or contains bioactive components with antioxidant capacity, which can reduce fibrotic liver damage. FAU - Pulido-Hornedo, Nayeli Amalinalli AU - Pulido-Hornedo NA AD - Basic Sciences Center, Department of Morphology, Universidad Autonoma de Aguascalientes, Aguascalientes 20100, Mexico. FAU - Ventura-Juarez, Javier AU - Ventura-Juarez J AUID- ORCID: 0000-0002-3083-0131 AD - Basic Sciences Center, Department of Morphology, Universidad Autonoma de Aguascalientes, Aguascalientes 20100, Mexico. FAU - Guevara-Lara, Fidel AU - Guevara-Lara F AD - Basic Sciences Center, Department of Chemistry, Universidad Autonoma de Aguascalientes, Aguascalientes 20100, Mexico. FAU - Gonzalez-Ponce, Herson Antonio AU - Gonzalez-Ponce HA AUID- ORCID: 0000-0002-5202-4624 AD - Instituto Tecnologico de Aguascalientes, Aguascalientes 20256, Mexico. FAU - Sanchez-Aleman, Esperanza AU - Sanchez-Aleman E AD - Basic Sciences Center, Department of Morphology, Universidad Autonoma de Aguascalientes, Aguascalientes 20100, Mexico. AD - Unidad de Medicina Familiar 8, Instituto Mexicano del Seguro Social (IMSS), Aguascalientes 20180, Mexico. FAU - Buist-Homan, Manon AU - Buist-Homan M AD - Department of Gastroenterology and Hepatology, University Medical Center of Groningen, University of Groningen, 9713 Groningen, The Netherlands. AD - Department Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands. FAU - Moshage, Han AU - Moshage H AUID- ORCID: 0000-0002-4764-0246 AD - Department of Gastroenterology and Hepatology, University Medical Center of Groningen, University of Groningen, 9713 Groningen, The Netherlands. AD - Department Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands. FAU - Martinez-Saldana, Ma Consolacion AU - Martinez-Saldana MC AD - Basic Sciences Center, Department of Morphology, Universidad Autonoma de Aguascalientes, Aguascalientes 20100, Mexico. LA - eng GR - 900987/Consejo Nacional de Ciencia y Tecnologia/ GR - PIT22-4/Autonomous University of Aguascalientes/ PT - Journal Article DEP - 20220804 PL - Switzerland TA - Plants (Basel) JT - Plants (Basel, Switzerland) JID - 101596181 PMC - PMC9370284 OTO - NOTNLM OT - antioxidants OT - biocompounds OT - functional foods OT - liver fibrosis OT - liver injury OT - oxidative stress COIS- The authors declare no conflict of interest. EDAT- 2022/08/13 06:00 MHDA- 2022/08/13 06:01 PMCR- 2022/08/04 CRDT- 2022/08/12 01:17 PHST- 2022/07/07 00:00 [received] PHST- 2022/07/26 00:00 [revised] PHST- 2022/07/29 00:00 [accepted] PHST- 2022/08/12 01:17 [entrez] PHST- 2022/08/13 06:00 [pubmed] PHST- 2022/08/13 06:01 [medline] PHST- 2022/08/04 00:00 [pmc-release] AID - plants11152039 [pii] AID - plants-11-02039 [pii] AID - 10.3390/plants11152039 [doi] PST - epublish SO - Plants (Basel). 2022 Aug 4;11(15):2039. doi: 10.3390/plants11152039. PMID- 35916497 OWN - NLM STAT- MEDLINE DCOM- 20221027 LR - 20260127 IS - 1936-086X (Electronic) IS - 1936-0851 (Print) IS - 1936-0851 (Linking) VI - 16 IP - 10 DP - 2022 Oct 25 TI - Platelet-Inspired Intravenous Nanomedicine for Injury-Targeted Direct Delivery of Thrombin to Augment Hemostasis in Coagulopathies. PG - 16292-16313 LID - 10.1021/acsnano.2c05306 [doi] AB - Severe hemorrhage associated with trauma, surgery, and congenital or drug-induced coagulopathies can be life-threatening and requires rapid hemostatic management via topical, intracavitary, or intravenous routes. For injuries that are not easily accessible externally, intravenous hemostatic approaches are needed. The clinical gold standard for this is transfusion of blood products, but due to donor dependence, specialized storage requirements, high risk of contamination, and short shelf life, blood product use faces significant challenges. Consequently, recent research efforts are being focused on designing biosynthetic intravenous hemostats, using intravenous nanoparticles and polymer systems. Here we report on the design and evaluation of thrombin-loaded injury-site-targeted lipid nanoparticles (t-TLNPs) that can specifically localize at an injury site via platelet-mimetic anchorage to the von Willebrand factor (vWF) and collagen and directly release thrombin via diffusion and phospholipase-triggered particle destabilization, which can locally augment fibrin generation from fibrinogen for hemostatic action. We evaluated t-TLNPs in vitro in human blood and plasma, where hemostatic defects were created by platelet depletion and anticoagulation. Spectrophotometric studies of fibrin generation, rotational thromboelastometry (ROTEM)-based studies of clot viscoelasticity, and BioFlux-based real-time imaging of fibrin generation under simulated vascular flow conditions confirmed that t-TLNPs can restore fibrin in hemostatic dysfunction settings. Finally, the in vivo feasibility of t-TLNPs was tested by prophylactic administration in a tail-clip model and emergency administration in a liver-laceration model in mice with induced hemostatic defects. Treatment with t-TLNPs was able to significantly reduce bleeding in both models. Our studies demonstrate an intravenous nanomedicine approach for injury-site-targeted direct delivery of thrombin to augment hemostasis. FAU - Girish, Aditya AU - Girish A AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Jolly, Ketan AU - Jolly K AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Alsaadi, Nijmeh AU - Alsaadi N AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States. FAU - de la Fuente, Maria AU - de la Fuente M AD - Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Recchione, Arielle AU - Recchione A AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - An, Ran AU - An R AD - Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Disharoon, Dante AU - Disharoon D AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Secunda, Zachary AU - Secunda Z AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States. FAU - Raghunathan, Shruti AU - Raghunathan S AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Luc, Norman F AU - Luc NF AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Desai, Cian AU - Desai C AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Knauss, Elizabeth AU - Knauss E AD - Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Han, Xu AU - Han X AD - Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Hu, Keren AU - Hu K AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Wang, Hanyang AU - Wang H AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Sekhon, Ujjal Didar Singh AU - Sekhon UDS AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Rohner, Nathan AU - Rohner N AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Gurkan, Umut A AU - Gurkan UA AD - Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Nieman, Marvin AU - Nieman M AD - Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States. FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States. FAU - Sen Gupta, Anirban AU - Sen Gupta A AUID- ORCID: 0000-0002-5773-0667 AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States. AD - Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States. LA - eng GR - R01 HL098217/HL/NHLBI NIH HHS/United States GR - S10 OD024996/OD/NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States GR - T32 GM008803/GM/NIGMS NIH HHS/United States GR - R01 HL141080/HL/NHLBI NIH HHS/United States GR - R01 HL129179/HL/NHLBI NIH HHS/United States GR - R01 HL121212/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220802 PL - United States TA - ACS Nano JT - ACS nano JID - 101313589 RN - EC 3.4.21.5 (Thrombin) RN - 0 (von Willebrand Factor) RN - 9001-31-4 (Fibrin) RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) RN - 0 (Polymers) RN - 0 (Anticoagulants) RN - 0 (Lipid Nanoparticles) RN - 0 (Liposomes) SB - IM MH - Humans MH - Mice MH - Animals MH - *Thrombin MH - von Willebrand Factor MH - Nanomedicine MH - Hemostasis MH - Blood Platelets MH - Fibrin MH - *Hemostatics/pharmacology/therapeutic use MH - Fibrinogen MH - Polymers MH - Anticoagulants MH - Liposomes MH - Nanoparticles PMC - PMC10195184 MID - NIHMS1872478 OTO - NOTNLM OT - Fibrin OT - Hemostasis OT - Nanoparticle OT - Platelets OT - Targeted delivery OT - Thrombin COIS- The authors declare the following competing financial interest(s): A.S.G. is an inventor and co-founder of Haima Therapeutics LLC, a biotechnology start-up company focused on the research and development of bioinspired hemostatic technologies. M.D.N. is a scientific advisory board member of Haima Therapeutics LLC. A.S.G. is a co-inventor on patents US 9107845, US 9636383, US 10426820, US 10434149 that are licensed to Haima. EDAT- 2022/08/03 06:00 MHDA- 2022/10/28 06:00 PMCR- 2023/05/18 CRDT- 2022/08/02 08:53 PHST- 2022/08/03 06:00 [pubmed] PHST- 2022/10/28 06:00 [medline] PHST- 2022/08/02 08:53 [entrez] PHST- 2023/05/18 00:00 [pmc-release] AID - 10.1021/acsnano.2c05306 [doi] PST - ppublish SO - ACS Nano. 2022 Oct 25;16(10):16292-16313. doi: 10.1021/acsnano.2c05306. Epub 2022 Aug 2. PMID- 35896767 OWN - NLM STAT- MEDLINE DCOM- 20230413 LR - 20230421 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 38 IP - 2 DP - 2023 Apr TI - Association of Thromboelastography with Progression of Hemorrhagic Injury in Children with Traumatic Brain Injury. PG - 326-334 LID - 10.1007/s12028-022-01562-8 [doi] AB - INTRODUCTION: Progression of hemorrhagic injury (PHI) in children with traumatic brain injury portends poor outcomes. The association between thromboelastography (TEG), functional coagulation assays, and PHI is not well characterized in children. METHODS: This was a retrospective cohort study of children presenting with PHI at a pediatric level I academic trauma center from 2015 to 2020. Inclusion criteria were as follows: age less than 18 years, intracranial hemorrhage on admission head computed tomography scan, and admission rapid TEG assay and conventional coagulation tests. PHI was defined by the following radiographic criteria: any expansion of or new intracranial hemorrhage on subsequent head computed tomography scan. Rapid TEG values included Activated Clotting Time (ACT), alpha angle, maximum amplitude, and lysis at 30 min. Wilcoxon rank-sum test was used to assess baseline differences between groups with PHI and without PHI, including laboratory assays. Univariate analysis was performed to examine the association between variables of interest and PHI. Patients were dichotomized on the basis of this cut point to generate a "low ACT" group and a "high ACT" group. These variables were included in a multivariable logistic regression model to determine independent association with traumatic brain injury progression. RESULTS: In total, 219 patients met criteria for analysis. In this cohort, the median (interquartile range [IQR]) age = 6 (2-12) years, median (IQR) Injury Severity Score = 21 (11-27), 68% were boys, and 69% sustained blunt injury. The rate of PHI was 25% (54). Median (IQR) time to PHI was 1 (0-4) days. Children with PHI had a higher Injury Severity Score (p < 0.001), lower Glasgow Coma Scale (p < 0.001), greater incidence of shock (p = 0.04), and lower admission hemoglobin (p = 0.02) compared with those without PHI. Children with PHI had a higher International Normalized Ratio (INR) and longer TEG-ACT; other TEG values (alpha angle, maximum amplitude, and lysis at 30 min) were not associated with PHI. In the logistic regression model accounting for other covariates associated with PHI, elevated ACT remained an independent predictor of progression (odds ratio = 2.25, 95% confidence interval 1.09-4.66; p = 0.03; area under the receiver operating characteristic curve = 0.76). After adjusting for confounders, INR fell out of the model and was not an independent predictor of progression (odds ratio = 1.32, 95% confidence interval 0.60-2.93; p = 0.49). CONCLUSIONS: Although INR was elevated in children with PHI and has been associated with poor clinical outcomes, only admission TEG-ACT was independently associated with PHI. Further study is warranted to determine whether TEG-ACT reflects an actionable therapeutic target. CI - (c) 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. FAU - Abou Khalil, Elissa AU - Abou Khalil E AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. FAU - Gaines, Barbara A AU - Gaines BA AD - Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. FAU - Kellogg, Robert G AU - Kellogg RG AD - Department of Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. FAU - Simon, Dennis W AU - Simon DW AD - Department of Critical Care Medicine, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. FAU - Morgan, Katrina M AU - Morgan KM AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. FAU - Richardson, Ward M AU - Richardson WM AD - Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. FAU - Leeper, Christine M AU - Leeper CM AUID- ORCID: 0000-0002-8561-8760 AD - Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. leepercm@upmc.edu. LA - eng PT - Journal Article DEP - 20220728 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Male MH - Humans MH - Child MH - Adolescent MH - Female MH - *Thrombelastography/adverse effects/methods MH - Retrospective Studies MH - Hemorrhage MH - *Brain Injuries, Traumatic/complications MH - Intracranial Hemorrhages/complications OTO - NOTNLM OT - Coagulation OT - Intracranial hemorrhage OT - Pediatric OT - Progression OT - Thromboelastography OT - Traumatic brain injury EDAT- 2022/07/28 06:00 MHDA- 2023/04/13 06:42 CRDT- 2022/07/27 23:32 PHST- 2022/04/18 00:00 [received] PHST- 2022/06/16 00:00 [accepted] PHST- 2023/04/13 06:42 [medline] PHST- 2022/07/28 06:00 [pubmed] PHST- 2022/07/27 23:32 [entrez] AID - 10.1007/s12028-022-01562-8 [pii] AID - 10.1007/s12028-022-01562-8 [doi] PST - ppublish SO - Neurocrit Care. 2023 Apr;38(2):326-334. doi: 10.1007/s12028-022-01562-8. Epub 2022 Jul 28. PMID- 35887803 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230615 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 14 DP - 2022 Jul 12 TI - Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures. LID - 10.3390/jcm11144029 [doi] LID - 4029 AB - The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy-a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis-remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery. FAU - Mamczak, Christiaan N AU - Mamczak CN AD - Department of Orthopaedic Trauma, Florida Orthopaedic Institute, St. Petersburg, FL 33701, USA. FAU - Speybroeck, Jacob AU - Speybroeck J AD - Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. FAU - Stillson, John E AU - Stillson JE AUID- ORCID: 0000-0003-3442-2706 AD - Department of Family Medicine, John Peter Smith Hospital, Fort Worth, TX 76104, USA. FAU - Dynako, Joseph AU - Dynako J AD - Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA. FAU - Piscoya, Andres AU - Piscoya A AD - Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA. FAU - Peck, Ethan E AU - Peck EE AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Aboukhaled, Michael AU - Aboukhaled M AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Cancel, Emily AU - Cancel E AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - McDonald, Michael AU - McDonald M AD - Department of Graduate Medical Education, Naval Medical Readiness and Training Command, Portsmouth, VA 23708, USA. FAU - Garcia, Diego AU - Garcia D AD - Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Lovejoy, John AU - Lovejoy J AD - Department of Orthopaedic Surgery, University of Florida Health Jacksonville, Jacksonville, FL 32209, USA. FAU - Lubin, Stephanie AU - Lubin S AD - Department of Orthopaedic Surgery, Hopital Sacre Coeur, Milot 1230, Haiti. FAU - Stanton, Robert AU - Stanton R AD - Department of Pediatric Orthopaedics, Nemours Children's Health-Florida, Orlando, FL 32827, USA. FAU - Kutcher, Matthew E AU - Kutcher ME AD - Departments of Surgery and Emergency Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA. LA - eng GR - K08 GM138812/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review DEP - 20220712 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9323142 OTO - NOTNLM OT - blood coagulation tests OT - blood transfusion OT - orthopedics OT - rotational thromboelastometry OT - thromboelastography OT - trauma OT - venous thromboembolism COIS- The authors declare no conflict of interest. EDAT- 2022/07/28 06:00 MHDA- 2022/07/28 06:01 PMCR- 2022/07/12 CRDT- 2022/07/27 01:27 PHST- 2022/05/23 00:00 [received] PHST- 2022/07/07 00:00 [revised] PHST- 2022/07/07 00:00 [accepted] PHST- 2022/07/27 01:27 [entrez] PHST- 2022/07/28 06:00 [pubmed] PHST- 2022/07/28 06:01 [medline] PHST- 2022/07/12 00:00 [pmc-release] AID - jcm11144029 [pii] AID - jcm-11-04029 [pii] AID - 10.3390/jcm11144029 [doi] PST - epublish SO - J Clin Med. 2022 Jul 12;11(14):4029. doi: 10.3390/jcm11144029. PMID- 35877567 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220728 IS - 2308-3425 (Electronic) IS - 2308-3425 (Linking) VI - 9 IP - 7 DP - 2022 Jun 29 TI - Biological Variation in Rotational Thromboelastometry in Patients with Atrial Fibrillation Receiving Rivaroxaban. LID - 10.3390/jcdd9070205 [doi] LID - 205 AB - Rotational thromboelastometry (ROTEM) is a viscoelastic hemostasis test used primarily in the management of bleeding after trauma or in cardiac surgery. To allow safe and valid clinical interpretation of test results, objective specifications for analytical performance are needed, which are generally based on biological variation within (CV(I)) and between (CV(G)) individuals. The aim of this study was to evaluate biological variation in ROTEM in patients receiving rivaroxaban. Sixty patients with atrial fibrillation on stable rivaroxaban therapy were included, from whom blood was collected on six occasions: three times at trough and three at peak rivaroxaban concentrations. ROTEM((R)) Extem and LowTF were measured as well as rivaroxaban concentration, PT, APTT, and anti-Xa. Within- (CV(I)) and between-subject (CV(G)) biological estimates were calculated. Knowledge of these biological variation components will help to establish the appropriate objective analytical performance specifications for ROTEM analysis. FAU - Bozic Mijovski, Mojca AU - Bozic Mijovski M AUID- ORCID: 0000-0003-1879-6353 AD - Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia. AD - Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia. FAU - Antovic, Jovan P AU - Antovic JP AD - Department of Coagulation Research, Institute for Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden. AD - Department of Clinical Chemistry, Karolinska University Hospital, 17177 Stockholm, Sweden. FAU - Malmstrom, Rickard E AU - Malmstrom RE AD - Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, 17177 Stockholm, Sweden. AD - Clinical Pharmacology, Karolinska University Hospital, 17177 Stockholm, Sweden. FAU - Mavri, Alenka AU - Mavri A AD - Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia. LA - eng GR - P3-0308/Slovenian Research Agency/ PT - Journal Article DEP - 20220629 PL - Switzerland TA - J Cardiovasc Dev Dis JT - Journal of cardiovascular development and disease JID - 101651414 PMC - PMC9321519 OTO - NOTNLM OT - atrial fibrillation OT - biological variation OT - rivaroxaban OT - rotational thromboelastometry COIS- The authors declare no conflict of interest. EDAT- 2022/07/26 06:00 MHDA- 2022/07/26 06:01 PMCR- 2022/06/29 CRDT- 2022/07/25 13:23 PHST- 2022/05/31 00:00 [received] PHST- 2022/06/23 00:00 [revised] PHST- 2022/06/27 00:00 [accepted] PHST- 2022/07/25 13:23 [entrez] PHST- 2022/07/26 06:00 [pubmed] PHST- 2022/07/26 06:01 [medline] PHST- 2022/06/29 00:00 [pmc-release] AID - jcdd9070205 [pii] AID - jcdd-09-00205 [pii] AID - 10.3390/jcdd9070205 [doi] PST - epublish SO - J Cardiovasc Dev Dis. 2022 Jun 29;9(7):205. doi: 10.3390/jcdd9070205. PMID- 35857032 OWN - NLM STAT- MEDLINE DCOM- 20230103 LR - 20230206 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 94 IP - 1 DP - 2023 Jan 1 TI - High-dose radiation exposure of cold-stored whole blood does not affect hemostatic function. PG - 162-168 LID - 10.1097/TA.0000000000003750 [doi] AB - BACKGROUND: Whole blood (WB) transfusion is routinely used to resuscitate severely injured military trauma patients. Blood can be stored refrigerated while still maintaining reasonable function but is susceptible to environmental influences, including radiation exposure. Immune-compromised patients are transfused with irradiated blood to inactivate donor lymphocyte function (25 Gy per Association for the Advancement of Blood and Biotherapies [AARB] standard 5.7.3.2). However, there is limited information on function of WB exposed to high radiation doses. OBJECTIVE: This study aimed to determine if stored irradiated WB still retains function. This will be important if the stored blood supply is exposed to radiation in a combat situation or mass casualty incident when the need for blood will be high. METHODS: Whole blood collected from healthy donors was irradiated at 0, 25, or 75 Gy and stored at 4 degrees C. Blood cell count, blood gas chemistry, thromboelastometry, platelet aggregation, and reactive oxygen species were measured before irradiation and at 1, 7, and 14 days of storage. Irradiated WB was compared with nonirradiated WB controls. RESULTS: Irradiated WB stored for up to 14 days was not significantly different than nonirradiated WB in most of the parameters measured. Stored blood showed expected changes associated with functional decline at longer storage times, but irradiation did not hasten the decline. There was a significant change in potassium and sodium ion concentrations after irradiation, but the functional relevance is not clear. CONCLUSION: High-dose irradiation had little effect on stored WB. Although there were changes in plasma sodium and potassium levels, there was little to no effect on hemostasis and blood cell viability. This suggests that stored blood subjected to a radiation event generating at least a dose of 75 Gy is still suitable for transfusion, which could be particularly important in the event of a mass casualty event where a large amount of blood is needed. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Becerra, Sandra C AU - Becerra SC AD - From the Pathology, Epidemiology, and Biostatistics (S.C.B.), US Army Institute of Surgical Research, Fort Sam Houston; Translational Science PhD Program (S.C.B., B.A.C.), UT Health San Antonio, San Antonio; Blood and Shock Research (D.N.D., I.E.A., M.C.H., J.A.B., B.A.C.), US Army Institute of Surgical Research, Fort Sam Houston; and Department of Surgery (D.N.D., J.A.B.) and Department of Molecular Medicine (B.A.C.), UT Health San Antonio, San Antonio, Texas. FAU - Darlington, Daniel N AU - Darlington DN FAU - Abaasah, Isaac E AU - Abaasah IE FAU - Herzig, Maryanne C AU - Herzig MC FAU - Bynum, James A AU - Bynum JA FAU - Christy, Barbara A AU - Christy BA LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20220719 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemostatics) SB - IM MH - Humans MH - Blood Preservation MH - Hemostasis MH - Blood Platelets/physiology MH - *Radiation Exposure MH - *Hemostatics EDAT- 2022/07/21 06:00 MHDA- 2023/01/04 06:00 CRDT- 2022/07/20 11:03 PHST- 2022/07/21 06:00 [pubmed] PHST- 2023/01/04 06:00 [medline] PHST- 2022/07/20 11:03 [entrez] AID - 01586154-202301000-00023 [pii] AID - 10.1097/TA.0000000000003750 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 Jan 1;94(1):162-168. doi: 10.1097/TA.0000000000003750. Epub 2022 Jul 19. PMID- 35814505 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230703 IS - 0973-6883 (Print) IS - 2213-3453 (Electronic) IS - 0973-6883 (Linking) VI - 12 IP - 4 DP - 2022 Jul-Aug TI - Surgical Risk Assessment in Patients with Chronic Liver Diseases. PG - 1175-1183 LID - 10.1016/j.jceh.2022.03.004 [doi] AB - Chronic liver diseases (CLD) is one of the leading causes of morbidity and mortality. The overall life span of patients with CLD has increased and so is the number of surgical procedures these patients undergo. Pathophysiological and hemodynamic changes in cirrhosis make these patients more susceptible to hypotension and hypoxia during surgery. They also have a high risk of drug induced liver injury, renal dysfunction and post-operative liver decompensation. Patients with CLD planned for elective or semi-elective surgery should undergo detailed preoperative risk assessment. Patients should be evaluated for the presence of clinically significant portal hypertension and cirrhosis. In the absence of both cirrhosis and clinically significant portal hypertension, patients with CLD can undergo surgery with minimal or low risk. Various risk assessment tools available for patients with advanced CLD are-CTP score, MELD Score, Mayo risk score, VOCAL-Penn score. A Child class C and/or Mayo risk score >15 in general is associated with high risk of post-operative mortality and elective surgery should be deferred in these patients. In patients with Child class, A and MELD 10-15 surgery is permissible with caution (except liver resection and cardiac surgery) while in Child A and MELD <10 surgery is well tolerated. VOCAL-Penn score is a new promising tool and can be the better alternative of CTP, MELD, and Mayo risk score models but more prospective studies with large patients' population are warranted. Certain surgeries like Hepatic resection, intraabdominal, and cardiothoracic have higher risk than abdominal wall hernia repair and orthopedic surgery. Laparoscopic approaches have better outcomes and less risk of liver failure than open surgery. Minimally invasive alternatives like colonic stent placement in case of obstruction can be considered in high-risk cases. Perioperative optimization and management of ascites, HE, bleeding, liver decompensation, and nutrition should be done with multidisciplinary approach. Patients with cirrhosis undergoing high risk elective surgery can develop liver failure in post-operative period and should be evaluated and counseled for liver transplantation if not contraindicated. CI - (c) 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. FAU - Jadaun, Shekhar S AU - Jadaun SS AD - Department of Gastroenterology and Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India. FAU - Saigal, Sanjiv AU - Saigal S AD - Department of Gastroenterology and Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India. LA - eng PT - Journal Article PT - Review DEP - 20220323 PL - India TA - J Clin Exp Hepatol JT - Journal of clinical and experimental hepatology JID - 101574137 PMC - PMC9257927 OTO - NOTNLM OT - ASA, American Society of Anaesthesiologists OT - CLD, Chronic liver disease OT - CTP, Child-Turcotte-Pugh OT - Cirrhosis OT - HCC, Hepatocellular carcinoma OT - HVPG, hepatic venous pressure gradient OT - MELD, Model for end stage liver disease OT - NASH, Non-alcoholic steatohepatitis OT - ROTEM, rotational thromboelastometry OT - Surgery in cirrhosis OT - Surgical risk assessment OT - TEG, Thromboelastography OT - VOCAL-Penn score, Veterans Outcomes and Costs Associated with Liver Disease-Penn score EDAT- 2022/07/12 06:00 MHDA- 2022/07/12 06:01 PMCR- 2023/07/01 CRDT- 2022/07/11 04:18 PHST- 2022/01/10 00:00 [received] PHST- 2022/03/16 00:00 [accepted] PHST- 2022/07/11 04:18 [entrez] PHST- 2022/07/12 06:00 [pubmed] PHST- 2022/07/12 06:01 [medline] PHST- 2023/07/01 00:00 [pmc-release] AID - S0973-6883(22)00051-2 [pii] AID - 10.1016/j.jceh.2022.03.004 [doi] PST - ppublish SO - J Clin Exp Hepatol. 2022 Jul-Aug;12(4):1175-1183. doi: 10.1016/j.jceh.2022.03.004. Epub 2022 Mar 23. PMID- 35808290 OWN - NLM STAT- MEDLINE DCOM- 20220712 LR - 20220716 IS - 1424-8220 (Electronic) IS - 1424-8220 (Linking) VI - 22 IP - 13 DP - 2022 Jun 24 TI - Evaluation of Blood Coagulation by Optical Vortex Tracking. LID - 10.3390/s22134793 [doi] LID - 4793 AB - Blood coagulation is a complicated dynamic process that maintains the blood's fluid state and prevents uncontrollable bleeding. The real-time monitoring of coagulation dynamics is critical for blood transfusion guidance, emergency management of trauma-induced coagulopathy, perioperative bleeding, and targeted hemostatic therapy. Here, we utilize optical vortex dynamics to detect the blood coagulation dynamic process in a rapid and non-contact manner. To characterize the temporal changes in viscoelastic properties of blood during coagulation, we track the stochastic motion of optical vortices in the time-varying speckles reflected from 100 blood samples with varied coagulation profiles. The mean square displacement (MSD) of the vortices increases nonlinearly with time lag during blood coagulation reminiscent of the particles in viscoelastic fluids. The MSD curves with coagulation time are similar to the tracings of thromboelastography (TEG) during the blood coagulation. The retrieved coagulation parameters, such as reaction time and activated clotting time measured using the optical vortex method, exhibit a close correlation to those parameters acquired from TEG. These results demonstrate the feasibility of the optical vortex method for monitoring blood coagulation at the point of care. Our method is also applicable to measuring the viscoelasticity of complex fluids and turbid soft matters. FAU - Gong, Jiaxing AU - Gong J AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. AD - Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China. FAU - Zhang, Yaowen AU - Zhang Y AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. FAU - Zhang, Hui AU - Zhang H AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. FAU - Li, Qi AU - Li Q AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. AD - Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China. FAU - Ren, Guangbin AU - Ren G AUID- ORCID: 0000-0002-6074-0516 AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. FAU - Lu, Wenjian AU - Lu W AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. FAU - Wang, Jing AU - Wang J AD - College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China. AD - Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518000, China. LA - eng GR - JCYJ20170818160118360/Basic Research Free Exploration Project of Shenzhen Science and Technology Innovation Committee/ PT - Journal Article DEP - 20220624 PL - Switzerland TA - Sensors (Basel) JT - Sensors (Basel, Switzerland) JID - 101204366 SB - IM MH - Blood Coagulation MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Coagulation Tests MH - Hemorrhage/therapy MH - Humans MH - *Thrombelastography/adverse effects/methods PMC - PMC9269077 OTO - NOTNLM OT - blood coagulation OT - laser speckle OT - mean square displacement OT - optical vortex COIS- The authors declare no conflict of interest. EDAT- 2022/07/10 06:00 MHDA- 2022/07/14 06:00 PMCR- 2022/06/24 CRDT- 2022/07/09 01:24 PHST- 2022/05/27 00:00 [received] PHST- 2022/06/20 00:00 [revised] PHST- 2022/06/21 00:00 [accepted] PHST- 2022/07/09 01:24 [entrez] PHST- 2022/07/10 06:00 [pubmed] PHST- 2022/07/14 06:00 [medline] PHST- 2022/06/24 00:00 [pmc-release] AID - s22134793 [pii] AID - sensors-22-04793 [pii] AID - 10.3390/s22134793 [doi] PST - epublish SO - Sensors (Basel). 2022 Jun 24;22(13):4793. doi: 10.3390/s22134793. PMID- 35806917 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220716 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 13 DP - 2022 Jun 23 TI - Operability of a Resonance-Based Viscoelastic Haemostatic Analyzer in the High-Vibration Environment of Air Medical Transport. LID - 10.3390/jcm11133630 [doi] LID - 3630 AB - Trauma and bleeding are associated with a high mortality, and most of these deaths occur early after injury. Viscoelastic haemostatic tests have gained increasing importance in goal-directed transfusion and bleeding management. A new generation of small-sized and thus portable ultrasound-based viscoelastic analysers have been introduced in clinical practice. We questioned whether a promising candidate can be used in emergency helicopters, with a focus on the susceptibility to vibration stress. We investigated whether the high vibration environment of an emergency helicopter would affect the operability of an ultrasound-based viscoelastic analyser and would yield reproducible results in flight and on the ground. We drew blood from 27 healthy volunteers and performed simultaneous analyses on two TEG 6s. Each measurement was performed in-flight on board an Airbus H135 emergency helicopter and was repeated on the ground, close to the flight area. Results from both measurements were compared, and the recorded tracings and numeric results were analysed for artifacts. Vibratometric measurements were performed throughout the flight in order to quantify changes in the magnitude and character of vibrations in different phases of helicopter operation. The high vibration environment was associated with the presence of artifacts in all recorded tracings. There were significant differences in citrated Kaolin + Heparinase measurements in-flight and on the ground. All other assays increased in variability but did not show significant differences between the two time points. We observed numerous artifacts in viscoelastic measurements that were performed in flight. Some parameters that were obtained from the same sample showed significant differences between in-flight and on-ground measurements. Performing resonance-based viscoelastic tests in helicopter medical service is prone to artifacts. However, a 10 min delay between initiation of measurement and take-off might produce more reliable results. FAU - Zipperle, Johannes AU - Zipperle J AUID- ORCID: 0000-0002-8222-3413 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. FAU - Ziegler, Bernhard AU - Ziegler B AD - Perioperative Medicine and General Intensive Care Medicine, Department of Anaesthesiology, Paracelsus Medical University, 5020 Salzburg, Austria. AD - OAMTC Air Rescue, 1030 Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AUID- ORCID: 0000-0001-6028-1551 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Voelckel, Wolfgang AU - Voelckel W AD - OAMTC Air Rescue, 1030 Vienna, Austria. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Schlimp, Christoph J AU - Schlimp CJ AUID- ORCID: 0000-0001-8124-9462 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - OAMTC Air Rescue, 1030 Vienna, Austria. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, 4010 Linz, Austria. FAU - Oberladstatter, Daniel AU - Oberladstatter D AUID- ORCID: 0000-0002-1350-5564 AD - Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria. AD - OAMTC Air Rescue, 1030 Vienna, Austria. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. LA - eng PT - Journal Article DEP - 20220623 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9267152 OTO - NOTNLM OT - emergency helicopter OT - haemostasis OT - point-of-care OT - trauma-induced coagulopathy OT - viscoelastic tests COIS- B.Z. has received speaker fees from CSL Behring. H.S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim and Tem International, Haemonetics, and Vifor and has received study grants from CSL Behring. C.J.S. has received honoraria for lectures or participation in advisory board meetings from CSL Behring, Boehringer Ingelheim, Portola, Shionogi, Octa. J.Z., D.O. and W.V. declare no conflicts of interest. No other competing interests declared. EDAT- 2022/07/10 06:00 MHDA- 2022/07/10 06:01 PMCR- 2022/06/23 CRDT- 2022/07/09 01:16 PHST- 2022/05/19 00:00 [received] PHST- 2022/06/15 00:00 [revised] PHST- 2022/06/21 00:00 [accepted] PHST- 2022/07/09 01:16 [entrez] PHST- 2022/07/10 06:00 [pubmed] PHST- 2022/07/10 06:01 [medline] PHST- 2022/06/23 00:00 [pmc-release] AID - jcm11133630 [pii] AID - jcm-11-03630 [pii] AID - 10.3390/jcm11133630 [doi] PST - epublish SO - J Clin Med. 2022 Jun 23;11(13):3630. doi: 10.3390/jcm11133630. PMID- 35761128 OWN - NLM STAT- MEDLINE DCOM- 20221121 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 37 IP - 3 DP - 2022 Dec TI - The Spot Sign and Intraventricular Hemorrhage are Associated with Baseline Coagulopathy and Outcome in Intracerebral Hemorrhage. PG - 660-669 LID - 10.1007/s12028-022-01537-9 [doi] AB - BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is the second most prevalent subtype of stroke and has high mortality and morbidity. The utility of radiographic features to predict secondary brain injury related to hematoma expansion (HE) or increased intracranial pressure has been highlighted in patients with ICH, including the computed tomographic angiography (CTA) spot sign and intraventricular hemorrhage (IVH). Understanding the pathophysiology of spot sign and IVH may help identify optimal therapeutic strategies. We examined factors related to the spot sign and IVH, including coagulation status, hematoma size, and location, and evaluated their prognostic value in patients with ICH. METHODS: Prospectively collected data from a single center between 2012 and 2015 were analyzed. Patients who underwent thromboelastography within 24 h of symptom onset and completed follow-up brain imaging and CTA within 48 h after onset were included for analysis. Multivariate logistic regression analyses were performed to identify determinants of the spot sign and IVH and their predictive value for HE, early neurological deterioration (END), in-hospital mortality, and functional outcome at discharge. RESULTS: Of 161 patients, 50 (31.1%) had a spot sign and 93 (57.8%) had IVH. In multivariable analysis, the spot sign was associated with greater hematoma volume (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03), decreased white blood cell count (OR 0.88; 95% CI 0.79-0.98), and prolonged activated partial thromboplastin time (OR 1.14; 95% CI 1.06-1.23). IVH was associated with greater hematoma volume (OR 1.02; 95% CI 1.01-1.04) and nonlobar location of hematoma (OR 0.23; 95% CI 0.09-0.61). The spot sign was associated with greater risk of all adverse outcomes. IVH was associated with an increased risk of END and reduced HE, without significant impact on mortality or functional outcome. CONCLUSIONS: The spot sign and IVH are associated with specific hematoma characteristics, such as size and location, but are related differently to coagulation status and clinical course. A combined analysis of the spot sign and IVH can improve the understanding of pathophysiology and risk stratification after ICH. CI - (c) 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. FAU - Ahn, Sung-Ho AU - Ahn SH AD - Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. FAU - Hong, Jeong-Ho AU - Hong JH AD - Department of Neurology, School of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. FAU - Torres, Glenda L AU - Torres GL AD - Division of Neurocritical Care, Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Savarraj, Jude P AU - Savarraj JP AD - Division of Neurocritical Care, Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Kim, Chang Hyeun AU - Kim CH AD - Department of Neurosurgery, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, and Pusan National University Yangsan Hospital, Pusan, South Korea. FAU - Kim, Young Ha AU - Kim YH AD - Department of Neurosurgery, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, and Pusan National University Yangsan Hospital, Pusan, South Korea. FAU - Day, Arthur L AU - Day AL AD - Division of Neurocritical Care, Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Choi, H Alex AU - Choi HA AD - Division of Neurocritical Care, Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Grotta, James C AU - Grotta JC AD - Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Lee, Kiwon AU - Lee K AD - Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA. FAU - Chang, Tiffany R AU - Chang TR AD - Division of Neurocritical Care, Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. Tiffany.R.Chang@uth.tmc.edu. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220628 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Humans MH - Cerebral Hemorrhage/complications/diagnostic imaging MH - Hematoma/diagnostic imaging/complications MH - Computed Tomography Angiography/methods MH - Tomography, X-Ray Computed/methods MH - *Stroke/complications MH - *Blood Coagulation Disorders/etiology MH - Cerebral Angiography MH - Predictive Value of Tests OTO - NOTNLM OT - Early neurological deterioration OT - Hematoma expansion OT - Intracerebral hemorrhage OT - Intraventricular hemorrhage OT - Outcome OT - Spot sign EDAT- 2022/06/28 06:00 MHDA- 2022/11/22 06:00 CRDT- 2022/06/27 23:34 PHST- 2021/12/02 00:00 [received] PHST- 2022/05/18 00:00 [accepted] PHST- 2022/06/28 06:00 [pubmed] PHST- 2022/11/22 06:00 [medline] PHST- 2022/06/27 23:34 [entrez] AID - 10.1007/s12028-022-01537-9 [pii] AID - 10.1007/s12028-022-01537-9 [doi] PST - ppublish SO - Neurocrit Care. 2022 Dec;37(3):660-669. doi: 10.1007/s12028-022-01537-9. Epub 2022 Jun 28. PMID- 35748809 OWN - NLM STAT- MEDLINE DCOM- 20220729 LR - 20250728 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 62 Suppl 1 DP - 2022 Aug TI - Cold-stored platelets are effective in an in vitro model of massive transfusion protocol assessed by rotational thromboelastometry. PG - S53-S62 LID - 10.1111/trf.16974 [doi] AB - BACKGROUND: Platelets are a key component of massive transfusion in treating actively bleeding patients. While optimized for prophylactic transfusions, the effectiveness of the current standard room temperature stored platelets (RPs) in treating actively bleeding patients is not clear. Cold-stored platelets (CPs) have been shown to have superior hemostatic functions and the potential to extend shelf life. In this study, we explored the effect of using CPs versus RPs in an in vitro transfusion model based on the massive transfusion protocol. STUDY DESIGN AND METHODS: RPs or CPs were combined with RBCs and plasma in a 1:1:1 volume ratio to make transfusion packages. Whole blood was collected and then either diluted to 20% hematocrit or mixed with tPA (8.8 mug/ml). By volume, 70% of transfusion package was mixed with 30% whole blood to simulate massive transfusions and analyzed by rotational thromboelastometry. Transfusion package supernatant was analyzed for PAI-1 activity as well. RESULTS: Both transfusion packages restored the clot characteristics of hemodiluted or hyperfibrinolytic whole blood. Specifically, only transfusion packages made with CPs significantly reduced the maximum clot lysis of hyperfibrinolytic whole blood. PAI-1 activity in CPs transfusion packages were also significantly higher. DISCUSSION: Transfusion packages containing cold-stored platelets may be able to restore the blood hemostatic profile of bleeding patients. In addition, transfusion packages made from CPs may provide additional benefit of resisting hyperfibrinolysis in bleeding patients. In trauma where post-transfusion platelet recovery is less of a concern, CPs are a viable option to restore hemostasis. CI - (c) 2022 AABB. FAU - Zhao, Han Qi AU - Zhao HQ AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Serrano, Katherine AU - Serrano K AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Culibrk, Brankica AU - Culibrk B AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Chen, Zhongming AU - Chen Z AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Devine, Dana V AU - Devine DV AUID- ORCID: 0000-0002-9059-0344 AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220624 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Hemostatics) RN - 0 (Plasminogen Activator Inhibitor 1) SB - IM MH - Blood Platelets MH - Blood Preservation/methods MH - Hemorrhage/prevention & control MH - *Hemostatics MH - Humans MH - Plasminogen Activator Inhibitor 1 MH - Platelet Transfusion MH - *Thrombelastography/methods OTO - NOTNLM OT - cold-stored platelets OT - storage OT - transfusion OT - trauma EDAT- 2022/06/25 06:00 MHDA- 2022/07/30 06:00 CRDT- 2022/06/24 10:32 PHST- 2022/02/09 00:00 [revised] PHST- 2021/11/09 00:00 [received] PHST- 2022/02/09 00:00 [accepted] PHST- 2022/06/25 06:00 [pubmed] PHST- 2022/07/30 06:00 [medline] PHST- 2022/06/24 10:32 [entrez] AID - 10.1111/trf.16974 [doi] PST - ppublish SO - Transfusion. 2022 Aug;62 Suppl 1:S53-S62. doi: 10.1111/trf.16974. Epub 2022 Jun 24. PMID- 35748674 OWN - NLM STAT- MEDLINE DCOM- 20220729 LR - 20250728 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 62 Suppl 1 DP - 2022 Aug TI - Minimal impact of anticoagulant on in vitro whole blood quality throughout a 35-day cold-storage regardless of leukoreduction timing. PG - S98-S104 LID - 10.1111/trf.16977 [doi] AB - BACKGROUND: There is increasing interest in leukoreduced whole blood (WB) as a transfusion product for trauma patients. In some jurisdictions, few leukoreduced filters are approved or appropriate for WB leukoreduction and quality information is therefore limited. This study assessed the impact of filtration timing of WB collected in CPDA-1 versus CPD on in vitro quality. STUDY DESIGN AND METHODS: WB was collected in CPDA-1 or CPD and leukoreduction filtered either after 3-8 h (early) or 18-24 h (late) from stop bleed time. In vitro quality was assessed after filtration and throughout 5 weeks of storage at 4 degrees C. Cell count and hemoglobin levels were determined by hematology analyzer, platelet activation and responsiveness to ADP by surface expression of P-selectin by flow cytometry, hemolysis by HemoCue, and metabolic parameters by blood gas analyzer. Hemostatic properties were assessed by rotational thromboelastometry. Plasma protein activities and clotting times were determined by automated coagulation. RESULTS: Although there were some data points which showed statistically significant differences associated with anticoagulant choices or the filtration timing, no general trend in inferiority/performance could be discerned. After 35 days' storage, only clotting time, alpha angle and factor II in the early filtration arm comparing anticoagulants and prothrombin time and factor II in the CPDA-1 study arm comparing filtration timing showed a significant difference. CONCLUSION: In vitro WB quality seems to be independent on the choice of anticoagulant and filtration timing supporting WB hold-times to up to 24 h, increasing operational flexibility for transfusion services. CI - (c) 2022 AABB. FAU - Schubert, Peter AU - Schubert P AUID- ORCID: 0000-0002-3310-6819 AD - Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada. AD - Center for Blood Research, Vancouver, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. FAU - Culibrk, Brankica AU - Culibrk B AD - Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada. AD - Center for Blood Research, Vancouver, Canada. FAU - Bhakta, Varsha AU - Bhakta V AD - Medical Affairs and Innovation, Canadian Blood Services, Hamilton, Canada. FAU - Closas, Tatiana AU - Closas T AD - Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada. FAU - Sheffield, William P AU - Sheffield WP AUID- ORCID: 0000-0002-5870-8189 AD - Medical Affairs and Innovation, Canadian Blood Services, Hamilton, Canada. AD - Department Pathology and Molecular Medicine, McMaster University, Hamilton, Canada. FAU - Devine, Dana V AU - Devine DV AUID- ORCID: 0000-0002-9059-0344 AD - Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada. AD - Center for Blood Research, Vancouver, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. FAU - McTaggart, Ken AU - McTaggart K AD - Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220624 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Anticoagulants) RN - 9001-26-7 (Prothrombin) SB - IM MH - Anticoagulants/metabolism/pharmacology MH - Blood Platelets/metabolism MH - *Blood Preservation MH - Humans MH - *Leukocyte Reduction Procedures MH - Prothrombin OTO - NOTNLM OT - WB cold-storage OT - WB in vitro quality OT - WB leukoreduction OT - blood component EDAT- 2022/06/25 06:00 MHDA- 2022/07/30 06:00 CRDT- 2022/06/24 09:22 PHST- 2022/05/04 00:00 [revised] PHST- 2022/02/03 00:00 [received] PHST- 2022/05/09 00:00 [accepted] PHST- 2022/06/25 06:00 [pubmed] PHST- 2022/07/30 06:00 [medline] PHST- 2022/06/24 09:22 [entrez] AID - 10.1111/trf.16977 [doi] PST - ppublish SO - Transfusion. 2022 Aug;62 Suppl 1:S98-S104. doi: 10.1111/trf.16977. Epub 2022 Jun 24. PMID- 35743393 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220716 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 12 DP - 2022 Jun 9 TI - Challenges in the Diagnosis and Management of Non-Severe Hemophilia. LID - 10.3390/jcm11123322 [doi] LID - 3322 AB - (1) Background: Mild and moderate hemophilia, synonymous with non-severe hemophilia (NSH), are of constant interest for the clinicians. Bleeding occurs usually after trauma, injury, surgery, or inhibitor development, sometimes leading to a shift of the clinical phenotype from mild to severe, even with life-threatening and unexpected outcomes. (2) Methods: We performed a retrospective observational study conducted on 112 persons with congenital coagulopathies, 26 of them with NSH, admitted to our clinic in the period 2000 to 2022. For the diagnosis, we used laboratory studies (complete blood cell count, coagulation assays, biochemistry, thromboelastography, genetic tests) and imaging investigations (X-ray, ultrasound, CT, MRI). We selected four cases confronted with pitfalls of diagnosis and evolution in order to illustrate the sometimes provocative field of NSH. (3) Results: Confronted with challenging cases with under-, missed or delayed diagnosis and severe consequences, we aimed at presenting four such selected cases with mild or moderate hemophilia, real pitfalls in our clinical activity. (4) Conclusions: In the field of NSH, if not timely recognized, tending sometimes to remain ignored by caregivers and patients themselves, we can be confronted with challenging diagnostic situations and life-threatening bleeds. FAU - Boeriu, Estera AU - Boeriu E AD - Department of Pediatrics, Division of Onco-Hematology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Arghirescu, Teodora Smaranda AU - Arghirescu TS AD - Department of Pediatrics, Division of Onco-Hematology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Serban, Margit AU - Serban M AD - Onco-Hematology Research Unit, Romanian Academy of Medical Sciences, Children Emergency Hospital "Louis Turcanu" Timisoara, European Hemophilia Treatment Centre, 300011 Timisoara, Romania. FAU - Patrascu, Jenel Marian AU - Patrascu JM AD - Department of Orthopedics, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Boia, Eugen AU - Boia E AD - Department of Pediatric Surgery, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Jinca, Cristian AU - Jinca C AD - Department of Pediatrics, Division of Onco-Hematology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania. FAU - Schramm, Wolfgang AU - Schramm W AD - Ludwig-Maximilians University (LMU) Rudolf Marx Stiftung Munich, 80539 Munchen, Germany. FAU - Traila, Adina AU - Traila A AD - Medical Centre for Evaluation Therapy, Medical Education and Rehabilitation of Children and Young Adults, European Hemophilia Treatment Centre, 305100 Buzias, Romania. FAU - Ursu, Cristina Emilia AU - Ursu CE AUID- ORCID: 0000-0003-4752-3741 AD - Onco-Hematology Research Unit, Romanian Academy of Medical Sciences, Children Emergency Hospital "Louis Turcanu" Timisoara, European Hemophilia Treatment Centre, 300011 Timisoara, Romania. LA - eng PT - Journal Article DEP - 20220609 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC9225229 OTO - NOTNLM OT - anti-FVIII antibodies OT - non-severe hemophilia OT - surgery OT - von Willebrand disease COIS- The authors declare no conflict of interest. EDAT- 2022/06/25 06:00 MHDA- 2022/06/25 06:01 PMCR- 2022/06/09 CRDT- 2022/06/24 01:24 PHST- 2022/04/09 00:00 [received] PHST- 2022/06/02 00:00 [revised] PHST- 2022/06/06 00:00 [accepted] PHST- 2022/06/24 01:24 [entrez] PHST- 2022/06/25 06:00 [pubmed] PHST- 2022/06/25 06:01 [medline] PHST- 2022/06/09 00:00 [pmc-release] AID - jcm11123322 [pii] AID - jcm-11-03322 [pii] AID - 10.3390/jcm11123322 [doi] PST - epublish SO - J Clin Med. 2022 Jun 9;11(12):3322. doi: 10.3390/jcm11123322. PMID- 35705826 OWN - NLM STAT- MEDLINE DCOM- 20221121 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 37 IP - 3 DP - 2022 Dec TI - Application of a TEG-Platelet Mapping Algorithm to Guide Reversal of Antiplatelet Agents in Adults with Mild-to-Moderate Traumatic Brain Injury: An Observational Pilot Study. PG - 638-648 LID - 10.1007/s12028-022-01535-x [doi] AB - BACKGROUND: Traumatic intracranial hemorrhages expand in one third of cases, and antiplatelet medications may exacerbate hematoma expansion. However, the reversal of an antiplatelet effect with platelet transfusion has been associated with harm. We sought to determine whether a thromboelastography platelet mapping (TEG-PM)-guided algorithm could limit platelet transfusion in patients with hemorrhagic traumatic brain injury (TBI) prescribed antiplatelet medications without a resultant clinically significant increase in hemorrhage volume, late hemostatic treatments, or delayed operative intervention. METHODS: A total of 175 consecutive patients with TBI were admitted to our university-affiliated, level I trauma center between March 2016 and December 2019: 54 preintervention patients (control) and 121 patients with TEG-PM (study). After exclusion for anticoagulant administration, availability of neuroimaging and emergent neurosurgery, 62 study patients and 37 control patients remained. Intervention consisted of administration of desmopressin (DDAVP) for nonsurgical patients with significant inhibition at the arachidonic acid or adenosine diphosphate receptor sites. For surgical patients with significant inhibition, dual therapy with DDAVP and platelet transfusion was employed. Study patients were compared with a group of historical controls, which were identified from a prospectively maintained registry and typically treated with empiric platelet transfusion. RESULTS: Median age was 75 years (interquartile range 85-67) and 77 years (interquartile range 81-65) in the TEG-PM and control patient groups, respectively. Admission hemorrhage volumes were similar (10.7 cm(3) [20.1] in patients with TEG-PM vs. 14.1 cm(3) [19.7] in controls; p = 0.41). There were no significant differences in admission Glasgow Coma Scale, mechanism of trauma, or baseline comorbidities. A total of 57% of controls versus 10% of patients with TEG-PM (p < 0.001) were transfused platelets; 52% of intervention patients and 0% controls were treated with DDAVP. Expansion hemorrhage volumes were not significantly different (14.0 cm(3) [20.2] patients with TEG-PM versus 13.6 cm(3) [23.7] controls; p = 0.93). There was no significant difference in rates of clinical deterioration, delayed neurosurgical intervention, or late platelet transfusion between groups. CONCLUSIONS: Among patients with hemorrhagic TBI prescribed preinjury antiplatelet therapy, our study suggests that the use of a TEG-PM algorithm may reduce platelet transfusions without a concurrent increase in clinically significant hematoma expansion. Further study is required to prove a causative relationship. CI - (c) 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. FAU - Kvint, Svetlana AU - Kvint S AUID- ORCID: 0000-0003-1168-7082 AD - Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 3 Silverstein, Philadelphia, PA, USA. Svetlana.Kvint@pennmedicine.upenn.edu. FAU - Gutierrez, Alexis AU - Gutierrez A AD - Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 3 Silverstein, Philadelphia, PA, USA. FAU - Venezia, Anya AU - Venezia A AD - Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 3 Silverstein, Philadelphia, PA, USA. FAU - Maloney, Eileen AU - Maloney E AD - Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 3 Silverstein, Philadelphia, PA, USA. FAU - Schuster, James AU - Schuster J AD - Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 3 Silverstein, Philadelphia, PA, USA. FAU - Kumar, Monisha A AU - Kumar MA AD - Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. LA - eng PT - Journal Article PT - Observational Study DEP - 20220616 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 RN - 0 (Platelet Aggregation Inhibitors) RN - ENR1LLB0FP (Deamino Arginine Vasopressin) SB - IM MH - Adult MH - Humans MH - *Platelet Aggregation Inhibitors/pharmacology/therapeutic use MH - Thrombelastography/methods MH - Pilot Projects MH - Deamino Arginine Vasopressin/pharmacology/therapeutic use MH - Retrospective Studies MH - *Brain Injuries, Traumatic/drug therapy/complications MH - Algorithms MH - Hematoma/complications OTO - NOTNLM OT - Antiplatelet OT - DDAVP OT - Progressive hemorrhagic injury OT - TBI OT - TEG-platelet mapping EDAT- 2022/06/16 06:00 MHDA- 2022/11/22 06:00 CRDT- 2022/06/15 23:33 PHST- 2021/09/27 00:00 [received] PHST- 2022/05/13 00:00 [accepted] PHST- 2022/06/16 06:00 [pubmed] PHST- 2022/11/22 06:00 [medline] PHST- 2022/06/15 23:33 [entrez] AID - 10.1007/s12028-022-01535-x [pii] AID - 10.1007/s12028-022-01535-x [doi] PST - ppublish SO - Neurocrit Care. 2022 Dec;37(3):638-648. doi: 10.1007/s12028-022-01535-x. Epub 2022 Jun 16. PMID- 35693425 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220716 IS - 2691-3593 (Electronic) IS - 2691-3593 (Linking) VI - 3 IP - 1 DP - 2022 Mar TI - Endotheliopathy is Associated with a 24-hour Fibrinolysis Phenotype Described by Low TEG Lysis and High D-Dimer after Trauma: a Secondary Analysis of the PROPPR Study. LID - e116 [pii] LID - 10.1097/as9.0000000000000116 [doi] AB - OBJECTIVES: Determine associations between biomarkers of endotheliopathy, 24-hour fibrinolysis phenotypes and clinical outcomes after trauma. BACKGROUND: The vascular endothelium is a critical regulator of hemostasis and organ function. The relationship between markers of endotheliopathy and fibrinolysis following trauma has not been evaluated. METHODS: We performed a secondary analysis of prospectively collected biomarker data in the Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized controlled trial. We stratified subjects by 24-hour thromboelastography (TEG) percent clot lysis (LY30) and plasma D-dimer (DD) levels and evaluated differences in endotheliopathy biomarkers and clinical outcomes between subjects with one of four 24-hour fibrinolysis phenotypes: LY30 0.9-2.9% (LY30(norm)), LY30 >2.9% (LY30(high)), LY30 <0.9% and low DD (LY30(low)+DD(low)), and LY30 <0.9% and high DD (LY30(low)+DD(high)). RESULTS: The analysis included 168 subjects with LY30(norm), 32 with LY30(high), 147 with LY30(low)+DD(low) and 124 with LY30(low)+DD(high). LY30(low)+DD(high) subjects had greater injury severity and a higher incidence of severe head injury, multiorgan failure (MOF), and mortality than the other phenotypes. All endotheliopathy biomarkers were significantly higher in the LY30(low)+DD(high) phenotype. Adjusting for injury severity, mechanism and head trauma, 24-hour angiopoietin-2 and soluble thrombomodulin were independently associated with the LY30(low)+DD(high) phenotype. Both endothelial biomarkers were discriminating for MOF. Subjects with thrombomodulin level >9.5 ng/mL and angiopoietin-2 level >3.6 ng/mL accounted for 64% of subjects who developed MOF. CONCLUSIONS: In a multicenter trauma cohort, subjects with a fibrinolysis phenotype characterized by low TEG lysis and elevated DD 24 hours after injury have significantly worse endotheliopathy and clinical outcomes. Our findings support mechanistic evaluations of the role of the endothelium in fibrinolysis dysregulation that may drive late-stage organ injury. FAU - Richter, Robert P AU - Richter RP AD - Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Joiner, Danielle M AU - Joiner DM AD - University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA. FAU - Griffin, Russell L AU - Griffin RL AD - University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama, USA. FAU - Jansen, Jan O AU - Jansen JO AD - Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Kerby, Jeffrey D AU - Kerby JD AD - Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Wade, Charles E AU - Wade CE AD - Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA. AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Richter, Jillian R AU - Richter JR AD - Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. LA - eng GR - R35 GM137958/GM/NIGMS NIH HHS/United States PT - Journal Article PL - United States TA - Ann Surg Open JT - Annals of surgery open : perspectives of surgical history, education, and clinical approaches JID - 101769928 PMC - PMC9187295 MID - NIHMS1810512 EDAT- 2022/06/14 06:00 MHDA- 2022/06/14 06:01 PMCR- 2022/01/26 CRDT- 2022/06/13 03:15 PHST- 2022/06/13 03:15 [entrez] PHST- 2022/06/14 06:00 [pubmed] PHST- 2022/06/14 06:01 [medline] PHST- 2022/01/26 00:00 [pmc-release] AID - e116 [pii] AID - 10.1097/as9.0000000000000116 [doi] PST - ppublish SO - Ann Surg Open. 2022 Mar;3(1):e116. doi: 10.1097/as9.0000000000000116. PMID- 35687811 OWN - NLM STAT- MEDLINE DCOM- 20221031 LR - 20240906 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 93 IP - 5 DP - 2022 Nov 1 TI - Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy. PG - 579-587 LID - 10.1097/TA.0000000000003723 [doi] AB - BACKGROUND: Trauma patients with abnormal fibrinolysis have increased morbidity and mortality. Knowledge of mechanisms differentiating fibrinolytic phenotypes is important to optimize treatment. We hypothesized that subjects with abnormal fibrinolysis identified by whole blood viscoelastometry can also be distinguished by plasma thrombin generation, clot structure, fibrin formation, and plasmin generation measurements. METHODS: Platelet-poor plasma (PPP) from an observational cross-sectional trauma cohort with fibrinolysis shutdown (% lysis at 30 minutes [LY30] < 0.9, n = 11) or hyperfibrinolysis (LY30 > 3%, n = 9) defined by whole blood thromboelastography were studied. Noninjured control subjects provided comparative samples. Thrombin generation, fibrin structure and formation, and plasmin generation were measured by fluorescence, confocal microscopy, turbidity, and a fluorescence-calibrated plasmin assay, respectively, in the absence/presence of tissue factor or tissue plasminogen activator (tPA). RESULTS: Whereas spontaneous thrombin generation was not detected in PPP from control subjects, PPP from hyperfibrinolysis or shutdown patients demonstrated spontaneous thrombin generation, and the lag time was shorter in hyperfibrinolysis versus shutdown. Addition of tissue factor masked this difference but revealed increased thrombin generation in hyperfibrinolysis samples. Compared with shutdown, hyperfibrinolysis PPP formed denser fibrin networks. In the absence of tPA, the fibrin formation rate was faster in shutdown than hyperfibrinolysis, but hyperfibrinolysis clots lysed spontaneously; these differences were masked by addition of tPA. Tissue plasminogen activator-stimulated plasmin generation was similar in hyperfibrinolysis and shutdown samples. Differences in LY30, fibrin structure, and lysis correlated with pH. CONCLUSION: This exploratory study using PPP-based assays identified differences in thrombin generation, fibrin formation and structure, and lysis in hyperfibrinolysis and shutdown subgroups. These groups did not differ in their ability to promote tPA-triggered plasmin generation. The ability to characterize these activities in PPP facilitates studies to identify mechanisms that promote adverse outcomes in trauma. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Lawson, Michael A AU - Lawson MA AD - From the Department of Surgery (M.A.L., N.E.D., K.F.), University of Vermont, Burlington, Vermont; Department of Pathology and Laboratory Medicine and UNC Blood Research Center (L.A.H., A.S.W.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Pharmacology (G.H.), University of Vermont, Burlington, Vermont; Synapse Research Institute (B.D.L.), Maastricht, the Netherlands; Department of Surgery (H.B.M., E.E.M., M.J.C.), University of Colorado School of Medicine (E.E.M.), Aurora; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), Denver, Colorado; and Department of Biochemistry and Laboratory for Clinical Biochemistry Research (B.A.B.), University of Vermont, Burlington, Vermont. FAU - Holle, Lori A AU - Holle LA FAU - Dow, Nathan E AU - Dow NE FAU - Hennig, Grant AU - Hennig G FAU - de Laat, Bas AU - de Laat B FAU - Moore, Hunter B AU - Moore HB FAU - Moore, Ernest E AU - Moore EE FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Bouchard, Beth A AU - Bouchard BA FAU - Freeman, Kalev AU - Freeman K FAU - Wolberg, Alisa S AU - Wolberg AS LA - eng GR - OT2 HL156812/HL/NHLBI NIH HHS/United States GR - R01 HL126974/HL/NHLBI NIH HHS/United States GR - R35 GM144099/GM/NIGMS NIH HHS/United States GR - S10 OD025030/OD/NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220610 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - EC 3.4.21.7 (Fibrinolysin) RN - EC 3.4.21.5 (Thrombin) RN - 9035-58-9 (Thromboplastin) RN - 9001-31-4 (Fibrin) SB - IM MH - Humans MH - *Tissue Plasminogen Activator MH - Fibrinolysis MH - Fibrinolysin MH - Thrombin MH - Thromboplastin MH - Cross-Sectional Studies MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Fibrin PMC - PMC9613511 MID - NIHMS1812586 COIS- CONFLICT OF INTEREST DISCLOSURE B.dL. is employed by Synapse Research Institute, a not-for-profit member of the STAGO Diagnostic group that produces calibrated automated thrombography for thrombin generation measurements in plasma. Synapse Research Institute holds the patent on calibrated plasmin generation. EDAT- 2022/06/11 06:00 MHDA- 2022/11/01 06:00 PMCR- 2023/11/01 CRDT- 2022/06/10 15:33 PHST- 2022/06/11 06:00 [pubmed] PHST- 2022/11/01 06:00 [medline] PHST- 2022/06/10 15:33 [entrez] PHST- 2023/11/01 00:00 [pmc-release] AID - 01586154-202211000-00003 [pii] AID - 10.1097/TA.0000000000003723 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Nov 1;93(5):579-587. doi: 10.1097/TA.0000000000003723. Epub 2022 Jun 10. PMID- 35686403 OWN - NLM STAT- MEDLINE DCOM- 20220613 LR - 20220613 IS - 1681-7168 (Electronic) IS - 1022-386X (Linking) VI - 32 IP - 6 DP - 2022 Jun TI - CeO(2) Nanoparticles Effect on Acute Hemorrhagic Shock Induced-hepatic Stress Injury in a Mouse Model. PG - 728-733 LID - 10.29271/jcpsp.2022.06.728 [doi] AB - OBJECTIVE: To explore the effects of CeO2 nanoparticles on liver injury, inflammation, oxidative stress, and coagulation function in hemorrhagic shock (HS)-induced hepatic stress injury. STUDY DESIGN: Experimental study. Study Place and Duration: Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China, from March 2017 to July 2020. METHODOLOGY: HS mice were treated with different doses of CeO2 nanoparticles suspension (1 mg/ml), 0.1 ml/100 g, 0.2 ml/100 g, 0.5 ml/100 g. Levels of NF-kappaB, IFN-gamma, IL-1beta, IL-6, and TNF-alpha in tissue homogenate were measured by ELISA. Oxidative stress-related factors in liver tissue homogenate were also evaluated. Coagulation function was determined by measurement of the prothrombin time (PT) and activated partial thromboplastin time (APTT) as well as using thromboelastography analysis. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected for liver function. Survival analysis within 24 hours after the model establishment was conducted by K-M curve. RESULTS: Hemorrhagic shock resulted in obvious tissue hemorrhage, elevated levels of AST and ALT, and significantly shorter survival for HS mice, which was improved by 0.5 ml/100 g CeO2 nanoparticles suspension. Treatment of CeO2 nanoparticles significantly decreased HS-induced inflammation, oxidative stress, and coagulation function in a dose-dependent manner. CONCLUSION: CeO2 nanoparticles could suppress inflammation and oxidative stress, as well as improve liver and coagulation function in hemorrhagic shock-induced hepatic stress injury mice. KEY WORDS: CeO2 nanoparticles, Hemorrhagic shock-induced hepatic stress injury, Inflammatory response, Oxidative stress, Coagulation function. FAU - Chen, Guoqiang AU - Chen G LA - eng PT - Journal Article PL - Pakistan TA - J Coll Physicians Surg Pak JT - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP JID - 9606447 SB - IM MH - Animals MH - China MH - Disease Models, Animal MH - Humans MH - Inflammation MH - Liver MH - Mice MH - *Nanoparticles MH - *Shock, Hemorrhagic/complications EDAT- 2022/06/11 06:00 MHDA- 2022/06/14 06:00 CRDT- 2022/06/10 03:24 PHST- 2021/08/11 00:00 [received] PHST- 2022/04/22 00:00 [accepted] PHST- 2022/06/10 03:24 [entrez] PHST- 2022/06/11 06:00 [pubmed] PHST- 2022/06/14 06:00 [medline] AID - 040579197 [pii] AID - 10.29271/jcpsp.2022.06.728 [doi] PST - ppublish SO - J Coll Physicians Surg Pak. 2022 Jun;32(6):728-733. doi: 10.29271/jcpsp.2022.06.728. PMID- 35659185 OWN - NLM STAT- MEDLINE DCOM- 20221010 LR - 20231118 IS - 1369-1635 (Electronic) IS - 0953-7104 (Print) IS - 0953-7104 (Linking) VI - 33 IP - 8 DP - 2022 Nov 17 TI - Apolipoprotein A-I, elevated in trauma patients, inhibits platelet activation and decreases clot strength. PG - 1119-1131 LID - 10.1080/09537104.2022.2078488 [doi] AB - Apolipoprotein A-I (ApoA-I) is elevated in the plasma of a subgroup of trauma patients with systemic hyperfibrinolysis. We hypothesize that apoA-I inhibits platelet activation and clot formation. The effects of apoA-I on human platelet activation and clot formation were assessed by whole blood thrombelastography (TEG), platelet aggregometry, P-selectin surface expression, microfluidic adhesion, and Akt phosphorylation. Mouse models of carotid artery thrombosis and pulmonary embolism were used to assess the effects of apoA-I in vivo. The ApoA-1 receptor was investigated with transgenic mice knockouts (KO) for the scavenger receptor class B member 1 (SR-BI). Compared to controls, exogenous human apoA-I inhibited arachidonic acid and collagen-mediated human and mouse platelet aggregation, decreased P-selectin surface expression and Akt activation, resulting in diminished clot strength and increased clot lysis by TEG. ApoA-I also decreased platelet aggregate size formed on a collagen surface under flow. In vivo, apoA-I delayed vessel occlusion in an arterial thrombosis model and conferred a survival advantage in a pulmonary embolism model. SR-BI KO mice significantly reduced apoA-I inhibition of platelet aggregation versus wild-type platelets. Exogenous human apoA-I inhibits platelet activation, decreases clot strength and stability, and protects mice from arterial and venous thrombosis via the SR-BI receptor. FAU - Jones, Wilbert L AU - Jones WL AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Ramos, Christopher R AU - Ramos CR AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Banerjee, Anirban AU - Banerjee A AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Moore, Ernest E AU - Moore EE AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Hansen, Kirk C AU - Hansen KC AD - Department of Biochemistry/Molecular Genetics, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Coleman, Julia R AU - Coleman JR AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Kelher, Marguerite AU - Kelher M AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Bioengineering, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Neeves, Keith B AU - Neeves KB AD - Department of Pediatrics, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. AD - Vitalant Research Institute, Vitalant Mountain Division, Denver, CO, USA. FAU - Silliman, Christopher C AU - Silliman CC AD - Departments of Surgery, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Bioengineering, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Pediatrics, School of Medicine University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Di Paola, Jorge AU - Di Paola J AD - Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, USA. FAU - Branchford, Brian AU - Branchford B AUID- ORCID: 0000-0002-4076-270X AD - Versiti Blood Research Institute, Hemostasis, Thrombosis, and Vascular Biology Program, Milwaukee, WI, USA. LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - L40 HL110130/HL/NHLBI NIH HHS/United States GR - R01 HL120728/HL/NHLBI NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - R01 HL139825/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - K08 HL146941/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20220605 PL - England TA - Platelets JT - Platelets JID - 9208117 RN - 0 (Apolipoprotein A-I) RN - 0 (CD36 Antigens) RN - 0 (P-Selectin) RN - 27YG812J1I (Arachidonic Acid) RN - EC 2.7.11.1 (Proto-Oncogene Proteins c-akt) SB - IM MH - Animals MH - Apolipoprotein A-I/metabolism/pharmacology MH - Arachidonic Acid/pharmacology MH - Blood Platelets/metabolism MH - CD36 Antigens/metabolism MH - Humans MH - Mice MH - P-Selectin/metabolism MH - Platelet Activation MH - Platelet Aggregation MH - Proto-Oncogene Proteins c-akt/metabolism MH - *Pulmonary Embolism MH - *Thrombosis PMC - PMC9547822 MID - NIHMS1812394 OTO - NOTNLM OT - Hyperfibrinolysis OT - SR-B1 receptor OT - microfluidics OT - platelet inhibition OT - thrombelastography COIS- Disclosure Statement No authors have relevant conflicts of interest to declare. EDAT- 2022/06/07 06:00 MHDA- 2022/10/12 06:00 PMCR- 2023/11/17 CRDT- 2022/06/06 10:32 PHST- 2022/06/07 06:00 [pubmed] PHST- 2022/10/12 06:00 [medline] PHST- 2022/06/06 10:32 [entrez] PHST- 2023/11/17 00:00 [pmc-release] AID - 10.1080/09537104.2022.2078488 [doi] PST - ppublish SO - Platelets. 2022 Nov 17;33(8):1119-1131. doi: 10.1080/09537104.2022.2078488. Epub 2022 Jun 5. PMID- 35641076 OWN - NLM STAT- MEDLINE DCOM- 20220602 LR - 20220622 IS - 1873-4030 (Electronic) IS - 1350-4533 (Linking) VI - 104 DP - 2022 Jun TI - Effects of type 2 diabetes on the viscoelastic behavior of human trabecular bone. PG - 103810 LID - S1350-4533(22)00059-5 [pii] LID - 10.1016/j.medengphy.2022.103810 [doi] AB - Type 2 diabetes (T2D) is a well-known disease that impaired bone mechanical properties and increases the risk of fragility fracture. The bone tissue is a viscoelastic material that means the loading rate determines its mechanical properties. This study investigates the impact of T2D on the viscoelastic properties of human bone and its association with microstructure and biochemical properties. INTRODUCTION: Viscoelasticity is an important mechanical property of bone and for this the interaction of individual constituents of bone plays an important role. The viscoelastic nature of bone can be affected by aging and diseases, which can further influence its deformation and damage behavior. METHODS: The present study investigated the effects of T2D on the viscoelastic behavior of trabecular bone. The femoral heads of T2D (n = 26) and non-T2D (n = 40) individuals with hip fragility fractures were collected for this investigation. Following the micro-CT scanning of all bone samples, the stress relaxation and dynamic mechanical analysis (DMA) tests were performed to quantify the viscoelasticity of bone. Further, a correlation analysis was performed to investigate the effects of alteration in bone microstructural and biochemical parameters on viscoelasticity. RESULTS: The stress relaxation and frequency sweep responses of T2D and non-T2D trabecular bone specimens were not found significantly different. However, the storage modulus, initial stiffness, and initial stress were found lower in T2D bone. The significant correlation of percentage stress relaxed is obtained between the mineral content (r= - 0.52, p-value = 0.003), organic content (r = 0.40, p-value = 0.02), and mineral-to-matrix ratio (r = - 0.43, p-value = 0.009). Further, storage and loss modulus were correlated with bone volume fraction (BV/TV) for both groups. The stress relaxation and frequency sweep characteristics were not found significantly connected with the other chemical, structural, or clinical parameters. CONCLUSION: This study suggests that T2D does not affect the time-dependent response of human femoral trabecular bone. The viscoelastic properties are positively correlated with organic content and negatively correlated with mineral content. CI - Copyright (c) 2022 IPEM. Published by Elsevier Ltd. All rights reserved. FAU - Yadav, Ram Naresh AU - Yadav RN AD - Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India. FAU - Sihota, Praveer AU - Sihota P AD - Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India. FAU - Neradi, Deepak AU - Neradi D AD - Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Bose, Jagadeesh Chandra AU - Bose JC AD - Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Dhiman, Vandana AU - Dhiman V AD - Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Karn, Shailesh AU - Karn S AD - Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Sharma, Sidhartha AU - Sharma S AD - Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Aggarwal, Sameer AU - Aggarwal S AD - Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Goni, Vijay G AU - Goni VG AD - Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Bhadada, Sanjay Kumar AU - Bhadada SK AD - Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. FAU - Kumar, Navin AU - Kumar N AD - Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India. Electronic address: nkumar@iitrpr.ac.in. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220425 PL - England TA - Med Eng Phys JT - Medical engineering & physics JID - 9422753 SB - IM MH - Cancellous Bone/diagnostic imaging/physiology MH - *Diabetes Mellitus, Type 2/complications MH - Femur Head MH - *Hip Fractures MH - Humans MH - X-Ray Microtomography OTO - NOTNLM OT - Bone fragility OT - Micro-CT OT - Trabecular bone OT - Type 2 diabetes OT - Viscoelastic EDAT- 2022/06/01 06:00 MHDA- 2022/06/03 06:00 CRDT- 2022/05/31 21:04 PHST- 2021/07/18 00:00 [received] PHST- 2022/04/17 00:00 [revised] PHST- 2022/04/21 00:00 [accepted] PHST- 2022/05/31 21:04 [entrez] PHST- 2022/06/01 06:00 [pubmed] PHST- 2022/06/03 06:00 [medline] AID - S1350-4533(22)00059-5 [pii] AID - 10.1016/j.medengphy.2022.103810 [doi] PST - ppublish SO - Med Eng Phys. 2022 Jun;104:103810. doi: 10.1016/j.medengphy.2022.103810. Epub 2022 Apr 25. PMID- 35637500 OWN - NLM STAT- MEDLINE DCOM- 20220602 LR - 20220716 IS - 1478-6362 (Electronic) IS - 1478-6354 (Print) IS - 1478-6354 (Linking) VI - 24 IP - 1 DP - 2022 May 30 TI - The anterior cruciate ligament in murine post-traumatic osteoarthritis: markers and mechanics. PG - 128 LID - 10.1186/s13075-022-02798-7 [doi] LID - 128 AB - BACKGROUND: Knee joint injuries, common in athletes, have a high risk of developing post-traumatic osteoarthritis (PTOA). Ligaments, matrix-rich connective tissues, play important mechanical functions stabilising the knee joint, and yet their role post-trauma is not understood. Recent studies have shown that ligament extracellular matrix structure is compromised in the early stages of spontaneous osteoarthritis (OA) and PTOA, but it remains unclear how ligament matrix pathology affects ligament mechanical function. In this study, we aim to investigate both structural and mechanical changes in the anterior cruciate ligament (ACL) in a mouse model of knee trauma. METHODS: Knee joints were analysed following non-invasive mechanical loading in male C57BL/6 J mice (10-week-old). Knee joints were analysed for joint space mineralisation to evaluate OA progression, and the ACLs were assessed with histology and mechanical testing. RESULTS: Joints with PTOA had a 33-46% increase in joint space mineralisation, indicating OA progression. Post-trauma ACLs exhibited extracellular matrix modifications, including COL2 and proteoglycan deposition. Additional changes included cells expressing chondrogenic markers (SOX9 and RUNX2) expanding from the ACL tibial enthesis to the mid-substance. Viscoelastic and mechanical changes in the ACLs from post-trauma knee joints included a 20-21% decrease in tangent modulus at 2 MPa of stress, a decrease in strain rate sensitivity at higher strain rates and an increase in relaxation during stress-relaxation, but no changes to hysteresis and ultimate load to failure were observed. CONCLUSIONS: These results demonstrate that ACL pathology and viscoelastic function are compromised in the post-trauma knee joint and reveal an important role of viscoelastic mechanical properties for ligament and potentially knee joint health. CI - (c) 2022. The Author(s). FAU - Ramos-Mucci, Lorenzo AU - Ramos-Mucci L AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. FAU - Elsheikh, Ahmed AU - Elsheikh A AD - School of Engineering, University of Liverpool, Brownlow Hill, Liverpool, L69 3GH, UK. AD - Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China. AD - NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. FAU - Keenan, Craig AU - Keenan C AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. AD - Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK. FAU - Eliasy, Ashkan AU - Eliasy A AD - School of Engineering, University of Liverpool, Brownlow Hill, Liverpool, L69 3GH, UK. FAU - D'Aout, Kristiaan AU - D'Aout K AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. FAU - Bou-Gharios, George AU - Bou-Gharios G AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. FAU - Comerford, Eithne AU - Comerford E AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. AD - School of Veterinary Science, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, University of Liverpool, Chester High Rd, Neston, CH64 7TE, UK. FAU - Poulet, Blandine AU - Poulet B AD - Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK. b.poulet@liverpool.ac.uk. LA - eng GR - 19770/ARC_/Arthritis Research UK/United Kingdom GR - 20859/VAC_/Versus Arthritis/United Kingdom GR - MR/P020941/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220530 PL - England TA - Arthritis Res Ther JT - Arthritis research & therapy JID - 101154438 RN - 0 (Biomarkers) SB - IM MH - Animals MH - Anterior Cruciate Ligament/pathology MH - *Anterior Cruciate Ligament Injuries/complications MH - Biomarkers MH - Humans MH - *Knee Injuries/pathology MH - Knee Joint/pathology MH - Male MH - Mice MH - Mice, Inbred C57BL MH - *Osteoarthritis/etiology/pathology PMC - PMC9150328 OTO - NOTNLM OT - Anterior cruciate ligament OT - Chondrogenesis OT - Mechanics OT - Post-traumatic osteoarthritis OT - Viscoelastic COIS- The authors declare that they have no competing interests. EDAT- 2022/06/01 06:00 MHDA- 2022/06/03 06:00 PMCR- 2022/05/30 CRDT- 2022/05/31 14:07 PHST- 2022/01/26 00:00 [received] PHST- 2022/05/03 00:00 [accepted] PHST- 2022/05/31 14:07 [entrez] PHST- 2022/06/01 06:00 [pubmed] PHST- 2022/06/03 06:00 [medline] PHST- 2022/05/30 00:00 [pmc-release] AID - 10.1186/s13075-022-02798-7 [pii] AID - 2798 [pii] AID - 10.1186/s13075-022-02798-7 [doi] PST - epublish SO - Arthritis Res Ther. 2022 May 30;24(1):128. doi: 10.1186/s13075-022-02798-7. PMID- 35635366 OWN - NLM STAT- MEDLINE DCOM- 20220712 LR - 20250728 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 62 IP - 7 DP - 2022 Jul TI - Freeze-dried plasma: From damage control resuscitation to coronavirus disease 2019 therapy. PG - 1408-1416 LID - 10.1111/trf.16947 [doi] AB - BACKGROUND: Freeze-dried plasma (FDP) is a promising blood component for prehospital resuscitation given its logistic advantages over fresh frozen plasma (FFP). COVID-19 convalescent (CC) plasma has been used to treat coronavirus disease 2019 (COVID-19) patients, and its corresponding FDP has potential use during future pandemics. Therefore, we conducted the study to determine if the hemostatic and immunological properties of plasma can be retained after lyophilization. STUDY DESIGN AND METHODS: Hemostatic tests were conducted with Rotational Thromboelastometry (ROTEM) and a Stago analyzer. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG (Immunoglobulin G) and neutralizing activity were analyzed using Meso Scale Diagnostics immunoassay kits. RESULTS: There were no differences in ROTEM parameters and Stago measurements for prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen and D-dimer concentrations, and antithrombin, factor V, VIII, and protein S activities between FFP and FDP for either pre-COVID-19 or CC samples. Differences were observed in INTEM clotting time and PT and PTT when comparing reconstituted FDP stored at 4 degrees C for 24 h or room temperature for 4 h to healthy control. Both CC-FFP and CC-FDP showed two orders of magnitude higher concentrations of IgG antibodies against SARS-CoV-2 antigens than pre-COVID-19-FFP and pre-COVID-19-FDP and healthy control. Similarly, the CC samples showed approximately 4-fold higher %-inhibition of receptor binding than the pre-COVID-19 samples. There were no differences in either the antibody levels or neutralization activity between CC-FFP and CC-FDP. DISCUSSION: We demonstrated that FDP and CC-FDP retained the same hemostatic and antibody functional activities relative to their initial plasma sources, supporting clinical evaluation of their benefits in severe trauma and COVID-19 patients. CI - (c) 2022 Her Majesty the Queen in Right of Canada. Transfusion (c) 2022 AABB. Reproduced with the permission of the Minister of National Defence. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Rhind, Shawn G AU - Rhind SG AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Moes, Katy AU - Moes K AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Devine, Dana AU - Devine D AUID- ORCID: 0000-0002-9059-0344 AD - Centre for Innovation, Canadian Blood Services, Edmonton, Alberta, Canada. FAU - Jenkins, Craig AU - Jenkins C AD - Centre for Innovation, Canadian Blood Services, Edmonton, Alberta, Canada. FAU - Beckett, Andrew AU - Beckett A AUID- ORCID: 0000-0002-4943-9415 AD - St. Michael's Hospital, Toronto, Ontario, Canada. AD - Royal Canadian Medical Services, Ottawa, Ontario, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220610 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Hemostatics) RN - 0 (Immunoglobulin G) SB - IM MH - *COVID-19/therapy MH - Freeze Drying MH - *Hemostatics MH - Humans MH - Immunoglobulin G MH - Plasma MH - SARS-CoV-2 OTO - NOTNLM OT - COVID-19 OT - convalescent plasma OT - freeze-dried plasma OT - hemostatic resuscitation OT - neutralizing antibodies EDAT- 2022/06/01 06:00 MHDA- 2022/07/14 06:00 CRDT- 2022/05/31 12:27 PHST- 2022/05/11 00:00 [received] PHST- 2022/05/15 00:00 [accepted] PHST- 2022/06/01 06:00 [pubmed] PHST- 2022/07/14 06:00 [medline] PHST- 2022/05/31 12:27 [entrez] AID - 10.1111/trf.16947 [doi] PST - ppublish SO - Transfusion. 2022 Jul;62(7):1408-1416. doi: 10.1111/trf.16947. Epub 2022 Jun 10. PMID- 35592998 OWN - NLM STAT- MEDLINE DCOM- 20220816 LR - 20250728 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 20 IP - 9 DP - 2022 Sep TI - Importance of catecholamine signaling in the development of platelet exhaustion after traumatic injury. PG - 2109-2118 LID - 10.1111/jth.15763 [doi] AB - BACKGROUND: Impaired ex vivo platelet aggregation is common in trauma patients. The mechanisms driving these impairments remain incompletely understood, but functional platelet exhaustion due to excessive in vivo activation is implicated. Given platelet adrenoreceptors and known catecholamine surges after injury, impaired ex vivo platelet aggregation in trauma patients may be linked to catecholamine-induced functional platelet exhaustion. OBJECTIVE: To determine the relationship of catecholamines with platelet-dependent hemostasis after injury and to model catecholamine-induced functional platelet exhaustion in healthy donor platelets. PATIENTS/METHODS: Whole blood was collected from 67 trauma patients as part of a prospective cohort study. Platelet aggregometry and rotational thromboelastometry were performed, and plasma epinephrine (EPI) and norepinephrine (NE) concentrations were measured. The effect of catecholamines on healthy donor platelets was examined in a microfluidic model, with platelet aggregometry, and by flow cytometry examining surface markers of platelet activation. RESULTS: In trauma patients, EPI and NE were associated with impaired platelet aggregation (both p < 0.05), and EPI was additionally associated with decreased viscoelastic clot strength, increased fibrinolysis, and mortality (all p < 0.05). In healthy donors, short duration incubation with EPI enhanced platelet aggregation, platelet adhesion under flow, and increased glycoprotein IIb/IIIa activation, while weaker effects were observed with NE. Compared with short incubation, longer incubation with EPI resulted in decreased platelet adhesion, platelet aggregation, and surface expression of glycoprotein IIb/IIIa. CONCLUSIONS: These findings suggest sympathoadrenal activation in trauma patients contributes to impaired ex vivo platelet aggregation, which mechanistically may be explained by a functionally exhausted platelet phenotype under prolonged exposure to high plasma catecholamine levels. CI - (c) 2022 International Society on Thrombosis and Haemostasis. FAU - Matthay, Zachary A AU - Matthay ZA AUID- ORCID: 0000-0002-3062-2535 AD - Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, USA. FAU - Fields, Alexander T AU - Fields AT AUID- ORCID: 0000-0001-9788-7848 AD - Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, USA. FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B AUID- ORCID: 0000-0002-0355-4557 AD - Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, USA. FAU - Park, John J AU - Park JJ AUID- ORCID: 0000-0001-6051-6912 AD - Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, USA. FAU - Jones, Chayse AU - Jones C AUID- ORCID: 0000-0001-8340-6628 AD - Department of Medicine, University of California, San Francisco, San Francisco, California, USA. FAU - Leligdowicz, Aleksandra AU - Leligdowicz A AUID- ORCID: 0000-0001-6055-4644 AD - Department of Medicine, University of California, San Francisco, San Francisco, California, USA. FAU - Hendrickson, Carolyn M AU - Hendrickson CM AUID- ORCID: 0000-0003-4662-2385 AD - Department of Medicine, University of California, San Francisco, San Francisco, California, USA. FAU - Callcut, Rachael A AU - Callcut RA AUID- ORCID: 0000-0002-1582-6716 AD - Department of Surgery, University of California, Davis, Sacramento, California, USA. FAU - Matthay, Michael A AU - Matthay MA AUID- ORCID: 0000-0003-3039-8155 AD - Department of Medicine, University of California, San Francisco, San Francisco, California, USA. FAU - Kornblith, Lucy Z AU - Kornblith LZ AUID- ORCID: 0000-0002-1861-9691 AD - Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, USA. LA - eng GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - K23 HL133495/HL/NHLBI NIH HHS/United States GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - UL1 TR001872/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20220530 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Catecholamines) RN - 0 (Platelet Glycoprotein GPIIb-IIIa Complex) SB - IM CIN - J Thromb Haemost. 2022 Nov;20(11):2717-2718. doi: 10.1111/jth.15869. PMID: 36271462 CIN - J Thromb Haemost. 2022 Nov;20(11):2715-2716. doi: 10.1111/jth.15868. PMID: 36271463 MH - *Blood Platelets/metabolism MH - *Catecholamines/metabolism/pharmacology MH - Humans MH - Platelet Aggregation MH - Platelet Glycoprotein GPIIb-IIIa Complex/metabolism MH - Prospective Studies PMC - PMC10450647 MID - NIHMS1921661 OTO - NOTNLM OT - blood coagulation disorders OT - catecholamines OT - platelet activation OT - platelet aggregation OT - platelets OT - trauma COIS- CONFLICT OF INTEREST The authors report no conflicts of interest. EDAT- 2022/05/21 06:00 MHDA- 2022/08/17 06:00 PMCR- 2023/08/25 CRDT- 2022/05/20 03:33 PHST- 2022/04/11 00:00 [revised] PHST- 2021/06/25 00:00 [received] PHST- 2022/05/09 00:00 [accepted] PHST- 2022/05/21 06:00 [pubmed] PHST- 2022/08/17 06:00 [medline] PHST- 2022/05/20 03:33 [entrez] PHST- 2023/08/25 00:00 [pmc-release] AID - S1538-7836(22)02094-3 [pii] AID - 10.1111/jth.15763 [doi] PST - ppublish SO - J Thromb Haemost. 2022 Sep;20(9):2109-2118. doi: 10.1111/jth.15763. Epub 2022 May 30. PMID- 35567618 OWN - NLM STAT- MEDLINE DCOM- 20220722 LR - 20250728 IS - 2366-0058 (Electronic) IS - 2366-004X (Print) VI - 47 IP - 8 DP - 2022 Aug TI - Thromboelastography: a review for radiologists and implications on periprocedural bleeding risk. PG - 2697-2703 LID - 10.1007/s00261-022-03539-9 [doi] AB - Thromboelastography (TEG) and rotational thromboelastometry are emerging technologies that are gaining increasing acceptance in the medical field to evaluate the coagulation status of patients on an individual level by assessing dynamic clot formation. TEG has been proven to reduce blood product use as well as improve patient outcomes in a variety of medical settings, including trauma and surgery due to the expediated nature of the test as well as the ability to determine specific deficiencies present in whole blood that are otherwise undetectable with traditional coagulation studies. Currently, no guidelines or recommendations are in place for the utilization of TEG in interventional or diagnostic radiology although access to TEG has become increasingly common in recent years. This manuscript presents a review of prior literature on the technical aspects of TEG as well as its use in various fields and explains the normal TEG-tracing parameters. Common hemodynamic abnormalities and their effect on the TEG tracing are illustrated, and the appropriate treatments for each abnormality are briefly mentioned. TEG has the potential to be a useful tool for determining the hemodynamic state of patients in both interventional and diagnostic radiology, and further research is needed to determine the value of these tests in the periprocedural setting. CI - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Willis, Joseph AU - Willis J AD - University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. FAU - Carroll, Caleb AU - Carroll C AD - University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. FAU - Planz, Virginia AU - Planz V AD - Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Galgano, Samuel J AU - Galgano SJ AUID- ORCID: 0000-0002-1592-9950 AD - Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA. samuelgalgano@uabmc.edu. LA - eng PT - Journal Article PT - Review DEP - 20220514 PL - United States TA - Abdom Radiol (NY) JT - Abdominal radiology (New York) JID - 101674571 SB - IM MH - *Blood Coagulation Disorders/diagnostic imaging MH - Blood Coagulation Tests MH - Humans MH - Radiologists MH - *Thrombelastography PMC - PMC9107068 OTO - NOTNLM OT - Biopsy OT - Hemorrhage OT - Interventional radiology OT - Thromboelastography COIS- The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. There was no financial support for this study. EDAT- 2022/05/15 06:00 MHDA- 2022/07/23 06:00 PMCR- 2022/05/14 CRDT- 2022/05/14 11:13 PHST- 2022/03/09 00:00 [received] PHST- 2022/04/20 00:00 [accepted] PHST- 2022/04/19 00:00 [revised] PHST- 2022/05/15 06:00 [pubmed] PHST- 2022/07/23 06:00 [medline] PHST- 2022/05/14 11:13 [entrez] PHST- 2022/05/14 00:00 [pmc-release] AID - 10.1007/s00261-022-03539-9 [pii] AID - 3539 [pii] AID - 10.1007/s00261-022-03539-9 [doi] PST - ppublish SO - Abdom Radiol (NY). 2022 Aug;47(8):2697-2703. doi: 10.1007/s00261-022-03539-9. Epub 2022 May 14. PMID- 35544678 OWN - NLM STAT- MEDLINE DCOM- 20220714 LR - 20220727 IS - 1528-1175 (Electronic) IS - 0003-3022 (Linking) VI - 137 IP - 2 DP - 2022 Aug 1 TI - Coagulopathy Underlying Rotational Thromboelastometry Derangements in Trauma Patients: A Prospective Observational Multicenter Study. PG - 232-242 LID - 10.1097/ALN.0000000000004268 [doi] AB - BACKGROUND: Viscoelastic hemostatic assays such as rotational thromboelastometry (ROTEM) are used to guide treatment of trauma induced coagulopathy. The authors hypothesized that ROTEM derangements reflect specific coagulation factor deficiencies after trauma. METHODS: This was a secondary analysis of a prospective cohort study in six European trauma centers in patients presenting with full trauma team activation. Patients with dilutional coagulopathy and patients on anticoagulants were excluded. Blood was drawn on arrival for measurement of ROTEM, coagulation factor levels, and markers of fibrinolysis. ROTEM cutoff values to define hypocoagulability were as follows: EXTEM clotting time greater than 80 s, EXTEM clot amplitude at 5 min less than 40 mm, EXTEM lysis index at 30 min less than 85%, FIBTEM clot amplitude at 5 min less than 10 mm, and FIBTEM lysis index at 30 min less than 85%. Based on these values, patients were divided into seven deranged ROTEM profiles and compared to the reference group (ROTEM values within reference range). The primary endpoint was coagulation factors levels and fibrinolysis. RESULTS: Of 1,828 patients, 732 (40%) had ROTEM derangements, most often consisting of a combined decrease in EXTEM and FIBTEM clot amplitude at 5 min, that was present in 217 (11.9%) patients. While an isolated EXTEM clotting time greater than 80 s had no impact on mortality, all other ROTEM derangements were associated with increased mortality. Also, coagulation factor levels in this group were similar to those of patients with a normal ROTEM. Of coagulation factors, a decrease was most apparent for fibrinogen (with a nadir of 0.78 g/l) and for factor V levels (with a nadir of 22.8%). In addition, increased fibrinolysis can be present when the lysis index at 30 min is normal but EXTEM and FIBTEM clot amplitude at 5 min is decreased. CONCLUSIONS: Coagulation factor levels and mortality in the group with an isolated clotting time prolongation are similar to those of patients with a normal ROTEM. Other ROTEM derangements are associated with mortality and reflect a depletion of fibrinogen and factor V. Increased fibrinolysis can be present when the lysis index after 30 min is normal. CI - Copyright (c) 2022, the American Society of Anesthesiologists. All Rights Reserved. FAU - Dujardin, Romein W G AU - Dujardin RWG AD - Department of Intensive Care Medicine, and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands. FAU - Kleinveld, Derek J B AU - Kleinveld DJB AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Brohi, Karim AU - Brohi K AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Davenport, Ross A AU - Davenport RA AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Curry, Nicola AU - Curry N AD - National Health Service Blood and Transplant/Oxford University Hospital National Health Service Trust, John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. FAU - Stanworth, Simon AU - Stanworth S AD - National Health Service Blood and Transplant/Oxford University Hospital National Health Service trust, John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. FAU - Johansson, Par I AU - Johansson PI AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesthesiology JT - Anesthesiology JID - 1300217 RN - 9001-24-5 (Factor V) RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Factor V MH - Fibrinogen MH - Humans MH - Prospective Studies MH - *Thrombelastography EDAT- 2022/05/12 06:00 MHDA- 2022/07/15 06:00 CRDT- 2022/05/11 14:53 PHST- 2022/05/12 06:00 [pubmed] PHST- 2022/07/15 06:00 [medline] PHST- 2022/05/11 14:53 [entrez] AID - 136379 [pii] AID - 10.1097/ALN.0000000000004268 [doi] PST - ppublish SO - Anesthesiology. 2022 Aug 1;137(2):232-242. doi: 10.1097/ALN.0000000000004268. PMID- 35535095 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230916 IS - 0973-6883 (Print) IS - 2213-3453 (Electronic) IS - 0973-6883 (Linking) VI - 12 IP - 2 DP - 2022 Mar-Apr TI - Principles, Interpretation, and Evidence-Based Role of Viscoelastic Point-of-Care Coagulation Assays in Cirrhosis and Liver Failure. PG - 533-543 LID - 10.1016/j.jceh.2021.05.001 [doi] AB - BACKGROUND AND AIMS: Standard coagulation tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio are determined by liver-synthesized coagulation factors. Despite an increased international normalized ratio, patients with cirrhosis are in a "rebalanced" state of hemostasis as the concomitant effect of reduced protein C, protein S, and thrombomodulin is not evaluated in standard coagulation tests. The cell-based model of hemostasis indicates additional mechanisms such as systemic inflammation, sepsis, and organ failures tip the delicate coagulation balance to an anticoagulant type in acute-on-chronic liver failure. In acute liver failure, thrombin generation and platelet function remain intact despite a marked prolongation in prothrombin time. We aimed to explain the principles, application, and utility of viscoelastic tests such as thromboelastography, rotational thromboelastometry, and Sonoclot. METHODS: We reviewed the available literature from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trial with the search terms 'coagulation', 'cirrhosis', 'acute-on-chronic liver failure', 'thromboelastography', 'thromboelastometry' and 'sonoclot' for cross sectional studies, cohort studies and randomized trials. RESULTS: The point-of-care viscoelastic tests provide actionable targets for correcting the coagulation defect in a patient with bleeding and provide evidence-based algorithms for use in liver disease. A limitation of these tests is the inability to assess vessel injury and endothelial elements. CONCLUSION: Global coagulation tests provide a comprehensive estimate of coagulation in vitro; however, their use has only been validated in the setting of liver transplantation. Newer guidelines for hemostatic resuscitation are now accepting these POC tests, but additional data are required to validate their use as standard of care. CI - (c) 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. FAU - Premkumar, Madhumita AU - Premkumar M AD - Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. FAU - Kulkarni, Anand V AU - Kulkarni AV AD - Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India. FAU - Kajal, Kamal AU - Kajal K AD - Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. FAU - Divyaveer, Smita AU - Divyaveer S AD - Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. LA - eng PT - Journal Article DEP - 20210508 PL - India TA - J Clin Exp Hepatol JT - Journal of clinical and experimental hepatology JID - 101574137 PMC - PMC9077199 OTO - NOTNLM OT - ACLF, acute-on-chronic liver failure OT - ACT, activated clotting time OT - ALF, acute liver failure OT - CR, clot rate OT - INR, international normalized ratio OT - MA, maximum amplitude OT - R, reaction time OT - ROTEM OT - ROTEM, rotational thromboelastometry OT - SCT, standard coagulation tests OT - TEG, thromboelastography OT - VWF, von Willebrand factor OT - aPTT, activated partial thromboplastin time OT - cirrhosis OT - coagulation OT - sonoclot OT - thromboelastography EDAT- 2022/05/11 06:00 MHDA- 2022/05/11 06:01 PMCR- 2023/03/01 CRDT- 2022/05/10 01:45 PHST- 2021/03/24 00:00 [received] PHST- 2021/05/02 00:00 [accepted] PHST- 2022/05/10 01:45 [entrez] PHST- 2022/05/11 06:00 [pubmed] PHST- 2022/05/11 06:01 [medline] PHST- 2023/03/01 00:00 [pmc-release] AID - S0973-6883(21)00103-1 [pii] AID - 10.1016/j.jceh.2021.05.001 [doi] PST - ppublish SO - J Clin Exp Hepatol. 2022 Mar-Apr;12(2):533-543. doi: 10.1016/j.jceh.2021.05.001. Epub 2021 May 8. PMID- 35533507 OWN - NLM STAT- MEDLINE DCOM- 20220524 LR - 20240917 IS - 1873-4235 (Electronic) IS - 0956-5663 (Print) IS - 0956-5663 (Linking) VI - 210 DP - 2022 Aug 15 TI - Assessment of fibrinolytic status in whole blood using a dielectric coagulometry microsensor. PG - 114299 LID - S0956-5663(22)00339-6 [pii] LID - 10.1016/j.bios.2022.114299 [doi] AB - Rapid assessment of the fibrinolytic status in whole blood at the point-of-care/point-of-injury (POC/POI) is clinically important to guide timely management of uncontrolled bleeding in patients suffering from hyperfibrinolysis after a traumatic injury. In this work, we present a three-dimensional, parallel-plate, capacitive sensor - termed ClotChip - that measures the temporal variation in the real part of blood dielectric permittivity at 1 MHz as the sample undergoes coagulation within a microfluidic channel with <10 muL of total volume. The ClotChip sensor features two distinct readout parameters, namely, lysis time (LT) and maximum lysis rate (MLR) that are shown to be sensitive to the fibrinolytic status in whole blood. Specifically, LT identifies the time that it takes from the onset of coagulation for the fibrin clot to mostly dissolve in the blood sample during fibrinolysis, whereas MLR captures the rate of fibrin clot lysis. Our findings are validated through correlative measurements with a rotational thromboelastometry (ROTEM) assay of clot viscoelasticity, qualitative/quantitative assessments of clot stability, and scanning electron microscope imaging of clot ultrastructural changes, all in a tissue plasminogen activator (tPA)-induced fibrinolytic environment. Moreover, we demonstrate the ClotChip sensor ability to detect the hemostatic rescue that occurs when the tPA-induced upregulated fibrinolysis is inhibited by addition of tranexamic acid (TXA) - a potent antifibrinolytic drug. This work demonstrates the potential of ClotChip as a diagnostic platform for rapid POC/POI assessment of fibrinolysis-related hemostatic abnormalities in whole blood to guide therapy. CI - Copyright (c) 2022 Elsevier B.V. All rights reserved. FAU - Pourang, Sina AU - Pourang S AD - Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. FAU - Sekhon, Ujjal D S AU - Sekhon UDS AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. FAU - Disharoon, Dante AU - Disharoon D AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. FAU - Ahuja, Sanjay P AU - Ahuja SP AD - Division of Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, 44106, USA. FAU - Suster, Michael A AU - Suster MA AD - Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. FAU - Sen Gupta, Anirban AU - Sen Gupta A AD - Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. Electronic address: axs262@case.edu. FAU - Mohseni, Pedram AU - Mohseni P AD - Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. Electronic address: pxm89@case.edu. LA - eng GR - R01 HL121212/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20220426 PL - England TA - Biosens Bioelectron JT - Biosensors & bioelectronics JID - 9001289 RN - 0 (Antifibrinolytic Agents) RN - 9001-31-4 (Fibrin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - *Antifibrinolytic Agents/pharmacology MH - *Biosensing Techniques MH - Fibrin MH - Fibrinolysis MH - Humans MH - *Thrombosis MH - Tissue Plasminogen Activator/pharmacology PMC - PMC10124761 MID - NIHMS1872486 OTO - NOTNLM OT - Dielectric coagulometry OT - Dielectric spectroscopy OT - Fibrinolysis monitoring OT - Microfluidics OT - Point-of-care diagnostics OT - Whole blood coagulation EDAT- 2022/05/10 06:00 MHDA- 2022/05/25 06:00 PMCR- 2023/04/24 CRDT- 2022/05/09 18:19 PHST- 2022/02/20 00:00 [received] PHST- 2022/04/12 00:00 [revised] PHST- 2022/04/19 00:00 [accepted] PHST- 2022/05/10 06:00 [pubmed] PHST- 2022/05/25 06:00 [medline] PHST- 2022/05/09 18:19 [entrez] PHST- 2023/04/24 00:00 [pmc-release] AID - S0956-5663(22)00339-6 [pii] AID - 10.1016/j.bios.2022.114299 [doi] PST - ppublish SO - Biosens Bioelectron. 2022 Aug 15;210:114299. doi: 10.1016/j.bios.2022.114299. Epub 2022 Apr 26. PMID- 35525809 OWN - NLM STAT- MEDLINE DCOM- 20230502 LR - 20230502 IS - 1036-7314 (Print) IS - 1036-7314 (Linking) VI - 36 IP - 3 DP - 2023 May TI - Implementing and sustaining Point of Care ROTEM(R) into a trauma activation protocol for the management of patients with traumatic injury: A mixed-methods study. PG - 336-344 LID - S1036-7314(22)00033-9 [pii] LID - 10.1016/j.aucc.2022.03.001 [doi] AB - BACKGROUND: Up to 40% of patients with traumatic injury experience critical bleeding, many requiring transfusion of blood products. International transfusion guidelines recommend the use of viscoelastic testing to guide blood product replacement. We implemented a Point of Care ROTEM(R) blood test for trauma patients who present and initiate a trauma activation. OBJECTIVES: The aim of this study was to undertake an evaluation of the implementation data to identify factors which helped and hindered this new practice. METHODS: A sequential mixed-methods design was conducted to evaluate intervention implementation. The intervention was designed with interprofessional collaboration and incorporated education and skills training supplemented with a decision aide. Patients aged >/= 18 years who met the trauma activation criteria were included. Data collection occurred throughout the 21-month implementation period inclusive of initial roll out, maintenance and sustainability and include the number of ROTEM(R) blood tests taken and clinical characteristics of patients. Individual interviews were conducted with health professionals with experience of the intervention after the implementation period was complete. RESULTS: A total of 1570 eligible patients were included. The number of patients who had a ROTEM(R) blood test taken increased over time to 63%. The proportion of patients having a ROTEM(R) blood test obtained was higher for major trauma patients (n=162, 66.9%) who were admitted to the Intensive Care Unit. Regression analysis found trauma service presence on arrival and the sustainability phase of implementation increased the likelihood of having a ROTEM(R) taken. Qualitative data suggest that a more tailored approach to intervention implementation would assist with adoption. CONCLUSION: Implementation of new practice requires careful planning and should be undertaken with input from end-users. Continuous evaluation is necessary to support ongoing implementation and sustainability. To ensure effective implementation occurs, complex interventions need to be made workable and integrated in everyday health care practice. CI - Crown Copyright (c) 2022. Published by Elsevier Ltd. All rights reserved. FAU - Wake, Elizabeth AU - Wake E AD - Trauma Service, Gold Coast University Hospital, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Australia. Electronic address: Elizabeth.wake@health.qld.gov.au. FAU - Walters, Kerin AU - Walters K AD - Intensive Care Unit, Gold Coast University Hospital, Queensland, Australia. FAU - Winearls, James AU - Winearls J AD - Intensive Care Unit, Gold Coast University Hospital, Queensland, Australia; Senior Lecturer, University of Queensland, Australia. FAU - Marshall, Andrea P AU - Marshall AP AD - Nursing, Midwifery Education and Research Unit, Gold Coast University Hospital, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia. LA - eng PT - Journal Article DEP - 20220504 PL - Australia TA - Aust Crit Care JT - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JID - 9207852 MH - Humans MH - *Blood Coagulation Disorders MH - Point-of-Care Systems MH - Thrombelastography/methods MH - Hemorrhage MH - Blood Transfusion/methods OTO - NOTNLM OT - Coagulation OT - Point-of-care assessment OT - Rotational thromboelastometry OT - Traumatic injury EDAT- 2022/05/08 06:00 MHDA- 2023/05/02 06:42 CRDT- 2022/05/07 22:13 PHST- 2021/04/18 00:00 [received] PHST- 2022/02/23 00:00 [revised] PHST- 2022/03/04 00:00 [accepted] PHST- 2023/05/02 06:42 [medline] PHST- 2022/05/08 06:00 [pubmed] PHST- 2022/05/07 22:13 [entrez] AID - S1036-7314(22)00033-9 [pii] AID - 10.1016/j.aucc.2022.03.001 [doi] PST - ppublish SO - Aust Crit Care. 2023 May;36(3):336-344. doi: 10.1016/j.aucc.2022.03.001. Epub 2022 May 4. PMID- 35508351 OWN - NLM STAT- MEDLINE DCOM- 20220506 LR - 20260518 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 12 IP - 5 DP - 2022 May 4 TI - Fibrinogen Early In Severe paediatric Trauma studY (FEISTY junior): protocol for a randomised controlled trial. PG - e057780 LID - 10.1136/bmjopen-2021-057780 [doi] LID - e057780 AB - INTRODUCTION: Trauma causes 40% of child deaths in high-income countries, with haemorrhage being a leading contributor to death in this population. There is a growing recognition that fibrinogen and platelets play a major role in trauma-induced coagulopathy (TIC) but the exact physiological mechanisms are poorly understood. METHODS AND ANALYSIS: This is a prospective multicentre, open-label, randomised, two-arm parallel feasibility study conducted in the emergency departments, intensive care units and operating theatres of participating hospitals. Severely injured children, aged between 3 months and 18 years, presenting with traumatic haemorrhage requiring transfusion of blood products will be screened for inclusion.Sixty-eight patients will be recruited and will be allocated to fibrinogen replacement using fibrinogen concentrate (FC) or cryoprecipitate in a 1:1 ratio. Fibrinogen replacement will be administered to patients with a FIBTEM A5 of 48 hours after admission). At presentation, platelet count and PA were not significantly different between those with and without incident VTE. However, at 24 hours, those who subsequently developed VTE had significantly lower platelet counts (126 x 10 9 /L vs. 164 x 10 9 /L, p = 0.01) and lower PA in response to ADP ( p < 0.05), collagen ( p < 0.05), and thrombin ( p = 0.06). Importantly, the magnitude of decrease in PA (delta) from presentation to 24 hours was independently associated with development of VTE (adjusted odds ratios per 10 aggregation unit decrease: delta-ADP, 1.31 [ p = 0.03]; delta-collagen, 1.36 [ p = 0.01]; delta-thrombin, 1.41 [ p < 0.01]). CONCLUSION: Severely injured patients with decreasing ex vivo measures of PA despite resuscitation have an increased risk of developing VTE. This may have implications for predicting development of VTE and for studying platelet targeted chemoprophylaxis regimens. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Matthay, Zachary A AU - Matthay ZA AD - From the Department of Surgery (Z.A.M., B.N.-G., A.T.F., J.C., M.M.K., L.Z.K.), Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California; Department of Surgery (Z.J.H.), Yale University, Hartford, Connecticut; Department of Surgery (M.D.N.), University of Pittsburg, Pittsburg, Pennsylvania; Department of Medicine (J.S.B., E.L.-W.), New York University Grossman School of Medicine, New York, New York; Department of Surgery (M.J.C.), University of Colorado, Aurora, Colorado; and Department of Surgery (R.A.C.), University of California Davis, Sacramento, California. FAU - Hellmann, Zane J AU - Hellmann ZJ FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B FAU - Fields, Alexander T AU - Fields AT FAU - Cuschieri, Joseph AU - Cuschieri J FAU - Neal, Matthew D AU - Neal MD FAU - Berger, Jeffrey S AU - Berger JS FAU - Luttrell-Williams, Elliot AU - Luttrell-Williams E FAU - Knudson, M Margaret AU - Knudson MM FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Callcut, Rachael A AU - Callcut RA FAU - Kornblith, Lucy Z AU - Kornblith LZ LA - eng GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural DEP - 20220521 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.5 (Thrombin) RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Humans MH - *Venous Thromboembolism/etiology/prevention & control MH - Platelet Aggregation MH - Thrombin MH - Platelet Function Tests MH - Adenosine Diphosphate PMC - PMC9585095 MID - NIHMS1798361 COIS- Conflicts of interest: The authors report no relevant conflicts of interest EDAT- 2022/04/22 06:00 MHDA- 2022/11/01 06:00 PMCR- 2023/11/01 CRDT- 2022/04/21 05:22 PHST- 2022/04/22 06:00 [pubmed] PHST- 2022/11/01 06:00 [medline] PHST- 2022/04/21 05:22 [entrez] PHST- 2023/11/01 00:00 [pmc-release] AID - 01586154-202211000-00006 [pii] AID - 10.1097/TA.0000000000003655 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Nov 1;93(5):604-612. doi: 10.1097/TA.0000000000003655. Epub 2022 May 21. PMID- 35416466 OWN - NLM STAT- MEDLINE DCOM- 20220715 LR - 20220718 IS - 1827-1596 (Electronic) IS - 0375-9393 (Linking) VI - 88 IP - 7-8 DP - 2022 Jul-Aug TI - Point of care coagulation management in anesthesiology and critical care. PG - 615-628 LID - 10.23736/S0375-9393.22.16380-7 [doi] AB - Point of care (POC) devices are increasingly used in the ICU and in anesthesia. Besides POC-devices for blood gas analysis, several devices are available for coagulation measurements. Although basic principles for thromboelastographic measurements are not novel, some promising developments were made during the last decade improving both user-friendliness and measurement reliability. For instance, POC measurements of activated clotting time (ACT) for heparin monitoring is still regarded as standard-of-care in cardiac interventions and surgery. In the field of anesthesia and intensive care medicine, POC-devices for thromboelastographic and platelet aggregation measurements are widely used. Their impact in case of bleeding and patient blood management for cardiothoracic and trauma surgery is well known. Moreover, there are promising concepts for anticoagulation monitoring including new oral anticoagulant drugs. Coagulation POC-devices may also identify patients at specific risk for thromboembolic events quickly. On the other hand, benefits of POC-devices need to be balanced against limitations, which include technical restrictions and operator related errors, mainly affecting reproducibility and interpretation of results. Therefore, it is recommendable to consider results of POC-coagulation testing in comparison to standard laboratory tests (SLT). Nevertheless, in urgent or emergency situations POC results enable fast decision making to optimize patient care. FAU - Heubner, Lars AU - Heubner L AD - Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany - lars.heubner@uniklinikum-dresden.de. FAU - Mirus, Martin AU - Mirus M AD - Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany. FAU - Vicent, Oliver AU - Vicent O AD - Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany. FAU - Guldner, Andreas AU - Guldner A AD - Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany. FAU - Tiebel, Oliver AU - Tiebel O AD - Institute of Clinical Chemistry, Carl Gustav Carus University Hospital, Dresden, Germany. FAU - Beyer-Westendorf, Jan AU - Beyer-Westendorf J AD - Unit of Thrombosis Research, Division of Hematology and Hemostasis, Department of Medicine I, Carl Gustav Carus University Hospital, Dresden, Germany. FAU - Fries, Dietmar AU - Fries D AD - Department for General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. FAU - Spieth, Peter M AU - Spieth PM AD - Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany. LA - eng PT - Journal Article DEP - 20220413 PL - Italy TA - Minerva Anestesiol JT - Minerva anestesiologica JID - 0375272 SB - IM MH - *Anesthesiology MH - Blood Coagulation MH - Critical Care MH - Humans MH - *Point-of-Care Systems MH - Reproducibility of Results EDAT- 2022/04/14 06:00 MHDA- 2022/07/16 06:00 CRDT- 2022/04/13 11:18 PHST- 2022/04/14 06:00 [pubmed] PHST- 2022/07/16 06:00 [medline] PHST- 2022/04/13 11:18 [entrez] AID - S0375-9393.22.16380-7 [pii] AID - 10.23736/S0375-9393.22.16380-7 [doi] PST - ppublish SO - Minerva Anestesiol. 2022 Jul-Aug;88(7-8):615-628. doi: 10.23736/S0375-9393.22.16380-7. Epub 2022 Apr 13. PMID- 35358159 OWN - NLM STAT- MEDLINE DCOM- 20220728 LR - 20250728 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 93 IP - 2 DP - 2022 Aug 1 TI - Dynamic use of fibrinogen under viscoelastic assessment results in reduced need for plasma and diminished overall transfusion requirements in severe trauma. PG - 166-175 LID - 10.1097/TA.0000000000003624 [doi] AB - BACKGROUND: Despite advances in trauma management, half of trauma deaths occur secondary to bleeding. Currently, hemostatic resuscitation strategies consist of empirical transfusion of blood products in a predefined fixed ratio (1:1:1) to both treat hemorrhagic shock and correct trauma-induced coagulopathy. At our hospital, the implementation of a resuscitation protocol guided by viscoelastic hemostatic assays (VHAs) with rotational thromboelastometry has resulted in a goal-directed approach. The objective of the study is twofold, first to analyze changes in transfusion practices overtime and second to identify the impact of these changes on coagulation parameters and clinical outcomes. We hypothesized that progressive VHA implementation results in a higher administration of fibrinogen concentrate (FC) and lower use of blood products transfusion, especially plasma. METHODS: A total of 135 severe trauma patients (January 2008 to July 2019), all requiring and initial assessment for high risk of trauma-induced coagulopathy based on high-energy injury mechanism, severity of bleeding and hemodynamic instability were included. After 2011 when we first modified the transfusion protocol, a progressive change in transfusional management occurred over time. Three treatment groups were established, reflecting different stages in the evolution of our strategy: plasma (P, n = 28), plasma and FC (PF, n = 64) and only FC (F, n = 42). RESULTS: There were no significant differences in baseline characteristics among groups. Progressive implementation of rotational thromboelastometry resulted in increased use of FC over time ( p < 0.001). Regression analysis showed that group F had a significant reduction in transfusion of packed red blood cells ( p = 0.005), plasma ( p < 0.001), and platelets ( p = 0.011). Regarding outcomes, F patients had less pneumonia ( p = 0.019) and multiorgan failure ( p < 0.001), without significant differences for other outcomes. Likewise, overall mortality was not significantly different. However, further analysis comparing specific mortality due only to massive hemorrhage in the F group versus all patients receiving plasma, it was significantly lower ( p = 0.037). CONCLUSION: Implementing a VHA-based algorithm resulted in a plasma-free strategy with higher use of FC and a significant reduction of packed red blood cells transfused. In addition, we observed an improvement in outcomes without an increase in thrombotic complications. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV. CI - Copyright (c) 2022 American Association for the Surgery of Trauma. FAU - Barquero Lopez, Marta AU - Barquero Lopez M AD - From the Department of Anesthesiolgy (M.B.L.), Bellvitge University Hospital L'Hospitalet de Llobregat; Department of Anesthesiology (J.M.C., C.S.I., M.D.l.R.E., G.P.C.), Parc Tauli University Hospital, Sabadell, Barcelona, Spain; Global Health, Division of Trauma and Surgery (A.M.V., J.C.P.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of General Surgery (A.C.S., S.N.S.), Parc Tauli University Hospital; and Department of Intensive Care (A.G.V.). Tauli University Hospital, Sabadell, Barcelona, Spain. FAU - Martinez Cabanero, Javier AU - Martinez Cabanero J FAU - Munoz Valencia, Alejandro AU - Munoz Valencia A FAU - Saez Ibarra, Clara AU - Saez Ibarra C FAU - De la Rosa Estadella, Marta AU - De la Rosa Estadella M FAU - Campos Serra, Andrea AU - Campos Serra A FAU - Gil Velazquez, Aurora AU - Gil Velazquez A FAU - Pujol Caballe, Gemma AU - Pujol Caballe G FAU - Navarro Soto, Salvador AU - Navarro Soto S FAU - Puyana, Juan Carlos AU - Puyana JC LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - UG3 HL151595/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220328 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM CIN - J Trauma Acute Care Surg. 2022 Oct 1;93(4):e149. doi: 10.1097/TA.0000000000003677. PMID: 35687800 CIN - J Trauma Acute Care Surg. 2022 Oct 1;93(4):e149-e150. doi: 10.1097/TA.0000000000003717. PMID: 35687801 MH - *Blood Coagulation Disorders/etiology/therapy MH - Blood Transfusion/methods MH - Fibrinogen/therapeutic use MH - Hemorrhage/drug therapy/therapy MH - *Hemostatics/therapeutic use MH - Humans MH - Thrombelastography/methods MH - *Wounds and Injuries/complications/therapy PMC - PMC9329202 MID - NIHMS1792719 COIS- CONFLICT OF INTEREST: We declare no conflicts of interest associated with this publication. EDAT- 2022/04/01 06:00 MHDA- 2022/07/29 06:00 PMCR- 2023/08/01 CRDT- 2022/03/31 17:14 PHST- 2022/04/01 06:00 [pubmed] PHST- 2022/07/29 06:00 [medline] PHST- 2022/03/31 17:14 [entrez] PHST- 2023/08/01 00:00 [pmc-release] AID - 01586154-202208000-00004 [pii] AID - 10.1097/TA.0000000000003624 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Aug 1;93(2):166-175. doi: 10.1097/TA.0000000000003624. Epub 2022 Mar 28. PMID- 35340703 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220329 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 7 IP - 1 DP - 2022 TI - Treatment with ddAVP improves platelet-based coagulation in a rat model of traumatic hemorrhagic shock. PG - e000852 LID - 10.1136/tsaco-2021-000852 [doi] LID - e000852 AB - OBJECTIVES: Trauma-induced hemorrhagic shock is characterized by increased endothelial permeability and coagulopathy. Vasopressin analog ddAVP (desmopressin) acts by reorganizing and redistributing adhesive and tight junction molecules, enhancing endothelial barrier function. Furthermore, ddAVP increases von Willebrand factor (vWF) plasma levels and thereby potentially enhances platelet-based coagulation. The objective of this study was to assess whether the use of ddAVP results in improvement of both endothelial barrier function and platelet-based coagulation, thereby improving shock reversal and reduce organ failure in a rat model of trauma and transfusion. METHODS: Blood products were prepared from syngeneic rat blood according to blood bank standards. Polytrauma was induced in Sprague Dawley rats by a fractured femur and crush injury to the intestines and liver. The rats were hemorrhaged until a mean arterial pressure of 40 mm Hg and transfused with RBCs, fresh frozen plasmas and platelets in a 1:1:1 ratio, and randomized to receive a single dose of ddAVP (n=7 per group). Blood samples were taken up to 6 hours after trauma to assess biochemistry, markers of endothelial injury and coagulation status by rotational thromboelastometry (ROTEM). Organ damage was assessed by histopathology. RESULTS: Rats receiving ddAVP showed significantly better shock reversal compared with controls. Also, coagulation parameters remained stable in the ddAVP treated group, whereas rats in the control group showed deterioration of coagulation parameters, including decreased clot strength and decreased platelet functioning (89% (IQR 82% to 92%) of baseline values). Platelet count and vWF antigen levels at exsanguination did not differ between groups. ddAVP did not reduce markers of endothelial dysfunction nor markers of organ injury. CONCLUSIONS: The use of ddAVP in a rat trauma-transfusion model improved shock parameters and ROTEM parameters of clot formation. However, this did not abrogate the amount of organ failure. LEVEL OF EVIDENCE: Level III. CI - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Wirtz, Mathijs R AU - Wirtz MR AUID- ORCID: 0000-0002-1923-083X AD - Department of Intensive Care Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centres, Amsterdam, Netherlands. FAU - Roelofs, Joris J AU - Roelofs JJ AD - Department of Pathology, Amsterdam University Medical Centres, Amsterdam, Netherlands. FAU - Goslings, J Carel AU - Goslings JC AD - Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, Netherlands. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centres, Amsterdam, Netherlands. LA - eng PT - Journal Article DEP - 20220308 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC8905935 OTO - NOTNLM OT - animal experimentation OT - blood coagulation OT - hemorrhage OT - multiple trauma COIS- Competing interests: None declared. EDAT- 2022/03/29 06:00 MHDA- 2022/03/29 06:01 PMCR- 2022/03/08 CRDT- 2022/03/28 05:13 PHST- 2021/11/08 00:00 [received] PHST- 2022/02/16 00:00 [accepted] PHST- 2022/03/28 05:13 [entrez] PHST- 2022/03/29 06:00 [pubmed] PHST- 2022/03/29 06:01 [medline] PHST- 2022/03/08 00:00 [pmc-release] AID - tsaco-2021-000852 [pii] AID - 10.1136/tsaco-2021-000852 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2022 Mar 8;7(1):e000852. doi: 10.1136/tsaco-2021-000852. eCollection 2022. PMID- 35328366 OWN - NLM STAT- MEDLINE DCOM- 20220408 LR - 20250530 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 23 IP - 6 DP - 2022 Mar 9 TI - The Efficacy of Fibrinogen Concentrates in Relation to Cryoprecipitate in Restoring Clot Integrity and Stability against Lysis. LID - 10.3390/ijms23062944 [doi] LID - 2944 AB - Loss of fibrinogen is a feature of trauma-induced coagulopathy (TIC), and restoring this clotting factor is protective against hemorrhages. We compared the efficacy of cryoprecipitate, and of the fibrinogen concentrates RiaSTAP((R)) and FibCLOT((R)) in restoring the clot integrity in models of TIC. Cryoprecipitate and FibCLOT((R)) produced clots with higher maximal absorbance and enhanced resistance to lysis relative to RiaSTAP((R)). The fibrin structure of clots, comprising cryoprecipitate and FibCLOT((R)), mirrored those of normal plasma, whereas those with RiaSTAP((R)) showed stunted fibers and reduced porosity. The hemodilution of whole blood reduced the maximum clot firmness (MCF) as assessed by thromboelastography. MCF could be restored with the inclusion of 1 mg/mL of fibrinogen, but only FibCLOT((R)) was effective at stabilizing against lysis. The overall clot strength, measured using the Quantra((R)) hemostasis analyzer, was restored with both fibrinogen concentrates but not cryoprecipitate. alpha(2)antiplasmin and plasminogen activator inhibitor-1 (PAI-1) were constituents of cryoprecipitate but were negligible in RiaSTAP((R)) and FibCLOT((R)). Interestingly, cryoprecipitate and FibCLOT((R)) contained significantly higher factor XIII (FXIII) levels, approximately three-fold higher than RiaSTAP((R)). Our data show that 1 mg/mL fibrinogen, a clinically achievable concentration, can restore adequate clot integrity. However, FibCLOT((R)), which contained more FXIII, was superior in normalizing the clot structure and in stabilizing hemodiluted clots against mechanical and fibrinolytic degradation. FAU - Whyte, Claire S AU - Whyte CS AUID- ORCID: 0000-0001-8127-6102 AD - Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. FAU - Rastogi, Akriti AU - Rastogi A AD - Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. FAU - Ferguson, Ellis AU - Ferguson E AD - Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. FAU - Donnarumma, Michela AU - Donnarumma M AD - Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. FAU - Mutch, Nicola J AU - Mutch NJ AUID- ORCID: 0000-0002-7452-0813 AD - Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. LA - eng GR - PG/15/82/31721/BHF_/British Heart Foundation/United Kingdom GR - PG/20/17/35050/BHF_/British Heart Foundation/United Kingdom GR - N/A/Friends of Anchor/ GR - G17.03/Tenovus Scotland Grampian/ PT - Journal Article DEP - 20220309 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Hemostatics) RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) SB - IM MH - *Blood Coagulation Disorders MH - Factor XIII/pharmacology/therapeutic use MH - Fibrin/chemistry MH - Fibrinogen/metabolism MH - *Hemostatics MH - Humans MH - Thrombelastography MH - *Thrombosis PMC - PMC8949572 OTO - NOTNLM OT - coagulation OT - cryoprecipitate OT - fibrinogen OT - fibrinolysis OT - trauma COIS- N.J.M. has received funding from LFB (Les Ulis, France) for investigator-led studies. EDAT- 2022/03/26 06:00 MHDA- 2022/04/09 06:00 PMCR- 2022/03/09 CRDT- 2022/03/25 01:06 PHST- 2022/02/15 00:00 [received] PHST- 2022/02/25 00:00 [revised] PHST- 2022/03/03 00:00 [accepted] PHST- 2022/03/25 01:06 [entrez] PHST- 2022/03/26 06:00 [pubmed] PHST- 2022/04/09 06:00 [medline] PHST- 2022/03/09 00:00 [pmc-release] AID - ijms23062944 [pii] AID - ijms-23-02944 [pii] AID - 10.3390/ijms23062944 [doi] PST - epublish SO - Int J Mol Sci. 2022 Mar 9;23(6):2944. doi: 10.3390/ijms23062944. PMID- 35327451 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220329 IS - 2227-9059 (Print) IS - 2227-9059 (Electronic) IS - 2227-9059 (Linking) VI - 10 IP - 3 DP - 2022 Mar 11 TI - The Antiplatelet Action of S-Nitroso Human Serum Albumin in Whole Blood. LID - 10.3390/biomedicines10030649 [doi] LID - 649 AB - Nitric oxide donors (NO-donors) have been shown to have therapeutic potential (e.g., ischemia/reperfusion injury). However, due to their release rate/antiplatelet properties, they may cause bleeding in patients. We therefore studied the antiplatelet effects of the two different NO-donors, i.e., S-NO-Human Serum Albumin (S-NO-HSA) and Diethylammonium (Z)-1-(N,N-diethylamino)diazen-1-ium-1,2-diolate (DEA-NONOate) in whole blood (WB) samples. WB samples were spiked with S-NO-HSA or DEA-NONOate (100 micromol/L or 200 micromol/L), and the NO release rate (nitrite/nitrate levels via HPLC) and antiplatelet efficacy (impedance aggregometry, platelet function analyzer, Cone-and-platelet analyzer, thrombelastometry) were assessed. S-NO-HSA had a significantly lower NO release compared to equimolar concentrations of DEA-NONOate. Virtually no antiplatelet action of S-NO-HSA was observed in WB samples, whereas DEA-NONOate significantly attenuated platelet function in WB. Impedance aggregometry measurements revealed that Amplitudes (slope: -0.04022 +/- 0.01045 ohm/micromol/L, p = 0.008) and Lag times (slope: 0.6389 +/- 0.2075 s/micromol/L, p = 0.0051) were dose-dependently decreased and prolonged by DEA-NONOate. Closure times (Cone-and-platelet analyzer) were dose-dependently prolonged (slope: 0.3738 +/- 0.1403 s/micromol/L, p = 0.0174 with collagen/ADP coating; slope: -0.5340 +/- 0.1473 s/micromol/L, p = 0.0019 with collagen/epinephrine coating) by DEA-NONOate. These results in WB further support the pharmacological potential of S-NO-HSA as an NO-donor due to its ability to presumably prevent bleeding events even at high concentrations up to 200 micromol/L. FAU - Tsiountsioura, Melina AU - Tsiountsioura M AD - Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria. FAU - Cvirn, Gerhard AU - Cvirn G AUID- ORCID: 0000-0002-1410-1844 AD - Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria. FAU - Schlagenhauf, Axel AU - Schlagenhauf A AD - Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria. FAU - Haidl, Harald AU - Haidl H AD - Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria. FAU - Zischmeier, Kathrin AU - Zischmeier K AD - Department of Pharmacology and Toxicology, University of Graz, 8010 Graz, Austria. FAU - Janschitz, Nicole AU - Janschitz N AD - Department of Pharmacology and Toxicology, University of Graz, 8010 Graz, Austria. FAU - Koestenberger, Martin AU - Koestenberger M AUID- ORCID: 0000-0003-1766-7859 AD - Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria. FAU - Wonisch, Willibald AU - Wonisch W AUID- ORCID: 0000-0001-7171-9539 AD - Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria. FAU - Paar, Margret AU - Paar M AUID- ORCID: 0000-0001-5494-8890 AD - Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria. FAU - Wagner, Thomas AU - Wagner T AD - Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria. FAU - Weiss, Eva-Christine AU - Weiss EC AD - Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria. FAU - Hallstrom, Seth AU - Hallstrom S AD - Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria. AD - Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria. LA - eng PT - Journal Article DEP - 20220311 PL - Switzerland TA - Biomedicines JT - Biomedicines JID - 101691304 PMC - PMC8945101 OTO - NOTNLM OT - impedance aggregometry OT - nitric oxide donors OT - platelet function COIS- The authors declare no conflict of interest. EDAT- 2022/03/26 06:00 MHDA- 2022/03/26 06:01 PMCR- 2022/03/11 CRDT- 2022/03/25 01:04 PHST- 2022/01/25 00:00 [received] PHST- 2022/03/01 00:00 [revised] PHST- 2022/03/09 00:00 [accepted] PHST- 2022/03/25 01:04 [entrez] PHST- 2022/03/26 06:00 [pubmed] PHST- 2022/03/26 06:01 [medline] PHST- 2022/03/11 00:00 [pmc-release] AID - biomedicines10030649 [pii] AID - biomedicines-10-00649 [pii] AID - 10.3390/biomedicines10030649 [doi] PST - epublish SO - Biomedicines. 2022 Mar 11;10(3):649. doi: 10.3390/biomedicines10030649. PMID- 35320155 OWN - NLM STAT- MEDLINE DCOM- 20220427 LR - 20230928 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 92 IP - 4 DP - 2022 Apr 1 TI - Traumatic brain injury patients with platelet inhibition receiving platelet transfusion demonstrate decreased need for neurosurgical intervention and decreased mortality. PG - 701-707 LID - 10.1097/TA.0000000000003516 [doi] AB - BACKGROUND: Platelet dysfunction is known to occur in patients with traumatic brain injury (TBI), and the correction of platelet dysfunction may prevent hemorrhagic progression in TBI. Thromboelastography with platelet mapping (TEG-PM; Haemonetics) evaluates the degree of platelet function inhibition through the adenosine diphosphate (ADP) and arachidonic acid (AA) pathways. We hypothesized that ADP and AA inhibition would improve with the transfusion of platelets in patients with TBI. METHODS: A retrospective review was conducted at a Level I trauma center of all patients presenting with TBI from December 2019 to December 2020. Per a practice management guideline, a platelet mapping assay was obtained on all patients with TBI upon admission. If ADP or AA was found to be inhibited (>60%), the patient was transfused 1 unit of platelets and a repeat platelet mapping assay was ordered. Demographic data, laboratory values, and outcomes were analyzed. RESULTS: Over the 13-month study period, 453 patients with TBI underwent TEG-PM with a protocol adherence rate of 66.5% resulting in a total of 147 patients who received platelets for ADP and/or AA inhibition; of those, 107 underwent repeat TEG-PM after platelets were administered. With the administration of platelets, ADP (p < 0.0001), AA (p < 0.0001), and MA (p = 0.0002) all significantly improved. Of 330 patients with TBI not taking antiplatelet medications, 50.9% showed inhibition in ADP and/or AA. If AA or ADP inhibition was noted on admission, mortality was increased (p = 0.0108). If ADP improved with platelet administration, the need for neurosurgical intervention was noted to decrease (p = 0.0182). CONCLUSION: Patients with TBI and platelet inhibition may benefit from the administration of platelets to correct platelet dysfunction. Thromboelastography with platelet mapping may be implemented in the initial workup of patients presenting with TBI to assess platelet dysfunction and provide prognostic information, which may guide treatment. LEVEL OF EVIDENCE: Therapeutic / Care Management, level III. CI - Copyright (c) 2022 American Association for the Surgery of Trauma. FAU - Miles, M Victoria P AU - Miles MVP AD - From the Department of Surgery, University of Tennessee College of Medicine Chattanooga (M.V.P.M., R.C.H., H.P., R.M.), Chattanooga; University of Tennessee College of Medicine (C.B., A.E.), Memphis; Department of Surgery, Erlanger Health System (K.S.); and Department of Mathematics (L.G.), University of Tennessee Chattanooga, Chattanooga, Tennessee. FAU - Hicks, R Chace AU - Hicks RC FAU - Parmer, Hunter AU - Parmer H FAU - Brown, Caroline AU - Brown C FAU - Edwards, Abigail AU - Edwards A FAU - Stewart, Kathryn AU - Stewart K FAU - Gao, Lani AU - Gao L FAU - Maxwell, Robert AU - Maxwell R LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 27YG812J1I (Arachidonic Acid) RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Adenosine Diphosphate MH - Arachidonic Acid MH - *Blood Platelet Disorders MH - *Brain Injuries, Traumatic/complications/surgery MH - Humans MH - Platelet Transfusion MH - Thrombelastography/methods EDAT- 2022/03/24 06:00 MHDA- 2022/04/28 06:00 CRDT- 2022/03/23 17:15 PHST- 2022/03/23 17:15 [entrez] PHST- 2022/03/24 06:00 [pubmed] PHST- 2022/04/28 06:00 [medline] AID - 01586154-202204000-00010 [pii] AID - 10.1097/TA.0000000000003516 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Apr 1;92(4):701-707. doi: 10.1097/TA.0000000000003516. PMID- 35311971 OWN - NLM STAT- MEDLINE DCOM- 20220620 LR - 20220727 IS - 1945-7197 (Electronic) IS - 0021-972X (Linking) VI - 107 IP - 7 DP - 2022 Jun 16 TI - Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis. PG - e2930-e2937 LID - 10.1210/clinem/dgac177 [doi] AB - CONTEXT: Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment. OBJECTIVE: We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules. METHODS: The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury. RESULTS: The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively. CONCLUSION: Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram. CI - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Zhao, Zhen-Long AU - Zhao ZL AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. FAU - Wei, Ying AU - Wei Y AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. FAU - Peng, Li-Li AU - Peng LL AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. FAU - Li, Yan AU - Li Y AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. FAU - Lu, Nai-Cong AU - Lu NC AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. FAU - Yu, Ming-An AU - Yu MA AUID- ORCID: 0000-0003-0797-4564 AD - Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China. LA - eng GR - 62176268/National Natural Science Foundation of China/ PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Endocrinol Metab JT - The Journal of clinical endocrinology and metabolism JID - 0375362 SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - *Recurrent Laryngeal Nerve Injuries/epidemiology/etiology/surgery MH - Retrospective Studies MH - Risk Factors MH - Thyroid Cancer, Papillary/surgery MH - *Thyroid Neoplasms/complications/epidemiology/surgery MH - *Thyroid Nodule/complications/epidemiology/surgery MH - Thyroidectomy/adverse effects OTO - NOTNLM OT - heat injury OT - hoarseness OT - recurrent laryngeal nerve OT - thermal ablation OT - thyroid nodule EDAT- 2022/03/22 06:00 MHDA- 2022/06/22 06:00 CRDT- 2022/03/21 12:17 PHST- 2021/11/09 00:00 [received] PHST- 2022/03/22 06:00 [pubmed] PHST- 2022/06/22 06:00 [medline] PHST- 2022/03/21 12:17 [entrez] AID - 6551221 [pii] AID - 10.1210/clinem/dgac177 [doi] PST - ppublish SO - J Clin Endocrinol Metab. 2022 Jun 16;107(7):e2930-e2937. doi: 10.1210/clinem/dgac177. PMID- 35290265 OWN - NLM STAT- MEDLINE DCOM- 20220502 LR - 20220502 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 234 IP - 4 DP - 2022 Apr 1 TI - Role of Fibrinogen in Trauma-Induced Coagulopathy. PG - 465-473 LID - 10.1097/XCS.0000000000000078 [doi] AB - BACKGROUND: Fibrinogen is the first coagulation factor to decrease after massive hemorrhage. European massive transfusion guidelines recommend early repletion of fibrinogen; however, this practice has not been widely adopted in the US. We hypothesize that hypofibrinogenemia is common at hospital arrival and is an integral component of trauma-induced coagulopathy. STUDY DESIGN: This study entailed review of a prospective observational database of adults meeting the highest-level activation criteria at an urban level 1 trauma center from 2014 through 2020. Resuscitation was initiated with 2:1 red blood cell (RBC) to fresh frozen plasma (FFP) ratios and continued subsequently with goal-directed thrombelastography. Hypofibrinogenemia was defined as fibrinogen below 150 mg/dL. Massive transfusion (MT) was defined as more than 10 units RBC or death after receiving at least 1 unit RBC over the first 6 hours of admission. RESULTS: Of 476 trauma activation patients, 70 (15%) were hypofibrinogenemic on admission, median age was 34 years, 78% were male, median New Injury Severity Score (NISS) was 25, and 72 patients died (15%). Admission fibrinogen level was an independent risk factor for MT (odds ratio [OR] 0.991, 95% CI 0.987-0.996]. After controlling for confounders, NISS (OR 1.034, 95% CI 1.017-1.052), systolic blood pressure (OR 0.991, 95% CI 0.983-0.998), thrombelastography angle (OR 0.925, 95% CI 0.896-0.954), and hyperfibrinolysis (OR 2.530, 95% CI 1.160-5.517) were associated with hypofibrinogenemia. Early cryoprecipitate administration resulted in the fastest correction of hypofibrinogenemia. CONCLUSION: Hypofibrinogenemia is common after severe injury and predicts MT. Cryoprecipitate transfusion results in the most expeditious correction. Earlier administration of cryoprecipitate should be considered in MT protocols. CI - Copyright (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Meizoso, Jonathan P AU - Meizoso JP AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). FAU - Moore, Ernest E AU - Moore EE AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). FAU - Pieracci, Fredric M AU - Pieracci FM AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). FAU - Saberi, Rebecca A AU - Saberi RA AD - DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL (Saberi, Namias). FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). FAU - Chandler, James AU - Chandler J AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). FAU - Namias, Nicholas AU - Namias N AD - DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL (Saberi, Namias). FAU - Sauaia, Angela AU - Sauaia A AD - From the Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO (Meizoso, Moore, Pieracci). AD - Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO (Meizoso, Moore, Pieracci, Ghasabyan, Chandler, Sauaia). AD - University of Colorado, School of Public Health, Aurora, CO (Sauaia). LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - *Afibrinogenemia/complications/therapy MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Female MH - Fibrinogen/therapeutic use MH - Hemorrhage/etiology MH - *Hemostatics MH - Humans MH - Male MH - Thrombelastography MH - *Wounds and Injuries/complications/therapy EDAT- 2022/03/16 06:00 MHDA- 2022/05/03 06:00 CRDT- 2022/03/15 17:18 PHST- 2022/03/15 17:18 [entrez] PHST- 2022/03/16 06:00 [pubmed] PHST- 2022/05/03 06:00 [medline] AID - 00019464-202204000-00008 [pii] AID - 10.1097/XCS.0000000000000078 [doi] PST - ppublish SO - J Am Coll Surg. 2022 Apr 1;234(4):465-473. doi: 10.1097/XCS.0000000000000078. PMID- 35282394 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220315 IS - 2574-2167 (Electronic) IS - 2574-2167 (Linking) VI - 5 IP - 1 Suppl DP - 2022 Mar TI - An in vivo rabbit joint injury model to measure trauma-induced coagulopathy and the effect of timing of administration of ketotifen fumarate on posttraumatic joint contracture. PG - e177 LID - 10.1097/OI9.0000000000000177 [doi] LID - e177 AB - OBJECTIVES: Using a rabbit in vivo joint injury model, the primary objective of the study was to determine if a relationship exists between earlier time to initiation of ketotifen fumarate (KF) treatment and posttraumatic joint contracture (PTJC) reduction. The secondary objective was to determine if a coagulation response could be detected with serial thrombelastography (TEG) analysis following acute trauma in this model. METHODS: PTJC of the knee were created in 25 skeletally mature, New Zealand White rabbits. Five groups of 5 animals were studied: a control group that received twice daily subcutaneous injections of normal saline and 4 treatment groups that received twice daily subcutaneous injections of KF (0.5 mg/kg) starting immediately, 1-, 2-, and 4-weeks post-injury. After 8 weeks of immobilization, flexion contractures were measured biomechanically. Serial TEG analysis was performed on the control group animals pre-injury and weekly post-injury. RESULTS: The average joint contracture in the Control Group (43.1 degrees +/- 16.2 degrees ) was higher than all KF treatment groups; however, the differences were not statistically significant. The average joint contracture was lowest in the 2-week post-injury treatment group (29.4 degrees +/- 12.1 degrees ), although not statistically significant compared to the other treatment groups. Serial TEG analysis demonstrated significantly higher mean maximal amplitude (maximal amplitude = 68.9 +/- 1.7 mm; P < .001), alpha-angle (81.9 degrees +/- 0.9 degrees ; P < .001), and coagulation index (4.5 +/- 0.3; P < .001) 1-week post-injury, which normalized to pre-injury values by 5-weeks post-injury. CONCLUSIONS: The use of the mast cell stabilizer KF within 2 weeks of injury demonstrated a nonsignificant trend towards reducing joint contracture in a rabbit in vivo model of PTJC. TEG and the in vivo rabbit joint injury model may be valuable in future preclinical studies of venous thromboembolism prevention and furthering our understanding of the pathophysiology of posttraumatic hypercoagulability. CI - Copyright (c) 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. FAU - You, Daniel AU - You D AD - Section of Orthopaedic Surgery. AD - McCaig Institute for Bone and Joint Health. FAU - Maarouf, Nadia AU - Maarouf N AD - McCaig Institute for Bone and Joint Health. FAU - Hildebrand, Kevin AU - Hildebrand K AD - Section of Orthopaedic Surgery. AD - McCaig Institute for Bone and Joint Health. FAU - Soo, Andrea AU - Soo A AD - Department of Critical Care Medicine, University of Calgary, Calgary, Canada. FAU - Schneider, Prism AU - Schneider P AD - Section of Orthopaedic Surgery. AD - McCaig Institute for Bone and Joint Health. LA - eng PT - Journal Article DEP - 20220310 PL - United States TA - OTA Int JT - OTA international : the open access journal of orthopaedic trauma JID - 101770383 PMC - PMC8900463 OTO - NOTNLM OT - joint contracture OT - ketotifen fumarate OT - mast cell stabilizer OT - posttraumatic OT - range of motion EDAT- 2022/03/15 06:00 MHDA- 2022/03/15 06:01 PMCR- 2022/03/10 CRDT- 2022/03/14 05:33 PHST- 2021/11/24 00:00 [received] PHST- 2021/12/20 00:00 [accepted] PHST- 2022/03/14 05:33 [entrez] PHST- 2022/03/15 06:00 [pubmed] PHST- 2022/03/15 06:01 [medline] PHST- 2022/03/10 00:00 [pmc-release] AID - OTAI-D-21-00086 [pii] AID - 10.1097/OI9.0000000000000177 [doi] PST - epublish SO - OTA Int. 2022 Mar 10;5(1 Suppl):e177. doi: 10.1097/OI9.0000000000000177. eCollection 2022 Mar. PMID- 35253989 OWN - NLM STAT- MEDLINE DCOM- 20220524 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 20 IP - 6 DP - 2022 Jun TI - Full-length plasma skeletal muscle myosin isoform deficiency is associated with coagulopathy in acutely injured patients. PG - 1385-1389 LID - 10.1111/jth.15695 [doi] AB - BACKGROUND: Skeletal muscle myosin (SkM) molecules are procoagulant both in vitro and in vivo. The association of plasma SkM isoforms with blood coagulability and hemostatic capacity has not been defined. OBJECTIVES: We hypothesized that coagulopathy in acutely injured patients is associated with procoagulant plasma SkM heavy chain levels. METHODS: To test this hypothesis, citrated whole blood and plasma from 104 trauma patients were collected and studied to obtain data for rapid thrombelastography, international normalized ratios, and plasma SkM levels. Coagulability parameters were dichotomized by the threshold for the hypercoagulable trauma-induced coagulopathy. RESULTS: Lower plasma full-length SkM heavy chain (full-SkM) levels were associated with higher international normalized ratio values (>1.3) (p = .03). The full-SkM levels were also associated with a lower rate of clot propagation (thrombelastography angle <65 degrees ) (p = .004), and plasma full-SkM levels were positively correlated with the thrombelastography angle (r(2) = .32, p = .0007). The trauma patient group with the lower plasma full-SkM levels showed an association with lower clot strength (maximum amplitude <55 mm) (p = .002), and plasma full-SkM levels positively correlated with maximum amplitude (r(2) = .27, p = .005). Hyperfibrinolysis was associated with significantly decreased full-SkM levels (p = .03). Trauma patients who required red blood cells and fresh frozen plasma transfusions had lower plasma full-SkM levels compared with those without transfusions (p = .04 and .02, respectively). CONCLUSIONS: In acutely injured trauma patients, lower levels of plasma full-SkM levels are linked to hypocoagulability in trauma-induced coagulopathy, implying that SkM plays a role in the hemostatic capacity in trauma patients and may contribute to trauma-induced coagulopathy. CI - (c) 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis. FAU - Coleman, Julia R AU - Coleman JR AUID- ORCID: 0000-0001-5610-9249 AD - Department of Surgery, University of Colorado, Aurora, Colorado, USA. FAU - Deguchi, Hiroshi AU - Deguchi H AUID- ORCID: 0000-0002-7721-1207 AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA. FAU - Deguchi, Taichi K AU - Deguchi TK AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA. FAU - Cohen, Mitchel J AU - Cohen MJ AD - Department of Surgery, University of Colorado, Aurora, Colorado, USA. AD - Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado, USA. AD - Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Griffin, John H AU - Griffin JH AUID- ORCID: 0000-0002-4302-2547 AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA. AD - Department of Medicine, University of California, San Diego, California, USA. LA - eng GR - R01 HL142975/HL/NHLBI NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - R01HL133728/HL/NHLBI NIH HHS/United States GR - R01 HL133728/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - R01HL142975/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220320 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Hemostatics) RN - 0 (Protein Isoforms) RN - EC 3.6.1.- (Skeletal Muscle Myosins) SB - IM MH - *Blood Coagulation Disorders/etiology MH - *Hemostatics MH - Humans MH - Plasma MH - Protein Isoforms MH - Skeletal Muscle Myosins MH - Thrombelastography MH - *Wounds and Injuries/complications PMC - PMC9310574 OTO - NOTNLM OT - blood coagulation OT - blood transfusion OT - myosin OT - thrombin OT - trauma COIS- The authors declare no competing financial interests. EDAT- 2022/03/08 06:00 MHDA- 2022/05/25 06:00 PMCR- 2022/07/25 CRDT- 2022/03/07 08:49 PHST- 2022/02/01 00:00 [revised] PHST- 2021/09/20 00:00 [received] PHST- 2022/02/22 00:00 [accepted] PHST- 2022/03/08 06:00 [pubmed] PHST- 2022/05/25 06:00 [medline] PHST- 2022/03/07 08:49 [entrez] PHST- 2022/07/25 00:00 [pmc-release] AID - S1538-7836(22)00190-8 [pii] AID - JTH15695 [pii] AID - 10.1111/jth.15695 [doi] PST - ppublish SO - J Thromb Haemost. 2022 Jun;20(6):1385-1389. doi: 10.1111/jth.15695. Epub 2022 Mar 20. PMID- 35253114 OWN - NLM STAT- MEDLINE DCOM- 20240424 LR - 20240729 IS - 1098-8785 (Electronic) IS - 0735-1631 (Linking) VI - 41 IP - 7 DP - 2024 May TI - Viscoelastic Testing in an Obstetric Population at High Risk of Hemorrhage. PG - 915-923 LID - 10.1055/a-1788-5025 [doi] AB - INTRODUCTION: Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test used in trauma for goal-directed transfusion. However, there are limited data on baseline ROTEM parameters in the U.S. obstetric population. Obtaining baseline parameters is a first step in implementing a goal-directed massive transfusion protocol in obstetric hemorrhage. OBJECTIVE: Our study aimed to establish pre- and postdelivery baseline parameters in a high-risk obstetric population and determine their association with postpartum hemorrhage (PPH). STUDY DESIGN: Prospective observational study of patients >/=34 weeks' gestation, at high risk of PPH, admitted for delivery. INTEM, EXTEM, FIBTEM, and APTEM assays were performed at the time of admission to labor and delivery and then 2 hours after delivery. Primary outcome was pre- and postdelivery ROTEM parameters among women without PPH. A sample size of 60 women was needed for >90% power to detect at least 50% correlation between pre- and postdelivery assuming a loss of 10% of participants to follow-up. RESULTS: Of 60 women in the study, 10 (17%) had PPH. Baseline characteristics were not different between those with or without PPH. Pre- and postdelivery ROTEM parameters were not significantly different except for APTEM. None of the patients who had PPH, compared with 4 (10%) of those who did not, had shortened clotting time and higher maximum clot firmness in postdelivery APTEM compared with EXTEM, a pattern suggestive of hyperfibrinolysis (p = 0.4). CONCLUSION: In this study, we describe baseline ROTEM parameters in women at high risk of PPH. The majority of patients did not have a ROTEM pattern that is suggestive of hyperfibrinolysis, for which tranexamic acid is thought to be beneficial. Based on our findings, previously established obstetric transfusion thresholds for goal-directed massive transfusion protocols are likely valid for the majority of the obstetric population regardless of the presence of comorbidities or pregnancy complications. KEY POINTS: . ROTEM parameters do not vary significantly before and after delivery.. . Most patients did not have a hyperfibrinolysis pattern, for which tranexamic acid is thought to be beneficial.. . Previous goal-directed obstetric transfusion thresholds are likely valid in most populations.. CI - Thieme. All rights reserved. FAU - Graves, Stephen M AU - Graves SM AUID- ORCID: 0000-0003-2723-0650 AD - Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio. FAU - Montemorano, Lauren AU - Montemorano L AD - Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. FAU - Rood, Kara M AU - Rood KM AD - Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio. FAU - Costantine, Maged M AU - Costantine MM AUID- ORCID: 0000-0003-4076-469X AD - Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio. FAU - Fiorini, Kasey AU - Fiorini K AD - Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio. FAU - Cackovic, Michael AU - Cackovic M AD - Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20220304 PL - United States TA - Am J Perinatol JT - American journal of perinatology JID - 8405212 SB - IM MH - Humans MH - Female MH - *Thrombelastography/methods MH - *Postpartum Hemorrhage/blood MH - Pregnancy MH - Prospective Studies MH - Adult MH - Blood Transfusion MH - Young Adult COIS- The ROTEM delta analyzer device was borrowed from Instrumentation Laboratory for the conduct of this project. Divisional funds were used to purchase the reagents. Instrumentation Laboratory had no input on the study protocol or interpretation of the findings. Otherwise, the authors report no conflict of interest. EDAT- 2022/03/08 06:00 MHDA- 2024/04/25 00:54 CRDT- 2022/03/07 06:12 PHST- 2024/04/25 00:54 [medline] PHST- 2022/03/08 06:00 [pubmed] PHST- 2022/03/07 06:12 [entrez] AID - 10.1055/a-1788-5025 [doi] PST - ppublish SO - Am J Perinatol. 2024 May;41(7):915-923. doi: 10.1055/a-1788-5025. Epub 2022 Mar 4. PMID- 35229804 OWN - NLM STAT- MEDLINE DCOM- 20220302 LR - 20220302 IS - 1319-2442 (Print) IS - 1319-2442 (Linking) VI - 32 IP - 4 DP - 2021 Jul-Aug TI - Potential Applicability of Perioperative Thromboelastography to Access the Coagulopathies in Live-Related Renal Transplantation - A Prospective Observational Pilot Study. PG - 1043-1053 LID - 10.4103/1319-2442.338278 [doi] AB - Ischemic and reperfusion injury (IRI) occurs during organ transplantation. IRI during liver transplantation is well studied and established; results in coagulopathy due to release of heparin-like substances and platelet trapping. During renal transplantation, similar IRI phenomenon occurs, and thromboelastography (TEG) can be used to detect and manage coagulopathy. The preoperative, immediate postreperfusion, and postoperative day 1 TEG was done on 25 cases of live-related renal transplantation. Coagulopathy was defined by deranged and abnormal TEG variables values from baseline and supported by the clinical presence of nonsurgical oozing and bleeding in the surgical field. The postreperfusion TEG values showed coagulopathic changes. About 64% of patients had R-time (RT) more than 12 min, 64% of patients showed maximum amplitude (MA) <55 mm, and 76% of patients had alpha angle <55 degrees . The presurgical TEG clotting index (CI) was +2.45 +/- 1.25, postreperfusion CI was -1.96 +/- 4.54, and postoperative CI was +4.02 +/- 1.35. Univariate analysis revealed that antithymocyte globulin was a significant, but etiology was closure to a significant level as protecting factor, but in multivariate analysis, both variables showed protecting factor with insignificant results. There was a weak correlation between CI with serum creatinine at all time points suggested no linear relationship between serum creatinine and corresponding CI. Hence, the results of study proves that IRI during renal transplant is associated with transient self-limiting coagulopathy, that may be early detected by TEG. CI values in postoperative 24 h apart indicating a hyper-coagulable or prothrombotic state and post-reperfusion CI values show a trend toward hypocoagulable status. No significant effect of different immunosuppression on coagulation and week correlation was found of serum creatinine level (graft function) with CI, which conclude that changes in coagulation have not affected graft function. FAU - Sam, Amal Francis AU - Sam AF AD - Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. FAU - Sahu, Sandeep AU - Sahu S AD - Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. FAU - Ponnappan, Karthik T AU - Ponnappan KT AD - Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India. FAU - Saeed, Zakia AU - Saeed Z AD - Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. FAU - Sindwani, Gaurav AU - Sindwani G AD - Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India. FAU - Srivastava, Aneesh AU - Srivastava A AD - Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India. FAU - Prasad, Narayan AU - Prasad N AD - Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India. LA - eng PT - Journal Article PT - Observational Study PL - Saudi Arabia TA - Saudi J Kidney Dis Transpl JT - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia JID - 9436968 SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Humans MH - *Kidney Transplantation/adverse effects MH - Pilot Projects MH - Prospective Studies MH - Thrombelastography/adverse effects/methods EDAT- 2022/03/02 06:00 MHDA- 2022/03/03 06:00 CRDT- 2022/03/01 08:42 PHST- 2022/03/01 08:42 [entrez] PHST- 2022/03/02 06:00 [pubmed] PHST- 2022/03/03 06:00 [medline] AID - SaudiJKidneyDisTranspl_2021_32_4_1043_338278 [pii] AID - 10.4103/1319-2442.338278 [doi] PST - ppublish SO - Saudi J Kidney Dis Transpl. 2021 Jul-Aug;32(4):1043-1053. doi: 10.4103/1319-2442.338278. PMID- 35207392 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220301 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 4 DP - 2022 Feb 20 TI - Use of Thromboelastography and Rotational Thromboelastometry in Otolaryngology: A Narrative Review. LID - 10.3390/jcm11041119 [doi] LID - 1119 AB - In the field of otolaryngology-head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient's real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis. FAU - Marsee, Mathew K AU - Marsee MK AD - Department of Graduate Medical Education, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA. FAU - Shariff, Faisal S AU - Shariff FS AD - Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Wiarda, Grant AU - Wiarda G AUID- ORCID: 0000-0002-1561-6161 AD - Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA. FAU - Watson, Patrick J AU - Watson PJ AD - Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Sualeh, Ali H AU - Sualeh AH AD - Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA. FAU - Brenner, Toby J AU - Brenner TJ AUID- ORCID: 0000-0002-5970-9730 AD - Department of Biochemistry, Indiana Wesleyan University, Marion, IN 46953, USA. FAU - McCoy, Max L AU - McCoy ML AUID- ORCID: 0000-0002-2143-7944 AD - Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA. FAU - Al-Fadhl, Hamid D AU - Al-Fadhl HD AD - Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA. FAU - Jones, Alexander J AU - Jones AJ AUID- ORCID: 0000-0002-9219-285X AD - Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Davis, Patrick K AU - Davis PK AD - Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Zimmer, David AU - Zimmer D AD - Cleveland Clinic Foundation, Cleveland, OH 44195, USA. FAU - Folsom, Craig AU - Folsom C AD - Department of Otolaryngology, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA. LA - eng PT - Journal Article PT - Review DEP - 20220220 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8876674 OTO - NOTNLM OT - adenoidectomy OT - adenotonsillectomy OT - epistaxis OT - head and neck oncology OT - head and neck surgery OT - microvascular free flap reconstruction OT - obstructive sleep apnea OT - otolaryngology OT - rotational thromboelastometry OT - thromboelastography OT - tonsillectomy COIS- The authors declare no conflict of interest. EDAT- 2022/02/26 06:00 MHDA- 2022/02/26 06:01 PMCR- 2022/02/20 CRDT- 2022/02/25 01:12 PHST- 2022/01/12 00:00 [received] PHST- 2022/02/09 00:00 [revised] PHST- 2022/02/18 00:00 [accepted] PHST- 2022/02/25 01:12 [entrez] PHST- 2022/02/26 06:00 [pubmed] PHST- 2022/02/26 06:01 [medline] PHST- 2022/02/20 00:00 [pmc-release] AID - jcm11041119 [pii] AID - jcm-11-01119 [pii] AID - 10.3390/jcm11041119 [doi] PST - epublish SO - J Clin Med. 2022 Feb 20;11(4):1119. doi: 10.3390/jcm11041119. PMID- 35203106 OWN - NLM STAT- MEDLINE DCOM- 20220719 LR - 20221015 IS - 1742-6723 (Electronic) IS - 1742-6731 (Print) IS - 1742-6723 (Linking) VI - 34 IP - 4 DP - 2022 Aug TI - Rotational thromboelastometry in children presenting to an Australian major trauma centre: A retrospective cohort study. PG - 590-598 LID - 10.1111/1742-6723.13939 [doi] AB - OBJECTIVE: This retrospective cohort study aims to describe patterns of rotational thromboelastometry (ROTEM) results in paediatric trauma following the implementation of a ROTEM-guided critical bleeding algorithm and major haemorrhage protocol (MHP). METHODS: This retrospective observational study was conducted in a tertiary trauma hospital in Queensland, Australia, where point-of-care ROTEM was introduced for paediatric patients in 2014. All children aged less than 18 years who had a ROTEM test during their presentation between January 2014 and December 2017 for a traumatic injury were included in the dataset. Other children with a record in the hospital's trauma registry in the same period were also screened for blood product usage. Data were collected for frequency of ROTEM testing, pathology and ROTEM results, blood product and antifibrinolytic use along with injury related data. Compliance with recommended treatment thresholds for detected coagulopathy was also reviewed. RESULTS: A total of 1039 children were listed in the trauma registry, including 167 children having a ROTEM test for trauma. Factors significantly associated with having a ROTEM test were older age, higher injury severity score (ISS >12) and penetrating injury. A result exceeding a treatment threshold was returned for 122 (73.1%) of 167 children, with hyperfibrinolysis identified in 88 (52.6%) of 167 and hypofibrinogenaemia identified in 54 (32.3%) of 167. Adherence with the recommended treatments for those children where a treatment threshold was exceeded was low in this cohort. CONCLUSION: The use of ROTEM-guided blood component replacement is an emerging practice in children for both traumatic and non-traumatic bleeding. Targeted replacement of identified coagulation defects guided by rapid point-of-care testing is an emerging alternative to fixed-ratio-based protocols. Further research is required to validate treatment thresholds in the paediatric population and further investigate the clinical outcomes for patients as a result of early correction of trauma-induced coagulopathy. CI - (c) 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine. FAU - George, Shane AU - George S AUID- ORCID: 0000-0002-8880-1245 AD - Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. FAU - Wake, Elizabeth AU - Wake E AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Sweeny, Amy AU - Sweeny A AUID- ORCID: 0000-0001-8392-5612 AD - Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Faculty of Medicine, Bond University, Gold Coast, Queensland, Australia. FAU - Campbell, Don AU - Campbell D AUID- ORCID: 0000-0003-0679-7455 AD - Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Winearls, James AU - Winearls J AD - Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia. LA - eng PT - Journal Article PT - Observational Study DEP - 20220224 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - Australia MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Transfusion/methods MH - Child MH - Cohort Studies MH - Hemorrhage/diagnosis/etiology MH - Humans MH - Retrospective Studies MH - *Thrombelastography/methods MH - Trauma Centers PMC - PMC9542394 OTO - NOTNLM OT - paediatric OT - trauma OT - viscoelastic haemostatic assay EDAT- 2022/02/25 06:00 MHDA- 2022/07/20 06:00 PMCR- 2022/10/07 CRDT- 2022/02/24 20:17 PHST- 2022/01/09 00:00 [revised] PHST- 2021/09/06 00:00 [received] PHST- 2022/01/29 00:00 [accepted] PHST- 2022/02/25 06:00 [pubmed] PHST- 2022/07/20 06:00 [medline] PHST- 2022/02/24 20:17 [entrez] PHST- 2022/10/07 00:00 [pmc-release] AID - EMM13939 [pii] AID - 10.1111/1742-6723.13939 [doi] PST - ppublish SO - Emerg Med Australas. 2022 Aug;34(4):590-598. doi: 10.1111/1742-6723.13939. Epub 2022 Feb 24. PMID- 35196304 OWN - NLM STAT- MEDLINE DCOM- 20220307 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 92 IP - 3 DP - 2022 Mar 1 TI - Variations in clot phenotype following injury: The MA-R ratio and fragile clots. PG - 504-510 LID - 10.1097/TA.0000000000003442 [doi] AB - INTRODUCTION: Trauma-induced coagulopathy is a continuum ranging from hypercoagulable to hypercoagulable phenotypes. In single-center studies, the maximum amplitude (MA) to r-time (R) (MA-R) ratio has identified a phenotype of injured patients with high mortality risk. The purpose of this study was to determine the relationship between MA-R and mortality using multicenter data and to investigate fibrinogen consumption in the development of this specific coagulopathy phenotype. METHODS: Using the Pragmatic Randomized Optimal Platelet and Plasma Ratios data set, patients were divided into blunt and penetrating injury cohorts. MA was divided by R time from admission thromboelastogram to calculate MA-R. MA-R was used to assess odds of early and late mortality using multivariable models. Multivariable models were used to assess thrombogram values in both cohorts. Refinement of the MA-R cut point was performed with Youden index. Repeat multivariable analysis was performed with a binary CRITICAL and NORMAL MA-R. RESULTS: In initial analysis, MA-R quartiles were not associated with mortality in the penetrating cohort. In the blunt cohort, there was an association between low MA-R and early and late mortality. A refined cut point of 11 was identified (CRITICAL: MA-R, 11). CRITICAL MA-R was associated with mortality in both penetrating and blunt subgroups. In further injury subgroup analysis, CRITICAL patients had significantly decreased fibrinogen levels in the blunt subgroup only. In both blunt and penetrating injury, there was no difference in time to initiation of thrombin burst (lagtime). However, both endogenous thrombin potential and peak thrombin levels were significantly lower in CRITICAL patients. CONCLUSIONS: MA-R identifies a trauma-induced coagulopathy phenotype characterized in blunt injury by impaired thrombin generation that is associated with early and late mortality. The endotheliopathy and tissue factor release likely plays a role in the cascade of impaired thrombin burst, possible early fibrinogen consumption and the weaker clot identified by MA-R. LEVEL OF EVIDENCE: Therapeutic/care management, level II. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Harrington, James AU - Harrington J AD - From the Department of Surgery, University of Wisconsin School of Medicine and Public Health (J.H., B.L.Z., S.A.S), Madison, Wisconsin; Department of Surgery, University of Texas Health Science Center at Houston (E.E.F., C.E.W.), Houston, Texas; and Department of Surgery, University of Alabama at Birmingham (J.B.H.), Birmingham, Alabama. FAU - Zarzaur, Ben L AU - Zarzaur BL FAU - Fox, Erin E AU - Fox EE FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB FAU - Savage, Stephanie A AU - Savage SA LA - eng GR - U01 HL077863/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/*etiology/*mortality/therapy MH - *Blood Coagulation Tests MH - Datasets as Topic MH - Female MH - Humans MH - Male MH - Phenotype MH - Thrombelastography MH - Wounds and Injuries/*complications PMC - PMC8887779 MID - NIHMS1750182 COIS- There are no conflicts of interest or financial support related to this study. EDAT- 2022/02/24 06:00 MHDA- 2022/03/08 06:00 PMCR- 2023/03/01 CRDT- 2022/02/23 17:12 PHST- 2022/02/23 17:12 [entrez] PHST- 2022/02/24 06:00 [pubmed] PHST- 2022/03/08 06:00 [medline] PHST- 2023/03/01 00:00 [pmc-release] AID - 01586154-202203000-00005 [pii] AID - 10.1097/TA.0000000000003442 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Mar 1;92(3):504-510. doi: 10.1097/TA.0000000000003442. PMID- 35175155 OWN - NLM STAT- MEDLINE DCOM- 20220412 LR - 20220516 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 82 IP - 2 DP - 2022 Apr TI - Real-life experiences with goal-directed prohemostatic therapy with fibrinogen concentrate, prothrombin complex concentrate, and recombinant factor VIIa: a retrospective study of 287 consecutive patients. PG - 156-161 LID - 10.1080/00365513.2022.2040048 [doi] AB - The Danish Capital Region Blood Bank operates a 24/7 on-call service staffed with physicians specialized in hemostatic management to guide clinicians in hemostatic resuscitation, including administration of prohemostatic therapy (PHT). The outcome of patients who receive PHT as part of hemostatic resuscitation remains unanswered. The objective of this study was therefore to investigate clinical outcome of patients receiving PHT managed by the on-call service. We identified 287 patients who received PHT during 2015-16, of which 161 (59%) received fibrinogen concentrate (FC), 111 (39%) received prothrombin complex concentrate (PCC), and 15 (5%) received recombinant factor VIIa (rFVIIa) as the first product. Patients were critically ill with a 30-day mortality of 31%. Among FC recipients, cardiothoracic admission, non-trauma, and antithrombotics predicted survival. FC recipients had lower platelet count and thrombelastography clot strengths than the other PHT groups and within the group, these factors predicted mortality. The symptomatic thromboembolic event (TE) rate at 30 days was 5%. For PCC recipients, vitamin K antagonists predicted survival, while rivaroxaban predicted mortality. TE rate was 2%. We did not identify factors associated with survival in the small group of rFVIIa recipients. TE rate was 13%. In summary, trauma and coagulopathy predicted mortality in patients who received FC and our data suggest that optimization of PHT algorithms may be possible. Outcome of patients who received PCC was comparable to results reported elsewhere and its use may be safe in a setting as reported here. Recombinant FVIIa was rarely used but had the highest incidence of arterial thromboembolism. FAU - Vigstedt, Martin AU - Vigstedt M AUID- ORCID: 0000-0003-0896-1204 AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Henriksen, Hanne H AU - Henriksen HH AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Chaachouh, Hadi W AU - Chaachouh HW AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. AD - Department of Anaesthesiology, Center of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. LA - eng PT - Journal Article DEP - 20220217 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) RN - 0 (Recombinant Proteins) RN - 37224-63-8 (prothrombin complex concentrates) RN - 9001-32-5 (Fibrinogen) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Blood Coagulation Factors/therapeutic use MH - Factor VIIa MH - Fibrinogen/analysis/therapeutic use MH - Goals MH - *Hemostatics/therapeutic use MH - Humans MH - Recombinant Proteins/adverse effects MH - Retrospective Studies MH - *Thromboembolism/drug therapy OTO - NOTNLM OT - Factor VIIa OT - fibrinogen OT - hemostasis OT - prothrombin complex concentrates OT - thrombelastography EDAT- 2022/02/18 06:00 MHDA- 2022/04/13 06:00 CRDT- 2022/02/17 12:19 PHST- 2022/02/18 06:00 [pubmed] PHST- 2022/04/13 06:00 [medline] PHST- 2022/02/17 12:19 [entrez] AID - 10.1080/00365513.2022.2040048 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2022 Apr;82(2):156-161. doi: 10.1080/00365513.2022.2040048. Epub 2022 Feb 17. PMID- 35170585 OWN - NLM STAT- MEDLINE DCOM- 20220623 LR - 20220807 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 93 IP - 1 DP - 2022 Jul 1 TI - Traumatic brain injury provokes low fibrinolytic activity in severely injured patients. PG - 8-12 LID - 10.1097/TA.0000000000003559 [doi] AB - BACKGROUND: Traumatic brain injury (TBI) in combination with shock has been associated with hypocoagulability. However, recent data suggest that TBI itself can promote a systemic procoagulant state via the release of brain-derived extracellular vesicles. The objective of our study was to identify if TBI was associated with differences in thrombelastography indices when controlling for other variables associated with coagulopathy following trauma. We hypothesized that TBI is independently associated with a less coagulopathic state. METHODS: Prospective study includes all highest-level trauma activations at an urban Level I trauma center, from 2014 to 2020. Traumatic brain injury was defined as Abbreviated Injury Scale head score greater than 3. Blood samples were drawn at emergency department admission. Linear regression was used to assess the role of independent predictors on trauma induced coagulopathy. Models adjusted for Injury Severity Score (ISS), shock (defined as ED SBP<70, or ED SBP<90 and ED HR>108, or first hospital base deficit >10), and prehospital Glasgow Coma Scale score. RESULTS: Of the 1,023 patients included, 291 (28%) suffered a TBI. Traumatic brain injury patients more often were female (26% vs. 19%, p = 0.01), had blunt trauma (83% vs. 43%, p < 0.0001), shock (33% vs. 25%, p = 0.009), and higher median ISS (29 vs. 10, p < 0.0001). Fibrinolysis shutdown (25% vs. 18%) was more common in the TBI group (p < 0.0001). When controlled for the confounding effects of ISS and shock, the presence of TBI independently decreases lysis at 30 minutes (LY30) (beta estimate: -0.16 +/- 0.06, p = 0.004). This effect of TBI on LY30 persisted when controlling for sex and mechanism of injury in addition to ISS and shock (beta estimate: -0.13 +/- 0.06, p = 0.022). CONCLUSION: Traumatic brain injury is associated with lower LY30 independent of shock, tissue injury, sex, and mechanism of injury. These findings suggest a propensity toward a hypercoagulable state in patients with TBI, possibly due to fibrinolysis shutdown. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III. CI - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved. FAU - Meizoso, Jonathan P AU - Meizoso JP AD - From the DeWitt Daughtry Family Department of Surgery (J.P.M., G.P.G.), University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida; Department of Surgery (H.B.M., E.E.M., F.M.P., A.S.), University of Colorado Denver; Ernest E. Moore Shock Trauma Center at Denver Health Medical Center (E.E.M., A.G., J.C., F.M.P.), Denver; and Colorado School of Public Health (A.S.), Aurora, Colorado. FAU - Moore, Hunter B AU - Moore HB FAU - Moore, Ernest E AU - Moore EE FAU - Gilna, Gareth P AU - Gilna GP FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chandler, James AU - Chandler J FAU - Pieracci, Fredric M AU - Pieracci FM FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220214 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Abbreviated Injury Scale MH - *Blood Coagulation Disorders/diagnosis/etiology MH - *Brain Injuries, Traumatic/complications/diagnosis MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Prospective Studies MH - *Shock/complications EDAT- 2022/02/17 06:00 MHDA- 2022/06/24 06:00 CRDT- 2022/02/16 08:43 PHST- 2022/02/17 06:00 [pubmed] PHST- 2022/06/24 06:00 [medline] PHST- 2022/02/16 08:43 [entrez] AID - 01586154-202207000-00002 [pii] AID - 10.1097/TA.0000000000003559 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Jul 1;93(1):8-12. doi: 10.1097/TA.0000000000003559. Epub 2022 Feb 14. PMID- 35160311 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220406 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 11 IP - 3 DP - 2022 Feb 7 TI - Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. LID - 10.3390/jcm11030860 [doi] LID - 860 AB - Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG((R)) 5000) and rotational thromboelastometry (ROTEM((R)) delta), have been supplanted not only by cartridge systems (TEG((R)) 6S and ROTEM((R)) sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot((R)), Quantra((R)), and ClotPro((R))). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy. FAU - Volod, Oksana AU - Volod O AUID- ORCID: 0000-0001-6285-7585 AD - Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. FAU - Bunch, Connor M AU - Bunch CM AUID- ORCID: 0000-0002-8566-7001 AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. AD - Department of Internal Medicine, Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Zackariya, Nuha AU - Zackariya N AD - Department of Internal Medicine, Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Moore, Ernest E AU - Moore EE AUID- ORCID: 0000-0002-0419-4848 AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO 80204, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO 80204, USA. FAU - Kwaan, Hau C AU - Kwaan HC AUID- ORCID: 0000-0002-5733-6248 AD - Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. FAU - Neal, Matthew D AU - Neal MD AD - Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. FAU - Al-Fadhl, Mahmoud D AU - Al-Fadhl MD AUID- ORCID: 0000-0002-3481-1966 AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Patel, Shivani S AU - Patel SS AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Wiarda, Grant AU - Wiarda G AUID- ORCID: 0000-0002-1561-6161 AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Al-Fadhl, Hamid D AU - Al-Fadhl HD AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - McCoy, Max L AU - McCoy ML AUID- ORCID: 0000-0002-2143-7944 AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Thomas, Anthony V AU - Thomas AV AUID- ORCID: 0000-0001-9520-9306 AD - Department of Internal Medicine, Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Thomas, Scott G AU - Thomas SG AD - Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA. FAU - Gillespie, Laura AU - Gillespie L AD - Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Khan, Rashid Z AU - Khan RZ AD - Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN 46545, USA. FAU - Zamlut, Mahmud AU - Zamlut M AD - Department of Critical Care Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Kamphues, Peter AU - Kamphues P AD - Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Fries, Dietmar AU - Fries D AD - Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Walsh, Mark M AU - Walsh MM AUID- ORCID: 0000-0002-5795-1144 AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. AD - Department of Internal Medicine, Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. LA - eng GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review DEP - 20220207 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8836477 OTO - NOTNLM OT - COVID-19 OT - coagulopathy OT - fibrinogen OT - hemorrhage OT - heparin OT - personalized medicine OT - rotational thromboelastometry OT - thromboelastography OT - thrombosis COIS- O.V. is a consultant for Haemonetics Corporation (Boston, MA, USA), served on the Clinical Care Improvement Steering Committee for Diagnostica Stago, Inc., and received honoraria for consultancy outside the submitted work. E.E.M., H.B.M., M.D.N. and M.M.W. have received research grants from Haemonetics Corporation outside the submitted work. M.D.N. has received an honorarium from Haemonetics Corporation for speaking engagements, as well as research support from Janssen Pharmaceuticals (Beerse, Belgium) and Noveome Biotherapeutics (Pittsburgh, PA, USA) outside the submitted work. He has served as a consultant to Janssen and CSL Behring (King of Prussia, PA, USA) and serves on the Scientific Advisory Board of Haima Therapeutics (Cleveland, OH, USA). M.M.W. has received honoraria from Alexion Pharmaceuticals (Boston, MA, USA). D.F. has received study funding, honoraria for consultancy, and shows board activity from Astra Zeneca, AOP orphan, Baxter, Bayer, B. Braun Medical, Biotest, CSL Behring, Delta Select, Dade Behring, Edwards, Fresenius, Glaxo, Haemoscope, Hemogem, Lilly, LFB, Mitsubishi Pharma, Novo Nordisk, Octapharma, Pfizer, and Tem Innovations outside the submitted work. EDAT- 2022/02/16 06:00 MHDA- 2022/02/16 06:01 PMCR- 2022/02/07 CRDT- 2022/02/15 01:07 PHST- 2022/01/07 00:00 [received] PHST- 2022/01/28 00:00 [revised] PHST- 2022/02/02 00:00 [accepted] PHST- 2022/02/15 01:07 [entrez] PHST- 2022/02/16 06:00 [pubmed] PHST- 2022/02/16 06:01 [medline] PHST- 2022/02/07 00:00 [pmc-release] AID - jcm11030860 [pii] AID - jcm-11-00860 [pii] AID - 10.3390/jcm11030860 [doi] PST - epublish SO - J Clin Med. 2022 Feb 7;11(3):860. doi: 10.3390/jcm11030860. PMID- 35128953 OWN - NLM STAT- MEDLINE DCOM- 20230612 LR - 20230612 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 89 IP - 5 DP - 2023 May TI - Massive Transfusion Activations in Non-Trauma Patients. PG - 1719-1724 LID - 10.1177/00031348221075752 [doi] AB - INTRODUCTION: Massive transfusion activations (MTAs) are commonly used in the care of the trauma patient. However, MTA for trauma patients constitutes only a small fraction of MTA at our institution. The aim of this study was to characterize MTA in non-trauma patients to better understand how this strategy is employed at a larger tertiary hospital. METHODS: All MTA involving non-trauma patients from January 2017 to April 2019 were reviewed. Patients with unclear indications for MTA were excluded. Data collected included patient demographics, reason for MTA, transfusion ratios, use of adjunctive antifibrinolytics, use of viscoelastic testing, and vasopressor administration at the time of MTA. RESULTS: There were 328 patients and 353 MTA identified over the study period. The mean age was 52.0 years and 40.9% were male. Patients were most commonly under the care of a medical service (55.2%), while 25.3% were obstetric patients and 19.5% were surgical patients. Compliance with 1:1:1 transfusion ratios was low. Concomitant vasopressor use was high (70.8%), while antifibrinolytic agents (13.0%) and viscoelastic testing (19.0%) were used less commonly. The overall mortality of the study population was 56.1%. CONCLUSIONS: Massive transfusion activations are frequently used in non-trauma patients. There was a low rate of adherence to 1:1:1 transfusion ratios as well as utilization of adjuncts and tools that could allow for targeted resuscitation. Understanding practice patterns relating to MTA may allow for an opportunity for improvement. FAU - Dhillon, Navpreet K AU - Dhillon NK AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Abumuhor, Ihab AU - Abumuhor I AD - Department of Pathology, Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Hayes, Chelsea AU - Hayes C AD - Department of Pathology, Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Nammalwar, Shruthi AU - Nammalwar S AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Ghoulian, Joshua AU - Ghoulian J AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Asadi, Mona AU - Asadi M AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 FAU - Ley, Eric J AU - Ley EJ AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RINGGOLD: 22494 LA - eng PT - Journal Article DEP - 20220205 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Vasoconstrictor Agents) SB - IM MH - Humans MH - Male MH - Middle Aged MH - Female MH - Retrospective Studies MH - *Blood Transfusion MH - Resuscitation MH - Vasoconstrictor Agents MH - Health Facilities MH - *Wounds and Injuries/therapy MH - Trauma Centers OTO - NOTNLM OT - blood OT - massive transfusion OT - massive transfusion activation OT - massive transfusion protocol OT - resuscitation EDAT- 2022/02/08 06:00 MHDA- 2023/06/12 06:42 CRDT- 2022/02/07 08:42 PHST- 2023/06/12 06:42 [medline] PHST- 2022/02/08 06:00 [pubmed] PHST- 2022/02/07 08:42 [entrez] AID - 10.1177/00031348221075752 [doi] PST - ppublish SO - Am Surg. 2023 May;89(5):1719-1724. doi: 10.1177/00031348221075752. Epub 2022 Feb 5. PMID- 35118557 OWN - NLM STAT- MEDLINE DCOM- 20220810 LR - 20250728 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 48 IP - 4 DP - 2022 Aug TI - Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy? PG - 2751-2761 LID - 10.1007/s00068-022-01882-6 [doi] AB - PURPOSE: It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PT(ratio) threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PT(ratio) (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis. METHODS: Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PT(ratio) or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PT(ratio) and ROTEM parameter subclasses with mortality. RESULTS: Three thresholds were, respectively, identified for PT(ratio) (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PT(ratio): 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91-130 s (moderate TIC), 131-200 s (severe TIC) and > 200 s (major TIC). We observed that when the PT(ratio) (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PT(ratio) and EXTEM-CT was independently associated with mortality at 24-h. CONCLUSION: In this study, we have described a pragmatic classification of coagulopathy utilizing PT(ratio) and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products. CI - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. FAU - David, Jean-Stephane AU - David JS AUID- ORCID: 0000-0001-6274-7044 AD - Department d'Anesthesie Reanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. js-david@univ-lyon1.fr. AD - Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France. js-david@univ-lyon1.fr. FAU - Friggeri, Arnaud AU - Friggeri A AD - Department d'Anesthesie Reanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. FAU - Vacheron, Charles-Herve AU - Vacheron CH AD - Department d'Anesthesie Reanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. FAU - Bouzat, Pierre AU - Bouzat P AD - Department of Anesthesia and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, 38000, Grenoble, France. FAU - Fraticelli, Laurie AU - Fraticelli L AD - RESUVAL Trauma Network, Lucien Hussel General Hospital, Vienne, France. AD - EA 4129 P2S Parcours Sante Systemique, University Claude Bernard Lyon 1, 69008, Lyon, France. FAU - Claustre, Clement AU - Claustre C AD - RESUVAL Trauma Network, Lucien Hussel General Hospital, Vienne, France. AD - EA 4129 P2S Parcours Sante Systemique, University Claude Bernard Lyon 1, 69008, Lyon, France. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, 200, 51109, Cologne, Germany. FAU - Inaba, Kenji AU - Inaba K AD - Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA. LA - eng PT - Journal Article DEP - 20220203 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - *Blood Coagulation Disorders/etiology MH - Blood Coagulation Tests MH - Humans MH - Retrospective Studies MH - *Thrombelastography OTO - NOTNLM OT - Blood products OT - Coagulopathy OT - Injury OT - Outcome OT - ROTEM EDAT- 2022/02/05 06:00 MHDA- 2022/08/11 06:00 CRDT- 2022/02/04 05:54 PHST- 2021/09/21 00:00 [received] PHST- 2022/01/17 00:00 [accepted] PHST- 2022/02/05 06:00 [pubmed] PHST- 2022/08/11 06:00 [medline] PHST- 2022/02/04 05:54 [entrez] AID - 10.1007/s00068-022-01882-6 [pii] AID - 10.1007/s00068-022-01882-6 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2022 Aug;48(4):2751-2761. doi: 10.1007/s00068-022-01882-6. Epub 2022 Feb 3. PMID- 35115430 OWN - NLM STAT- MEDLINE DCOM- 20220311 LR - 20230706 IS - 1873-233X (Electronic) IS - 0029-7844 (Linking) VI - 139 IP - 3 DP - 2022 Mar 1 TI - Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage. PG - 463-472 LID - 10.1097/AOG.0000000000004686 [doi] AB - Obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Thromboelastography and rotational thromboelastometry are laboratory methods of assessing the kinetics of blood clot formation through real-time measurement of viscoelastic clot strength and may aid in management of severe hemorrhage. Although first described more than 70 years ago, viscoelastic testing devices are now available that allow for rapid point-of-care use of this technology to aid in real-time management of blood product replacement in cases of severe hemorrhage. These devices can be used to visually estimate multiple facets of hemostasis-coagulation, platelet function, and fibrinolysis-within 10-20 minutes. They have been used successfully in cardiac surgery, trauma, and liver transplantation and have potential for use in management of obstetric hemorrhage. Goals with their use include targeted transfusion of blood and its components for specific coagulation deficiencies. To date, however, published experiences with the use of these viscoelastic tests for obstetric hemorrhage have been limited. Because of the increasing use of the point-of-care tests by anesthesiologists, surgeons, and intensivists, the purpose of this report is to familiarize obstetricians with the technology involved and its use in severe hemorrhage complicating pregnancy. CI - Copyright (c) 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Nelson, David B AU - Nelson DB AD - Department of Obstetrics and Gynecology and the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Ogunkua, Olutoyosi AU - Ogunkua O FAU - Cunningham, F Gary AU - Cunningham FG LA - eng PT - Journal Article PL - United States TA - Obstet Gynecol JT - Obstetrics and gynecology JID - 0401101 SB - IM MH - Female MH - Humans MH - *Point-of-Care Testing MH - Postpartum Hemorrhage/blood/*diagnosis/therapy MH - Pregnancy MH - Thrombelastography/*instrumentation/*methods COIS- Financial Disclosure F. Gary Cunningham discloses royalties from McGraw-Hill Publishing Company for textbook preparation and royalties from Wolters Kluwer for online publication. The other authors did not report any potential conflicts of interest. EDAT- 2022/02/05 06:00 MHDA- 2022/03/12 06:00 CRDT- 2022/02/04 05:44 PHST- 2021/09/24 00:00 [received] PHST- 2021/11/04 00:00 [accepted] PHST- 2022/02/05 06:00 [pubmed] PHST- 2022/03/12 06:00 [medline] PHST- 2022/02/04 05:44 [entrez] AID - 00006250-202203000-00019 [pii] AID - 10.1097/AOG.0000000000004686 [doi] PST - ppublish SO - Obstet Gynecol. 2022 Mar 1;139(3):463-472. doi: 10.1097/AOG.0000000000004686. PMID- 35110037 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220716 IS - 2667-677X (Print) IS - 2667-6370 (Electronic) IS - 2149-276X (Linking) VI - 49 IP - 5 DP - 2021 Oct TI - Evolution of Practices in a French Trauma Centre: Decrease in Blood Transfusions and Fresh Frozen Plasma to Red Blood Cell Ratios. PG - 365-372 LID - 10.5152/TJAR.2021.1229 [doi] AB - OBJECTIVE: The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEMVR in a trauma resuscitation unit (TRU) from a French teaching hospital (FTH). METHODS: This is a single-centre, retrospective study at a TRU from a FTH. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period. The secondary objectives aimed at assessing differences between populations according to the fresh frozen plasma (FFP):RBC ratio applied. RESULTS: A total of 122 patients were included. There was a significant decrease in the proportion of patients requiring at least 4 RBCs 24 hours after trauma (9% vs. 3%, P trend < .0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6 hours, P trend (1/4) .0056 and 86% vs. 56% at 24 hours, P trend (1/4) .0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio. CONCLUSION: An important evolution of practices occurred including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM protocol for fibrinogen administration. FAU - Pernod, Cyril AU - Pernod C AD - Department of Anesthesiology and Intensive care medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. FAU - Fraticelli, Laurie AU - Fraticelli L AD - RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France;EA4129, Systemic Health Pathway Laboratory, University Lyon, Lyon, France. FAU - Marcotte, Guillaume AU - Marcotte G AD - Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France. FAU - Floccard, Bernard AU - Floccard B AD - Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France. FAU - Girardot, Thibaut AU - Girardot T AD - Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France;EA7426, Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France. FAU - Claustre, Clement AU - Claustre C AD - RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France. FAU - Khoury, Carlos El AU - Khoury CE AD - RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France; Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France;Hesper Ea, Claude Bernard Lyon 1 University, Lyon, France. FAU - Rimmele, Thomas AU - Rimmele T AD - Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France;EA7426, Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France. LA - eng PT - Journal Article PL - Turkey TA - Turk J Anaesthesiol Reanim JT - Turkish journal of anaesthesiology and reanimation JID - 101680817 PMC - PMC9053685 COIS- Conflict of Interest: The authors have no conflicts of interest to declare. EDAT- 2022/02/04 06:00 MHDA- 2022/02/04 06:01 PMCR- 2021/10/21 CRDT- 2022/02/03 05:28 PHST- 2022/02/03 05:28 [entrez] PHST- 2022/02/04 06:00 [pubmed] PHST- 2022/02/04 06:01 [medline] PHST- 2021/10/21 00:00 [pmc-release] AID - tjar-49-5-365 [pii] AID - 10.5152/TJAR.2021.1229 [doi] PST - ppublish SO - Turk J Anaesthesiol Reanim. 2021 Oct;49(5):365-372. doi: 10.5152/TJAR.2021.1229. PMID- 35093142 OWN - NLM STAT- MEDLINE DCOM- 20220325 LR - 20220325 IS - 1749-799X (Electronic) IS - 1749-799X (Linking) VI - 17 IP - 1 DP - 2022 Jan 29 TI - Not all patients benefit from the postoperative antifibrinolytic treatment: clinical evidence against the universal use of tranexamic acid following total knee arthroplasty. PG - 59 LID - 10.1186/s13018-022-02958-0 [doi] LID - 59 AB - BACKGROUND: The empirical use of tranexamic acid (TXA) for bleeding remains controversial because of the distinct fibrinolytic phenotypes observed after injury. This study sought to assess the efficacy of postoperative TXA in patients presenting with different fibrinolytic phenotypes after total knee arthroplasty (TKA). METHODS: This retrospective study included 270 patients who underwent primary TKA. The patients were divided into two groups: Group A, received no postoperative TXA, and Group B, received postoperative TXA; they were further categorized into four subgroups based on postoperative fibrinolytic phenotypes (non-fibrinolytic shutdown [NFSD] and fibrinolytic shutdown [FSD]). Fibrinolytic phenotypes were determined using percentage of clot lysis 30 min after maximum strength (LY30) level measured on postoperative day 1 (POD1). Data on perioperative hidden blood loss (HBL), decrease in the hemoglobin level (DeltaHb), allogeneic blood transfusion (ABT) rate, fibrin degradation product (FDP) level, D-dimer (D-D) level, prothrombin time (PT), and activated partial thromboplastin time (APTT) as well as clinical baseline data were collected and compared. RESULTS: No differences in baseline clinical data were noted. Among patients presenting with NFSD, those in Group B had significantly lower HBL and DeltaHb on POD1 and POD3 than those in Group A. Among patients presenting with FSD, perioperative HBL and DeltaHb were similar between the two groups. No differences were observed in perioperative ABT rate, FDP level, D-D level, PT, and APTT. CONCLUSIONS: Patients exhibit various fibrinolytic phenotypes after TKA. Postoperative antifibrinolytic strategies may be beneficial for patients presenting with NFSD, but not for those presenting with FSD. The LY30 level may guide targeted TXA administration after TKA. However, well-designed prospective randomized controlled trials are needed to obtain more robust data. CI - (c) 2022. The Author(s). FAU - Liu, Jiacheng AU - Liu J AD - Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. FAU - Wang, Han AU - Wang H AD - Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, China. FAU - Wu, Xiangdong AU - Wu X AD - Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. FAU - Lei, Yiting AU - Lei Y AD - Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. FAU - Huang, Wei AU - Huang W AUID- ORCID: 0000-0001-9116-2985 AD - Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. huangwei68@263.net. LA - eng PT - Journal Article DEP - 20220129 PL - England TA - J Orthop Surg Res JT - Journal of orthopaedic surgery and research JID - 101265112 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Administration, Intravenous MH - Aged MH - Aged, 80 and over MH - Antifibrinolytic Agents/administration & dosage/*therapeutic use MH - Arthroplasty, Replacement, Knee/*adverse effects MH - Blood Loss, Surgical/*prevention & control MH - Female MH - Humans MH - Male MH - Middle Aged MH - Postoperative Hemorrhage/*prevention & control MH - Prospective Studies MH - Retrospective Studies MH - Thrombelastography MH - Tranexamic Acid/administration & dosage/*therapeutic use MH - Treatment Outcome PMC - PMC8800271 OTO - NOTNLM OT - Antifibrinolysis OT - Fibrinolytic shutdown OT - Total knee arthroplasty OT - Tranexamic acid COIS- The authors have no relevant financial or non-financial interests to disclose. EDAT- 2022/01/31 06:00 MHDA- 2022/03/26 06:00 PMCR- 2022/01/29 CRDT- 2022/01/30 20:27 PHST- 2021/12/18 00:00 [received] PHST- 2022/01/21 00:00 [accepted] PHST- 2022/01/30 20:27 [entrez] PHST- 2022/01/31 06:00 [pubmed] PHST- 2022/03/26 06:00 [medline] PHST- 2022/01/29 00:00 [pmc-release] AID - 10.1186/s13018-022-02958-0 [pii] AID - 2958 [pii] AID - 10.1186/s13018-022-02958-0 [doi] PST - epublish SO - J Orthop Surg Res. 2022 Jan 29;17(1):59. doi: 10.1186/s13018-022-02958-0. PMID- 35091729 OWN - NLM STAT- MEDLINE DCOM- 20220201 LR - 20220207 IS - 2972-4066 (Electronic) IS - 0304-4602 (Linking) VI - 51 IP - 1 DP - 2022 Jan TI - Trauma-induced coagulopathy: Mechanisms and clinical management. PG - 40-48 LID - 10.47102/annals-acadmedsg.2020381 [doi] AB - INTRODUCTION: Trauma-induced coagulopathy (TIC) is a form of coagulopathy unique to trauma patients and is associated with increased mortality. The complexity and incomplete understanding of TIC have resulted in controversies regarding optimum management. This review aims to summarise the pathophysiology of TIC and appraise established and emerging advances in the management of TIC. METHODS: This narrative review is based on a literature search (MEDLINE database) completed in October 2020. Search terms used were "trauma induced coagulopathy", "coagulopathy of trauma", "trauma induced coagulopathy pathophysiology", "massive transfusion trauma induced coagulopathy", "viscoelastic assay trauma induced coagulopathy", "goal directed trauma induced coagulopathy and "fibrinogen trauma induced coagulopathy'. RESULTS: TIC is not a uniform phenotype but a spectrum ranging from thrombotic to bleeding phenotypes. Evidence for the management of TIC with tranexamic acid, massive transfusion protocols, viscoelastic haemostatic assays (VHAs), and coagulation factor and fibrinogen concentrates were evaluated. Although most trauma centres utilise fixed-ratio massive transfusion protocols, the "ideal" transfusion ratio of blood to blood products is still debated. While more centres are using VHAs to guide blood product replacement, there is no agreed VHA-based transfusion strategy. The use of VHA to quantify the functional contributions of individual components of coagulation may permit targeted treatment of TIC but remains controversial. CONCLUSION: A greater understanding of TIC, advances in point-of-care coagulation testing, and availability of coagulation factors and fibrinogen concentrates allows clinicians to employ a more goal-directed approach. Still, hospitals need to tailor their approaches according to available resources, provide training and establish local guidelines. FAU - Ho, Vui Kian AU - Ho VK AD - Surgical Intensive Care, Division of Anaesthesiology, Singapore General Hospital, Singapore. FAU - Wong, Jolin AU - Wong J FAU - Martinez, Angelly AU - Martinez A FAU - Winearls, James AU - Winearls J LA - eng PT - Journal Article PT - Review PL - Singapore TA - Ann Acad Med Singap JT - Annals of the Academy of Medicine, Singapore JID - 7503289 RN - 0 (Hemostatics) SB - IM MH - *Blood Coagulation Disorders/etiology/therapy MH - Blood Transfusion MH - Hemorrhage MH - Hemostasis MH - *Hemostatics MH - Humans EDAT- 2022/01/30 06:00 MHDA- 2022/02/02 06:00 CRDT- 2022/01/29 05:45 PHST- 2022/01/29 05:45 [entrez] PHST- 2022/01/30 06:00 [pubmed] PHST- 2022/02/02 06:00 [medline] AID - 10.47102/annals-acadmedsg.2020381 [doi] PST - ppublish SO - Ann Acad Med Singap. 2022 Jan;51(1):40-48. doi: 10.47102/annals-acadmedsg.2020381. PMID- 35081595 OWN - NLM STAT- MEDLINE DCOM- 20220427 LR - 20240923 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 92 IP - 5 DP - 2022 May 1 TI - Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial. PG - 839-847 LID - 10.1097/TA.0000000000003551 [doi] AB - INTRODUCTION: Low titer group O whole blood (LTOWB) resuscitation is increasingly common in both military and civilian settings. Data regarding the safety and efficacy of prehospital LTOWB remain limited. METHODS: We performed a single-center, prospective, cluster randomized, prehospital through in-hospital whole blood pilot trial for injured air medical patients. We compared standard prehospital air medical care including red cell transfusion and crystalloids followed by in-hospital component transfusion to prehospital and in-hospital LTOWB resuscitation. Prehospital vital signs were used as inclusion criteria (systolic blood pressure /=108 beats per minute or systolic blood pressure /=30, >/=50, and >/=100 ng/mL were calculated. Results A total of 189 patients were included, ( n = 50) on apixaban, ( n = 62) on rivaroxaban, ( n = 53) on dabigatran, and ( n = 24) on no DOAC were studied. Using the direct thrombin inhibitor (DTI) channel, R-time demonstrated strong linear correlation with dabigatran levels (r = 0.93, p < 0.0001). Using the antifactor Xa (AFXa) channel, R-time demonstrated strong nonlinear correlation with rivaroxaban and apixaban levels ( r (s) = 0.92 and 0.84, respectively, p < 0.0001 for both). R-time revealed strong sensitivity and NPV in detecting low DOAC levels for the predefined concentrations. Conclusion R-time measured by TEG(R)6s DOAC-specific cartridge has a strong correlation with concentrations of the most commonly used DOACs with high sensitivity and NPV for detecting lower drug levels that are considered clinically relevant for patients in need of antidote, or prior to urgent surgery. Further studies to determine the relation of R-time to clinical outcomes are warranted. CI - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ). FAU - Artang, Ramin AU - Artang R AUID- ORCID: 0000-0002-3408-9547 AD - Essentia Health St. Mary's Heart and Vascular Center, Duluth, Minnesota, United States. AD - Bispebjerg University of Copenhagen Hospital, Department of Cardiology, Copenhagen, Denmark. FAU - Dias, Joao D AU - Dias JD AD - Haemonetics Corp., Braintree, Massachusetts, United States. FAU - Walsh, Mark AU - Walsh M AD - Memorial Hospital of South Bend, Department of Energy Medicine, Sound Bend, Indiana, United States. FAU - Bliden, Kevin AU - Bliden K AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States. FAU - Nielsen, Jorn D AU - Nielsen JD AD - Bispebjerg University of Copenhagen Hospital, Department of Cardiology, Copenhagen, Denmark. FAU - Anderson, Maren AU - Anderson M AD - University of Minnesota School of Medicine, Duluth, Minnesota, United States. FAU - Thurston, Brian C AU - Thurston BC AD - Spartanburg Regional Medical Center, Division of Surgery, Spartanburg, South Carolina, United States. FAU - Tantry, Udaya S AU - Tantry US AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States. FAU - Hartmann, Jan AU - Hartmann J AD - Haemonetics Corp., Braintree, Massachusetts, United States. FAU - Gurbel, Paul A AU - Gurbel PA AUID- ORCID: 0000-0002-5461-568X AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States. LA - eng PT - Journal Article DEP - 20211109 PL - Germany TA - TH Open JT - TH open : companion journal to thrombosis and haemostasis JID - 101715740 PMC - PMC8718262 OTO - NOTNLM OT - apixaban OT - clinical trials: oral anticoagulants OT - coagulation inhibitors OT - dabigatran OT - diagnosis management OT - rivaroxaban EDAT- 2022/01/06 06:00 MHDA- 2022/01/06 06:01 PMCR- 2021/11/01 CRDT- 2022/01/05 05:58 PHST- 2021/03/25 00:00 [received] PHST- 2021/11/04 00:00 [accepted] PHST- 2022/01/05 05:58 [entrez] PHST- 2022/01/06 06:00 [pubmed] PHST- 2022/01/06 06:01 [medline] PHST- 2021/11/01 00:00 [pmc-release] AID - 210061 [pii] AID - 10.1055/a-1692-1415 [doi] PST - epublish SO - TH Open. 2021 Nov 9;5(4):e570-e576. doi: 10.1055/a-1692-1415. eCollection 2021 Oct. PMID- 34959713 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211231 IS - 1424-8247 (Print) IS - 1424-8247 (Electronic) IS - 1424-8247 (Linking) VI - 14 IP - 12 DP - 2021 Dec 16 TI - Promising Antiviral Activity of Agrimonia pilosa Phytochemicals against Severe Acute Respiratory Syndrome Coronavirus 2 Supported with In Vivo Mice Study. LID - 10.3390/ph14121313 [doi] LID - 1313 AB - The global emergence of the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has focused the entire world's attention toward searching for a potential remedy for this disease. Thus, we investigated the antiviral activity of Agrimonia pilosa ethanol extract (APEE) against SARS-CoV-2 and it exhibited a potent antiviral activity with IC(50) of 1.1 +/- 0.03 microg/mL. Its mechanism of action was elucidated, and it exhibited a virucidal activity and an inhibition of viral adsorption. Moreover, it presented an immunomodulatory activity as it decreased the upregulation of gene expression of COX-2, iNOS, IL-6, TNF-alpha, and NF-kappaB in lipopolysaccharide (LPS)-induced peripheral blood mononuclear cells. A comprehensive analysis of the phytochemical fingerprint of APEE was conducted using LC-ESI-MS/MS technique for the first time. We detected 81 compounds and most of them belong to the flavonoid and coumarin classes. Interestingly, isoflavonoids, procyanidins, and anthocyanins were detected for the first time in A. pilosa. Moreover, the antioxidant activity was evidenced in DPPH (IC(50) 62.80 microg/mL) and ABTS (201.49 mg Trolox equivalents (TE)/mg) radical scavenging, FRAP (60.84 mg TE/mg), and ORAC (306.54 mg TE/g) assays. Furthermore, the protective effect of APEE was investigated in Lipopolysaccharides (LPS)-induced acute lung injury (ALI) in mice. Lung W/D ratio, serum IL-6, IL-18, IL-1beta, HO-1, Caspase-1, caspase-3, TLR-4 expression, TAC, NO, MPO activity, and histopathological examination of lung tissues were assessed. APEE induced a marked downregulation in all inflammation, oxidative stress, apoptosis markers, and TLR-4 expression. In addition, it alleviated all histopathological abnormalities confirming the beneficial effects of APEE in ALI. Therefore, APEE could be a potential source for therapeutic compounds that could be investigated, in future preclinical and clinical trials, in the treatment of patients with COVID-19. FAU - Attallah, Nashwah G M AU - Attallah NGM AD - Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia. AD - Egyptian Drug Authority (EDA), Giza 8655, Egypt. FAU - El-Kadem, Aya H AU - El-Kadem AH AUID- ORCID: 0000-0001-7915-0949 AD - Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31111, Egypt. FAU - Negm, Walaa A AU - Negm WA AUID- ORCID: 0000-0003-0463-8047 AD - Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Tanta 31111, Egypt. FAU - Elekhnawy, Engy AU - Elekhnawy E AUID- ORCID: 0000-0001-8287-1026 AD - Pharmaceutical Microbiology Department, Faculty of Pharmacy, Tanta University, Tanta 31111, Egypt. FAU - El-Masry, Thanaa A AU - El-Masry TA AD - Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31111, Egypt. FAU - Elmongy, Elshaymaa I AU - Elmongy EI AUID- ORCID: 0000-0003-1160-5040 AD - Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia. AD - Pharmaceutical Chemistry Department, Faculty of Pharmacy, Helwan University, Helwan 11795, Egypt. FAU - Altwaijry, Najla AU - Altwaijry N AUID- ORCID: 0000-0001-6372-7141 AD - Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia. FAU - Alanazi, Ashwag S AU - Alanazi AS AD - Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia. FAU - Al-Hamoud, Gadah Abdulaziz AU - Al-Hamoud GA AD - Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia. FAU - Ragab, Amany E AU - Ragab AE AUID- ORCID: 0000-0001-8276-5397 AD - Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Tanta 31111, Egypt. LA - eng GR - RGP-1441-0028/the Deanship of Scientific Research (DSR), at Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia, through the Research Groups Program Grant no. (RGP-1441-0028)./ PT - Journal Article DEP - 20211216 PL - Switzerland TA - Pharmaceuticals (Basel) JT - Pharmaceuticals (Basel, Switzerland) JID - 101238453 PMC - PMC8709118 OTO - NOTNLM OT - ALI OT - LC-ESI-MS/MS OT - LPS OT - SARS-CoV-2 OT - TLR-4 OT - immunomodulatory OT - plaque reduction COIS- The authors declare no conflict of interest. EDAT- 2021/12/29 06:00 MHDA- 2021/12/29 06:01 PMCR- 2021/12/16 CRDT- 2021/12/28 01:04 PHST- 2021/11/11 00:00 [received] PHST- 2021/12/08 00:00 [revised] PHST- 2021/12/13 00:00 [accepted] PHST- 2021/12/28 01:04 [entrez] PHST- 2021/12/29 06:00 [pubmed] PHST- 2021/12/29 06:01 [medline] PHST- 2021/12/16 00:00 [pmc-release] AID - ph14121313 [pii] AID - pharmaceuticals-14-01313 [pii] AID - 10.3390/ph14121313 [doi] PST - epublish SO - Pharmaceuticals (Basel). 2021 Dec 16;14(12):1313. doi: 10.3390/ph14121313. PMID- 34954696 OWN - NLM STAT- MEDLINE DCOM- 20230626 LR - 20260225 IS - 1421-9921 (Electronic) IS - 0014-312X (Print) IS - 0014-312X (Linking) VI - 64 IP - 2 DP - 2023 TI - Mitochondrial Dysfunction in Trauma-Related Coagulopathy: Is There Causality? Study Protocol for a Prospective Observational Study. PG - 304-309 LID - 10.1159/000521670 [doi] AB - Hemorrhage control often poses a great challenge for clinicians due to trauma-induced coagulopathy (TIC). The pathogenesis of TIC is not completely revealed; however, growing evidence attributes a central role to altered platelet biology. The activation of thrombocytes and subsequent clot formation are highly energetic processes being tied to mitochondrial activity, and the inhibition of the electron transport chain (ETC) impedes on thrombogenesis, suggesting the potential role of mitochondria in TIC. Our present study protocol provides a guide to quantitatively characterize the derangements of mitochondrial functions in TIC. One hundred eleven severely injured (injury severity score >/=16), bleeding trauma patients with an age of 18 or greater will be included in this prospective observational study. Patients receiving oral antiplatelet agents including cyclooxygenase-1 or adenosine diphosphate receptor inhibitors (aspirin, clopidogrel, prasugrel, and ticagrelor) will be excluded from the final analysis. Hemorrhage will be confirmed and assessed with computer tomography. Conventional laboratory markers of hemostasis such as prothrombin time and international normalized ratio will be measured and rotational thromboelastometry (ROTEM) will be performed directly upon patient arrival. Platelets will be isolated from venous blood samples and subjected to high-resolution fluororespirometry (Oxygraph-2k, Oroboros Instruments, Innsbruck, Austria) to evaluate the efficacy of mitochondrial respiration. Oxidative phosphorylation (OxPhos), coupling of the ETC, mitochondrial superoxide formation, mitochondrial membrane potential changes, and extramitochondrial Ca2+-movement will be recorded. The association between OxPhos capacity of platelet mitochondria and numerical parameters of ROTEM aggregometry will constitute our primary outcome. The relation between OxPhos capacity and results of viscoelastic assays and conventional markers of hemostasis will serve as secondary outcomes. The association of the OxPhos capacity of platelet mitochondria upon patient arrival to the need for massive blood transfusion and 24-h mortality will constitute our tertiary outcomes. Mitochondrial dysfunction and its importance in TIC are yet to be assessed for the deeper understanding of this common, life-threatening condition. Disclosure of mitochondria-mediated processes in thrombocytes may reveal new therapeutic targets in the management of hemorrhaging trauma patients, thereby leading to a reduction of potentially preventable mortality. The present protocol was registered to ClinicalTrials.gov on 12 August 2021, under the reference number NCT05004844. CI - (c) 2021 The Author(s). Published by S. Karger AG, Basel. FAU - Javor, Peter AU - Javor P AD - Department of Traumatology, University of Szeged, Szeged, Hungary, javorpeter25@gmail.com. FAU - Rarosi, Ferenc AU - Rarosi F AD - Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary. FAU - Horvath, Tamara AU - Horvath T AD - Institute of Surgical Research, University of Szeged, Szeged, Hungary. FAU - Torok, Laszlo AU - Torok L AD - Department of Traumatology, University of Szeged, Szeged, Hungary. FAU - Hartmann, Petra AU - Hartmann P AD - Department of Traumatology, University of Szeged, Szeged, Hungary. LA - eng SI - ClinicalTrials.gov/NCT05004844 PT - Clinical Trial Protocol PT - Journal Article DEP - 20211224 PL - Switzerland TA - Eur Surg Res JT - European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes JID - 0174752 RN - R16CO5Y76E (Aspirin) SB - IM MH - Humans MH - *Blood Coagulation Disorders/etiology MH - Hemorrhage/etiology/therapy MH - Hemostasis MH - Thrombelastography/adverse effects/methods MH - Aspirin MH - *Wounds and Injuries/complications MH - Observational Studies as Topic PMC - PMC9808649 OTO - NOTNLM OT - Blood coagulation disorders OT - Blood platelet disorders OT - Coagulopathy OT - Hemorrhage OT - Mitochondria OT - Trauma induced COIS- The authors have no conflicts of interest to declare. EDAT- 2021/12/27 06:00 MHDA- 2023/06/26 06:42 PMCR- 2021/12/24 CRDT- 2021/12/26 20:58 PHST- 2021/10/14 00:00 [received] PHST- 2021/12/21 00:00 [accepted] PHST- 2023/06/26 06:42 [medline] PHST- 2021/12/27 06:00 [pubmed] PHST- 2021/12/26 20:58 [entrez] PHST- 2021/12/24 00:00 [pmc-release] AID - 000521670 [pii] AID - esr-0063-0192 [pii] AID - 10.1159/000521670 [doi] PST - ppublish SO - Eur Surg Res. 2023;64(2):304-309. doi: 10.1159/000521670. Epub 2021 Dec 24. PMID- 34952618 OWN - NLM STAT- MEDLINE DCOM- 20211228 LR - 20220531 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 29 IP - 1 DP - 2021 Dec 24 TI - Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation? PG - 174 LID - 10.1186/s13049-021-00988-x [doi] LID - 174 AB - BACKGROUND: In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L(-1), but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L(-1) or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. METHODS: Prospective analysis of retrospectively collected data from a trauma registry (01/2011-12/2019). MFD-C was defined by a fibrinogenemia 1.51-1.99 g L(-1) or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L(-1) (HemoCue(R)), and base deficit > 5 mEq L(-1). Data are expressed as count (%), median [IQR]. RESULTS: 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19-36] vs. 24 [17-29]) and had more impaired vital signs (base deficit: 5.4 [3.6-7.8] vs. 3.8 [2.0-6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L(-1) and < 2.0 g L(-1), FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L(-1), or a base deficit > 5.0 mEq L(-1) received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06-1.82] for MFD-C, and 2.17 [1.48-3.19] for MFD-A5. Results were not modified after adjustment on the ISS. CONCLUSIONS: We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD. CI - (c) 2021. The Author(s). FAU - David, Jean-Stephane AU - David JS AUID- ORCID: 0000-0001-6274-7044 AD - Service d'anesthesie-reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. js-david@univ-lyon1.fr. AD - Faculte de Medecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France. js-david@univ-lyon1.fr. AD - Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France. js-david@univ-lyon1.fr. AD - Service d'Anesthesie Reanimation, Centre Hospitalier Lyon Sud, 69495, Pierre Benite cedex, France. js-david@univ-lyon1.fr. FAU - Lambert, Aline AU - Lambert A AD - Service d'anesthesie-reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. AD - Faculte de Medecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France. FAU - Taverna, Xavier-Jean AU - Taverna XJ AD - Service d'anesthesie-reanimation, Hopital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France. FAU - Incagnoli, Pascal AU - Incagnoli P AD - Service des Urgences - SAMU, Hopital Universitaire de Dijon, Dijon, France. FAU - Geay-Baillat, Marie-Odile AU - Geay-Baillat MO AD - Laboratoire d'Hemostase, Hopital Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. FAU - Vassal, Olivia AU - Vassal O AD - Service d'anesthesie-reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. AD - Faculte de Medecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France. FAU - Friggeri, Arnaud AU - Friggeri A AD - Service d'anesthesie-reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. AD - Faculte de Medecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France. FAU - Inaba, Kenji AU - Inaba K AD - Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA. LA - eng PT - Journal Article DEP - 20211224 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Afibrinogenemia MH - *Blood Coagulation Disorders/epidemiology MH - Fibrinogen/*therapeutic use MH - Humans MH - Retrospective Studies MH - Thrombelastography MH - Wounds and Injuries/*drug therapy PMC - PMC8709958 OTO - NOTNLM OT - Coagulopathy OT - Fibrinogen OT - ROTEM OT - Shock OT - Trauma COIS- JS David received honoraria for lectures, advisory boards (LFB, Les Ullis, France; Werfen/TEM International, Le pre St Germain, France). No conflict of interest for the other authors. EDAT- 2021/12/26 06:00 MHDA- 2021/12/29 06:00 PMCR- 2021/12/24 CRDT- 2021/12/25 05:15 PHST- 2021/09/03 00:00 [received] PHST- 2021/12/13 00:00 [accepted] PHST- 2021/12/25 05:15 [entrez] PHST- 2021/12/26 06:00 [pubmed] PHST- 2021/12/29 06:00 [medline] PHST- 2021/12/24 00:00 [pmc-release] AID - 10.1186/s13049-021-00988-x [pii] AID - 988 [pii] AID - 10.1186/s13049-021-00988-x [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2021 Dec 24;29(1):174. doi: 10.1186/s13049-021-00988-x. PMID- 34952323 OWN - NLM STAT- MEDLINE DCOM- 20220127 LR - 20220127 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 52 DP - 2022 Feb TI - Evaluation of direct oral anticoagulant use on thromboelastography in an emergency department population. PG - 191-195 LID - S0735-6757(21)00981-5 [pii] LID - 10.1016/j.ajem.2021.12.011 [doi] AB - BACKGROUND: Direct oral anticoagulant (DOAC) use presents a challenge to all providers involved in emergency care of patients since widely accepted laboratory tests to assess the level of anticoagulation for such medications are lacking. Viscoelastic tests such as thromboelastography (TEG) tests are increasingly used throughout major trauma centers to help guide resuscitation efforts in patients presenting with trauma and/or hemorrhagic shock. OBJECTIVE: The primary outcome compared TEG parameters between emergency department trauma patients reporting DOAC therapy and known normal TEG parameter values. The secondary outcome evaluated patients who reported time of last known DOAC dose within a preferred time frame of <12 h for once daily dosing DOAC therapy or < 6 h for twice daily dosing DOAC therapy. METHODS: This single-center, retrospective cohort study assessed TEG values in patients receiving DOAC therapy and compared these to institution TEG ranges considered normal. TEG values of reaction time (R time), kinetics (K), alpha angle (AA), maximum amplitude (MA), and percent lysis in 30 min (LY30) were collected for patients reporting DOAC therapy. RESULTS: 40 patients were included in this study. 19 patients reported apixaban therapy and 21 reported rivaroxaban therapy. 5 (12.5%) patients had an elevated R time and 1 (2.5%) patient had a reduced MA. All other TEG values did not suggest hypocoagulability. For the secondary outcome assessing patients reporting last known dose within the preferred time frame, only the R time was elevated in 2 (14.3%) patients. Lastly, in a subgroup analysis of patients with elevated low-molecular-weight heparin (LMWH) orAnti- Xa levels, the R time was the only parameter affected in 25% of patients. CONCLUSION: TEG values were typically not affected by rivaroxaban or apixaban use in an emergency department trauma population suggesting that TEG is not sensitive for Xa inhibitor detection and should not be relied upon for assessing anticoagulation in such settings. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Jenrette, Jordan AU - Jenrette J AD - Department of Pharmacy, UCHealth University of Colorado Hospital, Aurora, CO, USA; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Jordan.Jenrette@cuanschutz.edu. FAU - Schwarz, Kerry AU - Schwarz K AD - Department of Pharmacy, UCHealth University of Colorado Hospital, Aurora, CO, USA; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Kerry.Schwarz@uchealth.org. FAU - Trujillo, Toby AU - Trujillo T AD - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA; Anticoagulation Services, UCHealth University of Colorado Hospital, Aurora, CO, USA. Electronic address: Toby.Trujillo@cuanschutz.edu. FAU - Ray, Lance AU - Ray L AD - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA; Department of Pharmacy, Denver Health, Denver, CO, USA. Electronic address: Lance.Ray@dhha.org. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20211210 PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 RN - 0 (Factor Xa Inhibitors) RN - 0 (Pyrazoles) RN - 0 (Pyridones) RN - 3Z9Y7UWC1J (apixaban) RN - 9NDF7JZ4M3 (Rivaroxaban) SB - IM MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/*drug effects MH - Factor Xa Inhibitors/administration & dosage/*pharmacology MH - Female MH - Humans MH - Male MH - Pyrazoles/administration & dosage/*pharmacology MH - Pyridones/administration & dosage/*pharmacology MH - Retrospective Studies MH - Rivaroxaban/administration & dosage/*pharmacology MH - Thrombelastography/standards OTO - NOTNLM OT - Anticoagulant OT - Coagulation OT - DOAC OT - TEG OT - Thromboelastography OT - Viscoelastic EDAT- 2021/12/25 06:00 MHDA- 2022/01/28 06:00 CRDT- 2021/12/24 20:16 PHST- 2021/08/03 00:00 [received] PHST- 2021/11/16 00:00 [revised] PHST- 2021/12/03 00:00 [accepted] PHST- 2021/12/25 06:00 [pubmed] PHST- 2022/01/28 06:00 [medline] PHST- 2021/12/24 20:16 [entrez] AID - S0735-6757(21)00981-5 [pii] AID - 10.1016/j.ajem.2021.12.011 [doi] PST - ppublish SO - Am J Emerg Med. 2022 Feb;52:191-195. doi: 10.1016/j.ajem.2021.12.011. Epub 2021 Dec 10. PMID- 34948283 OWN - NLM STAT- MEDLINE DCOM- 20220131 LR - 20231213 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 22 IP - 24 DP - 2021 Dec 15 TI - A Genus-Wide Bioactivity Analysis of Daboia (Viperinae: Viperidae) Viper Venoms Reveals Widespread Variation in Haemotoxic Properties. LID - 10.3390/ijms222413486 [doi] LID - 13486 AB - The snake genus Daboia (Viperidae: Viperinae; Oppel, 1811) contains five species: D. deserti, D. mauritanica, and D. palaestinae, found in Afro-Arabia, and the Russell's vipers D. russelii and D. siamensis, found in Asia. Russell's vipers are responsible for a major proportion of the medically important snakebites that occur in the regions they inhabit, and their venoms are notorious for their coagulopathic effects. While widely documented, the extent of venom variation within the Russell's vipers is poorly characterised, as is the venom activity of other species within the genus. In this study we investigated variation in the haemotoxic activity of Daboia using twelve venoms from all five species, including multiple variants of D. russelii, D. siamensis, and D. palaestinae. We tested the venoms on human plasma using thromboelastography, dose-response coagulometry analyses, and calibrated automated thrombography, and on human fibrinogen by thromboelastography and fibrinogen gels. We assessed activation of blood factors X and prothrombin by the venoms using fluorometry. Variation in venom activity was evident in all experiments. The Asian species D. russelii and D. siamensis and the African species D. mauritanica possessed procoagulant venom, while D. deserti and D. palaestinae were net-anticoagulant. Of the Russell's vipers, the venom of D. siamensis from Myanmar was most toxic and D. russelli of Sri Lanka the least. Activation of both factor X and prothrombin was evident by all venoms, though at differential levels. Fibrinogenolytic activity varied extensively throughout the genus and followed no phylogenetic trends. This venom variability underpins one of the many challenges facing treatment of Daboia snakebite envenoming. Comprehensive analyses of available antivenoms in neutralising these variable venom activities are therefore of utmost importance. FAU - Op den Brouw, Bianca AU - Op den Brouw B AUID- ORCID: 0000-0002-3650-5129 AD - Venom Evolution Lab, School of Biological Sciences, The University of Queensland, St. Lucia 4072, Australia. FAU - Coimbra, Francisco C P AU - Coimbra FCP AD - Venom Evolution Lab, School of Biological Sciences, The University of Queensland, St. Lucia 4072, Australia. FAU - Casewell, Nicholas R AU - Casewell NR AUID- ORCID: 0000-0002-8035-4719 AD - Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK. FAU - Ali, Syed Abid AU - Ali SA AUID- ORCID: 0000-0003-0226-8257 AD - Third World Center for Science and Technology, H.E.J. Research Institute of Chemistry, University of Karachi, Karachi 75270, Pakistan. FAU - Vonk, Freek J AU - Vonk FJ AD - Naturalis Biodiversity Center, 2333 CR Leiden, The Netherlands. AD - Division of BioAnalytical Chemistry, Amsterdam Institute of Molecular and Life Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands. FAU - Fry, Bryan G AU - Fry BG AUID- ORCID: 0000-0001-6661-1283 AD - Venom Evolution Lab, School of Biological Sciences, The University of Queensland, St. Lucia 4072, Australia. LA - eng GR - 200517/Z/16/Z/WT_/Wellcome Trust/United Kingdom GR - 200517/Z/16/Z/Royal Society of Medicine/ GR - PDRF Phase II Batch-V; NRPU No.20-3891/Higher Education Commission/ GR - DP190100304/Australian Research Council/ PT - Journal Article DEP - 20211215 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Antivenins) RN - 0 (Hemolytic Agents) RN - 0 (Viper Venoms) RN - 9001-26-7 (Prothrombin) RN - 9001-29-0 (Factor X) SB - IM MH - Animals MH - Antivenins MH - Asia MH - Factor X/analysis MH - Hemolytic Agents/analysis/*chemistry MH - Humans MH - Plasma/drug effects MH - Prothrombin/analysis MH - Daboia MH - Snake Bites MH - Viper Venoms/analysis/*chemistry/*toxicity MH - Viperidae PMC - PMC8706385 OTO - NOTNLM OT - Daboia OT - Russell's viper OT - coagulopathy OT - fibrinogenolysis OT - haemotoxicity OT - snakebite envenoming OT - toxin OT - venom OT - venom variation COIS- The authors declare no conflict of interest. EDAT- 2021/12/25 06:00 MHDA- 2022/02/01 06:00 PMCR- 2021/12/15 CRDT- 2021/12/24 01:17 PHST- 2021/09/22 00:00 [received] PHST- 2021/12/01 00:00 [revised] PHST- 2021/12/02 00:00 [accepted] PHST- 2021/12/24 01:17 [entrez] PHST- 2021/12/25 06:00 [pubmed] PHST- 2022/02/01 06:00 [medline] PHST- 2021/12/15 00:00 [pmc-release] AID - ijms222413486 [pii] AID - ijms-22-13486 [pii] AID - 10.3390/ijms222413486 [doi] PST - epublish SO - Int J Mol Sci. 2021 Dec 15;22(24):13486. doi: 10.3390/ijms222413486. PMID- 34936590 OWN - NLM STAT- MEDLINE DCOM- 20220427 LR - 20230928 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 92 IP - 4 DP - 2022 Apr 1 TI - Sex dimorphisms in coagulation characteristics in the pediatric trauma population appear after puberty. PG - 675-682 LID - 10.1097/TA.0000000000003508 [doi] AB - BACKGROUND: The role of age and sex in mediating coagulation characteristics in injured children is not well defined. We hypothesize that thromboelastography (TEG) profiles are equivalent across sex in younger children and diverge after puberty. METHODS: Consecutive trauma patients younger than 18 years were identified from a university-affiliated, Level I, pediatric trauma center (2016-2020) database. Demographics, injury characteristics, and TEG parameters were recorded. Children were categorized by sex and age (younger, /=11 years). Baseline characteristics, outcomes, and TEG parameters were compared using nonparametric tests as appropriate. To account for the effects of confounding variables, analysis of covariance was performed controlling for Injury Severity Score (ISS), admission Glasgow Coma Scale score, and pediatric age-adjusted shock index. RESULTS: Six hundred forty-seven subjects were identified (70.2% male, median ISS, 10; interquartile range, 5-24; blunt mechanism, 75.4%). Among 395 younger children (/=11 years), males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (69.6 degrees vs73.7 degrees ; p < 0.001), and lower maximum amplitudes (59.4 vs. 61.5 mm; p = 0.01). Fibrinolysis was significantly lower in older females compared with younger females (0.4% vs. 1.5%, p < 0.001) and age-matched males (0.4% vs. 1.0%, p = 0.02). Compared with younger male children, adolescent males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (73.5 degrees vs. 69.6 degrees , p < 0.001), lower maximum amplitudes (59.4 vs. 62 mm, p < 0.001), and less fibrinolysis (1.0% vs. 1.3%, p = 0.03). This interaction persisted after controlling for ISS, Glasgow Coma Scale, and pediatric age-adjusted shock index. CONCLUSION: Sex dimorphisms in TEG coagulation profiles appear after puberty. This divergence appears to be driven by a shift in male coagulation profiles to a relatively hypocoagulable state and female coagulation profiles to a relatively hypercoagulable state after puberty. LEVEL OF EVIDENCE: Prognostic and Epidemiologic, Level III. CI - Copyright (c) 2021 American Association for the Surgery of Trauma. FAU - Hrebinko, Katherine A AU - Hrebinko KA AD - From the Department of Surgery (K.A.H.), University of Pittsburgh; Division of Pediatric General and Thoracic Surgery (S.S., W.R., B.A.G.), University of Pittsburgh Medical Center Children's Hospital of Pittsburgh; and Division of Trauma and Acute Care Surgery, Department of Surgery (C.M.L.), University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Strotmeyer, Stephen AU - Strotmeyer S FAU - Richardson, Ward AU - Richardson W FAU - Gaines, Barbara A AU - Gaines BA FAU - Leeper, Christine M AU - Leeper CM LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Aged MH - Blood Coagulation MH - *Blood Coagulation Disorders/epidemiology/etiology MH - Child MH - Female MH - Humans MH - Male MH - Puberty MH - *Sex Characteristics MH - Thrombelastography EDAT- 2021/12/23 06:00 MHDA- 2022/04/28 06:00 CRDT- 2021/12/22 17:15 PHST- 2021/12/23 06:00 [pubmed] PHST- 2022/04/28 06:00 [medline] PHST- 2021/12/22 17:15 [entrez] AID - 01586154-202204000-00007 [pii] AID - 10.1097/TA.0000000000003508 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Apr 1;92(4):675-682. doi: 10.1097/TA.0000000000003508. PMID- 34908543 OWN - NLM STAT- MEDLINE DCOM- 20220118 LR - 20230721 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 134 IP - 1 DP - 2022 Jan 1 TI - Pro-Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma. PG - 21-31 LID - 10.1213/ANE.0000000000005709 [doi] AB - Major trauma patients at risk of traumatic coagulopathy are commonly treated with early clotting factor replacement to maintain hemostasis and prevent microvascular bleeding. In the United States, trauma transfusions are often dosed by empiric, low-ratio massive transfusion protocols, which pair plasma and platelets in some ratio relative to the red cells, such as the "1:1:1" combination of 1 units of red cells, 1 unit of plasma, and 1 donor's worth of pooled platelets. Empiric transfusion increases the rate of overtransfusion when unnecessary blood products are administered based on a formula and not on at patient's hemostatic profile. Viscoelastic hemostatic assays (VHAs) are point-of-care hemostatic assays that provided detailed information about abnormal clotting pathways. VHAs are used at many centers to better target hemostatic therapies in trauma. This Pro/Con section will address whether VHA guidance should replace empiric fixed ratio protocols in major trauma. CI - Copyright (c) 2021 International Anesthesia Research Society. FAU - Blaine, Kevin P AU - Blaine KP AD - From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon. FAU - Dudaryk, Roman AU - Dudaryk R AD - Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Health System/Ryder Trauma Center, Miami, Florida. LA - eng PT - Journal Article PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Blood Coagulation Factors) SB - IM CIN - Anesth Analg. 2022 Jan 1;134(1):19-20. doi: 10.1213/ANE.0000000000005765. PMID: 34908542 CIN - Anesth Analg. 2022 Jun 1;134(6):e41-e42. doi: 10.1213/ANE.0000000000006003. PMID: 35595706 MH - Blood Coagulation Disorders/blood MH - Blood Coagulation Factors MH - Blood Coagulation Tests/*methods MH - Blood Transfusion/methods/*standards MH - Elasticity MH - Emergency Medicine/methods/*standards MH - Hemorrhage/*therapy MH - *Hemostasis MH - Humans MH - Plasma MH - Point-of-Care Testing MH - Resuscitation MH - Transfusion Reaction MH - Treatment Outcome MH - Viscosity MH - Wounds and Injuries/*therapy COIS- The authors declare no conflicts of interest. EDAT- 2021/12/16 06:00 MHDA- 2022/01/19 06:00 CRDT- 2021/12/15 12:22 PHST- 2021/12/15 12:22 [entrez] PHST- 2021/12/16 06:00 [pubmed] PHST- 2022/01/19 06:00 [medline] AID - 00000539-202201000-00007 [pii] AID - 10.1213/ANE.0000000000005709 [doi] PST - ppublish SO - Anesth Analg. 2022 Jan 1;134(1):21-31. doi: 10.1213/ANE.0000000000005709. PMID- 34906908 OWN - NLM STAT- MEDLINE DCOM- 20220405 LR - 20220502 IS - 1898-4002 (Electronic) IS - 1896-1126 (Print) IS - 1896-1126 (Linking) VI - 67 IP - 1 DP - 2022 Mar TI - Cardiac injury and COVID-19 associated coagulopathy in patients with acute SARS-CoV-2 pneumonia: A rotational thromboelastometry study. PG - 39-44 LID - S1896-1126(21)00055-9 [pii] LID - 10.1016/j.advms.2021.12.001 [doi] AB - PURPOSE: Coronavirus disease 2019 (COVID-19) is a systemic inflammatory condition associated with coagulopathy which may result in severe thromboembolic complications. Cardiac injury is not uncommon in hospitalized COVID-19 patients and therefore we aimed to investigate whether it stems from an abnormal coagulative state. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study on consecutive patients hospitalized due to COVID-19. Traditional coagulation and whole blood rotational thromboelastometry tests were compared between patients with and without cardiac injury. Cardiac injury was defined by increased levels of high-sensitivity cardiac troponin I (hs-cTnI). RESULTS: The study population consisted of 104 patients (67% males, median age 65 years), of whom 40 (38%) developed cardiac injury. No clinical differences in the traditional coagulation parameters were observed between patients with and without cardiac injury. Thromboelastometry analysis revealed abnormal maximum clot firmness (MCF) levels in FIBTEM assay in 80 (77%) patients. No significant differences in MCF values (p ​= ​0.450) and percentage of abnormal MCF (p ​= ​0.290) were detected between patients with and without cardiac injury. Cardiac injury - not hypercoagulability - was associated with mortality (p ​= ​0.016). CONCLUSIONS: No differences in traditional coagulation and rotational thromboelastometry parameters were found among hospitalized COVID-19 patients with and without cardiac injury. Other mechanisms besides hypercoagulability may be a main culprit for cardiac injury in COVID-19 patients. CI - Copyright (c) 2021 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved. FAU - Capone, Federico AU - Capone F AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Cipriani, Alberto AU - Cipriani A AD - Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy. FAU - Molinari, Leonardo AU - Molinari L AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Poretto, Anna AU - Poretto A AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Sella, Nicolo AU - Sella N AD - Anaesthesia and Intensive Care Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Boscolo, Annalisa AU - Boscolo A AD - Anaesthesia and Intensive Care Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Campello, Elena AU - Campello E AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Saller, Alois AU - Saller A AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Vettor, Roberto AU - Vettor R AD - Division of Internal Medicine, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Navalesi, Paolo AU - Navalesi P AD - Anaesthesia and Intensive Care Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Cattelan, Anna Maria AU - Cattelan AM AD - Infectious Diseases Unit, Padua University Hospital, Padua, Italy. FAU - Simioni, Paolo AU - Simioni P AD - General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Spiezia, Luca AU - Spiezia L AD - General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. Electronic address: luca.spiezia@unipd.it. LA - eng PT - Journal Article DEP - 20211211 PL - Netherlands TA - Adv Med Sci JT - Advances in medical sciences JID - 101276222 SB - IM CIN - Adv Med Sci. 2022 Mar;67(1):139-141. doi: 10.1016/j.advms.2022.02.001. PMID: 35227984 MH - Aged MH - *COVID-19/complications MH - Cross-Sectional Studies MH - Female MH - Humans MH - Male MH - Retrospective Studies MH - SARS-CoV-2 MH - Thrombelastography PMC - PMC8664656 OTO - NOTNLM OT - COVID-19 OT - Coronary thrombosis OT - Hypercoagulability OT - Rotational thromboelastometry OT - Troponin COIS- Declaration of competing interest None of the authors have any conflicts of interest. EDAT- 2021/12/16 06:00 MHDA- 2022/04/06 06:00 PMCR- 2021/12/11 CRDT- 2021/12/15 06:33 PHST- 2021/06/19 00:00 [received] PHST- 2021/09/13 00:00 [revised] PHST- 2021/12/02 00:00 [accepted] PHST- 2021/12/16 06:00 [pubmed] PHST- 2022/04/06 06:00 [medline] PHST- 2021/12/15 06:33 [entrez] PHST- 2021/12/11 00:00 [pmc-release] AID - S1896-1126(21)00055-9 [pii] AID - 10.1016/j.advms.2021.12.001 [doi] PST - ppublish SO - Adv Med Sci. 2022 Mar;67(1):39-44. doi: 10.1016/j.advms.2021.12.001. Epub 2021 Dec 11. PMID- 34905596 OWN - NLM STAT- MEDLINE DCOM- 20220414 LR - 20220531 IS - 1528-0020 (Electronic) IS - 0006-4971 (Linking) VI - 139 IP - 11 DP - 2022 Mar 17 TI - Platelet ACKR3/CXCR7 favors antiplatelet lipids over an atherothrombotic lipidome and regulates thromboinflammation. PG - 1722-1742 LID - 10.1182/blood.2021013097 [doi] AB - Platelet ACKR3/CXCR7 surface expression is enhanced and influences prognosis in coronary artery disease (CAD) patients, who exhibit a distinct atherothrombotic platelet lipidome. Current investigation validates the potential of ACKR3/CXCR7 in regulating thromboinflammatory response through its impact on the platelet lipidome. CAD patients with enhanced platelet ACKR3/CXCR7 expression exhibited reduced aggregation. Pharmacological CXCR7 agonist (VUF11207) significantly reduced prothrombotic platelet response in blood from acute coronary syndrome patients ex vivo. CXCR7 agonist administration reduced thrombotic functions and thromboinflammatory plateletleukocyte interactions post-myocardial infarction and arterial injury in vivo. ACKR3/CXCR7 ligation did not affect surface availability of surface receptors, coagulation profile, bleeding time, plasma-dependent thrombin generation (thrombinoscopy), or clot formation (thromboelastography) but counteracted activation-induced phosphatidylserine exposure and procoagulant platelet-assisted thrombin generation. Targeted (micro-UHPLC-ESI-QTrap-MS/MS) and untargeted (UHPLCESI-QTOF-MS/MS) lipidomics analysis revealed that ACKR3/CXCR7 ligation favored generation of antithrombotic lipids (dihomo-gamma-linolenic acid [DGLA], 12-hydroxyeicosatrienoic acid [12-HETrE]) over cyclooxygenase-1 (COX-1) or 12-lipoxygenase (12-LOX) metabolized prothrombotic and phospholipase-derived atherogenic lipids in healthy subjects and CAD patients, contrary to antiplatelet therapy. Through 12-HETrE, ACKR3/CXCR7 ligation coordinated with Galphas-coupled prostacyclin receptor to trigger cyclic adenosine monophosphate/protein kinase A-mediated platelet inhibition. ACKR3/CXCR7 ligation reduced generation of lipid agonists and lipid signaling intermediates, which affected calcium mobilization, intracellular signaling, and consequently platelet interaction with physiological matrices and thromboinflammatory secretome. This emphasized its functional dichotomy from prothrombotic CXCR4. Moreover, CXCR7 agonist regulated heparin-induced thrombocytopenia-sera/immunoglobulin G-triggered platelet and neutrophil activation, heparin-induced platelet aggregation, generation of thromboinflammatory lipids, platelet-neutrophil aggregate formation, and thromboinflammatory secretion ex vivo. Therefore, ACKR3/CXCR7 may offer a novel therapeutic strategy in acute/chronic thromboinflammation exaggerated cardiovascular pathologies and CAD. CI - (c) 2022 by The American Society of Hematology. FAU - Cebo, Malgorzata AU - Cebo M AD - Institute of Pharmaceutical Sciences, University of Tubingen, Tubingen, Germany. FAU - Dittrich, Kristina AU - Dittrich K AD - Institute of Pharmaceutical Sciences, University of Tubingen, Tubingen, Germany. FAU - Fu, Xiaoqing AU - Fu X AD - Institute of Pharmaceutical Sciences, University of Tubingen, Tubingen, Germany. FAU - Manke, Mailin C AU - Manke MC AUID- ORCID: 0000-0001-9197-4940 AD - Department of Cardiology and Angiology and. AD - Deutsche Forschungsgemeinschaft (DFG) Heisenberg Group Thrombocardiology, University Hospital Tubingen, Tubingen, Germany. FAU - Emschermann, Frederic AU - Emschermann F AUID- ORCID: 0000-0002-9564-2000 AD - Department of Cardiology and Angiology and. FAU - Rheinlaender, Johannes AU - Rheinlaender J AUID- ORCID: 0000-0002-1976-9245 AD - Institute of Applied Physics, University of Tubingen, Tubingen, Germany. FAU - von Eysmondt, Hendrik AU - von Eysmondt H AUID- ORCID: 0000-0003-0759-2056 AD - Institute of Applied Physics, University of Tubingen, Tubingen, Germany. FAU - Ferreiros, Nerea AU - Ferreiros N AD - Pharmazentrum Frankfurt, University Hospital Frankfurt, Frankfurt, Germany; and. FAU - Sudman, Jessica AU - Sudman J AD - Department of Cardiology and Angiology and. FAU - Witte, Alexander AU - Witte A AD - Department of Cardiology and Angiology and. FAU - Pelzl, Lisann AU - Pelzl L AD - Institute for Clinical and Experimental Transfusion Medicine (IKET), University Hospital Tubingen, Tubingen, Germany. FAU - Borst, Oliver AU - Borst O AD - Department of Cardiology and Angiology and. AD - Deutsche Forschungsgemeinschaft (DFG) Heisenberg Group Thrombocardiology, University Hospital Tubingen, Tubingen, Germany. FAU - Geisler, Tobias AU - Geisler T AD - Department of Cardiology and Angiology and. FAU - Rath, Dominik AU - Rath D AD - Department of Cardiology and Angiology and. FAU - Bakchoul, Tamam AU - Bakchoul T AD - Institute for Clinical and Experimental Transfusion Medicine (IKET), University Hospital Tubingen, Tubingen, Germany. FAU - Gawaz, Meinrad AU - Gawaz M AD - Department of Cardiology and Angiology and. FAU - Schaffer, Tilman E AU - Schaffer TE AUID- ORCID: 0000-0001-5643-8384 AD - Institute of Applied Physics, University of Tubingen, Tubingen, Germany. FAU - Lammerhofer, Michael AU - Lammerhofer M AUID- ORCID: 0000-0002-1318-0974 AD - Institute of Pharmaceutical Sciences, University of Tubingen, Tubingen, Germany. FAU - Chatterjee, Madhumita AU - Chatterjee M AUID- ORCID: 0000-0002-3428-4107 AD - Department of Cardiology and Angiology and. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Blood JT - Blood JID - 7603509 RN - 0 (ACKR3 protein, human) RN - 0 (Lipids) RN - 0 (Receptors, CXCR) RN - EC 3.4.21.5 (Thrombin) SB - IM CIN - Blood. 2022 Mar 17;139(11):1612-1613. doi: 10.1182/blood.2021015052. PMID: 35298603 MH - Blood Platelets/metabolism MH - Humans MH - Inflammation/metabolism MH - Lipidomics MH - Lipids MH - Receptors, CXCR/*metabolism MH - Tandem Mass Spectrometry MH - Thrombin/metabolism MH - Thromboinflammation MH - *Thrombosis/metabolism EDAT- 2021/12/15 06:00 MHDA- 2022/04/15 06:00 CRDT- 2021/12/14 17:19 PHST- 2021/06/25 00:00 [received] PHST- 2021/11/30 00:00 [accepted] PHST- 2021/12/15 06:00 [pubmed] PHST- 2022/04/15 06:00 [medline] PHST- 2021/12/14 17:19 [entrez] AID - S0006-4971(21)06960-3 [pii] AID - 10.1182/blood.2021013097 [doi] PST - ppublish SO - Blood. 2022 Mar 17;139(11):1722-1742. doi: 10.1182/blood.2021013097. PMID- 34882351 OWN - NLM STAT- MEDLINE DCOM- 20211213 LR - 20211214 IS - 0869-2084 (Print) IS - 0869-2084 (Linking) VI - 66 IP - 11 DP - 2021 Nov 29 TI - The effect of hyperoxia on the hemostasiological status of severely burned patients. PG - 666-672 LID - 10.51620/0869-2084-2021-66-11-666-672 [doi] AB - The state of the hemostasis system was studied in 9 patients of the middle age group (44 +/- 9.94 years) who received thermal trauma on an area of more than 32% (49.4 +/- 18.3) of the body surface, accompanied by the development of burn shock. The standard therapy for burn injury was supplemented with HBO sessions. Treatment with hyperbaric oxygen was carried out in pressure chambers BLKS-307, BLKS-307/1. The state of the coagulation, anticoagulant and fibrinolytic links of the hemostasis system, as well as the viscoelastic properties of the blood, were assessed immediately before the HBO session and immediately after it. The total number of comparison pairs was 45. Under the influence of HBO therapy, there was an increase in the activity of antithrombin III (ATIII), protein C (PrS) and a decrease in the viscoelastic properties of blood (p <0.05). Positive deviations in the values of ATIII, Pr C, von Willebrand factor, APTT, prothrombin and thrombin time, fibrinogen, factor XIII, XIIa-dependent fibrinolysis, D-dimers and thromboelastography parameters were revealed. The maximum frequency of their occurrence was recorded for ATIII (95%), the minimum - for the D-dimer (62%). After HBO procedures, undesirable deviations of the hemostatic system parameters were also noted. They were chaotic, were compensated by an increase in the activity of physiological anticoagulants and were not accompanied by complications of a thrombogenic nature. Thus, conducting HBO therapy sessions in the acute period of burn disease increases the activity of physiological anticoagulants and stabilizes the viscoelastic properties of blood. There is a high frequency of occurrence of positive effects of hyperoxia on the components of the hemostasis system. The identification of its undesirable effects indicates the need to monitor the state of the hemostasis system during HBO procedures. FAU - Presnyakova, M V AU - Presnyakova MV AUID- ORCID: 0000-0002-3951-9403 AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. FAU - Zagrekov, V I AU - Zagrekov VI AUID- ORCID: 0000-0001-8235-7705 AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. FAU - Kostina, O V AU - Kostina OV AUID- ORCID: 0000-0001-7529-2544 AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. FAU - Pushkin, Artem Sergeevich AU - Pushkin AS AUID- ORCID: 0000-0002-7170-7885 AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. FAU - Kuznetsova, V L AU - Kuznetsova VL AUID- ORCID: 0000-0002-4146-689X AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. FAU - Arefyev, I Yu AU - Arefyev IY AUID- ORCID: 0000-0002-2209-5448 AD - Federal State Budgetary Educational Institution of Higher Education <> of the Ministry of Health of the Russian Federation. LA - eng PT - Journal Article TT - capital VE, Cyrillicsmall el, Cyrillicsmall i, Cyrillicsmall ya, Cyrillicsmall en, Cyrillicsmall i, Cyrillicsmall ie, Cyrillic small ghe, Cyrillicsmall i, Cyrillicsmall pe, Cyrillicsmall ie, Cyrillicsmall er, Cyrillicsmall o, Cyrillicsmall ka, Cyrillicsmall es, Cyrillicsmall i, Cyrillicsmall i, Cyrillic small en, Cyrillicsmall a, Cyrillic small ghe, Cyrillicsmall ie, Cyrillicsmall em, Cyrillicsmall o, Cyrillicsmall es, Cyrillicsmall te, Cyrillicsmall a, Cyrillicsmall ze, Cyrillicsmall i, Cyrillicsmall o, Cyrillicsmall el, Cyrillicsmall o, Cyrillicsmall ghe, Cyrillicsmall i, Cyrillicsmall che, Cyrillicsmall ie, Cyrillicsmall es, Cyrillicsmall ka, Cyrillicsmall i, Cyrillicsmall short i, Cyrillic small es, Cyrillicsmall te, Cyrillicsmall a, Cyrillicsmall te, Cyrillicsmall u, Cyrillicsmall es, Cyrillic small te, Cyrillicsmall ya, Cyrillicsmall zhe, Cyrillicsmall ie, Cyrillicsmall el, Cyrillicsmall o, Cyrillicsmall o, Cyrillicsmall be, Cyrillicsmall o, Cyrillicsmall zhe, Cyrillicsmall zhe, Cyrillicsmall ie, Cyrillicsmall en, Cyrillicsmall en, Cyrillicsmall yeru, Cyrillicsmall ha, Cyrillic. PL - Russia (Federation) TA - Klin Lab Diagn JT - Klinicheskaia laboratornaia diagnostika JID - 9432021 SB - IM MH - Adult MH - Blood Coagulation Tests MH - *Burns/therapy MH - Hemostasis MH - Humans MH - *Hyperoxia MH - Middle Aged MH - Thrombelastography OTO - NOTNLM OT - TEG OT - burns OT - endothelial dysfunction OT - hemostasis system OT - hyperbaric oxygen COIS- The authors declare no conflict of interest. EDAT- 2021/12/10 06:00 MHDA- 2021/12/15 06:00 CRDT- 2021/12/09 12:29 PHST- 2021/12/09 12:29 [entrez] PHST- 2021/12/10 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] AID - 10.51620/0869-2084-2021-66-11-666-672 [doi] PST - ppublish SO - Klin Lab Diagn. 2021 Nov 29;66(11):666-672. doi: 10.51620/0869-2084-2021-66-11-666-672. PMID- 34844010 OWN - NLM STAT- MEDLINE DCOM- 20220420 LR - 20250623 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 159 DP - 2022 Mar TI - Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review. PG - 221-236.e4 LID - S1878-8750(21)01691-0 [pii] LID - 10.1016/j.wneu.2021.10.180 [doi] AB - BACKGROUND: Coagulopathy in traumatic brain injury (TBI) occurs frequently and is associated with poor outcomes. Conventional coagulation assays (CCA) traditionally used to diagnose coagulopathy are often not time sensitive and do not assess complete hemostatic function. Viscoelastic hemostatic assays (VHAs) including thromboelastography and rotational thromboelastography provide a useful rapid and comprehensive point-of-care alternative for identifying coagulopathy, which is of significant consequence in patients with TBI with intracranial hemorrhage. METHODS: A systematic review was performed in accordance with PRISMA guidelines to identify studies comparing VHA with CCA in adult patients with TBI. The following differences in outcomes were assessed based on ability to diagnose coagulopathy: mortality, need for neurosurgical intervention, and progression of traumatic intracranial hemorrhage (tICH). RESULTS: Abnormal reaction time (R time), maximum amplitude, and K value were associated with increased mortality in certain studies but not all studies. This association was reflected across studies using different statistical parameters with different outcome definitions. An abnormal R time was the only VHA parameter found to be associated with the need for neurosurgical intervention in 1 study. An abnormal R time was also the only VHA parameter associated with progression of tICH. Overall, many studies also reported abnormal CCAs, mainly activated partial thromboplastin time, to be associated with poor outcomes. CONCLUSIONS: Given the heterogenous nature of the available evidence including methodology and study outcomes, the comparative difference between VHA and CCA in predicting rates of neurosurgical intervention, tICH progression, or mortality in patients with TBI remains inconclusive. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Shammassian, Berje H AU - Shammassian BH AD - Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: berje.shammassian@jhsmiami.org. FAU - Ronald, Andrew AU - Ronald A AD - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. FAU - Smith, Arvin AU - Smith A AD - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. FAU - Sajatovic, Martha AU - Sajatovic M AD - Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. FAU - Mangat, Halinder S AU - Mangat HS AD - Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center Kansas City, Kansas, USA. FAU - Kelly, Michael L AU - Kelly ML AD - Metrohealth Medical Center, Department of Neurological Surgery, Cleveland, Ohio, USA. LA - eng PT - Journal Article PT - Systematic Review DEP - 20211127 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 RN - 0 (Hemostatics) SB - IM CIN - World Neurosurg. 2022 Oct;166:291-293. doi: 10.1016/j.wneu.2022.04.040. PMID: 36192854 MH - Adult MH - *Blood Coagulation Disorders/diagnosis/etiology MH - *Brain Injuries, Traumatic/complications/surgery MH - Hemostasis MH - *Hemostatics MH - Humans MH - *Intracranial Hemorrhage, Traumatic/complications/diagnosis/surgery MH - Thrombelastography/methods OTO - NOTNLM OT - Hemostatic assays OT - Neurologic outcomes OT - Traumatic brain injury OT - Viscoelastic EDAT- 2021/11/30 06:00 MHDA- 2022/04/21 06:00 CRDT- 2021/11/29 20:16 PHST- 2021/08/09 00:00 [received] PHST- 2021/10/27 00:00 [revised] PHST- 2021/10/28 00:00 [accepted] PHST- 2021/11/30 06:00 [pubmed] PHST- 2022/04/21 06:00 [medline] PHST- 2021/11/29 20:16 [entrez] AID - S1878-8750(21)01691-0 [pii] AID - 10.1016/j.wneu.2021.10.180 [doi] PST - ppublish SO - World Neurosurg. 2022 Mar;159:221-236.e4. doi: 10.1016/j.wneu.2021.10.180. Epub 2021 Nov 27. PMID- 34831304 OWN - NLM STAT- MEDLINE DCOM- 20211223 LR - 20211223 IS - 2073-4409 (Electronic) IS - 2073-4409 (Linking) VI - 10 IP - 11 DP - 2021 Nov 9 TI - The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. LID - 10.3390/cells10113081 [doi] LID - 3081 AB - The physical-chemical, structural, hydrodynamic, and biological properties of hyaluronic acid within tendons are still poorly investigated. Medical history and clinical applications of hyaluronic acid for tendinopathies are still debated. In general, the properties of hyaluronic acid depend on several factors including molecular weight. Several preclinical and clinical experiences show a good efficacy and safety profile of hyaluronic acid, despite the absence of consensus in the literature regarding the classification according to molecular weight. In in vitro and preclinical studies, hyaluronic acid has shown physical-chemical properties, such as biocompatibility, mucoadhesivity, hygroscopicity, and viscoelasticity, useful to contribute to tendon healing. Additionally, in clinical studies, hyaluronic acid has been used with promising results in different tendinopathies. In this narrative review, findings encourage the clinical application of HA in tendinopathies such as rotator cuff, epicondylitis, Achilles, and patellar tendinopathy. FAU - Oliva, Francesco AU - Oliva F AD - Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy. AD - Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy. FAU - Marsilio, Emanuela AU - Marsilio E AD - Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy. AD - Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy. FAU - Asparago, Giovanni AU - Asparago G AUID- ORCID: 0000-0001-7617-8700 AD - Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy. AD - Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy. FAU - Frizziero, Antonio AU - Frizziero A AUID- ORCID: 0000-0001-9533-6444 AD - Physical and Rehabilitation Medicine Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy. FAU - Berardi, Anna Concetta AU - Berardi AC AUID- ORCID: 0000-0002-5078-6158 AD - Department of Haematology, Laboratory of Stem Cells, Transfusion Medicine and Biotechnologies, Santo Spirito Hospital, 65123 Pescara, Italy. FAU - Maffulli, Nicola AU - Maffulli N AUID- ORCID: 0000-0002-5327-3702 AD - Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy. AD - Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. AD - School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK. LA - eng PT - Journal Article PT - Review DEP - 20211109 PL - Switzerland TA - Cells JT - Cells JID - 101600052 RN - 9004-61-9 (Hyaluronic Acid) SB - IM MH - Animals MH - Humans MH - Hyaluronic Acid/*pharmacology MH - Models, Biological MH - Tendinopathy/*pathology MH - Tendons/drug effects/*physiopathology MH - Tissue Engineering MH - Wound Healing PMC - PMC8625461 OTO - NOTNLM OT - biology OT - degeneration OT - effect OT - hyaluronic acid OT - hygroscopic OT - inflammation OT - receptor OT - structure OT - tendinopathy OT - tendon OT - viscoelastic COIS- The authors declare no conflict of interest. EDAT- 2021/11/28 06:00 MHDA- 2021/12/24 06:00 PMCR- 2021/11/09 CRDT- 2021/11/27 01:14 PHST- 2021/09/24 00:00 [received] PHST- 2021/11/01 00:00 [revised] PHST- 2021/11/05 00:00 [accepted] PHST- 2021/11/27 01:14 [entrez] PHST- 2021/11/28 06:00 [pubmed] PHST- 2021/12/24 06:00 [medline] PHST- 2021/11/09 00:00 [pmc-release] AID - cells10113081 [pii] AID - cells-10-03081 [pii] AID - 10.3390/cells10113081 [doi] PST - epublish SO - Cells. 2021 Nov 9;10(11):3081. doi: 10.3390/cells10113081. PMID- 34817129 OWN - NLM STAT- MEDLINE DCOM- 20220307 LR - 20220307 IS - 1613-6829 (Electronic) IS - 1613-6810 (Linking) VI - 18 IP - 3 DP - 2022 Jan TI - A Bioinspired Hemostatic Powder Derived from the Skin Secretion of Andrias davidianus for Rapid Hemostasis and Intraoral Wound Healing. PG - e2101699 LID - 10.1002/smll.202101699 [doi] AB - High-performance hemostasis has become increasingly essential in treating various traumas. However, available topical hemostats still have various drawbacks and side-effects. Herein, hemostatic powders derived from the skin secretion of Andrias davidianus (SSAD) with controllable particle size are prepared using feasible frozen-ball milling following lyophilization for hemorrhage-control. Scanning electron microscopy, rheometry, and Brunauer-Emmett-Teller test are used to characterize the coagulation-promoting surface topography, rheological properties, and porous structure of the SSAD particles. The blood-coagulation assays showed that the SSAD powders can induce blood-absorption in a particle size-dependent manner. Particle sizes of the SSAD powders larger than 200 microm and smaller than 800 microm greatly affect the blood-clotting rate. Associated with the thromboelastography (TEG) and amino acid/protein composition analyses, the accessibility and diffusion of blood are mainly dependent on the wettability, adhesivity, and clotting factors of the SSAD particles. Rapid hemostasis in vivo further involves three hemorrhage models (liver, femoral artery, and tail) as well as an oral wound model, which suggest favorable hemostatic and simultaneous regenerative effects of the SSAD hemostatic powder. Considering its degradability and good biocompatibility, SSAD can be an optimal candidate for a new class of inexpensive, natural, and promising hemostatic and wound-dressing agent. CI - (c) 2021 Wiley-VCH GmbH. FAU - Zhang, Ximu AU - Zhang X AUID- ORCID: 0000-0002-4070-1958 AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Jiang, Lin AU - Jiang L AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Li, Xian AU - Li X AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Zheng, Liwen AU - Zheng L AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Dang, Ruyi AU - Dang R AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Liu, Xiang AU - Liu X AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Wang, Xiaoping AU - Wang X AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Chen, Liling AU - Chen L AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. FAU - Zhang, Yu Shrike AU - Zhang YS AD - Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA. FAU - Zhang, Jixi AU - Zhang J AD - Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China. FAU - Yang, Deqin AU - Yang D AUID- ORCID: 0000-0002-2579-8384 AD - Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20211123 PL - Germany TA - Small JT - Small (Weinheim an der Bergstrasse, Germany) JID - 101235338 RN - 0 (Hemostatics) RN - 0 (Powders) SB - IM MH - Blood Coagulation MH - *Hemostasis MH - *Hemostatics/pharmacology MH - Powders/pharmacology MH - Wound Healing OTO - NOTNLM OT - Andrias davidianus OT - hemostasis OT - particle size OT - wound dressing OT - wound healing EDAT- 2021/11/25 06:00 MHDA- 2022/03/08 06:00 CRDT- 2021/11/24 09:16 PHST- 2021/05/20 00:00 [revised] PHST- 2021/03/22 00:00 [received] PHST- 2021/11/25 06:00 [pubmed] PHST- 2022/03/08 06:00 [medline] PHST- 2021/11/24 09:16 [entrez] AID - 10.1002/smll.202101699 [doi] PST - ppublish SO - Small. 2022 Jan;18(3):e2101699. doi: 10.1002/smll.202101699. Epub 2021 Nov 23. PMID- 34789706 OWN - NLM STAT- MEDLINE DCOM- 20220307 LR - 20260127 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 92 IP - 3 DP - 2022 Mar 1 TI - Thromboelastometry fails to detect autoheparinization after major trauma and hemorrhagic shock. PG - 535-541 LID - 10.1097/TA.0000000000003464 [doi] AB - BACKGROUND: Heparan sulfate is an integral component of the glycocalyx that provides an anticoagulant layer close to the endothelium. Hypoperfusion, inflammation, and sympathoadrenal activation following major trauma result in glycocalyx shedding and subsequent release of heparan sulfate into the bloodstream. The possible anticoagulant effect of this "autoheparinization" has been suggested as a potential driver of trauma-induced coagulopathy. We investigated whether thromboelastometry can be used to detect trauma-induced autoheparinization. METHODS: This study comprised three parts. First, in a retrospective clinical study of 264 major trauma patients, the clotting time (CT) in the intrinsic activation (INTEM) and intrinsic activation plus heparinase (HEPTEM) assays were evaluated upon emergency room admission. Second, in an in vivo experimental rat model of hemorrhagic-traumatic shock, the release of heparan sulfate was investigated with INTEM and HEPTEM analyses of whole blood. Third, in vitro spiking of whole blood from healthy volunteers was undertaken to assess the effects of clinically relevant quantities of heparan sulfate and heparin on CT in the INTEM and HEPTEM assays. RESULTS: In the first part, severe injury and hemorrhagic shock was not associated with any increases in INTEM CT versus HEPTEM CT. Part 2 showed that an approximate threefold increase in heparan sulfate resulting from hemorrhagic traumatic shock in rats did not prolong INTEM CT, and no significant differences between INTEM CT and HEPTEM CT were observed. Third, spiking of whole blood with heparan sulfate had no impact on INTEM CT, whereas heparin elicited significant prolongation of INTEM CT. CONCLUSION: Despite structural similarity between heparan sulfate and heparin, the amounts of heparan sulfate shed in response to trauma did not exert an anticoagulant effect that was measurable by the intrinsically activated CT in thromboelastometry. The extent to which heparan sulfate contributes to trauma-induced coagulopathy has yet to be elucidated. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Zipperle, Johannes AU - Zipperle J AD - From the Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (J.Z., D.O., C.J.S., N.H., G.I., M.O., H.S.), AUVA Trauma Research Centre, Vienna; Department of Anaesthesiology and Intensive Care Medicine (D.O., N.W., W.V., H.S.), AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; Paracelsus Medical University (N.W.), Salzburg; Department of Anaesthesiology and Intensive Care Medicine (C.J.S.), AUVA Trauma Centre Linz, Linz; Department of Anaesthesiology, Perioperative Medicine and General Intensive Care Medicine (B.Z.), Paracelsus Medical University, Salzburg, Austria; and Department of Anaesthesiology (O.G.), RWTH Aachen University Hospital, Aachen, Germany. FAU - Oberladstatter, Daniel AU - Oberladstatter D FAU - Weichselbaum, Nadja AU - Weichselbaum N FAU - Schlimp, Christoph J AU - Schlimp CJ FAU - Hofmann, Nikolaus AU - Hofmann N FAU - Iapichino, Giacomo AU - Iapichino G FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Ziegler, Bernhard AU - Ziegler B FAU - Grottke, Oliver AU - Grottke O FAU - Osuchowski, Marcin AU - Osuchowski M FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Clinical Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9005-49-6 (Heparin) RN - 9050-30-0 (Heparan Sulfate) SB - IM MH - Animals MH - Blood Coagulation Disorders/*blood MH - Blood Coagulation Tests MH - Female MH - Glycocalyx/*metabolism MH - Heparin/*metabolism/pharmacology MH - Heparan Sulfate/*metabolism/pharmacology MH - Humans MH - Male MH - Rats MH - Retrospective Studies MH - Shock, Hemorrhagic/*metabolism MH - Thrombelastography/*methods MH - Wounds and Injuries/*metabolism EDAT- 2021/11/19 06:00 MHDA- 2022/03/08 06:00 CRDT- 2021/11/18 06:13 PHST- 2021/11/19 06:00 [pubmed] PHST- 2022/03/08 06:00 [medline] PHST- 2021/11/18 06:13 [entrez] AID - 01586154-202203000-00009 [pii] AID - 10.1097/TA.0000000000003464 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Mar 1;92(3):535-541. doi: 10.1097/TA.0000000000003464. PMID- 34775801 OWN - NLM STAT- MEDLINE DCOM- 20220301 LR - 20240404 IS - 1938-2723 (Electronic) IS - 1076-0296 (Print) IS - 1076-0296 (Linking) VI - 27 DP - 2021 Jan-Dec TI - Therapeutic Plasma Exchange Protects Patients with Sepsis-Associated Disseminated Intravascular Coagulation by Improving Endothelial Function. PG - 10760296211053313 LID - 10.1177/10760296211053313 [doi] LID - 10760296211053313 AB - The mortality rate of sepsis-associated disseminated intravascular coagulation (DIC) is high. This study aimed to explore the efficacy of therapeutic plasma exchange (TPE) in sepsis-associated DIC patients by improving endothelial function. A total of 112 sepsis-associated DIC patients were randomly divided into the TPE group (n = 40), the heparin (HP) group (n = 36), and the SHAM group (n = 36). The SHAM group received conventional treatment; the HP group was treated with HP based on conventional treatment; and the TPE group received conventional treatment plus TPE. The differences in thromboelastogram (TEG), platelet (PLT), coagulation function, and the endothelial cell (EC) injury biomarkers at 6 h, 24 h, 48 h, 72 h, and 7 days after TPE were compared among the three groups, and the three groups were compared in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sepsis-Related Organ Failure Assessment (SOFA) score, the length of intensive care unit (ICU) hospitalization, 28-day mortality rate, 28-day cumulative survival rate, the incidence of bleeding events, the incidence of acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS). The efficacy of TPE is superior to the HP in increasing PLT, improving coagulation function, increasing the 28-day cumulative survival rate, and reducing the length of ICU hospitalization, 28-day mortality, and the incidence of bleeding events, AKI, and ARDS with statistically significant differences (P < .05). Moreover, the effect of TPE outperforms HP on the EC injury biomarkers with statistically significant differences (P < .05). Our results suggest that TPE may be more effective than HP in the treatment of patients with sepsis-associated DIC. The possible mechanism is via improving endothelial function. FAU - Weng, Junting AU - Weng J AUID- ORCID: 0000-0001-8820-0960 AD - Affiliated Hospital of Putian University, Putian, China. FAU - Chen, Min AU - Chen M AD - Affiliated Hospital of Putian University, Putian, China. FAU - Fang, Dexiang AU - Fang D AD - Affiliated Hospital of Putian University, Putian, China. FAU - Liu, Danjuan AU - Liu D AD - Affiliated Hospital of Putian University, Putian, China. FAU - Guo, Rongjie AU - Guo R AD - Affiliated Hospital of Putian University, Putian, China. FAU - Yang, Shuzhen AU - Yang S AD - Affiliated Hospital of Putian University, Putian, China. LA - eng PT - Journal Article PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 SB - IM MH - Disseminated Intravascular Coagulation/mortality/*therapy MH - Endothelial Cells/*metabolism MH - Female MH - Humans MH - Male MH - Middle Aged MH - Plasma Exchange/*methods MH - Sepsis/*etiology/*therapy MH - Survival Analysis PMC - PMC8597066 OTO - NOTNLM OT - disseminated intravascular coagulation OT - endothelial function OT - sepsis OT - therapeutic plasma exchange COIS- Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2021/11/16 06:00 MHDA- 2022/03/03 06:00 PMCR- 2021/11/15 CRDT- 2021/11/15 05:33 PHST- 2021/11/15 05:33 [entrez] PHST- 2021/11/16 06:00 [pubmed] PHST- 2022/03/03 06:00 [medline] PHST- 2021/11/15 00:00 [pmc-release] AID - 10.1177_10760296211053313 [pii] AID - 10.1177/10760296211053313 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211053313. doi: 10.1177/10760296211053313. PMID- 34768556 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211118 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 21 DP - 2021 Oct 28 TI - Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury. LID - 10.3390/jcm10215039 [doi] LID - 5039 AB - A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays-such as prothrombin time, partial thromboplastin time, and international normalized ratio-have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes. FAU - Bradbury, Jamie L AU - Bradbury JL AD - Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Thomas, Scott G AU - Thomas SG AD - Department of Trauma Surgery, Memorial Hospital, South Bend, IN 46601, USA. FAU - Sorg, Nikki R AU - Sorg NR AUID- ORCID: 0000-0002-7624-2765 AD - Department of Emergency Medicine, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA. FAU - Mjaess, Nicolas AU - Mjaess N AUID- ORCID: 0000-0001-8702-1805 AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Berquist, Margaret R AU - Berquist MR AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Brenner, Toby J AU - Brenner TJ AUID- ORCID: 0000-0002-5970-9730 AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Langford, Jack H AU - Langford JH AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Marsee, Mathew K AU - Marsee MK AD - Department of Otolaryngology, Portsmouth Naval Medical Center, Portsmouth, VA 23708, USA. FAU - Moody, Ashton N AU - Moody AN AD - Department of Emergency Medicine, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA. FAU - Bunch, Connor M AU - Bunch CM AUID- ORCID: 0000-0002-8566-7001 AD - Department of Emergency Medicine, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA. FAU - Sing, Sandeep R AU - Sing SR AD - Department of Emergency Medicine, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA. FAU - Al-Fadhl, Mahmoud D AU - Al-Fadhl MD AUID- ORCID: 0000-0002-3481-1966 AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Salamah, Qussai AU - Salamah Q AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Saleh, Tarek AU - Saleh T AD - Department of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Patel, Neal B AU - Patel NB AD - Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA. AD - Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Shaikh, Kashif A AU - Shaikh KA AD - Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA. AD - Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Smith, Stephen M AU - Smith SM AD - Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA. AD - Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Langheinrich, Walter S AU - Langheinrich WS AD - Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA. AD - Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Fulkerson, Daniel H AU - Fulkerson DH AD - Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA. AD - Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Sixta, Sherry AU - Sixta S AD - Department of Trauma Surgery, Envision Physician Services, Plano, TX 75093, USA. LA - eng PT - Journal Article PT - Review DEP - 20211028 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8584585 OTO - NOTNLM OT - adenosine diphosphate OT - arachidonic acid OT - blood platelets OT - brain injuries OT - cerebral hemorrhage OT - critical care OT - fibrinolysis OT - mortality OT - resuscitation OT - thromboelastography OT - traumatic COIS- All the authors declare no conflict of interest. EDAT- 2021/11/14 06:00 MHDA- 2021/11/14 06:01 PMCR- 2021/10/28 CRDT- 2021/11/13 01:02 PHST- 2021/09/30 00:00 [received] PHST- 2021/10/24 00:00 [revised] PHST- 2021/10/27 00:00 [accepted] PHST- 2021/11/13 01:02 [entrez] PHST- 2021/11/14 06:00 [pubmed] PHST- 2021/11/14 06:01 [medline] PHST- 2021/10/28 00:00 [pmc-release] AID - jcm10215039 [pii] AID - jcm-10-05039 [pii] AID - 10.3390/jcm10215039 [doi] PST - epublish SO - J Clin Med. 2021 Oct 28;10(21):5039. doi: 10.3390/jcm10215039. PMID- 34764800 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211113 IS - 1426-3912 (Print) IS - 1644-4124 (Electronic) IS - 1426-3912 (Linking) VI - 46 IP - 3 DP - 2021 TI - The posttraumatic response of CD4+ regulatory T cells is modulated by direct cell-cell contact via CD40L- and P-selectin-dependent pathways. PG - 283-294 LID - 10.5114/ceji.2021.109171 [doi] AB - CD4+ FoxP3+ regulatory T cells (CD4+ Tregs) are important for the posttraumatic anti-inflammatory host response. As described previously, platelets are able to modulate CD4+ Treg activity in a reciprocally activating interaction following injury. The underlying mechanisms of the posttraumatic interaction between platelets and CD4+ Tregs remain unclear. We investigated the potential influence of CD40L and P-selectin, molecules known to be involved in direct cell contact of these cell types. In a murine burn injury model, the potential interaction pathways were addressed using CD40L- and P-selectin-deficient mice. Draining lymph nodes were harvested following trauma (1 h) and following a sham procedure. Early rapid activation of CD4+ Tregs was assessed by phospho-flow cytometry (signaling molecules (p)PKC-delta and (p)ZAP-70). Platelet function was analyzed performing rotational thromboelastometry (ROTEM). We hypothesized that disruption of the direct cell-cell contact via CD40L and P-selectin would affect posttraumatic activation of CD4+ Tregs and influence the hemostatic function of platelets. Indeed, while injury induced early activation of CD4+ Tregs in wild-type mice (ZAP-70: p = 0.13, pZAP-70: p < 0.05, PKC-delta: p < 0.05, pPKC-delta: p < 0.05), disruption of CD40L-dependent interaction (ZAP-70: p = 0.57, pZAP-70: p = 0.68, PKC-delta: p = 0.68, pPKC-delta: p = 0.9) or P-selectin-dependent interaction (ZAP-70: p = 0.78, pZAP-70: p = 0.58, PKC-delta: p = 0.81, pPKC-delta: p = 0.73) resulted in reduced posttraumatic activation. Furthermore, hemostatic function was impaired towards hypocoagulability in either deficiency. Our results suggest that the posttraumatic activation of CD4+ Tregs and hemostatic function of platelets are affected by direct cell-cell-signaling via CD40L and P-selectin. CI - Copyright (c) 2021 Termedia. FAU - Rupp, Marco-Christopher AU - Rupp MC AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Bergmann, Christian Benjamin AU - Bergmann CB AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Jung, Sonja AU - Jung S AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Bock, Matthias AU - Bock M AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Biberthaler, Peter AU - Biberthaler P AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Heimann, Laura AU - Heimann L AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Hanschen, Marc AU - Hanschen M AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. LA - eng PT - Journal Article DEP - 20211019 PL - Poland TA - Cent Eur J Immunol JT - Central-European journal of immunology JID - 9702239 PMC - PMC8574106 OTO - NOTNLM OT - CD4+ regulatory T cells OT - adaptive immune response OT - cell communication OT - hemostasis OT - platelets OT - trauma COIS- The authors declare no conflict of interest. EDAT- 2021/11/13 06:00 MHDA- 2021/11/13 06:01 PMCR- 2021/01/01 CRDT- 2021/11/12 06:59 PHST- 2020/11/18 00:00 [received] PHST- 2021/05/14 00:00 [accepted] PHST- 2021/11/12 06:59 [entrez] PHST- 2021/11/13 06:00 [pubmed] PHST- 2021/11/13 06:01 [medline] PHST- 2021/01/01 00:00 [pmc-release] AID - 45167 [pii] AID - 10.5114/ceji.2021.109171 [doi] PST - ppublish SO - Cent Eur J Immunol. 2021;46(3):283-294. doi: 10.5114/ceji.2021.109171. Epub 2021 Oct 19. PMID- 34761698 OWN - NLM STAT- MEDLINE DCOM- 20211223 LR - 20250527 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 88 IP - 1 DP - 2022 Jan TI - Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article. PG - 10-19 LID - 10.1177/00031348211060424 [doi] AB - Shock is a sequelae in trauma and burn patients that substantially increases the risk for morbidity and mortality. The use of resuscitation endpoints allows for improved management of these patients, with the potential to prevent further morbidity/mortality. We conducted a review of the current literature on the efficacy of hemodynamic, metabolic, and regional resuscitation endpoints for use in trauma and burn patients. Hemodynamic endpoints included mean arterial pressure (MAP), heart rate (HR), urinary output (UO), compensatory reserve index (CRI), intrathoracic blood volume, and stroke volume variation (SVV). Metabolic endpoints measure cellular responses to decreased oxygen delivery and include serum lactic acid (LA), base deficit (BD), bicarbonate, anion gap, apparent strong ion difference, and serum pH. Mean arterial pressure, HR, UO, and LA are the most established markers of trauma and burn resuscitation. The evidence suggests LA is a superior metabolic endpoint marker. Newer resuscitation endpoint technologies such as point-of-care ultrasound (PoCUS), thromboelastography (TEG), and rotational thromboelastometry (ROTEM) may improve patient outcomes; however, additional research is needed to establish the efficacy in trauma and burn patients. The endpoints discussed have situational strengths and weaknesses and no single universal resuscitation endpoint has yet emerged. This review may increase knowledge and aid in guideline development. We recommend clinicians continue to integrate multiple endpoints with emphasis on MAP, HR, UO, LA, and BD. Future investigation should aim to standardize endpoints for each clinical presentation. The search for universal and novel resuscitation parameters in trauma and burns should also continue. FAU - Belaunzaran, Miguel AU - Belaunzaran M AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. FAU - Raslan, Shahm AU - Raslan S AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. FAU - Ali, Aleeza AU - Ali A AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. FAU - Newsome, Kevin AU - Newsome K AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. FAU - McKenney, Mark AU - McKenney M AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. AD - 14506University of South Florida, Tampa, FL, USA. FAU - Elkbuli, Adel AU - Elkbuli A AD - Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA. LA - eng PT - Journal Article PT - Systematic Review DEP - 20211111 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Bicarbonates) RN - 33X04XA5AT (Lactic Acid) RN - S88TT14065 (Oxygen) SB - IM ECI - Am Surg. 2025 Mar;91(3):464-472. doi: 10.1177/00031348241305412. PMID: 39791244 MH - Acid-Base Equilibrium MH - Bicarbonates/blood MH - Blood Pressure/physiology MH - Blood Volume/physiology MH - Burns/*complications MH - Heart Rate/physiology MH - Humans MH - Lactic Acid/blood MH - Oxygen/administration & dosage MH - Point-of-Care Testing MH - Resuscitation/*methods MH - Shock/blood/etiology/physiopathology/*therapy MH - Stroke Volume/physiology MH - Thrombelastography MH - Treatment Outcome MH - Urine MH - Wounds and Injuries/*complications OTO - NOTNLM OT - Trauma resuscitation endpoints OT - hemodynamic endpoints OT - metabolic endpoints OT - regional endpoints OT - trauma outcomes EDAT- 2021/11/12 06:00 MHDA- 2021/12/24 06:00 CRDT- 2021/11/11 08:36 PHST- 2021/11/12 06:00 [pubmed] PHST- 2021/12/24 06:00 [medline] PHST- 2021/11/11 08:36 [entrez] AID - 10.1177/00031348211060424 [doi] PST - ppublish SO - Am Surg. 2022 Jan;88(1):10-19. doi: 10.1177/00031348211060424. Epub 2021 Nov 11. PMID- 34755760 OWN - NLM STAT- MEDLINE DCOM- 20211203 LR - 20220629 IS - 1980-5322 (Electronic) IS - 1807-5932 (Print) IS - 1807-5932 (Linking) VI - 76 DP - 2021 TI - Early administration of fibrinogen concentrate in patients with polytrauma with thromboelastometry suggestive of hypofibrinogenemia: A randomized feasibility trial. PG - e3168 LID - 10.6061/clinics/2021/e3168 [doi] LID - e3168 AB - OBJECTIVE: To evaluate the clinical effects of early administration of fibrinogen concentrate in patients with severe trauma and hypofibrinogenemia. METHODS: We conducted an open randomized feasibility trial between December 2015 and January 2017 in patients with severe trauma admitted to the emergency department of a large trauma center. Patients presented with hypotension, tachycardia, and FIBTEM findings suggestive of hypofibrinogenemia. The intervention group received fibrinogen concentrate (50 mg/kg), and the control group did not receive early fibrinogen replacement. The primary outcome was feasibility assessed as the proportion of patients receiving the allocated treatment within 60 min after randomization. The secondary outcomes were transfusion requirements and other exploratory outcomes. Randomization was performed using sequentially numbered and sealed opaque envelopes. ClinicalTrials.gov: NCT02864875. RESULTS: Thirty-two patients were randomized (16 in each group). All patients received the allocated treatment within 60 min after randomization (100%, 95% confidence interval, 86.7%-100%). The median length of intensive care unit stay was shorter in the intervention group (8 days, interquartile range [IQR] 5.75-10.0 vs. 11 days, IQR 8.5-16.0; p=0.02). There was no difference between the groups in other clinical outcomes. No adverse effects related to treatment were recorded in either group. CONCLUSION: Early fibrinogen replacement with fibrinogen concentrate was feasible. Larger trials are required to properly evaluate clinical outcomes. FAU - Lucena, Lucas Siqueira de AU - Lucena LS AUID- ORCID: 0000-0001-6530-6420 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. AD - Departamento de Anestesiologia, Hospital Universitario Walter Cantidio, Fortaleza, CE, BR. FAU - Rodrigues, Roseny Dos Reis AU - Rodrigues RDR AUID- ORCID: 0000-0002-3796-5952 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Carmona, Maria Jose Carvalho AU - Carmona MJC AUID- ORCID: 0000-0002-3031-2924 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Noronha, Francisco Jose Diniz AU - Noronha FJD AUID- ORCID: 0000-0003-0431-1108 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Oliveira, Heleno de Paiva AU - Oliveira HP AUID- ORCID: 0000-0001-7335-3438 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Lima, Natalia Martins AU - Lima NM AUID- ORCID: 0000-0002-5023-3991 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Pinheiro, Rodrigo Brandao AU - Pinheiro RB AUID- ORCID: 0000-0002-4422-7296 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. FAU - Silva, Wallace Andrino da AU - Silva WAD AUID- ORCID: 0000-0002-7049-0979 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. AD - Departamento de Anestesiologia, Hospital Universitario Onofre Lopes, Natal, RN, BR. FAU - Cavalcanti, Alexandre Biasi AU - Cavalcanti AB AUID- ORCID: 0000-0003-2798-6263 AD - Programa de Pos-graduacao em Anestesiologia, Ciencias Cirurgicas e Medicina Perioperatoria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. AD - Instituto de Pesquisa Hcor, Sao Paulo, SP, BR. LA - eng SI - ClinicalTrials.gov/NCT02864875 PT - Journal Article PT - Randomized Controlled Trial DEP - 20211108 PL - United States TA - Clinics (Sao Paulo) JT - Clinics (Sao Paulo, Brazil) JID - 101244734 RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Afibrinogenemia/drug therapy MH - Feasibility Studies MH - Fibrinogen/*administration & dosage MH - Humans MH - *Multiple Trauma/therapy MH - Thrombelastography MH - Treatment Outcome PMC - PMC8552954 COIS- Conflicts of Interest. Roseny Rodrigues gives lectures to CSL Behring regarding coagulation and hemostatic drugs. The other authors declare that they have no competing interests. EDAT- 2021/11/11 06:00 MHDA- 2021/12/15 06:00 PMCR- 2021/10/28 CRDT- 2021/11/10 09:12 PHST- 2021/06/07 00:00 [received] PHST- 2021/09/30 00:00 [accepted] PHST- 2021/11/10 09:12 [entrez] PHST- 2021/11/11 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/10/28 00:00 [pmc-release] AID - S1807-5932(22)00227-7 [pii] AID - cln_76p1 [pii] AID - 10.6061/clinics/2021/e3168 [doi] PST - epublish SO - Clinics (Sao Paulo). 2021 Nov 8;76:e3168. doi: 10.6061/clinics/2021/e3168. eCollection 2021. PMID- 34749909 OWN - NLM STAT- MEDLINE DCOM- 20220110 LR - 20220110 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 53 IP - 1 DP - 2022 Jan TI - Massive transfusion protocols in the Netherlands. Consensus or confusion? PG - 49-53 LID - S0020-1383(21)00905-0 [pii] LID - 10.1016/j.injury.2021.10.034 [doi] AB - INTRODUCTION: Transfusion strategy for trauma patients with massive haemorrhage is often incorporated in massive transfusion protocols (MTP). Albeit correct MTP use results in better patient outcome, research regarding the state of MTP knowledge is scarce. The objective of this study is therefore to assess knowledge of local MTP and massive transfusion strategy in the level 1 trauma centres in the Netherlands. Our hypothesis is that actual MTP knowledge is low and transfusion strategy differs. MATERIALS AND METHODS: Surveys were sent out in January 2020 to all trauma and vascular surgeons, anaesthesiologists, emergency department physicians of the largest level 1 trauma centre (locally, n = 113) and to one trauma surgeon, emergency physician and anaesthesiologist in each of the nine other governmentally assigned level 1 trauma centres in the Netherlands (nationally, n = 27). The respondents were subdivided into a frequent user group (MTP usage >/= 4 times in 2019) and a non-frequent user group (MTP usage < 4 in 2019). Data are expressed as numbers and percentages. RESULTS: Response rate was (n = 48; 42%) for the local survey and (n = 14; 52%) for the national survey. Locally, (n = 23; 48%) and (n = 25; 52%) respondents were defined frequent and non-frequent users respectively and national respondents all as frequent users. In total, (n = 13; 27%) of local respondents were aware of the current local composition of the MTP. Respondents indicated to transfuse erythrocytes first, followed by plasma and platelets (local non-frequent users n = 23; 92%, local frequent users n = 21; 91% and national frequent users n = 13; 93%). The indication for platelet transfusion was units erythrocytes transfused (local non-frequent users n = 10; 40% frequent users locally n = 11; 48% and nationally n = 5; 36%) and clinical view (local non-frequent users n = 9; 36%, frequent users locally n = 8; 35% and n<5 nationally. Whereas few respondents claimed (n = 5; 21% non-frequent users locally and n <5 nationally) to transfuse platelets based on platelet counts. Viscoelastic haemostatic assays were performed during MTP, but only by frequent users. CONCLUSION: The majority of physicians dealing with massive transfusion in trauma patients were not aware of the exact composition of the MTP and consensus regarding transfusion strategy and indication for platelet transfusion was low. CI - Copyright (c) 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Rijnhout, Tim W H AU - Rijnhout TWH AD - Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: twhrijnhout@alrijne.nl. FAU - Noorman, Femke AU - Noorman F AD - Military Blood Bank, Ministry of Defence, 3584 EZ Utrecht, the Netherlands. Electronic address: f.noorman@mindef.nl. FAU - van Waes, Oscar J F AU - van Waes OJF AD - Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: o.vanwaes@erasmusmc.nl. FAU - van Bohemen, Michaela AU - van Bohemen M AD - Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, CE 3015 Rotterdam, the Netherlands. Electronic address: m.vanbohemen@erasmusmc.nl. FAU - Verhofstad, Michael H J AU - Verhofstad MHJ AD - Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: m.verhofstad@erasmusmc.nl. FAU - Hoencamp, Rigo AU - Hoencamp R AD - Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, the Netherlands; Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, the Netherlands. Electronic address: r.hoencamp@erasmusmc.nl. LA - eng PT - Journal Article DEP - 20211031 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - *Blood Transfusion MH - Clinical Protocols MH - Consensus MH - Humans MH - Netherlands MH - Retrospective Studies MH - Trauma Centers MH - *Wounds and Injuries/therapy OTO - NOTNLM OT - Bleeding OT - Damage control resuscitation OT - Haemorrhage OT - Massive transfusion OT - Massive transfusion protocol OT - Platelets OT - Resuscitation OT - Shock OT - Trauma COIS- Declaration of Competing Interest None EDAT- 2021/11/10 06:00 MHDA- 2022/01/11 06:00 CRDT- 2021/11/09 05:47 PHST- 2021/09/27 00:00 [received] PHST- 2021/10/26 00:00 [revised] PHST- 2021/10/29 00:00 [accepted] PHST- 2021/11/10 06:00 [pubmed] PHST- 2022/01/11 06:00 [medline] PHST- 2021/11/09 05:47 [entrez] AID - S0020-1383(21)00905-0 [pii] AID - 10.1016/j.injury.2021.10.034 [doi] PST - ppublish SO - Injury. 2022 Jan;53(1):49-53. doi: 10.1016/j.injury.2021.10.034. Epub 2021 Oct 31. PMID- 34738997 OWN - NLM STAT- MEDLINE DCOM- 20220221 LR - 20260330 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 92 IP - 2 DP - 2022 Feb 1 TI - A new trauma frontier: Exploratory pilot study of platelet transcriptomics in trauma patients. PG - 313-322 LID - 10.1097/TA.0000000000003450 [doi] AB - BACKGROUND: The earliest measurable changes to postinjury platelet biology may be in the platelet transcriptome, as platelets are known to carry messenger ribonucleic acids (RNAs), and there is evidence in other inflammatory and infectious disease states of differential and alternative platelet RNA splicing in response to changing physiology. Thus, the aim of this exploratory pilot study was to examine the platelet transcriptome and platelet RNA splicing signatures in trauma patients compared with healthy donors. METHODS: Preresuscitation platelets purified from trauma patients (n = 9) and healthy donors (n = 5) were assayed using deep RNA sequencing. Differential gene expression analysis, weighted gene coexpression network analysis, and differential alternative splicing analyses were performed. In parallel samples, platelet function was measured with platelet aggregometry, and clot formation was measured with thromboelastography. RESULTS: Differential gene expression analysis identified 49 platelet RNAs to have differing abundance between trauma patients and healthy donors. Weighted gene coexpression network analysis identified coexpressed platelet RNAs that correlated with platelet aggregation. Differential alternative splicing analyses revealed 1,188 splicing events across 462 platelet RNAs that were highly statistically significant (false discovery rate <0.001) in trauma patients compared with healthy donors. Unsupervised principal component analysis of these platelet RNA splicing signatures segregated trauma patients in two main clusters separate from healthy controls. CONCLUSION: Our findings provide evidence of finetuning of the platelet transcriptome through differential alternative splicing of platelet RNA in trauma patients and that this finetuning may have relevance to downstream platelet signaling. Additional investigations of the trauma platelet transcriptome should be pursued to improve our understanding of the platelet functional responses to trauma on a molecular level. CI - Copyright (c) 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma. FAU - Fields, Alexander T AU - Fields AT AD - From the Department of Surgery (A.T.F., Y.A.S., Z.A.M., J.C., L.Z.K.), Department of Anesthesia (M.-C.L., F.M., C.M.V.B., N.M., R.J.B.), Zuckerberg San Francisco General Hospital and the University of California, San Francisco; and Bakar Computational Health Sciences Institute (R.A.C., K.M.K.), University of California, San Francisco, San Francisco, California. FAU - Lee, Man-Cheung AU - Lee MC FAU - Mayer, Fahima AU - Mayer F FAU - Santos, Yale A AU - Santos YA FAU - Bainton, Cedric M V AU - Bainton CMV FAU - Matthay, Zachary A AU - Matthay ZA FAU - Callcut, Rachael A AU - Callcut RA FAU - Mayer, Nasima AU - Mayer N FAU - Cuschieri, Joseph AU - Cuschieri J FAU - Kober, Kord M AU - Kober KM FAU - Bainton, Roland J AU - Bainton RJ FAU - Kornblith, Lucy Zumwinkle AU - Kornblith LZ LA - eng GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - T32 GM008440/GM/NIGMS NIH HHS/United States GR - TL1 TR001871/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 63231-63-0 (RNA) SB - IM MH - Blood Coagulation Disorders/*etiology/*genetics MH - Blood Platelets/*metabolism MH - Female MH - Gene Expression Profiling MH - Humans MH - Male MH - Pilot Projects MH - Platelet Activation MH - Platelet Aggregation MH - RNA/*metabolism MH - Thrombelastography MH - *Transcriptome MH - Wounds and Injuries/*complications PMC - PMC8781218 MID - NIHMS1751760 EDAT- 2021/11/06 06:00 MHDA- 2022/02/22 06:00 PMCR- 2022/01/21 CRDT- 2021/11/05 12:14 PHST- 2021/11/06 06:00 [pubmed] PHST- 2022/02/22 06:00 [medline] PHST- 2021/11/05 12:14 [entrez] PHST- 2022/01/21 00:00 [pmc-release] AID - 01586154-202202000-00010 [pii] AID - JT_210404 [pii] AID - 10.1097/TA.0000000000003450 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Feb 1;92(2):313-322. doi: 10.1097/TA.0000000000003450. PMID- 34724559 OWN - NLM STAT- MEDLINE DCOM- 20220207 LR - 20260327 IS - 1528-1175 (Electronic) IS - 0003-3022 (Linking) VI - 136 IP - 1 DP - 2022 Jan 1 TI - Temporal Transitions in Fibrinolysis after Trauma: Adverse Outcome Is Principally Related to Late Hypofibrinolysis. PG - 148-161 LID - 10.1097/ALN.0000000000004036 [doi] AB - BACKGROUND: The relationship between late clinical outcomes after injury and early dynamic changes between fibrinolytic states is not fully understood. The authors hypothesized that temporal transitions in fibrinolysis states using rotational thromboelastometry (ROTEM) would aid stratification of adverse late clinical outcomes and improve understanding of how tranexamic acid modulates the fibrinolytic response and impacts mortality. METHODS: The authors conducted a secondary analysis of previously collected data from trauma patients enrolled into an ongoing prospective cohort study (International Standard Randomised Controlled Trial Number [ISRCTN] 12962642) at a major trauma center in the United Kingdom. ROTEM was performed on admission and at 24 h with patients retrospectively grouped into three fibrinolysis categories: tissue factor-activated ROTEM maximum lysis of less than 5% (low); tissue factor-activated ROTEM maximum lysis of 5 to 15% (normal); or tissue factor-activated ROTEM maximum lysis of more than 15% (high). Primary outcomes were multiorgan dysfunction syndrome and 28-day mortality. RESULTS: Seven-hundred thirty-one patients were included: 299 (41%) were treated with tranexamic acid and 432 (59%) were untreated. Two different cohorts with low-maximum lysis at 24 h were identified: (1) severe brain injury and (2) admission shock and hemorrhage. Multiple organ dysfunction syndrome was greatest in those with low-maximum lysis on admission and at 24 h, and late mortality was four times higher than in patients who remained normal during the first 24 h (7 of 42 [17%] vs. 9 of 223 [4%]; P = 0.029). Patients that transitioned to or remained in low-maximum lysis had increased odds of organ dysfunction (5.43 [95% CI, 1.43 to 20.61] and 4.85 [95% CI, 1.83 to 12.83], respectively). Tranexamic acid abolished ROTEM hyperfibrinolysis (high) on admission, increased the frequency of persistent low-maximum lysis (67 of 195 [34%]) vs. 8 of 79 [10%]; P = 0.002), and was associated with reduced early mortality (28 of 195 [14%] vs. 23 of 79 [29%]; P = 0.015). No increase in late deaths, regardless of fibrinolysis transition patterns, was observed. CONCLUSIONS: Adverse late outcomes are more closely related to 24-h maximum lysis, irrespective of admission levels. Tranexamic acid alters early fibrinolysis transition patterns, but late mortality in patients with low-maximum lysis at 24 h is not increased. CI - Copyright (c) 2021, the American Society of Anesthesiologists. All Rights Reserved. FAU - Rossetto, Andrea AU - Rossetto A AUID- ORCID: 0000-0002-9176-8351 AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. FAU - Vulliamy, Paul AU - Vulliamy P AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. FAU - Lee, Kim May AU - Lee KM AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom. FAU - Brohi, Karim AU - Brohi K AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. FAU - Davenport, Ross AU - Davenport R AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesthesiology JT - Anesthesiology JID - 1300217 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM CIN - Anesthesiology. 2022 Jan 1;136(1):7-9. doi: 10.1097/ALN.0000000000004020. PMID: 34874993 MH - Adult MH - Antifibrinolytic Agents/administration & dosage MH - Blood Coagulation Tests/trends MH - Cohort Studies MH - Female MH - Fibrinolysis/drug effects/*physiology MH - Hemorrhage/*blood/*mortality/prevention & control MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Retrospective Studies MH - Thrombelastography/drug effects/trends MH - Time Factors MH - Tranexamic Acid/administration & dosage MH - United Kingdom/epidemiology MH - Wounds and Injuries/*blood/drug therapy/*mortality EDAT- 2021/11/02 06:00 MHDA- 2022/02/08 06:00 CRDT- 2021/11/01 17:23 PHST- 2021/11/02 06:00 [pubmed] PHST- 2022/02/08 06:00 [medline] PHST- 2021/11/01 17:23 [entrez] AID - 117849 [pii] AID - 10.1097/ALN.0000000000004036 [doi] PST - ppublish SO - Anesthesiology. 2022 Jan 1;136(1):148-161. doi: 10.1097/ALN.0000000000004036. PMID- 34714087 OWN - NLM STAT- MEDLINE DCOM- 20220309 LR - 20220309 IS - 1530-6992 (Electronic) IS - 1530-6984 (Linking) VI - 21 IP - 21 DP - 2021 Nov 10 TI - Getting to the Core of It All: Nanocapsules to Mitigate Infusion Reactions Can Promote Hemostasis and Be a Platform for Intravenous Therapies. PG - 9069-9076 LID - 10.1021/acs.nanolett.1c02746 [doi] AB - One of the significant challenges to translation of intravenously administered nanomaterials has been complement-mediated infusion reactions which can be lethal. Slow infusions can reduce infusion reactions, but slow infusions are not always possible in applications like controlling bleeding following trauma. Thus, avoiding complement activation and infusion responses is essential to manage bleeding. We identified nanocapsules based on polyurethane as candidates that did not activate C5a and explored their PEGylation and functionalization with the GRGDS peptide to create a new class of hemostatic nanomaterials. Using the clinically relevant rotational thromboelastography (ROTEM), we determined that nanocapsules promote faster clotting than controls and maintain the maximum clot firmness, which is critical for reducing bleeding. Excitingly, these polyurethane-based nanocapsules did not activate complement or the major pro-inflammatory cytokines. This work provides critical evidence for the role of modulating the core material in developing safer nanomedicines for intravenous applications. FAU - Maisha, Nuzhat AU - Maisha N AD - University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States. FAU - Rubenstein, Michael AU - Rubenstein M AD - University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States. FAU - Bieberich, Charles J AU - Bieberich CJ AD - University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States. FAU - Lavik, Erin AU - Lavik E AUID- ORCID: 0000-0002-0644-744X AD - University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20211029 PL - United States TA - Nano Lett JT - Nano letters JID - 101088070 RN - 0 (Hemostatics) RN - 0 (Nanocapsules) SB - IM MH - Hemorrhage/drug therapy MH - Hemostasis MH - *Hemostatics/therapeutic use MH - Humans MH - *Nanocapsules MH - Thrombelastography OTO - NOTNLM OT - Procoagulant OT - hemostatic OT - immune response OT - nanomaterial OT - nanoparticle OT - polymer EDAT- 2021/10/30 06:00 MHDA- 2022/03/11 06:00 CRDT- 2021/10/29 12:13 PHST- 2021/10/30 06:00 [pubmed] PHST- 2022/03/11 06:00 [medline] PHST- 2021/10/29 12:13 [entrez] AID - 10.1021/acs.nanolett.1c02746 [doi] PST - ppublish SO - Nano Lett. 2021 Nov 10;21(21):9069-9076. doi: 10.1021/acs.nanolett.1c02746. Epub 2021 Oct 29. PMID- 34695058 OWN - NLM STAT- MEDLINE DCOM- 20211110 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 91 IP - 5 DP - 2021 Nov 1 TI - Thromboelastography with platelet mapping: Limited predictive ability in detecting preinjury antiplatelet agent use. PG - 803-808 LID - 10.1097/TA.0000000000003172 [doi] AB - BACKGROUND: Preinjury antiplatelet agent (APA) use in trauma patients can increase traumatic hemorrhage and worsen outcomes. Thromboelastography with platelet mapping (TEGPM) has characterized platelet function via arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition in nontrauma settings, but limited data exist in the acute trauma population. METHODS: A prospective observational study of adult trauma patients with suspected preinjury APA use who received TEGPM testing from 2017 to 2020 was performed. Patients on anticoagulants were excluded. Patients were grouped according to preinjury APA regimen: 81 mg or 325 mg of aspirin daily, 81 mg of aspirin and 75 mg of clopidrogrel daily, 75 mg of clopidrogrel daily, or no antiplatelet. Ability of TEGPM to detect APA use was assessed using predictive statistics and area under receiver operating characteristic curves (AUROCs). RESULTS: A total of 824 patients were included with most patients taking 81 mg of aspirin (n = 558). Patients on no antiplatelet were younger and had higher baseline platelet counts, while patients on 75 mg of clopidrogrel were more likely to be admitted after ground level fall. All other baseline characteristics were balanced. Admission TEG values were similar between groups. Median AA inhibition was higher in patients on aspirin containing regimens (p < 0.0001). Median ADP inhibition was higher in patients on clopidogrel containing regimens and those taking 325 mg of aspirin (p < 0.0001). Arachidonic acid inhibition accurately detected preinjury APA use and aspirin use (AUROC, 0.89 and 0.84, respectively); however, ADP inhibition performed poorly (AUROC, 0.58). Neither AA nor ADP inhibition was able to discern specific APA regimens or rule out APA use entirely. CONCLUSION: High AA inhibition accurately detects preinjury APA use in trauma patients. High ADP inhibition after trauma is common, limiting its utility to accurately identify preinjury APA use. Further study is needed to identify assays that can reliably detect and further characterize preinjury APA use in trauma populations. LEVEL OF EVIDENCE: Diagnostic test, level II. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Barton, Cassie A AU - Barton CA AD - From the Department of Pharmacy (C.A.B., H.J.O., G.J.R.), and Department of Surgery (E.N.D., A.G., M.S.), Oregon Health & Science University, Portland, Oregon. FAU - Oetken, Heath J AU - Oetken HJ FAU - Roberti, Gregory J AU - Roberti GJ FAU - Dewey, Elizabeth N AU - Dewey EN FAU - Goodman, Andrew AU - Goodman A FAU - Schreiber, Martin AU - Schreiber M LA - eng PT - Journal Article PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Platelet Aggregation Inhibitors) RN - 27YG812J1I (Arachidonic Acid) RN - 5587267Z69 (Domperidone) RN - 7C6TA32SD2 (clopimozide) RN - R16CO5Y76E (Aspirin) SB - IM MH - Aged MH - Aged, 80 and over MH - Arachidonic Acid/analysis/antagonists & inhibitors/metabolism MH - Aspirin/administration & dosage/adverse effects MH - Blood Platelets/drug effects/metabolism MH - Domperidone/administration & dosage/adverse effects/analogs & derivatives MH - Female MH - Hemorrhage/blood/etiology/*prevention & control MH - Humans MH - Male MH - Medication Reconciliation/*methods MH - Platelet Aggregation/drug effects MH - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects MH - Predictive Value of Tests MH - Prospective Studies MH - ROC Curve MH - Thrombelastography/*statistics & numerical data MH - Wounds and Injuries/blood/*complications/therapy EDAT- 2021/10/26 06:00 MHDA- 2021/11/11 06:00 CRDT- 2021/10/25 17:19 PHST- 2021/10/25 17:19 [entrez] PHST- 2021/10/26 06:00 [pubmed] PHST- 2021/11/11 06:00 [medline] AID - 01586154-202111000-00005 [pii] AID - 10.1097/TA.0000000000003172 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Nov 1;91(5):803-808. doi: 10.1097/TA.0000000000003172. PMID- 34668240 OWN - NLM STAT- MEDLINE DCOM- 20220425 LR - 20220425 IS - 1399-0012 (Electronic) IS - 0902-0063 (Linking) VI - 36 IP - 2 DP - 2022 Feb TI - Thromboelastography profiles for controlled circulatory death donors: Validating the role of heparin. PG - e14518 LID - 10.1111/ctr.14518 [doi] AB - Controlled donation after circulatory death (cDCD) liver transplants are associated with increased ischemic-type biliary complications. Microvascular thrombosis secondary to decreased donor fibrinolysis may contribute to bile duct injury. We hypothesized that cDCD donors are hypercoagulable with impaired fibrinolysis and aim to use thromboelastography to characterize cDCD coagulation profiles. CI - (c) 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. FAU - Crannell, W Christian AU - Crannell WC AUID- ORCID: 0000-0001-7958-734X AD - Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA. FAU - Sally, Mitch AU - Sally M AD - Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - McConnell, Keeley AU - McConnell K AD - Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Connelly, Chris AU - Connelly C AD - Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA. FAU - Maynard, Erin AU - Maynard E AD - Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA. FAU - Dewey, Elizabeth AU - Dewey E AD - Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA. FAU - Abt, Peter AU - Abt P AD - Department of Surgery, Division of Transplantation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Enestvedt, C Kristian AU - Enestvedt CK AD - Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA. LA - eng PT - Journal Article DEP - 20211129 PL - Denmark TA - Clin Transplant JT - Clinical transplantation JID - 8710240 RN - 9005-49-6 (Heparin) SB - IM MH - Brain Death MH - Death MH - Graft Survival MH - Heparin MH - Humans MH - *Liver Transplantation MH - Retrospective Studies MH - Thrombelastography MH - Tissue Donors MH - *Tissue and Organ Procurement OTO - NOTNLM OT - coagulation and hemostasis OT - donors and donation: donation after circulatory death (DCD) OT - thrombolytic therapy/thrombolysis EDAT- 2021/10/21 06:00 MHDA- 2022/04/26 06:00 CRDT- 2021/10/20 07:03 PHST- 2021/09/23 00:00 [revised] PHST- 2021/05/29 00:00 [received] PHST- 2021/09/23 00:00 [accepted] PHST- 2021/10/21 06:00 [pubmed] PHST- 2022/04/26 06:00 [medline] PHST- 2021/10/20 07:03 [entrez] AID - 10.1111/ctr.14518 [doi] PST - ppublish SO - Clin Transplant. 2022 Feb;36(2):e14518. doi: 10.1111/ctr.14518. Epub 2021 Nov 29. PMID- 34640507 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211016 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 19 DP - 2021 Sep 29 TI - Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study. LID - 10.3390/jcm10194491 [doi] LID - 4491 AB - BACKGROUND: Current guidelines recommend the monitoring of anti-factor Xa (anti-Xa) levels to avoid an accumulation of low-molecular-weight heparins in patients with acute kidney injury, but there is no evidence on how to proceed with such monitoring during continuous renal replacement therapy. Against this background, we investigated the potential accumulation of enoxaparin administered subcutaneously for venous thromboembolism prophylaxis in critically ill patients during continuous renal replacement therapy covered by regional citrate anticoagulation. METHODS: Anti-Xa levels were measured at baseline (18 years) admitted to our Level I trauma center with an ABC Score>/=2 were enrolled. Partial thromboplastin time (PTT), international normalized ratio (INR), and thromboelastography (TEG) parameters were recorded at arrival. Injury characteristics and clinical outcomes were obtained. Plasma HA levels were measured in healthy controls (HC) and in trauma subjects at arrival (t = 0 h) and 12, 24, and 48 h. ATC was defined as admission INR>1.2 or PTT>/=36.5 s. Comparisons of HA levels were assessed, and Spearman's correlations were performed between 0 h and 24 h HA levels, coagulation measures and clinical outcomes. P values < 0.05 were considered significant. RESULTS: Forty-eight trauma patients and 22 controls were enrolled for study. Sixteen trauma subjects were coagulopathic at admission. HA levels in subjects with ATC were higher than non-coagulopathic subjects at all time points and elevated above HC levels at 24 and 48 h. At arrival, HA levels correlated with TEG R-time, PTT, and INR. HA levels at 24 h correlated with increased transfusion requirements and intensive care unit and hospital lengths of stay. CONCLUSION: Shed HA is associated with early coagulation abnormalities in trauma patients, which may contribute to worse outcomes. These findings highlight the need for additional studies to evaluate the mechanistic role of HA in ATC. CI - Copyright (c) 2021 by the Shock Society. FAU - Walker, Shannon C AU - Walker SC AD - University of Alabama at Birmingham School of Medicine, Birmingham, Alabama. FAU - Richter, Robert P AU - Richter RP AD - Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. AD - Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Zheng, Lei AU - Zheng L AD - Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Ashtekar, Amit R AU - Ashtekar AR AD - Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Jansen, Jan O AU - Jansen JO AD - Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Kerby, Jeffrey D AU - Kerby JD AD - Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Richter, Jillian R AU - Richter JR AD - Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama. AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. LA - eng GR - R35 GM137958/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Biomarkers) RN - 9004-61-9 (Hyaluronic Acid) SB - IM MH - Adult MH - Aged MH - Biomarkers/blood MH - Blood Coagulation Disorders/blood/*complications MH - Blood Transfusion/statistics & numerical data MH - Case-Control Studies MH - Female MH - Humans MH - Hyaluronic Acid/*blood MH - International Normalized Ratio MH - Length of Stay MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*complications PMC - PMC8678307 MID - NIHMS1742269 COIS- The authors report no conflicts of interest. EDAT- 2021/10/06 06:00 MHDA- 2022/03/03 06:00 PMCR- 2023/01/01 CRDT- 2021/10/05 05:51 PHST- 2021/10/06 06:00 [pubmed] PHST- 2022/03/03 06:00 [medline] PHST- 2021/10/05 05:51 [entrez] PHST- 2023/01/01 00:00 [pmc-release] AID - 00024382-202201000-00015 [pii] AID - 10.1097/SHK.0000000000001867 [doi] PST - ppublish SO - Shock. 2022 Jan 1;57(1):113-117. doi: 10.1097/SHK.0000000000001867. PMID- 34607730 OWN - NLM STAT- MEDLINE DCOM- 20220131 LR - 20220131 IS - 1532-9496 (Electronic) IS - 0887-7963 (Linking) VI - 35 IP - 4 DP - 2021 Oct TI - Viscoelastic Testing in Traumatic Brain Injury: Key Research Insights. PG - 108-112 LID - S0887-7963(21)00042-0 [pii] LID - 10.1016/j.tmrv.2021.08.002 [doi] AB - The role of viscoelastic testing in the evaluation and management of traumatic brain injury (TBI) remains a subject of ongoing exploration. This review highlights four key publications that provide significant insights into this subject. Holcomb et al. provided early evidence of the relationship between thromboelastography (TEG) and conventional coagulation tests (CCTs). Later, Samuels et al. used TEG to identify a unique coagulopathy phenotype in TBI characterized by a notable absence of fibrinolytic abnormalities. Dixon et al. built upon these findings by exploring the application of TEG in the context of antifibrinolytic administration, noting a similar lack of effect on LY30. Finally, Guillotte et al. demonstrated the utility of TEG-PM in assessing platelet dysfunction in TBI. While these studies provide key early support for the utility of viscoelastic testing in the TBI, further exploration is needed to define evidence-based guidelines for clinical application. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Anderson, Taylor N AU - Anderson TN AD - Department of Surgery, Stanford University, Stanford, California, USA. Electronic address: tand@stanford.edu. FAU - Schreiber, Martin A AU - Schreiber MA AD - Professor of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, USA. FAU - Rowell, Susan E AU - Rowell SE AD - Professor of Surgery, Division of Trauma Surgery and Critical Care Medicine, University of Chicago, USA. LA - eng PT - Journal Article PT - Review DEP - 20210904 PL - United States TA - Transfus Med Rev JT - Transfusion medicine reviews JID - 8709027 RN - 0 (Antifibrinolytic Agents) SB - IM MH - *Antifibrinolytic Agents MH - *Blood Coagulation Disorders/diagnosis MH - Blood Coagulation Tests MH - *Brain Injuries, Traumatic/diagnosis MH - Humans MH - Thrombelastography MH - *Wounds and Injuries OTO - NOTNLM OT - Blood coagulation OT - Blood transfusion OT - Brain injuries OT - Craniocerebral trauma OT - Fibrinolysis OT - Platelet transfusion OT - Resuscitation OT - Thromboelastography OT - Tranexamic acid OT - Traumatic EDAT- 2021/10/06 06:00 MHDA- 2022/02/01 06:00 CRDT- 2021/10/05 05:43 PHST- 2021/06/03 00:00 [received] PHST- 2021/08/26 00:00 [revised] PHST- 2021/08/29 00:00 [accepted] PHST- 2021/10/06 06:00 [pubmed] PHST- 2022/02/01 06:00 [medline] PHST- 2021/10/05 05:43 [entrez] AID - S0887-7963(21)00042-0 [pii] AID - 10.1016/j.tmrv.2021.08.002 [doi] PST - ppublish SO - Transfus Med Rev. 2021 Oct;35(4):108-112. doi: 10.1016/j.tmrv.2021.08.002. Epub 2021 Sep 4. PMID- 34588132 OWN - NLM STAT- MEDLINE DCOM- 20220615 LR - 20220615 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 57 IP - 7 DP - 2022 Jul TI - Does the mechanism matter? Comparing thrombelastography between blunt and penetrating pediatric trauma patients. PG - 1363-1369 LID - S0022-3468(21)00602-3 [pii] LID - 10.1016/j.jpedsurg.2021.09.010 [doi] AB - BACKGROUND/PURPOSE: The utility of thrombelastography (TEG) in pediatric trauma remains unknown, and differences in coagulopathy between blunt and penetrating mechanisms are not established. We aimed to compare TEG patterns in pediatric trauma patients with blunt solid organ injuries (BSOI) and penetrating injuries to determine the role of mechanism in coagulopathy. METHODS: Highest-level pediatric trauma activations with BSOI or penetrating injuries and admission TEG at two pediatric trauma centers were included. TEG abnormalities were defined by each institution's normative values and compared separately by injury mechanism and evidence of shock (elevated SIPA) using Kruskal-Wallis or Fisher's exact tests. RESULTS: Of 118 patients included, 64 had BSOI and 54 had penetrating injuries. There were no significant differences in TEG abnormalities between the BSOI and penetrating injury groups. Patients with shock were more likely to have decreased alpha-angles (30.9% vs. 8.0%, p = 0.01) and decreased maximum amplitude (MA) (44.1% vs. 8.0%, p < 0.001) compared to those without shock, regardless of mechanism of injury. CONCLUSIONS: TEG abnormalities were not significantly different between the BSOI and penetrating groups, but there were significant differences in alpha-angle and MA in those with shock, independent of mechanism. Hemodynamic status, rather than mechanism of injury, may be more predictive of coagulopathy in pediatric trauma patients. LEVEL OF EVIDENCE/STUDY TYPE: Level III, retrospective. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Stevens, Jenny AU - Stevens J AD - Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: jenny.stevens@childrenscolorado.org. FAU - Phillips, Ryan AU - Phillips R AD - Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Reppucci, Marina L AU - Reppucci ML AD - Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Pickett, Kaci AU - Pickett K AD - The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Moore, Hunter AU - Moore H AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Bensard, Denis AU - Bensard D AD - Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA. LA - eng PT - Journal Article DEP - 20210920 PL - United States TA - J Pediatr Surg JT - Journal of pediatric surgery JID - 0052631 SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Child MH - Humans MH - Injury Severity Score MH - Retrospective Studies MH - *Shock MH - Thrombelastography MH - Trauma Centers MH - *Wounds and Injuries/complications/diagnosis MH - *Wounds, Nonpenetrating/diagnosis MH - *Wounds, Penetrating/diagnosis OTO - NOTNLM OT - Pediatric trauma OT - Shock index pediatric age-adjusted (SIPA) OT - Thrombelastography (TEG) OT - Trauma-induced coagulopathy (TIC) COIS- Declaration of Competing Interest The authors have no conflicts of interest, financial or otherwise, to disclose. No grant funding was used to support this research. Institutional funding was provided by the Colorado Firefighters Endowed Chair for Burn and Trauma Care at Children's Hospital Colorado and the Children's Hospital Center for Research in Outcomes in Children's Surgery. EDAT- 2021/10/01 06:00 MHDA- 2022/06/16 06:00 CRDT- 2021/09/30 05:47 PHST- 2021/04/01 00:00 [received] PHST- 2021/06/25 00:00 [revised] PHST- 2021/09/10 00:00 [accepted] PHST- 2021/10/01 06:00 [pubmed] PHST- 2022/06/16 06:00 [medline] PHST- 2021/09/30 05:47 [entrez] AID - S0022-3468(21)00602-3 [pii] AID - 10.1016/j.jpedsurg.2021.09.010 [doi] PST - ppublish SO - J Pediatr Surg. 2022 Jul;57(7):1363-1369. doi: 10.1016/j.jpedsurg.2021.09.010. Epub 2021 Sep 20. PMID- 34587639 OWN - NLM STAT- MEDLINE DCOM- 20220616 LR - 20220616 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 122 IP - 5 DP - 2022 May TI - Characteristics of the Thrombus Formation in Transgenic Mice with Platelet-Targeted Factor VIII Expression. PG - 755-766 LID - 10.1055/s-0041-1735531 [doi] AB - Platelet-targeted FVIII gene therapy can efficiently recover bleeding phenotype for hemophilia A (HA), yet characteristics of thrombus formation with this ectopic expression of factor VIII (FVIII) in platelets remain unclear. Here, we generated 2bF8(trans) mice restrictively expressing human B-domain-deleted FVIII (hBDD FVIII) in platelets on a hemophilic (FVIII(null)) mice background. The results showed no statistical difference in clot strength and stability between wild-type (WT) and 2bF8(trans) mice, but with a prolonged reaction time (R-time), by thromboelastography. Fluid dynamics analysis showed that at the shear rates of 500 to 1,500 s(-1), where physiological hemostasis often develops, the thrombi formed in 2bF8(trans) mice were more stable than those in FVIII(null) mice, while at high pathological shear rates (2,500 s(-1)), mimicking atherosclerosis, thrombus size and fibrin deposition in 2bF8(trans) mice were less than those in WT mice. Thrombus morphology analysis showed that there was a locally concentrated deposition of fibrin in thrombus at the injured site and fibrin co-localized with activated platelets in 2bF8(trans) mice. Moreover, a higher ratio of fibrin to platelets was found in thrombus from 2bF8(trans) mice following laser-induced injury in cremaster arterioles, which might be the underlying mechanism of thrombus stability in 2bF8(trans) mice at physiological arterial circumstance. These observations suggest that specific morphological features of the thrombi might contribute to the efficacy and safety of platelet-targeted FVIII gene therapy for HA. CI - Thieme. All rights reserved. FAU - Wang, Yun AU - Wang Y AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Mao, Jianhua AU - Mao J AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Li, Li AU - Li L AD - Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. FAU - Xiao, Bing AU - Xiao B AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Ruan, Zheng AU - Ruan Z AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Liu, Yichen AU - Liu Y AD - Department of Hematology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China. FAU - Zhang, Guowei AU - Zhang G AD - Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Department of Basic Medical Sciences, Hangzhou Normal University School of Medicine, Hangzhou, Zhejiang, China. FAU - Wang, Dawei AU - Wang D AUID- ORCID: 0000-0002-1556-1594 AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Mi, Jian-Qing AU - Mi JQ AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Fang, Chao AU - Fang C AD - Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. FAU - Xi, Xiaodong AU - Xi X AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Shi, Xiaofeng AU - Shi X AD - Department of Hematology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China. AD - Department of Hematology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. FAU - Wang, Jin AU - Wang J AD - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Pole Sino-Francais des Sciences du Vivant et Genomique, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. LA - eng GR - National Natural Science Foundation of China/81570178/ GR - National Natural Science Foundation of China/81700130/ GR - National Natural Science Foundation of China/81970112/ GR - National Natural Science Foundation of China/81670127/ GR - National Natural Science Foundation of China/81270594/ GR - Shanghai Municipal Health Commission in China/201940342/ PT - Journal Article DEP - 20210929 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Hemostatics) RN - 9001-27-8 (Factor VIII) RN - 9001-31-4 (Fibrin) SB - IM MH - Animals MH - Blood Platelets/metabolism MH - Factor VIII/genetics/metabolism MH - Fibrin/metabolism MH - *Hemophilia A/therapy MH - *Hemostatics/metabolism MH - Humans MH - Mice MH - Mice, Knockout MH - Mice, Transgenic MH - *Thrombosis/genetics/metabolism COIS- None declared. EDAT- 2021/09/30 06:00 MHDA- 2022/06/18 06:00 CRDT- 2021/09/29 20:13 PHST- 2021/09/30 06:00 [pubmed] PHST- 2022/06/18 06:00 [medline] PHST- 2021/09/29 20:13 [entrez] AID - 10.1055/s-0041-1735531 [doi] PST - ppublish SO - Thromb Haemost. 2022 May;122(5):755-766. doi: 10.1055/s-0041-1735531. Epub 2021 Sep 29. PMID- 34564733 OWN - NLM STAT- MEDLINE DCOM- 20221202 LR - 20221203 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 48 IP - 6 DP - 2022 Dec TI - Infrastructure, logistics and clinical practice management of acute trauma hemorrhage and coagulopathy: a survey across German trauma centers. PG - 4461-4472 LID - 10.1007/s00068-021-01788-9 [doi] AB - PURPOSE: Early detection and management of acute trauma hemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructure, logistics and clinical strategies may differ. METHODS: To assess local differences in infrastructure, logistics and clinical management of acute trauma hemorrhage and coagulopathy we have conducted a web-based survey amongst clinicians working in DGU((R))-certified supraregional, regional and local trauma centers. RESULTS: 137/1875 respondents completed the questionnaire yielding a response rate of 7.3%. The majority specified to work as head of department or senior consultant (95%) in trauma/orthopedic surgery (80%) of supraregional (38%), regional (34%) or local (27%) trauma centers. Conventional coagulation assays are most frequently used to monitor bleeding trauma patients. Only half of the respondents (53%) rely on extended coagulation tests, e.g. viscoelastic hemostatic assays. Tests to assess preinjury use of direct oral anticoagulants and platelet inhibitors are still not widely available and vary according to level of care. Conventional blood products are widely available but there remain differences between trauma centers of different level of care to access other hemostatic therapies, e.g. coagulation factor concentrates. Trauma centers of higher level of care are more likely to implement treatment protocols. CONCLUSION: This survey confirms still existing differences in infrastructure, logistics and clinical practice management for the detection of acute trauma hemorrhage and coagulopathy amongst DGU((R))-certified supraregional, regional and local trauma centers. Further work is recommended to locally implement diagnostics, therapies and treatment algorithms compliant to current guidelines to ensure the best possible outcomes in bleeding trauma patients. CI - (c) 2021. The Author(s). FAU - Karl, Vivien AU - Karl V AD - Department of Medicine, Faculty of Health, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany. FAU - Schafer, Nadine AU - Schafer N AD - Department of Medicine, Faculty of Health, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany. FAU - Maegele, Marc AU - Maegele M AUID- ORCID: 0000-0002-0634-4723 AD - Department of Medicine, Faculty of Health, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany. Marc.Maegele@t-online.de. AD - Department of Traumatology, Orthopedic Surgery and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. Marc.Maegele@t-online.de. LA - eng PT - Journal Article DEP - 20210926 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 0 (Hemostatics) SB - IM MH - Humans MH - Trauma Centers MH - Blood Transfusion/methods MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Hemorrhage/diagnosis/etiology/therapy MH - *Hemostatics/therapeutic use MH - Surveys and Questionnaires MH - *Practice Management MH - *Wounds and Injuries/complications/therapy PMC - PMC9712372 OTO - NOTNLM OT - Coagulopathy OT - Guidelines OT - Trauma hemorrhage OT - Treatment COIS- The authors declare no conflicts of interest. EDAT- 2021/09/27 06:00 MHDA- 2022/12/03 06:00 PMCR- 2021/09/26 CRDT- 2021/09/26 21:07 PHST- 2021/05/20 00:00 [received] PHST- 2021/09/16 00:00 [accepted] PHST- 2021/09/27 06:00 [pubmed] PHST- 2022/12/03 06:00 [medline] PHST- 2021/09/26 21:07 [entrez] PHST- 2021/09/26 00:00 [pmc-release] AID - 10.1007/s00068-021-01788-9 [pii] AID - 1788 [pii] AID - 10.1007/s00068-021-01788-9 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2022 Dec;48(6):4461-4472. doi: 10.1007/s00068-021-01788-9. Epub 2021 Sep 26. PMID- 34558091 OWN - NLM STAT- MEDLINE DCOM- 20220317 LR - 20220317 IS - 1423-0410 (Electronic) IS - 0042-9007 (Linking) VI - 117 IP - 3 DP - 2022 Mar TI - Transfusion management of trauma from the 2019 El Paso mass shooting incident. PG - 299-312 LID - 10.1111/vox.13206 [doi] AB - BACKGROUND AND OBJECTIVES: Mortality rates, transfusion ratios, trauma management logistics, and assault characteristics from the El Paso mass shooting incident (MSI) are evaluated in comparison to other MSIs. In 2019, El Paso, TX experienced the eighth-deadliest MSIs in modern US history. In this 21st mass killing in the United States of 2019, 19 people died immediately, and four of 27 injured, later died from ballistic injuries. MATERIALS AND METHODS: We examined the victims' injuries, pre-hospital treatments, transfusions, rotational thromboelastometry (ROTEM) interpretation, tranexamic acid (TXA) use, and compared El Paso's outcomes with other MSIs. RESULTS: Fifteen casualties were treated for bullet injuries at University Medical Center (UMC). Three were in critical condition; one died during surgery. Of the remaining victims, two were guarded, and the remaining ten in stable condition. Anatomic trauma locations included chest, abdomen, hip, breast, thigh and arm. Haemostatic agents and TXA were administered to arriving patients. Seven casualties receiving blood products were administered 95 units at UMC (45 red blood cells [RBC], 38 fresh frozen plasma [FFP], 8 platelets and 4 cryoprecipitate). ROTEM guided mass transfusion decisions in three patients. Out of seven MSIs reviewed, El Paso had the highest mortality rate (50.0%) and lowest RBC:FFP:admission ratio (1.18 at UMC). CONCLUSION: We report the greatest proportion of transfusions per admission for an MSI and are first to discuss ROTEM roles to guide transfusion and manage coagulopathy during an MSI. This case highlights the severity and impact of MSIs on victims and requirements to follow established transfusion protocols with adjunct use of ROTEM, TXA and haemostatic agents. CI - (c) 2021 International Society of Blood Transfusion. FAU - Qiao, Jesse AU - Qiao J AUID- ORCID: 0000-0002-8348-4893 AD - Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA. FAU - Ray, Bradford AU - Ray B AD - Patient Blood Management and Research, University Medical Center, El Paso, TX, USA. FAU - Wians, Frank AU - Wians F AUID- ORCID: 0000-0002-1715-7886 AD - Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA. FAU - Abadie, Jude AU - Abadie J AD - Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA. LA - eng GR - None./ PT - Journal Article PT - Review DEP - 20210923 PL - England TA - Vox Sang JT - Vox sanguinis JID - 0413606 RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - *Blood Coagulation Disorders MH - Blood Transfusion/methods MH - Humans MH - Plasma MH - Retrospective Studies MH - Thrombelastography/methods MH - *Tranexamic Acid/therapeutic use OTO - NOTNLM OT - mass trauma OT - patient blood management OT - shooting OT - transfusion challenges OT - viscoelastic testing EDAT- 2021/09/25 06:00 MHDA- 2022/03/18 06:00 CRDT- 2021/09/24 07:24 PHST- 2021/08/31 00:00 [revised] PHST- 2021/05/10 00:00 [received] PHST- 2021/09/06 00:00 [accepted] PHST- 2021/09/25 06:00 [pubmed] PHST- 2022/03/18 06:00 [medline] PHST- 2021/09/24 07:24 [entrez] AID - 10.1111/vox.13206 [doi] PST - ppublish SO - Vox Sang. 2022 Mar;117(3):299-312. doi: 10.1111/vox.13206. Epub 2021 Sep 23. PMID- 34549189 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210929 IS - 2639-8028 (Electronic) IS - 2639-8028 (Linking) VI - 3 IP - 9 DP - 2021 Sep TI - Use of Thromboelastography in the Evaluation and Management of Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis. PG - e0526 LID - 10.1097/CCE.0000000000000526 [doi] LID - e0526 AB - Traumatic brain injury is associated with coagulopathy that increases mortality risk. Viscoelastic hemostatic assays such as thromboelastography (Haemonetics SA, Signy, Switzerland) provide rapid coagulopathy assessment and may be particularly useful for goal-directed treatment of traumatic brain injury patients. We conducted a systematic review to assess thromboelastography in the evaluation and management of coagulopathy in traumatic brain injury patients. DATA SOURCES: MEDLINE, PubMed Central, Embase, and CENTRAL. STUDY SELECTION: Clinical studies of adult patients with traumatic brain injury (isolated or polytrauma) who were assessed by either standard thromboelastography or thromboelastography with platelet mapping plus either conventional coagulation assays or platelet function assays from January 1999 to June 2021. DATA EXTRACTION: Demographics, injury mechanism and severity, diagnostic, laboratory data, therapies, and outcome data were extracted for analysis and comparison. DATA SYNTHESIS: Database search revealed 1,169 sources; eight additional articles were identified by the authors. After review, 31 publications were used for qualitative analysis, and of these, 16 were used for quantitative analysis. Qualitative and quantitative analysis found unique patterns of thromboelastography and thromboelastography with platelet mapping parameters in traumatic brain injury patients. Patterns were distinct compared with healthy controls, nontraumatic brain injury trauma patients, and traumatic brain injury subpopulations including those with severe traumatic brain injury or penetrating traumatic brain injury. Abnormal thromboelastography K-time and adenosine diphosphate % inhibition on thromboelastography with platelet mapping are associated with decreased survival after traumatic brain injury. Subgroup meta-analysis of severe traumatic brain injury patients from two randomized controlled trials demonstrated improved survival when using a viscoelastic hemostatic assay-guided resuscitation strategy (odds ratio, 0.39; 95% CI, 0.17-0.91; p = 0.030). CONCLUSIONS: Thromboelastography and thromboelastography with platelet mapping characterize coagulopathy patterns in traumatic brain injury patients. Abnormal thromboelastography profiles are associated with poor outcomes. Conversely, treatment protocols designed to normalize abnormal parameters may be associated with improved traumatic brain injury patient outcomes. Current quality of evidence in this population is low; so future efforts should evaluate viscoelastic hemostatic assay-guided hemostatic resuscitation in larger numbers of traumatic brain injury patients with specific focus on those with traumatic brain injury-associated coagulopathy. CI - Copyright (c) 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. FAU - Cannon, Jeremy W AU - Cannon JW FAU - Dias, Joao D AU - Dias JD AD - Medical Affairs & Clinical Development, Haemonetics Corporation, Boston, MA. FAU - Kumar, Monisha A AU - Kumar MA AD - Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. FAU - Walsh, Mark AU - Walsh M AD - Indiana University School of Medicine, South Bend, Notre Dame Campus, Mishawaka, IN. FAU - Thomas, Scott G AU - Thomas SG AD - Memorial Hospital of South Bend, South Bend, IN. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, McGovern Medical School, UTHealth, Houston, TX. FAU - Schuster, James M AU - Schuster JM AD - Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. FAU - Evans, Susan L AU - Evans SL AD - Department of Surgery, Carolinas Medical Center, Charlotte, NC. FAU - Schreiber, Martin A AU - Schreiber MA AD - Department of Surgery, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD. AD - Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University, Portland, OR. FAU - Adam, Elisabeth H AU - Adam EH AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany. FAU - Zacharowski, Kai AU - Zacharowski K AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany. FAU - Hartmann, Jan AU - Hartmann J AD - Medical Affairs & Clinical Development, Haemonetics Corporation, Boston, MA. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. FAU - Kaplan, Lewis J AU - Kaplan LJ AD - Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. AD - Department of Surgery, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA. LA - eng PT - Journal Article PT - Review DEP - 20210914 PL - United States TA - Crit Care Explor JT - Critical care explorations JID - 101746347 PMC - PMC8443808 OTO - NOTNLM OT - blood coagulation tests OT - hemostasis OT - mortality OT - platelet function OT - thromboelastography OT - traumatic brain injury COIS- Dr. Cannon is a consultant for CSL Behring and has received honoraria from UpToDate for article authorship unrelated to this work. Drs. Dias and Hartmann are employees of Haemonetics. Dr. Kumar has received honoraria for participation in advisory board meetings from Portola Pharmaceuticals and study grants from Haemonetics. Dr. Cotton has received honoraria for consulting services and participation in scientific advisory meetings for Haemonetics. Dr. Schreiber is a consultant for Haemonetics, CSL Behring, and Tricol and has received grant funding from Haemonetics and CSL Behring. Dr. Zacharowski has received honoraria for participation in advisory board meetings for Haemonetics and Vifor and received speaker fees from CSL Behring and GE Healthcare. He is the Principal Investigator of the European Union-Horizon 2020 project ENVISION (Intelligent plug-and-play digital tool for real-time surveillance of coronavirus disease 2019 patients and smart decision-making in ICUs). Dr. Schochl has received honoraria for participation in advisory board meetings from Bayer Healthcare, Boehringer Ingelheim, Tem International GmbH, speaker fees from Haemonetics and Vifor, and study grants from CSL Behring. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2021/09/23 06:00 MHDA- 2021/09/23 06:01 PMCR- 2021/09/14 CRDT- 2021/09/22 07:13 PHST- 2021/09/22 07:13 [entrez] PHST- 2021/09/23 06:00 [pubmed] PHST- 2021/09/23 06:01 [medline] PHST- 2021/09/14 00:00 [pmc-release] AID - 10.1097/CCE.0000000000000526 [doi] PST - epublish SO - Crit Care Explor. 2021 Sep 14;3(9):e0526. doi: 10.1097/CCE.0000000000000526. eCollection 2021 Sep. PMID- 34538821 OWN - NLM STAT- MEDLINE DCOM- 20220209 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 92 IP - 1 DP - 2022 Jan 1 TI - The alpha-globin chain of hemoglobin potentiates tissue plasminogen activator induced hyperfibrinolysis in vitro. PG - 159-166 LID - 10.1097/TA.0000000000003410 [doi] AB - BACKGROUND: Severe injury predisposes patients to trauma-induced coagulopathy, which may be subdivided by the state of fibrinolysis. Systemic hyperfibrinolysis (HF) occurs in approximately 25% of these patients with mortality as high as 70%. Severe injury also causes the release of numerous intracellular proteins, which may affect coagulation, one of which is hemoglobin, and hemoglobin substitutes induce HF in vitro. We hypothesize that the alpha-globin chain of hemoglobin potentiates HF in vitro by augmenting plasmin activity. METHODS: Proteomic analysis was completed on a pilot study of 30 injured patients before blood component resuscitation, stratified by their state of fibrinolysis, plus 10 healthy controls. Different concentrations of intact hemoglobin A, the alpha- and beta-globin chains, or normal saline (controls) were added to whole blood, and tissue plasminogen activator (tPA)-challenged thrombelastography was used to assess the degree of fibrinolysis. Interactions with plasminogen (PLG) were evaluated using surface plasmon resonance. Tissue plasminogen activator-induced plasmin activity was evaluated in the presence of the alpha-globin chain. RESULTS: Only the alpha- and beta-globin chains increased in HF patients (p < 0.01). The alpha-globin chain but not hemoglobin A or the beta-globin chain decreased the reaction time and significantly increased lysis time 30 on citrated native thrombelastographies (p < 0.05). The PLG and alpha-globin chain had interaction kinetics similar to tPA:PLG, and the alpha-globin chain increased tPA-induced plasmin activity. CONCLUSIONS: The alpha-globin chain caused HF in vitro by binding to PLG and augmenting plasmin activity and may represent a circulating "moonlighting" mediator released by the tissue damage and hemorrhagic shock inherent to severe injury. LEVEL OF EVIDENCE: Prognostic, level III. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Morton, Alexander P AU - Morton AP AD - From the Departments of Surgery (A.P.M., J.B.H., A.G., M.R.K., E.E.M., M.S.C., A.B., C.C.S.), Pediatrics (C.C.S.), and Biochemistry and Molecular Genetics (S.B., M.D., K.C.H.), School of Medicine University of Colorado Denver, Aurora; Department of Surgery (A.P.M., A.G., M.R.K., E.E.M.), Denver Health Medical Center; and Vitalant Mountain Division (C.C.S.), Vitalant Research Institute, Denver, Colorado. FAU - Hadley, Jamie B AU - Hadley JB FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Kelher, Marguerite R AU - Kelher MR FAU - Moore, Ernest E AU - Moore EE FAU - Bevers, Shaun AU - Bevers S FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M FAU - Hansen, Kirk C AU - Hansen KC FAU - Cohen, Mitchell S AU - Cohen MS FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Fibrinolytic Agents) RN - 0 (Hemoglobins) RN - 0 (alpha-Globins) RN - 0 (beta-Globins) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Adult MH - *Blood Coagulation Disorders/blood/diagnosis/etiology MH - Female MH - Fibrinolysin/*metabolism MH - *Fibrinolysis/drug effects/physiology MH - Fibrinolytic Agents/pharmacology MH - Hemoglobins/metabolism MH - Humans MH - Male MH - Metabolic Networks and Pathways MH - Prognosis MH - Proteomics/methods MH - Thrombelastography/methods MH - Tissue Plasminogen Activator/*pharmacology MH - *Wounds and Injuries/blood/complications MH - alpha-Globins/metabolism MH - beta-Globins/*metabolism PMC - PMC8692352 MID - NIHMS1739601 COIS- Conflict of Interest None of the authors have an actual or potential conflict of interest with any of the reported data or methodologies used within this manuscript. EDAT- 2021/09/21 06:00 MHDA- 2022/02/10 06:00 PMCR- 2023/01/01 CRDT- 2021/09/20 05:49 PHST- 2021/09/21 06:00 [pubmed] PHST- 2022/02/10 06:00 [medline] PHST- 2021/09/20 05:49 [entrez] PHST- 2023/01/01 00:00 [pmc-release] AID - 01586154-202201000-00026 [pii] AID - 10.1097/TA.0000000000003410 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Jan 1;92(1):159-166. doi: 10.1097/TA.0000000000003410. PMID- 34533617 OWN - NLM STAT- MEDLINE DCOM- 20211019 LR - 20220218 IS - 1437-9813 (Electronic) IS - 0179-0358 (Print) IS - 0179-0358 (Linking) VI - 37 IP - 11 DP - 2021 Nov TI - It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion. PG - 1613-1620 LID - 10.1007/s00383-021-04944-9 [doi] AB - BACKGROUND: Hemorrhage is the leading cause of preventable death in pediatric trauma patients. In adults, goal-directed thrombelastography (TEG) has been shown to reduce mortality when used to guide massive transfusion (MT) resuscitation. There remains a paucity of data on the utility of TEG in directing resuscitation of pediatric trauma patients. We hypothesize that abnormalities on admission TEG will differ in pediatric trauma patients who undergo MT, compared to those who do not. METHODS: Pediatric patients ( 40 cc/kg total blood product within 6 h of admission) and those who did not. We defined TEG abnormalities based on each institution's normative values and compared TEG abnormalities between the groups. RESULTS: Of 117 children included, 39 had MT. MT patients had higher injury severity scores (30 vs. 23, p = 0.0004), lactates levels (7.0 vs. 3.5, p < 0.001), base deficit levels ( - 12.2 vs. - 5.8, p < 0.001), and INR values (1.8 vs. 1.3, p < 0.001). MT patients had significantly shortened alpha-angles (35.9% vs. 15.4%, p = 0.023), maximum amplitude (MA) values (43.6% vs. 10.3%, p < 0.001), and significantly lower platelet counts (165 vs. 281, p < 0.001) compared to those who did not receive MT. There was no difference in the trends in R-time, LY30 (lysis or shutdown), or fibrinogen concentration between the groups. Logistic regression identified a decreased MA as a significant predictor for MT [OR 3.68 (CI 1.29-10.52)] CONCLUSIONS: Pediatric trauma patients who undergo MT are more likely to have lower alpha-angles and MA values, as well as lower platelet counts. These findings support the use of TEG to identify hemorrhaging pediatric trauma patients, who may benefit from cryoprecipitate and/or platelet transfusions. TEG provides real-time information on coagulation status, which may expedite the delivery of specific blood products during trauma resuscitation. LEVEL OF EVIDENCE: LEVEL III: Type of study: Retrospective comparative study. CI - (c) 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Phillips, Ryan AU - Phillips R AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. Ryan.Phillips@childrenscolorado.org. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Ryan.Phillips@childrenscolorado.org. FAU - Moore, Hunter AU - Moore H AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Bensard, Denis AU - Bensard D AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Shahi, Niti AU - Shahi N AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Shirek, Gabrielle AU - Shirek G AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Reppucci, Marina L AU - Reppucci ML AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Meier, Maxene AU - Meier M AD - The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Recicar, John AU - Recicar J AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. FAU - Acker, Shannon AU - Acker S AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. FAU - Kim, John AU - Kim J AD - Department of Pediatrics, School of Medicine, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA. FAU - Moulton, Steven AU - Moulton S AD - Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. AD - Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. LA - eng PT - Journal Article DEP - 20210917 PL - Germany TA - Pediatr Surg Int JT - Pediatric surgery international JID - 8609169 SB - IM MH - Adult MH - Blood Transfusion MH - Child MH - Humans MH - Injury Severity Score MH - Retrospective Studies MH - *Thrombelastography MH - Trauma Centers MH - *Wounds and Injuries/therapy PMC - PMC8445780 OTO - NOTNLM OT - Goal-directed hemostatic resuscitation OT - Pediatric trauma OT - TEG OT - Thrombelastography OT - Trauma-induced coagulopathy COIS- None of the authors has a conflict of interest to disclose. EDAT- 2021/09/18 06:00 MHDA- 2021/10/21 06:00 PMCR- 2021/09/17 CRDT- 2021/09/17 12:19 PHST- 2021/06/01 00:00 [accepted] PHST- 2021/09/18 06:00 [pubmed] PHST- 2021/10/21 06:00 [medline] PHST- 2021/09/17 12:19 [entrez] PHST- 2021/09/17 00:00 [pmc-release] AID - 10.1007/s00383-021-04944-9 [pii] AID - 4944 [pii] AID - 10.1007/s00383-021-04944-9 [doi] PST - ppublish SO - Pediatr Surg Int. 2021 Nov;37(11):1613-1620. doi: 10.1007/s00383-021-04944-9. Epub 2021 Sep 17. PMID- 34528682 OWN - NLM STAT- MEDLINE DCOM- 20220407 LR - 20220501 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 61 IP - 3 DP - 2022 Feb 18 TI - Protective effects of 17beta-oestradiol on coagulation and systemic inflammation after total occlusion of the descending aorta in male rats. PG - 666-674 LID - 10.1093/ejcts/ezab381 [doi] AB - OBJECTIVES: The surgical treatment for diseases of the descending aorta is related to a high mortality rate because of the activation of a systemic inflammatory process due to ischaemia and reperfusion (I/R) injury. Activation of coagulation can contribute to the inflammatory process, resulting in microcirculatory damage and multiple organ failure. Our goal was to evaluate the role of prophylactic intravenous 17beta-oestradiol (E2) in coagulation, the inflammatory response and hepatic injury after occlusion of the descendent proximal aorta in male rats. METHODS: Wistar male rats were randomized and allocated to 3 groups (n = 8 per group): sham, surgically manipulated; IR, animals subjected to I/R; and E2, animals treated with E2 (280 microg/kg, intravenously) before I/R. I/R was induced by insertion of a 2-Fr Fogarty arterial embolectomy catheter in the descending aorta, which was occluded for 20 min, followed by a reperfusion period of 2 h. Serological markers, platelet aggregation, hepatic vascular flow, systemic and liver inflammatory response and apoptosis were analysed. The coagulation process was evaluated by thromboelastometry. RESULTS: The aortic occlusion led to a reduction in plasma fibrinogen concentration in parallel with increased clotting time, greater clot firmness and reduced lysis. E2 treatment was able to increase fibrinogen, prevent the increase in clotting time and normalize clot firmness, but it exerted only a mild effect on clot lysis. Platelet aggregation was increased by IR, and E2 treatment was able to reduce it. There was a reduction in flow percentage in the IR group that was not prevented by E2. In parallel, higher aggregate formation was observed in the vessels of the IR group of animals. There was increased systemic release of interleukin-1-beta, interleukin-6 and interleukin-10 in the IR group, which was reduced in the treated animals. CONCLUSIONS: The current results suggest that pretreatment with E2 before an ischaemic period induced by occlusion of the proximal descending aorta is effective in preventing alterations in coagulation and systemic inflammation due to I/R injury. CI - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Sobral, Marcelo Luiz Peixoto AU - Sobral MLP AUID- ORCID: 0000-0003-3431-7033 AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Dias, Ricardo Ribeiro AU - Dias RR AUID- ORCID: 0000-0001-6206-7081 AD - Department of Cardiovascular Surgery, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Correia, Cristiano de Jesus AU - Correia CJ AUID- ORCID: 0000-0002-1690-9951 AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Coutinho E Silva, Raphael Dos Santos AU - Coutinho E Silva RDS AUID- ORCID: 0000-0001-8818-5043 AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - da Anunciacao, Lucas Ferreira AU - da Anunciacao LF AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Breithaupt-Faloppa, Ana Cristina AU - Breithaupt-Faloppa AC AUID- ORCID: 0000-0003-0554-0674 AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Moreira, Luiz Felipe Pinho AU - Moreira LFP AUID- ORCID: 0000-0003-0179-4976 AD - Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulacao (LIM-11), Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. LA - eng PT - Journal Article PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 RN - 4TI98Z838E (Estradiol) SB - IM MH - Animals MH - *Aorta, Thoracic/surgery MH - Estradiol/pharmacology/therapeutic use MH - Humans MH - Inflammation/prevention & control MH - Male MH - Microcirculation MH - Rats MH - Rats, Wistar MH - *Reperfusion Injury/prevention & control OTO - NOTNLM OT - *17beta-oestradiol OT - *Coagulation OT - *Inflammation OT - *Ischaemia and reperfusion OT - *Rat OT - *Thromboelastometry EDAT- 2021/09/17 06:00 MHDA- 2022/04/08 06:00 CRDT- 2021/09/16 08:58 PHST- 2021/02/23 00:00 [received] PHST- 2021/06/14 00:00 [revised] PHST- 2021/07/04 00:00 [accepted] PHST- 2021/09/17 06:00 [pubmed] PHST- 2022/04/08 06:00 [medline] PHST- 2021/09/16 08:58 [entrez] AID - 6370993 [pii] AID - 10.1093/ejcts/ezab381 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2022 Feb 18;61(3):666-674. doi: 10.1093/ejcts/ezab381. PMID- 34501395 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230921 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 17 DP - 2021 Aug 31 TI - Viscoelastic Hemostatic Assays for Postpartum Hemorrhage. LID - 10.3390/jcm10173946 [doi] LID - 3946 AB - This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need. FAU - Liew-Spilger, Alyson E AU - Liew-Spilger AE AD - Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA. FAU - Sorg, Nikki R AU - Sorg NR AUID- ORCID: 0000-0002-7624-2765 AD - Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Brenner, Toby J AU - Brenner TJ AUID- ORCID: 0000-0002-5970-9730 AD - Division of Natural Sciences, Indiana Wesleyan University, Marion, IN 46953, USA. FAU - Langford, Jack H AU - Langford JH AD - College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA. FAU - Berquist, Margaret AU - Berquist M AD - College of Science, University of Notre Dame, Notre Dame, IN 46556, USA. FAU - Mark, Natalie M AU - Mark NM AD - Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Moore, Spencer H AU - Moore SH AD - Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA. FAU - Mark, Julie AU - Mark J AD - Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA. FAU - Baumgartner, Sara AU - Baumgartner S AD - Department of Obstetrics and Gynecology, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Abernathy, Mary P AU - Abernathy MP AD - Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. LA - eng PT - Journal Article PT - Review DEP - 20210831 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8432102 OTO - NOTNLM OT - amniotic fluid embolism OT - blood coagulation OT - blood component transfusion OT - disseminated intravascular coagulation OT - obstetrics OT - postpartum hemorrhage OT - pregnancy OT - rotational thromboelastometry OT - thromboelastography OT - von Willebrand factor COIS- The authors declare no conflict of interest. EDAT- 2021/09/11 06:00 MHDA- 2021/09/11 06:01 PMCR- 2021/08/31 CRDT- 2021/09/10 01:03 PHST- 2021/07/27 00:00 [received] PHST- 2021/08/26 00:00 [revised] PHST- 2021/08/29 00:00 [accepted] PHST- 2021/09/10 01:03 [entrez] PHST- 2021/09/11 06:00 [pubmed] PHST- 2021/09/11 06:01 [medline] PHST- 2021/08/31 00:00 [pmc-release] AID - jcm10173946 [pii] AID - jcm-10-03946 [pii] AID - 10.3390/jcm10173946 [doi] PST - epublish SO - J Clin Med. 2021 Aug 31;10(17):3946. doi: 10.3390/jcm10173946. PMID- 34501379 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210913 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 17 DP - 2021 Aug 31 TI - First-Line Administration of Fibrinogen Concentrate in the Bleeding Trauma Patient: Searching for Effective Dosages and Optimal Post-Treatment Levels Limiting Massive Transfusion-Further Results of the RETIC Study. LID - 10.3390/jcm10173930 [doi] LID - 3930 AB - Fibrinogen supplementation is recommended for treatment of severe trauma hemorrhage. However, required dosages and aimed for post-treatment fibrinogen levels remain a matter of discussion. Within the published RETIC study, adult patients suffering trauma-induced coagulopathy were randomly assigned to receive fibrinogen concentrate (FC) as first-line (n = 50) or crossover rescue (n = 20) therapy. Depending on bodyweight, a single dose of 3, 4, 5, or 6 g FC was administered and repeated if necessary (FibA10 < 9 mm). The dose-dependent response (changes in plasma fibrinogen and FibA10) was analyzed. Receiver operating characteristics (ROC) analysis regarding the need for massive transfusion and correlation analyses regarding fibrinogen concentrations and polymerization were performed. Median FC single doses amounted to 62.5 (57 to 66.66) mg.kg(-)(1). One FC single-dose sufficiently corrected fibrinogen and FibA10 (median fibrinogen 213 mg.dL(-1), median FibA10 11 mm) only in patients with baseline fibrinogen above 100 mg.dL(-1) and FibA10 above 5 mm, repeated dosing was required in patients with lower baseline fibrinogen/FibA10. Fibrinogen increased by 83 or 107 mg.dL(-1) and FibA10 by 4 or 4.5 mm after single or double dose of FC, respectively. ROC curve analysis revealed post-treatment fibrinogen levels under 204.5 mg.dL(-)(1) to predict the need for massive transfusion (AUC 0.652; specificity: 0.667; sensitivity: 0.688). Baseline fibrinogen/FibA10 levels should be considered for FC dosing as only sufficiently corrected post-treatment levels limit transfusion requirements. FAU - Innerhofer, Nicole AU - Innerhofer N AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Treichl, Benjamin AU - Treichl B AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Rugg, Christopher AU - Rugg C AUID- ORCID: 0000-0002-7150-7357 AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Fries, Dietmar AU - Fries D AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Mittermayr, Markus AU - Mittermayr M AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Hell, Tobias AU - Hell T AD - Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, 6020 Innsbruck, Austria. FAU - Oswald, Elgar AU - Oswald E AUID- ORCID: 0000-0002-6531-0275 AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Innerhofer, Petra AU - Innerhofer P AUID- ORCID: 0000-0002-3265-1321 AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - On Behalf Of The Retic Study Group AU - On Behalf Of The Retic Study Group LA - eng PT - Journal Article DEP - 20210831 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8432065 OTO - NOTNLM OT - fibrinogen concentrate OT - fibrinogen plasma OT - massive transfusion OT - rotational thromboelastometry OT - trauma induced coagulopathy COIS- PI has received personal fees from Baxter GmbH, personal fees from CSL Behring GmbH, personal fees from Fresenius Kabi GmbH Austria, personal fees from Bayer GmbH Austria, personal fees from LFB, non-financial support from TEM International, outside the submitted work. DF has received study funding, honoraria for consultancy and board activity from Astra Zeneca, AOP orphan, Baxter, Bayer, BBraun, Biotest, CSL Behring, Delta Select, Dade Behring, Edwards, Fresenius, Glaxo, Haemoscope, Hemogem, Lilly, LFB, Mitsubishi Pharma, NovoNordisk, Octapharm, Pfizer, Tem-Innovation, outside the submitted work. MM has received personal fees from CSL Behring GmbH, outside the submitted work. The remaining authors have disclosed that they have no potential conflicts of interest. EDAT- 2021/09/11 06:00 MHDA- 2021/09/11 06:01 PMCR- 2021/08/31 CRDT- 2021/09/10 01:03 PHST- 2021/07/18 00:00 [received] PHST- 2021/08/23 00:00 [revised] PHST- 2021/08/25 00:00 [accepted] PHST- 2021/09/10 01:03 [entrez] PHST- 2021/09/11 06:00 [pubmed] PHST- 2021/09/11 06:01 [medline] PHST- 2021/08/31 00:00 [pmc-release] AID - jcm10173930 [pii] AID - jcm-10-03930 [pii] AID - 10.3390/jcm10173930 [doi] PST - epublish SO - J Clin Med. 2021 Aug 31;10(17):3930. doi: 10.3390/jcm10173930. PMID- 34476426 OWN - NLM STAT- MEDLINE DCOM- 20211004 LR - 20231107 IS - 1473-0189 (Electronic) IS - 1473-0197 (Print) IS - 1473-0189 (Linking) VI - 21 IP - 19 DP - 2021 Sep 28 TI - Point of care whole blood microfluidics for detecting and managing thrombotic and bleeding risks. PG - 3667-3674 LID - 10.1039/d1lc00465d [doi] AB - Point-of-care diagnostics of platelet and coagulation function present demanding challenges. Current clinical diagnostics often use centrifuged plasmas or platelets and frozen plasma standards, recombinant protein standards, or even venoms. Almost all commercialized tests of blood do not recreate the in vivo hemodynamics where platelets accumulate to high densities and thrombin is generated from a procoagulant surface. Despite numerous drugs that target platelets, insufficient coagulation, or excess coagulation, POC blood testing is essentially limited to viscoelastic methods that provide a clotting time, clot strength, and clot lysis, while used mostly in trauma centers with specialized capabilities. Microfluidics now allows small volumes of whole blood (<1 mL) to be tested under venous or arterial shear rates with multi-color readouts to follow platelet function, thrombin generation, fibrin production, and clot stability. Injection molded chips containing pre-patterned fibrillar collagen and lipidated tissue factor can be stored dry for 6 months at 4C, thus allowing rapid blood testing on single-use disposable chips. Using only a small imaging microscope and micropump, these microfluidic devices can detect platelet inhibitors, direct oral anticoagulants (DOACs) and their reversal agents. POC microfluidics are ideal for neonatal surgical applications that involve small blood samples, rapid DOAC testing in stroke or bleeding or emergency surgery situations with patients presenting high risk cofactors for either bleeding or thrombosis. FAU - Diamond, Scott L AU - Diamond SL AUID- ORCID: 0000-0002-9791-2238 AD - Institute for Medicine and Engineering, Department of Chemical and Biomolecular Engineering, University of Pennsylvania, 1024 Vagelos Research Laboratory, Philadelphia, PA 19104, USA. sld@seas.upenn.edu. FAU - Rossi, Jason M AU - Rossi JM AUID- ORCID: 0000-0001-7408-7266 AD - Institute for Medicine and Engineering, Department of Chemical and Biomolecular Engineering, University of Pennsylvania, 1024 Vagelos Research Laboratory, Philadelphia, PA 19104, USA. sld@seas.upenn.edu. LA - eng GR - R01 HL103419/HL/NHLBI NIH HHS/United States GR - U01 HL131053/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review DEP - 20210928 PL - England TA - Lab Chip JT - Lab on a chip JID - 101128948 RN - 9001-31-4 (Fibrin) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Coagulation MH - Blood Platelets MH - Fibrin MH - Humans MH - Infant, Newborn MH - *Microfluidics MH - Point-of-Care Systems MH - Thrombin MH - *Thrombosis/diagnosis PMC - PMC8478847 MID - NIHMS1738887 EDAT- 2021/09/04 06:00 MHDA- 2021/10/05 06:00 PMCR- 2022/09/28 CRDT- 2021/09/03 06:56 PHST- 2021/09/04 06:00 [pubmed] PHST- 2021/10/05 06:00 [medline] PHST- 2021/09/03 06:56 [entrez] PHST- 2022/09/28 00:00 [pmc-release] AID - 10.1039/d1lc00465d [doi] PST - epublish SO - Lab Chip. 2021 Sep 28;21(19):3667-3674. doi: 10.1039/d1lc00465d. PMID- 34458242 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210831 IS - 2296-4185 (Print) IS - 2296-4185 (Electronic) IS - 2296-4185 (Linking) VI - 9 DP - 2021 TI - A Hyper-Viscoelastic Continuum-Level Finite Element Model of the Spinal Cord Assessed for Transverse Indentation and Impact Loading. PG - 693120 LID - 10.3389/fbioe.2021.693120 [doi] LID - 693120 AB - Finite Element (FE) modelling of spinal cord response to impact can provide unique insights into the neural tissue response and injury risk potential. Yet, contemporary human body models (HBMs) used to examine injury risk and prevention across a wide range of impact scenarios often lack detailed integration of the spinal cord and surrounding tissues. The integration of a spinal cord in contemporary HBMs has been limited by the need for a continuum-level model owing to the relatively large element size required to be compatible with HBM, and the requirement for model development based on published material properties and validation using relevant non-linear material data. The goals of this study were to develop and assess non-linear material model parameters for the spinal cord parenchyma and pia mater, and incorporate these models into a continuum-level model of the spinal cord with a mesh size conducive to integration in HBM. First, hyper-viscoelastic material properties based on tissue-level mechanical test data for the spinal cord and hyperelastic material properties for the pia mater were determined. Secondly, the constitutive models were integrated in a spinal cord segment FE model validated against independent experimental data representing transverse compression of the spinal cord-pia mater complex (SCP) under quasi-static indentation and dynamic impact loading. The constitutive model parameters were fit to a quasi-linear viscoelastic model with an Ogden hyperelastic function, and then verified using single element test cases corresponding to the experimental strain rates for the spinal cord (0.32-77.22 s(-1)) and pia mater (0.05 s(-1)). Validation of the spinal cord model was then performed by re-creating, in an explicit FE code, two independent ex-vivo experimental setups: 1) transverse indentation of a porcine spinal cord-pia mater complex and 2) dynamic transverse impact of a bovine SCP. The indentation model accurately matched the experimental results up to 60% compression of the SCP, while the impact model predicted the loading phase and the maximum deformation (within 7%) of the SCP experimental data. This study quantified the important biomechanical contribution of the pia mater tissue during spinal cord deformation. The validated material models established in this study can be implemented in computational HBM. CI - Copyright (c) 2021 Rycman, McLachlin and Cronin. FAU - Rycman, Aleksander AU - Rycman A AD - Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada. FAU - McLachlin, Stewart AU - McLachlin S AD - Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada. FAU - Cronin, Duane S AU - Cronin DS AD - Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada. LA - eng PT - Journal Article DEP - 20210812 PL - Switzerland TA - Front Bioeng Biotechnol JT - Frontiers in bioengineering and biotechnology JID - 101632513 PMC - PMC8387872 OTO - NOTNLM OT - finite element method OT - hyper-viscoelastic material model OT - impact loading OT - indentation OT - spinal cord COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2021/08/31 06:00 MHDA- 2021/08/31 06:01 PMCR- 2021/01/01 CRDT- 2021/08/30 06:01 PHST- 2021/04/09 00:00 [received] PHST- 2021/07/15 00:00 [accepted] PHST- 2021/08/30 06:01 [entrez] PHST- 2021/08/31 06:00 [pubmed] PHST- 2021/08/31 06:01 [medline] PHST- 2021/01/01 00:00 [pmc-release] AID - 693120 [pii] AID - 10.3389/fbioe.2021.693120 [doi] PST - epublish SO - Front Bioeng Biotechnol. 2021 Aug 12;9:693120. doi: 10.3389/fbioe.2021.693120. eCollection 2021. PMID- 34446654 OWN - NLM STAT- MEDLINE DCOM- 20220209 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 92 IP - 1 DP - 2022 Jan 1 TI - Thrombelastography and transfusion patterns in severely injured pediatric trauma patients with blunt solid organ injuries. PG - 152-158 LID - 10.1097/TA.0000000000003392 [doi] AB - BACKGROUND: Thrombelastography (TEG) has emerged as a useful tool to diagnose coagulopathy and guide blood product usage during trauma resuscitations. This study sought to evaluate the correlation between TEG-directed blood product administration in severely injured pediatric trauma patients with blunt solid organ injuries (BSOIs). METHODS: Patients (3% was seen in 17.0% (9). Thrombelastography-directed resuscitation of fresh frozen plasma was followed 54.7% of the time compared with 67.2% and 81.2% for platelets and cryoprecipitate, respectively. Thrombelastography-directed resuscitation with platelets (odds ratio, 0.56; 95% confidence interval, 0.33-0.93; p = 0.03) and/or cryoprecipitate (odds ratio, 0.09; 95% confidence interval, 0.01-0.42, p = 0.003) were associated with decreased hospital length of stay and mortality, respectively. CONCLUSION: Severely injured pediatric trauma patients with BSOIs were often coagulopathic upon presentation to the emergency department. Thrombelastography-directed resuscitation with platelets and/or cryoprecipitate was followed for the majority of patients and was associated with improved outcomes. LEVEL OF EVIDENCE: Therapeutic/Care Management, level III. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Stevens, Jenny AU - Stevens J AD - From the Division of Pediatric Surgery (J.S., M.L.R., R.P., S.M., D.B.), Children's Hospital Colorado, Division of Pediatric Surgery, Department of Surgery (J.S., M.L.R., R.P., S.M., D.B.), and Center for Research in Outcomes for Children's Surgery (K.P.), Center for Children's Surgery, University of Colorado School of Medicine, Aurora; and Department of Surgery (H.M., D.B.), Denver Health Medical Center, Denver, Colorado. FAU - Pickett, Kaci AU - Pickett K FAU - Moore, Hunter AU - Moore H FAU - Reppucci, Marina L AU - Reppucci ML FAU - Phillips, Ryan AU - Phillips R FAU - Moulton, Steven AU - Moulton S FAU - Bensard, Denis AU - Bensard D LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - *Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Component Transfusion/methods MH - Blood Transfusion/*methods MH - Child MH - Female MH - Humans MH - Injury Severity Score MH - Length of Stay MH - Male MH - Mortality MH - Outcome Assessment, Health Care MH - Plasma MH - Resuscitation/*methods MH - Thrombelastography/*methods MH - Trauma Centers/statistics & numerical data MH - United States/epidemiology MH - *Wounds and Injuries/blood/complications/epidemiology/therapy MH - Wounds, Nonpenetrating EDAT- 2021/08/28 06:00 MHDA- 2022/02/10 06:00 CRDT- 2021/08/27 06:09 PHST- 2021/08/28 06:00 [pubmed] PHST- 2022/02/10 06:00 [medline] PHST- 2021/08/27 06:09 [entrez] AID - 01586154-202201000-00025 [pii] AID - 10.1097/TA.0000000000003392 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2022 Jan 1;92(1):152-158. doi: 10.1097/TA.0000000000003392. PMID- 34441771 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210831 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 16 DP - 2021 Aug 6 TI - Impact of Idarucizumab and Andexanet Alfa on DOAC Plasma Concentration and ClotPro((R)) Clotting Time: An Ex Vivo Spiking Study in A Cohort of Trauma Patients. LID - 10.3390/jcm10163476 [doi] LID - 3476 AB - Specific antagonists have been developed for the reversal of direct oral anticoagulants (DOAC). We investigated the impact of these reversal agents on the plasma concentration and visco-elastic test results of dabigatran and factor Xa inhibitors. After baseline measurements of dabigatran, the plasma concentration, and the visco-elastic ClotPro((R)) ecarin clotting time (ECA-CT), we added the reversal agent Idarucizumab in vitro and these two analyses were repeated. Likewise, the baseline plasma concentration of apixaban, edoxaban, and rivaroxaban as well as ClotPro((R)) Russell's viper venom test clotting time (RVV-CT) were measured and reanalyzed following Andexanet alfa spiking. We analyzed fifty blood samples from 37 patients and 10 healthy volunteers. Idarucizumab decreased the measured dabigatran plasma concentration from 323.9 +/- 185.4 ng/mL to 5.9 +/- 2.3 ng/mL and ECA-CT from 706.2 +/- 344.6 s to 70.6 +/- 20.2 s, (all, p < 0.001). Andexanet alfa decreased the apixaban concentration from 165.1 +/- 65.5 ng/mL to 9.8 +/- 8.1 ng/mL, edoxaban from 152.4 +/- 79.0 ng/mL to 36.4 +/- 19.2 ng/mL, and rivaroxaban from 153.2 +/- 111.8 ng/mL to 18.1 +/- 9.1 ng/mL (all p < 0.001). Andexanet alfa shortened the RVV-CT of patients with apixaban from 239.2 +/- 71.7 s to 151.1 +/- 30.2 s, edoxaban from 288.2 +/- 65.0 s to 122.7 +/- 37.1 s, and rivaroxaban from 225.9 +/- 49.3 s to 103.7 +/- 12.1 s (all p < 0.001). In vitro spiking of dabigatran-containing blood with Idarucizumab substantially reduced the plasma concentration and ecarin-test clotting time. Andexanet alfa lowered the concentration of the investigated factor Xa-inhibitors but did not normalize the RVV-CT. In healthy volunteers' blood, Idarucizumab spiking had no impact on ECA-CT. Andexanet alfa spiking of non-anticoagulated blood prolonged RVV-CT (p = 0.001), potentially as a consequence of a competitive antagonism with human factor Xa. FAU - Oberladstatter, Daniel AU - Oberladstatter D AUID- ORCID: 0000-0002-1350-5564 AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria. FAU - Schlimp, Christoph J AU - Schlimp CJ AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria. AD - AUVA Trauma Centre Linz, Department of Anaesthesiology and Intensive Care Medicine, 4010 Linz, Austria. FAU - Zipperle, Johannes AU - Zipperle J AUID- ORCID: 0000-0002-8222-3413 AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria. FAU - Osuchowski, Marcin F AU - Osuchowski MF AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria. FAU - Voelckel, Wolfgang AU - Voelckel W AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Grottke, Oliver AU - Grottke O AD - Department of Anaesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany. FAU - Schochl, Herbert AU - Schochl H AD - AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria. LA - eng PT - Journal Article DEP - 20210806 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8396852 OTO - NOTNLM OT - Andexanet alfa OT - DOAC OT - ECA-test OT - Idarucizumab OT - RVV-test OT - reversal COIS- H.S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim, and TEM International. He has also received speaker fees from Haemonetics and Vifor, and study grants from CSL Behring. O.G. has received research funding from Bayer, Biotest, Boehringer Ingelheim, CSL Behring, Octapharma, Novo Nordisk and Nycomed. O.G. has also received honoraria for lectures and consultancy support from Baxalta, Bayer Healthcare, Boehringer Ingelheim, Ferring, CSL Behring, Octapharma, Pfizer, Takeda, Portola and Sanofi. C.J.S. has received speaker honoraria from CSL Behring, Boehringer Ingelheim, Portola and research support from TEM Innovation. No other competing interests declared. EDAT- 2021/08/28 06:00 MHDA- 2021/08/28 06:01 PMCR- 2021/08/06 CRDT- 2021/08/27 01:10 PHST- 2021/07/05 00:00 [received] PHST- 2021/07/28 00:00 [revised] PHST- 2021/07/31 00:00 [accepted] PHST- 2021/08/27 01:10 [entrez] PHST- 2021/08/28 06:00 [pubmed] PHST- 2021/08/28 06:01 [medline] PHST- 2021/08/06 00:00 [pmc-release] AID - jcm10163476 [pii] AID - jcm-10-03476 [pii] AID - 10.3390/jcm10163476 [doi] PST - epublish SO - J Clin Med. 2021 Aug 6;10(16):3476. doi: 10.3390/jcm10163476. PMID- 34430436 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220426 IS - 2224-4344 (Print) IS - 2224-4344 (Electronic) IS - 2224-4336 (Linking) VI - 10 IP - 7 DP - 2021 Jul TI - Efficacy evaluation and mechanical study of short- and long-term antithrombotic therapy for Kawasaki disease. PG - 1883-1889 LID - 10.21037/tp-21-299 [doi] AB - BACKGROUND: Antithrombotic therapy was commonly applied in treating Kawasaki disease (KD) children; however, the effects and mechanisms of different plans were not fully elucidated. In this study, we aimed to evaluate different antithrombotic drugs. METHODS: Eighty-two children diagnosed with KD in Hebei Children's Hospital from January 2017 to January 2020 were recruited. For cohort study, KD children were divided into a series of groups according to whether they were complicated with coronary artery lesions (CAL), drug therapy plan, and the presence of liver damage. The thromboelastogram (TEG) indexes [clotting time (R), clot formation time (K), clot formation angle (alpha), maximum amplitude of the clot (MA), arachidonic acid (AA), and adenosine diphosphate (ADP)] were employed to evaluate the relationship between disease state and drug treatment efficacy. Meanwhile, children were divided into different therapy groups according to their degree of CAL, the treatment efficiency was evaluated by TEG indexes, and the bleeding ratio was recorded. In addition, the warfarin metabolic gene was detected to explain the changes of coagulation parameters in children treated with warfarin. RESULTS: The R value and coagulation index (CoI) were significantly lower (P<0.05) and MA value was significantly higher (P<0.05) in CAL group than those in non-coronary artery lesion (NCAL) group. There were significant individual differences in platelet inhibition between aspirin and dipyridamole groups. The AA% in aspirin group was 64% [95% confidence interval (CI): 49% to 74.3%] and the ADP% was 28.5% (95% CI: 26.2% to 37.2%) in dipyridamole group, and were significantly between groups. Warfarin and aspirin had a synergistic effect in anticoagulation. Warfarin metabolic gene detection was shown to be helpful for adjusting warfarin treatment dose, and shortening the initial attainment time of standard international normalized ratio (INR) index. The R value was significantly higher (P<0.05) in the liver injury group than that in the control group. CONCLUSIONS: KD Children complicated with CAL presented a hypercoagulable state, and the CAL was predictable with the R value. Warfarin metabolic gene detection and TEG can effectively evaluate and guide short- and long-term antithrombotic therapy in KD children. CI - 2021 Translational Pediatrics. All rights reserved. FAU - Hao, Jingxia AU - Hao J AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. FAU - Wang, Hua AU - Wang H AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. FAU - Chen, Jingshi AU - Chen J AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. FAU - Li, Bo AU - Li B AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. FAU - Zhang, Huimin AU - Zhang H AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. FAU - Zhang, Yingqian AU - Zhang Y AD - Department of Cardiology, Hebei Children's Hospital, Shijiazhuang, China. LA - eng PT - Journal Article PL - China TA - Transl Pediatr JT - Translational pediatrics JID - 101649179 PMC - PMC8349964 OTO - NOTNLM OT - Kawasaki disease (KD) OT - coagulation function OT - coronary artery lesion (CAL) OT - gene polymorphism detection OT - thrombelastography COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tp-21-299). The authors declare no conflict of interest. EDAT- 2021/08/26 06:00 MHDA- 2021/08/26 06:01 PMCR- 2021/07/01 CRDT- 2021/08/25 06:26 PHST- 2021/06/02 00:00 [received] PHST- 2021/07/19 00:00 [accepted] PHST- 2021/08/25 06:26 [entrez] PHST- 2021/08/26 06:00 [pubmed] PHST- 2021/08/26 06:01 [medline] PHST- 2021/07/01 00:00 [pmc-release] AID - tp-10-07-1883 [pii] AID - 10.21037/tp-21-299 [doi] PST - ppublish SO - Transl Pediatr. 2021 Jul;10(7):1883-1889. doi: 10.21037/tp-21-299. PMID- 34397955 OWN - NLM STAT- MEDLINE DCOM- 20210922 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 91 IP - 2 DP - 2021 Aug 1 TI - Prehospital evaluation and detection of induced coagulopathy in trauma: The PREDICT study. PG - 344-351 LID - 10.1097/TA.0000000000003246 [doi] AB - BACKGROUND: Hemorrhage with trauma-induced coagulopathy (TIC) and hyperfibrinolysis (HF) increases the mortality risk after severe trauma. While TIC at hospital admission is well studied, little is known about coagulopathy at the incident site. The aim of the study was to investigate coagulation disorders already present on scene. METHODS: In a prospective single-center observational study, blood samples of trauma patients obtained before and at hospital admission were analyzed. Data on rotational thromboelastometry, blood gas analysis, prehospital treatment, injury severity, in-hospital blood transfusions, and mortality were investigated according to the presence of coagulation disorders at the incident site. The patients were divided into three groups according to the presence of coagulation disorders (no coagulopathy, TIC, TIC with HF). In a subgroup analysis, patients with a Trauma-Induced Coagulopathy Clinical Score (TICCS) of >/=10 were investigated. RESULTS: Between August 2015 and February 2018, 148 patients were enrolled in the study. The mean Injury Severity Score was 22.1, and overall mortality was 7.4%. Trauma-induced coagulopathy and HF were already detectable at the incident site in 18.2% and 6.1%, respectively. Patients with HF had significantly altered circulation parameters with significant changes in pH, hemoglobin, lactate, and base excess at the incident site. In patients with TICCS of >/=10 (14.2%), TIC was detected in 47.6% of the cases and HF in 28.6%. Furthermore, in these patients, blood gas parameters significantly changed and the need for blood transfusion and mortality. CONCLUSION: Trauma-induced coagulopathy and HF can be detected in severely injured patients even before medical treatment is started. Furthermore, in patients with HF and TICCS of >/=10, blood gas parameters were significantly changed at the incident site. LEVEL OF EVIDENCE: Prognostic study, level III. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Gaessler, Holger AU - Gaessler H AD - From the Armed Forces Medical Centre Ulm, Department of Anesthesiology and Intensive Care Medicine, Section Emergency Medicine, Ulm, Germany. FAU - Helm, Matthias AU - Helm M FAU - Kulla, Martin AU - Kulla M FAU - Hossfeld, Bjoern AU - Hossfeld B FAU - Schmid, Uta AU - Schmid U FAU - Kerschowski, Juergen AU - Kerschowski J FAU - Bretschneider, Ingeborg AU - Bretschneider I LA - eng PT - Journal Article PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Aged MH - Blood Coagulation MH - Blood Coagulation Disorders/blood/*diagnosis/therapy MH - Blood Gas Analysis MH - Emergency Medical Services/*methods MH - Female MH - Hemorrhage/blood/*diagnosis/therapy MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Multiple Trauma/blood/*diagnosis/therapy MH - Prospective Studies MH - Thrombelastography MH - Young Adult EDAT- 2021/08/17 06:00 MHDA- 2021/09/23 06:00 CRDT- 2021/08/16 12:51 PHST- 2021/08/16 12:51 [entrez] PHST- 2021/08/17 06:00 [pubmed] PHST- 2021/09/23 06:00 [medline] AID - 01586154-202108000-00014 [pii] AID - 10.1097/TA.0000000000003246 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Aug 1;91(2):344-351. doi: 10.1097/TA.0000000000003246. PMID- 34397954 OWN - NLM STAT- MEDLINE DCOM- 20210922 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 91 IP - 2 DP - 2021 Aug 1 TI - Critical traumatic brain injury is associated with worse coagulopathy. PG - 331-335 LID - 10.1097/TA.0000000000003253 [doi] AB - OBJECTIVES: As thromboelastography (TEG) becomes the standard of care in patients with hemorrhagic shock (HS), an association between concomitant traumatic brain injury (TBI) and coagulopathy by TEG parameters is not well understood and is thus investigated. METHODS: Retrospective analysis of trauma registry data at a single level 1 trauma center of 772 patients admitted with head Abbreviated Injury Scale (AIS) score of 3 and TEG studies between 2014 and 2017. Patients were stratified to moderate-severe TBI by head AIS scores of 3 and 4 (435 patients) and critical TBI by head AIS score of 5 (328 patients). Hemorrhagic shock was defined by base deficit of 4 or shock index of 0.9. Statistical analysis with unpaired t tests compared patients with critical TBI with patients with moderate-severe TBI, and patients were grouped by presence or absence of HS. A comparison of TBI data with conventional coagulation studies was also evaluated. RESULTS: In the setting of HS, critical TBI versus moderate-severe TBI was associated with longer R time (p = 0.004), longer K time (p < 0.05), less acute angle (p = 0.001), and lower clot strength and stability (maximum amplitude [MA]) (p = 0.01). Worse TBI did not correlate with increased fibrinolysis by clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (p = 0.3). Prothrombin time and international normalized ratio failed to demonstrate more severe coagulopathy, while partial thromboplastin time was found to correlate with severity of TBI (p = 0.01). In patients with critical TBI, the presence of HS correlated with a statistically significant worsening of all parameters (p < 0.05) except for clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (LY-30). CONCLUSION: Thromboelastography demonstrates that, with and without hemorrhagic shock, critical TBI correlates with a significant worsening of traumatic coagulopathy in comparison with moderate/severe TBI. In HS, critical TBI correlates with impaired clot initiation, impaired clot kinetics, and impaired platelet-associated clot strength and stability versus parameters found in moderate-severe TBI. Hemorrhagic shock correlates with worse traumatic coagulopathy in all evaluated patient groups with TBI. Conventional coagulation studies underestimate TBI-associated coagulopathy. Traumatic brain injury-associated coagulopathy is not associated with fibrinolysis. LEVEL OF EVIDENCE: Prognostic/epidemiological, level IV; prognostic/epidemiological, level III. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Cucher, Daniel AU - Cucher D AD - From the Division of Trauma (D.C., A.C., C.H.), Chandler Regional Medical Center, Chandler, Arizona; Section of Trauma Acute Care Surgery, Surgical Critical Care, and Burn Surgery (L.H.), Anschutz Medical Center, University of Colorado, Aurora, Colorado; Division of Critical Care & Acute Care Surgery (B.M.), University of Minnesota Health, Saint Paul, Minnesota; Division of Trauma Surgery & Surgical Critical Care (A.N.), Riverside University Health System Medical Center, Riverside, California; Department of Surgery (T.R.), Vanderbilt University Medical Center, Nashville, Tennessee; Program in Trauma ( R.T., T.S., D.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland. FAU - Harmon, Laura AU - Harmon L FAU - Myer, Brian AU - Myer B FAU - Ngyuen, Andrew AU - Ngyuen A FAU - Rankin, Timothy AU - Rankin T FAU - Cook, Alan AU - Cook A FAU - Hu, Charles AU - Hu C FAU - Tesoriero, Ronald AU - Tesoriero R FAU - Scalea, Thomas AU - Scalea T FAU - Stein, Deborah AU - Stein D LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Abbreviated Injury Scale MH - Blood Coagulation Tests MH - Brain Injuries, Traumatic/*blood/*complications/pathology MH - Humans MH - Injury Severity Score MH - International Normalized Ratio MH - Logistic Models MH - Retrospective Studies MH - Shock, Hemorrhagic/*blood/etiology MH - *Thrombelastography MH - Thrombosis/blood/etiology MH - Trauma Centers EDAT- 2021/08/17 06:00 MHDA- 2021/09/23 06:00 CRDT- 2021/08/16 12:51 PHST- 2021/08/16 12:51 [entrez] PHST- 2021/08/17 06:00 [pubmed] PHST- 2021/09/23 06:00 [medline] AID - 01586154-202108000-00012 [pii] AID - 10.1097/TA.0000000000003253 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Aug 1;91(2):331-335. doi: 10.1097/TA.0000000000003253. PMID- 34395207 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220425 IS - 2229-5151 (Print) IS - 2231-5004 (Electronic) IS - 2229-5151 (Linking) VI - 11 IP - 2 DP - 2021 Apr-Jun TI - Safety and efficacy of thromboelastography guidance of antifibrinolytic therapy in trauma patients: An observational cohort analysis. PG - 67-72 LID - 10.4103/IJCIIS.IJCIIS_79_20 [doi] AB - BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic therapy intended to decrease blood loss and improve hemostasis in traumatic hemorrhage. Viscoelastic assays, such as thromboelastography (TEG), allow for the identification of a patient's specific hemostasis. The purpose of this research study was to explore the safety and efficacy of TEG-guided antifibrinolytic therapy in trauma patients. METHODS: This study was a retrospective review of trauma patients meeting institution-specific inclusion criteria for TXA. Patients were assigned to fibrinolytic groups per TEG LY30 data. Safety outcomes (24-h mortality, overall in-hospital mortality, and thromboembolic events) were compared between patients who did or did not receive TXA and within fibrinolytic groups. Mortality outcomes were adjusted for baseline Injury Severity Score (ISS). Secondary aims included blood product utilization, length of hospital, and intensive care unit stay. RESULTS: Hypofibrinolysis was the most common fibrinolytic phenotype. Adjusting for ISS, there were no significant differences in mortality. A 30.7% thromboembolism incidence was identified in the TXA group compared to 16.6% not receiving TXA (P = 0.26), with 72.7% of these patients experiencing fibrinolytic shutdown. CONCLUSIONS: There were no differences in 24-h mortality, all-cause mortality, or secondary outcomes. The difference in thromboembolic rates between patients receiving TXA and those who did not, while not statistically significant, poses clinical concern. CI - Copyright: (c) 2021 International Journal of Critical Illness and Injury Science. FAU - Heilbronner, Rachel N AU - Heilbronner RN AD - Department of Pharmacy, OhioHealth Doctors Hospital, Columbus, Ohio, USA. FAU - Kincaid, Michelle AU - Kincaid M AD - Department of Trauma, OhioHealth Grant Medical Center, Columbus, Ohio, USA. FAU - Walliser, Grant AU - Walliser G AD - Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, Ohio, USA. FAU - Pershing, Michelle AU - Pershing M AD - Department of Research, OhioHealth Research and Innovation Institute, Columbus, Ohio, USA. FAU - Spalding, M Chance AU - Spalding MC AD - Department of Trauma, OhioHealth Grant Medical Center, Columbus, Ohio, USA. LA - eng PT - Journal Article DEP - 20210629 PL - India TA - Int J Crit Illn Inj Sci JT - International journal of critical illness and injury science JID - 101571136 PMC - PMC8318174 OTO - NOTNLM OT - Antifibrinolytic agents OT - Injury Severity Score OT - thromboelastography OT - tranexamic acid OT - wounds and injuries COIS- There are no conflicts of interest. EDAT- 2021/08/17 06:00 MHDA- 2021/08/17 06:01 PMCR- 2021/04/01 CRDT- 2021/08/16 06:00 PHST- 2020/06/01 00:00 [received] PHST- 2020/10/24 00:00 [revised] PHST- 2021/01/01 00:00 [accepted] PHST- 2021/08/16 06:00 [entrez] PHST- 2021/08/17 06:00 [pubmed] PHST- 2021/08/17 06:01 [medline] PHST- 2021/04/01 00:00 [pmc-release] AID - IJCIIS-11-67 [pii] AID - 10.4103/IJCIIS.IJCIIS_79_20 [doi] PST - ppublish SO - Int J Crit Illn Inj Sci. 2021 Apr-Jun;11(2):67-72. doi: 10.4103/IJCIIS.IJCIIS_79_20. Epub 2021 Jun 29. PMID- 34369848 OWN - NLM STAT- MEDLINE DCOM- 20220426 LR - 20220426 IS - 1369-1635 (Electronic) IS - 0953-7104 (Linking) VI - 33 IP - 4 DP - 2022 May 19 TI - The role of viscoelastic testing in assessing peri-interventional platelet function and coagulation. PG - 520-530 LID - 10.1080/09537104.2021.1961709 [doi] AB - We carried out a literature search in MEDLINE (PubMed) and EMBASE literature databases to provide a concise review of the role of viscoelastic testing in assessing peri-interventional platelet function and coagulation. The search identified 130 articles that were relevant for the review, covering the basic science of VHA and VHA in clinical settings including cardiac surgery, cardiology, neurology, trauma, non-cardiac surgery, obstetrics, liver disease, and COVID-19. Evidence from these articles is used to describe the important role of VHAs and platelet function testing in various peri-interventional setups. VHAs can help us to comprehensively assess the contribution of platelets and coagulation dynamics to clotting at the site-of-care much faster than standard laboratory measures. In addition to standard coagulation tests, VHAs are beneficial in reducing allogeneic transfusion requirements and bleeding, in predicting ischemic events, and improving outcomes in several peri-interventional care settings. Further focused studies are needed to confirm their utility in the peri-interventional case. FAU - Tantry, Udaya S AU - Tantry US AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA. FAU - Hartmann, Jan AU - Hartmann J AD - Medical Affairs and Clinical Development, Haemonetics Corporation, Boston, MA, USA. FAU - Neal, Matthew D AU - Neal MD AD - Department of General Surgery, The University of Pittsburgh Medical Center, Pittsburgh, PA, USA. FAU - Schoechl, Herbert AU - Schoechl H AD - Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. AD - AUVA Trauma Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. FAU - Bliden, Kevin P AU - Bliden KP AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA. FAU - Agarwal, Seema AU - Agarwal S AD - Department of Anaesthesia, Manchester University Foundation Trust, Manchester, UK. FAU - Mason, Dan AU - Mason D AD - Medical Affairs and Clinical Development, Haemonetics Corporation, Boston, MA, USA. FAU - Dias, Joao D AU - Dias JD AD - Medical Affairs and Clinical Development, Haemonetics Corporation, Boston, MA, USA. FAU - Mahla, Elisabeth AU - Mahla E AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. FAU - Gurbel, Paul A AU - Gurbel PA AD - Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA. LA - eng PT - Journal Article DEP - 20210809 PL - England TA - Platelets JT - Platelets JID - 9208117 SB - IM MH - Blood Coagulation MH - *Blood Coagulation Disorders MH - Blood Coagulation Tests MH - *COVID-19 MH - Hemostasis MH - Humans MH - Thrombelastography OTO - NOTNLM OT - Bleeding OT - critical care OT - ischemia OT - platelet function OT - site-of-care OT - trauma OT - viscoelastic hemostatic assay EDAT- 2021/08/10 06:00 MHDA- 2022/04/27 06:00 CRDT- 2021/08/09 12:17 PHST- 2021/08/10 06:00 [pubmed] PHST- 2022/04/27 06:00 [medline] PHST- 2021/08/09 12:17 [entrez] AID - 10.1080/09537104.2021.1961709 [doi] PST - ppublish SO - Platelets. 2022 May 19;33(4):520-530. doi: 10.1080/09537104.2021.1961709. Epub 2021 Aug 9. PMID- 34357921 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210809 IS - 2306-7381 (Electronic) IS - 2306-7381 (Linking) VI - 8 IP - 7 DP - 2021 Jul 12 TI - Improved Cardiovascular Tolerance to Hemorrhage after Oral Resveratrol Pretreatment in Dogs. LID - 10.3390/vetsci8070129 [doi] LID - 129 AB - Resveratrol has been shown to preserve organ function and improve survival in hemorrhagic shock rat models. This study investigated whether seven days of oral resveratrol could improve hemodynamic response to hemorrhage and confer benefits on risk of acute kidney injury (AKI) without inducing coagulopathy in a canine model. Twelve greyhound dogs were randomly allocated to receive oral resveratrol (1000 mg/day) or placebo for seven days prior to inducing hemorrhage until a targeted mean blood pressure of /=42; high TSK group]). All participants were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. RESULTS: There were 16 participants (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3-25.4]), 28 participants (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5-30.8]), and 15 participants (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. CONCLUSION: Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. IMPACT: Evaluating the degree of kinesiophobia in individuals with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery. CI - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com. FAU - Alghamdi, Nabeel Hamdan AU - Alghamdi NH AUID- ORCID: 0000-0002-0718-0556 AD - Department of Physical Therapy, King Abdulaziz University, Jeddah, Saudi Arabia. AD - Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. FAU - Pohlig, Ryan T AU - Pohlig RT AD - Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. FAU - Lundberg, Mari AU - Lundberg M AD - Department of Health and Rehabilitation, University of Gothenburg, Goteborg, Sweden. AD - Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden. FAU - Silbernagel, Karin Gravare AU - Silbernagel KG AUID- ORCID: 0000-0001-7566-407X AD - Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. LA - eng GR - R01 AR072034/AR/NIAMS NIH HHS/United States GR - R21 AR067390/AR/NIAMS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - Phys Ther JT - Physical therapy JID - 0022623 SB - IM MH - Achilles Tendon/*injuries MH - Adult MH - Aged MH - Fear/*psychology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pain/*psychology MH - Pain Measurement MH - Prospective Studies MH - Recovery of Function MH - Surveys and Questionnaires MH - Tendinopathy/*psychology/*therapy PMC - PMC8801001 OTO - NOTNLM OT - Achilles Tendinitis OT - Fear of Movement OT - Heel-Rise OT - Physical Activity Level OT - VISA-A OT - Viscoelastic Properties EDAT- 2021/07/22 06:00 MHDA- 2021/12/28 06:00 PMCR- 2022/07/21 CRDT- 2021/07/21 17:33 PHST- 2020/10/26 00:00 [received] PHST- 2021/04/28 00:00 [revised] PHST- 2021/06/04 00:00 [accepted] PHST- 2021/07/22 06:00 [pubmed] PHST- 2021/12/28 06:00 [medline] PHST- 2021/07/21 17:33 [entrez] PHST- 2022/07/21 00:00 [pmc-release] AID - 6324957 [pii] AID - pzab178 [pii] AID - 10.1093/ptj/pzab178 [doi] PST - ppublish SO - Phys Ther. 2021 Nov 1;101(11):pzab178. doi: 10.1093/ptj/pzab178. PMID- 34281177 OWN - NLM STAT- MEDLINE DCOM- 20210729 LR - 20210729 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 22 IP - 13 DP - 2021 Jul 1 TI - Albumin Infusion in Critically Ill COVID-19 Patients: Hemodilution and Anticoagulation. LID - 10.3390/ijms22137126 [doi] LID - 7126 AB - Hypercoagulation is one of the major risk factors for ICU treatment, mechanical ventilation, and death in critically ill patients infected with SARS-CoV-2. At the same time, hypoalbuminemia is one risk factor in such patients, independent of age and comorbidities. Especially in patients with severe SARS-CoV-2-infection, albumin infusion may be essential to improve hemodynamics and to reduce the plasma level of the main marker of thromboembolism, namely, the D-dimer plasma level, as suggested by a recent report. Albumin is responsible for 80% of the oncotic pressure in the vessels. This is necessary to keep enough water within the systemic circulatory system and for the maintenance of sufficient blood pressure, as well as for sufficient blood supply for vital organs like the brain, lungs, heart, and kidney. The liver reacts to a decrease in oncotic pressure with an increase in albumin synthesis. This is normally possible through the use of amino acids from the proteins introduced with the nutrients reaching the portal blood. If these are not sufficiently provided with the diet, amino acids are delivered to the liver from muscular proteins by systemic circulation. The liver is also the source of coagulation proteins, such as fibrinogen, fibronectin, and most of the v WF VIII, which are physiological components of the extracellular matrix of the vessel wall. While albumin is the main negative acute-phase protein, fibrinogen, fibronectin, and v WF VIII are positive acute-phase proteins. Acute illnesses cause the activation of defense mechanisms (acute-phase reaction) that may lead to an increase of fibrinolysis and an increase of plasma level of fibrinogen breakdown products, mainly fibrin and D-dimer. The measurement of the plasma level of the D-dimer has been used as a marker for venous thromboembolism, where a fourfold increase of the D-dimer plasma level was used as a negative prognostic marker in critically ill SARS-CoV-2 hospitalized patients. Increased fibrinolysis can take place in ischemic peripheral sites, where the mentioned coagulation proteins can become part of the provisional clot (e.g., in the lungs). Although critically ill SARS-CoV-2-infected patients are considered septic shock patients, albumin infusions have not been considered for hemodynamic resuscitation and as anticoagulants. The role of coagulation factors as provisional components of the extracellular matrix in case of generalized peripheral ischemia due to hypoalbuminemia and hypovolemia is discussed in this review. FAU - Ramadori, Giuliano AU - Ramadori G AUID- ORCID: 0000-0002-7921-7186 AD - Internal Medicine University Clinic, University of Gottingen, Gottingen, Germany Robert-Koch-Strasse 40, 37075 Gottingen, Germany. LA - eng PT - Journal Article PT - Review DEP - 20210701 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Albumins) RN - 0 (Anticoagulants) SB - IM MH - Albumins/*administration & dosage MH - Anticoagulants/administration & dosage MH - Blood Coagulation/drug effects MH - COVID-19/blood/metabolism/*therapy MH - Critical Illness/therapy MH - Fibrinolysis/drug effects MH - Hemodilution/*methods MH - Humans MH - SARS-CoV-2/isolation & purification MH - Thrombelastography PMC - PMC8268290 OTO - NOTNLM OT - COVID-19 hypercoagulability OT - D-dimer OT - albumin infusion OT - fibrin OT - hypoalbuminemia OT - ischemia OT - lung injury kidney injury OT - provisional clot COIS- The author declares no conflict of interest. EDAT- 2021/07/21 06:00 MHDA- 2021/07/30 06:00 PMCR- 2021/07/01 CRDT- 2021/07/20 01:03 PHST- 2021/05/22 00:00 [received] PHST- 2021/06/21 00:00 [revised] PHST- 2021/06/28 00:00 [accepted] PHST- 2021/07/20 01:03 [entrez] PHST- 2021/07/21 06:00 [pubmed] PHST- 2021/07/30 06:00 [medline] PHST- 2021/07/01 00:00 [pmc-release] AID - ijms22137126 [pii] AID - ijms-22-07126 [pii] AID - 10.3390/ijms22137126 [doi] PST - epublish SO - Int J Mol Sci. 2021 Jul 1;22(13):7126. doi: 10.3390/ijms22137126. PMID- 34269465 OWN - NLM STAT- MEDLINE DCOM- 20210816 LR - 20210816 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 Suppl 1 DP - 2021 Jul TI - Ex vivo hemostatic and immuno-inflammatory profiles of freeze-dried plasma. PG - S119-S130 LID - 10.1111/trf.16502 [doi] AB - BACKGROUND: Hemorrhage is a leading cause of preventable death in civilian and military trauma. Freeze-dried plasma is promising for hemostatic resuscitation in remote prehospital settings, given its potential benefits in reducing blood loss and mortality, long storage at ambient temperatures, high portability, and rapid reconstitution for transfusion in austere environments. Here we assess the ex vivo characteristics of a novel Terumo's freeze-dried plasma product (TFDP). STUDY DESIGN AND METHODS: Rotational thromboelastometry (ROTEM) tests (INTEM, EXTEM, and FIBTEM) were conducted on plasma samples at 37 degrees C with a ROTEM delta-machine using standard reagents and procedures. The following samples were analyzed: pooled plasma to produce TFDP, TFDP reconstituted, and stored immediately at -80 degrees C, reconstituted TFDP stored at 4 degrees C for 24 h and room temperature (RT) for 4 h before freezing at -80 degrees C. Analysis of plasma concentrations of selected cytokines, chemokines, and vascular molecules was performed using a multiplex immunoassay system. One-way ANOVA with post hoc tests assessed differences in hemostatic and inflammatory properties. RESULTS: No significant differences in ROTEM variables (coagulation time [CT], clot formation time, alpha-angle, maximum clot firmness, and lysis index 30) between the TFDP-producing plasma and reconstituted TFDP samples were observed. Compared to control plasma, reconstituted TFDP stored at 4 degrees C for 24 h or RT for 4 h showed a longer INTEM CT. Levels of immuno-inflammatory mediators were similar between frozen plasma and TFDP. CONCLUSIONS: TFDP is equivalent to frozen plasma with respect to global hemostatic and immuno-inflammatory mediator profiles. Further investigations of TFDP in trauma-induced coagulopathy models and bleeding patients are warranted. CI - (c) 2021 Her Majesty the Queen in Right of Canada Transfusion (c) 2021 AABB Reproduced with the permission of the Minister of Defence Research & Development Canada. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Rhind, Shawn G AU - Rhind SG AUID- ORCID: 0000-0003-2300-0620 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Devine, Dana AU - Devine D AUID- ORCID: 0000-0002-9059-0344 AD - Canadian Blood Services, Ottawa, Ontario, Canada. FAU - Jenkins, Craig AU - Jenkins C AD - Canadian Blood Services, Ottawa, Ontario, Canada. FAU - Beckett, Andrew AU - Beckett A AD - St. Michael's Hospital, Toronto, Ontario, Canada. AD - Royal Canadian Medical Services, Ottawa, Ontario, Canada. LA - eng GR - Defense Research & Development Canada/ GR - Health Research/ GR - Canadian Blood Services/ GR - Terumo BCT/ PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Blood Coagulation MH - Blood Coagulation Tests MH - *Blood Preservation MH - *Freeze Drying MH - Humans MH - Inflammation/immunology MH - Plasma/*immunology OTO - NOTNLM OT - ROTEM OT - chemokines OT - coagulopathy OT - cytokines OT - dried plasma OT - inflammation OT - trauma EDAT- 2021/07/17 06:00 MHDA- 2021/08/17 06:00 CRDT- 2021/07/16 08:56 PHST- 2021/04/01 00:00 [revised] PHST- 2020/12/31 00:00 [received] PHST- 2021/04/01 00:00 [accepted] PHST- 2021/07/16 08:56 [entrez] PHST- 2021/07/17 06:00 [pubmed] PHST- 2021/08/17 06:00 [medline] AID - 10.1111/trf.16502 [doi] PST - ppublish SO - Transfusion. 2021 Jul;61 Suppl 1:S119-S130. doi: 10.1111/trf.16502. PMID- 34269460 OWN - NLM STAT- MEDLINE DCOM- 20210816 LR - 20210816 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 Suppl 1 DP - 2021 Jul TI - Evaluation of trauma-induced coagulopathy in the fibrinogen in the initial resuscitation of severe trauma trial. PG - S49-S57 LID - 10.1111/trf.16488 [doi] AB - BACKGROUND: Coagulopathic bleeding is frequently present after major trauma. However, trauma-induced coagulopathy (TIC) remains incompletely understood. This laboratory analysis of blood samples derived from our completed trial on fibrinogen in the initial resuscitation of severe trauma (FiiRST) was conducted to evaluate TIC and associated responses to fibrinogen replacement. STUDY DESIGN AND METHODS: We conducted a retrospective evaluation of TIC in 45 FiiRST trial patients based on rotational thromboelastometry (ROTEM), international normalized ratio (INR), and biomarkers for hemostasis and endotheliopathy. Whole blood was analyzed by ROTEM. Plasma was analyzed for INR and biomarkers. RESULTS: Overall, 19.0% and 30.0% of the FiiRST trial patients were coagulopathic on admission defined by EXTEM maximum clot firmness out of the range of 40-71 mm and INR >1.2, respectively. The FiiRST patients showed lower fibrinogen, factor II and V levels, protein C and antiplasmin activities, higher activated protein C, tissue plasminogen activator, d-dimer, and thrombomodulin concentrations at admission than healthy controls. Most of the biomarkers changed their activities during 48-h hospitalization, but were at abnormal levels even 48-h after admission. The fibrinogen treatment reduced hypofibrinogenemia and increased factor XIII level, but had no significant effects on other biomarkers levels. Limited development of endotheliopathy was indicated by syndean-1, thrombomodulin, and sE-selectin. CONCLUSIONS: About 19%-30% of the trauma patients in the FiiRST trial were coagulopathic on hospital admission depending on the definition of TIC. Analyses of the TIC biomarkers demonstrated that hemostasis would not return to normal after 48-h hospitalization, and fibrinogen replacement improved hypofibrinogenemia. CI - (c) 2021 Her Majesty the Queen in Right of Canada. Transfusion (c) 2021 AABB. Reproduced with the permission of the Minister of Natural Defence Canada. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Nascimento, Barto AU - Nascimento B AD - Hospital Getulio Vargas, Recife, Brazil. FAU - Rhind, Shawn G AU - Rhind SG AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - da Luz, Luis AU - da Luz L AUID- ORCID: 0000-0003-0292-9676 AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. FAU - Beckett, Andrew AU - Beckett A AD - Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Royal Canadian Medical Services, Ottawa, Ontario, Canada. LA - eng GR - Defence Research and Development Canada/ PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/*etiology/*therapy MH - Female MH - Fibrinogen/analysis/*therapeutic use MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Thrombelastography MH - Wounds and Injuries/blood/*complications/*therapy MH - Young Adult OTO - NOTNLM OT - ROTEM OT - biomarkers OT - coagulopathy OT - endotheliopathy OT - fibrinogen OT - trauma EDAT- 2021/07/17 06:00 MHDA- 2021/08/17 06:00 CRDT- 2021/07/16 08:56 PHST- 2021/03/31 00:00 [revised] PHST- 2020/12/31 00:00 [received] PHST- 2021/04/01 00:00 [accepted] PHST- 2021/07/16 08:56 [entrez] PHST- 2021/07/17 06:00 [pubmed] PHST- 2021/08/17 06:00 [medline] AID - 10.1111/trf.16488 [doi] PST - ppublish SO - Transfusion. 2021 Jul;61 Suppl 1:S49-S57. doi: 10.1111/trf.16488. PMID- 34269454 OWN - NLM STAT- MEDLINE DCOM- 20210816 LR - 20210816 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 Suppl 1 DP - 2021 Jul TI - Cold-stored leukoreduced whole blood: Extending the time between donation and filtration has minimal impact on in vitro quality. PG - S131-S143 LID - 10.1111/trf.16540 [doi] AB - BACKGROUND: Leukoreduced whole blood (LR-WB) has received renewed attention as alternative to component-based transfusion in trauma. According to the manufacturer's instructions, leukoreduction should be carried out within 8 h after collection. This study assessed impact of (1) WB collection bag, (2) LR filtration, and (3) timing of filtration on in vitro quality. STUDY DESIGN AND METHODS: WB collected into different vendor bags was held at room temperature for <8 h or >16 h but <24 h prior to LR. In vitro quality was assessed before and after filtration, and throughout 3 weeks of storage at 4 degrees C. Cell count and hemoglobin levels were determined by hematology analyzer, platelet activation, and responsiveness to ADP by surface expression of P-selectin by flow cytometry, hemolysis by HemoCue, and metabolic parameters by blood gas analyzer. Hemostatic properties were assessed by rotational thromboelastometry. Plasma protein activities and clotting times were determined by automated coagulation analyzer or quantitative immunoblotting. RESULTS: Bag type had no impact on WB in vitro quality. LR by filtration had some impact, but is aligned with data in the literature. The time between donation and filtration resulted in some statistically significant differences in metabolic activity, platelet yield, platelet activation, and factor protein activity initially; however, these differences in in vitro quality attributes decreased throughout 21-day cold storage. CONCLUSION: WB hold time showed only a minor impact on WB in vitro quality, so it may be possible for blood processing facilities to explore extended hold times prior to filtration in order to provide greater operational flexibility. CI - (c) 2021 AABB. FAU - Schubert, Peter AU - Schubert P AUID- ORCID: 0000-0002-3310-6819 AD - Centre for Innovation, Canadian Blood Services, Vancouver, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. FAU - Chen, Zhongming AU - Chen Z AD - Centre for Innovation, Canadian Blood Services, Vancouver, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, Canada. FAU - Bhakta, Varsha AU - Bhakta V AD - Centre for Innovation, Canadian Blood Services, Hamilton, Canada. FAU - Culibrk, Brankica AU - Culibrk B AD - Centre for Innovation, Canadian Blood Services, Vancouver, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, Canada. FAU - Wambolt, Richard AU - Wambolt R AD - Centre for Innovation, Canadian Blood Services, Vancouver, Canada. FAU - Sheffield, William P AU - Sheffield WP AD - Centre for Innovation, Canadian Blood Services, Hamilton, Canada. AD - Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada. FAU - Devine, Dana V AU - Devine DV AUID- ORCID: 0000-0002-9059-0344 AD - Centre for Innovation, Canadian Blood Services, Vancouver, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, Canada. AD - Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. FAU - McTaggart, Ken AU - McTaggart K AD - Centre for Innovation, Canadian Blood Services, Ottawa, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Blood Cell Count MH - Blood Preservation/*methods MH - Cold Temperature MH - Hemolysis MH - Hemostasis MH - Humans MH - Leukocyte Reduction Procedures/methods MH - Platelet Activation MH - Thrombelastography OTO - NOTNLM OT - WB cold storage OT - WB in vitro quality OT - WB leukoreduction OT - blood component EDAT- 2021/07/17 06:00 MHDA- 2021/08/17 06:00 CRDT- 2021/07/16 08:56 PHST- 2021/05/21 00:00 [revised] PHST- 2020/12/22 00:00 [received] PHST- 2021/05/28 00:00 [accepted] PHST- 2021/07/16 08:56 [entrez] PHST- 2021/07/17 06:00 [pubmed] PHST- 2021/08/17 06:00 [medline] AID - 10.1111/trf.16540 [doi] PST - ppublish SO - Transfusion. 2021 Jul;61 Suppl 1:S131-S143. doi: 10.1111/trf.16540. PMID- 34266290 OWN - NLM STAT- MEDLINE DCOM- 20220224 LR - 20220224 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 88 IP - 3 DP - 2022 Mar TI - Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage. PG - 512-518 LID - 10.1177/00031348211033542 [doi] AB - BACKGROUND: Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. METHODS: A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. RESULTS: A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 +/- .9 vs 41.1 +/- .6 years, P = .01). On TEG, females had longer reaction times (6.1 +/- .9 min vs 4.8 +/- .2 min, P = .03), increased alpha angle (68.6 +/- .8 vs 65.7 +/- .4, P < .001), and higher maximum amplitude (59.8 +/- .8 vs 56.3 +/- .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 +/- 13.7 vs 75.1 +/- 2.6 sec, P = .09) and clot formation time (153.6 +/- 10.6 sec vs 106.9 +/- 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group (P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). CONCLUSIONS: Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed. FAU - Smith, Alison AU - Smith A AD - Department of Surgery, 12256Tulane University School of Medicine, New Orleans, LA, USA. FAU - Duchesne, Juan AU - Duchesne J AD - Department of Surgery, 12256Tulane University School of Medicine, New Orleans, LA, USA. FAU - Marturano, Matthew AU - Marturano M AD - Department of Surgery, 12256Tulane University School of Medicine, New Orleans, LA, USA. FAU - Lawicki, Shaun AU - Lawicki S AD - Department of Pathology, 12258Louisiana State University, New Orleans, LA, USA. FAU - Sexton, Kevin AU - Sexton K AD - Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Taylor, John R AU - Taylor JR AD - Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA. FAU - Richards, Justin AU - Richards J AD - Department of Anesthesia, 12264University of Maryland, Baltimore, MD, USA. FAU - Harris, Charles AU - Harris C AD - Department of Surgery, 12256Tulane University School of Medicine, New Orleans, LA, USA. FAU - Moreno-Ponte, Oscar AU - Moreno-Ponte O AD - Department of Surgery, 12253University of Kentucky, Lexington, KY, USA. FAU - Cannon, Jeremy W AU - Cannon JW AD - Department of Surgery, 6569University of Pennsylvania, Philadelphia, PA, USA. FAU - Guzman, Jessica F AU - Guzman JF AD - Department of Surgery, 6569University of Pennsylvania, Philadelphia, PA, USA. FAU - Pickett, Maryanne L AU - Pickett ML AD - Department of Surgery, 12334University of Texas Southwestern, Dallas, TX, USA. FAU - Cripps, Michael W AU - Cripps MW AD - Department of Surgery, 12334University of Texas Southwestern, Dallas, TX, USA. FAU - Curry, Terry AU - Curry T AD - Department of Surgery, 8784University of California San Diego, San Diego, CA, USA. FAU - Costantini, Todd AU - Costantini T AD - Department of Surgery, 8784University of California San Diego, San Diego, CA, USA. FAU - Guidry, Chrissy AU - Guidry C AD - Department of Surgery, 12256Tulane University School of Medicine, New Orleans, LA, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20210715 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Analysis of Variance MH - Blood Coagulation/*physiology MH - Blood Transfusion MH - Female MH - Hemorrhage/*blood/etiology/mortality MH - Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Retrospective Studies MH - *Sex Factors MH - Thrombelastography/*methods MH - Trauma Centers MH - Wounds and Injuries/*blood/complications/mortality OTO - NOTNLM OT - coagulopathy OT - gender OT - hemorrhagic shock OT - rotational thromboelastometry OT - thromboelastography EDAT- 2021/07/17 06:00 MHDA- 2022/02/25 06:00 CRDT- 2021/07/16 05:29 PHST- 2021/07/17 06:00 [pubmed] PHST- 2022/02/25 06:00 [medline] PHST- 2021/07/16 05:29 [entrez] AID - 10.1177/00031348211033542 [doi] PST - ppublish SO - Am Surg. 2022 Mar;88(3):512-518. doi: 10.1177/00031348211033542. Epub 2021 Jul 15. PMID- 34250259 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220424 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 6 IP - 1 DP - 2021 TI - Hypercoagulability in pregnant trauma patients. PG - e000714 LID - 10.1136/tsaco-2021-000714 [doi] LID - e000714 AB - Circulating hormones affect coagulopathy in pregnancy and after trauma. The hemostatic profile of pregnant women after injury has not been characterized. We hypothesized that injured pregnant females would present with an initial thrombelastography (TEG) reflecting a more hypercoagulable profile and a higher incidence of venous thromboembolic events (VTE) when compared with non-pregnant females and males. METHODS: Cohort study of adult trauma patients with TEG measured on arrival was performed from 2009 to 2018 with data extracted from medical records. Nearest-neighbor matching was used to match each pregnant patient by age, Injury Severity Score, prehospital transfusion, and arrival Glasgow Coma Scale with non-pregnant females and males, each in a maximum 1:4 ratio. Hypercoagulable profiles were defined as alpha (alpha) angle >/=76 degrees and maximum amplitude (MA) >/=65 mm. Lysis at 30 minutes after MA (LY-30) was considered high if >/=3.0% and low if 34 ng/ml) (64.7% vs 26.4%; P = .008). There was a pattern of increased mortality among patients with IHI and endotheliopathy (0% vs 72.7%; P = .004). Significant differences between patients with and without IHI were found in measures assessing fibrinolytic potential and endotheliopathy. Mortality was associated with abnormal fibrinolysis, endotheliopathy, and IHI. However, the extent to which IHI-associated dysfunction is independent of TBSA burn size remains to be elucidated. CI - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. FAU - Keyloun, John W AU - Keyloun JW AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, DC, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - Le, Tuan D AU - Le TD AD - U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, USA. AD - Department of Epidemiology and Biostatistics, University of Texas Health Science Center, Tyler, USA. FAU - Brummel-Ziedins, Kathleen E AU - Brummel-Ziedins KE AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - Mclawhorn, Melissa M AU - Mclawhorn MM AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - Bravo, Maria C AU - Bravo MC AD - Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, USA. FAU - Orfeo, Thomas AU - Orfeo T AD - Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, USA. FAU - Johnson, Laura S AU - Johnson LS AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, DC, USA. AD - Department of Surgery, Georgetown University, Washington, DC, USA. FAU - Moffatt, Lauren T AU - Moffatt LT AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. AD - Department of Surgery, Georgetown University, Washington, DC, USA. AD - Department of Biochemistry, Georgetown University, Washington, DC, USA. FAU - Pusateri, Anthony E AU - Pusateri AE AD - U.S. Naval Medical Research Unit, JBSA Fort Sam Houston, San Antonio, TX, USA. FAU - Shupp, Jeffrey W AU - Shupp JW AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, DC, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. AD - Department of Surgery, Georgetown University, Washington, DC, USA. AD - Department of Biochemistry, Georgetown University, Washington, DC, USA. CN - SYSCOT Study Group LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - J Burn Care Res JT - Journal of burn care & research : official publication of the American Burn Association JID - 101262774 SB - IM MH - *Burns/complications MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Phenotype MH - Retrospective Studies MH - Thrombelastography PMC - PMC8946676 FIR - McLawhorn, Melissa M IR - McLawhorn MM FIR - Moffatt, Lauren T IR - Moffatt LT FIR - Shupp, Jeffrey W IR - Shupp JW FIR - Callcut, Rachael A IR - Callcut RA FIR - Cohen, Mitchell J IR - Cohen MJ FIR - Petzold, Linda R IR - Petzold LR FIR - Varner, Jeffrey D IR - Varner JD FIR - Bravo, Maria Cristina IR - Bravo MC FIR - Brummel-Ziedins, Kathleen E IR - Brummel-Ziedins KE FIR - Freeman, Kalev IR - Freeman K FIR - Mann, Kenneth G IR - Mann KG FIR - Orfeo, Thomas IR - Orfeo T FIR - Gautam, Aarti IR - Gautam A FIR - Hammamieh, Rasha IR - Hammamieh R FIR - Jett, Marti IR - Jett M FIR - Pusateri, Anthony E IR - Pusateri AE EDAT- 2021/06/06 06:00 MHDA- 2022/04/19 06:00 PMCR- 2021/06/05 CRDT- 2021/06/05 17:05 PHST- 2021/06/06 06:00 [pubmed] PHST- 2022/04/19 06:00 [medline] PHST- 2021/06/05 17:05 [entrez] PHST- 2021/06/05 00:00 [pmc-release] AID - 6293955 [pii] AID - irab102 [pii] AID - 10.1093/jbcr/irab102 [doi] PST - ppublish SO - J Burn Care Res. 2022 Mar 23;43(2):432-439. doi: 10.1093/jbcr/irab102. PMID- 34085509 OWN - NLM STAT- MEDLINE DCOM- 20211025 LR - 20211025 IS - 1488-2310 (Electronic) IS - 0008-428X (Print) IS - 0008-428X (Linking) VI - 64 IP - 3 DP - 2021 Jun 4 TI - Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis. PG - E324-E329 LID - 10.1503/cjs.021019 [doi] AB - BACKGROUND: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a whole-blood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. METHODS: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. RESULTS: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). CONCLUSION: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed. CI - (c) 2021 CMA Joule Inc. or its licensors. FAU - You, Daniel AU - You D AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Skeith, Leslie AU - Skeith L AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Korley, Robert AU - Korley R AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Cantle, Paul AU - Cantle P AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Lee, Adrienne AU - Lee A AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - McBeth, Paul AU - McBeth P AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - McDonald, Braedon AU - McDonald B AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Buckley, Richard AU - Buckley R AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Duffy, Paul AU - Duffy P AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Martin, C Ryan AU - Martin CR AUID- ORCID: ; AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Soo, Andrea AU - Soo A AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). FAU - Schneider, Prism AU - Schneider P AD - From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo). LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210604 PL - Canada TA - Can J Surg JT - Canadian journal of surgery. Journal canadien de chirurgie JID - 0372715 RN - 0 (Anticoagulants) SB - IM MH - Aged, 80 and over MH - Anticoagulants/*therapeutic use MH - Blood Coagulation Tests MH - Female MH - Hip Fractures/*surgery MH - Humans MH - Male MH - Prospective Studies MH - *Thrombelastography MH - Thrombophilia/*diagnosis MH - Venous Thromboembolism/*prevention & control PMC - PMC8327983 COIS- Leslie Skeith reports research funding from CSL Behring and honoraria from LEO Pharma, outside the submitted work. Adrienne Lee reports research support from Bayer and speaker fees from Takeda, outside the submitted work. Ryan Martin consults for Smith & Nephew and DePuy Synthes. Prism Schneider reports honoraria from Amgen, Stryker and DePuy Synthes, outside the submitted work. No other competing interests were declared. EDAT- 2021/06/05 06:00 MHDA- 2021/10/26 06:00 PMCR- 2021/06/01 CRDT- 2021/06/04 08:18 PHST- 2021/06/04 08:18 [entrez] PHST- 2021/06/05 06:00 [pubmed] PHST- 2021/10/26 06:00 [medline] PHST- 2021/06/01 00:00 [pmc-release] AID - 064e324 [pii] AID - 10.1503/cjs.021019 [doi] PST - epublish SO - Can J Surg. 2021 Jun 4;64(3):E324-E329. doi: 10.1503/cjs.021019. PMID- 34076610 OWN - NLM STAT- MEDLINE DCOM- 20211129 LR - 20230814 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 479 IP - 11 DP - 2021 Nov 1 TI - Rotational Thromboelastometry Findings Are Associated with Symptomatic Venous Thromboembolic Complications after Hip Fracture Surgery. PG - 2457-2467 LID - 10.1097/CORR.0000000000001832 [doi] AB - BACKGROUND: Venous thromboembolism is a common complication after hip fractures. However, there are no reliable laboratory assays to identify patients at risk for venous thromboembolic (VTE) events after major orthopaedic surgery. QUESTION/PURPOSES: (1) Are rotational thromboelastometry (ROTEM) findings associated with the presence or development of symptomatic VTE after hip fracture surgery? (2) Were any other patient factors associated with the presence or development of symptomatic VTE after hip fracture surgery? (3) Which ROTEM parameters were the most accurate in terms of detecting the association of hypercoagulability with symptomatic VTE? METHODS: This retrospective study was conducted over a 13-month period. In all, 354 patients with femoral neck and peritrochanteric fractures who underwent hip hemiarthoplasty or cephallomedullary nailing were assessed for eligibility. Of those, 99% (349 of 354) were considered eligible for the study, 1% (3 of 354) of patients were excluded due to coagulation disorders, and another 1% (2 of 354) were excluded because they died before the postoperative ROTEM analysis. An additional 4% (13 of 354) of patients were lost before the minimum study follow-up of 3 months, leaving 95% (336 of 354) for analysis. A ROTEM analysis was performed in all patients at the time of their hospital admission, within hours of the injury, and on the second postoperative day. The patients were monitored for the development of symptoms indicative of VTE, and the gold standard tests for diagnosing VTE, such as CT pulmonary angiography or vascular ultrasound, were selectively performed only in symptomatic patients and not routinely in all patients. Therefore, this study evaluates the association of ROTEM with only clinically evident VTE events and not with all VTE events. ROTEM results did not affect the clinical surveillance of the study group and the decision for further work up. To determine whether ROTEM findings were associated with the presence or development of symptomatic VTE, ROTEM parameters were compared between patients with and without symptomatic VTE. To establish whether any other patient factors were associated with the presence or development of symptomatic VTE after hip fracture surgery, clinical parameters and conventional laboratory values were also compared between patients with and without symptomatic VTE. Finally, to determine which ROTEM parameters were the most accurate in terms of detecting the association of hypercoagulability with symptomatic VTE, the area under the curve (AUC) for certain cut off values of ROTEM parameters was calculated. RESULTS: We found several abnormal ROTEM values to be associated with the presence or development of symptomatic VTE. The preoperative maximum clot firmness was higher in patients with clinically evident VTE than in patients without these complications (median [interquartile range] 70 mm [68 to 71] versus 65 mm [61 to 68]; p < 0.001). The preoperative clot formation time was lower in patients with clinically evident VTE than those without clinically evident VTE (median 61 seconds [58 to 65] versus 70 seconds [67 to 74]; p < 0.001), and also the postoperative clot formation time was lower in patients with clinically evident VTE than those without these complications (median 52 seconds [49 to 59] versus 62 seconds [57 to 68]; p < 0.001). Increased BMI was also associated with clinically evident VTE (odds ratio 1.26 [95% confidence interval 1.07 to 1.53]; p < 0.001). We found no differences between patients with and without clinically evident VTE in terms of age, sex, smoking status, comorbidities, and preoperative use of anticoagulants. Lastly, preoperative clot formation time demonstrated the best performance for detecting the association of hypercoagulability with symptomatic VTE (AUC 0.89 [95% CI 0.81 to 0.97]), with 81% (95% CI 48% to 97%) sensitivity and 86% (95% CI 81% to 89%) specificity for clot formation time /= 350 pg/mL. IL-6 >/= 350 pg/mL was associated with a lower prothrombin time index, a higher activated partial thromboplastin time, and a lower fibrinogen concentration compared with IL-6 < 350 pg/mL (p <0.0001 for all). Thromboelastometric parameters were significantly different between groups (p <0.03 in all). More patients in the high-IL-6 group received MT (p <0.0001). The ROCs revealed an area under the curve of 0.76 vs. 0.82 for the high-IL-6 group for receiving MT in the first 6 and 24 h. IL-6 >/= 350 pg/mL predicted MT within 6 and 24 h with a sensitivity of 45% and 58%, respectively, and a specificity of 89%. IL-6 >/= 350 pg/mL appears to be a reasonable early predictor for coagulopathy and MT within the first 6 and 24 h intervals. Large-scale prospective studies are warranted to confirm these findings. FAU - Weichselbaum, Nadja AU - Weichselbaum N AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. AD - Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Oberladstatter, Daniel AU - Oberladstatter D AUID- ORCID: 0000-0002-1350-5564 AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria. FAU - Schlimp, Christoph J AU - Schlimp CJ AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, 4010 Linz, Austria. FAU - Zipperle, Johannes AU - Zipperle J AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria. FAU - Voelckel, Wolfgang AU - Voelckel W AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Grottke, Oliver AU - Grottke O AD - Department of Anaesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany. FAU - Zimmermann, Georg AU - Zimmermann G AD - Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria. AD - Department of Research and Innovation, Paracelsus Medical University, 5020 Salzburg, Austria. FAU - Osuchowski, Marcin AU - Osuchowski M AUID- ORCID: 0000-0002-1321-9883 AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria. LA - eng PT - Journal Article DEP - 20210524 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8197216 OTO - NOTNLM OT - coagulopathy OT - interleukin-6 OT - massive transfusion OT - trauma COIS- H.S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim, and TEM International. He has also received speaker fees from Haemonetics and Vifor, and study grants from CSL Behring. O.G. has received research funding from Bayer, Biotest, Boehringer Ingelheim, CSL Behring, Octapharma, Novo Nordisk, and Nycomed. O.G. has also received honoraria for lectures and consultancy support from Baxalta, Bayer Healthcare, Boehringer Ingelheim, Ferring, CSL Behring, Octapharma, Pfizer, Takeda, Portola, and Sanofi. C.J.S. has received speaker honoraria from CSL Behring, Boehringer Ingelheim, Portola, and research support from TEM Innovation. The remaining authors do not declare any competing interests. EDAT- 2021/06/03 06:00 MHDA- 2021/06/03 06:01 PMCR- 2021/05/24 CRDT- 2021/06/02 01:39 PHST- 2021/04/20 00:00 [received] PHST- 2021/05/11 00:00 [revised] PHST- 2021/05/18 00:00 [accepted] PHST- 2021/06/02 01:39 [entrez] PHST- 2021/06/03 06:00 [pubmed] PHST- 2021/06/03 06:01 [medline] PHST- 2021/05/24 00:00 [pmc-release] AID - jcm10112268 [pii] AID - jcm-10-02268 [pii] AID - 10.3390/jcm10112268 [doi] PST - epublish SO - J Clin Med. 2021 May 24;10(11):2268. doi: 10.3390/jcm10112268. PMID- 34065924 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210605 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 10 DP - 2021 May 12 TI - Combined Administration of Fibrinogen and Factor XIII Concentrate Does Not Improve Dilutional Coagulopathy Superiorly Than Sole Fibrinogen Therapy: Results of an In-Vitro Thrombelastographic Study. LID - 10.3390/jcm10102068 [doi] LID - 2068 AB - The early administration of fibrinogen has gained wide acceptance for the treatment of major hemorrhage, whereas the substitution of coagulation factor XIII (FXIII) is only supported by a low level of evidence. This study aimed to answer the question of whether a combined therapy of fibrinogen/FXIII substitution performs superiorly to sole fibrinogen administration in the treatment of dilutional coagulopathy. An in-vitro model of massive transfusion was used to compare the effect of combined fibrinogen/FXIII administration to that of sole fibrinogen therapy for the treatment of dilutional coagulopathy. For this purpose, the blood of red blood cell concentrates, fresh frozen plasma, and platelet concentrates were reconstituted in a ratio of 4:4:1, and then diluted with gelatin by 20% and 40%, respectively. Clot formation and stability were analyzed by thrombelastography. Both sole fibrinogen therapy (equivalent to 50 mg/kg) and the combined administration of fibrinogen (equivalent to 50 mg/kg) and FXIII (equivalent to 75 International Units (IU)/kg) increased fibrinogen-dependent mean clot firmness independently of the degree of dilution (20% dilution: 7 (6.3-7.8) mm; 20% dilution fibrinogen: 13.5 (13-17.3) mm; 20% dilution fibrinogen/FXIII: 16.5 (15.3-18.8) mm; 40% dilution: 3 (2-3.8) mm; 40% dilution fibrinogen: 8 (7-11.3) mm; 40% dilution fibrinogen/FXIII: 10 (8.3-11.8) mm; all p < 0.01). However, no differences were identified between the two treatment arms. Compared to fibrinogen therapy, no beneficial effect of the combined administration of fibrinogen and FXIII for the treatment of dilutional coagulopathy was detected in this in-vitro massive transfusion model. The result was independent of the degree of dilution. FAU - Schneck, Emmanuel AU - Schneck E AUID- ORCID: 0000-0003-0565-1550 AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Muelich, Marcus AU - Muelich M AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Markmann, Melanie AU - Markmann M AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Edinger, Fabian AU - Edinger F AUID- ORCID: 0000-0002-7149-9705 AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Cooper, Nina AU - Cooper N AD - Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany. FAU - Moeller, Annette AU - Moeller A AD - Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany. FAU - Bein, Gregor AU - Bein G AUID- ORCID: 0000-0002-7571-8362 AD - Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany. FAU - Hecker, Andreas AU - Hecker A AD - Department of General & Thoracic Surgery, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Koch, Christian AU - Koch C AUID- ORCID: 0000-0002-2655-7363 AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Sander, Michael AU - Sander M AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. FAU - Wolff, Matthias AU - Wolff M AUID- ORCID: 0000-0003-3793-4109 AD - Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany. LA - eng GR - n.n./EIC Waermetechnik GmbH/ PT - Journal Article DEP - 20210512 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC8150940 OTO - NOTNLM OT - coagulation OT - hemorrhage OT - impedance aggregometry OT - major bleeding OT - thrombelastometry OT - trauma COIS- Matthias Wolff received lecture honoraria from CSL Behring GmbH, Marburg, Germany. All other authors declare no competing interests. EDAT- 2021/06/03 06:00 MHDA- 2021/06/03 06:01 PMCR- 2021/05/12 CRDT- 2021/06/02 01:14 PHST- 2021/04/05 00:00 [received] PHST- 2021/05/04 00:00 [revised] PHST- 2021/05/07 00:00 [accepted] PHST- 2021/06/02 01:14 [entrez] PHST- 2021/06/03 06:00 [pubmed] PHST- 2021/06/03 06:01 [medline] PHST- 2021/05/12 00:00 [pmc-release] AID - jcm10102068 [pii] AID - jcm-10-02068 [pii] AID - 10.3390/jcm10102068 [doi] PST - epublish SO - J Clin Med. 2021 May 12;10(10):2068. doi: 10.3390/jcm10102068. PMID- 34050732 OWN - NLM STAT- MEDLINE DCOM- 20211210 LR - 20211214 IS - 1535-2900 (Electronic) IS - 1079-2082 (Linking) VI - 78 IP - 22 DP - 2021 Nov 9 TI - A primer on ocular viscosurgical devices. PG - 2020-2032 LID - 10.1093/ajhp/zxab228 [doi] AB - PURPOSE: To provide pharmacists with an overview of ocular viscosurgical devices (OVDs) and a comprehensive resource describing characteristics of commercially available agents. SUMMARY: OVDs are substances that are injected into the eye during ophthalmic procedures, such as cataract surgery, to reduce injury to the endothelium that may result from surgical manipulation. Currently available OVDs are composed of one or more of the following active ingredients: sodium hyaluronate, sodium chondroitin sulfate, and hydroxypropylmethylcellulose. Rheologic properties of OVDs, such as viscosity, elasticity, pseudoplasticity, and cohesion, affect the products' function and performance. Based on rheologic properties, OVDs can be generally classified as cohesive or dispersive. Given each products' unique characteristics, OVDs are not interchangeable. An understanding of OVD characteristics and role in practice allows for improved product selection, which varies based on patient characteristics and procedure. Availability of OVD information and literature is generally lacking since OVDs are regulated by the US Food and Drug Administration (FDA) as medical devices. This primer includes an overview of relevant ophthalmic surgical practices and the landscape of comparative efficacy and safety literature to assist in formulary decision-making. This review also provides a comprehensive guide to commercially available OVDs and a discussion on practical considerations for the pharmacist. CONCLUSION: Pharmacists may be tasked with handling OVDs in institutional settings. Knowledge about OVD rheologic properties, product characteristics, role in practice, and available literature is necessary for managing formularies and ensuring optimal product selection. CI - (c) American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Gerberich, Amanda J AU - Gerberich AJ AD - Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA. FAU - Ipema, Heather J AU - Ipema HJ AD - Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA. LA - eng PT - Journal Article PT - Review PL - England TA - Am J Health Syst Pharm JT - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JID - 9503023 RN - 9004-61-9 (Hyaluronic Acid) RN - 9007-28-7 (Chondroitin Sulfates) SB - IM MH - *Cataract Extraction MH - *Chondroitin Sulfates MH - Humans MH - Hyaluronic Acid MH - United States MH - Viscosity OTO - NOTNLM OT - cataract surgery OT - ocular viscosurgical device OT - refractive surgical procedure OT - viscoelastic OT - viscoelastic substances EDAT- 2021/05/30 06:00 MHDA- 2021/12/15 06:00 CRDT- 2021/05/29 12:06 PHST- 2021/05/30 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/05/29 12:06 [entrez] AID - 6288435 [pii] AID - 10.1093/ajhp/zxab228 [doi] PST - ppublish SO - Am J Health Syst Pharm. 2021 Nov 9;78(22):2020-2032. doi: 10.1093/ajhp/zxab228. PMID- 34048424 OWN - NLM STAT- MEDLINE DCOM- 20220216 LR - 20230824 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 56 IP - 1S DP - 2021 Dec 1 TI - After 800 Mtp Events, Mortality Due to Hemorrhagic Shock Remains High and Unchanged Despite Several In-Hospital Hemorrhage Control Advancements. PG - 70-78 LID - 10.1097/SHK.0000000000001817 [doi] AB - BACKGROUND: Numerous advancements in hemorrhage control and volume replacement that comprise damage control resuscitation (DCR) have been implemented in the last decade to reduce deaths from bleeding. We sought to determine the impact of DCR interventions on mortality over 12 years in a massive transfusion protocol (MTP) population. We hypothesized that mortality would be decreased in later years, which would have used more DCR interventions. STUDY DESIGN: This was a retrospective review of all MTP patients treated at a large regional Level I trauma center from 2008 to 2019. Interventions by year of implementation examined included MTP 1:1 ratio (2009), liquid plasma (2010), tranexamic acid (2012), prehospital tourniquets (2013), REBOA/TEG (2017), satellite blood station (2018), and whole blood transfusion (2019). Relative risk and odds of mortality for DCR interventions were examined. RESULTS: There were 824 MTP patients included. The cohort was primarily male (80.6%) injured by penetrating mechanism (68.1%) with median (interquartile range) age 31 years (23-44) and New Injury Severity Score 25 (16-34). Overall mortality was unchanged [(38.3%-56.6%); P = 0.26]. Tourniquets (P = 0.02) and whole blood (WB) (P = 0.03) were associated with lower unadjusted mortality; only tourniquets remained significant after adjustment (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). CONCLUSIONS: Despite lower mortality with use of tourniquets and WB, mortality rates due to hemorrhage have not improved at our high MTP volume institution, suggesting implementation of new in-hospital strategies is insufficient to reduce mortality. Future efforts should be directed toward moving hemorrhage control and effective resuscitation interventions to the injury scene. CI - Copyright (c) 2021 by the Shock Society. FAU - Duchesne, Juan AU - Duchesne J AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Taghavi, Sharven AU - Taghavi S AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Ninokawa, Scott AU - Ninokawa S AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Harris, Charles AU - Harris C AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Schroll, Rebecca AU - Schroll R AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - McGrew, Patrick AU - McGrew P AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - McGinness, Clifton AU - McGinness C AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Reily, Robert AU - Reily R AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Guidry, Chrissy AU - Guidry C AD - Tulane University School of Medicine, New Orleans, Louisiana. FAU - Tatum, Danielle AU - Tatum D AD - Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana. LA - eng PT - Journal Article PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Antifibrinolytic Agents/therapeutic use MH - Blood Transfusion MH - Female MH - *Hemostatic Techniques MH - Humans MH - Louisiana MH - Male MH - Retrospective Studies MH - Shock, Hemorrhagic/*mortality/therapy MH - Tourniquets MH - Tranexamic Acid/therapeutic use MH - Trauma Centers MH - Wounds and Injuries/therapy MH - Young Adult COIS- The authors report no conflicts of interest. EDAT- 2021/05/29 06:00 MHDA- 2022/02/17 06:00 CRDT- 2021/05/28 17:20 PHST- 2021/05/29 06:00 [pubmed] PHST- 2022/02/17 06:00 [medline] PHST- 2021/05/28 17:20 [entrez] AID - 00024382-202112001-00013 [pii] AID - 10.1097/SHK.0000000000001817 [doi] PST - ppublish SO - Shock. 2021 Dec 1;56(1S):70-78. doi: 10.1097/SHK.0000000000001817. PMID- 34044056 OWN - NLM STAT- MEDLINE DCOM- 20210705 LR - 20210705 IS - 1879-3169 (Electronic) IS - 0378-4274 (Linking) VI - 348 DP - 2021 Sep 15 TI - Clinical implications of ontogenetic differences in the coagulotoxic activity of Bothrops jararacussu venoms. PG - 59-72 LID - S0378-4274(21)00137-5 [pii] LID - 10.1016/j.toxlet.2021.05.005 [doi] AB - Is snake venom activity influenced by size? This is a long-standing question that can have important consequences for the treatment of snake envenomation. Ontogenetic shifts in venom composition are a well-documented characteristic of numerous snake species. Although snake venoms can cause a range of pathophysiological disturbances, establishing the coagulotoxic profiles related to such shifts is a justified approach because coagulotoxicity can be deadly, and its neutralisation is a challenge for current antivenom therapy. Thus, we aimed to assess the coagulotoxicity patterns on plasma and fibrinogen produced by B othrops jararacussu venoms from individuals of different sizes and sex, and the neutralisation potential of SAB (anti bothropic serum produced by Butantan Institute). The use of a metalloproteinase inhibitor (Prinomastat) and a serine proteinase inhibitor (AEBSF) enabled us to determine the toxin class responsible for the observed coagulopathy: activity on plasma was found to be metalloprotease driven, while the activity on fibrinogen is serine protease driven. To further explore differences in venom activity, the activation of Factor X and prothrombin as a function of snake size was also evaluated. All the venoms exhibited a potent procoagulant effect upon plasma and were less potent in their pseudo-procoagulant clotting effect upon fibrinogen. On human plasma, the venoms from smaller snakes produced more rapid clotting than the larger ones. In contrast, the venom activity on fibrinogen had no relation with size or sex. The difference in procoagulant potency was correlated with the bigger snakes being proportionally better neutralized by antivenom due to the lower levels of procoagulant toxins, than the smaller. Thus, while the antivenom ultimately neutralized the venoms, proportionally more would be needed for an equal mass of venom from a small snake than a large one. Similarly, the neutralisation by SAB of the pseudo-procoagulant clotting effects was also correlated with relative potency, with the smaller and bigger snakes being neutralized proportional to potency, but with no correlation to size. Thromboelastography (TEG) tests on human and toad plasma revealed that small snakes' venoms acted quicker than large snakes' venom on both plasmas, with the action upon amphibian plasma consistent with smaller snakes taking a larger proportion of anuran prey than adults. Altogether, the ontogenetic differences regarding coagulotoxic potency and corresponding impact upon relative antivenom neutralisation of snakes with different sizes were shown, underscoring the medical importance of investigating ontogenetic changes in order to provide data crucial for evidence-based design of clinical management strategies. CI - Copyright (c) 2021 Elsevier B.V. All rights reserved. FAU - Rodrigues, Caroline Fabri Bittencourt AU - Rodrigues CFB AD - Laboratorio de Herpetologia, Instituto Butantan, Sao Paulo, 05508-040, SP, Brazil; Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia. FAU - Zdenek, Christina N AU - Zdenek CN AD - Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia. FAU - Bourke, Lachlan A AU - Bourke LA AD - Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia. FAU - Seneci, Lorenzo AU - Seneci L AD - Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia; Institute of Biology Lieden (IBL), Lieden University, 2333 BE Lieden, the Netherlands. FAU - Chowdhury, Abhinandan AU - Chowdhury A AD - Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia. FAU - Freitas-de-Sousa, Luciana Aparecida AU - Freitas-de-Sousa LA AD - Laboratorio de Imunopatologia, Instituto Butantan, Sao Paulo, 05508-040, SP, Brazil. FAU - de Alcantara Menezes, Frederico AU - de Alcantara Menezes F AD - Laboratorio de Colecoes Zoologicas, Instituto Butantan, Sao Paulo, 05508-040, SP, Brazil. FAU - Moura-da-Silva, Ana Maria AU - Moura-da-Silva AM AD - Laboratorio de Imunopatologia, Instituto Butantan, Sao Paulo, 05508-040, SP, Brazil; Instituto de Pesquisa Clinica Carlos Borborema, Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-000 Manaus, AM, Brazil. FAU - Tanaka-Azevedo, Anita Mitico AU - Tanaka-Azevedo AM AD - Laboratorio de Herpetologia, Instituto Butantan, Sao Paulo, 05508-040, SP, Brazil. FAU - Fry, Bryan G AU - Fry BG AD - Venom Evolution Lab, University of Queensland, St. Lucia, 4072, QLD, Australia. Electronic address: bgfry@uq.edu.au. LA - eng PT - Journal Article DEP - 20210525 PL - Netherlands TA - Toxicol Lett JT - Toxicology letters JID - 7709027 RN - 0 (Antivenins) RN - 0 (Crotalid Venoms) RN - 9001-29-0 (Factor X) SB - IM MH - Animals MH - Antivenins/*pharmacology MH - Blood Coagulation/*drug effects MH - Bothrops MH - Crotalid Venoms/*toxicity MH - Factor X/metabolism MH - Female MH - Humans MH - Male MH - Snake Bites/*drug therapy MH - Thrombelastography OTO - NOTNLM OT - Antivenom neutralisation OT - B. jararacussu OT - Coagulotoxicity OT - Ontogeny COIS- Declaration of Competing Interest The authors report no declarations of interest. EDAT- 2021/05/28 06:00 MHDA- 2021/07/06 06:00 CRDT- 2021/05/27 20:24 PHST- 2020/12/14 00:00 [received] PHST- 2021/05/18 00:00 [revised] PHST- 2021/05/21 00:00 [accepted] PHST- 2021/05/28 06:00 [pubmed] PHST- 2021/07/06 06:00 [medline] PHST- 2021/05/27 20:24 [entrez] AID - S0378-4274(21)00137-5 [pii] AID - 10.1016/j.toxlet.2021.05.005 [doi] PST - ppublish SO - Toxicol Lett. 2021 Sep 15;348:59-72. doi: 10.1016/j.toxlet.2021.05.005. Epub 2021 May 25. PMID- 34027822 OWN - NLM STAT- MEDLINE DCOM- 20220308 LR - 20230822 IS - 1752-6116 (Electronic) IS - 1476-3141 (Linking) VI - 21 IP - 4 DP - 2022 Apr TI - Hysteresis and stiffness of the lateral ankle complex in those with chronic ankle instability. PG - 517-530 LID - 10.1080/14763141.2021.1925335 [doi] AB - The role of mechanical laxity and viscoelastic tissue properties in chronic ankle instability (CAI) is unclear, but may influence repeated injury. The purpose was to determine if lateral ankle complex stiffness and hysteresis was altered in CAI individuals with and without mechanical laxity, compared to copers and uninjured controls. Thirty-five recreational athletes (19 females, 22.1 +/- 2.7 years, 69.7 +/- 15.7 kg, 168.4 +/- 10.7 cm) were assessed for ankle injury history and self-reported instability. An instrumented arthrometer was applied and laxity, stiffness and hysteresis values were captured. Results from ANOVA tests indicated the CAI with laxity group had lower beginning- (3.2 +/- 0.6 N/mm) and end-range stiffness (4.5 +/- 0.4 N/mm) than the CAI without laxity group (4.7 +/- 0.6; 6.0 +/- 0.6 N/mm) and uninjured controls (4.6 +/- 1.1; 5.8 +/- 0.8 N/mm, p < 0.003). Hysteresis was greater in the CAI with laxity group than without laxity (91.0 +/- 17.3 vs 62.8 +/- 12.0 dN*mm; p = 0.03). Altered tissue properties in a CAI with laxity group likely indicate diminished ability of the lateral ankle complex to respond to loading. Accurately assessing, then avoiding or restoring tissue impairments after injury, may encourage better patient outcomes. FAU - Brown, Cathleen N AU - Brown CN AUID- ORCID: 0000-0002-3414-7938 AD - College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA. FAU - Samson, Christine O AU - Samson CO AUID- ORCID: 0000-0002-3504-9344 AD - Department of Kinesiology and Outdoor Recreation, Southern Utah University, Cedar City, UT, USA. FAU - Hsieh, Katherine L AU - Hsieh KL AUID- ORCID: 0000-0003-2005-4519 AD - Wake Forest School of Medicine, Department of Internal Medicine, J Paul Sticht Center on Aging, Winston-Salem, NC, USA. LA - eng GR - T32 AG033534/AG/NIA NIH HHS/United States PT - Journal Article DEP - 20210524 PL - England TA - Sports Biomech JT - Sports biomechanics JID - 101151352 SB - IM MH - *Ankle MH - Ankle Joint MH - Biomechanical Phenomena MH - Chronic Disease MH - Female MH - Humans MH - *Joint Instability OTO - NOTNLM OT - Viscoelastic OT - instrumented arthrometer OT - ligament EDAT- 2021/05/25 06:00 MHDA- 2022/03/09 06:00 CRDT- 2021/05/24 09:30 PHST- 2021/05/25 06:00 [pubmed] PHST- 2022/03/09 06:00 [medline] PHST- 2021/05/24 09:30 [entrez] AID - 10.1080/14763141.2021.1925335 [doi] PST - ppublish SO - Sports Biomech. 2022 Apr;21(4):517-530. doi: 10.1080/14763141.2021.1925335. Epub 2021 May 24. PMID- 34016926 OWN - NLM STAT- MEDLINE DCOM- 20210923 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 90 IP - 6 DP - 2021 Jun 1 TI - P-selectin antibody treatment after blunt thoracic trauma prevents early pulmonary arterial thrombosis without changes in viscoelastic measurements of coagulation. PG - 1032-1039 LID - 10.1097/TA.0000000000003162 [doi] AB - INTRODUCTION: Previously, in a murine model of blunt thoracic trauma, we provided evidence of primary pulmonary thrombosis associated with increased expression of the cell adhesion molecule, P-selectin. In this study, mice are treated with P-selectin blocking antibody after injury to investigate the clinical viability of this antibody for the prevention of pulmonary thrombosis. In addition, viscoelastic testing is performed to investigate if P-selectin inhibition has a detrimental impact on normal hemostasis. METHODS: A murine model of thoracic trauma was used. Mice were divided into sham control and experimental injury groups. Thirty minutes after trauma, mice were treated with the following: P-selectin blocking antibody, isotype control antibody, low-dose heparin, high-dose heparin, or normal saline. At 90 minutes, whole blood was collected for characterization of coagulation by viscoelastic coagulation monitor (VCM Vet; Entegrion, Durham, NC). Mean clotting time, clot formation time, clot kinetics (alpha angle), and maximum clot firmness were compared between each treatment group. RESULTS: Mice that received P-selectin antibody 30 minutes after blunt thoracic trauma had four- to fivefold less (p < 0.001) arterial fibrin accumulation than those that received the isotype control. In both sham and trauma groups, compared with vehicle (normal saline) alone, no statistical difference was noted in any coagulation parameters after injection with P-selectin antibody, isotype control, or low-dose heparin. In addition, blinded histopathological evaluation yielded no difference in hemorrhage scores between injured mice treated with P-selectin blocking antibody and those treated with isotype antibody control. CONCLUSION: This study supports the clinical use of P-selectin blocking antibody for the prevention of pulmonary thrombosis by confirming its efficacy when given after a blunt thoracic trauma. In addition, we demonstrated that the administration of P-selectin antibody does not adversely affect systemic coagulation as measured by viscoelastic testing, suggesting that P-selectin antibody can be safely given during the acute posttraumatic period. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Schutzman, Linda M AU - Schutzman LM AD - From the Department of Surgery (L.M.S., R.R.R., Y.-L.J.L., A.N.D., P.H.L., H.B.S., B.Y., P.H.W., C.C.M., I.J.C., J.M.G., I.E.B.), University of California Davis School of Medicine; and Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery (J.M.G, I.E.B.), University of California Davis Medical Center, Sacramento, California. FAU - Rigor, Rob R AU - Rigor RR FAU - Lin, Yung-Ling J AU - Lin YJ FAU - Dang, An N AU - Dang AN FAU - Le, Peter H AU - Le PH FAU - Singh, Harjeet B AU - Singh HB FAU - Yu, Bohan AU - Yu B FAU - Wisner, Peter H AU - Wisner PH FAU - Musson, Cristien C AU - Musson CC FAU - Clark, Isaiah J AU - Clark IJ FAU - Galante, Joseph M AU - Galante JM FAU - Brown, Ian E AU - Brown IE LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antibodies, Monoclonal) RN - 0 (P-Selectin) RN - 9005-49-6 (Heparin) SB - IM MH - Animals MH - Antibodies, Monoclonal/*administration & dosage MH - Blood Coagulation/drug effects MH - Disease Models, Animal MH - Heparin/administration & dosage MH - Humans MH - Male MH - Mice MH - P-Selectin/*antagonists & inhibitors MH - Pulmonary Embolism/blood/etiology/*prevention & control MH - Thoracic Injuries/blood/*complications/therapy MH - Wounds, Nonpenetrating/blood/*complications/therapy EDAT- 2021/05/22 06:00 MHDA- 2021/09/24 06:00 CRDT- 2021/05/21 06:03 PHST- 2021/05/21 06:03 [entrez] PHST- 2021/05/22 06:00 [pubmed] PHST- 2021/09/24 06:00 [medline] AID - 01586154-202106000-00016 [pii] AID - 10.1097/TA.0000000000003162 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Jun 1;90(6):1032-1039. doi: 10.1097/TA.0000000000003162. PMID- 34011123 OWN - NLM STAT- MEDLINE DCOM- 20210601 LR - 20230103 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 100 IP - 20 DP - 2021 May 21 TI - Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty: A STROBE compliant article. PG - e26058 LID - 10.1097/MD.0000000000026058 [doi] LID - e26058 AB - Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy.Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Venous blood sample at different time points (preoperative, intraoperative, postoperative 6 hours, 12 hours, 24 hours, 48 hours) were drawn to test D-dimer, fibrin (-ogen) degradation products (FDP) and TEG.The TEG parameters associated with coagulation (R, K, alpha, MA, and CI) and fibrinolysis (estimate percent lysis and Ly30) were all in normal range although had a higher level than preoperative time (P < .05). The postoperative levels of D-dimer and FDP were higher than preoperative level (P < .05). The dynamics of D-dimer and FDP presented a bimodal pattern, which peaked at 6 hours postoperatively, then remained and decreased until 24 hours, but would rebound at 48 hours postoperatively with smaller amplitude. Moreover, FDP6h (P = .028), D-Dimer6h (P = .044), FDP12h (P = .009), D-dimer12h (P = .007), and FDP48h (P = .016) were all correlated with total blood loss on POD3.FDP and D-dimer were effective and practical markers for prediction of acute postoperative fibrinolytic activity, which peaked at 6 hours after end of surgery and would maintain for at least 24 hours. CI - Copyright (c) 2021 the Author(s). Published by Wolters Kluwer Health, Inc. FAU - Wang, Yan AU - Wang Y AD - Core Facility of West China Hospital. FAU - Xie, Jinwei AU - Xie J AD - Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China. FAU - Pei, Fuxing AU - Pei F AD - Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China. LA - eng GR - 201302007/National Health and Family Planning Commission of the People's Republic of China/ GR - 2018HXBH073/Postdoctoral Research Program of West China Hospital, Sichuan University/ GR - Z2018B11/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University/ PT - Journal Article PT - Observational Study PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Biomarkers) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (fibrin fragment D) SB - IM MH - Adult MH - Aged MH - Arthroplasty, Replacement, Hip/*adverse effects MH - Arthroplasty, Replacement, Knee/*adverse effects MH - Biomarkers/blood MH - Cohort Studies MH - Female MH - Fibrin Fibrinogen Degradation Products/*metabolism MH - Fibrinolysis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Postoperative Hemorrhage/*blood/diagnosis/*etiology MH - Predictive Value of Tests MH - Thrombelastography PMC - PMC8136990 COIS- The authors have no conflicts of interests to disclose. EDAT- 2021/05/21 06:00 MHDA- 2021/06/02 06:00 PMCR- 2021/05/21 CRDT- 2021/05/20 01:01 PHST- 2020/11/19 00:00 [received] PHST- 2021/04/30 00:00 [accepted] PHST- 2021/05/20 01:01 [entrez] PHST- 2021/05/21 06:00 [pubmed] PHST- 2021/06/02 06:00 [medline] PHST- 2021/05/21 00:00 [pmc-release] AID - 00005792-202105210-00104 [pii] AID - MD-D-20-11332 [pii] AID - 10.1097/MD.0000000000026058 [doi] PST - ppublish SO - Medicine (Baltimore). 2021 May 21;100(20):e26058. doi: 10.1097/MD.0000000000026058. PMID- 34006056 OWN - NLM STAT- MEDLINE DCOM- 20210802 LR - 20240917 IS - 1731-2531 (Electronic) IS - 1642-5758 (Print) IS - 1642-5758 (Linking) VI - 53 IP - 2 DP - 2021 TI - COVID-19: coagulation disorders and anticoagulant treatment in patients hospitalised in ICU. PG - 153-161 LID - 43960 [pii] LID - 10.5114/ait.2021.105783 [doi] AB - Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen levels, the abnormalities in standard coagulation tests and platelet count are minimal. Recent studies suggest contribution of fibrinolysis shutdown to this phenomenon. Endothelial injury and alteration of its antithrombotic activity can lead to micro- and macrovascular thrombosis in the lungs, occurrence of which is associated with poor clinical outcome in critically ill patients with COVID-19. Additionally, the hypercoagulability induced by activation of coagulation pathways during the immune response to SARS-CoV-2 infection contributes to impaired organ perfusion. This, alongside with hypoxemia, leads to multiorgan failure. Various diagnostic regimens, some of which include global assays of haemostasis, are currently being published and discussed. Numerous guidelines and recommendations of scientific societies and groups of specialists have been published. However, there is no single optimal algorithm for anticoagulation treatment and monitoring specific to the ICU patients with COVID-19. The authors have attempted to summarize the data related to CAC and thrombotic disease and develop an algorithm consistent with the latest clinical practice guideline recommendations. FAU - Pluta, Jan AU - Pluta J AD - 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland. FAU - Cieniewicz, Agnieszka AU - Cieniewicz A AD - 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland. FAU - Trzebicki, Janusz AU - Trzebicki J AD - 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland. LA - eng PT - Journal Article PT - Review PL - Poland TA - Anaesthesiol Intensive Ther JT - Anaesthesiology intensive therapy JID - 101472620 RN - 0 (Anticoagulants) SB - IM MH - Algorithms MH - Anticoagulants/*therapeutic use MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/*drug therapy/*etiology MH - COVID-19/*complications MH - Female MH - Humans MH - Intensive Care Units MH - Male MH - Thrombosis/etiology/prevention & control MH - Venous Thromboembolism/etiology/prevention & control MH - COVID-19 Drug Treatment PMC - PMC10158437 OTO - NOTNLM OT - CAC OT - COVID-19 OT - SARS-CoV-2 OT - anticoagulation OT - anty-Xa OT - coagulopathy OT - fibrynolysis. OT - thromboelastometry OT - thrombosis OT - heparin COIS- none. EDAT- 2021/05/20 06:00 MHDA- 2021/08/03 06:00 PMCR- 2021/06/01 CRDT- 2021/05/19 03:51 PHST- 2021/05/20 06:00 [pubmed] PHST- 2021/08/03 06:00 [medline] PHST- 2021/05/19 03:51 [entrez] PHST- 2021/06/01 00:00 [pmc-release] AID - 43960 [pii] AID - 10.5114/ait.2021.105783 [doi] PST - ppublish SO - Anaesthesiol Intensive Ther. 2021;53(2):153-161. doi: 10.5114/ait.2021.105783. PMID- 33994274 OWN - NLM STAT- MEDLINE DCOM- 20211210 LR - 20220527 IS - 1532-3374 (Electronic) IS - 0959-289X (Linking) VI - 47 DP - 2021 Aug TI - The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study. PG - 102983 LID - S0959-289X(21)00041-8 [pii] LID - 10.1016/j.ijoa.2021.102983 [doi] AB - INTRODUCTION: Between 2017 and 2018 a national quality improvement initiative was introduced incorporating point-of-care viscoelastic haemostatic assays (VHA) to guide blood product transfusion. Laboratory coagulation profiles, use and results of VHA, and administration of blood products were investigated. METHODS: A two-year prospective cohort study of maternal outcomes of women experiencing massive postpartum haemorrhage (PPH) >1000 mL in Wales. In this study, cases of massive PPH (>/=2500 mL and/or >/=5 units red blood cell (RBC) transfusion) were identified. RESULTS: Massive PPH occurred in 349 of 60 914 maternities (rate 5.7 per 1000). There were no deaths from PPH. Intensive care unit admission and/or hysterectomy occurred in 34/311 (10.9%) and 16/347 (4.6%), respectively. The leading cause of massive PPH was genital tract trauma (107/349, 30.6%). Two hundred and seventy-nine (80.6%) required RBC transfusion and 79/345 (22.9%) received at least one blood coagulation product. Results of VHA were recorded in 245/349 (70.2%), with 44/98 (44.9%) women tested in the first six months vs 63/77 (81.8%) in the final six months. Hypofibrinogenaemia (Clauss fibrinogen <2 g/L or FIBTEM A5 <12 mm) was observed in 56/328 (17.1%) of women, thrombocytopaenia (count <75 x 10(9)/L) in 17/334 (5.1%) and either PT or aPTT >1.5xreference range in 10/293 (3.4%). CONCLUSION: In Wales, the use of VHA in cases of massive PPH increased over time, enabling clinicians to adopt a targeted, patient-specific approach to blood product administration, with only 22.9% of women receiving blood coagulation products and 17.1% having a documented clotting abnormality. CI - Copyright (c) 2021 Elsevier Ltd. All rights reserved. FAU - Bell, S F AU - Bell SF AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK. Electronic address: Sarah.bell3@wales.nhs.uk. FAU - Collis, R E AU - Collis RE AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK. FAU - Bailey, C AU - Bailey C AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, UK. FAU - James, K AU - James K AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK. FAU - John, M AU - John M AD - Department of Emergency Medicine, Aneurin Bevan University Health Board, Newport, UK. FAU - Kelly, K AU - Kelly K AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, UK. FAU - Kitchen, T AU - Kitchen T AD - Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK. FAU - Scarr, C AU - Scarr C AD - Department of Obstetrics and Gynaecology, Cardiff and Vale University Health Board, Cardiff, UK. FAU - Macgillivray, E AU - Macgillivray E AD - Improvement Cymru, Public Health Wales, Cardiff, UK. FAU - Collins, P W AU - Collins PW AD - Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210326 PL - Netherlands TA - Int J Obstet Anesth JT - International journal of obstetric anesthesia JID - 9200430 SB - IM EIN - Int J Obstet Anesth. 2022 Aug;51:103549. doi: 10.1016/j.ijoa.2022.103549. PMID: 35623997 MH - Blood Coagulation MH - Blood Transfusion MH - Female MH - Humans MH - Incidence MH - *Postpartum Hemorrhage/epidemiology/therapy MH - Prospective Studies OTO - NOTNLM OT - Coagulopathy OT - Fibrinogen OT - Hysterectomy OT - Postpartum haemorrhage EDAT- 2021/05/18 06:00 MHDA- 2021/12/15 06:00 CRDT- 2021/05/17 05:48 PHST- 2020/11/07 00:00 [received] PHST- 2021/02/23 00:00 [revised] PHST- 2021/03/14 00:00 [accepted] PHST- 2021/05/18 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/05/17 05:48 [entrez] AID - S0959-289X(21)00041-8 [pii] AID - 10.1016/j.ijoa.2021.102983 [doi] PST - ppublish SO - Int J Obstet Anesth. 2021 Aug;47:102983. doi: 10.1016/j.ijoa.2021.102983. Epub 2021 Mar 26. PMID- 33987432 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210516 IS - 2305-5839 (Print) IS - 2305-5847 (Electronic) IS - 2305-5839 (Linking) VI - 9 IP - 8 DP - 2021 Apr TI - Liver failure-future challenges and remaining questions. PG - 734 LID - 10.21037/atm-20-4968 [doi] LID - 734 AB - This review compiles the current state of controversial aspects of liver failure and outlines future challenges. The definition of acute liver failure (ALF) is widely accepted and implies no previous liver injury whereas the term "acute-on-chronic liver failure" remains contested. We will promote a concept, in which we differentiate three types of liver failure: ALF, acute-on-chronic liver failure (AOCLF) and acute-on-liver-cirrhosis (AOCi). The mechanistical insights into the coagulation system in patients with hepatic insufficiency have increased fundamentally in the past 10 years. Therefore, we follow now the concept of the so-called rebalanced hemostasis. This lower-level equilibrium arises from the fact that most coagulation factors and inhibitors are synthesized within the liver. We will demonstrate the advantage of viscoelastic test methods, which can assess the coagulation situation in patients with liver insufficiency much more precisely than conventional global coagulation tests. The therapeutic option of emergency liver transplantation (ELT) has significantly improved the prognosis of patients with ALF. However, limiting factors such as shortage of organs increase more and more the need for reliable prognostic markers. Due to a better understanding of the regenerative process during ALF new survival markers and prognostic tools have been emerging on the horizon in the last decade. Therefore, we will describe the current state of research in this field. CI - 2021 Annals of Translational Medicine. All rights reserved. FAU - Lemmer, Peter AU - Lemmer P AD - Department of Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany. FAU - Pospiech, Josef Christian AU - Pospiech JC AD - Department of Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany. FAU - Canbay, Ali AU - Canbay A AD - Department of Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany. LA - eng PT - Journal Article PT - Review PL - China TA - Ann Transl Med JT - Annals of translational medicine JID - 101617978 PMC - PMC8106069 OTO - NOTNLM OT - Hepatic insufficiency OT - liver failure OT - prediction of prognosis OT - rebalanced hemostasis OT - survival markers COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-4968). The series "Unresolved Basic Issues in Hepatology" was commissioned by the editorial office without any funding or sponsorship. AC serves as an unpaid editorial board member of Annals of Translational Medicine from Aug 2020 to Jul 2022. The authors have no other conflicts of interest to declare. EDAT- 2021/05/15 06:00 MHDA- 2021/05/15 06:01 PMCR- 2021/04/01 CRDT- 2021/05/14 07:03 PHST- 2021/05/14 07:03 [entrez] PHST- 2021/05/15 06:00 [pubmed] PHST- 2021/05/15 06:01 [medline] PHST- 2021/04/01 00:00 [pmc-release] AID - atm-09-08-734 [pii] AID - 10.21037/atm-20-4968 [doi] PST - ppublish SO - Ann Transl Med. 2021 Apr;9(8):734. doi: 10.21037/atm-20-4968. PMID- 33966826 OWN - NLM STAT- MEDLINE DCOM- 20211004 LR - 20211004 IS - 1879-1344 (Electronic) IS - 0144-8617 (Linking) VI - 265 DP - 2021 Aug 1 TI - Non-oxidized cellulose nanofibers as a topical hemostat: In vitro thromboelastometry studies of structure vs function. PG - 118043 LID - S0144-8617(21)00430-6 [pii] LID - 10.1016/j.carbpol.2021.118043 [doi] AB - Hemorrhage remains a significant cause of morbidity and mortality following trauma and during complex surgeries. A variety of nanomaterials, including oxidized cellulose nanofibers (OCNFs), have been studied to overcome the disadvantages of current commercial topical hemostats. However, the relationship between nano-structural characteristics and hemostatic efficacy of non-oxidized cellulose nanofibers (CNFs) has not been elucidated. Herein, we present the first report of the correlation between structure and hemostatic performance of CNFs. In vitro thromboelastometry studies on CNFs, synthesized by ball-milling, showed that there is an optimum balance point between the aspect ratio (AR) and specific surface area (SSA) of nanofibers in terms of their maximum contribution to platelet function and plasma coagulation. The optimized CNFs with high SSA (17 m(2)/g) and a high AR (166) shortened normal whole blood clotting time by 68 %, outperforming cellulose-based hemostats. Additionally, CNFs reduced clotting time in platelet-deficient blood (by 80 %) and heparinized blood (by 54 %). CI - Copyright (c) 2021 Elsevier Ltd. All rights reserved. FAU - Mohamed, Elmira AU - Mohamed E AD - Research School of Electrical, Energy and Materials Engineering, College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia. Electronic address: elmira.mohamed@anu.edu.au. FAU - Coupland, Lucy A AU - Coupland LA AD - ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia. Electronic address: lucy.coupland@anu.edu.au. FAU - Crispin, Philip J AU - Crispin PJ AD - ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia; Hematology Department, The Canberra Hospital, Canberra, ACT, Australia. Electronic address: philip.crispin@act.gov.au. FAU - Fitzgerald, Ailene AU - Fitzgerald A AD - Department of Trauma, The Canberra Hospital, ACT, Australia. Electronic address: Ailene.fitzgerald@act.gov.au. FAU - Nisbet, David R AU - Nisbet DR AD - ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia; Research School of Chemistry, The Australian National University, Canberra, ACT, Australia. Electronic address: david.nisbet@anu.edu.au. FAU - Tsuzuki, Takuya AU - Tsuzuki T AD - Research School of Electrical, Energy and Materials Engineering, College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia. Electronic address: takuya.tsuzuki@anu.edu.au. LA - eng PT - Journal Article DEP - 20210408 PL - England TA - Carbohydr Polym JT - Carbohydrate polymers JID - 8307156 RN - 0 (Cellulose, Oxidized) RN - 0 (Hemostatics) RN - 9004-34-6 (Cellulose) SB - IM MH - Cellulose/*chemistry/pharmacology MH - Cellulose, Oxidized/chemistry MH - Hemorrhage/pathology/therapy MH - Hemostatics/*chemistry/pharmacology MH - Humans MH - Nanofibers/*chemistry MH - Spectroscopy, Fourier Transform Infrared/methods MH - Thrombelastography/*methods OTO - NOTNLM OT - Ball-milling OT - Blood-material interaction OT - Green hemostatic material OT - In vitro thromboelastometry OT - Non-oxidized cellulose nanofibers EDAT- 2021/05/11 06:00 MHDA- 2021/10/05 06:00 CRDT- 2021/05/10 06:03 PHST- 2021/01/21 00:00 [received] PHST- 2021/03/24 00:00 [revised] PHST- 2021/04/03 00:00 [accepted] PHST- 2021/05/10 06:03 [entrez] PHST- 2021/05/11 06:00 [pubmed] PHST- 2021/10/05 06:00 [medline] AID - S0144-8617(21)00430-6 [pii] AID - 10.1016/j.carbpol.2021.118043 [doi] PST - ppublish SO - Carbohydr Polym. 2021 Aug 1;265:118043. doi: 10.1016/j.carbpol.2021.118043. Epub 2021 Apr 8. PMID- 33956283 OWN - NLM STAT- MEDLINE DCOM- 20220606 LR - 20261012 IS - 1573-2614 (Electronic) IS - 1387-1307 (Linking) VI - 36 IP - 3 DP - 2022 Jun TI - Platelet aggregometry for hip fracture surgery in patients treated with clopidogrel: a pilot study. PG - 823-828 LID - 10.1007/s10877-021-00714-z [doi] AB - Surgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the drug and have a normal platelets reactivity. We propose thromboelastography (TEG) with an ADP Platelet Mapping assay kit to assess platelet aggregation, a safe tool that could help to avoid surgery delay in those patients treated with antiplatelet therapy. A patient's blood sample was collected for aggregometry. If MA-ADP and platelets aggregation (%) were within normal values, the patient was fit for immediate surgery with neuraxial anesthesia and ultrasound-guided nerve block. If one of the two parameters or both were deranged, a mortality risk assessment was estimated. In the low risk category, the patients waited till normalization of the parameters, whereas in the high-risk group a general anesthesia and peripheral antalgic block was carried out. Nine patients were enrolled. Four of them showed normal aggregometry and surgery was performed within 24 h from admission. Two patients were classified as high mortality risk and surgery was carried out under general anesthesia. Three patients awaited operation till normalization of parameters. No peri or post-operative complications were reported. An aggregometry-guided protocol can safely expedite hip fracture surgery in patients taking clopidogrel. Nonetheless, in presence of a normal platelets function, clinician can opt for a neuraxial instead of general anesthesia reducing the incidence of postoperative delirium and cognitive dysfunction.Trial registration: prospectively registered at clinicaltrials.gov (NCT04642209; date of registration: 23rd November 2020). CI - (c) 2021. The Author(s), under exclusive licence to Springer Nature B.V. FAU - Tescione, Marco AU - Tescione M AUID- ORCID: 0000-0002-0053-6935 AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. marcotescione.mt@gmail.com. FAU - Vadala, Eugenio AU - Vadala E AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Marano, Graziella AU - Marano G AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Battaglia, Enzo AU - Battaglia E AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Bruni, Andrea AU - Bruni A AD - Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. FAU - Garofalo, Eugenio AU - Garofalo E AD - Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. FAU - Longhini, Federico AU - Longhini F AD - Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. FAU - Rovida, Serena AU - Rovida S AD - Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK. FAU - Polimeni, Nicola AU - Polimeni N AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Squillaci, Rosalba AU - Squillaci R AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Lascala, Stefano AU - Lascala S AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Franco, Gaetana AU - Franco G AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Labate, Demetrio AU - Labate D AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Caracciolo, Massimo AU - Caracciolo M AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. FAU - Macheda, Sebastiano AU - Macheda S AD - Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. LA - eng SI - ClinicalTrials.gov/NCT04642209 PT - Journal Article PT - Observational Study DEP - 20210506 PL - Netherlands TA - J Clin Monit Comput JT - Journal of clinical monitoring and computing JID - 9806357 RN - 0 (Platelet Aggregation Inhibitors) RN - 61D2G4IYVH (Adenosine Diphosphate) RN - A74586SNO7 (Clopidogrel) RN - OM90ZUW7M1 (Ticlopidine) SB - IM MH - Adenosine Diphosphate MH - *Blood Platelets/physiology MH - Clopidogrel/therapeutic use MH - *Hip Fractures/surgery MH - Humans MH - Pilot Projects MH - Platelet Aggregation Inhibitors/therapeutic use MH - Ticlopidine/therapeutic use OTO - NOTNLM OT - Aggregometry OT - Anesthesia OT - Clopidogrel OT - Hip fracture OT - Thromboelastography EDAT- 2021/05/07 06:00 MHDA- 2022/06/07 06:00 CRDT- 2021/05/06 13:10 PHST- 2020/12/27 00:00 [received] PHST- 2021/04/23 00:00 [accepted] PHST- 2021/05/07 06:00 [pubmed] PHST- 2022/06/07 06:00 [medline] PHST- 2021/05/06 13:10 [entrez] AID - 10.1007/s10877-021-00714-z [pii] AID - 10.1007/s10877-021-00714-z [doi] PST - ppublish SO - J Clin Monit Comput. 2022 Jun;36(3):823-828. doi: 10.1007/s10877-021-00714-z. Epub 2021 May 6. PMID- 33948950 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20250530 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 IP - 7 DP - 2021 Jul TI - Platelet-enhanced plasma: Characterization of a novel candidate resuscitation fluid's extracellular vesicle content, clotting parameters, and thrombin generation capacity. PG - 2179-2194 LID - 10.1111/trf.16423 [doi] AB - BACKGROUND: Platelet transfusion is challenging in emergency medicine because of short platelet shelf life and stringent storage conditions. Platelet-derived extracellular vesicles (PEV) exhibit platelet-like properties. A plasma generated from expired platelet units rich in procoagulant PEV may be able to combine the benefits of plasma and platelets for resuscitation while increasing shelf life and utilizing an otherwise wasted resource. STUDY DESIGN AND METHODS: Freeze-thaw cycling of platelet-rich plasma (PRP) followed by centrifugation to remove platelet remnants was utilized to generate platelet-enhanced plasma (PEP). An in vitro model of dilutional coagulopathy was also designed and used to test PEP. Rotational thromboelastometry and calibrated automated thrombography were used to assess clotting and extracellular vesicles (EV) procoagulant activity. Capture arrays were used to specifically measure EV subpopulations of interest (ExoView, NanoView Biosciences). Captured vesicles were quantified and labeled with Annexin-V-FITC, CD41-PE, and CD63-AF647. Platelet alpha granule content (platelet-derived growth factor AB, soluble P-selectin, vascular endothelial growth factor A, and neutrophil activating peptide 2-chemokine (C-X-C motif) ligand 7) was measured. Commercially available platelet lysates were also characterized. RESULTS: PEP is highly procoagulant, rich in growth factors, exhibits enhanced thrombin generation, and restores hemostasis within an in vitro model of dilutional coagulopathy. The predominant vesicle population were PEV with 7.0 x 10(9) CD41+PS+ EV/ml compared to 4.7 x 10(7) CD41+PS+ EV/ml in platelet-free plasma (p = .0079). Commercial lysates show impaired but rescuable clotting. DISCUSSION: PEP is a unique candidate resuscitation fluid containing high PEV concentration with preliminary evidence, indicating a potential for upscaling the approach using platelet concentrates. Commercial lysate manufacturer workflows may be suitable for this, but further optimization and characterization of PEP is required. CI - (c) 2021 AABB. FAU - Price, Joshua AU - Price J AUID- ORCID: 0000-0001-9950-7992 AD - Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. FAU - Gardiner, Chris AU - Gardiner C AD - Haemostasis Research, University College London, London, UK. FAU - Harrison, Paul AU - Harrison P AUID- ORCID: 0000-0003-4610-8909 AD - Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. LA - eng GR - Defence and Security Accelerator (DASA)/ GR - DSTLX1000125420/Defence Science and Technology Laboratory/ GR - FS/19/68/34583/BHF_/British Heart Foundation/United Kingdom GR - EP/S017844/1/Engineering and Physical Sciences Research Council/ GR - Proximity to Discovery/MRC_/Medical Research Council/United Kingdom GR - BHF/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210504 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Intercellular Signaling Peptides and Proteins) RN - 0 (P-Selectin) RN - 0 (Platelet Membrane Glycoprotein IIb) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Cell Count MH - *Blood Coagulation MH - Blood Platelets MH - Blood Preservation/methods MH - Extracellular Vesicles/*transplantation MH - Fibrinogen/analysis/pharmacology MH - Humans MH - Intercellular Signaling Peptides and Proteins/blood MH - P-Selectin/blood MH - Partial Thromboplastin Time MH - *Plasma MH - Platelet Membrane Glycoprotein IIb/blood MH - *Platelet Transfusion MH - Platelet-Rich Plasma MH - Prothrombin Time MH - *Resuscitation MH - Temperature MH - Thrombelastography MH - Thrombin/*biosynthesis MH - Time Factors OTO - NOTNLM OT - ExoView OT - hemorrhage OT - hemostasis OT - platelet OT - platelet extracellular vesicle OT - procoagulant OT - resuscitation OT - trauma EDAT- 2021/05/06 06:00 MHDA- 2021/08/14 06:00 CRDT- 2021/05/05 06:40 PHST- 2021/03/08 00:00 [revised] PHST- 2020/12/17 00:00 [received] PHST- 2021/04/16 00:00 [accepted] PHST- 2021/05/06 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] PHST- 2021/05/05 06:40 [entrez] AID - 10.1111/trf.16423 [doi] PST - ppublish SO - Transfusion. 2021 Jul;61(7):2179-2194. doi: 10.1111/trf.16423. Epub 2021 May 4. PMID- 33927200 OWN - NLM STAT- MEDLINE DCOM- 20211125 LR - 20250530 IS - 2056-676X (Electronic) IS - 2056-676X (Linking) VI - 7 IP - 1 DP - 2021 Apr 29 TI - Trauma-induced coagulopathy. PG - 30 LID - 10.1038/s41572-021-00264-3 [doi] AB - Uncontrolled haemorrhage is a major preventable cause of death in patients with traumatic injury. Trauma-induced coagulopathy (TIC) describes abnormal coagulation processes that are attributable to trauma. In the early hours of TIC development, hypocoagulability is typically present, resulting in bleeding, whereas later TIC is characterized by a hypercoagulable state associated with venous thromboembolism and multiple organ failure. Several pathophysiological mechanisms underlie TIC; tissue injury and shock synergistically provoke endothelial, immune system, platelet and clotting activation, which are accentuated by the 'lethal triad' (coagulopathy, hypothermia and acidosis). Traumatic brain injury also has a distinct role in TIC. Haemostatic abnormalities include fibrinogen depletion, inadequate thrombin generation, impaired platelet function and dysregulated fibrinolysis. Laboratory diagnosis is based on coagulation abnormalities detected by conventional or viscoelastic haemostatic assays; however, it does not always match the clinical condition. Management priorities are stopping blood loss and reversing shock by restoring circulating blood volume, to prevent or reduce the risk of worsening TIC. Various blood products can be used in resuscitation; however, there is no international agreement on the optimal composition of transfusion components. Tranexamic acid is used in pre-hospital settings selectively in the USA and more widely in Europe and other locations. Survivors of TIC experience high rates of morbidity, which affects short-term and long-term quality of life and functional outcome. FAU - Moore, Ernest E AU - Moore EE AUID- ORCID: 0000-0002-0419-4848 AD - Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA. Ernest.Moore@dhha.org. AD - Department of Surgery, University of Colorado Denver, Aurora, CO, USA. Ernest.Moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, Aurora, CO, USA. FAU - Kornblith, Lucy Z AU - Kornblith LZ AUID- ORCID: 0000-0002-1861-9691 AD - Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. FAU - Neal, Matthew D AU - Neal MD AD - Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. FAU - Hoffman, Maureane AU - Hoffman M AD - Duke University School of Medicine, Transfusion Service, Durham VA Medical Center, Durham, NC, USA. FAU - Mutch, Nicola J AU - Mutch NJ AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria. FAU - Hunt, Beverley J AU - Hunt BJ AUID- ORCID: 0000-0002-4709-0774 AD - King's College, London, UK. FAU - Sauaia, Angela AU - Sauaia A AUID- ORCID: 0000-0002-8493-389X AD - Department of Surgery, University of Colorado Denver, Aurora, CO, USA. AD - Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA. LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - PG/07/122/24195/BHF_/British Heart Foundation/United Kingdom GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - U54 GM062119/GM/NIGMS NIH HHS/United States GR - PG/20/17/35050/BHF_/British Heart Foundation/United Kingdom GR - PG/11/1/28461/BHF_/British Heart Foundation/United Kingdom GR - FS/11/2/28579/BHF_/British Heart Foundation/United Kingdom GR - K99 HL151887/HL/NHLBI NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - PG/15/82/31721/BHF_/British Heart Foundation/United Kingdom GR - R01 HL141080/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review DEP - 20210429 PL - England TA - Nat Rev Dis Primers JT - Nature reviews. Disease primers JID - 101672103 SB - IM EIN - Nat Rev Dis Primers. 2022 Apr 22;8(1):25. doi: 10.1038/s41572-022-00360-y. PMID: 35459275 CIN - Nat Rev Dis Primers. 2022 May 26;8(1):34. doi: 10.1038/s41572-022-00367-5. PMID: 35618733 CIN - Nat Rev Dis Primers. 2022 May 26;8(1):35. doi: 10.1038/s41572-022-00368-4. PMID: 35618800 MH - *Blood Coagulation Disorders/etiology MH - Fibrinolysis MH - Hemorrhage/etiology MH - Hemostasis MH - Humans MH - *Quality of Life PMC - PMC9107773 MID - NIHMS1804536 EDAT- 2021/05/01 06:00 MHDA- 2021/11/26 06:00 PMCR- 2022/05/15 CRDT- 2021/04/30 06:16 PHST- 2021/03/19 00:00 [accepted] PHST- 2021/04/30 06:16 [entrez] PHST- 2021/05/01 06:00 [pubmed] PHST- 2021/11/26 06:00 [medline] PHST- 2022/05/15 00:00 [pmc-release] AID - 10.1038/s41572-021-00264-3 [pii] AID - 10.1038/s41572-021-00264-3 [doi] PST - epublish SO - Nat Rev Dis Primers. 2021 Apr 29;7(1):30. doi: 10.1038/s41572-021-00264-3. PMID- 33924780 OWN - NLM STAT- MEDLINE DCOM- 20210528 LR - 20210528 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 22 IP - 9 DP - 2021 Apr 28 TI - Modulation of Diverse Procoagulant Venom Activities by Combinations of Platinoid Compounds. LID - 10.3390/ijms22094612 [doi] LID - 4612 AB - Procoagulant snake venoms have been inhibited by the ruthenium containing compounds CORM-2 and RuCl(3) separately, presumably by interacting with critical histidine or other sulfur-containing amino acids on key venom enzymes. However, combinations of these and other platinoid containing compounds could potentially increase, decrease or not affect the procoagulant enzyme function of venom. Thus, the purpose of this investigation was to determine if formulations of platinoid compounds could inhibit venom procoagulant activity and if the formulated compounds interacted to enhance inhibition. Using a human plasma coagulation kinetic model to assess venom activity, six diverse venoms were exposed to various combinations and concentrations of CORM-2, CORM-3, RuCl(3) and carboplatin (a platinum containing compound), with changes in venom activity determined with thrombelastography. The combinations of CORM-2 or CORM-3 with RuCl(3) were found to enhance inhibition significantly, but not in all venoms nor to the same extent. In sharp contrast, carboplatin-antagonized CORM-2 mediated the inhibition of venom activity. These preliminary results support the concept that platinoid compounds may inhibit venom enzymatic activity at the same or different molecular sites and may antagonize inhibition at the same or different sites. Further investigation is warranted to determine if platinoid formulations may serve as potential antivenoms. FAU - Nielsen, Vance G AU - Nielsen VG AUID- ORCID: 0000-0002-8072-9883 AD - Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ 85719, USA. LA - eng PT - Journal Article DEP - 20210428 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Organometallic Compounds) RN - 0 (Ruthenium Compounds) RN - 0 (Snake Venoms) RN - 0 (tricarbonylchloro(glycinato)ruthenium(II)) RN - 0 (tricarbonyldichlororuthenium (II) dimer) RN - BG3F62OND5 (Carboplatin) RN - RY8V1UJV23 (ruthenium chloride) SB - IM MH - Blood Coagulation/*drug effects MH - Carboplatin/pharmacology/therapeutic use MH - Drug Evaluation, Preclinical MH - Drug Therapy, Combination MH - Humans MH - Organometallic Compounds/pharmacology/*therapeutic use MH - Ruthenium Compounds/pharmacology/*therapeutic use MH - Snake Bites/*drug therapy MH - Snake Venoms/pharmacology MH - Thrombelastography PMC - PMC8124986 OTO - NOTNLM OT - carbon monoxide releasing molecule OT - platinum OT - procoagulant venom OT - ruthenium OT - thrombelastography COIS- The author does not have any conflict of interest. EDAT- 2021/05/01 06:00 MHDA- 2021/05/29 06:00 PMCR- 2021/04/28 CRDT- 2021/04/30 01:29 PHST- 2021/03/13 00:00 [received] PHST- 2021/04/26 00:00 [revised] PHST- 2021/04/26 00:00 [accepted] PHST- 2021/04/30 01:29 [entrez] PHST- 2021/05/01 06:00 [pubmed] PHST- 2021/05/29 06:00 [medline] PHST- 2021/04/28 00:00 [pmc-release] AID - ijms22094612 [pii] AID - ijms-22-04612 [pii] AID - 10.3390/ijms22094612 [doi] PST - epublish SO - Int J Mol Sci. 2021 Apr 28;22(9):4612. doi: 10.3390/ijms22094612. PMID- 33917073 OWN - NLM STAT- MEDLINE DCOM- 20210917 LR - 20210917 IS - 2218-273X (Electronic) IS - 2218-273X (Linking) VI - 11 IP - 4 DP - 2021 Apr 7 TI - Viscoelastic Response of Neurofilaments: An Atomistic Simulation Approach. LID - 10.3390/biom11040540 [doi] LID - 540 AB - Existent literature has limitations regarding the mechanical behavior of axonal cytoskeletal components in a high strain rate scenario, which is mainly due to limitations regarding the structure of some components such as tau protein and neurofilaments (NF). This study performs molecular dynamics (MD) simulations on NFs to extract their strain rate-dependent behavior. It is found that they are highly stretchable and show multiple stages of unfolding. Furthermore, NFs show high tensile stiffness. Also, viscoelastic modeling shows that they correspond to simplified viscoelastic models. This study effectively enhances the existent axonal models focusing on axonal injury. FAU - Khan, Md Ishak AU - Khan MI AUID- ORCID: 0000-0001-7680-9613 AD - Department of Mechanical and Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA. FAU - Hasan, Fuad AU - Hasan F AUID- ORCID: 0000-0003-1889-4877 AD - Department of Mechanical and Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA. FAU - Mahmud, Khandakar Abu Hasan Al AU - Mahmud KAHA AD - Department of Mechanical and Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA. FAU - Adnan, Ashfaq AU - Adnan A AD - Department of Mechanical and Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA. LA - eng GR - N00014-18-1-2082/Office of Naval Research/ PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20210407 PL - Switzerland TA - Biomolecules JT - Biomolecules JID - 101596414 RN - 0 (tau Proteins) SB - IM MH - Cytoskeleton MH - Intermediate Filaments/*chemistry/metabolism MH - *Molecular Dynamics Simulation MH - Tensile Strength MH - tau Proteins/chemistry PMC - PMC8067762 OTO - NOTNLM OT - axonal cytoskeleton OT - axonal injury OT - mechanical behavior OT - neurofilaments OT - viscoelastic modeling COIS- The authors declare no competing interests. EDAT- 2021/05/01 06:00 MHDA- 2021/09/18 06:00 PMCR- 2021/04/07 CRDT- 2021/04/30 01:05 PHST- 2021/02/23 00:00 [received] PHST- 2021/03/29 00:00 [revised] PHST- 2021/04/05 00:00 [accepted] PHST- 2021/04/30 01:05 [entrez] PHST- 2021/05/01 06:00 [pubmed] PHST- 2021/09/18 06:00 [medline] PHST- 2021/04/07 00:00 [pmc-release] AID - biom11040540 [pii] AID - biomolecules-11-00540 [pii] AID - 10.3390/biom11040540 [doi] PST - epublish SO - Biomolecules. 2021 Apr 7;11(4):540. doi: 10.3390/biom11040540. PMID- 33913163 OWN - NLM STAT- MEDLINE DCOM- 20210819 LR - 20210819 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 IP - 8 DP - 2021 Aug TI - Evaluation of the hemostatic capacity of methylene blue-treated liquid (not frozen) plasma stored up 14 days at 2 degrees to 6 degrees C. PG - 2450-2457 LID - 10.1111/trf.16427 [doi] AB - BACKGROUND: Early plasma transfusion for management of bleeding, particularly trauma, is associated with better outcomes. Improving the availability/safety of plasma transfusion for patients is essential for transfusion services. The aim of this study is to evaluate the hemostatic capacity of methylene-blue (MB) liquid (not frozen) plasma over time. MATERIALS AND METHODS: Twenty whole blood-derived plasma units collected from male donors were separated and processed within 18 h of collection. Individual plasmas were treated with MB and stored in liquid status at 2-6 degrees C for 14 days. A range of coagulation assays, including thrombin generation, rotational thromboelastometry (ROTEM), and Thrombodynamics were tested at different time-points, together with bacterial growth. RESULTS: Apart from Factor (F)XII, other coagulation factors (fibrinogen, FV, FVIII, FXI) reduced significantly after MB treatment, with levels remaining stable except for FVIII afterward. By day 14, most clotting factors were >0.7 IU/ml, apart from FVIII. There was a disproportionate decrease in Protein S (PS) activity compared to free PS antigen and by day 14 its value was ~50%. There was no significant difference in maximum clot formation (ROTEM) and clot-density (Thrombodynamics) over time. Endogenous thrombin potential (Thrombin-Generation), clot-size, and velocity index (Thrombodynamics) decreased significantly over time consistent with clotting factor reduction. There was no bacterial growth. CONCLUSIONS: MB-treated liquid plasma stored at 2-6 degrees C can be used for up to 14 days: the long shelf-life, the liquid status, and the MB treatment will improve its availability for management of bleeding as well as providing a safe component from pathogens. CI - (c) 2021 AABB. FAU - Rapaille, Andre AU - Rapaille A AUID- ORCID: 0000-0003-2566-149X AD - Service du Sang, Belgian Red Cross, Suarlee, Belgium. FAU - Lotens, Anais AU - Lotens A AD - Service du Sang, Belgian Red Cross, Suarlee, Belgium. FAU - de Valensart, Nicolas AU - de Valensart N AD - Service du Sang, Belgian Red Cross, Suarlee, Belgium. FAU - Najdovski, Tome AU - Najdovski T AD - Service du Sang, Belgian Red Cross, Suarlee, Belgium. FAU - Green, Laura AU - Green L AD - NHS Blood and Transplant and Barts Health NHS Trust, Queen Mary University of London, London, UK. LA - eng PT - Journal Article DEP - 20210429 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - T42P99266K (Methylene Blue) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests MH - Blood Component Transfusion MH - Blood Preservation/*methods MH - Blood Safety/*methods MH - Humans MH - Male MH - Methylene Blue/*pharmacology MH - Plasma/chemistry/*metabolism OTO - NOTNLM OT - hemostasis OT - liquid plasma OT - methylene blue OT - pathogen inactivation EDAT- 2021/04/30 06:00 MHDA- 2021/08/20 06:00 CRDT- 2021/04/29 06:45 PHST- 2021/03/22 00:00 [revised] PHST- 2020/11/18 00:00 [received] PHST- 2021/04/16 00:00 [accepted] PHST- 2021/04/30 06:00 [pubmed] PHST- 2021/08/20 06:00 [medline] PHST- 2021/04/29 06:45 [entrez] AID - 10.1111/trf.16427 [doi] PST - ppublish SO - Transfusion. 2021 Aug;61(8):2450-2457. doi: 10.1111/trf.16427. Epub 2021 Apr 29. PMID- 33893737 OWN - NLM STAT- MEDLINE DCOM- 20211122 LR - 20260518 IS - 2474-9842 (Electronic) IS - 2474-9842 (Linking) VI - 5 IP - 2 DP - 2021 Mar 5 TI - Early abnormal fibrinolysis and mortality in patients with thermal injury: a prospective cohort study. LID - 10.1093/bjsopen/zrab017 [doi] LID - zrab017 AB - INTRODUCTION: Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality. METHODS: Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared. RESULTS: Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28-57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6-30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034). DISCUSSION: Early abnormal fibrinolytic function is associated with mortality in burn patients. CI - Published by Oxford University Press on behalf of BJS Society Ltd 2021. This work is written by US Government employees and is in the public domain in the US. FAU - Pusateri, A E AU - Pusateri AE AD - U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA. FAU - Le, T D AU - Le TD AD - U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA. AD - Department of Epidemiology and Biostatistics, University of Texas Health Science Center, Tyler, Texas, USA. FAU - Keyloun, J W AU - Keyloun JW AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - Moffatt, L T AU - Moffatt LT AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. AD - Department of Biochemistry, Georgetown University, Washington, DC, USA. FAU - Orfeo, T AU - Orfeo T AD - Department of Biochemistry, College of Medicine, University of Vermont, Colchester, Vermont, USA. FAU - Brummel-Ziedins, K E AU - Brummel-Ziedins KE AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - McLawhorn, M M AU - McLawhorn MM AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. FAU - Callcut, R A AU - Callcut RA AD - Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA. FAU - Shupp, J W AU - Shupp JW AD - The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA. AD - Department of Surgery, Georgetown University, Washington, DC, USA. CN - SYSCOT Study Group LA - eng GR - R01 HL149670/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - England TA - BJS Open JT - BJS open JID - 101722685 SB - IM MH - Adult MH - Blood Coagulation Disorders/*etiology/*mortality MH - Body Surface Area MH - Burns/*complications/diagnostic imaging MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Incidence MH - Logistic Models MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography PMC - PMC8065965 FIR - Cohen, M J IR - Cohen MJ IRAD- Denver Health and Hospital Authority, Denver, CO FIR - Petzold, L R IR - Petzold LR IRAD- University of California Santa Barbara, Santa Barbara, CA FIR - Varner, J D IR - Varner JD IRAD- Cornell University, Ithaca, NY FIR - Bravo, M C IR - Bravo MC IRAD- University of Vermont, Colchester, VT FIR - Freeman, K IR - Freeman K IRAD- University of Vermont Larner College of Medicine, Burlington, VT FIR - Mann, K G IR - Mann KG IRAD- Haematologic Technologies Inc., Essex Junction, VT FIR - Gautam, A IR - Gautam A IRAD- Walter Reed Army Institute of Research, Silver Spring, MD FIR - Hammamieh, R IR - Hammamieh R IRAD- Walter Reed Army Institute of Research, Silver Spring, MD FIR - Jett, M IR - Jett M IRAD- Walter Reed Army Institute of Research, Silver Spring, MD EDAT- 2021/04/25 06:00 MHDA- 2021/11/23 06:00 PMCR- 2021/04/24 CRDT- 2021/04/24 08:32 PHST- 2020/10/09 00:00 [received] PHST- 2021/02/03 00:00 [accepted] PHST- 2021/04/24 08:32 [entrez] PHST- 2021/04/25 06:00 [pubmed] PHST- 2021/11/23 06:00 [medline] PHST- 2021/04/24 00:00 [pmc-release] AID - 6248890 [pii] AID - zrab017 [pii] AID - 10.1093/bjsopen/zrab017 [doi] PST - ppublish SO - BJS Open. 2021 Mar 5;5(2):zrab017. doi: 10.1093/bjsopen/zrab017. PMID- 33878779 OWN - NLM STAT- MEDLINE DCOM- 20211213 LR - 20211214 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 47 IP - 5 DP - 2021 Jul TI - Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations. PG - 527-537 LID - 10.1055/s-0041-1722970 [doi] AB - Posttraumatic coagulopathy involves disruption of both the coagulation and fibrinolytic pathways secondary to tissue damage, hypotension, and inflammatory upregulation. This phenomenon contributes to delayed complications after traumatic brain injury (TBI), including intracranial hemorrhage progression and systemic disseminated intravascular coagulopathy. Development of an early hyperfibrinolytic state may result in uncontrolled bleeding and is associated with increased mortality in patients with TBI. Although fibrinolytic assays are not routinely performed in the assessment of posttraumatic coagulopathy, circulating biomarkers such as D-dimer and fibrin degradation products have demonstrated potential utility in outcome prediction. Unfortunately, the relatively delayed nature of these tests limits their clinical utility. In contrast, viscoelastic tests are able to provide a rapid global assessment of coagulopathy, although their ability to reliably identify disruptions in the fibrinolytic cascade remains unclear. Limited evidence supports the use of hypertonic saline, cryoprecipitate, and plasma to correct fibrinolytic disruption; however, some studies suggest more harm than benefit. Recently, early use of tranexamic acid in patients with TBI and confirmed hyperfibrinolysis has been proposed as a strategy to further improve clinical outcomes. Moving forward, further delineation of TBI phenotypes and the clinical implications of fibrinolysis based on phenotypic variation is needed. In this review, we summarize the clinical aspects of fibrinolysis in TBI, including diagnosis, treatment, and clinical correlates, with identification of targeted areas for future research efforts. CI - Thieme. All rights reserved. FAU - Anderson, Taylor N AU - Anderson TN AD - School of Medicine, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon. FAU - Farrell, David H AU - Farrell DH AD - School of Medicine, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon. FAU - Rowell, Susan E AU - Rowell SE AD - Department of Surgery, Duke University Medical Center, Durham, North Carolina. LA - eng PT - Journal Article PT - Review DEP - 20210420 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Blood Coagulation MH - *Blood Coagulation Disorders/diagnosis/drug therapy MH - *Brain Injuries, Traumatic/diagnosis/drug therapy MH - Fibrinolysis MH - Humans MH - *Tranexamic Acid COIS- The Oregon Health and Science University (OHSU) and the author D.H.F. have a significant interest in Gamma Therapeutics, a company that may have a commercial interest in the results of this research and technology. This potential individual and institutional conflict of interest has been reviewed and managed by OHSU. D.H.F. is the Founder and Chief Scientific Officer of Gamma Therapeutics, Inc. T.N.A. and S.E.R. hold no relevant conflicts of interest. EDAT- 2021/04/21 06:00 MHDA- 2021/12/15 06:00 CRDT- 2021/04/20 20:25 PHST- 2021/04/21 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/04/20 20:25 [entrez] AID - 10.1055/s-0041-1722970 [doi] PST - ppublish SO - Semin Thromb Hemost. 2021 Jul;47(5):527-537. doi: 10.1055/s-0041-1722970. Epub 2021 Apr 20. PMID- 37608855 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230824 IS - 2574-2167 (Electronic) IS - 2574-2167 (Linking) VI - 4 IP - 2 Suppl DP - 2021 Apr TI - The polytrauma patient: Current concepts and evolving care. LID - 10.1097/OI9.0000000000000108 [doi] LID - e108(1-6) AB - Principles of care in the polytraumatized patient have continued to evolve with advancements in technology. Although hemorrhage has remained a primary cause of morbidity and mortality in acute trauma, emerging strategies that can be applied pre-medical facility as well as in-hospital have continued to improve care. Exo-vascular modalities, including the use of devices to address torso hemorrhage and areas not amenable to traditional tourniquets, have revolutionized prehospital treatment. Endovascular advancements including the resuscitative endovascular balloon occlusion of the aorta (REBOA), have led to dramatic improvements in systolic blood pressure, although not without their own unique complications. Although novel treatment options have continued to emerge, so too have concepts regarding optimal time frames for intervention. Though prior care has focused on Injury Severity Score (ISS) as a marker to determine timing of intervention, current consensus contends that unnecessary delays in fracture care should be avoided, while respecting the complex physiology of certain patient groups that may remain at increased risk for complications. Thromboelastography (TEG) has been one technique that focuses on the unique pathophysiology of each patient, providing guidance for resuscitation in addition to providing information in recognizing the at-risk patient for venous thromboembolism. Negative pressure wound therapy (NPWT) has emerged as a therapeutic adjuvant for select trauma patients with significant soft tissue defects and open wounds. With significant advancements in medical technology and improved understanding of patient physiology, the optimal approach to the polytrauma patient continues to evolve. CI - Copyright (c) 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. FAU - Lee, Christopher AU - Lee C AD - Department of Orthopaedic Surgery, University of California - Los Angeles, Los Angeles, CA. FAU - Rasmussen, Todd E AU - Rasmussen TE AD - Department of General Surgery, F. Edward Hebert School of Medicine at the Uniformed Services University, Bethesda, MD. FAU - Pape, Hans-Christoph AU - Pape HC AD - Department of Trauma Surgery, University of Zurich, Zurich, Switzerland. FAU - Gary, Joshua L AU - Gary JL AD - Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX. FAU - Stannard, James P AU - Stannard JP AD - Department of Orthopaedic Surgery, University of Missouri, Columbia, MO. FAU - Haller, Justin M AU - Haller JM AD - Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT. LA - eng PT - Journal Article DEP - 20210415 PL - United States TA - OTA Int JT - OTA international : the open access journal of orthopaedic trauma JID - 101770383 PMC - PMC10441682 OTO - NOTNLM OT - hemorrhage control OT - polytrauma patient OT - thromboelastography EDAT- 2021/04/15 00:00 MHDA- 2021/04/15 00:01 PMCR- 2021/04/15 CRDT- 2023/08/23 03:49 PHST- 2021/04/15 00:01 [medline] PHST- 2021/04/15 00:00 [pubmed] PHST- 2023/08/23 03:49 [entrez] PHST- 2021/04/15 00:00 [pmc-release] AID - OTAI-D-20-00059 [pii] AID - 10.1097/OI9.0000000000000108 [doi] PST - epublish SO - OTA Int. 2021 Apr 15;4(2 Suppl):e108(1-6). doi: 10.1097/OI9.0000000000000108. eCollection 2021 Apr. PMID- 33846901 OWN - NLM STAT- MEDLINE DCOM- 20220303 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 35 IP - 3 DP - 2021 Dec TI - Thromboelastography is a Marker for Clinically Significant Progressive Hemorrhagic Injury in Severe Traumatic Brain Injury. PG - 738-746 LID - 10.1007/s12028-021-01217-0 [doi] AB - BACKGROUND: Coagulopathy in traumatic brain injury (TBI) is associated with increased risk of poor outcomes, but accurate prediction of clinically significant progressive hemorrhagic injury (PHI) in patients with severe TBI remains a challenge. Thromboelastography (TEG) is a real-time test of whole blood coagulation that provides dynamic information about global hemostasis. This study aimed to identify differences in TEG values between patients with severe TBI who did or did not experience clinically significant PHI. METHODS: This was a single-center retrospective cohort study of adult patients with severe TBI. Patients were eligible for inclusion if initial Glasgow coma scale (GCS) was /= .05). The effect of PI treatment waned when PI-WB was enriched with fibrinogen. CONCLUSION: ROTEM investigations suggest that PI treatment has a negative impact on WB clot formation unless fibrinogen supplementation is used. CI - (c) 2021 AABB. FAU - Arbaeen, Ahmad F AU - Arbaeen AF AD - Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Faculty of Applied Medical Sciences, Department Laboratory Medicine, Umm al-Qura University, Makkah, Saudi Arabia. FAU - Schubert, Peter AU - Schubert P AUID- ORCID: 0000-0002-3310-6819 AD - Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Sheffield, William P AU - Sheffield WP AD - Centre for Innovation, Canadian Blood Services, Hamilton, Ontario, Canada. AD - Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. FAU - Devine, Dana V AU - Devine DV AUID- ORCID: 0000-0002-9059-0344 AD - Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. LA - eng GR - 1012479/Burroughs Wellcome Fund/ GR - Canadian Blood Services/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210321 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation MH - Blood Safety/*methods MH - *Blood Transfusion/methods MH - Fibrinogen/analysis/*therapeutic use MH - Hemostasis MH - Humans MH - Sterilization/methods MH - Thrombelastography MH - Wounds and Injuries/blood/*therapy OTO - NOTNLM OT - fibrinogen OT - massive transfusion OT - pathogen inactivation technology OT - riboflavin and ultraviolet light OT - rotational thromboelastometry (ROTEM) OT - whole blood (WB) EDAT- 2021/03/22 06:00 MHDA- 2021/07/23 06:00 CRDT- 2021/03/21 21:27 PHST- 2021/03/08 00:00 [revised] PHST- 2020/11/29 00:00 [received] PHST- 2021/03/09 00:00 [accepted] PHST- 2021/03/22 06:00 [pubmed] PHST- 2021/07/23 06:00 [medline] PHST- 2021/03/21 21:27 [entrez] AID - 10.1111/trf.16382 [doi] PST - ppublish SO - Transfusion. 2021 Jun;61(6):1884-1893. doi: 10.1111/trf.16382. Epub 2021 Mar 21. PMID- 33740916 OWN - NLM STAT- MEDLINE DCOM- 20211228 LR - 20260127 IS - 1471-2253 (Electronic) IS - 1471-2253 (Linking) VI - 21 IP - 1 DP - 2021 Mar 19 TI - Glycocalyx components affect platelet function, whole blood coagulation, and fibrinolysis: an in vitro study suggesting a link to trauma-induced coagulopathy. PG - 83 LID - 10.1186/s12871-021-01300-1 [doi] LID - 83 AB - BACKGROUND: The mechanisms of trauma induced coagulopathy (TIC) are considered multifactorial. Amongst others, however, shedding of the endothelial glycocalyx resulting in increased concentrations of glycocalyx fragments in plasma might also play a role. Thus, we hypothesized that shedded glycocalyx components affect coagulation and may act as humoral mediators of TIC. METHODS: To investigate effects of heparan sulfate, chondroitin sulfate, syndecan-1, versican, and thrombomodulin we added these fragments to in vitro assays of whole blood from healthy volunteers to yield concentrations observed in trauma patients. Platelet function, whole blood coagulation, and fibrinolysis were measured by standard coagulation tests, impedance aggregometry (IA), and viscoelastic tests (VET). To assess dose-response relationships, we performed IA with increasing concentrations of versican and VET with increasing concentrations of thrombomodulin. RESULTS: Intrinsically activated clotting times (i.e., activated partial thromboplastin time and intrinsically activated VET with and without heparinase) were unaffected by any glycocalyx fragment. Thrombomodulin, however, significantly and dose-dependently diminished fibrinolysis as assessed by VET with exogenously added rt-PA, and increased rt-PA-induced lysis Indices after 30 (up to 108% of control, p < 0,0001), 45 (up to 368% of control, p < 0,0001), and 60 min (up to 950% of control, p < 0,0001) in VET. Versican impaired platelet aggregation in response to arachidonic acid (up to - 37,6%, p < 0,0001), ADP (up to - 14,5%, p < 0,0001), and collagen (up to - 31,8%, p < 0,0001) in a dose-dependent manner, but did not affect TRAP-6 induced platelet aggregation. Clotting time in extrinsically activated VET was shortened by heparan sulfate (- 7,2%, p = 0,024), chondroitin sulfate (- 11,6%, p = 0,016), versican (- 13%, p = 0,012%), and when combined (- 7,2%, p = 0,007). CONCLUSIONS: Glycocalyx components exert distinct inhibitory effects on platelet function, coagulation, and fibrinolysis. These data do not support a 'heparin-like auto-anticoagulation' by shed glycosaminoglycans but suggest a possible role of versican in trauma-induced thrombocytopathy and of thrombomodulin in trauma-associated impairment of endogenous fibrinolysis. FAU - Britten, Martin W AU - Britten MW AD - Klinik fur Anasthesiologie & Intensivmedizin, University of Duisburg-Essen & University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany. Martin.Britten@uk-essen.de. FAU - Lumers, Laura AU - Lumers L AD - Klinik fur Anasthesiologie & Intensivmedizin, University of Duisburg-Essen & University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany. FAU - Tominaga, Kenji AU - Tominaga K AD - Klinik fur Anasthesiologie & Intensivmedizin, University of Duisburg-Essen & University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany. AD - Present Address: Department of Anesthesiology and Critical Care Medicine, Fukuoka University School of Medicine, Fukuoka, Japan. FAU - Peters, Jurgen AU - Peters J AD - Klinik fur Anasthesiologie & Intensivmedizin, University of Duisburg-Essen & University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany. FAU - Dirkmann, Daniel AU - Dirkmann D AD - Klinik fur Anasthesiologie & Intensivmedizin, University of Duisburg-Essen & University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210319 PL - England TA - BMC Anesthesiol JT - BMC anesthesiology JID - 100968535 RN - 9007-28-7 (Chondroitin Sulfates) RN - 9050-30-0 (Heparan Sulfate) RN - 0 (Syndecan-1) RN - 0 (Thrombomodulin) RN - 126968-45-4 (Versicans) SB - IM MH - Adult MH - Chondroitin Sulfates/physiology MH - Female MH - Fibrinolysis/*physiology MH - Glycocalyx/*physiology MH - Heparan Sulfate/physiology MH - Humans MH - In Vitro Techniques MH - Male MH - *Partial Thromboplastin Time MH - Platelet Aggregation/*physiology MH - Syndecan-1/physiology MH - Thrombomodulin/physiology MH - Versicans/physiology PMC - PMC7977584 OTO - NOTNLM OT - Glycosaminoglycans OT - Shock OT - Syndecan-1 OT - Thrombomodulin OT - Versicans COIS- D. D. and M. W. B. received honoraria for scientific lectures and / or travel support from CSL Behring GmbH, Marburg, Germany. D. D. received honoraria for scientific lectures and / or travel support from Abbott Point of Care, Princeton, NJ, USA, TEM international GmbH Munich, Germany, and was a member of a Scientific Advisory Committee for Werfen, Barcelona, Spain. L. L., K. T., and J. P. declare no competing interests. EDAT- 2021/03/21 06:00 MHDA- 2021/12/29 06:00 PMCR- 2021/03/19 CRDT- 2021/03/20 05:34 PHST- 2020/10/11 00:00 [received] PHST- 2021/03/04 00:00 [accepted] PHST- 2021/03/20 05:34 [entrez] PHST- 2021/03/21 06:00 [pubmed] PHST- 2021/12/29 06:00 [medline] PHST- 2021/03/19 00:00 [pmc-release] AID - 10.1186/s12871-021-01300-1 [pii] AID - 1300 [pii] AID - 10.1186/s12871-021-01300-1 [doi] PST - epublish SO - BMC Anesthesiol. 2021 Mar 19;21(1):83. doi: 10.1186/s12871-021-01300-1. PMID- 33740787 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 90 IP - 4 DP - 2021 Apr 1 TI - Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma: Erratum. PG - 766-767 LID - 10.1097/TA.0000000000003126 [doi] LA - eng PT - Journal Article PT - Published Erratum PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM EFR - J Trauma Acute Care Surg. 2020 Dec;89(6):999-1017. doi: 10.1097/TA.0000000000002944. PMID: 32941349 EDAT- 2021/03/20 06:00 MHDA- 2021/03/20 06:01 CRDT- 2021/03/19 20:27 PHST- 2021/03/19 20:27 [entrez] PHST- 2021/03/20 06:00 [pubmed] PHST- 2021/03/20 06:01 [medline] AID - 01586154-202104000-00021 [pii] AID - 10.1097/TA.0000000000003126 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Apr 1;90(4):766-767. doi: 10.1097/TA.0000000000003126. PMID- 33733606 OWN - NLM STAT- MEDLINE DCOM- 20211027 LR - 20211027 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 33 IP - 5 DP - 2021 Oct TI - Introduction of point-of-care ROTEM testing in the emergency department of an Australian level 1 trauma centre and its effect on blood product use. PG - 893-899 LID - 10.1111/1742-6723.13767 [doi] AB - OBJECTIVE: To assess whether the introduction of point-of-care rotational thromboelastometry (ROTEM) analysis influences blood product transfusion and coagulation management in a modern Australian level 1 trauma centre. METHODS: Retrospective blood transfusion data collection from all level 1 trauma patients with an Injury Severity Score (ISS) >12 presenting to the Royal Adelaide Hospital in 2016 and 2018. Evaluation of changes in blood product administration with the addition of point-of-care viscoelastic testing in the ED in 2018. RESULTS: A total of 774 patients were analysed with 380 in 2016 and 394 in 2018. Almost a quarter of all 2018 trauma patients (93/394) had ROTEM performed within 24 h of ED arrival, 42% of these having an ISS >25. There was a significant increase in the number of patients receiving cryoprecipitate following the introduction of ROTEM (P = 0.01). In those receiving cryoprecipitate, there was a significant reduction in subsequent platelet and fresh frozen plasma use (P < 0.001). Overall, there was a reduction in expenditure on red cells, platelets and fresh frozen plasma from 2016 to 2018. CONCLUSION: Point-of-care ROTEM was performed in a small proportion of patients, mainly those with a higher ISS. ROTEM introduction in the ED altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products. CI - (c) 2021 Australasian College for Emergency Medicine. FAU - Bainbridge, Frederick J AU - Bainbridge FJ AUID- ORCID: 0000-0003-4591-7878 AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. FAU - Sinha, Romi AU - Sinha R AD - Transfusion Medicine, SA Department for Health and Wellbeing, Flinders Medical Centre and Royal Adelaide Hospital, Adelaide, South Australia, Australia. FAU - Tocchetti, Rick AU - Tocchetti R AD - Transfusion Medicine, SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia. FAU - Clarke, Chris AU - Clarke C AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. FAU - Martin, Daniel AU - Martin D AD - MedSTAR Emergency Medical Retrieval Service, SA Ambulance Service, Adelaide, South Australia, Australia. FAU - Foo, Ngee AU - Foo N AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. FAU - Palmer, Cameron S AU - Palmer CS AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Ellis, Daniel Y AU - Ellis DY AUID- ORCID: 0000-0003-0898-334X AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - MedSTAR Emergency Medical Retrieval Service, SA Ambulance Service, Adelaide, South Australia, Australia. LA - eng PT - Journal Article DEP - 20210317 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - Australia MH - *Blood Coagulation Disorders/diagnosis MH - Humans MH - Point-of-Care Systems MH - Retrospective Studies MH - *Thrombelastography MH - Trauma Centers OTO - NOTNLM OT - cryoprecipitate OT - haemorrhage OT - rotational thromboelastometry OT - thromboelastography OT - trauma EDAT- 2021/03/19 06:00 MHDA- 2021/10/28 06:00 CRDT- 2021/03/18 07:15 PHST- 2021/01/23 00:00 [revised] PHST- 2020/02/11 00:00 [received] PHST- 2021/02/15 00:00 [accepted] PHST- 2021/03/19 06:00 [pubmed] PHST- 2021/10/28 06:00 [medline] PHST- 2021/03/18 07:15 [entrez] AID - 10.1111/1742-6723.13767 [doi] PST - ppublish SO - Emerg Med Australas. 2021 Oct;33(5):893-899. doi: 10.1111/1742-6723.13767. Epub 2021 Mar 17. PMID- 33671748 OWN - NLM STAT- MEDLINE DCOM- 20210527 LR - 20250530 IS - 1422-0067 (Electronic) IS - 1422-0067 (Linking) VI - 22 IP - 4 DP - 2021 Feb 22 TI - Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter? LID - 10.3390/ijms22042185 [doi] LID - 2185 AB - Fibrinogen is the first coagulation protein to reach critically low levels during traumatic haemorrhage. There have been no differential effects on clinical outcomes between the two main sources of fibrinogen replacement: cryoprecipitate and fibrinogen concentrate (Fg-C). However, the constituents of these sources are very different. The aim of this study was to determine whether these give rise to any differences in clot stability that may occur during trauma haemorrhage. Fibrinogen deficient plasma (FDP) was spiked with fibrinogen from cryoprecipitate or Fg-C. A panel of coagulation factors, rotational thromboelastography (ROTEM), thrombin generation (TG), clot lysis and confocal microscopy were performed to measure clot strength and stability. Increasing concentrations of fibrinogen from Fg-C or cryoprecipitate added to FDP strongly correlated with Clauss fibrinogen, demonstrating good recovery of fibrinogen (r(2) = 0.99). A marked increase in Factor VIII, XIII and alpha(2)-antiplasmin was observed in cryoprecipitate (p < 0.05). Increasing concentrations of fibrinogen from both sources were strongly correlated with ROTEM parameters (r(2) = 0.78-0.98). Cryoprecipitate therapy improved TG potential, increased fibrinolytic resistance and formed more homogeneous fibrin clots, compared to Fg-C. In summary, our data indicate that cryoprecipitate may be a superior source of fibrinogen to successfully control bleeding in trauma coagulopathy. However, these different products require evaluation in a clinical setting. FAU - Morrow, Gael B AU - Morrow GB AD - Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. FAU - Carlier, Molly S A AU - Carlier MSA AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. FAU - Dasgupta, Sruti AU - Dasgupta S AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. FAU - Craigen, Fiona B AU - Craigen FB AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. FAU - Mutch, Nicola J AU - Mutch NJ AD - Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. FAU - Curry, Nicola AU - Curry N AD - Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. AD - Oxford Haemophilia & Thrombosis Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK. LA - eng GR - PG/20/17/35050/BHF_/British Heart Foundation/United Kingdom GR - FS/11/2/28579/BHF_/British Heart Foundation/United Kingdom GR - MR/T023961/1/MRC_/Medical Research Council/United Kingdom GR - PG/15/82/31721/BHF_/British Heart Foundation/United Kingdom GR - PGfAR01590/National Institute for Health Research/ PT - Journal Article DEP - 20210222 PL - Switzerland TA - Int J Mol Sci JT - International journal of molecular sciences JID - 101092791 RN - 0 (Coagulants) RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Coagulation Disorders/etiology/*therapy MH - Coagulants/administration & dosage/*therapeutic use MH - Dose-Response Relationship, Drug MH - Factor VIII/therapeutic use MH - Fibrinogen/administration & dosage/*therapeutic use MH - Fibrinolysis MH - Hemorrhage/*complications/therapy MH - Humans MH - Microscopy, Confocal MH - Thrombelastography MH - Thrombin/metabolism MH - Thrombosis/chemically induced PMC - PMC7926643 OTO - NOTNLM OT - cryoprecipitate OT - factor XIII OT - fibrinogen OT - trauma coagulopathy OT - alpha2-antiplasmin COIS- N.C. has received funding from CSL Behring for investigator-led studies. EDAT- 2021/03/07 06:00 MHDA- 2021/05/28 06:00 PMCR- 2021/02/22 CRDT- 2021/03/06 01:11 PHST- 2021/01/25 00:00 [received] PHST- 2021/02/11 00:00 [revised] PHST- 2021/02/15 00:00 [accepted] PHST- 2021/03/06 01:11 [entrez] PHST- 2021/03/07 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] PHST- 2021/02/22 00:00 [pmc-release] AID - ijms22042185 [pii] AID - ijms-22-02185 [pii] AID - 10.3390/ijms22042185 [doi] PST - epublish SO - Int J Mol Sci. 2021 Feb 22;22(4):2185. doi: 10.3390/ijms22042185. PMID- 33641993 OWN - NLM STAT- MEDLINE DCOM- 20210527 LR - 20210527 IS - 1873-7145 (Electronic) IS - 0963-9969 (Linking) VI - 141 DP - 2021 Mar TI - The antimicrobial efficacy of remote cold atmospheric plasma effluent against single and mixed bacterial biofilms of varying age. PG - 110126 LID - S0963-9969(21)00023-5 [pii] LID - 10.1016/j.foodres.2021.110126 [doi] AB - Cold atmospheric plasma (CAP) is a minimal food processing technology of increasing interest in the food industry, as it is mild in nature compared to traditional methods (e.g. pasteurisation) and thus can maintain the food's desirable qualities. However, due to this mild nature, the potential exists for post-treatment microbial survival and/or stress adaptation. Furthermore, biofilm inactivation by CAP is underexplored and mostly studied on specific foods or on plastic/polymer surfaces. Co-culture effects, biofilm age, and innate biofilm-associated resistance could all impact CAP efficacy, while studies on real foods are limited to the food product investigated without accounting for structural complexity. The effect of a Remote and Enclosed CAP device (Fourth State Medicine Ltd) was investigated on Escherichia coli and Listeria innocua grown as planktonic cells and as single or mixed bacterial biofilms of variable age, on a biphasic viscoelastic food model of controlled rheological and structural complexity. Post-CAP viability was assessed by plate counts, cell sublethal injury was quantified using flow cytometry, and biofilms were characterised and assessed using total protein content and microscopy techniques. A greater impact of CAP on planktonic cells was observed at higher air flow rates, where the ReCAP device operates in a mode more favourable to reactive oxygen species than reactive nitrogen species. Although planktonic E. coli was more susceptible to CAP than planktonic L. innocua, the opposite was observed in biofilm form. The efficacy of CAP was reduced with increasing biofilm age. Furthermore, E. coli produced much higher protein content in both single and mixed biofilms than L. innocua. Consequently, greater survival of L. innocua in mixed biofilms was attributed to a protective effect from E. coli. These results show that biofilm susceptibility to CAP is age and bacteria dependent, and that in mixed biofilms bacteria may become less susceptible to CAP. These findings are of significance to the food industry for the development of effective food decontamination methods using CAP. CI - Copyright (c) 2021. Published by Elsevier Ltd. FAU - El Kadri, Hani AU - El Kadri H AD - Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford GU2 7XH, UK. FAU - Costello, Katherine M AU - Costello KM AD - Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford GU2 7XH, UK. FAU - Thomas, Phillip AU - Thomas P AD - Surrey Space Centre, University of Surrey, Guildford GU2 7XH, UK. FAU - Wantock, Thomas AU - Wantock T AD - Fourth State Medicine Ltd, Longfield, Fernhurst, Haslemere GU27 3HA, UK. FAU - Sandison, Gavin AU - Sandison G AD - Fourth State Medicine Ltd, Longfield, Fernhurst, Haslemere GU27 3HA, UK. FAU - Harle, Thomas AU - Harle T AD - Fourth State Medicine Ltd, Longfield, Fernhurst, Haslemere GU27 3HA, UK. FAU - Fabris, Andrea Lucca AU - Fabris AL AD - Surrey Space Centre, University of Surrey, Guildford GU2 7XH, UK. FAU - Gutierrez-Merino, Jorge AU - Gutierrez-Merino J AD - School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK. FAU - Velliou, Eirini G AU - Velliou EG AD - Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford GU2 7XH, UK. Electronic address: e.velliou@surrey.ac.uk. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210109 PL - Canada TA - Food Res Int JT - Food research international (Ottawa, Ont.) JID - 9210143 RN - 0 (Plasma Gases) RN - Listeria innocua SB - IM MH - Bacteria MH - Biofilms MH - Escherichia coli MH - Food Microbiology MH - Listeria MH - *Plasma Gases/pharmacology OTO - NOTNLM OT - Biphasic viscoelastic food model OT - Cold atmospheric plasma OT - Escherichia coli OT - Listeria innocua OT - Microbial inactivation OT - Mixed bacterial biofilms EDAT- 2021/03/02 06:00 MHDA- 2021/05/28 06:00 CRDT- 2021/03/01 05:30 PHST- 2020/06/26 00:00 [received] PHST- 2021/01/07 00:00 [revised] PHST- 2021/01/07 00:00 [accepted] PHST- 2021/03/01 05:30 [entrez] PHST- 2021/03/02 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] AID - S0963-9969(21)00023-5 [pii] AID - 10.1016/j.foodres.2021.110126 [doi] PST - ppublish SO - Food Res Int. 2021 Mar;141:110126. doi: 10.1016/j.foodres.2021.110126. Epub 2021 Jan 9. PMID- 33636020 OWN - NLM STAT- MEDLINE DCOM- 20220105 LR - 20231125 IS - 1527-3350 (Electronic) IS - 0270-9139 (Print) IS - 0270-9139 (Linking) VI - 74 IP - 2 DP - 2021 Aug TI - Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury/Failure. PG - 937-949 LID - 10.1002/hep.31767 [doi] AB - BACKGROUND AND AIMS: Patients with acute liver injury or failure (ALI/ALF) experience bleeding complications uncommonly despite an abnormal hemostatic profile. Rotational thromboelastometry (ROTEM), which assesses clot formation in whole blood, was used to determine the nature of abnormal hemostasis and whether it contributes to bleeding events, illness severity, or survival. APPROACH AND RESULTS: A total of 200 patients were recruited from sites of the ALF Study Group. Blood collected daily for up to 5 days was analyzed using ROTEM delta devices. Consistent with standard laboratory evidence of hypocoagulability (median international normalized ratio = 2.9 and platelet count = 144 x 10(9) /L), patients frequently exhibited ROTEM parameters outside the normal range (73% and 62% had abnormalities in clot formation from extrinsic and intrinsic clotting cascades, respectively); however, measures of clot stability were generally normal. Eighteen patients (9%) experienced bleeding events, in whom clot initiation, assembly, and firmness were more severely deranged than patients without bleeding. Abnormal ROTEM parameters were more frequently observed in patients with non-acetaminophen ALI/ALF than those with acetaminophen ALI/ALF (clot initiation [P < 0.001], assembly [P = 0.02], firmness at 10 minutes [P = 0.05], and maximal firmness [P = 0.06]). Patients with more severe systemic complications (high-grade hepatic encephalopathy and need for renal replacement therapy) also had a higher incidence of abnormal ROTEM parameters. Finally, more hypocoagulable ROTEM parameters (clot initiation (P = 0.005), stiffness at 10 minutes (P = 0.05), and maximal stiffness by fibrin assembly (P = 0.004)) were observed in patients who died or underwent liver transplantation than those who survived with their native liver. CONCLUSIONS: In patients with ALI/ALF, abnormal ROTEM parameters are frequent and proportional to disease severity. Whether the increased bleeding risk associated with abnormal ROTEM indicates hemostatic failure or is a proxy for disease severity requires additional study. CI - (c) 2021 by the American Association for the Study of Liver Diseases. FAU - Stravitz, R Todd AU - Stravitz RT AUID- ORCID: 0000-0001-9901-854 AD - Hume-Lee Transplant Center of Virginia Commonwealth UniversityRichmondVA. FAU - Fontana, Robert J AU - Fontana RJ AD - Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI. FAU - Meinzer, Caitlyn AU - Meinzer C AD - Department of Public Health SciencesMedical University of South CarolinaCharlestonSC. FAU - Durkalski-Mauldin, Valerie AU - Durkalski-Mauldin V AD - Department of Public Health SciencesMedical University of South CarolinaCharlestonSC. FAU - Hanje, A James AU - Hanje AJ AD - Department of MedicineThe Ohio State UniversityColumbusOH. FAU - Olson, Jody AU - Olson J AUID- ORCID: 0000-0003-2818-4959 AD - Division of GastroenterologyUniversity of Kansas Medical CenterKansas CityKS. FAU - Koch, David AU - Koch D AD - Department of MedicineMedical University of South CarolinaCharlestonSC. FAU - Hamid, Bilal AU - Hamid B AD - Department of MedicineUniversity of California at San FranciscoSan FranciscoCA. FAU - Schilsky, Michael L AU - Schilsky ML AD - Divisions of Digestive Disease and Transplant and ImmunologyYale UniversityNew HavenCT. FAU - McGuire, Brendan AU - McGuire B AD - Division of GastroenterologyUniversity of AlabamaBirminghamAL. FAU - Ganger, Daniel AU - Ganger D AD - Division of GastroenterologyNorthwestern UniversityChicagoIL. FAU - Liou, Iris AU - Liou I AD - Department of MedicineUniversity of WashingtonSeattleWA. FAU - Karvellas, Constantine J AU - Karvellas CJ AUID- ORCID: 0000-0002-1555-1089 AD - Division of Gastroenterology (Liver Unit) and Department of Critical Care MedicineUniversity of AlbertaEdmontonABCanada. FAU - Rule, Jody A AU - Rule JA AD - Department of Internal MedicineUniversity of Texas, Southwestern Medical CenterDallasTX. FAU - Lisman, Ton AU - Lisman T AUID- ORCID: 0000-0002-3503-7140 AD - Department of SurgeryUniversity of GroningenGroningenThe Netherlands. FAU - Clasen, Kristin AU - Clasen K AD - Department of Public Health SciencesMedical University of South CarolinaCharlestonSC. FAU - Reuben, Adrian AU - Reuben A AD - Department of MedicineMedical University of South CarolinaCharlestonSC. FAU - Cripps, Michael AU - Cripps M AD - Department of SurgeryUniversity of Texas, Southwestern Medical CenterDallasTX. FAU - Lee, William M AU - Lee WM AUID- ORCID: 0000-0002-2783-5441 AD - Department of Internal MedicineUniversity of Texas, Southwestern Medical CenterDallasTX. CN - ALF Study Group LA - eng GR - R01 DK058369/DK/NIDDK NIH HHS/United States GR - U01 DK058369/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - Hepatology JT - Hepatology (Baltimore, Md.) JID - 8302946 RN - 362O9ITL9D (Acetaminophen) SB - IM MH - Acetaminophen/adverse effects MH - Adolescent MH - Adult MH - Aged MH - Blood Coagulation Disorders/blood/diagnosis/*epidemiology/etiology MH - Chemical and Drug Induced Liver Injury/*blood/diagnosis/etiology/mortality MH - Female MH - Hemorrhage/blood/diagnosis/*epidemiology/etiology MH - Humans MH - Liver Failure, Acute/*blood/complications/diagnosis/mortality MH - Male MH - Middle Aged MH - Severity of Illness Index MH - Thrombelastography/statistics & numerical data MH - Young Adult PMC - PMC10668528 MID - NIHMS1943479 EDAT- 2021/02/27 06:00 MHDA- 2022/01/06 06:00 PMCR- 2023/11/24 CRDT- 2021/02/26 17:10 PHST- 2020/12/16 00:00 [received] PHST- 2021/02/01 00:00 [accepted] PHST- 2021/02/27 06:00 [pubmed] PHST- 2022/01/06 06:00 [medline] PHST- 2021/02/26 17:10 [entrez] PHST- 2023/11/24 00:00 [pmc-release] AID - 01515467-202108000-00028 [pii] AID - 10.1002/hep.31767 [doi] PST - ppublish SO - Hepatology. 2021 Aug;74(2):937-949. doi: 10.1002/hep.31767. PMID- 33634214 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220420 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 6 IP - 1 DP - 2021 TI - Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis. PG - e000648 LID - 10.1136/tsaco-2020-000648 [doi] LID - e000648 AB - BACKGROUND: Prehospital plasma administration during air medical transport reduces the endotheliopathy of trauma, circulating pro-inflammatory cytokines, and 30-day mortality among traumatically injured patients at risk of hemorrhagic shock. No clinical data currently exists evaluating the age of thawed plasma and its association with clinical outcomes and biomarker expression post-injury. METHODS: We performed a secondary analysis from the prehospital plasma administration randomized controlled trial, PAMPer. We dichotomized the age of thawed plasma creating three groups: standard-care, YOUNG (day 0-1) plasma, and OLD (day 2-5) plasma. We generated HRs and 95% CIs for mortality. Among all patients randomized to plasma, we compared predicted biomarker values at hospital admission (T0) and 24 hours later (T24) controlling for key difference between groups with a multivariable linear regression. Analyses were repeated in a severely injured subgroup. RESULTS: Two hundred and seventy-one patients were randomized to standard-care and 230 to plasma (40% YOUNG, 60% OLD). There were no clinically or statistically significant differences in demographics, injury, admission vital signs, or laboratory values including thromboelastography between YOUNG and OLD. Compared with standard-care, YOUNG (HR 0.66 (95% CI 0.41 to 1.07), p=0.09) and OLD (HR 0.64 (95% CI 0.42 to 0.96), p=0.03) plasma demonstrated reduced 30-day mortality. Among those randomized to plasma, plasma age did not affect mortality (HR 1.04 (95% CI 0.60 to 1.82), p=0.90) and/or adjusted serum markers by plasma age at T0 or T24 (p>0.05). However, among the severely injured subgroup, OLD plasma was significantly associated with increased adjusted inflammatory and decreased adjusted endothelial biomarkers at T0. DISCUSSION: Age of thawed plasma does not result in clinical outcome or biomarker expression differences in the overall PAMPer study cohort. There were biomarker expression differences in those patients with severe injury. Definitive investigation is needed to determine if the age of thawed plasma is associated with biomarker expression and outcome differences following traumatic injury. LEVEL OF EVIDENCE: II. CI - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Reitz, Katherine M AU - Reitz KM AUID- ORCID: 0000-0002-9397-321X AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Gruen, Danielle S AU - Gruen DS AUID- ORCID: 0000-0003-1019-4390 AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Guyette, Frances AU - Guyette F AD - Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Brown, Joshua B AU - Brown JB AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Yazer, Mark H AU - Yazer MH AD - Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA. FAU - Vodovotz, Yoram AU - Vodovotz Y AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Johanssen, Par I AU - Johanssen PI AD - Capital Region Blood Bank, Section for Transfusion Medicine, University of Copenhagen, Kobenhavn, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Capital Region Blood Bank, Section for Transfusion Medicine, University of Copenhagen, Kobenhavn, Denmark. FAU - Daley, Brian AU - Daley B AD - The University of Tennessee Health Science Center, Memphis, Tennessee, USA. FAU - Miller, Richard S AU - Miller RS AD - Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. FAU - Harbrecht, Brian G AU - Harbrecht BG AD - University of Louisville, Louisville, Kentucky, USA. FAU - Claridge, Jeffrey AU - Claridge J AD - Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA. FAU - Phelan, Herb A AU - Phelan HA AD - Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA. FAU - Neal, Matthew D AU - Neal MD AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Zuckerbraun, Brian S AU - Zuckerbraun BS AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Sperry, Jason L AU - Sperry JL AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. LA - eng GR - L30 AG064730/AG/NIA NIH HHS/United States GR - T32 HL098036/HL/NHLBI NIH HHS/United States GR - UL1 TR002548/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20210211 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC7880105 OTO - NOTNLM OT - blood coagulation factors OT - cytokines OT - mortality OT - multiple trauma OT - plasma OT - resuscitation COIS- Competing interests: None declared. EDAT- 2021/02/27 06:00 MHDA- 2021/02/27 06:01 PMCR- 2021/02/11 CRDT- 2021/02/26 06:05 PHST- 2020/11/16 00:00 [received] PHST- 2021/01/13 00:00 [revised] PHST- 2021/01/25 00:00 [accepted] PHST- 2021/02/26 06:05 [entrez] PHST- 2021/02/27 06:00 [pubmed] PHST- 2021/02/27 06:01 [medline] PHST- 2021/02/11 00:00 [pmc-release] AID - tsaco-2020-000648 [pii] AID - 10.1136/tsaco-2020-000648 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2021 Feb 11;6(1):e000648. doi: 10.1136/tsaco-2020-000648. eCollection 2021. PMID- 33629880 OWN - NLM STAT- MEDLINE DCOM- 20220615 LR - 20220615 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 88 IP - 7 DP - 2022 Jul TI - "Death Diamond" Tracing on Thromboelastography as a Marker of Poor Survival After Trauma. PG - 1689-1693 LID - 10.1177/0003134821998684 [doi] AB - BACKGROUND: Improvements in health care innovations have resulted in an enhanced ability to extend patient viability. As a consequence, resources are being increasingly utilized at an unsustainable level. As we implement novel treatments, identifying futility should be a focus. The "death diamond" (DD) is a unique thrombelastography (TEG) tracing that is indicative of failure of the coagulation system, with a mortality rate exceeding 90%. The purpose of this study was to determine if the DD was a consistent marker of poor survival in a multicenter study population. We hypothesize that the DD, while an infrequent occurrence, predicts poor survival and can be used to stratify patients in whom resuscitation efforts are futile. METHODS: A retrospective multi-institutional study of trauma patients presenting with TEG DDs between 8/2008 and 12/2018 at four American College of Surgeons trauma centers was completed. Demographics, injury mechanisms, TEG results, management, and survival were examined. RESULTS: A total of 50 trauma patients presented with DD tracings, with a 94% (n = 47) mortality rate. Twenty-six (52%) patients received a repeat TEG with 10 patients re-demonstrating the DD tracing. There was 100% mortality in patients with serial DD tracings. The median use of total blood products was 18 units (interquartile range 6, 34.25) per patient. DISCUSSION: The DD is highly predictive of trauma-associated mortality. This multicenter study highlights that serial DDs may represent a possible biomarker of futility. FAU - Farrell, Michael S AU - Farrell MS AD - Departments of Trauma, Surgery, and Critical Care Medicine, 5973Christiana Care Health Services, Wilmington, DE, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, 129263University of Colorado-Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA. FAU - Thomas, Anthony V AU - Thomas AV AD - 158720Notre Dame Campus, Indiana University School of Medicine, South Bend, IN, USA. AD - Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, 129263University of Colorado-Anschutz Medical Campus, Aurora, CO, USA. FAU - Thomas, Scott AU - Thomas S AD - Memorial Trauma Center, Memorial Hospital, South Bend, IN, USA. FAU - Vande Lune, Stefani AU - Vande Lune S AD - Emergency Medicine Department, Navy Medicine Readiness and Training Command, Portsmouth, VA, USA. FAU - Marconi, Thomas Jr AU - Marconi T Jr AD - Departments of Trauma, Surgery, and Critical Care Medicine, 5973Christiana Care Health Services, Wilmington, DE, USA. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, 129263University of Colorado-Anschutz Medical Campus, Aurora, CO, USA. AD - Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Radiology, University of Colorado-Denver, Denver, CO, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, 129263University of Colorado-Anschutz Medical Campus, Aurora, CO, USA. FAU - Walsh, Mark M AU - Walsh MM AD - 158720Notre Dame Campus, Indiana University School of Medicine, South Bend, IN, USA. AD - Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA. FAU - Sixta, Sherry AU - Sixta S AD - Departments of Trauma, Surgery, and Critical Care Medicine, 5973Christiana Care Health Services, Wilmington, DE, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20210225 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Biomarkers) SB - IM MH - Biomarkers MH - *Blood Coagulation Disorders MH - Humans MH - Retrospective Studies MH - Thrombelastography/methods MH - Trauma Centers MH - *Wounds and Injuries/diagnosis/therapy OTO - NOTNLM OT - coagulopathy OT - hyperfibrinolysis OT - resuscitation OT - thromboelastography OT - trauma EDAT- 2021/02/26 06:00 MHDA- 2022/06/16 06:00 CRDT- 2021/02/25 12:12 PHST- 2021/02/26 06:00 [pubmed] PHST- 2022/06/16 06:00 [medline] PHST- 2021/02/25 12:12 [entrez] AID - 10.1177/0003134821998684 [doi] PST - ppublish SO - Am Surg. 2022 Jul;88(7):1689-1693. doi: 10.1177/0003134821998684. Epub 2021 Feb 25. PMID- 33594694 OWN - NLM STAT- MEDLINE DCOM- 20210726 LR - 20210726 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 61 IP - 5 DP - 2021 May TI - Post-expiry stability of freeze-dried plasma under field conditions - Can shelf life be extended? PG - 1570-1577 LID - 10.1111/trf.16319 [doi] AB - BACKGROUND: This prospective study evaluated the effect of routine, uncontrolled, Israeli field storage conditions on the safety and efficacy of Lyo-Plas N Freeze-Dried Plasma (FDP) at the end of the manufacturer's shelf life, and up to 24 months post expiry. Clotting factors V, VIII and XI, proteins S, C, fibrinogen, PTT, ATIII, VWF, and INR as well as TEG, DDM, residual moisture, pH, and sterility of FDP returned from field units after uncontrolled storage were evaluated. STUDY DESIGN AND METHODS: Parameters measured at the end of manufacturer shelf life, as well as 6, 12, 18, and 24 months after expiry, were compared to those of freshly supplied FDP doses. RESULTS: Changes were found when comparing freshly supplied FDP to all field-stored groups in INR, PT, PTT, pH, fibrinogen, and factor VIII. A significant change was also seen in Factor XI in the 12, 18, and 24 months post-expiry samples, Factor V and R in the 24 months post-expiry samples, MA in the 12, 24 months post-expiry group, and Protein C in the 18 months post-expiry group. An increase in the residual moisture from 0.90% in freshly supplied FDP to 1.35% in 24 months post-expiry FDP.; all p < .05. No growth was found in sterility analysis. CONCLUSION: Despite uncontrolled field storage conditions, the findings demonstrate that the safety and efficacy of FDP units, stored in uncontrolled conditions are only slightly affected, even beyond their expiration date. This information allows consideration of possibly extending the shelf life. CI - (c) 2021 AABB. FAU - Zur, Meital AU - Zur M AUID- ORCID: 0000-0002-2963-1610 AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. FAU - Gorenbein, Pavel AU - Gorenbein P AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. FAU - Nachshon, Akiva AU - Nachshon A AD - Hadassah Medical Center, Jerusalem, Israel. FAU - Radomislensky, Irina AU - Radomislensky I AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. AD - Israel National Center for Trauma and Emergency Medicine Research, Sheba Medical Center, Gertner Institute for Epidemiology and Public Health Policy Research, Ramat Gan, Israel. FAU - Tsur, Avishai M AU - Tsur AM AUID- ORCID: 0000-0002-1564-6395 AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. FAU - Benov, Avi AU - Benov A AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. FAU - Wagnert-Avraham, Linn AU - Wagnert-Avraham L AD - Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. FAU - Glassberg, Elon AU - Glassberg E AD - Israel Defense Forces (IDF) Medical Corps, Tel Aviv, Israel. AD - Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. AD - Faculty of Medicine, Bar Ilan University, Safed, Israel. AD - Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. LA - eng GR - IMOD DDR&D/2018/26/Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research and Development, Israeli Ministry of Defense/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210217 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Blood Coagulation Factors) RN - 0 (Protein S) RN - 839MOZ74GK (F8 protein, human) RN - 9001-24-5 (Factor V) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) RN - 9013-55-2 (Factor XI) SB - IM MH - Blood Coagulation MH - Blood Coagulation Factors/*analysis MH - Blood Preservation MH - Factor V/analysis MH - Factor VIII/analysis MH - Factor XI/analysis MH - Fibrinogen/analysis MH - *Freeze Drying MH - Humans MH - Hydrogen-Ion Concentration MH - Plasma/*chemistry MH - Protein S/analysis MH - Protein Stability MH - Thrombelastography OTO - NOTNLM OT - battlefield conditions OT - freeze-dried plasma OT - post-expiry OT - stability EDAT- 2021/02/18 06:00 MHDA- 2021/07/27 06:00 CRDT- 2021/02/17 06:01 PHST- 2020/11/15 00:00 [revised] PHST- 2020/07/16 00:00 [received] PHST- 2021/01/11 00:00 [accepted] PHST- 2021/02/18 06:00 [pubmed] PHST- 2021/07/27 06:00 [medline] PHST- 2021/02/17 06:01 [entrez] AID - 10.1111/trf.16319 [doi] PST - ppublish SO - Transfusion. 2021 May;61(5):1570-1577. doi: 10.1111/trf.16319. Epub 2021 Feb 17. PMID- 33586229 OWN - NLM STAT- MEDLINE DCOM- 20210514 LR - 20210514 IS - 1540-8191 (Electronic) IS - 0886-0440 (Linking) VI - 36 IP - 4 DP - 2021 Apr TI - Do all cardiac surgery patients benefit from antifibrinolytic therapy? PG - 1450-1457 LID - 10.1111/jocs.15406 [doi] AB - BACKGROUND: In trauma patients, the recognition of fibrinolysis phenotypes has led to a re-evaluation of the risks and benefits of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, but the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this hypothesis-generating study was to fill that gap. METHODS: Seventy-eight cardiac surgery patients were retrospectively reviewed. Phenotypes were defined as hypofibrinolytic (LY30 <0.8%), physiologic (0.8%-3.0%), and hyperfibrinolytic (>3%) based on thromboelastogram. RESULTS: The population was 65 +/- 10-years old, 74% male, average body mass index of 29 +/- 5 kg/m(2) . Fibrinolytic phenotypes were distributed as physiologic = 45% (35 of 78), hypo = 32% (25 of 78), and hyper = 23% (18 of 78). There was no obvious effect of age, gender, race, or ethnicity on this distribution; 47% received AF. For AF versus no AF, the time with chest tube was longer (4 [1] vs. 3 [1] days, p = .037), and all-cause morbidity was more prevalent (51% vs. 25%, p = .017). However, when these two groups were further stratified by phenotypes, there were within-group differences in the percentage of patients with congestive heart failure (p = .022), valve disease (p = .024), on-pump surgery (p < .0001), estimated blood loss during surgery (p = .015), transfusion requirement (p = .015), and chest tube output (p = .008), which highlight other factors along with AF that might have affected all-cause morbidity. CONCLUSION: This is the first description of the prevalence of three different fibrinolytic phenotypes and their potential influence on cardiac surgery patients. The use of AF was associated with increased morbidity, but because of the small sample size and treatment allocation bias, additional confirmatory studies are necessary. We hope these present findings open the dialog on whether it is safe to administer AFs to cardiac surgery patients who are normo- or hypofibrinolytic. CI - (c) 2021 Wiley Periodicals LLC. FAU - Sussman, Matthew S AU - Sussman MS AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Urrechaga, Eva M AU - Urrechaga EM AUID- ORCID: 0000-0001-9708-8368 AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Cioci, Alessia C AU - Cioci AC AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Iyengar, Rahul S AU - Iyengar RS AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Herrington, Tyler J AU - Herrington TJ AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Ryon, Emily L AU - Ryon EL AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Namias, Nicholas AU - Namias N AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Galbut, David L AU - Galbut DL AD - Division of Cardiothoracic Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Salerno, Tomas A AU - Salerno TA AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - Division of Cardiothoracic Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. FAU - Proctor, Kenneth G AU - Proctor KG AUID- ORCID: 0000-0003-1326-6628 AD - Divisions of Trauma, Surgical Critical Care, and Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. AD - University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA. LA - eng PT - Journal Article DEP - 20210214 PL - United States TA - J Card Surg JT - Journal of cardiac surgery JID - 8908809 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Aged MH - *Antifibrinolytic Agents MH - Blood Loss, Surgical MH - Blood Transfusion MH - *Cardiac Surgical Procedures MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Tranexamic Acid OTO - NOTNLM OT - aminocaproic acid OT - thromboelastogram OT - tranexamic acid EDAT- 2021/02/16 06:00 MHDA- 2021/05/15 06:00 CRDT- 2021/02/15 06:17 PHST- 2020/12/03 00:00 [revised] PHST- 2020/08/26 00:00 [received] PHST- 2020/12/22 00:00 [accepted] PHST- 2021/02/16 06:00 [pubmed] PHST- 2021/05/15 06:00 [medline] PHST- 2021/02/15 06:17 [entrez] AID - 10.1111/jocs.15406 [doi] PST - ppublish SO - J Card Surg. 2021 Apr;36(4):1450-1457. doi: 10.1111/jocs.15406. Epub 2021 Feb 14. PMID- 33584329 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220822 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 11 DP - 2020 TI - Protective Effect of Xinmailong Injection on Rats With Myocardial Infarction. PG - 595760 LID - 10.3389/fphys.2020.595760 [doi] LID - 595760 AB - This study aimed to investigate the protective effect of Xinmailong injection on rats with myocardial infarction. Thirty-six rats were induced myocardial infarction by operation, and six underwent sham operation. The myocardial infarction rats were randomly divided into three groups, 12 in each, and administered intraperitoneal injection of Xinmailong 5 mg/(kg.d), sodium creatine phosphate 80 mg/(kg.d), or normal saline as control respectively for 14 days. When the treatments were completed, the hemodynamic parameters of the rats were observed, and blood samples were taken to examine blood routine, blood coagulation index, liver and kidney function, inflammatory index, myocardial marker, thrombo-elastography, and other indicators. The morphology of cardiomyocytes was observed through light microscopy, and the microstructure of the myocardial cells was observed under electron microscope. No significant difference was found in blood routine, liver and kidney function, and blood coagulation index between the Xinmailong and sodium creatine phosphate groups compared with the saline control group. However, the inflammatory index and levels of myocardial markers were significantly decreased, and cardiac function was significantly improved. In terms of the morphology of myocardial cells, the Xinmailong group was similar to the sodium creatine phosphate group, the myocardial cell membrane was protected, and myocardial cell damage was reduced. In conclusion, Xinmailong is safe and had anti-inflammatory, heart-improving, and myocardial-protective effects. Its effectiveness is not inferior to that of sodium creatine phosphate. CI - Copyright (c) 2021 Zhang, Li, Ding, Ren, Wang and Si. FAU - Zhang, Wei AU - Zhang W AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. FAU - Li, Kailiang AU - Li K AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. FAU - Ding, Yu AU - Ding Y AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. FAU - Ren, Jiefeng AU - Ren J AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. FAU - Wang, Haijun AU - Wang H AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. FAU - Si, Quanjin AU - Si Q AD - Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China. LA - eng PT - Journal Article PT - Retracted Publication DEP - 20210113 PL - Switzerland TA - Front Physiol JT - Frontiers in physiology JID - 101549006 RIN - Front Physiol. 2022 Aug 04;13:1006572. doi: 10.3389/fphys.2022.1006572. PMID: 35991186 PMC - PMC7873907 OTO - NOTNLM OT - Xinmailong injection OT - myocardial infarction OT - myocardial injury marker OT - protective effect OT - rat model COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2021/02/16 06:00 MHDA- 2021/02/16 06:01 PMCR- 2021/01/13 CRDT- 2021/02/15 06:07 PHST- 2020/08/17 00:00 [received] PHST- 2020/12/16 00:00 [accepted] PHST- 2021/02/15 06:07 [entrez] PHST- 2021/02/16 06:00 [pubmed] PHST- 2021/02/16 06:01 [medline] PHST- 2021/01/13 00:00 [pmc-release] AID - 10.3389/fphys.2020.595760 [doi] PST - epublish SO - Front Physiol. 2021 Jan 13;11:595760. doi: 10.3389/fphys.2020.595760. eCollection 2020. PMID- 33556992 OWN - NLM STAT- MEDLINE DCOM- 20211027 LR - 20211027 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 33 IP - 5 DP - 2021 Oct TI - Acute traumatic coagulopathy and the relationship to prehospital care and on-scene red blood cell transfusion. PG - 834-840 LID - 10.1111/1742-6723.13734 [doi] AB - OBJECTIVE: To identify the incidence of acute traumatic coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital, analyse prehospital contributors, including red blood cell transfusion and assess the clinical significance of ATC. METHODS: A retrospective database review was undertaken using conventional coagulation assays and viscoelastic testing (ROTEM) for diagnosis of ATC. RESULTS: Baseline ATC incidence is 10% in trauma patients, increasing to over 80% among those where the prehospital team has attended and given a transfusion of red cells. ATC was significantly associated with higher severity of trauma (odds ratio [OR] 1.11, P < 0.0001), prehospital (OR 11.8, P < 0.0001) and in-hospital blood transfusions (OR 17.9, P < 0.0001), and massive transfusions (P < 0.001). CONCLUSIONS: Prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma. CI - (c) 2021 Australasian College for Emergency Medicine. FAU - Harris, Daniel AU - Harris D AUID- ORCID: 0000-0002-5946-5596 AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - Emergency Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. AD - Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia. AD - MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia. FAU - Martin, Daniel AU - Martin D AD - MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia. AD - School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia. FAU - Bednarz, Jana AU - Bednarz J AD - Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia. FAU - Ellis, Daniel Y AU - Ellis DY AD - Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia. AD - School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia. LA - eng PT - Journal Article DEP - 20210208 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - *Blood Coagulation Disorders/epidemiology/etiology/therapy MH - Blood Transfusion MH - *Emergency Medical Services MH - Erythrocyte Transfusion MH - Humans MH - Retrospective Studies MH - *Wounds and Injuries/complications/therapy OTO - NOTNLM OT - coagulopathy OT - transfusion OT - trauma EDAT- 2021/02/09 06:00 MHDA- 2021/10/28 06:00 CRDT- 2021/02/08 20:22 PHST- 2021/01/14 00:00 [revised] PHST- 2020/07/10 00:00 [received] PHST- 2021/01/15 00:00 [accepted] PHST- 2021/02/09 06:00 [pubmed] PHST- 2021/10/28 06:00 [medline] PHST- 2021/02/08 20:22 [entrez] AID - 10.1111/1742-6723.13734 [doi] PST - ppublish SO - Emerg Med Australas. 2021 Oct;33(5):834-840. doi: 10.1111/1742-6723.13734. Epub 2021 Feb 8. PMID- 33548446 OWN - NLM STAT- MEDLINE DCOM- 20210930 LR - 20220921 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 232 IP - 5 DP - 2021 May TI - Whole Blood Thrombin Generation in Severely Injured Patients Requiring Massive Transfusion. PG - 709-716 LID - S1072-7515(21)00057-0 [pii] LID - 10.1016/j.jamcollsurg.2020.12.058 [doi] AB - 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. CI - Copyright (c) 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. Electronic address: Ernest.moore@dhha.org. FAU - Samuels, Jason M AU - Samuels JM AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Vitalant Research Institute, Vitalant Denver, Denver, CO. FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. FAU - Chandler, James AU - Chandler J AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. FAU - Butenas, Saulius AU - Butenas S AD - Department of Biochemistry, University of Vermont, Burlington, VT. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20210204 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - EC 3.4.21.5 (Thrombin) SB - IM CIN - J Am Coll Surg. 2021 May;232(5):716. doi: 10.1016/j.jamcollsurg.2021.02.001. PMID: 33896477 MH - Adult MH - Blood Coagulation Disorders/blood/diagnosis/*epidemiology MH - Blood Transfusion/*statistics & numerical data MH - Feasibility Studies MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prospective Studies MH - ROC Curve MH - Risk Assessment/methods/statistics & numerical data MH - Thrombelastography MH - Thrombin/*analysis MH - Trauma Centers/statistics & numerical data MH - Wounds and Injuries/blood/*complications/diagnosis/therapy PMC - PMC8589345 MID - NIHMS1671515 EDAT- 2021/02/07 06:00 MHDA- 2021/10/01 06:00 PMCR- 2022/05/01 CRDT- 2021/02/06 20:10 PHST- 2020/12/26 00:00 [received] PHST- 2020/12/29 00:00 [accepted] PHST- 2021/02/07 06:00 [pubmed] PHST- 2021/10/01 06:00 [medline] PHST- 2021/02/06 20:10 [entrez] PHST- 2022/05/01 00:00 [pmc-release] AID - S1072-7515(21)00057-0 [pii] AID - 10.1016/j.jamcollsurg.2020.12.058 [doi] PST - ppublish SO - J Am Coll Surg. 2021 May;232(5):709-716. doi: 10.1016/j.jamcollsurg.2020.12.058. Epub 2021 Feb 4. PMID- 33478011 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210218 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 2 DP - 2021 Jan 19 TI - The European Perspective on the Management of Acute Major Hemorrhage and Coagulopathy after Trauma: Summary of the 2019 Updated European Guideline. LID - 10.3390/jcm10020362 [doi] LID - 362 AB - Non-controlled hemorrhage with accompanying trauma-induced coagulopathy (TIC) remains the most common cause of preventable death after multiple injury. Rapid identification followed by aggressive treatment is the key for improved outcomes. Treatment of trauma hemorrhage begins at the scene, with manual compression, the use of tourniquets and (non) commercial pelvic slings, and rapid transfer to an adequate trauma center. Upon hospital admission, coagulation monitoring and support are to be initiated immediately. Bleeding is controlled surgically following damage control principles. Modern coagulation management includes goal-oriented, individualized therapies, guided by point-of-care viscoelastic assays. Idarucizumab can be used as an antidote to the thrombin inhibitor dabigatran, andexanet alpha as an antidote to factor Xa inhibitors. This review summarizes the key recommendations of the 2019 updated European guideline on the management of major bleeding and coagulopathy following trauma. These evidence-based recommendations may form the backbone of algorithms adapted to local logistics and infrastructure. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University Witten-Herdecke, D-51109 Cologne, Germany. LA - eng PT - Journal Article DEP - 20210119 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC7835990 OTO - NOTNLM OT - coagulopathgy OT - guideline OT - hemorrhage OT - trauma COIS- The author has received fees for lectures, speakers bureaus, congress travel support as well as support for research projects from the following: Astra Zeneca, Bayer, Biotest, CSL Behring, LFB Biomedicamants, Portola Inc. (South San Francisco, CA, USA) and TEM International/IL-Werfen. EDAT- 2021/01/23 06:00 MHDA- 2021/01/23 06:01 PMCR- 2021/01/19 CRDT- 2021/01/22 01:03 PHST- 2020/11/11 00:00 [received] PHST- 2020/12/09 00:00 [revised] PHST- 2020/12/14 00:00 [accepted] PHST- 2021/01/22 01:03 [entrez] PHST- 2021/01/23 06:00 [pubmed] PHST- 2021/01/23 06:01 [medline] PHST- 2021/01/19 00:00 [pmc-release] AID - jcm10020362 [pii] AID - jcm-10-00362 [pii] AID - 10.3390/jcm10020362 [doi] PST - epublish SO - J Clin Med. 2021 Jan 19;10(2):362. doi: 10.3390/jcm10020362. PMID- 33477257 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240806 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 10 IP - 2 DP - 2021 Jan 17 TI - Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review. LID - 10.3390/jcm10020320 [doi] LID - 320 AB - This narrative review explores the pathophysiology, geographic variation, and historical developments underlying the selection of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. We also detail a physiologically driven and goal-directed alternative to fixed ratio and whole blood, whereby viscoelastic testing guides the administration of blood components and factor concentrates to the severely bleeding trauma patient. The major studies of each resuscitation method are highlighted, and upcoming comparative trials are detailed. FAU - Walsh, Mark AU - Walsh M AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. AD - Departments of Emergency & Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA. FAU - Moore, Ernest E AU - Moore EE AD - Ernest E. Moore Shock Trauma Center, Denver Health, Denver, CO 80204, USA. AD - Department of Surgery, University of Colorado Health Science Center, Denver, CO 80204, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Health Science Center, Denver, CO 80204, USA. FAU - Thomas, Scott AU - Thomas S AD - Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA. FAU - Kwaan, Hau C AU - Kwaan HC AD - Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. FAU - Speybroeck, Jacob AU - Speybroeck J AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Marsee, Mathew AU - Marsee M AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Bunch, Connor M AU - Bunch CM AUID- ORCID: 0000-0002-8566-7001 AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Stillson, John AU - Stillson J AUID- ORCID: 0000-0003-3442-2706 AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Thomas, Anthony V AU - Thomas AV AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Grisoli, Annie AU - Grisoli A AUID- ORCID: 0000-0001-9081-4814 AD - Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA. FAU - Aversa, John AU - Aversa J AD - Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Fulkerson, Daniel AU - Fulkerson D AD - Department of Neurosurgery, Beacon Medical Group, South Bend, IN 46601, USA. FAU - Vande Lune, Stefani AU - Vande Lune S AD - Emergency Medicine Department, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA. FAU - Sjeklocha, Lucas AU - Sjeklocha L AD - The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. FAU - Tran, Quincy K AU - Tran QK AUID- ORCID: 0000-0002-7774-154X AD - The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. LA - eng PT - Journal Article PT - Review DEP - 20210117 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC7830337 OTO - NOTNLM OT - blood component transfusion OT - blood transfusion OT - exsanguination OT - fibrinogen OT - hemostatics OT - thromboelastography COIS- Ernest Moore, Hunter Moore, Scott Thomas, and Hau Kwaan have received research grants from Haemonetics Corporation (Braintree, Massachusetts, USA). EDAT- 2021/01/23 06:00 MHDA- 2021/01/23 06:01 PMCR- 2021/01/17 CRDT- 2021/01/22 01:01 PHST- 2020/11/10 00:00 [received] PHST- 2021/01/15 00:00 [revised] PHST- 2021/01/15 00:00 [accepted] PHST- 2021/01/22 01:01 [entrez] PHST- 2021/01/23 06:00 [pubmed] PHST- 2021/01/23 06:01 [medline] PHST- 2021/01/17 00:00 [pmc-release] AID - jcm10020320 [pii] AID - jcm-10-00320 [pii] AID - 10.3390/jcm10020320 [doi] PST - epublish SO - J Clin Med. 2021 Jan 17;10(2):320. doi: 10.3390/jcm10020320. PMID- 33443923 OWN - NLM STAT- MEDLINE DCOM- 20210422 LR - 20230924 IS - 1473-5733 (Electronic) IS - 0957-5235 (Print) IS - 0957-5235 (Linking) VI - 32 IP - 3 DP - 2021 Apr 1 TI - Viscoelastic hemostasis assays in septic, critically ill coronavirus disease 2019 patients: a practical guide for clinicians. PG - 225-228 LID - 10.1097/MBC.0000000000000999 [doi] AB - Coronavirus disease 2019 (COVID-19)-associated coagulopathy is unusual, poorly defined and is linked with significant hypercoagulability and microthrombotic and macrothrombotic complications leading to worse outcomes and higher mortality. Conventional coagulation assays do not always actively reflect these derangements and might fail to detect this coagulopathy. Viscoelastic hemostatic assays (VHA) provide a possible tool that adds to conventional coagulation assays in identifying this hypercoagulable state. VHA has been mostly used in surgery and trauma but it's still not well defined in sepsis patients with lack of large randomized trials. Few studies described VHA findings in patients with COVID-19 showing significant hypercoagulability and fibrinolysis shutdown. Clinicians taking care of these patients might have little experience interpreting VHA results. By reviewing the available literature on the use of VHA in sepsis, and the current knowledge on COVID-19-associated coagulopathy we provide clinicians with a practical guide on VHA utilization in patients with COVID-19. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Gergi, Mansour AU - Gergi M AD - Department of Medicine/Division of Hematology Oncology. FAU - Goodwin, Andrew AU - Goodwin A AD - Department of Pathology and Laboratory Medicine. FAU - Freeman, Kalev AU - Freeman K AD - Department of Surgery. FAU - Colovos, Christos AU - Colovos C AD - Department of Surgery. FAU - Volod, Oksana AU - Volod O AD - Department of Pathology, University of Vermont Medical Center, Burlington, Vermont, USA. AD - Cedars-Sinai Medical Center-David Geffen School of Medicine at UCLA. LA - eng GR - R01 GM123010/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 SB - IM MH - Blood Coagulation Disorders/complications/*diagnosis/virology MH - COVID-19/*blood/complications/physiopathology MH - Critical Illness MH - *Hemostasis MH - Humans MH - Sepsis/blood MH - *Thrombelastography PMC - PMC8451615 MID - NIHMS1721115 EDAT- 2021/01/15 06:00 MHDA- 2021/04/23 06:00 PMCR- 2021/09/20 CRDT- 2021/01/14 13:33 PHST- 2021/01/15 06:00 [pubmed] PHST- 2021/04/23 06:00 [medline] PHST- 2021/01/14 13:33 [entrez] PHST- 2021/09/20 00:00 [pmc-release] AID - 00001721-202104000-00011 [pii] AID - 10.1097/MBC.0000000000000999 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2021 Apr 1;32(3):225-228. doi: 10.1097/MBC.0000000000000999. PMID- 33437775 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220419 IS - 2305-5839 (Print) IS - 2305-5847 (Electronic) IS - 2305-5839 (Linking) VI - 8 IP - 23 DP - 2020 Dec TI - Insights into the association between coagulopathy and inflammation: abnormal clot mechanics are a warning of immunologic dysregulation following major injury. PG - 1576 LID - 10.21037/atm-20-3651 [doi] LID - 1576 AB - BACKGROUND: Severe injury initiates a complex physiologic response encompassing multiple systems and varies phenotypically between patients. Trauma-induced coagulopathy may be an early warning of a poorly coordinated response at the molecular level, including a deleterious immunologic response and worsening of shock states. The onset of trauma-induced coagulopathy (TIC) may be subtle however. In previous work, we identified an early warning sign of coagulopathy from the admission thromboelastogram, called the MAR ratio. We hypothesized that a low MAR ratio would be associated with specific derangements in the inflammatory response. METHODS: In this prospective, observational study, 88 blunt trauma patients admitted to the intensive care unit (ICU) were identified. Concentrations of inflammatory mediators were recorded serially over the course of a week and the MAR ratio was calculated from the admission thromboelastogram. Correlation analysis was used to assess the relationship between MAR and inflammatory mediators. Dynamic network analysis was used to assess coordination of immunologic response. RESULTS: Seventy-nine percent of patients were male and mean age was 37 years (SD 12). The mean ISS was 30.2 (SD 12) and mortality was 7.2%. CRITICAL patients (MAR ratio 14.2). CRITICAL patients had significant differences in IL-6 (P=0.0065), IL-8 (P=0.0115), IL-10 (P=0.0316) and MCP-1 (P=0.0039) concentrations compared to NORMAL. Differences in degree of expression and discoordination of immune response continued in CRITICAL patients throughout the first day. CONCLUSIONS: The admission MAR ratio may be the earliest warning signal of a pathologic inflammatory response associated with hypoperfusion and TIC. A low MAR ratio is an early indication of complicated dysfunction of multiple molecular processes following trauma. CI - 2020 Annals of Translational Medicine. All rights reserved. FAU - Savage, Stephanie A AU - Savage SA AD - Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA. FAU - Zarzaur, Ben L AU - Zarzaur BL AD - Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA. FAU - Gaski, Greg E AU - Gaski GE AD - Department of Orthopedics, Inova Fairfax Medical Campus, Fairfax, Virginia, USA. FAU - McCarroll, Tyler AU - McCarroll T AD - Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana, USA. FAU - Zamora, Ruben AU - Zamora R AD - Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Namas, Rami A AU - Namas RA AD - Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Vodovotz, Yoram AU - Vodovotz Y AD - Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Callcut, Rachael A AU - Callcut RA AD - Department of Surgery, University of California Davis School of Medicine, Davis, California, USA. FAU - Billiar, Timothy R AU - Billiar TR AD - Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - McKinley, Todd O AU - McKinley TO AD - Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana, USA. LA - eng GR - R01 HL149670/HL/NHLBI NIH HHS/United States PT - Journal Article PL - China TA - Ann Transl Med JT - Annals of translational medicine JID - 101617978 PMC - PMC7791215 OTO - NOTNLM OT - Accidental injury OT - blood clotting OT - disseminated coagulation OT - inflammation OT - intravascular OT - thromboelastography COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3651). YV serves as an unpaid editorial board member of Annals of Translational Medicine from Mar 2019 to Feb 2021. Dr. YV reports grants from Indiana University internal funds, during the conduct of the study; other from Immunetrics, Inc., outside the submitted work. Dr. RAC reports grants from NIH, during the conduct of the study. Dr. TOM reports personal fees from Innomed, outside the submitted work. The other authors have no conflicts of interest to declare. EDAT- 2021/01/14 06:00 MHDA- 2021/01/14 06:01 PMCR- 2020/12/01 CRDT- 2021/01/13 06:13 PHST- 2021/01/13 06:13 [entrez] PHST- 2021/01/14 06:00 [pubmed] PHST- 2021/01/14 06:01 [medline] PHST- 2020/12/01 00:00 [pmc-release] AID - atm-08-23-1576 [pii] AID - 10.21037/atm-20-3651 [doi] PST - ppublish SO - Ann Transl Med. 2020 Dec;8(23):1576. doi: 10.21037/atm-20-3651. PMID- 33417398 OWN - NLM STAT- MEDLINE DCOM- 20210901 LR - 20210901 IS - 1078-7496 (Print) IS - 1078-7496 (Linking) VI - 28 IP - 1 DP - 2021 Jan-Mar 01 TI - Current Practices in Tranexamic Acid Administration for Pediatric Trauma Patients in the United States. PG - 21-25 LID - 10.1097/JTN.0000000000000553 [doi] AB - BACKGROUND: Although controversial, early administration of tranexamic acid (TXA) has been shown to reduce mortality in adult patients with major trauma. Tranexamic acid has also been successfully used in elective pediatric surgery, with significant reduction in blood loss and transfusion requirements. There are limited data to guide its use in pediatric trauma patients. We sought to determine the current practices for TXA administration in pediatric trauma patients in the United States. METHODS: A survey was conducted of all the American College of Surgeons-verified Level I and II trauma centers in the United States. The survey data underwent quantitative analysis. RESULTS: Of the 363 Level I and II qualifying centers, we received responses from 220 for an overall response rate of 61%. Eighty of 99 verified pediatric trauma centers responded for a pediatric trauma center response rate of 81%. Of all responding centers, 148 (67%) reported they care for pediatric trauma patients, with an average of 513 pediatric trauma patients annually. The pediatric trauma centers report caring for an average of 650 pediatric trauma patients annually. Of all centers caring for pediatric trauma, 52 (35%) report using TXA, with the most common initial dosing being 15 mg/kg (68%). A follow-up infusion was utilized by 45 (87%) of the programs, most commonly dosed at 2 mg/kg/hr x 8 hr utilized by 24 centers (54%). CONCLUSION: Although the clinical evidence for TXA in pediatric trauma patients is limited, we believe that consideration should be given for use in major trauma with hemodynamic instability or significant risk for ongoing hemorrhage. If available, resuscitation should be guided by thromboelastography to identify candidates who would most benefit from antithrombolytic administration. This represents a low-cost/low-risk and high-yield therapy for pediatric trauma patients. CI - Copyright (c) 2021 Society of Trauma Nurses. FAU - Cornelius, Brian AU - Cornelius B AD - Graduate Program in Nurse Anesthesia, Texas Wesleyan University, Fort Worth (Dr B. Cornelius); Envision Anesthesia (Dr B. Cornelius) and Integrative Emergency Services (Dr A. Cornelius), John Peter Smith Hospital, Fort Worth, Texas; Department of Anesthesia, Ochsner LSU Health-Shreveport, Shreveport, Louisiana (Dr B. Cornelius); Doctorate of Nurse Anesthesia Practice Program, Midwestern University, Glendale, Arizona (Dr B. Cornelius); and Departments of Emergency Medicine (Drs Cummings and A. Cornelius) and Anesthesia (Dr Gennuso), LSUHSC-Shreveport (Drs Assercq and Rizzo), Shreveport, Louisiana. FAU - Cummings, Quinn AU - Cummings Q FAU - Assercq, Mathieu AU - Assercq M FAU - Rizzo, Erin AU - Rizzo E FAU - Gennuso, Sonja AU - Gennuso S FAU - Cornelius, Angela AU - Cornelius A LA - eng PT - Journal Article PL - United States TA - J Trauma Nurs JT - Journal of trauma nursing : the official journal of the Society of Trauma Nurses JID - 9512997 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) MH - Adult MH - *Antifibrinolytic Agents/administration & dosage/therapeutic use MH - Blood Transfusion MH - Child MH - Hemorrhage MH - Humans MH - *Tranexamic Acid/administration & dosage/therapeutic use MH - Trauma Centers MH - Trauma Nursing MH - United States COIS- The authors declare no conflicts of interest. EDAT- 2021/01/09 06:00 MHDA- 2021/09/02 06:00 CRDT- 2021/01/08 14:48 PHST- 2021/01/08 14:48 [entrez] PHST- 2021/01/09 06:00 [pubmed] PHST- 2021/09/02 06:00 [medline] AID - 00043860-202101000-00005 [pii] AID - 10.1097/JTN.0000000000000553 [doi] PST - ppublish SO - J Trauma Nurs. 2021 Jan-Mar 01;28(1):21-25. doi: 10.1097/JTN.0000000000000553. PMID- 33405468 OWN - NLM STAT- MEDLINE DCOM- 20210506 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 90 IP - 4 DP - 2021 Apr 1 TI - The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile. PG - 607-614 LID - 10.1097/TA.0000000000003058 [doi] AB - INTRODUCTION: Recent in vitro data have shown that the hemostatic profile of whole blood (WB) degrades significantly after 14 days, yet the optimal storage remains debated. We hypothesized that arrival coagulation studies would be improved in patients receiving younger WB in the prehospital setting. METHODS: This study was approved by our institutional institutional review board. We evaluated all trauma patients who received prehospital blood products by our helicopter service between July 2017 and July 2019. "Young" WB was defined as 14 days or less. Patients who received at least 1 U of young WB were classified as YOUNG, while the remainder was classified as OLD. Continuous data are presented as medians (25th-75th interquartile range) with comparisons performed using Wilcoxon rank sum. Assessments of clinical hemostatic potential included arrival platelet cell count and rapid thrombelastography. Multivariate regression analysis was also performed (Stata 12.1; College Station, TX). RESULTS: A total of 220 patients received prehospital WB during the study period. Of these, 153 patients received YOUNG WB, while 67 were transfused only OLD WB units. There were no differences in demographics, prehospital or arrival physiology, or Injury Severity Score among the two groups. The measures of clot initiation (activated clotting time) and kinetics (k time) were improved, as were the measures of clot acceleration/fibrinogen function (angle) and platelet function (maximum amplitude). As well, arrival platelet count was higher in the YOUNG cohort. No significant differences in postarrival transfusion were noted (p = 0.220). Multivariate analysis showed the greatest differences in maximum amplitude and alpha angle but failed to reach significance. CONCLUSION: Previous in vitro data have suggested deterioration of platelet function in cold-stored WB after 14 days. The current study demonstrated decreased global hemostasis by clinically available laboratory tests, especially related to fibrinogen and platelet interactions on univariate, but not multivariate analysis. This did not translate into increased transfusion requirements. Further studies are needed to determine the optimal storage duration for cold-stored WB for transfusion in the bleeding trauma patient, as well as rule out the presence of confounding variables. LEVEL OF EVIDENCE: Therapeutic, level IV. CI - Copyright (c) 2021 American Association for the Surgery of Trauma. FAU - Clements, Thomas AU - Clements T AD - From the Cumming School of Medicine (T.C., S.A.), University of Calgary; Center of Translational Injury Research and the Department of Surgery, McGovern Medical School (C.M., J.C., C.W., D.M., B.A.C.), University of Texas Health Science Center, Houston, Texas. FAU - McCoy, Cameron AU - McCoy C FAU - Assen, Scott AU - Assen S FAU - Cardenas, Jessica AU - Cardenas J FAU - Wade, Charles AU - Wade C FAU - Meyer, David AU - Meyer D FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Tests MH - *Blood Preservation MH - *Blood Transfusion MH - Cohort Studies MH - *Emergency Medical Services MH - Female MH - Hemostasis/*physiology MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Platelet Count MH - Time Factors MH - Wounds and Injuries/*blood/mortality/*therapy EDAT- 2021/01/07 06:00 MHDA- 2021/05/07 06:00 CRDT- 2021/01/06 13:46 PHST- 2021/01/07 06:00 [pubmed] PHST- 2021/05/07 06:00 [medline] PHST- 2021/01/06 13:46 [entrez] AID - 01586154-202104000-00001 [pii] AID - 10.1097/TA.0000000000003058 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Apr 1;90(4):607-614. doi: 10.1097/TA.0000000000003058. PMID- 33399876 OWN - NLM STAT- MEDLINE DCOM- 20220413 LR - 20220608 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 48 IP - 2 DP - 2022 Apr TI - Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting. PG - 763-774 LID - 10.1007/s00068-020-01563-2 [doi] AB - PURPOSE: Trauma is a leading cause of mortality, with major bleeding and trauma-induced coagulopathy (TIC) contributing to negative patient outcomes. Treatments for TIC include tranexamic acid (TXA), fresh frozen plasma (FFP), and coagulation factor concentrates (CFCs, e.g. prothrombin complex concentrates [PCCs] and fibrinogen concentrate [FCH]). Guidelines for TIC management vary across Europe and a clear definition of TIC is still lacking. METHODS: An advisory board involving European trauma experts was held on 02 February 2019, to discuss clinical experience in the management of trauma-related bleeding and recommendations from European guidelines, focusing on CFC use (mainly FCH). This review summarises the discussions, including TIC definitions, gaps in the guidelines that affect their implementation, and barriers to use of CFCs, with suggested solutions. RESULTS: A definition of TIC, which incorporates clinical (e.g. severe bleeding) and laboratory parameters (e.g. low fibrinogen) is suggested. TIC should be treated immediately with TXA and FCH/red blood cells; subsequently, if fibrinogen 0.05). GM experienced no significant changes after ankle sprain in any of the variables (p > 0.05). To conclude, previous history of lateral ankle sprain results in higher TA and GL muscle tone. Likewise, these muscles in addition to PL exhibit less deformation against resistance due to their increased stiffness, thus needing a shorter time to restore to their original shape after deformation. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Serra-Ano, Pilar AU - Serra-Ano P AD - UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain. FAU - Ingles, Marta AU - Ingles M AD - UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; Freshage Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valencia, Centro de Investigacion Biomedica en Red Fragilidad y Envejecimiento Saludable (CIBERFES-ISCIII), Fundacion Investigacion del Hospital Clinico Universitario de Valencia (INCLIVA), 46010 Valencia, Spain. Electronic address: marta.ingles@uv.es. FAU - Espi-Lopez, Gemma V AU - Espi-Lopez GV AD - UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain. FAU - Sempere-Rubio, Nuria AU - Sempere-Rubio N AD - UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain. FAU - Aguilar-Rodriguez, Marta AU - Aguilar-Rodriguez M AD - UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20201229 PL - United States TA - J Biomech JT - Journal of biomechanics JID - 0157375 SB - IM MH - *Ankle MH - *Ankle Injuries MH - Ankle Joint MH - Electromyography MH - Humans MH - Leg MH - Male MH - Muscle, Skeletal OTO - NOTNLM OT - Ankle sprain OT - Elasticity OT - Muscle tone OT - Stiffness OT - Stress relaxation time OT - Viscoelastic properties COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2021/01/02 06:00 MHDA- 2021/05/28 06:00 CRDT- 2021/01/01 20:14 PHST- 2020/07/14 00:00 [received] PHST- 2020/11/09 00:00 [revised] PHST- 2020/12/11 00:00 [accepted] PHST- 2021/01/02 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] PHST- 2021/01/01 20:14 [entrez] AID - S0021-9290(20)30615-1 [pii] AID - 10.1016/j.jbiomech.2020.110191 [doi] PST - ppublish SO - J Biomech. 2021 Jan 22;115:110191. doi: 10.1016/j.jbiomech.2020.110191. Epub 2020 Dec 29. PMID- 33385053 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220419 IS - 2352-5517 (Print) IS - 2352-5517 (Electronic) IS - 2352-5517 (Linking) VI - 23 DP - 2021 Jan TI - Characterization of analytical errors in thromboelastography interpretation. PG - e00196 LID - 10.1016/j.plabm.2020.e00196 [doi] LID - e00196 AB - INTRODUCTION: Interpretation of Thromboelastography (TEG) curve involves correlating patient's clinical profile with TEG parameters and the tracing, keeping in mind the potential sources of errors, and hence requires expertise. We aimed to analyse the analytical errors in TEG interpretation due to paucity of literature in this regard. MATERIAL AND METHODS: The retrospective study was conducted in an apex trauma center in North India. Five months of data was reviewed by two laboratory physicians, with differences resolved by consensus. Cases with pre-analytical errors, missing data and TEG runs lasting <10 ​min were excluded. The analytical errors were classified into: preventable, potentially preventable, non-preventable, and non-preventable but care could have been improved. RESULTS: Out of 440 TEG tracings reviewed, 70 were excluded. An analytical error was present in 60/370 (16.2%) tracings. There were six types analytical errors, of which, tracings of severe hypocoagulable states showing k-time ​= ​0 (33.3%) was the commonest, followed by tracings with spikes at irregular intervals (30%). Of all the analytical errors, 29/60 (48.2%) were preventable and 5/60 (8.3%) were potentially preventable. CONCLUSION: Analytical variables that lead to errors in TEG interpretation were identified in about one-sixth of the cases and almost half of them were preventable. Awareness about the common errors amongst clinicians and laboratory physicians is critical to prevent treatment delay and safeguard patient safety. CI - (c) 2020 The Author(s). FAU - Mukhopadhyay, Tapasyapreeti AU - Mukhopadhyay T AD - Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, 110029, India. FAU - Subramanian, Arulselvi AU - Subramanian A AD - Room No. 207, Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, 110029, India. FAU - Pati, Hara Prasad AU - Pati HP AD - Department of Hematology, All India Institute Medical Sciences, New Delhi, 110029, India. AD - Indian Society of Hematology & Blood Transfusion, India. FAU - Saxena, Renu AU - Saxena R AD - Department of Hematology, All India Institute Medical Sciences, New Delhi, 110029, India. LA - eng PT - Journal Article DEP - 20201215 PL - Netherlands TA - Pract Lab Med JT - Practical laboratory medicine JID - 101690848 PMC - PMC7771099 OTO - NOTNLM OT - Diagnostic delay OT - Laboratory error OT - Patient safety OT - TEG misinterpretation OT - Turnaround time EDAT- 2021/01/02 06:00 MHDA- 2021/01/02 06:01 PMCR- 2020/12/15 CRDT- 2021/01/01 05:23 PHST- 2020/05/18 00:00 [received] PHST- 2020/12/11 00:00 [accepted] PHST- 2021/01/01 05:23 [entrez] PHST- 2021/01/02 06:00 [pubmed] PHST- 2021/01/02 06:01 [medline] PHST- 2020/12/15 00:00 [pmc-release] AID - S2352-5517(20)30159-1 [pii] AID - e00196 [pii] AID - 10.1016/j.plabm.2020.e00196 [doi] PST - epublish SO - Pract Lab Med. 2020 Dec 15;23:e00196. doi: 10.1016/j.plabm.2020.e00196. eCollection 2021 Jan. PMID- 33381763 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240330 IS - 2639-8028 (Electronic) IS - 2639-8028 (Linking) VI - 2 IP - 12 DP - 2020 Dec TI - Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019-Related Coagulopathy. PG - e0287 LID - 10.1097/CCE.0000000000000287 [doi] LID - e0287 AB - OBJECTIVES: Coagulopathy of coronavirus disease 2019 is largely described as hypercoagulability, yet both thrombotic and hemorrhagic complications occur. Although therapeutic and prophylactic anticoagulant interventions have been recommended, empiric use of antifactor medications (heparin/enoxaparin) may result in hemorrhagic complications, including death. Furthermore, traditional (antifactor) anticoagulation does not address the impact of overactive platelets in coronavirus disease 2019. The primary aim was to evaluate if algorithm-guided thromboelastography with platelet mapping could better characterize an individual's coronavirus disease 2019-relatedcoagulopathic state and, secondarily, improve outcomes. DESIGN SETTING AND PATIENTS: Coronavirus disease 2019 patients (n = 100), receiving thromboelastography with platelet mapping assay upon admission to an 800-bed tertiary-care hospital, were followed prospectively by a hospital-based thromboelastography team. Treating clinicians were provided with the option of using a pre-established algorithm for anticoagulation, including follow-up thromboelastography with platelet mapping assays. Two groups evolved: 1) patients managed by thromboelastography with platelet mapping algorithm (algorithm-guided-thromboelastography); 2) those treated without thromboelastography with platelet mapping protocols (non-algorithm-guided). Outcomes included thrombotic/hemorrhagic complications, pulmonary failure, need for mechanical ventilation, acute kidney injury, dialysis requirement, and nonsurvival. INTERVENTIONS: Standard-of-care therapy with or without algorithm-guided-thromboelastography support. MEASUREMENTS AND MAIN RESULTS: Although d-dimer, C-reactive protein, and ferritin were elevated significantly in critically ill (nonsurvivors, acute kidney injury, pulmonary failure), they did not distinguish between coagulopathic and noncoagulopathic patients. Platelet hyperactivity (maximum amplitude-arachidonic acid/adenosine diphosphate > 50 min), with or without thrombocytosis, was associated with thrombotic/ischemic complications, whereas severe thrombocytopenia (platelet count < 100,000/muL) was uniformly fatal. Hemorrhagic complications were observed with decreased factor activity (reaction time > 8 min). Non-algorithm-guided patients had increased risk for subsequent mechanical ventilation (relative risk = 10.9; p < 0.0001), acute kidney injury (relative risk = 2.3; p = 0.0017), dialysis (relative risk = 7.8; p < 0.0001), and death (relative risk = 7.7; p < 0.0001), with 17 of 28 non-algorithm-guided patients (60.7%) dying versus four algorithm-guided-thromboelastography patients (5.6%) (p < 0.0001). Thromboelastography with platelet mapping-guided antiplatelet treatment decreased mortality 82% (p = 0.0002), whereas non-algorithm-guided (compared with algorithm-guided-thromboelastography) use of antifactor therapy (heparin/enoxaparin) resulted in 10.3-fold increased mortality risk (p = 0.0001). CONCLUSIONS: Thromboelastography with platelet mapping better characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more tailored, patient-specific therapies in those infected with coronavirus disease 2019. CI - Copyright (c) 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. FAU - Hranjec, Tjasa AU - Hranjec T AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - Estreicher, Michael AU - Estreicher M AD - Emergency Department, Memorial Regional Hospital, Hollywood, FL. FAU - Rogers, Bradley AU - Rogers B AD - Pharmacy, Memorial Regional Hospital, Hollywood, FL. FAU - Kohler, Lisa AU - Kohler L AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - Solomon, Rachele AU - Solomon R AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. FAU - Hennessy, Sara AU - Hennessy S AD - Department of Surgery, Division of Trauma/Acute Care/Critical Care Surgery, Bariatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX. FAU - Cibulas, Megan AU - Cibulas M AD - Memorial Hospital West, Pembroke Pines, FL. FAU - Hurst, Deborah AU - Hurst D AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - Hegazy, Mohamed AU - Hegazy M AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. FAU - Lee, Jieun AU - Lee J AD - Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL. FAU - Perez, Donny AU - Perez D AD - Emergency Department, Memorial Regional Hospital, Hollywood, FL. FAU - Doctor, Norman AU - Doctor N AD - Pharmacy, Memorial Regional Hospital, Hollywood, FL. FAU - Kiffin, Chauniqua AU - Kiffin C AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - Pigneri, Danielle AU - Pigneri D AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - LaGuardia, Heather AU - LaGuardia H AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. FAU - Shaw, Kathryn AU - Shaw K AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. FAU - Arenas, Juan AU - Arenas J AD - Division of Transplantation, Memorial Regional Hospital, Hollywood, FL. FAU - Rosenthal, Andrew AU - Rosenthal A AD - Division of Trauma/Acute Care/Critical Care Surgery, Memorial Regional Hospital, Hollywood, FL. FAU - Katz, Randy S AU - Katz RS AD - Emergency Department, Memorial Regional Hospital, Hollywood, FL. FAU - Sawyer, Robert G AU - Sawyer RG AD - Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI. FAU - Pepe, Paul E AU - Pepe PE AD - Metropolitan Emergency Medical Services Medical Directors Alliance, Dallas, TX. AD - Department of Management, Policy and Community Health, University of Texas Health Sciences Center, School of Public Health, Houston, TX. LA - eng PT - Journal Article DEP - 20201221 PL - United States TA - Crit Care Explor JT - Critical care explorations JID - 101746347 PMC - PMC7769351 OTO - NOTNLM OT - COVID-19 anticoagulation OT - COVID-19 coagulopathy OT - TEG-PM OT - platelet hyperactivity OT - platelet mapping OT - thromboelastrography COIS- The authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2021/01/01 06:00 MHDA- 2021/01/01 06:01 PMCR- 2020/12/21 CRDT- 2020/12/31 05:28 PHST- 2020/12/31 05:28 [entrez] PHST- 2021/01/01 06:00 [pubmed] PHST- 2021/01/01 06:01 [medline] PHST- 2020/12/21 00:00 [pmc-release] AID - 10.1097/CCE.0000000000000287 [doi] PST - epublish SO - Crit Care Explor. 2020 Dec 21;2(12):e0287. doi: 10.1097/CCE.0000000000000287. eCollection 2020 Dec. PMID- 33350861 OWN - NLM STAT- MEDLINE DCOM- 20220224 LR - 20220224 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 88 IP - 3 DP - 2022 Mar TI - Does the Degree of Platelet Adenosine Diphosphate and Arachidonic Acid Receptor Inhibition Correlate With the Severity of Injury in Non-Brain-Injured Trauma Patients? PG - 384-388 LID - 10.1177/0003134820954832 [doi] AB - BACKGROUND: Direct correlations between platelet adenosine diphosphate (ADP) and arachidonic acid (AA) receptor inhibition have been described in the traumatic brain injury (TBI) population. Our goal was to evaluate the percent inhibition of ADP receptor inhibition (ADPri) and AA receptor inhibition (AAri) receptors in non-TBI patients and correlate injury severity and outcomes. METHODS: We performed a retrospective review of non-TBI patients admitted to our trauma center, who received thromboelastography with platelet mapping prior to blood transfusion. Exclusion criteria included patients younger than 18 years, current antiplatelet therapy, or history of renal failure. Univariate descriptive statistics and bivariate comparisons were performed on patient demographic and outcomes. Multivariable linear regression models were constructed to quantify any association between ADPri and AAri with injury outcomes. High ADP inhibition was defined >20% and high AA inhibition >7%. RESULTS: 117 patients met inclusion criteria. Mean age was 53 years with 61% male. Mean ADPri was 64% and AAri 42%. On bivariate analysis, no statistically significant differences with respect to injury severity measures or outcomes were identified. On multivariable linear regression, AAri was associated with longer hospital length of stay. DISCUSSION: There was a high degree of platelet dysfunction in this cohort of severely injured patients without TBI. Despite this, the only correlation identified between injury severity and outcomes was AAri correlating with hospital length of stay. Irrespective of injury severity or outcomes, these patients' results were far from reported "normal" values. Further, research is needed to determine the significance and clinical implications of thromboelastography with platelet mapping use in trauma care. FAU - Woodruff, Grant AU - Woodruff G AD - Department of Surgery, 137869University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA. FAU - Price, Dustin AU - Price D AD - Department of Surgery, 12235University of Miami Jackson Memorial Hospital, Miami, FL, USA. FAU - Sodhi, Aparna AU - Sodhi A AD - 3270Northwestern University, Evanston, IL, USA. FAU - Kerwin, Andrew AU - Kerwin A AD - Department of Surgery, 137869University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA. FAU - Crandall, Marie AU - Crandall M AD - Department of Surgery, 137869University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA. LA - eng PT - Journal Article DEP - 20201222 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Anticoagulants) RN - 0 (Receptors, Purinergic P1) RN - 27YG812J1I (Arachidonic Acid) RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Adenosine Diphosphate/*blood MH - Anticoagulants/administration & dosage MH - Arachidonic Acid/*blood MH - *Blood Platelets MH - Female MH - Humans MH - Injury Severity Score MH - Length of Stay MH - Linear Models MH - Male MH - Middle Aged MH - Receptors, Purinergic P1 MH - Retrospective Studies MH - *Thrombelastography/methods MH - Wounds and Injuries/*blood OTO - NOTNLM OT - trauma OT - trauma acute care EDAT- 2020/12/23 06:00 MHDA- 2022/02/25 06:00 CRDT- 2020/12/22 12:16 PHST- 2020/12/23 06:00 [pubmed] PHST- 2022/02/25 06:00 [medline] PHST- 2020/12/22 12:16 [entrez] AID - 10.1177/0003134820954832 [doi] PST - ppublish SO - Am Surg. 2022 Mar;88(3):384-388. doi: 10.1177/0003134820954832. Epub 2020 Dec 22. PMID- 33337787 OWN - NLM STAT- MEDLINE DCOM- 20211215 LR - 20230824 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 55 IP - 1 DP - 2021 Jan 1 TI - Is Tranexamic Acid Associated With Mortality or Multiple Organ Failure Following Severe Injury? PG - 55-60 LID - 10.1097/SHK.0000000000001608 [doi] AB - BACKGROUND: Tranexamic acid (TXA) administration is recommended in severely injured trauma patients. We examined TXA administration, admission fibrinolysis phenotypes, and clinical outcomes following traumatic injury and hypothesized that TXA was associated with increased multiple organ failure (MOF). METHODS: Two-year, single-center, retrospective investigation. Inclusion criteria were age >/= 18 years, Injury Severity Score (ISS) >16, admitted from scene of injury, thromboelastography within 30 min of arrival. Fibrinolysis was evaluated by lysis at 30 min (LY30) and fibrinolysis phenotypes were defined as: Shutdown: LY30 /= 3.0%. Primary outcomes were 28-day mortality and MOF. The association of TXA with mortality and MOF was assessed among the entire study population and in each of the fibrinolysis phenotypes. RESULTS: Four hundred twenty patients: 144/420 Shutdown (34.2%), 96/420 Physiologic (22.9%), and 180/410 Hyperfibrinolysis (42.9%). There was no difference in 28-day mortality by TXA administration among the entire study population (P = 0.52). However, there was a significant increase in MOF in patients who received TXA (11/46, 23.9% vs 16/374, 4.3%; P < 0.001). TXA was associated MOF (OR: 3.2, 95% CI 1.2-8.9), after adjusting for confounding variables. There was no difference in MOF in patients who received TXA in the Physiologic (1/5, 20.0% vs 7/91, 7.7%; P = 0.33) group. There was a significant increase in MOF among patients who received TXA in the Shutdown (3/11, 27.3% vs 5/133, 3.8%; P = 0.001) and Hyperfibrinolysis (7/30, 23.3% vs 5/150, 3.3%; P = 0.001) groups. CONCLUSIONS: Administration of TXA following traumatic injury was associated with MOF in the fibrinolysis shutdown and hyperfibrinolysis phenotypes and warrants continued evaluation. CI - Copyright (c) 2020 by the Shock Society. FAU - Richards, Justin E AU - Richards JE AD - Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Fedeles, Benjamin T AU - Fedeles BT AD - Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. FAU - Chow, Jonathan H AU - Chow JH AD - Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. FAU - Morrison, Jonathan J AU - Morrison JJ AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Renner, Corinne AU - Renner C AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Trinh, Anthony T AU - Trinh AT AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Schlee, Caroline S AU - Schlee CS AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Koerner, Ken AU - Koerner K AD - Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Grissom, Thomas E AU - Grissom TE AD - Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Betzold, Richard D AU - Betzold RD AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Scalea, Thomas M AU - Scalea TM AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. FAU - Kozar, Rosemary A AU - Kozar RA AD - Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. AD - University of Maryland School of Medicine, Baltimore, Maryland. LA - eng PT - Journal Article PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Antifibrinolytic Agents/*therapeutic use MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Multiple Organ Failure/*epidemiology MH - Retrospective Studies MH - Survival Rate MH - Thrombelastography MH - Tranexamic Acid/*therapeutic use MH - Trauma Centers MH - Wounds and Injuries/complications/*mortality/*therapy COIS- The authors report no conflicts of interest. EDAT- 2020/12/19 06:00 MHDA- 2021/12/16 06:00 CRDT- 2020/12/18 15:18 PHST- 2020/12/18 15:18 [entrez] PHST- 2020/12/19 06:00 [pubmed] PHST- 2021/12/16 06:00 [medline] AID - 00024382-202101000-00008 [pii] AID - 10.1097/SHK.0000000000001608 [doi] PST - ppublish SO - Shock. 2021 Jan 1;55(1):55-60. doi: 10.1097/SHK.0000000000001608. PMID- 33336308 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201220 IS - 2197-425X (Print) IS - 2197-425X (Electronic) IS - 2197-425X (Linking) VI - 8 IP - Suppl 1 DP - 2020 Dec 18 TI - Therapeutic application of recombinant human ADAMTS-13 improves shock reversal and coagulation status in a trauma hemorrhage and transfusion rat model. PG - 42 LID - 10.1186/s40635-020-00328-w [doi] LID - 42 AB - INTRODUCTION: In hemorrhaging trauma patients, the endothelium is activated, resulting in excessive endothelial synthesis of von Willebrand Factor (vWF), which may enhance micro-thrombi formation, resulting in obstruction of the microcirculation and endothelial injury, aggravating bleeding, as well as contributing to organ failure. Under normal conditions, vWF is cleaved by the metalloprotease ADAMTS-13. After trauma, ADAMTS-13 levels are reduced. OBJECTIVES: To assess whether recombinant human ADAMTS-13 inhibits endothelial injury and organ failure in a rat trauma-transfusion model. METHODS: Blood products were prepared from syngeneic rat blood according to blood bank standards. Polytrauma was induced in rats by crush injury to the intestines and liver and by fracture of the femur. The rats were hemorrhaged until a mean arterial pressure (MAP) of 40 mmHg was reached. Rats were randomized to receive transfusion of RBCs, FFPs, and platelets in a 1:1:1 ratio to achieve a MAP of 70 mmHg, with or without the addition of ADAMTS-13 (50 mug/kg). Blood samples were assessed for biochemistry and rotational thromboelastometry (ROTEM). Syndecan-1 and VE-cadherin levels were measured as a reflection of endothelial integrity. The amount of leakage of dextran-FITC from the vascular system to the parenchyma in lungs was quantified. To assess inflammation, IL-6 and IL-8 levels were determined. Organ damage was assessed by histopathology. RESULTS: All rats were severely shocked, with no significant differences in shock parameters between groups. Rats treated with ADAMTS-13 showed signs of a more effective shock reversal (higher blood pressure, lower lactate levels) compared to controls. Also, ROTEM parameters of clot formation in rats receiving ADAMTS-13 improved compared to controls, which was mainly platelet-dependent. Syndecan-1 levels relative to baseline trended to be lower in ADAMTS-13 treated rats compared to controls (107 vs 149%, p = 0.08). ADAMTS-13 reduced albuminuria (1.7 vs 4.4 g/L, p < 0.01) and organ-specific inflammation (pulmonary IL-6 243 vs 369 pg/mL, p = 0.08; splenic IL-6 253 vs 307, p = 0.03) compared to controls, but did not improve histopathological scores. CONCLUSIONS: The use of ADAMTS-13 in a rat trauma-transfusion model improves parameters of shock, platelet-driven coagulation, endothelial damage, and organ inflammation. These results suggest that ADAMTS-13 is important in mediating outcome of trauma. Whether ADAMTS-13 can be used as a therapeutic adjunct to treat bleeding trauma patients remains to be determined. FAU - Wirtz, Mathijs R AU - Wirtz MR AUID- ORCID: 0000-0002-1923-083X AD - Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. m.r.wirtz@amsterdamumc.nl. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. m.r.wirtz@amsterdamumc.nl. AD - Department of Trauma Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. m.r.wirtz@amsterdamumc.nl. FAU - van den Brink, Daan P AU - van den Brink DP AD - Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. AD - Department of Trauma Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. FAU - Roelofs, Joris J T H AU - Roelofs JJTH AD - Department of Pathology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. FAU - Goslings, J Carel AU - Goslings JC AD - Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. LA - eng PT - Journal Article DEP - 20201218 PL - Germany TA - Intensive Care Med Exp JT - Intensive care medicine experimental JID - 101645149 PMC - PMC7746419 OTO - NOTNLM OT - ADAMTS-13 OT - Coagulopathy OT - Hemorrhage OT - Resuscitation OT - Trauma COIS- None. EDAT- 2020/12/19 06:00 MHDA- 2020/12/19 06:01 PMCR- 2020/12/18 CRDT- 2020/12/18 05:55 PHST- 2020/07/14 00:00 [received] PHST- 2020/07/16 00:00 [accepted] PHST- 2020/12/18 05:55 [entrez] PHST- 2020/12/19 06:00 [pubmed] PHST- 2020/12/19 06:01 [medline] PHST- 2020/12/18 00:00 [pmc-release] AID - 10.1186/s40635-020-00328-w [pii] AID - 328 [pii] AID - 10.1186/s40635-020-00328-w [doi] PST - epublish SO - Intensive Care Med Exp. 2020 Dec 18;8(Suppl 1):42. doi: 10.1186/s40635-020-00328-w. PMID- 33326931 OWN - NLM STAT- MEDLINE DCOM- 20210910 LR - 20210910 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 260 DP - 2021 Apr TI - The Impact of Rapid Infuser Use on the Platelet Count, Platelet Function, and Hemostatic Potential of Whole Blood. PG - 76-81 LID - S0022-4804(20)30810-6 [pii] LID - 10.1016/j.jss.2020.10.030 [doi] AB - BACKGROUND: Rapid infusion pumps employing filters, roller pumps, and heat exchangers for the administration of blood products are not approved for platelets or cryoprecipitate. This technology may decrease platelet count and degrade coagulation proteins. The effect of rapid infusers on the hemostatic potential of whole blood is unknown. METHODS: Five units of low titer O+ whole blood were obtained from anonymous donors. Each unit was subjected to infusion by five different techniques: (1) gravity infusion without a filter, (2) gravity infusion with a filter, (3) Belmont rapid infuser at 70 mL/min, (4) Belmont at 100 mL/min, and (5) pressurized infusion with a pneumatic pressure bag and filter. After infusion, platelet count, platelet function, thrombin generation, and hemostatic potential were measured for each aliquot. Infusion techniques were compared, using gravity infusion without a filter as the control. RESULTS: There was a significant decrease in platelet count from baseline (168,000) in the BELMONT70 (97,000) and BELMONT100 (94,000) groups (P < 0.05). However, there were no differences in platelet function (all P > 0.20). While there were no differences in thromboelastography parameters between control and infusion models (all P > 0.20), there were significant increases in thrombin generation parameters by CAT in both the BELMONT70 and BELMONT100 groups (all P < 0.05). CONCLUSIONS: The use of a rapid infuser decreases the platelet count of WB but does not decrease platelet function or overall hemostatic potential. In fact, thrombin generation and thrombin potential are actually increased. Rapid infusers are safe for the transfusion of WB. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Zaza, Mouayyad AU - Zaza M AD - Department of Surgery at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. FAU - Meyer, David E AU - Meyer DE AD - Department of Surgery at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas; Center for Translational Injury Research (CeTIR) at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. Electronic address: david.e.meyer@uth.tmc.edu. FAU - Wang, Yao-Wei AU - Wang YW AD - Center for Translational Injury Research (CeTIR) at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. FAU - George, Mitchell AU - George M AD - Department of Surgery at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. FAU - Daniels, Katherine AU - Daniels K AD - Center for Translational Injury Research (CeTIR) at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research (CeTIR) at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas; Center for Translational Injury Research (CeTIR) at the University of Texas Health Science Center's McGovern Medical School, Houston, Texas. LA - eng PT - Comparative Study PT - Journal Article DEP - 20201214 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Biomarkers) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Biomarkers/blood MH - Blood Platelets/*physiology MH - Blood Transfusion/*instrumentation/methods MH - Hemostasis/*physiology MH - Humans MH - Infusion Pumps/*adverse effects MH - Platelet Count MH - Platelet Function Tests MH - Thrombelastography MH - Thrombin/metabolism OTO - NOTNLM OT - Hemostasis OT - Rapid infuser OT - Resuscitation OT - Trauma OT - Whole blood EDAT- 2020/12/17 06:00 MHDA- 2021/09/11 06:00 CRDT- 2020/12/16 20:08 PHST- 2020/05/03 00:00 [received] PHST- 2020/09/02 00:00 [revised] PHST- 2020/10/31 00:00 [accepted] PHST- 2020/12/17 06:00 [pubmed] PHST- 2021/09/11 06:00 [medline] PHST- 2020/12/16 20:08 [entrez] AID - S0022-4804(20)30810-6 [pii] AID - 10.1016/j.jss.2020.10.030 [doi] PST - ppublish SO - J Surg Res. 2021 Apr;260:76-81. doi: 10.1016/j.jss.2020.10.030. Epub 2020 Dec 14. PMID- 33317318 OWN - NLM STAT- MEDLINE DCOM- 20210913 LR - 20230920 IS - 1555-9823 (Electronic) IS - 0003-1348 (Print) IS - 0003-1348 (Linking) VI - 87 IP - 7 DP - 2021 Jul TI - Pathologic Fibrinolysis is More Common in a Rural Trauma Setting. PG - 1112-1117 LID - 10.1177/0003134820973726 [doi] AB - INTRODUCTION: Fibrinolysis (lysis) has been extensively studied in trauma patients. Many studies on the distribution of lysis phenotype have been conducted in setting with short prehospital time. This study aimed to evaluate the distribution of lysis phenotypes in a population with prolonged prehospital times in a rural environment. METHODS: A retrospective study was performed at an American College of Surgeons-verified level 1 trauma center, serving a large rural population. Full trauma team activations from January 1, 2017 to August 31, 2018 were evaluated, and all patients with an ISS>15 analyzed. Thromboelastography was routinely performed on all participants on arrival. Lysis phenotypes were classified based on LY30 results: shutdown (2.9%). RESULTS: 259 patients were evaluated, 134 (52%) presented direct from the scene. For scene patients, lysis distribution was 24% physiologic, 49% shutdown, and 27% hyper. Transferred patients demonstrated a reduction in physiologic lysis to 14% (P = .03), shutdown present in 66%, and hyper in 20%. Empiric prehospital tranexamic acid was given to 18 patients, physiologic lysis was present in 6%, shutdown 72%, and hyper 22%; this increase was not statistically significant (P = .5). CONCLUSION: Fibrinolysis phenotypes are not consistent across all trauma populations. This study showed rural trauma patients had a significantly increased rate of pathologic lysis. This was consistent for scene and transfer patients who received care at another facility prior to arrival for definitive care. Future studies to evaluate the factors influencing these differences are warranted. FAU - Bardes, James M AU - Bardes JM AD - Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 53422West Virginia University, Morgantown, WV, USA. FAU - Grabo, Daniel J AU - Grabo DJ AD - Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 53422West Virginia University, Morgantown, WV, USA. FAU - Wen, Sijin AU - Wen S AD - School of Public Health, Department of Biostatics, 53422West Virginia University, Morgantown, WV, USA. FAU - Wilson, Alison AU - Wilson A AD - Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 53422West Virginia University, Morgantown, WV, USA. LA - eng GR - U54 GM104942/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20201215 PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*diagnosis/*epidemiology MH - Female MH - *Fibrinolysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Retrospective Studies MH - Rural Population/*statistics & numerical data MH - Thrombelastography MH - West Virginia MH - Wounds and Injuries/*blood/*complications/mortality PMC - PMC8203746 MID - NIHMS1681898 OTO - NOTNLM OT - fibrinolysis OT - rural trauma COIS- Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2020/12/16 06:00 MHDA- 2021/09/14 06:00 PMCR- 2022/07/01 CRDT- 2020/12/15 05:38 PHST- 2020/12/16 06:00 [pubmed] PHST- 2021/09/14 06:00 [medline] PHST- 2020/12/15 05:38 [entrez] PHST- 2022/07/01 00:00 [pmc-release] AID - 10.1177/0003134820973726 [doi] PST - ppublish SO - Am Surg. 2021 Jul;87(7):1112-1117. doi: 10.1177/0003134820973726. Epub 2020 Dec 15. PMID- 33280852 OWN - NLM STAT- MEDLINE DCOM- 20210616 LR - 20210616 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 56 IP - 2 DP - 2021 Feb TI - Meaningful viscoelastic abnormalities in abusive and non-abusivepediatric trauma. PG - 397-400 LID - S0022-3468(20)30767-3 [pii] LID - 10.1016/j.jpedsurg.2020.10.018 [doi] AB - BACKGROUND/PURPOSE: There remains a lack of data on the utility of viscoelastic tests in managing abused patients. We hypothesize that abnormalities on admission thrombelastography (TEG) will differ in abused patients compared to those accidentally injured. METHODS: Pediatric trauma patients ( 0.7). Cryoprecipitate improved R-time (7.5 versus 11.9 min, P < 0.01), angle (56.8 versus 30.2 degrees ) and MA (49 mm versus 36.25 mm), while platelets improved MA (44 mm versus 36.25 mm) compared to TIC + tPA (P < 0.03 for all). CONCLUSIONS: No single blood component or volume of whole blood led to attenuation of tPA-mediated fibrinolysis in an in vitro model of TIC. Cryoprecipitate was the most effective at improving coagulation function. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado. Electronic address: ernest.moore@dhha.org. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Kelher, Marguerite AU - Kelher M AD - Department of Surgery, University of Colorado, Aurora, Colorado; Vitalant Research Institute, Vitalant Mountain Division, Denver, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado, Aurora, Colorado; Vitalant Research Institute, Vitalant Mountain Division, Denver, Colorado; Department of Pediatrics, University of Colorado, Aurora, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20201202 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - EC 3.4.21.68 (PLAT protein, human) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Blood Coagulation Disorders/blood/diagnosis/etiology/*therapy MH - Blood Component Transfusion/*methods MH - Healthy Volunteers MH - Humans MH - In Vitro Techniques MH - Resuscitation/*methods MH - Thrombelastography MH - Tissue Plasminogen Activator/blood/metabolism MH - Trauma Severity Indices MH - Wounds and Injuries/blood/*complications/diagnosis PMC - PMC7897253 MID - NIHMS1645439 OTO - NOTNLM OT - Blood component therapy OT - Hyperfibrinolysis OT - Trauma-induced coagulopathy OT - Whole blood EDAT- 2020/12/06 06:00 MHDA- 2021/05/11 06:00 PMCR- 2022/03/01 CRDT- 2020/12/05 20:14 PHST- 2020/06/07 00:00 [received] PHST- 2020/09/24 00:00 [revised] PHST- 2020/10/31 00:00 [accepted] PHST- 2020/12/06 06:00 [pubmed] PHST- 2021/05/11 06:00 [medline] PHST- 2020/12/05 20:14 [entrez] PHST- 2022/03/01 00:00 [pmc-release] AID - S0022-4804(20)30767-8 [pii] AID - 10.1016/j.jss.2020.10.022 [doi] PST - ppublish SO - J Surg Res. 2021 Mar;259:55-61. doi: 10.1016/j.jss.2020.10.022. Epub 2020 Dec 2. PMID- 33275705 OWN - NLM STAT- MEDLINE DCOM- 20210324 LR - 20210324 IS - 1520-4383 (Electronic) IS - 1520-4391 (Print) IS - 1520-4383 (Linking) VI - 2020 IP - 1 DP - 2020 Dec 4 TI - "TEG talk": expanding clinical roles for thromboelastography and rotational thromboelastometry. PG - 67-75 LID - 10.1182/hematology.2020000090 [doi] AB - Viscoelastic assays (VEAs) that include thromboelastography and rotational thromboelastometry add value to the investigation of coagulopathies and goal-directed management of bleeding by providing a complete picture of clot formation, strength, and lysis in whole blood that includes the contribution of platelets, fibrinogen, and coagulation factors. Conventional coagulation assays have several limitations, such as their lack of correlation with bleeding and hypercoagulability; their inability to reflect the contribution of platelets, factor XIII, and plasmin during clot formation and lysis; and their slow turnaround times. VEA-guided transfusion algorithms may reduce allogeneic blood exposure during and after cardiac surgery and in the emergency management of trauma-induced coagulopathy and hemorrhage. However, the popularity of VEAs for other indications is driven largely by extrapolation of evidence from cardiac surgery, by the drawbacks of conventional coagulation assays, and by institution-specific preferences. Robust diagnostic studies validating and standardizing diagnostic cutoffs for VEA parameters and randomized trials comparing VEA-guided algorithms with standard care on clinical outcomes are urgently needed. Lack of such studies represents the biggest barrier to defining the role and impact of VEA in clinical care. CI - (c) 2020 by The American Society of Hematology. FAU - Selby, Rita AU - Selby R AD - Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article PL - United States TA - Hematology Am Soc Hematol Educ Program JT - Hematology. American Society of Hematology. Education Program JID - 100890099 RN - 9013-56-3 (Factor XIII) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - *Algorithms MH - Blood Platelets/metabolism MH - *Blood Transfusion MH - *Cardiac Surgical Procedures MH - Factor XIII/metabolism MH - Fibrinolysin/metabolism MH - *Hemorrhage/blood/diagnosis/therapy MH - Humans MH - *Thrombelastography MH - *Thrombophilia/blood/diagnosis/therapy PMC - PMC7727516 COIS- Conflict-of-interest disclosure R. S. has no conflicts of interest to declare. EDAT- 2020/12/05 06:00 MHDA- 2021/03/25 06:00 PMCR- 2020/12/04 CRDT- 2020/12/04 17:10 PHST- 2020/12/04 17:10 [entrez] PHST- 2020/12/05 06:00 [pubmed] PHST- 2021/03/25 06:00 [medline] PHST- 2020/12/04 00:00 [pmc-release] AID - 474316 [pii] AID - 2020000090C [pii] AID - 10.1182/hematology.2020000090 [doi] PST - ppublish SO - Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):67-75. doi: 10.1182/hematology.2020000090. PMID- 33262965 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201207 IS - 2296-2360 (Print) IS - 2296-2360 (Electronic) IS - 2296-2360 (Linking) VI - 8 DP - 2020 TI - Hemostatic Balance in Severe Trauma. PG - 600501 LID - 10.3389/fped.2020.600501 [doi] LID - 600501 AB - Acute coagulopathy is prevalent in adult and pediatric trauma patients and is associated with increased morbidity and mortality. While reasonable hypotheses have been created to explain the underlying perturbations of adult trauma coagulopathy (i.e., tissue factor-related increase in thrombin generation, protein C activation, hypoperfusion, and hyperfibrinolysis), only a small number of studies have been performed to prove whether these mechanisms can likewise be detected in pediatric trauma patients. In addition, severe hypofibrinogenemia (<100 mg/dL) is a frequent finding in pediatric trauma patients (>20%). Although the probability of life-threatening coagulopathy is low with minor to moderate injury, it is present in almost all patients with an injury severity score >25, hypotension, hypothermia, and acidosis. As these multifactorial changes in hemostasis cannot be adequately and rapidly measured using standard laboratory testing, the use of viscoelastic measurements has been established in adult trauma management, but prospective studies in children are urgently needed. Apart from diagnostic challenges, several studies have focused on the impact of blood product ratios on the treatment of massively bleeding pediatric trauma patients. The majority of these studies were unable to show improved survival by using higher plasma to red blood cell ratios or higher platelet to red blood cells ratios, but there are no published randomized trials to definitively answer this question. A goal-directed transfusion protocol using viscoelastic tests together with early substitution with an antifibrinolytic and fibrinogen replacement is a promising alternative to traditional ratio-based interventions. Another crucial factor in treating trauma-induced coagulopathy is the early detection of hypofibrinogenemia, a common condition in massively transfused patients. Early treatment of hypofibrinogenemia is associated with improved morbidity and mortality in adults, but needs to be further studied in future pediatric trials. Pediatric trauma patients are not only threatened by coagulopathy-related bleeding but are also at higher risk for venous thromboembolism. Pediatric trauma patients with brain injury, central venous catheters, immobilization, or surgical procedures are at highest risk for developing a deep venous thrombosis. There are no specific pediatric guidelines established to prevent venous thromboembolism in children suffering from traumatic injury. CI - Copyright (c) 2020 Haas and Cushing. FAU - Haas, Thorsten AU - Haas T AD - Department of Pediatric Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland. FAU - Cushing, Melissa M AU - Cushing MM AD - Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States. LA - eng PT - Journal Article PT - Review DEP - 20201111 PL - Switzerland TA - Front Pediatr JT - Frontiers in pediatrics JID - 101615492 PMC - PMC7687220 OTO - NOTNLM OT - coagulation factor concentrates OT - massive bleeding OT - pediatrics OT - thrombosis OT - transfusion OT - trauma OT - viscoelastic testing EDAT- 2020/12/03 06:00 MHDA- 2020/12/03 06:01 PMCR- 2020/11/11 CRDT- 2020/12/02 05:33 PHST- 2020/08/30 00:00 [received] PHST- 2020/10/15 00:00 [accepted] PHST- 2020/12/02 05:33 [entrez] PHST- 2020/12/03 06:00 [pubmed] PHST- 2020/12/03 06:01 [medline] PHST- 2020/11/11 00:00 [pmc-release] AID - 10.3389/fped.2020.600501 [doi] PST - epublish SO - Front Pediatr. 2020 Nov 11;8:600501. doi: 10.3389/fped.2020.600501. eCollection 2020. PMID- 33231378 OWN - NLM STAT- MEDLINE DCOM- 20210614 LR - 20210614 IS - 1751-553X (Electronic) IS - 1751-5521 (Linking) VI - 43 IP - 3 DP - 2021 Jun TI - Higher coagulation activity in hip fracture patients: A case-control study using rotational thromboelastometry. PG - 477-484 LID - 10.1111/ijlh.13409 [doi] AB - INTRODUCTION: Trauma-induced coagulopathy has been extensively investigated in the multitrauma setting, but only sparsely following moderate orthopedic trauma. The purpose of this study was to evaluate changes in the hemostatic profile of patients with hip fractures, using rotational thromboelastometry (ROTEM). METHODS: 198 patients with hip fractures who underwent surgery were included in the study. A matched group of 52 healthy individuals was also enrolled. Demographics, conventional laboratory assays, and ROTEM parameters were recorded and compared between patients and healthy adults. The preoperative and postoperative ROTEM values of fractured patients were also compared. RESULTS: The conventional coagulation assays were similar for the 2 groups. However, several ROTEM parameters including EXTEM MCF (P < .001), EXTEM alpha angle (P < .001), INTEM MCF (P < .001), INTEM A10 (P < .001), and INTEM alpha angle (P < .001) significantly differed between the 2 groups indicating a higher coagulation potential following hip fractures. Also, fractured patients had significantly lower INTEM and EXTEM CT values (P = .008 and P = .012, respectively) and significantly lower INTEM and EXTEM CFT values (P < .001). Adjusted analysis for confounders further confirmed the direct relationship between hip fracture and higher coagulation activity. Last, INTEM CT and CFT significantly decreased (P = .008 and P < .001, respectively), while INTEM MCF, A10, and alpha angle significantly increased (P < .001) postoperatively, indicating that surgery further increases the coagulation potential. CONCLUSION: A higher coagulation activity following hip fractures and surgical treatment can be detected by ROTEM shortly after the injury, even when this is undetectable by conventional coagulation assays. CI - (c) 2020 John Wiley & Sons Ltd. FAU - Tsantes, Andreas G AU - Tsantes AG AUID- ORCID: 0000-0002-3695-0759 AD - Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. FAU - Trikoupis, Ioannis G AU - Trikoupis IG AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Papadopoulos, Dimitrios V AU - Papadopoulos DV AD - Department of Orthopaedic Surgery, University of Pittsburgh, Orthopedic Specialists-UPMC, Pittsburgh, PA, USA. FAU - Tsante, Konstantina A AU - Tsante KA AD - Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Caring Sciences, University of West Attica (UniWA), Egaleo, Greece. FAU - Mavrogenis, Andreas F AU - Mavrogenis AF AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Koulouvaris, Panagiotis AU - Koulouvaris P AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Savvidou, Olga D AU - Savvidou OD AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Kontogeorgakos, Vasilios A AU - Kontogeorgakos VA AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Piovani, Daniele AU - Piovani D AD - Department of Biomedical Sciences, Humanitas University, Milan, Italy. AD - Humanitas Clinical and Research Center- IRCCS, Milan, Italy. FAU - Kriebardis, Anastasios G AU - Kriebardis AG AD - Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Caring Sciences, University of West Attica (UniWA), Egaleo, Greece. FAU - Bonovas, Stefanos AU - Bonovas S AD - Department of Biomedical Sciences, Humanitas University, Milan, Italy. AD - Humanitas Clinical and Research Center- IRCCS, Milan, Italy. FAU - Papagelopoulos, Panayiotis J AU - Papagelopoulos PJ AD - First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. FAU - Tsantes, Argirios E AU - Tsantes AE AD - Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. LA - eng PT - Journal Article DEP - 20201124 PL - England TA - Int J Lab Hematol JT - International journal of laboratory hematology JID - 101300213 SB - IM MH - Aged MH - Aged, 80 and over MH - *Blood Coagulation MH - Case-Control Studies MH - Female MH - Hip Fractures/*blood/complications/surgery MH - Humans MH - Male MH - Postoperative Period MH - Preoperative Period MH - *Thrombelastography/methods MH - Thrombophilia/*blood/complications OTO - NOTNLM OT - hip fractures OT - hypercoagulability OT - rotational thromboelastometry OT - trauma-induced coagulopathy OT - viscoelastic method EDAT- 2020/11/25 06:00 MHDA- 2021/06/16 06:00 CRDT- 2020/11/24 08:40 PHST- 2020/11/02 00:00 [revised] PHST- 2020/09/21 00:00 [received] PHST- 2020/11/07 00:00 [accepted] PHST- 2020/11/25 06:00 [pubmed] PHST- 2021/06/16 06:00 [medline] PHST- 2020/11/24 08:40 [entrez] AID - 10.1111/ijlh.13409 [doi] PST - ppublish SO - Int J Lab Hematol. 2021 Jun;43(3):477-484. doi: 10.1111/ijlh.13409. Epub 2020 Nov 24. PMID- 33230046 OWN - NLM STAT- MEDLINE DCOM- 20210304 LR - 20210520 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 89 IP - 6 DP - 2020 Dec TI - Plasmin thrombelastography rapidly identifies trauma patients at risk for massive transfusion, mortality, and hyperfibrinolysis: A diagnostic tool to resolve an international debate on tranexamic acid? PG - 991-998 LID - 10.1097/TA.0000000000002941 [doi] AB - BACKGROUND: Trauma patients with hyperfibrinolysis and depletion of fibrinolytic inhibitors (DFIs) measured by thrombelastography (TEG) gain clot strength with TXA, but TEG results take nearly an hour. We aimed to develop an assay, plasmin TEG (P-TEG), to more expeditiously stratify risk for massive transfusion (MT), mortality, and hyperfibrinolysis. METHODS: Trauma patients (N = 148) were assessed using TEG assays without exogenous additives (rapid/native), with exogenous plasmin (P-TEG) or tissue plasminogen activator (tPA TEG). The plasmin dose used does not effect healthy-control clot lysis 30 minutes after maximum amplitude (LY30) but causes shortened reaction time (R time) relative to native TEG (P-TEG R time < native TEG R time considered P-TEG negative). If P-TEG R time is greater than or equal to native TEG R time, the patient was considered P-TEG positive. Each assay's ability to predict MT, mortality, and (risk for) hyperfibrinolysis was determined. chi and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. Results were reported as median +/- interquartile range or n (%). RESULTS: Plasmin TEG provided results faster than all other assays (4.7 +/- 2.5-9.1 minutes), approximately 11-fold faster than rapid-TEG (rTEG) LY30 (54.2 +/- 51.1-58.1 minutes; p < 0.001). Plasmin TEG-positive patients had greater than fourfold higher MT rate (30% vs. 7%; p = 0.0015) with an area under the receiver operating characteristic curve of 0.686 (p = 0.028), greater than fourfold higher 24-hour mortality (33.3% vs. 7.8%; p = 0.0177), greater than twofold higher 30-day mortality (35% vs. 16.4%; p = 0.0483), higher rates of DFI (55% vs. 18%; p < 0.001), and a trend toward elevated D-dimer (19.9 vs. 3.3 mug/mL; p = 0.14). Plasmin TEG was associated with hyperfibrinolysis on rTEG LY30 at the 7.6% threshold (p = 0.04) but not the 3% threshold (p = 0.40). Plasmin TEG performed best in relation to DFI, with a positive predictive value of 58% and negative predictive value of 81%. When combined with tPA TEG time to maximum amplitude, P-TEG outperformed rTEG LY30 for predicting MT (area under the receiver operating characteristic curve, 0.811 vs. 0.708). CONCLUSION: Within 5 minutes, P-TEG can stratify patients at highest risk for MT, mortality, and risk for hyperfibrinolysis. In composite with tPA TEG time to maximum amplitude, P-TEG outperforms rTEG LY30 for predicting MT and does so four times faster (12.7 vs. 54.1 minutes). The rapid results of P-TEG may be useful for those who practice selective TXA administration to maximize TXA's time-dependent efficacy. LEVEL OF EVIDENCE: Diagnostic test, level V. FAU - Barrett, Christopher D AU - Barrett CD AD - From the Koch Institute for Integrative Cancer Research (C.D.B., S.D., M.B.Y.), Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge; Division of Acute Care Surgery and Critical Care (C.D.B., M.B.Y.), Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Surgery (H.B.M., N.V., A.S., E.E.M.), University of Colorado Denver, Denver, Colorado; Ernest E. Moore Shock and Trauma Center (J.C., E.E.M.), Denver Health Medical Center; and Department of Radiology (M.P.C.), University of Colorado Denver, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB FAU - Vigneshwar, Navin AU - Vigneshwar N FAU - Dhara, Sanjeev AU - Dhara S FAU - Chandler, James AU - Chandler J FAU - Chapman, Michael P AU - Chapman MP FAU - Sauaia, Angela AU - Sauaia A FAU - Moore, Ernest E AU - Moore EE FAU - Yaffe, Michael B AU - Yaffe MB LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - F32 HL134244/HL/NHLBI NIH HHS/United States GR - L30 GM120751/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 0 (Biomarkers) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Adult MH - Antifibrinolytic Agents/pharmacology MH - Biomarkers/blood MH - Blood Coagulation Disorders/*etiology MH - Blood Transfusion MH - Female MH - Fibrinolysin/metabolism MH - Fibrinolysis/*drug effects MH - Hemorrhage/blood/etiology/prevention & control MH - Humans MH - Male MH - Middle Aged MH - Mortality MH - Predictive Value of Tests MH - ROC Curve MH - Thrombelastography/*methods MH - Time Factors MH - Tissue Plasminogen Activator/metabolism MH - Tranexamic Acid/*pharmacology MH - Wounds and Injuries/*blood/complications/diagnosis EDAT- 2020/11/25 06:00 MHDA- 2021/03/05 06:00 CRDT- 2020/11/24 05:58 PHST- 2020/11/24 05:58 [entrez] PHST- 2020/11/25 06:00 [pubmed] PHST- 2021/03/05 06:00 [medline] AID - 01586154-202012000-00001 [pii] AID - 10.1097/TA.0000000000002941 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Dec;89(6):991-998. doi: 10.1097/TA.0000000000002941. PMID- 33218680 OWN - NLM STAT- MEDLINE DCOM- 20210616 LR - 20210616 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 56 IP - 2 DP - 2021 Feb TI - Decision-making in pediatric blunt solid organ injury: A deep learning approach to predict massive transfusion, need for operative management, and mortality risk. PG - 379-384 LID - S0022-3468(20)30770-3 [pii] LID - 10.1016/j.jpedsurg.2020.10.021 [doi] AB - BACKGROUND: The principal triggers for intervention in the setting of pediatric blunt solid organ injury (BSOI) are declining hemoglobin values and hemodynamic instability. The clinical management of BSOI is, however, complex. We therefore hypothesized that state-of-art machine learning (computer-based) algorithms could be leveraged to discover new combinations of clinical variables that might herald the need for an escalation in care. We developed algorithms to predict the need for massive transfusion (MT), failure of non-operative management (NOM), mortality, and successful non-operative management without intervention, all within 4 hours of emergency department (ED) presentation. METHODS: Children (/=90 mm Hg were randomized prehospital to receive placebo bolus/placebo infusion (placebo), 1 g of TXA bolus/1 g of TXA infusion (bolus maintenance), or 2 g of TXA bolus/placebo infusion (bolus only). Thromboelastography was performed, and coagulation measures including prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, D-dimer, plasmin-antiplasmin (PAP), thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were quantified at admission and 6 hours later. RESULTS: Of 966 patients receiving study drug, 700 had laboratory tests drawn at admission and 6 hours later. There were no statistically significant differences in TEG values, including LY30, between groups (p > 0.05). No differences between prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were demonstrated across treatment groups. Concentrations of D-dimer in TXA treatment groups were less than placebo at 6 hours (p < 0.001). Concentrations of PAP in TXA treatment groups were less than placebo on admission (p < 0.001) and 6 hours (p = 0.02). No differences in D-dimer and PAP were observed between bolus maintenance and bolus only. CONCLUSION: While D-dimer and PAP levels reflect a lower degree of fibrinolysis following prehospital administration of TXA when compared with placebo in a large prehospital trial of patients with TBI, TEG obtained on admission and 6 hours later did not demonstrate any differences in fibrinolysis between the two TXA dosing regimens and placebo. LEVEL OF EVIDENCE: Diagnostic test, level III. FAU - Dixon, Alexandra L AU - Dixon AL AD - From the Departments of Surgery (A.L.D., B.H.M., E.A.R., E.D., D.H.F., S.E.R., M.A.S., M.F.) and Emergency Medicine (J. Jui), Oregon Health and Science University, Portland, Oregon; Departments of Emergency Medicine (J.M.) and Surgery (J. Johannigman), University of Cincinnati, Cincinnati, Ohio; Departments of Surgery (B.R.H.R., E.M.B., P.K.) and Biostatistics (D.K., B.M., E.N.M., S.M., K.S., J.H.), University of Washington, Seattle, Washington; Trauma Surgery (B.T.), Texas Health Presbyterian Hospital; Department of Emergency Medicine (J.S.G.), Baylor University Medical Center, Dallas, Texas; Johns Hopkins School of Medicine (M.L.W.), Baltimore, Maryland; Department of Emergency Medicine (T.P.A., M.R.C.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Emergency Medicine (J.M.T., J.C.), University of British Columbia, Vancouver, British Columbia, Canada; Department of Surgery (S.E.R.), Scripps Memorial Hospital La Jolla, La Jolla, California; Departments of Emergency Medicine (A.H.I.) and Internal Medicine (A.H.I.), University of Texas Southwestern Medical Center, Dallas, Texas; Providence Health Care Research Institute (J.C.), Vancouver, British Columbia, Canada; Rescu, Li Ka Shing Knowledge Institute (L.J.M.), and Department of Surgery (S.R.), St. Michael's Hospital; Division of Emergency Medicine, Department of Medicine Faculty of Medicine (L.J.M.), and Department of Laboratory Medicine and Pathobiology (J.C.), University of Toronto, Toronto, Ontario, Canada; Departments of Emergency Medicine (R.J.F.) and Surgery (D.J.D.), Regions Hospital, St. Paul, Minnesota; Department of Surgery (C.W., P.L.B.), University of Alabama, Birmingham, Alabama; Department of Surgery (C.E.W., B.A.C., L.E.V.), McGovern Medical School, University of Texas Health Science Center, Houston, Texas; Department of Laboratory Medicine and Molecular Diagnostics (J.C.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Departments of Emergency Medicine (N.J.R.) and Surgery (R.R.G.), John Peter Smith Health Network, Fort Worth, Texas; Department of Surgery (M.D.Z., M.F.), Mayo Clinic, Rochester, Minnesota; British Columbia Emergency Health Services (J.M.T., R.S.), Vancouver, British Columbia, Canada; Department of Emergency Medicine (L.K., A.H.), Hennepin County Medical Center, Minneapolis, Minnesota; Department of Surgery (S.R.), St. Michael's Hospital, Toronto, Ontario, Canada; Department of Emergency Medicine (M.G.), Medical City Plano, Plano; Emergency Medicine (R.S.), Methodist Dallas Medical Center, Dallas, Texas; National Heart, Lung, and Blood Institute, National Institutes of Health (G.S.), Bethesda, Maryland; and Department of Trauma Surgery (W.W.), Texas Health Harris Methodist Hospital, Fort Worth, Texas. FAU - McCully, Belinda H AU - McCully BH FAU - Rick, Elizabeth A AU - Rick EA FAU - Dewey, Elizabeth AU - Dewey E FAU - Farrell, David H AU - Farrell DH FAU - Morrison, Laurie J AU - Morrison LJ FAU - McMullan, Jason AU - McMullan J FAU - Robinson, Bryce R H AU - Robinson BRH FAU - Callum, Jeannie AU - Callum J FAU - Tibbs, Brian AU - Tibbs B FAU - Dries, David J AU - Dries DJ FAU - Jui, Jonathan AU - Jui J FAU - Gandhi, Rajesh R AU - Gandhi RR FAU - Garrett, John S AU - Garrett JS FAU - Weisfeldt, Myron L AU - Weisfeldt ML FAU - Wade, Charles E AU - Wade CE FAU - Aufderheide, Tom P AU - Aufderheide TP FAU - Frascone, Ralph J AU - Frascone RJ FAU - Tallon, John M AU - Tallon JM FAU - Kannas, Delores AU - Kannas D FAU - Williams, Carolyn AU - Williams C FAU - Rowell, Susan E AU - Rowell SE FAU - Schreiber, Martin A AU - Schreiber MA LA - eng GR - L30 HL138880/HL/NHLBI NIH HHS/United States GR - U01 HL077866/HL/NHLBI NIH HHS/United States GR - U01 HL077871/HL/NHLBI NIH HHS/United States GR - U01 HL077887/HL/NHLBI NIH HHS/United States GR - U01 HL077863/HL/NHLBI NIH HHS/United States GR - U01 HL077873/HL/NHLBI NIH HHS/United States GR - R01 HL126585/HL/NHLBI NIH HHS/United States GR - U01 HL077881/HL/NHLBI NIH HHS/United States PT - Clinical Trial, Phase II PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (SERPINF2 protein, human) RN - 0 (alpha-2-Antiplasmin) RN - 0 (fibrin fragment D) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Abbreviated Injury Scale MH - Adolescent MH - Adult MH - Antifibrinolytic Agents/*administration & dosage MH - Blood Coagulation/*drug effects MH - Blood Coagulation Disorders MH - Brain Injuries, Traumatic/blood/diagnosis/*drug therapy MH - Female MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinolysin/analysis MH - Fibrinolysis/*drug effects MH - Humans MH - Infusions, Intravenous MH - Injections, Intravenous MH - Male MH - Middle Aged MH - Thrombelastography/statistics & numerical data MH - Time-to-Treatment MH - Tranexamic Acid/*administration & dosage MH - Treatment Outcome MH - Young Adult MH - alpha-2-Antiplasmin/analysis PMC - PMC7878849 MID - NIHMS1622831 COIS- Conflicts of Interest: Dr. Schreiber is a consultant for Haemonetics EDAT- 2020/10/27 06:00 MHDA- 2021/02/03 06:00 PMCR- 2021/11/01 CRDT- 2020/10/26 20:17 PHST- 2020/10/26 20:17 [entrez] PHST- 2020/10/27 06:00 [pubmed] PHST- 2021/02/03 06:00 [medline] PHST- 2021/11/01 00:00 [pmc-release] AID - 01586154-202011000-00009 [pii] AID - 10.1097/TA.0000000000002932 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Nov;89(5):900-907. doi: 10.1097/TA.0000000000002932. PMID- 33093294 OWN - NLM STAT- MEDLINE DCOM- 20210415 LR - 20230825 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 90 IP - 2 DP - 2021 Feb 1 TI - The swine as a vehicle for research in trauma-induced coagulopathy: Introducing principal component analysis for viscoelastic coagulation tests. PG - 360-368 LID - 10.1097/TA.0000000000002997 [doi] AB - BACKGROUND: Uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. Tissue injury and shock result in trauma-induced coagulopathy (TIC). There are still uncertainties regarding detection methods and best practice management for TIC, and a deeper understanding of the pathophysiology requires robust animal models. The applicability of swine in coagulation studies, particularly after trauma has not been sufficiently elucidated. We, therefore, evaluated the swine as a vehicle for TIC research in a selection of trauma modalities. METHODS: Twenty-six landrace swine (3 females/23 males) (mean weight, 60.0 kg) were anesthetized and randomized to negative controls, receiving no manipulation (n = 5), positive controls by hemodilution (n = 5), pulmonary contusion without hemorrhage (n = 5), pulmonary contusion with hemorrhage (n = 5), and blast polytrauma with hypothermia, hypoperfusion, hypoventilation, and systemic inflammation (n = 6). A comprehensive coagulation panel was analyzed at baseline, 20 minutes and 120 minutes after trauma. RESULTS: PT(INR), aPTT, thrombocytes, and fibrinogen did not change after trauma. D-dimer increased (p < 0.0001), prothrombin decreased (p < 0.05) and aPC decreased (p < 0.01) after polytrauma. PAI-1 decreased after pulmonary contusion with hemorrhage (p < 0.05). Positive controls displayed changes in PT(INR), thrombocytes, fibrinogen, prothrombin, aPC (p < 0.05). Principal Component Analysis of rotational thromboelastometry presented pathologic coagulation profiles in both polytrauma and positive control groups with vectors extending outside the 95% confidence interval, which were not detected in negative controls. CONCLUSION: Coagulopathy was induced after severe porcine blast polytrauma, specifically detected in rotational thromboelastometry. A novel method for principal component analysis of viscoelastic tests was introduced which may increase the detection sensitivity and differentiation of TIC phenotypes and should be further investigated in trauma populations. CI - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved. FAU - Brannstrom, Andreas AU - Brannstrom A AD - From the Department of Clinical Science and Education (A.B., L.E.D., A.D., M.G.), Department of Physiology and Pharmacology (E.v.O.), and Department of Neuroscience (A.H., J.G.), Karolinska Institutet, Stockholm, Sweden. FAU - von Oelreich, Erik AU - von Oelreich E FAU - Degerstedt, Louise Elander AU - Degerstedt LE FAU - Dahlquist, Albin AU - Dahlquist A FAU - Hanell, Anders AU - Hanell A FAU - Gustavsson, Jenny AU - Gustavsson J FAU - Gunther, Mattias AU - Gunther M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Animals MH - Blood Coagulation/physiology MH - Blood Coagulation Tests/*methods MH - *Disease Models, Animal MH - *Hemorrhage/blood/diagnosis/etiology/therapy MH - Humans MH - Principal Component Analysis MH - Sensitivity and Specificity MH - *Swine MH - Thrombelastography/*methods MH - Trauma Severity Indices MH - *Wounds and Injuries/blood/classification/complications EDAT- 2020/10/24 06:00 MHDA- 2021/04/16 06:00 CRDT- 2020/10/23 05:50 PHST- 2020/10/24 06:00 [pubmed] PHST- 2021/04/16 06:00 [medline] PHST- 2020/10/23 05:50 [entrez] AID - 01586154-202102000-00021 [pii] AID - 10.1097/TA.0000000000002997 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2021 Feb 1;90(2):360-368. doi: 10.1097/TA.0000000000002997. PMID- 33091949 OWN - NLM STAT- MEDLINE DCOM- 20210708 LR - 20210708 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) VI - 40 IP - 4 DP - 2020 Nov TI - Massive Hemorrhage: The Role of Whole Blood Viscoelastic Assays. PG - 515-523 LID - 10.1055/a-1227-8050 [doi] AB - Viscoelastic whole blood tests are increasingly used to guide hemostatic therapy in bleeding patients in the perioperative, trauma, and obstetric settings. Compared with standard laboratory tests of hemostasis, they have a shorter turnaround time and provide simultaneous information on various aspects of clot formation and lysis. The two available brands TEG (thromboelastography) and ROTEM (rotational thromboelastometry) provide devices that are either manually operated or fully automated. The automation allows for the assays to be used as point-of-care tests increasing their usefulness in massively bleeding patients with rapidly changing hemostatic profiles. While the number of research papers on the subject and the number of published treatment algorithms increase rapidly, the influence of the use of these devices on patient outcome needs yet to be established. In this article, we first review the technology of these devices and the parameters provided by the assays. Next, we present the problems encountered when choosing cut-off values that trigger intervention. Furthermore, we discuss the studies examining their influence on clinical outcomes, and finally, we briefly highlight some of the most important limitations and pitfalls inherent to these assays. CI - Thieme. All rights reserved. FAU - Scala, Emmanuelle AU - Scala E AD - Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland. FAU - Marcucci, Carlo AU - Marcucci C AD - Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland. AD - Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. LA - eng PT - Journal Article DEP - 20201022 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 SB - IM MH - Blood Coagulation Disorders/*etiology MH - Blood Coagulation Tests/*methods MH - Hemorrhage/*etiology MH - Humans MH - Thrombelastography/*methods COIS- Dr. Marcucci reports nonfinancial support from Axon Lab, during the conduct of the study. Dr. Scala reports nonfinancial support from Axon Lab, during the conduct of the study. EDAT- 2020/10/23 06:00 MHDA- 2021/07/09 06:00 CRDT- 2020/10/22 20:21 PHST- 2020/10/22 20:21 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/07/09 06:00 [medline] AID - 10.1055/a-1227-8050 [doi] PST - ppublish SO - Hamostaseologie. 2020 Nov;40(4):515-523. doi: 10.1055/a-1227-8050. Epub 2020 Oct 22. PMID- 33089938 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20210813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 6 DP - 2020 Oct TI - Viscoelastic testing in pediatric patients. PG - S75-S85 LID - 10.1111/trf.16076 [doi] AB - A tailored transfusion algorithm based on viscoelastic testing in the perioperative period or in trauma patients is recommended by guidelines for bleeding management. Bleeding management strategies in neonates and children are mostly extrapolated from the adult experience, as published evidence in the youngest age group is scarce. This manuscript is intended to give a structured overview of what has been published on the use of viscoelastic testing to guide bleeding management in neonates and children. Several devices that use either the traditional viscoelastic method or resonance viscoelastography technology are on the market. Reference ranges for children have been evaluated in only some of them. As most of the hemostasis maturation processes can be observed during the first year of life, adult reference ranges for viscoelastic testing could be applied over the age of 1 year. The majority of the published trials in children are based on retrospective analyses describing the correlation between viscoelastic testing and standard laboratory testing or focusing on the prediction of bleeding. Clinically more relevant studies in pediatric patients undergoing cardiac surgery have demonstrated that the implementation of a transfusion algorithm based on viscoelastic testing has significantly reduced transfusion requirements and that this approach has enabled a rapid detection of coagulation disorders in the presence of excessive bleeding. Although further studies are urgently needed, experts have reviewed the use of a transfusion algorithm based on viscoelastic testing in children as a feasible approach, as it has been shown to improve bleeding management and rationalize blood product transfusion. CI - (c) 2020 AABB. FAU - Haas, Thorsten AU - Haas T AUID- ORCID: 0000-0002-9520-8693 AD - Department of Pediatric Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland. FAU - Faraoni, David AU - Faraoni D AUID- ORCID: 0000-0002-1093-4523 AD - Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Adolescent MH - Algorithms MH - Blood Coagulation Disorders/blood/congenital/diagnosis MH - Blood Loss, Surgical MH - Blood Transfusion MH - Child MH - Child, Preschool MH - Cohort Studies MH - Craniofacial Abnormalities/surgery MH - Heart Defects, Congenital/blood MH - Humans MH - Infant MH - Infant, Newborn MH - Ontario MH - Postoperative Hemorrhage/blood/therapy MH - Randomized Controlled Trials as Topic MH - Switzerland MH - Tertiary Care Centers MH - Thrombelastography/instrumentation/*methods EDAT- 2020/10/23 06:00 MHDA- 2021/08/14 06:00 CRDT- 2020/10/22 08:49 PHST- 2020/04/24 00:00 [received] PHST- 2020/06/04 00:00 [revised] PHST- 2020/06/14 00:00 [accepted] PHST- 2020/10/22 08:49 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] AID - 10.1111/trf.16076 [doi] PST - ppublish SO - Transfusion. 2020 Oct;60 Suppl 6:S75-S85. doi: 10.1111/trf.16076. PMID- 33089937 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20210813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 6 DP - 2020 Oct TI - Viscoelastic testing in oncology patients (including for the diagnosis of fibrinolysis): Review of existing evidence, technology comparison, and clinical utility. PG - S86-S100 LID - 10.1111/trf.16102 [doi] AB - The quantification of the coagulopathic state associated with oncologic and hematologic diseases is imperfectly assessed by common coagulation tests such as prothrombin time, activated partial thromboplastin time, fibrinogen levels, and platelet count. These tests provide a static representation of a component of hemostatic integrity, presenting an incomplete picture of coagulation in these patients. Viscoelastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), as whole blood analyses, provide data related to the cumulative effects of blood components and all stages of the coagulation and fibrinolytic processes. The utility of VETs has been demonstrated since the late 1960s in guiding blood component therapy for patients undergoing liver transplantation. Since then, the scope of viscoelastic testing has expanded to become routinely used for cardiac surgery, obstetrics, and trauma. In the past decade, VETs' expanded usage has been most significant in trauma resuscitation. However, use of VETs for patients with malignancy-associated coagulopathy (MAC) and hematologic malignancies is increasing. For the purposes of this narrative review, we discuss the similarities between trauma-induced coagulopathy (TIC) and MAC. These similarities center on the thrombomodulin-thrombin complex as it switches between the thrombin-activatable fibrinolysis inhibitor coagulation pathway and activating the protein C anticoagulation pathway. This produces a spectrum of coagulopathy and fibrinolytic alterations ranging from shutdown to hyperfibrinolysis that are common to TIC, MAC, and hematologic malignancies. There is expanding literature regarding the utility of TEG and ROTEM to describe the hemostatic integrity of patients with oncologic and hematologic conditions, which we review here. CI - (c) 2020 AABB. FAU - Walsh, Mark AU - Walsh M AUID- ORCID: 0000-0002-5795-1144 AD - Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana, USA. AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Kwaan, Hau AU - Kwaan H AD - Department of Hematology Oncology, Northwestern University School of Medicine, Chicago, Illinois, USA. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Marsee, Mathew AU - Marsee M AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Speybroeck, Jacob AU - Speybroeck J AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Thomas, Scott AU - Thomas S AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana, USA. FAU - Hatch, Jordan AU - Hatch J AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Vande Lune, Stefani AU - Vande Lune S AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Grisoli, Anne AU - Grisoli A AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Wadsworth, Sarah AU - Wadsworth S AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana, USA. FAU - Shariff, Faisal AU - Shariff F AD - Indiana University School of Medicine, South Bend, Indiana, USA. FAU - Aversa, John G AU - Aversa JG AD - Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA. FAU - Shariff, Faadil AU - Shariff F AD - Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. FAU - Zackariya, Nuha AU - Zackariya N AD - Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. FAU - Khan, Rashid AU - Khan R AD - Michiana Hematology Oncology, Mishawaka, Indiana, USA. FAU - Agostini, Vanessa AU - Agostini V AD - Department of Transfusion Medicine, IRCC Polyclinic Hospital San Marino, Genoa, Italy. FAU - Campello, Elena AU - Campello E AD - Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Simioni, Paolo AU - Simioni P AD - Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Scarlatescu, Escaterina AU - Scarlatescu E AD - Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania. FAU - Hartmann, Jan AU - Hartmann J AUID- ORCID: 0000-0003-4978-8014 AD - Department of Medical Affairs, Haemonetics Corporation, Boston, Massachusetts, USA. LA - eng GR - Haemonetics, Inc./ PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Antineoplastic Agents) SB - IM MH - Antineoplastic Agents/adverse effects MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Evidence-Based Medicine MH - *Fibrinolysis MH - Hematologic Diseases/blood MH - Hematologic Neoplasms/blood MH - Humans MH - Neoplasms/*blood/complications MH - Polycythemia Vera/blood MH - Thrombelastography/instrumentation/*methods MH - Thrombocytopenia/blood/chemically induced MH - Wounds and Injuries/blood/complications OTO - NOTNLM OT - ROTEM OT - TEG OT - coagulopathy OT - fibrinolysis OT - hematology OT - hypercoagulable OT - malignancy OT - oncology OT - thromboembolism OT - tumor EDAT- 2020/10/23 06:00 MHDA- 2021/08/14 06:00 CRDT- 2020/10/22 08:49 PHST- 2020/03/21 00:00 [received] PHST- 2020/09/09 00:00 [revised] PHST- 2020/09/09 00:00 [accepted] PHST- 2020/10/22 08:49 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] AID - 10.1111/trf.16102 [doi] PST - ppublish SO - Transfusion. 2020 Oct;60 Suppl 6:S86-S100. doi: 10.1111/trf.16102. PMID- 33089936 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20210813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 6 DP - 2020 Oct TI - Viscoelastic testing in benign hematologic disorders: Clinical perspectives and future implications of point-of-care testing to assess hemostatic competence. PG - S101-S121 LID - 10.1111/trf.16088 [doi] AB - Viscoelastic tests (VETs) have been used routinely for liver transplantation, cardiac surgery, and trauma, but only recently have found clinical utility in benign hematologic disorders. Therefore, guidelines for diagnosis and treatment of these disorders based on viscoelastic variables have been adapted from the existing transplant, cardiothoracic surgery, and trauma resuscitation literature. As a result, diagnostic and therapeutic strategies for benign hematologic disorders utilizing VETs are not uniform. Accordingly, even though there has been a recent increase in the utilization of VET for the diagnosis and treatment of such disorders, the literature is still in its early stages. Analysis of point-of-care viscoelastic tracings from benign hematologic disorders has the potential to allow prompt recognition of disease and to guide patient-specific intervention. Here we present a review describing the application of VETs to benign hematologic disorders. CI - (c) 2020 AABB. FAU - Speybroeck, Jacob AU - Speybroeck J AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Marsee, Mathew AU - Marsee M AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Shariff, Faadil AU - Shariff F AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Zackariya, Nuha AU - Zackariya N AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Grisoli, Anne AU - Grisoli A AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Lune, Stefani Vande AU - Lune SV AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Larson, Emilee E AU - Larson EE AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Hatch, Jordan AU - Hatch J AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Shariff, Faisal AU - Shariff F AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. FAU - Aversa, John G AU - Aversa JG AD - Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Son, Michael AU - Son M AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Agostini, Vanessa AU - Agostini V AD - Department of Transfusion Medicine, IRCC Polyclinic Hospital San Marino, Genoa, Italy. FAU - Campello, Elena AU - Campello E AD - Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Simioni, Paolo AU - Simioni P AD - Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Scarlatescu, Escaterina AU - Scarlatescu E AD - Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania. FAU - Kwaan, Hau AU - Kwaan H AD - Department of Hematology Oncology, Northwestern University School of Medicine, Chicago, Illinois. FAU - Hartmann, Jan AU - Hartmann J AUID- ORCID: 0000-0003-4978-8014 AD - Department of Medical Affairs, Haemonetics Corporation, Boston, Massachusetts. FAU - Fries, Dietmar AU - Fries D AD - Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Walsh, Mark AU - Walsh M AUID- ORCID: 0000-0002-5795-1144 AD - Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana. AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. LA - eng PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Animals MH - Autoimmune Diseases/blood MH - Blood Coagulation Disorders/blood/genetics MH - Blood Component Transfusion MH - Disease Models, Animal MH - Forecasting MH - Hematologic Diseases/*blood MH - Hemostasis/physiology MH - Humans MH - *Point-of-Care Testing MH - *Thrombelastography/instrumentation/methods MH - Thrombophilia/blood/etiology/genetics/immunology MH - Vasculitis/blood EDAT- 2020/10/23 06:00 MHDA- 2021/08/14 06:00 CRDT- 2020/10/22 08:49 PHST- 2020/05/01 00:00 [received] PHST- 2020/09/04 00:00 [revised] PHST- 2020/09/05 00:00 [accepted] PHST- 2020/10/22 08:49 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] AID - 10.1111/trf.16088 [doi] PST - ppublish SO - Transfusion. 2020 Oct;60 Suppl 6:S101-S121. doi: 10.1111/trf.16088. PMID- 33089933 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20210813 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 6 DP - 2020 Oct TI - Viscoelastic monitoring in trauma resuscitation. PG - S33-S51 LID - 10.1111/trf.16074 [doi] AB - BACKGROUND: Traumatic injury results in both physical and physiologic insult. Successful care of the trauma patient depends upon timely correction of both physical and biochemical injury. Trauma-induced coagulopathy is a derangement of hemostasis and thrombosis that develops rapidly and can be fatal if not corrected. Viscoelastic monitoring (VEM) assays have been developed to provide rapid, accurate, and relatively comprehensive depictions of an individual's coagulation profile. VEM are increasingly being integrated into trauma resuscitation guidelines to provide dynamic and individualized guidance to correct coagulopathy. STUDY DESIGN AND METHODS: We performed a narrative review of the search terms viscoelastic, thromboelastography, thromboelastometry, TEG, ROTEM, trauma, injury, resuscitation, and coagulopathy using PubMed. Particular focus was directed to articles describing algorithms for management of traumatic coagulopathy based on VEM assay parameters. RESULTS: Our search identified 16 papers with VEM-guided resuscitation strategies in adult patients based on TEG, 12 such protocols in adults based on ROTEM, 1 protocol for children based on TEG, and 2 protocols for children based on ROTEM. CONCLUSIONS: This review presents evidence to support VEM use to detect traumatic coagulopathy, discusses the role of VEM in trauma resuscitation, provides a summary of proposed treatment algorithms, and discusses pending questions in the field. CI - (c) 2020 AABB. FAU - Sayce, Andrew C AU - Sayce AC AUID- ORCID: 0000-0003-1108-3895 AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Leeper, Christine M AU - Leeper CM AUID- ORCID: 0000-0002-8561-8760 AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. LA - eng PT - Journal Article PT - Systematic Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Anticoagulants) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - Algorithms MH - Anticoagulants/adverse effects/therapeutic use MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Blood Coagulation Tests MH - Blood Component Transfusion MH - Child MH - Child, Preschool MH - Fibrinogen/analysis MH - Fibrinolysis MH - Forecasting MH - Hemorrhage/blood/etiology/therapy MH - Humans MH - Infant MH - Practice Guidelines as Topic MH - Resuscitation/*methods MH - Thrombelastography MH - Validation Studies as Topic MH - Wounds and Injuries/*blood/complications/therapy MH - Young Adult EDAT- 2020/10/23 06:00 MHDA- 2021/08/14 06:00 CRDT- 2020/10/22 08:49 PHST- 2020/04/16 00:00 [received] PHST- 2020/06/13 00:00 [revised] PHST- 2020/06/14 00:00 [accepted] PHST- 2020/10/22 08:49 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] AID - 10.1111/trf.16074 [doi] PST - ppublish SO - Transfusion. 2020 Oct;60 Suppl 6:S33-S51. doi: 10.1111/trf.16074. PMID- 33089931 OWN - NLM STAT- MEDLINE DCOM- 20210813 LR - 20211204 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 6 DP - 2020 Oct TI - Implementing thrombelastography: Experiences from a level I trauma institution. PG - S29-S32 LID - 10.1111/trf.16070 [doi] AB - Viscoelastic hemostatic assays such as thrombelastography (TEG) and rotational thrombelastometry have proven to be important point-of-care tools in the management of acute traumatic hemorrhage. Despite the availability of prospective studies that have confirmed the utility of TEG in reducing transfusion requirements and mortality in bleeding patients when compared to conventional coagulation tests, many institutions run into barriers implementing these viscoelastic hemostatic assays due to concerns regarding cost and benefit. At our academic Level 1 trauma institution, the Division of Trauma, Critical Care, and Acute Care Surgery advocated for the addition of TEG to the clinical armamentarium of providers caring for injured patients and thus spearheaded the clinical implementation of TEG. With the approval of the central laboratory, the Division developed an extensive and well-trained team to run and interpret TEGs as well as perform machine validation and upkeep. The Division continues to perform point-of-care testing throughout the hospital today. CI - (c) 2020 AABB. FAU - Dixon, Alexandra AU - Dixon A AUID- ORCID: 0000-0002-4066-8625 AD - Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Underwood, Samantha AU - Underwood S AD - Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Schreiber, Martin AU - Schreiber M AD - Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Blood Coagulation Tests/economics MH - Blood Platelets/drug effects MH - Diagnostic Tests, Routine MH - Electronic Health Records MH - Health Personnel/education MH - Hemorrhage/*blood/etiology MH - Humans MH - Injury Severity Score MH - Oregon MH - Point-of-Care Testing/economics/standards MH - Procedures and Techniques Utilization MH - Quality Control MH - Reimbursement Mechanisms MH - Thrombelastography/economics/instrumentation/*methods/statistics & numerical data MH - Translational Research, Biomedical MH - Trauma Centers MH - Wounds and Injuries/*blood/complications OTO - NOTNLM OT - administration OT - transfusion practices (adult) EDAT- 2020/10/23 06:00 MHDA- 2021/08/14 06:00 CRDT- 2020/10/22 08:49 PHST- 2020/04/30 00:00 [received] PHST- 2020/05/07 00:00 [revised] PHST- 2020/05/07 00:00 [accepted] PHST- 2020/10/22 08:49 [entrez] PHST- 2020/10/23 06:00 [pubmed] PHST- 2021/08/14 06:00 [medline] AID - 10.1111/trf.16070 [doi] PST - ppublish SO - Transfusion. 2020 Oct;60 Suppl 6:S29-S32. doi: 10.1111/trf.16070. PMID- 33073224 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220417 IS - 2589-8450 (Electronic) IS - 2589-8450 (Linking) VI - 2 IP - 4 DP - 2020 Oct TI - Admission thrombelastography does not guide dose adjustment of enoxaparin in trauma patients. PG - 41-44 LID - 10.1016/j.sopen.2020.03.003 [doi] AB - BACKGROUND: Enoxaparin is used as chemoprophylaxis to reduce incidence of venous thromboembolism and its complications following trauma. Serum anti-Xa monitoring is used to assess efficacy but requires several doses to be administered. Thrombelastography assesses hypercoagulability and may have utility identifying high-risk patients for venous thromboembolism. The objective was to evaluate whether thrombelastography parameters could identify trauma patients requiring enoxaparin dose adjustment earlier than serum anti-Xa concentrations. METHODS: A single-center, retrospective medical record review evaluated patients admitted to a regional level I trauma center that received an admission thrombelastography and a dose of enoxaparin with a serum trough anti-Xa concentration drawn. Patients were divided into standard-dose or dose-adjusted enoxaparin. Venous thromboembolism incidence between groups and risk factors for enoxaparin dose adjustment and venous thromboembolism development were evaluated. RESULTS: A total of 204 patients were included. Differences observed between groups included age (standard-dose enoxaparin, 48.5 [29.3-72] vs dose-adjusted enoxaparin, 38.5 [25-55.7] years; P = .005), admission creatinine clearance (standard-dose enoxaparin, 92.9 [67.4-113.4] vs dose-adjusted enoxaparin, 102.1 [83.8-129.2] mL/min; P = .017), and time to venous thromboembolism prophylaxis initiation (standard-dose enoxaparin, 23.8 [11.2-36.4] vs dose-adjusted enoxaparin, 34.5 [18.3-52.7] hours; P = .004). No differences in thrombelastography parameters or venous thromboembolism incidence were observed. No independent risk factors for enoxaparin dose adjustment were identified; however, risk assessment profile score > 10 was an independent risk factor for venous thromboembolism development. CONCLUSION: No relationship between admission thrombelastography and need for enoxaparin dose adjustment in trauma patients was observed. As thrombelastography continues growing in clinical use, it is prudent to investigate other potential applications. Currently, thrombelastography should not be used to guide enoxaparin dosing. CI - (c) 2020 The Authors. FAU - Hayes, Hannah V AU - Hayes HV AD - University of Cincinnati Department of Surgery, Cincinnati, OH. FAU - Droege, Molly E AU - Droege ME AD - UC Health-University of Cincinnati Medical Center Department of Pharmacy, Cincinnati, OH. AD - University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmacy Practice and Administrative Sciences, Cincinnati, OH. FAU - Furnish, Craig J AU - Furnish CJ AD - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO. FAU - Goodman, Michael D AU - Goodman MD AD - University of Cincinnati Department of Surgery, Cincinnati, OH. FAU - Ernst, Neil E AU - Ernst NE AD - UC Health-University of Cincinnati Medical Center Department of Pharmacy, Cincinnati, OH. AD - University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmacy Practice and Administrative Sciences, Cincinnati, OH. FAU - Droege, Christopher A AU - Droege CA AD - UC Health-University of Cincinnati Medical Center Department of Pharmacy, Cincinnati, OH. AD - University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmacy Practice and Administrative Sciences, Cincinnati, OH. LA - eng PT - Journal Article DEP - 20200414 PL - United States TA - Surg Open Sci JT - Surgery open science JID - 101768812 PMC - PMC7545004 EDAT- 2020/10/20 06:00 MHDA- 2020/10/20 06:01 PMCR- 2020/04/14 CRDT- 2020/10/19 06:01 PHST- 2020/01/12 00:00 [received] PHST- 2020/03/12 00:00 [revised] PHST- 2020/03/25 00:00 [accepted] PHST- 2020/10/19 06:01 [entrez] PHST- 2020/10/20 06:00 [pubmed] PHST- 2020/10/20 06:01 [medline] PHST- 2020/04/14 00:00 [pmc-release] AID - S2589-8450(20)30009-9 [pii] AID - 10.1016/j.sopen.2020.03.003 [doi] PST - epublish SO - Surg Open Sci. 2020 Apr 14;2(4):41-44. doi: 10.1016/j.sopen.2020.03.003. eCollection 2020 Oct. PMID- 33071074 OWN - NLM STAT- MEDLINE DCOM- 20210128 LR - 20210128 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 38 IP - 12 DP - 2020 Dec TI - Massive transfusion protocol in adult trauma population. PG - 2661-2666 LID - S0735-6757(20)30635-5 [pii] LID - 10.1016/j.ajem.2020.07.041 [doi] AB - BACKGROUND: Acute blood loss in trauma requires quick identification and action to restore circulating volume and save the patient. Massive transfusion protocols (MTPs) have become standard at Trauma Centers, in order to rapidly deliver blood products to bleeding patients. This literature review presents current standards of transfusion ratios, as well as insights into adjuncts during massive transfusions. METHODS: PubMED was searched for articles from 2005 to 2020 on MTPs, the article were assessed for single vs. multi-institutional, mechanism of injury, type of MTP, timing in which blood products should be administered, timing of delivery of blood products to trauma bay, pre-hospital treatment and adjuncts, and outcomes. RESULTS: Eleven studies addressed transfusion ratios. Seven studies looked at timing of blood products. Nine studies addressed MTP pre-hospital treatment and adjuncts. Prior to 2015, studies supported the benefits of a balanced transfusion ratio, which was then confirmed by the PROPPR randomized controlled trial. The shorter the time to blood product delivery the better the outcomes. New advances in technology have allowed us to measure different patterns of coagulation, allowing more individualized approaches to the bleeding patient. CONCLUSION: Current massive transfusion protocols should utilize between 1:1:1 and 1:1:2 ratios of the 3 main products; plasma, platelets, and red blood cells. Massive transfusion protocols are effective in decreasing mortality. Better resuscitation efforts were seen when blood products were readily available in the trauma bay when the patient arrived and the faster the replacement of blood, the better the outcomes. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Meneses, Evander AU - Meneses E AD - Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA. FAU - Boneva, Dessy AU - Boneva D AD - Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA. FAU - McKenney, Mark AU - McKenney M AD - Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA. FAU - Elkbuli, Adel AU - Elkbuli A AD - Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA. Electronic address: Adel.Elkbuli@hcahealthcare.com. LA - eng PT - Journal Article PT - Review DEP - 20200722 PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 RN - 0 (Antifibrinolytic Agents) RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Adult MH - Antifibrinolytic Agents/therapeutic use MH - Blood Coagulation Disorders/diagnosis MH - Blood Coagulation Factors/therapeutic use MH - Blood Component Transfusion/*methods MH - Clinical Protocols MH - Emergency Medical Services MH - Erythrocyte Transfusion/methods MH - Factor VIIa/therapeutic use MH - Hemorrhage/etiology/*therapy MH - Humans MH - Plasma MH - Platelet Transfusion/methods MH - Thrombelastography MH - Time Factors MH - Time-to-Treatment MH - Tranexamic Acid/therapeutic use MH - Treatment Outcome MH - Wounds and Injuries/complications/*therapy OTO - NOTNLM OT - Acute blood loss OT - Balanced transfusion ratio OT - Blood products OT - Coagulopathy OT - Massive transfusion protocol OT - Trauma mortality COIS- Declaration of Competing Interest None. EDAT- 2020/10/20 06:00 MHDA- 2021/01/29 06:00 CRDT- 2020/10/19 05:29 PHST- 2020/05/18 00:00 [received] PHST- 2020/07/07 00:00 [revised] PHST- 2020/07/15 00:00 [accepted] PHST- 2020/10/20 06:00 [pubmed] PHST- 2021/01/29 06:00 [medline] PHST- 2020/10/19 05:29 [entrez] AID - S0735-6757(20)30635-5 [pii] AID - 10.1016/j.ajem.2020.07.041 [doi] PST - ppublish SO - Am J Emerg Med. 2020 Dec;38(12):2661-2666. doi: 10.1016/j.ajem.2020.07.041. Epub 2020 Jul 22. PMID- 33051112 OWN - NLM STAT- MEDLINE DCOM- 20211018 LR - 20211018 IS - 1532-9496 (Electronic) IS - 0887-7963 (Linking) VI - 34 IP - 4 DP - 2020 Oct TI - Quality of Platelets in Stored Whole Blood. PG - 234-241 LID - S0887-7963(20)30053-5 [pii] LID - 10.1016/j.tmrv.2020.09.007 [doi] AB - Transfusion of whole blood rather than blood components is gaining popularity. It is easy to use, with one transfusion product to administer rather than 3, and is held at one storage temperature. It only contains anticoagulant-preservative solution, while components contain various storage solutions, which in theory may induce dilution coagulopathy. In this review, the quality of platelets in stored whole blood is summarized. In cold-stored whole blood, the platelet count declines by 1% to 2% per day. The responsiveness to various agonists declines during the storage time, but this appears to have a limited impact on clotting time or on clot strength as measured with thromboelastography. Animal studies have confirmed that platelets from stored whole blood participate equally well in clot formation. The recovery of platelets in stored whole blood is acceptable during at least 15 days of storage. The survival of platelets after transfusion is only 1 day, but this is likely to be sufficient for the intended patient group requiring massive transfusions, as the platelets are rapidly consumed in the wound area. In addition to the logistic benefits, there are drawbacks, most importantly having a sufficiently large inventory with an acceptable outdating rate, particularly since massive transfusions are rare, while requiring a lot of whole blood. The positive experience of the United States military with whole blood transfusion is often brought forward for introduction in the civilian blood bank, but patients with trauma are only a small fraction of the civilian population requiring massive transfusions. It needs to be determined whether in the resourceful environment of the hospital, these patients benefit from whole blood transfusions. Optimization of whole blood storage, with focus on platelet quality, needs to be performed to allow extension of the storage time beyond 15 days to a point where the number of units in inventory and outdating can be balanced. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - van der Meer, Pieter F AU - van der Meer PF AD - Sanquin Blood Bank, Department of Product and Process Development, Amsterdam, The Netherlands; Haga Teaching Hospital, Department Hematology, The Hague, The Netherlands. Electronic address: p.vandermeer@sanquin.nl. FAU - Klei, Thomas Rl AU - Klei TR AD - Sanquin Blood Bank, Department of Product and Process Development, Amsterdam, The Netherlands. FAU - de Korte, Dirk AU - de Korte D AD - Sanquin Blood Bank, Department of Product and Process Development, Amsterdam, The Netherlands; Sanquin Research, Department Blood Cell Research, Amsterdam, The Netherlands. LA - eng PT - Journal Article PT - Review DEP - 20200919 PL - United States TA - Transfus Med Rev JT - Transfusion medicine reviews JID - 8709027 SB - IM MH - Blood Platelets/*physiology MH - Blood Preservation/*methods MH - Blood Safety/methods MH - Blood Transfusion/*methods MH - Cell Survival MH - Cryopreservation/*methods MH - Humans MH - Outcome Assessment, Health Care MH - Platelet Count MH - Thrombelastography OTO - NOTNLM OT - Blood components OT - Massive transfusion OT - Pathogen inactivation OT - Platelets OT - Recovery OT - Survival OT - Transfusion OT - Whole blood EDAT- 2020/10/15 06:00 MHDA- 2021/10/21 06:00 CRDT- 2020/10/14 08:58 PHST- 2020/06/30 00:00 [received] PHST- 2020/09/09 00:00 [revised] PHST- 2020/09/10 00:00 [accepted] PHST- 2020/10/15 06:00 [pubmed] PHST- 2021/10/21 06:00 [medline] PHST- 2020/10/14 08:58 [entrez] AID - S0887-7963(20)30053-5 [pii] AID - 10.1016/j.tmrv.2020.09.007 [doi] PST - ppublish SO - Transfus Med Rev. 2020 Oct;34(4):234-241. doi: 10.1016/j.tmrv.2020.09.007. Epub 2020 Sep 19. PMID- 33048195 OWN - NLM STAT- MEDLINE DCOM- 20210531 LR - 20230311 IS - 1432-1238 (Electronic) IS - 0342-4642 (Print) IS - 0342-4642 (Linking) VI - 47 IP - 1 DP - 2021 Jan TI - Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. PG - 49-59 LID - 10.1007/s00134-020-06266-1 [doi] AB - PURPOSE: Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). METHODS: This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). RESULTS: Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34). CONCLUSION: There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols. FAU - Baksaas-Aasen, K AU - Baksaas-Aasen K AD - Oslo University Hospital & University of Oslo, Oslo, Norway. FAU - Gall, L S AU - Gall LS AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Stensballe, J AU - Stensballe J AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Juffermans, N P AU - Juffermans NP AD - Amsterdam University Medical Centres, Amsterdam, The Netherlands. FAU - Curry, N AU - Curry N AD - Oxford University Hospital NHS Trust, Oxford, UK. FAU - Maegele, M AU - Maegele M AD - Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Brooks, A AU - Brooks A AD - Nottingham University Hospitals NHS Trust, Nottingham, UK. FAU - Rourke, C AU - Rourke C AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Gillespie, S AU - Gillespie S AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Murphy, J AU - Murphy J AD - Queen Mary University of London, London, UK. FAU - Maroni, R AU - Maroni R AD - Queen Mary University of London, London, UK. FAU - Vulliamy, P AU - Vulliamy P AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Henriksen, H H AU - Henriksen HH AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Pedersen, K Holst AU - Pedersen KH AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Kolstadbraaten, K M AU - Kolstadbraaten KM AD - Oslo University Hospital & University of Oslo, Oslo, Norway. FAU - Wirtz, M R AU - Wirtz MR AD - Amsterdam University Medical Centres, Amsterdam, The Netherlands. FAU - Kleinveld, D J B AU - Kleinveld DJB AD - Amsterdam University Medical Centres, Amsterdam, The Netherlands. FAU - Schafer, N AU - Schafer N AD - Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Chinna, S AU - Chinna S AD - Nottingham University Hospitals NHS Trust, Nottingham, UK. FAU - Davenport, R A AU - Davenport RA AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Naess, P A AU - Naess PA AD - Oslo University Hospital & University of Oslo, Oslo, Norway. FAU - Goslings, J C AU - Goslings JC AD - Amsterdam University Medical Centres, Amsterdam, The Netherlands. FAU - Eaglestone, S AU - Eaglestone S AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. FAU - Stanworth, S AU - Stanworth S AD - Oxford University Hospital NHS Trust, Oxford, UK. AD - NHS Blood and Transplant, Bristol, UK. FAU - Johansson, P I AU - Johansson PI AD - Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Gaarder, C AU - Gaarder C AD - Oslo University Hospital & University of Oslo, Oslo, Norway. FAU - Brohi, K AU - Brohi K AD - Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK. k.brohi@qmul.ac.uk. LA - eng GR - F3-2013-602771/Seventh Framework Programme/ PT - Journal Article PT - Randomized Controlled Trial DEP - 20201013 PL - United States TA - Intensive Care Med JT - Intensive care medicine JID - 7704851 RN - 0 (Hemostatics) SB - IM CIN - Intensive Care Med. 2021 Jan;47(1):80-82. doi: 10.1007/s00134-020-06301-1. PMID: 33123786 CIN - Intensive Care Med. 2021 Jun;47(6):726-727. doi: 10.1007/s00134-021-06396-0. PMID: 33860340 CIN - Intensive Care Med. 2022 Nov;48(11):1642-1645. doi: 10.1007/s00134-022-06834-7. PMID: 35925321 MH - *Blood Coagulation Disorders MH - Hemorrhage/etiology/therapy MH - Hemostasis MH - *Hemostatics MH - Humans MH - Multicenter Studies as Topic MH - Thrombelastography MH - *Wounds and Injuries/complications/therapy PMC - PMC7550843 OTO - NOTNLM OT - Coagulopathy OT - Haemorrhage OT - Thrombelastography OT - Thromboelastometry OT - Trauma COIS- K.Baksaas-Aasen, L.S.Gall, J.Stensballe, N.P.Juffermans, N.Curry, C.Rourke, S.Gillespie, J.Murphy, R.Maroni, P.Vulliamy, H.H.Henriksen, K.Holst Pedersen, K.M. Kolstadbraaten, M.R.Wirtz, D.J.B. Kleinveld, N.Schafer, S.Chinna, P.A.Naess, J.C.Goslings, S.Eaglestone and S.Stanworth declare no conflicts of interest. M.Maegele has received honoraria for lectures and speakers' bureaus, congress travel support as well as financial support for research projects from Astra Zeneca, Bayer, CSL Behring, IL-Werfen/TEM International, LFB Biomedicaments and Portola Inc. A. Brooks has received a research grant from Haemonetics Corp. in the form of cartridges and reagent support. He has also served on advisory panel for Haemonetics Corp. and TEM International and received honoraria for education lectures for Johnson and Johnson. P.I. Johansson s has received unrestricted research grants from Haemonetics Corp. and Octapharma AG. C.Gaarder has received honoraria for lectures from Octapharma and research grant support from Haemonetics and TEM International in the form of device and reagent support. She has also previously served on the advisory board for Nycomed. K.Brohi and R.Davenport have received research grant support from TEM International in the form of device and reagent support. K.Brohi has previously served on external advisory panels for Haemonetics Corp, TEM International, CSL Behring, Bayer and Astra Zeneca. EDAT- 2020/10/14 06:00 MHDA- 2021/06/01 06:00 PMCR- 2020/10/13 CRDT- 2020/10/13 12:12 PHST- 2020/02/16 00:00 [received] PHST- 2020/09/20 00:00 [accepted] PHST- 2020/10/14 06:00 [pubmed] PHST- 2021/06/01 06:00 [medline] PHST- 2020/10/13 12:12 [entrez] PHST- 2020/10/13 00:00 [pmc-release] AID - 10.1007/s00134-020-06266-1 [pii] AID - 6266 [pii] AID - 10.1007/s00134-020-06266-1 [doi] PST - ppublish SO - Intensive Care Med. 2021 Jan;47(1):49-59. doi: 10.1007/s00134-020-06266-1. Epub 2020 Oct 13. PMID- 33012548 OWN - NLM STAT- MEDLINE DCOM- 20210617 LR - 20210617 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 52 IP - 2 DP - 2021 Feb TI - Thromboelastography Use in the Acute Young Trauma Patient: Early Experience of Two Level One Trauma Centers. PG - 200-204 LID - S0020-1383(20)30758-0 [pii] LID - 10.1016/j.injury.2020.09.017 [doi] AB - BACKGROUND: Thromboelastography (TEG) point-of-care systems allow for analysis of the sum of platelet function, coagulation proteases and inhibitors, and the fibrinolytic system within 30 minutes. This allows a clinician to guide transfusion more precisely with an appropriate type of blood product. Literature has supported that TEG-guided resuscitation had lower mortality compared to standardized 1:1:1 (red blood cells (RBC), fresh-frozen plasma (FFP), and platelets) massive transfusion protocol (MTP) in penetrating trauma patients, but data has been sparse in examining the young trauma patient. METHODS: This was a cross-sectional chart review study performed with patients up to 30 years old seen in two level one trauma centers serving children with active bleeding resulting from trauma from January 1, 2010 to June 26, 2018. TEG use was evaluated in these patients. RESULTS: 258 patients were included in the analysis. 112 (43%) had penetrating trauma and 225 (87%) had polytrauma. MTP was instituted in 176 (69%) patients and 88 (34%) patients who had TEG measured. There were significant correlations between PTT and alpha (r=-0.46; p<0.001), PTT and Kinetics (r=0.53; p<0.001), PTT and maximum amplitude (r=0.449; p<0.001). There were also significant correlations between PT and alpha (r=-0.29; p=0.008), and PT and maximum amplitude (r= -0.27; p=0.013). There was no significant correlation between TEG measures and INR. There were significant associations with requiring surgery within 24 hours 45% vs 61% (p=0.018), receiving TXA 20% vs 59% (p<0.001), and with receiving MTP 62% vs 83% (p=0.001), respectively. CONCLUSIONS: Measurement of TEG was associated with patients receiving TXA, MTP and larger amounts of blood products. Components of TEG correlated with PT and PTT levels. Although there was no association with survival to hospital discharge, patients having TEG measured were more likely to undergo surgery within the first 24 hours of hospital arrival. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Dudek, Christopher J AU - Dudek CJ AD - Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children, 86 West Underwood St. Suite 200, Orlando, Florida 32806. Electronic address: Chris@ChristopherDudek.com. FAU - Little, Ian AU - Little I AD - Department of Emergency Medicine, Orlando Health Regional Medical Center, 86 West Underwood St. Suite 200, Orlando, Florida 32806. Electronic address: ian.h.little98@gmail.com. FAU - Wiser, Kyle AU - Wiser K AD - Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children, 86 West Underwood St. Suite 200, Orlando, Florida 32806. Electronic address: kyle.wiser@orlandohealth.com. FAU - Ibrahim, Joseph AU - Ibrahim J AD - Department of Surgery, Orlando Health Regional Medical Center, 86 West Underwood St. MP 201, Orlando, Florida 32806. Electronic address: Joseph.Ibrahim@orlandohealth.com. FAU - Ramirez, Jose AU - Ramirez J AD - Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children, 86 West Underwood St. Suite 200, Orlando, Florida 32806. Electronic address: Jose.Ramirez@orlandohealth.com. FAU - Papa, Linda AU - Papa L AD - Department of Emergency Medicine, Orlando Health Regional Medical Center, 86 West Underwood St. Suite 200, Orlando, Florida 32806. Electronic address: Linda.papa@orlandohealth.com. LA - eng PT - Journal Article DEP - 20200928 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - *Blood Coagulation Disorders/diagnosis MH - Blood Transfusion MH - Child MH - Cross-Sectional Studies MH - Humans MH - Resuscitation MH - Thrombelastography MH - Trauma Centers MH - *Wounds and Injuries/therapy OTO - NOTNLM OT - TEG OT - coagulopathy OT - hemorrhage OT - thromboelastography OT - trauma COIS- Declaration of Competing Interest None. EDAT- 2020/10/06 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/10/05 05:33 PHST- 2020/05/14 00:00 [received] PHST- 2020/07/27 00:00 [revised] PHST- 2020/09/15 00:00 [accepted] PHST- 2020/10/06 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/10/05 05:33 [entrez] AID - S0020-1383(20)30758-0 [pii] AID - 10.1016/j.injury.2020.09.017 [doi] PST - ppublish SO - Injury. 2021 Feb;52(2):200-204. doi: 10.1016/j.injury.2020.09.017. Epub 2020 Sep 28. PMID- 32996292 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231129 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 33 IP - 3 DP - 2021 Jun TI - Implementation of point-of-care ROTEM(R) into a trauma major haemorrhage protocol: A before and after study. PG - 457-464 LID - 10.1111/1742-6723.13643 [doi] AB - OBJECTIVE: The aim of the present study was to assess transfusion practices with the implementation of a targeted viscoelastic haemostatic assay (VHA) (ROTEM(R)) guided coagulation management programme into a major haemorrhage protocol for trauma patients requiring ICU admission, starting from time of arrival in the ED. METHODS: This retrospective observational study was conducted in a major trauma centre in Australia. One hundred and sixty-two trauma patients admitted to the ICU between January 2013 and December 2015 with an Injury Severity Score >/=12 and who received blood products were included: 37 in the pre-group, 48 during implementation and 77 in post-group. The primary outcome was blood and blood product administration amounts. RESULTS: Packed red blood cell transfusion amounts did not significantly change post introduction of the ROTEM(R). There was a significant increase in fibrinogen replacement between the pre- and post-groups (P < 0.001), accompanied by a reduction in the use of fresh frozen plasma (P < 0.001) and prothrombinex (P < 0.001). Platelet usage in the post-group was higher but not reaching statistical significance (P = 0.051). Post-implementation point-of-care ROTEM(R) testing was able to be performed in the ED in 94.8% of cases. CONCLUSION: Although there was no overall reduction of packed red blood cell usage, a change in the pattern of administration of other blood products was observed with the implementation of a targeted VHA (ROTEM(R)) guided coagulation management programme. Larger studies are needed to further define the role of early VHA testing to guide correction of trauma-induced coagulopathy and the effect on clinical outcomes. CI - (c) 2020 Australasian College for Emergency Medicine. FAU - Campbell, Don AU - Campbell D AUID- ORCID: 0000-0003-0679-7455 AD - Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. FAU - Wake, Elizabeth AU - Wake E AD - Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. FAU - Walters, Kerin AU - Walters K AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Ho, Debbie AU - Ho D AD - Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Keijzers, Gerben AU - Keijzers G AD - Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - School of Medicine, Bond University, Gold Coast, Queensland, Australia. FAU - Wullschleger, Martin AU - Wullschleger M AD - Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. FAU - Winearls, James AU - Winearls J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. AD - Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia. LA - eng GR - EMSS-406-R21-Campbell/Emergency Medicine Foundation, Gold Coast Hospital Foundation/ PT - Journal Article DEP - 20200929 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM OTO - NOTNLM OT - ROTEM(R) OT - major haemorrhage protocol OT - trauma EDAT- 2020/10/01 06:00 MHDA- 2020/10/01 06:01 CRDT- 2020/09/30 06:22 PHST- 2020/08/07 00:00 [revised] PHST- 2020/03/05 00:00 [received] PHST- 2020/09/11 00:00 [accepted] PHST- 2020/10/01 06:01 [medline] PHST- 2020/10/01 06:00 [pubmed] PHST- 2020/09/30 06:22 [entrez] AID - 10.1111/1742-6723.13643 [doi] PST - ppublish SO - Emerg Med Australas. 2021 Jun;33(3):457-464. doi: 10.1111/1742-6723.13643. Epub 2020 Sep 29. PMID- 32988649 OWN - NLM STAT- MEDLINE DCOM- 20210310 LR - 20210830 IS - 1097-6760 (Electronic) IS - 0196-0644 (Linking) VI - 77 IP - 3 DP - 2021 Mar TI - New Uses for Thromboelastography and Other Forms of Viscoelastic Monitoring in the Emergency Department: A Narrative Review. PG - 357-366 LID - S0196-0644(20)30592-8 [pii] LID - 10.1016/j.annemergmed.2020.07.026 [doi] AB - Patients frequently visit the emergency department with conditions that place them at risk of worse outcomes when accompanied by coagulopathy. Routine tests of coagulation-prothrombin time, partial thromboplastin time, platelets, and fibrinogen-have shortcomings that limit their use in providing emergency care. One alternative is to investigate coagulation disturbance with viscoelastic monitoring (VEM), a coagulation test that measures the timing and strength of blood clot development in real time. VEM is widely used and studied in cardiac surgery, liver transplant surgery, anesthesia, and trauma. In this article, we review the technique of VEM and the biologic rationale of using it in addition to routine tests of coagulation in emergency clinical situations. Then, we review the evidence (or lack thereof) for using VEM in the diagnosis and treatment of specific conditions. Finally, we describe the limitations of the test and future directions for clinical use and research in emergency medicine. CI - Copyright (c) 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. FAU - Tyler, Patrick D AU - Tyler PD AD - Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: ptyler1@bidmc.harvard.edu. FAU - Yang, Lauren M AU - Yang LM AD - Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Snider, Samuel B AU - Snider SB AD - Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. FAU - Lerner, Adam B AU - Lerner AB AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Aird, William C AU - Aird WC AD - Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Shapiro, Nathan I AU - Shapiro NI AD - Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. LA - eng PT - Journal Article PT - Review DEP - 20200926 PL - United States TA - Ann Emerg Med JT - Annals of emergency medicine JID - 8002646 SB - IM CIN - Ann Emerg Med. 2021 Sep;78(3):462-463. doi: 10.1016/j.annemergmed.2021.05.012. PMID: 34420566 MH - Blood Coagulation Disorders/*diagnosis MH - *Emergency Service, Hospital MH - Humans MH - Thrombelastography/*methods EDAT- 2020/09/30 06:00 MHDA- 2021/03/11 06:00 CRDT- 2020/09/29 05:29 PHST- 2020/02/21 00:00 [received] PHST- 2020/07/10 00:00 [revised] PHST- 2020/07/14 00:00 [accepted] PHST- 2020/09/30 06:00 [pubmed] PHST- 2021/03/11 06:00 [medline] PHST- 2020/09/29 05:29 [entrez] AID - S0196-0644(20)30592-8 [pii] AID - 10.1016/j.annemergmed.2020.07.026 [doi] PST - ppublish SO - Ann Emerg Med. 2021 Mar;77(3):357-366. doi: 10.1016/j.annemergmed.2020.07.026. Epub 2020 Sep 26. PMID- 32981618 OWN - NLM STAT- MEDLINE DCOM- 20201005 LR - 20201005 IS - 1558-0539 (Electronic) IS - 0733-8627 (Linking) VI - 38 IP - 4 DP - 2020 Nov TI - Emergency Transfusions. PG - 795-805 LID - S0733-8627(20)30061-4 [pii] LID - 10.1016/j.emc.2020.06.005 [doi] AB - Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. There is an ongoing debate regarding the best approach to transfusions, with some advocating for resuscitation with a fixed ratio of blood products and others preferring to use viscoelastic assays to guide transfusions. Whole-blood transfusion also is a debated strategy. Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited. As hemodynamic stability is restored, endpoints of resuscitation should be used to guide the resuscitation. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Farrell, Michael S AU - Farrell MS AD - Department of Surgery, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA 94110, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. Electronic address: https://twitter.com/mfarrellmd. FAU - Kim, Woon Cho AU - Kim WC AD - Department of Surgery, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA 94110, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. FAU - Stein, Deborah M AU - Stein DM AD - Department of Surgery, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA 94110, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. Electronic address: Deborah.Stein@ucsf.edu. LA - eng PT - Journal Article PT - Review DEP - 20200721 PL - United States TA - Emerg Med Clin North Am JT - Emergency medicine clinics of North America JID - 8219565 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/therapeutic use MH - Blood Grouping and Crossmatching MH - *Blood Transfusion MH - Catheterization, Central Venous MH - Clinical Decision-Making MH - Clinical Protocols MH - Critical Illness MH - Emergency Medical Services MH - Emergency Service, Hospital MH - Humans MH - Hypotension MH - Infusions, Intraosseous MH - Infusions, Intravenous MH - Resuscitation MH - Shock, Hemorrhagic/*therapy MH - Thrombelastography MH - Tranexamic Acid/therapeutic use MH - Wounds and Injuries/therapy OTO - NOTNLM OT - Blood OT - Coagulopathy OT - Resuscitation OT - Transfusion COIS- Disclosure The authors have nothing to disclose. EDAT- 2020/09/29 06:00 MHDA- 2020/10/06 06:00 CRDT- 2020/09/28 05:32 PHST- 2020/09/28 05:32 [entrez] PHST- 2020/09/29 06:00 [pubmed] PHST- 2020/10/06 06:00 [medline] AID - S0733-8627(20)30061-4 [pii] AID - 10.1016/j.emc.2020.06.005 [doi] PST - ppublish SO - Emerg Med Clin North Am. 2020 Nov;38(4):795-805. doi: 10.1016/j.emc.2020.06.005. Epub 2020 Jul 21. PMID- 32946123 OWN - NLM STAT- MEDLINE DCOM- 20210222 LR - 20210222 IS - 1365-2044 (Electronic) IS - 0003-2409 (Linking) VI - 76 IP - 3 DP - 2021 Mar TI - A prospective observational study of the rapid detection of clinically-relevant plasma direct oral anticoagulant levels following acute traumatic injury. PG - 373-380 LID - 10.1111/anae.15254 [doi] AB - In urgent clinical situations, such as trauma, urgent surgery or before thrombolysis, rapid quantification of direct oral anticoagulant plasma drug levels is warranted. Using the ClotPro(R) analyser, we assessed two novel viscoelastic tests for detection of clinically-relevant plasma drug levels in trauma patients. The ecarin clotting time was used to assess the plasma concentration of dabigatran and Russell s viper venom clotting time to determine the plasma concentration of direct factor Xa inhibitors. In parallel, plasma concentrations were analysed using plasma-based chromogenic assays. A total of 203 simultaneous measurements were performed. Strong to very strong linear correlations were detected between ecarin clotting time and plasma concentration of dabigatran (r = 0.9693), and between Russell s viper venom clotting time and plasma concentrations of apixaban (r = 0.7391), edoxaban (r = 0.9251) and rivaroxaban (r = 0.8792), all p < 0.001. An ecarin clotting time >/= 189 seconds provided 100% sensitivity and 90% specificity for detecting plasma dabigatran concentrations >/= 50 ng.ml(-1) . Corresponding Russell s viper venom clotting time cut-off values were >/= 136 seconds for apixaban (80% sensitivity, 88% specificity), >/= 168 seconds for edoxaban (100% sensitivity, 100% specificity) and >/= 177 seconds for rivaroxaban (90% sensitivity, 100% specificity). Detection of drug levels >/= 100 ng.ml(-1) was also investigated: for dabigatran, an ecarin clotting time >/= 315 seconds yielded 92% sensitivity and 100% specificity; while Russell s viper venom clotting time cut-offs of 191, 188 and 196 seconds were calculated for apixaban (67% sensitivity, 88% specificity), edoxaban (100% sensitivity, 75% specificity) and rivaroxaban (100% sensitivity, 91% specificity), respectively. We have demonstrated strong positive correlations between plasma drug levels and clotting time values in the specific ClotPro assays. Cut-off values for detecting clinically-relevant drug levels showed high levels of sensitivity and specificity. CI - (c) 2020 Association of Anaesthetists. FAU - Oberladstatter, D AU - Oberladstatter D AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria. FAU - Voelckel, W AU - Voelckel W AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. FAU - Schlimp, C AU - Schlimp C AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria. FAU - Zipperle, J AU - Zipperle J AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria. FAU - Ziegler, B AU - Ziegler B AD - Department of Anaesthesiology and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria. FAU - Grottke, O AU - Grottke O AD - Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany. FAU - Schochl, H AU - Schochl H AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria. LA - eng PT - Journal Article PT - Observational Study DEP - 20200918 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 RN - 0 (Anticoagulants) SB - IM MH - Acute Disease MH - Administration, Oral MH - Adult MH - Aged MH - Aged, 80 and over MH - Anticoagulants/administration & dosage/*blood MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Sensitivity and Specificity MH - Wounds and Injuries/*blood OTO - NOTNLM OT - ClotPro OT - ECA-test OT - RVV-test OT - direct oral anticoagulant EDAT- 2020/09/19 06:00 MHDA- 2021/02/23 06:00 CRDT- 2020/09/18 12:14 PHST- 2020/08/17 00:00 [accepted] PHST- 2020/09/19 06:00 [pubmed] PHST- 2021/02/23 06:00 [medline] PHST- 2020/09/18 12:14 [entrez] AID - 10.1111/anae.15254 [doi] PST - ppublish SO - Anaesthesia. 2021 Mar;76(3):373-380. doi: 10.1111/anae.15254. Epub 2020 Sep 18. PMID- 32941349 OWN - NLM STAT- MEDLINE DCOM- 20210304 LR - 20210506 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 89 IP - 6 DP - 2020 Dec TI - Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma. PG - 999-1017 LID - 10.1097/TA.0000000000002944 [doi] AB - BACKGROUND: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests, which are thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical, and critically ill patients. METHODS: Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM with non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS: Using TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. Thromboelastography/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. Thromboelastography/ROTEM-guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION: In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and adult patients with critical illness. LEVEL OF EVIDENCE: Systematic Review/Meta-Analysis, level III. FAU - Bugaev, Nikolay AU - Bugaev N AD - From the Division of Trauma and Acute Care Surgery (N.B.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; Department of Surgery (J.J.C.), MetroHealth Medical Center, Cleveland, Ohio; Department of Surgery A (G.G.), Soroka Medical Center, Beer Sheva, Israel; Department of Surgery (J.J.F.), TCU and UNTHSC School of Medicine, Fort Worth, Texas; Maine Medical Center (J.S.S.), Portland, Maine; Division of Trauma and Critical Care Surgery (C.J.V.), Department of Surgery, Duke University School of Medicine, Durham, North Carolina; University of Florida College of Medicine-Jacksonville (B.K.Y.), Jacksonville, Florida; Case Western University School of Medicine (L.A.K.), Cleveland, Ohio; Division of Trauma, Surgical Critical Care, and Acute Care Surgery (N.M.G.), Department of Surgery, Brody School of Medicine, East Carolina University, Greenville; Weill Cornell University (H.A.A.), Doha, Qatar; Department of Surgery (P.A.P.), College of Medicine, University of Central Florida, Orlando; Division of Trauma and Acute Care Surgery (E.J.M.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; 2D Medical Battalion, 2D Marine Logistics Group (Z.W.B.), Camp LeJeune, North Carolina; Department of Surgery (Z.W.B.), Uniformed Services University of the Health Sciences, Bethesda; and Division of Trauma and Critical Care Surgery (G.K.), Department of Surgery, Duke University School of Medicine, Durham, North Carolina. FAU - Como, John J AU - Como JJ FAU - Golani, Guy AU - Golani G FAU - Freeman, Jennifer J AU - Freeman JJ FAU - Sawhney, Jaswin S AU - Sawhney JS FAU - Vatsaas, Cory J AU - Vatsaas CJ FAU - Yorkgitis, Brian K AU - Yorkgitis BK FAU - Kreiner, Laura A AU - Kreiner LA FAU - Garcia, Nicole M AU - Garcia NM FAU - Aziz, Hiba Abdel AU - Aziz HA FAU - Pappas, Peter A AU - Pappas PA FAU - Mahoney, Eric J AU - Mahoney EJ FAU - Brown, Zachary W AU - Brown ZW FAU - Kasotakis, George AU - Kasotakis G LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM CIN - J Trauma Acute Care Surg. 2020 Dec;89(6):1018-1022. doi: 10.1097/TA.0000000000002977. PMID: 33048910 EIN - J Trauma Acute Care Surg. 2021 Apr 1;90(4):766-767. doi: 10.1097/TA.0000000000003126. PMID: 33740787 MH - Adult MH - Blood Coagulation Disorders/*blood/diagnosis MH - Blood Coagulation Tests MH - Blood Transfusion/methods/*standards MH - Critical Illness MH - Hemorrhage/blood/etiology/mortality/*therapy MH - Humans MH - Outcome Assessment, Health Care MH - *Practice Guidelines as Topic MH - Societies, Medical MH - Surgical Procedures, Operative/adverse effects MH - Thrombelastography/adverse effects/*methods MH - Wounds and Injuries/complications/mortality EDAT- 2020/09/18 06:00 MHDA- 2021/03/05 06:00 CRDT- 2020/09/17 17:16 PHST- 2020/09/18 06:00 [pubmed] PHST- 2021/03/05 06:00 [medline] PHST- 2020/09/17 17:16 [entrez] AID - 01586154-202012000-00002 [pii] AID - 10.1097/TA.0000000000002944 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Dec;89(6):999-1017. doi: 10.1097/TA.0000000000002944. PMID- 32929548 OWN - NLM STAT- MEDLINE DCOM- 20220210 LR - 20220224 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 48 IP - 1 DP - 2022 Feb TI - Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care. PG - 431-439 LID - 10.1007/s00068-020-01493-z [doi] AB - BACKGROUND: Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC). Thromboelastometry (ROTEM) and thrombelastography (TEG) are valuable alternatives to standard coagulation testing, providing a more comprehensive overview of the coagulation process. PURPOSE: Evaluating thromboelastographic profile, the incidence of fibrinolysis (defined as Ly30 > 3%) in severe trauma patients, and factors influencing pathological coagulation pattern. METHODS: Prospective observational 2 years cohort study on severe trauma patients assisted by Helicopter Emergency Medical System (HEMS) and Level 1 Trauma Center, in a tertiary referral University Hospital. RESULTS: Eighty three patients were enrolled, mean NISS (new injury severity score) 36 (+/- 13). Mean R value decreased from 7.25 (+/- 2.6) to 6.19 (+/- 2.5) min (p < 0.03); 48 (60%) patients had a reduction in R from T(0) to T(1). In NISS 25-40 and NISS > 40 groups, changes in R value increased their significance (p = 0.04 and p < 0.03, respectively). Pathological TEG was found in 71 (88.8%) patients at T(0) and 74 (92.5%) at T(1). Hypercoagulation was present in 57 (71.3%) patients at T(0,) and in 66(82.5%) at T(1). 9 (11.3%) patients had hyperfibrinolysis at T(0), 7 (8.8%) patients at T(1). Prevalence of StO(2) < 75% at T(0) was greater in patients whose TEG worsened (7 patients, 46.7%) against whose TEG remained stable or improved (8 patients, 17.4%) from T(0) to T(1) (p = 0.02). 48 (57.8%) patients received < 1000 mL of fluids, while 35 (42.2%) received >/= 1000 mL. The first group had fewer patients with hypercoagulation (20, 41.6%) than the second (6, 17.6%) at T(1) (p < 0.03). No differences were found for same TEG pattern at T(0), nor other TEG pattern. CONCLUSION: Our population is representative of a non-hemorrhagic severe injury subgroup. Almost all of our trauma population had coagulation abnormalities immediately after the trauma; pro-coagulant changes were the most represented regardless of the severity of injury. NISS appears to affect only R parameter on TEG. Hyperfibrinolysis has been found in a low percentage of patients. Hypoperfusion parameters do not help to identify patients with ongoing coagulation impairment. Small volume resuscitation and mild hypotermia does not affect coagulation, at least in the early post-traumatic phase. CI - (c) 2020. The Author(s). FAU - Spasiano, Alessandra AU - Spasiano A AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. FAU - Barbarino, Cristina AU - Barbarino C AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. FAU - Marangone, Anna AU - Marangone A AUID- ORCID: 0000-0002-2369-8937 AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. 8annamarangone8@gmail.com. FAU - Orso, Daniele AU - Orso D AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. FAU - Trillo, Giulio AU - Trillo G AD - HEMS Division, Department of Anesthesia and Intensive Care Medicine, ASUFC Udine, 33100, Udine, Italy. FAU - Giacomello, Roberta AU - Giacomello R AD - Department of Laboratory Medicine, Institute of Clinical Pathology, University of Udine, ASUFC Udine, 33100, Udine, Italy. FAU - Bove, Tiziana AU - Bove T AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. FAU - Della Rocca, Giorgio AU - Della Rocca G AD - Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. LA - eng PT - Journal Article PT - Review DEP - 20200914 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Cohort Studies MH - Hospitals MH - Humans MH - Observational Studies as Topic MH - Thrombelastography MH - Trauma Centers MH - *Wounds and Injuries/complications PMC - PMC8825617 OTO - NOTNLM OT - Coagulation disorder OT - Fibrinolysis OT - TEG OT - Thromboelastography OT - Trauma OT - Trauma-associated coagulopathy COIS- The authors have disclosed that they do not have any potential financial or ethical conflict of interest. EDAT- 2020/09/16 06:00 MHDA- 2022/02/11 06:00 PMCR- 2020/09/14 CRDT- 2020/09/15 05:48 PHST- 2020/05/06 00:00 [received] PHST- 2020/09/04 00:00 [accepted] PHST- 2020/09/16 06:00 [pubmed] PHST- 2022/02/11 06:00 [medline] PHST- 2020/09/15 05:48 [entrez] PHST- 2020/09/14 00:00 [pmc-release] AID - 10.1007/s00068-020-01493-z [pii] AID - 1493 [pii] AID - 10.1007/s00068-020-01493-z [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2022 Feb;48(1):431-439. doi: 10.1007/s00068-020-01493-z. Epub 2020 Sep 14. PMID- 32925014 OWN - NLM STAT- MEDLINE DCOM- 20201204 LR - 20250310 IS - 1875-8622 (Electronic) IS - 1386-0291 (Linking) VI - 76 IP - 2 DP - 2020 TI - Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study. PG - 299-308 LID - 10.3233/CH-209210 [doi] AB - BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients' overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM(R)). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM(R) thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM(R) coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM(R) measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM(R) than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM(R) measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. CONCLUSION: This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM(R) are taken into account in addition to standard coagulation parameters. FAU - Lonic, Daniel AU - Lonic D AD - Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany. AD - Department of Plastic, Reconstructive and Aesthetic Surgery, Helios Hospital Munich West, Munich, Germany. AD - Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. FAU - Heidekrueger, Paul I AU - Heidekrueger PI AD - Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany. AD - Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. FAU - Bosselmann, Talia AU - Bosselmann T AD - Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany. FAU - Niclas Broer, P AU - Niclas Broer P AD - Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. FAU - Gertler, Ralph AU - Gertler R AD - Department of Anesthesiology and Intensive Care Medicine, Helios Hospital Munich West, Munich, Germany. FAU - Wolfgang Martin, Klaus AU - Wolfgang Martin K AD - Department of Anesthesiology and Intensive Care Medicine, Helios Hospital Munich West, Munich, Germany. FAU - Prantl, Lukas AU - Prantl L AD - Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany. FAU - Ninkovic, Milomir AU - Ninkovic M AD - Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. FAU - Giunta, Riccardo AU - Giunta R AD - Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany. FAU - Ehrl, Denis AU - Ehrl D AD - Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany. AD - Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Clin Hemorheol Microcirc JT - Clinical hemorheology and microcirculation JID - 9709206 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis MH - Burns/*etiology MH - Female MH - Humans MH - Male MH - Prospective Studies MH - Thrombelastography/*methods OTO - NOTNLM OT - Thrombelastometry OT - burn injury OT - coagulation EDAT- 2020/09/15 06:00 MHDA- 2020/12/15 06:00 CRDT- 2020/09/14 15:42 PHST- 2020/09/15 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2020/09/14 15:42 [entrez] AID - CH209210 [pii] AID - 10.3233/CH-209210 [doi] PST - ppublish SO - Clin Hemorheol Microcirc. 2020;76(2):299-308. doi: 10.3233/CH-209210. PMID- 32924629 OWN - NLM STAT- MEDLINE DCOM- 20211006 LR - 20211006 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 80 IP - 7 DP - 2020 Nov TI - FIBTEM clot firmness parameters correlate well with the fibrinogen concentration measured by the Clauss assay in patients and healthy subjects. PG - 600-605 LID - 10.1080/00365513.2020.1818283 [doi] AB - The Clauss assay is the assay most often used for measuring plasma fibrinogen levels. However, the FIBTEM-assay, determined using thromboelastometry (ROTEM) can also be used to estimate fibrinogen levels. A major advantage of the FIBTEM is that it can provide information about fibrinogen levels within minutes, while the Clauss assay needs 30-60 min before the result is available. The aim of this study was to investigate the correlation between fibrinogen levels measured by the Clauss assay and results from the FIBTEM-assay. We included 111 patients >/=18 years for whom both ROTEM analyses and a fibrinogen measurement using the Clauss assay were available. In addition, ROTEM and Clauss measurements from 75 healthy subjects were included. Spearman correlation was used to determine the association between the results of both assays. The patients included were mostly patients with major trauma or undergoing large surgery (e.g. cardiac surgery or liver transplantation). Strong correlations were found between FIBTEM clot firmness parameters and fibrinogen levels measured by the Clauss assay in patients (Spearman's correlation coefficients (r(s)) above 0.80 (p < .001) for all subgroups) and healthy subjects (r(s) = 0.66, p < .001). The correlation between early FIBTEM parameters (clot firmness at 5 or 10 min) and the maximum clot firmness was almost perfect (r(s) above 0.96). Also, the correlation between the alpha-angle and FIBTEM parameters was strong (r(s) above 0.7). In conclusion, strong correlations were found between early FIBTEM parameters and fibrinogen levels. FAU - de Vries, Judith J AU - de Vries JJ AUID- ORCID: 0000-0002-5007-2147 AD - Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. FAU - Veen, Caroline S B AU - Veen CSB AD - Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. FAU - Snoek, Charlotte J M AU - Snoek CJM AD - Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. FAU - Kruip, Marieke J H A AU - Kruip MJHA AD - Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. FAU - de Maat, Moniek P M AU - de Maat MPM AD - Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. LA - eng PT - Journal Article DEP - 20200914 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Aged MH - *Blood Coagulation MH - Blood Coagulation Tests/*methods MH - Female MH - Fibrinogen/*analysis MH - *Healthy Volunteers MH - Humans MH - Male MH - Middle Aged OTO - NOTNLM OT - Clauss assay OT - FIBTEM OT - Fibrinogen OT - correlation OT - rotational thromboelastometry EDAT- 2020/09/15 06:00 MHDA- 2021/10/07 06:00 CRDT- 2020/09/14 15:38 PHST- 2020/09/15 06:00 [pubmed] PHST- 2021/10/07 06:00 [medline] PHST- 2020/09/14 15:38 [entrez] AID - 10.1080/00365513.2020.1818283 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2020 Nov;80(7):600-605. doi: 10.1080/00365513.2020.1818283. Epub 2020 Sep 14. PMID- 32907709 OWN - NLM STAT- MEDLINE DCOM- 20210106 LR - 20210903 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 220 IP - 6 DP - 2020 Dec TI - A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation. PG - 1379-1386 LID - S0002-9610(20)30499-2 [pii] LID - 10.1016/j.amjsurg.2020.07.034 [doi] AB - BACKGROUND: An NIH clinical coagulopathy score has been devised for trauma patients, but no such clinical score exists in transplantation surgery. We hypothesize that that this coagulopathy score can effectively identify laboratory defined coagulopathy during liver transplantation and correlates to blood product utilization. METHODS: TEGs were performed and coagulopathy scores (1, normal bleeding - 5, diffuse coagulopathic bleeding) were assigned by the surgeons at 5 intra-operative time points. Blood products used during the case were recorded between time points. Statistical analyses were performed to identify correlations between coagulopathy scores, TEG-detected abnormalities, and blood product utilization. RESULT: Transfusions rarely correlated with the appropriate TEG measurements of coagulation dysfunction. Coagulopathy score had significant correlation to various transfusions and TEG-detected coagulopathies at multiple points during the case. High aggregate coagulopathy scores identified patients receiving more transfusions, re-operations, and longer hospital stays CONCLUSION: The combination of viscoelastic testing and a standardized clinical coagulopathy score has the potential to optimize transfusions if used in tandem as well as standardize communication between surgery and anesthesia teams about clinically evident coagulopathy. CI - Copyright (c) 2020. Published by Elsevier Inc. FAU - Schulick, Alexander C AU - Schulick AC AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. Electronic address: hunter.moore@cuanschutz.edu. FAU - Walker, Carson B AU - Walker CB AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Yaffe, Hillary AU - Yaffe H AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Pomposelli, James J AU - Pomposelli JJ AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Azam, Fareed AU - Azam F AD - Department of Anesthesiology, University of Colorado, United States. FAU - Wachs, Michael AU - Wachs M AD - Department of Surgery, Childrens Hospital Colorado, United States. FAU - Bak, Thomas AU - Bak T AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Kennealey, Peter AU - Kennealey P AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Conzen, Kendra AU - Conzen K AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Adams, Megan AU - Adams M AD - Department of Surgery, Childrens Hospital Colorado, United States. FAU - Pshak, Thomas AU - Pshak T AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Choudhury, Rashikh AU - Choudhury R AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Pomfret, Elizabeth A AU - Pomfret EA AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. FAU - Nydam, Trevor L AU - Nydam TL AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, United States. LA - eng GR - K99 HL151887/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20200901 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM CIN - Am J Surg. 2020 Dec;220(6):1378. doi: 10.1016/j.amjsurg.2020.09.023. PMID: 33066953 MH - Adult MH - Blood Coagulation Disorders/*classification MH - Blood Component Transfusion/*statistics & numerical data MH - Female MH - *Hemostatic Techniques MH - Humans MH - *Liver Transplantation MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Prospective Studies MH - Resuscitation/*methods MH - Thrombelastography MH - Viscosity PMC - PMC8204641 MID - NIHMS1700924 OTO - NOTNLM OT - Clinical coagulopathy OT - Coagulopathy score OT - Hemostatic resuscitation OT - Liver transplantation OT - Thrombelastography COIS- Declaration of competing interest The authors of this paper have no conflicts of interest to declare. EDAT- 2020/09/11 06:00 MHDA- 2021/01/07 06:00 PMCR- 2021/09/01 CRDT- 2020/09/10 05:27 PHST- 2020/03/27 00:00 [received] PHST- 2020/06/14 00:00 [revised] PHST- 2020/07/16 00:00 [accepted] PHST- 2020/09/11 06:00 [pubmed] PHST- 2021/01/07 06:00 [medline] PHST- 2020/09/10 05:27 [entrez] PHST- 2021/09/01 00:00 [pmc-release] AID - S0002-9610(20)30499-2 [pii] AID - 10.1016/j.amjsurg.2020.07.034 [doi] PST - ppublish SO - Am J Surg. 2020 Dec;220(6):1379-1386. doi: 10.1016/j.amjsurg.2020.07.034. Epub 2020 Sep 1. PMID- 32894876 OWN - NLM STAT- MEDLINE DCOM- 20220117 LR - 20220117 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) VI - 41 IP - 4 DP - 2021 Aug TI - Trauma-Induced Coagulopathy and Massive Bleeding: Current Hemostatic Concepts and Treatment Strategies. PG - 307-315 LID - 10.1055/a-1232-7721 [doi] AB - Hemorrhage after trauma remains a significant cause of preventable death. Trauma-induced coagulopathy (TIC) at the time of hospital admission is associated with an impaired outcome. Rather than a universal phenotype, TIC represents a complex hemostatic disorder, and standard coagulation tests are not designed to adequately reflect the complexity of TIC. Viscoelastic testing (VET) has gained increasing interest for the characterization of TIC because it provides a more comprehensive depiction of the coagulation process. Thus, VET has been established as a point-of-care-available hemostatic monitoring tool in many trauma centers. Damage-control resuscitation and early administration of tranexamic acid provide the basis for treating TIC. To improve survival, ratio-driven massive transfusion protocols favoring early and high-dose plasma transfusion have been implemented in many trauma centers around the world. Although plasma contains all coagulation factors and inhibitors, only high-volume plasma transfusion allows for adequate substitution of lacking coagulation proteins. However, high-volume plasma transfusion has been associated with several relevant risks. In some European trauma facilities, a more individualized hemostatic therapy concept has been implemented. The hemostatic profile of the bleeding patient is evaluated by VET. Subsequently, goal-directed hemostatic therapy is primarily based on coagulation factor concentrates such as fibrinogen concentrate or prothrombin complex concentrate. However, a clear difference in survival benefit between these two treatment strategies has not yet been shown. This concise review aims to summarize current evidence for different diagnostic and therapeutic strategies in patients with TIC. CI - Thieme. All rights reserved. FAU - Gratz, Johannes AU - Gratz J AD - Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Austria. FAU - Oberladstatter, Daniel AU - Oberladstatter D AD - Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. LA - eng PT - Journal Article DEP - 20200907 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 RN - 0 (Hemostatics) SB - IM MH - *Blood Coagulation Disorders/etiology/therapy MH - Blood Component Transfusion MH - Hemorrhage/etiology/therapy MH - *Hemostatics/therapeutic use MH - Humans MH - Plasma MH - *Wounds and Injuries/complications COIS- Dr. Gratz reports personal fees and nonfinancial support from CSL Behring, nonfinancial support from Johnson & Johnson Medical Products, personal fees and nonfinancial support from Mitsubishi Tanabe Pharma, personal fees and nonfinancial support from Instrumentation Laboratory, and personal fees from Portola, outside the submitted work. Dr. Schochl reports grants, personal fees, and nonfinancial support from CSL Behring, grants, personal fees, and nonfinancial support from TEM International, outside the submitted work. Dr. Oberladstatter declares that he has no potential conflicts of interest. EDAT- 2020/09/08 06:00 MHDA- 2022/01/18 06:00 CRDT- 2020/09/07 20:02 PHST- 2020/09/08 06:00 [pubmed] PHST- 2022/01/18 06:00 [medline] PHST- 2020/09/07 20:02 [entrez] AID - 10.1055/a-1232-7721 [doi] PST - ppublish SO - Hamostaseologie. 2021 Aug;41(4):307-315. doi: 10.1055/a-1232-7721. Epub 2020 Sep 7. PMID- 32894784 OWN - NLM STAT- MEDLINE DCOM- 20210512 LR - 20220202 IS - 1423-0410 (Electronic) IS - 0042-9007 (Print) IS - 0042-9007 (Linking) VI - 116 IP - 2 DP - 2021 Feb TI - 28-day thawed plasma maintains alpha(2) -antiplasmin levels and inhibits tPA-induced fibrinolysis. PG - 181-189 LID - 10.1111/vox.12997 [doi] AB - INTRODUCTION: Evidence supports the use of plasma-first resuscitation in the treatment of trauma-induced coagulopathy (TIC). While thawed plasma (TP) has logistical benefits, the ability of plasma proteins to attenuate fibrinolysis and correct TIC remain unknown. We hypothesize that TP retains the ability to inhibit tissue plasminogen activator(tPA)-induced fibrinolysis at 28-day storage. METHODS: Healthy volunteers underwent blood draws followed by 50% dilution of whole blood (WB) with TP at 28-, 21-, 14-, 7-, 5-, and, 0-day storage, normal saline (NS), and WB control. Samples underwent citrated tPA-challenge (75 ng/ml) thromboelastography (TEG). Plasminogen activator inhibitor-1 (PAI-1) and alpha(2) -antiplasmin (alpha(2) -AP) concentrations in thawed or stored plasma were determined. RESULTS: In the presence of tPA, 28-day TP inhibited tPA-induced coagulopathy as effectively as WB. 28-day TP had a similar R-time, MA, and fibrinolysis (P > 0.05 for all) compared to WB, while angle was enhanced (P = 0.02) compared to WB. Significant correlations were present between storage time and clot strength (P = 0.04) and storage time and fibrinolysis (P = 0.0029). Active PAI-1 levels in thawed plasma were 1.10 +/- 0.54 ng/mL while total PAI-1 levels were 4.79 +/- 1.41 ng/mL. There was no difference of alpha(2) -AP levels in FFP (40.45 +/- 3.5 mug/mL) compared to plasma thawed for 14 (36.78 +/- 5.39 mug/mL, P = 0.65) or 28 days (45.16 +/- 5.61 mug/mL, P = 0.51). DISCUSSION: Thawed plasma retained the ability to inhibit tPA-induced fibrinolysis over 28-day storage at 1-4 degrees C. alpha(2) -AP levels were maintained in plasma thawed for 28 days and FFP. These in vitro results suggest consideration should be made to increasing the storage life of TP. CI - (c) 2020 International Society of Blood Transfusion. FAU - Stettler, Gregory R AU - Stettler GR AUID- ORCID: 0000-0002-0967-9035 AD - Department of Surgery, University of Colorado, Auora, CO, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Auora, CO, USA. AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado, Auora, CO, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado, Auora, CO, USA. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado, Auora, CO, USA. FAU - Kelher, Marguerite AU - Kelher M AD - Department of Surgery, University of Colorado, Auora, CO, USA. AD - Vitalant Mountain Division, Denver, CO, USA. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Auora, CO, USA. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado, Auora, CO, USA. AD - Vitalant Mountain Division, Denver, CO, USA. AD - Department of Pediatrics, University of Colorado, Auora, CO, USA. LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - UM1-HL120877/National Heart Lung and Blood Institute/ GR - USAMRAA/U.S. Department of Defense/ GR - W81XWH-12-2-0028/U.S. Department of Defense/ GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - P50-GM49222/GM/NIGMS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20200907 PL - England TA - Vox Sang JT - Vox sanguinis JID - 0413606 RN - 0 (SERPINF2 protein, human) RN - 0 (alpha-2-Antiplasmin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - *Blood Component Transfusion MH - Female MH - *Fibrinolysis MH - Humans MH - Male MH - Plasma/*metabolism MH - Tissue Plasminogen Activator/*metabolism MH - alpha-2-Antiplasmin/*analysis PMC - PMC7962918 MID - NIHMS1677421 OTO - NOTNLM OT - hemostasis OT - plasma OT - transfusion OT - traum EDAT- 2020/09/08 06:00 MHDA- 2021/05/13 06:00 PMCR- 2022/02/01 CRDT- 2020/09/07 17:05 PHST- 2020/06/29 00:00 [received] PHST- 2020/08/01 00:00 [revised] PHST- 2020/08/04 00:00 [accepted] PHST- 2020/09/08 06:00 [pubmed] PHST- 2021/05/13 06:00 [medline] PHST- 2020/09/07 17:05 [entrez] PHST- 2022/02/01 00:00 [pmc-release] AID - 10.1111/vox.12997 [doi] PST - ppublish SO - Vox Sang. 2021 Feb;116(2):181-189. doi: 10.1111/vox.12997. Epub 2020 Sep 7. PMID- 32890345 OWN - NLM STAT- MEDLINE DCOM- 20210202 LR - 20221005 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 89 IP - 5 DP - 2020 Nov TI - A rat model of orthopedic injury-induced hypercoagulability and fibrinolytic shutdown. PG - 926-931 LID - 10.1097/TA.0000000000002924 [doi] AB - BACKGROUND: Postinjury hypercoagulability occurs in >25% of injured patients, increasing risk of thromboembolic complications despite chemoprophylaxis. However, few clinically relevant animal models of posttraumatic hypercoagulability exist. We aimed to evaluate a rodent model of bilateral hindlimb injury as a preclinical model of postinjury hypercoagulability. METHODS: Forty Wistar rats were anesthetized with isoflurane: 20 underwent bilateral hindlimb fibula fracture, soft tissue and muscular crush injury, and bone homogenate injection intended to mimic the physiological severity of bilateral femur fracture. Twenty sham rats underwent anesthesia only. Terminal citrated blood samples were drawn at 0, 6, 12, and 24 hours (n = 5 per timed group) for analysis by native thromboelastography in the presence and absence of taurocholic acid to augment fibrinolysis. Plasminogen activator inhibitor 1 and alpha-2 antiplasmin levels in plasma were assessed via enzyme-linked immunosorbent assay. RESULTS: Injured rats became hypercoagulable relative to baseline by 6 hours based on thromboelastography maximal amplitude (MA) and G (p < 0.005); sham rats became hypercoagulable to a lesser degree by 24 hours (p < 0.005). Compared with sham animals, injured rats were hypercoagulable by MA and G within 6 hours of injury, remained hypercoagulable by MA and G through at least 24 hours (all p < 0.01), and showed impaired fibrinolysis by taurocholic acid LY30 at 12 hours (p = 0.019) and native LY30 at 24 hours (p = 0.045). In terms of antifibrinolytic mediators, alpha-2 antiplasmin was elevated in trauma animals at 24 hours (p = 0.009), and plasminogen activator inhibitor 1 was elevated in trauma animals at 6 hours (p = 0.004) and 12 hours (p < 0.001) when compared with sham. CONCLUSIONS: Orthopedic injury in rodents induced platelet and overall hypercoagulability within 6 hours and fibrinolytic impairment by 12 to 24 hours, mimicking postinjury hypercoagulability in injured patients. This rodent model of orthopedic injury may serve as a preclinical testing ground for potential therapies to mitigate hypercoagulability, maintain normal fibrinolysis, and prevent thromboembolic complications. FAU - Carter, Kristen T AU - Carter KT AD - From the Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery (K.T.C., A.C.P., F.T.S., B.M.W., L.M., M.E.K.), and Department of Physiology and Biophysics (R.L.H.), University of Mississippi Medical Center, Jackson, Mississippi. FAU - Palei, Ana C AU - Palei AC FAU - Spradley, Frank T AU - Spradley FT FAU - Witcher, Brycen M AU - Witcher BM FAU - Martin, Larry AU - Martin L FAU - Hester, Robert L AU - Hester RL FAU - Kutcher, Matthew E AU - Kutcher ME LA - eng GR - UL1 TR003096/TR/NCATS NIH HHS/United States GR - K08 GM138812/GM/NIGMS NIH HHS/United States GR - T32 HL105324/HL/NHLBI NIH HHS/United States GR - R00 HL130577/HL/NHLBI NIH HHS/United States GR - P20 GM121334/GM/NIGMS NIH HHS/United States GR - U54 GM115428/GM/NIGMS NIH HHS/United States PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Plasminogen Activator Inhibitor 1) RN - 0 (Serpine1 protein, rat) RN - 0 (alpha-2-Antiplasmin) SB - IM MH - Animals MH - Disease Models, Animal MH - Fibrinolysis/*physiology MH - Hindlimb/*injuries MH - Humans MH - Leg Injuries/blood/*complications MH - Male MH - Plasminogen Activator Inhibitor 1/analysis MH - Rats MH - Thrombophilia/blood/*etiology/physiopathology MH - alpha-2-Antiplasmin/analysis PMC - PMC7897415 MID - NIHMS1622643 EDAT- 2020/09/06 06:00 MHDA- 2021/02/03 06:00 PMCR- 2021/11/01 CRDT- 2020/09/05 17:07 PHST- 2020/09/06 06:00 [pubmed] PHST- 2021/02/03 06:00 [medline] PHST- 2020/09/05 17:07 [entrez] PHST- 2021/11/01 00:00 [pmc-release] AID - 01586154-202011000-00013 [pii] AID - 10.1097/TA.0000000000002924 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Nov;89(5):926-931. doi: 10.1097/TA.0000000000002924. PMID- 32864298 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220416 IS - 2198-6096 (Print) IS - 2198-6096 (Electronic) IS - 2198-6096 (Linking) VI - 6 IP - 1 DP - 2020 Mar TI - Modern Management of Bleeding, Clotting, and Coagulopathy in Trauma Patients: What Is the Role of Viscoelastic Assays? PG - 69-81 LID - 10.1007/s40719-020-00183-w [doi] AB - PURPOSE OF REVIEW: The purpose of this review is to briefly outline the current state of hemorrhage control and resuscitation in trauma patients with a specific focus on the role viscoelastic assays have in this complex management, to include indications for use across all phases of care in the injured patient. RECENT FINDINGS: Viscoelastic assay use to guide blood-product resuscitation in bleeding trauma patients can reduce mortality by up to 50%. Viscoelastic assays also reduce total blood products transfused, reduce ICU length of stay, and reduce costs. There are a large number of observational and retrospective studies evaluating viscoelastic assay use in the initial trauma resuscitation, but only one randomized control trial. There is a paucity of data evaluating use of viscoelastic assays in the operating room, post-operatively, and during ICU management in trauma patients, rendering their use in these settings extrapolative/speculative based on theory and data from other surgical disciplines and settings. SUMMARY: Both hypocoagulable and hypercoagulable states exist in trauma patients, and better indicate what therapy may be most appropriate. Further study is needed, particularly in the operating room and post-operative/ICU settings in trauma patients. FAU - Dhara, Sanjeev AU - Dhara S AD - University of Chicago School of Medicine, Chicago, IL. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Yaffe, Michael B AU - Yaffe MB AD - Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge, MA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Barrett, Christopher D AU - Barrett CD AD - Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge, MA. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20200123 PL - Switzerland TA - Curr Trauma Rep JT - Current trauma reports JID - 101663913 PMC - PMC7453728 MID - NIHMS1551509 OTO - NOTNLM OT - coagulopathy OT - hemorrhage OT - rotational thromboelastometry (ROTEM) OT - thromboelastography (TEG) OT - trauma OT - viscoelastic assay EDAT- 2020/08/31 06:00 MHDA- 2020/08/31 06:01 PMCR- 2021/03/01 CRDT- 2020/09/01 06:00 PHST- 2020/09/01 06:00 [entrez] PHST- 2020/08/31 06:00 [pubmed] PHST- 2020/08/31 06:01 [medline] PHST- 2021/03/01 00:00 [pmc-release] AID - 10.1007/s40719-020-00183-w [doi] PST - ppublish SO - Curr Trauma Rep. 2020 Mar;6(1):69-81. doi: 10.1007/s40719-020-00183-w. Epub 2020 Jan 23. PMID- 32852184 OWN - NLM STAT- MEDLINE DCOM- 20210202 LR - 20211102 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 89 IP - 5 DP - 2020 Nov TI - Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma. PG - 871-879 LID - 10.1097/TA.0000000000002820 [doi] AB - BACKGROUND: Mobilization of intra and extracellular calcium is required for platelet activation, aggregation, and degranulation. However, the importance of alterations in the calcium-platelet axis after injury is unknown. We hypothesized that in injured patients, in vivo initial calcium concentrations (pretransfusion) predict ex vivo platelet activation and aggregation, viscoelastic clot strength, and transfusion of blood products. We additionally hypothesized that increasing calcium concentrations ex vivo increases the expression of platelet activation surface receptors and platelet aggregation responses to agonist stimulation in healthy donor blood. METHODS: Blood samples were collected from 538 trauma patients on arrival to the emergency department. Standard assays (including calcium), platelet aggregometry (PA) and thromboelastometry (ROTEM) were performed. In PA, platelet activation (prestimulation impedance [Omega]) and aggregation responses to agonist stimulation (area under the aggregation curve [AUC]) with adenosine diphosphate (ADP), thrombin receptor-activating peptide, arachidonic acid (AA), and collagen (COL) were measured. Multivariable regression tested the associations of calcium with PA, ROTEM, and transfusions. To further examine the calcium-platelet axis, calcium was titrated in healthy blood. Platelet aggregometry and ROTEM were performed, and expression of platelet glycoprotein IIb/IIIa and P-selectin was measured by flow cytometry. RESULTS: The patients were moderately injured with normal calcium and platelet counts. Higher calcium on arrival (pretransfusion) was independently associated with increased platelet activation (prestimulation, Omega; p < 0.001), aggregation (ADP-stimulated, AUC; p = 0.002; thrombin receptor-activating peptide-stimulated, AUC; p = 0.038), and clot strength (ROTEM max clot firmness; p < 0.001), and inversely associated with 24-hour transfusions of blood, plasma, and platelets (all p < 0.005). Up-titrating calcium in healthy blood increased platelet activation (prestimulation, Omega; p < 0.001), aggregation (ADP, AA, COL-stimulated AUCs; p < 0.050), and expression of P-selectin (p = 0.003). CONCLUSION: Initial calcium concentrations (pretransfusion) are independently associated with platelet activation, aggregation, clot-strength, and transfusions after injury. These changes may be mediated by calcium driven expression of surface receptors necessary for platelet activation and aggregation. However, the therapeutic benefit of early, empiric calcium repletion in trauma patients remains undefined. LEVEL OF EVIDENCE: Prognostic, level V. FAU - Matthay, Zachary A AU - Matthay ZA AD - From the Department of Surgery (Z.A.M., A.T.F., B.N.-G., M.P., R.A.C., L.Z.K.), Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California; and Department of Surgery (M.J.C.), Denver Health Medical Center and the University of Colorado, Denver, Colorado. FAU - Fields, Alexander T AU - Fields AT FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B FAU - Patel, Maya H AU - Patel MH FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Callcut, Rachael A AU - Callcut RA FAU - Kornblith, Lucy Z AU - Kornblith LZ LA - eng GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - TL1 TR001871/TR/NCATS NIH HHS/United States GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - K01 ES026834/ES/NIEHS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - SY7Q814VUP (Calcium) SB - IM MH - Adult MH - Blood Component Transfusion/*statistics & numerical data MH - Blood Platelets/drug effects/*physiology MH - Calcium/administration & dosage/blood/*metabolism MH - Cell Degranulation/drug effects/physiology MH - Female MH - Hemorrhage/blood/etiology/physiopathology/*therapy MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Platelet Activation/drug effects/physiology MH - Platelet Aggregation/drug effects/physiology MH - Platelet Count MH - Prospective Studies MH - Thrombelastography MH - Wounds and Injuries/blood/complications/diagnosis/*physiopathology PMC - PMC7830742 MID - NIHMS1598134 COIS- Conflicts of Interest: Disclosure outside the scope of this work: none. EDAT- 2020/08/28 06:00 MHDA- 2021/02/03 06:00 PMCR- 2021/11/01 CRDT- 2020/08/28 06:00 PHST- 2020/08/28 06:00 [pubmed] PHST- 2021/02/03 06:00 [medline] PHST- 2020/08/28 06:00 [entrez] PHST- 2021/11/01 00:00 [pmc-release] AID - 01586154-202011000-00005 [pii] AID - 10.1097/TA.0000000000002820 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Nov;89(5):871-879. doi: 10.1097/TA.0000000000002820. PMID- 32833584 OWN - NLM STAT- MEDLINE DCOM- 20211028 LR - 20220531 IS - 2153-7933 (Electronic) IS - 2153-7658 (Linking) VI - 11 IP - 1 DP - 2021 Mar TI - Thromboelastography to Assess Coagulopathy in Traumatic Brain Injury Patients Undergoing Therapeutic Hypothermia. PG - 53-57 LID - 10.1089/ther.2020.0025 [doi] AB - Therapeutic hypothermia has been a treatment option for patients with severe traumatic brain injury (TBI) for many years. There has, however, been uncertainty whether hypothermia in this context also increased clinical bleeding risk, perhaps due to platelet dysfunction. Standard coagulation tests do not allow accurate assessment of in vivo coagulation. We studied specific coagulation abnormalities in patients undergoing therapeutic hypothermia for severe TBI using bedside thromboelastography (TEG).We studied 20 patients with severe blunt TBI from a single tertiary ICU who were enrolled in the prophylactic hypothermia to lessen traumatic brain injury (POLAR) trial. Ten patients had been randomized to hypothermia, and 10 were controls receiving normothermic standard care. TEG was undertaken during and after therapeutic hypothermia, and at the same time points in controls. Coagulation profiles were then compared between the hypothermic and control patients, and also between hypothermia and later normothermia in the study patients. Patients were primarily young (mean age 34 years) and male (85%). Measures of injury severity, including Glasgow coma score and injury severity scale, were not different between groups. Using TEG, the median alpha angle was reduced in hypothermic patients compared with controls (69.2 degrees vs. 72.0 degrees , p = 0.02), although both were within the normal range. LY30 was also reduced (0.0% vs. 0.5%, p < 0.01). Both differences persisted when hypothermic patients were compared with themselves during later normothermia. Therapeutic hypothermia during severe TBI causes a small decrease in the rate of clot formation. However, this decrease is within the normal range, and is unlikely to be clinically significant. FAU - Quine, Edward J AU - Quine EJ AD - Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. FAU - Murray, Lynnette AU - Murray L AD - Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. FAU - Trapani, Tony AU - Trapani T AD - Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. FAU - Cooper, D James AU - Cooper DJ AD - Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. AD - Department of Intensive Care, Alfred Health, Melbourne, Australia. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20200821 PL - United States TA - Ther Hypothermia Temp Manag JT - Therapeutic hypothermia and temperature management JID - 101543518 SB - IM MH - Adult MH - Blood Coagulation MH - *Brain Injuries, Traumatic/complications/diagnosis/therapy MH - Humans MH - *Hypothermia MH - *Hypothermia, Induced MH - Male MH - Thrombelastography OTO - NOTNLM OT - coagulation OT - hypothermia OT - thromboelastography OT - traumatic brain injury EDAT- 2020/08/25 06:00 MHDA- 2021/10/29 06:00 CRDT- 2020/08/25 06:00 PHST- 2020/08/25 06:00 [pubmed] PHST- 2021/10/29 06:00 [medline] PHST- 2020/08/25 06:00 [entrez] AID - 10.1089/ther.2020.0025 [doi] PST - ppublish SO - Ther Hypothermia Temp Manag. 2021 Mar;11(1):53-57. doi: 10.1089/ther.2020.0025. Epub 2020 Aug 21. PMID- 32798961 OWN - NLM STAT- MEDLINE DCOM- 20210617 LR - 20210903 IS - 1879-2472 (Electronic) IS - 0049-3848 (Print) IS - 0049-3848 (Linking) VI - 193 DP - 2020 Sep TI - Post-TBI splenectomy may exacerbate coagulopathy and platelet activation in a murine model. PG - 211-217 LID - S0049-3848(20)30442-4 [pii] LID - 10.1016/j.thromres.2020.08.002 [doi] AB - INTRODUCTION: Traumatic brain injury (TBI) induces acute hypocoagulability, subacute hypercoagulability, and persistently elevated risk for thromboembolic events. Splenectomy is associated with increased mortality in patients with moderate or severe TBI. We hypothesized that the adverse effects of splenectomy in TBI patients may be secondary to the exacerbation of pathologic coagulation and platelet activation changes. METHODS: An established murine weight-drop TBI model was utilized and a splenectomy was performed immediately following TBI. Sham as well as TBI and splenectomy alone mice were used as injury controls. Mice were sacrificed for blood draws at 1, 6, and 24 h, as well as 7 days post-TBI. Viscoelastic coagulation parameters were assessed by rotational thromboelastometry (ROTEM) and platelet activation was measured by expression of P-selectin via flow cytometry analysis of platelet rich plasma samples. RESULTS: At 6 h following injury, TBI/splenectomy demonstrated hypocoagulability with prolonged clot formation time (CFT) compared to TBI alone. By 24 h following injury, TBI/splenectomy and splenectomy mice were hypercoagulable with a shorter CFT, a higher alpha angle, and increased MCF, despite a lower percentage of platelet contribution to clot compared to TBI alone. However, only the TBI/splenectomy continued to display this hypercoagulable state at 7 days. While TBI/splenectomy had greater P-selectin expression at 1-h post-injury, TBI alone had significantly greater P-selectin expression at 24 h post-injury compared to TBI/splenectomy. Interestingly, P-selectin expression remained elevated only in TBI/splenectomy at 7 days post-injury. CONCLUSION: Splenectomy following TBI exacerbates changes in the post-injury coagulation state. The combination of TBI and splenectomy induces an acute hypocoagulable state that could contribute to an increase in intracranial bleeding. Subacutely, the addition of splenectomy to TBI exacerbates post-injury hypercoagulability and induces persistent platelet activation. These polytrauma effects on coagulation may contribute to the increased mortality observed in patients with combined brain and splenic injuries. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Morris, Mackenzie C AU - Morris MC AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - John, Devin AU - John D AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Singer, Kathleen E AU - Singer KE AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Moran, Ryan AU - Moran R AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - McGlone, Emily AU - McGlone E AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Veile, Rosalie AU - Veile R AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Goetzman, Holly S AU - Goetzman HS AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA; Division of Research, Shriners Hospital for Children, Cincinnati, OH, USA. FAU - Makley, Amy T AU - Makley AT AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. FAU - Caldwell, Charles C AU - Caldwell CC AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA; Division of Research, Shriners Hospital for Children, Cincinnati, OH, USA. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: goodmamd@ucmail.uc.edu. LA - eng GR - R01 GM124156/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20200807 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM MH - Animals MH - *Blood Coagulation Disorders MH - Disease Models, Animal MH - Humans MH - Mice MH - Platelet Activation MH - *Splenectomy/adverse effects MH - Thrombelastography PMC - PMC7484105 MID - NIHMS1620063 OTO - NOTNLM OT - Coagulopathy OT - Platelets OT - Rotational thromboelastometry OT - Splenectomy OT - Traumatic brain injury COIS- Declaration of competing interest All authors have no conflicts of interest to disclose. EDAT- 2020/08/18 06:00 MHDA- 2021/06/22 06:00 PMCR- 2021/09/01 CRDT- 2020/08/18 06:00 PHST- 2020/05/18 00:00 [received] PHST- 2020/07/25 00:00 [revised] PHST- 2020/08/03 00:00 [accepted] PHST- 2020/08/18 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/08/18 06:00 [entrez] PHST- 2021/09/01 00:00 [pmc-release] AID - S0049-3848(20)30442-4 [pii] AID - 10.1016/j.thromres.2020.08.002 [doi] PST - ppublish SO - Thromb Res. 2020 Sep;193:211-217. doi: 10.1016/j.thromres.2020.08.002. Epub 2020 Aug 7. PMID- 32755664 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 1873-1570 (Electronic) IS - 0300-9572 (Linking) VI - 155 DP - 2020 Oct TI - Prognostic value of repeated thromboelastography measurement for favorable neurologic outcome during targeted temperature management in out-of-hospital cardiac arrest survivors. PG - 65-73 LID - S0300-9572(20)30295-1 [pii] LID - 10.1016/j.resuscitation.2020.07.019 [doi] AB - BACKGROUND: Cardiac arrest can activate blood coagulation, which clinically manifests as obstruction of the microcirculation and multiple organ dysfunction. Thromboelastography (TEG) provides a rapid and comprehensive assessment of hemostatic processes, but there are limited data on the use of sequential TEG values during targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to investigate the prognostic value of coagulopathy assessed by repeated TEG to predict neurologically intact survival. METHODS: A prospective cohort of consecutive non-trauma OHCA patients who were successfully resuscitated and treated with TTM. Patients with a target temperature of 36 ℃, no TEG data, and who declined appropriate treatment were excluded. TEG was measured at three time points of TTM (initial phase, target phase, and rewarming phase). The primary outcome was 28 day favorable neurologic function, defined as a Cerebral Performance Category of 1 or 2. RESULTS: A total of 125 patients (mean age, 61 years; 63.2% male) were analyzed. A favorable neurologic outcome at 28 days was seen in 40 patients (32.0%). TEG values of R and LY30 in the initial phase were significantly lower in the favorable neurologic outcome group than in the unfavorable group (5.8 vs. 8.1 and 0.1 vs. 0.7, respectively; p < 0.01). TEG values of R < 5 or LY30 < 7.5 in the initial phase were more frequently seen in the favorable outcomes group than in the unfavorable group (37.5% vs. 12.9%, p = 0.002 and 95.0% vs. 72.9%, p = 0.004, respectively). However, no significant differences were seen between the two groups in other TEG values (R, K, alpha, and MA) in the target and rewarming phases (p > 0.05 for all). Univariate analysis showed higher D-dimer levels, prothrombin time, and activated partial thromboplastin time in the unfavorable outcome group. In the multivariable analysis, TEG values of combination of R < 5 and LY30 < 7.5 in the initial phase were the only coagulation profiles seen to be independently associated with favorable neurologic outcome (OR, 4.508, 95% CI, 1.254-16.210). CONCLUSION: TEG results are available within minutes, and shorted R values or the absence of prolonged LY30 values in the initial phase are an early predictor of neurologically intact survival in successfully resuscitated OHCA patients. CI - Copyright (c) 2020 Elsevier B.V. All rights reserved. FAU - Yu, Gina AU - Yu G AD - Department of Emergency Medicine, University of Yonsei College of Medicine, Seoul, Republic of Korea. FAU - Kim, Youn-Jung AU - Kim YJ AD - Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Kim, June-Sung AU - Kim JS AD - Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Kim, Sang-Il AU - Kim SI AD - Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea. FAU - Ryoo, Seung Mok AU - Ryoo SM AD - Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Ahn, Shin AU - Ahn S AD - Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Kim, Won Young AU - Kim WY AD - Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: wonpia73@naver.com. LA - eng PT - Journal Article DEP - 20200802 PL - Ireland TA - Resuscitation JT - Resuscitation JID - 0332173 SB - IM MH - Female MH - Humans MH - *Hypothermia, Induced MH - Male MH - Middle Aged MH - *Out-of-Hospital Cardiac Arrest/therapy MH - Prognosis MH - Prospective Studies MH - Survivors MH - Thrombelastography OTO - NOTNLM OT - Cardiac arrest OT - Neurologic progronsis OT - Postcardiac arrest syndrome OT - Targeted temperature management OT - Thromboleastography EDAT- 2020/08/07 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/08/07 06:00 PHST- 2020/03/12 00:00 [received] PHST- 2020/05/31 00:00 [revised] PHST- 2020/07/14 00:00 [accepted] PHST- 2020/08/07 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/08/07 06:00 [entrez] AID - S0300-9572(20)30295-1 [pii] AID - 10.1016/j.resuscitation.2020.07.019 [doi] PST - ppublish SO - Resuscitation. 2020 Oct;155:65-73. doi: 10.1016/j.resuscitation.2020.07.019. Epub 2020 Aug 2. PMID- 32751629 OWN - NLM STAT- MEDLINE DCOM- 20210324 LR - 20240329 IS - 1424-8220 (Electronic) IS - 1424-8220 (Linking) VI - 20 IP - 15 DP - 2020 Jul 30 TI - Point-of-Care Diagnostics in Coagulation Management. LID - 10.3390/s20154254 [doi] LID - 4254 AB - This review provides a comprehensive and up-to-date overview of point-of-care (POC) devices most commonly used for coagulation analyses in the acute settings. Fast and reliable assessment of hemostasis is essential for the management of trauma and other bleeding patients. Routine coagulation assays are not designed to visualize the process of clot formation, and their results are obtained only after 30-90 m due to the requirements of sample preparation and the analytical process. POC devices such as viscoelastic coagulation tests, platelet function tests, blood gas analysis and other coagulometers provide new options for the assessment of hemostasis, and are important tools for an individualized, goal-directed, and factor-based substitution therapy. We give a detailed overview of the related tests, their characteristics and clinical implications. This review emphasizes the evident advantages of the speed and predictive power of POC clot measurement in the context of a goal-directed and algorithm-based therapy to improve the patient's outcome. Interpretation of viscoelastic tests is facilitated by a new visualization technology. FAU - Sahli, Sebastian D AU - Sahli SD AUID- ORCID: 0000-0002-2030-0313 AD - Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland. FAU - Rossler, Julian AU - Rossler J AD - Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland. FAU - Tscholl, David W AU - Tscholl DW AUID- ORCID: 0000-0003-4284-6859 AD - Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland. FAU - Studt, Jan-Dirk AU - Studt JD AD - Division of Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland. FAU - Spahn, Donat R AU - Spahn DR AD - Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland. FAU - Kaserer, Alexander AU - Kaserer A AD - Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland. LA - eng PT - Journal Article PT - Review DEP - 20200730 PL - Switzerland TA - Sensors (Basel) JT - Sensors (Basel, Switzerland) JID - 101204366 SB - IM MH - *Blood Coagulation MH - Blood Coagulation Tests MH - *Hemorrhage/prevention & control/therapy MH - Humans MH - *Point-of-Care Testing PMC - PMC7435714 OTO - NOTNLM OT - ROTEM(R) OT - coagulation management OT - hemorrhage OT - platelet function test OT - point-of-care systems COIS- S.D.S. and J.R. have no conflict of interest to declare. J.-D.S. received lecture and advisory honoraria from Bayer (Switzerland), Shire/Takeda (Switzerland), Sanofi (Switzerland), and Siemens Healthineers (Switzerland). A.K. received honoraria for lecturing from Bayer AG Switzerland. The University of Zurich and Instrumentation Laboratory Company/Werfen Corporation, Bedford, MA, USA, signed a letter of intent regarding a joint development and licensing agreement to develop a product based on the concept of Visual Clot. Within the framework of this letter of intent and a potential later agreement, D.W.T. and D.R.S. might receive royalties as designated inventors. The University of Zurich and Philips Medizin Systeme Boblingen GmbH, Boblingen, Germany and Konikljike Philips N.V., Amsterdam, The Netherlands signed a joint development and licensing agreement to develop a product based on the concept of Visual Patient. Within the framework of this agreement, D.W.T. might receive royalties as designated inventor. D.W.T. received travel support for consulting Instrumentation Laboratory, Bedford, MA, USA and consults Philips Research/Philips Electronics Nederland B.V., Eindhoven, The Netherlands. Dr. Spahn's academic department is receiving grant support from the Swiss National Science Foundation, Berne, Switzerland, the Swiss Society of Anesthesiology and Reanimation (SGAR), Berne, Switzerland, the Swiss Foundation for Anesthesia Research, Zurich, Switzerland, Vifor SA, Villars-sur-Glane, Switzerland. Dr. Spahn is co-chair of the ABC-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biomedicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland. Dr. Spahn received honoraria/travel support for consulting or lecturing from: Danube University of Krems, Austria, US Department of Defense, Washington, USA, European Society of Anesthesiology, Brussels, BE, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anesthesiologists, Seoul, Korea, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France, Baxalta Switzerland AG, Volketswil, Switzerland, Bayer AG, Zurich, Switzerland, B. Braun Melsungen AG, Melsungen, Germany, Boehringer Ingelheim GmbH, Basel, Switzerland, Bristol-Myers-Squibb, Rueil-Malmaison Cedex, France and Baar, Switzerland, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II Sarl, Couvet, Switzerland, Daiichi Sankyo AG, Thalwil, Switzerland, Ethicon Sarl, Neuchatel, Switzerland, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biomedicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Photonics Healthcare B.V., Utrecht, Netherlands, Pfizer AG, Zurich, Switzerland, Pierre Fabre Pharma, Alschwil, Switzerland, Roche Diagnostics International Ltd., Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and Numbrecht, Germany, Shire Switzerland GmbH, Zug, Switzerland, Tem International GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Neuilly sur Seine, France and Villars-sur-Glane, Switzerland, Vifor (International) AG, St. Gallen, Switzerland, Zuellig Pharma Holdings, Singapore, Singapore. EDAT- 2020/08/06 06:00 MHDA- 2021/03/25 06:00 PMCR- 2020/08/01 CRDT- 2020/08/06 06:00 PHST- 2020/06/24 00:00 [received] PHST- 2020/07/17 00:00 [revised] PHST- 2020/07/28 00:00 [accepted] PHST- 2020/08/06 06:00 [entrez] PHST- 2020/08/06 06:00 [pubmed] PHST- 2021/03/25 06:00 [medline] PHST- 2020/08/01 00:00 [pmc-release] AID - s20154254 [pii] AID - sensors-20-04254 [pii] AID - 10.3390/s20154254 [doi] PST - epublish SO - Sensors (Basel). 2020 Jul 30;20(15):4254. doi: 10.3390/s20154254. PMID- 32732500 OWN - NLM STAT- MEDLINE DCOM- 20210519 LR - 20210519 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 31 IP - 8 DP - 2020 Dec TI - Tranexamic acid is associated with reduced complement activation in trauma patients with hemorrhagic shock and hyperfibrinolysis on thromboelastography. PG - 578-582 LID - 10.1097/MBC.0000000000000938 [doi] AB - : Trauma with hemorrhagic shock causes massive tissue plasminogen activator release, plasmin generation, and hyperfibrinolysis. Tranexamic acid (TXA) has recently been used to treat bleeding in trauma by preventing plasmin generation to limit fibrinolysis. Trauma patients also have increased complement activation that correlates with mortality and organ failure, but the source of activation is not clear, and plasmin has recently been shown to efficiently cleave C3 and C5 to their activated fragments. We hypothesized that trauma patients in hemorrhagic shock with hyperfibrinolysis on thromboelastography (TEG) LY30 would have increased complement activation at early time points, as measured by soluble C5b-9 complex, and TXA would prevent this. Plasma samples were obtained from an unrelated, previously performed IRB-approved prospective randomized study of trauma patients. Three groups were studied with n = 5 patients in each group: patients without hyperfibrinolysis (TEG LY30 < 3%) (who therefore did not get TXA), patients with hyperfibrinolysis (TEG LY30 > 3%) who did not get TXA, and patients with hyperfibrinolysis who were then treated with TXA. We found that patients who did not receive TXA, regardless of fibrinolytic phenotype, had elevated soluble C5b-9 levels at 6 h relative to emergency department levels. In contrast, all five patients with initial TEG LY30 more than 3% and were then treated with TXA had reduced soluble C5b-9 levels at 6 h relative to emergency department levels. There were no differences in PF1 + 2, Bb, or C4d levels between groups, suggesting that coagulation and complement activation pathways may not be primarily responsible for the observed differences. FAU - Barrett, Christopher D AU - Barrett CD AD - Departments of Biological Engineering and Biology, Center for Precision Cancer Medicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge. AD - Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. FAU - Vigneshwar, Navin AU - Vigneshwar N AD - Department of Surgery, University of Colorado Denver. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver. FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Chandler, James AU - Chandler J AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver. AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, USA. FAU - Yaffe, Michael B AU - Yaffe MB AD - Departments of Biological Engineering and Biology, Center for Precision Cancer Medicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge. AD - Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Aged MH - Antifibrinolytic Agents/*therapeutic use MH - Complement Activation/*drug effects MH - Fibrinolysis/*drug effects MH - Humans MH - Male MH - Middle Aged MH - Shock, Hemorrhagic/blood/complications/*drug therapy/immunology MH - Thrombelastography MH - Tranexamic Acid/*therapeutic use MH - Wounds and Injuries/blood/complications/*drug therapy/immunology MH - Young Adult EDAT- 2020/08/01 06:00 MHDA- 2021/05/20 06:00 CRDT- 2020/08/01 06:00 PHST- 2020/08/01 06:00 [pubmed] PHST- 2021/05/20 06:00 [medline] PHST- 2020/08/01 06:00 [entrez] AID - 00001721-202012000-00014 [pii] AID - 10.1097/MBC.0000000000000938 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2020 Dec;31(8):578-582. doi: 10.1097/MBC.0000000000000938. PMID- 32731571 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 9 IP - 8 DP - 2020 Jul 28 TI - Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion-A Sub-Study of the Randomized Controlled RETIC Trial. LID - 10.3390/jcm9082420 [doi] LID - 2420 AB - Although platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC Study "Reversal of Trauma-induced Coagulopathy using First-line Coagulation Factor Concentrates or Fresh-Frozen Plasma" trial, we here analysed whether the type of first-line haemostatic resuscitation influences the frequency of platelet transfusion and determined the effects of platelet transfusion in coagulopathic patients with major trauma. Patients randomly received first-line plasma (FFP) or coagulation factor concentrates (CFC), mainly fibrinogen concentrate. In both groups, platelets were transfused to maintain platelet counts between 50 and 100 x 10(9) /L. Transfusion rates were significantly higher in the FFP (n = 44) vs. CFC (n = 50) group (FFP 47.7% vs. CFC 26%); p = 0.0335. Logistic regression analysis adjusted for the stratification variables injury severity score (ISS) and brain injury confirmed that first-line FFP therapy increases the odds for platelet transfusion (odds ratio (OR) 5.79 (1.89 to 20.62), p = 0.0036) and this effect was larger than a 16-point increase in ISS (OR 4.33 (2.17 to 9.74), p =0.0001). In conclusion, early fibrinogen supplementation exerted a platelet-saving effect while platelet transfusions did not substantially improve platelet count and might contribute to poor clinical outcome. FAU - Tauber, Helmuth AU - Tauber H AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Innerhofer, Nicole AU - Innerhofer N AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - von Langen, Daniel AU - von Langen D AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Strohle, Mathias AU - Strohle M AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Fries, Dietmar AU - Fries D AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Mittermayr, Markus AU - Mittermayr M AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Hell, Tobias AU - Hell T AD - Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, 6020 Innsbruck, Austria. FAU - Oswald, Elgar AU - Oswald E AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. FAU - Innerhofer, Petra AU - Innerhofer P AD - Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria. LA - eng PT - Journal Article DEP - 20200728 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC7465283 OTO - NOTNLM OT - blood coagulation disorders OT - fibrinogen concentrate OT - plasma OT - platelet transfusion OT - thrombelastography COIS- P.I. has received personal fees from Baxter GmbH, personal fees from CSL Behring GmbH, personal fees from Fresenius Kabi GmbH Austria, personal fees from Bayer GmbH Austria, personal fees from LFB, and non-financial support from TEM International, outside the submitted work. D.F. has received study funding, honoraria for consultancy, and board activity from Astra Zeneca, AOP orphan, Baxter, Bayer, BBraun, Biotest, CSL Behring, Delta Select, Dade Behring, Edwards, Fresenius, Glaxo, Haemoscope, Hemogem, Lilly, LFB, Mitsubishi Pharma, NovoNordisk, Octapharm, Pfizer, and Tem-Innovation, outside the submitted work. M.M. has received personal fees from CSL Behring GmbH, outside the submitted work. The remaining authors have disclosed that they have no potential conflicts of interest. EDAT- 2020/08/01 06:00 MHDA- 2020/08/01 06:01 PMCR- 2020/07/28 CRDT- 2020/08/01 06:00 PHST- 2020/06/01 00:00 [received] PHST- 2020/07/21 00:00 [revised] PHST- 2020/07/24 00:00 [accepted] PHST- 2020/08/01 06:00 [entrez] PHST- 2020/08/01 06:00 [pubmed] PHST- 2020/08/01 06:01 [medline] PHST- 2020/07/28 00:00 [pmc-release] AID - jcm9082420 [pii] AID - jcm-09-02420 [pii] AID - 10.3390/jcm9082420 [doi] PST - epublish SO - J Clin Med. 2020 Jul 28;9(8):2420. doi: 10.3390/jcm9082420. PMID- 32708960 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2075-4418 (Print) IS - 2075-4418 (Electronic) IS - 2075-4418 (Linking) VI - 10 IP - 7 DP - 2020 Jul 17 TI - Site-Of-Care Viscoelastic Assay in Major Trauma Improves Outcomes and Is Cost Neutral Compared with Standard Coagulation Tests. LID - 10.3390/diagnostics10070486 [doi] LID - 486 AB - Major hemorrhage is often associated with trauma-induced coagulopathy. Targeted blood product replacement could achieve faster hemostasis and reduce mortality. This study aimed to investigate whether thromboelastography (TEG((R))) goal-directed transfusion improved blood utilization, reduced mortality, and was cost effective. Data were prospectively collected in a U.K. level 1 trauma center, in patients with major hemorrhage one year pre- and post-implementation of TEG((R)) 6s Hemostasis Analyzers. Mortality, units of blood products transfused, and costs were compared between groups. Patient demographics in pre-TEG (n = 126) and post-TEG (n = 175) groups were similar. Mortality was significantly lower in the post-TEG group at 24 h (13% vs. 5%; p = 0.006) and at 30 days (25% vs. 11%; p = 0.002), with no difference in the number or ratio of blood products transfused. Cost of blood products transfused was comparable, with the exception of platelets (average pound38 higher post-TEG). Blood product wastage was significantly lower in the post-TEG group (1.8 +/- 2.1 vs. 1.1 +/- 2.0; p = 0.002). No statistically significant difference in cost was observed between the two groups ( pound753 +/- 651 pre-TEG; pound830 +/- 847 post-TEG; p = 0.41). These results demonstrate TEG 6s-driven resuscitation algorithms are associated with reduced mortality, reduced blood product wastage, and are cost neutral compared to standard coagulation tests. FAU - Cochrane, Catriona AU - Cochrane C AD - Major Trauma, East Midlands Major Trauma Centre, Queen's Medical Centre Nottingham, Nottingham NG7 2UH, UK. FAU - Chinna, Shalini AU - Chinna S AD - Major Trauma, East Midlands Major Trauma Centre, Queen's Medical Centre Nottingham, Nottingham NG7 2UH, UK. FAU - Um, Ju Young AU - Um JY AD - Major Trauma, East Midlands Major Trauma Centre, Queen's Medical Centre Nottingham, Nottingham NG7 2UH, UK. FAU - Dias, Joao D AU - Dias JD AUID- ORCID: 0000-0002-1150-4357 AD - Haemonetics Corporation, Boston, MA 02110, USA. FAU - Hartmann, Jan AU - Hartmann J AUID- ORCID: 0000-0003-4978-8014 AD - Haemonetics Corporation, Boston, MA 02110, USA. FAU - Bradley, Jim AU - Bradley J AD - Department of Anaesthetics, Nottingham University Hospitals, Nottingham NG5 1PB, UK. FAU - Brooks, Adam AU - Brooks A AD - Department of Anaesthetics, Nottingham University Hospitals, Nottingham NG5 1PB, UK. LA - eng GR - N/A/Haemonetics/ PT - Journal Article DEP - 20200717 PL - Switzerland TA - Diagnostics (Basel) JT - Diagnostics (Basel, Switzerland) JID - 101658402 PMC - PMC7400090 OTO - NOTNLM OT - TEG OT - TEG 6s OT - cost OT - thromboelastography OT - trauma COIS- J.D. and J.H. are and were employees of Haemonetics at the time of the research and were involved in the statistical analysis, the writing of the manuscript, and the decision to publish the results. There were no conflicts of interest for the other authors other than the source of funding (see above). EDAT- 2020/07/28 06:00 MHDA- 2020/07/28 06:01 PMCR- 2020/07/17 CRDT- 2020/07/26 06:00 PHST- 2020/05/22 00:00 [received] PHST- 2020/07/10 00:00 [revised] PHST- 2020/07/11 00:00 [accepted] PHST- 2020/07/26 06:00 [entrez] PHST- 2020/07/28 06:00 [pubmed] PHST- 2020/07/28 06:01 [medline] PHST- 2020/07/17 00:00 [pmc-release] AID - diagnostics10070486 [pii] AID - diagnostics-10-00486 [pii] AID - 10.3390/diagnostics10070486 [doi] PST - epublish SO - Diagnostics (Basel). 2020 Jul 17;10(7):486. doi: 10.3390/diagnostics10070486. PMID- 32667207 OWN - NLM STAT- MEDLINE DCOM- 20200917 LR - 20240330 IS - 1535-4970 (Electronic) IS - 1073-449X (Print) IS - 1073-449X (Linking) VI - 202 IP - 5 DP - 2020 Sep 1 TI - Pulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging, and Hematologic Observations. PG - 690-699 LID - 10.1164/rccm.202004-1412OC [doi] AB - Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology.Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia.Methods: Clinical, physiologic, and laboratory data were collated. Radiologic (computed tomography (CT) pulmonary angiography [n = 39] and dual-energy CT [DECT, n = 20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence and extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography.Measurements and Results: In 39 consecutive patients (male:female, 32:7; mean age, 53 +/- 10 yr [range, 29-79 yr]; Black and minority ethnic, n = 25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead space (dynamic compliance, 33.7 +/- 14.7 ml/cm H(2)O; Murray lung injury score, 3.14 +/- 0.53; mean ventilatory ratios, 2.6 +/- 0.8) with evidence of hypercoagulability and fibrinolytic "shutdown". The mean CT extent (+/-SD) of normally aerated lung, ground-glass opacification, and dense parenchymal opacification were 23.5 +/- 16.7%, 36.3 +/- 24.7%, and 42.7 +/- 27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6).Conclusions: Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis. FAU - Patel, Brijesh V AU - Patel BV AUID- ORCID: 0000-0002-5573-2503 AD - Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer. AD - Centre for Haematology, Department of Immunology and Inflammation, and. FAU - Arachchillage, Deepa J AU - Arachchillage DJ AUID- ORCID: 0000-0001-5993-4850 AD - National Heart and Lung Institute, Imperial College London, London, United Kingdom. AD - Department of Adult Intensive Care. FAU - Ridge, Carole A AU - Ridge CA AUID- ORCID: 0000-0003-2510-5856 AD - Department of Haematology. AD - Department of Radiology. FAU - Bianchi, Paolo AU - Bianchi P AUID- ORCID: 0000-0001-9973-9283 AD - Department of Adult Intensive Care, and. FAU - Doyle, James F AU - Doyle JF AUID- ORCID: 0000-0002-7060-0373 AD - Department of Adult Intensive Care, and. FAU - Garfield, Benjamin AU - Garfield B AD - Department of Adult Intensive Care, and. FAU - Ledot, Stephane AU - Ledot S AUID- ORCID: 0000-0001-9261-3186 AD - Department of Adult Intensive Care, and. FAU - Morgan, Cliff AU - Morgan C AD - Department of Adult Intensive Care, and. FAU - Passariello, Maurizio AU - Passariello M AD - Department of Adult Intensive Care, and. FAU - Price, Susanna AU - Price S AUID- ORCID: 0000-0002-6425-3360 AD - Department of Haematology. AD - Department of Adult Intensive Care, and. FAU - Singh, Suveer AU - Singh S AUID- ORCID: 0000-0003-3219-8966 AD - Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer. AD - Department of Adult Intensive Care, and. FAU - Thakuria, Louit AU - Thakuria L AUID- ORCID: 0000-0003-1298-6578 AD - Department of Adult Intensive Care, and. FAU - Trenfield, Sarah AU - Trenfield S AD - Department of Adult Intensive Care, and. FAU - Trimlett, Richard AU - Trimlett R AD - Department of Adult Intensive Care, and. FAU - Weaver, Christine AU - Weaver C AUID- ORCID: 0000-0002-7023-8044 AD - Department of Adult Intensive Care, and. FAU - Wort, S John AU - Wort SJ AUID- ORCID: 0000-0003-4287-1173 AD - Department of Haematology. AD - The Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. FAU - Xu, Tina AU - Xu T AD - Department of Adult Intensive Care, and. FAU - Padley, Simon P G AU - Padley SPG AUID- ORCID: 0000-0002-7381-2339 AD - Department of Haematology. AD - Department of Radiology. FAU - Devaraj, Anand AU - Devaraj A AD - Department of Haematology. AD - Department of Radiology. FAU - Desai, Sujal R AU - Desai SR AUID- ORCID: 0000-0002-5237-3613 AD - Department of Haematology. AD - Department of Radiology. LA - eng PT - Journal Article PT - Observational Study PL - England TA - Am J Respir Crit Care Med JT - American journal of respiratory and critical care medicine JID - 9421642 SB - IM CIN - Am J Respir Crit Care Med. 2020 Sep 1;202(5):642-644. doi: 10.1164/rccm.202007-2833ED. PMID: 32687386 CIN - Am J Respir Crit Care Med. 2021 Jan 15;203(2):258-259. doi: 10.1164/rccm.202009-3446LE. PMID: 33085901 CIN - Am J Respir Crit Care Med. 2021 Jan 15;203(2):260-261. doi: 10.1164/rccm.202009-3564LE. PMID: 33085902 CIN - Am J Respir Crit Care Med. 2021 Jan 15;203(2):261-263. doi: 10.1164/rccm.202008-3340LE. PMID: 33085905 CIN - Am J Respir Crit Care Med. 2021 Jan 15;203(2):259-260. doi: 10.1164/rccm.202009-3508LE. PMID: 33085907 CIN - Am J Respir Crit Care Med. 2021 Jan 15;203(2):257-258. doi: 10.1164/rccm.202008-3139LE. PMID: 33085908 MH - Adult MH - Aged MH - *Betacoronavirus MH - COVID-19 MH - Coronavirus Infections/*complications/epidemiology MH - Female MH - Humans MH - Lung/*blood supply/diagnostic imaging MH - Male MH - Middle Aged MH - Pandemics MH - Pneumonia, Viral/*complications/epidemiology MH - Pulmonary Circulation/*physiology MH - SARS-CoV-2 MH - Tomography, X-Ray Computed MH - Vascular Diseases/diagnosis/*etiology/physiopathology PMC - PMC7462405 OTO - NOTNLM OT - acute respiratory distress syndrome OT - mechanical ventilation OT - novel coronavirus disease 2019 OT - pulmonary perfusion OT - thoracic imaging EDAT- 2020/07/16 06:00 MHDA- 2020/09/18 06:00 PMCR- 2020/09/01 CRDT- 2020/07/16 06:00 PHST- 2020/07/16 06:00 [pubmed] PHST- 2020/09/18 06:00 [medline] PHST- 2020/07/16 06:00 [entrez] PHST- 2020/09/01 00:00 [pmc-release] AID - 10.1164/rccm.202004-1412OC [doi] PST - ppublish SO - Am J Respir Crit Care Med. 2020 Sep 1;202(5):690-699. doi: 10.1164/rccm.202004-1412OC. PMID- 32656219 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2296-858X (Print) IS - 2296-858X (Electronic) IS - 2296-858X (Linking) VI - 7 DP - 2020 TI - Thromboelastometry for Assessing Risks of Free Flap Thrombosis in Patients Undergoing Microvascular Surgery. PG - 289 LID - 10.3389/fmed.2020.00289 [doi] LID - 289 AB - Introduction: Coagulation assessment is often missing in microvascular surgery. We aimed at evaluating the predictive value of thromboelastometry for free flap thrombosis in microvascular surgery patients. Materials and Methods: We enrolled 103 adult patients with traumatic injuries scheduled for microvascular free flap surgery into a prospective observational study. Thirty-six patients with recent trauma underwent surgery within 30 days (ES group), and were compared with 67 trauma patients who underwent surgery later than 30 days (late surgery, LS group) after the injury. Rotational thromboelastometry (RTE) was performed before surgery. Functional fibrinogen to platelet ratio (FPR) >/= 42 was selected as the main hypercoagulability index. Free flap thrombosis was set as primary outcome. Thrombotic risk factors and duration of surgery related to free flap thrombosis were secondary outcomes. Statistical significance p < 0.05; not significant NS. Results: Six patients (16.7%) in the ES group and 10 (14.9%) in the LS group had free flap thrombosis (NS). In the entire cohort, free flap thrombosis rate increased in the presence of thrombogenic comorbidities (OR 4.059, CI 1.33-12.37; p = 0.014) and prolonged surgery times (OR 1.007, CI 1 - 1.012; p = 0.05). Although hypercoagulability occurred more frequently in the ES group (44.4%) than in the LS group (11.9%; p < 0.001), it was not associated with higher free flap thrombosis rate. In ES group patients with surgery times > 240 min, the risk of free flap thrombosis increased (OR 3.5, CI 1.16-10.6; p = 0.026) with 93.3% sensitivity and 86.7% specificity (AUC 0.85; p = 0.007). In contrast, in LS patients hypercoagulability increased the odds of free flap thrombosis (OR 8.83, CI 1.74-44.76; p = 0.009). Moreover, a positive correlation was found between FPR >/= 42 and free flap thrombosis rate (r = 0.362; p = 0.003). In the LS group, the presence of thrombogenic comorbidities correlated with free flap thrombosis rate (OR 7, CI 1.591-30.8; p = 0.01). Conclusions: In LS patients with thrombogenic comorbidities, thromboelastometry supports the detection of hypercoagulability and predicts free flap thrombosis risk. In ES patients, postoperative hypercoagulability did not predict free flap thrombosis. Prolonged surgery time should be considered as a risk factor. CI - Copyright (c) 2020 Vanags, Stepanovs, Ozolina, Mukans, Bjertnaes and Mamaja. FAU - Vanags, Indulis AU - Vanags I AD - Department of Anaesthesiology and Reanimatology, Riga Stradins University, Riga, Latvia. AD - Department of Anaesthesiology and Intensive Care Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia. FAU - Stepanovs, Jevgenijs AU - Stepanovs J AD - Department of Anaesthesiology, Riga East Clinical University Hospital, Riga, Latvia. FAU - Ozolina, Agnese AU - Ozolina A AD - Department of Anaesthesiology and Reanimatology, Riga Stradins University, Riga, Latvia. AD - Department of Anaesthesiology, Riga East Clinical University Hospital, Riga, Latvia. FAU - Mukans, Maksims AU - Mukans M AD - Statistical Unit, Riga Stradins University, Riga, Latvia. FAU - Bjertnaes, Lars J AU - Bjertnaes LJ AD - Anesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, Tromso, Norway. FAU - Mamaja, Biruta AU - Mamaja B AD - Department of Anaesthesiology and Reanimatology, Riga Stradins University, Riga, Latvia. AD - Department of Anaesthesiology, Riga East Clinical University Hospital, Riga, Latvia. LA - eng PT - Journal Article DEP - 20200623 PL - Switzerland TA - Front Med (Lausanne) JT - Frontiers in medicine JID - 101648047 PMC - PMC7324680 OTO - NOTNLM OT - free flap thrombosis OT - hypercoagulability OT - microsurgery OT - risk OT - rotational thromboelastometry (RTEM) EDAT- 2020/07/14 06:00 MHDA- 2020/07/14 06:01 PMCR- 2020/06/23 CRDT- 2020/07/14 06:00 PHST- 2020/02/20 00:00 [received] PHST- 2020/05/22 00:00 [accepted] PHST- 2020/07/14 06:00 [entrez] PHST- 2020/07/14 06:00 [pubmed] PHST- 2020/07/14 06:01 [medline] PHST- 2020/06/23 00:00 [pmc-release] AID - 10.3389/fmed.2020.00289 [doi] PST - epublish SO - Front Med (Lausanne). 2020 Jun 23;7:289. doi: 10.3389/fmed.2020.00289. eCollection 2020. PMID- 32620738 OWN - NLM STAT- MEDLINE DCOM- 20210504 LR - 20210504 IS - 1643-3750 (Electronic) IS - 1234-1010 (Print) IS - 1234-1010 (Linking) VI - 26 DP - 2020 Jul 4 TI - Implementation of Thromboelastometry for Coagulation Management in Isolated Traumatic Brain Injury Patients Undergoing Craniotomy. PG - e922879 LID - 10.12659/MSM.922879 [doi] AB - BACKGROUND Coagulopathy (CP) is a modifiable factor linked with secondary brain damage and poor outcome of traumatic brain injury (TBI). A shift towards goal-directed coagulation management has been observed recently. We investigated whether rotational thromboelastometry (ROTEM) based management could be successfully implemented in TBI patients and improve outcomes. MATERIAL AND METHODS A prospective, case-control study was performed. Adult patients with isolated TBI requiring craniotomy were included in this study. All patients underwent standard coagulation tests (SCT). Patients were identified as either in control group or in case group. Patients in the case group were additionally tested with ROTEM to specify their coagulation status. Management of the patients in the control group was based on SCT, whereas management of patients in the case group was guided by ROTEM. Outcome measures were as follows: CP rate, protocol adhesion, blood loss, transfusions, progressive hemorrhagic injury (PHI), re-intervention, Glasgow coma score (GCS) and Glasgow outcome score (GOS) at discharge, and in-hospital mortality. RESULTS There were 134 patients enrolled (65 patients in the control group and 69 patients in the case group). Twenty-six patients in the control group (40%) were found to be coagulopathic (control-CP subgroup) and 34 patients in the case group (49.3%) were found to be coagulopathic (case-CP subgroup). Twenty-five case-CP patients had ROTEM abnormalities triggering protocolized intervention, and 24 of them were treated. Overall ROTEM-based protocol adhesion rate was 85.3%. Postoperative ROTEM parameters of case-CP patients significantly improved, and the number of coagulopathic patients decreased. The incidence of PHI (control versus case group) and neurosurgical re-intervention (control-CP versus case-CP subgroup) was in favor of ROTEM guidance (P<0.05). Mortality and GCS and GOS at discharge did not differ significantly between groups. CONCLUSIONS ROTEM led to consistent coagulation management, improved clot quality, and decreased incidence of PHI and neurosurgical re-intervention. Further studies are needed to confirm benefits of ROTEM in cases of TBI. FAU - Rimaitis, Marius AU - Rimaitis M AD - Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. FAU - Bilskiene, Diana AU - Bilskiene D AD - Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. FAU - Tamosuitis, Tomas AU - Tamosuitis T AD - Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. FAU - Vilcinis, Rimantas AU - Vilcinis R AD - Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. FAU - Rimaitis, Kestutis AU - Rimaitis K AD - Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. FAU - Macas, Andrius AU - Macas A AD - Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. LA - eng PT - Journal Article DEP - 20200704 PL - United States TA - Med Sci Monit JT - Medical science monitor : international medical journal of experimental and clinical research JID - 9609063 SB - IM MH - Adult MH - Aged MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/blood MH - Blood Coagulation Tests/methods MH - Blood Transfusion/methods MH - Brain Injuries, Traumatic/complications/*surgery MH - Case-Control Studies MH - Craniotomy/adverse effects/*methods MH - Female MH - Hemorrhage/etiology MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography/*methods PMC - PMC7357252 EDAT- 2020/07/06 06:00 MHDA- 2021/05/05 06:00 PMCR- 2020/07/04 CRDT- 2020/07/05 06:00 PHST- 2020/07/05 06:00 [entrez] PHST- 2020/07/06 06:00 [pubmed] PHST- 2021/05/05 06:00 [medline] PHST- 2020/07/04 00:00 [pmc-release] AID - 922879 [pii] AID - 10.12659/MSM.922879 [doi] PST - epublish SO - Med Sci Monit. 2020 Jul 4;26:e922879. doi: 10.12659/MSM.922879. PMID- 32583073 OWN - NLM STAT- MEDLINE DCOM- 20220210 LR - 20261010 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 48 IP - 1 DP - 2022 Feb TI - Evaluation of the altitude impact on a point-of-care thromboelastography analyzer measurement: prerequisites for use in airborne medical evacuation courses. PG - 489-495 LID - 10.1007/s00068-020-01420-2 [doi] AB - PURPOSE: Hemorrhagic shock is the first cause of preventable death in combat. Evacuations of wounded by aircraft are increasingly used and severely injured patients can spend consequent time in the air, mostly during strategic evacuation. In these situations, monitoring of blood coagulation may be pivotal in the management of blood product transfusion. Viscoelastic-guided transfusion is relevant in these situations. However, evaluation of these devices used in aircraft is lacking, especially the impact of decreased atmospheric pressure. The aim of this study is to evaluate the performance of an easy-to-carry viscoelastic system (TEG((R)) 6s, Haemonetics). METHODS: First, TEG((R)) 6s repeatability, reproducibility, and correlation with chronometric methods and TEG-5000 were assessed on quality controls, healthy volunteers, and patients. Secondly, we tested the influence of vibrations and altitude on TEG((R)) 6s parameters (0ft vs. 8000 ft = 2428 m) and on quality control samples (normal and hypocoagulable). RESULTS: TEG((R)) 6s exhibited good correlation with the reference method and TEG((R)) 5000. Repeatability and reproducibility CVs were satisfactory. The tests performed in the hypobaric chamber revealed that performance at 0 ft and 8000 ft (2428 m) for 9 out of 13 parameters was not significantly different. However, we showed a significant increasing of CRT.Alpha (p = 0.049), CK.Alpha, CK.MA (p < 0.001 and p < 0.01, respectively) and CFF.MA increased (p < 0.05). CONCLUSION: Our study provides proof of concept to validate testing in an actual aeromedical situation. Indeed, TEG((R)) 6s appears to ease of use, resistance to high altitude conditions, and reliability on healthy humans. It is necessary to carry out a study on hemorrhagic injured patients in an aircraft. CI - (c) 2020. Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Boye, Matthieu AU - Boye M AD - Department of Anesthesiology and Intensive Care, Percy Military Medical Center, Clamart, France. FAU - Boissin, Jacqueline AU - Boissin J AD - French Military Health Service Directorate, Arcueil, France. FAU - Poyat, Chrystelle AU - Poyat C AD - Department of Anesthesiology and Intensive Care, Percy Military Medical Center, Clamart, France. FAU - Pasquier, Pierre AU - Pasquier P AD - Department of Anesthesiology and Intensive Care, Percy Military Medical Center, Clamart, France. FAU - Martinaud, Christophe AU - Martinaud C AUID- ORCID: 0000-0001-5439-4699 AD - Department of Clinical Operations, French Military Blood Institute, Clamart, France. martinaudctsa@gmail.com. LA - eng PT - Journal Article DEP - 20200624 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Altitude MH - Blood Transfusion MH - Humans MH - *Point-of-Care Systems MH - Reproducibility of Results MH - *Thrombelastography OTO - NOTNLM OT - Altitude OT - Sensitivity OT - Temperature OT - Thromboelastography EDAT- 2020/06/26 06:00 MHDA- 2022/02/11 06:00 CRDT- 2020/06/26 06:00 PHST- 2020/03/26 00:00 [received] PHST- 2020/06/15 00:00 [accepted] PHST- 2020/06/26 06:00 [pubmed] PHST- 2022/02/11 06:00 [medline] PHST- 2020/06/26 06:00 [entrez] AID - 10.1007/s00068-020-01420-2 [pii] AID - 10.1007/s00068-020-01420-2 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2022 Feb;48(1):489-495. doi: 10.1007/s00068-020-01420-2. Epub 2020 Jun 24. PMID- 32574484 OWN - NLM STAT- MEDLINE DCOM- 20200909 LR - 20211125 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 89 IP - 1 DP - 2020 Jul TI - Actin is associated with tissue injury in trauma patients and produces a hypercoagulable profile in vitro. PG - 87-95 LID - 10.1097/TA.0000000000002739 [doi] AB - BACKGROUND: While tissue injury provokes fibrinolysis shutdown in trauma, the mechanism remains elusive. Cellular death causes release of structural proteins, including actin and myosin, which may interact with clot formation and structure. We hypothesized that tissue injury is associated with high circulating actin and that actin produces a hypercoagulable profile with decreased fibrinolysis in vitro. METHODS: Blood was collected from trauma activation patients at a single Level I trauma center for thrombelastography and proteomics. Proteomic analyses were performed through targeted liquid chromatography coupled with mass spectrometry using isotope-labeled standards for quantification of actin and its endogenous inhibitor gelsolin. Based on the results, we added physiologic concentrations of cytoskeletal G-actin to whole blood from healthy volunteers and analyzed changes in thrombelastography, as well as to plasma and examined clot architecture using confocal microscopy of fluorescently labeled fibrinogen. RESULTS: Overall, 108 trauma patients were included: majority (71%) men, median age of 32.7 years, 66% blunt mechanism, median New Injury Severity Score (NISS) of 41. Compared with patients without severe tissue injury (NISS < 15, n = 10), patients with severe tissue injury (NISS > 15, n = 98) had higher levels of circulating actin (0.0428 vs. 0.0301, p = 0.02). Further, there was a trend toward lower gelsolin levels in patients with fibrinolysis shutdown (0.1844 vs. 0.2052, p = 0.17) and tissue plasminogen activator resistance (0.1676 vs. 0.2188, p = 0.06).Ten healthy volunteers were included in the in vitro experiments (50% male; median age, 31.3 years). Actin significantly increased angle (40.0 degrees to 52.9 degrees , p = 0.002) and decreased fibrinolysis (percent clot lysis 30 minutes after reaching maximum amplitude, 4.0% to 1.6%; p = 0.002), provoking fibrinolytic shutdown in three patients. The addition of actin to control plasma decreased fiber resolvability of fibrin clots, monitored by microscopy, and decreased plasmin-mediated fibrinolysis. CONCLUSION: Actin increases clot propagation and provokes fibrinolysis shutdown in vitro, through a mechanism of plasmin inhibition. High circulating levels of actin are present in trauma patients with severe tissue injury, suggesting actin contributes to fibrinolysis shutdown in the setting of tissue injury. FAU - Coleman, Julia R AU - Coleman JR AD - From the Department of Surgery (J.R.C., E.E.M., M.J.C., J.M.S.), University of Colorado-Denver; Department of Surgery (E.E.M., M.J.C.), Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado; Department of Emergency Medicine (K.F., N.D.G.), Department of Pharmacology (G.W.H.), University of Vermont Medical Center, Burlington, Vermont; and Department of Biochemistry and Molecular Genetics (K.H.), University of Colorado School of Medicine, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Freeman, Kalev AU - Freeman K FAU - Grubinger, Nicholas D AU - Grubinger ND FAU - Hennig, Grant W AU - Hennig GW FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Samuels, Jason M AU - Samuels JM FAU - Hansen, Kirk AU - Hansen K LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - S10 OD025030/OD/NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Actins) RN - 0 (Gelsolin) SB - IM MH - Actins/*blood MH - Adult MH - Chromatography, Liquid MH - Female MH - *Fibrinolysis MH - Gelsolin/blood MH - Humans MH - In Vitro Techniques MH - Injury Severity Score MH - Male MH - Mass Spectrometry MH - Microscopy, Confocal MH - Proteomics MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*blood PMC - PMC8610777 MID - NIHMS1756513 EDAT- 2020/06/24 06:00 MHDA- 2020/09/10 06:00 PMCR- 2021/11/24 CRDT- 2020/06/24 06:00 PHST- 2020/06/24 06:00 [entrez] PHST- 2020/06/24 06:00 [pubmed] PHST- 2020/09/10 06:00 [medline] PHST- 2021/11/24 00:00 [pmc-release] AID - 01586154-202007000-00015 [pii] AID - 10.1097/TA.0000000000002739 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Jul;89(1):87-95. doi: 10.1097/TA.0000000000002739. PMID- 32557110 OWN - NLM STAT- MEDLINE DCOM- 20210929 LR - 20261010 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 34 IP - 1 DP - 2021 Feb TI - Incidence of Antithrombin Deficiency and Anti-Cardiolipin Antibodies After Severe Traumatic Brain Injury: A Prospective Cohort Study. PG - 227-235 LID - 10.1007/s12028-020-01026-x [doi] AB - BACKGROUND: Animal studies suggested that cerebral mitochondrial cardiolipin phospholipids were released after severe traumatic brain injury (TBI), contributing to the pathogenesis of thromboembolism. OBJECTIVES: To determine the incidence of anti-cardiolipin antibodies after severe TBI and whether this was related to the severity of TBI and development of venous thromboembolism. METHODS: Serial anti-cardiolipin antibodies, antithrombin levels, viscoelastic testing, and coagulation parameters were measured on admission, day-1, and between day-5 and day-7 in patients with severe TBI requiring intracranial pressure monitoring. RESULTS: Of the 40 patients included (85% male and median age 42 years), 7 (18%) had a raised Ig-G or Ig-M anti-cardiolipin antibody titer after TBI. Antithrombin levels were below the normal level-especially on day-0 and day-1-in 15 patients (38%), and 14 patients (38%) developed an increase in maximum clot firmness on the viscoelastic test in conjunction with elevations in fibrinogen concentration and platelet count. Four patients (10%) developed deep vein thrombosis, and 10 patients (25%) died, both of which were not significantly related to the presence of anti-cardiolipin antibodies (P = 0.619 and P = 0.638, respectively). CONCLUSIONS: A reduction in antithrombin level and development of anti-cardiolipin antibodies were not rare immediately after severe TBI; these abnormalities were followed by an increase in in vitro clot strength due to elevations in fibrinogen concentration and platelet count. The quantitative relationships between the development of anti-cardiolipin antibodies and severity of TBI or clinical thromboembolic events deserve further investigation. FAU - Kalgudi, Shankar AU - Kalgudi S AD - Department of Intensive Care Medicine, Royal Perth Hospital, ICU, 4th Floor, North Block, Wellington Street, Perth, WA, 6000, Australia. FAU - Ho, Kwok M AU - Ho KM AUID- ORCID: 0000-0002-6705-6004 AD - Department of Intensive Care Medicine, Royal Perth Hospital, ICU, 4th Floor, North Block, Wellington Street, Perth, WA, 6000, Australia. kwok.ho@health.wa.gov.au. AD - Medical School, University of Western Australia, Perth, Australia. kwok.ho@health.wa.gov.au. AD - School of Veterinary and Life Sciences, Murdoch University, Perth, Australia. kwok.ho@health.wa.gov.au. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 RN - 0 (Antithrombins) SB - IM MH - Animals MH - Antithrombins MH - *Brain Injuries, Traumatic MH - Female MH - Humans MH - Incidence MH - Infant, Newborn MH - Male MH - Prospective Studies MH - *Venous Thromboembolism OTO - NOTNLM OT - Anti-cardiolipin antibodies OT - Antithrombin OT - Prothrombotic state OT - Traumatic brain injury OT - Venous thromboembolism EDAT- 2020/06/20 06:00 MHDA- 2021/09/30 06:00 CRDT- 2020/06/20 06:00 PHST- 2020/06/20 06:00 [pubmed] PHST- 2021/09/30 06:00 [medline] PHST- 2020/06/20 06:00 [entrez] AID - 10.1007/s12028-020-01026-x [pii] AID - 10.1007/s12028-020-01026-x [doi] PST - ppublish SO - Neurocrit Care. 2021 Feb;34(1):227-235. doi: 10.1007/s12028-020-01026-x. PMID- 32553426 OWN - NLM STAT- MEDLINE DCOM- 20210519 LR - 20210519 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 51 IP - 9 DP - 2020 Sep TI - Targeted cryoprecipitate transfusion in severe traumatic haemorrhage. PG - 1949-1955 LID - S0020-1383(20)30472-1 [pii] LID - 10.1016/j.injury.2020.05.044 [doi] AB - BACKGROUND: Severe traumatic haemorrhage is the leading cause of death in young adults. Trauma Induced Coagulopathy is a complex and multifactorial phenomenon associated with severe traumatic haemorrhage. Fibrinogen is one of the first coagulation factors to become depleted in TIC and evidence suggests that severely injured trauma patients with hypofibrinogenaemia have poor outcomes. It is postulated that early fibrinogen replacement can improve clinical outcomes. This study investigated cryoprecipitate transfusion in hyopfibrinogeneamic trauma patients. METHODS: This retrospective, single center, observational study investigated the use of cryoprecipitate in severely injured trauma patients admitted to an Australian Level I Trauma Centre. The primary outcome was time to administration of cryoprecipitate after identification of hypofibrinogenaemia using ROTEM (FIBTEM A5). Data collected included demographics, ISS, laboratory values of coagulation and blood product usage. RESULTS: 71 patients received cryoprecipitate with a median time of 61 minutes [IQR 37-93] from FIBTEM A5 result to initial cryoprecipitate administration. At 24 hours following admission to ED, Clauss Fibrinogen levels increased by 1.30g/L [IQR 0.45-1.85] and FIBTEM A5 assay increased by 8mm [IQR 3.0-11.3]. Changes in both variables were highly significant (p<0.001) and Clauss Fibrinogen versus FIBTEM A5 values showed moderate to strong correlation (R=0.75-0.80). CONCLUSION: This study demonstrated that early administration of cryoprecipitate was both feasible and efficacious in fibrinogen replacement in severe traumatic haemorrhage. High-level evidence supporting cryoprecipitate or fibrinogen concentrate replacement with regards to efficacy and feasibility is required to guide future clinical practice. This study provided baseline data to inform the design of further clinical trials investigating fibrinogen replacement in traumatic haemorrhage. CI - Copyright (c) 2020. Published by Elsevier Ltd. FAU - Ho, Debbie AU - Ho D AD - Principal House Officer, Department of Surgery, Gold Coast Hospital and Health Service; Lecturer, Griffith University, Australia. Electronic address: debbie.ho@health.qld.gov.au. FAU - Chan, Erick AU - Chan E AD - Principal House Officer, Department of Surgery, Gold Coast Hospital and Health Service; Lecturer, Griffith University, Australia. Electronic address: Erick.Chan@health.qld.gov.au. FAU - Campbell, Don AU - Campbell D AD - Deputy Director, Department of Trauma, Gold Coast Hospital and Health Service; Senior Lecturer, Griffith University, Australia. Electronic address: Don.Campbell@health.qld.gov.au. FAU - Wake, Elizabeth AU - Wake E AD - Research Coordinator, Department of Trauma, Gold Coast Hospital and Health Service, Australia. Electronic address: Elizabeth.Wake@health.qld.gov.au. FAU - Walters, Kerin AU - Walters K AD - Research Coordinator, Intensive Care Unit, Gold Coast Hospital and Health Service, Australia. Electronic address: Kerin.Walters@health.qld.gov.au. FAU - Bulmer, Andrew C AU - Bulmer AC AD - Associate Professor, School of Medical Science, Griffith University, Australia. Electronic address: a.bulmer@griffith.edu.au. FAU - McCullough, James AU - McCullough J AD - Staff Specialist, Intensive Care Unit, Gold Coast Hospital and Health Service, Australia. Electronic address: James.McCullough@health.qld.gov.au. FAU - Wullschleger, Martin AU - Wullschleger M AD - Director, Department of Trauma and Surgery, Gold Coast Hospital and Health Service, Australia; Professor, Griffith University, Australia. Electronic address: Martin.Wullschleger@health.qld.gov.au. FAU - Winearls, James AU - Winearls J AD - Staff Specialist, Intensive Care Unit, Gold Coast Hospital and Health Service, Australia; Consultant Intensivist, St Andrew's War Memorial Hospital, Australia; Senior Lecturer, University of Queensland, Australia. Electronic address: James.Winearls@health.qld.gov.au. LA - eng PT - Journal Article PT - Observational Study DEP - 20200603 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Australia MH - *Blood Transfusion MH - Fibrinogen/therapeutic use MH - *Hemorrhage/therapy MH - Humans MH - Retrospective Studies MH - Thrombelastography MH - *Wounds and Injuries/complications MH - Young Adult OTO - NOTNLM OT - Cryoprecipitate OT - Fibrinogen OT - Haemorrhage OT - ROTEM OT - Trauma COIS- Declaration of Competing Interest JW has received educational and research support from CSL Behring and Haemoview Diagnostics. The other authors declare no conflict of interest. EDAT- 2020/06/20 06:00 MHDA- 2021/05/20 06:00 CRDT- 2020/06/20 06:00 PHST- 2020/02/04 00:00 [received] PHST- 2020/05/14 00:00 [revised] PHST- 2020/05/29 00:00 [accepted] PHST- 2020/06/20 06:00 [pubmed] PHST- 2021/05/20 06:00 [medline] PHST- 2020/06/20 06:00 [entrez] AID - S0020-1383(20)30472-1 [pii] AID - 10.1016/j.injury.2020.05.044 [doi] PST - ppublish SO - Injury. 2020 Sep;51(9):1949-1955. doi: 10.1016/j.injury.2020.05.044. Epub 2020 Jun 3. PMID- 32529513 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2363-9024 (Electronic) IS - 2363-9024 (Linking) VI - 6 IP - 1 DP - 2020 Jun 11 TI - Anesthetic management of a patient with musculocontractural Ehlers-Danlos syndrome undergoing scoliosis surgery. PG - 46 LID - 10.1186/s40981-020-00352-5 [doi] LID - 46 AB - BACKGROUND: Musculocontractural Ehlers-Danlos syndrome is a new and rare subtype of Ehlers-Danlos syndrome in which anesthetic considerations for airway and respiratory management, prevention of skin injuries and joint dislocations, and hemostatic management for severe perioperative bleeding are required. CASE PRESENTATION: A 19-year-old woman with musculocontractural Ehlers-Danlos syndrome was scheduled to undergo posterior spinal fusion from the 4th thoracic to the 4th lumbar vertebrae under general anesthesia. Her trachea was easily intubated with a videolaryngoscope despite a small mouth and micrognathia. Pressure-controlled ventilation with limited peak inspiratory pressure was performed for prevention of pneumothorax. Skin damage and joint luxation were prevented by using a low rebounding mattress, terpolymer-based barrier film, and careful patient positioning. Blood transfusion was effectively performed on the basis of point-of-care viscoelastic hemostatic assay monitoring. She had an uneventful postoperative course without any complications. CONCLUSIONS: We safely managed a patient with musculocontractural Ehlers-Danlos syndrome undergoing scoliosis surgery. FAU - Wakabayashi, Ryo AU - Wakabayashi R AUID- ORCID: 0000-0002-6198-5806 AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. waka0924@shinshu-u.ac.jp. FAU - Tanaka, Satoshi AU - Tanaka S AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Tsuchiyama, Keiko AU - Tsuchiyama K AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Yamamoto, Katsumi AU - Yamamoto K AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Maruyama, Yuki AU - Maruyama Y AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Numata, Kaori AU - Numata K AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Kawamata, Mikito AU - Kawamata M AD - Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. LA - eng PT - Journal Article DEP - 20200611 PL - Germany TA - JA Clin Rep JT - JA clinical reports JID - 101682121 PMC - PMC7289930 OTO - NOTNLM OT - Massive bleeding OT - Musculocontractural Ehlers-Danlos syndrome OT - Viscoelastic hemostatic assay monitoring COIS- The authors declare that they have no competing interests. EDAT- 2020/06/13 06:00 MHDA- 2020/06/13 06:01 PMCR- 2020/06/11 CRDT- 2020/06/13 06:00 PHST- 2020/04/23 00:00 [received] PHST- 2020/06/03 00:00 [accepted] PHST- 2020/06/13 06:00 [entrez] PHST- 2020/06/13 06:00 [pubmed] PHST- 2020/06/13 06:01 [medline] PHST- 2020/06/11 00:00 [pmc-release] AID - 10.1186/s40981-020-00352-5 [pii] AID - 352 [pii] AID - 10.1186/s40981-020-00352-5 [doi] PST - epublish SO - JA Clin Rep. 2020 Jun 11;6(1):46. doi: 10.1186/s40981-020-00352-5. PMID- 32528475 OWN - NLM STAT- MEDLINE DCOM- 20210329 LR - 20210329 IS - 1664-3224 (Electronic) IS - 1664-3224 (Linking) VI - 11 DP - 2020 TI - Hepatic Surgical Stress Promotes Systemic Immunothrombosis That Results in Distant Organ Injury. PG - 987 LID - 10.3389/fimmu.2020.00987 [doi] LID - 987 AB - Innate immunity can initiate platelet activation during the development of thrombosis through a process, termed immunothrombosis. Neutrophils form neutrophil extracellular traps (NETs) that have been shown to interact directly with platelets and play pro-coagulant roles in a variety of infectious and sterile inflammatory settings. Hepatic surgical stress initiated by ischemia/reperfusion (I/R) injury has wide systemic consequences on distant organs. However, the mechanisms of this remote injury phenomenon are not well-understood. Here, we sought to determine the role of NETs in causing systemic immunothrombosis and distant organ injury following a local inflammatory insult with liver I/R. Postoperative thromboelastographic revealed that the speed of clot formation (alpha-angle) was significantly increased whereas time to clot formation (R-time) were decreased by in patients undergoing liver resection, indicating a hypercoagulable state after surgery. In mice subjected to liver I/R, circulating platelet activation and platelet-neutrophil aggregates were significantly increased. Injured distant organs such as the lung and kidney displayed NETs and platelet-rich micro-thrombi in the microvasculature following liver I/R. The immune-thrombi and organ damage were dramatically decreased when NETs were inhibited by DNase treatment. Depletion of Tlr4 on platelets limited NET-induced activation of platelets but had no effect on NET formation. Furthermore, platelet-specific TLR4 KO mice had significantly reduced distant organ injury with decreased circulating platelet activation, platelet-neutrophil aggregates following liver I/R in comparison to their control counterparts. These data establish that after an acute local inflammatory process, NET-activated platelets can lead to a systemic pro-coagulant state with resultant remote organ injury by immunothrombosis. CI - Copyright (c) 2020 Zhang, Goswami, Varley, van der Windt, Ren, Loughran, Yazdani, Neal, Simmons, Zhang, Tsung and Huang. FAU - Zhang, Hongji AU - Zhang H AD - Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States. AD - Department of Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, China. FAU - Goswami, Julie AU - Goswami J AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Varley, Patrick AU - Varley P AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - van der Windt, Dirk J AU - van der Windt DJ AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Ren, Jinghua AU - Ren J AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. AD - Cancer Center, Union Hospital, Huazhong University of Science and Technology, Wuhan, China. FAU - Loughran, Patricia AU - Loughran P AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. AD - Department of Cell Biology, Center for Biologic Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Yazdani, Hamza AU - Yazdani H AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Neal, Matthew D AU - Neal MD AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Simmons, Richard L AU - Simmons RL AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. FAU - Zhang, Jinxiang AU - Zhang J AD - Department of Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, China. FAU - Tsung, Allan AU - Tsung A AD - Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States. FAU - Huang, Hai AU - Huang H AD - Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States. LA - eng GR - R01 CA214865/CA/NCI NIH HHS/United States GR - R01 GM095566/GM/NIGMS NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20200522 PL - Switzerland TA - Front Immunol JT - Frontiers in immunology JID - 101560960 RN - 0 (Tlr4 protein, mouse) RN - 0 (Toll-Like Receptor 4) RN - EC 3.5.3.15 (Protein-Arginine Deiminase Type 4) RN - EC 3.5.3.15 (peptidylarginine deiminase 4, mouse) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Animals MH - *Blood Coagulation MH - Blood Platelets/*immunology/metabolism MH - Case-Control Studies MH - Child MH - Child, Preschool MH - Disease Models, Animal MH - Extracellular Traps/*immunology/metabolism MH - Female MH - Hepatectomy/*adverse effects MH - Humans MH - Male MH - Mice, Inbred C57BL MH - Mice, Knockout MH - Middle Aged MH - Neutrophils/*immunology/metabolism MH - *Platelet Activation MH - Protein-Arginine Deiminase Type 4/deficiency/genetics MH - Reperfusion Injury/blood/*immunology MH - Signal Transduction MH - Stress, Physiological MH - Thrombosis/blood/*immunology MH - Toll-Like Receptor 4/deficiency/genetics MH - Young Adult PMC - PMC7256968 OTO - NOTNLM OT - immunothrombosis OT - liver sterile inflammation OT - neutrophil extracellular traps OT - platelets OT - surgical stress EDAT- 2020/06/13 06:00 MHDA- 2021/03/30 06:00 PMCR- 2020/01/01 CRDT- 2020/06/13 06:00 PHST- 2020/03/12 00:00 [received] PHST- 2020/04/27 00:00 [accepted] PHST- 2020/06/13 06:00 [entrez] PHST- 2020/06/13 06:00 [pubmed] PHST- 2021/03/30 06:00 [medline] PHST- 2020/01/01 00:00 [pmc-release] AID - 10.3389/fimmu.2020.00987 [doi] PST - epublish SO - Front Immunol. 2020 May 22;11:987. doi: 10.3389/fimmu.2020.00987. eCollection 2020. PMID- 32525050 OWN - NLM STAT- MEDLINE DCOM- 20210514 LR - 20210514 IS - 1878-7568 (Electronic) IS - 1742-7061 (Linking) VI - 113 DP - 2020 Sep 1 TI - Changes and quantitative characterization of hyper-viscoelastic biomechanical properties for young corneal stroma after standard corneal cross-linking treatment with different ultraviolet-A energies. PG - 438-451 LID - S1742-7061(20)30326-3 [pii] LID - 10.1016/j.actbio.2020.06.005 [doi] AB - Corneal collagen cross-linking (CXL) treatment can restore vision in patients suffering from keratoconus and corneal injury, by improving the mechanical properties of the cornea. The correlation between ultraviolet-A (UVA) irradiant energies of standard CXL (SCXL) and corneal visco-hyperelastic mechanical behavior remains unknown. In this study, SCXL with four different UVA irradiant energy doses (0-5.4 J/cm(2)) were administered as part of quantitative treatments of corneal stromal lenticules extracted from young myopic patients via small incision lenticule extraction (SMILE) corneal refractive surgery. Double-strip samples with symmetric geometries were cut simultaneously for SCXL treatment and non-treated control. First, 40 pairs of strips were loaded to failure to assess the mechanical parameters of the material. Then, another 40 pairs were tested using a special uniaxial tensile test including quasi-static loading-unloading, instantaneous loading, and stress relaxation, to determine the visco-hyperelastic mechanical behavior. Upon combining the collagen fibril crimping constitutive model with the quasi-linear viscoelastic model, it was observed that with increasing UVA energy dose, the corneal strength and hyperelastic stiffness were significantly enhanced, while the maximum stretch and viscosity of the cornea were significantly reduced. Considering the quantitative analysis of SCXL and the rehabilitation prediction of keratoconus treatment, the results clarify the biomechanical behavior of human corneal stroma in SCXL clinical surgery. STATEMENT OF SIGNIFICANCE: This study quantitatively analyzes the improvement in the biomechanical properties of young central corneal stroma, due to SCXL treatment with different energies. Furthermore, the correlation between the hyper-viscoelastic mechanical parameters and UVA irradiant energy doses of SCXL are clarified. The contribution of this study fills the knowledge gap of the CXL on corneal biomechanics. It can not only clarify this mechanism better but also assist with guiding SCXL surgery for individualized patient corneas. CI - Copyright (c) 2020. Published by Elsevier Ltd. FAU - Liu, Taiwei AU - Liu T AD - Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350 China; Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai 200240, China. FAU - Shen, Min AU - Shen M AD - Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350 China. Electronic address: minshen@tju.edu.cn. FAU - Li, Hongxun AU - Li H AD - Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020 China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070 China. FAU - Zhang, Yan AU - Zhang Y AD - Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020 China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070 China. FAU - Mu, Bokun AU - Mu B AD - Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020 China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070 China. FAU - Zhao, Xinheng AU - Zhao X AD - Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020 China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070 China. FAU - Wang, Yan AU - Wang Y AD - Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020 China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070 China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200607 PL - England TA - Acta Biomater JT - Acta biomaterialia JID - 101233144 RN - 0 (Cross-Linking Reagents) RN - 0 (Photosensitizing Agents) RN - 9007-34-5 (Collagen) RN - TLM2976OFR (Riboflavin) SB - IM MH - Biomechanical Phenomena MH - Collagen MH - Cornea MH - *Corneal Stroma MH - Cross-Linking Reagents MH - Humans MH - Photosensitizing Agents/pharmacology MH - *Riboflavin/pharmacology MH - Ultraviolet Rays OTO - NOTNLM OT - Corneal stroma OT - Different ultraviolet-A energies OT - Hyper-viscoelastic biomechanical properties OT - Standard corneal collagen cross-linking OT - Tensile behavior OT - Young patients COIS- Declaration of Competing Interest The authors declared that they have no conflicts of interest to this work. EDAT- 2020/06/12 06:00 MHDA- 2021/05/15 06:00 CRDT- 2020/06/12 06:00 PHST- 2020/01/23 00:00 [received] PHST- 2020/05/30 00:00 [revised] PHST- 2020/06/02 00:00 [accepted] PHST- 2020/06/12 06:00 [pubmed] PHST- 2021/05/15 06:00 [medline] PHST- 2020/06/12 06:00 [entrez] AID - S1742-7061(20)30326-3 [pii] AID - 10.1016/j.actbio.2020.06.005 [doi] PST - ppublish SO - Acta Biomater. 2020 Sep 1;113:438-451. doi: 10.1016/j.actbio.2020.06.005. Epub 2020 Jun 7. PMID- 32479129 OWN - NLM STAT- MEDLINE DCOM- 20210128 LR - 20220416 IS - 1751-2441 (Electronic) IS - 1751-2433 (Linking) VI - 13 IP - 7 DP - 2020 Jul TI - Current perspective on fibrinogen concentrate in critical bleeding. PG - 761-778 LID - 10.1080/17512433.2020.1776608 [doi] AB - INTRODUCTION: . Massive hemorrhage continues to be a treatable cause of death. Its management varies from prefixed ratio-driven administration of blood components to goal-directed therapy based on point-of-care testing and administration of coagulation factor concentrates. AREAS COVERED: . We review the current role of fibrinogen concentrate (FC) for the management of massive hemorrhage, either administered without coagulation testing in life-threatening hemorrhage, or within an algorithm based on viscoelastic hemostatic assays and plasma fibrinogen level. We identified relevant guidelines, meta-analyzes, randomized controlled trials, and observational studies that included indications, dosage, and adverse effects of FC, especially thromboembolic events. EXPERT OPINION: . Moderate- to high-grade evidence supports the use of FC for the treatment of severe hemorrhage in trauma and cardiac surgery; a lower grade of evidence is available for its use in postpartum hemorrhage and end-stage liver disease. Pre-emptive FC administration in non-bleeding patients is not recommended. FC should be administered early, in a goal-directed manner, guided by early amplitude of clot firmness parameters (A5- or A10-FIBTEM) or hypofibrinogenemia. Further investigation is required into the early use of FC, as well as its potential advantages over cryoprecipitate, and whether or not its administration at high doses leads to a greater risk of adverse events. FAU - Leal-Noval, Santiago R AU - Leal-Noval SR AD - Neuro Critical Care Department, University Hospital "Virgen Del Rocio" and Institute of Biomedicine "IBIS" , 41013, Seville, Spain. FAU - Fernandez Pacheco, Jose AU - Fernandez Pacheco J AD - Pharmacy and Statistics and Design, University Hospital "Virgen Del Rocio" and Institute of Biomedicine "IBIS" , 41013, Seville, Spain. FAU - Casado Mendez, Manuel AU - Casado Mendez M AD - Critical Care Department, University Hospital "Virgen Del Rocio" and Institute of Biomedicine "IBIS" , 41013, Seville, Spain. FAU - Cuenca-Apolo, Diego AU - Cuenca-Apolo D AD - Critical Care Department, University Hospital "Virgen Del Rocio" and Institute of Biomedicine "IBIS" , 41013, Seville, Spain. FAU - Munoz-Gomez, Manuel AU - Munoz-Gomez M AD - Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga , 29071, Malaga, Spain. LA - eng PT - Comparative Study PT - Journal Article PT - Review DEP - 20200717 PL - England TA - Expert Rev Clin Pharmacol JT - Expert review of clinical pharmacology JID - 101278296 RN - 0 (Coagulants) RN - 0 (Hemostatics) RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Coagulants/administration & dosage/adverse effects MH - Factor VIII/administration & dosage MH - Fibrinogen/*administration & dosage/adverse effects MH - Hemorrhage/etiology/*therapy MH - Hemostatics/*administration & dosage/adverse effects MH - Humans MH - Point-of-Care Testing MH - Randomized Controlled Trials as Topic OTO - NOTNLM OT - Bleeding OT - a5-FIBTEM OT - cardiac surgery OT - coagulopathy OT - fibrinogen concentrate OT - postpartum hemorrhage OT - ratio OT - rotem OT - trauma OT - trauma-induced coagulopathy EDAT- 2020/06/02 06:00 MHDA- 2021/01/29 06:00 CRDT- 2020/06/02 06:00 PHST- 2020/06/02 06:00 [pubmed] PHST- 2021/01/29 06:00 [medline] PHST- 2020/06/02 06:00 [entrez] AID - 10.1080/17512433.2020.1776608 [doi] PST - ppublish SO - Expert Rev Clin Pharmacol. 2020 Jul;13(7):761-778. doi: 10.1080/17512433.2020.1776608. Epub 2020 Jul 17. PMID- 32478880 OWN - NLM STAT- MEDLINE DCOM- 20210716 LR - 20250310 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 Suppl 3 DP - 2020 Jun TI - A prospective observational study of acute traumatic coagulopathy in traumatic bleeding from the battlefield. PG - S52-S61 LID - 10.1111/trf.15658 [doi] AB - BACKGROUND: Acute trauma coagulopathy (ATC) after military trauma has not been comprehensively studied. ATC is defined as a prolonged prothrombin time ratio (PTr) or reduced clot amplitude (A5) in viscoelastic testing. Compared to civilian trauma, military trauma has more injuries from explosions and gunshot wounds (GSWs), potentially leading to a different pathophysiology for traumatic coagulopathy. This study aimed to characterize military ATC on admission to a military hospital in Afghanistan and to explore any differences due to the mechanism of injury. METHODS: Severely injured military casualties were enrolled in the study. Blood samples were taken on admission and after routine testing, waste plasma was prepared, frozen, and transported to the United Kingdom for in-depth hemostatic analysis. RESULTS: Seventy-seven percent of casualties had ATC defined by a PTr greater than 1.2 and 19% when defined by rotational thromboelastometry (ROTEM) A5 less than 36 mm. Coagulation factor depletion correlated with degree of shock, particularly factor V (p < 0.01), factor X (p < 0.01), and fibrinogen levels (p < 0.01). Thrombin generation was well preserved. Fibrinolytic biomarkers were raised correlating with the degree of shock (p < 0.01), and 8% of casualties had hyperfibrinolysis on ROTEM analysis. Plasmin-antiplasmin complexes (p < 0.01) and d-dimer levels (p = 0.01) were higher and clot firmness lower (p = 0.02) in those injured by explosion compared to GSW's. CONCLUSIONS: ATC was present and correlated with shock, similar to civilian trauma. Thrombin generation remained adequate. Fibrinogen and factor V levels were disproportionately low but still sufficient to allow clot formation. Fibrinolysis is a key feature, probably due to a tissue plasminogen activator surge at the time of injury. Blast injuries are associated with a greater activation of fibrinolysis than GSWs. CI - (c) 2019 AABB. FAU - Woolley, Tom AU - Woolley T AUID- ORCID: 0000-0001-9957-6453 AD - Anaesthetics and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK. FAU - Gwyther, Robert AU - Gwyther R AD - CBR Division, Defence Science and Technology Laboratory, Salisbury, UK. FAU - Parmar, Kiran AU - Parmar K AD - St Thomas' Hospital, Thrombosis and Vascular Biology Group, Rayne Institute, Westminster, UK. FAU - Kirkman, Emrys AU - Kirkman E AD - CBR Division, Defence Science and Technology Laboratory, Salisbury, UK. FAU - Watts, Sarah AU - Watts S AD - CBR Division, Defence Science and Technology Laboratory, Salisbury, UK. FAU - Midwinter, Mark AU - Midwinter M AD - School Biomedical Science, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. FAU - Lucca, Juandir Dalle AU - Lucca JD AD - Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland. FAU - Hunt, Beverley J AU - Hunt BJ AD - St Thomas' Hospital, Thrombosis & Haemophilia Centre & Thrombosis and Vascular Biology Group, London, UK. LA - eng GR - SGD15/16-002/Ministry of Defence/ GR - Defense Science and Technology Laboratory/ PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20200601 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (fibrin fragment D) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Armed Conflicts MH - Blood Coagulation Disorders/*blood/etiology MH - *Blood Coagulation Tests MH - Erythrocyte Transfusion MH - Female MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinogen/analysis MH - Hemorrhage/etiology/prevention & control MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Wounds and Injuries/blood/complications EDAT- 2020/06/02 06:00 MHDA- 2021/07/17 06:00 CRDT- 2020/06/02 06:00 PHST- 2019/10/21 00:00 [received] PHST- 2019/12/17 00:00 [revised] PHST- 2019/12/17 00:00 [accepted] PHST- 2020/06/02 06:00 [pubmed] PHST- 2021/07/17 06:00 [medline] PHST- 2020/06/02 06:00 [entrez] AID - 10.1111/trf.15658 [doi] PST - ppublish SO - Transfusion. 2020 Jun;60 Suppl 3:S52-S61. doi: 10.1111/trf.15658. Epub 2020 Jun 1. PMID- 32467473 OWN - NLM STAT- MEDLINE DCOM- 20210105 LR - 20210210 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 89 IP - 3 DP - 2020 Sep TI - Hemostatic potential of cold-stored non-leukoreduced whole blood over time: An assessment of platelet function and thrombin generation for optimal shelf life. PG - 429-434 LID - 10.1097/TA.0000000000002799 [doi] AB - OBJECTIVES: Cold-stored low-titer whole blood (WB) is becoming increasingly used as the preferred product for initial hemorrhagic shock resuscitation. The purpose of this study was to identify whether the current 21-day shelf life is the optimal duration for storage of WB, maintaining hemostatic efficacy. METHODS: Five units of fresh low-titer group O WB (non-leukoreduced) were acquired from our regional blood center. These units were stored at 4 degrees C for up to 21 days as per current clinical storage guidelines in our emergency department. Hemostatic parameters were measured in vitro at 0 days, 7 days, 14 days, and 21 days. Assessments of hemostatic potential included cell count, rapid thrombelastography (r-TEG) and kaolin thrombelastography (TEG), multiplate impedance aggregometry, and calibrated automated thrombogram (CAT). Univariate analysis, including one-way analysis of variance with repeated measures, was performed (STATA 12.1). RESULTS: Compared with baseline product (0 days), both platelet count and platelet function of WB showed sharp decreases at 7 days and again at 14 days. Platelet function deterioration was noted by r-TEG c (MA), TEG-MA, and multiplate arachidonic acid and adenosine diphosphate (all p < 0.001). With respect to clot initiation, r-TEG ACT and TEG R-time were similar over the 21-day shelf life (p = 0.058 and p = 0.620, respectively). Thrombin generation assessed by CAT demonstrated stable endogenous thrombin potential over the course of storage (p = 0.162), but increased peak thrombin generation and quicker time to peak generation after 7 days. CONCLUSION: While the platelet function of WB degrades significantly at 7 days (and again at 14 days), clot initiation remains stable over time, and thrombin generation appears to be improved at 7 days. This study supports a current storage limit for cold-stored, low-titer WB of 14 days. FAU - Assen, Scott AU - Assen S AD - From the Department of Surgery (S.A.), University of Calgary Cumming School of Medicine, Calgary, Canada; The Center for Translational Injury Research (J.C., Y.W.W., C.E.W., B.A.C.); Department of Surgery (M.G., C.E.W., D.M., B.A.C.), The McGovern Medical School at the University of Texas Health Science Center (D.M., B.A.C.); and The Red Duke Trauma Institute at Memorial Hermann Hospital (D.M., B.A.C.), Texas Medical Center, Houston, Texas. FAU - Cardenas, Jessica AU - Cardenas J FAU - George, Mitchell AU - George M FAU - Wang, Yao-Wei AU - Wang YW FAU - Wade, Charles E AU - Wade CE FAU - Meyer, David AU - Meyer D FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Platelets MH - *Blood Preservation MH - Cold Temperature MH - *Hemostasis MH - Humans MH - In Vitro Techniques MH - Leukocyte Reduction Procedures MH - Platelet Aggregation MH - Shock, Hemorrhagic/therapy MH - Thrombelastography MH - Thrombin/metabolism EDAT- 2020/05/30 06:00 MHDA- 2021/01/06 06:00 CRDT- 2020/05/30 06:00 PHST- 2020/05/30 06:00 [pubmed] PHST- 2021/01/06 06:00 [medline] PHST- 2020/05/30 06:00 [entrez] AID - 01586154-202009000-00002 [pii] AID - 10.1097/TA.0000000000002799 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Sep;89(3):429-434. doi: 10.1097/TA.0000000000002799. PMID- 32467044 OWN - NLM STAT- MEDLINE DCOM- 20210412 LR - 20210412 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 51 Suppl 2 DP - 2020 May TI - Limiting Blood Loss in Orthopaedic Trauma: Strategies and Effects. PG - S123-S127 LID - S0020-1383(20)30385-5 [pii] LID - 10.1016/j.injury.2020.04.040 [doi] AB - Trauma is a major cause of mortality globally, with post-traumatic hemorrhage being the leading cause of death amongst trauma patients. In this paper, the authors review the underlying pathophysiology of trauma-related hemorrhagic shock, specifically the factors which contribute to the development of the acute coagulopathy of trauma shock (ACoTS). We then review the best available evidence for treatment strategies in the pre-hospital setting, as well as the in-hospital setting. Interventions that are strongly supported in the literature include utilization of a well-organized trauma system with direct transport to a designated trauma centre, the early use of tranexamic acid, and damage control orthopaedic surgical techniques and resuscitation protocols. Targeted resuscitation is an evolving field, with use of thromboelastography to guide resuscitation being a particularly promising area. Special trauma populations at particularly high risk are also reviewed, including the geriatric population, as well as unstable pelvic fractures, which are each at increased risk for poor outcomes, and deserve special attention. Major advances have been made in this important area, and ongoing research into the understanding and correction of ACoTS will continue to guide practice. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Leighton, Jennifer L AU - Leighton JL AD - FRCSC, Dalhousie University, Halifax, NS, Canada. Electronic address: j.leighton@dal.ca. FAU - You, Daniel AU - You D AD - University of Calgary, Calgary, AB, Canada. FAU - Schneider, Prism AU - Schneider P AD - FRCSC, University of Calgary, Calgary, AB, Canada. LA - eng PT - Journal Article PT - Review DEP - 20200511 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Blood Coagulation Disorders/blood/etiology/mortality/*therapy MH - Hemostasis MH - Humans MH - Orthopedic Procedures/adverse effects MH - Resuscitation/*methods MH - Shock, Hemorrhagic/blood/etiology/mortality/*therapy MH - Thrombelastography MH - Tranexamic Acid/therapeutic use MH - Wounds and Injuries/blood/*complications/mortality/*therapy OTO - NOTNLM OT - Acute coagulopathy of trauma OT - Blood loss OT - Hemorrhage OT - Hemostasis OT - Thromboelastography COIS- Declaration of Competing Interest All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for iportant intellectual content; and (c) approval of the final version. This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue. The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript EDAT- 2020/05/30 06:00 MHDA- 2021/04/13 06:00 CRDT- 2020/05/30 06:00 PHST- 2020/04/06 00:00 [received] PHST- 2020/04/17 00:00 [revised] PHST- 2020/04/25 00:00 [accepted] PHST- 2020/05/30 06:00 [pubmed] PHST- 2021/04/13 06:00 [medline] PHST- 2020/05/30 06:00 [entrez] AID - S0020-1383(20)30385-5 [pii] AID - 10.1016/j.injury.2020.04.040 [doi] PST - ppublish SO - Injury. 2020 May;51 Suppl 2:S123-S127. doi: 10.1016/j.injury.2020.04.040. Epub 2020 May 11. PMID- 32441353 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 60 IP - 6 DP - 2020 Jun TI - Traumatic injury results in prolonged circulation of ultralarge von Willebrand factor and a reduction in ADAMTS13 activity. PG - 1308-1318 LID - 10.1111/trf.15856 [doi] AB - BACKGROUND: Increases in plasma von Willebrand Factor (VWF) levels, accompanied by decreases in the metalloprotease ADAMTS13, have been demonstrated soon after traumatic injury while downstream effects remain unclear. STUDY DESIGN AND METHODS: A cohort of 37 injured trauma patients from a randomized control trial investigating the use of prehospital plasma transfusion were analyzed for activity and antigen levels of ADAMTS13 and VWF at 0 and 24 hours after admission. Relevant clinical data were abstracted from the medical records. Trauma patient plasma was analyzed via agarose gel electrophoresis to evaluate the effects of injury on VWF multimer composition compared to healthy controls. RESULTS: von Willebrand factor levels were elevated at presentation (189% [110%-263%] vs. 95% [74%-120%]), persisting through 24 hours (213% [146%-257%] vs. 132% [57%-160%]), compared to healthy controls. Ultralarge VWF (UL-VWF) forms were elevated in trauma patients at both 0 and 24 hours, when compared to pooled normal plasma (10.0% [8.9%-14.3%] and 11.3% [9.1%-21.2%], respectively, vs. 0.6%). Circulating plasma ADAMTS13 activity was decreased at 0 hours (66% [47%-86%] vs. 100% [98%-100%]) and at 24 hours (72.5% [56%-87.3%] vs. 103% [103%-103%]) in trauma patients. ADAMTS13 activity independently predicted the development of coagulopathy and correlated with international normalized ratio, thromboelastography values, injury severity, and blood product transfusion. CONCLUSION: Traumatic injury is associated with acute coagulopathy that is characterized by increased UL-VWF multimers and reduction in ADAMTS13, which correlates with blood loss, transfusion requirement, and injury severity. These findings suggest the potential for future trials targeting ADAMTS13 repletion to enhance clearance of VWF multimers. CI - (c) 2020 AABB. FAU - Dyer, Mitchell R AU - Dyer MR AD - Pittsburgh Trauma Research Center and the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Plautz, William E AU - Plautz WE AUID- ORCID: 0000-0002-9140-1023 AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Ragni, Margaret V AU - Ragni MV AD - Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Alexander, Wyeth AU - Alexander W AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Haldeman, Shannon AU - Haldeman S AD - Pittsburgh Trauma Research Center and the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Sperry, Jason L AU - Sperry JL AD - Pittsburgh Trauma Research Center and the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Guyette, Francis X AU - Guyette FX AD - Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Zuckerbraun, Brian S AU - Zuckerbraun BS AD - Pittsburgh Trauma Research Center and the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Rollins-Raval, Marian A AU - Rollins-Raval MA AD - Department of Pathology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA. AD - Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA. FAU - Raval, Jay S AU - Raval JS AUID- ORCID: 0000-0001-9835-957X AD - Department of Pathology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA. AD - Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA. FAU - Neal, Matthew D AU - Neal MD AUID- ORCID: 0000-0001-8931-6236 AD - Pittsburgh Trauma Research Center and the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. CN - A TACTIC Publication LA - eng GR - Carolyn L. Kuckein Student Research Fellowship/Alpha Omega Alpha Honor Medical Society/ GR - W81XWH-12-2-0023/Medical Research and Materiel Command/ GR - 1R35GM119526-01/NIH Clinical Center/ GR - 5T32GM008516/NIH Clinical Center/ GR - UM1HL120877/NIH Clinical Center/ PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20200522 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (von Willebrand Factor) RN - EC 3.4.24.87 (ADAMTS13 Protein) RN - EC 3.4.24.87 (ADAMTS13 protein, human) SB - IM MH - ADAMTS13 Protein/*blood MH - Adult MH - *Blood Component Transfusion MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Plasma MH - Time Factors MH - Trauma Severity Indices MH - Wounds and Injuries/*blood/mortality/*therapy MH - von Willebrand Factor/*metabolism EDAT- 2020/05/23 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/05/23 06:00 PHST- 2019/07/10 00:00 [received] PHST- 2020/02/19 00:00 [revised] PHST- 2020/04/05 00:00 [accepted] PHST- 2020/05/23 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/05/23 06:00 [entrez] AID - 10.1111/trf.15856 [doi] PST - ppublish SO - Transfusion. 2020 Jun;60(6):1308-1318. doi: 10.1111/trf.15856. Epub 2020 May 22. PMID- 32418869 OWN - NLM STAT- MEDLINE DCOM- 20210623 LR - 20210623 IS - 0736-4679 (Print) IS - 0736-4679 (Linking) VI - 59 IP - 2 DP - 2020 Aug TI - Tracing the Lines: A Review of Viscoelastography for Emergency Medicine Clinicians. PG - 201-215 LID - S0736-4679(20)30339-5 [pii] LID - 10.1016/j.jemermed.2020.04.009 [doi] AB - BACKGROUND: Viscoelastography (VE) is an established method to identify coagulopathies in various disease processes. Clinical decisions can be made with real-time tracings and quantitative values at the bedside. Thromboelastography (TEG(R)) and rotational thromboelastometry (ROTEM(R)) have been utilized in several disease states with clinical varying success. OBJECTIVES: This review will summarize the literature and provide recommendations pertaining to major disease processes where VE may be beneficial, including trauma, anticoagulation reversal, liver disease, acute ischemic stroke, and acquired brain injuries. DISCUSSION: VE has a role in many emergency medicine patients encountered by clinicians. Reduced mortality, decreased blood product utilization, and prognostication ability makes VE an intriguing tool that can be utilized by providers to improve patient care. CONCLUSION: This review serves as a way for emergency medicine clinicians to utilize VE in their practice and provides an insightful literature overview. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Gilbert, Brian W AU - Gilbert BW AD - Department of Emergency Medicine, Wesley Medical Center, Wichita, Kansas. FAU - Bissell, Brittany D AU - Bissell BD AD - Medical Intensive Care Unit, University of Kentucky Healthcare, Lexington, Kentucky. FAU - Santiago, Ruben D AU - Santiago RD AD - Department of Emergency Medicine, Jackson Memorial Hospital, Miami, Florida. FAU - Rech, Megan A AU - Rech MA AD - Department of Emergency Medicine, Loyola University Medical Center, Maywood, Illinois. LA - eng PT - Journal Article PT - Review DEP - 20200514 PL - United States TA - J Emerg Med JT - The Journal of emergency medicine JID - 8412174 SB - IM MH - *Blood Coagulation Disorders/diagnosis MH - *Brain Ischemia MH - *Emergency Medicine MH - Humans MH - *Stroke MH - Thrombelastography OTO - NOTNLM OT - rotational thromboelastometry OT - thromboelastography OT - viscoelastography EDAT- 2020/05/19 06:00 MHDA- 2021/06/24 06:00 CRDT- 2020/05/19 06:00 PHST- 2019/12/14 00:00 [received] PHST- 2020/03/25 00:00 [revised] PHST- 2020/04/08 00:00 [accepted] PHST- 2020/05/19 06:00 [pubmed] PHST- 2021/06/24 06:00 [medline] PHST- 2020/05/19 06:00 [entrez] AID - S0736-4679(20)30339-5 [pii] AID - 10.1016/j.jemermed.2020.04.009 [doi] PST - ppublish SO - J Emerg Med. 2020 Aug;59(2):201-215. doi: 10.1016/j.jemermed.2020.04.009. Epub 2020 May 14. PMID- 32380672 OWN - NLM STAT- MEDLINE DCOM- 20210302 LR - 20210302 IS - 2072-6651 (Electronic) IS - 2072-6651 (Linking) VI - 12 IP - 5 DP - 2020 May 5 TI - Novel Treatment Strategy for Patients with Venom-Induced Consumptive Coagulopathy from a Pit Viper Bite. LID - 10.3390/toxins12050295 [doi] LID - 295 AB - Pit viper venom commonly causes venom-induced consumptive coagulopathy (VICC), which can be complicated by life-threatening hemorrhage. VICC has a complex pathophysiology affecting multiple steps of the coagulation pathway. Early detection of VICC is challenging because conventional blood tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are unreliable for early-stage monitoring of VICC progress. As the effects on the coagulation cascade may differ, even in the same species, the traditional coagulation pathways cannot fully explain the mechanisms involved in VICC or may be too slow to have any clinical utility. Antivenom should be promptly administered to neutralize the lethal toxins, although its efficacy remains controversial. Transfusion, including fresh frozen plasma, cryoprecipitate, and specific clotting factors, has also been performed in patients with bleeding. The effectiveness of viscoelastic monitoring in the treatment of VICC remains poorly understood. The development of VICC can be clarified using thromboelastography (TEG), which shows the procoagulant and anticoagulant effects of snake venom. Therefore, we believe that TEG may be able to be used to guide hemostatic resuscitation in victims of VICC. Here, we aim to discuss the advantages of TEG by comparing it with traditional coagulation tests and propose potential treatment options for VICC. FAU - Park, Eun Jung AU - Park EJ AUID- ORCID: 0000-0001-7854-0961 AD - Emergency Department, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, Korea. FAU - Choi, Sangchun AU - Choi S AUID- ORCID: 0000-0003-2271-3434 AD - Emergency Department, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, Korea. FAU - Kim, Hyuk-Hoon AU - Kim HH AUID- ORCID: 0000-0003-1957-3020 AD - Emergency Department, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, Korea. FAU - Jung, Yoon Seok AU - Jung YS AD - Emergency Department, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, Korea. LA - eng PT - Journal Article PT - Review DEP - 20200505 PL - Switzerland TA - Toxins (Basel) JT - Toxins JID - 101530765 RN - 0 (Antivenins) RN - 0 (Crotalid Venoms) SB - IM MH - Animals MH - Antivenins/*therapeutic use MH - Blood Coagulation/*drug effects MH - *Blood Transfusion MH - Crotalid Venoms/*metabolism MH - Crotalinae/*metabolism MH - Disseminated Intravascular Coagulation/blood/diagnosis/physiopathology/*therapy MH - Drug Monitoring MH - Humans MH - Predictive Value of Tests MH - Snake Bites/blood/diagnosis/physiopathology/*therapy MH - *Thrombelastography MH - Treatment Outcome PMC - PMC7290867 OTO - NOTNLM OT - antivenins OT - blood transfusion OT - consumption coagulopathy OT - snake venoms OT - thromboelastography COIS- The authors declare no conflict of interest. EDAT- 2020/05/10 06:00 MHDA- 2021/03/03 06:00 PMCR- 2020/05/01 CRDT- 2020/05/09 06:00 PHST- 2020/03/22 00:00 [received] PHST- 2020/05/01 00:00 [revised] PHST- 2020/05/02 00:00 [accepted] PHST- 2020/05/09 06:00 [entrez] PHST- 2020/05/10 06:00 [pubmed] PHST- 2021/03/03 06:00 [medline] PHST- 2020/05/01 00:00 [pmc-release] AID - toxins12050295 [pii] AID - toxins-12-00295 [pii] AID - 10.3390/toxins12050295 [doi] PST - epublish SO - Toxins (Basel). 2020 May 5;12(5):295. doi: 10.3390/toxins12050295. PMID- 32339433 OWN - NLM STAT- MEDLINE DCOM- 20210407 LR - 20210407 IS - 1445-2197 (Electronic) IS - 1445-1433 (Linking) VI - 90 IP - 4 DP - 2020 Apr TI - Randomized controlled trials and Cochrane analyses versus precision-based medicine for tranexamic acid and viscoelastic testing in trauma. PG - 415-416 LID - 10.1111/ans.15557 [doi] FAU - Walsh, Mark AU - Walsh M AUID- ORCID: 0000-0002-5795-1144 AD - Department of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Department of Trauma, Memorial Hospital, South Bend, Indiana, USA. AD - Indiana University School of Medicine South Bend Campus, Notre Dame, Indiana, USA. AD - W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, USA. FAU - Grisoli, Annie AU - Grisoli A AD - Indiana University School of Medicine South Bend Campus, Notre Dame, Indiana, USA. FAU - Zackariya, Nuha AU - Zackariya N AD - Department of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Department of Trauma, Memorial Hospital, South Bend, Indiana, USA. FAU - Thomas, Anthony V AU - Thomas AV AUID- ORCID: 0000-0001-9520-9306 AD - Department of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Department of Trauma, Memorial Hospital, South Bend, Indiana, USA. FAU - Sualeh, Ali AU - Sualeh A AD - Department of Emergency Medicine and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Department of Trauma, Memorial Hospital, South Bend, Indiana, USA. LA - eng PT - Comparative Study PT - Journal Article PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/administration & dosage/adverse effects/therapeutic use MH - Blood Component Transfusion/methods MH - Fibrinolysis/genetics MH - Humans MH - Incidence MH - Precision Medicine/*methods/statistics & numerical data MH - Randomized Controlled Trials as Topic MH - Resuscitation/methods MH - Thrombelastography/*methods MH - Tranexamic Acid/administration & dosage/*adverse effects/therapeutic use MH - Venous Thromboembolism/chemically induced/epidemiology MH - Wounds and Injuries/*blood EDAT- 2020/04/28 06:00 MHDA- 2021/04/10 06:00 CRDT- 2020/04/28 06:00 PHST- 2019/08/17 00:00 [received] PHST- 2019/10/07 00:00 [revised] PHST- 2019/10/10 00:00 [accepted] PHST- 2020/04/28 06:00 [entrez] PHST- 2020/04/28 06:00 [pubmed] PHST- 2021/04/10 06:00 [medline] AID - 10.1111/ans.15557 [doi] PST - ppublish SO - ANZ J Surg. 2020 Apr;90(4):415-416. doi: 10.1111/ans.15557. PMID- 32339427 OWN - NLM STAT- MEDLINE DCOM- 20210514 LR - 20210514 IS - 1445-2197 (Electronic) IS - 1445-1433 (Linking) VI - 90 IP - 4 DP - 2020 Apr TI - Value of viscoelastic testing in detecting fibrinolysis and coagulopathy in malignancy-associated coagulopathy and orthopaedic trauma. PG - 422-423 LID - 10.1111/ans.15675 [doi] FAU - Walsh, Mark AU - Walsh M AUID- ORCID: 0000-0002-5795-1144 AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Memorial Hospital Trauma Center, South Bend, Indiana, USA. AD - Indiana University School of Medicine, Notre Dame, Indiana, USA. AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, USA. FAU - Patel, Shivani AU - Patel S AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Memorial Hospital Trauma Center, South Bend, Indiana, USA. FAU - Zackariya, Sufyan AU - Zackariya S AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Memorial Hospital Trauma Center, South Bend, Indiana, USA. FAU - Al-Fadhl, Mahmoud AU - Al-Fadhl M AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA. AD - Memorial Hospital Trauma Center, South Bend, Indiana, USA. FAU - Marsee, Mathew AU - Marsee M AD - Indiana University School of Medicine, Notre Dame, Indiana, USA. LA - eng PT - Journal Article PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Fibrinolysis MH - Humans MH - *Neoplasms MH - *Orthopedics MH - Thrombelastography MH - *Wounds and Injuries/complications EDAT- 2020/04/28 06:00 MHDA- 2021/05/15 06:00 CRDT- 2020/04/28 06:00 PHST- 2019/08/16 00:00 [received] PHST- 2019/11/27 00:00 [revised] PHST- 2019/12/08 00:00 [accepted] PHST- 2020/04/28 06:00 [entrez] PHST- 2020/04/28 06:00 [pubmed] PHST- 2021/05/15 06:00 [medline] AID - 10.1111/ans.15675 [doi] PST - ppublish SO - ANZ J Surg. 2020 Apr;90(4):422-423. doi: 10.1111/ans.15675. PMID- 32332776 OWN - NLM STAT- MEDLINE DCOM- 20201214 LR - 20210424 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 10 IP - 1 DP - 2020 Apr 24 TI - FIBTEM Improves the Sensitivity of Hyperfibrinolysis Detection in Severe Trauma Patients: A Retrospective Study Using Thromboelastometry. PG - 6980 LID - 10.1038/s41598-020-63724-y [doi] LID - 6980 AB - Rotational thromboelastometry (ROTEM) can only detect high-degree hyperfibrinolysis (HF), despite being frequently used in trauma patients. We investigated whether considering FIBTEM HF (the presence of maximal lysis (ML) > 15%) could increase ROTEM-based HF detection's sensitivity. This observational cohort study was performed at a level 1 trauma centre. Trauma patients with an Injury Severity Score (ISS) > 15 who underwent ROTEM in the emergency department between 2016 and 2017 were included. EXTEM HF was defined as ML > 15% in EXTEM. We compared mortality rates between EXTEM HF, FIBTEM HF, and non-HF patient groups. Overall, 402 patients were included, of whom 45% were men (mean age, 52.5 years; mean ISS, 27). The EXTEM HF (n = 37), FIBTEM HF (n = 132), and non-HF (n = 233) groups had mortality rates of 81.1%, 22.3%, and 10.3%, respectively. The twofold difference in mortality rates between the FIBTEM HF and non-HF groups remained statistically significant after Bonferroni correction (P = 0.01). On multivariable Cox regression analysis, FIBTEM HF was independently associated with in-hospital mortality (adjusted hazard ratio 2.15, 95% confidence interval 1.21-3.84, P = 0.009). Here, trauma patients with FIBTEM HF had significantly higher mortality rates than those without HF. FIBTEM be a valuable diagnostic method to improve HF detection's sensitivity in trauma patients. FAU - Wang, Il-Jae AU - Wang IJ AUID- ORCID: 0000-0003-2479-2359 AD - Department of Emergency Medicine, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, Korea. AD - Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. FAU - Park, Sung-Wook AU - Park SW AUID- ORCID: 0000-0001-6699-8553 AD - Department of Emergency Medicine, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, Korea. FAU - Bae, Byung-Kwan AU - Bae BK AD - Department of Emergency Medicine, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, Korea. FAU - Lee, Sung-Hwa AU - Lee SH AD - Department of Emergency Medicine, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, Korea. FAU - Choi, Hyuk Jin AU - Choi HJ AD - Department of Neurosurgery, Pusan National University Hospital, Busan, Korea. FAU - Park, Sung Jin AU - Park SJ AUID- ORCID: 0000-0002-4852-5442 AD - Department of Trauma Surgery, Pusan National University Hospital, Busan, Seoul, Korea. FAU - Ahn, Tae Young AU - Ahn TY AD - Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Seoul, Korea. FAU - Goh, Tae Sik AU - Goh TS AD - Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Seoul, Korea. FAU - Lee, Min Jee AU - Lee MJ AD - Department of Emergency Medicine, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Yangsan, Korea. FAU - Yeom, Seok Ran AU - Yeom SR AUID- ORCID: 0000-0002-1000-9637 AD - Department of Emergency Medicine, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, Korea. seokrany@gmail.com. AD - Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. seokrany@gmail.com. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200424 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 SB - IM MH - Adult MH - Aged MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Factors MH - Thrombelastography/*methods MH - Wounds and Injuries/*diagnosis/*physiopathology PMC - PMC7181804 COIS- The authors declare no competing interests. EDAT- 2020/04/26 06:00 MHDA- 2020/12/15 06:00 PMCR- 2020/04/24 CRDT- 2020/04/26 06:00 PHST- 2019/11/11 00:00 [received] PHST- 2020/03/31 00:00 [accepted] PHST- 2020/04/26 06:00 [entrez] PHST- 2020/04/26 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2020/04/24 00:00 [pmc-release] AID - 10.1038/s41598-020-63724-y [pii] AID - 63724 [pii] AID - 10.1038/s41598-020-63724-y [doi] PST - epublish SO - Sci Rep. 2020 Apr 24;10(1):6980. doi: 10.1038/s41598-020-63724-y. PMID- 32332276 OWN - NLM STAT- MEDLINE DCOM- 20210104 LR - 20210203 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 31 IP - 4 DP - 2020 Jun TI - In-vitro assessment of the effects of fibrinogen, recombinant factor VIIa and factor XIII on trauma-induced coagulopathy. PG - 253-257 LID - 10.1097/MBC.0000000000000910 [doi] AB - : Trauma-induced coagulopathy (TIC) occurs commonly as a second event following severe injury. We evaluated the effects of fibrinogen, recombinant factor VIIa and factor XIII on blood clotting and fibrinolysis in an in-vitro TIC model. The TIC model included hemodilution, hyperfibrinolysis, acidosis and hypothermia. The extent of clot formation and fibrinolysis was evaluated using rotational thromboelastometry. Clot strength was increased following spiking the TIC blood with either 1.0 mg/ml fibrinogen, 3.0 mug/ml recombinant factor VIIa or 2.0 IU/ml factor XIII. Maximal effect was achieved by all agents in combination approximating the extent of clot formation to those in normal blood. Fibrinolysis was inhibited by factor XIII, while the reduction was stronger using all agents together. When each of the agents used in two times lower concentrations, clot strength was near to threshold. Fibrinogen and factor XIII but not factor VIIa exerted stimulation of clot strength, whereas synergistic effect of fibrinogen and factor XIII was observed. Maximal effect was achieved combining all agents. The antifibrinolytic effect was observed only by co-administration of fibrinogen, factor XIII and factor VIIa. On the basis of our study, we suggest that stimulation of clot formation and inhibition of fibrinolysis may be achieved by combination of FG, rFVIIa an FXIII using each of them at minimal effective concentration. Taken into consideration, multifactorial TIC pathogenesis, this approach may be preferable for improving coagulopathy than separate blood spiking with the essayed factors at high concentrations. FAU - Budnik, Ivan AU - Budnik I AD - Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia. FAU - Shenkman, Boris AU - Shenkman B AD - Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Morozova, Olga AU - Morozova O AD - Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia. FAU - Einav, Yulia AU - Einav Y AD - Faculty of Engineering, Holon Institute of Technology, Holon, Israel. LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) SB - IM MH - Adult MH - Blood Coagulation Disorders/*drug therapy MH - Factor XIII/pharmacology/*therapeutic use MH - Female MH - Fibrinogen/pharmacology/*therapeutic use MH - Healthy Volunteers MH - Humans MH - Male EDAT- 2020/04/26 06:00 MHDA- 2021/01/05 06:00 CRDT- 2020/04/26 06:00 PHST- 2020/04/26 06:00 [pubmed] PHST- 2021/01/05 06:00 [medline] PHST- 2020/04/26 06:00 [entrez] AID - 00001721-202006000-00003 [pii] AID - 10.1097/MBC.0000000000000910 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2020 Jun;31(4):253-257. doi: 10.1097/MBC.0000000000000910. PMID- 32310702 OWN - NLM STAT- MEDLINE DCOM- 20210526 LR - 20210526 IS - 1747-4094 (Electronic) IS - 1747-4094 (Linking) VI - 13 IP - 7 DP - 2020 Jul TI - Evolution of viscoelastic coagulation testing. PG - 697-707 LID - 10.1080/17474086.2020.1758929 [doi] AB - INTRODUCTION: The methods of viscoelastic coagulation testing (VCT) have evolved since the original invention of thrombelastography over 60 years ago, and new generations of devices are clinically used to guide hemostatic interventions at bedside. The utility of VCTs has been demonstrated in several clinical trials, but diagnostic performance of VCT may vary between devices, various transfusion algorithms, and patient populations. AREAS COVERED: Working principles and currently available data on the evolving VCTs for coagulation monitoring in acute care settings are reviewed. The PubMed database was used to search pertinent retrospective, prospective, and meta-analysis data on VCTs. EXPERT OPINION: Point-of-care VCTs provide clinically useful information on platelet count, fibrin polymerization, and other procoagulant factor activities in acute bleeding due to trauma or major surgery, and antithrombotic therapy. The addition of fibrin-specific VCT channel has brought renewed attention to early correction of fibrinogen deficiency using fibrinogen-rich component therapy, and stabilization of fibrin with antifibrinolytic agents. Normal reference ranges vary between devices, and diagnostic and treatment algorithms should be specifically established for each device and indication. There is interest in utilizing VCTs in complex coagulation management relating to hemophilia with inhibitors, but the standardized protocol has not been established. FAU - Tanaka, Kenichi A AU - Tanaka KA AUID- ORCID: 0000-0002-5051-1365 AD - School of Medicine, University of Maryland , Baltimore, MD, USA. FAU - Henderson, Reney A AU - Henderson RA AD - School of Medicine, University of Maryland , Baltimore, MD, USA. FAU - Strauss, Erik R AU - Strauss ER AD - School of Medicine, University of Maryland , Baltimore, MD, USA. LA - eng PT - Journal Article PT - Meta-Analysis DEP - 20200503 PL - England TA - Expert Rev Hematol JT - Expert review of hematology JID - 101485942 SB - IM MH - Aged MH - Algorithms MH - *Blood Coagulation MH - Blood Coagulation Disorders/blood/diagnosis/etiology MH - *Blood Coagulation Tests MH - Clinical Decision-Making MH - Disease Management MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Count MH - Platelet Function Tests MH - Point-of-Care Testing MH - *Thrombelastography/methods OTO - NOTNLM OT - Bleeding OT - cardiopulmonary bypass OT - coagulopathy OT - direct oral anticoagulant OT - hemodilution OT - surgery OT - trauma OT - viscoelastic coagulation testing OT - warfarin EDAT- 2020/04/21 06:00 MHDA- 2021/05/27 06:00 CRDT- 2020/04/21 06:00 PHST- 2020/04/21 06:00 [pubmed] PHST- 2021/05/27 06:00 [medline] PHST- 2020/04/21 06:00 [entrez] AID - 10.1080/17474086.2020.1758929 [doi] PST - ppublish SO - Expert Rev Hematol. 2020 Jul;13(7):697-707. doi: 10.1080/17474086.2020.1758929. Epub 2020 May 3. PMID- 32299155 OWN - NLM STAT- MEDLINE DCOM- 20210716 LR - 20210716 IS - 2005-7563 (Electronic) IS - 2005-6419 (Print) IS - 2005-6419 (Linking) VI - 73 IP - 4 DP - 2020 Aug TI - Influence of alcohol consumption on blood coagulation in rotational thromboelastometry (ROTEM): an in-vivo study. PG - 334-341 LID - 10.4097/kja.20071 [doi] AB - BACKGROUND: Twenty-five to 85% of trauma patients are under the influence of alcohol in addition to experiencing injury-related coagulation impairment. Viscoelastic point-of-care tests (thrombelastography [TEG], rotational thromboelastometry [ROTEM]) are popular tools for rapid hemostasis assessment and therapeutic decision-making in this and other settings. While alcohol affects these tests in-vitro, their specific effects in-vivo are unclear. Therefore, we evaluated the effects of alcohol ingestion on ROTEM parameters. METHODS: Twenty volunteers provided informed consent to drinking red wine, whisk(e)y, or vodka to a target blood alcohol concentration of 1 per thousand within one hour, calculated with the Widmark formula. Blood samples were collected before drinking, at a breath alcohol concentration of 0.5 per thousand, and at 1.0 per thousand, but no later than one hour. After each blood collection, ExTEM and FibTEM tests were performed directly "at the bedside." RESULTS: All participants had a blood alcohol concentration (BAC) of 0.00 per thousand at the beginning. The mean BACs at the second and third collection were 0.48 and 0.76 per thousand, respectively. There were no significant differences in the ExTEM parameters. FibTEM measurements showed a significant difference at the A10 value (13.0 vs. 14.0 mm, P = 0.014) and a trend at the maximum amplitude (maximum clot firmness [MCF] 13.7 vs. 16.2 mm, P = 0.075). We saw no significant differences in fibrinolysis parameters and no hyperfibrinolysis in our ROTEM measurements. CONCLUSIONS: Ethanol ingestion can impair early fibrin polymerization. These results might be of special relevance in trauma and support routine application of ROTEM/TEG in such cases. FAU - Eismann, Hendrik AU - Eismann H AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. FAU - Sieg, Lion AU - Sieg L AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. FAU - Ahmed, Hala AU - Ahmed H AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. FAU - Teske, Joerg AU - Teske J AD - Institute of Legal Medicine, Hannover Medical School, Hannover, Germany. FAU - Behrendt, Patrick AU - Behrendt P AD - Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. AD - TWINCORE, Center for Experimental and Clinical Infection Research, Institute for Experimental Infection Research, Hannover, Germany. FAU - Friedrich, Lars AU - Friedrich L AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. FAU - Schumacher, Carsten AU - Schumacher C AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. FAU - Johanning, Kai AU - Johanning K AD - Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. LA - eng PT - Journal Article DEP - 20200416 PL - Korea (South) TA - Korean J Anesthesiol JT - Korean journal of anesthesiology JID - 101502451 RN - 0 (Blood Alcohol Content) SB - IM MH - Adult MH - Alcohol Drinking/adverse effects/*blood/*trends MH - *Blood Alcohol Content MH - Blood Coagulation/*drug effects/physiology MH - Female MH - Humans MH - Male MH - Thrombelastography/*trends PMC - PMC7403120 OTO - NOTNLM OT - Alcoholic intoxication OT - Blood coagulation test OT - Ethanol OT - Point-of-care testing COIS- Conflicts of Interest No potential conflict of interest relevant to this article was reported. EDAT- 2020/04/17 06:00 MHDA- 2021/07/17 06:00 PMCR- 2020/08/01 CRDT- 2020/04/17 06:00 PHST- 2020/02/12 00:00 [received] PHST- 2020/04/14 00:00 [accepted] PHST- 2020/04/17 06:00 [pubmed] PHST- 2021/07/17 06:00 [medline] PHST- 2020/04/17 06:00 [entrez] PHST- 2020/08/01 00:00 [pmc-release] AID - kja.20071 [pii] AID - kja-20071 [pii] AID - 10.4097/kja.20071 [doi] PST - ppublish SO - Korean J Anesthesiol. 2020 Aug;73(4):334-341. doi: 10.4097/kja.20071. Epub 2020 Apr 16. PMID- 32299044 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20250821 LR - 20250821 IS - 1873-4529 (Electronic) IS - 0952-8180 (Linking) VI - 64 DP - 2020 Sep TI - Viscoelastic haemostatic assays in the perioperative period of surgical procedures: Systematic review and meta-analysis. PG - 109809 LID - S0952-8180(19)32028-8 [pii] LID - 10.1016/j.jclinane.2020.109809 [doi] AB - OBJECTIVE: The aim of this study is to evaluate the safety and efficacy of Viscoelastic Haemostatic Assays (VHA) to guide transfusions in patients undergoing surgical procedures. DESIGN: Systematic review with meta-analysis of randomized controlled trials up until June 5, 2019. SETTING: Hospitalized patients. INTERVENTIONS: VHAs compared to the Standard-Of-Care (SOC), which are represented by standard laboratory tests and/or clinical decisions. MEASUREMENTS: Primary - Risk of death, acute kidney injury, thrombotic events and reoperation for bleeding; Secondary - Risk of use of red blood cells (RBC), platelets, fresh frozen plasma (FFP), fibrinogen, factor VIIa, prothrombin complex, volume of RBC, platelets and FFP, length of hospital stay, and length of ICU stay. RESULTS: VHAs were associated to a statistically significant reduction in mortality (7.3% vs. 12.1%; RR = 0.64, p-value = 0.03), risk of acute kidney injury (10.5% vs. 17.6%; RR = 0.53, p-value = 0.005), volume of red blood cells (RBCs) transfused (MD = -1.63 U, p-value = 0.02), risk of platelet transfusion (23.9% vs. 27.3%; RR = 0.74, p-value = 0.006), risk of fresh frozen plasma (FFP) transfusion (RR = 0.57, p-value = 0.001), and volume of FFP transfused (MD = -0.90, p-value = 0.0003). No significant differences were observed in terms of thrombotic events, reexploration for bleeding, RBC transfusion, volume of platelets transfused, use of fibrinogen, prothrombin complex, or factor VIIa, length of hospitalization and length of ICU stay. CONCLUSION: Viscoelastic haemostatic assays are safe and efficacious for coagulation control in patients undergoing surgical procedures, therefore it should be considered for use in practice. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Santos, Andre Soares AU - Santos AS AD - Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigenia, 30.130-100 Belo Horizonte, Brazil.; Department of Economical Sciences, School of Economics, Universidade Federal de Minas Gerais, Av. Presidente Antonio Carlos, 6627, Pampulha, 31.270-901 Belo Horizonte, Brazil. Electronic address: andresantos111@ufmg.br. FAU - Oliveira, Ananda Jessyla Felix AU - Oliveira AJF AD - Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigenia, 30.130-100 Belo Horizonte, Brazil.; Department of Health Management, School of Nursing, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Santa Efigenia, 30.130-100 Belo Horizonte, Brazil. FAU - Barbosa, Maria Carolina Lage AU - Barbosa MCL AD - Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigenia, 30.130-100 Belo Horizonte, Brazil.; Collegy of Pharmacy, Universidade Federal de Minas Gerais, Av. Presidente Antonio Carlos, 6627, Pampulha, 31.270-901 Belo Horizonte, Brazil. FAU - Nogueira, Jose Luiz Dos Santos AU - Nogueira JLDS AD - Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigenia, 30.130-100 Belo Horizonte, Brazil. LA - eng PT - Journal Article PT - Review DEP - 20200413 PL - United States TA - J Clin Anesth JT - Journal of clinical anesthesia JID - 8812166 SB - IM OTO - NOTNLM OT - Blood coagulation OT - Blood coagulation tests OT - General surgery OT - Review OT - Thrombelastography EDAT- 2020/04/17 06:00 MHDA- 2020/04/17 06:01 CRDT- 2020/04/17 06:00 PHST- 2019/12/16 00:00 [received] PHST- 2020/02/20 00:00 [revised] PHST- 2020/04/04 00:00 [accepted] PHST- 2020/04/17 06:01 [medline] PHST- 2020/04/17 06:00 [pubmed] PHST- 2020/04/17 06:00 [entrez] AID - S0952-8180(19)32028-8 [pii] AID - 10.1016/j.jclinane.2020.109809 [doi] PST - ppublish SO - J Clin Anesth. 2020 Sep;64:109809. doi: 10.1016/j.jclinane.2020.109809. Epub 2020 Apr 13. PMID- 32279464 OWN - NLM STAT- MEDLINE DCOM- 20210719 LR - 20210719 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 32 IP - 5 DP - 2020 Oct TI - Viscoelastic haemostatic assays in aeromedical transport. PG - 786-792 LID - 10.1111/1742-6723.13510 [doi] AB - OBJECTIVE: To assess the feasibility of using rotational thromboelastometry (ROTEM(R))-sigma and thromboelastography (TEG(R))-6s viscoelastic point-of-care assays during rotary wing aeromedical transport, and to determine the reliability of the results obtained. METHODS: A single centre, prospective, observational, non-interventional feasibility study performed at Gold Coast University Hospital intensive care unit, and in a LifeFlight Retrieval Medicine operated Leonardo AW139 helicopter. Blood was collected from eight healthy volunteers on 18 April 2019 and all testing was performed on that day. Functions measured were ROTEM-sigma extrinsically activated thromboelastometry (EXTEM) clotting time (CT), EXTEM amplitude at 5 min after CT (A5) and fibrin-based extrinsically activated thromboelastometry (FIBTEM) A5, and TEG-6s Kaolin (CK) reaction time (R), functional fibrinogen (CFF) maximal amplitude (MA) and CFF amplitude at 10 min after R (A10). Differences between the results obtained in the helicopter and control results at Gold Coast University Hospital during flight and after flight, and also differences in control results over time up to 3 h were analysed. RESULTS: During flight both the ROTEM-sigma and TEG-6s devices failed to give reliable results. Post flight, the helicopter and control samples correlated well. Repeat testing of control samples at 1 and 3 h also revealed good correlation over time. CONCLUSION: It is feasible to reliably run tests on both the ROTEM-sigma and TEG-6s after the devices have been flown in a rotary wing aircraft. However, testing cannot be performed while in flight conditions. It is also possible to run blood samples collected up to 3 h prior and acquire results which correlate well with initial testing. CI - (c) 2020 Australasian College for Emergency Medicine. FAU - Bates, Alexander AU - Bates A AUID- ORCID: 0000-0001-5650-9509 AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Donohue, Andrew AU - Donohue A AD - Anaesthetic Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia. AD - LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia. FAU - McCullough, James AU - McCullough J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - Winearls, James AU - Winearls J AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. LA - eng GR - Gold Coast University Hospital Critical Care Research Group/International PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200411 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 RN - 0 (Hemostatics) SB - IM MH - *Air Ambulances MH - *Blood Coagulation Disorders MH - *Hemostatics MH - Humans MH - Prospective Studies MH - Reproducibility of Results MH - Thrombelastography OTO - NOTNLM OT - haemorrhage OT - haemostasis OT - point-of-care testing OT - prehospital care, helicopter retrieval OT - trauma EDAT- 2020/04/13 06:00 MHDA- 2021/07/20 06:00 CRDT- 2020/04/13 06:00 PHST- 2019/07/05 00:00 [received] PHST- 2019/12/06 00:00 [revised] PHST- 2020/03/22 00:00 [accepted] PHST- 2020/04/13 06:00 [pubmed] PHST- 2021/07/20 06:00 [medline] PHST- 2020/04/13 06:00 [entrez] AID - 10.1111/1742-6723.13510 [doi] PST - ppublish SO - Emerg Med Australas. 2020 Oct;32(5):786-792. doi: 10.1111/1742-6723.13510. Epub 2020 Apr 11. PMID- 32251150 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20210427 IS - 1365-2346 (Electronic) IS - 0265-0215 (Linking) VI - 37 IP - 10 DP - 2020 Oct TI - Comparison of fresh frozen plasma vs. coagulation factor concentrates for reconstitution of blood: An in vitro study. PG - 879-888 LID - 10.1097/EJA.0000000000001202 [doi] AB - BACKGROUND: Many trauma centres have adopted the administration of fixed ratios of packed red blood cells (PRBCs), platelet concentrates and fresh frozen plasma (FFP) for bleeding patients. However, the haemostatic efficacy of this concept is not well proven. OBJECTIVE: Our objective was to characterise the haemostatic profile of different ratios (2 : 1 : 1, 1 : 1 : 1 and 1 : 1 : 2) of PRBCs, platelet concentrates and FFP in comparison with coagulation factor concentrates (fibrinogen and/or prothrombin complex concentrate). DESIGN: An in vitro study. SETTING: Research laboratories of the department of transfusion medicine, Linz, Austria. MATERIALS: Whole blood donations from a total of 20 male volunteers. INTERVENTION: Reconstitution of blood at different ratios of PRBCs, platelet concentrates and FFP or coagulation factor concentrates. MAIN OUTCOME MEASURES: Cell count, conventional and thromboelastometric coagulation parameters, single coagulation factor activities as well as endogenous thrombin potential. RESULTS: Fibrinogen levels and haematocrit were lower in the FFP group at any ratio compared with the concentrate-based groups (P < 0.0001). Reconstitution of blood with FFP at different ratios resulted in haematocrit or fibrinogen levels that were borderline with regard to recommended substitution triggers (haematocrit 41 +/- 2% and fibrinogen 1.5 +/- 0.3 g l at the 2 : 1 : 1 ratio vs. 21 +/- 1% and 2.1 +/- 0.4 g l respectively at the 1 : 1 : 2 ratio). Compared with FFP at any ratio, maximum clot firmness showed higher values in the groups using fibrinogen concentrate (P < 0.0001), whereas endogenous thrombin potential revealed higher values in the groups using prothrombin complex concentrate (P < 0.0001). CONCLUSION: Use of coagulation factor concentrates for the reconstitution of blood allows for delivery of a higher haematocrit and a higher fibrinogen content compared with FFP. However, prothrombin complex concentrate might result in an unnecessary excess of thrombin generation. Clinical studies are warranted to further investigate these in vitro findings. FAU - Gratz, Johannes AU - Gratz J AD - From the Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna (JG), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre Vienna, Vienna, Austria (MP, CJS, JZ, DO, HS, CG), Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, Linz, Austria (MP, CJS), Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center, Rozzano, Italy (GEI), Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (JC), Department of Anesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany (OG), Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz (CG), Formerly: Red Cross Transfusion Service of Upper Austria, Linz (CG), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Salzburg (BZ), Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg (HS). FAU - Ponschab, Martin AU - Ponschab M FAU - Iapichino, Giacomo E AU - Iapichino GE FAU - Schlimp, Christoph J AU - Schlimp CJ FAU - Cadamuro, Janne AU - Cadamuro J FAU - Grottke, Oliver AU - Grottke O FAU - Zipperle, Johannes AU - Zipperle J FAU - Oberladstatter, Daniel AU - Oberladstatter D FAU - Gabriel, Christian AU - Gabriel C FAU - Ziegler, Bernhard AU - Ziegler B FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article PL - England TA - Eur J Anaesthesiol JT - European journal of anaesthesiology JID - 8411711 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Austria MH - *Blood Coagulation Factors MH - Fibrinogen MH - Humans MH - Male MH - *Plasma MH - Thrombelastography EDAT- 2020/04/07 06:00 MHDA- 2021/04/28 06:00 CRDT- 2020/04/07 06:00 PHST- 2020/04/07 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2020/04/07 06:00 [entrez] AID - 00003643-202010000-00008 [pii] AID - 10.1097/EJA.0000000000001202 [doi] PST - ppublish SO - Eur J Anaesthesiol. 2020 Oct;37(10):879-888. doi: 10.1097/EJA.0000000000001202. PMID- 32218020 OWN - NLM STAT- MEDLINE DCOM- 20200909 LR - 20260306 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 89 IP - 1 DP - 2020 Jul TI - Identification of injury and shock driven effects on ex vivo platelet aggregometry: A cautionary tale of phenotyping. PG - 20-28 LID - 10.1097/TA.0000000000002707 [doi] AB - BACKGROUND: Platelet behavior in trauma-induced coagulopathy is poorly understood. Injured patients have impaired platelet aggregation (dysfunction) in ex vivo agonist-stimulated platelet aggregometry (PA). However, PA assumes that platelets are inactivated before ex vivo stimulated aggregation, which may be altered by injury. We hypothesized that following trauma, platelet aggregation (area under the curve) is decreased regardless of injury burden, but that (1) minor injury is associated with an increased baseline electrical impedance, characteristic of a functional platelet phenotype (platelets that activate in response to injury), and that (2) severe injury is not associated with an increased baseline electrical impedance, characteristic of a dysfunctional phenotype (platelets that do not activate well in response to injury) compared with healthy controls. METHODS: Blood from 458 trauma patients and 30 healthy donors was collected for PA. Baseline electrical impedance (Omega); platelet aggregation stimulated by adenosine diphosphate, collagen, thrombin, and arachidonic acid; and rotational thromboelastometry were measured. Multivariate regression was performed to identify associations of PA measures with blood transfusion. RESULTS: Compared with healthy controls, injured patients had impaired platelet aggregation in response to ex vivo stimulation, regardless of injury burden. However, minorly injured patients had increased endogenous platelet activation (baseline electrical impedance, Omega: with shock, p = 0.012; without shock, p = 0.084), but severely injured patients did not have significant increases in endogenous platelet activation (baseline electrical impedance, Omega: with shock, p = 0.86; without shock, p = 0.37). For every 10 Omega increase in baseline electrical impedance, there was an 8% decrease in units of blood transfused in the first 24 h (-0.08; confidence interval, -0.14 to -0.02; p = 0.015). CONCLUSION: Injury and shock confer differential patterns of platelet aggregation in PA. Minor injury overestimates the presence of platelet dysfunction, while severe injury induces a truly dysfunctional phenotype-platelets that do not activate nor aggregate appropriately after injury. This is consequential in improving accurate phenotyping of postinjury platelet behavior for platelet-based therapeutics. LEVEL OF EVIDENCE: Prognostic, level IV. FAU - Starr, Nichole E AU - Starr NE AD - From the Department of Surgery (N.E.S., Z.A.M., A.T.F., B.N.-G., R.A.C., L.Z.K.), Zuckerberg San Francisco General Hospital, University of California, San Francisco, California; and Department of Surgery (M.J.C.), Denver Health Medical Center, University of Colorado, Denver, Colorado. FAU - Matthay, Zachary A AU - Matthay ZA FAU - Fields, Alexander T AU - Fields AT FAU - Nunez-Garcia, Brenda AU - Nunez-Garcia B FAU - Callcut, Rachael A AU - Callcut RA FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Kornblith, Lucy Zumwinkle AU - Kornblith LZ LA - eng GR - D43 TW010540/TW/FIC NIH HHS/United States GR - R01 HL149670/HL/NHLBI NIH HHS/United States GR - TL1 TR001871/TR/NCATS NIH HHS/United States GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - T32 DK007573/DK/NIDDK NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - K01 ES026834/ES/NIEHS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*etiology MH - Case-Control Studies MH - Electric Impedance MH - Female MH - Humans MH - Male MH - Phenotype MH - Platelet Activation MH - *Platelet Aggregation MH - Platelet Function Tests MH - Shock/*blood MH - Thrombelastography MH - Wounds and Injuries/*blood/*complications PMC - PMC7386285 MID - NIHMS1608026 COIS- DISCLOSURE For all authors, no conflicts are declared. EDAT- 2020/03/29 06:00 MHDA- 2020/09/10 06:00 PMCR- 2020/07/28 CRDT- 2020/03/29 06:00 PHST- 2020/03/29 06:00 [pubmed] PHST- 2020/09/10 06:00 [medline] PHST- 2020/03/29 06:00 [entrez] PHST- 2020/07/28 00:00 [pmc-release] AID - 01586154-202007000-00006 [pii] AID - 10.1097/TA.0000000000002707 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Jul;89(1):20-28. doi: 10.1097/TA.0000000000002707. PMID- 32193125 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20220414 IS - 1873-4529 (Electronic) IS - 0952-8180 (Linking) VI - 63 DP - 2020 Aug TI - The effect of fibrinogen concentrate on postoperative blood loss: A systematic review and meta-analysis of randomized controlled trials. PG - 109782 LID - S0952-8180(19)32091-4 [pii] LID - 10.1016/j.jclinane.2020.109782 [doi] AB - BACKGROUND: Low level of fibrinogen is a risk factor of perioperative bleeding, which is a major complication in surgical patients. However, the safety and efficacy of fibrinogen supplementation with fibrinogen concentrate to minimize postoperative bleeding remains unclear. OBJECTIVES: The primary aim of this review was to investigate the effect of fibrinogen concentrate in postoperative blood loss in adult surgical patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Databases of MEDLINE, EMBASE and CENTRAL were searched from their start date until July 2019. ELIGIBILITY CRITERIA: All randomized clinical trials comparing intravenous fibrinogen concentrate and placebo in adult surgical patients were included, regardless of type of surgery. Observational studies, case reports, case series and non-systematic reviews were excluded. RESULTS: Thirteen trials (n = 900) were included in this review. In comparison to placebo, fibrinogen concentrate significantly reduced the first 12-hour postoperative blood loss, with a mean difference of -134.6 ml (95% CI -181.9 to -87.4). It also significantly increased clot firmness in thromboelastometry (FIBTEM) with a mean difference of 2.5 mm (95%CI 1.1 to 3.8). No significant differences were demonstrated in the adverse events associated with fibrinogen concentrate use, namely incidence of thromboembolism, myocardial infarction and acute kidney injury. CONCLUSIONS: In this meta-analysis of 13 randomized trials, low level of evidence and substantial heterogeneity with small sample size limit strong recommendation on the use of fibrinogen concentrate in adult surgical patients. However, its use is tolerable without any notable adverse events. TRIAL REGISTRATION: CRD42019149164. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Ng, Ka Ting AU - Ng KT AD - Department of Anaesthesiology, University of Malaya, 50603 Kuala Lumpur, Malaysia. Electronic address: katingng1@gmail.com. FAU - Yap, Jasmine Li Ling AU - Yap JLL AD - Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia. FAU - Kwok, Pei En AU - Kwok PE AD - Department of Surgery, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20200317 PL - United States TA - J Clin Anesth JT - Journal of clinical anesthesia JID - 8812166 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - *Fibrinogen/adverse effects MH - *Hemostatics MH - Humans MH - Postoperative Hemorrhage/chemically induced/epidemiology/prevention & control MH - Randomized Controlled Trials as Topic MH - Thrombelastography OTO - NOTNLM OT - Blood loss OT - Blood transfusion OT - Fibrinogen OT - Fibrinogen concentrate OT - Placebo OT - Surgery COIS- Declaration of competing interest All authors have declared that they do not have any conflicts of interest in this review. EDAT- 2020/03/21 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/03/21 06:00 PHST- 2019/12/27 00:00 [received] PHST- 2020/02/01 00:00 [revised] PHST- 2020/03/07 00:00 [accepted] PHST- 2020/03/21 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/03/21 06:00 [entrez] AID - S0952-8180(19)32091-4 [pii] AID - 10.1016/j.jclinane.2020.109782 [doi] PST - ppublish SO - J Clin Anesth. 2020 Aug;63:109782. doi: 10.1016/j.jclinane.2020.109782. Epub 2020 Mar 17. PMID- 32160645 OWN - NLM STAT- MEDLINE DCOM- 20201019 LR - 20201019 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 46 IP - 2 DP - 2020 Mar TI - Whole Blood for Civilian Urban Trauma Resuscitation: Historical, Present, and Future Considerations. PG - 221-234 LID - 10.1055/s-0040-1702174 [doi] AB - Whole blood (WB) has been used for more than a century for far-forward combat resuscitation. Following the Iraq/Afghanistan combat, maritime, and austere environment use of WB for the resuscitation of severely hemorrhaging patients, there has been an increasing use of WB for the civilian urban resuscitation environment population. The impetus for this was not just improved outcomes in far-forward hospitals, which had different populations and different needs than the civilian urban population, but also an application of the lessons suggested by recent 1:1:1 plasma:platelets:packed red cells fixed-ratio studies for patients with massive transfusion needs. Mechanistic, logistic, and standardization concerns have been addressed and are evolving as the WB project advances. A small number of studies have been published on WB in the civilian urban trauma population. In addition, European experience with viscoelastic testing and resuscitation with fibrinogen and prothrombin complex concentrate has provided another viewpoint regarding the choice of resuscitation strategies for severely bleeding trauma patients in urban civilian environments. There are randomized controlled trials in process, which are testing the hypothesis that WB may be beneficial for the civilian urban population. Whether WB will improve mortality significantly is now a matter of intense study, and this commentary reviews the history, mechanistic foundations, and logistical aspects for the use of WB in the civilian trauma population. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Walsh, Mark AU - Walsh M AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana. FAU - Fries, Dietmar AU - Fries D AD - Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Moore, Ernest AU - Moore E AD - Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado. FAU - Moore, Hunter AU - Moore H AD - Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado. FAU - Thomas, Scott AU - Thomas S AD - Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana. FAU - Kwaan, Hau C AU - Kwaan HC AD - Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. FAU - Marsee, Mathew K AU - Marsee MK AD - Indiana University School of Medicine, South Bend, Indiana. FAU - Grisoli, Anne AU - Grisoli A AD - Indiana University School of Medicine, South Bend, Indiana. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine, South Bend, Indiana. FAU - Vande Lune, Stefani AU - Vande Lune S AD - Indiana University School of Medicine, South Bend, Indiana. FAU - Chitta, Swetha AU - Chitta S AD - Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana. FAU - Vyakaranam, Sudhir AU - Vyakaranam S AD - Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Waxman, Dan AU - Waxman D AD - Versiti Blood Center of Indiana, Indianapolis, Indiana. FAU - McCurdy, Michael T AU - McCurdy MT AD - Department of Critical Care and Emergency Medicine, University of Maryland, Baltimore, Maryland. FAU - Zimmer, Donald AU - Zimmer D AD - Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana. FAU - Patel, Bhavesh AU - Patel B AD - Department of Critical Care Medicine, Mayo Clinic Phoenix, Arizona. FAU - Thachil, Jecko AU - Thachil J AD - Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom. LA - eng PT - Journal Article PT - Review DEP - 20200311 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Transfusion/*methods MH - Humans MH - Resuscitation/*methods MH - Wounds and Injuries/*therapy COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2020/03/12 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/03/12 06:00 PHST- 2020/03/12 06:00 [entrez] PHST- 2020/03/12 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] AID - 10.1055/s-0040-1702174 [doi] PST - ppublish SO - Semin Thromb Hemost. 2020 Mar;46(2):221-234. doi: 10.1055/s-0040-1702174. Epub 2020 Mar 11. PMID- 32160644 OWN - NLM STAT- MEDLINE DCOM- 20201019 LR - 20201019 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 46 IP - 2 DP - 2020 Mar TI - Temporal Changes in Fibrinolysis following Injury. PG - 189-198 LID - 10.1055/s-0039-1701016 [doi] AB - Trauma patients present to the emergency department with a spectrum of fibrinolytic activity. This wide variance in fibrinolysis activity is a complex multifactorial process impacted by the degree of hemorrhagic shock and the amount of tissue injury the individual sustains. The fibrinolytic activity of the trauma patient at presentation to the hospital has prognostic and therapeutic implications. Those patients with high fibrinolytic activity (hyperfibrinolysis) are at risk of mortality from hemorrhage, whereas those patients with low fibrinolytic activity (shutdown or hypofibrinolysis) are at an increased risk of delayed mortality from traumatic brain injury or organ failure. These phenotypes of fibrinolysis acutely following injury change with resuscitation, and the majority of trauma patients will transition to a fibrinolytic resistant state several hours after injury. The mechanism for this near-global transition to this acquired fibrinolysis appears to be related to the generation of plasminogen activator inhibitor-1 in the liver. Those patients who do not recover from this fibrinolytic state 24 hours after injury have a poor prognosis. The purpose of this article is to review the different states of fibrinolytic activity following injury and how they change over time following resuscitation and in the intensive care unit. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Moore, Hunter B AU - Moore HB AD - Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. AD - Department of Surgery, Ernest E. Moore Shock and Trauma Center at Denver Health, Denver, Colorado. LA - eng GR - National Institute of General Medical Sciences (NIGMS)/T32-GM008315/ GR - National Heart Lung and Blood Institute (NHLBI)/1UM1HL120877/ PT - Journal Article PT - Review DEP - 20200311 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Fibrinolysis/*physiology MH - Humans MH - Prognosis MH - Thrombelastography/*methods MH - Wounds and Injuries/*physiopathology COIS- Both authors report nonfinancial support from Thrombo Therapeutics Inc., outside the submitted work. In addition, both authors have a patent tPA TEG assay pending. EDAT- 2020/03/12 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/03/12 06:00 PHST- 2020/03/12 06:00 [entrez] PHST- 2020/03/12 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] AID - 10.1055/s-0039-1701016 [doi] PST - ppublish SO - Semin Thromb Hemost. 2020 Mar;46(2):189-198. doi: 10.1055/s-0039-1701016. Epub 2020 Mar 11. PMID- 32160642 OWN - NLM STAT- MEDLINE DCOM- 20201019 LR - 20201019 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 46 IP - 2 DP - 2020 Mar TI - Changes in Coagulation following Brain Injury. PG - 155-166 LID - 10.1055/s-0040-1702178 [doi] AB - Traumatic brain injury (TBI) is a worldwide public health concern due to increasing mortality, affecting around 10 million patients per year. A wide variety of clinical presentations are a function of the magnitude of injury and the anatomical perturbation of the brain parenchyma, supporting structures, and cerebral vasculature, with subsequent alteration of the blood-brain barrier. These disturbances correspond with the evolution of intracerebral hemorrhage and clinical outcomes. The associated hemostatic alterations associated with TBI are caused by the disruption of the delicate balance between bleeding and thrombosis formation, which can exacerbate initial injury. TBI-associated coagulopathy is a function of a cross-talk between coagulation and inflammation, with varying influences on the immunomodulation and regulation of coagulation that occur on platelets and the endothelium of injured TBI patients. In addition to the severity of initial injury, the following factors modulate the hemocoagulative response to TBI: time from the onset of injury to treatment, age, gender, catecholamine secretion, platelet dysfunction, endotheliopathy, premorbid anticoagulation, fibrinolysis, tissue factor, and activated protein C contribution. All these entities are intertwined and influence the pathologic evolution of TBI. These factors have implications for therapeutic options such as the choice of blood components for transfusion and hemostatic agents such as tranexamic acid. Monitoring hemostatic changes of TBI patients requires an understanding of these interactions between immunology and coagulation, which can be discerned by point-of-care viscoelastic testing with specific limitations. This review considers the implications of these interrelated influences on the evaluation of coagulopathy in TBI. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Maegele, Marc AU - Maegele M AD - Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne-Merheim Campus, Cologne, Germany. AD - Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne-Merheim Campus, Cologne, Germany. FAU - Aversa, John AU - Aversa J AD - Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Marsee, Mathew K AU - Marsee MK AD - Indiana University School of Medicine, South Bend Campus, Notre Dame, Indiana. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine, South Bend Campus, Notre Dame, Indiana. FAU - Chitta, Swetha Hanuma AU - Chitta SH AD - Beacon Health Trauma Center, South Bend, Indiana. FAU - Vyakaranam, Sudhir AU - Vyakaranam S AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Walsh, Mark AU - Walsh M AD - Indiana University School of Medicine, South Bend Campus, Notre Dame, Indiana. AD - Beacon Health Trauma Center, South Bend, Indiana. AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. LA - eng PT - Journal Article PT - Review DEP - 20200311 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Coagulation Disorders/*etiology MH - Brain Injuries/*blood MH - Female MH - Humans MH - Male COIS- In the past, Marc Maegele has received speaker's fees and travel payments from Abbott, Laboratories, AstraZeneca, Bayer, Biotest, CSL Behring, LFB Biomedicaments (France), Portola Inc., and TEM International/IL Werfen. Mark Walsh receives research grants from Haemonetics Inc., Braintree, MA, and is on the Speaker's Bureau for Portola Inc., San Francisco, CA. EDAT- 2020/03/12 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/03/12 06:00 PHST- 2020/03/12 06:00 [entrez] PHST- 2020/03/12 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] AID - 10.1055/s-0040-1702178 [doi] PST - ppublish SO - Semin Thromb Hemost. 2020 Mar;46(2):155-166. doi: 10.1055/s-0040-1702178. Epub 2020 Mar 11. PMID- 32160640 OWN - NLM STAT- MEDLINE DCOM- 20201019 LR - 20201019 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 46 IP - 2 DP - 2020 Mar TI - Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography. PG - 134-146 LID - 10.1055/s-0040-1702171 [doi] AB - This article explores the application of viscoelastic tests (VETs) in trauma-induced coagulopathy and trauma resuscitation. We describe the advantages of VETs over conventional coagulation tests in the trauma setting and refer to previous disciplines in which VET use has reduced blood product utilization, guided prohemostatic agents, and improved clinical outcomes such as the mortality of critically bleeding patients. We describe different VETs and provide guidance for blood component therapy and prohemostatic therapy based on specific VET parameters. Because the two most commonly used VET systems, rotational thromboelastometry and thromboelastography, use different activators and have different terminologies, this practical narrative review will directly compare and contrast these two VETs to help the clinician easily interpret either and use the interpretation to determine hemostatic integrity in the bleeding trauma patient. Finally, we anticipate the future of new viscoelastic technologies that can be used in this setting. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Hartmann, Jan AU - Hartmann J AD - Haemonetics Corporation, Boston, Massachusetts. FAU - Walsh, Mark AU - Walsh M AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Memorial Hospital Trauma Center, South Bend, Indiana. AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana. FAU - Grisoli, Anne AU - Grisoli A AD - Indiana University School of Medicine-South Bend Campus, Notre Dame, Indiana. FAU - Thomas, Anthony V AU - Thomas AV AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Shariff, Faisal AU - Shariff F AD - Indiana University School of Medicine-South Bend Campus, Notre Dame, Indiana. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine-South Bend Campus, Notre Dame, Indiana. FAU - Vande Lune, Stefani AU - Vande Lune S AD - Indiana University School of Medicine-South Bend Campus, Notre Dame, Indiana. FAU - Zackariya, Nuha AU - Zackariya N AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Patel, Shivani AU - Patel S AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Farrell, Michael S AU - Farrell MS AD - Department of Trauma, Surgery, and Critical Care Medicine, Christiana Care Health Services, Wilmington, Delaware. FAU - Sixta, Sherry AU - Sixta S AD - Department of Trauma, Surgery, and Critical Care Medicine, Christiana Care Health Services, Wilmington, Delaware. FAU - March, Robert AU - March R AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Evans, Edward AU - Evans E AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. FAU - Tracy, Rebecca AU - Tracy R AD - Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois. FAU - Campello, Elena AU - Campello E AD - Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. FAU - Scarlatescu, Ecaterina AU - Scarlatescu E AD - Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania. FAU - Agostini, Vanessa AU - Agostini V AD - Department of Clinical Pathology, Transfusion Medicine Cesena/Forli and Blood Establishment, Azienda USL della Romagna, Romagna, Italy. FAU - Dias, Joao AU - Dias J AD - Haemonetics S. A., Signy, Switzerland. FAU - Greve, Sarah AU - Greve S AD - Haemonetics Corporation, Boston, Massachusetts. FAU - Thomas, Scott AU - Thomas S AD - Memorial Hospital Trauma Center, South Bend, Indiana. AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana. LA - eng PT - Journal Article PT - Review DEP - 20200311 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Coagulation Disorders/*diagnosis/*therapy MH - Humans MH - Thrombelastography/*methods MH - Wounds and Injuries/*blood/complications COIS- J.H. and S.G. are employees of Haemonetics Corp., the manufacturer of TEG Hemostasis Analyzers. M.W. and S.T. have received research grants from Haemonetics Corp., Braintree, MA. M.W. is on the speakers' bureau for Portola Inc., San Francisco, CA. E.S. reports grants from the International Society on Thrombosis and Haemostasis and personal fees from Danube University of Krems, Austria; CSL Behring; Weill-Cornell Medicine-Qatar; EurAsia Heart Foundation; and University Hospital Zurich Foundation, outside the submitted work. V.A. reports grants from CSL Behring, Werfen and Ablynx, outside the submitted work. J.D. reports that he is an employee of Haemonetics S.A. Signy, Switzerland. The other authors have nothing to disclose. EDAT- 2020/03/12 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/03/12 06:00 PHST- 2020/03/12 06:00 [entrez] PHST- 2020/03/12 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] AID - 10.1055/s-0040-1702171 [doi] PST - ppublish SO - Semin Thromb Hemost. 2020 Mar;46(2):134-146. doi: 10.1055/s-0040-1702171. Epub 2020 Mar 11. PMID- 32157340 OWN - NLM STAT- MEDLINE DCOM- 20211203 LR - 20211214 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 47 IP - 6 DP - 2021 Dec TI - Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients. PG - 1827-1835 LID - 10.1007/s00068-020-01328-x [doi] AB - INTRODUCTION: High alcohol consumption has been associated with decreased fibrinolysis and enhanced thrombosis risk in cardiovascular disease. In trauma, alcohol has been associated with poor clot formation; however, its effect on fibrinolysis has not been fully investigated. We assessed the association of blood alcohol levels and fibrinolysis in trauma activation patients. METHODS: We queried our prospective registry of trauma activations from 2014 to 2016. Associations between viscoelastic measurements [rapid thrombelastography (rTEG)] and blood alcohol level (BAL) were determined and adjusted for confounders by a multinomial logistic regression. Lysis phenotypes were defined by the % lysis in 30 min (LY30) as follows: hyperfibrinolysis >/= 3%, physiologic 0.9-2.9%, and fibrinolysis shutdown < 0.9%. RESULTS: Overall, 191 (43.8%) had BAL measured. There were 65 (34%) patients that had no detectable BAL, 32 (16.8%) had BAL of 10-150 mg/dL, and 94 (49.2%) patients had BAL > 150 mg/dL. BAL had a moderate, but significant inverse correlation with LY30 (Rho = - 0.315, p < 0.001), while there were no significant correlations between BAL and other TEG values. The distribution of fibrinolysis phenotypes varied significantly by BAL levels (p < 0.009, with high BAL having more shutdown and less hyperfibrinolysis than the other two BAL level groups. Multinomial logistic regression showed that after adjustment for confounders, BAL levels > 150 mg/dL were independently associated with a threefold increase in the odds of shutdown compared to undetectable BAL (OR 3.37, 95% CI 1.04-8.05, p = 0.006). High BAL was also significantly associated with higher odds of shutdown compared to low BAL (OR 2.63, 95% CI 1.15-6.06). Compared to physiologic fibrinolysis, fibrinolysis shutdown was associated with increased mortality (OR 2.87, 95% CI 1.41-5.83) and VFD < 28 (OR 2.54, 95% CI 1.47-4.39). CONCLUSION: In the injured patient, high blood alcohol levels are associated with increased incidence of fibrinolysis shutdown. This finding has implications for postinjury hemostatic resuscitation as these patients may be harmed by anti-fibrinolytics. Further research is needed to assess whether the association with fibrinolysis is modified by the chronicity and type of alcohol consumed and whether anti-fibrinolytic therapy in intoxicated patients produces adverse effects. CI - (c) 2020. Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. gregory.stettler@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. AD - Denver Health Medical Center, Aurora, USA. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. AD - Department of Pediatrics, University of Colorado Denver, Aurora, USA. AD - Vitalant Research Institute, Denver, USA. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. AD - School of Public Health, University of Colorado, Aurora, USA. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315 and P50-GM49222/GM/NIGMS NIH HHS/United States GR - USAMRAA and W81XWH-12-2-0028/U.S. Department of Defense/ GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - UM1-HL120877/HL/NHLBI NIH HHS/United States GR - T32-GM008315 and P50-GM49222/GM/NIGMS NIH HHS/United States GR - UM1-HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20200310 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - *Alcoholic Intoxication MH - *Blood Coagulation Disorders MH - Fibrinolysis MH - Humans MH - Logistic Models MH - Thrombelastography MH - *Wounds and Injuries/complications PMC - PMC7222146 OTO - NOTNLM OT - Alcohol OT - Alcohol intoxication OT - Fibrinolysis shutdown OT - Trauma-induced coagulopathy COIS- Gregory R Stettler MD declares that he has no conflict of interest. Ernest E Moore MD declares that he has no conflict of interest. Geoffrey R Nunns MD declares that he has no conflict of interest. Hunter B Moore MD declares that he has no conflict of interest. Benjamin R Huebner MD declares that he has no conflict of interest. Christopher C Silliman MD, PhD, serves on the Scientific Advisory Board for Hemanext. Anirban Banerjee PhD declares that he has no conflict of interest. Angela Sauaia MD, PhD, declares that he has no conflict of interest. EDAT- 2020/03/12 06:00 MHDA- 2021/12/15 06:00 PMCR- 2020/05/14 CRDT- 2020/03/12 06:00 PHST- 2019/10/25 00:00 [received] PHST- 2020/02/11 00:00 [accepted] PHST- 2020/03/12 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2020/03/12 06:00 [entrez] PHST- 2020/05/14 00:00 [pmc-release] AID - 10.1007/s00068-020-01328-x [pii] AID - 1328 [pii] AID - 10.1007/s00068-020-01328-x [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2021 Dec;47(6):1827-1835. doi: 10.1007/s00068-020-01328-x. Epub 2020 Mar 10. PMID- 32153133 OWN - NLM STAT- MEDLINE DCOM- 20210818 LR - 20210818 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 32 IP - 2 DP - 2020 Apr TI - Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review. PG - 313-319 LID - 10.1111/1742-6723.13484 [doi] AB - OBJECTIVE: Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. RESULTS: There is limited high-quality prospective data on the use of VHA in the management of acute traumatic coagulopathy in the paediatric population. While the use of fibrinogen early in major haemorrhage is becoming standard practice, there are currently no randomised prospective studies comparing fibrinogen concentrate to cryoprecipitate. CONCLUSIONS: The early identification of hypo-fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high-level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi-centre randomised trials. CI - (c) 2020 Australasian College for Emergency Medicine. FAU - Maconachie, Sharon AU - Maconachie S AD - Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia. FAU - Jansen, Melanie AU - Jansen M AD - Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia. AD - Paediatric Intensive Care Unit, Children's Hospital at Westmead, Sydney, New South Wales, Australia. FAU - Cottle, Emma AU - Cottle E AD - Mental Health Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. FAU - Roy, John AU - Roy J AD - Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia. AD - Department of Haematology, Pathology Queensland, Brisbane, Queensland, Australia. AD - Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. FAU - Ross, Bryony AU - Ross B AD - Department of Haematology, Children's Hospital at Westmead, Sydney, New South Wales, Australia. FAU - Winearls, James AU - Winearls J AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. FAU - George, Shane AU - George S AUID- ORCID: 0000-0002-8880-1245 AD - School of Medicine, Griffith University, Gold Coast, Queensland, Australia. AD - Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. AD - Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20200309 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Child MH - Fibrinogen/therapeutic use MH - Hemorrhage MH - *Hemostatics MH - Humans MH - Prospective Studies MH - *Wounds and Injuries/complications OTO - NOTNLM OT - coagulopathy OT - fibrinogen OT - major haemorrhage OT - paediatric OT - trauma OT - viscoelastic haemostatic assay EDAT- 2020/03/11 06:00 MHDA- 2021/08/19 06:00 CRDT- 2020/03/11 06:00 PHST- 2019/09/10 00:00 [received] PHST- 2020/02/05 00:00 [revised] PHST- 2020/02/05 00:00 [accepted] PHST- 2020/03/11 06:00 [pubmed] PHST- 2021/08/19 06:00 [medline] PHST- 2020/03/11 06:00 [entrez] AID - 10.1111/1742-6723.13484 [doi] PST - ppublish SO - Emerg Med Australas. 2020 Apr;32(2):313-319. doi: 10.1111/1742-6723.13484. Epub 2020 Mar 9. PMID- 32142926 OWN - NLM STAT- MEDLINE DCOM- 20210201 LR - 20250326 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 230 IP - 5 DP - 2020 May TI - Thromboelastography Reaction-Time Thresholds for Optimal Prediction of Coagulation Factor Deficiency in Trauma. PG - 798-808 LID - 10.1016/j.jamcollsurg.2020.01.033 [doi] AB - BACKGROUND: Coagulopathy is common in multitrauma patients and repletion of procoagulant factor deficiency with fresh frozen plasma (FFP) improves hemostasis. Optimal kaolin-thromboelastography thresholds for FFP transfusion in trauma patients have not been well established. STUDY DESIGN: Adult trauma patients with an Injury Severity Score >/=15 were included in this retrospective observational cohort study. The primary end point was area under the receiver operating characteristic curve (AUROC) for reaction time (R-time) to detect procoagulant factor deficiency, as reflected by an elevated international normalized ratio (INR) or aPTT. Test characteristics for the optimal R-time threshold calculated in our study were compared against thresholds recommended by the American College of Surgeons for FFP transfusion. RESULTS: Six hundred and ninety-four pairs of thromboelastography and conventional coagulation tests were performed in 550 patients, with 144 patients having additional pairs of tests after the first hour. The R-time was able to detect procoagulant factor deficiency (INR >/=1.5 AUROC 0.80; 95% CI, 0.75 to 0.85; aPTT >/=40 seconds AUROC 0.85; 95% 0.80 to 0.89) and severe procoagulant factor deficiency (INR >/=2.0 AUROC 0.82; 95% CI, 0.73 to 0.99; aPTT >/=60 seconds AUROC 0.89; 95% CI, 0.81 to 0.98) with good accuracy. Optimal thresholds to maximize sensitivity and specificity were 3.9 minutes for detection of INR >/=1.5, 4.1 minutes for detection of aPTT >/=40 seconds, 4.3 minutes for detection of INR >/=2.0, and 4.3 for detection of aPTT >/=60 seconds. Currently recommended R-time thresholds for FFP transfusion had 100% specificity for detecting procoagulant factor deficiency, but low sensitivity (3% to 7%). CONCLUSIONS: R-time can detect procoagulant factor deficiency in multitrauma patients with good accuracy, but currently recommended R-time thresholds are highly specific and not sensitive. Use of low-sensitivity thresholds might result in undertreatment of many patients with procoagulant factor deficiency. CI - Copyright (c) 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Chow, Jonathan H AU - Chow JH AD - From the Divisions of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD; Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD. FAU - Fedeles, Benjamin AU - Fedeles B FAU - Richards, Justin E AU - Richards JE FAU - Tanaka, Kenichi A AU - Tanaka KA FAU - Morrison, Jonathan J AU - Morrison JJ FAU - Rock, Peter AU - Rock P FAU - Scalea, Thomas M AU - Scalea TM FAU - Mazzeffi, Michael A AU - Mazzeffi MA CN - TROPIC-Trauma Investigators LA - eng PT - Journal Article PT - Observational Study DEP - 20200303 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM MH - Adult MH - Aged MH - Area Under Curve MH - Blood Transfusion MH - Coagulation Protein Disorders/*diagnosis/etiology/therapy MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Plasma MH - ROC Curve MH - *Reaction Time MH - Retrospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications/therapy EDAT- 2020/03/07 06:00 MHDA- 2021/02/02 06:00 CRDT- 2020/03/07 06:00 PHST- 2019/12/10 00:00 [received] PHST- 2020/01/10 00:00 [revised] PHST- 2020/01/27 00:00 [accepted] PHST- 2020/03/07 06:00 [pubmed] PHST- 2021/02/02 06:00 [medline] PHST- 2020/03/07 06:00 [entrez] AID - 00019464-202005000-00011 [pii] AID - 10.1016/j.jamcollsurg.2020.01.033 [doi] PST - ppublish SO - J Am Coll Surg. 2020 May;230(5):798-808. doi: 10.1016/j.jamcollsurg.2020.01.033. Epub 2020 Mar 3. PMID- 32118819 OWN - NLM STAT- MEDLINE DCOM- 20200909 LR - 20210210 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 89 IP - 1 DP - 2020 Jul TI - Viscoelastic testing in combat resuscitation: Is it time for a new standard? PG - 145-152 LID - 10.1097/TA.0000000000002634 [doi] AB - BACKGROUND: Traumatic hemorrhage and coagulopathy represent major sources of morbidity and mortality on the modern battlefield. Viscoelastic testing (VET) offers a potentially more personalized approach to resuscitation. We sought to evaluate outcomes of combat trauma patients who received VET-guided resuscitation compared with standard balanced blood product resuscitation. METHODS: Retrospective analysis of the Department of Defense Trauma Registry, 2008 to 2016 was performed. Multivariate logistic regression analyses of all adult patients initially presenting to NATO Role III facilities who required blood products were performed to identify factors associated with VET-guided resuscitation and mortality. A propensity score matched comparison of outcomes in patient cohorts treated at VET versus non-VET Role III facilities was performed. RESULTS: There are 3,320 patients, predominately male (98%), median age ranges from 25 years to 29 years, Injury Severity Score of 18.8, with a penetrating injury (84%) were studied. Overall mortality was 9.7%. Five hundred ninety-four patients had VET during their initial resuscitation. After adjusting for confounders, VET during initial resuscitation was independently associated with decreased mortality (odds ratio, 0.63; p = 0.04). Propensity analysis confirmed this survival advantage with a 57% reduction in overall mortality (7.3% vs. 13.1%; p = 0.001) for all patients requiring blood products. CONCLUSION: Viscoelastic testing offers the possibility of a product-specific resuscitation for critically injured patients requiring transfusion in combat settings. Routine VET may be superior to non-VET-guided resuscitation for combat trauma victims. LEVEL OF EVIDENCE: Therapeutic study, level IV. FAU - Lammers, Daniel T AU - Lammers DT AD - From the Department of General Surgery, Madigan Army Medical Center (D.T.L., C.W.M., K.R.M., J.R.B., M.J.E.), Tacoma, Washington; and Trauma and Emergency Surgery Service (M.J.M.), Scripps Mercy Hospital, San Diego, California. FAU - Marenco, Christopher W AU - Marenco CW FAU - Morte, Kaitlin R AU - Morte KR FAU - Bingham, Jason R AU - Bingham JR FAU - Martin, Matthew J AU - Martin MJ FAU - Eckert, Matthew J AU - Eckert MJ LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - *Blood Component Transfusion MH - *Blood Viscosity MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Military Medicine/*methods MH - Propensity Score MH - Registries MH - Resuscitation/*methods MH - Retrospective Studies MH - Wounds and Injuries/*blood EDAT- 2020/03/03 06:00 MHDA- 2020/09/10 06:00 CRDT- 2020/03/03 06:00 PHST- 2020/03/03 06:00 [pubmed] PHST- 2020/09/10 06:00 [medline] PHST- 2020/03/03 06:00 [entrez] AID - 01586154-202007000-00023 [pii] AID - 10.1097/TA.0000000000002634 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Jul;89(1):145-152. doi: 10.1097/TA.0000000000002634. PMID- 32114212 OWN - NLM STAT- MEDLINE DCOM- 20200914 LR - 20200914 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 251 DP - 2020 Jul TI - ROTEM as a Predictor of Mortality in Patients With Severe Trauma. PG - 107-111 LID - S0022-4804(20)30068-8 [pii] LID - 10.1016/j.jss.2020.01.013 [doi] AB - BACKGROUND: Hemorrhage, especially when complicated by coagulopathy, is the most preventable cause of death in trauma patients. We hypothesized that assessing hemostatic function using rotational thromboelastometry (ROTEM) or conventional coagulation tests can predict the risk of mortality in patients with severe trauma indicated by an injury severity score greater than 15. METHODS: We retrospectively reviewed trauma patients with an injury severity score >15 who were admitted to the emergency department between November 2015 and August 2017 in a single level I trauma center. Patients with available ROTEM and conventional coagulation data (partial thromboplastin time [PTT], prothrombin time [PT], and international normalized ratio) were included in the study cohort. Logistic regression was performed to assess the relationship between coagulation status and mortality. RESULTS: The study cohort included 301 patients with an average age of 47 y, and 75% of the patients were males. Mortality was 23% (n = 68). Significant predictors of mortality included abnormal APTEM (thromboelastometry (TEM) assay in which fibrinolysis is inhibited by aprotinin (AP) in the reagent) parameters, specifically a low APTEM alpha angle, a high APTEM clot formation time, and a high APTEM clotting time. In addition, an abnormal international normalized ratio significantly predicted mortality, whereas abnormal PT and PTT did not. CONCLUSIONS: A low APTEM alpha angle, an elevated APTEM clot formation time, and a high APTEM clotting time significantly predicted mortality, whereas abnormal PT and PTT did not appear to be associated with increased mortality in this patient population. Viscoelastic testing such as ROTEM appears to have indications in the management and stabilization of trauma patients. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Smith, Alaina R AU - Smith AR AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Karim, Saleema A AU - Karim SA AD - The Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas. FAU - Reif, Rebecca R AU - Reif RR AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Beck, William C AU - Beck WC AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Taylor, John R AU - Taylor JR AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Davis, Benjamin L AU - Davis BL AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Bhavaraju, Avi V AU - Bhavaraju AV AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Jensen, Hanna K AU - Jensen HK AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Kimbrough, Mary K AU - Kimbrough MK AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. FAU - Sexton, Kevin W AU - Sexton KW AD - Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: kevin.sexton@uams.edu. LA - eng PT - Journal Article DEP - 20200228 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Adult MH - Aged MH - Arkansas/epidemiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Thrombelastography MH - Trauma Centers/statistics & numerical data MH - Trauma Severity Indices MH - Wounds and Injuries/*mortality OTO - NOTNLM OT - Coagulopathy OT - Hemorrhage OT - Injury severity OT - ROTEM OT - Rotational thromboelastometry OT - Score OT - Trauma EDAT- 2020/03/03 06:00 MHDA- 2020/09/15 06:00 CRDT- 2020/03/02 06:00 PHST- 2019/03/01 00:00 [received] PHST- 2020/01/10 00:00 [revised] PHST- 2020/01/25 00:00 [accepted] PHST- 2020/03/03 06:00 [pubmed] PHST- 2020/09/15 06:00 [medline] PHST- 2020/03/02 06:00 [entrez] AID - S0022-4804(20)30068-8 [pii] AID - 10.1016/j.jss.2020.01.013 [doi] PST - ppublish SO - J Surg Res. 2020 Jul;251:107-111. doi: 10.1016/j.jss.2020.01.013. Epub 2020 Feb 28. PMID- 32095322 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220413 IS - 2167-8359 (Print) IS - 2167-8359 (Electronic) IS - 2167-8359 (Linking) VI - 8 DP - 2020 TI - Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model. PG - e8399 LID - 10.7717/peerj.8399 [doi] LID - e8399 AB - BACKGROUND: Fast and effective treatment of hemorrhagic shock is one of the most important preclinical trauma care tasks e.g., in combat casualties in avoiding severe end-organ damage or death. In scenarios without immediate availability of blood products, alternate regimens of fluid resuscitation represent the only possibility of maintaining sufficient circulation and regaining adequate end-organ oxygen supply. However, the fluid choice alone may affect the extent of the bleeding by interfering with coagulation pathways. This study investigates the impact of hydroxyethyl starch (HES), gelatine-polysuccinate (GP) and balanced electrolyte solution (BES) as commonly used agents for fluid resuscitation on coagulation using a porcine hemorrhagic shock model. METHODS: Following approval by the State and Institutional Animal Care Committee, life-threatening hemorrhagic shock was induced via arterial blood withdrawal in 24 anesthetized pigs. Isovolumetric fluid resuscitation with either HES, GP or BES (n = 3 x 8) was performed to compensate for the blood loss. Over four hours, hemodynamics, laboratory parameters and rotational thromboelastometry-derived coagulation were analyzed. As secondary endpoint the porcine values were compared to human blood. RESULTS: All the agents used for fluid resuscitation significantly affected coagulation. We measured a restriction of laboratory parameters, clot development and clot firmness, particularly in HES- and GP-treated animals. Hemoglobin content dropped in all groups but showed a more pronounced decline in colloid-treated pigs. This effect was not maintained over the four-hour monitoring period. CONCLUSION: HES, GP, and BEL sufficiently stabilized the macrocirculation, but significantly affected coagulation. These effects were most pronounced after colloid and particularly HES administration. Despite suitability for rapid hemodynamic stabilization, colloids have to be chosen with caution, because their molecular properties may affect coagulation directly and as a consequence of pronounced hemodilution. Our comparison of porcine and human coagulation showed increased coagulation activity in pig blood. CI - (c)2020 Ziebart et al. FAU - Ziebart, Alexander AU - Ziebart A AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Ruemmler, Robert AU - Ruemmler R AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Mollmann, Christian AU - Mollmann C AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Kamuf, Jens AU - Kamuf J AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Garcia-Bardon, Andreas AU - Garcia-Bardon A AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Thal, Serge C AU - Thal SC AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. FAU - Hartmann, Erik K AU - Hartmann EK AD - Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany. LA - eng PT - Journal Article DEP - 20200210 PL - United States TA - PeerJ JT - PeerJ JID - 101603425 PMC - PMC7017792 OTO - NOTNLM OT - Blood OT - Fluid resuscitation OT - Gelatine-polysuccinate OT - HES OT - Hemorrhagic shock OT - Hydroxyethyl starch OT - Pig model OT - ROTEM OT - Thromboelastometry COIS- The authors declare there are no competing interests. EDAT- 2020/02/26 06:00 MHDA- 2020/02/26 06:01 PMCR- 2020/02/10 CRDT- 2020/02/26 06:00 PHST- 2019/10/02 00:00 [received] PHST- 2019/12/16 00:00 [accepted] PHST- 2020/02/26 06:00 [entrez] PHST- 2020/02/26 06:00 [pubmed] PHST- 2020/02/26 06:01 [medline] PHST- 2020/02/10 00:00 [pmc-release] AID - 8399 [pii] AID - 10.7717/peerj.8399 [doi] PST - epublish SO - PeerJ. 2020 Feb 10;8:e8399. doi: 10.7717/peerj.8399. eCollection 2020. PMID- 32093938 OWN - NLM STAT- MEDLINE DCOM- 20210208 LR - 20210208 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 51 IP - 4 DP - 2020 Apr TI - Improvements in National Code Red transfusion practice in Scotland after adoption of recommendations from the Scottish National Code Red 2015 review. PG - 913-918 LID - S0020-1383(20)30158-3 [pii] LID - 10.1016/j.injury.2020.02.079 [doi] AB - AIMS: The Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) previously reviewed all National Code Red activations between June 1st 2013 and October 31st 2015, generating a number of recommendations to be adopted to optimise the transfusion support given to patients following major trauma in Scotland. A repeat National survey was undertaken for all patients for whom Code Red was activated between 1st November 2015 and 31st December 2017. METHODS: A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCap). RESULTS: During the study period there were 66 activations (24 South-East of Scotland, 32 West, 10 East). Mean age was 45 years and 88% were male. Mean Injury Severity Score (ISS) was 28 with 75% blunt trauma. 93% (62/66) of Code Red patients received blood components with a 300% increase in pre-hospital transfusion (48 vs 16 patients; p<0.001). Median time from 999 call to Code Red activation reduced significantly to 37 min from 70 min (p = 0.01) giving the hospital more time to prepare transfusion components. 78% patients received pre-hospital tranexamic acid (TXA; improved from 70%, p = 0.67, ns). Concentrated Red Cell (CRC): Fresh Frozen Plasma (FFP) ratio was always less than 2:1 and below 1.4:1 at 90 min, compared to 2013-15 when CRC: FFP ratios did not drop to below 2:1 until 150 min after arrival in the ED. Mean time for Full Blood Count (FBC; 46 mins versus 81; p = 0.004) and clotting (53 mins versus 119; p<0.001) result was reduced. Survival to hospital discharge was unchanged (66% versus 63%; p = 1.00 ns). CONCLUSIONS: Code Red practice has improved in several ways since our last survey with earlier Code Red activation, more patients receiving pre-hospital transfusion and improved CRC:FFP ratios. Interventions such as earlier on scene Code Red activation, provision of pre-hospital TXA, Emergency Department (ED) resuscitation room pre-thawed FFP and point-of-care viscoelastic coagulation testing have all contributed to these improvements in transfusion practice in Scotland. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Reed, Matthew J AU - Reed MJ AD - Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom; Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom; Edinburgh Acute Care, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: matthew.reed@nhslothian.scot.nhs.uk. FAU - Cooke, Claire AU - Cooke C AD - Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom. FAU - McMahon, Niall AU - McMahon N AD - Department of Emergency Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Rd, Paisley PA2 9PN, United Kingdom; EMRS, Emergency Medical Retrieval Service, ScotSTAR, Hangar B, 180 Abbotsinch Road, Paisley, PA3 2RY, United Kingdom. FAU - Hands, Katherine AU - Hands K AD - Department of Transfusion Medicine, Ninewells Hospital, Dundee DD2 1UB, United Kingdom. FAU - Henderson, Susan AU - Henderson S AD - Department of Transfusion Medicine, Ninewells Hospital, Dundee DD2 1UB, United Kingdom. FAU - Knight, Eleanor AU - Knight E AD - Department of Transfusion Medicine, Ninewells Hospital, Dundee DD2 1UB, United Kingdom. FAU - Littlewood, Nicola AU - Littlewood N AD - Department of Emergency Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Rd, Paisley PA2 9PN, United Kingdom; Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. FAU - Latif, Munsoor AU - Latif M AD - Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. FAU - Tod, Naomi AU - Tod N AD - Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. FAU - McGarvey, Margaret AU - McGarvey M AD - Department of Transfusion Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. FAU - Hughes, Neil AU - Hughes N AD - Department of Emergency Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Rd, Paisley PA2 9PN, United Kingdom; Department of Emergency Medicine, Monklands Hospital, NHS Lanarkshire, Monkscourt Ave, Airdrie ML6 0JS, United Kingdom. FAU - Donald, Michael AU - Donald M AD - Department of Emergency Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Rd, Paisley PA2 9PN, United Kingdom; Department of Emergency Medicine, Ninewells Hospital, Dundee DD2 1UB, United Kingdom. FAU - Rowley, Megan AU - Rowley M AD - Department of Transfusion Medicine, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom. FAU - Innes, Catherine AU - Innes C AD - Department of Transfusion Medicine, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom. FAU - Lockhart, Symon AU - Lockhart S AD - Department of Transfusion Medicine, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom. CN - Scottish Transfusion and Laboratory Support in Trauma Group LA - eng PT - Journal Article DEP - 20200218 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Adult MH - Blood Component Transfusion/*statistics & numerical data MH - Blood Transfusion/*methods MH - Female MH - Hemorrhage/etiology/mortality/*therapy MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Plasma MH - Practice Guidelines as Topic MH - Resuscitation/*methods MH - Retrospective Studies MH - Scotland MH - Survival Rate MH - Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/mortality/*therapy OTO - NOTNLM OT - Critical care OT - Massive transfusion OT - Trauma COIS- Declaration of Competing Interest The authors declare that they have no competing interests EDAT- 2020/02/26 06:00 MHDA- 2021/02/09 06:00 CRDT- 2020/02/26 06:00 PHST- 2020/01/22 00:00 [received] PHST- 2020/02/16 00:00 [accepted] PHST- 2020/02/26 06:00 [pubmed] PHST- 2021/02/09 06:00 [medline] PHST- 2020/02/26 06:00 [entrez] AID - S0020-1383(20)30158-3 [pii] AID - 10.1016/j.injury.2020.02.079 [doi] PST - ppublish SO - Injury. 2020 Apr;51(4):913-918. doi: 10.1016/j.injury.2020.02.079. Epub 2020 Feb 18. PMID- 32072617 OWN - NLM STAT- MEDLINE DCOM- 20200901 LR - 20220731 IS - 1365-2044 (Electronic) IS - 0003-2409 (Print) IS - 0003-2409 (Linking) VI - 75 IP - 9 DP - 2020 Sep TI - Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic function in cardiac surgical patients: a randomised controlled trial. PG - 1180-1190 LID - 10.1111/anae.14994 [doi] AB - Whether third-generation hydroxyethyl starch solutions provoke kidney injury or haemostatic abnormalities in patients having cardiac surgery remains unclear. We tested the hypotheses that intra-operative administration of a third-generation starch does not worsen postoperative kidney function or haemostasis in cardiac surgical patients compared with human albumin 5%. This triple-blind, non-inferiority, clinical trial randomly allocated patients aged 40-85 who underwent elective aortic valve replacement, with or without coronary artery bypass grafting, to plasma volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our primary outcome was postoperative urinary neutrophil gelatinase-associated lipocalin concentrations, a sensitive and early marker of postoperative kidney injury. Secondarily, we evaluated urinary interleukin-18; acute kidney injury using creatinine RIFLE criteria, coagulation measures, platelet count and function. Non-inferiority (delta 15%) was assessed with correction for multiple comparisons. We enrolled 141 patients (69 starch, 72 albumin) as planned. Results of the primary analysis demonstrated that postoperative urine neutrophil gelatinase-associated lipocalin (median (IQR [range])) was slightly lower with hydroxyethyl starch (5 (1-68 [0-996]) ng.ml(-1) ) vs. albumin (5 (2-74 [0-1604]) ng.ml(-1) ), although not non-inferior [ratio of geometric means (95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected variability. Urine interleukin-18 concentrations were reduced, but interleukin-18 and kidney injury were again not non-inferior. Of 11 individual coagulation measures, platelet count and function, nine were non-inferior to albumin. Two remaining measures, thromboelastographic R value and arachidonic acid-induced platelet aggregation, were clinically similar but with wide confidence intervals. Starch administration during cardiac surgery produced similar observed effects on postoperative kidney function, coagulation, platelet count and platelet function compared with albumin, though greater than expected variability and wide confidence intervals precluded the conclusion of non-inferiority. Long-term mortality and kidney function appeared similar between starch and albumin. CI - (c) 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. FAU - Duncan, A E AU - Duncan AE AD - Departments of Cardiothoracic Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Jia, Y AU - Jia Y AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Soltesz, E AU - Soltesz E AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. FAU - Leung, S AU - Leung S AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Yilmaz, H O AU - Yilmaz HO AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Mao, G AU - Mao G AD - Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Timur, A A AU - Timur AA AD - Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA. FAU - Kottke-Marchant, K AU - Kottke-Marchant K AD - Department of Pathology and Laboratory Administration, Cleveland Clinic, Cleveland, OH, USA. FAU - Rogers, H J AU - Rogers HJ AD - Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA. FAU - Ma, C AU - Ma C AD - Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Ince, I AU - Ince I AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Karimi, N AU - Karimi N AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Yagar, S AU - Yagar S AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. FAU - Trombetta, C AU - Trombetta C AD - Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA. FAU - Sessler, D I AU - Sessler DI AD - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. LA - eng SI - ClinicalTrials.gov/NCT02192502 PT - Journal Article PT - Randomized Controlled Trial DEP - 20200218 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 RN - 0 (Hemostatics) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Plasma Substitutes) SB - IM CIN - Anaesthesia. 2021 Apr;76(4):576. doi: 10.1111/anae.15386. PMID: 33464559 MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/*drug effects MH - *Cardiac Surgical Procedures MH - Double-Blind Method MH - Female MH - Hemostatics MH - Humans MH - Hydroxyethyl Starch Derivatives/*pharmacology MH - Intraoperative Care/*methods MH - Kidney/*drug effects/physiology MH - Male MH - Middle Aged MH - Plasma Substitutes/*pharmacology PMC - PMC9291605 OTO - NOTNLM OT - cardiac surgery OT - hydroxyethyl starch OT - urinary interleukin-18 OT - urinary neutrophil gelatinase-associated lipocalin EDAT- 2020/02/20 06:00 MHDA- 2020/09/02 06:00 PMCR- 2022/07/18 CRDT- 2020/02/20 06:00 PHST- 2019/12/30 00:00 [accepted] PHST- 2020/02/20 06:00 [pubmed] PHST- 2020/09/02 06:00 [medline] PHST- 2020/02/20 06:00 [entrez] PHST- 2022/07/18 00:00 [pmc-release] AID - ANAE14994 [pii] AID - 10.1111/anae.14994 [doi] PST - ppublish SO - Anaesthesia. 2020 Sep;75(9):1180-1190. doi: 10.1111/anae.14994. Epub 2020 Feb 18. PMID- 32032282 OWN - NLM STAT- MEDLINE DCOM- 20200827 LR - 20210502 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 88 IP - 5 DP - 2020 May TI - Accelerating availability of clinically-relevant parameter estimates from thromboelastogram point-of-care device. PG - 654-660 LID - 10.1097/TA.0000000000002608 [doi] AB - BACKGROUND: Modeling approaches offer a novel way to detect and predict coagulopathy in trauma patients. A dynamic model, built and tested on thromboelastogram (TEG) data, was used to generate a virtual library of over 160,000 simulated RapidTEGs. The patient-specific parameters are the initial platelet count, platelet activation rate, thrombus growth rate, and lysis rate (P(0), k1, k2, and k3, respectively). METHODS: Patient data from both STAAMP (n = 182 patients) and PAMPer (n = 111 patients) clinical trials were collected. A total of 873 RapidTEGs were analyzed. One hundred sixteen TEGs indicated maximum amplitude (MA) below normal and 466 TEGs indicated lysis percent above normal. Each patient's TEG response was compared against the virtual library of TEGs to determine library trajectories having the least sum-of-squared error versus the patient TEG up to each specified evaluation time in (3, 4, 5, 7.5, 10, 15, 20 minutes). Using 10 nearest-neighbor trajectories, a logistic regression was performed to predict if the patient TEG indicated MA below normal (<50 mm), lysis percent 30 minutes after MA (LY30) greater than 3%, and/or blood transfusion need using the parameters from the dynamic model. RESULTS: The algorithm predicts abnormal MA values using the initial 3 minutes of RapidTEG data with a median area under the curve of 0.95, and improves with more data to 0.98 by 10 minutes. Prediction of future platelet and packed red blood cell transfusion based on parameters at 4 and 5 minutes, respectively, provides equivalent predictions to the traditional TEG parameters in significantly less time. Dynamic model parameters could not predict abnormal LY30 or future fresh-frozen plasma transfusion. CONCLUSION: This analysis could be incorporated into TEG software and workflow to quickly estimate if the MA would be below or above threshold value within the initial minutes following a TEG, along with an estimate of what blood products to have on hand. LEVEL OF EVIDENCE: Therapeutic/Care Management: Level IV. FAU - Pressly, Michelle A AU - Pressly MA AD - From the Department of Chemical and Petroleum Engineering (M.A.P., R.S.P., G.C.), Swanson School of Engineering, Department of Critical Care Medicine (R.S.P., M.D.N., J.L.S., G.C.), Department of Surgery (M.D.N., J.L.S.), and Department of Bioengineering (R.S.P., G.C.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA. FAU - Parker, Robert S AU - Parker RS FAU - Neal, Matthew D AU - Neal MD FAU - Sperry, Jason L AU - Sperry JL FAU - Clermont, Gilles AU - Clermont G LA - eng GR - R21 HL133891/HL/NHLBI NIH HHS/United States GR - R35 GM119526/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Algorithms MH - Blood Coagulation Disorders/blood/*diagnosis/therapy MH - Blood Component Transfusion/*statistics & numerical data MH - Clinical Trials as Topic MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Models, Cardiovascular MH - Platelet Activation MH - Platelet Count MH - Point-of-Care Systems/statistics & numerical data MH - Prognosis MH - Thrombelastography/instrumentation/*statistics & numerical data MH - Time Factors MH - Wounds and Injuries/blood/*complications/therapy MH - Young Adult PMC - PMC7887698 MID - NIHMS1553967 COIS- Conflict of Interest Statement Dr. Clermont has received support from Edwards Life Sciences and Astute Medical Inc. though the University of Pittsburgh. Dr. Clermont has received royalties from UpToDate, Inc. No other conflicts of interest are declared. EDAT- 2020/02/08 06:00 MHDA- 2020/08/28 06:00 PMCR- 2021/05/01 CRDT- 2020/02/08 06:00 PHST- 2020/02/08 06:00 [pubmed] PHST- 2020/08/28 06:00 [medline] PHST- 2020/02/08 06:00 [entrez] PHST- 2021/05/01 00:00 [pmc-release] AID - 01586154-202005000-00011 [pii] AID - 10.1097/TA.0000000000002608 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 May;88(5):654-660. doi: 10.1097/TA.0000000000002608. PMID- 32022729 OWN - NLM STAT- MEDLINE DCOM- 20200310 LR - 20210125 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 33 IP - 2 DP - 2020 Apr TI - Point-of-Care diagnostics of coagulation in the management of bleeding and transfusion in trauma patients. PG - 246-252 LID - 10.1097/ACO.0000000000000836 [doi] AB - PURPOSE OF REVIEW: Trauma-associated bleeding and coagulopathy require timely identification, prevention, and effective treatment. The present review summarizes the recent literature around point-of-care (POC) coagulation tests, their usefulness in the management of trauma-induced coagulopathy (TIC), their impact on trauma patient outcomes, and the requirement of quality assurance. RECENT FINDINGS: Best practice algorithms to manage TIC have been compiled in the 2019 European Guideline on the management of major bleeding and coagulopathy after trauma. Evidence supports the use of goal-directed approaches to manage TIC. POC coagulation tests can accelerate and tailor individualized therapies. Recent findings emphasize: the time sparing of POC tests in prehospital settings and the validity of POC measurements in extreme environments; the potential scalability of POC-guided TIC algorithms in burn injuries and the pediatric population; the need for careful considerations of strategies to monitor and reverse the effects of direct oral anticoagulants in major trauma. SUMMARY: In contrast to an abundance of reviews and practical approaches to POC coagulation management in trauma patients, there is a scarcity of research in the field and large-scale clinical trials are urgently needed. The paneuropean multicenter trial Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (iTACTIC) will inform on the potential of viscoelastic tests to augment transfusion protocols for better patient outcomes. FAU - Francis, Roland C E AU - Francis RCE AD - Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health. Klinik fur Anasthesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVK, Augustenburger Platz 1, 13353 Berlin, Germany. FAU - Theurl, Igor AU - Theurl I AD - Medical University of Innsbruck, Department of Internal Medicine II, Anichstr. 35, A-6020 Innsbruck, Austria. FAU - Maegele, Marc AU - Maegele M AD - University Witten/Herdecke (UW/H), Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), and Institute for Research in Operative Medicine (IFOM), Campus Cologne-Merheim, Ostmerheimerstr. 22, 51109 Cologne, Germany. FAU - Graw, Jan A AU - Graw JA AD - Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health. Klinik fur Anasthesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVK, Augustenburger Platz 1, 13353 Berlin, Germany. AD - Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 1, 10178 Berlin, Germany. LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Blood Coagulation Disorders/*diagnosis MH - *Blood Transfusion MH - Hemorrhage/*therapy MH - Humans MH - Multicenter Studies as Topic MH - *Point-of-Care Systems MH - Wounds and Injuries/*therapy EDAT- 2020/02/06 06:00 MHDA- 2020/03/11 06:00 CRDT- 2020/02/06 06:00 PHST- 2020/02/06 06:00 [pubmed] PHST- 2020/03/11 06:00 [medline] PHST- 2020/02/06 06:00 [entrez] AID - 00001503-202004000-00020 [pii] AID - 10.1097/ACO.0000000000000836 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2020 Apr;33(2):246-252. doi: 10.1097/ACO.0000000000000836. PMID- 32008656 OWN - NLM STAT- MEDLINE DCOM- 20201123 LR - 20260127 IS - 1932-2275 (Print) IS - 1932-2275 (Linking) VI - 38 IP - 1 DP - 2020 Mar TI - Anesthesia for the Patient with Severe Liver Failure. PG - 35-50 LID - S1932-2275(19)30084-9 [pii] LID - 10.1016/j.anclin.2019.10.002 [doi] AB - The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. The coagulopathy of liver failure is a balanced coagulopathy better assessed by thromboelastography than conventional testing, and it is not directly associated with bleeding risk. CI - Crown Copyright (c) 2019. Published by Elsevier Inc. All rights reserved. FAU - Spring, Aidan AU - Spring A AD - Abdominal Organ Transplantation Anesthesia Fellowship Program, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. FAU - Saran, Jagroop S AU - Saran JS AD - Abdominal Organ Transplantation Anesthesia Fellowship Program, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. FAU - McCarthy, Sinead AU - McCarthy S AD - Abdominal Organ Transplantation Anesthesia Fellowship Program, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. FAU - McCluskey, Stuart A AU - McCluskey SA AD - Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Electronic address: Stuart.McCluskey@uhn.ca. LA - eng PT - Journal Article PT - Review DEP - 20200103 PL - United States TA - Anesthesiol Clin JT - Anesthesiology clinics JID - 101273663 SB - IM MH - Abdomen/surgery MH - Anesthesia/*methods MH - Blood Coagulation MH - Cardiac Surgical Procedures MH - Humans MH - Liver Failure/*complications MH - Monitoring, Intraoperative MH - Postoperative Pain/prevention & control MH - Wounds and Injuries/surgery OTO - NOTNLM OT - Anesthesia OT - Anesthesia considerations OT - End-stage liver disease OT - Liver failure COIS- Conflicts of Interest None. EDAT- 2020/02/06 06:00 MHDA- 2020/11/24 06:00 CRDT- 2020/02/04 06:00 PHST- 2020/02/04 06:00 [entrez] PHST- 2020/02/06 06:00 [pubmed] PHST- 2020/11/24 06:00 [medline] AID - S1932-2275(19)30084-9 [pii] AID - 10.1016/j.anclin.2019.10.002 [doi] PST - ppublish SO - Anesthesiol Clin. 2020 Mar;38(1):35-50. doi: 10.1016/j.anclin.2019.10.002. Epub 2020 Jan 3. PMID- 31999655 OWN - NLM STAT- MEDLINE DCOM- 20200811 LR - 20221005 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 88 IP - 2 DP - 2020 Feb TI - Dense and dangerous: The tissue plasminogen activator-resistant fibrinolysis shutdown phenotype is due to abnormal fibrin polymerization. PG - 258-265 LID - 10.1097/TA.0000000000002554 [doi] AB - BACKGROUND: Both hyperfibrinolysis and fibrinolysis shutdown can occur after severe trauma. The subgroup of trauma patients with fibrinolysis shutdown resistant to tissue plasminogen activator (t-PA)-mediated fibrinolysis have increased mortality. Fibrin polymerization and structure may influence fibrinolysis subgroups in trauma, but fibrin architecture has not been characterized in acutely injured subjects. We hypothesized that fibrin polymerization measured in situ will correlate with fibrinolysis subgroups. METHODS: Blood samples were collected from trauma patients and noninjured controls. We selected samples across a range of fibrinolysis phenotypes (shutdown, physiologic, hyperfibrinolysis) and t-PA sensitivities (sensitive, physiologic, resistant) determined by thrombelastography. Plasma clots were created in situ with fluorescent fibrinogen and imaged using confocal microscopy for analysis of clot architecture in three dimensions. For each clot, we quantified the fiber resolvability, a metric of fiber distinctness or clarity, by mapping the variance of fluorescence intensity relative to background fluorescence. We also determined clot porosity by measuring the size and distribution of the gaps between fibrin fibers in three-dimensional space. We compared these measures across fibrinolysis subgroups. RESULTS: Fiber resolvability was significantly lower in all trauma subgroups compared with controls (n = 35 and 5, respectively; p < 0.05). We observed markedly different patterns of fibrin architecture among trauma patients stratified by fibrinolysis subgroup. Subjects with t-PA-resistant fibrinolysis shutdown exhibited abnormal, densely packed fibrin clots nearly devoid of pores. Individuals with t-PA-hypersensitive fibrinolysis shutdown had highly irregular clots with pores as large as 2500 mum to 20,000 mum, versus 78 mum to 1250 mum in noninjured controls. CONCLUSION: Fiber resolvability was significantly lower in trauma patients than controls, and subgroups of fibrinolysis differ in the porosity of the fibrin clot structure. The dense fibrin network in the t-PA-resistant group may prevent access to plasmin, suggesting a mechanism for thrombotic morbidity after injury. FAU - Dow, Nathan AU - Dow N AD - From the Department of Surgery (N.D., Z.T.O., A.M.S., K.F.), University of Vermont, Burlington, Vermont; Ernest E Moore Shock Trauma Center at Denver Health (J.R.C., H.M., E.E.M.), University of Colorado Denver, Denver, Colorado; Department of Pharmacology (G.H., M.T.N.), University of Vermont, Burlington; and Department of Biochemistry (S.B.), University of Vermont, Colchester, Vermont. FAU - Coleman, Julia R AU - Coleman JR FAU - Moore, Hunter AU - Moore H FAU - Osborn, Zachary T AU - Osborn ZT FAU - Sackheim, Adrian M AU - Sackheim AM FAU - Hennig, Grant AU - Hennig G FAU - Butenas, Saulius AU - Butenas S FAU - Nelson, Mark T AU - Nelson MT FAU - Moore, Ernest E AU - Moore EE FAU - Freeman, Kalev AU - Freeman K LA - eng GR - R01 GM123010/GM/NIGMS NIH HHS/United States GR - R35 HL140027/HL/NHLBI NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) RN - 9001-31-4 (Fibrin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Biomarkers/blood MH - Blood Coagulation Disorders/*blood/diagnosis/mortality MH - Female MH - Fibrin/*chemistry MH - *Fibrinolysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Polymerization MH - Retrospective Studies MH - Thrombelastography MH - Tissue Plasminogen Activator/*blood MH - Wounds and Injuries/blood/*complications/diagnosis MH - Young Adult PMC - PMC7546039 MID - NIHMS1624519 EDAT- 2020/01/31 06:00 MHDA- 2020/08/12 06:00 PMCR- 2020/10/09 CRDT- 2020/01/31 06:00 PHST- 2020/01/31 06:00 [entrez] PHST- 2020/01/31 06:00 [pubmed] PHST- 2020/08/12 06:00 [medline] PHST- 2020/10/09 00:00 [pmc-release] AID - 01586154-202002000-00007 [pii] AID - 10.1097/TA.0000000000002554 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Feb;88(2):258-265. doi: 10.1097/TA.0000000000002554. PMID- 31997668 OWN - NLM STAT- MEDLINE DCOM- 20210106 LR - 20210106 IS - 1556-9519 (Electronic) IS - 1556-3650 (Linking) VI - 58 IP - 9 DP - 2020 Sep TI - Thromboelastometry (ROTEM) and thromboelastography (TEG) in copperhead snakebites: a case series. PG - 931-934 LID - 10.1080/15563650.2020.1713332 [doi] AB - Introduction: Copperhead snakes account for approximately half of treated snakebites in the US, and bites can result in significant swelling, bruising and pain. While other pit vipers, such as rattlesnakes, frequently cause coagulopathy demonstrated by standard coagulation tests including international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, and fibrinogen, copperheads do not appear to do so. Functional coagulation tests, such as rotational thromboelastometry (ROTEM((R))) and thromboelastography (TEG((R))) illustrate the clotting process and may detect coagulation defects that were not evident on standard tests.Methods: We reviewed a series of patients presenting with copperhead envenomation and compared coagulation parameters between those receiving standard coagulation tests and those receiving standard tests and ROTEM or TEG.Results: Sixteen adults and children presented with copperhead snakebites, and four received ROTEM or TEG. None of the sixteen patients had abnormalities in PT, INR, PTT, platelets, or fibrinogen, and only one patient had an elevated D-dimer test. All four patients receiving ROTEM or TEG had normal values for ROTEM/TEG parameters and for standard coagulation tests.Conclusion: This corroborates previous research indicating that copperhead bites generally do not produce clinically significant coagulopathy. The role of thromboelastometry or thromboelastography in North American crotalid bites warrants further study. FAU - Mullins, Michael E AU - Mullins ME AUID- ORCID: 0000-0001-8605-0217 AD - Section of Medical Toxicology, Division of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, USA. FAU - Freeman, William E AU - Freeman WE AD - Section of Medical Toxicology, Division of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, USA. LA - eng PT - Journal Article DEP - 20200130 PL - England TA - Clin Toxicol (Phila) JT - Clinical toxicology (Philadelphia, Pa.) JID - 101241654 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - *Agkistrodon MH - Animals MH - Blood Coagulation Disorders/*etiology MH - Blood Coagulation Tests MH - Female MH - Fibrinogen/analysis MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Platelet Count MH - Retrospective Studies MH - Snake Bites/*complications MH - *Thrombelastography OTO - NOTNLM OT - Agkistrodon contortrix OT - case series OT - coagulation OT - copperhead OT - thromboelastography OT - thromboelastometry EDAT- 2020/01/31 06:00 MHDA- 2021/01/07 06:00 CRDT- 2020/01/31 06:00 PHST- 2020/01/31 06:00 [pubmed] PHST- 2021/01/07 06:00 [medline] PHST- 2020/01/31 06:00 [entrez] AID - 10.1080/15563650.2020.1713332 [doi] PST - ppublish SO - Clin Toxicol (Phila). 2020 Sep;58(9):931-934. doi: 10.1080/15563650.2020.1713332. Epub 2020 Jan 30. PMID- 31948701 OWN - NLM STAT- MEDLINE DCOM- 20200917 LR - 20240425 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 220 IP - 2 DP - 2020 Aug TI - gamma' fibrinogen levels are associated with blood clot strength in traumatic brain injury patients. PG - 459-463 LID - S0002-9610(19)31583-1 [pii] LID - 10.1016/j.amjsurg.2019.12.028 [doi] AB - BACKGROUND: gamma' fibrinogen is an alternatively-spliced fibrinogen variant that displays different coagulation parameters in vitro than the major form of fibrinogen. Purified gamma' fibrinogen has slower clotting kinetics than unfractionated fibrinogen, but forms clots that are stronger and resistant to fibrinolysis. However, these properties have only been investigated in human populations in a limited number of studies. We therefore performed a retrospective analysis to test the hypothesis that gamma' fibrinogen levels influence coagulation in vivo. METHODS: In the present study, we utilized blood samples that were collected from traumatic brain injury patients to probe the relationship between gamma' fibrinogen levels and traditional coagulation parameters. RESULTS: The results show that the levels of gamma' fibrinogen were inversely associated with clotting kinetics, indicated by a shortened INR. In addition, the levels of gamma' fibrinogen were associated with stronger clots by thrombelastography. However, these changes were not associated with significant changes in hemorrhage progression. CONCLUSIONS: These findings verify that gamma' fibrinogen properties observed in purified systems result in similar properties in a clinical setting, and may affect coagulation. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Farrell, David H AU - Farrell DH AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA. Electronic address: farrelld@ohsu.edu. FAU - Rick, Elizabeth A AU - Rick EA AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA. FAU - Dewey, Elizabeth N AU - Dewey EN AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA. FAU - Schreiber, Martin A AU - Schreiber MA AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA. FAU - Rowell, Susan E AU - Rowell SE AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA. LA - eng GR - UL1 TR000128/TR/NCATS NIH HHS/United States GR - UL1 TR002369/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20191228 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/physiology MH - Brain Injuries, Traumatic/*complications MH - Female MH - Fibrinogen/*analysis MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Thrombosis/*blood/*etiology MH - Young Adult PMC - PMC7641475 MID - NIHMS1549688 OTO - NOTNLM OT - Coagulation OT - Fibrinogen OT - Hemostasis OT - Thrombelastography OT - Traumatic brain injury COIS- Declaration of competing interest OHSU and David H. Farrell have a significant interest in Gamma Therapeutics, a company that may have a commercial interest in the results of this research and technology. This potential individual and institutional conflict of interest has been reviewed and managed by OHSU. Dr. Farrell was blinded to the results until the analysis by Ms. Dewey. EDAT- 2020/01/18 06:00 MHDA- 2020/09/18 06:00 PMCR- 2021/08/01 CRDT- 2020/01/18 06:00 PHST- 2019/06/20 00:00 [received] PHST- 2019/11/20 00:00 [revised] PHST- 2019/12/23 00:00 [accepted] PHST- 2020/01/18 06:00 [pubmed] PHST- 2020/09/18 06:00 [medline] PHST- 2020/01/18 06:00 [entrez] PHST- 2021/08/01 00:00 [pmc-release] AID - S0002-9610(19)31583-1 [pii] AID - 10.1016/j.amjsurg.2019.12.028 [doi] PST - ppublish SO - Am J Surg. 2020 Aug;220(2):459-463. doi: 10.1016/j.amjsurg.2019.12.028. Epub 2019 Dec 28. PMID- 31939843 OWN - NLM STAT- MEDLINE DCOM- 20200504 LR - 20240229 IS - 1528-1175 (Electronic) IS - 0003-3022 (Linking) VI - 132 IP - 2 DP - 2020 Feb TI - Correlation of Thromboelastography with Apparent Rivaroxaban Concentration: Has Point-of-Care Testing Improved? PG - 280-290 LID - 10.1097/ALN.0000000000003061 [doi] AB - 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 (rho = 0.67; P < 0.001), TEG6S reaction time (rho = 0.68; P < 0.001), and prothrombin time (rho = 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 rho = 0.62; P = 0.101; TEG6S reaction time rho = 0.57; P = 0.112) and small nonsignificant association for controls (TEG reaction time: rho = -0.04; P = 0.845; TEG6S reaction time: rho = -0.09; P = 0.667; PT-neoplastine: rho = 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. FAU - Myers, Sara P AU - Myers SP AD - 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. FAU - Dyer, Mitchell R AU - Dyer MR FAU - Hassoune, Adnan AU - Hassoune A FAU - Brown, Joshua B AU - Brown JB FAU - Sperry, Jason L AU - Sperry JL FAU - Meyer, Michael P AU - Meyer MP FAU - Rosengart, Matthew R AU - Rosengart MR FAU - Neal, Matthew D AU - Neal MD LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesthesiology JT - Anesthesiology JID - 1300217 RN - 0 (Factor Xa Inhibitors) RN - 9NDF7JZ4M3 (Rivaroxaban) SB - IM MH - Aged MH - Aged, 80 and over MH - Cohort Studies MH - Dose-Response Relationship, Drug MH - Factor Xa Inhibitors/*administration & dosage/blood MH - Female MH - Humans MH - Male MH - Middle Aged MH - Point-of-Care Testing/*standards/trends MH - Prospective Studies MH - Rivaroxaban/*administration & dosage/blood MH - Thrombelastography/*standards/trends EDAT- 2020/01/16 06:00 MHDA- 2020/05/06 06:00 CRDT- 2020/01/16 06:00 PHST- 2020/01/16 06:00 [entrez] PHST- 2020/01/16 06:00 [pubmed] PHST- 2020/05/06 06:00 [medline] AID - 00000542-202002000-00014 [pii] AID - 10.1097/ALN.0000000000003061 [doi] PST - ppublish SO - Anesthesiology. 2020 Feb;132(2):280-290. doi: 10.1097/ALN.0000000000003061. PMID- 31927395 OWN - NLM STAT- MEDLINE DCOM- 20210617 LR - 20210617 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 186 DP - 2020 Feb TI - The stressed vascular barrier and coagulation - The impact of key glycocalyx components on in vitro clot formation. PG - 93-102 LID - S0049-3848(19)30549-3 [pii] LID - 10.1016/j.thromres.2019.12.015 [doi] AB - INTRODUCTION: A functional vascular barrier controlling leukocyte recruitment into the perivascular space relies on an intact endothelial glycocalyx (EGX). Critical disease states such as sepsis or trauma can induce massive shedding of EGX components into the blood stream. Previous studies have shown that high blood levels of EGX components are correlated with bleeding in patients. The mechanism behind that observation remains to be fully elucidated. MATERIAL AND METHODS: The EGX components syndecan-1 (S1), hyaluronic acid (HA) and heparan sulfate (HS) were added to blood samples of 10 healthy male volunteers separately in three distinct concentrations to mimic three severity levels of in vitro EGX shedding. We analyzed spiked blood samples for leukocyte derived reactive oxygen species (ROS) release as a measure for innate immune activation and evaluated the impact on coagulation using clinical standard coagulation tests (SCTs) as well as rotational thrombelastometry (ROTEM(R)). RESULTS: Whereas ROS formation by polymorphonuclear leukocytes (PMN) was unaltered by all three substances, high concentrations of HS showed prolonged aPTT and TT compared to controls and S1 or HA. Changes in ROTEM(R) were discrete and mostly within normal range of values but analyses showed a significant reduction of clot firmness and formation by all EGX components compared to controls. Furthermore, alterations by HA and HS were dose dependent. Only HS showed a heparin like effect supporting the findings of SCTs. CONCLUSIONS: All EGX components interfere with clot formation and strength. HS mimics heparin effects in ROTEM(R) that confirm detectable alterations of standard coagulation tests. CI - Copyright (c) 2019. Published by Elsevier Ltd. FAU - Buchheim, Judith-Irina AU - Buchheim JI AD - Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; Laboratory of Translational Research "Stress and Immunity", Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany. FAU - Enzinger, Max C AU - Enzinger MC AD - Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Strasse 77, 81925 Munich, Germany. FAU - Chouker, Alexander AU - Chouker A AD - Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany; Laboratory of Translational Research "Stress and Immunity", Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany. FAU - Bruegel, Mathias AU - Bruegel M AD - Institute of Laboratory Medicine, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany. FAU - Holdt, Lesca AU - Holdt L AD - Institute of Laboratory Medicine, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany. FAU - Rehm, Markus AU - Rehm M AD - Department of Anesthesiology, Hospital of the University of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany. Electronic address: markus.rehm@med.uni-muenchen.de. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191228 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 RN - 9005-49-6 (Heparin) SB - IM MH - *Blood Coagulation Disorders MH - Blood Coagulation Tests MH - Endothelium MH - *Glycocalyx MH - Heparin MH - Humans MH - Male MH - Thrombelastography OTO - NOTNLM OT - Clot formation OT - Endothelial glycocalyx OT - Heparan sulfate OT - Hyaluronic acid OT - Rotational thrombelastometry OT - Syndecan 1 EDAT- 2020/01/14 06:00 MHDA- 2021/06/22 06:00 CRDT- 2020/01/14 06:00 PHST- 2019/08/04 00:00 [received] PHST- 2019/12/19 00:00 [revised] PHST- 2019/12/20 00:00 [accepted] PHST- 2020/01/14 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/01/14 06:00 [entrez] AID - S0049-3848(19)30549-3 [pii] AID - 10.1016/j.thromres.2019.12.015 [doi] PST - ppublish SO - Thromb Res. 2020 Feb;186:93-102. doi: 10.1016/j.thromres.2019.12.015. Epub 2019 Dec 28. PMID- 31903737 OWN - NLM STAT- MEDLINE DCOM- 20210701 LR - 20210701 IS - 2157-6580 (Electronic) IS - 2157-6564 (Print) IS - 2157-6564 (Linking) VI - 9 IP - 4 DP - 2020 Apr TI - Procoagulant in vitro effects of clinical cellular therapeutics in a severely injured trauma population. PG - 491-498 LID - 10.1002/sctm.19-0206 [doi] AB - Clinical trials in trauma populations are exploring the use of clinical cellular therapeutics (CCTs) like human mesenchymal stromal cells (MSC) and mononuclear cells (MNC). Recent studies demonstrate a procoagulant effect of these CCTs related to their expression of tissue factor (TF). We sought to examine this relationship in blood from severely injured trauma patients and identify methods to reverse this procoagulant effect. Human MSCs from bone marrow, adipose, and amniotic tissues and freshly isolated bone marrow MNC samples were tested. TF expression and phenotype were quantified using flow cytometry. CCTs were mixed individually with trauma patients' whole blood, assayed with thromboelastography (TEG), and compared with healthy subjects mixed with the same cell sources. Heparin was added to samples at increasing concentrations until TEG parameters normalized. Clotting time or R time in TEG decreased relative to the TF expression of the CCT treatment in a logarithmic fashion for trauma patients and healthy subjects. Nonlinear regression curves were significantly different with healthy subjects demonstrating greater relative decreases in TEG clotting time. In vitro coadministration of heparin normalized the procoagulant effect and required dose escalation based on TF expression. TF expression in human MSC and MNC has a procoagulant effect in blood from trauma patients and healthy subjects. The procoagulant effect is lower in trauma patients possibly because their clotting time is already accelerated. The procoagulant effect due to MSC/MNC TF expression could be useful in the bleeding trauma patient; however, it may emerge as a safety release criterion due to thrombotic risk. The TF procoagulant effect is reversible with heparin. CI - (c) 2020 The Authors. STEM CELLS TRANSLATIONAL MEDICINE published by Wiley Periodicals, Inc. on behalf of AlphaMed Press. FAU - George, Mitchell J AU - George MJ AUID- ORCID: 0000-0003-1668-821X AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Prabhakara, Karthik AU - Prabhakara K AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Toledano-Furman, Naama E AU - Toledano-Furman NE AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Gill, Brijesh S AU - Gill BS AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Cap, Andrew P AU - Cap AP AD - U.S. Army Institute of Surgical Research, JBSA-FT Sam Houston, San Antonio, Texas. FAU - Olson, Scott D AU - Olson SD AUID- ORCID: 0000-0001-8032-3755 AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. FAU - Cox, Charles S Jr AU - Cox CS Jr AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20200106 PL - England TA - Stem Cells Transl Med JT - Stem cells translational medicine JID - 101578022 RN - 0 (Biomarkers) RN - 9005-49-6 (Heparin) SB - IM MH - Adult MH - Biomarkers/metabolism MH - *Blood Coagulation/drug effects MH - Case-Control Studies MH - Female MH - Heparin/pharmacology MH - Humans MH - Male MH - Thrombelastography MH - Wounds and Injuries/*blood PMC - PMC7103617 OTO - NOTNLM OT - adipose stem cells OT - adult hematopoietic stem cells OT - adult stem cells OT - bone marrow stromal cells OT - flow cytometry OT - heparin OT - mesenchymal stem cells OT - stem cells COIS- C.W. declared stock ownership with Decisio Health LLC that is unrelated to research and research funding from Grifols and Prytime that was paid to the institution. S.O. declared research funding from Hope Bio, Biostage, Athersys, and CBR. C.C. declared patient holder in Cellvation, Inc., consultant/advisory role with Cellvation Inc., Athersys Inc., Hope Biosciences, CBR, Inc., Biostage, Inc., stock ownership with Cellvation, Inc., Coagulex, Inc., Biostage, Inc., and research funding with Cellvation, Inc., Hope Bio. All the remaining authors declare no potential conflicts of interest. EDAT- 2020/01/07 06:00 MHDA- 2021/07/02 06:00 PMCR- 2020/01/06 CRDT- 2020/01/07 06:00 PHST- 2019/07/08 00:00 [received] PHST- 2019/12/04 00:00 [accepted] PHST- 2020/01/07 06:00 [pubmed] PHST- 2021/07/02 06:00 [medline] PHST- 2020/01/07 06:00 [entrez] PHST- 2020/01/06 00:00 [pmc-release] AID - SCT312656 [pii] AID - 10.1002/sctm.19-0206 [doi] PST - ppublish SO - Stem Cells Transl Med. 2020 Apr;9(4):491-498. doi: 10.1002/sctm.19-0206. Epub 2020 Jan 6. PMID- 31894349 OWN - NLM STAT- MEDLINE DCOM- 20211015 LR - 20261010 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 47 IP - 4 DP - 2021 Aug TI - Thromboelastometry assessment of the effects of fibrinogen, activated prothrombin complex concentrate, and tranexamic acid on clot formation and fibrinolysis in a model of trauma-induced coagulopathy. PG - 1057-1063 LID - 10.1007/s00068-019-01283-2 [doi] AB - PURPOSE: Coagulation abnormalities are common following major trauma. The aim of this study was to assess the improvement of trauma-induced coagulopathy (TIC) in an in vitro model. METHODS: TIC was created on blood taken from healthy individuals by inducing hemodilution, acidosis, hypothermia and fibrinolysis. Next, blood samples were subjected to rotational thromboelastometry to assess the effect of hemostasis modulators on blood coagulation and fibrinolysis. RESULTS: Introducing to blood fibrinogen at 0.75 mg/mL, prothrombin complex concentrate at 0.66 IU/mL or tranexamic acid at 95 microg/mL increased clot strength. Higher effect was observed by combination of fibrinogen with tranexamic acid and prothrombin complex with tranexamic acid, whereas the maximal effect was achieved using all agents together. Fibrinolysis was inhibited by tranexamic acid and stronger by triple combination of the agents. Selective treating the TIC blood with fibrinogen, prothrombin complex or tranexamic acid at two time lower concentrations did not affect clot strength. Combining fibrinogen with prothrombin complex or with tranexamic acid stimulated clot strength but at lower extent compared to higher concentrations. Lysis onset time was prolonged by tranexamic acid. Maximal effect on both clot formation and fibrinolysis was achieved using all three agents together. CONCLUSIONS: Blood clotting stimulation and fibrinolysis inhibition in the TIC model was enough combining subthreshold concentrations of fibrinogen, prothrombin complex and tranexamic acid. Further experiments are warranted in both in vitro and in vivo conditions with minimally effective concentrations of both pro-coagulant and anti-fibrinolytic drugs assuming that this combinatorial approach may not only improve coagulopathy but also minimize the risk of thrombotic complications. CI - (c) 2020. Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Budnik, Ivan AU - Budnik I AD - Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. FAU - Shenkman, Boris AU - Shenkman B AD - National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel. FAU - Morozova, Olga AU - Morozova O AD - Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. FAU - Einav, Yulia AU - Einav Y AUID- ORCID: 0000-0001-8222-7695 AD - Faculty of Engineering, Holon Institute of Technology, Holon, Israel. yulia_e@hit.ac.il. LA - eng PT - Journal Article DEP - 20200101 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Coagulation Factors MH - Fibrinogen MH - Fibrinolysis MH - Humans MH - Thrombelastography MH - *Tranexamic Acid/pharmacology/therapeutic use OTO - NOTNLM OT - Fibrinogen OT - Prothrombin complex OT - Tranexamic acid OT - Trauma-induced coagulopathy EDAT- 2020/01/03 06:00 MHDA- 2021/10/16 06:00 CRDT- 2020/01/03 06:00 PHST- 2019/09/26 00:00 [received] PHST- 2019/12/03 00:00 [accepted] PHST- 2020/01/03 06:00 [pubmed] PHST- 2021/10/16 06:00 [medline] PHST- 2020/01/03 06:00 [entrez] AID - 10.1007/s00068-019-01283-2 [pii] AID - 10.1007/s00068-019-01283-2 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2021 Aug;47(4):1057-1063. doi: 10.1007/s00068-019-01283-2. Epub 2020 Jan 1. PMID- 31889401 OWN - NLM STAT- MEDLINE DCOM- 20210203 LR - 20210203 IS - 1751-553X (Electronic) IS - 1751-5521 (Linking) VI - 42 IP - 2 DP - 2020 Apr TI - Age- and gender-related reference ranges for thromboelastography from a healthy Indian population. PG - 180-189 LID - 10.1111/ijlh.13148 [doi] AB - INTRODUCTION: Thromboelastography (TEG) is a whole blood clotting assay largely used in major surgeries and trauma to monitor patients' in vivo hemostatic status. Standardization of kaolin-activated citrated whole blood thromboelastography is not done in the Indian population. This study primarily aims to derive reference ranges of kaolin-activated TEG for healthy volunteers in the Indian population. Secondarily, it aims to study the age- and gender-related hemostatic changes in the study population. METHODS: A total of 120 healthy volunteers were enrolled (55 adult males, 32 adult females, and 33 children). The volunteers were interviewed for any bleeding history or drug intake which affects coagulation. Kaolin-activated TEG was performed on citrated whole blood, and parameters including R-time, K-time, angle, MA, LY30, and CI were analyzed. RESULTS: Derived reference range for total volunteers irrespective of age and sex were as follows: R-time: 3.8-10.6, K-time: 1.2-3.1, angle: 44.9-72.0, MA: 41.2-64.5, LY30: 0-9.9, and CI: -3.7 to 3.4. Statistically significant difference was observed in different age and sex groups for R-time, K-time, and angle. About 40% of the volunteers had at least one abnormal parameter according to the manufacturer's reference range which decreased to 12.5% when the derived reference ranges were considered. CONCLUSION: Gender- and age-related variances were observed in reference ranges of our population and which was also differed from the other ethnic population. Many of our healthy volunteers were categorized as coagulopathic when manufacturer's reference range was considered. So, it is important to derive the reference range of the target population before using the TEG into clinical practice. CI - (c) 2019 John Wiley & Sons Ltd. FAU - Ahammad, Javed AU - Ahammad J AUID- ORCID: 0000-0001-5461-5957 AD - Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India. FAU - Kurien, Annamma AU - Kurien A AD - Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India. FAU - Shastry, Shamee AU - Shastry S AD - Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. FAU - Shah, Hitesh H AU - Shah HH AD - Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. FAU - Nayak, Dinesh AU - Nayak D AD - Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India. FAU - Kamath, Asha AU - Kamath A AD - Department of Statistics, Manipal Academy of Higher Education, Manipal, India. FAU - Badagabettu, Sulochana AU - Badagabettu S AD - Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India. LA - eng PT - Journal Article DEP - 20191231 PL - England TA - Int J Lab Hematol JT - International journal of laboratory hematology JID - 101300213 SB - IM MH - Adolescent MH - Adult MH - Age Factors MH - Female MH - Humans MH - Male MH - Middle Aged MH - Reference Values MH - Sex Factors MH - *Thrombelastography MH - Wounds and Injuries/*blood OTO - NOTNLM OT - age OT - gender OT - population OT - reference range OT - thromboelastography EDAT- 2020/01/01 06:00 MHDA- 2021/02/04 06:00 CRDT- 2020/01/01 06:00 PHST- 2019/10/19 00:00 [received] PHST- 2019/11/18 00:00 [revised] PHST- 2019/12/04 00:00 [accepted] PHST- 2020/01/01 06:00 [pubmed] PHST- 2021/02/04 06:00 [medline] PHST- 2020/01/01 06:00 [entrez] AID - 10.1111/ijlh.13148 [doi] PST - ppublish SO - Int J Lab Hematol. 2020 Apr;42(2):180-189. doi: 10.1111/ijlh.13148. Epub 2019 Dec 31. PMID- 31887624 OWN - NLM STAT- MEDLINE DCOM- 20210617 LR - 20210617 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 186 DP - 2020 Feb TI - Oxygenation extremes after traumatic brain injury transiently affect coagulation. PG - 58-63 LID - S0049-3848(19)30546-8 [pii] LID - 10.1016/j.thromres.2019.12.013 [doi] AB - INTRODUCTION: Trauma patients may become hypoxic or iatrogenically hyperoxic in the early post-injury period. While both extremes of oxygenation may be harmful following injury, the mechanism has yet to be elucidated. We hypothesized that hypoxia or hyperoxia would induce changes in coagulation, creating a secondary insult exacerbating the primary injury. MATERIALS AND METHODS: Mice underwent traumatic brain injury (TBI) or sham and were subsequently exposed to room air or brief hypoxia (15% FiO(2)) then sacrificed at intervals. Another cohort of uninjured mice underwent more prolonged hypoxia (10% FiO(2)) or hyperoxia (60% FiO(2)). Platelet function was evaluated by ADP- or ASPi-induced impedance aggregometry and viscoelastic coagulation parameters were assessed with rotational thromboelastometry. RESULTS: In uninjured mice, ADP-induced platelet aggregation was acutely increased after prolonged hypoxia, but this difference did not persist at 6 h. Hypoxic and hyperoxic TBI mice had increased ADP induced platelet aggregation at 1 h compared to the normoxia group. TBI mice demonstrated an early increased platelet aggregation after hypoxia or hyperoxia. Viscoelastic coagulation parameters were similar between hypoxic, hyperoxic and room air groups at 1 h and 6 h. However, ROTEM clotting time and clot formation time were prolonged and maximal clot firmness were lower in sham TBI/hypoxia mice at 24 h. CONCLUSION: Post-TBI hypoxia and hyperoxia resulted in transiently increased platelet aggregation in response to ADP, without lasting effecting on platelet function or coagulation. Hypoxia also induced delayed hypocoagulability after platelet aggregation normalized. Brief changes in oxygenation may temporally affect coagulation and platelet aggregation, which could contribute to physiologic secondary injury after trauma. CI - Copyright (c) 2019 Elsevier Ltd. All rights reserved. FAU - Morris, Mackenzie C AU - Morris MC AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Singer, Kathleen E AU - Singer KE AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Niziolek, Grace M AU - Niziolek GM AD - Department of Surgery, University of Cincinnati, United States of America. FAU - McGlone, Emily AU - McGlone E AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Veile, Rosalie AU - Veile R AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Friend, Lou Ann AU - Friend LA AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Makley, Amy T AU - Makley AT AD - Department of Surgery, University of Cincinnati, United States of America. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, United States of America. Electronic address: goodmamd@ucmail.uc.edu. LA - eng PT - Journal Article DEP - 20191224 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM MH - Animals MH - *Blood Coagulation MH - *Brain Injuries, Traumatic/complications MH - Humans MH - Mice MH - Platelet Aggregation MH - Platelet Function Tests MH - Thrombelastography OTO - NOTNLM OT - Coagulopathy OT - Hyperoxia OT - Hypoxia OT - Oxygen OT - Traumatic brain injury EDAT- 2019/12/31 06:00 MHDA- 2021/06/22 06:00 CRDT- 2019/12/31 06:00 PHST- 2019/10/26 00:00 [received] PHST- 2019/12/09 00:00 [revised] PHST- 2019/12/19 00:00 [accepted] PHST- 2019/12/31 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2019/12/31 06:00 [entrez] AID - S0049-3848(19)30546-8 [pii] AID - 10.1016/j.thromres.2019.12.013 [doi] PST - ppublish SO - Thromb Res. 2020 Feb;186:58-63. doi: 10.1016/j.thromres.2019.12.013. Epub 2019 Dec 24. PMID- 31885913 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220412 IS - 2090-1305 (Print) IS - 2090-1313 (Electronic) IS - 2090-1305 (Linking) VI - 2019 DP - 2019 TI - Correlation between Maximum Clot Firmness in FIBTEM and Fibrinogen Level in Critical Trauma Patients. PG - 2756461 LID - 10.1155/2019/2756461 [doi] LID - 2756461 AB - BACKGROUND: Both fibrinogen level and rotational thromboelastometry (ROTEM(R)) are accurate tests to demonstrate a bleeding tendency. FIBTEM(R) is one type of ROTEM test to determine the function of fibrinogen. An advantage of FIBTEM is helping physicians make proper decisions for blood component transfusions. However, the correlation between fibrinogen level and FIBTEM is still unclear. OBJECTIVE: The aim of this study was to demonstrate a correlation between maximum clot firmness (MCF) in FIBTEM and fibrinogen level in critical trauma patients. METHODS: Data were retrospectively collected from 87 patients who visited the emergency department between May 2017 and January 2019 in Songklanagarind Hospital. Blood specimens were sent for both ROTEM evaluation and fibrinogen level. The data were analysed with STATA program version 12.1. RESULTS: Eighty-seven patients were enrolled in the study over the 21-month period. The patients consisted of 73 males (83.9%) with a median age of 40 years. Seventy-three patients (83.9%) were still alive. The following equation from FIBTEM MCF was used to predict fibrinogen level: fibrinogen level = 138 + (15.2 x FIBTEM MCF) (Lin's concordance correlation coefficient of 0.52, P < 0.001). The results showed a good correlation of FIBTEM MCF to predict patients with hypofibrinogenemia (area under ROC curve = 0.81). Patients with normal fibrinogen levels received significantly fewer units of all types of blood components. CONCLUSION: FIBTEM MCF had poor prediction of fibrinogen level; however, it can help to identify patients who have hypofibrinogenemia. CI - Copyright (c) 2019 Supphamongkhon Khunakanan et al. FAU - Khunakanan, Supphamongkhon AU - Khunakanan S AUID- ORCID: 0000-0003-2935-9802 AD - Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. FAU - Akaraborworn, Osaree AU - Akaraborworn O AUID- ORCID: 0000-0002-9343-9498 AD - Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. FAU - Sangthong, Burapat AU - Sangthong B AD - Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. FAU - Thongkhao, Komet AU - Thongkhao K AD - Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. LA - eng PT - Journal Article DEP - 20191122 PL - United States TA - Crit Care Res Pract JT - Critical care research and practice JID - 101539357 PMC - PMC6893256 COIS- The authors declare that there are no conflicts of interest regarding the publication of this paper. EDAT- 2019/12/31 06:00 MHDA- 2019/12/31 06:01 PMCR- 2019/11/22 CRDT- 2019/12/31 06:00 PHST- 2019/08/16 00:00 [received] PHST- 2019/10/06 00:00 [revised] PHST- 2019/10/12 00:00 [accepted] PHST- 2019/12/31 06:00 [entrez] PHST- 2019/12/31 06:00 [pubmed] PHST- 2019/12/31 06:01 [medline] PHST- 2019/11/22 00:00 [pmc-release] AID - 10.1155/2019/2756461 [doi] PST - epublish SO - Crit Care Res Pract. 2019 Nov 22;2019:2756461. doi: 10.1155/2019/2756461. eCollection 2019. PMID- 31866177 OWN - NLM STAT- MEDLINE DCOM- 20210825 LR - 20210825 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 46 IP - 5 DP - 2020 Aug TI - The effect of the acute inflammatory response of burns and its treatment on clot characteristics and quality: A prospective case controlled study. PG - 1051-1059 LID - S0305-4179(19)30450-4 [pii] LID - 10.1016/j.burns.2019.11.008 [doi] AB - INTRODUCTION: Burns are known to have an effect on coagulation in the early period after burn. Current coagulation tests have been criticised in acute burns due to their inherent limitations. This study aims to investigate the potential for a new quantitative functional biomarker of clot quality, fractal dimension, to identify changes in clot microstructure as a result of the burn inflammatory response and its treatment. METHODS: A total of fifty-eight burn patients were included in this prospective case-controlled study. The control group (29 patients mean TBSA 1%), and case group (29 patients mean TBSA 30%) were compared at baseline and the case group investigated further over four time points (baseline, 12h, 24h and 5-7 days). Fractal analysis was performed, as well as current markers of coagulation, inflammatory markers and point-of-care tests, Thromboelastography and Multiplate analysis. RESULTS: Fractal dimension did not differ between groups at admission (1.73+/-0.06 and 1.72+/-0.1), and fell within the healthy index normal range (1.74+/-0.7), suggesting a normal clot microstructure in the early period after burn. Fractal dimension significantly reduced from baseline over the first 24h following injury (1.59+/-0.03 p<0.005), indicating a significant reduction in mechanical clot strength and functionality consistent with a hypocoagulable state, not identified with other markers. CONCLUSIONS: This is the first study to quantify the changes in clot microstructure following burn injury. This study confirms clot microstructure is significantly altered during the first 24h after burn, with the production of a weaker, more porous fibrin clot, consistent with a hypocoagulable state. CI - Copyright (c) 2019 Elsevier Ltd and ISBI. All rights reserved. FAU - Marsden, N J AU - Marsden NJ AD - Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK. FAU - Lawrence, M AU - Lawrence M AD - Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea, UK; Swansea University Medical School, Swansea, UK. FAU - Davies, N AU - Davies N AD - Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea, UK; Swansea University Medical School, Swansea, UK. FAU - Davies, G AU - Davies G AD - Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea, UK. FAU - Morris, K AU - Morris K AD - Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK. FAU - Williams, P R AU - Williams PR AD - School of Engineering, Swansea University, Swansea, UK. FAU - Whitaker, I S AU - Whitaker IS AD - Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK. FAU - Evans, P A AU - Evans PA AD - Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea, UK; Swansea University Medical School, Swansea, UK. Electronic address: Phillip.Evans2@wales.nhs.uk. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191220 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - 0 (Colloids) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (Interleukin-6) RN - 0 (Procalcitonin) RN - 0 (Tumor Necrosis Factor-alpha) RN - 0 (fibrin fragment D) RN - 9001-27-8 (Factor VIII) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*blood/metabolism/pathology MH - Blood Coagulation Tests MH - Burns/*blood/pathology/therapy MH - Case-Control Studies MH - Colloids/therapeutic use MH - Disease Progression MH - Factor VIII/metabolism MH - Female MH - Fibrin Fibrinogen Degradation Products/metabolism MH - Fluid Therapy/methods MH - Fractals MH - Humans MH - Inflammation/*blood/metabolism MH - Interleukin-6/metabolism MH - Male MH - Microscopy, Electron, Scanning MH - Middle Aged MH - Platelet Aggregation MH - Platelet Function Tests MH - Procalcitonin/metabolism MH - Prospective Studies MH - Thrombelastography MH - Tumor Necrosis Factor-alpha/metabolism MH - Young Adult OTO - NOTNLM OT - Biomarker OT - Burns OT - Clot microstructure OT - Coagulation OT - Thermal injury EDAT- 2019/12/24 06:00 MHDA- 2021/08/26 06:00 CRDT- 2019/12/24 06:00 PHST- 2019/06/18 00:00 [received] PHST- 2019/10/07 00:00 [revised] PHST- 2019/11/13 00:00 [accepted] PHST- 2019/12/24 06:00 [pubmed] PHST- 2021/08/26 06:00 [medline] PHST- 2019/12/24 06:00 [entrez] AID - S0305-4179(19)30450-4 [pii] AID - 10.1016/j.burns.2019.11.008 [doi] PST - ppublish SO - Burns. 2020 Aug;46(5):1051-1059. doi: 10.1016/j.burns.2019.11.008. Epub 2019 Dec 20. PMID- 31847951 OWN - NLM STAT- MEDLINE DCOM- 20200708 LR - 20200708 IS - 1866-0452 (Electronic) IS - 1866-0452 (Linking) VI - 116 IP - 47 DP - 2019 Nov 22 TI - The Diagnosis and Treatment of Acute Traumatic Bleeding and Coagulopathy. PG - 799-806 LID - arztebl.2019.0799 [pii] LID - 10.3238/arztebl.2019.0799 [doi] AB - BACKGROUND: Uncontrolled bleeding with trauma-induced coagulopathy (TIC) is still the most common avoidable cause of death in multiple trauma. The aging of the population has led to an increasing number of bleeding trauma patients with pre-existing anticoagulation. Such patients are not treated uniformly, even in major trauma centers. METHODS: This review is based on a selective search of the literature (Medline/PubMed, Cochrane Reviews) and summarizes current treatment recommendations, including those of the newly revised European trauma guidelines. RESULTS: The treatment of traumatic hemorrhage begins at the site of the accident, with compression, tourniquets, pelvic binders, and rapid transport to a certified trauma center. The early use of tourniquets was shown to lessen the trans- fusion requirement (packed red blood cells: 2.0 +/- 0.1 vs. 9.3 +/- 0.6; p < 0.001; fresh frozen plasma concentrates: 1.4 +/- 0.08 vs. 6.2 +/- 0.4; p < 0.001), while external pelvic stabilization was shown to reduce mortality (19.1% vs. 33.3%). Upon the patient's arrival in the hospital, steps are taken to measure, monitor, and support clotting function. Bleeding is controlled surgically according to the principles of damage control. Modern clotting management consists of goal-oriented, individualized therapy, including the use of point-of-care viscoelastic test procedures. Idarucizumab can be used as an antidote to the thrombin inhibitor dabigatran, andexanet alpha as an antidote to factor Xa inhibitors. CONCLUSION: The evidence-based treatment of patients with hemorrhage from severe trauma, in accordance with the existing guidelines, can improve the clinical outcome. Corresponding algorithms, adapted to local logistics and infrastructure, must be developed and implemented. FAU - Maegele, Marc AU - Maegele M AD - Department of Orthopedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne. LA - eng PT - Journal Article PT - Review PL - Germany TA - Dtsch Arztebl Int JT - Deutsches Arzteblatt international JID - 101475967 SB - IM MH - Blood Coagulation Disorders/*diagnosis/*therapy MH - Hemorrhage/*diagnosis/*therapy MH - Humans MH - Practice Guidelines as Topic MH - Trauma Centers MH - Treatment Outcome PMC - PMC6937546 EDAT- 2019/12/19 06:00 MHDA- 2020/07/09 06:00 PMCR- 2019/11/01 CRDT- 2019/12/19 06:00 PHST- 2019/06/13 00:00 [received] PHST- 2019/06/13 00:00 [revised] PHST- 2019/09/06 00:00 [accepted] PHST- 2019/12/19 06:00 [entrez] PHST- 2019/12/19 06:00 [pubmed] PHST- 2020/07/09 06:00 [medline] PHST- 2019/11/01 00:00 [pmc-release] AID - arztebl.2019.0799 [pii] AID - 10.3238/arztebl.2019.0799 [doi] PST - ppublish SO - Dtsch Arztebl Int. 2019 Nov 22;116(47):799-806. doi: 10.3238/arztebl.2019.0799. PMID- 31843691 OWN - NLM STAT- MEDLINE DCOM- 20200924 LR - 20220922 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 230 IP - 3 DP - 2020 Mar TI - Examining the Effect of Hypertonic Saline Administered for Reduction of Intracranial Hypertension on Coagulation. PG - 322-330.e2 LID - S1072-7515(19)32231-8 [pii] LID - 10.1016/j.jamcollsurg.2019.11.011 [doi] AB - BACKGROUND: Hypertonic saline (23.4%, HTS) bolus administration is common practice for refractory intracranial hypertension, but its effects on coagulation are unknown. We hypothesize that 23.4% HTS in whole blood results in progressive impairment of coagulation in vitro and in vivo in a murine model of traumatic brain injury (TBI). STUDY DESIGN: For the in vitro study, whole blood was collected from 10 healthy volunteers, and citrated native thrombelastography was performed with normal saline (0.9%, NS) and 23.4% HTS in serial dilutions (2.5%, 5%, and 10%). For the in vivo experiment, we assessed the effects of 23.4% HTS bolus vs NS on serial thrombelastography and tail-bleeding times in a TBI murine model (n = 10 rats with TBI and 10 controls). RESULTS: For the in vitro work, clinically relevant concentrations of HTS (2.5% dilution) shortened time to clot formation and increased clot strength (maximum amplitude) compared with control and NS. With higher HTS dosing (5% and 10% blood dilution), there was progressive prolongation of time to clot formation, decreased angle, and decreased maximum amplitude. In the in vivo study, there was no significant difference in thrombelastography measurements or tail-bleeding times after bolus administration of 23.4% HTS compared with NS at 2.5% blood volume. CONCLUSIONS: At clinically relevant dilutions of HTS, there is a paradoxical shortening of time to clot formation and increase in clot strength in vitro and no significant effects in a murine TBI model. However, with excess dilution, caution should be exercised when using serial HTS boluses in TBI patients at risk for trauma-induced coagulopathy. CI - Copyright (c) 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. Electronic address: Ernest.moore@dhha.org. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Hematology, Children's Hospital of Colorado, Aurora, CO; Vitalant Research Institute, Vitalant Denver, Denver, CO. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Samuels, Jason M AU - Samuels JM AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Bartley, Matthew G AU - Bartley MG AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Vigneshwar, Navin G AU - Vigneshwar NG AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO. FAU - Fragoso, Miguel AU - Fragoso M AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. LA - eng GR - R01 HL146442/HL/NHLBI NIH HHS/United States GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20191214 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 0 (Saline Solution, Hypertonic) SB - IM MH - Animals MH - Blood Coagulation/*drug effects MH - Brain Injuries, Traumatic/complications MH - Disease Models, Animal MH - Female MH - Humans MH - Intracranial Hypertension/*blood/*drug therapy/etiology MH - Male MH - Rats, Sprague-Dawley MH - Saline Solution, Hypertonic/*pharmacology/*therapeutic use MH - Self Report MH - Thrombelastography MH - Time Factors PMC - PMC7050279 MID - NIHMS1552018 EDAT- 2019/12/18 06:00 MHDA- 2020/09/25 06:00 PMCR- 2021/03/01 CRDT- 2019/12/18 06:00 PHST- 2019/09/26 00:00 [received] PHST- 2019/11/18 00:00 [revised] PHST- 2019/11/19 00:00 [accepted] PHST- 2019/12/18 06:00 [pubmed] PHST- 2020/09/25 06:00 [medline] PHST- 2019/12/18 06:00 [entrez] PHST- 2021/03/01 00:00 [pmc-release] AID - S1072-7515(19)32231-8 [pii] AID - 10.1016/j.jamcollsurg.2019.11.011 [doi] PST - ppublish SO - J Am Coll Surg. 2020 Mar;230(3):322-330.e2. doi: 10.1016/j.jamcollsurg.2019.11.011. Epub 2019 Dec 14. PMID- 31833475 OWN - NLM STAT- MEDLINE DCOM- 20200610 LR - 20200610 IS - 1879-3150 (Electronic) IS - 0041-0101 (Linking) VI - 175 DP - 2020 Feb TI - Comparison of thromboelastography versus conventional coagulation tests in simulated Crotalus atrox envenomation using human blood. PG - 19-27 LID - S0041-0101(19)30757-3 [pii] LID - 10.1016/j.toxicon.2019.12.001 [doi] AB - INTRODUCTION: Pit viper bites are a source of significant morbidity and mortality. Pit viper bites can cause venom-induced consumptive coagulopathy (VICC), typically evaluated with laboratory-based conventional coagulation tests (CCTs). However, CCTs require a laboratory and average 1 h to conduct. Thromboelastography (TEG) provides real-time, point-of-care tests of coagulation that are fast and require no separate laboratory facilities, which could be advantageous in both hospital and austere settings. However, the relative efficacy of TEG versus CCTs was unclear, particularly at low venom concentrations. Therefore, the objectives of this study were to test human blood with various concentrations of pit viper venom using CCTs and TEG to determine dose-dependent changes, lowest observed effect concentration (LOEC), and sensitivity to detecting samples out of normal diagnostic range. METHODS: Blood samples from 20 volunteers were mixed with varying concentrations of western diamond back rattlesnake (Crotalus atrox) venom based on the mouse LD50(IV) (none, 0.5%, 1%, 2%, 33%, 66%, and 100% LD50(IV)). Samples were split and assessed with both CCTs including prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), fibrinogen, and D-dimer, along with TEG measures of reaction time (R), kinetic time (K), rate of clot formation (alpha-angle), and clot strength (MA). Data were analyzed as dose-dependent concentration-based changes in raw values and in percent of samples exceeding diagnostic thresholds using ANOVA and nonparametric statistics at the p < .05 threshold. RESULTS: All evaluations showed significant concentration-dependent changes, and 100% of samples exceeded diagnostic thresholds at 33%LD50(IV) and above, save D-dimer. At 0.5%LD50(IV), R, K, alpha-angle, PT, and INR were significantly different from controls, and at 1%LD50(IV), mean values exceeded diagnostic thresholds for R, K, alpha-angle, MA, PT, and INR, but not for PTT, D-dimer, or fibrinogen. At 2%LD50(IV,) 100% of samples were out of normal range for K, alpha-angle, and PT(.) CONCLUSION: TEG is effective in coagulopathy evaluations of in vitro simulated pit viper envenomation. At low venom concentrations, TEG performed as well or better than the majority of CCTs. These findings provide empirical evidence supporting the use of TEG to rapidly and accurately evaluate VICC. CI - Published by Elsevier Ltd. FAU - Fortner, Grady A AU - Fortner GA AD - Combat Trauma Research Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA. Electronic address: grady.a.fortner2.mil@mail.mil. FAU - Devlin, John J AU - Devlin JJ AD - Combat Trauma Research Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA. FAU - McGowan, Andrew J AU - McGowan AJ AD - Combat Trauma Research Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA. FAU - Boboc, Michael AU - Boboc M AD - Combat Trauma Research Group, Naval Medical Center Portsmouth; General Dynamics Information Technology (GDIT), Fairfax, VA, USA. FAU - Natarajan, Ramesh AU - Natarajan R AD - Combat Trauma Research Group, Naval Medical Center Portsmouth; General Dynamics Information Technology (GDIT), Fairfax, VA, USA. FAU - Zarow, Gregory J AU - Zarow GJ AD - Combat Trauma Research Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA; The Emergency Statistician, Idyllwild, CA, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20191205 PL - England TA - Toxicon JT - Toxicon : official journal of the International Society on Toxinology JID - 1307333 SB - IM MH - Animals MH - *Blood Coagulation Tests MH - *Crotalus MH - Humans MH - Mice MH - *Snake Bites MH - *Thrombelastography OTO - NOTNLM OT - Rattlesnake OT - Snakebite OT - Thromboelastography OT - Venom OT - Venom-induced consumptive coagulopathy EDAT- 2019/12/14 06:00 MHDA- 2020/06/11 06:00 CRDT- 2019/12/14 06:00 PHST- 2019/08/13 00:00 [received] PHST- 2019/11/29 00:00 [revised] PHST- 2019/12/01 00:00 [accepted] PHST- 2019/12/14 06:00 [pubmed] PHST- 2020/06/11 06:00 [medline] PHST- 2019/12/14 06:00 [entrez] AID - S0041-0101(19)30757-3 [pii] AID - 10.1016/j.toxicon.2019.12.001 [doi] PST - ppublish SO - Toxicon. 2020 Feb;175:19-27. doi: 10.1016/j.toxicon.2019.12.001. Epub 2019 Dec 5. PMID- 31831587 OWN - NLM STAT- MEDLINE DCOM- 20200914 LR - 20200914 IS - 1472-0213 (Electronic) IS - 1472-0205 (Linking) VI - 37 IP - 2 DP - 2020 Feb TI - Massive transfusion in The Netherlands. PG - 65-72 LID - 10.1136/emermed-2019-208665 [doi] AB - OBJECTIVES: Massive transfusion protocols (MTPs) may improve survival in patients with uncontrolled haemorrhage. An MTP was introduced into the Dutch transfusion guidelines in 2011, the ninth edition of the advanced trauma life support course in 2012 and the third version of the European guideline in 2013. This is the first survey of MTPs in Dutch trauma centres. METHODS: The aim of the study was to compare MTP strategies in level 1 trauma centres in The Netherlands, and with (inter)national guidelines. A contact in each government assigned level 1 trauma centre in The Netherlands and the Dutch Ministry of Defence was approached to share their MTPs and elucidate their protocol in a survey and oral follow-up interview. RESULTS: All 11 level 1 trauma centres responded. The content of the packages and transfusion ratios (red blood cells/plasma/platelets) were 3:3:1, 5:5:1, 5:3:1, 2:3:1, 4:4:1, 5:2:1, 2:2:1 and 4:3:1. Tranexamic acid was used in all centres and an additional dose was administered in eight centres. Fibrinogen was given directly (n=4), with persistent bleeding (n=3), based on Clauss fibrinogen (n=3) or rotational thromboelastometry (n=1). All centres used additional medication in patients in the form of anticoagulants, but their use was ambiguous. CONCLUSION: MTPs differed between institutes and guidelines. The discrepancies in transfusion ratios can be explained by (inter)national differences in preparation and volume of blood components and/or interpretation of the '1:1:1' guideline. We recommend updating MTPs every year using the latest guidelines and evaluating the level of evidence for treatment during massive transfusion. CI - (c) Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Rijnhout, Tim W H AU - Rijnhout TWH AUID- ORCID: 0000-0002-2736-5101 AD - Department of Surgery, Alrijne Hospital Leiderdorp, Leiderdorp, The Netherlands twhrijnhout@alrijne.nl. AD - Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands. FAU - Noorman, Femke AU - Noorman F AD - Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands. FAU - Bek, Annemarije AU - Bek A AD - Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands. FAU - Zoodsma, Margreet AU - Zoodsma M AD - Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands. FAU - Hoencamp, Rigo AU - Hoencamp R AD - Department of Surgery, Alrijne Hospital Leiderdorp, Leiderdorp, The Netherlands. AD - Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands. AD - Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. AD - Defence Healthcare Organization, Ministry of Defence, Utrecht, The Netherlands. LA - eng PT - Journal Article DEP - 20191212 PL - England TA - Emerg Med J JT - Emergency medicine journal : EMJ JID - 100963089 SB - IM MH - Adult MH - Blood Transfusion/instrumentation/*methods MH - Clinical Protocols/*standards MH - Female MH - Hemorrhage/therapy MH - Humans MH - Male MH - Netherlands MH - Resuscitation/methods MH - Surveys and Questionnaires OTO - NOTNLM OT - blood OT - emergency OT - massive OT - military OT - platelets OT - protocol OT - surgery OT - tranexamic acid OT - transfusion OT - trauma COIS- Competing interests: None declared. EDAT- 2019/12/14 06:00 MHDA- 2020/09/15 06:00 CRDT- 2019/12/14 06:00 PHST- 2019/04/17 00:00 [received] PHST- 2019/10/16 00:00 [revised] PHST- 2019/10/25 00:00 [accepted] PHST- 2019/12/14 06:00 [pubmed] PHST- 2020/09/15 06:00 [medline] PHST- 2019/12/14 06:00 [entrez] AID - emermed-2019-208665 [pii] AID - 10.1136/emermed-2019-208665 [doi] PST - ppublish SO - Emerg Med J. 2020 Feb;37(2):65-72. doi: 10.1136/emermed-2019-208665. Epub 2019 Dec 12. PMID- 31815829 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 1531-2291 (Electronic) IS - 0890-5339 (Linking) VI - 34 IP - 6 DP - 2020 Jun TI - Ability of Thromboelastography to Detect Hypercoagulability: A Systematic Review and Meta-Analysis. PG - 278-286 LID - 10.1097/BOT.0000000000001714 [doi] AB - OBJECTIVE: To review the current literature on the use of viscoelastic hemolytic assays, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), during the perioperative period of patients and determine the ability of TEG and ROTEM to detect hypercoagulability and identify increased risk of the development of venous thromboembolism (VTE). DATA SOURCES: PubMed, EMBASE, and Cochrane online databases were queried through February 11, 2018, by pairing the terms "thromboelastography," "viscoelastic hemostatic assays," and "rotational thromboelastometry" with "venous thromboembolism," "deep vein thrombosis," "pulmonary embolism," and "hypercoagulability." STUDY SELECTION: Inclusion and exclusion criteria were established to determine relevance and quality of data, of which 2.54% of initially identified studies met. DATA EXTRACTION AND SYNTHESIS: Articles and citations were reviewed for relevance by 2 independent individuals following PRISMA guidelines as well as a quality assessment of data as established by Zaza et al. In studies that separated patients postoperatively by VTE development or no VTE development, data were pooled utilizing a modified DerSimmion and Laird random effects model. RESULTS: One thousand eight hundred ninety-three articles were assessed for eligibility, yielding 370 abstracts. Of the 370 abstracts, 35 studies were included, and of these, only 5 were included in the meta-analysis. Studies included postsurgical patients in a variety of surgical fields, encompassing a total of 8939 patients, with 717 thrombotic events reported. Elevated maximum amplitude (MA) was a statistically significant indicator of hypercoagulability across at least 1 perioperative time point in 17 (50%) of the articles reviewed, consisting of 6348 (72%) patients. The pooled mean MA value for defining hypercoagulability was greater than 66.70 mm. Using a prepublished value for hypercoagulability of 65 mm, the combined effect of MA on the development of VTE in postsurgical patients was determined to be 1.31 (95% confidence, 0.74-2.34, P = 0.175) and was 46% sensitive and 62% specific in predicting a postoperative VTE. CONCLUSIONS: Only 1 parameter, MA, was consistently used to both define hypercoagulability and be predictive of VTE after traumatic injury and surgical intervention; however, there remains a broad variability in the definition of hypercoagulability as determined by MA and thus limits its predictive ability. In addition, when hypercoagulability was measured throughout the perioperative period, TEG consistently demonstrated hypercoagulability starting on post-op day 1 (POD1). LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. FAU - Brown, Wesley AU - Brown W AD - Medical College of Georgia, Augusta, GA. FAU - Lunati, Matthew AU - Lunati M AD - Emory University Orthopaedics, Atlanta, GA; and. FAU - Maceroli, Michael AU - Maceroli M AD - Emory University Orthopaedics, Atlanta, GA; and. AD - Grady Memorial Hospital, Atlanta, GA. FAU - Ernst, Alexandra AU - Ernst A AD - Emory University Orthopaedics, Atlanta, GA; and. FAU - Staley, Christopher AU - Staley C AD - Emory University Orthopaedics, Atlanta, GA; and. FAU - Johnson, Richard AU - Johnson R AD - Emory University Orthopaedics, Atlanta, GA; and. AD - Grady Memorial Hospital, Atlanta, GA. FAU - Schenker, Mara AU - Schenker M AD - Emory University Orthopaedics, Atlanta, GA; and. AD - Grady Memorial Hospital, Atlanta, GA. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - United States TA - J Orthop Trauma JT - Journal of orthopaedic trauma JID - 8807705 SB - IM MH - Humans MH - *Pulmonary Embolism MH - Thrombelastography MH - *Thrombophilia/diagnosis MH - *Venous Thromboembolism/diagnosis EDAT- 2019/12/10 06:00 MHDA- 2021/06/22 06:00 CRDT- 2019/12/10 06:00 PHST- 2019/12/10 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2019/12/10 06:00 [entrez] AID - 00005131-202006000-00002 [pii] AID - 10.1097/BOT.0000000000001714 [doi] PST - ppublish SO - J Orthop Trauma. 2020 Jun;34(6):278-286. doi: 10.1097/BOT.0000000000001714. PMID- 31804296 OWN - NLM STAT- MEDLINE DCOM- 20210723 LR - 20221005 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 54 IP - 2 DP - 2020 Aug TI - Burn-Induced Coagulopathies: a Comprehensive Review. PG - 154-167 LID - 10.1097/SHK.0000000000001484 [doi] AB - Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed. FAU - Ball, Robert L AU - Ball RL AD - The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia. FAU - Keyloun, John W AU - Keyloun JW AD - The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia. AD - Department of Surgery, Georgetown University School of Medicine, Washington, Dist of Columbia. FAU - Brummel-Ziedins, Kathleen AU - Brummel-Ziedins K AD - Department of Biochemistry, College of Medicine, University of Vermont, Colchester, Vermont. FAU - Orfeo, Thomas AU - Orfeo T AD - Department of Biochemistry, College of Medicine, University of Vermont, Colchester, Vermont. FAU - Palmieri, Tina L AU - Palmieri TL AD - Department of Surgery, University of California, Davis, Regional Burn Center, Davis, California. FAU - Johnson, Laura S AU - Johnson LS AD - The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia. AD - Department of Surgery, Georgetown University School of Medicine, Washington, Dist of Columbia. FAU - Moffatt, Lauren T AU - Moffatt LT AD - The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia. FAU - Pusateri, Anthony E AU - Pusateri AE AD - U.S. Army Institute of Surgical Research, JBSA, Fort Same Houston, Texas. FAU - Shupp, Jeffrey W AU - Shupp JW AD - The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia. AD - Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia. AD - Department of Surgery, Georgetown University School of Medicine, Washington, Dist of Columbia. LA - eng PT - Journal Article PT - Review PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM MH - Blood Coagulation Disorders/diagnosis/*etiology MH - Burns/*complications MH - Female MH - Fibrinolysis/physiology MH - Humans MH - Inflammation/physiopathology MH - Male PMC - PMC7439938 COIS- The authors report no conflicts of interest. EDAT- 2019/12/06 06:00 MHDA- 2021/07/24 06:00 PMCR- 2020/08/20 CRDT- 2019/12/06 06:00 PHST- 2019/12/06 06:00 [pubmed] PHST- 2021/07/24 06:00 [medline] PHST- 2019/12/06 06:00 [entrez] PHST- 2020/08/20 00:00 [pmc-release] AID - 00024382-202008000-00003 [pii] AID - SHOCK-D-19-00569 [pii] AID - 10.1097/SHK.0000000000001484 [doi] PST - ppublish SO - Shock. 2020 Aug;54(2):154-167. doi: 10.1097/SHK.0000000000001484. PMID- 33829078 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210410 IS - 2364-4133 (Print) IS - 2364-4141 (Electronic) IS - 2364-4141 (Linking) VI - 5 IP - 4 DP - 2019 Dec TI - Biocompatibility and Viscoelastic Properties of Injectable Resilin-Like Polypeptide and Hyaluronan Hybrid Hydrogels in Rabbit Vocal Folds. PG - 373-386 LID - 10.1007/s40883-019-00094-6 [doi] AB - Vocal fold scar, characterized by alterations in the lamina propria extracellular matrix, disrupts normal voice quality and function. Due to a lack of satisfactory clinical treatments, there is a need for tissue engineering strategies to restore voice. Candidate biomaterials for vocal fold tissue engineering must match the unique biomechanical and viscoelastic properties of native tissue without provoking inflammation. We sought to introduce elastomeric properties to hyaluronic acid (HA)-based biomaterials by incorporating resilin-like polypeptide (RLP) into hybrid hydrogels. Physically crosslinked RLP/HA and chemically crosslinked RLP-acrylamide/thiolated HA (RLP-AM/HA-SH) hydrogels were fabricated using cytocompatible chemistries. Mechanical properties of hydrogels were assessed in vitro using oscillatory rheology. Hybrid hydrogels were injected into rabbit vocal folds and tissues were assessed using rheology and histology. A small number of animals underwent acute vocal fold injury followed by injection of RLP-AM/HA-SH hydrogel alone or as a carrier for human bone marrow mesenchymal stem cells (BM-MSCs). Rheological testing confirmed that mechanical properties of materials in vitro resembled native vocal fold tissue and that viscoelasticity of vocal fold mucosa was preserved days 5 and 21 after injection. Histological analysis revealed that hybrid hydrogels provoked only mild inflammation in vocal fold lamina propria with demonstrated safety in the airway for up to 3 weeks, confirming acute biocompatibility of crosslinking chemistries. After acute injury, RLP-AM/HA-SH gel with and without BM-MSCs did not result in adverse effects or increased inflammation. Collectively, results indicate that RLP and HA-based hybrid hydrogels are highly promising for engineering the vocal fold lamina propria. FAU - King, Renee E AU - King RE AD - Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 5118 WIMR, 1111 Highland Ave, Madison, WI 53705-2275, USA. AD - Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1975 Willow Dr, Madison, WI 53706, USA. FAU - Lau, Hang Kuen AU - Lau HK AD - Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA. FAU - Zhang, Haiyan AU - Zhang H AD - Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 5118 WIMR, 1111 Highland Ave, Madison, WI 53705-2275, USA. AD - Present address: Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China. FAU - Sidhu, Ishnoor AU - Sidhu I AD - Department of Biological Sciences, University of Delaware, Newark, DE 19716, USA. FAU - Christensen, Michael B AU - Christensen MB AD - The National Center for Voice and Speech, University of Utah, 136 S Main St, Ste 320, Salt Lake City, UT 84101, USA. AD - Department of Bioengineering, University of Utah, 36 S Wasatch Dr. Rm 3100, Salt Lake City, UT 84112, USA. FAU - Fowler, Eric W AU - Fowler EW AD - Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA. FAU - Li, Linqing AU - Li L AD - Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA. FAU - Jia, Xinqiao AU - Jia X AD - Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA. FAU - Kiick, Kristi L AU - Kiick KL AD - Department of Materials Science and Engineering, University of Delaware, Newark, DE 19716, USA. AD - Department of Biological Sciences, University of Delaware, Newark, DE 19716, USA. FAU - Thibeault, Susan L AU - Thibeault SL AD - Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 5118 WIMR, 1111 Highland Ave, Madison, WI 53705-2275, USA. AD - Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1975 Willow Dr, Madison, WI 53706, USA. LA - eng GR - P30 GM103519/GM/NIGMS NIH HHS/United States GR - T32 DC009401/DC/NIDCD NIH HHS/United States GR - P30 GM110758/GM/NIGMS NIH HHS/United States GR - P20 GM103446/GM/NIGMS NIH HHS/United States GR - R01 DC011377/DC/NIDCD NIH HHS/United States GR - P20 GM104316/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20190227 PL - Switzerland TA - Regen Eng Transl Med JT - Regenerative engineering and translational medicine JID - 101669762 PMC - PMC8022864 MID - NIHMS1610989 OTO - NOTNLM OT - Biocompatibility OT - Injectable hydrogels OT - Resilin OT - Viscoelastic properties OT - Vocal folds COIS- Conflict of Interest The authors declare that they have no conflict of interest. EDAT- 2019/12/01 00:00 MHDA- 2019/12/01 00:01 PMCR- 2021/04/06 CRDT- 2021/04/08 06:32 PHST- 2021/04/08 06:32 [entrez] PHST- 2019/12/01 00:00 [pubmed] PHST- 2019/12/01 00:01 [medline] PHST- 2021/04/06 00:00 [pmc-release] AID - 10.1007/s40883-019-00094-6 [doi] PST - ppublish SO - Regen Eng Transl Med. 2019 Dec;5(4):373-386. doi: 10.1007/s40883-019-00094-6. Epub 2019 Feb 27. PMID- 31778223 OWN - NLM STAT- MEDLINE DCOM- 20200311 LR - 20250530 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 11 IP - 11 DP - 2019 Nov 28 TI - Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiac surgery or invasive procedures. PG - CD012745 LID - 10.1002/14651858.CD012745.pub2 [doi] LID - CD012745 AB - BACKGROUND: In the absence of bleeding, plasma is commonly transfused to people prophylactically to prevent bleeding. In this context, it is transfused before operative or invasive procedures (such as liver biopsy or chest drainage tube insertion) in those considered at increased risk of bleeding, typically defined by abnormalities of laboratory tests of coagulation. As plasma contains procoagulant factors, plasma transfusion may reduce perioperative bleeding risk. This outcome has clinical importance given that perioperative bleeding and blood transfusion have been associated with increased morbidity and mortality. Plasma is expensive, and some countries have experienced issues with blood product shortages, donor pool reliability, and incomplete screening for transmissible infections. Thus, although the benefit of prophylactic plasma transfusion has not been well established, plasma transfusion does carry potentially life-threatening risks. OBJECTIVES: To determine the clinical effectiveness and safety of prophylactic plasma transfusion for people with coagulation test abnormalities (in the absence of inherited bleeding disorders or use of anticoagulant medication) requiring non-cardiac surgery or invasive procedures. SEARCH METHODS: We searched for randomised controlled trials (RCTs), without language or publication status restrictions in: Cochrane Central Register of Controlled Trials (CENTRAL; 2017 Issue 7); Ovid MEDLINE (from 1946); Ovid Embase (from 1974); Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOHost) (from 1937); PubMed (e-publications and in-process citations ahead of print only); Transfusion Evidence Library (from 1950); Latin American Caribbean Health Sciences Literature (LILACS) (from 1982); Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (Thomson Reuters, from 1990); ClinicalTrials.gov; and World Health Organization (WHO) International Clinical Trials Registry Search Platform (ICTRP) to 28 January 2019. SELECTION CRITERIA: We included RCTs comparing: prophylactic plasma transfusion to placebo, intravenous fluid, or no intervention; prophylactic plasma transfusion to alternative pro-haemostatic agents; or different haemostatic thresholds for prophylactic plasma transfusion. We included participants of any age, and we excluded trials incorporating individuals with previous active bleeding, with inherited bleeding disorders, or taking anticoagulant medication before enrolment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included five trials in this review, all were conducted in high-income countries. Three additional trials are ongoing. One trial compared fresh frozen plasma (FFP) transfusion with no transfusion given. One trial compared FFP or platelet transfusion or both with neither FFP nor platelet transfusion given. One trial compared FFP transfusion with administration of alternative pro-haemostatic agents (factors II, IX, and X followed by VII). One trial compared the use of different transfusion triggers using the international normalised ratio measurement. One trial compared the use of a thromboelastographic-guided transfusion trigger using standard laboratory measurements of coagulation. Four trials enrolled only adults, whereas the fifth trial did not specify participant age. Four trials included only minor procedures that could be performed by the bedside. Only one trial included some participants undergoing major surgical operations. Two trials included only participants in intensive care. Two trials included only participants with liver disease. Three trials did not recruit sufficient participants to meet their pre-calculated sample size. Overall, the quality of evidence was low to very low across different outcomes according to GRADE methodology, due to risk of bias, indirectness, and imprecision. One trial was stopped after recruiting two participants, therefore this review's findings are based on the remaining four trials (234 participants). When plasma transfusion was compared with no transfusion given, we are very uncertain whether there was a difference in 30-day mortality (1 trial comparing FFP or platelet transfusion or both with neither FFP nor platelet transfusion, 72 participants; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.13 to 1.10; very low-quality evidence). We are very uncertain whether there was a difference in major bleeding within 24 hours (1 trial comparing FFP transfusion vs no transfusion, 76 participants; RR 0.33, 95% CI 0.01 to 7.93; very low-quality evidence; 1 trial comparing FFP or platelet transfusion or both with neither FFP nor platelet transfusion, 72 participants; RR 1.59, 95% CI 0.28 to 8.93; very low-quality evidence). We are very uncertain whether there was a difference in the number of blood product transfusions per person (1 trial, 76 participants; study authors reported no difference; very low-quality evidence) or in the number of people requiring transfusion (1 trial comparing FFP or platelet transfusion or both with neither FFP nor platelet transfusion, 72 participants; study authors reported no blood transfusion given; very low-quality evidence) or in the risk of transfusion-related adverse events (acute lung injury) (1 trial, 76 participants; study authors reported no difference; very low-quality evidence). When plasma transfusion was compared with other pro-haemostatic agents, we are very uncertain whether there was a difference in major bleeding (1 trial; 21 participants; no events; very low-quality evidence) or in transfusion-related adverse events (febrile or allergic reactions) (1 trial, 21 participants; RR 9.82, 95% CI 0.59 to 162.24; very low-quality evidence). When different triggers for FFP transfusion were compared, the number of people requiring transfusion may have been reduced (for overall blood products) when a thromboelastographic-guided transfusion trigger was compared with standard laboratory tests (1 trial, 60 participants; RR 0.18, 95% CI 0.08 to 0.39; low-quality evidence). We are very uncertain whether there was a difference in major bleeding (1 trial, 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence) or in transfusion-related adverse events (allergic reactions) (1 trial; 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence). Only one trial reported 30-day mortality. No trials reported procedure-related harmful events (excluding bleeding) or quality of life. AUTHORS' CONCLUSIONS: Review findings show uncertainty for the utility and safety of prophylactic FFP use. This is due to predominantly very low-quality evidence that is available for its use over a range of clinically important outcomes, together with lack of confidence in the wider applicability of study findings, given the paucity or absence of study data in settings such as major body cavity surgery, extensive soft tissue surgery, orthopaedic surgery, or neurosurgery. Therefore, from the limited RCT evidence, we can neither support nor oppose the use of prophylactic FFP in clinical practice. CI - Copyright (c) 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Huber, Jonathan AU - Huber J AD - University Hospital Southampton NHS Foundation Trust, Shackleton Department of Anaesthesia, Tremona Road, Southampton, Hampshire, UK, So16 6YD. FAU - Stanworth, Simon J AU - Stanworth SJ AD - Oxford University Hospitals NHS Foundation Trust and University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK, OX3 9BQ. FAU - Doree, Carolyn AU - Doree C AD - NHS Blood and Transplant, Systematic Review Initiative, John Radcliffe Hospital, Oxford, UK, OX3 9BQ. FAU - Fortin, Patricia M AU - Fortin PM AD - 5639 Gowland Rd., Sechelt, BC, Canada, V0N 3A8. FAU - Trivella, Marialena AU - Trivella M AD - University of Oxford, Centre for Statistics in Medicine, Botnar Research Centre, Windmill Road, Oxford, UK, OX3 7LD. FAU - Brunskill, Susan J AU - Brunskill SJ AD - NHS Blood and Transplant, Systematic Review Initiative, John Radcliffe Hospital, Oxford, UK, OX3 9BQ. FAU - Hopewell, Sally AU - Hopewell S AD - University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, Windmill Road, Oxford, Oxfordshire, UK, OX3 7LD. FAU - Wilkinson, Kirstin L AU - Wilkinson KL AD - Southampton University NHS Hospital, Paediatric and Adult Cardiothoracic Anaesthesia, Tremona Road, Southampton, UK, SO16 6YD. FAU - Estcourt, Lise J AU - Estcourt LJ AD - NHS Blood and Transplant, Haematology/Transfusion Medicine, Level 2, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9BQ. LA - eng GR - 13/89/09/DH_/Department of Health/United Kingdom PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20191128 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 RN - 0 (Anticoagulants) RN - 0 (Hemostatics) SB - IM UOF - Cochrane Database Syst Rev. 2017 Aug 17;2017(8):CD012745. doi: 10.1002/14651858.CD012745. PMID: 29151811 MH - Anticoagulants/adverse effects/*therapeutic use MH - Blood Component Transfusion/*methods MH - Hemorrhage/*prevention & control MH - Hemostatics/therapeutic use MH - Humans MH - Plasma MH - Preoperative Care MH - Randomized Controlled Trials as Topic MH - *Surgical Procedures, Operative MH - Thrombelastography PMC - PMC6993082 COIS- Jonathan Huber: none to declare. Simon Stanworth: none to declare. Carolyn Doree: none to declare. Patricia Fortin: funded in part by the NIHR Cochrane Programme Grant - Safe and Appropriate Use of Blood Components. Marialena Trivella: funded in part by the NIHR Cochrane Programme Grant - Safe and Appropriate Use of Blood Components. Susan Brunskill: none to declare. Sally Hopewell: funded in part by the NIHR Cochrane Programme Grant - Safe and Appropriate Use of Blood Components. Kirstin Wilkinson: none to declare. Lise Estcourt: funded in part by the NIHR Cochrane Programme Grant - Safe and Appropriate Use of Blood Components. EDAT- 2019/11/30 06:00 MHDA- 2020/03/12 06:00 PMCR- 2020/11/28 CRDT- 2019/11/29 06:00 PHST- 2019/11/29 06:00 [entrez] PHST- 2019/11/30 06:00 [pubmed] PHST- 2020/03/12 06:00 [medline] PHST- 2020/11/28 00:00 [pmc-release] AID - CD012745.pub2 [pii] AID - 10.1002/14651858.CD012745.pub2 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2019 Nov 28;11(11):CD012745. doi: 10.1002/14651858.CD012745.pub2. PMID- 31776369 OWN - NLM STAT- MEDLINE DCOM- 20201111 LR - 20210110 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 9 IP - 1 DP - 2019 Nov 27 TI - Platelet-derived- Extracellular Vesicles Promote Hemostasis and Prevent the Development of Hemorrhagic Shock. PG - 17676 LID - 10.1038/s41598-019-53724-y [doi] LID - 17676 AB - Every year more than 500,000 deaths are attributed to trauma worldwide and severe hemorrhage is present in most of them. Transfused platelets have been shown to improve survival in trauma patients, although its mechanism is only partially known. Platelet derived-extracellular vesicles (PEVs) are small vesicles released from platelets upon activation and/or mechanical stimulation and many of the benefits attributed to platelets could be mediated through PEVs. Based on the available literature, we hypothesized that transfusion of human PEVs would promote hemostasis, reduce blood loss and attenuate the progression to hemorrhagic shock following severe trauma. In this study, platelet units from four different donors were centrifuged to separate platelets and PEVs. The pellets were washed to obtain plasma-free platelets to use in the rodent model. The supernatant was subjected to tangential flow filtration for isolation and purification of PEVs. PEVs were assessed by total count and particle size distribution by Nanoparticle Tracking Analysis (NTA) and characterized for cells of origin and expression of EV specific-surface and cytosolic markers by flow cytometry. The coagulation profile from PEVs was assessed by calibrated automated thrombography (CAT) and thromboelastography (TEG). A rat model of uncontrolled hemorrhage was used to compare the therapeutic effects of 8.7 x 10(8) fresh platelets (FPLT group, n = 8), 7.8 x 10(9) PEVs (PEV group, n = 8) or Vehicle (Control, n = 16) following severe trauma. The obtained pool of PEVs from 4 donors had a mean size of 101 +/- 47 nm and expressed the platelet-specific surface marker CD41 and the EV specific markers CD9, CD61, CD63, CD81 and HSP90. All PEV isolates demonstrated a dose-dependent increase in the rate and amount of thrombin generated and overall clot strength. In vivo experiments demonstrated a 24% reduction in abdominal blood loss following liver trauma in the PEVs group when compared with the control group (9.9 +/- 0.4 vs. 7.5 +/- 0.5 mL, p < 0.001>). The PEV group also exhibited improved outcomes in blood pressure, lactate level, base excess and plasma protein concentration compared to the Control group. Fresh platelets failed to improve these endpoints when compared to Controls. Altogether, these results indicate that human PEVs provide pro-hemostatic support following uncontrolled bleeding. As an additional therapeutic effect, PEVs improve the outcome following severe trauma by maintaining hemodynamic stability and attenuating the development of ischemia, base deficit, and cardiovascular shock. FAU - Lopez, Ernesto AU - Lopez E AUID- ORCID: 0000-0003-3211-0098 AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. jose.e.lopezvalencia@uth.tmc.edu. FAU - Srivastava, Amit K AU - Srivastava AK AD - Department of Pediatric Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA. FAU - Burchfield, John AU - Burchfield J AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. FAU - Wang, Yao-Wei AU - Wang YW AUID- ORCID: 0000-0001-8784-1854 AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. FAU - Togarrati, Padma Priya AU - Togarrati PP AD - Vitalant Research Institute, San Francisco, CA, USA. FAU - Miyazawa, Byron AU - Miyazawa B AD - Department of Laboratory Medicine, University of California, San Francisco, CA, USA. FAU - Gonzalez, Erika AU - Gonzalez E AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. FAU - Pati, Shibani AU - Pati S AD - Department of Laboratory Medicine, University of California, San Francisco, CA, USA. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center at Houston, Houston, McGovern Medical School, Houston, TX, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191127 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Animals MH - Blood Platelets/*metabolism MH - Disease Models, Animal MH - Extracellular Vesicles/*metabolism MH - Female MH - Hemostasis/*physiology MH - Humans MH - Liver/injuries MH - Male MH - Middle Aged MH - Platelet Transfusion/*methods MH - Rats MH - Rats, Sprague-Dawley MH - Shock, Hemorrhagic/prevention & control/*therapy MH - Thrombelastography/methods MH - Thrombin/metabolism MH - Young Adult PMC - PMC6881357 COIS- The authors declare no competing interests. EDAT- 2019/11/30 06:00 MHDA- 2020/11/12 06:00 PMCR- 2019/11/27 CRDT- 2019/11/29 06:00 PHST- 2019/01/07 00:00 [received] PHST- 2019/11/04 00:00 [accepted] PHST- 2019/11/29 06:00 [entrez] PHST- 2019/11/30 06:00 [pubmed] PHST- 2020/11/12 06:00 [medline] PHST- 2019/11/27 00:00 [pmc-release] AID - 10.1038/s41598-019-53724-y [pii] AID - 53724 [pii] AID - 10.1038/s41598-019-53724-y [doi] PST - epublish SO - Sci Rep. 2019 Nov 27;9(1):17676. doi: 10.1038/s41598-019-53724-y. PMID- 31761396 OWN - NLM STAT- MEDLINE DCOM- 20200508 LR - 20200508 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 167 IP - 2 DP - 2020 Feb TI - Early intravenous administration of tranexamic acid ameliorates intestinal barrier injury induced by neutrophil extracellular traps in a rat model of trauma/hemorrhagic shock. PG - 340-351 LID - S0039-6060(19)30730-5 [pii] LID - 10.1016/j.surg.2019.10.009 [doi] AB - BACKGROUND: Early intravenous administration of tranexamic acid has been shown to protect the intestinal barrier after a model of trauma-hemorrhagic shock in the rat, but the potential mechanism remains unclear. Our previous studies have demonstrated that neutrophil extracellular traps contribute to the intestinal barrier dysfunction during sepsis and other critical conditions. Meanwhile, there are high levels of neutrophil infiltration in the intestine during trauma-hemorrhagic shock. Here, we hypothesized that neutrophil extracellular trap formation played a vital role during trauma-hemorrhagic shock-induced intestinal injury and that tranexamic acid, a serine protease inhibitor, may inhibit neutrophil extracellular trap formation and protect intestinal barrier function in trauma-hemorrhagic shock. METHODS: A model of trauma-hemorrhagic shock in male rats was established. The rats were divided into 6 groups: (1) sham group; (2) trauma-hemorrhagic shock group; (3) trauma-hemorrhagic shock + DNase I group; (4) trauma-hemorrhagic shock + tranexamic acid group; (5) trauma-hemorrhagic shock + tranexamic acid (different time) group; and (6) trauma-hemorrhagic shock + tranexamic acid (different doses) group. The DNase I solution was injected intravenously to disrupt neutrophil extracellular traps immediately after the trauma-hemorrhagic shock model was completed. After 24 hours, the small intestine and blood were collected for analysis. Human neutrophils were harvested and incubated with phorbol-12-myristate-13-acetate or tranexamic acid, generation of reactive oxygen species, and key proteins expression were detected. RESULTS: Trauma-hemorrhagic shock induced the formation of intestinal neutrophil extracellular traps and disrupted the intestinal tight junction proteins. Clearing of neutrophil extracellular traps by DNase I resulted in increased expression of tight junction proteins and alleviated the intestinal injury. Early intravenous tranexamic acid administration (1 hour after trauma-hemorrhagic shock) decreased neutrophil extracellular trap formation and prevented tight junction protein disruption compared to the non-tranexamic acid group; however, after delayed administration of tranexamic acid (6 hours), there were no changes in neutrophil extracellular trap formation and intestinal injuries compared to the non-tranexamic acid group. Furthermore, tranexamic acid inhibited neutrophil extracellular trap formation and protected the intestinal barrier in a dose-dependent manner and high-dose (20 mg/kg) treatment of tranexamic acid showed a better effect compared with the therapeutic dose (10 mg/kg). The results of thromboelastography demonstrated that the R and K values in the high-dose group decreased (R, 1.85 +/- 0.14 vs 3.87 +/- 0.16 minutes, P < .001; K, 0.95 +/- 0.04 vs 1.48 +/- 0.07 minutes, P < .001), accompanied by a decrease in LY30, indicating that treatment with a high dose of tranexamic acid may cause hypercoagulability and shutdown of fibrinolysis. In addition, less neutrophil extracellular trap formation was detected in neutrophils incubated with neutrophils via an reactive oxygen species-dependent pathway. CONCLUSION: We first demonstrated a novel role of neutrophil extracellular traps in the pathophysiology of intestinal barrier dysfunction during trauma-hemorrhagic shock. Notably, early but not delayed intravenous administration of tranexamic acid effectively inhibits neutrophil extracellular trap formation and protects intestinal barrier function. Therefore, these results suggested a potential theoretic intervention for the protection of the intestinal barrier during trauma-hemorrhagic shock. In such a process, tranexamic acid appears to regulate neutrophil extracellular trap formation via the classic reactive oxygen species/mitogen-activated protein kinase pathway. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Chu, Chengnan AU - Chu C AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Yang, Chao AU - Yang C AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Wang, Xinyu AU - Wang X AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Xie, Tian AU - Xie T AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Sun, Shilong AU - Sun S AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Liu, Baochen AU - Liu B AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Wang, Kai AU - Wang K AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Duan, Zehua AU - Duan Z AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. FAU - Ding, Weiwei AU - Ding W AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. Electronic address: dingwei_nju@hotmail.com. FAU - Li, Jieshou AU - Li J AD - Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191121 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Animals MH - Antifibrinolytic Agents/*administration & dosage MH - Cells, Cultured MH - Drug Evaluation, Preclinical MH - Extracellular Traps/*drug effects MH - Humans MH - Intestinal Diseases/etiology/*prevention & control MH - Intestinal Mucosa/*drug effects/injuries MH - MAP Kinase Signaling System/drug effects MH - Male MH - Neutrophils/drug effects MH - Random Allocation MH - Rats, Sprague-Dawley MH - Shock, Hemorrhagic/*complications MH - Tranexamic Acid/*administration & dosage EDAT- 2019/11/26 06:00 MHDA- 2020/05/10 06:00 CRDT- 2019/11/26 06:00 PHST- 2019/06/22 00:00 [received] PHST- 2019/09/29 00:00 [revised] PHST- 2019/10/14 00:00 [accepted] PHST- 2019/11/26 06:00 [pubmed] PHST- 2020/05/10 06:00 [medline] PHST- 2019/11/26 06:00 [entrez] AID - S0039-6060(19)30730-5 [pii] AID - 10.1016/j.surg.2019.10.009 [doi] PST - ppublish SO - Surgery. 2020 Feb;167(2):340-351. doi: 10.1016/j.surg.2019.10.009. Epub 2019 Nov 21. PMID- 31743167 OWN - NLM STAT- MEDLINE DCOM- 20200413 LR - 20240229 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 129 IP - 6 DP - 2019 Dec TI - Viscoelastic Signals for Optimal Resuscitation in Trauma: Kaolin Thrombelastography Cutoffs for Diagnosing Hypofibrinogenemia (VISOR Study). PG - 1482-1491 LID - 10.1213/ANE.0000000000004315 [doi] AB - BACKGROUND: Acute traumatic coagulopathy is common in trauma patients. Prompt diagnosis of hypofibrinogenemia allows for early treatment with cryoprecipitate or fibrinogen concentrate. At present, optimal cutoffs for diagnosing hypofibrinogenemia with kaolin thrombelastography (TEG) have not been established. We hypothesized that kaolin kaolin-TEG parameters, such as kinetic time (K-time), alpha-angle, and maximum amplitude (MA), would accurately diagnose hypofibrinogenemia (fibrinogen <200 mg/dL) and severe hypofibrinogenemia (fibrinogen <100 mg/dL). METHODS: Adult trauma patients (injury severity score >15) presenting to our trauma center between October 2015 and October 2017 were identified retrospectively. All patients had a traditional plasma fibrinogen measurement and kaolin-TEG performed within 15 minutes of each other and within 1 hour of admission. Some patients had additional measurements after. Receiver operating characteristic (ROC) curve analysis was performed to evaluate whether K-time, alpha-angle, and MA could diagnose hypofibrinogenemia and severe hypofibrinogenemia. Area under the ROC curve (AUROC) was calculated for each TEG parameter with a bootstrapped 99% confidence interval (CI). Further, ROC analysis was used to estimate ideal cutoffs for diagnosing hypofibrinogenemia and severe hypofibrinogenemia by maximizing sensitivity and specificity. In addition, likelihood ratios were also calculated for different TEG variable cutoffs to diagnose hypofibrinogenemia and severe hypofibrinogenemia. RESULTS: Seven hundred twenty-two pairs of TEGs and traditional plasma fibrinogen measurements were performed in 623 patients with 99 patients having additional pairs of tests after the first hour. MA (AUROC = 0.84) and K-time (AUROC = 0.83) better diagnosed hypofibrinogenemia than alpha-angle (AUROC = 0.8; P = .03 and P < .001 for AUROC comparisons, respectively). AUROCs statistically improved for each parameter when severe hypofibrinogenemia was modeled as the outcome (P < .001). No differences were found between parameters for diagnosing severe hypofibrinogenemia (P > .05 for all comparisons). The estimated optimal cutoffs for diagnosing hypofibrinogenemia were 1.5 minutes for K-time (95% CI, 1.4-1.6), 70.0 degrees for alpha-angle (95% CI, 69.8-71.0), and 60.9 mm for MA (95% CI, 59.2-61.8). The estimated optimal cutoffs for diagnosing severe hypofibrinogenemia were 2.4 minutes for K-time (95% CI, 1.7-2.8), 60.6 degrees for alpha-angle (95% CI, 57.2-67.3), and 51.2 mm for MA (95% CI, 49.0-56.2). Currently recommended K-time and alpha-angle cutoffs from the American College of Surgeons had low sensitivity for diagnosing hypofibrinogenemia (3%-29%), but sensitivity improved to 74% when using optimal cutoffs. CONCLUSIONS: Kaolin-TEG parameters can accurately diagnose hypofibrinogenemia and severe hypofibrinogenemia in trauma patients. Currently recommended cutoffs for the treatment of hypofibrinogenemia are skewed toward high specificity and low sensitivity. Many patients are likely to be undertreated for hypofibrinogenemia using current national guidelines. FAU - Chow, Jonathan H AU - Chow JH AD - From the Department of Anesthesiology, Division of Critical Care, University of Maryland School of Medicine, Baltimore, Maryland. FAU - Richards, Justin E AU - Richards JE FAU - Morrison, Jonathan J AU - Morrison JJ FAU - Galvagno, Samuel M Jr AU - Galvagno SM Jr FAU - Tanaka, Kenichi A AU - Tanaka KA FAU - Madurska, Marta J AU - Madurska MJ FAU - Rock, Peter AU - Rock P FAU - Scalea, Thomas M AU - Scalea TM FAU - Mazzeffi, Michael A AU - Mazzeffi MA LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Biomarkers) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Afibrinogenemia/blood/complications/*diagnosis/*therapy MH - Biomarkers/blood MH - *Blood Coagulation MH - Clinical Decision-Making MH - Early Diagnosis MH - Female MH - Fibrinogen/*analysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Patient Selection MH - Predictive Value of Tests MH - Reproducibility of Results MH - *Resuscitation MH - Retrospective Studies MH - *Thrombelastography MH - Time Factors MH - Wounds and Injuries/blood/complications/*diagnosis/*therapy MH - Young Adult EDAT- 2019/11/20 06:00 MHDA- 2020/04/14 06:00 CRDT- 2019/11/20 06:00 PHST- 2019/11/20 06:00 [entrez] PHST- 2019/11/20 06:00 [pubmed] PHST- 2020/04/14 06:00 [medline] AID - 00000539-201912000-00012 [pii] AID - 10.1213/ANE.0000000000004315 [doi] PST - ppublish SO - Anesth Analg. 2019 Dec;129(6):1482-1491. doi: 10.1213/ANE.0000000000004315. PMID- 31738314 OWN - NLM STAT- MEDLINE DCOM- 20200214 LR - 20260307 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 88 IP - 2 DP - 2020 Feb TI - A comparison between the TEG 6s and TEG 5000 analyzers to assess coagulation in trauma patients. PG - 279-285 LID - 10.1097/TA.0000000000002545 [doi] AB - BACKGROUND: Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS: Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn 84.5 sec (p = 0.049), decreased EXTEM amplitude at 10 minutes (A10) <43.5 mm (p = 0.025), and decreased EXTEM maximal clot firmness (MCF) <64.5 mm (p = 0.026) were associated with need for blood product transfusion. Additionally, EXTEM CT longer than 68.5 seconds was associated with mortality or disability at discharge. CONCLUSION: Coagulation dysregulation on thromboelastometry is associated with disability and mortality in children. Based on our findings, we propose ROTEM thresholds: plasma transfusion for EXTEM CT longer than 84.5 seconds, fibrinogen replacement for EXTEM A10 less than 43.5 mm, and platelet transfusion for EXTEM MCF less than 64.5 mm. LEVEL OF EVIDENCE: Prognostic, Level III; Therapeutic, Level IV. FAU - Cunningham, Aaron J AU - Cunningham AJ AD - From the Department of Surgery (A.J.C.), Oregon Health and Sciences University; Trauma and Acute Care Surgical Services (M.C.), St. Charles Health System, Bend; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (M.C., M.A.S.), Oregon Health and Sciences University; Division of Pediatric Surgery (K.A., N.A.H., M.A.J.), Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, OR; Trauma Services (K.D., W.B.L.), Legacy Emanuel Medical Center; Department of Anesthesiology (B.G.M.), Randall Children's Hospital at Legacy Emanuel; and Division of Pediatric Surgery (M.A.J.), Randall Children's Hospital at Legacy Emanuel, Portland, Oregon. FAU - Condron, Mary AU - Condron M FAU - Schreiber, Martin A AU - Schreiber MA FAU - Azarow, Kenneth AU - Azarow K FAU - Hamilton, Nicholas A AU - Hamilton NA FAU - Downie, Katie AU - Downie K FAU - Long, William B AU - Long WB FAU - Maxwell, Bryan G AU - Maxwell BG FAU - Jafri, Mubeen A AU - Jafri MA LA - eng PT - Evaluation Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Blood Coagulation Disorders/*diagnosis/etiology/mortality/therapy MH - Blood Component Transfusion/methods/*standards/statistics & numerical data MH - Child MH - Clinical Decision-Making MH - Female MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Practice Guidelines as Topic MH - Predictive Value of Tests MH - Prognosis MH - ROC Curve MH - Retrospective Studies MH - Thrombelastography/*methods MH - Trauma Centers/statistics & numerical data MH - Treatment Outcome MH - Wounds and Injuries/*complications/diagnosis/mortality/therapy EDAT- 2019/11/07 06:00 MHDA- 2020/06/25 06:00 CRDT- 2019/11/06 06:00 PHST- 2019/11/07 06:00 [pubmed] PHST- 2020/06/25 06:00 [medline] PHST- 2019/11/06 06:00 [entrez] AID - 01586154-202001000-00018 [pii] AID - 10.1097/TA.0000000000002533 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Jan;88(1):134-140. doi: 10.1097/TA.0000000000002533. PMID- 31688782 OWN - NLM STAT- MEDLINE DCOM- 20200624 LR - 20210210 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 88 IP - 1 DP - 2020 Jan TI - Desmopressin is a transfusion sparing option to reverse platelet dysfunction in patients with severe traumatic brain injury. PG - 80-86 LID - 10.1097/TA.0000000000002521 [doi] AB - BACKGROUND: Platelet dysfunction (PD) is an independent predictor of mortality in patients with severe traumatic brain injury (sTBI). Platelet transfusions (PLTs) have been shown to be an effective treatment strategy to reverse platelet inhibition. Their use is contingent on availability and may be associated with increased cost and transfusion-related complications, making desmopressin (DDAVP) attractive. We hypothesized that DDAVP would correct PD similarly to PLTs in patients with sTBI. METHODS: This retrospective study evaluated all blunt trauma patients admitted to an urban, level 1 trauma center from July 2015 to October 2016 with sTBI (defined as head abbreviated injury scale [AIS] >/=3) and PD (defined as adenosine diphosphate [ADP] inhibition >/=60% on thromboelastography) and subsequently received treatment. Per our institutional practice, patients with sTBI and PD are transfused one unit of apheresis platelets to reverse inhibition. During a platelet shortage, we interchanged DDAVP for the initial treatment. Patients were classified as receiving DDAVP or PLT based on the initial treatment. RESULTS: A total of 57 patients were included (DDAVP, n = 23; PLT, n = 34). Patients who received DDAVP were more severely injured (injury severity score, 29 vs. 23; p = 0.045), but there was no difference in head AIS (4 vs. 4, p = 0.16). There was no difference between the two groups in admission platelet count (244 +/- 68 x 10/muL vs. 265 +/- 66 x 10/muL, p = 0.24) or other coagulation parameters such as prothrombin time, partial thromboplastin time, or international normalized ratio. Before treatment, both groups had similar ADP inhibition as measured by thromboelastography (ADP, 86% vs. 89%, p = 0.34). After treatment, both the DDAVP and PLT groups had similar correction of platelet ADP inhibition (p = 0.28). CONCLUSION: In patients with severe traumatic brain injury and PD, DDAVP may be an alternative to PLTs to correct PD. LEVEL OF EVIDENCE: Therapeutic, level IV. FAU - Furay, Elisa J AU - Furay EJ AD - From the Department of Surgery and Perioperative Care, Dell Seton Medical Center (E.J.F., M.J.D., P.S., S.L., J.D.A., P.G.T., T.B.C., S.A., C.V.R.B.), University of Texas, Austin, Texas. FAU - Daley, Mitch J AU - Daley MJ FAU - Satarasinghe, Praveen AU - Satarasinghe P FAU - Lara, Sabino AU - Lara S FAU - Aydelotte, Jayson D AU - Aydelotte JD FAU - Teixeira, Pedro G AU - Teixeira PG FAU - Coopwood, Thomas B AU - Coopwood TB FAU - Ali, Sadia AU - Ali S FAU - Brown, Carlos V R AU - Brown CVR LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemostatics) RN - ENR1LLB0FP (Deamino Arginine Vasopressin) SB - IM MH - Abbreviated Injury Scale MH - Adult MH - Blood Platelet Disorders/blood/diagnosis/etiology/*therapy MH - Blood Platelets/drug effects MH - Brain Injuries, Traumatic/blood/diagnosis/etiology/*therapy MH - Deamino Arginine Vasopressin/*administration & dosage MH - Female MH - Head Injuries, Closed/blood/complications/diagnosis/*therapy MH - Hemostatics/*administration & dosage MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Platelet Transfusion/*statistics & numerical data MH - Retrospective Studies MH - Thrombelastography MH - Treatment Outcome MH - Young Adult EDAT- 2019/11/07 06:00 MHDA- 2020/06/25 06:00 CRDT- 2019/11/06 06:00 PHST- 2019/11/07 06:00 [pubmed] PHST- 2020/06/25 06:00 [medline] PHST- 2019/11/06 06:00 [entrez] AID - 01586154-202001000-00010 [pii] AID - 10.1097/TA.0000000000002521 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2020 Jan;88(1):80-86. doi: 10.1097/TA.0000000000002521. PMID- 31681912 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220411 VI - 2 IP - 1 DP - 2019 TI - Cocaine Use is Associated with More Rapid Clot Formation and Weaker Clot Strength in Acute Stroke Patients. LID - 110 [pii] AB - INTRODUCTION: 1.1.Cocaine use is a known risk factor for stroke and has been associated with worse outcomes. Cocaine may cause an altered coagulable state by a number of different proposed mechanisms, including platelet activation, endothelial injury, and tissue factor expression. This study analyzes the effect of cocaine use on Thrombelastography (TEG) in acute stroke patients. PATIENT AND METHODS: 1.2.Patients presenting with Acute Ischemic Stroke (AIS) and spontaneous Intracerebral Hemorrhage (ICH) to a single academic center between 2009 and 2014 were prospectively enrolled. Blood was collected for TEG analysis at the time of presentation. Patient demographics and baseline TEG values were compared between two groups: cocaine and non-cocaine users. Multivariable Quantile regression models were used to compare the median TEG components between groups after controlling for the effect of confounders. RESULTS: 1.3.91 patients were included, 53 with AIS and 38 with ICH. 8 (8.8%) patients were positive for cocaine, 4 (50%) with AIS, and 4 (50%) with ICH. There were no significant differences in age, blood pressure, platelet count, or PT/PTT between the cocaine positive and cocaine negative group. Following multivariable analysis, and adjusting for factors known to influence TEG including stroke subtype, cocaine use was associated with shortened median R time (time to initiate clotting) of 3.8 minutes compared to 4.8 minutes in non-cocaine users (p=0.04). Delta (thrombin burst) was also earlier among cocaine users (0.4 minutes) compared with non-cocaine users (0.5 min, p=0.04). The median MA and G (measurements of final clot strength) were reduced in cocaine users (MA=62.5 mm, G=7.8 dynes/cm2) compared to non-cocaine users (MA=66.5 mm, G=10.1 dynes/cm2; p=0.047, p=0.04, respectively). CONCLUSION: 1.4.Cocaine users demonstrate more rapid clot formation but reduced overall clot strength based on admission TEG values. FAU - Almaghrabi, Tareq S AU - Almaghrabi TS AD - Department of Internal Medicine, University of Tabuk, Tabuk, Saudi Arabia. FAU - McDonald, Mark M AU - McDonald MM AD - Department of Neurology, University of Virginia School of Medicine, Virginia, USA. FAU - Cai, Chunyan AU - Cai C AD - Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA. FAU - Rahbar, Mohammed H AU - Rahbar MH AD - Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA. FAU - Choi, H Alex AU - Choi HA AD - Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA. FAU - Lee, Kiwon AU - Lee K AD - Department of Neurology, Robert Wood Johnson Medical School, New Jersey, USA. FAU - Naval, Neeraj S AU - Naval NS AD - Department of Neurosurgery, Baptist Medical Center, Florida, USA. FAU - Grotta, James C AU - Grotta JC AD - Department of Neurology, Memorial Hermann Hospital, Texas, USA. FAU - Chang, Tiffany R AU - Chang TR AD - Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA. LA - eng GR - UL1 TR000371/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20190118 PL - United States TA - Int J Cerebrovasc Dis Stroke JT - International journal of cerebrovascular disease and stroke JID - 101740388 PMC - PMC6824539 MID - NIHMS1006997 OTO - NOTNLM OT - Coagulation OT - Cocaine OT - Intracerebral Hemorrhage OT - Ischemic Stroke OT - Thrombelastography COIS- Conflicts of Interest The authors declare no conflicts of interest. EDAT- 2019/11/05 06:00 MHDA- 2019/11/05 06:01 PMCR- 2019/11/01 CRDT- 2019/11/05 06:00 PHST- 2019/11/05 06:00 [entrez] PHST- 2019/11/05 06:00 [pubmed] PHST- 2019/11/05 06:01 [medline] PHST- 2019/11/01 00:00 [pmc-release] AID - 110 [pii] PST - ppublish SO - Int J Cerebrovasc Dis Stroke. 2019;2(1):110. Epub 2019 Jan 18. PMID- 31681282 OWN - NLM STAT- MEDLINE DCOM- 20201029 LR - 20201029 IS - 1664-3224 (Electronic) IS - 1664-3224 (Linking) VI - 10 DP - 2019 TI - Trauma Induces Interleukin-17A Expression on Th17 Cells and CD4+ Regulatory T Cells as Well as Platelet Dysfunction. PG - 2389 LID - 10.3389/fimmu.2019.02389 [doi] LID - 2389 AB - Background: The organism's immune response to trauma is distinctively controlled, its dysregulation leading to severe post-traumatic complications. Platelets, CD4+ regulatory T cells (CD4+ Tregs) and T helper 17 (Th17) cells have been identified to participate in the post-traumatic immune response. Unfortunately, little is known about their exact role and potential interdependency in humans. Aims of this clinical trial were to phenotype the human immune response following injury and to identify risk factors rendering the host more susceptible to trauma induced injury. Methods: This non-interventional prospective clinical trial enrolled patients following multiple trauma, follow up was conducted for 10 days. Peripheral blood CD4+ Tregs and Th17 cells were analyzed using flow cytometry to determine Interleukin 17A (IL-17A) expression. Hemostasis and platelet function were assessed with rotational thromboelastometry (ROTEM((R))). Subgroup analysis was conducted for the factors gender, age, and trauma severity. Results and Conclusion: This is the first clinical trial to phenotype the immune response following trauma, focusing on platelets, and the adaptive immune response. We discovered a novel increased IL-17A expression on Th17 cells and on CD4+ Tregs following trauma and describe the kinetics of the immune response. The IL-17A response on CD4+ Tregs challenges the ascribed role of CD4+ Tregs to be solely counter inflammatory in this setting. Furthermore, despite a rising number of platelets, ROTEM analysis shows post-traumatic platelet dysfunction. Subgroup analysis revealed gender, age, and trauma severity as influencing factors for several of the analyzed parameters. CI - Copyright (c) 2019 Hefele, Ditsch, Krysiak, Caldwell, Biberthaler, van Griensven, Huber-Wagner and Hanschen. FAU - Hefele, Friederike AU - Hefele F AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. AD - Division of Oncology and Hematology (CCM), Medical Department, Charite-Universitatsmedizin Berlin, Berlin, Germany. FAU - Ditsch, Alexander AU - Ditsch A AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Krysiak, Niels AU - Krysiak N AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. AD - Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany. FAU - Caldwell, Charles C AU - Caldwell CC AD - Division of Research, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. AD - Division of Research, Shriners Hospital for Children, Cincinnati, OH, United States. FAU - Biberthaler, Peter AU - Biberthaler P AD - Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - van Griensven, Martijn AU - van Griensven M AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Huber-Wagner, Stefan AU - Huber-Wagner S AD - Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Hanschen, Marc AU - Hanschen M AD - Experimental Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. AD - Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. LA - eng PT - Clinical Trial PT - Journal Article DEP - 20191011 PL - Switzerland TA - Front Immunol JT - Frontiers in immunology JID - 101560960 RN - 0 (IL17A protein, human) RN - 0 (Interleukin-17) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Blood Platelets/*immunology/pathology MH - Female MH - Gene Expression Regulation/*immunology MH - Humans MH - Interleukin-17/*immunology MH - Male MH - Middle Aged MH - Multiple Trauma/*immunology/pathology MH - Prospective Studies MH - Sex Factors MH - T-Lymphocytes, Regulatory/*immunology/pathology MH - Th17 Cells/*immunology/pathology MH - Thrombelastography PMC - PMC6797820 OTO - NOTNLM OT - CD4+ regulatory T cells OT - IL-17A OT - T helper 17 cells OT - flow cytometry OT - hemostasis OT - thromboelastometry OT - trauma EDAT- 2019/11/05 06:00 MHDA- 2020/10/30 06:00 PMCR- 2019/01/01 CRDT- 2019/11/05 06:00 PHST- 2019/03/05 00:00 [received] PHST- 2019/09/23 00:00 [accepted] PHST- 2019/11/05 06:00 [entrez] PHST- 2019/11/05 06:00 [pubmed] PHST- 2020/10/30 06:00 [medline] PHST- 2019/01/01 00:00 [pmc-release] AID - 10.3389/fimmu.2019.02389 [doi] PST - epublish SO - Front Immunol. 2019 Oct 11;10:2389. doi: 10.3389/fimmu.2019.02389. eCollection 2019. PMID- 31668435 OWN - NLM STAT- MEDLINE DCOM- 20200226 LR - 20210201 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 246 DP - 2020 Feb TI - A Novel Platelet Function Assay for Trauma. PG - 605-613 LID - S0022-4804(19)30697-3 [pii] LID - 10.1016/j.jss.2019.09.052 [doi] AB - BACKGROUND: Platelet function tests such as thrombelastography platelet mapping and impedance aggregometry have demonstrated universal platelet dysfunction in trauma patients. In this study, we introduce the measurement of platelet contraction force as a test of platelet function. We hypothesize that force will correlate with established coagulation tests such as thrombelastography, demonstrate significant differences between healthy subjects and trauma patients, and identify critically ill trauma patients. METHODS: Blood samples were prospectively collected from level 1 trauma patients at initial presentation, assayed for force of and time to contraction and compared with thrombelastography. Blood from healthy subjects was assayed to establish a reference range. Results from trauma patients were compared with healthy controls and trauma patients that died. RESULTS: The study includes one hundred trauma patients with mean age 45 y, 74% were male, and median injury severity score of 14 +/- 12. Patients that survived (n = 90) demonstrated significantly elevated platelet contraction force compared with healthy controls (n = 12) (6390 +/- 2340 versus 4790 +/- 470 muN, P = 0.043) and trauma patients that died (n = 10) (6390 +/- 2340 versus 2860 +/- 1830 muN, P = 0.0001). Elapsed time to start of platelet contraction was faster in trauma patients that survived compared with healthy controls (660 +/- 467 versus 1130 +/- 140 s, P = 0.0022) and those that died (660 +/- 470 versus 1460 +/- 1340 s, P < 0.0001). CONCLUSIONS: In contrast with all existing platelet function tests reported in the literature, which report platelet dysfunction in trauma patients, contractile force demonstrates hyperfunction in surviving trauma patients and dysfunction in nonsurvivors. Platelet contraction reflects platelet metabolic reserve and thus may be a potential biomarker for survival after trauma. Contractile force warrants further investigation to predict mortality in severely injured trauma patients. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - George, Mitchell J AU - George MJ AD - Department of Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas. Electronic address: Mitchell.J.George@uth.tmc.edu. FAU - Aroom, Kevin R AU - Aroom KR AD - Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas. FAU - Cox, Charles S Jr AU - Cox CS Jr AD - Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas. FAU - Gill, Brijesh S AU - Gill BS AD - Department of Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural DEP - 20191023 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/physiology MH - Blood Platelet Disorders/blood/*diagnosis/etiology/physiopathology MH - Blood Platelets/*physiology MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Platelet Function Tests/methods MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies MH - ROC Curve MH - Thrombelastography MH - Wounds and Injuries/blood/*complications/diagnosis/mortality MH - Young Adult PMC - PMC6941788 MID - NIHMS1543768 OTO - NOTNLM OT - Mortality OT - Platelet contraction OT - Thrombelastography EDAT- 2019/11/02 06:00 MHDA- 2020/02/27 06:00 PMCR- 2021/02/01 CRDT- 2019/11/01 06:00 PHST- 2019/05/27 00:00 [received] PHST- 2019/09/02 00:00 [revised] PHST- 2019/09/20 00:00 [accepted] PHST- 2019/11/02 06:00 [pubmed] PHST- 2020/02/27 06:00 [medline] PHST- 2019/11/01 06:00 [entrez] PHST- 2021/02/01 00:00 [pmc-release] AID - S0022-4804(19)30697-3 [pii] AID - 10.1016/j.jss.2019.09.052 [doi] PST - ppublish SO - J Surg Res. 2020 Feb;246:605-613. doi: 10.1016/j.jss.2019.09.052. Epub 2019 Oct 23. PMID- 33329765 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201218 IS - 1975-5171 (Print) IS - 2383-7977 (Electronic) IS - 1975-5171 (Linking) VI - 14 IP - 4 DP - 2019 Oct 31 TI - Coagulation abnormalities and bleeding in pregnancy: an anesthesiologist's perspective. PG - 371-379 LID - 10.17085/apm.2019.14.4.371 [doi] AB - During pregnancy, the procoagulant activity increases (manifested by elevation in factor VII, factor VIII, factor X, and fibrinogen levels), while the anticoagulant activity decreases (characterized by reduction in fibrinolysis and protein S activity), resulting in hypercoagulation. Standard coagulation tests, such as prothrombin time or activated partial thromboplastin time, are still used despite the lack of evidence supporting its accuracy in evaluating the coagulation status of pregnant women. Thromboelastography and rotational thromboelastometry, which are used to assess the function of platelets, soluble coagulation factors, fibrinogen, and fibrinolysis, can replace standard coagulation tests. Platelet count and function and the effect of anticoagulant treatment should be assessed to determine the risk of hematoma associated with regional anesthesia. Moreover, anesthesiologists should monitor patients for postpartum hemorrhage (PPH), and attention should be paid when performing rapid coagulation tests, transfusions, and prohemostatic pharmacotherapy. Transfusion of a high ratio of plasma and platelets to red blood cells (RBCs) showed high hemostasis success and low bleeding-related mortality rates in patients with severe trauma. However, the effects of high ratios of plasma and platelets and the ratio of plasma to RBCs and platelets to RBCs in the treatment of massive PPH were not established. Intravenous tranexamic acid should be administered immediately after the onset of postpartum bleeding. Pre-emptive treatment with fibrinogen for PPH is not effective in reducing bleeding. If fibrinogen levels of less than 2 g/L are identified, 2-4 g of fibrinogen or 5-10 ml/kg cryoprecipitate should be administered. CI - Copyright: (c) Anesthesia and Pain Medicine. FAU - Yoon, Hea-Jo AU - Yoon HJ AUID- ORCID: 0000-0003-2180-4940 AD - Department of Anesthesiology and Pain Medicine, Ilsan Jeil Hospital, Goyang, Korea. LA - eng PT - Journal Article PT - Review PL - Korea (South) TA - Anesth Pain Med (Seoul) JT - Anesthesia and pain medicine JID - 101517708 PMC - PMC7713810 OTO - NOTNLM OT - Blood transfusion OT - Conduction anesthesia OT - Fibrinogen OT - Postpartum hemorrhage OT - Tranexamic acid COIS- CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported. EDAT- 2019/10/31 00:00 MHDA- 2019/10/31 00:01 PMCR- 2019/10/31 CRDT- 2020/12/17 05:51 PHST- 2019/09/10 00:00 [received] PHST- 2019/10/01 00:00 [accepted] PHST- 2020/12/17 05:51 [entrez] PHST- 2019/10/31 00:00 [pubmed] PHST- 2019/10/31 00:01 [medline] PHST- 2019/10/31 00:00 [pmc-release] AID - APM-14-371 [pii] AID - 10.17085/apm.2019.14.4.371 [doi] PST - ppublish SO - Anesth Pain Med (Seoul). 2019 Oct 31;14(4):371-379. doi: 10.17085/apm.2019.14.4.371. PMID- 31630825 OWN - NLM STAT- MEDLINE DCOM- 20200309 LR - 20200309 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 218 IP - 6 DP - 2019 Dec TI - An evaluation of blood product utilization rates with massive transfusion protocol: Before and after thromboelastography (TEG) use in trauma. PG - 1175-1180 LID - S0002-9610(19)30425-8 [pii] LID - 10.1016/j.amjsurg.2019.08.027 [doi] AB - PURPOSE: The purpose of this study was to determine if thromboelastography (TEG) is associated with reduced blood product utilization for trauma patients undergoing massive transfusion protocol (MTP) compared to traditional coagulation tests. METHODS: A retrospective review was conducted on an intent-to-treat basis of trauma patients undergoing MTP (Pre-TEG = Period I vs. Post-TEG = Period II). Traditional coagulation tests guided transfusion during Period I (n = 20) and the intent was that TEG guided transfusions during Period II (n = 47). Blood product administration and outcomes were compared. RESULTS: Intent-to-treat analysis demonstrated a significant reduction in red blood cell transfusions (11 vs. 6 units, P = 0.001), number of patients receiving fresh frozen plasma (85.0 vs. 17.0%, P < 0.001), and platelets (75.0 vs. 38.3%, P = 0.006) in Period II. No difference was seen between Periods I and II in ICU days (7.0 vs. 11.0 days, P = 0.073), hospital length of stay (10.5 vs. 14.0 days, P = 0.618), or mortality (55.0 vs. 31.9%, P = 0.076). CONCLUSION: Use of TEG-guided transfusion in the critically-ill trauma patient conserved blood product utilization and appears to offer similar outcomes when compared to traditional coagulation tests. CI - Copyright (c) 2019. Published by Elsevier Inc. FAU - Unruh, Mitchell AU - Unruh M AD - Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA. FAU - Reyes, Jared AU - Reyes J AD - Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA. FAU - Helmer, Stephen D AU - Helmer SD AD - Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA; Department of Medical Education, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA. FAU - Haan, James M AU - Haan JM AD - Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA; Department of Trauma Services, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA. Electronic address: James.Haan.Research@viachristi.org. LA - eng PT - Comparative Study PT - Journal Article DEP - 20190910 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Blood Coagulation Tests MH - Blood Transfusion/*statistics & numerical data MH - Clinical Protocols MH - Female MH - Humans MH - Intention to Treat Analysis MH - Male MH - Middle Aged MH - Registries MH - Retrospective Studies MH - *Thrombelastography MH - *Utilization Review MH - Wounds and Injuries/*therapy OTO - NOTNLM OT - Massive transfusion protocol OT - Thromboelastography OT - Trauma EDAT- 2019/10/22 06:00 MHDA- 2020/03/10 06:00 CRDT- 2019/10/22 06:00 PHST- 2019/03/20 00:00 [received] PHST- 2019/08/27 00:00 [revised] PHST- 2019/08/30 00:00 [accepted] PHST- 2019/10/22 06:00 [pubmed] PHST- 2020/03/10 06:00 [medline] PHST- 2019/10/22 06:00 [entrez] AID - S0002-9610(19)30425-8 [pii] AID - 10.1016/j.amjsurg.2019.08.027 [doi] PST - ppublish SO - Am J Surg. 2019 Dec;218(6):1175-1180. doi: 10.1016/j.amjsurg.2019.08.027. Epub 2019 Sep 10. PMID- 31630507 OWN - NLM STAT- MEDLINE DCOM- 20200915 LR - 20200915 IS - 1827-1596 (Electronic) IS - 0375-9393 (Linking) VI - 85 IP - 12 DP - 2019 Dec TI - Comparison between thromboelastography and thromboelastometry. PG - 1346-1356 LID - 10.23736/S0375-9393.19.13687-5 [doi] AB - Two of the most commonly used viscoelastic hemostatic assays, thromboelastometry (ROTEM) and thrombelastography (TEG), have proven to decrease allogenic blood transfusions with cost reduction and possibly decrease mortality and morbidity in cardiac, trauma, and other bleeding patients. This article compares the two devices to provide guidance on the selection and use of these monitoring systems. Their second-generation assays, TEG 6S and ROTEM Sigma, are also discussed. FAU - Sakai, Tetsuro AU - Sakai T AD - Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA - sakait@upmc.edu. LA - eng PT - Comparative Study PT - Journal Article PT - Review DEP - 20191014 PL - Italy TA - Minerva Anestesiol JT - Minerva anestesiologica JID - 0375272 RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Minerva Anestesiol. 2019 Dec;85(12):1262-1264. doi: 10.23736/S0375-9393.19.14248-4. PMID: 31854178 MH - Fibrinogen/analysis MH - Fibrinolysis MH - Hemostatic Techniques MH - Humans MH - Thrombelastography/*methods MH - Thrombosis/diagnosis EDAT- 2019/10/22 06:00 MHDA- 2020/09/17 06:00 CRDT- 2019/10/22 06:00 PHST- 2019/10/22 06:00 [pubmed] PHST- 2020/09/17 06:00 [medline] PHST- 2019/10/22 06:00 [entrez] AID - S0375-9393.19.13687-5 [pii] AID - 10.23736/S0375-9393.19.13687-5 [doi] PST - ppublish SO - Minerva Anestesiol. 2019 Dec;85(12):1346-1356. doi: 10.23736/S0375-9393.19.13687-5. Epub 2019 Oct 14. PMID- 31618457 OWN - NLM STAT- MEDLINE DCOM- 20200608 LR - 20200608 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 59 IP - 11 DP - 2019 Nov TI - Effect of storage of plasma in the presence of red blood cells and platelets: re-evaluating the shelf life of whole blood. PG - 3468-3477 LID - 10.1111/trf.15549 [doi] AB - BACKGROUND: There is renewed interest in administering whole blood (WB) for the resuscitation of patients with bleeding trauma. The shelf life of WB was established decades ago based on the viability of red blood cells. However, plasma quality during WB storage is not established. STUDY DESIGN AND METHODS: White blood cell- and platelet-reduced WB (WB-PLT) was prepared using standard processes and compared to WB processed using a platelet-sparing WBC reduction (WB + PLT) filter. WB (+/- PLT) was held at 2 to 6 degrees C for 35 days alongside control units of red blood cells (RBCs) in saline, adenine, glucose, and mannitol and liquid plasma. A series of assays explored the coagulation potential and RBC quality. RESULTS: While fibrinogen and alpha2-antiplasmin remained unaffected by storage, other factors varied between components or over time at 2 to 6 degrees C. At 14 days factor V, factor VII, alpha(2) -antiplasmin and free protein S antigen remained on average greater than 0.50 IU/mL or 50%, as appropriate, in WB +/- PLT. Factor VIII was on average 0.49 IU/mL in WB+PLT, and 0.56 IU/mL for WB-PLT. Free protein S activity decreased significantly in all arms but remained on average greater than 40% at Day 14. Contact activation was not demonstrated before Day 14. Thrombin generation in plasma remained relatively stable to Day 35 in all arms. CONCLUSIONS: Clotting factor activity remained at or above a mean of 0.5 IU/mL, or 50%, at Day 14 for factor V, factor VII, factor VIII, free protein S, fibrinogen, and alpha2-antiplasmin in all arms. Further data on platelet function in WB+PLT is needed to inform its shelf life. CI - (c) 2019 AABB. FAU - Huish, Sian AU - Huish S AUID- ORCID: 0000-0002-5611-554X AD - NHS Blood and Transplant, Cambridge, UK. FAU - Green, Laura AU - Green L AD - NHS Blood and Transplant, London, UK. AD - Barts Health NHS Trust, London, UK. AD - Blizard Institute, Queen Mary University of London, London, UK. FAU - Curnow, Elinor AU - Curnow E AD - NHS Blood and Transplant, Bristol, UK. FAU - Wiltshire, Michael AU - Wiltshire M AD - NHS Blood and Transplant, Cambridge, UK. FAU - Cardigan, Rebecca AU - Cardigan R AD - NHS Blood and Transplant, Cambridge, UK. AD - Department of Haematology, University of Cambridge, Cambridge, UK. LA - eng PT - Journal Article DEP - 20191016 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Protein S) RN - 0 (alpha-2-Antiplasmin) RN - 8L70Q75FXE (Adenosine Triphosphate) SB - IM CIN - Transfusion. 2019 Nov;59(11):3293-3294. doi: 10.1111/trf.15579. PMID: 31696552 MH - Adenosine Triphosphate/blood MH - Blood Coagulation MH - Blood Platelets/*physiology MH - Blood Preservation/*methods MH - Blood Specimen Collection MH - Erythrocytes/*physiology MH - Humans MH - Leukocyte Reduction Procedures MH - *Plasma MH - Protein S/analysis MH - Thrombelastography MH - alpha-2-Antiplasmin/analysis EDAT- 2019/10/17 06:00 MHDA- 2020/06/09 06:00 CRDT- 2019/10/17 06:00 PHST- 2019/01/23 00:00 [received] PHST- 2019/08/13 00:00 [revised] PHST- 2019/08/15 00:00 [accepted] PHST- 2019/10/17 06:00 [pubmed] PHST- 2020/06/09 06:00 [medline] PHST- 2019/10/17 06:00 [entrez] AID - 10.1111/trf.15549 [doi] PST - ppublish SO - Transfusion. 2019 Nov;59(11):3468-3477. doi: 10.1111/trf.15549. Epub 2019 Oct 16. PMID- 31613865 OWN - NLM STAT- MEDLINE DCOM- 20200812 LR - 20240922 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 52 IP - 5 DP - 2019 Nov TI - Cardiac and Skeletal Muscle Myosin Exert Procoagulant Effects. PG - 554-555 LID - 10.1097/SHK.0000000000001426 [doi] AB - INTRODUCTION: Trauma-induced coagulopathy (TIC) and the tissue injury-provoked procoagulant profile are prevalent in severely injured patients, but their mechanisms remain unclear. Myosin, exposed by or released from tissue injury, may play a role in promoting thrombin generation and attenuating fibrinolysis. The objective of the study is to examine the effects of cardiac and skeletal muscle myosins on coagulation in whole blood using thrombelastography (TEG). MATERIALS AND METHODS: Whole blood was collected from healthy adult volunteers (n=8) and native TEGs were performed to evaluate the global coagulation response in the presence of cardiac or skeletal muscle myosin by measuring reaction (R) time (minutes), clot angle (), and maximum amplitude (MA, mm). TEG measurements were compared using paired t tests. RESULTS: Cardiac and skeletal muscle myosins decreased R, from 10.8 min to 8.0 min (P<0.0001) and 6.9 min (P =0.0007), respectively. There were no effects observed on clot propagation (angle) or clot strength (MA) with myosin addition. In the presence of tPA, both cardiac and skeletal muscle myosins shortened R from 11.1 min to 8.62 min (P=0.0245) and 7.75 min (P =0.0027), respectively), with no changes on angle or MA. CONCLUSIONS: Cardiac and skeletal muscle myosins exhibit procoagulant effects in TEG assays. These whole blood TEG results support the hypothesis that cardiac and skeletal muscle myosins may be either pro-hemostatic or prothrombotic depending on context. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado. AD - Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado. FAU - Zilberman-Rudenko, Jevgenia AU - Zilberman-Rudenko J AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California. AD - Biomedical Engineering, School of Medicine and Division of Hematology, Oregon Health and Science University, Portland, Oregon. FAU - Samuels, Jason M AU - Samuels JM AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of Colorado, Aurora, Colorado. AD - Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado, Aurora, Colorado. AD - Children's Hospital Colorado, Aurora, Colorado. AD - Vitalant Blood Center, Denver, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Griffin, John H AU - Griffin JH AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California. FAU - Deguchi, Hiroshi AU - Deguchi H AD - Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - R01 HL133728/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - R01 HL142975/HL/NHLBI NIH HHS/United States GR - F31 HL136230/HL/NHLBI NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - EC 3.6.4.1 (Myosins) SB - IM MH - Adult MH - *Blood Coagulation MH - Blood Coagulation Disorders/etiology/*metabolism/pathology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Muscle, Skeletal/*metabolism MH - Myocardium/*metabolism MH - Myosins/*metabolism MH - Wounds and Injuries/complications/*metabolism/pathology PMC - PMC6989346 MID - NIHMS1535801 COIS- Conflict of Interest Statement The authors Julia R Coleman, Jevgenia Zilberman-Rudenko, Jason M Samuels, Mitchell J Cohen, Christopher C Silliman MD PhD, Anirban Banerjee PhD, Angela Sauaia MD PhD, John H Griffin PhD, Hiroshi Deguchi MD PhD have no conflicts of interest related to this work to report. Ernest E Moore receives consumable support from Haemonetics and Instrumentation Laboratories, as well as holds a patent for the tPA-challenge TEG. EDAT- 2019/10/16 06:00 MHDA- 2020/08/13 06:00 PMCR- 2020/11/01 CRDT- 2019/10/16 06:00 PHST- 2019/10/16 06:00 [entrez] PHST- 2019/10/16 06:00 [pubmed] PHST- 2020/08/13 06:00 [medline] PHST- 2020/11/01 00:00 [pmc-release] AID - 00024382-201911000-00011 [pii] AID - 10.1097/SHK.0000000000001426 [doi] PST - ppublish SO - Shock. 2019 Nov;52(5):554-555. doi: 10.1097/SHK.0000000000001426. PMID- 31610683 OWN - NLM STAT- MEDLINE DCOM- 20210528 LR - 20210528 IS - 1369-1635 (Electronic) IS - 0953-7104 (Linking) VI - 31 IP - 6 DP - 2020 Aug 17 TI - Platelet consumption and hyperreactivity coexist in experimental traumatic hemorrhagic model. PG - 777-783 LID - 10.1080/09537104.2019.1678120 [doi] AB - INTRODUCTION: Platelets are critical for hemostasis, and a low platelet count predicts mortality in trauma. The role of platelet dysfunction in severe traumatic hemorrhage and coagulopathy needs to be further defined. The aim of this study was to evaluate the platelet function in a new model of experimental traumatic hemorrhage. MATERIAL AND METHODS: New Zealand white rabbits (n = 10) were subjected to tracheostomy and trauma laparotomy, and then bilateral femur fractures with 40% hemorrhage of their estimated blood volume. Arterial blood gases, standard coagulation tests, mean platelet volume, platelet aggregation using impedance aggregometry with agonist collagen, arachidonic acid (ASPI), and adenosine diphosphate (ADP), rotational thromboelastometry, and fibrinogen binding of platelets were analyzed using flow cytometry. RESULTS: After traumatic hemorrhage, there was a significant physiological response with a rise in lactate (P < .001) and a decrease in base excess (P < .001) and temperature (P < .001). Platelet count decreased from a mean of 244x10(9)/L to 94 x10(9)/L (P = .004) and the mean platelet volume increased from 5.1fL to 6.1fL (P = .002). Impedance aggregometry with the agonist collagen, ASPI, and ADP was all significantly decreased after hemorrhage (P = .007). However, there was an increased fibrinogen binding of ADP-activated platelets after traumatic hemorrhage analyzed by flow cytometry (P < .05). CONCLUSIONS: This traumatic hemorrhage model presents two parallel pathophysiological responses of platelets; platelet consumption as evidenced by a significant decrease in platelet count and aggregation, and platelet hyperreactivity as shown by a higher mean platelet volume and enhanced platelet fibrinogen binding. Further studies are needed to characterize these different aspects of platelet function in severe traumatic hemorrhage. FAU - Wannberg, Marcus AU - Wannberg M AD - Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Vascular Surgery, Karolinska University Hospital , Stockholm, Sweden. FAU - Miao, Xinyan AU - Miao X AD - Karolinska Institutet, Department of Medicine-Solna, Clinical Pharmacology Group , Stockholm, Sweden. FAU - Li, Nailin AU - Li N AD - Karolinska Institutet, Department of Medicine-Solna, Clinical Pharmacology Group , Stockholm, Sweden. FAU - Wikman, Agneta AU - Wikman A AD - Department of Clinical Immunology and Transfusion Medicine, Karolinska Institutet/Karolinska University Hospital , Stockholm, Sweden. FAU - Wahlgren, Carl-Magnus AU - Wahlgren CM AD - Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Vascular Surgery, Karolinska University Hospital , Stockholm, Sweden. LA - eng PT - Journal Article DEP - 20191015 PL - England TA - Platelets JT - Platelets JID - 9208117 SB - IM MH - Animals MH - Blood Platelets/cytology/*metabolism MH - Disease Models, Animal MH - Hemorrhage/*blood MH - Humans MH - Rabbits MH - Wounds and Injuries/*blood OTO - NOTNLM OT - Animal model OT - coagulopathy OT - hemorrhage OT - platelets OT - shock OT - trauma EDAT- 2019/10/16 06:00 MHDA- 2021/05/29 06:00 CRDT- 2019/10/16 06:00 PHST- 2019/10/16 06:00 [pubmed] PHST- 2021/05/29 06:00 [medline] PHST- 2019/10/16 06:00 [entrez] AID - 10.1080/09537104.2019.1678120 [doi] PST - ppublish SO - Platelets. 2020 Aug 17;31(6):777-783. doi: 10.1080/09537104.2019.1678120. Epub 2019 Oct 15. PMID- 31596452 OWN - NLM STAT- MEDLINE DCOM- 20200710 LR - 20200710 IS - 2168-6262 (Electronic) IS - 2168-6254 (Linking) VI - 154 IP - 12 DP - 2019 Dec 1 TI - Thromboelastography-Guided Resuscitation of the Trauma Patient. PG - 1152-1153 LID - 10.1001/jamasurg.2019.3136 [doi] FAU - Subramanian, Madhu AU - Subramanian M AD - Division of Trauma, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Hospital Systems, Philadelphia. FAU - Kaplan, Lewis J AU - Kaplan LJ AD - Division of Trauma, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Hospital Systems, Philadelphia. AD - Department of Surgery, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. FAU - Cannon, Jeremy W AU - Cannon JW AD - Division of Trauma, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Hospital Systems, Philadelphia. AD - Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. LA - eng PT - Journal Article PT - Review PL - United States TA - JAMA Surg JT - JAMA surgery JID - 101589553 SB - IM MH - Blood Coagulation Disorders/*diagnosis MH - Blood Transfusion MH - Humans MH - Resuscitation/*methods MH - *Thrombelastography MH - Wounds and Injuries/*therapy EDAT- 2019/10/10 06:00 MHDA- 2020/07/11 06:00 CRDT- 2019/10/10 06:00 PHST- 2019/10/10 06:00 [pubmed] PHST- 2020/07/11 06:00 [medline] PHST- 2019/10/10 06:00 [entrez] AID - 2752281 [pii] AID - 10.1001/jamasurg.2019.3136 [doi] PST - ppublish SO - JAMA Surg. 2019 Dec 1;154(12):1152-1153. doi: 10.1001/jamasurg.2019.3136. PMID- 31593862 OWN - NLM STAT- MEDLINE DCOM- 20200220 LR - 20211125 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 246 DP - 2020 Feb TI - High Rate of Fibrinolytic Shutdown and Venous Thromboembolism in Patients With Severe Pelvic Fracture. PG - 182-189 LID - S0022-4804(19)30646-8 [pii] LID - 10.1016/j.jss.2019.09.012 [doi] AB - BACKGROUND: Trauma patients with pelvic fractures have a high rate of venous thromboembolism (VTEs). The reason for this high rate is unknown. We hypothesize that fibrinolysis shutdown (SD) predicts VTE in patients with severe pelvic fracture. METHODS: Retrospective chart review of trauma patients who presented with pelvic fracture from 2007 to 2017 was performed. Inclusion criteria were injury severity score > 15, abdomen/pelvis abbreviated injury scale >/= 3, blunt mechanism, admission citrated rapid thrombelastography (TEG). Fibrinolytic phenotypes were defined by fibrinolysis on citrated rapid TEG as hyperfibrinolysis, physiologic lysis, and SD. Univariate analysis of TEG measurements and clinical outcomes, followed by multivariable logistic regression (MV) with stepwise selection, was performed. RESULTS: Overall, 210 patients were included. Most patients (59%) presented in fibrinolytic shutdown. VTE incidence was 11%. There were no significant differences in fibrinolytic phenotypes or other TEG measurements between those who developed VTE and those who did not. There was a higher rate of VTE in patients who underwent pelvic external fixation or resuscitative thoracotomy. On MV, pelvic fixation and resuscitative thoracotomy were independent predictors of VTE. CONCLUSIONS: In severely injured patients with pelvic fractures, there was a high rate of VTE and the majority presented in SD. However, we were unable to correlate initial SD with VTE. Ultimately, the high rate of VTE in this patient population supports the concept of implementing VTE chemoprophylaxis measures as soon as hemostasis is achieved. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Nelson, Jesse T AU - Nelson JT AD - Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. Electronic address: julia.coleman@cuanschutz.edu. FAU - Carmichael, Heather AU - Carmichael H AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Mauffrey, Cyril AU - Mauffrey C AD - Department of Orthopedics, Denver Health Medical Center, Denver, Colorado. FAU - Vintimilla, David Rojas AU - Vintimilla DR AD - Department of Orthopedics, Denver Health Medical Center, Denver, Colorado. FAU - Samuels, Jason M AU - Samuels JM AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado; Department of Health Systems, Management and Policy, University of Colorado-Denver, School of Public Health, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20191005 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Abbreviated Injury Scale MH - Adult MH - Female MH - Fibrinolysis/*physiology MH - Fractures, Bone/*complications/diagnosis/physiopathology MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Pelvic Bones/*injuries MH - Retrospective Studies MH - Thrombelastography MH - Trauma Centers/statistics & numerical data MH - Venous Thromboembolism/diagnosis/*epidemiology/physiopathology MH - Wounds, Nonpenetrating/*complications/diagnosis/physiopathology PMC - PMC8610778 MID - NIHMS1756520 OTO - NOTNLM OT - Coagulation OT - Fibrinolysis OT - Fibrinolysis shutdown OT - Pelvic fracture OT - Trauma OT - Venous thromboembolism COIS- Disclosure There are no conflicts of interest to report. EDAT- 2019/10/09 06:00 MHDA- 2020/02/23 06:00 PMCR- 2021/11/24 CRDT- 2019/10/09 06:00 PHST- 2019/03/01 00:00 [received] PHST- 2019/08/31 00:00 [revised] PHST- 2019/09/12 00:00 [accepted] PHST- 2019/10/09 06:00 [pubmed] PHST- 2020/02/23 06:00 [medline] PHST- 2019/10/09 06:00 [entrez] PHST- 2021/11/24 00:00 [pmc-release] AID - S0022-4804(19)30646-8 [pii] AID - 10.1016/j.jss.2019.09.012 [doi] PST - ppublish SO - J Surg Res. 2020 Feb;246:182-189. doi: 10.1016/j.jss.2019.09.012. Epub 2019 Oct 5. PMID- 31575420 OWN - NLM STAT- MEDLINE DCOM- 20200309 LR - 20200309 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 218 IP - 6 DP - 2019 Dec TI - Platelet dysfunction on thromboelastogram is associated with severity of blunt traumatic brain injury. PG - 1134-1137 LID - S0002-9610(19)30377-0 [pii] LID - 10.1016/j.amjsurg.2019.09.024 [doi] AB - BACKGROUND: Platelet dysfunction associated with isolated traumatic brain injury (TBI) can be measured using thromboelastography-platelet mapping (TEG-PM). We hypothesized that platelet dysfunction can be detected after blunt TBI, and the degree of dysfunction is associated with increased TBI severity and in-hospital mortality. METHODS: This was a retrospective review of adult trauma patients admitted to a single level 1 trauma center from August 2013 to March 2015 who suffered isolated severe blunt TBI. Subjects were included if they received a TEG-PM within 24 h from injury, and excluded if on preinjury antiplatelet medications. RESULTS: 119 subjects were analyzed. Severe TBI subjects (AIS-head 5) had ADPi 18.4 points higher than moderate TBI subjects (AIS-head 3) (p = 0.001). Platelet dysfunction was not associated with TBI progression. ADPi significantly predicted mortality (OR 1.033; 95% CI 1.005-1.061, p = 0.02). CONCLUSION: Platelet dysfunction occurs immediately after isolated blunt TBI, is more pronounced with increasing TBI severity, and is associated with higher odds of in-hospital mortality. Further investigation is needed to determine whether this is a marker of disease severity or a therapeutic target. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Kay, Annika B AU - Kay AB AD - Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA. Electronic address: Annika.kay@imail.org. FAU - Morris, David S AU - Morris DS AD - Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA. Electronic address: Dave.morris2@imail.org. FAU - Collingridge, Dave S AU - Collingridge DS AD - Office of Research, Intermountain Medical Center, Murray, UT, USA. Electronic address: Dave.collingridge@imail.org. FAU - Majercik, Sarah AU - Majercik S AD - Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA. Electronic address: Sarah.majercik@imail.org. LA - eng PT - Journal Article DEP - 20190923 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Blood Platelet Disorders/*etiology/mortality MH - Brain Injuries, Traumatic/*complications/diagnostic imaging/mortality MH - Female MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Registries MH - Retrospective Studies MH - *Thrombelastography MH - Tomography, X-Ray Computed MH - Trauma Centers MH - Wounds, Nonpenetrating/*complications/diagnostic imaging/mortality EDAT- 2019/10/03 06:00 MHDA- 2020/03/10 06:00 CRDT- 2019/10/03 06:00 PHST- 2019/03/12 00:00 [received] PHST- 2019/09/11 00:00 [revised] PHST- 2019/09/22 00:00 [accepted] PHST- 2019/10/03 06:00 [pubmed] PHST- 2020/03/10 06:00 [medline] PHST- 2019/10/03 06:00 [entrez] AID - S0002-9610(19)30377-0 [pii] AID - 10.1016/j.amjsurg.2019.09.024 [doi] PST - ppublish SO - Am J Surg. 2019 Dec;218(6):1134-1137. doi: 10.1016/j.amjsurg.2019.09.024. Epub 2019 Sep 23. PMID- 31574543 OWN - NLM STAT- MEDLINE DCOM- 20201014 LR - 20201014 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 46 IP - 1 DP - 2020 Feb TI - Fibrinogen Supplementation and Its Indications. PG - 38-49 LID - 10.1055/s-0039-1696946 [doi] AB - Adequate plasma levels of fibrinogen are essential for clot formation, and in severe bleeding, fibrinogen reaches a critically low plasma concentration earlier than other coagulation factors. Although the critical minimum concentration of fibrinogen to maintain hemostasis is a matter of debate, many patients with coagulopathic bleeding require fibrinogen supplementation. Among the treatment options for fibrinogen supplementation, fibrinogen concentrate may be viewed by some as preferable to fresh frozen plasma or cryoprecipitate. The authors review major studies that have assessed fibrinogen treatment in trauma, cardiac surgery, end-stage liver disease, postpartum hemorrhage, and pediatric patients. Some but not all randomized controlled trials have shown that fibrinogen concentrate can be beneficial in these settings. The use of fibrinogen as part of coagulation factor concentrate based therapy guided by point-of-care viscoelastic coagulation monitoring (ROTEM [rotational thromboelastometry] or TEG [thromboelastography]) appears promising. In addition to reducing patients' exposure to allogeneic blood products, this strategy may reduce the risk of complications such as transfusion-associated circulatory overload, transfusion-related acute lung injury, and thromboembolic adverse events. Randomized controlled trials are challenging to perform in patients with critical bleeding, and more evidence is needed in this setting. However, current scientific rationale and clinical data support fibrinogen repletion in patients with ongoing bleeding and confirmed fibrinogen deficiency. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Grottke, Oliver AU - Grottke O AD - Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Mallaiah, Shuba AU - Mallaiah S AD - Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom. FAU - Karkouti, Keyvan AU - Karkouti K AD - Department of Anesthesia and Pain Management, Sinai Health System, University Health Network and Women's College Hospital, Toronto, Ontario, Canada. FAU - Saner, Fuat AU - Saner F AD - Department of General, Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany. FAU - Haas, Thorsten AU - Haas T AD - Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland. LA - eng PT - Journal Article PT - Review DEP - 20191001 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Component Transfusion MH - Fibrinogen/metabolism/*therapeutic use MH - Hemorrhage/blood/*therapy MH - Humans MH - *Plasma MH - Point-of-Care Systems MH - Randomized Controlled Trials as Topic MH - Risk Factors MH - Thrombelastography MH - Transfusion-Related Acute Lung Injury/blood/prevention & control COIS- O. G. has received research funding from Bayer Healthcare, Boehringer Ingelheim, Biotest, CSL Behring, Octapharma, Novo Nordisk, Nycomed, and Portola. He has also received honoraria for lectures and consultancy support from Bayer Healthcare, Boehringer Ingelheim, CSL Behring, Octapharma, Sanofi, Shire, Pfizer, and Portola. S. M. has received speaker fees and travel expenses from Tem UK (now Werfen). K. K. receives research funding from Octapharma and is a consultant for Instrumentation Laboratories. K. K. is partially supported by a merit award from the Department of Anesthesia, University of Toronto. F. S. has received research funding from CSL Behring and Werfen, consultancy honoraria from CSL Behring, Werfen, Biotest, Gilead, and CytoSorb, and a travel grant from Astellas. T. H. has received lecturer fees and travel support from Octapharma and Instrumentation Laboratory and consultancy support from Octapharma. EDAT- 2019/10/02 06:00 MHDA- 2020/10/21 06:00 CRDT- 2019/10/02 06:00 PHST- 2019/10/02 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] PHST- 2019/10/02 06:00 [entrez] AID - 10.1055/s-0039-1696946 [doi] PST - ppublish SO - Semin Thromb Hemost. 2020 Feb;46(1):38-49. doi: 10.1055/s-0039-1696946. Epub 2019 Oct 1. PMID- 31574017 OWN - NLM STAT- MEDLINE DCOM- 20200422 LR - 20200422 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) VI - 25 IP - 6 DP - 2019 Dec TI - Coagulopathy in the surgical patient: trauma-induced and drug-induced coagulopathies. PG - 668-674 LID - 10.1097/MCC.0000000000000676 [doi] AB - PURPOSE OF REVIEW: Coagulopathy is the derangement of hemostasis that in surgical patients may result in excessive bleeding, clotting or no measurable effect. The purpose of this review is to provide an overview of the most current evidence and practical approach to trauma- and drug-induced coagulopathy in surgical patients. RECENT FINDINGS: Early identification and timely correction of coagulopathy in surgical patients with significant bleeding is paramount to prevent death and other consequences of hemorrhage. Trauma-induced coagulopathy is managed by protocols recommending fibrinogen replacement, FFP, platelets, TXA and frequent lab monitorization including viscoelastic tests. For warfarin- or DOAC-induced coagulopathy, the management follows similar principles plus drug reversal. Warfarin is diagnosed by prolonged international normalized ratio and reversed by PCC or FFP. DOACs are inconsistently diagnosed by routine coagulation tests, and reversed by a combination of TXA, PCC and specific antidotes (if available). SUMMARY: Despite different understandings of the pathophysiology, trauma- and drug-induced coagulopathies are managed following similar protocols. In most of cases of significant surgical bleeding, timely and protocolized approach to correct the coagulopathy is likely to improve patients' outcome. FAU - Peralta, Ruben AU - Peralta R AD - Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar. AD - Department of Surgery, Universidad Nacional Pedro Henriquez Urena, School of Medicine, Santo Domingo, Dominican Republic. FAU - Thani, Hassan Al AU - Thani HA AD - Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar. FAU - Rizoli, Sandro AU - Rizoli S AD - Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar. LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM MH - Blood Coagulation Disorders/chemically induced/*etiology/*therapy MH - *Blood Loss, Surgical MH - Humans MH - Wounds and Injuries/complications EDAT- 2019/10/02 06:00 MHDA- 2020/04/23 06:00 CRDT- 2019/10/02 06:00 PHST- 2019/10/02 06:00 [pubmed] PHST- 2020/04/23 06:00 [medline] PHST- 2019/10/02 06:00 [entrez] AID - 10.1097/MCC.0000000000000676 [doi] PST - ppublish SO - Curr Opin Crit Care. 2019 Dec;25(6):668-674. doi: 10.1097/MCC.0000000000000676. PMID- 31567468 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20210427 IS - 1365-2346 (Electronic) IS - 0265-0215 (Linking) VI - 37 IP - 3 DP - 2020 Mar TI - Fibrinolytic shutdown diagnosed with rotational thromboelastometry represents a moderate form of coagulopathy associated with transfusion requirement and mortality: A retrospective analysis. PG - 170-179 LID - 10.1097/EJA.0000000000001096 [doi] AB - BACKGROUND: Viscoelastic techniques have made it possible to describe specific fibrinolytic phenotypes (physiological, hyperfibrinolysis and shutdown) and to establish a relationship of these phenotypes with outcome. However, there remains a debate as to whether shutdown is a state of hypercoagulability or rather a coagulopathy with moderate fibrinolysis and fibrinogen consumption. OBJECTIVES: Our objectives were to describe the relationship between fibrinolytic phenotypes and outcomes, and to report the effects of tranexamic acid (TXA) administration. DESIGN: This was a retrospective analysis of prospectively acquired data from a trauma registry. SETTING: An academic level 1 trauma centre in the Lyon Region, from March 2011 to December 2016. PATIENTS: We included all injured patients who had a rotational thromboelastometry analysis at admission. Fibrinolytic phenotypes were determined according to the maximum lysis: shutdown less than 3%, physiological 3 to 15%, hyperfibrinolysis more than 15%. MAIN OUTCOME MEASURE: Mortality at 24 h and at hospital discharge. RESULTS: During the study period, 473 patients were included with the following phenotypes: physiological (344 patients, 73%), shutdown (107 patients, 23%) and hyperfibrinolysis (22 patients, 5%). There was an increase in injury severity, prothrombin time ratio, fibrin degradation products and transfusion requirements from the physiological to the shutdown and hyperfibrinolysis phenotypes. Prehospital TXA administration increased the rate of shutdown and decreased the maximum lysis value at admission. After adjustment, multivariate analysis showed that fibrinolytic phenotypes, but not TXA, were independently associated with an increased risk of early death and death before hospital discharge: shutdown [odds ratio (95% confidence interval)] 2.4 (1.2 to 4.8) and hyperfibrinolysis 67.9 (7.4 to 624.2). CONCLUSION: The results of the current study suggest that shutdown, which is associated with injury severity and mortality, probably reflects a moderate form of coagulopathy and fibrinolysis rather than a hypercoagulopathy. Therefore, the observation of shutdown fibrinolysis on thromboelastography/rotational thromboelastometry should not lead to withholding but rather to the administration of TXA. FAU - David, Jean-Stephane AU - David JS AD - From the Department of Anaesthesia and Intensive Care, Lyon-Sud Hospital, Hospices Civils de Lyon (J-SD, AL, PI), University Claude Bernard Lyon 1, Lyon (J-SD, AL), Department of Anaesthesia and Intensive Care, Grenoble University Hospital, Grenoble (PB), Department of Haemostasis, Lyon Sud Hospital (A-MG-B), Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France (X-JT), Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, California, USA (KI) and Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany (MM). FAU - Lambert, Aline AU - Lambert A FAU - Bouzat, Pierre AU - Bouzat P FAU - Incagnoli, Pascal AU - Incagnoli P FAU - Geay-Baillat, Anne-Marie AU - Geay-Baillat AM FAU - Taverna, Xavier-Jean AU - Taverna XJ FAU - Inaba, Kenji AU - Inaba K FAU - Maegele, Marc AU - Maegele M LA - eng PT - Journal Article PL - England TA - Eur J Anaesthesiol JT - European journal of anaesthesiology JID - 8411711 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - *Antifibrinolytic Agents/pharmacology MH - *Blood Coagulation Disorders/diagnosis MH - Fibrinolysis MH - Humans MH - Retrospective Studies MH - Thrombelastography MH - *Tranexamic Acid/pharmacology MH - *Wounds and Injuries/diagnosis EDAT- 2019/10/01 06:00 MHDA- 2021/04/28 06:00 CRDT- 2019/10/01 06:00 PHST- 2019/10/01 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2019/10/01 06:00 [entrez] AID - 00003643-202003000-00003 [pii] AID - 10.1097/EJA.0000000000001096 [doi] PST - ppublish SO - Eur J Anaesthesiol. 2020 Mar;37(3):170-179. doi: 10.1097/EJA.0000000000001096. PMID- 31560304 OWN - NLM STAT- MEDLINE DCOM- 20191004 LR - 20191007 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 85 IP - 8 DP - 2019 Aug 1 TI - Thromboelastogram-Guided Resuscitation for Patients with Traumatic Brain Injury on Novel Anticoagulants. PG - 861-864 AB - Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group (P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent (P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively (P = 0.73). Blood product utilization was significantly lower in the TEG group (P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG. FAU - Hota, Salini AU - Hota S FAU - Ng, Matthew AU - Ng M FAU - Hilliard, DaShaunda AU - Hilliard D FAU - Burgess, Jessica AU - Burgess J LA - eng PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Anticoagulants) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Anticoagulants/*administration & dosage MH - Blood Component Transfusion/statistics & numerical data MH - Brain Injuries, Traumatic/*blood/diagnostic imaging/mortality MH - Female MH - Humans MH - Injury Severity Score MH - Intracranial Hemorrhages/*blood/diagnostic imaging/mortality MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Retrospective Studies MH - *Thrombelastography MH - Tomography, X-Ray Computed MH - Treatment Outcome EDAT- 2019/09/29 06:00 MHDA- 2019/10/08 06:00 CRDT- 2019/09/28 06:00 PHST- 2019/09/28 06:00 [entrez] PHST- 2019/09/29 06:00 [pubmed] PHST- 2019/10/08 06:00 [medline] PST - ppublish SO - Am Surg. 2019 Aug 1;85(8):861-864. PMID- 31540685 OWN - NLM STAT- MEDLINE DCOM- 20200309 LR - 20201201 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 218 IP - 6 DP - 2019 Dec TI - It's sooner than you think: Blunt solid organ injury patients are already hypercoagulable upon hospital admission - Results of a bi-institutional, prospective study. PG - 1065-1073 LID - S0002-9610(19)30345-9 [pii] LID - 10.1016/j.amjsurg.2019.08.024 [doi] AB - INTRODUCTION: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC). MATERIAL AND METHODS: This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers' trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents. RESULTS: On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h CONCLUSIONS: BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: julia.coleman@cuanschutz.edu. FAU - Kay, Annika B AU - Kay AB AD - Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: Annika.Kay@imail.org. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: ernest.moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: hunter.moore@ucdenver.edu. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: Eduardo.GonzalezBarreda@nyulangone.org. FAU - Majercik, Sarah AU - Majercik S AD - Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: sarah.majercik@imail.org. FAU - Cohen, Mitchell J AU - Cohen MJ AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: Mitchell.cohen@dhha.org. FAU - White, Thomas AU - White T AD - Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: tom.white@imail.org. FAU - Pieracci, Fredric M AU - Pieracci FM AD - University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: Fredric.pieracci@dhha.org. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20190910 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - 0 (Anticoagulants) SB - IM MH - Adult MH - Anticoagulants/*therapeutic use MH - Blood Coagulation Disorders/*drug therapy/*etiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography MH - Time-to-Treatment MH - Trauma Centers MH - Venous Thromboembolism/*prevention & control MH - Wounds, Nonpenetrating/*complications PMC - PMC6878200 MID - NIHMS1539480 OTO - NOTNLM OT - Blunt solid organ injury OT - Hypercoagulability OT - Thrombelastography OT - Thrombosis COIS- Conflict of Interest: Haemonetics provided thrombelastography supplies at discounted rates. EDAT- 2019/09/22 06:00 MHDA- 2020/03/10 06:00 PMCR- 2020/12/01 CRDT- 2019/09/22 06:00 PHST- 2019/03/16 00:00 [received] PHST- 2019/05/15 00:00 [revised] PHST- 2019/08/25 00:00 [accepted] PHST- 2019/09/22 06:00 [pubmed] PHST- 2020/03/10 06:00 [medline] PHST- 2019/09/22 06:00 [entrez] PHST- 2020/12/01 00:00 [pmc-release] AID - S0002-9610(19)30345-9 [pii] AID - 10.1016/j.amjsurg.2019.08.024 [doi] PST - ppublish SO - Am J Surg. 2019 Dec;218(6):1065-1073. doi: 10.1016/j.amjsurg.2019.08.024. Epub 2019 Sep 10. PMID- 31535453 OWN - NLM STAT- MEDLINE DCOM- 20210407 LR - 20210407 IS - 1445-2197 (Electronic) IS - 1445-1433 (Linking) VI - 90 IP - 4 DP - 2020 Apr TI - Clinical relevance and practical assessment of fibrinolysis shutdown. PG - 413-414 LID - 10.1111/ans.15426 [doi] FAU - Moore, Hunter B AU - Moore HB AUID- ORCID: 0000-0002-5939-3828 AD - Department of Surgery, Ernest E. Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA. FAU - Moore, Brooke A AU - Moore BA AD - Department of Surgery, Ernest E. Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, Ernest E. Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E. Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA. LA - eng PT - Journal Article DEP - 20190919 PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 RN - 0 (Antifibrinolytic Agents) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (alpha-2-Antiplasmin) RN - 0 (fibrin fragment D) RN - 0 (plasmin-plasmin inhibitor complex) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Antifibrinolytic Agents/adverse effects/pharmacology MH - Blood Coagulation Disorders/physiopathology MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinolysin/analysis MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Thrombelastography/*methods MH - Tranexamic Acid/adverse effects/pharmacology MH - Wounds and Injuries/*blood/physiopathology MH - alpha-2-Antiplasmin/analysis EDAT- 2019/09/20 06:00 MHDA- 2021/04/10 06:00 CRDT- 2019/09/20 06:00 PHST- 2019/07/08 00:00 [received] PHST- 2019/08/04 00:00 [revised] PHST- 2019/08/16 00:00 [accepted] PHST- 2019/09/20 06:00 [pubmed] PHST- 2021/04/10 06:00 [medline] PHST- 2019/09/20 06:00 [entrez] AID - 10.1111/ans.15426 [doi] PST - ppublish SO - ANZ J Surg. 2020 Apr;90(4):413-414. doi: 10.1111/ans.15426. Epub 2019 Sep 19. PMID- 31522748 OWN - NLM STAT- MEDLINE DCOM- 20200224 LR - 20201201 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 166 IP - 6 DP - 2019 Dec TI - Whole blood thrombin generation is distinct from plasma thrombin generation in healthy volunteers and after severe injury. PG - 1122-1127 LID - S0039-6060(19)30477-5 [pii] LID - 10.1016/j.surg.2019.07.014 [doi] AB - BACKGROUND: Plasma thrombin generation has been used to characterize trauma-induced coagulopathy, but description of whole blood thrombin generation is lacking. This study aimed to evaluate plasma and whole blood thrombin generation in healthy volunteers and trauma patients. We hypothesized that (1) plasma and whole blood thrombin generation are distinct, (2) whole blood thrombin generation is more pronounced in trauma patients than in healthy volunteers, and (3) thrombin generation correlates with clinical coagulation assays. METHODS: Blood was collected from healthy volunteers and trauma patients at a single, level-1 trauma center. Whole blood thrombin generation was assessed with a prototype point-of-care whole blood thrombin generation device, and plasma thrombin generation was measured with a calibrated automated thrombogram analogue. Plasma and whole blood thrombin generation were compared and correlated with international normalized ratio and thrombelastography. RESULTS: Overall, 10 healthy volunteers (average age 30, 50% men) were included and 58 trauma patients (average age 34, 76% men, 55% blunt mechanism, and with a median new injury severity score of 17) were included. Plasma and whole blood thrombin generation differed with more robust thrombin generation in plasma. Trauma patients had a significantly increased whole blood thrombin generation compared with healthy volunteers]. Plasma thrombin generation correlated with international normalized ratio, whereas whole blood thrombin generation did not correlate with thrombelastography. CONCLUSION: Plasma and whole blood thrombin generation are distinct, highlighting the need to perform standardized assays to better understand their correlation and to assess how whole blood thrombin generation confers differential outcomes in trauma. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Coleman, Julia R AU - Coleman JR AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. Electronic address: julia.coleman@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, CO. FAU - Samuels, Jason M AU - Samuels JM AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Ryon, Joshua J AU - Ryon JJ AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, CO. FAU - Nelson, Jesse T AU - Nelson JT AD - Rosalind Franklin School of Medicine, North Chicago, IL. FAU - Olson, Alexander AU - Olson A AD - Department of Biochemistry, University of Vermont, Burlington, VT. FAU - Caus, Sandi AU - Caus S AD - Department of Biochemistry, University of Vermont, Burlington, VT. FAU - Bartley, Matthew G AU - Bartley MG AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Vigneshwar, Navin G AU - Vigneshwar NG AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado-Denver, Aurora, CO. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Hematology, Children's Hospital of Colorado, Aurora, CO; Vitalant Research Institute, Denver, CO. FAU - Butenas, Saulius AU - Butenas S AD - Department of Biochemistry, University of Vermont, Burlington, VT. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20190913 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Female MH - Healthy Volunteers MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Plasma/*metabolism MH - Prospective Studies MH - Thrombelastography/methods MH - Thrombin/analysis/*metabolism MH - Wounds and Injuries/blood/*complications/diagnosis PMC - PMC6861673 MID - NIHMS1536100 COIS- COI/DISCLOSURES: Research conducted by these investigations for this manuscript and other works is supported with materials from Haemonetics and Instrumentation Laboratories. EDAT- 2019/09/17 06:00 MHDA- 2020/02/25 06:00 PMCR- 2020/12/01 CRDT- 2019/09/17 06:00 PHST- 2019/01/21 00:00 [received] PHST- 2019/05/16 00:00 [revised] PHST- 2019/07/03 00:00 [accepted] PHST- 2019/09/17 06:00 [pubmed] PHST- 2020/02/25 06:00 [medline] PHST- 2019/09/17 06:00 [entrez] PHST- 2020/12/01 00:00 [pmc-release] AID - S0039-6060(19)30477-5 [pii] AID - 10.1016/j.surg.2019.07.014 [doi] PST - ppublish SO - Surgery. 2019 Dec;166(6):1122-1127. doi: 10.1016/j.surg.2019.07.014. Epub 2019 Sep 13. PMID- 31504640 OWN - NLM STAT- MEDLINE DCOM- 20210706 LR - 20210706 IS - 1559-0488 (Electronic) IS - 1559-047X (Linking) VI - 41 IP - 1 DP - 2020 Jan 30 TI - Hypercoagulation and Hypermetabolism of Fibrinogen in Severely Burned Adults. PG - 23-29 LID - 10.1093/jbcr/irz147 [doi] AB - This study investigated changes in plasma fibrinogen metabolism and changes in coagulation in severely burned adults. Ten patients (27 +/- 3 years; 91 +/- 6 kg) with 51 +/- 3% TBSA were consented and enrolled into an institutional review board-approved prospective study. On the study day, stable isotope infusion of 1-13C-phenylalanine and d5-phenylalanine was performed to quantify fibrinogen production and consumption. During the infusion, vital signs were recorded and blood samples were drawn every hour. Coagulation was measured by thromboelastograph (TEG). Ten normal healthy volunteers (37 +/- 7 years; 74 +/- 4 kg) were included as the control group. Burned adults had elevated heart rates (120 +/- 2 vs 73 +/- 5 [control] beats/minute), respiration rates (23 +/- 2 vs 15 +/- 1 breaths/minute), plasma glucose (127 +/- 10 vs 89 +/- 2 mg/dl), and fibrinogen levels (613 +/- 35 vs 239 +/- 17 mg/dl); and decreased albumin (1.3 +/- 0.2 vs 3.7 +/- 0.1 g/dl) and total protein (4.4 +/- 0.2 vs 6.8 +/- 0.1 g/dl, all P < .05). Fibrinogen breakdown was elevated in the burn group (2.3 +/- 0.4 vs. 1.0 +/- 0.3 micromol/kg/minute); and fibrinogen synthesis was further enhanced in the burn group (4.4 +/- 0.7 vs 0.7 +/- 0.2 micromol/kg/minute, both P < .05). Clotting speed (TEG-alpha) and clot strength (TEG-MA) were increased in the burn group (62 +/- 4 vs 50 +/- 4 degrees , and 76 +/- 2 vs 56 +/- 2 mm, respectively, both P < .05). Fibrinolysis of TEG-LY60 was accelerated in the burn group (16 +/- 6 vs 3 +/- 1) and so was the increase in D-dimer level in the burn group (4.5 +/- 0.4 vs 1.9 +/- 0.3 mg/l, both P < .05). The hypercoagulable state postburn is in part a result of increased fibrinogen synthesis, over and above increased fibrinogen breakdown. CI - Published by Oxford University Press on behalf of the American Burn Association 2019. FAU - Martini, Wenjun Z AU - Martini WZ AD - U.S. Army Institute of Surgical Research, Ft. Sam Houston, Texas. FAU - Holcomb, John B AU - Holcomb JB AD - University of Texas Health Science Center at Houston, Texas. FAU - Yu, Yong-Ming AU - Yu YM AD - Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. FAU - Wolf, Steven E AU - Wolf SE AD - Shriner's Burn Hospital for Children, Galveston, Texas. FAU - Cancio, Leopoldo C AU - Cancio LC AD - U.S. Army Institute of Surgical Research, Ft. Sam Houston, Texas. FAU - Pusateri, Anthony E AU - Pusateri AE AD - U.S. Army Institute of Surgical Research, Ft. Sam Houston, Texas. FAU - Dubick, Michael A AU - Dubick MA AD - U.S. Army Institute of Surgical Research, Ft. Sam Houston, Texas. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - J Burn Care Res JT - Journal of burn care & research : official publication of the American Burn Association JID - 101262774 RN - 0 (Blood Glucose) RN - 0 (Serum Albumin) RN - 33X04XA5AT (Lactic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - Blood Coagulation Tests MH - Blood Glucose MH - Burns/*complications/*metabolism MH - Case-Control Studies MH - Female MH - Fibrinogen/*metabolism MH - Heart Rate MH - Humans MH - Lactic Acid/blood MH - Length of Stay MH - Male MH - Respiratory Rate MH - Serum Albumin MH - Thrombophilia/*etiology MH - Young Adult EDAT- 2019/09/11 06:00 MHDA- 2021/07/07 06:00 CRDT- 2019/09/11 06:00 PHST- 2019/09/11 06:00 [pubmed] PHST- 2021/07/07 06:00 [medline] PHST- 2019/09/11 06:00 [entrez] AID - 5555889 [pii] AID - 10.1093/jbcr/irz147 [doi] PST - ppublish SO - J Burn Care Res. 2020 Jan 30;41(1):23-29. doi: 10.1093/jbcr/irz147. PMID- 31462204 OWN - NLM STAT- MEDLINE DCOM- 20190913 LR - 20190913 IS - 1441-2772 (Print) IS - 1441-2772 (Linking) VI - 21 IP - 3 DP - 2019 Sep TI - Targeted fibrinogen concentrate use in severe traumatic haemorrhage. PG - 171-178 AB - OBJECTIVE: Fibrinogen is one of the first coagulation factors to be depleted during traumatic haemorrhage, and evidence suggests hypofibrinogenaemia leads to poor outcomes. A number of fibrinogen replacement products are currently available, with no clear consensus on the ideal product to use in severe traumatic haemorrhage. We hypothesised that it will be possible to rapidly administer fibrinogen concentrate (FC) guided by rotational thromboelastometry (ROTEM) FIBTEM A5 in patients presenting with trauma haemorrhage. METHODS: We examined 36 consecutive patients with trauma admitted to a level 1 trauma centre in Australia who received FC as part of their initial resuscitation. ROTEM analysis was conducted at various time points from emergency department (ED) admission to 48 hours after admission. The primary outcome was time to administration of FC after identification of hypofibrinogenaemia using ROTEM FIBTEM A5. Data were collected on quantity and timing of product transfusion, demographics, Injury Severity Score and laboratory values of coagulation. Spearman rank order correlation was used to determine the correlation between FIBTEM A5 and Clauss fibrinogen (FibC). RESULTS: Thirty-six patients received FC as their initial form of fibrinogen replacement during the study. Patients were hypofibrinogenaemic by both FIBTEM A5 (6 mm) and FibC (1.7 g/L) on presentation to the ED. It took a median of 22 minutes (IQR, 17-30 minutes) from time of a FIBTEM A5 analysis to FC administration. Both parameters increased significantly (P < 0.05) by 24 hours after admission. CONCLUSION: This study suggests that administration of FC represents a rapid and feasible method to replace fibrinogen in severe traumatic haemorrhage. However, the optimal method for replacing fibrinogen in traumatic haemorrhage is controversial and large multicentre randomised controlled trials are needed to provide further evidence. This study provided baseline data to inform the design of further clinical trials investigating fibrinogen replacement in traumatic haemorrhage. FAU - Seebold, Jacqueline A AU - Seebold JA AD - Gold Coast Health, Gold Coast, QLD, Australia. jacqueline.seebold@health.qld.gov.au. FAU - Campbell, Don AU - Campbell D AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Wake, Elizabeth AU - Wake E AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Walters, Kerin AU - Walters K AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Ho, Debbie AU - Ho D AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Chan, Erick AU - Chan E AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Bulmer, Andrew C AU - Bulmer AC AD - Griffith University, Gold Coast, QLD, Australia. FAU - Wullschleger, Martin AU - Wullschleger M AD - Gold Coast Health, Gold Coast, QLD, Australia. FAU - Winearls, James AU - Winearls J AD - Gold Coast Health, Gold Coast, QLD, Australia. LA - eng PT - Journal Article PL - Netherlands TA - Crit Care Resusc JT - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JID - 100888170 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Australia MH - Blood Coagulation/*drug effects MH - Blood Transfusion MH - Fibrinogen/*administration & dosage/therapeutic use MH - Hemorrhage/diagnosis/*prevention & control MH - Humans MH - Thrombelastography/*instrumentation MH - Wounds and Injuries/*drug therapy EDAT- 2019/08/30 06:00 MHDA- 2019/09/14 06:00 CRDT- 2019/08/30 06:00 PHST- 2019/08/30 06:00 [entrez] PHST- 2019/08/30 06:00 [pubmed] PHST- 2019/09/14 06:00 [medline] PST - ppublish SO - Crit Care Resusc. 2019 Sep;21(3):171-178. PMID- 31453984 OWN - NLM STAT- MEDLINE DCOM- 20200525 LR - 20200525 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 87 IP - 5 DP - 2019 Nov TI - Not all in your head (and neck): Stroke after blunt cerebrovascular injury is associated with systemic hypercoagulability. PG - 1082-1087 LID - 10.1097/TA.0000000000002443 [doi] AB - BACKGROUND: Stroke secondary to blunt cerebrovascular injury (BCVI) most often occurs before initiation of antithrombotic therapy. Earlier treatment, especially in multiply injured patients with relative contraindications to antithrombotic agents, could be facilitated with improved risk stratification; furthermore, the relationship between BCVI-attributed stroke and hypercoagulability remains unknown. We hypothesized that patients who suffer BCVI-related stroke are hypercoagulable compared with those with BCVI who do not stroke. METHODS: Rapid thromboelastography (TEG) was evaluated for patients with BCVI-attributed stroke at an urban Level I trauma center from 2011 to 2018. Contemporary controls who had BCVI but did not stroke were selected for comparison using propensity-score matching with 20% caliper that accounted for age, sex, injury severity, and BCVI location and grade. RESULTS: During the study period, 15,347 patients were admitted following blunt trauma. Blunt cerebrovascular injury was identified in 435 (3%) patients, of whom 28 experienced associated stroke and had a TEG within 24 hours of arrival. Forty-nine patients who had BCVI but did not suffer stroke served as matched controls. Stroke patients formed clots faster as evident in their larger angle (77.5 degrees vs. 74.6 degrees, p = 0.03) and had greater clot strength as indicated by their higher maximum amplitude (MA) (66.9 mm vs. 61.9 mm, p < 0.01). Activated clotting time was shorter among stroke patients but not significantly (113 seconds vs. 121 seconds, p > 0.05). Increased angle and elevated MA were significant predictors of stroke with odds ratios of 2.97 for angle greater than 77.3 degrees and 4.30 for MA greater than 63.0 mm. CONCLUSION: Patients who suffer BCVI-related stroke are hypercoagulable compared with those with BCVI who remain asymptomatic. Increased angle or MA should be considered when assessing the risk of thrombosis and determining the optimal time to initiate antithrombotic therapy in patients with BCVI. LEVEL OF EVIDENCE: Prognostic, Level III. FAU - Sumislawski, Joshua J AU - Sumislawski JJ AD - From the Department of Surgery (J.J.S., H.B.M., E.E.M., M.L.S., F.M.P., C.J.F., E.M.C., R.A.L., K.B.P., A.S., M.J.C., C.C.B.), Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB FAU - Moore, Ernest E AU - Moore EE FAU - Swope, Megan L AU - Swope ML FAU - Pieracci, Fredric M AU - Pieracci FM FAU - Fox, Charles J AU - Fox CJ FAU - Campion, Eric M AU - Campion EM FAU - Lawless, Ryan A AU - Lawless RA FAU - Platnick, K Barry AU - Platnick KB FAU - Sauaia, Angela AU - Sauaia A FAU - Cohen, Mitchell Jay AU - Cohen MJ FAU - Burlew, Clay Cothren AU - Burlew CC LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Fibrinolytic Agents) SB - IM MH - Adult MH - Cerebrovascular Trauma/blood/*complications/therapy MH - Female MH - Fibrinolytic Agents/therapeutic use MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Retrospective Studies MH - Stroke/*blood/etiology/therapy MH - Thrombelastography MH - Thrombophilia/blood/diagnosis/*etiology/prevention & control MH - Time Factors MH - Trauma Centers MH - Wounds, Nonpenetrating/blood/*complications/therapy MH - Young Adult EDAT- 2019/08/28 06:00 MHDA- 2020/05/26 06:00 CRDT- 2019/08/28 06:00 PHST- 2019/08/28 06:00 [pubmed] PHST- 2020/05/26 06:00 [medline] PHST- 2019/08/28 06:00 [entrez] AID - 10.1097/TA.0000000000002443 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Nov;87(5):1082-1087. doi: 10.1097/TA.0000000000002443. PMID- 31425218 OWN - NLM STAT- MEDLINE DCOM- 20200217 LR - 20240922 IS - 1526-7598 (Electronic) IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 129 IP - 3 DP - 2019 Sep TI - Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications. PG - 762-773 LID - 10.1213/ANE.0000000000004234 [doi] AB - Despite over a half-century of recognizing fibrinolytic abnormalities after trauma, we remain in our infancy in understanding the underlying mechanisms causing these changes, resulting in ineffective treatment strategies. With the increased utilization of viscoelastic hemostatic assays (VHAs) to measure fibrinolysis in trauma, more questions than answers are emerging. Although it seems certain that low fibrinolytic activity measured by VHA is common after injury and associated with increased mortality, we now recognize subphenotypes within this population and that specific cohorts arise depending on the specific time from injury when samples are collected. Future studies should focus on these subtleties and distinctions, as hypofibrinolysis, acute shutdown, and persistent shutdown appear to represent distinct, unique clinical phenotypes, with different pathophysiology, and warranting different treatment strategies. FAU - Moore, Hunter B AU - Moore HB AD - From the Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - From the Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. AD - Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Neal, Matthew D AU - Neal MD AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Sheppard, Forest R AU - Sheppard FR AD - Department of Surgery, Maine Medical Center, Portland, Maine. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California. FAU - Draxler, Dominik F AU - Draxler DF AD - Australian Centre for Blood Diseases, Monash University, Melbourne, Australia. FAU - Walsh, Mark AU - Walsh M AD - Departments of Surgery. AD - Emergency Medicine, Memorial Hospital Trauma Center, Springfield, Illinois. FAU - Medcalf, Robert L AU - Medcalf RL AD - Australian Centre for Blood Diseases, Monash University, Melbourne, Australia. FAU - Cohen, Mitch J AU - Cohen MJ AD - From the Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. AD - Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. FAU - Thomas, Scott G AU - Thomas SG AD - Departments of Surgery. AD - Emergency Medicine, Memorial Hospital Trauma Center, Springfield, Illinois. FAU - Leeper, Christine M AU - Leeper CM AD - Department of Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Gaines, Barbara A AU - Gaines BA AD - Department of Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Sauaia, Angela AU - Sauaia A AD - From the Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado. AD - Division of Health Systems, Management, and Policy, University of Colorado School of Public Health, Aurora, Colorado. LA - eng GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UL1 RR025780/RR/NCRR NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM CIN - Anesth Analg. 2019 Sep;129(3):644-646. doi: 10.1213/ANE.0000000000004320. PMID: 31425200 CIN - Shock. 2021 Jun 1;55(6):845-846. doi: 10.1097/SHK.0000000000001666. PMID: 33989265 MH - Blood Coagulation Disorders/diagnosis/therapy MH - Clinical Trials as Topic/methods MH - Fibrinolysis/*physiology MH - Humans MH - *Injury Severity Score MH - Thrombelastography/methods MH - Wounds and Injuries/*diagnosis/*therapy PMC - PMC7340109 MID - NIHMS1602052 COIS- The authors declare no conflicts of interest. EDAT- 2019/08/20 06:00 MHDA- 2020/02/18 06:00 PMCR- 2020/09/01 CRDT- 2019/08/20 06:00 PHST- 2019/08/20 06:00 [entrez] PHST- 2019/08/20 06:00 [pubmed] PHST- 2020/02/18 06:00 [medline] PHST- 2020/09/01 00:00 [pmc-release] AID - 00000539-201909000-00024 [pii] AID - 10.1213/ANE.0000000000004234 [doi] PST - ppublish SO - Anesth Analg. 2019 Sep;129(3):762-773. doi: 10.1213/ANE.0000000000004234. PMID- 31407209 OWN - NLM STAT- MEDLINE DCOM- 20210602 LR - 20210602 IS - 1937-6995 (Electronic) IS - 1556-9039 (Print) IS - 1556-9039 (Linking) VI - 16 IP - 1 DP - 2020 Jan TI - Thromboelastography with Platelet Studies (TEG(R) with PlateletMapping(R)) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis. PG - 24-32 LID - 10.1007/s13181-019-00729-8 [doi] AB - INTRODUCTION: Hematologic effects of North American rattlesnake envenomation can include fibrinogenolysis and thrombocytopenia, depending on species, geography, and other variables. During treatment, these effects are routinely monitored through assessment of fibrinogen concentrations and platelet counts. However, these tests provide no information about fibrinolysis or platelet dysfunction, both of which can also occur with venom from some species. METHODS: This was a retrospective chart review of patients admitted to a quaternary care academic hospital (Banner - University Medical Center Phoenix) in the southwestern United States for treatment of rattlesnake envenomation, over an approximately 1-year period from March 2017 through April 2018. Patients who had thromboelastography with platelet studies (TEG(R) with PlateletMapping(R)) during their care were included. RESULTS: Twelve patients were identified for this study. Four patients exhibited inhibition of ADP-induced platelet activation: one had normal fibrinogen and platelet count, two had concurrent hypofibrinogenemia, and one had concurrent thrombocytopenia. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in the single patient for whom serial thromboelastographs were available. Fibrinolysis was present in seven patients and resolved in the two patients with serial thromboelastographs. CONCLUSIONS: Inhibition of ADP-induced platelet aggregation and fibrinolysis occurred independent of hypofibrinogenemia and thrombocytopenia, indicating fibrinogen concentration (or protime) and platelet count monitoring alone is insufficient to assess the extent of hematologic toxicity in rattlesnake envenomation. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in one case, suggesting platelet inhibition could also be used in treatment decisions. Fibrinolysis could also be reversed, although the timing to antivenom administration was less clear. FAU - Kang, A Min AU - Kang AM AUID- ORCID: 0000-0001-7784-0655 AD - Department of Child Health; and Department of Medicine, Division of Medical Toxicology and Precision Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. aaron.kang@bannerhealth.com. AD - Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA. aaron.kang@bannerhealth.com. AD - Department of Medicine, Section of Toxicology, Phoenix Children's Hospital, Phoenix, AZ, USA. aaron.kang@bannerhealth.com. FAU - Fisher, Erik S AU - Fisher ES AD - Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA. AD - Department of Medicine, Division of Medical Toxicology and Precision Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. LA - eng PT - Journal Article DEP - 20190812 PL - United States TA - J Med Toxicol JT - Journal of medical toxicology : official journal of the American College of Medical Toxicology JID - 101284598 RN - 0 (Antivenins) RN - 0 (Crotalid Venoms) RN - 0 (Crotalidae Polyvalent immune Fab) RN - 0 (Immunoglobulin Fab Fragments) SB - IM MH - Adult MH - Aged MH - Animals MH - Antivenins/therapeutic use MH - Arizona MH - Blood Platelets/drug effects/*metabolism MH - *Crotalid Venoms/antagonists & inhibitors/immunology MH - *Crotalus MH - *Fibrinolysis/drug effects MH - Humans MH - Immunoglobulin Fab Fragments/therapeutic use MH - Middle Aged MH - *Platelet Aggregation/drug effects MH - *Platelet Function Tests MH - Predictive Value of Tests MH - Retrospective Studies MH - Snake Bites/*blood/diagnosis/drug therapy/immunology MH - *Thrombelastography MH - Time Factors MH - Young Adult PMC - PMC6942104 OTO - NOTNLM OT - Antivenom OT - Fibrinolysis OT - Platelet activation OT - Rattlesnake envenomation OT - Thromboelastography (TEG) with PlateletMapping COIS- None EDAT- 2019/08/14 06:00 MHDA- 2021/06/03 06:00 PMCR- 2021/01/01 CRDT- 2019/08/14 06:00 PHST- 2019/06/20 00:00 [received] PHST- 2019/08/01 00:00 [accepted] PHST- 2019/07/25 00:00 [revised] PHST- 2019/08/14 06:00 [pubmed] PHST- 2021/06/03 06:00 [medline] PHST- 2019/08/14 06:00 [entrez] PHST- 2021/01/01 00:00 [pmc-release] AID - 10.1007/s13181-019-00729-8 [pii] AID - 729 [pii] AID - 10.1007/s13181-019-00729-8 [doi] PST - ppublish SO - J Med Toxicol. 2020 Jan;16(1):24-32. doi: 10.1007/s13181-019-00729-8. Epub 2019 Aug 12. PMID- 31405423 OWN - NLM STAT- MEDLINE DCOM- 20190816 LR - 20190816 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 85 IP - 7 DP - 2019 Jul 1 TI - The "Death Diamond": Death Beyond Trauma. PG - 757-760 AB - Thromboelastography (TEG) has become a critical tool for the diagnosis, assessment, and management of hyperfibrinolysis and coagulopathy in trauma. In 2015, Chapman et al. of the Denver group coined the term "Death Diamond" (DD) to describe a TEG tracing identified in a unique trauma population. The DD was associated with a 100 per cent positive predictive value for mortality. Given the potential prognostic implications and resource savings associated with validating the DD as a marker of futile care, we sought to further evaluate DD outcomes. A retrospective review of 6850 TEGs, 34 patients (24 trauma and 10 nontrauma), displayed a DD tracing. Through invasive procedures and transfusions, nine DD tracing "normalized," but, ultimately, this did not impact the outcome because the DD had a positive predictive value of 100 per cent for mortality in both populations. The median survival time in trauma patients was two hours compared with seven hours in nontrauma patients. Overall, this study further validates the predictive value of the DD in a trauma population while also serving as an assessment of the DD in a nontrauma population. Given these findings, a DD may prove to be an indicator of futile care. Further multicenter studies should be conducted to confirm these results. FAU - Farrell, Michael AU - Farrell M FAU - Marconi, Thomas Jr AU - Marconi T Jr FAU - Getchell, John AU - Getchell J FAU - Green, Raymond AU - Green R FAU - Cipolle, Mark AU - Cipolle M FAU - Sixta, Sherry AU - Sixta S LA - eng PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*diagnosis MH - Female MH - *Fibrinolysis MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Retrospective Studies MH - Thrombelastography/*methods MH - Wounds and Injuries/*diagnosis EDAT- 2019/08/14 06:00 MHDA- 2019/08/17 06:00 CRDT- 2019/08/14 06:00 PHST- 2019/08/14 06:00 [entrez] PHST- 2019/08/14 06:00 [pubmed] PHST- 2019/08/17 06:00 [medline] PST - ppublish SO - Am Surg. 2019 Jul 1;85(7):757-760. PMID- 31383642 OWN - NLM STAT- MEDLINE DCOM- 20200220 LR - 20221108 IS - 1528-0020 (Electronic) IS - 0006-4971 (Print) IS - 0006-4971 (Linking) VI - 134 IP - 19 DP - 2019 Nov 7 TI - Targeting protease nexin-1, a natural anticoagulant serpin, to control bleeding and improve hemostasis in hemophilia. PG - 1632-1644 LID - 10.1182/blood.2019000281 [doi] AB - Hemophilia A and B, diseases caused by the lack of factor VIII (FVIII) and factor IX (FIX) respectively, lead to insufficient thrombin production, and therefore to bleeding. New therapeutic strategies for hemophilia treatment that do not rely on clotting factor replacement, but imply the neutralization of natural anticoagulant proteins, have recently emerged. We propose an innovative approach consisting of targeting a natural and potent thrombin inhibitor, expressed by platelets, called protease nexin-1 (PN-1). By using the calibrated automated thrombin generation assay, we showed that a PN-1-neutralizing antibody could significantly shorten the thrombin burst in response to tissue factor in platelet-rich plasma (PRP) from patients with mild or moderate hemophilia. In contrast, in PRP from patients with severe hemophilia, PN-1 neutralization did not improve thrombin generation. However, after collagen-induced platelet activation, PN-1 deficiency in F8-/-mice or PN-1 blocking in patients with severe disease led to a significantly improved thrombin production in PRP, underlining the regulatory role of PN-1 released from platelet granules. In various bleeding models, F8-/-/PN-1-/- mice displayed significantly reduced blood loss and bleeding time compared with F8-/-mice. Moreover, platelet recruitment and fibrin(ogen) accumulation were significantly higher in F8-/-/PN-1-/- mice than in F8-/-mice in the ferric chloride-induced mesenteric vessel injury model. Thromboelastometry studies showed enhanced clot stability and lengthened clot lysis time in blood from F8-/-/PN-1-/- and from patients with hemophilia A incubated with a PN-1-neutralizing antibody compared with their respective controls. Our study thus provides proof of concept that PN-1 neutralization can be a novel approach for future clinical care in hemophilia. CI - (c) 2019 by The American Society of Hematology. FAU - Aymonnier, Karen AU - Aymonnier K AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. FAU - Kawecki, Charlotte AU - Kawecki C AD - Hemostase Inflammation Thrombose, INSERM, UMR_S1176, Universite Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France. FAU - Venisse, Laurence AU - Venisse L AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. FAU - Boulaftali, Yacine AU - Boulaftali Y AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. FAU - Christophe, Olivier D AU - Christophe OD AD - Hemostase Inflammation Thrombose, INSERM, UMR_S1176, Universite Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France. FAU - Lenting, Peter J AU - Lenting PJ AD - Hemostase Inflammation Thrombose, INSERM, UMR_S1176, Universite Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France. FAU - Arocas, Veronique AU - Arocas V AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. FAU - de Raucourt, Emmanuelle AU - de Raucourt E AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. AD - Departement d'Hematologie, Hopital Beaujon, Clichy, France; and. AD - Centre de Traitement de l'Hemophilie Hopital Mignot, Le Chesnay, France. FAU - Denis, Cecile V AU - Denis CV AD - Hemostase Inflammation Thrombose, INSERM, UMR_S1176, Universite Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France. FAU - Bouton, Marie-Christine AU - Bouton MC AD - INSERM, UMR_S 1148-Laboratory for Vascular Translational Science, Universite de Paris, Paris, France. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Blood JT - Blood JID - 7603509 RN - 0 (Antibodies, Neutralizing) RN - 0 (Serpin E2) SB - IM CIN - Blood. 2019 Nov 7;134(19):1566-1568. doi: 10.1182/blood.2019002713. PMID: 31698423 MH - Animals MH - Antibodies, Neutralizing/pharmacology MH - Blood Coagulation Disorders, Inherited/complications/*enzymology MH - Hemorrhage/etiology MH - Hemostasis/drug effects MH - Humans MH - Mice MH - Mice, Knockout MH - Platelet Activation/drug effects MH - Serpin E2/*antagonists & inhibitors PMC - PMC9635585 EDAT- 2019/08/07 06:00 MHDA- 2020/02/23 06:00 PMCR- 2020/11/07 CRDT- 2019/08/07 06:00 PHST- 2019/02/22 00:00 [received] PHST- 2019/07/18 00:00 [accepted] PHST- 2019/08/07 06:00 [pubmed] PHST- 2020/02/23 06:00 [medline] PHST- 2019/08/07 06:00 [entrez] PHST- 2020/11/07 00:00 [pmc-release] AID - S0006-4971(20)73997-2 [pii] AID - 2019/BLD2019000281 [pii] AID - 10.1182/blood.2019000281 [doi] PST - ppublish SO - Blood. 2019 Nov 7;134(19):1632-1644. doi: 10.1182/blood.2019000281. PMID- 31382848 OWN - NLM STAT- MEDLINE DCOM- 20220113 LR - 20220416 IS - 1557-9042 (Electronic) IS - 0897-7151 (Print) IS - 0897-7151 (Linking) VI - 38 IP - 8 DP - 2021 Apr 15 TI - Fibrinolytic Activation in Patients with Progressive Intracranial Hemorrhage after Traumatic Brain Injury. PG - 960-966 LID - 10.1089/neu.2018.6234 [doi] AB - Progression of intracranial hemorrhage (PICH) is a significant cause of secondary brain injury in patients with traumatic brain injury (TBI). Previous studies have implicated a variety of mediators that contribute to PICH. We hypothesized that patients with PICH would display either a hypocoagulable state, hyperfibrinolysis, or both. We conducted a prospective study of adult trauma patients with isolated TBI. Blood was obtained for routine coagulation assays, platelet count, fibrinogen, thrombelastography, markers of thrombin generation, and markers of fibrinolysis at admission and 6, 12, 24, and 48 h. Univariate analyses were performed to compare baseline characteristics between groups. Linear regression models were created, adjusting for baseline differences, to determine the relationship between individual assays and PICH. One hundred forty-one patients met entry criteria, of whom 71 had hemorrhage progression. Patients with PICH had a higher Injury Severity Score and Abbreviated Injury Scale score (head), a lower Glasgow Coma Scale score, and lower plasma sodium on admission. Patients with PICH had higher D-dimers on admission. After adjusting for baseline differences, elevated D-dimers remained significantly associated with PICH compared to patients without PICH at admission. Hypocoagulation was not significantly associated with PICH in these patients. The association between PICH and elevated D-dimers early after injury suggests that fibrinolytic activation may contribute to PICH in patients with TBI. FAU - Fair, Kelly A AU - Fair KA AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Farrell, David H AU - Farrell DH AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - McCully, Belinda H AU - McCully BH AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Rick, Elizabeth A AU - Rick EA AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Dewey, Elizabeth N AU - Dewey EN AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Hilliard, Cole AU - Hilliard C AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Dean, Rondi AU - Dean R AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Lin, Amber AU - Lin A AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Hinson, Holly AU - Hinson H AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Barbosa, Ronald AU - Barbosa R AD - Legacy Emanuel Hospital and Health Center, Portland, Oregon, USA. FAU - Schreiber, Martin A AU - Schreiber MA AD - Oregon Health & Science University, Portland, Oregon, USA. FAU - Rowell, Susan E AU - Rowell SE AD - Oregon Health & Science University, Portland, Oregon, USA. LA - eng GR - K23 NS110828/NS/NINDS NIH HHS/United States GR - UL1 TR000128/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - J Neurotrauma JT - Journal of neurotrauma JID - 8811626 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Aged MH - Brain Injuries, Traumatic/*blood/complications/*diagnostic imaging MH - *Disease Progression MH - Female MH - Fibrinogen/metabolism MH - Fibrinolysis/*physiology MH - Glasgow Coma Scale/trends MH - Humans MH - Intracranial Hemorrhages/*blood/*diagnostic imaging/etiology MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography/trends PMC - PMC8054516 OTO - NOTNLM OT - coagulopathy OT - fibrinolysis OT - thrombelastography OT - traumatic brain injury COIS- OHSU and Dr. David Farrell have a significant interest in Gamma Therapeutics, a company that may have a commercial interest in the results of this research and technology. This potential individual and institutional conflict of interest has been reviewed and managed by OHSU. EDAT- 2019/08/07 06:00 MHDA- 2022/01/14 06:00 PMCR- 2022/04/15 CRDT- 2019/08/07 06:00 PHST- 2019/08/07 06:00 [pubmed] PHST- 2022/01/14 06:00 [medline] PHST- 2019/08/07 06:00 [entrez] PHST- 2022/04/15 00:00 [pmc-release] AID - 10.1089/neu.2018.6234 [pii] AID - 10.1089/neu.2018.6234 [doi] PST - ppublish SO - J Neurotrauma. 2021 Apr 15;38(8):960-966. doi: 10.1089/neu.2018.6234. PMID- 31382318 OWN - NLM STAT- MEDLINE DCOM- 20200305 LR - 20200305 IS - 1365-3148 (Electronic) IS - 0958-7578 (Print) IS - 0958-7578 (Linking) VI - 29 IP - 5 DP - 2019 Oct TI - Effects of whole blood leukoreduction on platelet function and hemostatic parameters. PG - 351-357 LID - 10.1111/tme.12622 [doi] AB - AIMS/OBJECTIVES: The aim of this study was to evaluate the hemostatic consequences of whole blood leukoreduction (LR). BACKGROUND: Whole blood is being used for trauma resuscitation in the military, and an increasing number of civilian trauma centres across the nation. The benefits of LR, such as decreased infectious and transfusion-related complications, are well established, but the effects on hemostatic parameters remain a concern. METHODS: Twenty-four units of whole blood were assigned to one of the four groups: non-leukoreduced (NLR), leukoreduced at 1 h and a height of 33 in. (LR-1), leukoreduced at 4 h and a height of 33 in. (LR-4(33)), or leukoreduced at 4 h and a height of 28 in. (LR-4(28)). Viscoelastic parameters, platelet aggregation, cell counts, physiological parameters and thrombin potential were evaluated immediately before and after LR, and on days 1, 7, 14 and 21 following LR. RESULTS: The viscoelastic parameters and thrombin generation potential were unchanged between the groups. Platelet aggregation was reduced in the LR-1 group compared with NLR after 7 days. The LR-4(28) group also showed a trend of reduced platelet aggregation compared with NLR. Aggregation in LR-4(33) was similar to NLR throughout the storage time. Physiological and electrolyte changes over the whole blood storage period were not affected by LR. CONCLUSION: Our study shows that whole blood can be LR at 4 h after collection and a height of 33 in. while maintaining platelet count and without altering platelet function and hemostatic performance. CI - (c) 2019 British Blood Transfusion Society. FAU - Morris, M C AU - Morris MC AUID- ORCID: 0000-0002-8047-5510 AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. FAU - Veile, R AU - Veile R AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. FAU - Friend, L A AU - Friend LA AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. FAU - Oh, D AU - Oh D AD - Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. AD - Hoxworth Blood Center, Cincinnati, Ohio, USA. FAU - Pritts, T A AU - Pritts TA AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. FAU - Dorlac, W C AU - Dorlac WC AD - Department of Surgery, University of Colorado and UC Health, Ft. Collins, Colorado, USA. FAU - Spinella, P C AU - Spinella PC AD - Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. FAU - Goodman, M D AU - Goodman MD AUID- ORCID: 0000-0001-7218-4855 AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. LA - eng GR - T32 GM008478/GM/NIGMS NIH HHS/United States GR - FA8650-15-2-6B36 FCT/U.S. Air Force/ PT - Journal Article DEP - 20190805 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Adult MH - Blood Platelets/*metabolism MH - *Blood Preservation MH - Humans MH - *Leukocyte Reduction Procedures MH - Male MH - Platelet Aggregation MH - Platelet Function Tests MH - Thrombelastography MH - Time Factors MH - Transfusion Reaction/blood/prevention & control PMC - PMC6863083 MID - NIHMS1059346 OTO - NOTNLM OT - coagulopathy OT - haemorrhage OT - resuscitation, whole blood OT - shock OT - trauma COIS- CONFLICT OF INTEREST The authors have no competing interests. EDAT- 2019/08/06 06:00 MHDA- 2020/03/07 06:00 PMCR- 2019/11/19 CRDT- 2019/08/06 06:00 PHST- 2019/05/15 00:00 [received] PHST- 2019/07/10 00:00 [revised] PHST- 2019/07/11 00:00 [accepted] PHST- 2019/08/06 06:00 [pubmed] PHST- 2020/03/07 06:00 [medline] PHST- 2019/08/06 06:00 [entrez] PHST- 2019/11/19 00:00 [pmc-release] AID - 10.1111/tme.12622 [doi] PST - ppublish SO - Transfus Med. 2019 Oct;29(5):351-357. doi: 10.1111/tme.12622. Epub 2019 Aug 5. PMID- 31376979 OWN - NLM STAT- MEDLINE DCOM- 20200819 LR - 20210114 IS - 1873-2380 (Electronic) IS - 0021-9290 (Print) IS - 0021-9290 (Linking) VI - 94 DP - 2019 Sep 20 TI - Changes in shear wave propagation within skeletal muscle during active and passive force generation. PG - 115-122 LID - S0021-9290(19)30481-6 [pii] LID - 10.1016/j.jbiomech.2019.07.019 [doi] AB - Muscle force can be generated actively through changes in neural excitation, and passively through externally imposed changes in muscle length. Disease and injury can disrupt force generation, but it can be challenging to separate passive from active contributions to these changes. Ultrasound elastography is a promising tool for characterizing the mechanical properties of muscles and the forces that they generate. Most prior work using ultrasound elastography in muscle has focused on the group velocity of shear waves, which increases with increasing muscle force. Few studies have quantified the phase velocity, which depends on the viscoelastic properties of muscle. Since passive and active forces within muscle involve different structures for force transmission, we hypothesized that measures of phase velocity could detect changes in shear wave propagation during active and passive conditions that cannot be detected when considering only group velocity. We measured phase and group velocity in the human biceps brachii during active and passive force generation and quantified the differences in estimates of shear elasticity obtained from each of these measurements. We found that measures of group velocity consistently overestimate the shear elasticity of muscle. We used a Voigt model to characterize the phase velocity and found that the estimated time constant for the Voigt model provided a way to distinguish between passive and active force generation. Our results demonstrate that shear wave elastography can be used to distinguish between passive and active force generation when it is used to characterize the phase velocity of shear waves propagating in muscle. CI - Copyright (c) 2019 Elsevier Ltd. All rights reserved. FAU - Wang, Allison B AU - Wang AB AD - Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA; Shirley Ryan AbilityLab, Chicago, IL, USA. Electronic address: bwang15@u.northwestern.edu. FAU - Perreault, Eric J AU - Perreault EJ AD - Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern, Chicago, IL, USA; Shirley Ryan AbilityLab, Chicago, IL, USA. FAU - Royston, Thomas J AU - Royston TJ AD - Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA. FAU - Lee, Sabrina S M AU - Lee SSM AD - Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA. LA - eng GR - R01 AR071162/AR/NIAMS NIH HHS/United States GR - T32 EB009406/EB/NIBIB NIH HHS/United States PT - Journal Article DEP - 20190725 PL - United States TA - J Biomech JT - Journal of biomechanics JID - 0157375 SB - IM MH - Adult MH - Elasticity MH - Elasticity Imaging Techniques/methods MH - Female MH - Humans MH - Male MH - Muscle, Skeletal/*physiology MH - Reproduction MH - Viscosity MH - Young Adult PMC - PMC6736689 MID - NIHMS1536091 OTO - NOTNLM OT - Forces OT - Muscle OT - Shear wave elastography OT - Viscoelastic COIS- Conflict of interest statement The authors of this paper have no competing financial interest or personal relationships with other people or organization that could inappropriately influence this work. EDAT- 2019/08/05 06:00 MHDA- 2020/08/20 06:00 PMCR- 2020/09/20 CRDT- 2019/08/05 06:00 PHST- 2019/03/05 00:00 [received] PHST- 2019/07/15 00:00 [revised] PHST- 2019/07/16 00:00 [accepted] PHST- 2019/08/05 06:00 [pubmed] PHST- 2020/08/20 06:00 [medline] PHST- 2019/08/05 06:00 [entrez] PHST- 2020/09/20 00:00 [pmc-release] AID - S0021-9290(19)30481-6 [pii] AID - 10.1016/j.jbiomech.2019.07.019 [doi] PST - ppublish SO - J Biomech. 2019 Sep 20;94:115-122. doi: 10.1016/j.jbiomech.2019.07.019. Epub 2019 Jul 25. PMID- 31348595 OWN - NLM STAT- MEDLINE DCOM- 20200225 LR - 20200225 IS - 1545-5017 (Electronic) IS - 1545-5009 (Linking) VI - 66 IP - 11 DP - 2019 Nov TI - Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors-a single-center cohort. PG - e27886 LID - 10.1002/pbc.27886 [doi] AB - BACKGROUND: Emicizumab is a bispecific antibody that bridges factor IXa and factor X to restore hemostasis in patients with hemophilia A (HA). Its efficacy and safety have been proven in multicenter trials. However, real world data regarding its use in very young children are currently lacking. Ancillary test results for monitoring emicizumab's hemostatic effect and their clinical correlations are scarce. METHODS: Children with HA and inhibitors treated by emicizumab were prospectively followed at our center. Laboratory follow-up included rotational thromboelastometry (ROTEM) and thrombin generation (TG), prior to and during treatment. RESULTS: Eleven children whose median age was 26 months were treated by emicizumab and followed for a median of 36 weeks. During follow-up, none experienced hemarthrosis or any other spontaneous bleeds. For 7/11 patients, emicizumab prophylaxis was sufficient to maintain hemostasis without additional supplemental therapy. Only 4/11 patients were occasionally treated with recombinant activated FVII for trauma. Two minor surgeries were safely performed without supplemental therapy while another procedure was complicated by major bleeding. TG parameters improved for all patients, correlating with their clinical status. Interestingly, the lowest TG values were obtained for patients experiencing bleeding episodes, while ROTEM parameters in all patients were close to the normal range. CONCLUSIONS: This study confirms the safety and efficacy of emicizumab in reducing bleeds in young children with HA with inhibitors, including infants. However, surgeries warrant caution as emicizumab prophylaxis may not be sufficient for some procedures. TG may more accurately reflect the hemostasis state than ROTEM in pediatric patients treated with emicizumab. CI - (c) 2019 Wiley Periodicals, Inc. FAU - Barg, Assaf A AU - Barg AA AUID- ORCID: 0000-0002-8329-8409 AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Avishai, Einat AU - Avishai E AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Budnik, Ivan AU - Budnik I AD - Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. FAU - Levy-Mendelovich, Sarina AU - Levy-Mendelovich S AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Barazani, Tami B AU - Barazani TB AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Kenet, Gili AU - Kenet G AUID- ORCID: 0000-0002-1279-2557 AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. FAU - Livnat, Tami AU - Livnat T AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel. AD - The Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. LA - eng PT - Journal Article PT - Pragmatic Clinical Trial DEP - 20190726 PL - United States TA - Pediatr Blood Cancer JT - Pediatric blood & cancer JID - 101186624 RN - 0 (Antibodies, Bispecific) RN - 0 (Antibodies, Monoclonal, Humanized) RN - 7NL2E3F6K3 (emicizumab) RN - 9001-29-0 (Factor X) RN - EC 3.4.21.22 (Factor IXa) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Antibodies, Bispecific/*therapeutic use MH - Antibodies, Monoclonal, Humanized/*therapeutic use MH - Blood Loss, Surgical/prevention & control MH - Child, Preschool MH - Factor IXa/immunology MH - Factor X/immunology MH - Follow-Up Studies MH - Hemophilia A/blood/complications/*drug therapy MH - Hemorrhage/etiology/*prevention & control MH - Humans MH - Infant MH - Male MH - Prospective Studies MH - Thrombelastography MH - Thrombin/analysis MH - Treatment Outcome OTO - NOTNLM OT - ROTEM OT - emicizumab OT - hemophilia A OT - inhibitors OT - thrombin generation EDAT- 2019/07/28 06:00 MHDA- 2020/02/26 06:00 CRDT- 2019/07/27 06:00 PHST- 2018/04/11 00:00 [received] PHST- 2019/05/07 00:00 [revised] PHST- 2019/05/22 00:00 [accepted] PHST- 2019/07/28 06:00 [pubmed] PHST- 2020/02/26 06:00 [medline] PHST- 2019/07/27 06:00 [entrez] AID - 10.1002/pbc.27886 [doi] PST - ppublish SO - Pediatr Blood Cancer. 2019 Nov;66(11):e27886. doi: 10.1002/pbc.27886. Epub 2019 Jul 26. PMID- 31346913 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240718 IS - 2197-425X (Print) IS - 2197-425X (Electronic) IS - 2197-425X (Linking) VI - 7 IP - Suppl 1 DP - 2019 Jul 25 TI - Use of a high platelet-to-RBC ratio of 2:1 is more effective in correcting trauma-induced coagulopathy than a ratio of 1:1 in a rat multiple trauma transfusion model. PG - 42 LID - 10.1186/s40635-019-0242-5 [doi] LID - 42 AB - BACKGROUND: Platelet dysfunction importantly contributes to trauma-induced coagulopathy (TIC). Our aim was to examine the impact of transfusing platelets (PLTs) in a 2:1 PLT-to-red blood cell (RBC) ratio versus the standard 1:1 ratio on transfusion requirements, correction of TIC, and organ damage in a rat multiple trauma transfusion model. METHODS: Mechanically ventilated male Sprague Dawley rats were traumatized by crush injury to the small intestine and liver and a fracture of the femur, followed by exsanguination until a mean arterial pressure (MAP) of 40 mmHg. Animals were randomly assigned to receive resuscitation in a high PLT dose (PLT to plasma to RBC in a ratio of 2:1:1) or a standard PLT dose (ratio of 1:1:1) until a MAP of 60 mmHg was reached (n = 8 per group). Blood samples were taken for biochemical and thromboelastometry (ROTEM) assessment. Organs were harvested for histopathology.Outcome measures were transfusion requirements needed to reach a pretargeted MAP, as well as ROTEM correction and organ failure. RESULTS: Trauma resulted in coagulopathy as assessed by deranged ROTEM results. Mortality rate was 19%, with all deaths occurring in the standard dose group. The severity of hypovolemic shock as assessed by lactate and base excess was not different in both groups. The volume of transfusion needed to reach the MAP target was lower in the high PLT dose group compared to the standard dose, albeit not statistically significant (p = 0.054). Transfusion with a high PLT dose resulted in significant stronger clot firmness compared to the standard dose at all time points following trauma, while platelet counts were similar. Organ failure as assessed by biochemical analysis and histopathology was not different between groups, nor were there any thromboembolic events recorded. CONCLUSIONS: Resuscitation with a high (2:1) PLT-to-RBC ratio was more effective compared to standard (1:1) PLT-to-RBC ratio in treating TIC, with a trend towards reduced transfusion volumes. Also, high PLT dose did not aggravate organ damage. Transfusion strategies using higher PLT dose regiments might be a feasible treatment option in hemorrhaging trauma patients for the correction of TIC. FAU - Kleinveld, Derek J B AU - Kleinveld DJB AD - Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. AD - Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands. FAU - Wirtz, Mathijs R AU - Wirtz MR AD - Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. AD - Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands. FAU - van den Brink, Daan P AU - van den Brink DP AD - Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. FAU - Maas, M Adrie W AU - Maas MAW AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. FAU - Roelofs, Joris J T H AU - Roelofs JJTH AD - Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands. FAU - Goslings, J Carel AU - Goslings JC AD - Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. FAU - Hollmann, Markus W AU - Hollmann MW AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. AD - Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. FAU - Juffermans, Nicole P AU - Juffermans NP AUID- ORCID: 0000-0002-3039-6574 AD - Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. n.p.juffermans@amc.nl. AD - Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands. n.p.juffermans@amc.nl. LA - eng PT - Journal Article DEP - 20190725 PL - Germany TA - Intensive Care Med Exp JT - Intensive care medicine experimental JID - 101645149 PMC - PMC6658636 OTO - NOTNLM OT - Coagulopathy OT - Experimental OT - Platelets OT - Transfusion OT - Trauma COIS- The authors declare that they have no competing interests. EDAT- 2019/07/28 06:00 MHDA- 2019/07/28 06:01 PMCR- 2019/07/25 CRDT- 2019/07/27 06:00 PHST- 2019/03/04 00:00 [received] PHST- 2019/03/07 00:00 [accepted] PHST- 2019/07/27 06:00 [entrez] PHST- 2019/07/28 06:00 [pubmed] PHST- 2019/07/28 06:01 [medline] PHST- 2019/07/25 00:00 [pmc-release] AID - 10.1186/s40635-019-0242-5 [pii] AID - 242 [pii] AID - 10.1186/s40635-019-0242-5 [doi] PST - epublish SO - Intensive Care Med Exp. 2019 Jul 25;7(Suppl 1):42. doi: 10.1186/s40635-019-0242-5. PMID- 31305285 OWN - NLM STAT- MEDLINE DCOM- 20200312 LR - 20200312 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 270 IP - 3 DP - 2019 Sep TI - Window of Opportunity to Mitigate Trauma-induced Coagulopathy: Fibrinolysis Shutdown not Prevalent Until 1 Hour Post-injury. PG - 528-534 LID - 10.1097/SLA.0000000000003464 [doi] AB - OBJECTIVE: The aim of this study was to delineate the kinetics of coagulation dysregulation after injury in children. SUMMARY BACKGROUND DATA: Trauma-induced coagulopathy is common and portends poor outcomes in severely-injured children. Transfer to pediatric trauma centers is common; time from injury to laboratory testing is therefore highly variable. METHODS: Records of severely injured children age <18 years with rapid thromboelastography (TEG) on arrival and documented time of injury were queried. Standard definitions of hyperfibrinolysis (LY30 >/=3), fibrinolysis shutdown (SD; LY30 /=3 defined severe traumatic brain injury (TBI). Variables of interest included demographics, injury mechanism, medications, mortality, and functional disability. Wilcoxon rank-sum and Kruskal-Wallis testing were utilized for skewed continuous data, and Chi-square or Fisher exact test was used for categorical data. To determine independent predictors of SD, multivariable logistic regression modeling was performed using the time from injury variable as well as variables determined a priori to be clinically relevant contributors to the development of SD (TBI, injury mechanism, and age). RESULTS: A total of 285 patients were included: median (interquartile range) age = 11 (6-15), injury severity score = 17 (10-25), 75% blunt mechanism, 32% severe TBI, 11% mortality, 28% functional disability. None received antifibrinolytics or blood products before TEG testing. Physiologic phenotype was predominant within 1 hour of injury (51%); beyond 1 hour, fibrinolysis SD was the predominant phenotype (1-3 hours = 46%, >3 hours = 59%). Patients with TBI had significant increase in incidence of fibrinolysis SD beyond 1 hour after injury as compared to non-TBI patients. Physiologic fibrinolysis was associated with survival at all timepoints (P = 0.005). CONCLUSIONS: Fibrinolysis SD is a reactive, compensatory mechanism that is evident soon after injury. There appears to be an early and brief window of opportunity for intervention to mitigate the progression to TIC. Further studies should focus on understanding the dynamic events occurring immediately after injury to identify specific targets for intervention. FAU - Leeper, Christine M AU - Leeper CM AD - Department of Surgery, Division of General Surgery and Trauma, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Strotmeyer, Stephen J AU - Strotmeyer SJ AD - Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. FAU - Neal, Matthew D AU - Neal MD AD - Department of Surgery, Division of General Surgery and Trauma, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Gaines, Barbara A AU - Gaines BA AD - Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 RN - 0 (Antifibrinolytic Agents) SB - IM MH - Abbreviated Injury Scale MH - Academic Medical Centers MH - Adolescent MH - Antifibrinolytic Agents/*administration & dosage MH - Blood Coagulation Disorders/diagnosis/*drug therapy/*etiology/mortality MH - Child MH - Child, Preschool MH - Cohort Studies MH - Emergency Service, Hospital MH - Female MH - Fibrinolysis/physiology MH - Hospitals, Pediatric MH - Humans MH - Injury Severity Score MH - Male MH - Prognosis MH - Prospective Studies MH - Risk Assessment MH - Survival Analysis MH - Thrombelastography/methods MH - Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/*blood/*complications/mortality/therapy EDAT- 2019/07/16 06:00 MHDA- 2020/03/13 06:00 CRDT- 2019/07/16 06:00 PHST- 2019/07/16 06:00 [pubmed] PHST- 2020/03/13 06:00 [medline] PHST- 2019/07/16 06:00 [entrez] AID - 10.1097/SLA.0000000000003464 [doi] PST - ppublish SO - Ann Surg. 2019 Sep;270(3):528-534. doi: 10.1097/SLA.0000000000003464. PMID- 31304022 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231104 IS - 2052-8817 (Electronic) IS - 2052-8817 (Linking) VI - 6 IP - 3 DP - 2019 Jul TI - Bad blood: A coagulopathy associated with trauma and massive transfusion review. PG - 215-222 LID - 10.1002/ams2.402 [doi] AB - Coagulopathy in trauma patients is a known contributor to death due to hemorrhage. In fact, it seen as frequently as 35% of the time. The complexity of the coagulopathy pathway requires a deliberate and planned approach. The methods used to assess and detect if a patient is coagulopathic remain challenging, but tools have been developed to assist the practitioner to effectively manage and even quickly reverse the coagulopathy. The purpose of this review is to educate trauma and emergency medicine staff on the currently available diagnostic tools to assess coagulopathy, to provide an overview of the coagulopathy pathway, as well as provide examples of how to intervene and treat coagulopathy, including the use of crew resource management during mass transfusion protocol activations. FAU - Vernon, Tawnya AU - Vernon T AUID- ORCID: 0000-0002-5674-7002 AD - Trauma Services Penn Medicine Lancaster General Health Lancaster Pennsylvania. FAU - Morgan, Madison AU - Morgan M AD - Trauma Services Penn Medicine Lancaster General Health Lancaster Pennsylvania. FAU - Morrison, Chet AU - Morrison C AUID- ORCID: 0000-0003-1742-9375 AD - Trauma Services Penn Medicine Lancaster General Health Lancaster Pennsylvania. LA - eng PT - Journal Article PT - Review DEP - 20190327 PL - United States TA - Acute Med Surg JT - Acute medicine & surgery JID - 101635464 PMC - PMC6603326 OTO - NOTNLM OT - Fibrinolysis OT - fresh frozen plasma OT - massive transfusion protocol OT - packed red blood cells OT - platelets OT - trauma-induced coagulopathy OT - viscoelastic assay EDAT- 2019/07/16 06:00 MHDA- 2019/07/16 06:01 PMCR- 2019/03/27 CRDT- 2019/07/16 06:00 PHST- 2019/01/21 00:00 [received] PHST- 2019/02/02 00:00 [accepted] PHST- 2019/07/16 06:00 [entrez] PHST- 2019/07/16 06:00 [pubmed] PHST- 2019/07/16 06:01 [medline] PHST- 2019/03/27 00:00 [pmc-release] AID - AMS2402 [pii] AID - 10.1002/ams2.402 [doi] PST - epublish SO - Acute Med Surg. 2019 Mar 27;6(3):215-222. doi: 10.1002/ams2.402. eCollection 2019 Jul. PMID- 31279258 OWN - NLM STAT- MEDLINE DCOM- 20200130 LR - 20201201 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 244 DP - 2019 Dec TI - The Role of Chemoprophylactic Agents in Modulating Platelet Aggregability After Traumatic Brain Injury. PG - 1-8 LID - S0022-4804(19)30409-3 [pii] LID - 10.1016/j.jss.2019.06.022 [doi] AB - BACKGROUND: The pathophysiology behind the subacute but persistent hypercoagulable state after traumatic brain injury (TBI) is poorly understood but contributes to morbidity induced by venous thromboembolism. Because platelets and their microvesicles have been hypothesized to play a role in post-traumatic hypercoagulability, administration of commonly used agents may ameliorate this coagulability. We hypothesized that utilization of aspirin, ketorolac, amitriptyline, unfractionated heparin, or enoxaparin would modulate the platelet aggregation response after TBI. METHODS: Concussive TBI was induced by weight drop. Mice were then randomized to receive aspirin, ketorolac, amitriptyline, heparin, enoxaparin, or saline control at 2 and 8 h after TBI. Mice were sacrificed at 6 or 24 h after injury to determine coagulability by rotational thromboelastometry (ROTEM), platelet function testing with impedance aggregometry, and microvesicle enumeration. Platelet sphingolipid metabolites were analyzed by mass spectrometry. RESULTS: ROTEM demonstrated increased platelet contribution to maximum clot firmness at 6 h after TBI in mice that received aspirin or amitriptyline, but this did not persist at 24 h. By contrast, adenosine diphosphate- and arachidonic acid-induced platelet aggregation at 6 h was significantly lower in mice receiving ketorolac, aspirin, and amitriptyline compared with mice receiving saline at 6 h after injury and only arachidonic acid-initiated platelet aggregation was decreased by aspirin at 24 h. There were no differences in microvesicle production at either time point. Platelet sphingosine-1-phosphate levels were decreased at 6 h in the group receiving amitriptyline and increased at 24 h along with platelet ceramide levels at 24 h in the amitriptyline group. CONCLUSION: After TBI, amitriptyline decreased platelet aggregability and increased contribution to clot in a manner similar to aspirin. The amitriptyline effects on platelet function and sphingolipid metabolites may represent a possible role of the acid sphingomyelinase in the hypercoagulability observed after injury. In addition, inhibition of platelet reactivity may be an underappreciated benefit of low molecular weight heparins, such as enoxaparin. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Morris, Mackenzie C AU - Morris MC AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Kassam, Farzaan AU - Kassam F AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Bercz, Aron AU - Bercz A AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Beckmann, Nadine AU - Beckmann N AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Schumacher, Fabian AU - Schumacher F AD - Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Institute of Nutritional Science, University of Potsdam, Potsdam, Germany. FAU - Gulbins, Erich AU - Gulbins E AD - Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. FAU - Makley, Amy T AU - Makley AT AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: goodmamd@ucmail.uc.edu. LA - eng GR - R01 GM124156/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190703 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Enoxaparin) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Sphingolipids) RN - 1806D8D52K (Amitriptyline) RN - R16CO5Y76E (Aspirin) SB - IM MH - Amitriptyline/administration & dosage MH - Animals MH - Aspirin/administration & dosage MH - Blood Coagulation/drug effects MH - Brain Injuries, Traumatic/blood/*complications/physiopathology MH - Disease Models, Animal MH - Enoxaparin/administration & dosage MH - Humans MH - Lipid Metabolism/drug effects MH - Male MH - Mice MH - Platelet Aggregation/drug effects/physiology MH - Platelet Aggregation Inhibitors/*administration & dosage MH - Platelet Function Tests MH - Sphingolipids/metabolism MH - Thrombelastography MH - Venous Thromboembolism/blood/etiology/*prevention & control PMC - PMC6815704 MID - NIHMS1533622 OTO - NOTNLM OT - Chemoprophylaxis OT - Sphingolipids OT - Trauma OT - Traumatic brain injury OT - Venous thromboembolism COIS- Conflicts of interest: All authors have no conflicts of interest to disclose. EDAT- 2019/07/07 06:00 MHDA- 2020/01/31 06:00 PMCR- 2020/12/01 CRDT- 2019/07/07 06:00 PHST- 2019/02/27 00:00 [received] PHST- 2019/04/22 00:00 [revised] PHST- 2019/06/06 00:00 [accepted] PHST- 2019/07/07 06:00 [pubmed] PHST- 2020/01/31 06:00 [medline] PHST- 2019/07/07 06:00 [entrez] PHST- 2020/12/01 00:00 [pmc-release] AID - S0022-4804(19)30409-3 [pii] AID - 10.1016/j.jss.2019.06.022 [doi] PST - ppublish SO - J Surg Res. 2019 Dec;244:1-8. doi: 10.1016/j.jss.2019.06.022. Epub 2019 Jul 3. PMID- 31267192 OWN - NLM STAT- MEDLINE DCOM- 20200528 LR - 20210101 IS - 1433-7347 (Electronic) IS - 0942-2056 (Print) IS - 0942-2056 (Linking) VI - 28 IP - 1 DP - 2020 Jan TI - Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height. PG - 245-252 LID - 10.1007/s00167-019-05608-x [doi] AB - PURPOSE: Achilles tendon rupture leads to long-term plantar flexor deficits, but some patients recover functional performance better than others. Early indicators of tendon healing could be helpful in establishing patient prognosis and making individualized decisions regarding rehabilitation progression. The purpose of this study was to investigate relationships between early tendon morphology and mechanical properties to long-term heel-rise and jumping function in individuals after Achilles tendon rupture. METHODS: Individuals after Achilles tendon rupture were assessed at 4, 8, 12, 24, and 52 weeks post-injury. Tendon cross-sectional area, length, and mechanical properties were measured using ultrasound. Heel-rise and jump tests were performed at 24 and 52 weeks. Correlation and regression analysis were used to identify relationships between tendon structural variables in the first 12 weeks to functional outcomes at 52 weeks, and determine whether the addition of tendon structural characteristics at 24 weeks strengthened relationships between functional performance at 24 and 52 weeks. Functional outcomes of individuals with < 3 cm of elongation were compared to those with > 3 cm of elongation using a Mann-Whitney U test. RESULTS: Twenty-two participants [mean (SD) age = 40 (11) years, 17 male] were included. Tendon cross-sectional area at 12 weeks was the strongest predictor of heel-rise height (R(2) = 0.280, p = 0.014) and work symmetry (R(2) = 0.316, p = 0.008) at 52 weeks. Jumping performance at 52 weeks was not significantly related to any of the tendon structural measures in the first 12 weeks. Performance of all functional tasks at 24 weeks was positively related to performance on the same task at 52 weeks (r = 0.456-0.708, p < 0.05). The addition of tendon cross-sectional area improved the model for height LSI (R(2) = 0.519, p = 0.001). Tendon elongation > 3 cm significantly reduced jumping symmetry (p < 0.05). CONCLUSION: Tendon cross-sectional area and excessive elongation related to plantar flexor performance on functional testing after Achilles tendon rupture. Once an individual is able to perform function-based testing, tendon structural measures may inform long-term prognosis. Ultrasound-based measures of tendon structure early in recovery seem to relate to later performance on functional testing. Clinically, assessing tendon structure has the potential to be used as a biomarker of tendon healing early in recovery and better predict patients at risk of negative functional outcome. LEVEL OF EVIDENCE: II. FAU - Zellers, Jennifer A AU - Zellers JA AUID- ORCID: 0000-0002-0601-1355 AD - Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. FAU - Pohlig, Ryan T AU - Pohlig RT AD - College of Health Sciences biostatistics Core Facility, University of Delaware, Newark, DE, USA. FAU - Cortes, Daniel H AU - Cortes DH AD - Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA, USA. FAU - Gravare Silbernagel, Karin AU - Gravare Silbernagel K AD - Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA. kgs@udel.edu. LA - eng GR - P30-GM103333/NH/NIH HHS/United States GR - T32 HD007434/HD/NICHD NIH HHS/United States GR - R21AR067390/AR/NIAMS NIH HHS/United States GR - P30 GM103333/GM/NIGMS NIH HHS/United States GR - R21 AR067390/AR/NIAMS NIH HHS/United States PT - Journal Article DEP - 20190702 PL - Germany TA - Knee Surg Sports Traumatol Arthrosc JT - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JID - 9314730 SB - IM MH - Achilles Tendon/*diagnostic imaging/*injuries/physiopathology MH - Adult MH - Female MH - Heel/physiopathology MH - Humans MH - Male MH - Middle Aged MH - Prognosis MH - *Recovery of Function MH - Rupture/physiopathology MH - Tendon Injuries/physiopathology/*rehabilitation MH - Treatment Outcome MH - Ultrasonography PMC - PMC6939153 MID - NIHMS1533529 OTO - NOTNLM OT - Ankle OT - Morphology OT - Ultrasound OT - Viscoelastic properties EDAT- 2019/07/04 06:00 MHDA- 2020/05/29 06:00 PMCR- 2021/01/01 CRDT- 2019/07/04 06:00 PHST- 2019/01/25 00:00 [received] PHST- 2019/06/26 00:00 [accepted] PHST- 2019/07/04 06:00 [pubmed] PHST- 2020/05/29 06:00 [medline] PHST- 2019/07/04 06:00 [entrez] PHST- 2021/01/01 00:00 [pmc-release] AID - 10.1007/s00167-019-05608-x [pii] AID - 10.1007/s00167-019-05608-x [doi] PST - ppublish SO - Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):245-252. doi: 10.1007/s00167-019-05608-x. Epub 2019 Jul 2. PMID- 31263903 OWN - NLM STAT- MEDLINE DCOM- 20200325 LR - 20200325 IS - 1943-7722 (Electronic) IS - 0002-9173 (Linking) VI - 152 IP - 4 DP - 2019 Sep 9 TI - The Utility of Thromboelastography to Guide Blood Product Transfusion. PG - 407-422 LID - 10.1093/ajcp/aqz074 [doi] AB - OBJECTIVES: To provide an overview of the clot viscoelastic testing technology and to describe its utility in guiding blood product transfusions. METHODS: A case scenario will be discussed as well as interpretation of thromboelastography (TEG) tracings. In addition, literature examining the utility of viscoelastic testing in guiding patient management and blood product transfusions will be reviewed. RESULTS: TEG/rotational thromboelastometry (ROTEM) is useful in evaluating clot kinetics in trauma and acutely bleeding patients. TEG/ROTEM parameters are reflective of values measured using standard coagulation assays; however, TEG/ROTEM parameters are more rapidly available and more costly. TEG and ROTEM are used in three main settings: cardiac surgery, liver transplantation, and trauma to assess global hemostasis and administration of blood products. CONCLUSIONS: TEG/ROTEM can be helpful in guiding resuscitation and blood product transfusion. Several studies have demonstrated a reduction in transfusion of blood components with TEG/ROTEM; however, other studies have suggested that TEG/ROTEM is not clinically effective in guiding transfusion. CI - (c) American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Schmidt, Amy E AU - Schmidt AE AD - Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY. FAU - Israel, Anna Karolina AU - Israel AK AD - Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY. FAU - Refaai, Majed A AU - Refaai MA AD - Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY. LA - eng PT - Journal Article PT - Review PL - England TA - Am J Clin Pathol JT - American journal of clinical pathology JID - 0370470 SB - IM MH - *Blood Coagulation MH - Blood Coagulation Disorders/*therapy MH - Blood Transfusion/*methods MH - Cardiac Surgical Procedures MH - Hemorrhage/*therapy MH - Humans MH - Liver Transplantation MH - *Thrombelastography OTO - NOTNLM OT - Blood product OT - TEG OT - Thromboelastography OT - Transfusion EDAT- 2019/07/03 06:00 MHDA- 2020/03/26 06:00 CRDT- 2019/07/03 06:00 PHST- 2019/07/03 06:00 [pubmed] PHST- 2020/03/26 06:00 [medline] PHST- 2019/07/03 06:00 [entrez] AID - 5526928 [pii] AID - 10.1093/ajcp/aqz074 [doi] PST - ppublish SO - Am J Clin Pathol. 2019 Sep 9;152(4):407-422. doi: 10.1093/ajcp/aqz074. PMID- 31246911 OWN - NLM STAT- MEDLINE DCOM- 20200528 LR - 20200528 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 87 IP - 1S Suppl 1 DP - 2019 Jul TI - Freeze-dried plasma mitigates the dilution effects of a hemoglobin-based oxygen carrier (HBOC-201) in a model of resuscitation for hemorrhage and hemodilution. PG - S83-S90 LID - 10.1097/TA.0000000000002317 [doi] AB - BACKGROUND: Hemoglobin-based oxygen carriers (HBOCs) have proven useful for supplementing oxygen delivery when red cells are unavailable; however, HBOCs do not promote hemostasis. The need for prehospital bridges to blood transfusion informed this study which sought to determine the impact of HBOCs on coagulation, with or without cotransfusion of freeze-dried plasma (FDP). METHODS: Treatment was simulated in vitro by replacing whole blood volume (or whole blood prediluted with 25% plasmalyte A as a hemodilution model) with HBOC-201, FDP, or both at ratios of 10% to 50% of original volume. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, complete blood count, viscosity, thromboelastography (TEG), and platelet adhesion to collagen under flow were evaluated. Subsequently, tissue plasminogen activator was added to model hemorrhagic shock effects on fibrinolysis. RESULTS: Substituting blood with HBOC resulted in dose-dependent decreases in fibrinogen and cells, which lengthened PT (+61% at highest dose) and aPTT (+40% at highest dose) and produced TEG parameters consistent with dilutional coagulopathy. While substituting blood with FDP decreased cell counts accordingly, fibrinogen, PT, aPTT, and TEG parameters were not statistically changed. When HBOC and FDP were combined 1:1 for volume replacement, observed HBOC-only detriments were mitigated: PT and aPTT were increased by 17% and 11%, respectively, at the highest doses. In prediluted samples, similar trends were seen with exacerbated differences. Platelet adhesion to collagen was directly affected by hematocrit. Samples containing both HBOC and tissue plasminogen activator were highly susceptible to fibrinolysis. CONCLUSION: A dose equivalent to 1 unit to 2 units each of HBOC-201 and FDP had a modest impact on functional coagulation measures and is reasonable to consider for clinical study as a part of early transfusion intervention. Higher doses may impart hemodilution risks similar to resuscitation with crystalloid or other colloids in coagulation-compromised patients. Further study of HBOC effects on fibrinolysis is also indicated. STUDY TYPE: In vitro laboratory study. FAU - Meledeo, Michael Adam AU - Meledeo MA AD - From the United States Army Institute of Surgical Research, JBSA-Fort Sam Houston (G.C.P., C.S.M., A.S.T., J.A.B., A.E.P., A.P.C.)., Houston, Texas. FAU - Peltier, Grantham C AU - Peltier GC FAU - McIntosh, Colby S AU - McIntosh CS FAU - Taylor, Ashley S AU - Taylor AS FAU - Bynum, James A AU - Bynum JA FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Cap, Andrew P AU - Cap AP LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Blood Substitutes) RN - 0 (Hemoglobins) RN - 1XQE66T19H (HBOC 201) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Substitutes/*pharmacology MH - *Hemodilution MH - Hemoglobins/*pharmacology MH - Humans MH - *Models, Biological MH - *Plasma MH - *Resuscitation MH - Shock, Hemorrhagic/*therapy EDAT- 2019/06/28 06:00 MHDA- 2020/05/29 06:00 CRDT- 2019/06/28 06:00 PHST- 2019/06/28 06:00 [entrez] PHST- 2019/06/28 06:00 [pubmed] PHST- 2020/05/29 06:00 [medline] AID - 01586154-201907001-00014 [pii] AID - 10.1097/TA.0000000000002317 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S83-S90. doi: 10.1097/TA.0000000000002317. PMID- 31233444 OWN - NLM STAT- MEDLINE DCOM- 20200526 LR - 20200526 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 87 IP - 4 DP - 2019 Oct TI - Obesity is associated with postinjury hypercoagulability. PG - 876-882 LID - 10.1097/TA.0000000000002414 [doi] AB - BACKGROUND: Obesity is linked to hypercoagulability with an increased risk of venous thromboembolic events (VTE) in the uninjured population. Therefore, we hypothesize that obesity (body mass index [BMI] >/=30 kg/m [BMI30]) is associated with a hypercoagulable state postinjury characterized by increased clot strength and resistance to fibrinolysis. METHODS: Our prospective Trauma Activation Protocol database includes all trauma activations patients for whom a rapid thrombelastography is obtained within 60 minutes postinjury prior to any transfusions. The data set was then stratified by BMI and subjects with BMI30 were compared with those with BMI less than 30 kg/m). The following thrombelastography measurements were obtained: activated clotting time, clot formation rate (angle), maximum clot strength (MA), and % clot lysis 30 minutes after MA (LY30, %). Fibrinolysis shutdown (SD) was defined as LY30 < 0.6% and hyperfibrinolysis (HF) as LY30 greater than 7.6%. Continuous variables are expressed as median (interquartile range). RESULTS: Overall, 687 patients were included of whom 161 (23%) had BMI30. The BMI30 group was older, had a lower proportion of males and of blunt trauma, and was less severely injured. After adjustment for confounders, BMI30 was independently associated with lower odds of MA less than 55 mm (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.13-0.60) and of HF (OR, 0.31; 95% CI, 0.10-0.97) and higher odds of SD (OR, 1.82; 95% CI, 1.09-3.05). No independent association was observed with angle less than 65 degrees (OR 0.57 95% CI 0.30-1.05). While VTEs were more frequent among BMI30 patients (5.0 vs. 3.3%), this did not reach significance after confounding adjustment (p = 0.11). CONCLUSION: Obesity was protective against diminished clot strength and hyperfibrinolysis, and obesity was associated with an increased risk of fibrinolytic SD in severely injured patients. These findings suggest a relative hypercoagulability. Although no difference in VTEs was noted in this study, these findings may explain the higher rate of VTEs reported in other studies. LEVEL OF EVIDENCE: Prognostic and Epidemiological, level III. FAU - Samuels, Jason M AU - Samuels JM AD - From the Department of Surgery (J.M.S., J.R.C., J.J.S., A.B., A.S.), University of Colorado Denver; Department of Surgery (E.E.M., M.J.C., A.G., J.C.), Denver Health Medical Center; Department of Pediatrics (C.C.S.); and School of Public Health (A.S.), University of Colorado Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Coleman, Julia R AU - Coleman JR FAU - Sumislawski, Joshua J AU - Sumislawski JJ FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chandler, James AU - Chandler J FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Tests/methods MH - Body Mass Index MH - Correlation of Data MH - Female MH - Fibrinolysis/physiology MH - Humans MH - Male MH - *Obesity/blood/diagnosis/epidemiology MH - Prognosis MH - Protective Factors MH - Thrombelastography/methods MH - *Thrombophilia/diagnosis/etiology/prevention & control MH - Trauma Severity Indices MH - United States MH - *Venous Thrombosis/etiology/prevention & control MH - *Wounds and Injuries/blood/complications/diagnosis/epidemiology PMC - PMC6773476 MID - NIHMS1038692 EDAT- 2019/06/25 06:00 MHDA- 2020/05/27 06:00 PMCR- 2019/11/01 CRDT- 2019/06/25 06:00 PHST- 2019/06/25 06:00 [pubmed] PHST- 2020/05/27 06:00 [medline] PHST- 2019/06/25 06:00 [entrez] PHST- 2019/11/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000002414 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Oct;87(4):876-882. doi: 10.1097/TA.0000000000002414. PMID- 31230841 OWN - NLM STAT- MEDLINE DCOM- 20200120 LR - 20260829 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 166 IP - 3 DP - 2019 Sep TI - Clot activators do not expedite the time to predict massive transfusion in trauma patients analyzed with tissue plasminogen activator thrombelastography. PG - 408-415 LID - S0039-6060(19)30251-X [pii] LID - 10.1016/j.surg.2019.05.011 [doi] AB - BACKGROUND: Trauma patients with hypersensitivity to tissue plasminogen activator mediated fibrinolysis quantified by tissue plasminogen activator thromboelastography are at increased risk of massive transfusion. The tissue plasminogen activator thromboelastography assay has been tested in trauma patients using native thromboelastography with no exogenous activator. We hypothesize that adding an activator will expedite the time to results. METHODS: Healthy whole blood was assayed with and without exogenous plasmin, which acts to deplete inhibitors of fibrinolysis, mimicking trauma blood. Samples were assessed using native, kaolin, and rapid thromboelastography with and without tissue plasminogen activator. The tissue plasminogen activator thromboelastography indices of time to maximum amplitude and lysis at 30 minutes were contrasted between healthy blood with and without plasmin using the three different activators. The activators were then used with a tissue plasminogen activator thromboelastography in 100 trauma patients to assess performance in predicting massive transfusion. RESULTS: In healthy blood, regardless of activator, lysis at 30 minutes did not increase with plasmin alone, but did increase with tissue plasminogen activator (P = .012). Adding tissue plasminogen activator and plasmin increased lysis at 30 minutes (P = .036). Time to maximum amplitude was reduced with tissue plasminogen activator and plasmin compared with tissue plasminogen activator alone (P = .012). Activated thromboelastographies had increased lysis at 30 minutes (P = .002), but no difference in time to maximum amplitude compared with native thromboelastographies. In trauma patients, native tissue plasminogen activator thromboelastography had greater performance in predicting massive transfusion than activated tissue plasminogen activator thromboelastographies with no difference in time to maximum amplitude. CONCLUSION: Adding an activator to tissue plasminogen activator thromboelastography does not expedite time to maximum amplitude in healthy blood depleted of fibrinolysis inhibitors. Activated tissue plasminogen activator thromboelastographies are inferior to native tissue plasminogen activator thromboelastography for predicting massive transfusion and do not reduce the time to results. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Walker, Carson B AU - Walker CB AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, Denver, CO; Department of Surgery, Denver Health Medical Center, Denver, CO. FAU - Kam, Adi AU - Kam A AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Dexter-Meldrum, Jacob AU - Dexter-Meldrum J AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Nydam, Trevor L AU - Nydam TL AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Surgery, University of Colorado Denver, Denver, CO. FAU - Chandler, James AU - Chandler J AD - Department of Surgery, Denver Health Medical Center, Denver, CO. FAU - Sauaia, Angela AU - Sauaia A AD - School of Public Health, University of Colorado Denver, Denver, CO. FAU - Barrett, Christopher D AU - Barrett CD AD - Department of Surgery, Koch Institute for Integrative Cancer Research/Massachusetts Institute of Technology, Cambridge, MA. FAU - Yaffe, Michael B AU - Yaffe MB AD - Department of Surgery, Koch Institute for Integrative Cancer Research/Massachusetts Institute of Technology, Cambridge, MA; Departments of Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, Denver, CO. Electronic address: hunter.moore@ucdenver.edu. LA - eng PT - Journal Article DEP - 20190621 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Biomarkers) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adolescent MH - Adult MH - Biomarkers MH - *Blood Coagulation MH - *Blood Transfusion/methods MH - Blood Viscosity MH - Case-Control Studies MH - Disease Management MH - Female MH - Humans MH - Male MH - Prognosis MH - *Thrombelastography MH - Thrombosis/*blood/*diagnosis MH - *Tissue Plasminogen Activator MH - Wounds and Injuries/*blood/diagnosis/*therapy MH - Young Adult EDAT- 2019/06/25 06:00 MHDA- 2020/01/21 06:00 CRDT- 2019/06/25 06:00 PHST- 2019/02/28 00:00 [received] PHST- 2019/04/24 00:00 [revised] PHST- 2019/04/06 00:00 [accepted] PHST- 2019/06/25 06:00 [pubmed] PHST- 2020/01/21 06:00 [medline] PHST- 2019/06/25 06:00 [entrez] AID - S0039-6060(19)30251-X [pii] AID - 10.1016/j.surg.2019.05.011 [doi] PST - ppublish SO - Surgery. 2019 Sep;166(3):408-415. doi: 10.1016/j.surg.2019.05.011. Epub 2019 Jun 21. PMID- 31219873 OWN - NLM STAT- MEDLINE DCOM- 20200709 LR - 20200709 IS - 1365-2346 (Electronic) IS - 0265-0215 (Linking) VI - 36 IP - 11 DP - 2019 Nov TI - Comparison between the new fully automated viscoelastic coagulation analysers TEG 6s and ROTEM Sigma in trauma patients: A prospective observational study. PG - 834-842 LID - 10.1097/EJA.0000000000001032 [doi] AB - BACKGROUND: Viscoelastic coagulation testing is increasingly used to diagnose trauma-induced coagulopathy. Two fully automated analysers, TEG 6s and ROTEM Sigma, were launched recently. No previous studies have compared these devices in trauma paients. OBJECTIVE: The aim of this study was to evaluate whether both fully automatic devices deliver comparable results. DESIGN: Prospective observational study. SETTING: Level one trauma centre from August 2017 to September 2018. PATIENTS: A total of 105 blood samples from 67 trauma patients were analysed simultaneously on TEG 6s and ROTEM Sigma. MAIN OUTCOME MEASURES: TEG 6s assays kaolin (CK), RapidTEG (CRT), kaolin with heparinase (CKH) and functional fibrinogen were compared with ROTEM Sigma assays INTEM, EXTEM, HEPTEM and FIBTEM. TEG 6s functional fibrinogen level was compared with plasma fibrinogen concentration, measured using the Clauss method. Correlations were classified as weak (Spearman correlation coefficient 0.20 to 0.39), moderate (0.40 to 0.59), strong (0.60 to 0.79) or very strong (>/=0.80). RESULTS: The TEG 6s parameters reaction time, kinetic time and alpha-angle (CK, CRT and CKH assays) mostly showed strong correlations with the corresponding ROTEM parameters clotting time, clot formation time and alpha-angle (INTEM, EXTEM and HEPTEM assays). The exceptions were CRT reaction time vs. EXTEM clotting time, and CK alpha-angle vs. INTEM alpha-angle, which correlated moderately. Absolute values for many of these parameters showed significant differences between the two devices. Very strong correlations and similar absolute values were observed between TEG 6s maximum amplitude (CRT, CK and CKH assays) and ROTEM maximum clot firmness (EXTEM, INTEM and HEPTEM assays). Correlations were also very strong for functional fibrinogen maximum amplitude vs. FIBTEM maximum clot firmness and functional fibrinogen level vs. Clauss fibrinogen concentration, but absolute values were significantly different. CONCLUSION: Strong to very strong correlations were observed between corresponding TEG 6s and ROTEM Sigma parameters. However, absolute values showed significant differences for most of the measurements. FAU - Ziegler, Bernhard AU - Ziegler B AD - From the Departement of Anesthesiology and Intensive Care Medicine, University Hospital of Salzburg (BZ), Departement of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg (WV, HS), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria (JZ, HS) and Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany (OG). FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Zipperle, Johannes AU - Zipperle J FAU - Grottke, Oliver AU - Grottke O FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study PL - England TA - Eur J Anaesthesiol JT - European journal of anaesthesiology JID - 8411711 SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/*diagnosis/etiology MH - *Blood Coagulation Tests MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography/*instrumentation MH - Wounds and Injuries/complications EDAT- 2019/06/21 06:00 MHDA- 2020/07/10 06:00 CRDT- 2019/06/21 06:00 PHST- 2019/06/21 06:00 [pubmed] PHST- 2020/07/10 06:00 [medline] PHST- 2019/06/21 06:00 [entrez] AID - 10.1097/EJA.0000000000001032 [doi] PST - ppublish SO - Eur J Anaesthesiol. 2019 Nov;36(11):834-842. doi: 10.1097/EJA.0000000000001032. PMID- 31183527 OWN - NLM STAT- MEDLINE DCOM- 20211015 LR - 20261010 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 47 IP - 2 DP - 2021 Apr TI - Diagnostic performance of thromboelastometry in trauma-induced coagulopathy: a comparison between two level I trauma centres using two different devices. PG - 343-351 LID - 10.1007/s00068-019-01165-7 [doi] AB - PURPOSE: The implementation of a ROTEM((R))-based algorithm requires reliable thresholds to mirror a prothrombin time (PT) ratio > 1.2 and/or a fibrinogen concentration < 1.5 g l(-1). Our goal was to compare the diagnostic performances of two devices (ROTEM((R)) Sigma and Delta, IL Werfen, Munich, Germany) in two level-I trauma centres for the diagnostic of post-traumatic coagulopathy. METHODS: We conducted a retrospective analysis of two registries across two periods of time: from September 2014 to December 2015 in Lyon-Sud university trauma centre and from April 2016 to January 2018 in the Grenoble Alps Trauma Centre. Accuracies of EXTEM and FIBTEM assays to detect patients with coagulation disorders were tested for each device using receiver operating characteristic (ROC) analyses. RESULTS: Within the study period, 74 trauma patients in the Grenoble cohort and 75 trauma patients in the Lyon cohort had concomitant ROTEM((R)) and standard coagulation testing on admission. No statistically significant difference was found between the two ROC curves for FIBTEM amplitude at 5 min (A5), FIBTEM maximum clot firmness, EXTEM clotting time (CT) and EXTEM A5 for ROTEM((R)) Sigma and Delta to diagnose post-traumatic coagulation disorders. The best threshold for FIBTEM A5 to predict low fibrinogen concentration was 7 mm for each device. EXTEM CT thresholds to diagnose PT ratio > 1.2 were 78 s and 74 s for ROTEM((R)) Sigma and Delta, respectively. CONCLUSIONS: These results suggest that ROTEM((R))-based algorithms may be transposed from one trauma centre to another independently of the setting and the ROTEM((R)) device in use. FAU - Bouzat, Pierre AU - Bouzat P AD - Department of Anaesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble University Hospital, 38000, Grenoble, France. PBouzat@chu-grenoble.fr. AD - Grenoble Alps University, 38000, Grenoble, France. PBouzat@chu-grenoble.fr. AD - Pole d'Anesthesie-Reanimation, Hopital Albert Michallon, BP 217, 38043, Grenoble, France. PBouzat@chu-grenoble.fr. FAU - Guerin, Romain AU - Guerin R AD - Department of Anaesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble University Hospital, 38000, Grenoble, France. FAU - Boussat, Bastien AU - Boussat B AD - Grenoble Alps University, 38000, Grenoble, France. AD - Quality of Care Unit, Grenoble University Hospital, 38000, Grenoble, France. AD - Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada. FAU - Nicolas, Jerome AU - Nicolas J AD - Charles Merieux-Lyon Sud School of Medicine, University Lyon 1, 69495, Oullins, France. FAU - Lambert, Aline AU - Lambert A AD - Charles Merieux-Lyon Sud School of Medicine, University Lyon 1, 69495, Oullins, France. FAU - Greze, Jules AU - Greze J AD - Department of Anaesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble University Hospital, 38000, Grenoble, France. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Center, Institue for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany. FAU - David, Jean-Stephane AU - David JS AD - Charles Merieux-Lyon Sud School of Medicine, University Lyon 1, 69495, Oullins, France. AD - Department of Anaesthesiology and Critical Care Medicine, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495, Pierre Benite, France. LA - eng PT - Journal Article DEP - 20190610 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - *Blood Coagulation Disorders/diagnosis/etiology MH - Blood Coagulation Tests MH - Humans MH - Retrospective Studies MH - *Thrombelastography MH - Trauma Centers OTO - NOTNLM OT - Coagulopathy OT - Diagnostic OT - Thromboelastometry OT - Trauma EDAT- 2019/06/12 06:00 MHDA- 2021/10/16 06:00 CRDT- 2019/06/12 06:00 PHST- 2019/03/26 00:00 [received] PHST- 2019/06/04 00:00 [accepted] PHST- 2019/06/12 06:00 [pubmed] PHST- 2021/10/16 06:00 [medline] PHST- 2019/06/12 06:00 [entrez] AID - 10.1007/s00068-019-01165-7 [pii] AID - 10.1007/s00068-019-01165-7 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2021 Apr;47(2):343-351. doi: 10.1007/s00068-019-01165-7. Epub 2019 Jun 10. PMID- 31157627 OWN - NLM STAT- MEDLINE DCOM- 20200203 LR - 20200203 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 32 IP - 5 DP - 2019 Oct TI - Transfusion in adults and children undergoing neurosurgery: the outcome evidence. PG - 574-579 LID - 10.1097/ACO.0000000000000754 [doi] AB - PURPOSE OF REVIEW: Transfusion is a common practice during neurosurgery. However, there is no evidence-based consensus on transfusion practice in neurosurgery. This review summarizes the evidence pertinent to the commonly used transfusion triggers in neurosurgical patients. RECENT FINDINGS: In the field of neurosurgery, there is only one randomized controlled trial, performed in patients with traumatic brain injury, to investigate the transfusion trigger of red blood cells. There is a lack-of-quality evidence pertinent to the transfusion triggers of other blood products. Most of the transfusion triggers used for neurosurgical patients are extrapolated from the evidence based on studies performed in nonneurosurgical patients. Clinical experience and expert opinions have played a major role in transfusion practice in neurosurgery. SUMMARY: There is a scarcity of high-quality outcome-based evidence for transfusion practice in neurosurgery. In the absence of quality evidence, the transfusion practice in neurosurgical patients should be based on the understanding of the complex pathophysiology related to anemia and coagulopathy and the balance between the risks and benefits associated with blood product transfusion. The practice guided by tissue oximeter and viscoelastic tests appears promising, but needs to be validated by future studies. FAU - Feng, Hua AU - Feng H AD - Department of Anesthesiology, Xuanwu Hospital of Capital Medical University, Beijing, China. FAU - Charchaflieh, Jean G AU - Charchaflieh JG AD - Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA. FAU - Wang, Tianlong AU - Wang T AD - Department of Anesthesiology, Xuanwu Hospital of Capital Medical University, Beijing, China. FAU - Meng, Lingzhong AU - Meng L AD - Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Adult MH - Anemia/etiology/prevention & control MH - Blood Coagulation Disorders/etiology/prevention & control MH - Blood Loss, Surgical/*prevention & control MH - Blood Transfusion/*standards MH - Child MH - Consensus MH - Evidence-Based Medicine/*standards MH - Humans MH - Neurosurgery/standards MH - Neurosurgical Procedures/*adverse effects MH - Practice Guidelines as Topic MH - Transfusion Reaction/*prevention & control EDAT- 2019/06/04 06:00 MHDA- 2020/02/06 06:00 CRDT- 2019/06/04 06:00 PHST- 2019/06/04 06:00 [pubmed] PHST- 2020/02/06 06:00 [medline] PHST- 2019/06/04 06:00 [entrez] AID - 10.1097/ACO.0000000000000754 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2019 Oct;32(5):574-579. doi: 10.1097/ACO.0000000000000754. PMID- 31128997 OWN - NLM STAT- MEDLINE DCOM- 20200724 LR - 20200724 IS - 1878-7533 (Electronic) IS - 1550-7289 (Print) IS - 1550-7289 (Linking) VI - 15 IP - 7 DP - 2019 Jul TI - Prospective assessment of fibrinolysis in morbid obesity: tissue plasminogen activator resistance improves after bariatric surgery. PG - 1153-1159 LID - S1550-7289(19)30131-5 [pii] LID - 10.1016/j.soard.2019.03.048 [doi] AB - BACKGROUND: Morbid obesity is associated with an increased risk of thrombotic events, which has been attributed to increased thrombotic activity. Multiple mechanisms have been proposed to explain this increased risk, including an inflammatory state with upregulation of procoagulant and antifibrinolytic proteins. We therefore hypothesize that patients with morbid obesity are hypercoagulable and will revert to normal after bariatric surgery. OBJECTIVES: To evaluate changes in the hypercoagulable state after bariatric surgery. SETTING: University Hospital, Bariatric Center of Excellence, United States. METHODS: Thromboelastography (TEG) data were collected on 72 subjects with morbid obesity, with 36 who had 6 months of follow-up after bariatric surgery. TEG data of 75 healthy subjects (HS) without obesity, recent trauma or surgery, acute infection, or chronic conditions (e.g., liver, cardiovascular, or kidney disease; cancer; diabetes; autoimmune or inflammatory disorders; and disorders of coagulation) were used for comparison. TEG was performed alone and with the addition of 75 and 150 ng/mL tissue plasminogen activator (tPA) to quantify fibrinolysis resistance (tPA-challenged TEG). RESULTS: The bariatric surgery cohort had a median age of 40.5 years, a median body mass index of 44.6 kg/m(2), and 90% female patients. Median body mass index reduced significantly 6 months post surgery but remained elevated compared with the HS group (31.4 versus 25.4 kg/m(2), P < .0001). At 6 months post surgery, subjects had longer reaction time (mean difference, 1.3; P = .02), lower maximum amplitude (-2.4, P = .01), and increased fibrinolysis with low-dose (3.1, P < .0001) and high-dose tPA-challenged TEG (9, P < .0001). Compared with HS, the postsurgery TEG values were still more likely to be abnormal (all P < .05). CONCLUSIONS: Patients with morbid obesity form stronger clots more rapidly and are more resistant to fibrinolysis than subjects without obesity. Bariatric surgery significantly improved the hypercoagulable profile and fibrinolysis resistance of morbid obesity. CI - Copyright (c) 2019. Published by Elsevier Inc. FAU - Samuels, Jason AU - Samuels J AD - Department of Surgery-Trauma Research Center, University of Colorado Denver, Denver, Colorado. Electronic address: Jason.Samuels@ucdenver.edu. FAU - Lawson, Peter J AU - Lawson PJ AD - Department of Surgery-Trauma Research Center, University of Colorado Denver, Denver, Colorado. FAU - Morton, Alexander P AU - Morton AP AD - Department of Surgery-Trauma Research Center, University of Colorado Denver, Denver, Colorado; Department of Surgery-Denver Health Medical Center, Denver, CO. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery-Trauma Research Center, University of Colorado Denver, Denver, Colorado. FAU - Hansen, Kirk C AU - Hansen KC AD - Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Denver, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery-Denver Health Medical Center, Denver, CO. FAU - Schoen, Jonathan A AU - Schoen JA AD - Department of Surgery-Division of GI, Trauma, and Endocrine Surgery, University of Colorado Denver, Denver, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20190410 PL - United States TA - Surg Obes Relat Dis JT - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JID - 101233161 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Bariatric Surgery MH - Case-Control Studies MH - Cohort Studies MH - Female MH - Fibrin Clot Lysis Time MH - Fibrinolysis/drug effects/*physiology MH - Humans MH - Male MH - Middle Aged MH - Obesity, Morbid/*blood/surgery MH - Thrombelastography MH - Tissue Plasminogen Activator/pharmacology PMC - PMC6719338 MID - NIHMS1038697 OTO - NOTNLM OT - Bariatric surgery OT - Coagulopathy OT - Fibrinolysis OT - Morbid obesity OT - Thromboelastography OT - Thrombosis OT - Venous thromboembolism EDAT- 2019/05/28 06:00 MHDA- 2020/07/25 06:00 PMCR- 2020/07/01 CRDT- 2019/05/27 06:00 PHST- 2019/01/19 00:00 [received] PHST- 2019/03/29 00:00 [revised] PHST- 2019/03/30 00:00 [accepted] PHST- 2019/05/28 06:00 [pubmed] PHST- 2020/07/25 06:00 [medline] PHST- 2019/05/27 06:00 [entrez] PHST- 2020/07/01 00:00 [pmc-release] AID - S1550-7289(19)30131-5 [pii] AID - 10.1016/j.soard.2019.03.048 [doi] PST - ppublish SO - Surg Obes Relat Dis. 2019 Jul;15(7):1153-1159. doi: 10.1016/j.soard.2019.03.048. Epub 2019 Apr 10. PMID- 31108555 OWN - NLM STAT- MEDLINE DCOM- 20191125 LR - 20231104 IS - 1098-9064 (Electronic) IS - 0094-6176 (Print) IS - 0094-6176 (Linking) VI - 45 IP - 4 DP - 2019 Jun TI - Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review. PG - 354-372 LID - 10.1055/s-0039-1688497 [doi] AB - The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin-thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Walsh, Mark AU - Walsh M AD - Saint Joseph Regional Medical Center, Mishawaka, Indiana. AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana. AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Moore, Ernest E AU - Moore EE AD - Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado. FAU - Moore, Hunter AU - Moore H AD - Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado. FAU - Thomas, Scott AU - Thomas S AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana. FAU - Lune, Stefani Vande AU - Lune SV AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Zimmer, David AU - Zimmer D AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Dynako, Joseph AU - Dynako J AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Hake, Daniel AU - Hake D AD - Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois. FAU - Crowell, Zachary AU - Crowell Z AD - Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois. FAU - McCauley, Ross AU - McCauley R AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Larson, Emilee E AU - Larson EE AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Miller, Michael AU - Miller M AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana. FAU - Pohlman, Tim AU - Pohlman T AD - Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana. FAU - Achneck, Hardean E AU - Achneck HE AD - Haemonetics Corporation, Braintree, Massachusetts. FAU - Martin, Peter AU - Martin P AD - Department of Emergency Medicine, Tulane School of Medicine, New Orleans, Louisiana. FAU - Nielsen, Nathan AU - Nielsen N AD - Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, Louisiana. FAU - Shariff, Faisal AU - Shariff F AD - Indiana University School of Medicine, South Bend Campus, South Bend, Indiana. FAU - Ploplis, Victoria A AU - Ploplis VA AD - W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana. AD - Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana. FAU - Castellino, Francis J AU - Castellino FJ AD - W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana. AD - Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana. LA - eng GR - R01 HL013423/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review DEP - 20190520 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Coagulation Disorders/blood/complications/*diagnosis MH - Blood Coagulation Tests/*methods MH - Humans MH - Neoplasms/*complications MH - Reproducibility of Results MH - Sensitivity and Specificity MH - Thrombelastography/methods MH - Thromboembolism/blood/diagnosis/etiology MH - Thrombosis/blood/complications/*diagnosis PMC - PMC7707018 MID - NIHMS1644724 COIS- Dr. Walsh reports grants from Haemonetics, outside the submitted work. Dr. H. Moore received research support from Instrument Laboratories and Haemonetics. He also shares intellectual property with Haemonetics and Thrombo Therapeutics Incorporated. He is also on the board of Thrombo Therapeutics Incorporated. Dr. E. Moore reports research grant from Haemonetics, outside the submitted work. In addition, he has a patent tPA TEG issued. Dr. Achneck reports having served as an employee of Haemonetics in the position of Director of Medical Affairs and Clinical Development during writing of the manuscript. The other authors have no conflict of interest to disclose. EDAT- 2019/05/21 06:00 MHDA- 2019/11/26 06:00 PMCR- 2020/12/01 CRDT- 2019/05/21 06:00 PHST- 2019/05/21 06:00 [pubmed] PHST- 2019/11/26 06:00 [medline] PHST- 2019/05/21 06:00 [entrez] PHST- 2020/12/01 00:00 [pmc-release] AID - 10.1055/s-0039-1688497 [doi] PST - ppublish SO - Semin Thromb Hemost. 2019 Jun;45(4):354-372. doi: 10.1055/s-0039-1688497. Epub 2019 May 20. PMID- 31090596 OWN - NLM STAT- MEDLINE DCOM- 20190909 LR - 20190909 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 30 IP - 4 DP - 2019 Jun TI - Recombinant human prothrombin (MEDI8111) combined with fibrinogen dose-dependently improved survival time and reduced blood loss in a porcine model of dilutional coagulopathy with uncontrolled bleeding. PG - 140-148 LID - 10.1097/MBC.0000000000000812 [doi] AB - : Uncontrolled bleeding due to trauma and coagulopathy is an area with high unmet medical need and high mortality rate. Treatment recommendations focus on transfusion of blood components while optimal therapy to improve coagulation remains to be established. The haemostatic effect of 2, 4 and 8 mg/kg recombinant prothrombin (MEDI8111) co-administered with 100 mg/kg fibrinogen (n = 7-8) was investigated in a porcine model of dilutional coagulopathy with uncontrolled bleeding. Vehicle (n = 11), fibrinogen alone (100 mg/kg , n = 15) were included as controls. Dilutional coagulopathy was induced by replacing approximately 75% of the blood volume with hydroxyethyl starch and a standardized liver incision was made followed by intravenous administration of study compounds. Survival time and blood loss were determined up to 120 min after liver incision. Rotational thromboelastometry (ROTEM EXTEM), prothrombin time (PT), thrombin--antithrombin complex and thrombin generation were measured at baseline, after dilution and 10, 40, 80 and 120 min after compound administration. Administration of MEDI8111+fibrinogen improved haemostasis, decreased blood loss and dose-dependently improved survival time compared to fibrinogen. All pigs receiving a dose of 8 mg/kg MEDI8111+fibrinogen, which restored normal prothrombin concentration, survived to the end of the experiment with close to normal haemostasis as measured by PT and ROTEM EXTEM CT. Administration of fibrinogen and MEDI8111 was sufficient to improve survival time and haemostasis in severely coagulopathic pigs. The dose-dependent haemostatic improvement observed with MEDI8111 administration suggests that prothrombin concentration was rate limiting for coagulation. FAU - Hansson, Kenny M AU - Hansson KM AD - Bioscience Cardiovascular, Early Cardiovascular, Renal and Metabolism, R&D Biopharmaceuticals, AstraZeneca, Gothenburg, AstraZeneca. FAU - Pehrsson, Susanne AU - Pehrsson S AD - Bioscience Cardiovascular, Early Cardiovascular, Renal and Metabolism, R&D Biopharmaceuticals, AstraZeneca, Gothenburg, AstraZeneca. FAU - Johansson, Karin J AU - Johansson KJ AD - Bioscience Cardiovascular, Early Cardiovascular, Renal and Metabolism, R&D Biopharmaceuticals, AstraZeneca, Gothenburg, AstraZeneca. AD - Cardiology Research Unit, Sahlgrenska University Hospital. FAU - Lindblom, Anna AU - Lindblom A AD - Bioscience Cardiovascular, Early Cardiovascular, Renal and Metabolism, R&D Biopharmaceuticals, AstraZeneca, Gothenburg, AstraZeneca. FAU - Nelander, Karin AU - Nelander K AD - Quantitative Systems Pharmacology, Clinical Pharmacology and Safety Sciences, R&D BioPharmaceuticals, AstraZeneca, Gothenburg. FAU - Lovgren, Ann AU - Lovgren A AD - Bioscience Cardiovascular, Early Cardiovascular, Renal and Metabolism, R&D Biopharmaceuticals, AstraZeneca, Gothenburg, AstraZeneca. AD - Leaflet Biotech Consulting, Solna, Sweden. LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Recombinant Proteins) RN - 9001-26-7 (Prothrombin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Animals MH - Blood Coagulation Disorders/complications/*drug therapy MH - Drug Therapy, Combination/methods MH - Fibrinogen/*therapeutic use MH - Hemorrhage/etiology/*prevention & control MH - Hemostasis/drug effects MH - Humans MH - Prothrombin/*therapeutic use MH - Recombinant Proteins MH - Survival Analysis MH - Swine MH - Time Factors EDAT- 2019/05/16 06:00 MHDA- 2019/09/10 06:00 CRDT- 2019/05/16 06:00 PHST- 2019/05/16 06:00 [entrez] PHST- 2019/05/16 06:00 [pubmed] PHST- 2019/09/10 06:00 [medline] AID - 00001721-201906000-00002 [pii] AID - 10.1097/MBC.0000000000000812 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2019 Jun;30(4):140-148. doi: 10.1097/MBC.0000000000000812. PMID- 31082919 OWN - NLM STAT- MEDLINE DCOM- 20200116 LR - 20260127 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 269 IP - 6 DP - 2019 Jun TI - The S100A10 Pathway Mediates an Occult Hyperfibrinolytic Subtype in Trauma Patients. PG - 1184-1191 LID - 10.1097/SLA.0000000000002733 [doi] AB - OBJECTIVE: To determine the characteristics of trauma patients with low levels of fibrinolysis as detected by viscoelastic hemostatic assay (VHA) and explore the underlying mechanisms of this subtype. BACKGROUND: Hyperfibrinolysis is a central component of acute traumatic coagulopathy but a group of patients present with low levels of VHA-detected fibrinolysis. There is concern that these patients may be at risk of thrombosis if empirically administered an antifibrinolytic agent. METHODS: A prospective multicenter observational cohort study was conducted at 5 European major trauma centers. Blood was drawn on arrival, within 2 hours of injury, for VHA (rotation thromboelastometry [ROTEM]) and fibrinolysis plasma protein analysis including the fibrinolytic mediator S100A10. An outcomes-based threshold for ROTEM hypofibrinolysis was determined and patients grouped by this and by D-dimer (DD) levels. RESULTS: Nine hundred fourteen patients were included in the study. The VHA maximum lysis (ML) lower threshold was determined to be <5%. Heterogeneity existed among patients with low ML, with survivors sharing similar clinical and injury characteristics to patients with normal ML values (5-15%). Those who died were critically injured with a preponderance of traumatic brain injury and had a 7-fold higher DD level (died vs. survived: 103,170 vs. 13,672 ng/mL, P < 0.001). Patients with low ML and high DD demonstrated a hyperfibrinolytic biomarker profile, low tissue plasminogen activator levels but high plasma levels of S100A10. S100A10 was negatively correlated with %ML (r = -0.26, P < 0.001) and caused a significant reduction in %ML when added to whole blood ex-vivo. CONCLUSIONS: Patients presenting with low ML and low DD levels have low injury severity and normal outcomes. Conversely, patients with low ML but high DD levels are severely injured, functionally coagulopathic and have poor clinical outcomes. These patients have low tissue plasminogen activator levels and are not detectable by ROTEM. S100A10 is a cell surface plasminogen receptor which may drive the hyperfibrinolysis in these patients and which when shed artificially lowers %ML ex-vivo. FAU - Gall, Lewis S AU - Gall LS AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Vulliamy, Paul AU - Vulliamy P AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Gillespie, Scarlett AU - Gillespie S AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Jones, Timothy F AU - Jones TF AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Pierre, Rochelle S J AU - Pierre RSJ AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Breukers, Sabine E AU - Breukers SE AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands. FAU - Maegele, Marc AU - Maegele M AD - Department for Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. AD - Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. AD - Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Davenport, Ross A AU - Davenport RA AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. CN - Targeted Action for Curing Trauma-Induced Coagulopathy (TACTIC) partners LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 RN - 0 (Annexin A2) RN - 0 (Blood Coagulation Factors) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (S100 Proteins) RN - 0 (S100 Calcium Binding Protein A10) RN - 0 (fibrin fragment D) SB - IM CIN - Ann Surg. 2020 Apr;271(4):e111-e112. doi: 10.1097/SLA.0000000000003691. PMID: 31800495 CIN - Ann Surg. 2020 Apr;271(4):e110-e111. doi: 10.1097/SLA.0000000000003690. PMID: 31800497 MH - Adult MH - Aged MH - Annexin A2/*blood MH - Blood Coagulation Factors/metabolism MH - Female MH - Fibrin Fibrinogen Degradation Products/metabolism MH - Fibrinolysis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - S100 Proteins/*blood MH - Survival Rate MH - Thrombelastography MH - Wounds and Injuries/*blood/*complications/mortality MH - Young Adult MH - S100 Calcium Binding Protein A10 EDAT- 2019/05/15 06:00 MHDA- 2020/01/17 06:00 CRDT- 2019/05/15 06:00 PHST- 2019/05/15 06:00 [entrez] PHST- 2019/05/15 06:00 [pubmed] PHST- 2020/01/17 06:00 [medline] AID - 00000658-201906000-00027 [pii] AID - 10.1097/SLA.0000000000002733 [doi] PST - ppublish SO - Ann Surg. 2019 Jun;269(6):1184-1191. doi: 10.1097/SLA.0000000000002733. PMID- 31078120 OWN - NLM STAT- MEDLINE DCOM- 20200225 LR - 20200225 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 179 DP - 2019 Jul TI - A review of global coagulation assays - Is there a role in thrombosis risk prediction? PG - 45-55 LID - S0049-3848(19)30228-2 [pii] LID - 10.1016/j.thromres.2019.04.033 [doi] AB - Normal haemostasis requires maintenance of a careful equilibrium between the necessity to clot when bleeding and the retention of fluid phase at all other times. Disruption of this equilibrium can result in catastrophic outcomes, e.g. acute myocardial infarction and pulmonary embolism. However, despite the significant therapeutic advances in cardiovascular medicine over recent years, our ability to provide an accurate cardiovascular risk assessment remains an unmet need. Routine coagulation testing is not a useful reflection of haemostasis and cannot be reliably used to predict bleeding and thrombosis risks. Global coagulation assays such as viscoelastic testing, thrombin and fibrin generation have been proposed as better measures of the haemostatic function. These assays, particularly viscoelastic testing, have been increasingly used to assess bleeding risks and guide blood product replacement in trauma and massive transfusion settings. However, the role of these assays in thrombosis is less well-defined but given the complexities of the coagulation system, these global coagulation assays when used in combination may provide a better assessment of cardiovascular and thrombosis risk at an individual level. Hence, we explore the role of some of the currently available global coagulation assays - the viscoelastic, thrombin generation and fibrin generation tests - and provide a review of the literature of the current evidence for these assays specifically in the field of venous thromboembolism and cardiovascular diseases. CI - Copyright (c) 2019 Elsevier Ltd. All rights reserved. FAU - Lim, Hui Yin AU - Lim HY AD - Department of Haematology, Northern Hospital, 185 Cooper St, Epping, VIC 3076, Australia; Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia. Electronic address: HuiYin.Lim@nh.org.au. FAU - O'Malley, Cindy AU - O'Malley C AD - RMIT University, Plenty Road, Bundoora, VIC 3083, Australia. FAU - Donnan, Geoffrey AU - Donnan G AD - The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia. FAU - Nandurkar, Harshal AU - Nandurkar H AD - Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia. FAU - Ho, Prahlad AU - Ho P AD - Department of Haematology, Northern Hospital, 185 Cooper St, Epping, VIC 3076, Australia; Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia. LA - eng PT - Journal Article PT - Review DEP - 20190501 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM CIN - Thromb Res. 2020 Apr;188:1-4. doi: 10.1016/j.thromres.2020.01.024. PMID: 32018167 MH - Blood Coagulation Tests/*methods MH - Humans MH - Risk Factors MH - Thrombosis/blood/*diagnosis OTO - NOTNLM OT - Cardiovascular disease OT - Fibrin OT - Global coagulation assays OT - Thrombin generation OT - Thromboelastography OT - Venous thromboembolism EDAT- 2019/05/12 06:00 MHDA- 2020/02/26 06:00 CRDT- 2019/05/12 06:00 PHST- 2019/03/22 00:00 [received] PHST- 2019/04/19 00:00 [revised] PHST- 2019/04/30 00:00 [accepted] PHST- 2019/05/12 06:00 [pubmed] PHST- 2020/02/26 06:00 [medline] PHST- 2019/05/12 06:00 [entrez] AID - S0049-3848(19)30228-2 [pii] AID - 10.1016/j.thromres.2019.04.033 [doi] PST - ppublish SO - Thromb Res. 2019 Jul;179:45-55. doi: 10.1016/j.thromres.2019.04.033. Epub 2019 May 1. PMID- 31053712 OWN - NLM STAT- MEDLINE DCOM- 20190606 LR - 20210109 IS - 2041-1723 (Electronic) IS - 2041-1723 (Linking) VI - 10 IP - 1 DP - 2019 May 3 TI - Microclot array elastometry for integrated measurement of thrombus formation and clot biomechanics under fluid shear. PG - 2051 LID - 10.1038/s41467-019-10067-6 [doi] LID - 2051 AB - Blood clotting at the vascular injury site is a complex process that involves platelet adhesion and clot stiffening/contraction in the milieu of fluid flow. An integrated understanding of the hemodynamics and tissue mechanics regulating this process is currently lacking due to the absence of an experimental system that can simultaneously model clot formation and measure clot mechanics under shear flow. Here we develop a microfluidic-integrated microclot-array-elastometry system (clotMAT) that recapitulates dynamic changes in clot mechanics under physiological shear. Treatments with procoagulants and platelet antagonists and studies with diseased patient plasma demonstrate the ability of the system to assay clot biomechanics associated with common antiplatelet treatments and bleeding disorders. The changes of clot mechanics under biochemical treatments and shear flow demonstrate independent yet equally strong effects of these two stimulants on clot stiffening. This microtissue force sensing system may have future research and diagnostic potential for various bleeding disorders. FAU - Chen, Zhaowei AU - Chen Z AUID- ORCID: 0000-0002-4850-9549 AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Lu, Jiankai AU - Lu J AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Zhang, Changjie AU - Zhang C AD - Department of Chemical and Biological Engineering and Clinical & Translational Research Center, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Hsia, Isaac AU - Hsia I AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Yu, Xinheng AU - Yu X AUID- ORCID: 0000-0002-7204-6476 AD - Department of Chemical and Biological Engineering and Clinical & Translational Research Center, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Marecki, Leo AU - Marecki L AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Marecki, Eric AU - Marecki E AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Asmani, Mohammadnabi AU - Asmani M AUID- ORCID: 0000-0003-0570-6208 AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. FAU - Jain, Shilpa AU - Jain S AD - Hemophilia Center of Western New York, Department of Pediatrics, Division of Pediatric Hematology-Oncology, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY, 14203, USA. FAU - Neelamegham, Sriram AU - Neelamegham S AD - Department of Chemical and Biological Engineering and Clinical & Translational Research Center, State University of New York at Buffalo, Buffalo, NY, 14260, USA. neel@buffalo.edu. FAU - Zhao, Ruogang AU - Zhao R AUID- ORCID: 0000-0002-5351-0843 AD - Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA. rgzhao@buffalo.edu. LA - eng GR - R01 EB019411/EB/NIBIB NIH HHS/United States GR - R01 HL077258/HL/NHLBI NIH HHS/United States GR - R01 HL103411/HL/NHLBI NIH HHS/United States GR - R01EB019411/U.S. Department of Health & Human Services | NIH | National Institute of Biomedical Imaging and Bioengineering (NIBIB)/International PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Video-Audio Media DEP - 20190503 PL - England TA - Nat Commun JT - Nature communications JID - 101528555 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Platelets/drug effects/metabolism MH - Female MH - Healthy Volunteers MH - Hemorrhage/*diagnosis MH - Human Umbilical Vein Endothelial Cells MH - Humans MH - Male MH - Microfluidics/*methods MH - Platelet Aggregation Inhibitors/pharmacology MH - Stress, Mechanical MH - Thrombelastography/*methods MH - Tissue Array Analysis/*methods MH - von Willebrand Disease, Type 2/blood PMC - PMC6499828 COIS- The authors declare no competing interests. EDAT- 2019/05/06 06:00 MHDA- 2019/06/07 06:00 PMCR- 2019/05/03 CRDT- 2019/05/05 06:00 PHST- 2018/09/12 00:00 [received] PHST- 2019/04/15 00:00 [accepted] PHST- 2019/05/05 06:00 [entrez] PHST- 2019/05/06 06:00 [pubmed] PHST- 2019/06/07 06:00 [medline] PHST- 2019/05/03 00:00 [pmc-release] AID - 10.1038/s41467-019-10067-6 [pii] AID - 10067 [pii] AID - 10.1038/s41467-019-10067-6 [doi] PST - epublish SO - Nat Commun. 2019 May 3;10(1):2051. doi: 10.1038/s41467-019-10067-6. PMID- 31045726 OWN - NLM STAT- MEDLINE DCOM- 20200122 LR - 20200122 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 87 IP - 2 DP - 2019 Aug TI - Rapid point-of-care detection and classification of direct-acting oral anticoagulants with the TEG 6s: Implications for trauma and acute care surgery. PG - 364-370 LID - 10.1097/TA.0000000000002357 [doi] AB - BACKGROUND: The trauma patient on direct oral anticoagulant (DOAC) therapy preinjury presents a challenge in trauma and acute care surgery. Our understanding of these patients is extrapolated from vitamin K antagonists. However, DOACs have different mechanisms of action, effects on laboratory coagulation assays, and reversal strategies. Rapid identification of DOACs in the blood will allow timely reversal of factor Xa inhibitors and direct thrombin inhibitors when necessary. The present study evaluated viscoelastic testing to detect and classify DOACs in patient blood samples. METHODS: This observational, prospective, open-label, multicenter study used point-of-care viscoelastic testing to analyze blood samples taken from patients with and without DOAC treatment, and healthy volunteers. Antifactor Xa and direct thrombin inhibition (DTI) assays were used to establish reference ranges for viscoelastic testing parameters on the TEG 6s system. These ranges were applied to produce a DOAC identification algorithm for patient blood samples. Internal consistency of the measurements, as well as algorithm sensitivity and specificity, was evaluated. RESULTS: Using the TEG 6s system, the R parameter reference range was 0.6 minutes to 1.5 minutes for the Antifactor Xa assay and 1.6 minutes to 2.5 minutes for the DTI assay. Our identification algorithm using these ranges for 2.5 minutes or less has sensitives of 98.3% and 100% for factor Xa inhibitor and direct thrombin inhibitor detection, respectively. Specificity was 100%. Both classes of DOAC were detectable, even when samples were collected during the "trough" between doses of medication. CONCLUSION: Point-of-care viscoelastic testing with TEG 6s can detect and classify DOACs with high sensitivity and specificity. This tool can be used to better determine the need for reversal in trauma and acute care surgery patients and guide optimal surgical timing in the acute setting. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level II. FAU - Dias, Joao D AU - Dias JD AD - From the Haemonetics S.A. (J.D.D.), Signy, Switzerland; Haemonetics Corporation (C.G.L-E., F.Z., A.A.M.), Rosemont, Illinois; Haemonetics Corporation (J.I., L.H.H., J.H., H.E.A.), Braintree, Massachusetts; Memorial Hospital of South Bend (S.G.T., M.W.), Trauma Center, South Bend, Indiana; Indiana University School of Medicine (M.W., A.J.J., A.G.), South Bend, Indiana; Spartanburg Regional Medical Center, General Surgery, Trauma (B.C.T.), Spartanburg, South Carolina; Essentia Health St. Mary's Heart and Vascular Center (R.A.), Cardiology, Duluth, Minnesota; and Inova Heart and Vascular Institute (K.P.B.), Inova Center for Thrombosis Research and Drug Development, Falls Church, Virginia. FAU - Lopez-Espina, Carlos G AU - Lopez-Espina CG FAU - Ippolito, Jeffrey AU - Ippolito J FAU - Hsiao, L Hsiuyin AU - Hsiao LH FAU - Zaman, Fowzia AU - Zaman F FAU - Muresan, Adina A AU - Muresan AA FAU - Thomas, Scott G AU - Thomas SG FAU - Walsh, Mark AU - Walsh M FAU - Jones, Alexander Joseph AU - Jones AJ FAU - Grisoli, Anne AU - Grisoli A FAU - Thurston, Brian C AU - Thurston BC FAU - Artang, Ramin AU - Artang R FAU - Bilden, Kevin P AU - Bilden KP FAU - Hartmann, Jan AU - Hartmann J FAU - Achneck, Hardean E AU - Achneck HE LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Anticoagulants) SB - IM MH - Adolescent MH - Adult MH - Anticoagulants/*blood/therapeutic use MH - Case-Control Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Point-of-Care Testing MH - Prospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds and Injuries/*surgery MH - Young Adult EDAT- 2019/05/03 06:00 MHDA- 2020/01/23 06:00 CRDT- 2019/05/03 06:00 PHST- 2019/05/03 06:00 [pubmed] PHST- 2020/01/23 06:00 [medline] PHST- 2019/05/03 06:00 [entrez] AID - 10.1097/TA.0000000000002357 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Aug;87(2):364-370. doi: 10.1097/TA.0000000000002357. PMID- 31033893 OWN - NLM STAT- MEDLINE DCOM- 20200120 LR - 20200120 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 87 IP - 1 DP - 2019 Jul TI - Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock. PG - 49-53 LID - 10.1097/TA.0000000000002340 [doi] AB - BACKGROUND: Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions. METHODS: Injured children, 2 years or older and 10 kg or greater with hemorrhagic shock received up to 30 mL/kg of cold-stored, low titer (<50) anti-A and -B, leukoreduced, group O- WB during their initial resuscitation. Patients were included if (1) they received WB and no conventional platelets, and (2) platelet count and thromboelastography maximum amplitude were measured both before and after transfusion. These data and relevant clinical outcomes (mortality, intensive care unit length of stay [LOS], hospital LOS and ventilator days) were compared to a historical cohort of pediatric trauma patients who received uncrossmatched red blood cells (RBC) and conventional room temperature platelets. RESULTS: Twenty-two children were included in the study; 14 in the component cohort versus 8 in the WB cohort. Neither posttransfusion platelet count (129 x 109/L vs. 135 x 109/L) nor function (thromboelastography maximum amplitude, 59.5 mm vs. 60.2 mm) differed significantly between children receiving cold-stored platelets within the WB unit versus children who received conventional warm platelets. Median (interquartile range) weight-adjusted platelet transfusion volume in the historical cohort was 4.6 (2.5-7.7) mL/kg vs. 2.4 (1.3-4.0) mL/kg in the WB cohort (p = 0.03). There was no difference between groups in age, race, mechanism of injury, Injury Severity Score, vital signs, and severe traumatic brain injury (TBI). Outcomes, including mortality, intensive care unit LOS, hospital LOS, and ventilator days, were not significantly different between groups. CONCLUSION: No difference was seen in posttransfusion platelet number or function in severely injured children receiving cold-stored WB platelets as compared to those receiving conventional room temperature-stored platelets. Larger cohorts are required to confirm these findings. LEVEL OF EVIDENCE: Therapeutic, level IV. FAU - Leeper, Christine M AU - Leeper CM AD - From the Department of Surgery, (C.M.L., B.A.G.); Department of Pathology (M.H.Y., D.T.), the University of Pittsburgh Medical Center; Department of Surgery (C.M.L., B.A.G.), Division of Pediatric Emergency Medicine (R.S.), Department of Anesthesiology and Perioperative Medicine (F.P.C.), Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania. FAU - Yazer, Mark H AU - Yazer MH FAU - Cladis, Franklyn P AU - Cladis FP FAU - Saladino, Richard AU - Saladino R FAU - Triulzi, Darrell J AU - Triulzi DJ FAU - Gaines, Barbara A AU - Gaines BA LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Blood Platelets/*physiology MH - *Blood Preservation/methods MH - *Blood Transfusion/methods MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Length of Stay/statistics & numerical data MH - Male MH - Platelet Count MH - Refrigeration MH - Shock, Hemorrhagic/blood/*therapy MH - Wounds and Injuries/blood/*therapy EDAT- 2019/04/30 06:00 MHDA- 2020/01/21 06:00 CRDT- 2019/04/30 06:00 PHST- 2019/04/30 06:00 [pubmed] PHST- 2020/01/21 06:00 [medline] PHST- 2019/04/30 06:00 [entrez] AID - 10.1097/TA.0000000000002340 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Jul;87(1):49-53. doi: 10.1097/TA.0000000000002340. PMID- 31032890 OWN - NLM STAT- MEDLINE DCOM- 20190624 LR - 20190624 IS - 1365-2044 (Electronic) IS - 0003-2409 (Linking) VI - 74 IP - 7 DP - 2019 Jul TI - Protocolised thromboelastometric-guided haemostatic management in patients with traumatic brain injury: a pilot study. PG - 883-890 LID - 10.1111/anae.14670 [doi] AB - Coagulopathy in patients with traumatic brain injury is associated with an increase in morbidity and mortality. Although timely and aggressive treatment of coagulopathy is of paramount importance, excessive transfusion of blood products has been linked with poor long-term outcomes in patients with traumatic brain injury. A point-of-care thromboelastometric-guided algorithm could assist in creating a more individually tailored approach to each patient. The aim of this study was to evaluate the feasibility of implementing a thromboelastometric-guided algorithm in centres that were formerly naive to thromboelastometry. Hence, we developed such an algorithm and provided training to four centres across Europe to direct the haemostatic management of patients with severe traumatic brain injury. The primary outcome was adherence to the algorithm and timing of the availability of relevant results. Thirty-two patients were included in the study. Complete adherence to the algorithm was observed in 20 out of 32 cases. The availability of thromboelastometric results after hospital admission was reported significantly earlier than conventional coagulation tests (median (IQR [range]) 33 (20-40 [14-250]) min vs. 71 (51-101 [32-290]) min; p = 0.037). Although only 5 out of 32 patients had abnormalities of conventional coagulation tests, 21 out of 32 patients had a coagulopathic baseline thromboelastometric trace. Implementing a thromboelastometric-guided algorithm for the haemostatic therapy of traumatic brain injury is feasible in centres formerly naive to this technology and may lead to more rapid and precise coagulation management. Further large-scale studies are warranted to confirm the results of this pilot trial and evaluate clinical outcomes. CI - (c) 2019 Association of Anaesthetists. FAU - Gratz, J AU - Gratz J AD - Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. FAU - Guting, H AU - Guting H AD - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany. FAU - Thorn, S AU - Thorn S AD - Monash University Melbourne, School of Public Health and Preventive Medicine, Melbourne, Australia. FAU - Brazinova, A AU - Brazinova A AD - Institute of Epidemiology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slokak Republic. FAU - Gorlinger, K AU - Gorlinger K AD - Department of Anaesthesia and Intensive Care Medicine, University Hospital Essen, Germany. AD - TEM Innovations GmbH, Munich, Germany. FAU - Schafer, N AU - Schafer N AD - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany. FAU - Schochl, H AU - Schochl H AD - Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria. AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre Vienna, Vienna, Austria. FAU - Stanworth, S AU - Stanworth S AD - Department of Haematology, Radcliffe Department of Medicine, Oxford University Hospitals NHS Foundation Trust, University of Oxford, UK. FAU - Maegele, M AU - Maegele M AD - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany. AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Centre, Cologne, Germany. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20190429 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 SB - IM MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/*complications/*therapy MH - Brain Injuries, Traumatic/*complications MH - Europe MH - Feasibility Studies MH - Female MH - Hemostasis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - Point-of-Care Systems MH - Practice Guidelines as Topic MH - Prospective Studies MH - Thrombelastography/*methods OTO - NOTNLM OT - anaemia OT - coagulation OT - point-of-care testing OT - thromboelastometry OT - traumatic brain injury, management EDAT- 2019/04/30 06:00 MHDA- 2019/06/25 06:00 CRDT- 2019/04/30 06:00 PHST- 2019/03/26 00:00 [accepted] PHST- 2019/04/30 06:00 [pubmed] PHST- 2019/06/25 06:00 [medline] PHST- 2019/04/30 06:00 [entrez] AID - 10.1111/anae.14670 [doi] PST - ppublish SO - Anaesthesia. 2019 Jul;74(7):883-890. doi: 10.1111/anae.14670. Epub 2019 Apr 29. PMID- 31029284 OWN - NLM STAT- MEDLINE DCOM- 20200113 LR - 20200601 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 217 IP - 6 DP - 2019 Jun TI - Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy. PG - 1037-1041 LID - S0002-9610(18)30412-4 [pii] LID - 10.1016/j.amjsurg.2019.01.014 [doi] AB - BACKGROUND: Trauma-induced coagulopathy can present as abnormalities in a conventional or viscoelastic coagulation assay or both. We hypothesized that patients with discordant coagulopathies reflect different clinical phenotypes. METHODS: Blood samples were collected prospectively from critically injured patients upon arrival at two urban Level I trauma centers. International normalized ratio (INR), partial thromboplastin time (PTT), thromboelastography (TEG), and coagulation factors were assayed. RESULTS: 278 patients (median ISS 17, mortality 26%) were coagulopathic: 20% with isolated abnormal INR and/or PTT (CONVENTIONAL), 49% with isolated abnormal TEG (VISCOELASTIC), and 31% with abnormal INR/PTT and TEG (BOTH). Compared with VISCOELASTIC, CONVENTIONAL and BOTH had higher ISS, lower GCS, larger base deficit, and decreased factor activities (all p < 0.017). They received more blood products and had more ICU/ventilation days (all p < 0.017). Mortality was higher in CONVENTIONAL (40%) and BOTH (49%) than VISCOELASTIC (6%, p < 0.017). CONCLUSIONS: Although TEG-guided resuscitation improves survival after injury, INR and PTT identify coagulopathic patients with highest mortality regardless of TEG and likely represent distinct mechanisms independent of biochemical clot strength. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Sumislawski, Joshua J AU - Sumislawski JJ AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: joshua.sumislawski@ucdenver.edu. FAU - Christie, S Ariane AU - Christie SA AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA, 94110, United States. Electronic address: sabrinah.christie@ucsf.edu. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA, 94110, United States. Electronic address: lucy.kornblith@ucsf.edu. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: gregory.stettler@ucdenver.edu. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: geoffrey.nunns@ucdenver.edu. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: hunter.moore@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: ernest.moore@dhha.org. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Pediatrics, Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, United States. Electronic address: christopher.silliman@ucdenver.edu. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: angela.sauaia@ucdenver.edu. FAU - Callcut, Rachael A AU - Callcut RA AD - Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 3A, San Francisco, CA, 94110, United States. Electronic address: rachael.callcut@ucsf.edu. FAU - Cohen, Mitchell Jay AU - Cohen MJ AD - Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street, MC 0206, Denver, CO, 80204, United States. Electronic address: mitchell.cohen@dhha.org. LA - eng GR - K01 ES026834/ES/NIEHS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20190123 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM CIN - Am J Surg. 2019 Nov;218(5):1033-1034. doi: 10.1016/j.amjsurg.2019.02.004. PMID: 30826006 MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology/mortality/therapy MH - Blood Transfusion MH - Female MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Prognosis MH - Prospective Studies MH - Resuscitation MH - Risk Factors MH - *Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*complications/mortality/therapy PMC - PMC6867692 MID - NIHMS1519384 OTO - NOTNLM OT - Precision medicine OT - Resuscitation OT - Thromboelastography OT - Transfusion OT - Trauma-induced coagulopathy EDAT- 2019/04/29 06:00 MHDA- 2020/01/14 06:00 PMCR- 2020/06/01 CRDT- 2019/04/29 06:00 PHST- 2018/03/17 00:00 [received] PHST- 2019/01/09 00:00 [revised] PHST- 2019/01/21 00:00 [accepted] PHST- 2019/04/29 06:00 [pubmed] PHST- 2020/01/14 06:00 [medline] PHST- 2019/04/29 06:00 [entrez] PHST- 2020/06/01 00:00 [pmc-release] AID - S0002-9610(18)30412-4 [pii] AID - 10.1016/j.amjsurg.2019.01.014 [doi] PST - ppublish SO - Am J Surg. 2019 Jun;217(6):1037-1041. doi: 10.1016/j.amjsurg.2019.01.014. Epub 2019 Jan 23. PMID- 31004574 OWN - NLM STAT- MEDLINE DCOM- 20191127 LR - 20191127 IS - 1873-3492 (Electronic) IS - 0009-8981 (Linking) VI - 495 DP - 2019 Aug TI - A comparative study of viscoelastic hemostatic assays and conventional coagulation tests in trauma patients receiving fibrinogen concentrate. PG - 253-262 LID - S0009-8981(19)31816-9 [pii] LID - 10.1016/j.cca.2019.04.066 [doi] AB - BACKGROUND: Both thrombelastography (TEG) and rotational thromboelastometry (ROTEM) have been investigated for diagnosis of coagulopathy and guidance of resuscitation in trauma and surgery. Given similarities between the two systems, it is important to determine whether one is superior to the other and how comparable they are to conventional coagulation tests (CCTs). Therefore, we conducted a comparative study of functional fibrinogen and coagulation assays using TEG and ROTEM and CCTs to determine their capability to monitor coagulation profiles, diagnose coagulopathy and predict blood transfusion requirements in trauma patients. METHODS: Blood samples were collected from 45 patients at admission and during 48-h hospitalization as part of a randomized control trial on early fibrinogen replacement in trauma. Functional fibrinogen (FF) TEG, ROTEM FIBTEM and EXTEM, and CCTs were performed and compared. RESULTS: We found significant differences between the placebo and fibrinogen groups over hospitalization time in FF TEG MA, ROTEM CT, MCF and LI30. FF TEG MA and ROTEM FIBTEM MCF mirrored plasma fibrinogen profiles, reached a maximum difference between the two groups 1-3 h after fibrinogen administration. In comparison, CCTs detected minimal hemostatic changes by fibrinogen treatment. TEG and ROTEM showed various degrees of correlations with CCTs. TEG MA and ROTEM MCF provided better predictions for plasma and RBC transfusions than CCTs, but poor accuracy for cryoprecipitate transfusion. Both TEG and ROTEM well predicted hypofibrinogenemia (fibrinogen concentration < 1 g/L), but poorly detected coagulopathy (INR >/= 1.2). CONCLUSIONS: TEG and ROTEM detected increases in clot strength following early use of fibrinogen. ROTEM also detected changes in coagulation time and clot lysis. Both were better than CCTs for monitoring coagulation profiles and predicting transfusion requirements. CI - Crown Copyright (c) 2019. Published by Elsevier B.V. All rights reserved. FAU - Peng, Henry T AU - Peng HT AD - Defence Research and Development Canada, Toronto Research Center, Toronto, ON, Canada. Electronic address: henry.peng@drdc-rddc.gc.ca. FAU - Nascimento, Bartolomeu AU - Nascimento B AD - Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. FAU - Tien, Homer AU - Tien H AD - Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. FAU - Callum, Jeannie AU - Callum J AD - Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. FAU - Rizoli, Sandro AU - Rizoli S AD - St Michael's Hospital, University of Toronto, Toronto, ON, Canada. FAU - Rhind, Shawn G AU - Rhind SG AD - Defence Research and Development Canada, Toronto Research Center, Toronto, ON, Canada. FAU - Beckett, Andrew AU - Beckett A AD - Royal Canadian Medical Services, Ottawa, ON, Canada; McGill University, Montreal, QC, Canada. LA - eng PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial DEP - 20190417 PL - Netherlands TA - Clin Chim Acta JT - Clinica chimica acta; international journal of clinical chemistry JID - 1302422 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Transfusion MH - *Elasticity MH - Feasibility Studies MH - Female MH - Fibrinogen/adverse effects/*pharmacology MH - Hemostasis/*drug effects MH - Humans MH - Male MH - Safety MH - Thrombelastography/*methods MH - Viscosity MH - Wounds and Injuries/*physiopathology/therapy OTO - NOTNLM OT - Blood transfusion OT - Coagulation tests OT - Fibrinogen concentrate OT - Thrombelastography OT - Thromboelastometry OT - Trauma coagulopathy EDAT- 2019/04/21 06:00 MHDA- 2019/11/28 06:00 CRDT- 2019/04/21 06:00 PHST- 2018/10/16 00:00 [received] PHST- 2019/03/27 00:00 [revised] PHST- 2019/04/15 00:00 [accepted] PHST- 2019/04/21 06:00 [pubmed] PHST- 2019/11/28 06:00 [medline] PHST- 2019/04/21 06:00 [entrez] AID - S0009-8981(19)31816-9 [pii] AID - 10.1016/j.cca.2019.04.066 [doi] PST - ppublish SO - Clin Chim Acta. 2019 Aug;495:253-262. doi: 10.1016/j.cca.2019.04.066. Epub 2019 Apr 17. PMID- 30988571 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 0971-4502 (Print) IS - 0974-0449 (Electronic) IS - 0971-4502 (Linking) VI - 35 IP - 2 DP - 2019 Apr TI - Efficacy of Thromboelastography (TEG) in Predicting Acute Trauma-Induced Coagulopathy (ATIC) in Isolated Severe Traumatic Brain Injury (iSTBI). PG - 325-331 LID - 10.1007/s12288-018-1003-4 [doi] AB - To evaluate the efficacy of point-of-care thromboelastography (TEG) to predict acute trauma-induced coagulopathy (ATIC) in isolated severe TBI (iSTBI). We conducted an observational diagnostic cohort. Patients for whom TEG was performed before blood transfusion were stratified by conventional coagulation tests (CCTs) on admission and classified as "ATIC" (prothrombin time >/= 16.70 s; international normalized ratio >/= 1.27; activated partial thromboplastin time >/= 28.80 s) (n = 24) or "no ATIC" (n = 34). Univariate analysis to compare groups, receiver operating characteristic analysis to establish cut-off and diagnostic validation was done. Fifty-eight patients were included [32(25-45) years; 97% male; GCS 6.3 +/- 1.5]. 41% developed ATIC. Compared to no-ATIC, ATIC group had significantly prolonged kappa-time (4.6 vs. 2.5 min; p = 0.01) and shortened alpha-angle (40.2 degrees vs. 56.3 degrees ; p = 0.03). A cut-off for kappa-time >/= 3.7 (AUC 0.68 95% CI 0.54-0.82, specificity 70%, sensitivity 63%) and alpha angle /=25%, platelet count >50,000, and fibrinogen >120 mg/dL. Commonly utilized thresholds for international normalized ratio correction are not supported by evidence. BEST PRACTICE ADVICE 5: Thrombopoietin agonists are a good alternative to platelet transfusion, but require time (about 10 days) to elevate platelet levels. BEST PRACTICE ADVICE 6: The large volume of fresh frozen plasma required to reach an arbitrary international normalized ratio target, limitations of the usual target, minimal effect on thrombin generation, and adverse effects on portal pressure limit the utility of this agent significantly. BEST PRACTICE ADVICE 7: The 4-factor prothrombin complex concentrate contains both pro- and anticoagulant factors that offer an attractive low-volume therapeutic to rebalance a disturbed hemostatic system. However, dosage is, in part, based on international normalized ratio, which is problematic in cirrhosis, and published experience in liver disease is limited. BEST PRACTICE ADVICE 8: Anti-fibrinolytic therapy may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity. Both epsilon-aminocaproic acid and tranexamic acid inhibit clot dissolution. Neither is believed to generate a hypercoagulable state, although both may exacerbate pre-existing thrombi. BEST PRACTICE ADVICE 9: Desmopressin releases von Willebrand factor as its primary hemostatic mechanism. As this factor is usually elevated in cirrhosis, the agent lacks a sound evidence-based foundation, but may be useful in patients with concomitant renal failure. BEST PRACTICE ADVICE 10: Systemic heparin infusion is recommended for symptomatic deep vein thrombosis and portal and mesenteric vein thrombosis, but there are unresolved issues regarding monitoring with both the anti-Xa assay and the partial thromboplastin time due to cirrhosis-related antithrombin deficiency (heparin cofactor). BEST PRACTICE ADVICE 11: Treatment of incidental portal and mesenteric vein thrombosis depends on estimated impact on transplantation surgical complexity vs risks of bleeding and falls. Therapy with low-molecular-weight heparin, vitamin K antagonists, and direct-acting anticoagulants improve portal vein repermeation vs observation alone. BEST PRACTICE ADVICE 12: Direct-acting anticoagulants, such as the factor Xa and thrombin inhibitors, are relatively safe and effective in stable cirrhotic patients, but are in need of further study in patients with more advanced liver disease. CI - Copyright (c) 2019 AGA Institute. Published by Elsevier Inc. All rights reserved. FAU - O'Leary, Jacqueline G AU - O'Leary JG AD - Dallas VA Medical Center, Dallas, Texas. Electronic address: Dr_jackieo@yahoo.com. FAU - Greenberg, Charles S AU - Greenberg CS AD - Medical University of South Carolina, Charleston, South Carolina. FAU - Patton, Heather M AU - Patton HM AD - Southern California Permanente Medical Group-San Diego, San Diego, California. FAU - Caldwell, Stephen H AU - Caldwell SH AD - University of Virginia, Charlottesville, Virginia. LA - eng PT - Journal Article PT - Practice Guideline PT - Review DEP - 20190412 PL - United States TA - Gastroenterology JT - Gastroenterology JID - 0374630 RN - 0 (Anticoagulants) RN - 0 (Antifibrinolytic Agents) RN - 0 (Antithrombins) RN - 0 (Blood Coagulation Factors) RN - 0 (Factor Xa Inhibitors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 9001-32-5 (Fibrinogen) RN - 9005-49-6 (Heparin) RN - 9014-42-0 (Thrombopoietin) MH - Anticoagulants/therapeutic use MH - Antifibrinolytic Agents/therapeutic use MH - Antithrombins/therapeutic use MH - Blood Coagulation Disorders/blood/complications/*therapy MH - Blood Coagulation Factors/therapeutic use MH - Blood Transfusion/*methods MH - Factor Xa Inhibitors/therapeutic use MH - Fibrinogen/metabolism MH - Hematocrit MH - Heparin/therapeutic use MH - Humans MH - International Normalized Ratio MH - Liver Cirrhosis/*blood/complications MH - Plasma MH - Platelet Count MH - Portal Vein MH - Thrombelastography MH - Thrombocytopenia MH - Thrombophilia/blood/complications/*therapy MH - Thrombopoietin/agonists MH - Transfusion Reaction MH - Venous Thrombosis/blood/complications/*therapy EDAT- 2019/04/16 06:00 MHDA- 2019/07/31 06:00 CRDT- 2019/04/16 06:00 PHST- 2019/01/30 00:00 [received] PHST- 2019/03/19 00:00 [revised] PHST- 2019/03/22 00:00 [accepted] PHST- 2019/04/16 06:00 [pubmed] PHST- 2019/07/31 06:00 [medline] PHST- 2019/04/16 06:00 [entrez] AID - S0016-5085(19)35694-X [pii] AID - 10.1053/j.gastro.2019.03.070 [doi] PST - ppublish SO - Gastroenterology. 2019 Jul;157(1):34-43.e1. doi: 10.1053/j.gastro.2019.03.070. Epub 2019 Apr 12. PMID- 30980757 OWN - NLM STAT- MEDLINE DCOM- 20190826 LR - 20190826 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 59 IP - S2 DP - 2019 Apr TI - Effect of leukoreduction and pathogen reduction on the hemostatic function of whole blood. PG - 1539-1548 LID - 10.1111/trf.15175 [doi] AB - BACKGROUND: There is renewed interest in the use of whole blood (WB) for resuscitation of patients in hemorrhagic shock. Leukoreduction with platelet-sparing filters and pathogen reduction may be used to improve the safety profile of WB, yet the effects of leukoreduction and pathogen reduction on WB hemostatic function are not well characterized. STUDY DESIGN AND METHODS: Blood from 32 healthy group O donors was divided into treatment groups (n = 8 for each group): untreated, pathogen reduced (PR(+) ), leukoreduced using an in-line filter (LR(+) ), or PR(+) LR(+) . Units were stored without agitation for 21 days between 1 degrees and 6 degrees C, with sampling on days 0 (pre- and post-treatments), 1, 3, 5, 10, 15, and 21 for hemostatic function as assessed by thromboelastometry, thrombin generation, platelet activation factors, and platelet impedance aggregometry. RESULTS: From day 3 (D3) to D15 of storage, platelet count was reduced in PR(+) /LR(+) units compared to PR(-) /LR(-) units. From D10 to D21 of storage, maximum clot firmness (MCF) was reduced in PR(+) /LR(+) units compared to PR(-) /LR(-) units. From D3 to D21 of storage, platelet aggregation was reduced in PR(+) /LR(+) units compared to PR(-) /LR(-) units. Total thrombin generation was similar in all groups from D0 to D21. CONCLUSIONS: The combination of LR with a platelet-sparing filter and PR significantly reduces hemostatic function compared to either treatment alone or untreated WB. The clinical consequences of LR and PR of WB in patients with severe bleeding should be examined in trials before both are used in combination in patients. CI - (c) 2019 AABB. FAU - Thomas, Kimberly A AU - Thomas KA AD - Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri. FAU - Shea, Susan M AU - Shea SM AD - Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri. FAU - Yazer, Mark H AU - Yazer MH AD - Institute for Transfusion Medicine, The University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Spinella, Philip C AU - Spinella PC AD - Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri. AD - Coagulation and Blood Research Program, United States Army Institute of Surgical Research, FT Sam Houston, San Antonio, Texas. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Transfusion JT - Transfusion JID - 0417360 MH - Blood Platelets/*metabolism/pathology MH - Blood Preservation/*methods MH - Blood Safety/*methods MH - Blood Transfusion MH - Female MH - Hemorrhage/blood/pathology/therapy MH - Humans MH - Leukocyte Reduction Procedures/*methods MH - Male MH - *Platelet Aggregation MH - Resuscitation MH - Shock, Hemorrhagic/blood/pathology/therapy MH - Thrombelastography EDAT- 2019/04/14 06:00 MHDA- 2019/08/27 06:00 CRDT- 2019/04/14 06:00 PHST- 2018/10/06 00:00 [received] PHST- 2019/01/08 00:00 [revised] PHST- 2019/01/14 00:00 [accepted] PHST- 2019/04/14 06:00 [entrez] PHST- 2019/04/14 06:00 [pubmed] PHST- 2019/08/27 06:00 [medline] AID - 10.1111/trf.15175 [doi] PST - ppublish SO - Transfusion. 2019 Apr;59(S2):1539-1548. doi: 10.1111/trf.15175. PMID- 30980752 OWN - NLM STAT- MEDLINE DCOM- 20190826 LR - 20190826 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 59 IP - S2 DP - 2019 Apr TI - Human primary fibroblasts perform similarly to MSCs in assays used to evaluate MSC safety and potency. PG - 1593-1600 LID - 10.1111/trf.15187 [doi] AB - BACKGROUND: Cellular therapeutic agents may benefit trauma patients by modulating the immune response to injury, and by reducing inflammation and vascular leakage. Administration of allogeneic mesenchymal stromal cells (MSCs) shows some benefit in preclinical and clinical trials, but less testing has been performed with other cell types. Human primary fibroblasts (FBs) were compared to MSCs in assays designed to evaluate MSCs to determine if these assays actually evaluate properties unique to MSCs or whether related cell types perform similarly. STUDY DESIGN AND METHODS: MSC-related surface marker expression, tissue factor, and human leukocyte antigen-D related were evaluated by flow cytometry, and in vitro adipogenic and osteogenic differentiation potential were determined. Procoagulant activity was determined by thromboelastography. Two potency assays correlated with immunomodulation potential were utilized: the mixed lymphocyte reaction and indoleamine 2,3-dioxygenase enzyme activity assays. RESULTS: Human primary FBs performed similarly to MSCs in assays designed to evaluate MSC characteristics and potency. Although similar for MSC-positive cell surface marker expression, FBs did not show robust adipose differentiation and expressed some level of markers not expected on MSCs. CONCLUSIONS: Human primary FBs are very similar to human MSCs, at least in assays currently used to evaluate MSC potency. Preclinical and clinical testing are required to determine if FBs show similar activity to MSCs in vivo. If FBs show inferior activity in vivo, development of new MSC-specific potency assays will be necessary to evaluate properties relevant to their unique clinical benefits. CI - (c) 2019 AABB. FAU - Christy, Barbara A AU - Christy BA AUID- ORCID: 0000-0001-5318-653X AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. AD - Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas. FAU - Herzig, Maryanne C AU - Herzig MC AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. FAU - Delavan, Christopher AU - Delavan C AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. FAU - Cantu, Carolina AU - Cantu C AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. FAU - Salgado, Christi AU - Salgado C AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. FAU - Bynum, James A AU - Bynum JA AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. AD - Institute of Biomedical Studies, Baylor University, Waco, Texas. AD - Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas. FAU - Cap, Andrew P AU - Cap AP AD - Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas. AD - Department of Surgery, UT Health San Antonio, San Antonio, Texas. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Transfusion JT - Transfusion JID - 0417360 MH - Cell Culture Techniques MH - *Cell Differentiation MH - Cell Line MH - Fibroblasts/cytology/immunology/*metabolism MH - Humans MH - *Immunomodulation MH - Mesenchymal Stem Cells/cytology/immunology/*metabolism MH - *Osteogenesis EDAT- 2019/04/14 06:00 MHDA- 2019/08/27 06:00 CRDT- 2019/04/14 06:00 PHST- 2018/11/27 00:00 [received] PHST- 2019/01/18 00:00 [revised] PHST- 2019/01/18 00:00 [accepted] PHST- 2019/04/14 06:00 [entrez] PHST- 2019/04/14 06:00 [pubmed] PHST- 2019/08/27 06:00 [medline] AID - 10.1111/trf.15187 [doi] PST - ppublish SO - Transfusion. 2019 Apr;59(S2):1593-1600. doi: 10.1111/trf.15187. PMID- 30980751 OWN - NLM STAT- MEDLINE DCOM- 20190826 LR - 20260327 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 59 IP - S2 DP - 2019 Apr TI - A prospective evaluation of thromboelastometry (ROTEM) to identify acute traumatic coagulopathy and predict massive transfusion in military trauma patients in Afghanistan. PG - 1601-1607 LID - 10.1111/trf.15176 [doi] AB - BACKGROUND: Hemorrhage is the leading cause of preventable trauma-related mortality and is frequently aggravated by acute traumatic coagulopathy (ATC). Viscoelastic tests such as rotational thromboelastometry (ROTEM) may improve identification and management of ATC. This study aimed to prospectively evaluate changes in ROTEM among combat casualties during the first 24 hours and compare the capabilities of our conventional clotting assay (international normalized ratio [INR], >1.2) to a proposed integrated ROTEM model (INR >1.2 with the addition of tissue factor pathway activation thromboelastometry [EXTEM] A5 250 ng/ml) and FPA (>3 ng/ml) were observed in 64% and 91.1% patients, respectively. Both D-dimer and FPA were elevated in 66.6% of patients. Disseminated intravascular coagulation (DIC) score, calculated using standard criteria, was >/=5 in 28% of patients indicating overt DIC. Hypofibrinogenemia was observed in 48% of patients. D-dimer, FPA, and DIC score was significantly (P < 0.001) higher and plasma fibrinogen significantly (P < 0.001) lower in nonsurvivors as compared to survivors. Elevated D-dimer and FPA and low fibrinogen levels were seen in patients irrespective of severity of injury. CONCLUSIONS: Elevated D-dimer and FPA were frequently observed in patients with isolated head trauma. As these markers rise soon after injury and indicate poor outcome, their measurement will help identify patients who will benefit with additional therapy, thus reducing morbidity and mortality. FAU - Sikka, Meera AU - Sikka M AD - Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital Hospital, New Delhi, India. FAU - Sodhi, Ruchika AU - Sodhi R AD - Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital Hospital, New Delhi, India. FAU - Kotru, Mrinalini AU - Kotru M AD - Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital Hospital, New Delhi, India. FAU - Singh, Gurubachan AU - Singh G AD - Department of Neurosurgery, University College of Medical Sciences and Guru Teg Bahadur Hospital Hospital, New Delhi, India. LA - eng PT - Journal Article PL - India TA - Asian J Neurosurg JT - Asian journal of neurosurgery JID - 101564712 PMC - PMC6417324 OTO - NOTNLM OT - D-dimer OT - Glasgow Coma Score OT - disseminated intravascular coagulation OT - fibrinopeptide A OT - traumatic brain injury COIS- There are no conflicts of interest. EDAT- 2019/04/03 06:00 MHDA- 2019/04/03 06:01 PMCR- 2019/01/01 CRDT- 2019/04/03 06:00 PHST- 2019/04/03 06:00 [entrez] PHST- 2019/04/03 06:00 [pubmed] PHST- 2019/04/03 06:01 [medline] PHST- 2019/01/01 00:00 [pmc-release] AID - AJNS-14-118 [pii] AID - 10.4103/ajns.AJNS_278_17 [doi] PST - ppublish SO - Asian J Neurosurg. 2019 Jan-Mar;14(1):118-121. doi: 10.4103/ajns.AJNS_278_17. PMID- 30936005 OWN - NLM STAT- MEDLINE DCOM- 20200518 LR - 20240725 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 229 IP - 1 DP - 2019 Jul TI - Does Tranexamic Acid Improve Clot Strength in Severely Injured Patients Who Have Elevated Fibrin Degradation Products and Low Fibrinolytic Activity, Measured by Thrombelastography? PG - 92-101 LID - S1072-7515(19)30236-4 [pii] LID - 10.1016/j.jamcollsurg.2019.03.015 [doi] AB - BACKGROUND: Elevated d-dimers in injured patients with paradoxically low fibrinolysis activity measured by viscoelastic assays have been speculated to be "occult" fibrinolysis. However, an alternative explanation is that these patients have previously activated their fibrinolytic system and have shut it down by the time of blood draw, and would gain no benefit in clot strength with tranexamic acid (TXA). We hypothesize that TXA will not increase clot strength in injured patients with low fibrinolytic activity measured by thrombelastography (TEG), despite biomarkers of fibrinolysis activation. STUDY DESIGN: Three TEG assays (rapid, tissue plasminogen activator, and functional fibrinogen) were run on trauma patients. The tissue plasminogen activator TEG served as a functional assay to quantify depletion of fibrinolysis inhibitors (DFI). Patients were stratified by DFI vs non-DFI and then by rapid TEG lysis at 30 minutes phenotype cutoffs. Response to TXA was evaluated with functional fibrinogen TEG by calculating percent change in clot strength with the addition of exogenous TXA in the TEG cup. RESULTS: Six hundred and thirty patients with a median new injury severity score of 20 were analyzed. Depletion of fibrinolysis inhibitors was present in 116 (18%). The DFI patients had significantly increased d-dimer (p < 0.001) and lower fibrinogen (p < 0.001). The DFI patients had increased rates of massive transfusion (33% vs 3.3%; p < 0.001) and mortality (40% vs 6.2%; p < 0.001). Among DFI patients, TXA significantly improved fibrin clot strength with hyperfibrinolysis (+19% clot strength; p < 0.001) but not with shutdown (+1.2%) or physiologic (-2.5%). CONCLUSIONS: Patients with DFI have multiple abnormalities of their coagulation system, but only DFI patients with hyperfibrinolysis have improved fibrin clot strength with TXA. CI - Copyright (c) 2019. Published by Elsevier Inc. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, School of Medicine, University of Colorado, Denver, CO. Electronic address: hunter.moore@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, School of Medicine, University of Colorado, Denver, CO; Department of Surgery, Ernest E Moore Shock and Trauma Center at Denver Health, Denver, CO. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Surgery, School of Medicine, University of Colorado, Denver, CO. FAU - Hansen, Kirk C AU - Hansen KC AD - Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Denver, CO. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, Ernest E Moore Shock and Trauma Center at Denver Health, Denver, CO. FAU - Pieracci, Frederic M AU - Pieracci FM AD - Department of Surgery, Ernest E Moore Shock and Trauma Center at Denver Health, Denver, CO. FAU - Chandler, James AU - Chandler J AD - Department of Surgery, Ernest E Moore Shock and Trauma Center at Denver Health, Denver, CO. FAU - Sauaia, Angela AU - Sauaia A AD - School of Public Health, University of Colorado, Denver, CO; Department of Surgery, Ernest E Moore Shock and Trauma Center at Denver Health, Denver, CO. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20190329 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 0 (Antifibrinolytic Agents) RN - 0 (Biomarkers) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM CIN - J Am Coll Surg. 2019 Jul;229(1):101-103. doi: 10.1016/j.jamcollsurg.2019.05.012. PMID: 31248516 MH - Adult MH - Antifibrinolytic Agents/pharmacology MH - Biomarkers/blood MH - Female MH - Fibrin Clot Lysis Time MH - Fibrin Fibrinogen Degradation Products/drug effects/*metabolism MH - Fibrinogen/metabolism MH - Fibrinolysis/*drug effects MH - Follow-Up Studies MH - Hemorrhage/blood/etiology/*prevention & control MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Thrombelastography/*methods MH - Tranexamic Acid/*pharmacology MH - Trauma Severity Indices MH - Wounds and Injuries/*blood/complications/diagnosis PMC - PMC6874093 MID - NIHMS1059182 EDAT- 2019/04/03 06:00 MHDA- 2020/05/19 06:00 PMCR- 2019/11/22 CRDT- 2019/04/03 06:00 PHST- 2019/01/04 00:00 [received] PHST- 2019/03/18 00:00 [revised] PHST- 2019/03/19 00:00 [accepted] PHST- 2019/04/03 06:00 [pubmed] PHST- 2020/05/19 06:00 [medline] PHST- 2019/04/03 06:00 [entrez] PHST- 2019/11/22 00:00 [pmc-release] AID - S1072-7515(19)30236-4 [pii] AID - 10.1016/j.jamcollsurg.2019.03.015 [doi] PST - ppublish SO - J Am Coll Surg. 2019 Jul;229(1):92-101. doi: 10.1016/j.jamcollsurg.2019.03.015. Epub 2019 Mar 29. PMID- 30935283 OWN - NLM STAT- MEDLINE DCOM- 20200930 LR - 20200930 IS - 1369-1635 (Electronic) IS - 0953-7104 (Linking) VI - 31 IP - 2 DP - 2020 TI - Whole blood platelet aggregation determined by the ROTEM platelet equipment; reference intervals and stability. PG - 215-220 LID - 10.1080/09537104.2019.1595562 [doi] AB - Point of care testing of residual effect of antiplatelet therapy in trauma patients or during major surgery may result in improved clinical management of significant bleeding. We included 121 healthy individuals (57 females and 64 males, aged 22-65 years) in order to establish reference intervals for platelet aggregation induced by adenosine diphosphate (ADPTEM, 10 microM), arachidonic acid (ARATEM, 0.42 mM) and thrombin activating peptide (TRAPTEM, 36 microM) employing the ROTEM platelet module. Further, the impact of citrate (3.2%) and hirudin (>15 microg/ml) as anticoagulants was evaluated. Finally, we investigated assay stability (15, 30, 60, and 120 min after blood sampling) (n = 8) and between-day variation (n = 5). We report reference intervals for 121 healthy individuals and reference intervals by gender. We observed significantly higher platelet aggregation in females than in males (all P-values < 0.05). No correlation between age and platelet aggregation was observed, except for the parameter TRAPTEM amplitude (A6), in which a decline in A6 was observed with increasing age (P = 0.03). We observed significantly lower levels of platelet aggregation in citrate tubes than in hirudin tubes (all P-values < 0.05), except from TRAPTEM maximum slope, where no significant difference was observed (P = 0.40).The stability was acceptable (/= 4 red blood cell [RBC] units) was performed. Blood was drawn in the emergency department, after administration of 4, 8 and 12 RBC units and 24 h post-injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC. Results Three hundred and nine bleeding and shocked patients were included. A mean dose of 3.8 g of fibrinogen increased FIBTEM CA5 by 5.2 mm (IQR: 4.1-6.3 mm). TXA administration decreased lysis by 5.4% (4.3-6.5%). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEM ca5 values was more pronounced in patients with a ROTEM value indicative of TIC than in the whole cohort. Plasma transfusion decreased EXTEM clotting time by 3.1 s (- 10 s to 3.9 s) in the whole cohort and by 10.6 s (- 45 s to 24 s) in the subgroup of patients with a ROTEM value indicative of TIC. Conclusion The effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values indicative of TIC, the efficacy of PLTs and plasma in correcting deranged ROTEM parameters is possibly more robust. CI - (c) 2019 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. FAU - Wirtz, Mathijs R AU - Wirtz MR AD - Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. FAU - Balvers, Kirsten AU - Balvers K AD - Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. FAU - Baksaas-Aasen, Kjersti AU - Baksaas-Aasen K AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. AD - Department of Anesthesiology, Oslo University Hospital, Oslo, Norway. FAU - van Dieren, Susan AU - van Dieren S AD - Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Naess, Paul A AU - Naess PA AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Stanworth, Simon AU - Stanworth S AD - NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK. AD - Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Johansson, Par I AU - Johansson PI AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Maegele, Marc AU - Maegele M AD - Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Goslings, J C AU - Goslings JC AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. FAU - Brohi, Karim AU - Brohi K AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. CN - TACTIC partners LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20190217 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Antifibrinolytic Agents/administration & dosage/adverse effects MH - Clinical Decision-Making MH - *Decision Support Techniques MH - Erythrocyte Transfusion/adverse effects MH - Europe MH - Female MH - Fibrinogen/administration & dosage/adverse effects MH - Hemorrhage/blood/diagnosis/*therapy MH - *Hemostasis/drug effects MH - Humans MH - Male MH - Middle Aged MH - Patient Selection MH - *Patient-Centered Care MH - Platelet Transfusion/adverse effects MH - Predictive Value of Tests MH - Prospective Studies MH - Resuscitation/adverse effects/*methods MH - *Thrombelastography MH - Time Factors MH - Tranexamic Acid/administration & dosage/adverse effects MH - Treatment Outcome MH - Wounds and Injuries/blood/diagnosis/*therapy PMC - PMC6850475 OTO - NOTNLM OT - ROTEM OT - hemorrhage OT - transfusion OT - trauma OT - viscoelastic hemostatic assay COIS- The authors state that they have no conflict of interest. EDAT- 2019/01/05 06:00 MHDA- 2020/04/09 06:00 PMCR- 2019/11/12 CRDT- 2019/01/05 06:00 PHST- 2018/10/16 00:00 [received] PHST- 2019/01/05 06:00 [pubmed] PHST- 2020/04/09 06:00 [medline] PHST- 2019/01/05 06:00 [entrez] PHST- 2019/11/12 00:00 [pmc-release] AID - S1538-7836(22)02827-6 [pii] AID - JTH14378 [pii] AID - 10.1111/jth.14378 [doi] PST - ppublish SO - J Thromb Haemost. 2019 Mar;17(3):441-448. doi: 10.1111/jth.14378. Epub 2019 Feb 17. PMID- 30601456 OWN - NLM STAT- MEDLINE DCOM- 20200528 LR - 20200528 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 86 IP - 4 DP - 2019 Apr TI - Severe traumatic brain injury is associated with a unique coagulopathy phenotype. PG - 686-693 LID - 10.1097/TA.0000000000002173 [doi] AB - BACKGROUND: Traumatic brain injury (TBI) patients present on a spectrum from hypocoagulability to hypercoagulability, depending on the injury complexity, severity, and time since injury. Prior studies have found a unique coagulopathy associated with TBI using conventional coagulation assays such as INR; however, few studies have assessed the association of TBI and coagulopathy using viscoelastic assays that comprehensively evaluate the coagulation in whole blood. This study aims to reevaluate the TBI-specific trauma-induced coagulopathy using arrival thrombelastography. Because brain tissue is high in key procoagulant molecules, we hypothesize that isolated TBI is associated with procoagulant and hypofibrinolytic profiles compared with injuries of the torso, extremities, and polytrauma, including TBI. METHODS: Data are from the prospective Trauma Activation Protocol study. Activated clotting time (ACT), angle, maximum amplitude (MA), 30-minute percent lysis after MA (LY30), and functional fibrinogen levels (FFLEV) were recorded. Patients were categorized into isolated severe TBI (I-TBI), severe TBI with torso and extremity injuries (TBI + TORSO/EXTREMITIES), and isolated torso and extremity injuries (I-TORSO/EXTREMITIES). Poisson regression was used to adjust for multiple confounders. RESULTS: Overall, 572 patients (48 I-TBI, 45 TBI + TORSO/EXTREMITIES, 479 I-TORSO/EXTREMITIES) were included in this analysis. The groups differed in INR, ACT, angle, MA, and FFLEV but not in 30-minute percent lysis. When compared with I-Torso/Extremities, after adjustment for confounders, severe I-TBI was independently associated with ACT less than 128 seconds (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1-2.2), angle less than 65 degrees (RR, 2.2; 95% CI, 1.4-3.6), FFLEV less than 356 (RR, 1.7; 95% CI, 1.2-2.4) but not MA less than 55 mm, hyperfibrinolysis, fibrinolysis shutdown, or partial thromboplastin time (PTT) greater than 30. CONCLUSION: Severe I-TBI was independently associated with a distinct coagulopathy with delayed clot formation but did not appear to be associated with fibrinolysis abnormalities. Low fibrinogen and longer ACT values associated with I-TBI suggest that early coagulation factor replacement may be indicated in I-TBI patients over empiric antifibrinolytic therapy. Mechanisms triggering coagulopathy in TBI are unique and warrant further investigation. LEVEL OF EVIDENCE: Retrospective cohort study, prognostic, level III. FAU - Samuels, Jason M AU - Samuels JM AD - From the Department of Surgery (J.M.S., A.B., J.R.C.), University of Colorado Denver; Department of Surgery (E.E.M., M.J.C., A.G., J.C.), Denver Health Medical Center; Department of Pediatrics (C.C.S.), University of Colorado School of Public Health (A.S.), Aurora, CO. FAU - Moore, Ernest E AU - Moore EE FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chandler, James AU - Chandler J FAU - Coleman, Julia R AU - Coleman JR FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9001-32-5 (Fibrinogen) SB - IM EIN - J Trauma Acute Care Surg. 2020 Aug;89(2):419. doi: 10.1097/TA.0000000000002827. PMID: 32740641 MH - Adult MH - Blood Coagulation Disorders/*blood/*diagnosis MH - Blood Coagulation Tests MH - Brain Injuries, Traumatic/*blood/diagnosis MH - Cohort Studies MH - Colorado MH - Correlation of Data MH - Extremities/injuries MH - Female MH - Fibrinogen/metabolism MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Multiple Trauma/blood/diagnosis MH - *Phenotype MH - Prognosis MH - Prospective Studies MH - Torso/injuries PMC - PMC6682404 MID - NIHMS1038694 EDAT- 2019/01/03 06:00 MHDA- 2020/05/29 06:00 PMCR- 2019/08/05 CRDT- 2019/01/03 06:00 PHST- 2019/01/03 06:00 [pubmed] PHST- 2020/05/29 06:00 [medline] PHST- 2019/01/03 06:00 [entrez] PHST- 2019/08/05 00:00 [pmc-release] AID - 10.1097/TA.0000000000002173 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Apr;86(4):686-693. doi: 10.1097/TA.0000000000002173. PMID- 30596098 OWN - NLM STAT- MEDLINE DCOM- 20190411 LR - 20200319 IS - 2314-6141 (Electronic) IS - 2314-6133 (Print) VI - 2018 DP - 2018 TI - Thromboelastography and Thromboelastometry in Assessment of Fibrinogen Deficiency and Prediction for Transfusion Requirement: A Descriptive Review. PG - 7020539 LID - 10.1155/2018/7020539 [doi] LID - 7020539 AB - Fibrinogen is crucial for the formation of blood clot and clinical outcomes in major bleeding. Both Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) have been increasingly used to diagnose fibrinogen deficiency and guide fibrinogen transfusion in trauma and surgical bleeding patients. We conducted a comprehensive and comparative review on the technologies and clinical applications of two typical functional fibrinogen assays using TEG (FF TEG) and ROTEM (FIBTEM) for assessment of fibrinogen level and deficiency, and prediction of transfusion requirement. Clot strength and firmness of FF TEG and ROTEM FIBTEM were the most used parameters, and their associations with fibrinogen levels as measured by Clauss method ranged from 0 to 0.9 for FF TEG and 0.27 to 0.94 for FIBTEM. A comparison of the interchangeability and clinical performance of the functional fibrinogen assays using the two systems showed that the results were correlated, but are not interchangeable between the two systems. It appears that ROTEM FIBTEM showed better associations with the Clauss method and more clinical use for monitoring fibrinogen deficiency and predicting transfusion requirements including fibrinogen replacement than FF TEG. TEG and ROTEM functional fibrinogen tests play important roles in the diagnosis of fibrinogen-related coagulopathy and guidance of transfusion requirements. Despite the fact that high-quality evidence is still needed, the two systems are likely to remain popular for the hemostatic management of bleeding patients. FAU - Peng, Henry T AU - Peng HT AUID- ORCID: 0000-0001-5276-9573 AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. AD - Research Institute of Xi'an Jiaotong University, Hangzhou, Zhejiang, China. FAU - Nascimento, Bartolomeu AU - Nascimento B AD - Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Canada. FAU - Beckett, Andrew AU - Beckett A AD - Royal Canadian Medical Services, Ottawa, Ontario, and McGill University, Montreal, Quebec, Canada. LA - eng PT - Journal Article PT - Review DEP - 20181125 PL - United States TA - Biomed Res Int JT - BioMed research international JID - 101600173 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Afibrinogenemia/metabolism/*physiopathology MH - Blood Coagulation Tests/methods MH - Blood Transfusion/methods MH - Fibrinogen/*metabolism MH - Humans MH - Thrombelastography/methods MH - Thrombosis/*physiopathology PMC - PMC6286766 EDAT- 2019/01/01 06:00 MHDA- 2019/04/12 06:00 PMCR- 2018/11/25 CRDT- 2019/01/01 06:00 PHST- 2018/05/28 00:00 [received] PHST- 2018/09/28 00:00 [revised] PHST- 2018/11/06 00:00 [accepted] PHST- 2019/01/01 06:00 [entrez] PHST- 2019/01/01 06:00 [pubmed] PHST- 2019/04/12 06:00 [medline] PHST- 2018/11/25 00:00 [pmc-release] AID - 10.1155/2018/7020539 [doi] PST - epublish SO - Biomed Res Int. 2018 Nov 25;2018:7020539. doi: 10.1155/2018/7020539. eCollection 2018. PMID- 30573702 OWN - NLM STAT- MEDLINE DCOM- 20200122 LR - 20200122 IS - 2052-0468 (Electronic) IS - 0035-8665 (Linking) VI - 165 IP - 5 DP - 2019 Oct TI - In-vitro study of species-specific coagulation differences in animals and humans using rotational thromboelastometry (ROTEM). PG - 356-359 LID - 10.1136/jramc-2018-001092 [doi] AB - Animal tests are conducted in all fields of trauma research, but transferability of these data to humans is limited. For example, it is still unclear which animal species is most similar to humans in terms of physiology of blood coagulation. To improve transferability and raise awareness of the existing differences, we compared human coagulation to coagulation of different animals. Rotational thromboelastometry was used to analyse the blood of pigs, sheep, rabbits and dogs. Animal data were compared with human coagulation based on the number of significant differences of the test parameters and on a descriptive comparison of the extent of relative deviation of the single values. All animal species showed significant differences in coagulation properties when compared with humans. Coagulation parameters of dogs and sheep were on average most similar to humans. However, there is no animal which is most similar to humans concerning all aspects of coagulation. Differences in coagulation between humans and animals are significant. This must be taken into account when transferring animal test data to humans. CI - (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Lechner, Raimund AU - Lechner R AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, German Armed Forces Hospital of Ulm, Ulm, Germany raimundedgarlechner@bundeswehr.org. FAU - Helm, M AU - Helm M AD - Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, German Armed Forces Hospital of Ulm, Ulm, Germany. FAU - Muller, M AU - Muller M AD - Department of Orthopaedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. FAU - Wille, T AU - Wille T AD - Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany. FAU - Riesner, H J AU - Riesner HJ AD - Department of Orthopaedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. FAU - Friemert, B AU - Friemert B AD - Department of Orthopaedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. LA - eng PT - Journal Article DEP - 20181219 PL - England TA - J R Army Med Corps JT - Journal of the Royal Army Medical Corps JID - 7505627 SB - IM MH - Adult MH - Animals MH - Blood Coagulation/physiology MH - Dogs MH - Humans MH - Male MH - Rabbits MH - Sheep MH - Species Specificity MH - Swine MH - *Thrombelastography/classification/standards OTO - NOTNLM OT - dog OT - human OT - pig OT - rabbit OT - rotational thromboelastometry OT - sheep COIS- Competing interests: None declared. EDAT- 2018/12/24 06:00 MHDA- 2020/01/23 06:00 CRDT- 2018/12/22 06:00 PHST- 2018/10/10 00:00 [received] PHST- 2018/10/11 00:00 [accepted] PHST- 2018/12/24 06:00 [pubmed] PHST- 2020/01/23 06:00 [medline] PHST- 2018/12/22 06:00 [entrez] AID - jramc-2018-001092 [pii] AID - 10.1136/jramc-2018-001092 [doi] PST - ppublish SO - J R Army Med Corps. 2019 Oct;165(5):356-359. doi: 10.1136/jramc-2018-001092. Epub 2018 Dec 19. PMID- 30568368 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220330 IS - 0974-2700 (Print) IS - 0974-519X (Electronic) IS - 0974-2700 (Linking) VI - 11 IP - 4 DP - 2018 Oct-Dec TI - World Academic Council of Emergency Medicine Experience Document: Implementation of Point-of-Care Thromboelastography at an Academic Emergency and Trauma Center. PG - 265-270 LID - 10.4103/JETS.JETS_134_17 [doi] AB - BACKGROUND: We aimed to discuss the initial experience of the implementation of point-of-care thromboelastography (POC-TEG) at the Level 1 Trauma Center of an academic health institution in Qatar. MATERIALS AND METHODS: A TEG protocol was developed and tailored to our hospital requirements and patient population, after an exhausting review of the literature and international published protocols, including a synthesis of a preexisting TEG protocol from our heart hospital. To successfully achieve the incorporation of point-of-care testing (POCT) in our clinical practice, a multidisciplinary organizational and education approach is required. The education and training of the physicians in this POCT modality during the first 3 months period has been described in detail. RESULTS: A TEG protocol has been developed and implemented according to hospital standards. Ten physicians from the department of trauma surgery have been trained over a 3-month period to perform the daily quality control as well as the patient samples in order to provide a 24/7 service. In patients with major trauma, brain injury, bleeding, sepsis, and coagulopathy are the most important determinants of the clinical course and outcomes. Viscoelastic whole-blood assays have already proved their values in cardiac as well as liver surgery. Therefore, this POCT-directed approach would be considered as a part of the goal-directed management in severe polytrauma patients. CONCLUSIONS: Our experience shows that implementation of POC-TEG program is feasible and it is a promising tool in the management of major trauma patients with a potential compromised coagulation. However, further prospective research projects and well-trained personnel still warranted. FAU - Wahlen, Bianca M AU - Wahlen BM AD - Department of Anesthesia and Trauma Surgery, Hamad General Hospital, Doha, Qatar. FAU - El-Menyar, Ayman AU - El-Menyar A AD - Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar. AD - Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. FAU - Peralta, Ruben AU - Peralta R AD - Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar. FAU - Al-Thani, Hassan AU - Al-Thani H AD - Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar. LA - eng PT - Journal Article PL - India TA - J Emerg Trauma Shock JT - Journal of emergencies, trauma, and shock JID - 101493921 PMC - PMC6262651 OTO - NOTNLM OT - Bleeding OT - coagulopathy OT - point-of-care testing OT - rotational thromboelastography OT - thromboelastogram OT - trauma COIS- There are no conflicts of interest. EDAT- 2018/12/21 06:00 MHDA- 2018/12/21 06:01 PMCR- 2018/10/01 CRDT- 2018/12/21 06:00 PHST- 2018/12/21 06:00 [entrez] PHST- 2018/12/21 06:00 [pubmed] PHST- 2018/12/21 06:01 [medline] PHST- 2018/10/01 00:00 [pmc-release] AID - JETS-11-265 [pii] AID - 10.4103/JETS.JETS_134_17 [doi] PST - ppublish SO - J Emerg Trauma Shock. 2018 Oct-Dec;11(4):265-270. doi: 10.4103/JETS.JETS_134_17. PMID- 30562328 OWN - NLM STAT- MEDLINE DCOM- 20200528 LR - 20240725 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 86 IP - 4 DP - 2019 Apr TI - Redefining postinjury fibrinolysis phenotypes using two viscoelastic assays. PG - 679-685 LID - 10.1097/TA.0000000000002165 [doi] AB - INTRODUCTION: Fibrinolysis was initially defined using rapid thrombelastography (rTEG). The cutoffs for the pathologic extremes of the fibrinolytic system, hyperfibrinolysis and shutdown, were both defined based on association with mortality. We propose to redefine these phenotypes for both TEG and for rotational thrombelastometry, the other commonly used viscoelastic assay. METHODS: Rotational thrombelastometry, rTEG, and clinical data were prospectively collected on trauma patients admitted to an urban Level I trauma center from 2010 to 2016. Hyperfibrinolysis was defined as the Youden index from EXTEM-clot lysis index 60 minutes after clotting time (CLI60) and rTEG-fibrinolysis 30 minutes after achieving MA (LY30) for predicting massive transfusion (>10 red blood cell units, or death per 6 hours after injury) as a surrogate for severe bleeding. Patients identified as having hyperfibrinolysis were then removed from the data set, and the cutoff for fibrinolysis shutdown was derived as the optimal cutoff for predicting mortality in the remaining patients. RESULTS: Overall, 216 patients (median age, 36 years (interquartile range, 27-49 years), 82% men, 58% blunt injury) were included. Of these, 16% required massive transfusion, and 12.5% died. Rapid thrombelastography phenotypes were redefined as hyperfibrinolysis: rTEG-LY30 greater than7.7%, physiologic rTEG-LY30 0.6% to7.6%, and shutdown rTEG-LY30 less than 0.6%. EXTEM-CLI60 fibrinolysis phenotypes were hyperfibrinolysis CLI60 less than 82%, physiologic (CLI60, 82-97.9%), and shutdown (CLI60 > 98%). Weighted kappa statistics revealed moderate agreement between rotational thrombelastometry- and rTEG-defined fibrinolysis (k = 0.51; 95% confidence interval, 0.39-0.63), with disagreement mostly in the shutdown and physiologic categories. CONCLUSION: We confirmed the U-shaped distribution of death related to fibrinolysis system abnormalities. Both rTEG LY30 and EXTEM CLI60 can identify the spectrum of fibrinolytic phenotypes, have moderate agreement, and can be used to guide hemostatic resuscitation. LEVEL OF EVIDENCE: Diagnostic study, level III. FAU - Stettler, Gregory R AU - Stettler GR AD - From the Department of Surgery (G.R.S., E.E.M., H.B.M., G.R.N., C.C.S., A.B., A.S.), University of Colorado School of Medicine, Aurora, Colorado; Denver Health Medical Center (E.E.M.), Denver, Colorado; Department of Pediatrics (C.C.S.), University of Colorado School of Medicine; Bonfils Blood Center (C.C.S.), Denver, Colorado; and University of Colorado School of Public Health (A.S.), Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Moore, Hunter B AU - Moore HB FAU - Nunns, Geoffrey R AU - Nunns GR FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Viscosity/physiology MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Male MH - Middle Aged MH - *Phenotype MH - Thrombelastography/*methods MH - Wounds and Injuries/*blood MH - Wounds, Nonpenetrating/blood PMC - PMC6870942 MID - NIHMS1059149 COIS- DISCLOSURE The authors declare no conflicts of interest. EDAT- 2018/12/19 06:00 MHDA- 2020/05/29 06:00 PMCR- 2019/11/21 CRDT- 2018/12/19 06:00 PHST- 2018/12/19 06:00 [pubmed] PHST- 2020/05/29 06:00 [medline] PHST- 2018/12/19 06:00 [entrez] PHST- 2019/11/21 00:00 [pmc-release] AID - 10.1097/TA.0000000000002165 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2019 Apr;86(4):679-685. doi: 10.1097/TA.0000000000002165. PMID- 30506352 OWN - NLM STAT- MEDLINE DCOM- 20190617 LR - 20200225 IS - 1573-742X (Electronic) IS - 0929-5305 (Linking) VI - 47 IP - 2 DP - 2019 Feb TI - Exploring the effect of factor Xa inhibitors on rotational thromboelastometry: a case series of bleeding patients. PG - 272-279 LID - 10.1007/s11239-018-1785-0 [doi] AB - Direct oral anticoagulants (DOACs) have become the standard for thromboembolic risk management. In cases of major bleeding, trauma, or urgent surgery, accurate monitoring of DOAC activity is desirable; however, there is often no rapid, readily available test. We therefore explored the degree to which DOAC activity correlated with two coagulation assays: rotational thromboelastometry (ROTEM) and a standard coagulation assay in bleeding patients. We conducted a retrospective review of patients who experienced bleeding while on DOAC therapy from 2015 to 2017 at a Level 1 trauma center. ROTEM (EXTEM-clotting time CT in seconds), activated partial thromboplastin time (aPTT) (in seconds), prothrombin time (PT) (in seconds), DOAC specific drug test (anti-Xa and Hemoclot in ng/mL), and relevant clinical parameters were recorded. Descriptive statistics (median, range) and Spearman correlation coefficients were estimated. Differences between correlations were tested using Williams' t test. Twelve cases were reviewed (13 separate bleeding episodes). Sixteen measurements of DOAC activity, EXTEM-CT, and PT were obtained. The correlations with rivaroxaban activity were 0.96 and 0.86 (p = 0.2062) for PT and EXTEM-CT, respectively. The correlations with apixaban activity were 0.63 and 0.56 (p = 0.7175) for PT and EXTEM-CT, respectively. Analyses were not conducted for dabigatran due to limited data. Although not statistically significant, PT appears to have a higher correlation with direct Xa inhibitor activity than EXTEM-CT. Further research with larger samples is necessary to clarify the differences between ROTEM and standard assays in detecting DOAC activity. FAU - Mahamad, Syed AU - Mahamad S AD - Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada. FAU - Chaudhry, Hina AU - Chaudhry H AD - Department of Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, ON, Canada. FAU - Nisenbaum, Rosane AU - Nisenbaum R AD - Applied Health Research Centre, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. AD - Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. FAU - McFarlan, Amanda AU - McFarlan A AD - Trauma Program and Quality Assurance, St. Michael's Hospital, Toronto, ON, Canada. FAU - Rizoli, Sandro AU - Rizoli S AD - Surgery & Critical Care Medicine, University of Toronto, Toronto, ON, Canada. AD - Trauma & Acute Care Service, St. Michael's Hospital, Toronto, ON, Canada. AD - Trauma Care, Toronto, ON, Canada. FAU - Ackery, Alun AU - Ackery A AD - Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada. FAU - Sholzberg, Michelle AU - Sholzberg M AD - Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada. SholzbergM@smh.ca. AD - Department of Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, ON, Canada. SholzbergM@smh.ca. AD - Applied Health Research Centre, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. SholzbergM@smh.ca. AD - Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada. SholzbergM@smh.ca. AD - St. Michael's Hospital, 30 Bond Street Room 2-007G Core Lab, Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada. SholzbergM@smh.ca. LA - eng PT - Comparative Study PT - Journal Article PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 RN - 0 (Factor Xa Inhibitors) RN - 0 (Pyrazoles) RN - 0 (Pyridones) RN - 3Z9Y7UWC1J (apixaban) RN - 9NDF7JZ4M3 (Rivaroxaban) RN - I0VM4M70GC (Dabigatran) SB - IM MH - Administration, Oral MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/*drug effects MH - Dabigatran/administration & dosage MH - Drug Monitoring/*methods MH - Factor Xa Inhibitors/*administration & dosage/adverse effects MH - Female MH - Hemorrhage/*blood/diagnosis/etiology MH - Humans MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Predictive Value of Tests MH - Prothrombin Time MH - Pyrazoles/*administration & dosage/adverse effects MH - Pyridones/*administration & dosage/adverse effects MH - Reproducibility of Results MH - Retrospective Studies MH - Rivaroxaban/*administration & dosage/adverse effects MH - *Thrombelastography MH - Treatment Outcome OTO - NOTNLM OT - Apixaban OT - Direct oral anticoagulant (DOAC) OT - Factor Xa inhibitors OT - Rivaroxaban OT - Thromboelastometry OT - Trauma EDAT- 2018/12/07 06:00 MHDA- 2019/06/18 06:00 CRDT- 2018/12/04 06:00 PHST- 2018/12/07 06:00 [pubmed] PHST- 2019/06/18 06:00 [medline] PHST- 2018/12/04 06:00 [entrez] AID - 10.1007/s11239-018-1785-0 [pii] AID - 10.1007/s11239-018-1785-0 [doi] PST - ppublish SO - J Thromb Thrombolysis. 2019 Feb;47(2):272-279. doi: 10.1007/s11239-018-1785-0. PMID- 30502239 OWN - NLM STAT- MEDLINE DCOM- 20191113 LR - 20191113 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 233 DP - 2019 Jan TI - Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury. PG - 132-138 LID - S0022-4804(18)30562-6 [pii] LID - 10.1016/j.jss.2018.07.074 [doi] AB - BACKGROUND: Tranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED). MATERIALS AND METHODS: We identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period. These patients had been selected prospectively for TXA administration using a protocol that selected adult trauma patients with high-risk mechanism and concern for severe hemorrhage to receive TXA. Patient demographics, vital signs, lab values including thromboelastography, blood administration, mortality, and complications were reviewed retrospectively and analyzed. RESULTS: One hundred sixteen patients were identified (62 prehospital versus 54 ED). Prehospital TXA patients were more likely to have sustained blunt injury (76% prehospital versus 46% ED, P = 0.002). There were no differences between groups in injury severity score or initial vital signs. There were no differences in complication rates or mortality. Patients receiving TXA had higher rates of venous thromboembolic events (8.1% in prehospital and 18.5% in ED) than the overall trauma population (2.1%, P < 0.001). CONCLUSIONS: Prehospital administration of TXA during aeromedical transport did not improve survival compared with ED administration. Treatment with TXA was associated with increased risk of venous thromboembolic events. Prehospital TXA protocols should be refined to identify patients with severe hemorrhagic shock or traumatic brain injury. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Boudreau, Ryan M AU - Boudreau RM AD - Division of Trauma, Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Deshpande, Keshav K AU - Deshpande KK AD - OhioHealth, Grant Medical Center, Department of Surgery, Columbus, Ohio. FAU - Day, Gregory M AU - Day GM AD - UC Health, Memorial Hospital, Department of General and Vascular Surgery, Colorado Springs, Colorado. FAU - Hinckley, William R AU - Hinckley WR AD - Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio. FAU - Harger, Nicole AU - Harger N AD - Department of Pharmacy, UC Health, University of Cincinnati Medical Center, Cincinnati, Ohio. FAU - Pritts, Timothy A AU - Pritts TA AD - Division of Trauma, Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Makley, Amy T AU - Makley AT AD - Division of Trauma, Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio. FAU - Goodman, Michael D AU - Goodman MD AD - Division of Trauma, Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: goodmamd@ucmail.uc.edu. LA - eng PT - Journal Article DEP - 20180821 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Air Ambulances/*statistics & numerical data MH - Antifibrinolytic Agents/*administration & dosage/adverse effects MH - Blood Transfusion/statistics & numerical data MH - Emergency Service, Hospital/*statistics & numerical data MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prospective Studies MH - Retrospective Studies MH - Shock, Hemorrhagic/etiology/mortality/*therapy MH - Thrombelastography MH - Time Factors MH - Tranexamic Acid/*administration & dosage/adverse effects MH - Treatment Outcome MH - Venous Thromboembolism/chemically induced/diagnosis/*epidemiology MH - Wounds and Injuries/complications/diagnosis MH - Young Adult OTO - NOTNLM OT - Prehospital care OT - Tranexamic acid OT - Trauma OT - VTE EDAT- 2018/12/07 06:00 MHDA- 2019/11/14 06:00 CRDT- 2018/12/04 06:00 PHST- 2018/02/05 00:00 [received] PHST- 2018/06/24 00:00 [revised] PHST- 2018/07/17 00:00 [accepted] PHST- 2018/12/04 06:00 [entrez] PHST- 2018/12/07 06:00 [pubmed] PHST- 2019/11/14 06:00 [medline] AID - S0022-4804(18)30562-6 [pii] AID - 10.1016/j.jss.2018.07.074 [doi] PST - ppublish SO - J Surg Res. 2019 Jan;233:132-138. doi: 10.1016/j.jss.2018.07.074. Epub 2018 Aug 21. PMID- 30439979 OWN - NLM STAT- MEDLINE DCOM- 20190422 LR - 20260306 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 13 IP - 11 DP - 2018 TI - Thromboelastographic analysis of novel polyethylene glycol based low volume resuscitation solutions. PG - e0207147 LID - 10.1371/journal.pone.0207147 [doi] LID - e0207147 AB - BACKGROUND: Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. METHODS: Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG). FINDINGS: In healthy volunteers and patients, 10% PEG-20k significantly increased clot amplification time (k), decreased propagation (angle), maximal clot size and strength (MA), and the overall coagulation index (CI), but not clot initiation (R) or fibrinolysis (Ly30), relative to paired saline dilutional controls. Clinically, K, angle, and MA were just outside of the normal limits in volunteers but not in patients. No statistical differences existed between PEG-20k and Hextend (HES) in either patient population. In a dose response series using volunteer blood, all effects of 10% PEG-20k on TEG were reversed and normalized by lower concentrations (7.5% and 5%). Furthermore, 7.5% PEG-20k produced similar resuscitation effects as 10% PEG in rodent hemorrhagic shock models (n = 5). CONCLUSIONS: In conclusion, PEG-20k based LVR solutions produced a dose-dependent minor hypocoagulative state, possibly associated with changes in clot propagation and platelet function, which can be reversed by dose reduction in concentration while providing superior LVR, microvascular rescue, and lactate clearance compared to saline or starch. FAU - Liebrecht, Loren K AU - Liebrecht LK AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Newton, Jason AU - Newton J AD - Department of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Martin, Erika J AU - Martin EJ AD - Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States of America. FAU - Wickramaratne, Nina AU - Wickramaratne N AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Jayaraman, Sudha AU - Jayaraman S AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Han, Jinfeng AU - Han J AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Aboutanos, Michel AU - Aboutanos M AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. FAU - Brophy, Donald F AU - Brophy DF AUID- ORCID: 0000-0003-3447-8523 AD - Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States of America. FAU - Mangino, Martin J AU - Mangino MJ AUID- ORCID: 0000-0003-2440-1952 AD - Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. AD - Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. AD - Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America. LA - eng GR - K99 HD096117/HD/NICHD NIH HHS/United States GR - L40 NS108774/NS/NINDS NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20181115 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Rehydration Solutions) RN - 0 (Solutions) RN - 3WJQ0SDW1A (Polyethylene Glycols) SB - IM MH - Adolescent MH - Adult MH - Animals MH - Blood Coagulation/drug effects MH - Blood Platelets/drug effects MH - Blood Volume MH - Disease Models, Animal MH - Dose-Response Relationship, Drug MH - Female MH - Fibrinolysis/drug effects MH - Fluid Therapy MH - Humans MH - Male MH - Middle Aged MH - Polyethylene Glycols/*administration & dosage MH - Rats, Sprague-Dawley MH - Rehydration Solutions/*administration & dosage MH - Shock/*therapy MH - Shock, Hemorrhagic/drug therapy MH - Solutions MH - Thrombelastography MH - Young Adult PMC - PMC6237338 COIS- The authors have declared that no competing interests exist. EDAT- 2018/11/16 06:00 MHDA- 2019/04/23 06:00 PMCR- 2018/11/15 CRDT- 2018/11/16 06:00 PHST- 2018/06/21 00:00 [received] PHST- 2018/10/25 00:00 [accepted] PHST- 2018/11/16 06:00 [entrez] PHST- 2018/11/16 06:00 [pubmed] PHST- 2019/04/23 06:00 [medline] PHST- 2018/11/15 00:00 [pmc-release] AID - PONE-D-18-18604 [pii] AID - 10.1371/journal.pone.0207147 [doi] PST - epublish SO - PLoS One. 2018 Nov 15;13(11):e0207147. doi: 10.1371/journal.pone.0207147. eCollection 2018. PMID- 30433835 OWN - NLM STAT- MEDLINE DCOM- 20190917 LR - 20190917 IS - 1747-4094 (Electronic) IS - 1747-4094 (Linking) VI - 11 IP - 12 DP - 2018 Dec TI - Current strategies for hemostatic control in acute trauma hemorrhage and trauma-induced coagulopathy. PG - 987-995 LID - 10.1080/17474086.2018.1548929 [doi] AB - Introduction: Despite advances in the treatment of severely injured patients that have resulted in overall improved outcomes, uncontrolled hemorrhage still represents the most common cause of preventable death following major injury. While addressing both endo- and exogenous factors that lead to an acute trauma-induced coagulopathy, massive transfusion plays a key role in managing bleeding trauma patients. However, the best practice for hemostatic control including massive transfusion in these patients is still under debate. Areas covered: This review summarizes the current knowledge and clinical practice for hemostatic control including massive transfusion for bleeding trauma patients. The recent literature was reviewed and extended by current guidelines and their underlying evidence was incorporated. Expert commentary: Treatment strategies for bleeding trauma patients are still an area of emerging scientific and clinical interest as advances are likely to translate into improved outcomes including survival. To date, damage control resuscitation principles with ratio-based transfusion of packed red blood cells, plasma and platelets still dominate as "gold standard" of care but goal-directed strategies guided either by conventional coagulation tests or viscoelastic assays may demonstrate a better characterization of the underlying coagulopathy thereby allowing individualized and targeted therapies. FAU - Caspers, Michael AU - Caspers M AD - a The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine , Witten/Herdecke University , Cologne , Germany. AD - b Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC) , Witten/Herdecke University , Cologne , Germany. FAU - Maegele, Marc AU - Maegele M AD - a The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine , Witten/Herdecke University , Cologne , Germany. AD - b Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC) , Witten/Herdecke University , Cologne , Germany. FAU - Frohlich, Matthias AU - Frohlich M AD - b Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC) , Witten/Herdecke University , Cologne , Germany. LA - eng PT - Journal Article PT - Review DEP - 20181127 PL - England TA - Expert Rev Hematol JT - Expert review of hematology JID - 101485942 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) SB - IM MH - Animals MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/blood/*etiology/*therapy MH - Blood Coagulation Factors/therapeutic use MH - Blood Transfusion/methods MH - Hemorrhage/blood/*etiology/*therapy MH - Hemostasis/drug effects MH - Hemostatics/therapeutic use MH - Humans MH - Resuscitation/methods MH - Wounds and Injuries/blood/*complications/therapy OTO - NOTNLM OT - Trauma-induced coagulopathy OT - coagulation management in trauma OT - damage control resuscitation (DCR) OT - directed coagulation therapy OT - hemostatic control in acute trauma EDAT- 2018/11/16 06:00 MHDA- 2019/09/19 06:00 CRDT- 2018/11/16 06:00 PHST- 2018/11/16 06:00 [pubmed] PHST- 2019/09/19 06:00 [medline] PHST- 2018/11/16 06:00 [entrez] AID - 10.1080/17474086.2018.1548929 [doi] PST - ppublish SO - Expert Rev Hematol. 2018 Dec;11(12):987-995. doi: 10.1080/17474086.2018.1548929. Epub 2018 Nov 27. PMID- 30407978 OWN - NLM STAT- MEDLINE DCOM- 20200110 LR - 20200110 IS - 1940-5480 (Electronic) IS - 1067-151X (Linking) VI - 27 IP - 14 DP - 2019 Jul 15 TI - Thromboelastography for the Orthopaedic Surgeon. PG - 503-508 LID - 10.5435/JAAOS-D-17-00603 [doi] AB - Evaluation of coagulation is vital in the care of the orthopaedic patients, particularly in the subspecialties of trauma, spine, arthroplasty, and revision surgery resulting from blood loss and coagulopathies. Although conventional tests (prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet count, and fibrinogen) are most commonly used, others like thromboelastography (TEG) are also available to the orthopaedic surgeons. TEG is a blood test developed in the 1950s, which provides a snapshot of a patient's coagulation profile by evaluating clot formation and lysis. Recently, TEG has been used to assess traumatic coagulopathy. The coagulation parameters measured by the TEG are reaction time (R-time), time to reach a certain clot strength (K-value), speed of fibrin build up (alpha-angle), maximum clot amplitude, and percentage decrease of clot in 30 minutes (LY30). Using these values, traumatologists have developed a better, faster, and more accurate overview of a patient's resuscitation and more successfully direct blood product use. However, many orthopaedic surgeons-despite performing surgical procedures that risk notable blood loss and postoperative clotting complications-are unaware of the existence of the TEG blood test and the critical information it provides. Increasing awareness of the TEG among orthopaedic surgeons could have a notable effect on numerous aspects of musculoskeletal care. FAU - Hagedorn, John C 2nd AU - Hagedorn JC 2nd AD - From the Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch Galveston, Galveston, TX (Dr. Hagedorn, Dr. Paris, and Dr. Lindsey), and the Division of Acute Care Surgery LAC + USC Medical Center, University of Southern California, Los Angeles, CA (Dr. Bardes). FAU - Bardes, James M AU - Bardes JM FAU - Paris, Creed L AU - Paris CL FAU - Lindsey, Ronald W AU - Lindsey RW LA - eng PT - Journal Article PT - Review PL - United States TA - J Am Acad Orthop Surg JT - The Journal of the American Academy of Orthopaedic Surgeons JID - 9417468 SB - IM MH - Blood Coagulation MH - Blood Coagulation Disorders/*diagnosis MH - Blood Coagulation Tests/*methods MH - Hemorrhage/complications MH - Humans MH - *Orthopedic Surgeons MH - Postoperative Complications/diagnosis/*diagnostic imaging/etiology MH - *Thrombelastography MH - Wounds and Injuries/complications EDAT- 2018/11/09 06:00 MHDA- 2020/01/11 06:00 CRDT- 2018/11/09 06:00 PHST- 2018/11/09 06:00 [pubmed] PHST- 2020/01/11 06:00 [medline] PHST- 2018/11/09 06:00 [entrez] AID - 10.5435/JAAOS-D-17-00603 [doi] PST - ppublish SO - J Am Acad Orthop Surg. 2019 Jul 15;27(14):503-508. doi: 10.5435/JAAOS-D-17-00603. PMID- 30402564 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220330 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 3 IP - 1 DP - 2018 TI - Laboratory measures of coagulation among trauma patients on NOAs: results of the AAST-MIT. PG - e000231 LID - 10.1136/tsaco-2018-000231 [doi] LID - e000231 AB - BACKGROUND: Warfarin is associated with poor outcomes after trauma, an effect correlated with elevations in the international normalized ratio (INR). In contrast, the novel oral anticoagulants (NOAs) have no validated laboratory measure to quantify coagulopathy. We sought to determine if use of NOAs was associated with elevated activated partial thromboplastin time (aPTT) or INR levels among trauma patients or increased clotting times on thromboelastography (TEG). METHODS: This was a post-hoc analysis of a prospective observational study across 16 trauma centers. Patients on dabigatran, rivaroxaban, or apixaban were included. Laboratory data were collected at admission and after reversal. Admission labs were compared between medication groups. Traditional measures of coagulopathy were compared with TEG results using Spearman's rank coefficient for correlation. Labs before and after reversal were also analyzed between medication groups. RESULTS: 182 patients were enrolled between June 2013 and July 2015: 50 on dabigatran, 123 on rivaroxaban, and 34 apixaban. INR values were mildly elevated among patients on dabigatran (median 1.3, IQR 1.1-1.4) and rivaroxaban (median 1.3, IQR 1.1-1.6) compared with apixaban (median 1.1, IQR 1.0-1.2). Patients on dabigatran had slightly higher than normal aPTT values (median 35, IQR 29.8-46.3), whereas those on rivaroxaban and apixaban did not. Fifty patients had TEG results. The median values for R, alpha, MA and lysis were normal for all groups. Prothrombin time (PT) and aPTT had a high correlation in all groups (dabigatran p=0.0005, rivaroxaban p<0.0001, and apixaban p<0.0001). aPTT correlated with the R value on TEG in patients on dabigatran (p=0.0094) and rivaroxaban (p=0.0028) but not apixaban (p=0.2532). Reversal occurred in 14%, 25%, and 18% of dabigatran, rivaroxaban, and apixaban patients, respectively. Both traditional measures of coagulopathy and TEG remained within normal limits after reversal. DISCUSSION: Neither traditional measures of coagulation nor TEG were able to detect coagulopathy in patients on NOAs. LEVEL OF EVIDENCE: Level IV. FAU - Kobayashi, Leslie M AU - Kobayashi LM AUID- ORCID: 0000-0002-9063-0908 AD - Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA. FAU - Brito, Alexandra AU - Brito A AD - Department of Surgery, University of California San Diego, San Diego, California, USA. FAU - Barmparas, Galinos AU - Barmparas G AD - Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA. FAU - Bosarge, Patrick AU - Bosarge P AD - Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Brown, Carlos V AU - Brown CV AD - Dell Medical School, University of Texas at Austin, Austin, Texas, USA. FAU - Bukur, Marko AU - Bukur M AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Surgical Intensive Care Unit Bellevue Hospital Center, New York, USA. FAU - Carrick, Matthew M AU - Carrick MM AD - University of North Texas Health Science Center, Fort Worth, Texas, USA. FAU - Catalano, Richard D AU - Catalano RD AD - Loma Linda University Medical Center, Loma Linda, California, USA. FAU - Holly-Nicolas, Jan AU - Holly-Nicolas J AD - Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. FAU - Inaba, Kenji AU - Inaba K AD - Division of Trauma & Critical Care, University of Southern California, Los Angeles, California, USA. FAU - Kaminski, Stephen AU - Kaminski S AD - Department of General Surgery and Surgical Critical Care, Santa Barbara Cottage Hospital, Santa Barbara, California, USA. FAU - Klein, Amanda L AU - Klein AL AD - Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA. FAU - Kopelman, Tammy AU - Kopelman T AD - Division of Burns, Trauma, and Surgical Critical Care, University of Arizona Medical School-Phoenix Campus, Phoenix, Arizona, USA. FAU - Ley, Eric J AU - Ley EJ AD - Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA. FAU - Martinez, Ericca M AU - Martinez EM AD - Chandler Regional Medical Center, Grand Canyon University, Phoenix, Arizona, USA. FAU - Moore, Forrest O AU - Moore FO AD - Department of General Surgery, Trauma and Surgical Critical Care, Chandler Regional Medical Center, University of Arizona College of Medicine, Chandler, Arizona, USA. FAU - Murry, Jason AU - Murry J AD - Department of General Surgery Trauma Services, East Texas Medical Center, Tyler, Texas, USA. FAU - Nirula, Raminder AU - Nirula R AD - Department of General Surgery, University of Utah, Salt Lake City, Utah, USA. FAU - Paul, Douglas AU - Paul D AD - Division of Trauma, Critical Care and Acute Care Surgery, Kettering Medical Center, Kettering, Ohio, USA. FAU - Quick, Jacob AU - Quick J AD - Division of Acute Care Surgery, University of Missouri, Columbia, Missouri, USA. FAU - Rivera, Omar AU - Rivera O AD - Division of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA. FAU - Schreiber, Martin AU - Schreiber M AD - Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Coimbra, Raul AU - Coimbra R AD - Department of General Surgery, Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, California, USA. LA - eng PT - Journal Article DEP - 20181015 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC6203140 OTO - NOTNLM OT - anticoagulation OT - coagulation tests OT - trauma management COIS- Competing interests: None declared. EDAT- 2018/11/08 06:00 MHDA- 2018/11/08 06:01 PMCR- 2018/10/15 CRDT- 2018/11/08 06:00 PHST- 2018/09/03 00:00 [received] PHST- 2018/09/11 00:00 [revised] PHST- 2018/09/15 00:00 [accepted] PHST- 2018/11/08 06:00 [entrez] PHST- 2018/11/08 06:00 [pubmed] PHST- 2018/11/08 06:01 [medline] PHST- 2018/10/15 00:00 [pmc-release] AID - tsaco-2018-000231 [pii] AID - 10.1136/tsaco-2018-000231 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2018 Oct 15;3(1):e000231. doi: 10.1136/tsaco-2018-000231. eCollection 2018. PMID- 30346865 OWN - NLM STAT- MEDLINE DCOM- 20190906 LR - 20190906 IS - 1362-301X (Electronic) IS - 0269-9052 (Linking) VI - 32 IP - 13-14 DP - 2018 TI - Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients. PG - 1849-1857 LID - 10.1080/02699052.2018.1536805 [doi] AB - OBJECTIVE: Platelet inhibition in traumatic brain injury (TBI) may be due to injury or antiplatelet medication use pre-injury. This study aims to identify factors associated with increased platelet arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition and determine if platelet transfusion reduces platelet dysfunction and affects outcome. METHODS: Prospective thromboelastography (TEG) assays were collected on adult patients with TBI with intracranial injuries detected by computed tomography (CT). Outcomes included in-hospital mortality, and CT lesion expansion. RESULTS: Of 153 patients, ADP inhibition was increased in moderate and severe TBI compared to mild TBI (p = 0.0011). P2Y12 inhibiting medications had increased ADP inhibition (p = 0.0077). Admission ADP inhibition was not associated with in-hospital mortality (p = 0.24) or CT lesion expansion (p = 0.94). Mean reduction of ADP inhibition from platelet transfusion (-15.1%) relative to no transfusion (+ 11.7%) was not statistically different (p = 0.0472). CONCLUSIONS: Mild TBI results in less ADP inhibition compared to moderate and severe TBI, suggesting a dose response relationship between TBI severity and degree of platelet dysfunction. Further, study is warranted to determine efficacy and parameters for platelet transfusion in patients with TBI. FAU - Guillotte, Andrew R AU - Guillotte AR AUID- ORCID: 0000-0001-7222-5856 AD - a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA. FAU - Herbert, Joseph P AU - Herbert JP AD - a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA. FAU - Madsen, Richard AU - Madsen R AD - b Biostatistics and Research Design , University of Missouri School of Medicine , Columbia , MO , USA. FAU - Hammer, Richard D AU - Hammer RD AD - c Department of Pathology and Anatomical Sciences , University of Missouri School of Medicine , Columbia , MO USA. FAU - Litofsky, N Scott AU - Litofsky NS AD - a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20181022 PL - England TA - Brain Inj JT - Brain injury JID - 8710358 RN - 27YG812J1I (Arachidonic Acid) RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Adenosine Diphosphate/blood MH - Adult MH - Aged MH - Aged, 80 and over MH - Arachidonic Acid/blood MH - Blood Platelet Disorders/*etiology MH - Brain Injuries, Traumatic/*complications/diagnostic imaging/*therapy MH - Female MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Platelet Transfusion/*methods MH - Prospective Studies MH - Thrombelastography/methods MH - Tomography Scanners, X-Ray Computed MH - Treatment Outcome OTO - NOTNLM OT - Coagulopathy OT - TEG OT - platelet dysfunction OT - thromboelastography OT - traumatic brain injury EDAT- 2018/10/23 06:00 MHDA- 2019/09/07 06:00 CRDT- 2018/10/23 06:00 PHST- 2018/10/23 06:00 [pubmed] PHST- 2019/09/07 06:00 [medline] PHST- 2018/10/23 06:00 [entrez] AID - 10.1080/02699052.2018.1536805 [doi] PST - ppublish SO - Brain Inj. 2018;32(13-14):1849-1857. doi: 10.1080/02699052.2018.1536805. Epub 2018 Oct 22. PMID- 30343500 OWN - NLM STAT- MEDLINE DCOM- 20190409 LR - 20190409 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 58 IP - 12 DP - 2018 Dec TI - Hemostatic profile under fluid resuscitation during rivaroxaban anticoagulation: an in vitro survey. PG - 3014-3026 LID - 10.1111/trf.14933 [doi] AB - BACKGROUND: Uncontrollable bleeding is the leading cause of death in traumatically injured patients. The extent to which direct factor Xa inhibitors interfere with the applied resuscitation measures is presently unknown. STUDY DESIGN AND METHODS: In this study, we investigated the effect of the resuscitation fluids saline, albumin, fresh frozen plasma (FFP) and solvent/detergent (S/D)-treated plasma, fibrinogen concentrate, prothrombin complex concentrate (PCC), and combinations thereof on the hemostatic profile of rivaroxaban-anticoagulated whole blood and plasma. We used rivaroxaban-spiked whole blood and plasma from healthy donors, as well as plasma from patients on rivaroxaban, and mimicked a resuscitation approach in a 50% plasma dilution setting. Thromboelastography, thrombin generation, and fibrin generation clot lysis test were assessed using tissue factor to initiate coagulation and tissue plasminogen activator to induce clot lysis. RESULTS: Rivaroxaban resulted in a hypocoagulant state that remained largely unaltered upon subsequent 50% dilution with S/D-treated plasma or FFP. Using S/D-treated plasma as a diluent, clot stability decreased due to its low alpha(2) -antiplasmin. Dilution with saline and albumin induced a profibrinolytic state and further deteriorated the impaired hemostatic potential of rivaroxaban-anticoagulated blood, even after PCC and fibrinogen support. Combined use of plasma (either FFP or S/D treated) and PCC, however, considerably improved both coagulation and clot stability. CONCLUSION: In the setting of rivaroxaban anticoagulation and major blood loss, transfusing plasma together with PCC may provide the most effective resuscitation approach with the notion that additional antifibrinolytic drug support (e.g., tranexamic acid) is likely required. CI - (c) 2018 AABB. FAU - Helin, Tuukka A AU - Helin TA AUID- ORCID: 0000-0002-5273-8088 AD - Coagulation Disorders Unit, Clinical Chemistry, HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland. FAU - Zuurveld, Marleen AU - Zuurveld M AD - Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands. FAU - Manninen, Mikko AU - Manninen M AD - Orton Orthopaedic Hospital, Helsinki, Finland. FAU - Meijers, Joost C M AU - Meijers JCM AD - Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands. AD - Amsterdam UMC, University of Amsterdam, Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. FAU - Lassila, Riitta AU - Lassila R AD - Coagulation Disorders Unit, Clinical Chemistry, HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland. FAU - Brinkman, Herm Jan M AU - Brinkman HJM AD - Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands. LA - eng PT - Journal Article DEP - 20181021 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Anticoagulants) RN - 9NDF7JZ4M3 (Rivaroxaban) SB - IM MH - *Anticoagulants/pharmacokinetics/pharmacology MH - Female MH - Hemostasis/*drug effects MH - Humans MH - Male MH - *Plasma MH - *Resuscitation MH - *Rivaroxaban/pharmacokinetics/pharmacology EDAT- 2018/10/22 06:00 MHDA- 2019/04/10 06:00 CRDT- 2018/10/22 06:00 PHST- 2018/03/28 00:00 [received] PHST- 2018/08/13 00:00 [revised] PHST- 2018/08/15 00:00 [accepted] PHST- 2018/10/22 06:00 [pubmed] PHST- 2019/04/10 06:00 [medline] PHST- 2018/10/22 06:00 [entrez] AID - 10.1111/trf.14933 [doi] PST - ppublish SO - Transfusion. 2018 Dec;58(12):3014-3026. doi: 10.1111/trf.14933. Epub 2018 Oct 21. PMID- 30327230 OWN - NLM STAT- MEDLINE DCOM- 20190610 LR - 20190613 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 45 IP - 1 DP - 2019 Feb TI - Thrombin generation in patients with severe thermal injury. PG - 54-62 LID - S0305-4179(18)30842-8 [pii] LID - 10.1016/j.burns.2018.09.020 [doi] AB - BACKGROUND: Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury. METHODS: We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D). RESULTS: Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values. CONCLUSIONS: In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal. CI - Copyright (c) 2018 Elsevier Ltd and ISBI. All rights reserved. FAU - Wiegele, Marion AU - Wiegele M AD - Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria. Electronic address: marion.wiegele@meduniwien.ac.at. FAU - Schaden, Eva AU - Schaden E AD - Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria. Electronic address: eva.schaden@meduniwien.ac.at. FAU - Koch, Stefan AU - Koch S AD - Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria. Electronic address: stefan.koch@meduniwien.ac.at. FAU - Bauer, Daniel AU - Bauer D AD - Department of Anaesthesiology and Intensive Care Medicine, Landeskrankenhaus Steyr, Sierninger Strasse 170, 4400 Steyr, Austria. Electronic address: daniel.bauer@gespag.at. FAU - Krall, Christoph AU - Krall C AD - Center for Medical Statistics, Informatics and Intelligent Systems, Section of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria. Electronic address: christoph.krall@meduniwien.ac.at. FAU - Adelmann, Dieter AU - Adelmann D AD - Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria; Department of Anesthesia & Perioperative Care, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: dieter.adelmann@ucsf.edu. LA - eng PT - Journal Article PT - Observational Study DEP - 20181013 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Aged MH - *Blood Coagulation Tests MH - Burns/*blood MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Point-of-Care Testing MH - Prospective Studies MH - Prothrombin Time MH - Thrombelastography MH - Thrombin/*metabolism MH - Thrombophilia/*blood/diagnosis OTO - NOTNLM OT - Burns OT - Hemostasis OT - Point-of-care testing OT - Thrombelastometry OT - Thrombin EDAT- 2018/10/18 06:00 MHDA- 2019/06/14 06:00 CRDT- 2018/10/18 06:00 PHST- 2018/04/30 00:00 [received] PHST- 2018/09/11 00:00 [revised] PHST- 2018/09/13 00:00 [accepted] PHST- 2018/10/18 06:00 [pubmed] PHST- 2019/06/14 06:00 [medline] PHST- 2018/10/18 06:00 [entrez] AID - S0305-4179(18)30842-8 [pii] AID - 10.1016/j.burns.2018.09.020 [doi] PST - ppublish SO - Burns. 2019 Feb;45(1):54-62. doi: 10.1016/j.burns.2018.09.020. Epub 2018 Oct 13. PMID- 30292526 OWN - NLM STAT- MEDLINE DCOM- 20200130 LR - 20200130 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 45 IP - 4 DP - 2019 Jun TI - Management of bleeding in major burn surgery. PG - 755-762 LID - S0305-4179(18)30754-X [pii] LID - 10.1016/j.burns.2018.08.024 [doi] AB - Major burn surgery is often associated with excessive bleeding and massive transfusion, and the development of a coagulopathy during major burn surgery is associated with increased morbidity and mortality. The aim of this study was to review the literature on intraoperative haemostatic resuscitation of burn patients during necrectomy to reveal strategies applied for haemostatic monitoring and resuscitation. We searched PubMed, EMBASE, and CENTRAL for studies published in the period 2006-2017 concerning bleeding issues related to burn surgery i.e. coagulopathy, transfusion requirements and clinical outcomes. In a broad search, a total of 1375 papers were identified. 124 of these fulfilled the inclusion criteria, and six of these were included for review. The literature confirmed that transfusion requirements increases with burn injury severity and that haemostatic monitoring by TEG((R)) (thrombelastography) or ROTEM((R)) (rotational thromboelastometry) significantly decreased intraoperative transfusions and was useful in predicting and goal-directing haemostatic therapy during excision surgery. Resuscitation of bleeding during major burn surgery in many instances was neither standardized nor haemostatic. We suggest that resuscitation should aim for normal haemostasis during the bleeding phase through close haemostatic monitoring and resuscitation. Randomised controlled trials are highly warranted to confirm the benefit of this concept. CI - Copyright (c) 2018 Elsevier Ltd and ISBI. All rights reserved. FAU - Welling, Harald AU - Welling H AD - Section for Transfusion Medicine, Rigshospitalet, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: harald.sorwad.welling@regionh.dk. FAU - Ostrowski, Sisse Rye AU - Ostrowski SR AD - Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: sisse.rye.ostrowski@regionh.dk. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Rigshospitalet, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark; Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: jakob.stensballe@regionh.dk. FAU - Vestergaard, Martin Risom AU - Vestergaard MR AD - Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: martin.risom.vestergaard.01@regionh.dk. FAU - Partoft, Soren AU - Partoft S AD - Department of Burn Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: soeren.partoft@regionh.dk. FAU - White, Jonathan AU - White J AD - Department of Intensive Care, Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Denmark. Electronic address: jonathan.oliver.white@regionh.dk. FAU - Johansson, Par Ingemar AU - Johansson PI AD - Section for Transfusion Medicine, Rigshospitalet, Capital Region Blood Bank, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, TX, USA; Centre for Systems Biology, The School of Engineering and Natural Sciences, University of Iceland, Iceland. Electronic address: per.johansson@regionh.dk. LA - eng PT - Journal Article PT - Review DEP - 20181003 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 SB - IM MH - Blood Coagulation Disorders/blood/diagnosis/*therapy MH - *Blood Loss, Surgical MH - Blood Transfusion/methods MH - Burns/*surgery MH - Hemorrhage/blood/*therapy MH - Hemostatic Techniques MH - Humans MH - Point-of-Care Testing MH - Resuscitation/methods MH - Thrombelastography/methods OTO - NOTNLM OT - Bleeding OT - Haemostatic OT - ROTEM OT - Resuscitation OT - Surgery OT - TEG EDAT- 2018/10/08 06:00 MHDA- 2020/01/31 06:00 CRDT- 2018/10/08 06:00 PHST- 2018/03/29 00:00 [received] PHST- 2018/06/25 00:00 [revised] PHST- 2018/08/17 00:00 [accepted] PHST- 2018/10/08 06:00 [pubmed] PHST- 2020/01/31 06:00 [medline] PHST- 2018/10/08 06:00 [entrez] AID - S0305-4179(18)30754-X [pii] AID - 10.1016/j.burns.2018.08.024 [doi] PST - ppublish SO - Burns. 2019 Jun;45(4):755-762. doi: 10.1016/j.burns.2018.08.024. Epub 2018 Oct 3. PMID- 30255897 OWN - NLM STAT- MEDLINE DCOM- 20181123 LR - 20181123 IS - 2040-3372 (Electronic) IS - 2040-3364 (Linking) VI - 10 IP - 38 DP - 2018 Oct 4 TI - Coaxial struts and microfractured structures of compressible thermoelectric foams for self-powered pressure sensors. PG - 18370-18377 LID - 10.1039/c8nr04582h [doi] AB - Long-term operation of wearable pressure sensors to detect body movement requires self-powered human-based energy sources to minimize the need for recharging. Recently, pressure sensors with thermoelectric properties based on conducting polymers have been reported; however, these devices are limited in their ability to simultaneously achieve sufficient power generation and sensitivity of the sensor. In this article, we suggest a coaxial strut structure of poly(styrene-ethylene/butylene-styrene)(SEBS)-poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate)(PEDOT:PSS)-melamine foam (MF) with a fractured microstructure for a highly sensitive, efficient self-powered pressure sensor. In the coaxial struts, the MF core provides a compressible and elastic framework; the intermediate PEDOT:PSS acts as a conductor and a thermoelectric material; and the SEBS shell ensures mechanical stability and resilience to stabilize the brittle PEDOT:PSS layer under high loading conditions. Additionally, by compressing the coaxial foam to 1/20, partial microfracture of PEDOT:PSS occurs only in the SEBS shell; thus, the pressure sensitivity increases significantly while maintaining high conductivity and thermoelectric performance. The coaxial foam was assembled into a wearable TEG to generate 338 nW from the forearms and demonstrate the high sensitivity of pressure sensors without an external power supply. FAU - Oh, Jinwoo AU - Oh J AD - Photo-electronic Hybrids Research Center, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea. jgson@kist.re.kr. FAU - Kim, Jong-Ho AU - Kim JH FAU - Park, Kyung Tae AU - Park KT FAU - Jo, Kiyoung AU - Jo K FAU - Lee, Jong-Chan AU - Lee JC FAU - Kim, Heesuk AU - Kim H FAU - Son, Jeong Gon AU - Son JG LA - eng PT - Journal Article PL - England TA - Nanoscale JT - Nanoscale JID - 101525249 RN - 0 (Polyethylenes) RN - 0 (Polymers) RN - 0 (Polystyrenes) RN - 0 (Thiophenes) RN - 0 (Triazines) RN - 0 (poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate)) RN - 104521-01-9 (styrene-ethylene-butylene-styrene-block copolymer) RN - N3GP2YSD88 (melamine) SB - IM MH - Electric Impedance MH - *Energy-Generating Resources MH - Fractures, Stress MH - Polyethylenes/chemistry MH - Polymers/chemical synthesis/*chemistry MH - Polystyrenes/chemistry MH - *Pressure MH - *Thermal Conductivity MH - Thiophenes/chemistry MH - Triazines/chemistry MH - Wearable Electronic Devices EDAT- 2018/09/27 06:00 MHDA- 2018/11/24 06:00 CRDT- 2018/09/27 06:00 PHST- 2018/09/27 06:00 [pubmed] PHST- 2018/11/24 06:00 [medline] PHST- 2018/09/27 06:00 [entrez] AID - 10.1039/c8nr04582h [doi] PST - ppublish SO - Nanoscale. 2018 Oct 4;10(38):18370-18377. doi: 10.1039/c8nr04582h. PMID- 30253452 OWN - NLM STAT- MEDLINE DCOM- 20200519 LR - 20200519 IS - 1445-2197 (Electronic) IS - 1445-1433 (Linking) VI - 89 IP - 4 DP - 2019 Apr TI - Point-of-care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer for surgeons. PG - 291-295 LID - 10.1111/ans.14836 [doi] AB - BACKGROUND: Bleeding is a common occurrence in surgery. Point-of-care testing with viscoelastic (VE) assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) has become more common place. TEG and ROTEM have the potential to guide management of coagulopathy. Many healthcare professionals still rely upon standard laboratory tests (SLTs) to manage a bleeding patient. It was our aim to investigate the literature surrounding management of the surgically bleeding patient via VE assays. METHODS: Literature review of Embase, MEDLINE, PubMed and the Cochrane Library using 'TEG, ROTEM and surgery' search terms was conducted. RESULTS: Through the literature search and reference lists reviewed by both authors, a total of 62 articles have been evaluated, 35 of these have been included in this review. CONCLUSION: VE assays are used most commonly during orthotopic liver transplantation, trauma, postpartum haemorrhage and cardiac surgery. Although the evidence is not overwhelming, we have identified recurrent themes where VE assays seem to be beneficial. VE assay use, especially when incorporated into an algorithm, appears to reduce blood product administration which in turn reduces cost and potential adverse events. They are quicker than SLTs and they can detect hyperfibrinolysis, the hallmark of coagulopathy, via in vivo clot analyses which SLTs are unable to do. Ultimately more randomized controlled trials are required. CI - (c) 2018 Royal Australasian College of Surgeons. FAU - Sharp, Gary AU - Sharp G AUID- ORCID: 0000-0001-7736-517X AD - Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. FAU - Young, Christopher J AU - Young CJ AUID- ORCID: 0000-0002-7213-5137 AD - Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. AD - Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia. LA - eng GR - Department of Colorectal Surgery, Royal Prince Alfred Hospital/International PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20180925 PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 RN - 0 (Viscoelastic Substances) SB - IM MH - Algorithms MH - Blood Coagulation Disorders/*diagnosis/epidemiology/*therapy MH - Blood Transfusion/standards MH - Cardiac Surgical Procedures/adverse effects MH - Female MH - Hemorrhage/diagnosis/*therapy MH - Humans MH - Liver Transplantation/adverse effects/standards MH - Perioperative Period/mortality MH - Point-of-Care Systems/*standards MH - Postpartum Hemorrhage/blood/diagnosis/therapy MH - Surgeons/standards MH - Thrombelastography/*instrumentation/trends MH - Viscoelastic Substances MH - Wounds and Injuries/complications/mortality OTO - NOTNLM OT - rotational thromboelastometry OT - surgery OT - thromboelastography EDAT- 2018/09/27 06:00 MHDA- 2020/05/20 06:00 CRDT- 2018/09/26 06:00 PHST- 2017/09/28 00:00 [received] PHST- 2018/05/28 00:00 [revised] PHST- 2018/06/24 00:00 [accepted] PHST- 2018/09/27 06:00 [pubmed] PHST- 2020/05/20 06:00 [medline] PHST- 2018/09/26 06:00 [entrez] AID - 10.1111/ans.14836 [doi] PST - ppublish SO - ANZ J Surg. 2019 Apr;89(4):291-295. doi: 10.1111/ans.14836. Epub 2018 Sep 25. PMID- 30238464 OWN - NLM STAT- MEDLINE DCOM- 20190315 LR - 20190315 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 58 IP - 10 DP - 2018 Oct TI - The contribution of the individual blood elements to the variability of thromboelastographic measures. PG - 2430-2436 LID - 10.1111/trf.14884 [doi] AB - BACKGROUND: Thromboelastography (TEG) is widely advocated as a rapid method for obtaining critical blood coagulation data to guide resuscitation, but the method suffers well-known limits in sensitivity, repeatability, and interpretability. STUDY DESIGN AND METHODS: Mixtures of fresh human blood components were prepared that represent the range of blood element concentrations seen in health and disease and after injury. These mixtures were tested in a TEG device after kaolin, tissue factor and phospholipid, or tissue factor and phospholipid with abciximab activation. The results were measured as reproducibility and nonlinear effects in regression analysis and evaluated for interpretability. RESULTS: Clot strength was associated with increased platelet (PLT) content and plasma fibrinogen concentration and content. Increasing hematocrit (Hct) reduced while increasing PLT or plasma concentration increased TEG clot strength. The abciximab dose used to block PLT activity did not fully inhibit the PLT contribution to clot strength. Clot strength is logarithmically correlated in the absence and linearly correlated to PLT concentration in the presence of abciximab. TEG clot strength with or without abciximab is dependent on Hct, PLT, and plasma (fibrinogen) concentrations in complex patterns. CONCLUSION: Interpretation of TEG variables is limited without knowledge of the concentration of the blood components present. When "normal" TEG values are known for a certain PLT-plasma-red blood cell concentration, the assay can be used to assess PLT and plasma function in coagulation. The TEG "functional fibrinogen" assay should be used only as a gross estimate of the fibrinogen concentration in whole blood. CI - (c) 2018 AABB. FAU - Noorman, Femke AU - Noorman F AD - Netherlands Ministry of Defense, Military Blood Bank, Leiden, the Netherlands. FAU - Hess, John R AU - Hess JR AUID- ORCID: 0000-0001-8596-4420 AD - Department of Laboratory Medicine, University of Washington, Seattle, Washington. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180920 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Transfusion. 2019 Jan;59(1):428-429. doi: 10.1111/trf.15023. PMID: 30615813 CIN - Transfusion. 2019 Feb;59(2):825-826. doi: 10.1111/trf.15125. PMID: 30727037 CIN - Transfusion. 2019 Feb;59(2):825. doi: 10.1111/trf.15092. PMID: 30727044 MH - *Blood Coagulation MH - Blood Coagulation Tests MH - Blood Platelets/*cytology MH - Fibrinogen/*analysis MH - Humans MH - Resuscitation MH - Thrombelastography/*methods/standards EDAT- 2018/09/22 06:00 MHDA- 2019/03/16 06:00 CRDT- 2018/09/22 06:00 PHST- 2017/10/20 00:00 [received] PHST- 2018/05/29 00:00 [revised] PHST- 2018/06/06 00:00 [accepted] PHST- 2018/09/22 06:00 [pubmed] PHST- 2019/03/16 06:00 [medline] PHST- 2018/09/22 06:00 [entrez] AID - 10.1111/trf.14884 [doi] PST - ppublish SO - Transfusion. 2018 Oct;58(10):2430-2436. doi: 10.1111/trf.14884. Epub 2018 Sep 20. PMID- 30234543 OWN - NLM STAT- MEDLINE DCOM- 20190124 LR - 20190124 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 29 IP - 7 DP - 2018 Nov TI - Thromboelastography in the management of snakebite-induced coagulopathy: a case series and literature review. PG - 656-660 LID - 10.1097/MBC.0000000000000771 [doi] AB - : North American crotaline envenomations are a significant source of morbidity annually. Envenomation is marked by a constellation of effects that can include severe tissue damage, systemic effects such as anaphylaxis, and coagulopathy with bleeding. Traditionally, static plasma-derived tests such as protime and PTT are used to assess coagulation status. However, other tests are available that provide a whole blood assessment of all portions of coagulation including initiation, propagation, and clot maintenance. One such analytical test is TEG. Minimal data is available regarding the effect of snake venom on TEG results. We report on three cases of North American crotaline envenomation with subsequent TEG analysis. Our results show that TEG analysis does relate the same information as traditional monitoring parameters. Although only in an isolated case, the TEG analysis potentially revealed a fibrinolytic process prior to the same process being apparent with traditional monitoring. Future research is necessary to identify the role of TEG in crotaline snakebite management. FAU - Leffers, Patrick AU - Leffers P AD - Department of Pharmacy. FAU - Ferreira, Jason AU - Ferreira J AD - Department of Pharmacy. FAU - Sollee, Dawn AU - Sollee D AD - Florida/USVI Poison Information Center - Jacksonville, UF Health Jacksonville, Jacksonville, Florida, USA. FAU - Schauben, Jay AU - Schauben J AD - Florida/USVI Poison Information Center - Jacksonville, UF Health Jacksonville, Jacksonville, Florida, USA. LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Crotalid Venoms) RN - 0 (Snake Venoms) SB - IM MH - Blood Coagulation/*drug effects MH - Crotalid Venoms MH - Fibrinolysis MH - Humans MH - Snake Bites/*diagnosis MH - Snake Venoms/*pharmacology MH - Thrombelastography/*methods EDAT- 2018/09/21 06:00 MHDA- 2019/01/25 06:00 CRDT- 2018/09/21 06:00 PHST- 2018/09/21 06:00 [pubmed] PHST- 2019/01/25 06:00 [medline] PHST- 2018/09/21 06:00 [entrez] AID - 10.1097/MBC.0000000000000771 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2018 Nov;29(7):656-660. doi: 10.1097/MBC.0000000000000771. PMID- 30232951 OWN - NLM STAT- MEDLINE DCOM- 20200708 LR - 20200708 IS - 1481-8043 (Electronic) IS - 1481-8035 (Linking) VI - 21 IP - 3 DP - 2019 May TI - The practicalities and barriers of using TEG6s in code red traumas: an observational study in one London major trauma centre. PG - 361-364 LID - 10.1017/cem.2018.426 [doi] AB - OBJECTIVE: Trauma induced coagulopathy is a disorder of the coagulation pathway that occurs following major trauma. "Code red trauma" require massive hemorrhage protocol activation. The aim was to qualitatively establish the reasons TEG is not currently utilized and the ongoing practicalities in performing a TEG sample for trauma-related massive hemorrhage. METHODS: A pilot study was performed using a TEG6s machine within one central London Major Trauma Centre's resuscitation department. Staff were asked to run a TEG sample on any "code red" patient who attended during the trial. Staff were given questionnaires both before and after the trial to assess the knowledge around TEG. RESULTS: A TEG sample was performed in 75% of the sixteen "code red traumas," with one sample being unsuccessful. Only one patient had their blood component management altered due to the TEG result with only 50% of consultants and registrars surveyed feeling confident in interpreting TEG results. CONCLUSION: TEG6s samples can be run within the resuscitation department in a "code red trauma." However, there is a significant lack of knowledge relating to TEG within the emergency department which is likely to hinder its impact on personalized blood component management. More research is required in how to provide appropriate education in a busy setting to enable TEG to be utilized appropriately. FAU - Morton, Sarah AU - Morton S AUID- ORCID: 0000-0002-9112-8821 AD - *St George's Hospital,Blackshaw Road,London,the United Kingdom. FAU - Galea, Judi AU - Galea J AD - *St George's Hospital,Blackshaw Road,London,the United Kingdom. FAU - Uprichard, James AU - Uprichard J AD - daggerthe Centre for Haemostasis and Thrombosis,St George's University Hospitals NHS Foundation Trust,London,the United Kingdom. FAU - Hudson, Anthony AU - Hudson A AD - *St George's Hospital,Blackshaw Road,London,the United Kingdom. LA - eng PT - Journal Article PT - Observational Study DEP - 20180920 PL - England TA - CJEM JT - CJEM JID - 100893237 SB - IM MH - Attitude of Health Personnel MH - Blood Coagulation Disorders/*diagnosis MH - Clinical Competence MH - Humans MH - Pilot Projects MH - Resuscitation MH - *Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*complications OTO - NOTNLM OT - TEG OT - coagulopathy OT - trauma EDAT- 2018/09/21 06:00 MHDA- 2020/07/09 06:00 CRDT- 2018/09/21 06:00 PHST- 2018/09/21 06:00 [pubmed] PHST- 2020/07/09 06:00 [medline] PHST- 2018/09/21 06:00 [entrez] AID - S1481803518004268 [pii] AID - 10.1017/cem.2018.426 [doi] PST - ppublish SO - CJEM. 2019 May;21(3):361-364. doi: 10.1017/cem.2018.426. Epub 2018 Sep 20. PMID- 30231210 OWN - NLM STAT- MEDLINE DCOM- 20191119 LR - 20260226 IS - 1522-1490 (Electronic) IS - 0363-6119 (Print) IS - 0363-6119 (Linking) VI - 316 IP - 2 DP - 2019 Feb 1 TI - Hemostatic responses to exercise, dehydration, and simulated bleeding in heat-stressed humans. PG - R145-R156 LID - 10.1152/ajpregu.00223.2018 [doi] AB - Heat stress followed by an accompanying hemorrhagic challenge may influence hemostasis. We tested the hypothesis that hemostatic responses would be increased by passive heat stress, as well as exercise-induced heat stress, each with accompanying central hypovolemia to simulate a hemorrhagic insult. In aim 1, subjects were exposed to passive heating or normothermic time control, each followed by progressive lower-body negative pressure (LBNP) to presyncope. In aim 2 subjects exercised in hyperthermic environmental conditions, with and without accompanying dehydration, each also followed by progressive LBNP to presyncope. At baseline, pre-LBNP, and post-LBNP (<1, 30, and 60 min), hemostatic activity of venous blood was evaluated by plasma markers of hemostasis and thrombelastography. For aim 1, both hyperthermic and normothermic LBNP (H-LBNP and N-LBNP, respectively) resulted in higher levels of factor V, factor VIII, and von Willebrand factor antigen compared with the time control trial (all P < 0.05), but these responses were temperature independent. Hyperthermia increased fibrinolysis [clot lysis 30 min after the maximal amplitude reflecting clot strength (LY(30))] to 5.1% post-LBNP compared with 1.5% (time control) and 2.7% in N-LBNP ( P = 0.05 for main effect). Hyperthermia also potentiated increased platelet counts post-LBNP as follows: 274 K/microl for H-LBNP, 246 K/microl for N-LBNP, and 196 K/microl for time control ( P < 0.05 for the interaction). For aim 2, hydration status associated with exercise in the heat did not affect the hemostatic activity, but fibrinolysis (LY(30)) was increased to 6-10% when subjects were dehydrated compared with an increase to 2-4% when hydrated ( P = 0.05 for treatment). Central hypovolemia via LBNP is a primary driver of hemostasis compared with hyperthermia and dehydration effects. However, hyperthermia does induce significant thrombocytosis and by itself causes an increase in clot lysis. Dehydration associated with exercise-induced heat stress increases clot lysis but does not affect exercise-activated or subsequent hypovolemia-activated hemostasis in hyperthermic humans. Clinical implications of these findings are that quickly restoring a hemorrhaging hypovolemic trauma patient with cold noncoagulant fluids (crystalloids) can have serious deleterious effects on the body's innate ability to form essential clots, and several factors can increase clot lysis, which should therefore be closely monitored. FAU - Borgman, Matthew A AU - Borgman MA AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas. AD - Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas. FAU - Zaar, Morten AU - Zaar M AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas. FAU - Aden, James K AU - Aden JK AD - Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas. FAU - Schlader, Zachary J AU - Schlader ZJ AD - Department of Exercise and Nutritional Sciences, Center for Research and Education in Special Environments, University of Buffalo , New York. FAU - Gagnon, Daniel AU - Gagnon D AUID- ORCID: 0000-0001-5396-9489 AD - Montreal Heart Institute and University of Montreal , Canada. FAU - Rivas, Eric AU - Rivas E AUID- ORCID: 0000-0002-4657-8292 AD - Department of Kinesiology & Sport Management, Texas Tech University , Lubbock, Texas. FAU - Kern, Jena AU - Kern J AD - Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital of Dallas , Dallas, Texas. FAU - Koons, Natalie J AU - Koons NJ AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas. FAU - Convertino, Victor A AU - Convertino VA AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas. FAU - Cap, Andrew P AU - Cap AP AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas. FAU - Crandall, Craig AU - Crandall C AUID- ORCID: 0000-0001-7792-9713 AD - Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital of Dallas , Dallas, Texas. AD - Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas , Dallas, Texas. LA - eng GR - R01 HL061388/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20180919 PL - United States TA - Am J Physiol Regul Integr Comp Physiol JT - American journal of physiology. Regulatory, integrative and comparative physiology JID - 100901230 SB - IM MH - Adult MH - Arterial Pressure/physiology MH - Dehydration/*physiopathology MH - Exercise/*physiology MH - Heat Stress Disorders/physiopathology MH - Heat-Shock Response/physiology MH - Hemorrhage/*physiopathology MH - Hemostasis/*physiology MH - Hot Temperature/*adverse effects MH - Humans MH - Hyperthermia, Induced/methods MH - Hypovolemia/physiopathology MH - Lower Body Negative Pressure/methods MH - Male PMC - PMC6397353 OTO - NOTNLM OT - coagulation OT - fibrinolysis OT - hyperthermia OT - hypovolemia OT - lower body negative pressure COIS- The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army or the Department of Defense or the US Government. No conflicts of interest, financial or otherwise, are declared by the authors. EDAT- 2018/09/20 06:00 MHDA- 2019/11/20 06:00 PMCR- 2020/02/01 CRDT- 2018/09/20 06:00 PHST- 2018/09/20 06:00 [pubmed] PHST- 2019/11/20 06:00 [medline] PHST- 2018/09/20 06:00 [entrez] PHST- 2020/02/01 00:00 [pmc-release] AID - R-00223-2018 [pii] AID - 10.1152/ajpregu.00223.2018 [doi] PST - ppublish SO - Am J Physiol Regul Integr Comp Physiol. 2019 Feb 1;316(2):R145-R156. doi: 10.1152/ajpregu.00223.2018. Epub 2018 Sep 19. PMID- 30223961 OWN - NLM STAT- MEDLINE DCOM- 20181115 LR - 20181115 IS - 1558-1349 (Electronic) IS - 1042-3680 (Linking) VI - 29 IP - 4 DP - 2018 Oct TI - Evaluation of Coagulation in the Neurosurgery Patient. PG - 485-492 LID - S1042-3680(18)30864-7 [pii] LID - 10.1016/j.nec.2018.06.001 [doi] AB - Normal hemostasis provides for balanced interactions between the blood vessel wall, coagulation proteins, and platelets. After vascular injury, primary hemostasis and secondary hemostasis function in a coordinated fashion to stop bleeding. Standard coagulation tests have been shown in multiple studies to predict bleeding and mortality in neurosurgical patients. Emerging coagulation tests are useful point-of-care assays that guide transfusion therapy and diagnose patients with hyperfibrinolysis. This article provides an overview of hemostasis, a summary of standard coagulation testing and point-of-care tests, and a brief review of coagulation test usefulness in neurosurgery, focusing on studies in patients with traumatic brain injury. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Rodgers, George M AU - Rodgers GM AD - Division of Hematology and Hematologic Malignancies, University of Utah Health Sciences Center, 30 North 1900 East, Salt Lake City, UT 84132, USA. Electronic address: george.rodgers@hsc.utah.edu. LA - eng PT - Journal Article PT - Review PL - United States TA - Neurosurg Clin N Am JT - Neurosurgery clinics of North America JID - 9008004 SB - IM MH - Animals MH - *Blood Coagulation MH - Blood Coagulation Disorders/*blood MH - Blood Coagulation Tests/methods MH - Blood Platelets/physiology MH - Fibrinolysis MH - Hemostasis, Surgical/*methods MH - Humans MH - Neurosurgical Procedures/*methods MH - Preoperative Care/*methods MH - Signal Transduction OTO - NOTNLM OT - Coagulation testing OT - Fibrinolysis OT - Hemostasis OT - Rotational elastometry OT - Thromboelastography OT - Traumatic brain injury OT - Viscoelastic assays EDAT- 2018/09/19 06:00 MHDA- 2018/11/16 06:00 CRDT- 2018/09/19 06:00 PHST- 2018/09/19 06:00 [entrez] PHST- 2018/09/19 06:00 [pubmed] PHST- 2018/11/16 06:00 [medline] AID - S1042-3680(18)30864-7 [pii] AID - 10.1016/j.nec.2018.06.001 [doi] PST - ppublish SO - Neurosurg Clin N Am. 2018 Oct;29(4):485-492. doi: 10.1016/j.nec.2018.06.001. PMID- 30200794 OWN - NLM STAT- MEDLINE DCOM- 20190708 LR - 20200309 IS - 1473-2300 (Electronic) IS - 0300-0605 (Print) IS - 0300-0605 (Linking) VI - 46 IP - 12 DP - 2018 Dec TI - Rotation thromboelastometry (ROTEM) enables improved outcomes in the pediatric trauma population. PG - 5195-5204 LID - 10.1177/0300060518794092 [doi] AB - OBJECTIVE: We evaluated the role of rotation thromboelastometry (ROTEM) in managing acute traumatic coagulopathy in pediatric patients with trauma. METHODS: A retrospective cohort of pediatric patients with trauma from six institutes was studied during a 10-year period from 2007 to 2017. The associations between ROTEM-guided, goal-directed coagulation therapy and clinical outcomes were determined. RESULTS: Three hundred thirty-two pediatric patients (age < 15 years) who were treated with ROTEM-guided, goal-directed coagulation therapy were matched to 332 control pediatric patients with conventional plasmatic coagulation tests. The ROTEM protocol was associated with a significant reduction in the interval for admission to acute traumatic coagulopathy treatment, less plasma transfusions in the first 24 hours of admission, and a favorable coagulopathy recovery. Furthermore, the median number of total hospital days was significantly shorter for patients who had the ROTEM protocol than for control patients. CONCLUSIONS: There are significant favorable outcomes, including rapid acute traumatic coagulopathy treatment and a lower 24-hour blood product requirement, following ROTEM-guided, goal-directed coagulation therapy among pediatric patients with blunt trauma. FAU - Deng, Qin AU - Deng Q AD - 1 Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, China. FAU - Hao, Fabao AU - Hao F AD - 1 Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, China. AD - 2 Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China. FAU - Wang, Yongming AU - Wang Y AD - 1 Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, China. AD - 2 Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China. FAU - Guo, Chunbao AU - Guo C AUID- ORCID: 0000-0001-5121-9377 AD - 1 Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, China. AD - 3 Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, China. LA - eng PT - Journal Article DEP - 20180910 PL - England TA - J Int Med Res JT - The Journal of international medical research JID - 0346411 SB - IM MH - Blood Coagulation MH - Blood Coagulation Disorders/*diagnosis/etiology/*therapy MH - *Blood Transfusion MH - Child MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Prognosis MH - Retrospective Studies MH - *Thrombelastography MH - Wounds and Injuries/*complications PMC - PMC6300942 OTO - NOTNLM OT - Rotation thromboelastometry (ROTEM) OT - acute traumatic coagulopathy OT - blunt trauma OT - pediatric OT - plasma transfusion OT - prothrombin complex concentrate EDAT- 2018/09/12 06:00 MHDA- 2019/07/10 06:00 PMCR- 2018/12/01 CRDT- 2018/09/12 06:00 PHST- 2018/09/12 06:00 [pubmed] PHST- 2019/07/10 06:00 [medline] PHST- 2018/09/12 06:00 [entrez] PHST- 2018/12/01 00:00 [pmc-release] AID - 10.1177_0300060518794092 [pii] AID - 10.1177/0300060518794092 [doi] PST - ppublish SO - J Int Med Res. 2018 Dec;46(12):5195-5204. doi: 10.1177/0300060518794092. Epub 2018 Sep 10. PMID- 30158145 OWN - NLM STAT- MEDLINE DCOM- 20190422 LR - 20190422 IS - 1472-0213 (Electronic) IS - 1472-0205 (Linking) VI - 35 IP - 12 DP - 2018 Dec TI - The reliability of thromboelastography in a simulated rotary wing environment. PG - 739-742 LID - 10.1136/emermed-2017-207418 [doi] AB - BACKGROUND: With the increasing role of point-of-care coagulation testing in trauma, we sought to test the reliability of the thromboelastography (TEG)6s machine in a simulated rotary wing environment. METHOD: A two-arm study was conducted, running TEG6s quality control cartridges in a helicopter flight simulator with realistic vibration and in stable ground conditions. The flight conditions during testing included take-offs, landings and inflight emergencies such as engine failures. TEG values for R time, K time, alpha-angle and maximum amplitude (MA) were collected and compared with manufacturers' normal ranges. RESULTS: 148 TEG samples were included for analysis (72 simulator arm, 76 ground arm). In the simulator arm, four of our K time values fell below the normal range and four MA values were above the normal range. All other values in both simulator and ground arms were in the normal range. CONCLUSION: The TEG6s is a viable technology in the simulated rotary wing environment, and it is feasible to conduct further studies using human blood in live rotary wing conditions. Extreme flight conditions should be avoided during further testing. CI - (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Scott, Robert AU - Scott R AD - Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia. FAU - Burns, Brian AU - Burns B AD - Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia. FAU - Ware, Sandra AU - Ware S AD - Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia. FAU - Oud, Floris AU - Oud F AD - Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia. FAU - Miller, Matthew AU - Miller M AUID- ORCID: 0000-0002-5251-7939 AD - Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia. AD - St George & Sutherland Clinical Schools, UNSW, Sydney, NSW. LA - eng PT - Journal Article DEP - 20180829 PL - England TA - Emerg Med J JT - Emergency medicine journal : EMJ JID - 100963089 SB - IM MH - Air Ambulances/organization & administration/statistics & numerical data MH - *Blood Coagulation MH - Humans MH - Point-of-Care Testing/*standards MH - Reproducibility of Results MH - Simulation Training/methods MH - Thrombelastography/methods/*standards MH - Vibration/adverse effects OTO - NOTNLM OT - prehospital care, helicopter retrieval OT - trauma COIS- Competing interests: QC cartridges for the TEG6s were supplied free of charge by Haemonetics Australia. EDAT- 2018/08/31 06:00 MHDA- 2019/04/23 06:00 CRDT- 2018/08/31 06:00 PHST- 2018/01/31 00:00 [received] PHST- 2018/07/26 00:00 [revised] PHST- 2018/08/14 00:00 [accepted] PHST- 2018/08/31 06:00 [pubmed] PHST- 2019/04/23 06:00 [medline] PHST- 2018/08/31 06:00 [entrez] AID - emermed-2017-207418 [pii] AID - 10.1136/emermed-2017-207418 [doi] PST - ppublish SO - Emerg Med J. 2018 Dec;35(12):739-742. doi: 10.1136/emermed-2017-207418. Epub 2018 Aug 29. PMID- 30124626 OWN - NLM STAT- MEDLINE DCOM- 20190827 LR - 20190827 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 85 IP - 5 DP - 2018 Nov TI - Goal-directed platelet transfusions correct platelet dysfunction and may improve survival in patients with severe traumatic brain injury. PG - 881-887 LID - 10.1097/TA.0000000000002047 [doi] AB - BACKGROUND: Platelet dysfunction, defined as adenosine diphosphate inhibition greater than 60% on thromboelastogram, is an independent predictor of increased mortality in patients with severe traumatic brain injury (TBI). We changed our practice to transfuse platelets for all patients with severe TBI and platelet dysfunction. We hypothesized that platelet transfusions would correct platelet dysfunction and improve mortality in patients with severe TBI. METHODS: This retrospective review included adult trauma patients admitted to our Level I trauma center from July 2015 to October 2016 with severe TBI (head Abbreviated Injury Scale score >/= 3) who presented with platelet dysfunction and subsequently received a platelet transfusion. Serial thromboelastograms were obtained to characterize the impact of platelet transfusion on clot strength. Subsequently, the platelet transfusion group was compared to a group of historical controls with severe TBI patients and platelet dysfunction who did not receive platelet transfusion. RESULTS: A total of 35 patients with severe TBI presented with platelet dysfunction. Following platelet transfusion clot strength improved as represented by decreased K time, increased alpha angle, maximum amplitude, and G-value, as well as correction of adenosine diphosphate inhibition. When comparing to 51 historic controls with severe TBI and platelet dysfunction, the 35 study patients who received a platelet transfusion had a lower mortality (9% vs. 35%; p = 0.005). In stepwise logistic regression, platelet transfusion was independently associated with decreased mortality (odds ratio, 0.23; 95% confidence interval, 0.06-0.92; p = 0.038). CONCLUSION: In patients with severe TBI and platelet dysfunction, platelet transfusions correct platelet inhibition and may be associated with decreased mortality. LEVEL OF EVIDENCE: Therapeutic, level II. FAU - Furay, Elisa AU - Furay E AD - From the Department of Surgery and Perioperative Care, Dell Medical School, Austin, Texas. lphia, Pennsylvania (J.C.). FAU - Daley, Mitch AU - Daley M FAU - Teixeira, Pedro G AU - Teixeira PG FAU - Coopwood, Thomas B AU - Coopwood TB FAU - Aydelotte, Jayson D AU - Aydelotte JD FAU - Malesa, Natalia AU - Malesa N FAU - Tellinghuisen, Christian AU - Tellinghuisen C FAU - Ali, Sadia AU - Ali S FAU - Brown, Lawrence H AU - Brown LH FAU - Brown, Carlos V R AU - Brown CVR LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Abbreviated Injury Scale MH - Adenosine Diphosphate/metabolism MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/etiology/physiopathology/*therapy MH - Blood Platelets/*physiology MH - Brain Injuries, Traumatic/complications/physiopathology/*therapy MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Platelet Transfusion MH - Retrospective Studies MH - Survival Rate MH - Thrombelastography MH - Thromboembolism/diagnosis/*etiology MH - Young Adult EDAT- 2018/08/21 06:00 MHDA- 2019/08/28 06:00 CRDT- 2018/08/21 06:00 PHST- 2018/08/21 06:00 [pubmed] PHST- 2019/08/28 06:00 [medline] PHST- 2018/08/21 06:00 [entrez] AID - 10.1097/TA.0000000000002047 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Nov;85(5):881-887. doi: 10.1097/TA.0000000000002047. PMID- 30124623 OWN - NLM STAT- MEDLINE DCOM- 20190827 LR - 20200702 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 85 IP - 5 DP - 2018 Nov TI - Dynamic coagulability after injury: Is delaying venous thromboembolism chemoprophylaxis worth the wait? PG - 907-914 LID - 10.1097/TA.0000000000002048 [doi] AB - BACKGROUND: Severely injured patients often progress from early hypocoagulable to normal and eventually hypercoagulable states, developing increased risk for venous thromboembolism (VTE). Prophylactic anticoagulation can decrease this risk, but its initiation is frequently delayed for extended periods due to concerns for bleeding. To facilitate timely introduction of VTE chemoprophylaxis, we characterized the transition from hypo- to hypercoagulability and hypothesized that trauma-induced coagulopathy resolves within 24 hours after injury. METHODS: Serial blood samples were collected prospectively from critically injured patients for 120 hours after arrival at an urban Level I trauma center. Extrinsic thromboelastometry maximum clot firmness was used to classify patients as hypocoagulable (HYPO, <49 mm), normocoagulable (NORM, 49-71 mm), or hypercoagulable (HYPER, >71 mm) at each time point. Changes in coagulability over hospital course, VTE occurrence, and timing of prophylaxis initiation were analyzed. RESULTS: 898 patients (median Injury Severity Score, 13; mortality, 12%; VTE, 8%) were enrolled. Upon arrival, 3% were HYPO (90% NORM, 7% HYPER), which increased to 9% at 6 hours before down-trending. Ninety-seven percent were NORM by 24 hours, and 53% were HYPER at 120 hours. Median maximum clot firmness began in the NORM range, up-trended gradually, and entered the HYPER range at 120 hours. Patients with traumatic brain injury (TBI) followed a similar course and were not more HYPO at any time point than those without TBI. Failure to initiate prophylaxis by 72 hours was predicted by TBI and associated with VTE development (27% vs 16%, p < 0.05). CONCLUSIONS: Regardless of injury pattern, trauma-induced coagulopathy largely resolves within 24 hours, after which hypercoagulability becomes increasingly more prevalent. Deferring initiation of chemoprophylaxis, which is often biased toward patients with intracranial injuries, is associated with VTE development. LEVEL OF EVIDENCE: Prognostic study, level III; Therapeutic, level IV. FAU - Sumislawski, Joshua J AU - Sumislawski JJ AD - From the Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, Colorado (J.J.S., M.J.C); Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California (L.Z.K., A.S.C., R.A.C). FAU - Kornblith, Lucy Z AU - Kornblith LZ FAU - Conroy, Amanda S AU - Conroy AS FAU - Callcut, Rachael A AU - Callcut RA FAU - Cohen, Mitchell Jay AU - Cohen MJ LA - eng GR - K01 ES026834/ES/NIEHS NIH HHS/United States GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Anticoagulants) SB - IM MH - Adult MH - Anticoagulants/*therapeutic use MH - Blood Coagulation MH - Blood Coagulation Disorders/etiology/*physiopathology MH - Brain Injuries, Traumatic/complications/physiopathology MH - Chemoprevention MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography MH - Time Factors MH - Venous Thromboembolism/etiology/*prevention & control MH - Wounds and Injuries/complications/*physiopathology MH - Young Adult PMC - PMC7326618 MID - NIHMS1602065 COIS- DISCLOSURE The authors declare no conflicts of interest. EDAT- 2018/08/21 06:00 MHDA- 2019/08/28 06:00 PMCR- 2020/06/30 CRDT- 2018/08/21 06:00 PHST- 2018/08/21 06:00 [pubmed] PHST- 2019/08/28 06:00 [medline] PHST- 2018/08/21 06:00 [entrez] PHST- 2020/06/30 00:00 [pmc-release] AID - 10.1097/TA.0000000000002048 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Nov;85(5):907-914. doi: 10.1097/TA.0000000000002048. PMID- 30111342 OWN - NLM STAT- MEDLINE DCOM- 20181105 LR - 20181114 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 26 IP - 1 DP - 2018 Aug 15 TI - How do external factors contribute to the hypocoagulative state in trauma-induced coagulopathy? - In vitro analysis of the lethal triad in trauma. PG - 66 LID - 10.1186/s13049-018-0536-8 [doi] LID - 66 AB - BACKGROUND: External factors following trauma and iatrogenic intervention influence blood coagulation and particularly clot formation. In particular, three external factors (in detail dilution via uncritical volume replacement, acidosis and hypothermia), in combination, referred to as the "lethal triad", substantially aggravate the hypocoagulative state after trauma. Contribution of these external factors to the resulting hypocoagulative state in trauma and especially their influence on primary haemostasis has still not been investigated systematically. This study aims to assess this contribution to the aggravating hypocoagulative state in trauma-induced coagulopathy (TIC) using an in vitro simulation assay. Emphasis is given to platelet contribution to clot formation and to the investigation of how platelet activation alters under the respective conditions. METHODS: To simulate the conditions of lethal triad in vitro, whole blood samples taken from five healthy volunteers were introduced to the respective conditions. Besides standard coagulation testing, thrombelastometric analysis and differentiated platelet mapping were performed. RESULTS: All three simulated conditions induced significant impairments of clot formation (clot formation time, CFT; alpha -angle) and propagation (maximum clot firmness, MCF; Diameter A5-A25), with the highest impact under hypothermia and dilution. Consistently, lethal triad resulted in an additive effect of all conditions. None of the simulated conditions induced a statistically relevant change in coagulation initiation assessed by EXTEM and FIBTEM thrombelastometry. Platelet contribution to clot formation decreased gradually under the respective conditions, reaching statistical significance for simulated dilution, and attaining its greatest extent under the conditions of lethal triad (Deltatrias/baseline 0.59; p = 0.01). Consistent, reduced CD62 expression levels were observed under experimental acidosis (Deltaacidosis/baseline 0.32; p = 0.006), dilution (Deltadilution/baseline 0.34; p = 0.01) and lethal triad (Deltalethal triad/baseline 0.24; p = 0.01). CONCLUSION: The respective external factors of lethal triad play a pivotal role in the development of coagulopathy, essentially influencing the kinetics of clot formation, and to a varying extent clot diameter, as measured by thrombelastometry. Moreover, impairment of platelet function under the conditions of lethal triad plays a key role in the pathophysiology of TIC, resulting in reduced responsiveness to stimulation with ADP that might also be present after trauma. Our data indicate that impairment of primary haemostasis contribute to the hypocoagulative state in TIC after trauma aggravated by external factors of lethal triad. FAU - Caspers, Michael AU - Caspers M AUID- ORCID: 0000-0002-8971-7715 AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. michael.caspers@uni-wh.de. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. michael.caspers@uni-wh.de. FAU - Schafer, Nadine AU - Schafer N AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. FAU - Frohlich, Matthias AU - Frohlich M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. FAU - Bauerfeind, Ursula AU - Bauerfeind U AD - Department of Transfusion Medicine, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne- Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. FAU - Bouillon, Bertil AU - Bouillon B AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. FAU - Mutschler, Manuel AU - Mutschler M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. FAU - Maegele, Marc AU - Maegele M AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. LA - eng PT - Journal Article DEP - 20180815 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Acidosis/*physiopathology MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/*etiology/*physiopathology MH - Blood Coagulation Tests MH - Blood Platelets/physiology MH - Humans MH - Hypothermia/*physiopathology MH - In Vitro Techniques MH - Male MH - Thrombelastography MH - Wounds and Injuries/*blood/complications PMC - PMC6094881 OTO - NOTNLM OT - Acidosis in trauma OT - Dilution in trauma OT - Hypothermia in trauma OT - Lethal triad OT - PlateletMapping(R) OT - ROTEM(R) COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Study design and protocol was approved by the Central Ethics Committee of the University Witten/Herdecke (no. 37/2005 and 168/2014). CONSENT FOR PUBLICATION: Six healthy volunteers (blood donors) gave their written and informed consent to participating in this study. COMPETING INTERESTS: Marc Maegele has received honoraria for lectures and traveller fees from TEM International. Other authors declare no conflict of interest. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/08/17 06:00 MHDA- 2018/11/06 06:00 PMCR- 2018/08/15 CRDT- 2018/08/17 06:00 PHST- 2018/04/28 00:00 [received] PHST- 2018/08/06 00:00 [accepted] PHST- 2018/08/17 06:00 [entrez] PHST- 2018/08/17 06:00 [pubmed] PHST- 2018/11/06 06:00 [medline] PHST- 2018/08/15 00:00 [pmc-release] AID - 10.1186/s13049-018-0536-8 [pii] AID - 536 [pii] AID - 10.1186/s13049-018-0536-8 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2018 Aug 15;26(1):66. doi: 10.1186/s13049-018-0536-8. PMID- 30094221 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2225-319X (Print) IS - 2304-1021 (Electronic) IS - 2225-319X (Linking) VI - 7 IP - 4 DP - 2018 Jul TI - Dual inflow, total-arterial, anaortic, off-pump coronary artery bypass grafting: how to do it. PG - 552-560 LID - 10.21037/acs.2018.06.17 [doi] AB - Coronary surgery performed on an arrested heart, using one internal mammary artery and a saphenous vein carries two main potential drawbacks: the known failure rate of vein grafts and the relatively high rate of neurologic injury. To address these concerns, we describe a technique that achieves complete revascularization without manipulating the ascending aorta (anaortic, off-pump) and utilizing total arterial grafts. All patients undergo thorough preoperative investigation, including bilateral carotid, vertebral and subclavian artery Duplex ultrasounds. A pulmonary artery catheter, transoesophageal echocardiography, and point-of-care coagulation testing are used in each case. The left and right internal mammary arteries and non-dominant radial artery are harvested using a fully skeletonised technique. Wide bilateral extrapleural retrothymic tunnels are developed and the pericardium is opened widely to facilitate cardiac positioning. A tandem graft is constructed with the right internal mammary artery (RIMA) in situ and radial artery using an end-to-end anastomosis. This graft is brought into the pericardium and through the transverse sinus in order to graft the lateral and inferior walls with multiple sequential distal anastomoses. The left internal mammary artery (LIMA) in situ is used to graft the anterior wall. Four main cardiac positions (high and low lateral walls, inferior and anterior walls) are obtained using a combination of off-pump stabilizer positioning, alternate tension on pericardial 'heart-strings', table tilting and folded wet sponges. All distal anastomoses are performed using silastic intracoronary shunts and an off-pump myocardial stabilizer. All grafts are checked using transit-flow time measurements. Milrinone is continued overnight and dual antiplatelet therapy is continued for 3 months postoperatively. FAU - Ramponi, Fabio AU - Ramponi F AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - The University of Sydney, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. FAU - Seco, Michael AU - Seco M AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - The University of Sydney, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. FAU - Edelman, James B AU - Edelman JB AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - The University of Sydney, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. AD - The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia. FAU - Sherrah, Andrew G AU - Sherrah AG AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. AD - The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia. FAU - Bannon, Paul G AU - Bannon PG AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - The University of Sydney, Sydney, Australia. AD - The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia. AD - Sydney Heart and Lung Surgeons, Sydney, Australia. FAU - Brereton, R John L AU - Brereton RJL AD - Cardiothoracic Surgical Unit, Royal North Shore Hospital, Sydney, Australia. FAU - Wilson, Michael K AU - Wilson MK AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. AD - Cardiothoracic Surgical Unit, Royal North Shore Hospital, Sydney, Australia. AD - Macquarie University Hospital, Sydney, Australia. FAU - Vallely, Michael P AU - Vallely MP AD - Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. AD - The University of Sydney, Sydney, Australia. AD - Coronary Artery Disease Institute, Sydney, Australia. AD - Sydney Heart and Lung Surgeons, Sydney, Australia. AD - Macquarie University Hospital, Sydney, Australia. LA - eng PT - Journal Article PT - Review PL - China TA - Ann Cardiothorac Surg JT - Annals of cardiothoracic surgery JID - 101605877 PMC - PMC6082787 OTO - NOTNLM OT - Coronary artery bypass OT - aorta OT - mammary arteries OT - radial artery OT - stroke COIS- Conflicts of Interest: The authors have no conflicts of interest to declare. EDAT- 2018/08/11 06:00 MHDA- 2018/08/11 06:01 PMCR- 2018/07/01 CRDT- 2018/08/11 06:00 PHST- 2018/08/11 06:00 [entrez] PHST- 2018/08/11 06:00 [pubmed] PHST- 2018/08/11 06:01 [medline] PHST- 2018/07/01 00:00 [pmc-release] AID - acs-07-04-552 [pii] AID - 10.21037/acs.2018.06.17 [doi] PST - ppublish SO - Ann Cardiothorac Surg. 2018 Jul;7(4):552-560. doi: 10.21037/acs.2018.06.17. PMID- 30080793 OWN - NLM STAT- MEDLINE DCOM- 20181005 LR - 20250623 IS - 1535-1815 (Electronic) IS - 0749-5161 (Linking) VI - 34 IP - 8 DP - 2018 Aug TI - Pediatric Massive Transfusion: A Systematic Review. PG - 594-598 LID - 10.1097/PEC.0000000000001570 [doi] AB - INTRODUCTION: Balanced resuscitation of plasma, platelets, and red blood cells is now recognized as improving outcomes in traumatic bleeding in adults. The correct approach in children has yet to be determined. METHODS: We performed a systematic review of the literature into transfusion protocols in traumatic hemorrhage in children by conducting an article search of significant databases to identify relevant articles. Studies of interest included interventional trials with comparisons relating to the transfusion of blood including blood component therapy. The search identified 422 articles of interest, the abstracts of which were independently reviewed by 2 authors for inclusion in the trial. This revealed 35 articles, the full texts of which were reviewed. There were no randomized controlled trials and 4 nonrandomized trials with a further 21 articles that were deemed relevant. The data were insufficient for meta-analysis, and so a descriptive analysis was performed. RESULTS: There were 4 main trials. Two trials were small (approximately 100 patients) nonrandomized trials into pediatric hemorrhage managed as per a massive transfusion protocol or at physician discretion. One was a retrospective analysis of pediatric trauma patients who received red blood cell transfusion with differing platelet ratios, and one was a trauma database review of component ratios in hemorrhaging children. All 4 trials found increased ratios had no effect on mortality. DISCUSSION: As well as blood component therapy, adjunctive therapies used in the management of bleeding children are discussed. These include tranexamic acid, viscoelastic hemostatic assays, factor VIIa, and fibrinogen use. CONCLUSIONS: There is little evidence for improved outcomes using component-based transfusion in a rigid 1:1:1 strategy in children. A goal-directed approach using viscoelastic hemostatic assay-guided treatment with early institution of tranexamic acid and fibrinogen replacement is considered the way forward. FAU - Maw, Graeme AU - Maw G FAU - Furyk, Claire AU - Furyk C AD - Australian and New Zealand College of Anaesthetists, Melbourne, Australia. LA - eng PT - Journal Article PT - Systematic Review PL - United States TA - Pediatr Emerg Care JT - Pediatric emergency care JID - 8507560 SB - IM MH - Adult MH - Blood Transfusion/*methods MH - Child MH - Hemorrhage/mortality/*therapy MH - Humans MH - Survival Rate MH - Wounds and Injuries/complications/mortality/*therapy EDAT- 2018/08/07 06:00 MHDA- 2018/10/06 06:00 CRDT- 2018/08/07 06:00 PHST- 2018/08/07 06:00 [entrez] PHST- 2018/08/07 06:00 [pubmed] PHST- 2018/10/06 06:00 [medline] AID - 00006565-201808000-00013 [pii] AID - 10.1097/PEC.0000000000001570 [doi] PST - ppublish SO - Pediatr Emerg Care. 2018 Aug;34(8):594-598. doi: 10.1097/PEC.0000000000001570. PMID- 30070065 OWN - NLM STAT- MEDLINE DCOM- 20190911 LR - 20190911 IS - 2157-6564 (Print) IS - 2157-6580 (Electronic) IS - 2157-6564 (Linking) VI - 7 IP - 10 DP - 2018 Oct TI - Clinical Cellular Therapeutics Accelerate Clot Formation. PG - 731-739 LID - 10.1002/sctm.18-0015 [doi] AB - Clinical cellular therapeutics (CCTs) have shown preliminary efficacy in reducing inflammation after trauma, preserving cardiac function after myocardial infarction, and improving functional recovery after stroke. However, most clinically available cell lines express tissue factor (TF) which stimulates coagulation. We sought to define the degree of procoagulant activity of CCTs as related to TF expression. CCT samples from bone marrow, adipose, amniotic fluid, umbilical cord, multi-potent adult progenitor cell donors, and bone marrow mononuclear cells were tested. TF expression and phenotype were quantified using flow cytometry. Procoagulant activity of the CCTs was measured in vitro with thromboelastography and calibrated thrombogram. Fluorescence-activated cell sorting (FACS) separated samples into high- and low-TF expressing populations to isolate the contribution of TF to coagulation. A TF neutralizing antibody was incubated with samples to demonstrate loss of procoagulant function. All CCTs tested expressed procoagulant activity that correlated with expression of tissue factor. Time to clot and thrombin formation decreased with increasing TF expression. High-TF expressing cells decreased clotting time more than low-TF expressing cells when isolated from a single donor using FACS. A TF neutralizing antibody restored clotting time to control values in some, but not all, CCT samples. CCTs demonstrate wide variability in procoagulant activity related to TF expression. Time to clot and thrombin formation decreases as TF load increases and this procoagulant effect is neutralized by a TF blocking antibody. Clinical trials using CCTs are in progress and TF expression may emerge as a safety release criterion. Stem Cells Translational Medicine 2018;7:731-739. CI - (c) 2018 The Authors. Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press. FAU - George, Mitchell J AU - George MJ AUID- ORCID: 0000-0003-1668-821X AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Prabhakara, Karthik AU - Prabhakara K AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Toledano-Furman, Naama E AU - Toledano-Furman NE AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Wang, Yao-Wei AU - Wang YW AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Gill, Brijesh S AU - Gill BS AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Olson, Scott D AU - Olson SD AUID- ORCID: 0000-0001-8032-3755 AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. FAU - Cox, Charles S Jr AU - Cox CS Jr AD - Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20180801 PL - England TA - Stem Cells Transl Med JT - Stem cells translational medicine JID - 101578022 RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adipose Tissue/cytology MH - Amniotic Fluid/cytology MH - *Blood Coagulation MH - Bone Marrow Cells/cytology MH - Cell- and Tissue-Based Therapy/*methods MH - Fetal Blood/cytology MH - Humans MH - Mesenchymal Stem Cells/cytology/metabolism MH - Thrombelastography MH - Thrombin/metabolism MH - Thromboplastin/genetics/*metabolism PMC - PMC6186273 OTO - NOTNLM OT - Clinical cellular therapeutics OT - Coagulation OT - Tissue factor EDAT- 2018/08/03 06:00 MHDA- 2019/09/12 06:00 PMCR- 2018/08/01 CRDT- 2018/08/03 06:00 PHST- 2018/01/19 00:00 [received] PHST- 2018/06/06 00:00 [accepted] PHST- 2018/08/03 06:00 [pubmed] PHST- 2019/09/12 06:00 [medline] PHST- 2018/08/03 06:00 [entrez] PHST- 2018/08/01 00:00 [pmc-release] AID - SCT312341 [pii] AID - 10.1002/sctm.18-0015 [doi] PST - ppublish SO - Stem Cells Transl Med. 2018 Oct;7(10):731-739. doi: 10.1002/sctm.18-0015. Epub 2018 Aug 1. PMID- 31723880 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220411 IS - 2586-6060 (Electronic) IS - 2586-6052 (Print) IS - 2586-6052 (Linking) VI - 33 IP - 3 DP - 2018 Aug TI - Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma. PG - 162-169 LID - 10.4266/acc.2018.00199 [doi] AB - BACKGROUND: Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma. METHODS: Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed. RESULTS: During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality. CONCLUSIONS: Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma. CI - Copyright (c) 2018 The Korean Society of Critical Care Medicine. FAU - Kim, Ji Soo AU - Kim JS AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Wang, Il Jae AU - Wang IJ AUID- ORCID: 0000-0003-2479-2359 AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Yeom, Seok Ran AU - Yeom SR AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Cho, Suck Ju AU - Cho SJ AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Kim, Jae Hun AU - Kim JH AD - Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea. FAU - Seok, June Pill AU - Seok JP AD - Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea. FAU - Lee, Seong Hwa AU - Lee SH AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Bae, Byung Gwan AU - Bae BG AD - Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. FAU - Min, Mun Ki AU - Min MK AD - Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea. LA - eng PT - Journal Article DEP - 20180831 PL - Korea (South) TA - Acute Crit Care JT - Acute and critical care JID - 101726905 PMC - PMC6786692 OTO - NOTNLM OT - coagulopathy OT - fibrinolysis OT - hemorrhage OT - thromboelastometry OT - trauma COIS- No potential conflict of interest relevant to this article was reported. EDAT- 2018/08/01 00:00 MHDA- 2018/08/01 00:01 PMCR- 2018/08/01 CRDT- 2019/11/15 06:00 PHST- 2018/05/29 00:00 [received] PHST- 2018/07/02 00:00 [revised] PHST- 2018/08/17 00:00 [accepted] PHST- 2019/11/15 06:00 [entrez] PHST- 2018/08/01 00:00 [pubmed] PHST- 2018/08/01 00:01 [medline] PHST- 2018/08/01 00:00 [pmc-release] AID - acc-2018-00199 [pii] AID - 10.4266/acc.2018.00199 [doi] PST - ppublish SO - Acute Crit Care. 2018 Aug;33(3):162-169. doi: 10.4266/acc.2018.00199. Epub 2018 Aug 31. PMID- 30059456 OWN - NLM STAT- MEDLINE DCOM- 20190827 LR - 20191001 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 85 IP - 4 DP - 2018 Oct TI - Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion. PG - 734-740 LID - 10.1097/TA.0000000000002037 [doi] AB - INTRODUCTION: Goal-directed hemostatic resuscitation based on thrombelastography (TEG) has a survival benefit compared with conventional coagulation assays such as international normalized ratio, activated partial thromboplastin time, fibrinogen level, and platelet count. While TEG-based transfusion thresholds for patients at risk for massive transfusion (MT) have been defined using rapid TEG, cutoffs have not been defined for TEG using other activators such as kaolin. The purpose of this study was to develop thresholds for blood product transfusion using citrated kaolin TEG (CK-TEG) in patients at risk for MT. METHODS: CK-TEG was assessed in trauma activation patients at two Level 1 trauma centers admitted between 2010 and 2017. Receiver operating characteristic (ROC) curve analyses were performed to test the predictive performance of CK-TEG measurements in patients requiring MT, defined as >10 units of red blood cells or death within the first 6 hours. The Youden Index defined optimal thresholds for CK-TEG-based resuscitation. RESULTS: Of the 825 trauma activations, 671 (81.3%) were men, 419 (50.8%) suffered a blunt injury, and 62 (7.5%) received a MT. Patients who had a MT were more severely injured, had signs of more pronounced shock, and more abnormal coagulation assays. CK-TEG R-time was longer (4.9 vs. 4.4 min, p = 0.0084), angle was lower (66.2 vs. 70.3 degrees, p < 0.0001), maximum amplitude was lower in MT (57 vs. 65.5 mm, p < 0.0001), and LY30 was greater (1.8% vs. 1.2%, p = 0.0012) in patients with MT compared with non-MT. To predict MT, R-time yielded an area under the ROC curve (AUROC) = 0.6002 and a cut point of >4.45 min. Angle had an AUROC = 0.6931 and a cut point of <67 degrees. CMA had an AUROC = 0.7425, and a cut point of <60 mm. LY30 had an AUROC = 0.623 with a cut point of >4.55%. CONCLUSION: We have identified CK-TEG thresholds that can guide MT in trauma. We propose plasma transfusion for R-time >4.45 min, fibrinogen products for an angle <67 degrees, platelet transfusion for MA <60 mm, and antifibrinolytics for LY30 >4.55%. LEVEL OF EVIDENCE: Therapeutic study, level V. FAU - Stettler, Gregory R AU - Stettler GR AD - From the Department of Surgery (G.R.S., J.J.S., G.R.N., A.S.), University of Colorado, Aurora, Colorado; Department of Surgery (E.E.M., M.J.C.), Denver Health Medical Center, Denver, Colorado; Department of Pediatrics (C.C.S.), University of Colorado, Aurora, Colorado; Bonfils Blood Center (C.C.S.), Denver, Colorado; University of Colorado School of Public Health (A.S.), University of Colorado, Aurora, Colorado; and Department of Surgery (L.Z.K., A.S.C., R.A.C.), Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California. FAU - Sumislawski, Joshua J AU - Sumislawski JJ FAU - Moore, Ernest E AU - Moore EE FAU - Nunns, Geoffrey R AU - Nunns GR FAU - Kornblith, Lucy Z AU - Kornblith LZ FAU - Conroy, Amanda S AU - Conroy AS FAU - Callcut, Rachael A AU - Callcut RA FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - K01 ES026834/ES/NIEHS NIH HHS/United States GR - K23 GM130892/GM/NIGMS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 24H4NWX5CO (Kaolin) SB - IM MH - Adult MH - Area Under Curve MH - *Blood Coagulation MH - Blood Transfusion MH - Female MH - Hemorrhage/etiology/*therapy MH - Humans MH - Kaolin MH - Male MH - Middle Aged MH - Patient Care Planning MH - ROC Curve MH - Resuscitation/methods MH - Thrombelastography/*methods MH - Wounds and Injuries/complications/*therapy PMC - PMC6158094 MID - NIHMS1500159 EDAT- 2018/07/31 06:00 MHDA- 2019/08/28 06:00 PMCR- 2019/10/01 CRDT- 2018/07/31 06:00 PHST- 2018/07/31 06:00 [pubmed] PHST- 2019/08/28 06:00 [medline] PHST- 2018/07/31 06:00 [entrez] PHST- 2019/10/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000002037 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Oct;85(4):734-740. doi: 10.1097/TA.0000000000002037. PMID- 30038462 OWN - NLM STAT- MEDLINE DCOM- 20181105 LR - 20181114 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 24 IP - 27 DP - 2018 Jul 21 TI - Perioperative thromboprophylaxis in liver transplant patients. PG - 2931-2948 LID - 10.3748/wjg.v24.i27.2931 [doi] AB - Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation (LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications (intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors (portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ''rebalanced hemostasis'' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors (venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT. FAU - De Pietri, Lesley AU - De Pietri L AD - Division of Anaesthesiology and Intensive Care Unit, Department of General Surgery, AUSL Reggio Emilia-IRCCS, Reggio Emilia 42123, Italy. lesley.depietri@yahoo.it. FAU - Montalti, Roberto AU - Montalti R AD - Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy. FAU - Nicolini, Daniele AU - Nicolini D AD - Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy. FAU - Troisi, Roberto Ivan AU - Troisi RI AD - Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent 185 3K3 9000, Belgium. FAU - Moccheggiani, Federico AU - Moccheggiani F AD - Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy. FAU - Vivarelli, Marco AU - Vivarelli M AD - Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy. LA - eng PT - Journal Article PT - Review PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 RN - 0 (Anticoagulants) SB - IM MH - Anticoagulants/pharmacology/*therapeutic use MH - Blood Coagulation/drug effects MH - Blood Loss, Surgical/prevention & control MH - Blood Transfusion MH - Humans MH - Liver Cirrhosis/blood/complications/*surgery MH - Liver Transplantation/*adverse effects MH - Perioperative Care/*methods/standards/trends MH - Postoperative Hemorrhage/chemically induced/prevention & control MH - Practice Guidelines as Topic MH - Thromboembolism/*prevention & control MH - Thrombophilia/blood/prevention & control PMC - PMC6054944 OTO - NOTNLM OT - Anticoagulation OT - Antiplatelets OT - Coagulation OT - Heparin OT - Hepatic artery thrombosis OT - Liver transplantation OT - Portal vein thrombosis OT - Thromboelastography OT - Thromboprophylaxis OT - Thrombosis COIS- Conflict-of-interest statement: All authors have no conflict of interest. EDAT- 2018/07/25 06:00 MHDA- 2018/11/06 06:00 PMCR- 2018/07/21 CRDT- 2018/07/25 06:00 PHST- 2018/03/25 00:00 [received] PHST- 2018/05/17 00:00 [revised] PHST- 2018/06/22 00:00 [accepted] PHST- 2018/07/25 06:00 [entrez] PHST- 2018/07/25 06:00 [pubmed] PHST- 2018/11/06 06:00 [medline] PHST- 2018/07/21 00:00 [pmc-release] AID - 10.3748/wjg.v24.i27.2931 [doi] PST - ppublish SO - World J Gastroenterol. 2018 Jul 21;24(27):2931-2948. doi: 10.3748/wjg.v24.i27.2931. PMID- 29998845 OWN - NLM STAT- MEDLINE DCOM- 20190306 LR - 20190306 IS - 0392-856X (Print) IS - 0392-856X (Linking) VI - 36 IP - 6 Suppl 115 DP - 2018 Nov-Dec TI - Why are male patients with Behcet's disease prone to thrombosis? A rotational thromboelastographic analysis. PG - 63-67 AB - OBJECTIVES: To investigate whether there is a difference between male and female patients with Behcet's disease (BD) in terms of hypercoagulability by using modified rotational thromboelastograhic (ROTEM) analysis. METHODS: 126 BD patients (71 male, 55 female; mean age: 41+/-9 yrs) who met ISSG criteria for BD were included into the study. 23 patients with vasculitis (16 female, 7 male; mean age 49+/-16 yrs), and 25 healthy individuals (11 female, 14 male; mean age: 37+/-10 yrs) were included to the study as disease and healthy control (HC) group, respectively. Clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) were determined by INTEM and EXTEM analyses. As a marker of vascular endothelial injury, along with inflammatory markers, vWFag levels were investigated in patients and HC group. RESULTS: Extem-CFT was shorter in only vasculitic group compared to HC group. Intem-CFT was found to be shorter in BD patients and vasculitis group compared to HC. Intem-MCF was significantly longer in male BD patients than female BD patients. Extem-CFT was found to be shorter in male BD patients compared to female BD patients. Extem-MCF was statistically longer in male BD patients. In inactive male BD patients, while Intem-CFT was shorter than HC individuals, Intem-MCF and Extem-MCF were statistically longer than HC (p<0.02, p<0.03), respectively. However, no significant differences were found between inactive female BD patients and HC in terms of all ROTEM parameters. CONCLUSIONS: These results support that male BD patients have a hypercoagulable state compared to female BD patients, which may explain why male patients are prone to thrombotic complications. FAU - Kara Kivanc, Banu AU - Kara Kivanc B AD - Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Gonullu, Emel AU - Gonullu E AD - Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Akay, Olga Meltem AU - Akay OM AD - Division of Haematology, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Erturk, Adem AU - Erturk A AD - Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Bal, Cengiz AU - Bal C AD - Department of Biostatistic, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Cansu, Dondu Uskudar AU - Cansu DU AD - Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. FAU - Korkmaz, Cengiz AU - Korkmaz C AD - Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey. ckorkmaz@ogu.edu.tr. LA - eng PT - Journal Article DEP - 20180608 PL - Italy TA - Clin Exp Rheumatol JT - Clinical and experimental rheumatology JID - 8308521 SB - IM MH - Adult MH - Behcet Syndrome/blood/*complications/diagnosis MH - *Blood Coagulation MH - Case-Control Studies MH - Cross-Sectional Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Risk Factors MH - Sex Factors MH - Thrombelastography/*methods MH - Thrombosis/blood/*diagnosis/etiology EDAT- 2018/07/13 06:00 MHDA- 2019/03/07 06:00 CRDT- 2018/07/13 06:00 PHST- 2018/01/17 00:00 [received] PHST- 2018/03/28 00:00 [accepted] PHST- 2018/07/13 06:00 [pubmed] PHST- 2019/03/07 06:00 [medline] PHST- 2018/07/13 06:00 [entrez] AID - 12624 [pii] PST - ppublish SO - Clin Exp Rheumatol. 2018 Nov-Dec;36(6 Suppl 115):63-67. Epub 2018 Jun 8. PMID- 29985230 OWN - NLM STAT- MEDLINE DCOM- 20190827 LR - 20191101 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 85 IP - 5 DP - 2018 Nov TI - Severely injured trauma patients with admission hyperfibrinolysis: Is there a role of tranexamic acid? Findings from the PROPPR trial. PG - 851-857 LID - 10.1097/TA.0000000000002022 [doi] AB - INTRODUCTION: Administration of tranexamic acid (TXA) in coagulopathy of trauma gained popularity after the CRASH-2 trial. The aim of our analysis was to analyze the role of TXA in severely injured trauma patients with admission hyperfibrinolysis. METHODS: We reviewed the prospectively collected Pragmatic, Randomized Optimal Platelet and Plasma Ratios database. We included patients with admission hyperfibrinolysis (Ly30 >3%) on thromboelastography. Patients were stratified into two groups (TXA and No-TXA) and were matched in 1:2 ratio using propensity score matching for demographics, admission vitals, and injury severity. Primary outcome measures were 6-, 12-, and 24-hour and 30-day mortality; 24-hour transfusion requirements; time to achieve hemostasis; and rebleeding after hemostasis requiring intervention. Secondary outcome measures were thrombotic complications. RESULTS: We analyzed 680 patients. Of those, 118 had admission hyperfibrinolysis, and 93 patients (TXA: 31 patients; No-TXA: 62 patients) were matched. Matched groups were similar in age (p = 0.33), gender (p = 0.84), race (p = 0.81), emergency department (ED) Glasgow Coma Scale (p = 0.34), ED systolic blood pressure (p = 0.28), ED heart rate (p = 0.43), mechanism of injury (p = 0.45), head Abbreviated Injury Scale score (p = 0.68), injury severity score (p = 0.56), and blood products ratio (p = 0.44). Patients who received TXA had a lower 6-hour mortality rate (34% vs. 13%, p = 0.04) and higher 24-hour transfusion of plasma (15 vs. 10 units, p = 0.03) compared with the No-TXA group. However, there was no difference in 12-hour (p = 0.24), 24-hour (p = 0.25), and 30-day mortality (p = 0.82). Similarly, there was no difference in 24-hour transfusion of RBC (p = 0.11) or platelets (p = 0.13), time to achieve hemostasis (p = 0.65), rebleeding requiring intervention (p = 0.13), and thrombotic complications (p = 0.98). CONCLUSION: Tranexamic acid was associated with increased 6-hour survival but does not improve long-term outcomes in severely injured trauma patients with hemorrhage who develop hyperfibrinolysis. Moreover, TXA administration was not associated with thrombotic complications. Further randomized clinical trials will identify the subset of trauma patients who may benefit from TXA. LEVEL OF EVIDENCE: Therapeutic study, level III. FAU - Khan, Muhammad AU - Khan M AD - From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (M.K., F.J., T.O., B.J.), College of Medicine, University of Arizona, Tucson, Arizona; Division of Trauma and Critical Care, Department of Surgery (E.M.B.), School of Medicine, University of Washington, Seattle, Washington; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (J.B.H., C.E.W.), Medical School, University of Texas Health Science Center, Houston, Texas; and Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (M.A.S.), School of Medicine, Oregon Health & Science University, Portland, Oregon. FAU - Jehan, Faisal AU - Jehan F FAU - Bulger, Eileen M AU - Bulger EM FAU - O'Keeffe, Terence AU - O'Keeffe T FAU - Holcomb, John B AU - Holcomb JB FAU - Wade, Charles E AU - Wade CE FAU - Schreiber, Martin A AU - Schreiber MA FAU - Joseph, Bellal AU - Joseph B CN - PROPPR Study Group LA - eng GR - U01 HL077863/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Antifibrinolytic Agents/*therapeutic use MH - Female MH - Fibrinolysis/*drug effects MH - Hemorrhage/*drug therapy/etiology/*physiopathology MH - Hemostasis/drug effects MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Plasma MH - Randomized Controlled Trials as Topic MH - Survival Rate MH - Tranexamic Acid/*therapeutic use MH - Wounds and Injuries/complications/*physiopathology MH - Young Adult PMC - PMC6077098 MID - NIHMS978461 COIS- Conflict of interest: There are no identifiable conflicts of interests to report. EDAT- 2018/07/10 06:00 MHDA- 2019/08/28 06:00 PMCR- 2019/11/01 CRDT- 2018/07/10 06:00 PHST- 2018/07/10 06:00 [pubmed] PHST- 2019/08/28 06:00 [medline] PHST- 2018/07/10 06:00 [entrez] PHST- 2019/11/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000002022 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Nov;85(5):851-857. doi: 10.1097/TA.0000000000002022. PMID- 29945043 OWN - NLM STAT- MEDLINE DCOM- 20190710 LR - 20190710 IS - 1879-0534 (Electronic) IS - 0010-4825 (Linking) VI - 99 DP - 2018 Aug 1 TI - Modeling and validation of a detailed FE viscoelastic lumbar spine model for vehicle occupant dummies. PG - 191-200 LID - S0010-4825(18)30161-6 [pii] LID - 10.1016/j.compbiomed.2018.06.013 [doi] AB - The dummies currently used for predicting vehicle occupant response during frontal crashes or whole-body vibration provide insufficient information about spinal loads. Although they aptly approximate upper-body rotations in different loading scenarios, they overlook spinal loads, which are crucial to injury assessment. This paper aims to develop a modified dummy finite element (FE) model with a detailed viscoelastic lumbar spine. This model has been developed and validated against in-vitro and in-silico data under different loading conditions, and its predicted ranges of motion (RoM) and intradiscal pressure (IDP) maintain close correspondence with the in-vitro data. The dominant frequency of the model was f = 8.92 Hz, which was close to previous results. In the relaxation test, a force reduction of up to 21% was obtained, showing high agreement in force relaxation during the in-vitro test. The FE lumbar spine model was placed in the HYBRID III test dummy and aligned in a seated position based on available MRI data. Under two impulsive acceleration loadings in flexion and lateral directions with a peak acceleration of 60 m/s(2), flexion responses of the modified and original dummies were close (RoMs of 29.1 degrees and 29.6 degrees , respectively), though not in lateral bending (RoMs of 34.1 degrees and 15.6 degrees , respectively), where the modified dummy was more flexible than the original. By reconstructing a real frontal crash, it was found that the modified dummy provided a 10% reduction in the Head Injury Criterion (HIC). Other than the more realistic behavior of this modified dummy, its capability of approximating lumbar loads and risk of lumbar spine injuries in vehicle crashes or whole-body vibration is of great importance. CI - Copyright (c) 2018 Elsevier Ltd. All rights reserved. FAU - Amiri, Sorosh AU - Amiri S AD - Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran. Electronic address: s_amiri@mech.sharif.ir. FAU - Naserkhaki, Sadegh AU - Naserkhaki S AD - Department of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. Electronic address: snkhaki@gmail.com. FAU - Parnianpour, Mohamad AU - Parnianpour M AD - Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran. Electronic address: parnianpour@sharif.ir. LA - eng PT - Journal Article DEP - 20180619 PL - United States TA - Comput Biol Med JT - Computers in biology and medicine JID - 1250250 SB - IM MH - *Acceleration MH - *Accidents, Traffic MH - Computer Simulation MH - Finite Element Analysis MH - Humans MH - *Lumbar Vertebrae/pathology/physiopathology MH - *Manikins MH - *Models, Biological MH - *Posture MH - Vibration/adverse effects OTO - NOTNLM OT - Finite element (FE) model OT - Lumbar spine OT - Modified HYBRID III dummy OT - Vehicle accident OT - Viscoelastic discs EDAT- 2018/06/27 06:00 MHDA- 2019/07/11 06:00 CRDT- 2018/06/27 06:00 PHST- 2018/05/21 00:00 [received] PHST- 2018/06/13 00:00 [revised] PHST- 2018/06/14 00:00 [accepted] PHST- 2018/06/27 06:00 [pubmed] PHST- 2019/07/11 06:00 [medline] PHST- 2018/06/27 06:00 [entrez] AID - S0010-4825(18)30161-6 [pii] AID - 10.1016/j.compbiomed.2018.06.013 [doi] PST - ppublish SO - Comput Biol Med. 2018 Aug 1;99:191-200. doi: 10.1016/j.compbiomed.2018.06.013. Epub 2018 Jun 19. PMID- 29937638 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220318 IS - 0974-2700 (Print) IS - 0974-519X (Electronic) IS - 0974-2700 (Linking) VI - 11 IP - 2 DP - 2018 Apr-Jun TI - A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned. PG - 98-103 LID - 10.4103/JETS.JETS_150_16 [doi] AB - BACKGROUND: Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring. MATERIALS AND METHODS: Injured children, aged <18 years, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulopathy were identified from a single, level-1 American College of Surgeons verified pediatric trauma center. Patients were grouped by coagulation assessment: no assessment (NA), conventional coagulation testing alone (CCT), and conventional coagulation testing with rapid thromboelastography (rTEG). Coagulation assessment was provider preference with all monitoring options continuously available. Groups were compared and outcomes were evaluated including blood product utilization, Intensive Care Unit (ICU) utilization, duration of mechanical ventilation, and mortality. RESULTS: A total of 155 patients were identified (NA = 78, CCT = 54, and rTEG = 23). There was no difference in age, gender, race, or mechanism. In practice, rTEG patients were more severely injured, more anemic, and received more blood products and crystalloid (P < 0.001). rTEG patients also had increased mortality with fewer ventilator and ICU-free days. Multivariate logistic regression and covariance analysis indicated that while rTEG use was not associated with mortality, it was associated with increased use of blood products, duration of mechanical ventilation, and ICU length of stay. CONCLUSIONS: Viscoelastic monitoring was infrequently performed, but utilized in more severely injured patients. Well-designed prospective studies in patients at high risk of coagulopathy are needed to evaluate goal-directed hemostatic resuscitation strategies in children. FAU - Aladegbami, Bola AU - Aladegbami B AD - Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. FAU - Choi, Pamela M AU - Choi PM AD - Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. FAU - Keller, Martin S AU - Keller MS AD - Department of Surgery, Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA. FAU - Vogel, Adam M AU - Vogel AM AD - Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Childresn's Hospital, Houston, Texas 77030, USA. LA - eng PT - Journal Article PL - India TA - J Emerg Trauma Shock JT - Journal of emergencies, trauma, and shock JID - 101493921 PMC - PMC5994857 OTO - NOTNLM OT - Coagulopathy OT - hemostatic resuscitation OT - pediatric trauma OT - rapid thromboelastography OT - viscoelastic monitoring COIS- There are no conflicts of interest. EDAT- 2018/06/26 06:00 MHDA- 2018/06/26 06:01 PMCR- 2018/04/01 CRDT- 2018/06/26 06:00 PHST- 2018/06/26 06:00 [entrez] PHST- 2018/06/26 06:00 [pubmed] PHST- 2018/06/26 06:01 [medline] PHST- 2018/04/01 00:00 [pmc-release] AID - JETS-11-98 [pii] AID - 10.4103/JETS.JETS_150_16 [doi] PST - ppublish SO - J Emerg Trauma Shock. 2018 Apr-Jun;11(2):98-103. doi: 10.4103/JETS.JETS_150_16. PMID- 29931617 OWN - NLM STAT- MEDLINE DCOM- 20190219 LR - 20190320 IS - 1573-742X (Electronic) IS - 0929-5305 (Linking) VI - 46 IP - 3 DP - 2018 Oct TI - Effects of cupric chloride on coagulation in human plasma: role of fibrinogen. PG - 359-364 LID - 10.1007/s11239-018-1704-4 [doi] AB - INTRODUCTION: Copper poisoning is associated with severe multiorgan injury and potentially death if chelation therapy is not administered. Of interest, while important gastrointestinal and urinary tract hemorrhage is associated with copper poisoning, very little is known concerning the nature of copper induced coagulopathy. METHODS: Using thrombelastography, we assessed changes in coagulation kinetics in human plasma following exposure to copper concentrations encountered during poisoning. RESULTS: While time to commence coagulation was not compromised, both velocity of thrombus growth and final strength were diminished. This result was duplicated with one concentration of copper in factor XIII deficient plasma. This pattern of coagulation kinetic response was interpreted as copper mediated fibrinogen dysfunction, perhaps via oxidation of key fibrinogen disulfide bridges. Lastly, experiments wherein glutathione was added implicated copper generated radical oxygen species as one of the mechanisms responsible for compromised coagulation kinetics. CONCLUSIONS: While chelation therapy is the key to survival following copper poisoning, perhaps this and future investigations of how copper affects coagulation may provide insight into effective supportive therapy for patients with active bleeding. FAU - Nielsen, Vance G AU - Nielsen VG AD - Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA. vgnielsen333@gmail.com. FAU - Ward, Timothy D AU - Ward TD AD - Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA. FAU - Ford, Paul M AU - Ford PM AD - Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA. LA - eng PT - Journal Article PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 RN - 789U1901C5 (Copper) RN - 9001-32-5 (Fibrinogen) RN - S2QG84156O (cupric chloride) SB - IM MH - Blood Coagulation/*drug effects MH - Copper/*pharmacology/toxicity MH - Factor XIII Deficiency MH - Fibrinogen/drug effects MH - Heavy Metal Poisoning MH - Hemorrhage/chemically induced MH - Humans MH - Thrombelastography OTO - NOTNLM OT - Copper poisoning OT - Factor XIII OT - Fibrinogen OT - Thrombelastography EDAT- 2018/06/23 06:00 MHDA- 2019/03/21 06:00 CRDT- 2018/06/23 06:00 PHST- 2018/06/23 06:00 [pubmed] PHST- 2019/03/21 06:00 [medline] PHST- 2018/06/23 06:00 [entrez] AID - 10.1007/s11239-018-1704-4 [pii] AID - 10.1007/s11239-018-1704-4 [doi] PST - ppublish SO - J Thromb Thrombolysis. 2018 Oct;46(3):359-364. doi: 10.1007/s11239-018-1704-4. PMID- 29920664 OWN - NLM STAT- MEDLINE DCOM- 20200707 LR - 20200707 IS - 1469-7793 (Electronic) IS - 0022-3751 (Print) IS - 0022-3751 (Linking) VI - 597 IP - 5 DP - 2019 Mar TI - The impact of loading, unloading, ageing and injury on the human tendon. PG - 1283-1298 LID - 10.1113/JP275450 [doi] AB - A tendon transfers force from the contracting muscle to the skeletal system to produce movement and is therefore a crucial component of the entire muscle-tendon complex and its function. However, tendon research has for some time focused on mechanical properties without any major appreciation of potential cellular and molecular changes. At the same time, methodological developments have permitted determination of the mechanical properties of human tendons in vivo, which was previously not possible. Here we review the current understanding of how tendons respond to loading, unloading, ageing and injury from cellular, molecular and mechanical points of view. A mechanistic understanding of tendon tissue adaptation will be vital for development of adequate guidelines in physical training and rehabilitation, as well as for optimal injury treatment. CI - (c) 2018 The Authors. The Journal of Physiology (c) 2018 The Physiological Society. FAU - Magnusson, S Peter AU - Magnusson SP AUID- ORCID: 0000-0002-4308-5484 AD - Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, NV. AD - Department of Physical and Occupational Therapy Bispebjerg Hospital, Copenhagen, NV. AD - Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark. FAU - Kjaer, Michael AU - Kjaer M AUID- ORCID: 0000-0002-4582-8755 AD - Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, NV. AD - Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20180719 PL - England TA - J Physiol JT - The Journal of physiology JID - 0266262 SB - IM MH - Aging/*physiology MH - Animals MH - Humans MH - Stress, Mechanical MH - Tendon Injuries/physiopathology MH - Tendons/*physiology PMC - PMC6395417 OTO - NOTNLM OT - collagen OT - extracellular matrix OT - tendon fibroblasts OT - tendon structure OT - viscoelastic properties EDAT- 2018/06/20 06:00 MHDA- 2020/07/08 06:00 PMCR- 2020/03/01 CRDT- 2018/06/20 06:00 PHST- 2018/03/20 00:00 [received] PHST- 2018/05/30 00:00 [accepted] PHST- 2018/06/20 06:00 [pubmed] PHST- 2020/07/08 06:00 [medline] PHST- 2018/06/20 06:00 [entrez] PHST- 2020/03/01 00:00 [pmc-release] AID - TJP13101 [pii] AID - 10.1113/JP275450 [doi] PST - ppublish SO - J Physiol. 2019 Mar;597(5):1283-1298. doi: 10.1113/JP275450. Epub 2018 Jul 19. PMID- 29914535 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 1749-799X (Electronic) IS - 1749-799X (Linking) VI - 13 IP - 1 DP - 2018 Jun 18 TI - Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study. PG - 149 LID - 10.1186/s13018-018-0855-5 [doi] LID - 149 AB - BACKGROUND: Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. METHODS: Twenty-three patients (Oxford Score 22-29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1.4 g/90 kg). Inflammatory mediators and ROTEM parameters were measured in blood at baseline, after the first bone-cut, immediately after surgery, and postoperative days 1 and 2. RESULTS: After the bone cut and surgery, TXA significantly increased MCP-1, TNF-alpha, IL-1beta and IL-6 levels compared to non-TXA patients, which was further amplified postoperatively. During surgery, TXA significantly prolonged EXTEM clot times, indicating a thrombin-slowing effect, despite little or no change in clot amplitude or fibrinogen. TXA was associated with three- to fivefold increases in FIBTEM maximum lysis (ML), a finding counter to TXA's antifibrinolytic effect. Maximum lysis for extrinsic and intrinsic pathways was < 8%, indicating little or no hyperfibrinolysis. No significant differences were found in postoperative hemoglobin between the two groups. CONCLUSIONS: TXA was associated with increased systemic inflammation during surgery compared to non-TXA patients, with further amplification on postoperative days 1 and 2. On the basis of little or no change in viscoelastic clot strength, fibrinogen or clot lysis, there appeared to be no clinical justification for TXA in our group of patients. Larger prospective, randomized trials are required to investigate a possible proinflammatory effect in TKA patients. FAU - Grant, Andrea L AU - Grant AL AD - The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia. AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - Letson, Hayley L AU - Letson HL AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - Morris, Jodie L AU - Morris JL AD - The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia. AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - McEwen, Peter AU - McEwen P AD - The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia. AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - Hazratwala, Kaushik AU - Hazratwala K AD - The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia. AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - Wilkinson, Matthew AU - Wilkinson M AD - The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia. AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. FAU - Dobson, Geoffrey P AU - Dobson GP AUID- ORCID: 0000-0001-7905-4551 AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. geoffrey.dobson@jcu.edu.au. LA - eng PT - Journal Article DEP - 20180618 PL - England TA - J Orthop Surg Res JT - Journal of orthopaedic surgery and research JID - 101265112 RN - 0 (Antifibrinolytic Agents) RN - 0 (Biomarkers) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Aged MH - Antifibrinolytic Agents/*adverse effects/pharmacology/therapeutic use MH - *Arthroplasty, Replacement, Knee MH - Biomarkers/blood MH - Blood Coagulation/drug effects MH - Blood Loss, Surgical/*prevention & control MH - Female MH - Humans MH - Inflammation/*blood/chemically induced/etiology MH - Male MH - Middle Aged MH - Osteoarthritis, Hip/*surgery MH - Pilot Projects MH - Prospective Studies MH - Tranexamic Acid/*adverse effects/pharmacology/therapeutic use PMC - PMC6006687 OTO - NOTNLM OT - Coagulation OT - Inflammation OT - Orthopaedic surgery OT - Total knee arthroplasty OT - Tranexamic acid OT - Trauma COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the Institutional Human Research Ethics Committee (MHS20140812-03). Informed consent was obtained prospectively from all participants. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/06/20 06:00 MHDA- 2018/12/12 06:00 PMCR- 2018/06/18 CRDT- 2018/06/20 06:00 PHST- 2018/02/21 00:00 [received] PHST- 2018/06/05 00:00 [accepted] PHST- 2018/06/20 06:00 [entrez] PHST- 2018/06/20 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2018/06/18 00:00 [pmc-release] AID - 10.1186/s13018-018-0855-5 [pii] AID - 855 [pii] AID - 10.1186/s13018-018-0855-5 [doi] PST - epublish SO - J Orthop Surg Res. 2018 Jun 18;13(1):149. doi: 10.1186/s13018-018-0855-5. PMID- 29907206 OWN - NLM STAT- MEDLINE DCOM- 20190429 LR - 20210109 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 228 DP - 2018 Aug TI - Rotational thromboelastometry thresholds for patients at risk for massive transfusion. PG - 154-159 LID - S0022-4804(18)30192-6 [pii] LID - 10.1016/j.jss.2018.03.027 [doi] AB - BACKGROUND: Goal-directed hemostatic resuscitation based on thrombelastography has a survival benefit compared to conventional coagulation assays. While thrombelastography transfusion thresholds for patients at risk for massive transfusion (MT) have been defined, similar cutoffs do not exist for the other commonly used viscoelastic assay, rotational thromboelastometry (ROTEM). The purpose of this study was to develop ROTEM blood product thresholds in patients at risk for MT. METHODS: ROTEM was assessed in trauma activation patients admitted from 2010 to 2016 (n = 222). Receiver operating characteristic curve analyses were performed to test the predictive performance of ROTEM measurements in patients requiring MT. The Youden Index defined optimal thresholds for ROTEM-based resuscitation. RESULTS: Patients who required MT (n = 37, 17%) were more severely injured. EXTEM clotting time (CT) was longer in patients with MT compared to non-MT (87 versus 64 s, P < 0.0001). EXTEM angle was shallower in MT patients compared to non-MT (54 degrees versus 69 degrees , P < 0.0001). Clot amplitude after 10 min (CA10) was less in MT compared to non-MT patients (30.5 versus 50 mm, P < 0.0001). Clot lysis index 60 min (CLI60) was lower in patients who had MT than non-MT (47 versus 94%, P = 0.0006). EXTEM CT yielded an area under the receiver operating characteristic curve (AUROC) = 0.7116 and a cut point of >78.5 s. EXTEM angle had an AUROC = 0.865 and a cut point of <64.5 degrees . EXTEM CA10 had an AUROC = 0.858, with a cut point of <40.5 mm. CLI60 had an AUROC = 0.6788 with a cut point at <74%. CONCLUSIONS: We have identified ROTEM thresholds for transfusion of blood components in severely injured patients requiring an MT. Based on our analysis, we propose plasma transfusion for EXTEM CT > 78.5 s, fibrinogen for angle <64.5 degrees , platelet transfusion for CA10 < 40.5 mm, and antifibrinolytics for CLI60 < 74%. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, Denver Health Medical Center, Denver, Colorado. Electronic address: ernest.moore@dhha.org. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Chandler, Jim AU - Chandler J AD - Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Peltz, Erik AU - Peltz E AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Pediatrics, University of Colorado, Aurora, Colorado; Bonfils Blood Center, Denver, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado, Aurora, Colorado; University of Colorado School of Public Health, University of Colorado, Aurora, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20180411 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Antifibrinolytic Agents) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Antifibrinolytic Agents/therapeutic use MH - Blood Coagulation MH - Blood Component Transfusion/*statistics & numerical data MH - Fibrinogen/therapeutic use MH - Hemorrhage/*diagnosis/etiology/therapy MH - Hemostatic Techniques/statistics & numerical data MH - Humans MH - Middle Aged MH - Patient Selection MH - Prospective Studies MH - ROC Curve MH - Resuscitation/*methods/statistics & numerical data MH - Thrombelastography/*methods MH - Trauma Severity Indices MH - Wounds and Injuries/complications/*diagnosis/therapy PMC - PMC6039387 MID - NIHMS978349 OTO - NOTNLM OT - Coagulopathy OT - Massive transfusion OT - ROTEM OT - Resuscitation OT - TEG EDAT- 2018/06/17 06:00 MHDA- 2019/04/30 06:00 PMCR- 2018/08/01 CRDT- 2018/06/17 06:00 PHST- 2017/12/01 00:00 [received] PHST- 2018/02/05 00:00 [revised] PHST- 2018/03/14 00:00 [accepted] PHST- 2018/06/17 06:00 [entrez] PHST- 2018/06/17 06:00 [pubmed] PHST- 2019/04/30 06:00 [medline] PHST- 2018/08/01 00:00 [pmc-release] AID - S0022-4804(18)30192-6 [pii] AID - 10.1016/j.jss.2018.03.027 [doi] PST - ppublish SO - J Surg Res. 2018 Aug;228:154-159. doi: 10.1016/j.jss.2018.03.027. Epub 2018 Apr 11. PMID- 29903508 OWN - NLM STAT- MEDLINE DCOM- 20190118 LR - 20191008 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 164 IP - 3 DP - 2018 Sep TI - Rapid TEG efficiently guides hemostatic resuscitation in trauma patients. PG - 489-493 LID - S0039-6060(18)30198-3 [pii] LID - 10.1016/j.surg.2018.04.029 [doi] AB - BACKGROUND: Several thrombelastography functional assays have been developed to guide transfusion in injured patients, but how this acceleration of thrombelastography affects its ability to predict massive transfusion is unknown. The objective of this study is to compare citrated native, citrated kaolin, and citrated rapid thromboelastographies for their prediction of massive transfusion after trauma. We hypothesized that citrated native thrombelastography best predicts massive transfusion. METHODS: Data were collected as part of a prospective study of trauma activation patients. All patients received citrated native, citrated kaolin, or citrated rapid thromboelastographies. Logistic regression was used to assess the predictive performance of different thrombelastography assays for massive transfusion. RESULTS: Measurements for all three TEG activating systems was available for 343 patients; 57 (16.6%) required a massive transfusion. Compared to citrated rapid thromboelastographies, citrated kaolin thromboelastographies performed better for activated clotting time/rapid and citrated native thromboelastographies for maximum amplitude and angle. Yet, the 95% confidence intervals overlapped considerably, suggesting the citrated rapid thromboelastographies produced comparable results to the other assays for activated clotting time/reaction time, maximum amplitude, and angle. CONCLUSION: There was substantial overlap in the performance of the different thrombelastography assays, suggesting citrated rapid thrombelastography is a quick and effective method to guide hemostatic resuscitation in trauma patients and does not perform inferiorly to the citrated native or citrated kaolin thrombelastography despite the addition of activation factors. CI - Published by Elsevier Inc. FAU - Coleman, Julia R AU - Coleman JR AD - University of Colorado-Denver, Aurora, CO. Electronic address: julia.coleman@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Denver Health Medical Center, Denver, CO. Electronic address: Ernest.moore@dhha.org. FAU - Chapman, Michael P AU - Chapman MP AD - University of Colorado-Denver, Aurora, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - University of Colorado-Denver, Aurora, CO. FAU - Silliman, Christopher C AU - Silliman CC AD - University of Colorado-Denver, Aurora, CO. FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - Denver Health Medical Center, Denver, CO. FAU - Chandler, James AU - Chandler J AD - Denver Health Medical Center, Denver, CO. FAU - Samuels, Jason M AU - Samuels JM AD - University of Colorado-Denver, Aurora, CO. FAU - Sauaia, Angela AU - Sauaia A AD - University of Colorado-Denver, Aurora, CO. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20180612 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Anticoagulants) RN - 24H4NWX5CO (Kaolin) RN - 2968PHW8QP (Citric Acid) SB - IM MH - Adult MH - Anticoagulants MH - *Blood Transfusion MH - Citric Acid MH - Female MH - Hemorrhage/diagnosis/etiology/*therapy MH - *Hemostatic Techniques MH - Humans MH - Kaolin MH - Logistic Models MH - Male MH - Middle Aged MH - Needs Assessment MH - Predictive Value of Tests MH - Prospective Studies MH - Resuscitation MH - *Thrombelastography MH - Wounds, Nonpenetrating/*complications/diagnosis/therapy MH - Wounds, Penetrating/*complications/diagnosis/therapy PMC - PMC6108915 MID - NIHMS974494 COIS- Disclosure of Financial Interests and Potential Conflicts of Interest There are no financial disclosures and conflicts of interest to disclose for any of the authors. EDAT- 2018/06/16 06:00 MHDA- 2019/01/19 06:00 PMCR- 2019/09/01 CRDT- 2018/06/16 06:00 PHST- 2018/01/09 00:00 [received] PHST- 2018/03/31 00:00 [revised] PHST- 2018/04/25 00:00 [accepted] PHST- 2018/06/16 06:00 [pubmed] PHST- 2019/01/19 06:00 [medline] PHST- 2018/06/16 06:00 [entrez] PHST- 2019/09/01 00:00 [pmc-release] AID - S0039-6060(18)30198-3 [pii] AID - 10.1016/j.surg.2018.04.029 [doi] PST - ppublish SO - Surgery. 2018 Sep;164(3):489-493. doi: 10.1016/j.surg.2018.04.029. Epub 2018 Jun 12. PMID- 29887293 OWN - NLM STAT- MEDLINE DCOM- 20200406 LR - 20210524 IS - 2173-5727 (Electronic) IS - 2173-5727 (Linking) VI - 43 IP - 7 DP - 2019 Oct TI - Rotational thromboelastometry (ROTEM) profile in a cohort of asystole donors. PG - 410-415 LID - S0210-5691(18)30151-7 [pii] LID - 10.1016/j.medin.2018.04.007 [doi] AB - BACKGROUND: Hypoperfusion plays a central role in shock states, and has been proposed as a coagulopathy trigger. The study of the rotational thromboelastometry (ROTEM) profile during cardiac arrest could offer new insights to the role of hypoperfusion in coagulation during shock states. OUTCOME: To describe the ROTEM profile in a cohort of asystole donors and elucidate the incidence of hyperfibrinolysis. DESIGN: A prospective observational study was carried out in 18 patients consecutively admitted to the ICU after out-of-hospital non-recovered cardiac arrest (CA). Initial rhythm and time between CA and admission were recorded. Conventional coagulation and ROTEM (EXTEM, APTEM, FIBTEM) tests were performed within 30minutes after blood sample collection. SCOPE: An asystole donor reference hospital. PARTICIPANTS: Patients admitted to the ICU after out-of-hospital non-recovered CA. RESULTS: The median age was 50years, and 14 of the patients were men (77.8%). The time from CA to hospital admission expressed as the median (interquartile range) was 91minutes (75-104). The results of the routine tests were: INR 1.25 (1.19-1.34), aPTT 55s (45-73) and fibrinogen 161mg/dl (95-295). For the ROTEM APTEM assay the results were: CT 126s (104-191), CFT 247s (203-694). Hyperfibrinolysis criteria were recorded in 15 patients (83.3%). In addition, MCF improved in APTEM versus EXTEM. Prolonged CA times were associated to lower fibrinogen levels and lower values for MCF FIBTEM (P<.05). CONCLUSIONS: The ROTEM assays revealed severe alterations of the clot formation parameters and a high incidence of hyperfibrinolysis. CI - Copyright (c) 2018 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved. FAU - Barea-Mendoza, J A AU - Barea-Mendoza JA AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. Electronic address: jbareamendoza@gmail.com. FAU - Terceros-Almanza, L J AU - Terceros-Almanza LJ AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Garcia-Fuentes, C AU - Garcia-Fuentes C AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Bermejo-Aznarez, S AU - Bermejo-Aznarez S AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Prieto Del Portillo, I J AU - Prieto Del Portillo IJ AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Mudarra-Reche, C AU - Mudarra-Reche C AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Valiente-Fernandez, M AU - Valiente-Fernandez M AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Rodriguez-Biendicho, A AU - Rodriguez-Biendicho A AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Montejo Gonzalez, J C AU - Montejo Gonzalez JC AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. FAU - Chico-Fernandez, M AU - Chico-Fernandez M AD - Grupo de Investigacion en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. LA - eng LA - spa PT - Journal Article PT - Observational Study TT - Perfil de tromboelastometria rotacional (ROTEM) en una cohorte de asistolia no controlada. DEP - 20180608 PL - Spain TA - Med Intensiva (Engl Ed) JT - Medicina intensiva JID - 101717568 SB - IM MH - Blood Coagulation Tests MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/*blood/physiopathology MH - Prospective Studies MH - Thrombelastography/*methods MH - Time Factors MH - *Tissue Donors OTO - NOTNLM OT - Asistolia OT - Asystolia OT - Coagulopathy OT - Coagulopatia OT - Hiperfibrinolisis OT - Hyperfibrinolysis OT - Perfusion OT - Perfusion OT - ROTEM OT - Shock OT - Trauma EDAT- 2018/06/12 06:00 MHDA- 2020/04/09 06:00 CRDT- 2018/06/12 06:00 PHST- 2018/01/23 00:00 [received] PHST- 2018/04/13 00:00 [revised] PHST- 2018/04/22 00:00 [accepted] PHST- 2018/06/12 06:00 [pubmed] PHST- 2020/04/09 06:00 [medline] PHST- 2018/06/12 06:00 [entrez] AID - S0210-5691(18)30151-7 [pii] AID - 10.1016/j.medin.2018.04.007 [doi] PST - ppublish SO - Med Intensiva (Engl Ed). 2019 Oct;43(7):410-415. doi: 10.1016/j.medin.2018.04.007. Epub 2018 Jun 8. PMID- 29851904 OWN - NLM STAT- MEDLINE DCOM- 20190502 LR - 20190502 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 85 IP - 3 DP - 2018 Sep TI - High-dose Factor XIII administration induces effective hemostasis for trauma-associated coagulopathy (TAC) both in vitro and in rat hemorrhagic shock in vivo models. PG - 588-597 LID - 10.1097/TA.0000000000001998 [doi] AB - BACKGROUND: Trauma-associated coagulopathy (TAC) is an early and primary complication in severe trauma patients. Factor XIII (FXIII) is reported to stabilize a clot in the late phase of the coagulation cascade. The goal of this study was to investigate whether the administration of FXIII improves the condition of TAC both in vitro and in vivo. METHODS: We evaluated the effects of different doses, including a very high dose of FXIII (3.6-32.4 IU/mL) on tissue-plasminogen activator-induced hyperfibrinolysis and the combined condition of dilutional coagulopathy and tissue-plasminogen activator-induced hyperfibrinolysis in vitro. The coagulation status was analyzed by rotational thromboelastometry (ROTEM) and Sonoclot. Then, we evaluated the effect of high-dose FXIII (300 IU/kg) for severe coagulopathy in vivo using a rat liver trauma model in which coagulopathy similar to TAC was observed. Survival time and the amount of intra-abdominal bleeding of rats were measured, and a coagulation test was also performed. Histologic evaluations of rats' lung and kidney after FXIII administration were completed. RESULTS: High-dose FXIII significantly improved clot strength as well as increased resistance to hyperfibrinolysis in vitro which was confirmed by ROTEM. Platelet function on Sonoclot was significantly increased by FXIII in a dose-dependent manner. Factor XIII significantly decreased the total amount of bleeding and prolonged the survival time compared to control (control vs FXIII: 108.9 +/- 11.4 vs 32.6 +/- 5.5 mL/kg; p < 0.001; 26.0 +/- 8.8 vs 120 minutes, p < 0.001) in a rat model. Rotational thromboelastometry parameters and platelet function on Sonoclot were significantly improved in the FXIII (+) group compared to control. No adverse effects of FXIII were detected histologically. CONCLUSION: Factor XIII not only generated stable clot resistance to hyperfibrinolysis but also enhanced platelet function by facilitating clot retraction. High-dose FXIII administration therapy has significant clinical impact for severe trauma accompanied with TAC. STUDY TYPE: Human in vitro and rat in vivo experimental study. FAU - Nagashima, Futoshi AU - Nagashima F AD - From the Division of Trauma Surgery and Surgical Critical Care, Saga University Hospital, Nabeshima Saga, Japan (F.N., S.I.); Department of Emergency Medicine, Saga University Hospital, Saga, Japan (H.K., T.M., Y.S.); and Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan (K.K.). FAU - Inoue, Satoshi AU - Inoue S FAU - Koami, Hiroyuki AU - Koami H FAU - Miike, Toru AU - Miike T FAU - Sakamoto, Yuichiro AU - Sakamoto Y FAU - Kai, Keita AU - Kai K LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Blood Coagulation Factors) RN - 9013-56-3 (Factor XIII) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Animals MH - Blood Coagulation Disorders/*drug therapy MH - Blood Coagulation Factors/administration & dosage/therapeutic use MH - Factor XIII/administration & dosage/adverse effects/*therapeutic use MH - Hemostasis/*drug effects MH - Humans MH - Liver/drug effects/*injuries/surgery MH - Male MH - Middle Aged MH - Platelet Function Tests/methods MH - Rats MH - Rats, Sprague-Dawley MH - Shock, Hemorrhagic/*drug therapy MH - Thrombelastography/methods MH - Tissue Plasminogen Activator EDAT- 2018/06/01 06:00 MHDA- 2019/05/03 06:00 CRDT- 2018/06/01 06:00 PHST- 2018/06/01 06:00 [pubmed] PHST- 2019/05/03 06:00 [medline] PHST- 2018/06/01 06:00 [entrez] AID - 10.1097/TA.0000000000001998 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Sep;85(3):588-597. doi: 10.1097/TA.0000000000001998. PMID- 29799542 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240314 IS - 2059-5131 (Electronic) IS - 2059-5131 (Linking) VI - 3 DP - 2017 Jan-Dec TI - Measuring coagulation in burns: an evidence-based systematic review. PG - 2059513117728201 LID - 10.1177/2059513117728201 [doi] LID - 2059513117728201 AB - INTRODUCTION: Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based. OBJECTIVES: Establishing the role of different coagulation markers in burn patients, diagnosing coagulopathy, tailoring blood product administration and indicating prognosis. METHODS: Literature during 2004-2017 from the Cochrane Library, PubMed, Scopus, Medline and Embase was reviewed. Eligibility criteria included randomised controlled trials, systematic reviews, multi-/single-centre study and meta-analyses. Keywords searched were 'burns', 'blood coagulation disorders', 'rotem', 'blood coagulation' and 'thromboelastography'. The PRISMA flow system was used for stratification and the CASP framework for appraisal of the studies retrieved. RESULTS: In total, 13 articles were included after inclusion/exclusion criteria had been applied to the initial 79 studies retrieved. Hypercoagulation increases in proportion to the severity of thermal injury. Whole blood testing, using thrombelastography (TEG) and rotation thromboelastometry (ROTEM), was superior to standard plasma based tests, including prothrombin time (PT) and activated partial thromboplastin time (APTT) at detecting burn-related coagulopathies. CONCLUSIONS: Routine laboratory markers such as PT/APTT are poor indicators of coagulation status in burns patients. Viscoelastic tests, such as TEG and ROTEM, are efficient, fast and have a potential use in the management of burn patients; however, strong evidence is lacking. This review highlights the need for more randomised controlled trials, to guide future practice. FAU - Marsden, Nicholas J AU - Marsden NJ AD - NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK. AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. FAU - Van, Martin AU - Van M AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. FAU - Dean, Samera AU - Dean S AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. FAU - Azzopardi, Ernest A AU - Azzopardi EA AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. AD - Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK. FAU - Hemington-Gorse, Sarah AU - Hemington-Gorse S AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. FAU - Evans, Phillip A AU - Evans PA AD - NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK. AD - Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK. FAU - Whitaker, Iain S AU - Whitaker IS AD - Welsh Centre for Burns and Plastic Surgery, Swansea, UK. AD - Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK. LA - eng PT - Journal Article PT - Review DEP - 20170905 PL - United States TA - Scars Burn Heal JT - Scars, burns & healing JID - 101718377 PMC - PMC5965330 OTO - NOTNLM OT - Burns OT - clotting OT - coagulation tests OT - point-of-care OT - rotation thromboelastometry OT - thrombelastography OT - viscoelastic test COIS- Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2018/05/26 06:00 MHDA- 2018/05/26 06:01 PMCR- 2017/09/05 CRDT- 2018/05/26 06:00 PHST- 2018/05/26 06:00 [entrez] PHST- 2018/05/26 06:00 [pubmed] PHST- 2018/05/26 06:01 [medline] PHST- 2017/09/05 00:00 [pmc-release] AID - 10.1177_2059513117728201 [pii] AID - 10.1177/2059513117728201 [doi] PST - epublish SO - Scars Burn Heal. 2017 Sep 5;3:2059513117728201. doi: 10.1177/2059513117728201. eCollection 2017 Jan-Dec. PMID- 29794847 OWN - NLM STAT- MEDLINE DCOM- 20200320 LR - 20200320 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 270 IP - 6 DP - 2019 Dec TI - Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study. PG - 1178-1185 LID - 10.1097/SLA.0000000000002825 [doi] AB - OBJECTIVE: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). BACKGROUND: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. METHODS: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x10/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. RESULTS: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30.Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. CONCLUSIONS: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma. FAU - Baksaas-Aasen, Kjersti AU - Baksaas-Aasen K AD - Department of Traumatology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway. FAU - Van Dieren, Susan AU - Van Dieren S AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. FAU - Balvers, Kirsten AU - Balvers K AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands. FAU - Naess, Pal A AU - Naess PA AD - Department of Traumatology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway. FAU - Rourke, Claire AU - Rourke C AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom. FAU - Eaglestone, Simon AU - Eaglestone S AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Stanworth, Simon AU - Stanworth S AD - NHS Blood and Transplant, Oxford University Hospital NHS Trust, John Radcliffe Hospital, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. FAU - Maegele, Marc AU - Maegele M AD - Department for Traumatology and Orthopedic Surgery, Cologne- Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. FAU - Goslings, J C AU - Goslings JC AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Brohi, Karim AU - Brohi K AD - Center for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. CN - TACTIC/INTRN collaborators LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Adult MH - *Algorithms MH - Blood Coagulation Disorders/*diagnosis/etiology/*therapy MH - Blood Coagulation Tests MH - Female MH - Hemorrhage/etiology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Sensitivity and Specificity MH - Thrombelastography MH - Wounds and Injuries/*complications/therapy EDAT- 2018/05/26 06:00 MHDA- 2020/03/21 06:00 CRDT- 2018/05/26 06:00 PHST- 2018/05/26 06:00 [pubmed] PHST- 2020/03/21 06:00 [medline] PHST- 2018/05/26 06:00 [entrez] AID - 10.1097/SLA.0000000000002825 [doi] PST - ppublish SO - Ann Surg. 2019 Dec;270(6):1178-1185. doi: 10.1097/SLA.0000000000002825. PMID- 29766129 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220317 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 3 IP - 1 DP - 2018 TI - Is thromboelastography (TEG)-based resuscitation better than empirical 1:1 transfusion? PG - e000140 LID - 10.1136/tsaco-2017-000140 [doi] LID - e000140 AB - Thomboelastography (TEG) is a whole blood measure of coagulation which was originally described in the 1950s. However, it has only been in the last few decades that assays have become accessible and viable as a point-of-care test. Following the observation that hemorrhagic shock is associated with an intrinsic coagulopathy, TEG has been used as a method of diagnosing specific coagulation defects in order to direct individualized blood products resuscitation. An alternative transfusion strategy is the administration of fixed ratio products, a paradigm borne out of military experience. It is unknown which strategy is superior and this topic was debated at the 36th Annual Point/Counterpoint Acute Care Surgery Conference. The following article summarizes the discussants points of view along with a summary of the evidence. LEVEL OF EVIDENCE: Level III. FAU - Howley, Isaac W AU - Howley IW AD - R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA. FAU - Haut, Elliott R AU - Haut ER AD - Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA. FAU - Jacobs, Lenwoth AU - Jacobs L AD - Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA. FAU - Morrison, Jonathan J AU - Morrison JJ AUID- ORCID: 0000-0001-7462-8456 AD - R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA. FAU - Scalea, Thomas M AU - Scalea TM AD - R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA. LA - eng PT - Journal Article DEP - 20180108 PL - England TA - Trauma Surg Acute Care Open JT - Trauma surgery & acute care open JID - 101698646 PMC - PMC5887764 OTO - NOTNLM OT - blood transfusion OT - coagulation tests OT - coagulopathy of trauma OT - shock resuscitation COIS- Competing interests: None declared. EDAT- 2018/05/17 06:00 MHDA- 2018/05/17 06:01 PMCR- 2018/01/08 CRDT- 2018/05/17 06:00 PHST- 2017/11/01 00:00 [received] PHST- 2017/11/08 00:00 [accepted] PHST- 2018/05/17 06:00 [entrez] PHST- 2018/05/17 06:00 [pubmed] PHST- 2018/05/17 06:01 [medline] PHST- 2018/01/08 00:00 [pmc-release] AID - tsaco-2017-000140 [pii] AID - 10.1136/tsaco-2017-000140 [doi] PST - epublish SO - Trauma Surg Acute Care Open. 2018 Jan 8;3(1):e000140. doi: 10.1136/tsaco-2017-000140. eCollection 2018. PMID- 29764673 OWN - NLM STAT- MEDLINE DCOM- 20190821 LR - 20210521 IS - 2173-5077 (Electronic) IS - 2173-5077 (Linking) VI - 96 IP - 7 DP - 2018 Aug-Sep TI - Comparison between thromboelastography and conventional coagulation test: Should we abandon conventional coagulation tests in polytrauma patients? PG - 443-449 LID - S0009-739X(18)30118-0 [pii] LID - 10.1016/j.ciresp.2018.04.003 [doi] AB - INTRODUCTION: TEG provides an in-vivo assessment of viscoelastic clot strength in whole blood compared with CCT, which may not reflect the influence of platelets. The aim of this study was to compare TEG vs. CCT in trauma patients stratified by mechanism of injury (MOI) and pre-existing coagulation status. METHODS: A retrospective, observational study of 230 polytrauma patients admitted to a University Hospital Level 1 Trauma Center, with TEG and CCT on admission stratified by MOI: multiple trauma (MT), isolated traumatic brain injury (TBI) or MT+TBI. Statistical analysis included correlation between TEG and CCT in all groups and a subgroup analysis of anticoagulated patients. Data were analyzed with ANOVA, Spearman and lineal regression when appropriate. Statistical significance was accepted at P<0.05. RESULTS: TEG was normal in 28.7%, hypercoagulable in 68.3%, hypocoagulable in 7%. There was no difference in TEG status among the groups. The coagulation status was not affected by age, ISS or shock. The CCT were abnormal in 63.6% of patients with normal TEG. Normal or hypercoagulable-TEG was found in 21/23 patients on Coumadin who had elevated INR and in 10/11 patients on NOAC. An analysis of the 23 patients on Coumadin stratified by INR showed a normal or hypercoagulable-TEG in 21/23 patients. Only 2 patients had a hypocoagulable-TEG. Mortality was 5.2% (58.3% severe TBI). CONCLUSIONS: TEG is more useful than CCT in polytrauma patients, including patients on anticoagulants. TBI could increase the incidence of hypercoagulability in trauma. CCT are not useful from the standpoint of treatment. CI - Copyright (c) 2018 AEC. Publicado por Elsevier Espana, S.L.U. All rights reserved. FAU - Tur Martinez, Jaume AU - Tur Martinez J AD - Hospital Univesitari Mutua de Terrassa, Barcelona, Espana; NYU Winthrop Hospital, Mineola, Long Island, New York, EE. UU. FAU - Petrone, Patrizio AU - Petrone P AD - NYU Winthrop Hospital, Mineola, Long Island, New York, EE. UU.; New York Medical College, Valhalla, New York, USA. Electronic address: patrizio.petrone@gmail.com. FAU - Axelrad, Alexander AU - Axelrad A AD - NYU Winthrop Hospital, Mineola, Long Island, New York, EE. UU. FAU - Marini, Corrado P AU - Marini CP AD - New York Medical College, Valhalla, New York, USA. LA - eng LA - spa PT - Comparative Study PT - Journal Article PT - Observational Study TT - Comparacion entre tromboelastografia y test de coagulacion convencionales: inverted question markdeberiamos abandonar los test de coagulacion convencional en el paciente politraumatizado? PL - Spain TA - Cir Esp (Engl Ed) JT - Cirugia espanola JID - 101771152 MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Tests MH - Child MH - Female MH - Humans MH - Male MH - Middle Aged MH - Multiple Trauma/*blood/*diagnostic imaging MH - Retrospective Studies MH - *Thrombelastography MH - Young Adult OTO - NOTNLM OT - Conventional coagulation test OT - Test coagulacion convencional OT - Thromboelastography OT - Trauma OT - Traumatismo OT - Trombolestografia EDAT- 2018/05/17 06:00 MHDA- 2019/08/23 06:00 CRDT- 2018/05/17 06:00 PHST- 2018/01/09 00:00 [received] PHST- 2018/04/05 00:00 [revised] PHST- 2018/04/08 00:00 [accepted] PHST- 2018/05/17 06:00 [pubmed] PHST- 2019/08/23 06:00 [medline] PHST- 2018/05/17 06:00 [entrez] AID - S0009-739X(18)30118-0 [pii] AID - 10.1016/j.ciresp.2018.04.003 [doi] PST - ppublish SO - Cir Esp (Engl Ed). 2018 Aug-Sep;96(7):443-449. doi: 10.1016/j.ciresp.2018.04.003. PMID- 29758989 OWN - NLM STAT- MEDLINE DCOM- 20181024 LR - 20200225 IS - 1938-2723 (Electronic) IS - 1076-0296 (Print) IS - 1076-0296 (Linking) VI - 24 IP - 6 DP - 2018 Sep TI - The Double Hazard of Bleeding and Thrombosis in Hemostasis From a Clinical Point of View: A Global Assessment by Rotational Thromboelastometry (ROTEM). PG - 850-858 LID - 10.1177/1076029618772336 [doi] AB - Hemostasis is a complex dynamic process involving bleeding and thrombosis as two end-points. Conventional coagulation tests which are measured in plasma examine only isolated portions of the coagulation cascade, thereby giving no information on important interactions essential to the clinical evaluation of hemostatic function. Thromboelastography (TEG), originally described in 1948 has improved over the decades and become a valuable tool of coagulation testing because of the limitations of standard coagulation tests. TEG is a technique that provides data about the entire coagulation system, from the beginning of clot formation to fibrinolysis, involving both cellular and plasma components of hemostasis. Rotational thromboelastometry (ROTEM) which evolved from TEG technology overcome several limitations of classical TEG while maintaining a good correlation with conventional TEG determination. ROTEM analyses are useful for rapid assessment of global clotting function in various clinical situations including liver transplantation, cardiac surgery, obstetrics, trauma, hemophilia and idiopathic thrombocytopenic purpura. ROTEM has been also reported to be useful in identifying various hypercoagulable conditions including major surgery, malignancy, Behcet's disease and apheresis. Further developments in ROTEM based transfusion strategies may also reduce transfusion requirements and improve clinical outcomes by optimizing the administration of blood components. This is a literature review of ROTEM including its technique, interpretation and specially clinical applications in different scenarios of bleeding and thrombotic disorders. FAU - Akay, Olga Meltem AU - Akay OM AD - 1 Department of Hematology, Koc University Medical School, Istanbul, Turkey. LA - eng PT - Historical Article PT - Journal Article PT - Review DEP - 20180514 PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 SB - IM MH - Animals MH - *Fibrinolysis MH - Hemorrhage/*blood MH - History, 20th Century MH - History, 21st Century MH - Humans MH - Thrombelastography/history/*methods MH - Thrombosis/*blood PMC - PMC6714726 OTO - NOTNLM OT - bleeding OT - hemostasis OT - thromboelastometry OT - thrombosis COIS- Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2018/05/16 06:00 MHDA- 2018/10/26 06:00 PMCR- 2018/05/14 CRDT- 2018/05/16 06:00 PHST- 2018/05/16 06:00 [pubmed] PHST- 2018/10/26 06:00 [medline] PHST- 2018/05/16 06:00 [entrez] PHST- 2018/05/14 00:00 [pmc-release] AID - 10.1177_1076029618772336 [pii] AID - 10.1177/1076029618772336 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2018 Sep;24(6):850-858. doi: 10.1177/1076029618772336. Epub 2018 May 14. PMID- 29729417 OWN - NLM STAT- MEDLINE DCOM- 20190522 LR - 20190522 IS - 1878-7568 (Electronic) IS - 1742-7061 (Linking) VI - 74 DP - 2018 Jul 1 TI - Compressive mechanical characterization of non-human primate spinal cord white matter. PG - 260-269 LID - S1742-7061(18)30271-X [pii] LID - 10.1016/j.actbio.2018.05.002 [doi] AB - The goal of developing computational models of spinal cord injury (SCI) is to better understand the human injury condition. However, finite element models of human SCI have used rodent spinal cord tissue properties due to a lack of experimental data. Central nervous system tissues in non human primates (NHP) closely resemble that of humans and therefore, it is expected that material constitutive models obtained from NHPs will increase the fidelity and the accuracy of human SCI models. Human SCI most often results from compressive loading and spinal cord white matter properties affect FE predicted patterns of injury; therefore, the objectives of this study were to characterize the unconfined compressive response of NHP spinal cord white matter and present an experimentally derived, finite element tractable constitutive model for the tissue. Cervical spinal cords were harvested from nine male adult NHPs (Macaca mulatta). White matter biopsy samples (3 mm in diameter) were taken from both lateral columns of the spinal cord and were divided into four strain rate groups for unconfined dynamic compression and stress relaxation (post-mortem <1-hour). The NHP spinal cord white matter compressive response was sensitive to strain rate and showed substantial stress relaxation confirming the viscoelastic behavior of the material. An Ogden 1st order model best captured the non-linear behavior of NHP white matter in a quasi-linear viscoelastic material model with 4-term Prony series. This study is the first to characterize NHP spinal cord white matter at high (>10/sec) strain rates typical of traumatic injury. The finite element derived material constitutive model of this study will increase the fidelity of SCI computational models and provide important insights for transferring pre-clinical findings to clinical treatments. STATEMENT OF SIGNIFICANCE: Spinal cord injury (SCI) finite element (FE) models provide an important tool to bridge the gap between animal studies and human injury, assess injury prevention technologies (e.g. helmets, seatbelts), and provide insight into the mechanisms of injury. Although, FE model outcomes depend on the assumed material constitutive model, there is limited experimental data for fresh spinal cords and all was obtained from rodent, porcine or bovine tissues. Central nervous system tissues in non human primates (NHP) more closely resemble humans. This study characterizes fresh NHP spinal cord material properties at high strains rates and large deformations typical of SCI for the first time. A constitutive model was defined that can be readily implemented in finite strain FE analysis of SCI. CI - Copyright (c) 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved. FAU - Jannesar, Shervin AU - Jannesar S AD - Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada. FAU - Allen, Mark AU - Allen M AD - California National Primate Research Center, University of California Davis, CA, USA. FAU - Mills, Sarah AU - Mills S AD - California National Primate Research Center, University of California Davis, CA, USA. FAU - Gibbons, Anne AU - Gibbons A AD - California National Primate Research Center, University of California Davis, CA, USA. FAU - Bresnahan, Jacqueline C AU - Bresnahan JC AD - Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, San Francisco, CA, USA. FAU - Salegio, Ernesto A AU - Salegio EA AD - California National Primate Research Center, University of California Davis, CA, USA. FAU - Sparrey, Carolyn J AU - Sparrey CJ AD - Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada. Electronic address: csparrey@sfu.ca. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180502 PL - England TA - Acta Biomater JT - Acta biomaterialia JID - 101233144 SB - IM MH - Animals MH - *Compressive Strength MH - *Elasticity MH - Finite Element Analysis MH - Humans MH - Macaca mulatta MH - *Models, Neurological MH - *Stress, Mechanical MH - White Matter/*chemistry OTO - NOTNLM OT - Non-human primate OT - Spinal cord injury OT - Tissue characterization OT - Viscoelastic constitutive model OT - White matter EDAT- 2018/05/08 06:00 MHDA- 2019/05/23 06:00 CRDT- 2018/05/06 06:00 PHST- 2017/11/13 00:00 [received] PHST- 2018/04/27 00:00 [revised] PHST- 2018/05/01 00:00 [accepted] PHST- 2018/05/08 06:00 [pubmed] PHST- 2019/05/23 06:00 [medline] PHST- 2018/05/06 06:00 [entrez] AID - S1742-7061(18)30271-X [pii] AID - 10.1016/j.actbio.2018.05.002 [doi] PST - ppublish SO - Acta Biomater. 2018 Jul 1;74:260-269. doi: 10.1016/j.actbio.2018.05.002. Epub 2018 May 2. PMID- 29709368 OWN - NLM STAT- MEDLINE DCOM- 20181226 LR - 20190802 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 164 IP - 2 DP - 2018 Aug TI - Empiric transfusion strategies during life-threatening hemorrhage. PG - 306-311 LID - S0039-6060(18)30125-9 [pii] LID - 10.1016/j.surg.2018.02.024 [doi] AB - BACKGROUND: Resuscitation guided by thrombelastography improves survival after injury. If bleeding is rapid, however, or if no thrombelastography data are available, the optimal strategy remains controversial. Our current practice gives fresh frozen plasma and red blood cells (1:2) empirically in patients with life-threatening hemorrhage, with subsequent administration based on rapid thrombelastography. We identified patients at risk of massive transfusion at 1 hour, examined their initial rapid thrombelastography, and used this value to provide empiric recommendations about transfusions. METHODS: Massive transfusion was defined as >4 units of red blood cells in the first hour. Patients managed by a trauma activation (2014-2017) had an admission rapid thrombelastography analyzed to determine what proportion met thresholds for administration of cryoprecipitate or platelets. RESULTS: Overall, 35 patients received >4 units of red blood cells in the first hour. Based on the admission rapid thrombelastography, 37% met criteria for both platelets and cryoprecipitate, 35% for either platelets or cryoprecipitate and 29% for neither. Kaplan-Meier analysis showed a significant delay in the administration of cryoprecipitate and platelets compared to fresh frozen plasma. CONCLUSION: Patients who require >4 units of red blood cells within the first hour should receive cryoprecipitate and platelets if thrombelastography results are not available. Point-of-care devices are needed for optimal care of trauma-induced-coagulopathy, but these data offer guidance in their absence. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Nunns, Geoffrey R AU - Nunns GR AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO; Denver Health Medical Center, Denver, CO. Electronic address: ernest.moore@dhha.org. FAU - Stettler, Gregory R AU - Stettler GR AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO. FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - Denver Health Medical Center, Denver, CO. FAU - Cohen, Mitchell AU - Cohen M AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO; Denver Health Medical Center, Denver, CO. FAU - Huebner, Benjamin R AU - Huebner BR AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO. FAU - Silliman, Christopher C AU - Silliman CC AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO; University of Colorado School of Medicine Department of Pediatrics, Aurora, CO; Bonfils Blood Center, Denver, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO. FAU - Sauaia, Angela AU - Sauaia A AD - University of Colorado School of Medicine Department of Surgery, Aurora, CO; University of Colorado School of Public Health, Aurora, CO. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20180427 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Blood Transfusion/methods/*statistics & numerical data MH - Cohort Studies MH - Colorado/epidemiology MH - Female MH - Hemorrhage/etiology/*mortality/therapy MH - Humans MH - Male MH - Middle Aged MH - Risk Assessment MH - Thrombelastography MH - Wounds and Injuries/complications PMC - PMC6056322 MID - NIHMS954505 EDAT- 2018/05/02 06:00 MHDA- 2018/12/27 06:00 PMCR- 2019/08/01 CRDT- 2018/05/01 06:00 PHST- 2018/01/15 00:00 [received] PHST- 2018/02/20 00:00 [accepted] PHST- 2018/05/02 06:00 [pubmed] PHST- 2018/12/27 06:00 [medline] PHST- 2018/05/01 06:00 [entrez] PHST- 2019/08/01 00:00 [pmc-release] AID - S0039-6060(18)30125-9 [pii] AID - 10.1016/j.surg.2018.02.024 [doi] PST - ppublish SO - Surgery. 2018 Aug;164(2):306-311. doi: 10.1016/j.surg.2018.02.024. Epub 2018 Apr 27. PMID- 29703240 OWN - NLM STAT- MEDLINE DCOM- 20180910 LR - 20181202 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 26 IP - 1 DP - 2018 Apr 27 TI - Temporal phenotyping of circulating microparticles after trauma: a prospective cohort study. PG - 33 LID - 10.1186/s13049-018-0499-9 [doi] LID - 33 AB - BACKGROUND: After severe polytrauma the dynamic process of coagulation may deteriorate towards a trauma-induced coagulopathy (TIC) promoting a dramatic increase in morbidity and mortality. Recent evidence suggests that microparticles (MPs) play a pivotal role at the interface between cellular and plasmatic coagulation systems. However, the impact of MPs on functional coagulation has not been clarified yet in the setting of traumatic injuries. We assessed the temporal patterns of circulating MP concentrations including their cellular origin in the context of clinical presentation and global coagulation assays. METHODS: Blood samples from 22 consecutive polytrauma patients (ISS >/=16) from 2015 were collected at hospital admission, after 24 and 72 h and compared to those from healthy individuals and minor injured patients with isolated extremity fractures. Flow cytometry (BD Accuri C6; Heidelberg/Germany) was used to determine MP concentrations and cellular origin using cell-specific markers (platelet derived (PDMP): CD42b(+), CD61(+), CD62p(+); endothelial cell derived (EDMP): CD144(+), CD62e(+), CD144(+)/62e(+)). Results were correlated with clinical data and results from viscoelastic testing (ROTEM). RESULTS: Twenty two polytrauma patients (17 males, age(median) 60 yrs) with a median ISS 26.5 (IQR 14.5) were assessed. PDMP and EDMP concentrations increased significantly in polytrauma patients as compared to healthy individuals and minor injured patients. MP concentrations correlated with injury severity (CD144(+): rho(sp) = 0.79, p < 0.001; CD42b(+): rho(sp) = 0.61, p < 0.001). EDMP displayed a negative correlation with aPTT (CD144/62e(+), rho(sp) = - 0.55, p < 0.05), INR (CD144/62e(+), rho(sp) = - 0.61, p < 0.05) and ROTEM-INTEM CT (CD144/62e(+), rho(sp) = - 0.68, p < 0.05) reflecting increased dynamics of clot formation and an overall procoagulative effect. Additionally, EDMP showed a negative association with FIBTEM values (10 min amplitude, maximum clot firmness) indicating a fibrinolytic potential. DISCUSSION: In a small cohort, analysing most severly injured patients, the association of increased MP levels and altered coagulation parameters could be demonstrated. However, these findings are based on correlation analysis, which do not enable causel evidence. Therefore, further in-vitro studies are needed analysing the underlying pathomechanisms. CONCLUSION: In conclusion, this study could demonstrate that PDMP and EDMP levels increase significantly following polytrauma correlating with injury severity. Although severe coagulopathy was not observed, EDMP levels were associated with improved coagulation parameters suggesting their essential role for regulating blood coagulation after trauma. FAU - Frohlich, Matthias AU - Frohlich M AUID- ORCID: 0000-0002-8444-632X AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de. FAU - Schafer, Nadine AU - Schafer N AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. FAU - Caspers, Michael AU - Caspers M AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. FAU - Bohm, Julia K AU - Bohm JK AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. FAU - Sturmer, Ewa K AU - Sturmer EK AD - Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Stockumer Street 10, D-58453, Witten, Germany. FAU - Bouillon, Bertil AU - Bouillon B AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. LA - eng GR - Internal Research Fund/University of Witten/Herdecke/ PT - Journal Article PT - Multicenter Study DEP - 20180427 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Biomarkers) SB - IM MH - Biomarkers/blood MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Blood Coagulation Tests MH - Cell-Derived Microparticles/*metabolism MH - Female MH - Flow Cytometry MH - Humans MH - Male MH - Middle Aged MH - Multiple Trauma/blood/*complications MH - Partial Thromboplastin Time MH - Prospective Studies MH - Thrombelastography/methods PMC - PMC5921785 OTO - NOTNLM OT - Coagulation OT - EDMP OT - Microparticle OT - PDMP OT - Trauma COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The present study is embedded in part in the multicentre Activation of Coagulation and Inflammation in Trauma II (ACIT II) study that obtained ethical approval from the Witten/Herdecke University (37/2005, 33/2015). Individual informed consent was obtained at hospital admission or in case of severe injury as soon as possible thereafter. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/04/29 06:00 MHDA- 2018/09/11 06:00 PMCR- 2018/04/27 CRDT- 2018/04/29 06:00 PHST- 2017/08/03 00:00 [received] PHST- 2018/04/11 00:00 [accepted] PHST- 2018/04/29 06:00 [entrez] PHST- 2018/04/29 06:00 [pubmed] PHST- 2018/09/11 06:00 [medline] PHST- 2018/04/27 00:00 [pmc-release] AID - 10.1186/s13049-018-0499-9 [pii] AID - 499 [pii] AID - 10.1186/s13049-018-0499-9 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2018 Apr 27;26(1):33. doi: 10.1186/s13049-018-0499-9. PMID- 29688784 OWN - NLM STAT- MEDLINE DCOM- 20180924 LR - 20260127 IS - 1943-5681 (Electronic) IS - 0002-9645 (Linking) VI - 79 IP - 5 DP - 2018 May TI - Thromboelastographic evaluation of dogs bitten by rattlesnakes native to southern California. PG - 532-537 LID - 10.2460/ajvr.79.5.532 [doi] AB - OBJECTIVE To validate that dogs become hypocoagulable following rattlesnake envenomation and to determine whether thromboelastographic abnormalities are correlated with envenomation severity for dogs bitten by rattlesnakes native to southern California. ANIMALS 14 dogs with observed or suspected rattlesnake envenomation (envenomated dogs) and 10 healthy control dogs. PROCEDURES For each dog, a citrate-anticoagulated blood sample underwent kaolin-activated thromboelastography. For each envenomated dog, a snakebite severity score was assigned on the basis of clinical findings, and prothrombin time, activated partial thromboplastin time, and platelet count were determined when the attending clinician deemed it necessary and owner finances allowed. RESULTS For 12 of 14 envenomated dogs, the thromboelastographically determined clot strength was below the 25th percentile for the clot strength of control dogs, which was indicative of a hypocoagulable state. No envenomated dog had thromboelastographic results indicative of a hypercoagulable state. One envenomated dog had a prolonged prothrombin time, but the activated partial thromboplastin time and all thromboelastographic variables were within the respective reference ranges for that dog. Seven of 13 envenomated dogs were thrombocytopenic (platelet count, /=10 red cell concentrates (RCC) in 24 h. Episodes were identified using the laboratory information system. Patient records were reviewed manually for demographics, transfusion indication, haemostatic drugs and mortality. The ATPs contained six units RCC, six units Octaplas and two platelet concentrates (four buffy coats/apheresis in platelet additive solution (PAS)). RESULTS: A total of 410 episodes were identified in 410 patients. The mean patient age was 60 years (9-94), with a male predominance (64%); 87.1% of MT episodes were in support of surgery (cardiac services 42.7%; trauma 17.6%), and 29.8% of MTs involved platelet inhibitors, with 82.6% of these undergoing cardiac procedures. MT accounted for 2.8% of all RCCs and 3.4% of platelets issued. The mean ratio of blood components RCC: plasma: platelets changed from 1.0 : 0.37 : 0.39 in 2002-2006 (n = 149) to 1.0 : 0.79 : 0.85 in 2008-2015 (n = 241, P < 0.001). A sub-analysis showed that cardiac specialities used proportionally more plasma and platelets. CONCLUSION: The MT programme changed transfusion practice, resulting in greater use of plasma and platelets. MT was primarily used in major surgery. The practice in cardiac surgery may reflect changes in antiplatelet medication. CI - (c) 2018 British Blood Transfusion Society. FAU - Doughty, H AU - Doughty H AD - NHS Blood and Transplant, Birmingham, UK. FAU - Apelseth, T O AU - Apelseth TO AD - Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. AD - Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway. FAU - Sivertsen, J AU - Sivertsen J AD - Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. FAU - Annaniasen, K AU - Annaniasen K AD - Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. FAU - Hervig, T AU - Hervig T AD - Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. AD - Institute of Clinical Science, University of Bergen, Bergen, Norway. LA - eng GR - Medical Women's Federation, United Kingdom/ PT - Journal Article DEP - 20180423 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Blood Component Transfusion MH - Child MH - *Databases, Factual MH - Female MH - Hemorrhage/epidemiology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Norway MH - Retrospective Studies MH - Sex Factors MH - Wounds and Injuries/epidemiology/*therapy OTO - NOTNLM OT - acute transfusion package OT - blood component therapy OT - massive transfusion OT - red cell: plasma: platelet ratio EDAT- 2018/04/24 06:00 MHDA- 2018/12/14 06:00 CRDT- 2018/04/24 06:00 PHST- 2018/01/04 00:00 [received] PHST- 2018/03/27 00:00 [revised] PHST- 2018/03/28 00:00 [accepted] PHST- 2018/04/24 06:00 [pubmed] PHST- 2018/12/14 06:00 [medline] PHST- 2018/04/24 06:00 [entrez] AID - 10.1111/tme.12529 [doi] PST - ppublish SO - Transfus Med. 2018 Oct;28(5):357-362. doi: 10.1111/tme.12529. Epub 2018 Apr 23. PMID- 29664836 OWN - NLM STAT- MEDLINE DCOM- 20200423 LR - 20200423 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 51 IP - 3 DP - 2019 Mar TI - TEG Lysis Shutdown Represents Coagulopathy in Bleeding Trauma Patients: Analysis of the PROPPR Cohort. PG - 273-283 LID - 10.1097/SHK.0000000000001160 [doi] AB - BACKGROUND: Thrombelastography (TEG) fibrinolysis shutdown after trauma is associated with increased mortality due to hypercoagulability-associated organ failure. However, a lack of mechanistic data has precluded the development of novel interventions to treat shutdown. OBJECTIVES: To define the pathophysiology of TEG shutdown in severely injured, bleeding patients through secondary analysis of the PROPPR trial. METHODS: Fibrinolysis was characterized in PROPPR subjects using admission TEG lysis at 30 min (LY30) or plasmin-antiplasmin (PAP) levels. LY30 categories were low (<0.9%), moderate (0.9-2.9%), or high (>/= 3%). PAP was classified as low (<1,500 mug/L), moderate (1,500-20,000 mug/L), or high (>20,000 mug/L). Demographics, outcomes, admission TEG values, platelet count and function, standard coagulation tests, and coagulation proteins were compared. RESULTS: Five hundred forty-seven patients had TEG data and 549 patients had PAP data available. Low LY30 was associated with reduced platelet count and aggregation, poorer TEG clot formation, prolonged clotting times, and reduced fibrinogen and alpha2 antiplasmin. Compared to moderate PAP, low PAP subjects had similar platelet parameters, TEG values, fibrinogen, and alpha2 antiplasmin, but reduced tPA, and elevated PAI-1. D-Dimer values increased as PAP increased, however patients with low LY30 had elevated D-Dimer compared with moderate LY30 patients. Most low LY30 deaths were due to TBI (45%) and hemorrhage (42%) versus one of each cause (TBI, hemorrhage, MOF) in low PAP patients. CONCLUSIONS: Low TEG LY30 does not reflect shutdown of enzymatic fibrinolysis with hypercoagulability, but rather a coagulopathic state of moderate fibrinolysis with fibrinogen consumption and platelet dysfunction that is associated with poor outcomes. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas. AD - Center for Translational Injury Research, Houston, Texas. FAU - Wade, Charles E AU - Wade CE AD - Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas. AD - Center for Translational Injury Research, Houston, Texas. FAU - Cotton, Bryan A AU - Cotton BA AD - Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas. AD - Center for Translational Injury Research, Houston, Texas. FAU - George, Mitchell J AU - George MJ AD - Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas. FAU - Holcomb, John B AU - Holcomb JB AD - Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, Houston, Texas. AD - Center for Translational Injury Research, Houston, Texas. FAU - Schreiber, Martin A AU - Schreiber MA AD - Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon. FAU - White, Nathan J AU - White NJ AD - The University of Washington Department of Emergency Medicine, Harborview Medical Center, Seattle, Washington. CN - PROPPR Study Group LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States GR - U01 HL077863/HL/NHLBI NIH HHS/United States GR - CRR-120612/CIHR/Canada PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Plasminogen Activator Inhibitor 1) RN - 0 (SERPINE1 protein, human) RN - 0 (alpha-2-Antiplasmin) RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Shock. 2019 Dec;52(6):639-640. doi: 10.1097/SHK.0000000000001341. PMID: 30855518 CIN - Shock. 2019 Dec;52(6):640-641. doi: 10.1097/SHK.0000000000001346. PMID: 30889045 MH - Adult MH - Female MH - Fibrinogen/metabolism MH - *Fibrinolysis MH - Hemorrhage/*blood MH - Humans MH - Male MH - Middle Aged MH - Plasminogen Activator Inhibitor 1/metabolism MH - Retrospective Studies MH - *Thrombelastography MH - Thrombophilia/*blood MH - alpha-2-Antiplasmin/metabolism PMC - PMC6191375 MID - NIHMS958955 COIS- Disclosures: The authors declare no conflicts of interest EDAT- 2018/04/18 06:00 MHDA- 2020/04/24 06:00 PMCR- 2020/03/01 CRDT- 2018/04/18 06:00 PHST- 2018/04/18 06:00 [pubmed] PHST- 2020/04/24 06:00 [medline] PHST- 2018/04/18 06:00 [entrez] PHST- 2020/03/01 00:00 [pmc-release] AID - 10.1097/SHK.0000000000001160 [doi] PST - ppublish SO - Shock. 2019 Mar;51(3):273-283. doi: 10.1097/SHK.0000000000001160. PMID- 29660502 OWN - NLM STAT- MEDLINE DCOM- 20190321 LR - 20260127 IS - 2352-5568 (Electronic) IS - 2352-5568 (Linking) VI - 37 IP - 4 DP - 2018 Aug TI - The place of fibrinogen concentrates in the management of perioperative bleeding: A position paper from the Francophone Working Group on Perioperative Haemostasis (GIHP). PG - 355-365 LID - S2352-5568(18)30093-6 [pii] LID - 10.1016/j.accpm.2018.04.002 [doi] AB - The consumption of fibrinogen concentrates has been increasing steadily for several years in surgery, trauma and obstetrics. However, data from the literature are conflicting. The French Working Group on Perioperative Haemostasis (GIHP) proposes a position paper based on a narrative review of the literature, and addresses the following questions: What is the exact role of fibrinogen in haemostasis? Which rational support for the use of perioperative fibrinogen? Which thrombotic risk? What are the most recent professional recommendations on the use of fibrinogen concentrates? Then, evidence-based recommendations are proposed: 1) it is suggested not to administer prophylactic FC to prevent haemorrhage; 2) it is suggested not to use FC alone. Haemostatic treatment must be comprehensive, include other haemostatic treatments and must be limited in cases of severe active haemorrhage; 3) the GIHP suggests urgent measurement of fibrinogen plasma concentration in a biology laboratory or functional fibrinogen by viscoelastic methods. The choice between the two methods must be guided by the time to receive the results from a certified organisation with, in particular, authorisation to perform delocalised biologic examinations; 4) it is suggested not to administer FC when the fibrinogen concentration is superior to 1.5g/L or when there is a functional fibrinogen deficit (with the possible exception in obstetrics where the threshold could be 2.0g/L); 5) if FC are administered, an initial dose of 25-50mg/kg is proposed. CI - Copyright (c) 2018 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved. FAU - Samama, Charles Marc AU - Samama CM AD - Department of anaesthesia and intensive care, hopital Cochin, CHU, Paris Descartes university, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. Electronic address: marc.samama@aphp.fr. FAU - Ickx, Brigitte AU - Ickx B AD - Department of anaesthesia and intensive care, Erasme hospital, route de Lennik, 808, 1070, Brussels, Belgium. Electronic address: brigitte.ickx@ulb.ac.be. FAU - Ozier, Yves AU - Ozier Y AD - Department of surgical anaesthesia and intensive care, CHRU de Brest, universite de Bretagne occidentale, hopital de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France. Electronic address: yves.ozier@chu-brest.fr. FAU - Steib, Annick AU - Steib A AD - Department of anaesthesia and intensive care, hopital civil, HUS, 67091 Strasbourg cedex, France. Electronic address: Annick.Steib@chru-strasbourg.fr. FAU - Susen, Sophie AU - Susen S AD - Institute of haematology and transfusion, CHRU de Lille, 59037 Lille cedex, France. Electronic address: sophie.susen@chru-lille.fr. FAU - Godier, Anne AU - Godier A AD - Department of anaesthesia, fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France. Electronic address: annegodier@yahoo.fr. LA - eng PT - Consensus Statement PT - Journal Article PT - Review DEP - 20180413 PL - France TA - Anaesth Crit Care Pain Med JT - Anaesthesia, critical care & pain medicine JID - 101652401 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Loss, Surgical/*prevention & control MH - Fibrinogen/adverse effects/*therapeutic use MH - *Hemostasis MH - Hemostatics/therapeutic use MH - Humans MH - Perioperative Care/*standards MH - Thrombosis/chemically induced/epidemiology OTO - NOTNLM OT - Fibrinogen OT - Haemorrhage OT - Obstetrics OT - Polytrauma OT - Surgery OT - Transfusion EDAT- 2018/04/17 06:00 MHDA- 2019/03/22 06:00 CRDT- 2018/04/17 06:00 PHST- 2018/03/10 00:00 [received] PHST- 2018/04/02 00:00 [accepted] PHST- 2018/04/17 06:00 [pubmed] PHST- 2019/03/22 06:00 [medline] PHST- 2018/04/17 06:00 [entrez] AID - S2352-5568(18)30093-6 [pii] AID - 10.1016/j.accpm.2018.04.002 [doi] PST - ppublish SO - Anaesth Crit Care Pain Med. 2018 Aug;37(4):355-365. doi: 10.1016/j.accpm.2018.04.002. Epub 2018 Apr 13. PMID- 29658985 OWN - NLM STAT- MEDLINE DCOM- 20190409 LR - 20190409 IS - 1365-2044 (Electronic) IS - 0003-2409 (Print) IS - 0003-2409 (Linking) VI - 73 IP - 9 DP - 2018 Sep TI - Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM((R)) EXTEM A5) to predict massive transfusion and in-hospital mortality in trauma: a retrospective analysis of 1146 patients. PG - 1103-1109 LID - 10.1111/anae.14297 [doi] AB - Viscoelastic assays such as TEG((R)) and ROTEM((R)) are increasingly used to guide transfusion of blood products. The EXTEM assay maximum clot firmness (MCF) is a ROTEM measure available after 25-29 min used to guide early decisions. EXTEM A10, the clot firmness at 10 min, is an accepted early surrogate, but investigators differ on whether A5, the clot firmness at 5 min, is acceptable. We re-examined this in a retrospective observational analysis of 1146 trauma patients in one centre who had ROTEM data recorded. A5 and A10 both correlated well with maximum clot firmness, with Pearson coefficients of r = 0.92 and r = 0.96, respectively. The correlations of A5, A10 and maximum clot firmness with requirement for massive transfusion were all similarly high, with c-stats of 0.87, 0.89 and 0.90, respectively. The correlations with mortality were also similar but weaker, with c-stats of 0.67, 0.69 and 0.69, respectively. Using a previously validated cut-off of A5 < 35 mm to predict massive transfusion gave a sensitivity of 95%, specificity 83%, positive predictive value 9.3% and negative predictive value 100%. Using a value of A5 < 29 mm, for a pragmatic positive predictive value of 20%, gave a sensitivity of 67%, specificity 95% and negative predictive value 99%. Whether aiming for a high sensitivity or a strong predictive value, A5 was non-inferior to A10 and actually missed fewer cases needing massive transfusion. A5 has similar utility to both A10 and maximum clot firmness as an early measure of clot firmness, and a low A5 value is strongly predictive of the need for massive transfusion. CI - (c) 2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. FAU - Kelly, J M AU - Kelly JM AD - Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham, UK. FAU - Rizoli, S AU - Rizoli S AD - Trauma Department, St Michael's Hospital, Toronto, Canada. FAU - Veigas, P AU - Veigas P AD - Trauma Department, St Michael's Hospital, Toronto, Canada. FAU - Hollands, S AU - Hollands S AD - Institute for Clinical Evaluative Studies, University of Toronto, Canada. FAU - Min, A AU - Min A AD - Royal College of Surgeons in Ireland, Dublin, Ireland. LA - eng PT - Journal Article PT - Observational Study DEP - 20180416 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*diagnosis/*etiology/mortality MH - Blood Transfusion/*statistics & numerical data MH - Female MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Ontario/epidemiology MH - Predictive Value of Tests MH - ROC Curve MH - Retrospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Triage/methods MH - Wounds and Injuries/blood/*complications/mortality MH - Young Adult PMC - PMC6120456 OTO - NOTNLM OT - ROTEM OT - bleeding OT - massive transfusion OT - trauma, coagulation EDAT- 2018/04/17 06:00 MHDA- 2019/04/10 06:00 PMCR- 2018/09/03 CRDT- 2018/04/17 06:00 PHST- 2018/03/03 00:00 [accepted] PHST- 2018/04/17 06:00 [pubmed] PHST- 2019/04/10 06:00 [medline] PHST- 2018/04/17 06:00 [entrez] PHST- 2018/09/03 00:00 [pmc-release] AID - ANAE14297 [pii] AID - 10.1111/anae.14297 [doi] PST - ppublish SO - Anaesthesia. 2018 Sep;73(9):1103-1109. doi: 10.1111/anae.14297. Epub 2018 Apr 16. PMID- 29621120 OWN - NLM STAT- MEDLINE DCOM- 20200304 LR - 20250724 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 51 IP - 2 DP - 2019 Feb TI - Absences of Endothelial Microvesicle Changes in the Presence of the Endotheliopathy of Trauma. PG - 180-184 LID - 10.1097/SHK.0000000000001149 [doi] AB - INTRODUCTION: Severe trauma is accompanied by endothelial glycocalyx disruption, which drives coagulopathy, increasing transfusion requirements and death. This syndrome has been termed endotheliopathy of trauma (EOT). Some have suggested EOT results from endothelial cellular damage and apoptosis. Endothelial microvesicles (EMVs) represent cellular damage. We hypothesized that EOT is associated with endothelial damage and apoptosis resulting in an increase in circulating EMVs. METHODS: Prospective, observational study enrolling severely injured patients. Twelve patients with EOT, based on elevated Syndecan-1 levels, were matched with 12 patients with lower levels, based on Injury Severity Score (ISS), abbreviated injury scale profile, and age. Thrombelastography and plasma levels of biomarkers indicative of cellular damage were measured from blood samples collected on admission. EMVs were determined by flow cytometry using varied monoclonal antibodies associated with endothelial cells. Significance was set at P < 0.05. RESULTS: Admission physiology and ISS (29 vs. 28) were similar between groups. Patients with EOT had higher Syndecan-1, 230 (158, 293) vs. 19 (14, 25) ng/mL, epinephrine, and soluble thrombomodulin levels. Based on thrombelastography, EOT had reductions in clot initiation, amplification, propagation and strength, and a greater frequency of transfusion, 92% vs. 33%. There were no differences in EMVs irrespective of the antibody used. Plasma norepinephrine, sE-selectin, sVE-cadherin, and histone-complexed DNA fragments levels were similar. CONCLUSION: In trauma patients presenting with EOT, endothelial cellular damage or apoptosis does not seem to occur based on the absence of an increase in EMVs and other biomarkers. Thus, this suggests endothelial glycocalyx disruption is the underlying primary cause of EOT. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Wang, Yao-Wei W AU - Wang YW AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Rodriguez, Erika G AU - Rodriguez EG AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Lopez, Ernesto AU - Lopez E AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Baer, Lisa A AU - Baer LA AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Chen, Tzu-An AU - Chen TA AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Tomasek, Jeffrey S AU - Tomasek JS AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Henriksen, Hanne H AU - Henriksen HH AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. AD - Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Cotton, Bryan A AU - Cotton BA AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Johansson, Par I AU - Johansson PI AD - Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, University of Texas Health Science Center at Houston, Houston, Texas. AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Apoptosis MH - Biomarkers/blood MH - *Blood Coagulation Disorders/blood/etiology/pathology MH - *Endothelial Cells/metabolism/pathology MH - *Glycocalyx/metabolism/pathology MH - Injury Severity Score MH - *Wounds and Injuries/blood/complications/pathology EDAT- 2018/04/06 06:00 MHDA- 2020/03/05 06:00 CRDT- 2018/04/06 06:00 PHST- 2018/04/06 06:00 [pubmed] PHST- 2020/03/05 06:00 [medline] PHST- 2018/04/06 06:00 [entrez] AID - 10.1097/SHK.0000000000001149 [doi] PST - ppublish SO - Shock. 2019 Feb;51(2):180-184. doi: 10.1097/SHK.0000000000001149. PMID- 29580113 OWN - NLM STAT- MEDLINE DCOM- 20181009 LR - 20211204 IS - 1369-1635 (Electronic) IS - 0953-7104 (Print) IS - 0953-7104 (Linking) VI - 29 IP - 5 DP - 2018 Jul TI - Platelet biomechanics, platelet bioenergetics, and applications to clinical practice and translational research. PG - 431-439 LID - 10.1080/09537104.2018.1453062 [doi] AB - The purpose of this review is to explore the relationship between platelet bioenergetics and biomechanics and how this relationship affects the clinical interpretation of platelet function devices. Recent experimental and technological advances highlight platelet bioenergetics and biomechanics as alternative avenues for collecting clinically relevant data. Platelet bioenergetics drive energy production for key biomechanical processes like adhesion, spreading, aggregation, and contraction. Platelet function devices like thromboelastography, thromboelastometry, and aggregometry measure these biomechanical processes. Platelet storage, stroke, sepsis, trauma, or the activity of antiplatelet drugs alters measures of platelet function. However, the specific mechanisms governing these alterations in platelet function and how they relate to platelet bioenergetics are still under investigation. FAU - George, Mitchell J AU - George MJ AUID- ORCID: 0000-0003-1668-821X AD - a Department of Surgery, McGovern Medical School , The University of Texas Health Science Center , Houston , TX , USA. FAU - Bynum, James AU - Bynum J AD - c Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort , Sam Houston , TX , USA. FAU - Nair, Prajeeda AU - Nair P AD - c Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort , Sam Houston , TX , USA. FAU - Cap, Andrew P AU - Cap AP AD - a Department of Surgery, McGovern Medical School , The University of Texas Health Science Center , Houston , TX , USA. AD - c Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort , Sam Houston , TX , USA. FAU - Wade, Charles E AU - Wade CE AD - a Department of Surgery, McGovern Medical School , The University of Texas Health Science Center , Houston , TX , USA. FAU - Cox, Charles S Jr AU - Cox CS Jr AD - b Department of Pediatric Surgery, McGovern Medical School , The University of Texas Health Science Center , Houston , TX , USA. FAU - Gill, Brijesh S AU - Gill BS AD - a Department of Surgery, McGovern Medical School , The University of Texas Health Science Center , Houston , TX , USA. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review DEP - 20180326 PL - England TA - Platelets JT - Platelets JID - 9208117 SB - IM MH - Biomechanical Phenomena/*immunology MH - Blood Platelets/*metabolism MH - Energy Metabolism/*immunology MH - Humans MH - Platelet Function Tests/*instrumentation/*methods MH - Translational Research, Biomedical/*methods PMC - PMC6323006 MID - NIHMS997841 OTO - NOTNLM OT - Platelet bioenergetics and biomechanics EDAT- 2018/03/28 06:00 MHDA- 2018/10/10 06:00 PMCR- 2019/07/01 CRDT- 2018/03/28 06:00 PHST- 2018/03/28 06:00 [pubmed] PHST- 2018/10/10 06:00 [medline] PHST- 2018/03/28 06:00 [entrez] PHST- 2019/07/01 00:00 [pmc-release] AID - 10.1080/09537104.2018.1453062 [doi] PST - ppublish SO - Platelets. 2018 Jul;29(5):431-439. doi: 10.1080/09537104.2018.1453062. Epub 2018 Mar 26. PMID- 29559805 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220316 IS - 1178-7031 (Print) IS - 1178-7031 (Electronic) IS - 1178-7031 (Linking) VI - 11 DP - 2018 TI - Moderate glucose supply reduces hemolysis during systemic inflammation. PG - 87-94 LID - 10.2147/JIR.S155614 [doi] AB - BACKGROUND: Systemic inflammation alters energy metabolism. A sufficient glucose level, however, is most important for erythrocytes, since erythrocytes rely on glucose as sole source of energy. Damage to erythrocytes leads to hemolysis. Both disorders of glucose metabolism and hemolysis are associated with an increased risk of death. The objective of the study was to investigate the impact of intravenous glucose on hemolysis during systemic inflammation. MATERIALS AND METHODS: Systemic inflammation was accomplished in male Wistar rats by continuous lipopolysaccharide (LPS) infusion (1 mg LPS/kg and h, 300 min). Sham control group rats received Ringer's solution. Glucose was supplied moderately (70 mg glucose/kg and h) or excessively (210 mg glucose/kg and h) during systemic inflammation. Vital parameters (eg, systemic blood pressure) as well as blood and plasma parameters (eg, concentrations of glucose, lactate and cell-free hemoglobin, and activity of lactate dehydrogenase) were measured hourly. Clot formation was analyzed by thromboelastometry. RESULTS: Continuous infusion of LPS led to a so-called post-aggression syndrome with disturbed electrolyte homeostasis (hypocalcemia, hyperkalemia, and hypernatremia), changes in hemodynamics (tachycardia and hypertension), and a catabolic metabolism (early hyperglycemia, late hypoglycemia, and lactate formation). It induced severe tissue injury (significant increases in plasma concentrations of transaminases and lactate dehydrogenase), alterations in blood coagulation (disturbed clot formation), and massive hemolysis. Both moderate and excessive glucose supply reduced LPS-induced increase in systemic blood pressure. Excessive but not moderate glucose supply increased blood glucose level and enhanced tissue injury. Glucose supply did not reduce LPS-induced alterations in coagulation, but significantly reduced hemolysis induced by LPS. CONCLUSION: Intravenous glucose infusion can diminish LPS-related changes in hemodynamics, glucose metabolism, and, more interestingly, LPS-induced hemolysis. Since cell-free hemoglobin is known to be a predictor for patient's survival, a reduction of hemolysis by 35% only by the addition of a small amount of glucose is another step to minimize mortality during systemic inflammation. FAU - Jagers, Johannes AU - Jagers J AD - Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. FAU - Brauckmann, Stephan AU - Brauckmann S AD - Clinic for Anesthesiology and Intensive Care, University Hospital Essen, Essen, Germany. FAU - Kirsch, Michael AU - Kirsch M AD - Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. FAU - Effenberger-Neidnicht, Katharina AU - Effenberger-Neidnicht K AD - Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. AD - Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. LA - eng PT - Journal Article DEP - 20180312 PL - New Zealand TA - J Inflamm Res JT - Journal of inflammation research JID - 101512684 PMC - PMC5856073 OTO - NOTNLM OT - cell-free hemoglobin OT - erythrocytes OT - glucose metabolism OT - lipopolysaccharide OT - red blood cells OT - sepsis COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2018/03/22 06:00 MHDA- 2018/03/22 06:01 PMCR- 2018/03/12 CRDT- 2018/03/22 06:00 PHST- 2018/03/22 06:00 [entrez] PHST- 2018/03/22 06:00 [pubmed] PHST- 2018/03/22 06:01 [medline] PHST- 2018/03/12 00:00 [pmc-release] AID - jir-11-087 [pii] AID - 10.2147/JIR.S155614 [doi] PST - epublish SO - J Inflamm Res. 2018 Mar 12;11:87-94. doi: 10.2147/JIR.S155614. eCollection 2018. PMID- 29554044 OWN - NLM STAT- MEDLINE DCOM- 20190306 LR - 20190610 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 84 IP - 6 DP - 2018 Jun TI - Systemic hyperfibrinolysis after trauma: a pilot study of targeted proteomic analysis of superposed mechanisms in patient plasma. PG - 929-938 LID - 10.1097/TA.0000000000001878 [doi] AB - BACKGROUND: Viscoelastic measurements of hemostasis indicate that 20% of seriously injured patients exhibit systemic hyperfibrinolysis, with increased early mortality. These patients have normal clot formation with rapid clot lysis. Targeted proteomics was applied to quantify plasma proteins from hyperfibrinolytic (HF) patients to elucidate potential pathophysiology. METHODS: Blood samples were collected in the field or at emergency department arrival and thrombelastography (TEG) was used to characterize in vitro clot formation under native and tissue plasminogen activator (tPA)-stimulated conditions. Ten samples were taken from injured patients exhibiting normal lysis time at 30 min (Ly30), "eufibrinolytic" (EF), 10 from HF patients, defined as tPA-stimulated TEG Ly30 >50%, and 10 from healthy controls. Trauma patient samples were analyzed by targeted proteomics and ELISA assays for specific coagulation proteins. RESULTS: HF patients exhibited increased plasminogen activation. Thirty-three proteins from the HF patients were significantly decreased compared with healthy controls and EF patients; 17 were coagulation proteins with anti-protease consumption (p < 0.005). The other 16 decreased proteins indicate activation of the alternate complement pathway, depletion of carrier proteins, and four glycoproteins. CXC7 was elevated in all injured patients versus healthy controls (p < 0.005), and 35 proteins were unchanged across all groups (p > 0.1 and fold change of concentrations of 0.75-1.3). CONCLUSION: HF patients had significant decreases in specific proteins and support mechanisms known in trauma-induced hyperfibrinolysis and also unexpected decreases in coagulation factors, factors II, X, and XIII, without changes in clot formation (SP, R times, or angle). Decreased clot stability in HF patients was corroborated with tPA-stimulated TEGs. LEVEL OF EVIDENCE: Prognostic, level III. FAU - Banerjee, Anirban AU - Banerjee A AD - From the Departments of Surgery (A.B., C.C.S., E.E.M., M.K., A.S., E.G., H.B.M., E.P., B.E.H., P.E., J.C., A.G.), Pediatrics (C.C.S., K.J.), Biochemistry and Molecular Genetics (A.D'A., K.H.), and Radiology (M.P.C.), School of Medicine, University of Colorado Denver, Aurora, CO; Research Laboratory (C.C.S., M.K.), Bonfils Blood Center, Denver, CO; and the Department of Surgery (E.E.M., M.D., A.S., E.G., H.B.M., B.E.H, P.E., J.C., A.G.), Denver Health Medical Center, Denver, CO. FAU - Silliman, Christopher C AU - Silliman CC FAU - Moore, Ernest E AU - Moore EE FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M FAU - Kelher, Marguerite AU - Kelher M FAU - Sauaia, Angela AU - Sauaia A FAU - Jones, Kenneth AU - Jones K FAU - Chapman, Michael P AU - Chapman MP FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Moore, Hunter B AU - Moore HB FAU - D'Alessandro, Angelo AU - D'Alessandro A FAU - Peltz, Erik AU - Peltz E FAU - Huebner, Benjamin E AU - Huebner BE FAU - Einerson, Peter AU - Einerson P FAU - Chandler, James AU - Chandler J FAU - Ghasabayan, Arsen AU - Ghasabayan A FAU - Hansen, Kirk AU - Hansen K LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) RN - 0 (Blood Proteins) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Biomarkers/metabolism MH - Blood Coagulation Disorders/mortality MH - Blood Proteins/*metabolism MH - Case-Control Studies MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Hydrogen-Ion Concentration MH - Injury Severity Score MH - Male MH - Mass Spectrometry MH - Middle Aged MH - Pilot Projects MH - Proteomics/*methods MH - Thrombelastography MH - Tissue Plasminogen Activator/metabolism MH - Wounds and Injuries/*blood PMC - PMC5970039 MID - NIHMS949321 COIS- The authors have no conflict of interest with the submitted work. EDAT- 2018/03/20 06:00 MHDA- 2019/03/07 06:00 PMCR- 2019/06/01 CRDT- 2018/03/20 06:00 PHST- 2018/03/20 06:00 [pubmed] PHST- 2019/03/07 06:00 [medline] PHST- 2018/03/20 06:00 [entrez] PHST- 2019/06/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000001878 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jun;84(6):929-938. doi: 10.1097/TA.0000000000001878. PMID- 29554042 OWN - NLM STAT- MEDLINE DCOM- 20190422 LR - 20210701 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 84 IP - 6S Suppl 1 DP - 2018 Jun TI - Effects of platelet-sparing leukocyte reduction and agitation methods on in vitro measures of hemostatic function in cold-stored whole blood. PG - S104-S114 LID - 10.1097/TA.0000000000001870 [doi] AB - BACKGROUND: Agitation of platelet units stored at room temperature is performed routinely to maintain platelet function, and leukoreduction of blood products is the standard of care in many countries to reduce immune consequences of transfusion. The effect of agitation and leukoreduction on whole blood stored at 4 degrees C requires investigation, as reductions in hemostatic capacity of whole blood may reduce its efficacy in treating trauma-induced coagulopathy and platelet dysfunction. We hypothesize that agitation of whole blood will not affect hemostatic function and that leukoreduction will reduce hemostatic function of whole blood. METHODS: In this in vitro randomized controlled study, 21 units of leukoreduced and 20 nonleukoreduced whole blood units were each randomly assigned into four agitation groups. Hemostatic parameters were measured using viscoelastic assays (rotational thromboelastometry-Extrinsic Screening Test (ROTEM-EXTEM) and thromboelastography (TEG) platelet mapping), impedance aggregometry (agonists-adenosine phosphate, arachidonic acid, thrombin receptor activating peptide, and collagen), and a thrombin generation assay from these whole blood units before and after filtration and on 0, 5, 10, and 15 days of storage at 4 degrees C. RESULTS: Leukoreduction compared to nonleukoreduction reduced platelet concentration on Day 0. Viscoelastic measures and thrombin generation parameters revealed significant reduction in hemostatic function between the leukoreduced units and the nonleukoreduced units at a few time points. Leukoreduced units consistently demonstrated reduced platelet aggregation compared to the nonleukoreduced units. Agitation methods did not significantly affect any of the hemostatic parameters examined. CONCLUSIONS: Leukoreduction of whole blood with a platelet-sparing filter caused a moderate but significant reduction in some measures of whole blood hemostatic function most evident early in storage. The benefits of leukoreduction should be weighed against the potential reduced hemostatic function of leukoreduced units. Agitation of whole blood is not required to maintain hemostatic function. LEVEL OF EVIDENCE: In vitro randomized controlled trial, level 1. FAU - Remy, Kenneth E AU - Remy KE AD - From the Division of Pediatric Critical Care Medicine, Department of Pediatrics (K.E.R., A.M-V., S.R.R., P.C.S.), Washington University School of Medicine, St. Louis, Missouri; Institute for Transfusion Medicine (M.H.Y.), University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Pediatric Critical Care Medicine, Department of Pediatrics (A.S.), The University of Tennessee Health Science Center, Memphis, Tennessee; and Coagulation and Blood Research Program (A.P.C., P.C.S.), United States Army Institute of Surgical Research; Ft Sam Houston, Texas. FAU - Yazer, Mark H AU - Yazer MH FAU - Saini, Arun AU - Saini A FAU - Mehanovic-Varmaz, Ajlana AU - Mehanovic-Varmaz A FAU - Rogers, Sharon R AU - Rogers SR FAU - Cap, Andrew P AU - Cap AP FAU - Spinella, Philip C AU - Spinella PC LA - eng GR - K08 GM129763/GM/NIGMS NIH HHS/United States GR - L40 HD089386/HD/NICHD NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Platelets MH - Blood Preservation/methods MH - Cold Temperature MH - *Hemostasis MH - Humans MH - In Vitro Techniques MH - *Leukocyte Reduction Procedures MH - Platelet Aggregation MH - Thrombelastography MH - Thrombin/metabolism PMC - PMC8242931 MID - NIHMS1604180 EDAT- 2018/03/20 06:00 MHDA- 2019/04/23 06:00 PMCR- 2021/06/30 CRDT- 2018/03/20 06:00 PHST- 2018/03/20 06:00 [pubmed] PHST- 2019/04/23 06:00 [medline] PHST- 2018/03/20 06:00 [entrez] PHST- 2021/06/30 00:00 [pmc-release] AID - 10.1097/TA.0000000000001870 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S104-S114. doi: 10.1097/TA.0000000000001870. PMID- 29553873 OWN - NLM STAT- MEDLINE DCOM- 20190417 LR - 20190417 IS - 1369-1635 (Electronic) IS - 0953-7104 (Linking) VI - 30 IP - 3 DP - 2019 TI - Activation, function and content of platelets in burn patients. PG - 396-402 LID - 10.1080/09537104.2018.1448379 [doi] AB - Burn injury has severe impact on the physiologic homeostasis. Platelet counts show a distinct course post-burn injury, with a nadir at day 3 followed by a thrombocytotic period with at peak at day 15, with a gradual return to normal. So far, it is unknown how the functionality and activational status of platelets develop post burn. In this study, we investigated if the function, activation and growth factor content of platelets of burn patients are affected and how this evolves in time. Six burn patients with over 15% total burned surface area were followed during 1 month. Standard hematological and coagulation analyses, thromboelastography (TEG), platelet-function analyzer-100 (PFA), several platelet activation parameters (CD62P-CD63, AnnexinV) and growth factors (TGFb1, VEGF, PDGF-AB/BB, EGF, TGFb2, FGF-2, PDGF-AA) analyses were performed. TEG analyses showed procoagulant changes. PFA-100 analyses were nearly all within normal range. CD62P and CD63 and Annexin-V indicated no clear activation of platelets. Growth factor content followed the same course as the platelet count, reflecting a constant growth factor per platelet ratio. Concluding, platelets post burn-injury appears to be functional and not overly activated. However, burn patients seem to remain in a procoagulant state for an extensive period, which may impact their pathology. FAU - Marck, Roos E AU - Marck RE AD - a Department of Plastic, Reconstructive & Hand Surgery , Academical Medical Center , Amsterdam , the Netherlands. AD - b Burn Center , Red Cross Hospital , Beverwijk , The Netherlands. AD - c Research Institute MOVE , VU University Medical Center , Amsterdam , the Netherlands. FAU - van der Bijl, Ivo AU - van der Bijl I AD - d Sanquin Research, Department of Blood Cell Research Landsteiner Laboratory , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands. FAU - Korsten, Herbert AU - Korsten H AD - e Department Product and Process Development , Sanquin Blood Bank , Amsterdam , the Netherlands. FAU - Lorinser, Jos AU - Lorinser J AD - e Department Product and Process Development , Sanquin Blood Bank , Amsterdam , the Netherlands. FAU - de Korte, Dirk AU - de Korte D AUID- ORCID: 0000-0001-9772-7377 AD - d Sanquin Research, Department of Blood Cell Research Landsteiner Laboratory , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands. AD - e Department Product and Process Development , Sanquin Blood Bank , Amsterdam , the Netherlands. FAU - Middelkoop, Esther AU - Middelkoop E AD - b Burn Center , Red Cross Hospital , Beverwijk , The Netherlands. AD - c Research Institute MOVE , VU University Medical Center , Amsterdam , the Netherlands. AD - f Association of Dutch Burn Centers , Beverwijk , The Netherlands. AD - g Department of Plastic, Reconstructive & Hand Surgery , VU University Medical , Amsterdam , the Netherlands. LA - eng PT - Journal Article DEP - 20180319 PL - England TA - Platelets JT - Platelets JID - 9208117 SB - IM MH - Adult MH - Burns/*blood MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Activation/*physiology MH - Platelet-Rich Plasma/*metabolism MH - Young Adult OTO - NOTNLM OT - Burn OT - growth factor OT - platelet OT - platelet function OT - platelet rich plasma EDAT- 2018/03/20 06:00 MHDA- 2019/04/18 06:00 CRDT- 2018/03/20 06:00 PHST- 2018/03/20 06:00 [pubmed] PHST- 2019/04/18 06:00 [medline] PHST- 2018/03/20 06:00 [entrez] AID - 10.1080/09537104.2018.1448379 [doi] PST - ppublish SO - Platelets. 2019;30(3):396-402. doi: 10.1080/09537104.2018.1448379. Epub 2018 Mar 19. PMID- 29538232 OWN - NLM STAT- MEDLINE DCOM- 20190422 LR - 20190422 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 84 IP - 6S Suppl 1 DP - 2018 Jun TI - Preparation of leukoreduced whole blood for transfusion in austere environments; effects of forced filtration, storage agitation, and high temperatures on hemostatic function. PG - S93-S103 LID - 10.1097/TA.0000000000001896 [doi] AB - BACKGROUND: Damage control resuscitation principles advocate the use of blood to treat traumatic hemorrhage. Hemorrhage is a leading cause of preventable death on the battlefield, but making blood components available far forward presents logistical challenges due to shelf life and storage requirements. Whole blood simplifies logistics and enables collection in the field but can cause leukocyte-related transfusion reactions. A field-adapted leukoreduction system must be fast and safe, and storage of whole blood should preserve hemostatic function. METHODS: Blood was collected using Imuflex WB-SP and leukoreduced at 0, 150, or 300 mm Hg. Additional bags were stored at 4 degrees C for 21 days unagitated, mixed daily, agitated or head-over-heel rotated, at 22 degrees C for 3 days, or 32 degrees C for 2 hours. Hematology, coagulation, CD62P/CD42b, thromboelastography (TEG)/thromboelastometry (ROTEM), and Multiplate was performed. RESULTS: Filtration time was 35 +/- 1, 14 +/- 0, and 9 +/- 0 minutes at 0, 150, and 300 mm Hg, respectively. One of 10 units at 150 mm Hg and 4 of 11 at 300 mm Hg had residual whole blood cells greater than 5.0 x 10 per unit. One of 11 at 300 mm Hg had platelet recovery of less than 80%. Hemolysis was less than 0.2%. Filtration decreased thromboelastography/thromboelastometry and Multiplate aggregation response. Stored at 4 degrees C, alpha and MA/MCF moderately decreased regardless of mixing. Significant loss of aggregation response and increased CD62P expression was seen by Day 10. By Day 3, storage at 22 degrees C caused loss of most aggregation. Two-hour storage at 32 degrees C did not significantly affect hemostatic capacity. CONCLUSION: Forced filtration reduced leukoreduction time, but increased residual whole blood cells reduced hemostatic function. Aggregation response deteriorated early in storage, while viscoelastic assays decreased more gradually. Mixing showed no benefits. LEVEL OF EVIDENCE: Diagnostic study, level IV. FAU - Sivertsen, Joar AU - Sivertsen J AD - From the Department of Immunology and Transfusion Medicine (J.S., H.B., T.H.F.L., G.S., T.O.A., T.A.H., E.K.K.), Haukeland University Hospital, Bergen, Norway; Department of Pediatrics (P.C.S.), Washington University St Louis School of Medicine, Washington; Trauma/Acute Care Surgery, Medical Center of the Rockies, Medical Center of the Rockies, Denver, Colorado (W.D.); Norwegian Naval Special Operations Command (G.S.), Bergen, Norway; and Department of Clinical Science (T.A.H., E.K.K.), University of Bergen, Bergen, Norway. FAU - Braathen, Hanne AU - Braathen H FAU - Lunde, Turid Helen F AU - Lunde THF FAU - Spinella, Philip C AU - Spinella PC FAU - Dorlac, Warren AU - Dorlac W FAU - Strandenes, Geir AU - Strandenes G FAU - Apelseth, Torunn O AU - Apelseth TO FAU - Hervig, Tor A AU - Hervig TA FAU - Kristoffersen, Einar K AU - Kristoffersen EK LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Hemoglobins) SB - IM MH - Blood Cell Count MH - Blood Preservation/adverse effects/methods MH - *Blood Specimen Collection/adverse effects MH - Blood Transfusion/*methods MH - Exsanguination/therapy MH - Female MH - Flowers MH - Hematocrit MH - Hemofiltration/methods MH - Hemoglobins/analysis MH - *Hemostasis MH - Hot Temperature/adverse effects MH - Humans MH - *Leukocyte Reduction Procedures/methods MH - Male MH - Military Medicine/methods MH - Platelet Aggregation MH - Thrombelastography EDAT- 2018/03/15 06:00 MHDA- 2019/04/23 06:00 CRDT- 2018/03/15 06:00 PHST- 2018/03/15 06:00 [pubmed] PHST- 2019/04/23 06:00 [medline] PHST- 2018/03/15 06:00 [entrez] AID - 10.1097/TA.0000000000001896 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S93-S103. doi: 10.1097/TA.0000000000001896. PMID- 29538230 OWN - NLM STAT- MEDLINE DCOM- 20190903 LR - 20190903 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 85 IP - 1S Suppl 2 DP - 2018 Jul TI - Enhanced platelet function in cold stored whole blood supplemented with resveratrol or cytochrome C. PG - S92-S97 LID - 10.1097/TA.0000000000001887 [doi] AB - BACKGROUND: Limited availability and use of whole blood (WB) following trauma is driven by perceptions that hemostatic function is limited by platelet dysfunction within 5 days storage. We sought to define the hemostatic function of WB stored at 4 degrees C for up to 25 days, elucidate changes in metabolic parameters and mitochondrial dysfunction in platelets in WB, and the effect of supplementation using resveratrol (Res) or cytochrome c (Cyt c). METHODS: Whole blood was collected, aliquoted, and stored at 4 degrees C without agitation. Resveratrol or Cyt c was supplemented before storage, or 10 days post-storage. Serial samples were collected and analyzed for hemostatic function by platelet mapping thromboelastography. Platelets isolated from WB were counted and mitochondrial function assessed by oxygen consumption, mitochondrial membrane potential, and biochemical parameters. RESULTS: Platelet function of WB was maintained up to 15 days at 4 degrees C before a significant decrease was observed at 25 days. Resveratrol or Cyt c improved WB aggregation potential when supplemented 10 days post-storage. Platelet oxygen consumption was maintained until 10-day storage but significantly decreased thereafter in the absence of change in platelet count. Cytochrome c increased oxygen consumption on Day 15 and platelet mitochondrial membrane potential steadily decreased over time, an effect attenuated by Res or Cyt c supplementation 10 days post-storage. Potassium and lactate levels increased during storage, while pH levels decreased, with no observed effect following Res or Cyt c supplementation. CONCLUSION: Storing cold WB with Res or Cyt c supplementation enhances ex vivo aggregation by improving platelet function, thereby extending overall storage life. These findings have potential significance for improving WB availability in immediate trauma situations, including treatment in a battlefield trauma setting. LEVEL OF EVIDENCE: Translational study, diagnostic test or criteria, level II. FAU - Ekaney, Michael L AU - Ekaney ML AD - From the FH "Sammy" Ross Trauma Center, Department of Surgery (M.L.E., G.G.G., I.H.M., S.L.E.), Carolinas Medical Center, Charlotte, North Carolina. FAU - Gray, Gabrielle Gonzalez AU - Gray GG FAU - McKillop, Iain H AU - McKillop IH FAU - Evans, Susan L AU - Evans SL LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9007-43-6 (Cytochromes c) RN - Q369O8926L (Resveratrol) SB - IM MH - Blood Platelets/*drug effects/metabolism MH - Blood Preservation/*methods MH - Cold Temperature MH - Cytochromes c/*pharmacology MH - Humans MH - Membrane Potential, Mitochondrial/drug effects MH - Oxygen Consumption/drug effects MH - Platelet Function Tests MH - Resveratrol/*pharmacology MH - Thrombelastography EDAT- 2018/03/15 06:00 MHDA- 2019/09/04 06:00 CRDT- 2018/03/15 06:00 PHST- 2018/03/15 06:00 [pubmed] PHST- 2019/09/04 06:00 [medline] PHST- 2018/03/15 06:00 [entrez] AID - 10.1097/TA.0000000000001887 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S92-S97. doi: 10.1097/TA.0000000000001887. PMID- 29493552 OWN - NLM STAT- MEDLINE DCOM- 20180914 LR - 20180914 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 31 IP - 2 DP - 2018 Apr TI - Pediatric trauma transfusion and cognitive aids. PG - 201-206 LID - 10.1097/ACO.0000000000000569 [doi] AB - PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial. In addition to the blood that is lost from the injury itself, trauma leads to inflammation and to a dysfunction in hemostasis, causing coagulopathy. RECENT FINDINGS: In one study in which children suffered from mainly blast and penetrating injuries in a combat setting (PEDTRAX trial), the early administration of tranexamic acid was associated with decreased mortality. Some authors suggest that this result may not apply to blunt trauma, which is much more common in children in noncombat settings. Using thromboelastography to guide the administration of recombinant Factor VIIa has been done in selected cases and may represent a future avenue of research. SUMMARY: This article explores new research from the past year in pediatric trauma, starting with the physiologic differences in pediatric red blood cells and coagulation profiles. We also looked at the dramatic change in thinking over the past decade in the tolerable level of anemia in critically ill pediatric patients, as well as scales for determining the need for massive transfusion and exploring if the concepts of damage control resuscitation apply to children. Other strategies, such as avoiding hypothermia, and the selective administration of antifibriniolytics, are important in pediatric trauma as well. Future research that is pediatric focused is needed for the optimal care of our youngest patients. FAU - Clebone, Anna AU - Clebone A AD - Department of Anesthesia and Critical Care, University of Chicago, Chicago IL 60637, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Antifibrinolytic Agents) SB - IM MH - Age Factors MH - Anemia/etiology/mortality/physiopathology/*therapy MH - Antifibrinolytic Agents/therapeutic use MH - Blood Coagulation/physiology MH - Blood Transfusion/*methods/standards MH - Child MH - Clinical Protocols MH - Critical Illness/mortality/*therapy MH - Erythrocytes/physiology MH - Hemorrhage/etiology/mortality/physiopathology/*therapy MH - Humans MH - Incidence MH - Resuscitation/adverse effects/methods/standards MH - Transfusion Reaction/epidemiology/physiopathology/prevention & control MH - Wounds and Injuries/*complications/mortality/physiopathology/therapy EDAT- 2018/03/02 06:00 MHDA- 2018/09/15 06:00 CRDT- 2018/03/02 06:00 PHST- 2018/03/02 06:00 [entrez] PHST- 2018/03/02 06:00 [pubmed] PHST- 2018/09/15 06:00 [medline] AID - 00001503-201804000-00014 [pii] AID - 10.1097/ACO.0000000000000569 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2018 Apr;31(2):201-206. doi: 10.1097/ACO.0000000000000569. PMID- 29449126 OWN - NLM STAT- MEDLINE DCOM- 20180827 LR - 20180827 IS - 1532-8511 (Electronic) IS - 1052-3057 (Linking) VI - 27 IP - 5 DP - 2018 May TI - Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage. PG - 1350-1356 LID - S1052-3057(17)30700-0 [pii] LID - 10.1016/j.jstrokecerebrovasdis.2017.12.026 [doi] AB - BACKGROUND: The objective of this study was to quantify coagulopathy using thrombelastography (TEG) in patients with renal dysfunction and intracerebral hemorrhage (ICH). METHODS: We reviewed patients admitted with spontaneous ICH between November 2009 and May 2015. TEG was performed at the time of admission. Creatinine clearance (CCr) was calculated using the Cockroft-Gault equation. Patients were divided into 2 groups based on normal (CCr >/= 90) or reduced renal function (CCr < 90). Multivariable regression models were conducted to compare the differences of TEG components. RESULTS: A total of 120 patients were included in the analysis. The normal CCr group was younger (56.1 versus 62.3 years, P < .01), was more often male (73.6% versus 53.7%, P = .03), and had higher mean admission hemoglobin (14.2 versus 13.2 mEq/L, P < .01) than the reduced renal function group. The 2 groups were similar with respect to antiplatelet or anticoagulant use, coagulation studies, and baseline ICH volume. Following multivariate analysis, the reduced renal function group was found to have shorter K (1.5 versus 2.2 min, P = 004), increased angle (66 versus 62.2 degrees, P = .04), increased MA (67.3 versus 62.3, P = .02), and increased G (11.3 versus 9.9 dynes/cm(2), P = .04) compared with the normal group. Mortality, poor functional outcome (modified Rankin Scale score 4-6), hematoma enlargement, hospital length of stay, and surgical interventions were not different between the 2 groups. CONCLUSIONS: Patients with ICH and reduced CCr display faster clotting rate and increased clot strength, suggesting that patients with renal dysfunction present with a relatively hypercoagulable state based on TEG parameters thought to reflect platelet activity. CI - Copyright (c) 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. FAU - Meier, Kevin AU - Meier K AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Saenz, Daniel M AU - Saenz DM AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Torres, Glenda L AU - Torres GL AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Cai, Chunyan AU - Cai C AD - Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas. FAU - Rahbar, Mohammed H AU - Rahbar MH AD - Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas. FAU - McDonald, Mark AU - McDonald M AD - Department of Neurology, University of Virginia, Charlottesville, Virginia. FAU - Fraser, Stuart AU - Fraser S AD - Department of Neurology, University of Virginia, Charlottesville, Virginia. FAU - Espino, Elena AU - Espino E AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Choi, H Alex AU - Choi HA AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Edwards, Nancy J AU - Edwards NJ AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Lee, Kiwon AU - Lee K AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. FAU - Grotta, James C AU - Grotta JC AD - Memorial Hermann Hospital, Texas Medical Center, Houston, Texas. FAU - Chang, Tiffany R AU - Chang TR AD - Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas. Electronic address: Tiffany.R.Chang@uth.tmc.edu. LA - eng PT - Journal Article DEP - 20180212 PL - United States TA - J Stroke Cerebrovasc Dis JT - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JID - 9111633 RN - 0 (Biomarkers) RN - AYI8EX34EU (Creatinine) SB - IM MH - Adult MH - Aged MH - Biomarkers/blood MH - *Blood Coagulation MH - Cerebral Hemorrhage/*blood/complications/diagnosis/mortality MH - Chi-Square Distribution MH - Creatinine/blood MH - Female MH - *Glomerular Filtration Rate MH - Humans MH - Kidney/*physiopathology MH - Kidney Diseases/complications/diagnosis/mortality/*physiopathology MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Predictive Value of Tests MH - Risk Factors MH - *Thrombelastography MH - Thrombophilia/blood/complications/*diagnosis/mortality OTO - NOTNLM OT - Thombelastography OT - acute kidney injury OT - coagulation OT - intracerebral hemorrhage OT - kidney disease OT - stroke OT - uremia EDAT- 2018/02/17 06:00 MHDA- 2018/08/28 06:00 CRDT- 2018/02/17 06:00 PHST- 2016/08/09 00:00 [received] PHST- 2017/05/02 00:00 [revised] PHST- 2017/12/19 00:00 [accepted] PHST- 2018/02/17 06:00 [pubmed] PHST- 2018/08/28 06:00 [medline] PHST- 2018/02/17 06:00 [entrez] AID - S1052-3057(17)30700-0 [pii] AID - 10.1016/j.jstrokecerebrovasdis.2017.12.026 [doi] PST - ppublish SO - J Stroke Cerebrovasc Dis. 2018 May;27(5):1350-1356. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.026. Epub 2018 Feb 12. PMID- 29443859 OWN - NLM STAT- MEDLINE DCOM- 20190501 LR - 20190501 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 85 IP - 1 DP - 2018 Jul TI - Overresuscitation with plasma is associated with sustained fibrinolysis shutdown and death in pediatric traumatic brain injury. PG - 12-17 LID - 10.1097/TA.0000000000001836 [doi] AB - BACKGROUND: Elevated International Normalized Ratio (INR) is a marker of poor outcome but not necessarily bleeding or clinical coagulopathy in injured children. Conversely, children with traumatic brain injury (TBI) tend to be hypercoagulable based on rapid thromboelastography (rTEG) parameters. Many clinicians continue to utilize INR as a treatment target. METHODS: Prospective observational study of severely injured children age < 18 with rTEG on arrival and daily thereafter for up to 7 days. Standard rTEG definitions of hyperfibrinolysis (LY30 >/= 3), fibrinolysis shutdown (SD) (LY30 /= 3 defined severe TBI. Sustained SD was defined as two consecutive rTEG with SD and no subsequent normalization. Primary outcomes were death and functional disability, based on functional independence measure score assessed at discharge. RESULTS: One hundred one patients were included: median age, 8 years (interquartile range, 4-12 years); Injury Severity Score, 25 (16-30); 72% blunt mechanism; 47% severe TBI; 16% mortality; 45% discharge disability. Neither total volume nor any single product volume transfused (mL/kg; all p > 0.1) differed between TBI and non-TBI groups. On univariate analysis, transfusion of packed red blood cells (p = 0.016), plasma (p < 0.001), and platelets (p = 0.006) were associated with sustained SD; however, in a regression model that included all products (mL/kg) and controlled for severe TBI (head Abbreviated Injury Scale score >/= 3), admission INR, polytrauma, and clinical bleeding, only plasma remained an independent predictor of sustained SD (odds ratio, 1.17; p = 0.031). Patients with both severe TBI and plasma transfusion had 100% sustained SD, 75% mortality, and 100% disability in survivors. Admission INR was elevated in TBI patients, but did not correlate with rTEG activated clotting time (p = NS) and was associated with sustained SD (p = 0.006). CONCLUSION: Plasma transfusion is independently associated with sustained fibrinolysis SD. Severe TBI is also associated with sustained SD; the combined effect of plasma transfusion and severe TBI is associated with extremely poor prognosis. Plasma transfusion should not be targeted to INR thresholds but rather to rTEG activated clotting time and clinical bleeding. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III. FAU - Leeper, Christine M AU - Leeper CM AD - From the Division of General Surgery and Trauma, Department of Surgery (C.M.L., M.D.N., T.R.B., J.L.S.), Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center; and Children's Hospital of Pittsburgh of UPMC (C.M.L., B.A.G.), Pittsburgh, Pennsylvania. FAU - Neal, Matthew D AU - Neal MD FAU - Billiar, Timothy R AU - Billiar TR FAU - Sperry, Jason L AU - Sperry JL FAU - Gaines, Barbara A AU - Gaines BA LA - eng PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/epidemiology/*etiology MH - Blood Component Transfusion/*adverse effects/statistics & numerical data MH - Brain Injuries, Traumatic/complications/mortality/*therapy MH - Child MH - Child, Preschool MH - Female MH - Fibrinolysis/*physiology MH - Hospital Mortality MH - Humans MH - International Normalized Ratio MH - Male MH - Medical Overuse/*statistics & numerical data MH - Plasma MH - Prognosis MH - Prospective Studies MH - Thrombelastography/methods EDAT- 2018/02/15 06:00 MHDA- 2019/05/02 06:00 CRDT- 2018/02/15 06:00 PHST- 2018/02/15 06:00 [pubmed] PHST- 2019/05/02 06:00 [medline] PHST- 2018/02/15 06:00 [entrez] AID - 10.1097/TA.0000000000001836 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jul;85(1):12-17. doi: 10.1097/TA.0000000000001836. PMID- 29369078 OWN - NLM STAT- MEDLINE DCOM- 20180810 LR - 20260127 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 29 IP - 2 DP - 2018 Mar TI - Thromboelastographic study of the snakebite-related coagulopathy in Djibouti. PG - 196-204 LID - 10.1097/MBC.0000000000000702 [doi] AB - : Hemostasis disorders are one of the major clinical conditions of snakebites and are because of mechanisms which may disrupt vessels, platelets, clotting factors and fibrinolysis. Thromboelastography (TEG) could help to understand these effects in the clinical practice. A retrospective study reports a series of patients presenting a snakebite-related coagulopathy, treated with antivenom and monitored with conventional tests and TEG in a French military treatment facility (Republic of Djibouti, East Africa) between August 2011 and September 2013. Conventional coagulation assays (platelets, prothrombin time, activated partial thromboplastin time, fibrinogen) and TEG measurements were taken on arrival and at various times during the first 72 h of hospitalization, at the discretion of the physician. The study included 14 patients (median age 28 years). Bleedings were present in five patients. All patients received antivenom. A coagulopathy was present in all patients and was detected by both conventional assays and TEG. None exhibited thrombocytopenia. Prothrombin time and fibrinogen remained abnormal for most of patients during the first 72 h. The TEG profiles of 11 patients (79%) showed incoagulability at admission (R-time > 60 min). TEG distinguished 10 patients with a generalized clotting factor deficiency and 4 patients with an isolated fibrinogen deficiency after an initial profile of incoagulability. Hyperfibrinolysis was evident for 12 patients (86%) after Hour 6. Snake envenomations in Djibouti involve a consumption coagulopathy in conjunction with delayed hyperfibrinolysis. TEG could improve medical management of the condition and assessment of additional therapeutics associated with the antivenom. FAU - Larreche, Sebastien AU - Larreche S AD - Departement de biologie medicale, Hopital d'instruction des armees Begin, Saint-Mande. FAU - Jean, Francois-Xavier AU - Jean FX AD - Service d'anesthesie-reanimation, Hopital d'instruction des armees Desgenettes, Lyon, France. FAU - Benois, Alain AU - Benois A AD - Service d'anesthesie-reanimation, Hopital medico-chirurgical Bouffard, Djibouti, Republique de Djibouti. FAU - Mayet, Aurelie AU - Mayet A AD - Centre d'epidemiologie et de sante publique des armees, Marseille, France. FAU - Bousquet, Aurore AU - Bousquet A AD - Departement de biologie medicale, Hopital d'instruction des armees Begin, Saint-Mande. FAU - Vedy, Serge AU - Vedy S AD - Service de biologie medicale, Hopital medico-chirurgical Bouffard, Djibouti, Republique de Djibouti. FAU - Clapson, Patrick AU - Clapson P AD - Service d'anesthesie-reanimation, Hopital medico-chirurgical Bouffard, Djibouti, Republique de Djibouti. FAU - Dehan, Celine AU - Dehan C AD - Service de biologie medicale, Hopital medico-chirurgical Bouffard, Djibouti, Republique de Djibouti. FAU - Rapp, Christophe AU - Rapp C AD - Service de maladies infectieuses et tropicales, Hopital d'instruction des armees Begin, Saint-Mande. FAU - Kaiser, Eric AU - Kaiser E AD - Service d'anesthesie-reanimation, Hopital medico-chirurgical Bouffard, Djibouti, Republique de Djibouti. FAU - Merens, Audrey AU - Merens A AD - Departement de biologie medicale, Hopital d'instruction des armees Begin, Saint-Mande. FAU - Mion, Georges AU - Mion G AD - Service d'anesthesie-reanimation, Centre hospitalo-universitaire Cochin, Paris. FAU - Martinaud, Christophe AU - Martinaud C AD - Centre de transfusion sanguine des armees, Clamart, France. LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 SB - IM MH - Adult MH - Animals MH - Djibouti MH - Female MH - Humans MH - Male MH - Retrospective Studies MH - Snake Bites/*blood/complications MH - Thrombelastography/*methods EDAT- 2018/01/26 06:00 MHDA- 2018/08/11 06:00 CRDT- 2018/01/26 06:00 PHST- 2018/01/26 06:00 [pubmed] PHST- 2018/08/11 06:00 [medline] PHST- 2018/01/26 06:00 [entrez] AID - 10.1097/MBC.0000000000000702 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2018 Mar;29(2):196-204. doi: 10.1097/MBC.0000000000000702. PMID- 29363269 OWN - NLM STAT- MEDLINE DCOM- 20190624 LR - 20231105 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 16 IP - 4 DP - 2018 Apr TI - Measuring fibrinolysis: from research to routine diagnostic assays. PG - 652-662 LID - 10.1111/jth.13957 [doi] AB - Development and standardization of fibrinolysis methods have progressed more slowly than coagulation testing and routine high-throughput screening tests for fibrinolysis are still lacking. In laboratory research, a variety of approaches are available and are applied to understand the regulation of fibrinolysis and its contribution to the hemostatic balance. Fibrinolysis in normal blood is slow to develop. For practical purposes plasminogen activators can be added to clotting plasma, or euglobulin prepared to reduce endogenous inhibitors, but results are complicated by these manipulations. Observational studies to identify a 'fibrinolysis deficit' have concluded that excess fibrinolysis inhibitors, plasminogen activator inhibitor 1 (PAI-1) or thrombin-activatable fibrinolysis inhibitor (TAFI), zymogen or active enzyme, may be associated with an increased risk of thrombosis. However, results are not always consistent and problems of adequate standardization are evident with these inhibitors and also for measurement of fibrin degradation products (D-dimer). Few methods are available to investigate fibrinolysis under flow, or in whole blood, but viscoelastic methods (VMs) such as ROTEM and TEG do permit the contribution of cells, and importantly platelets, to be explored. VMs are used to diagnose clinical hyperfibrinolysis, which is associated with high mortality. There is a debate on the usefulness of VMs as a point-of-care test method, particularly in trauma. Despite the difficulties of many fibrinolysis methods, research on the fibrinolysis system, taking in wider interactions with hemostasis proteins, is progressing so that in future we may have more complete models and better diagnostic methods and therapeutics. CI - (c) 2018 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis. FAU - Longstaff, C AU - Longstaff C AUID- ORCID: 0000-0001-7608-208X AD - Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, UK. LA - eng PT - Journal Article PT - Review DEP - 20180217 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 SB - IM MH - *Fibrinolysis MH - Hematologic Tests/*methods MH - Humans MH - Predictive Value of Tests MH - Reproducibility of Results MH - Thrombelastography/*methods MH - Thrombophilia/blood/*diagnosis MH - Time Factors PMC - PMC5947570 OTO - NOTNLM OT - carboxypeptidase B2 OT - euglobulin clot lysis time OT - fibrin clot lysis time OT - plasminogen activator inhibitor 1 OT - plasminogen activators OT - thromboelastometry EDAT- 2018/01/25 06:00 MHDA- 2019/06/25 06:00 PMCR- 2018/05/11 CRDT- 2018/01/25 06:00 PHST- 2017/10/30 00:00 [received] PHST- 2018/01/25 06:00 [pubmed] PHST- 2019/06/25 06:00 [medline] PHST- 2018/01/25 06:00 [entrez] PHST- 2018/05/11 00:00 [pmc-release] AID - S1538-7836(22)00956-4 [pii] AID - JTH13957 [pii] AID - 10.1111/jth.13957 [doi] PST - ppublish SO - J Thromb Haemost. 2018 Apr;16(4):652-662. doi: 10.1111/jth.13957. Epub 2018 Feb 17. PMID- 29355793 OWN - NLM STAT- MEDLINE DCOM- 20200925 LR - 20200925 IS - 2352-5568 (Electronic) IS - 2352-5568 (Linking) VI - 38 IP - 5 DP - 2019 Oct TI - Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations? PG - 539-548 LID - S2352-5568(17)30283-7 [pii] LID - 10.1016/j.accpm.2017.12.014 [doi] AB - PURPOSE: Viscoelastic tests (VETs), thromboelastography (TEG((R))) and thromboelastometry (ROTEM((R))) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. METHODS: A review of the literature. PRINCIPAL FINDINGS: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. CONCLUSION: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions. CI - Copyright (c) 2018 The Authors. Published by Elsevier Masson SAS.. All rights reserved. FAU - Roullet, Stephanie AU - Roullet S AD - Inserm U 12-11, service anesthesie-reanimation 1, universite de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France. Electronic address: stephanie.roullet@chu-bordeaux.fr. FAU - de Maistre, Emmanuel AU - de Maistre E AD - Unite d'hemostase, centre hospitalier universitaire, 21079 Dijon, France. FAU - Ickx, Brigitte AU - Ickx B AD - Universite Libre de Bruxelles, Erasme University Hospital, Department of Anesthesiology, Brussels, Belgium. FAU - Blais, Normand AU - Blais N AD - Hematologie et oncologie medicale, CHUM, Montreal, Canada. FAU - Susen, Sophie AU - Susen S AD - Institut d'hematologie et transfusion, CHRU de Lille, 59037 Lille, France. FAU - Faraoni, David AU - Faraoni D AD - Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada. FAU - Garrigue, Delphine AU - Garrigue D AD - Pole d'anesthesie-reanimation, CHRU de Lille, 59037 Lille, France. FAU - Bonhomme, Fanny AU - Bonhomme F AD - Service d'anesthesiologie, hopital universitaire de Geneve, Geneva, Switzerland. FAU - Godier, Anne AU - Godier A AD - Service d'anesthesie-reanimation, Fondation Rothschild, 75019 Paris, France. FAU - Lasne, Dominique AU - Lasne D AD - Laboratoire d'hematologie, hopital Necker, 75015 Paris, France. CN - GIHP LA - eng PT - Journal Article PT - Review DEP - 20180203 PL - France TA - Anaesth Crit Care Pain Med JT - Anaesthesia, critical care & pain medicine JID - 101652401 SB - IM MH - Adult MH - *Algorithms MH - Blood Coagulation MH - Cardiac Surgical Procedures MH - Child MH - Emergencies MH - Female MH - France MH - Hemorrhage/*therapy MH - Hemostasis, Surgical/*methods/standards MH - Humans MH - Liver Transplantation MH - Male MH - Postpartum Hemorrhage/blood MH - Societies, Medical MH - Thrombelastography/*methods/standards MH - Wounds and Injuries/blood OTO - NOTNLM OT - Cardiac surgery OT - Liver transplantation OT - Severe trauma OT - Thromboelastography OT - Thromboelastometry OT - Viscoelastic tests EDAT- 2018/01/23 06:00 MHDA- 2020/09/26 06:00 CRDT- 2018/01/23 06:00 PHST- 2017/10/24 00:00 [received] PHST- 2017/12/18 00:00 [revised] PHST- 2017/12/18 00:00 [accepted] PHST- 2018/01/23 06:00 [pubmed] PHST- 2020/09/26 06:00 [medline] PHST- 2018/01/23 06:00 [entrez] AID - S2352-5568(17)30283-7 [pii] AID - 10.1016/j.accpm.2017.12.014 [doi] PST - ppublish SO - Anaesth Crit Care Pain Med. 2019 Oct;38(5):539-548. doi: 10.1016/j.accpm.2017.12.014. Epub 2018 Feb 3. PMID- 29341793 OWN - NLM STAT- MEDLINE DCOM- 20190313 LR - 20190313 IS - 1362-301X (Electronic) IS - 0269-9052 (Print) IS - 0269-9052 (Linking) VI - 32 IP - 3 DP - 2018 TI - Platelet transfusion does not improve outcomes in patients with brain injury on antiplatelet therapy. PG - 325-330 LID - 10.1080/02699052.2018.1425804 [doi] AB - INTRODUCTION: Platelet dysfunction following traumatic brain injury (TBI) is associated with worse outcomes. The efficacy of platelet transfusion to reverse antiplatelet medication (APM) remains unknown. Thrombelastography platelet mapping (TEG-PM) assesses platelet function. We hypothesize that platelet transfusion can reverse the effects of APM but does not improve outcomes following TBI. METHODS: An observational study at six US trauma centres was performed. Adult patients on APM with CT evident TBI after blunt injury were enrolled. Demographics, brain CT and TEG-PM results before/after platelet transfusion, length of stay (LOS), and injury severity score (ISS) were abstracted. RESULTS: Sixty six patients were enrolled (89% aspirin, 50% clopidogrel, 23% dual APM) with 23 patients undergoing platelet transfusion. Transfused patients had significantly higher ISS and admission CT scores. Platelet transfusion significantly reduced platelet inhibition due to aspirin (76.0 +/- 30.2% to 52.7 +/- 31.5%, p < 0.01), but had a non-significant impact on clopidogrel-associated inhibition (p = 0.07). Platelet transfusion was associated with longer length of stay (7.8 vs. 3.5 days, p < 0.01), but there were no differences in mortality. CONCLUSION: Platelet transfusion significantly decreases platelet inhibition due to aspirin but is not associated with change in outcomes in patients on APM following TBI. FAU - Holzmacher, Jeremy L AU - Holzmacher JL AD - a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA. FAU - Reynolds, Cassandra AU - Reynolds C AD - b Department of Surgery , East Carolina University Brody School of Medicine , Greenville , NC. FAU - Patel, Mayur AU - Patel M AD - c Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences , Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center; Surgical Service, General Surgery Section, Nashville VA, Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs , Nashville , TN. FAU - Maluso, Patrick AU - Maluso P AD - a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA. FAU - Holland, Seth AU - Holland S AD - d Department of Surgery , San Antonio Military Medical Center , Fort Sam Houston , TX. FAU - Gamsky, Nathaniel AU - Gamsky N AD - a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA. FAU - Moore, Henry AU - Moore H AD - e Department of Surgery , Carle Foundation Hospital , Urbana , IL. FAU - Acquista, Elizabeth AU - Acquista E AD - f Department of Surgery , University of North Carolina At Chapel Hill , Chapel Hill , NC. FAU - Carrick, Matthew AU - Carrick M AD - g Department of Surgery , Medical Center at Plano , Plano , TX. FAU - Amdur, Richard AU - Amdur R AD - a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA. FAU - Hancock, Heather AU - Hancock H AD - d Department of Surgery , San Antonio Military Medical Center , Fort Sam Houston , TX. FAU - Metzler, Michael AU - Metzler M AD - h Department of Surgery , Medical Center of The Rockies , Loveland , CO. FAU - Dunn, Julie AU - Dunn J AD - h Department of Surgery , Medical Center of The Rockies , Loveland , CO. FAU - Sarani, Babak AU - Sarani B AUID- ORCID: 0000-0001-6247-3004 AD - a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA. LA - eng GR - R01 GM120484/GM/NIGMS NIH HHS/United States GR - R01 HL111111/HL/NHLBI NIH HHS/United States GR - UL1 TR000445/TR/NCATS NIH HHS/United States GR - UL1 TR002243/TR/NCATS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20180117 PL - England TA - Brain Inj JT - Brain injury JID - 8710358 RN - 0 (Platelet Aggregation Inhibitors) RN - A74586SNO7 (Clopidogrel) RN - R16CO5Y76E (Aspirin) SB - IM MH - Aged MH - Aged, 80 and over MH - Aspirin/therapeutic use MH - Brain Injuries/*therapy MH - Clopidogrel/therapeutic use MH - Female MH - Humans MH - Injury Severity Score MH - Length of Stay MH - Male MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Platelet Transfusion/*methods MH - Statistics, Nonparametric MH - *Treatment Outcome PMC - PMC6112855 MID - NIHMS1502337 OTO - NOTNLM OT - Traumatic brain injury OT - brain injury OT - closed head injury COIS- Declaration of Interest: Authors report no conflicts of interest. EDAT- 2018/01/18 06:00 MHDA- 2019/03/14 06:00 PMCR- 2019/01/17 CRDT- 2018/01/18 06:00 PHST- 2018/01/18 06:00 [pubmed] PHST- 2019/03/14 06:00 [medline] PHST- 2018/01/18 06:00 [entrez] PHST- 2019/01/17 00:00 [pmc-release] AID - 10.1080/02699052.2018.1425804 [doi] PST - ppublish SO - Brain Inj. 2018;32(3):325-330. doi: 10.1080/02699052.2018.1425804. Epub 2018 Jan 17. PMID- 29334497 OWN - NLM STAT- MEDLINE DCOM- 20180907 LR - 20180907 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 31 IP - 2 DP - 2018 Apr TI - Deep vein thrombosis and venous thromboembolism in trauma. PG - 215-218 LID - 10.1097/ACO.0000000000000567 [doi] AB - PURPOSE OF REVIEW: Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. RECENT FINDINGS: Elements of the patient's history and physical examination, along with thromboelastography, can be used to predict patients who are at greatest risk of DVT and venous thromboembolism (VTE). Novel assays and biomarkers hold promise for more accurate evaluation of coagulation status. Patients with traumatic injury are routinely treated with either mechanical or pharmacological treatments to prevent DVT, and a growing body of evidence suggests that DVT prophylaxis should be initiated as early as possible in a patient's hospital course. SUMMARY: In trauma patients with traumatic injury, early identification and targeted VTE prophylaxis in trauma patients may prevent this life-threatening complication. FAU - Ruskin, Keith J AU - Ruskin KJ AD - Department of Anesthesia and Critical Care, University of Chicago School of Medicine, Chicago, Illinois, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Anticoagulants) RN - 0 (Biomarkers) SB - IM MH - Anticoagulants/therapeutic use MH - Biomarkers/blood MH - Blood Coagulation MH - Hospital Mortality MH - Humans MH - Physical Examination MH - Risk Factors MH - Thrombelastography MH - Time Factors MH - Venous Thromboembolism/diagnosis/*etiology/mortality/prevention & control MH - Venous Thrombosis/diagnosis/*etiology/mortality/prevention & control MH - Wounds and Injuries/blood/*complications/mortality EDAT- 2018/01/16 06:00 MHDA- 2018/09/08 06:00 CRDT- 2018/01/16 06:00 PHST- 2018/01/16 06:00 [pubmed] PHST- 2018/09/08 06:00 [medline] PHST- 2018/01/16 06:00 [entrez] AID - 10.1097/ACO.0000000000000567 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2018 Apr;31(2):215-218. doi: 10.1097/ACO.0000000000000567. PMID- 29330077 OWN - NLM STAT- MEDLINE DCOM- 20180514 LR - 20190401 IS - 1878-8769 (Electronic) IS - 1878-8750 (Print) IS - 1878-8750 (Linking) VI - 112 DP - 2018 Apr TI - Blood Ethanol Levels Are Not Related to Coagulation Changes, as Measured by Thromboelastography, in Traumatic Brain Injury Patients. PG - e216-e222 LID - S1878-8750(18)30065-2 [pii] LID - 10.1016/j.wneu.2018.01.025 [doi] AB - BACKGROUND: Brain injury is a leading cause of death and disability in trauma patients. Ethanol (EtOH) use near the time of injury may contribute to worse outcomes in these patients by exacerbating coagulopathy. There are limited data regarding the effects of EtOH on coagulation and progression of traumatic intracranial hemorrhage (TICH). METHODS: We performed a retrospective analysis of a prospective observational study of 168 trauma patients with TBI at an urban level 1 trauma center. Thromboelastography (TEG) was performed on admission and over the subsequent 48 hours. Demographic, physiologic, and outcomes data were collected. Computed tomography imaging of the head performed within the first 48 hours of admission was analyzed for progression of TICH. RESULTS: Thirty-six percent of patients (n = 61) had positive blood EtOH on admission (median EtOH level = 198 mg/dL [range, 16-376 mg/dL]). EtOH-positive patients were less severely injured than EtOH-negative patients (P = 0.01). Other admission demographic and physiologic variables were similar between groups. There were no significant differences in TEG values between EtOH-positive and EtOH-negative patients on admission or during the subsequent 48 hours. There were no differences in radiographic progression of hemorrhage, the need for neurosurgical procedure, or mortality between EtOH-positive and EtOH-negative patients. CONCLUSIONS: EtOH use near the time of traumatic injury was not associated with alterations in coagulation, as measured by traditional coagulation tests or by TEG, in patients with TICH. Furthermore, a positive blood alcohol at admission was not associated with increased mortality or need for neurosurgical procedure these patients. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Rao, Abigail J AU - Rao AJ AD - Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Lin, Amber Laurie AU - Lin AL AD - School of Public Health & Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA. FAU - Hilliard, Cole AU - Hilliard C AD - Department of Surgery, Division of Trauma, Critical Care & Acute Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Fu, Rongwei AU - Fu R AD - School of Public Health & Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA. FAU - Lennox, Tori AU - Lennox T AD - Department of Surgery, Division of Trauma, Critical Care & Acute Surgery, Oregon Health & Science University, Portland, Oregon, USA. FAU - Barbosa, Ronald R AU - Barbosa RR AD - Trauma Services, Legacy Emanuel Hospital and Health Center, Portland, Oregon, USA. FAU - Rowell, Susan E AU - Rowell SE AD - Department of Surgery, Division of Trauma, Critical Care & Acute Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: rowells@ohsu.edu. LA - eng GR - K12 HL108974/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20180109 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 RN - 3K9958V90M (Ethanol) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*blood/*etiology MH - Brain Injuries, Traumatic/*complications MH - Ethanol/*blood MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Thrombelastography MH - Young Adult PMC - PMC5871559 MID - NIHMS933409 OTO - NOTNLM OT - Alcohol OT - Coagulation OT - Coagulopathy OT - Ethanol OT - Hemorrhage OT - Thromboelastography OT - Traumatic brain injury EDAT- 2018/01/14 06:00 MHDA- 2018/05/15 06:00 PMCR- 2019/04/01 CRDT- 2018/01/14 06:00 PHST- 2017/09/24 00:00 [received] PHST- 2017/12/30 00:00 [revised] PHST- 2018/01/04 00:00 [accepted] PHST- 2018/01/14 06:00 [pubmed] PHST- 2018/05/15 06:00 [medline] PHST- 2018/01/14 06:00 [entrez] PHST- 2019/04/01 00:00 [pmc-release] AID - S1878-8750(18)30065-2 [pii] AID - 10.1016/j.wneu.2018.01.025 [doi] PST - ppublish SO - World Neurosurg. 2018 Apr;112:e216-e222. doi: 10.1016/j.wneu.2018.01.025. Epub 2018 Jan 9. PMID- 29325878 OWN - NLM STAT- MEDLINE DCOM- 20190715 LR - 20190715 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 226 IP - 4 DP - 2018 Apr TI - Can We Identify Futility in Kids? An Evaluation of Admission Parameters Predicting 100% Mortality in 1,292 Severely Injured Children. PG - 662-667 LID - S1072-7515(18)30002-4 [pii] LID - 10.1016/j.jamcollsurg.2017.12.034 [doi] AB - BACKGROUND: Objective parameters predicting futility of care in severely injured pediatric patients are lacking. Although futility of care has been investigated in a limited number of studies in trauma patients, none of these studies achieves a 100% success rate in a large cohort of pediatric patients. The purpose of the current study was to identify extreme laboratory values that could be used to predict 100% mortality in severely injured children. STUDY DESIGN: We evaluated a registry-based, historical cohort of all severely injured children (Level I trauma, younger than 16 years old) who were not dead on arrival between January 2010 and December 2016 from a single Level I trauma center. Extreme arrival laboratory data were evaluated both alone and in conjunction with traumatic brain injury. RESULTS: There were 1,292 patients who met inclusion criteria, of which 1,169 (90.5%) survived and 123 (9.5%) died. Those who died were significantly younger, with higher head Abbreviated Injury Scale scores and overall Injury Severity Scores. Single extreme laboratory values were identified that predicted mortality perfectly (100% positive predictive value): international normalized ratio >/=3.0, pH /=50%. When 2 laboratory values or the presence of traumatic brain injury were added, lower thresholds for futility were noted. CONCLUSIONS: Extreme admission laboratory values are capable of predicting 100% mortality and futility of additional care in severely injured children with a high level of accuracy. Validation of these single-center findings is warranted and, if supported, should initiate a discussion within the pediatric trauma community about application and cessation of resuscitation efforts to optimize resource use. CI - Copyright (c) 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Kalkwarf, Kyle J AU - Kalkwarf KJ AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. Electronic address: kyle.kalkwarf@gmail.com. FAU - Jensen, Shane D AU - Jensen SD AD - Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA. FAU - Allukian, Myron 3rd AU - Allukian M 3rd AD - Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. FAU - Harting, Matthew T AU - Harting MT AD - Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. FAU - Cox, Charles S AU - Cox CS AD - Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. FAU - Fox, Erin E AU - Fox EE AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX. LA - eng PT - Journal Article DEP - 20180108 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM CIN - J Am Coll Surg. 2018 Apr;226(4):667-669. doi: 10.1016/j.jamcollsurg.2018.01.036. PMID: 29576168 MH - Abbreviated Injury Scale MH - Adolescent MH - Child MH - Child, Preschool MH - Female MH - Hospitalization MH - Humans MH - Injury Severity Score MH - Male MH - *Medical Futility MH - Predictive Value of Tests MH - Retrospective Studies MH - Thrombelastography MH - Wounds and Injuries/*diagnosis/*mortality/therapy EDAT- 2018/01/13 06:00 MHDA- 2019/07/16 06:00 CRDT- 2018/01/13 06:00 PHST- 2017/12/18 00:00 [received] PHST- 2017/12/18 00:00 [accepted] PHST- 2018/01/13 06:00 [pubmed] PHST- 2019/07/16 06:00 [medline] PHST- 2018/01/13 06:00 [entrez] AID - S1072-7515(18)30002-4 [pii] AID - 10.1016/j.jamcollsurg.2017.12.034 [doi] PST - ppublish SO - J Am Coll Surg. 2018 Apr;226(4):662-667. doi: 10.1016/j.jamcollsurg.2017.12.034. Epub 2018 Jan 8. PMID- 29324486 OWN - NLM STAT- MEDLINE DCOM- 20180907 LR - 20180907 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 31 IP - 2 DP - 2018 Apr TI - Fibrinolysis and antifibrinolytic treatment in the trauma patient. PG - 227-233 LID - 10.1097/ACO.0000000000000561 [doi] AB - PURPOSE OF REVIEW: The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. RECENT FINDINGS: Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage. The protein C pathway, endothelial dysfunction, platelet activity, shock, and tissue injury are key to the development of hyper fibrinolysis in trauma. D-dimer and viscoelastic haemostatic assays (rotational thromboelastometry, TEG) remain the best available diagnostic modalities but have a number of limitations compared with plasma biomarkers of fibrinolytic activation, for example, plasmin-alpha2-antiplasmin complex. Current evidence supports the continued empiric use of tranexamic acid in major trauma haemorrhage. SUMMARY: Improving the outcomes for bleeding trauma patients requires a deeper understanding of the mechanisms driving hyperfibrinolysis and the subsequent switch toward a prothrombotic state. Discovering the interplay between platelet activity, fibrinogen utilization, the immune response, and the fibrinolytic system may lead to development of novel therapeutics. FAU - Gall, Lewis S AU - Gall LS AD - Centre for Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Davenport, Ross A AU - Davenport RA LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Antifibrinolytic Agents) SB - IM MH - Antifibrinolytic Agents/*therapeutic use MH - Blood Coagulation Disorders/blood/*drug therapy/etiology/physiopathology MH - Blood Coagulation Tests MH - Critical Care/methods/standards MH - Fibrinolysis/drug effects/*physiology MH - Hemorrhage/blood/*drug therapy/etiology/physiopathology MH - Humans MH - Patient Selection MH - Practice Guidelines as Topic MH - Thrombosis/blood/chemically induced/physiopathology/*prevention & control MH - Time Factors MH - Treatment Outcome MH - Wounds and Injuries/*blood/complications/physiopathology EDAT- 2018/01/13 06:00 MHDA- 2018/09/08 06:00 CRDT- 2018/01/12 06:00 PHST- 2018/01/13 06:00 [pubmed] PHST- 2018/09/08 06:00 [medline] PHST- 2018/01/12 06:00 [entrez] AID - 10.1097/ACO.0000000000000561 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2018 Apr;31(2):227-233. doi: 10.1097/ACO.0000000000000561. PMID- 29313313 OWN - NLM STAT- MEDLINE DCOM- 20190930 LR - 20190930 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 28 IP - 3 DP - 2018 Jun TI - Relationship of Coagulopathy and Platelet Dysfunction to Transfusion Needs After Traumatic Brain Injury. PG - 330-337 LID - 10.1007/s12028-017-0485-5 [doi] AB - BACKGROUND: Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions. METHODS: We performed a retrospective study of patients admitted to the neuroscience intensive care unit of a level 1 trauma center from 2013 to 2015 with head Abbreviated Injury Scale >/=3. Patients were compared by mechanism of injury (blunt vs. penetrating). Admission demographics, injury characteristics, and laboratory parameters were evaluated. VerifyNow((R)) Aspirin and P2Y12 tests were used for platelet function analysis. RESULTS: Five hundred and thirty-four patients were included in the analysis. There were no differences between groups in platelet count or international normalized ratio; however, patients with penetrating TBI were more coagulopathic by TEG, with all of the TEG parameters being significantly different except for R time. Patients with penetrating head trauma were not more likely than their blunt counterparts to have abnormal PFA results, and PFA results did not correlate with any TEG parameter in either group. The penetrating cohort received more units of blood products in the first 4 and 24 h than the blunt cohort. CONCLUSIONS: Patients presenting with penetrating TBI demonstrated increased coagulopathy compared to those with blunt TBI as measured by TEG and need for transfusion. PFA results did not correlate with TEG findings in this population. FAU - Martin, Grace AU - Martin G AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Shah, Dhavan AU - Shah D AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Elson, Nora AU - Elson N AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Boudreau, Ryan AU - Boudreau R AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Hanseman, Dennis AU - Hanseman D AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Pritts, Timothy A AU - Pritts TA AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Makley, Amy T AU - Makley AT AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Foreman, Brandon AU - Foreman B AD - Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. FAU - Goodman, Michael D AU - Goodman MD AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA. goodmamd@ucmail.uc.edu. LA - eng PT - Journal Article PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/etiology/*therapy MH - *Blood Transfusion MH - Brain Injuries, Traumatic/complications/*therapy MH - Female MH - Head Injuries, Closed/complications/therapy MH - Head Injuries, Penetrating/complications/therapy MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Platelet Function Tests MH - *Registries MH - Retrospective Studies MH - Thrombelastography MH - Young Adult OTO - NOTNLM OT - Coagulopathy OT - Platelet function assays OT - Thromboelastography OT - Transfusion OT - Traumatic brain injury EDAT- 2018/01/10 06:00 MHDA- 2019/10/01 06:00 CRDT- 2018/01/10 06:00 PHST- 2018/01/10 06:00 [pubmed] PHST- 2019/10/01 06:00 [medline] PHST- 2018/01/10 06:00 [entrez] AID - 10.1007/s12028-017-0485-5 [pii] AID - 10.1007/s12028-017-0485-5 [doi] PST - ppublish SO - Neurocrit Care. 2018 Jun;28(3):330-337. doi: 10.1007/s12028-017-0485-5. PMID- 29304529 OWN - NLM STAT- MEDLINE DCOM- 20190912 LR - 20190912 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 118 IP - 1 DP - 2018 Jan TI - Passivating Injured Endothelium with Kinexins in Thrombolytic Therapy. PG - 90-102 LID - 10.1160/TH17-05-0330 [doi] AB - Without conjunctive administration of an anticoagulant, endothelial injury-induced thrombosis is resistant to thrombolysis and prone to re-thrombosis. We hypothesized that co-delivery of recombinant tissue plasminogen activator (rtPA) with annexin V-containing anticoagulants that specifically target the injured endothelium may passivate the thrombogenic elements of the vascular injury site and enhance rtPA-induced thrombolysis. In this study, the effects of conjunctive administration of Kinexins (Kunitz inhibitor-annexin V fusion proteins) with rtPA on thrombolysis were determined in vitro and in vivo. Thromboelastometry showed that both TAP-A (tick anticoagulant peptide-annexin V fusion protein; an inhibitor of factor Xa [FXa] and prothrombinase) and A-6L15 (annexin V-6L15 fusion protein; an inhibitor of tissue factor/FVIIa) exerted concentration-dependent (10-100 nM) effects on clot formation, with TAP-A being several folds more potent than A-6L15 in whole blood. Combination of TAP-A or A-6L15 with rtPA (1 mug/mL) led to decrease in lysis index, suggesting conjunctive enhancement of thrombolysis by combined use of rtPA with TAP-A or A-6L15. In a rat cremaster muscle preparation subjected to photochemical injury, conjunctive administration of rtPA and TAP-A significantly restored tissue perfusion to 56%, which is approximately two fold of that by rtPA or TAP-A alone. Near-infrared fluorescence images demonstrated local retention of a fluorescent A-6L15-S288 at the injury site, suggesting a targeting effect of the fusion protein. Pharmacokinetic analysis showed that (123)I-labelled TAP-A and A-6L15 had initial distribution half-lives (T(1/2alpha)) of approximately 6 minutes and elimination half-lives (T(1/2beta)) of approximately 2.3 hours. In conclusion, Kinexins were potentially useful adjunctive agents with rtPA thrombolytic therapy especially for thrombosis induced by endothelial injury. CI - Schattauer GmbH Stuttgart. FAU - Ma, Yunn-Hwa AU - Ma YH AD - Department of Pharmacology & Healthy Aging Research Center, Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China. AD - Department of Neurology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Republic of China. FAU - Huang, Chao-Wei AU - Huang CW AD - Department of Pharmacology & Healthy Aging Research Center, Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China. FAU - Wen, Chih-Jen AU - Wen CJ AD - Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Republic of China. FAU - Lu, Yi-Ching AU - Lu YC AD - Department of Pharmacology & Healthy Aging Research Center, Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China. FAU - Wey, Shiaw-Pyng AU - Wey SP AD - Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan City, Taiwan, Republic of China. AD - Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Republic of China. FAU - Wun, Tze-Chein AU - Wun TC AD - EVAS Therapeutics, Ballwin, Missouri, United States. LA - eng PT - Journal Article DEP - 20180105 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Annexin A5) RN - 0 (Anticoagulants) RN - 0 (Iodine Radioisotopes) RN - 0 (Peptides) RN - 0 (Protease Inhibitors) RN - 9088-41-9 (Trypsin Inhibitor, Kunitz Soybean) RN - EC 3.4.21.21 (Factor VIIa) RN - EC 3.4.21.6 (Factor Xa) SB - IM MH - Abdominal Muscles/*physiopathology MH - Animals MH - Annexin A5/*chemistry/therapeutic use MH - Anticoagulants/chemistry MH - Blood Coagulation/drug effects MH - Endothelium/*injuries/pathology MH - Factor VIIa/chemistry MH - Factor Xa/chemistry MH - Humans MH - Iodine Radioisotopes/chemistry MH - Male MH - Peptides/chemistry MH - Perfusion MH - Protease Inhibitors/metabolism MH - Rats MH - Rats, Sprague-Dawley MH - Spectrometry, Fluorescence MH - Spectroscopy, Near-Infrared MH - *Thrombelastography MH - *Thrombolytic Therapy MH - Thrombosis/physiopathology MH - Trypsin Inhibitor, Kunitz Soybean/*chemistry/therapeutic use COIS- Disclosures: Tze-Chein Wun is a proprietor of EVAS Therapeutics, LLC. The other authors have no conflicts of interest. EDAT- 2018/01/06 06:00 MHDA- 2019/09/13 06:00 CRDT- 2018/01/06 06:00 PHST- 2018/01/06 06:00 [entrez] PHST- 2018/01/06 06:00 [pubmed] PHST- 2019/09/13 06:00 [medline] AID - 10.1160/TH17-05-0330 [doi] PST - ppublish SO - Thromb Haemost. 2018 Jan;118(1):90-102. doi: 10.1160/TH17-05-0330. Epub 2018 Jan 5. PMID- 29299962 OWN - NLM STAT- MEDLINE DCOM- 20181212 LR - 20190620 IS - 2295-3337 (Electronic) IS - 1784-3286 (Linking) VI - 73 IP - 4 DP - 2018 Aug TI - Thromboelastometry in trauma care: a place in the 2018 Belgian health care system? PG - 244-250 LID - 10.1080/17843286.2017.1422311 [doi] AB - Introduction Evidence supporting the use of Thromboelastography (TEG(R)) and rotational thromboelastometric (ROTEM(R)) in the trauma setting remains limited. We present the results of a practical evaluation of the potential interest of ROTEM(R) in the diagnosis of acute coagulopathy and the need for emergent blood product transfusion in the general trauma population of a non-trauma Belgian emergency department. Methods Extracting a convenience cohort from the initial prospective TICCS study, we performed a retrospective analysis to test the following hypothesis: ROTEM(R) might be helpful to discriminate trauma patients with or without acute coagulopathy. Fifty patients were included and ROTEM(R) results were compared to conventional coagulation tests results, blood transfusion need and outcome. Results With a negative predictive value of 97.6% and a positive predictive value of 42.9%, a strictly normal ROTEM(R) profile at the time of admission seems to be able to exclude the presence of acute coagulopathy. ROTEM(R) also seems to be accurate in identifying patients without the need for emergent blood product transfusions. Conclusion In a population of trauma patients of a Belgian general emergency department, a strictly normal coagulation profile evaluated by ROTEM(R) at hospital entry is associated with a normal coagulation profile evaluated by INR and fibrinogen levels and the absence of any indication of blood product transfusion. ROTEM(R) may be useful for preselection of trauma patients at risk for coagulopathy within the global trauma population. This, however, would need confirmation in further investigations. TRIAL REGISTRATION: clinicaltrials.gov NCT02132208 Registered 6 May 2014. FAU - Tonglet, Martin Lucien AU - Tonglet ML AD - a Emergency Department , Liege University Hospital, Domaine du Sart Tilman , Liege , Belgium. FAU - Poplavsky, Jean-Louis AU - Poplavsky JL AD - b Scientific advisory board , European Drug Development Consulting , Amay , Belgium. FAU - Seidel, Laurence AU - Seidel L AD - c Departement des biostatistiques , Domaine du Sarti Tilman, CHU du Sart Tilman , Liege , Belgium. FAU - Minon, Jean Marc AU - Minon JM AD - d Laboratory and blood transfusions departments , CHR de la Citadelle , Liege , Belgium. FAU - D'Orio, Vincenzo AU - D'Orio V AD - a Emergency Department , Liege University Hospital, Domaine du Sart Tilman , Liege , Belgium. FAU - Ghuysen, Alexandre AU - Ghuysen A AD - a Emergency Department , Liege University Hospital, Domaine du Sart Tilman , Liege , Belgium. LA - eng SI - ClinicalTrials.gov/NCT02132208 PT - Journal Article DEP - 20180104 PL - England TA - Acta Clin Belg JT - Acta clinica Belgica JID - 0370306 SB - IM MH - Adult MH - Belgium MH - Blood Coagulation Disorders/*diagnosis/therapy MH - Blood Transfusion/statistics & numerical data MH - Emergency Medical Services/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Prospective Studies MH - Resuscitation MH - Retrospective Studies MH - Thrombelastography/*statistics & numerical data MH - Wounds and Injuries/epidemiology/*therapy MH - Young Adult OTO - NOTNLM OT - Trauma OT - acute traumatic coagulopathy OT - coagulopathy OT - consumption coagulopathy OT - hemostatic resuscitation EDAT- 2018/01/05 06:00 MHDA- 2018/12/13 06:00 CRDT- 2018/01/05 06:00 PHST- 2018/01/05 06:00 [pubmed] PHST- 2018/12/13 06:00 [medline] PHST- 2018/01/05 06:00 [entrez] AID - 10.1080/17843286.2017.1422311 [doi] PST - ppublish SO - Acta Clin Belg. 2018 Aug;73(4):244-250. doi: 10.1080/17843286.2017.1422311. Epub 2018 Jan 4. PMID- 29298240 OWN - NLM STAT- MEDLINE DCOM- 20190301 LR - 20220408 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 84 IP - 3 DP - 2018 Mar TI - Increased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid. PG - 426-432 LID - 10.1097/TA.0000000000001792 [doi] AB - BACKGROUND: The association between tranexamic acid (TXA) and fibrinolysis shutdown is unknown. We hypothesize that TXA is associated with fibrinolysis shutdown in critically injured trauma patients. METHODS: Two hundred eighteen critically injured adults admitted to the intensive care unit at an urban Level I trauma center from August 2011 to January 2015 who had thromboelastography performed upon intensive care unit admission were reviewed. Groups were stratified based on fibrinolysis shutdown, which was defined as LY30 of 0.8% or less. Continuous variables were expressed as mean +/- standard deviation or median (interquartile range). Poisson regression analysis was used to determine predictors of shutdown. RESULTS: Patients were age 46 +/- 18 years, 81% male, 75% blunt trauma, Injury Severity Score of 28 +/- 13, 16% received TXA, 64% developed fibrinolysis shutdown, and mortality was 15%. In the first 24 hours, 4 (2-9) units packed red blood cells and 2 (0-6) units fresh frozen plasma were administered. Those with shutdown had worse initial systolic blood pressure (114 +/- 38 mm Hg vs. 129 +/- 43 mm Hg, p = 0.006) and base deficit (-5 +/- 6 mEq/L vs -3 +/- 5 mEq/L, p = 0.013); received more packed red blood cells [6 (2-11) vs. 2 (1-5) units, p < 0.0001], and fresh frozen plasma [3 (0-8) vs. 0 (0-4) units, p < 0.0001]; and more often received TXA (23% vs. 4%, p <0.0001). After controlling for confounders, TXA (relative risk, 1.35; 95% confidence interval, 1.10-1.64; p = 0.004) and cryoprecipitate transfusion (relative risk, 1.29; 95% confidence interval, 1.07-1.56; p = 0.007) were independently associated with fibrinolysis shutdown. CONCLUSION: Patients who received TXA were at increased risk of fibrinolysis shutdown compared with patients who did not receive TXA. We recommend that administration of TXA be limited to severely injured patients with evidence of hyperfibrinolysis and recommend caution in those with evidence of fibrinolysis shutdown. LEVEL OF EVIDENCE: Therapeutic, level III. FAU - Meizoso, Jonathan P AU - Meizoso JP AD - From the DeWitt Daughtry Family Department of Surgery (J.P.M., M.B.M., J.J.R., C.A.K., S.A.E., N.N., C.I.S., K.G.P.), and Department of Anesthesiology (R.D.), Perioperative Medicine, and Pain Management, Ryder Trauma Center, University of Miami/Jackson Memorial Medical Center, Miami, Florida. FAU - Dudaryk, Roman AU - Dudaryk R FAU - Mulder, Michelle B AU - Mulder MB FAU - Ray, Juliet J AU - Ray JJ FAU - Karcutskie, Charles A AU - Karcutskie CA FAU - Eidelson, Sarah A AU - Eidelson SA FAU - Namias, Nicholas AU - Namias N FAU - Schulman, Carl I AU - Schulman CI FAU - Proctor, Kenneth G AU - Proctor KG LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/administration & dosage MH - Blood Coagulation Disorders/blood/*drug therapy/etiology MH - Dose-Response Relationship, Drug MH - Female MH - Fibrinolysis/*drug effects MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography MH - Tranexamic Acid/*administration & dosage MH - *Trauma Centers MH - Trauma Severity Indices MH - Treatment Outcome MH - Wounds and Injuries/blood/*complications/diagnosis EDAT- 2018/01/04 06:00 MHDA- 2019/03/02 06:00 CRDT- 2018/01/04 06:00 PHST- 2018/01/04 06:00 [pubmed] PHST- 2019/03/02 06:00 [medline] PHST- 2018/01/04 06:00 [entrez] AID - 10.1097/TA.0000000000001792 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Mar;84(3):426-432. doi: 10.1097/TA.0000000000001792. PMID- 29289392 OWN - NLM STAT- MEDLINE DCOM- 20180911 LR - 20260518 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 163 IP - 4 DP - 2018 Apr TI - Abnormalities of laboratory coagulation tests versus clinically evident coagulopathic bleeding: results from the prehospital resuscitation on helicopters study (PROHS). PG - 819-826 LID - S0039-6060(17)30788-2 [pii] LID - 10.1016/j.surg.2017.10.050 [doi] AB - BACKGROUND: Laboratory-based evidence of coagulopathy (LC) is observed in 25-35% of trauma patients, but clinically-evident coagulopathy (CC) is not well described. METHODS: Prospective observational study of adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers in 2015. Patients meeting predefined highest-risk criteria were divided into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC-. We used a mixed-effects, Poisson regression with robust error variance to test the hypothesis that abnormalities on rapid thrombelastography (r-TEG) and international normalized ratio (INR) were independently associated with CC+. RESULTS: Of 1,019 highest-risk patients, CC+ (n=41, 4%) were more severely injured (median ISS 32 vs 17), had evidence of LC on r-TEG and INR, received more transfused blood products at 4 hours (37 vs 0 units), and had greater 30-day mortality (59% vs 12%) than CC- (n=978, 96%). The overall incidence of LC was 39%. 30-day mortality was 22% vs 9% in those with and without LC. In two separate models, r-TEG K-time >2.5 min (RR 1.3, 95% CI 1.1-1.7), r-TEG mA <55 mm (RR 2.5, 95% CI 2.0-3.2), platelet count <150 x 10(9)/L (RR 1.2, 95% CI 1.1-1.3), and INR >1.5 (RR 5.4, 95% CI 1.8-16.3) were independently associated with CC+. A combined regression model was not generated because too few patients underwent both r-TEG and INR. CONCLUSION: CC was rare compared to LC. CC was associated with poor outcomes and impairment of both clotting factor and platelet-mediated coagulation components. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Chang, Ronald AU - Chang R AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, McGovern Medical School, Houston, TX. Electronic address: ronald.chang@uth.tmc.edu. FAU - Fox, Erin E AU - Fox EE AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX. FAU - Greene, Thomas J AU - Greene TJ AD - Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. FAU - Swartz, Michael D AU - Swartz MD AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. FAU - DeSantis, Stacia M AU - DeSantis SM AD - Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. FAU - Stein, Deborah M AU - Stein DM AD - Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. FAU - Bulger, Eileen M AU - Bulger EM AD - Department of Surgery, University of Washington School of Medicine, Seattle, WA. FAU - Melton, Sherry M AU - Melton SM AD - Department of Surgery, New York Health and Hospitals, New York, NY. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH. FAU - Schreiber, Martin A AU - Schreiber MA AD - Department of Surgery, Oregon Health & Science University, Portland, OR. FAU - Zielinski, Martin D AU - Zielinski MD AD - Department of Surgery, Mayo Clinic, Rochester, MN. FAU - O'Keeffe, Terence AU - O'Keeffe T AD - Department of Surgery, University of Arizona Health Sciences, Tucson, AZ. FAU - Inaba, Kenji AU - Inaba K AD - Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA. FAU - Tomasek, Jeffrey S AU - Tomasek JS AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX. FAU - Podbielski, Jeanette M AU - Podbielski JM AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX. FAU - Appana, Savitri AU - Appana S AD - Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. FAU - Yi, Misung AU - Yi M AD - Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX. FAU - Johansson, Par I AU - Johansson PI AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Henriksen, Hanne H AU - Henriksen HH AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Steinmetz, Jacob AU - Steinmetz J AD - Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark; Helicopter Emergency Medical Service, Denmark. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, McGovern Medical School, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, McGovern Medical School, Houston, TX. CN - PROHS Study Group LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States GR - T32 GM074902/GM/NIGMS NIH HHS/United States GR - U01 HL077863/HL/NHLBI NIH HHS/United States GR - UL1 TR000371/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20171227 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Aged MH - Air Ambulances MH - Blood Coagulation Disorders/*diagnosis/etiology/therapy MH - *Emergency Medical Services MH - Female MH - Humans MH - Injury Severity Score MH - *International Normalized Ratio MH - Male MH - Middle Aged MH - Phenotype MH - Poisson Distribution MH - Prospective Studies MH - Regression Analysis MH - *Resuscitation MH - *Thrombelastography MH - Wounds and Injuries/*complications/therapy PMC - PMC5903880 MID - NIHMS930881 FIR - Holcomb, John B IR - Holcomb JB IRAD- Clinical Coordinating Center. FIR - Wade, Charles E IR - Wade CE IRAD- Clinical Coordinating Center. FIR - Fox, Erin E IR - Fox EE IRAD- Clinical Coordinating Center. FIR - Chang, Ronald IR - Chang R IRAD- Clinical Coordinating Center. FIR - Podbielski, Jeanette M IR - Podbielski JM IRAD- Clinical Coordinating Center. FIR - Tomasek, Jeffrey S IR - Tomasek JS IRAD- Clinical Coordinating Center. FIR - Del Junco, Deborah J IR - Del Junco DJ IRAD- Clinical Coordinating Center. FIR - Swartz, Michael D IR - Swartz MD IRAD- Data Coordinating Center. FIR - DeSantis, Stacia M IR - DeSantis SM IRAD- Data Coordinating Center. FIR - Appana, Savitri N IR - Appana SN IRAD- Data Coordinating Center. FIR - Greene, Thomas J IR - Greene TJ IRAD- Data Coordinating Center. FIR - Yi, Misung IR - Yi M IRAD- Data Coordinating Center. FIR - Gonzalez, Michael O IR - Gonzalez MO IRAD- Data Coordinating Center. FIR - Baraniuk, Sarah IR - Baraniuk S IRAD- Data Coordinating Center. FIR - van Belle, Gerald IR - van Belle G IRAD- Resuscitation Outcomes Consortium at the University of Washington. FIR - Leroux, Brian G IR - Leroux BG IRAD- Resuscitation Outcomes Consortium at the University of Washington. FIR - Howard, Carrie L IR - Howard CL IRAD- University of Texas Health Science Center at Houston. FIR - Haymaker, Amanda IR - Haymaker A IRAD- University of Texas Health Science Center at Houston. FIR - Stein, Deborah M IR - Stein DM IRAD- Shock, Trauma and Anesthesiology Research-Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. FIR - Scalea, Thomas M IR - Scalea TM IRAD- Shock, Trauma and Anesthesiology Research-Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. FIR - Ayd, Benjamin IR - Ayd B IRAD- Shock, Trauma and Anesthesiology Research-Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. FIR - Das, Pratik IR - Das P IRAD- Shock, Trauma and Anesthesiology Research-Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. FIR - Herrera, Anthony V IR - Herrera AV IRAD- Shock, Trauma and Anesthesiology Research-Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center. FIR - Bulger, Eileen M IR - Bulger EM IRAD- University of Washington. FIR - Robinson, Bryce R H IR - Robinson BRH IRAD- University of Washington. FIR - Klotz, Patricia IR - Klotz P IRAD- University of Washington. FIR - Minhas, Aniqa IR - Minhas A IRAD- University of Washington. FIR - Kerby, Jeffrey D IR - Kerby JD IRAD- University of Alabama at Birmingham. FIR - Melton, Sherry M IR - Melton SM IRAD- University of Alabama at Birmingham. FIR - Williams, Carolyn R IR - Williams CR IRAD- University of Alabama at Birmingham. FIR - Stephens, Shannon W IR - Stephens SW IRAD- University of Alabama at Birmingham. FIR - Goodman, Michael IR - Goodman M IRAD- University of Cincinnati. FIR - Johannigman, Jay A IR - Johannigman JA IRAD- University of Cincinnati. FIR - McMullan, Jason IR - McMullan J IRAD- University of Cincinnati. FIR - Branson, Richard D IR - Branson RD IRAD- University of Cincinnati. FIR - Gomaa, Dina IR - Gomaa D IRAD- University of Cincinnati. FIR - Barczak, Christopher IR - Barczak C IRAD- University of Cincinnati. FIR - Schreiber, Martin A IR - Schreiber MA IRAD- Oregon Health and Science University. FIR - Underwood, Samantha J IR - Underwood SJ IRAD- Oregon Health and Science University. FIR - Watson, Cheri IR - Watson C IRAD- Oregon Health and Science University. FIR - Zielinski, Martin D IR - Zielinski MD IRAD- Mayo Clinic. FIR - Stubbs, James R IR - Stubbs JR IRAD- Mayo Clinic. FIR - Headlee, Amy IR - Headlee A IRAD- Mayo Clinic. FIR - O'Keeffe, Terence IR - O'Keeffe T IRAD- University of Arizona. FIR - Rhee, Peter IR - Rhee P IRAD- University of Arizona. FIR - Rokowski, Laurel L IR - Rokowski LL IRAD- University of Arizona. FIR - Santoro, John Jr IR - Santoro J Jr IRAD- University of Arizona. FIR - Seach, Andrea IR - Seach A IRAD- University of Arizona. FIR - Bradford, David IR - Bradford D IRAD- University of Arizona. FIR - Fealk, Michelle IR - Fealk M IRAD- University of Arizona. FIR - Latifi, Fortesa IR - Latifi F IRAD- University of Arizona. FIR - Inaba, Kenji IR - Inaba K IRAD- University of Southern California. FIR - Kim, Henry IR - Kim H IRAD- University of Southern California. FIR - Chudnofsky, Carl IR - Chudnofsky C IRAD- University of Southern California. FIR - Wong, Monica D IR - Wong MD IRAD- University of Southern California. EDAT- 2018/01/01 06:00 MHDA- 2018/09/12 06:00 PMCR- 2019/04/01 CRDT- 2018/01/01 06:00 PHST- 2017/03/02 00:00 [received] PHST- 2017/09/22 00:00 [revised] PHST- 2017/10/18 00:00 [accepted] PHST- 2018/01/01 06:00 [pubmed] PHST- 2018/09/12 06:00 [medline] PHST- 2018/01/01 06:00 [entrez] PHST- 2019/04/01 00:00 [pmc-release] AID - S0039-6060(17)30788-2 [pii] AID - 10.1016/j.surg.2017.10.050 [doi] PST - ppublish SO - Surgery. 2018 Apr;163(4):819-826. doi: 10.1016/j.surg.2017.10.050. Epub 2017 Dec 27. PMID- 29276028 OWN - NLM STAT- MEDLINE DCOM- 20190619 LR - 20190619 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 36 IP - 8 DP - 2018 Aug TI - Evaluation for effects of severe acidosis on hemostasis in trauma patients using thrombelastography analyzer. PG - 1332-1340 LID - S0735-6757(17)31039-2 [pii] LID - 10.1016/j.ajem.2017.12.037 [doi] AB - OBJECTIVE: To investigate effects of metabolic acidosis on hemostasis function in trauma patients using thromboelastography analyzer. METHODS: 65 critically injured patients and 19 healthy volunteers were enrolled in the study. Three samples of whole blood were collected from each patient or healthy volunteer. These three samples were acidified with 50mmol/l phosphate-buffered saline (PBS) (pH5.8) or a neutral buffer (50mmol/l phosphate, pH7.4) and acidified blood sample with target pH of 6.95, 7.15 or 7.35 was obtained respectively. These three samples with target pH value were added into thrombelastography analyzer (TEG(R) 5000 Thrombelastograph Hemostasis Analyzers; Haemoscope Corporation, Niles, Illinois, USA) respectively and variables of Clot time (r), Rate of clot formation (alpha Angle), Clot formation time (K), Coagulation Index (CI) and Maximum strength (MA) were monitored at 37 degrees C. Besides, association between TEG(R) parameters and clinicopathological features was analyzed by the Pearson chi(2) test. RESULTS: In trauma patients, all 5 thrombelastographic variables, Clot time (r), Clot formation time (K), Maximum Amplitude (MA), Rate of clot formation (alpha Angle) and Coagulation Index (CI), were significantly affected by blood acidification, F(1.321,83.213)=88.960, P<0.001, F(2,128)=112.738, P<0.001, F(1.199,76.748)=37.964, P<0.001, F(1.195,76.452)=16.789, P<0.001 and F(2,128)=178.674, P<0.001. Post hoc tests showed that moderate acidosis (pH7.15) significantly elongated K time (from 2.6 to 3.4min, P=0.0013) and increased alpha Angle (from 51.9 degrees to 52.2 degrees , P=0.0040). r, MA and CI were not markedly influenced under moderate acidification. Comparing to mild acidosis (pH7.15), severe acidosis (pH6.95) induced more serious impairment to hemostasis and all 5 variables was substantially affected, r (from 5.9 to 6.8min, P<0.001), K (from 3.4 to 3.9min, P<0.001), alpha Angle (from 52.2 degrees to 50.8 degrees , P=0.002), MA (from 52.9 to 51.6mm, P<0.001) and CI (from -2.3 to -4.2, P<0.001). Additionally, higher r elongation under severe acidosis was significantly associated with an increased mortality rate and transfusion requirement (P=0.019 and 0.031). In healthy volunteers, similar effects on hemostasis were detected. Inhibition ratios of thrombelastographic parameters were significantly higher in trauma patients than in healthy volunteers indicating severer impairment of metabolic acidosis to hemostasis in critically injured patients. CONCLUSIONS: The degree of metabolic acidosis in trauma patients is positively correlated to the severity of hemostasis dysfunction. Additionally, acidosis induces more serious impairment to hemostasis in trauma patients than in healthy volunteers. Moreover, acidosis-induced r time elongation is positively related to a higher death rate and increased transfusion requirement and this indicates a predictive role of TEG(R) variables for prognosis of traumatized patients. CI - Copyright (c) 2018. Published by Elsevier Inc. FAU - Lv, Xin AU - Lv X AD - Department of Intensive Care Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China. FAU - Mao, Yong AU - Mao Y AD - Department of Intensive Care Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China. FAU - Qin, Zonghe AU - Qin Z AD - Department of Intensive Care Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China. Electronic address: qzh66@sina.cn. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20171214 PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 SB - IM MH - Acidosis/*complications MH - Adolescent MH - Adult MH - *Blood Coagulation MH - Blood Transfusion/statistics & numerical data MH - Case-Control Studies MH - China MH - Female MH - Hemorrhage/*complications MH - *Hemostasis MH - Humans MH - Male MH - Middle Aged MH - *Thrombelastography MH - Wounds and Injuries/*complications MH - Young Adult OTO - NOTNLM OT - Acute traumatic coagulopathy OT - Metabolic acidosis OT - Thrombelastography OT - Trauma EDAT- 2017/12/26 06:00 MHDA- 2019/06/20 06:00 CRDT- 2017/12/26 06:00 PHST- 2017/08/06 00:00 [received] PHST- 2017/12/13 00:00 [revised] PHST- 2017/12/13 00:00 [accepted] PHST- 2017/12/26 06:00 [pubmed] PHST- 2019/06/20 06:00 [medline] PHST- 2017/12/26 06:00 [entrez] AID - S0735-6757(17)31039-2 [pii] AID - 10.1016/j.ajem.2017.12.037 [doi] PST - ppublish SO - Am J Emerg Med. 2018 Aug;36(8):1332-1340. doi: 10.1016/j.ajem.2017.12.037. Epub 2017 Dec 14. PMID- 29270080 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220408 IS - 1477-9560 (Print) IS - 1477-9560 (Electronic) IS - 1477-9560 (Linking) VI - 15 DP - 2017 TI - Video-assisted Thoracoscopic surgery (VATS) lobectomy for lung cancer does not induce a procoagulant state. PG - 29 LID - 10.1186/s12959-017-0152-2 [doi] LID - 29 AB - BACKGROUND: Changes in the coagulation system in patients undergoing surgery for lung cancer have been sparsely investigated and the impact of the surgical trauma on the coagulation system is largely unknown in these patients. An increased knowledge could potentially improve the thromboprophylaxis regimes. The aim of this study was to assess the coagulation profile evoked in patients undergoing curative surgery by Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. METHODS: Thirty-one patients diagnosed with primary lung cancer undergoing VATS lobectomy were prospectively included. The coagulation profile was assessed preoperatively and in the first two days postoperatively using a wide range of standard coagulation tests, dynamic whole blood coagulation measured by rotational thromboelastometry (ROTEM(R)) and thrombin generation evaluated by calibrated automated thrombography. Patients did not receive thromboprophylactic treatment. Data was analyzed using repeated measures one-way ANOVA. RESULTS: The standard coagulation parameters displayed only subtle changes after surgery and the ROTEM(R) and thrombin generation results remained largely unchanged. CONCLUSIONS: Patients undergoing VATS lobectomy are normocoagulable in the preoperative state and a VATS lobectomy does not significantly influence the coagulation. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (Identifier: NCT01741506) and at EudraCTno. 2012-002409-23. Registered December 2012. FAU - Christensen, Thomas Decker AU - Christensen TD AUID- ORCID: 0000-0001-6509-8510 AD - Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c AD - Department of Clinical Medicine, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c FAU - Vad, Henrik AU - Vad H AD - Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c AD - Department of Clinical Medicine, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c FAU - Pedersen, Soren AU - Pedersen S AD - Department of Anesthesiology and Intensive Care, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c AD - Department of Clinical Medicine, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c FAU - Licht, Peter B AU - Licht PB AD - Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, DK - 5000 Odense C, Denmark. ISNI: 0000 0004 0512 5013. GRID: grid.7143.1 FAU - Nybo, Mads AU - Nybo M AD - Department of Clinical Biochemistry, Odense University Hospital, DK - 5000 Odense C, Denmark. ISNI: 0000 0004 0512 5013. GRID: grid.7143.1 FAU - Hornbech, Kare AU - Hornbech K AD - Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, DK - 2100 Copenhagen, Denmark. ISNI: 0000 0004 0646 7373. GRID: grid.4973.9 FAU - Zois, Nora Elisabeth AU - Zois NE AD - Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, DK - 2100 Copenhagen, Denmark. ISNI: 0000 0004 0646 7373. GRID: grid.4973.9 FAU - Hvas, Anne-Mette AU - Hvas AM AD - Department of Clinical Biochemistry, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c AD - Department of Clinical Medicine, Aarhus University Hospital, DK - 8200 Aarhus N, Denmark. ISNI: 0000 0004 0512 597X. GRID: grid.154185.c LA - eng SI - ClinicalTrials.gov/NCT01741506 PT - Journal Article DEP - 20171220 PL - England TA - Thromb J JT - Thrombosis journal JID - 101170542 PMC - PMC5738757 OTO - NOTNLM OT - Blood coagulation OT - Blood coagulation test OT - Lung neoplasm OT - Thoracic surgery OT - Venous thrombosis OT - Video assisted COIS- The patients were included after oral and written consent. The study protocol complied with the Helsinki II declaration and was approved by the local scientific ethical committee (File number: 1-10-72-364-12) and The Danish Data Protection Agency. The study was conducted according to Good Clinical Practice (GCP) standards and was monitored and approved by the GCP-unit, Aarhus University Hospital, Aarhus, Denmark. The trial is registered at ClinicalTrials.gov (Identifier: NCT01741506) and at EudraCTno. 2012-002409-23.Not applicableThomas Decker Christensen has been on the speaker bureaus for AstraZeneca, Boehringer-Ingelheim, Pfizer, Roche Diagnostics, Takeda, Bristol-Myers Squibb and Merck Sharp & Dohme (MSD) and has been in an Advisory Board for Bayer, Merck Sharp & Dohme (MSD) and Boehringer-Ingelheim. Anne-Mette Hvas has received speaker's fees from CSL Behring, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb and Leo Pharma and unrestricted research support from Octapharma, CSL Behring and Leo Pharma. Mads Nybo has received speaker's fees from Astra Zeneca, Pfizer, Boehringer-Ingelheim, and Roche Diagnostics. Peter Licht has received speaker's fees from Ethicon Endo-Surgery. Other authors - none declared.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/12/23 06:00 MHDA- 2017/12/23 06:01 PMCR- 2017/12/20 CRDT- 2017/12/23 06:00 PHST- 2017/09/15 00:00 [received] PHST- 2017/12/11 00:00 [accepted] PHST- 2017/12/23 06:00 [entrez] PHST- 2017/12/23 06:00 [pubmed] PHST- 2017/12/23 06:01 [medline] PHST- 2017/12/20 00:00 [pmc-release] AID - 152 [pii] AID - 10.1186/s12959-017-0152-2 [doi] PST - epublish SO - Thromb J. 2017 Dec 20;15:29. doi: 10.1186/s12959-017-0152-2. eCollection 2017. PMID- 29267182 OWN - NLM STAT- MEDLINE DCOM- 20190123 LR - 20190123 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 84 IP - 1 DP - 2018 Jan TI - Exposing the bidirectional effects of alcohol on coagulation in trauma: Impaired clot formation and decreased fibrinolysis in rotational thromboelastometry. PG - 97-103 LID - 10.1097/TA.0000000000001716 [doi] AB - BACKGROUND: Alcohol has been associated with altered viscoelastic testing in trauma, indicative of impaired coagulation. Such alterations, however, show no correlation to coagulopathy-related outcomes. Other data suggest that alcohol may inhibit fibrinolysis. We sought to clarify these mechanisms after traumatic injury using thromboelastometry (ROTEM), hypothesizing that alcohol-related clot formation impairment may be counter-balanced by inhibited fibrinolysis. METHODS: Laboratory, demographic, clinical, and outcome data were prospectively collected from 406 critically injured trauma patients at a Level I trauma center. ROTEM and standard coagulation measures were conducted in parallel. Univariate comparisons were performed by alcohol level (EtOH), with subsequent regression analysis. RESULTS: Among 274 (58%) patients with detectable EtOH, median EtOH was 229 mg/dL. These patients were primarily bluntly injured and had lower GCS (p < 0.05) than EtOH-negative patients, but had similar admission pH and injury severity (p = NS). EtOH-positive patients had prolonged ROTEM clotting time and rate of clot formation time (CFT/alpha); they also had decreased fibrinolysis (max lysis %; all p < 0.05). In linear regression, for every 100 mg/dL increase in EtOH, clotting time increased by 13 seconds and fibrinolysis decreased by 1.5% (both p < 0.05). However, EtOH was not an independent predictor of transfusion requirements or mortality. In high-EtOH patients with coagulopathic ROTEM tracings, transfusion rates were significantly lower than expected, relative to EtOH-negative patients with similar ROTEM findings. CONCLUSION: As assayed by ROTEM, alcohol appears to have a bidirectional effect on coagulation in trauma, both impairing initial clot formation and inhibiting fibrinolysis. This balancing of mechanisms may explain lack of correlation between altered ROTEM and coagulopathy-related outcomes. Viscoelastic testing should be used with caution in intoxicated trauma patients. LEVEL OF EVIDENCE: Epidemiological study, level III. FAU - Howard, Benjamin Michael AU - Howard BM AD - From the Department of Surgery (B.M.H., L.Z.K., B.J.R., A.S.C., M.F.N., R.A.C.), San Francisco General Hospital and Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Anesthesia (C.S.C.), University of California San Francisco; San Francisco, California; Denver Health Medical Center (M.J.C.), University of Colorado School of Medicine, Denver, Colorado. FAU - Kornblith, Lucy Z AU - Kornblith LZ FAU - Redick, Brittney J AU - Redick BJ FAU - Conroy, Amanda S AU - Conroy AS FAU - Nelson, Mary F AU - Nelson MF FAU - Calfee, Carolyn S AU - Calfee CS FAU - Callcut, Rachael A AU - Callcut RA FAU - Cohen, Mitchell Jay AU - Cohen MJ LA - eng GR - K01 ES026834/ES/NIEHS NIH HHS/United States PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 3K9958V90M (Ethanol) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Critical Illness MH - Ethanol/*pharmacology MH - Female MH - Fibrinolysis/*drug effects MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - *Thrombelastography MH - Wounds and Injuries/*physiopathology PMC - PMC6063843 MID - NIHMS909517 COIS- Conflict of Interest Statement: The authors declare no conflicts of interest related to this manuscript. EDAT- 2017/12/22 06:00 MHDA- 2019/01/24 06:00 PMCR- 2019/01/01 CRDT- 2017/12/22 06:00 PHST- 2017/12/22 06:00 [entrez] PHST- 2017/12/22 06:00 [pubmed] PHST- 2019/01/24 06:00 [medline] PHST- 2019/01/01 00:00 [pmc-release] AID - 01586154-201801000-00014 [pii] AID - 10.1097/TA.0000000000001716 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jan;84(1):97-103. doi: 10.1097/TA.0000000000001716. PMID- 29266754 OWN - NLM STAT- Publisher LR - 20240227 IS - 1445-2197 (Electronic) IS - 1445-1433 (Linking) DP - 2017 Dec 20 TI - Thromboelastography does not provide additional information to guide resuscitation in the severely injured. LID - 10.1111/ans.14357 [doi] FAU - van Wessem, Karlijn J P AU - van Wessem KJP AUID- ORCID: 0000-0002-1166-0990 AD - Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - Leenen, Luke P H AU - Leenen LPH AD - Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. LA - eng PT - Journal Article DEP - 20171220 PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 OTO - NOTNLM OT - conventional coagulation assay OT - haemostatic resuscitation OT - polytrauma OT - thromboelastography EDAT- 2017/12/22 06:00 MHDA- 2017/12/22 06:00 CRDT- 2017/12/22 06:00 PHST- 2017/08/21 00:00 [received] PHST- 2017/10/23 00:00 [revised] PHST- 2017/11/09 00:00 [accepted] PHST- 2017/12/22 06:00 [entrez] PHST- 2017/12/22 06:00 [pubmed] PHST- 2017/12/22 06:00 [medline] AID - 10.1111/ans.14357 [doi] PST - aheadofprint SO - ANZ J Surg. 2017 Dec 20. doi: 10.1111/ans.14357. PMID- 29248181 OWN - NLM STAT- MEDLINE DCOM- 20180911 LR - 20180911 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 163 IP - 4 DP - 2018 Apr TI - Principal component analysis of coagulation assays in severely injured children. PG - 827-831 LID - S0039-6060(17)30671-2 [pii] LID - 10.1016/j.surg.2017.09.031 [doi] AB - BACKGROUND: Trauma-induced coagulopathy is common and associated with poor outcome in injured children. Our aim is to identify patterns of coagulation dysregulation after injury and associate these phenotypes with relevant clinical outcomes. METHODS: We performed principal components analysis on prospectively collected data from children with the highest-level trauma activation June 2015-June 2016. Parameters included admission international normalized ratio, platelet count and thromboelastograms. Variables were reduced to principal components; principal component scores were generated for each subject and used in logistic regression with outcomes including mortality, disability, venous thromboembolism, and blood transfusion in the first 24 hours. RESULTS: We included 133 subjects with median interquartile range age =10 (5-13 years), median interquartile range Injury Severity Score =17 (9-25), 73.5% boys, 70.8% blunt trauma. principal component analysis identified 3 significant principal components accounting for 75.0% of overall variance. Principal component 1 reflected clot strength; principal component 2 reflected abnormal fibrinolysis, both hyperfibrinolysis and fibrinolysis shutdown; principal component 3 reflected global clotting factor depletion. High principal component 1 score was associated with increased mortality (odds ratio =1.63) and blood transfusion (odds ratio 1.36). Principal component 2 score was correlated with Injury Severity Score (rho 0.4) and associated with venous thromboembolism (odds ratio 1.84), functional disability (odds ratio 1.66), mortality (odds ratio 2.07) and blood transfusion (odds ratio 2.79). PC3 score was associated with increased mortality (odds ratio 1.92) and blood transfusion (odds ratio 1.25). CONCLUSION: Principal component analysis detects 3 patterns of coagulation dysregulation using widely available laboratory parameters: (1) abnormalities in clot strength; (2) abnormalities in fibrinolysis, and (3) clotting factor depletion. While all were associated with mortality and transfusion, fibrinolytic dysregulation was associated with injury severity and portends particularly poor outcome including venous thromboembolism and disability. CI - Copyright (c) 2017. Published by Elsevier Inc. FAU - Leeper, Christine M AU - Leeper CM AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. FAU - Neal, Matthew D AU - Neal MD AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - McKenna, Christine AU - McKenna C AD - Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. FAU - Billiar, Timothy AU - Billiar T AD - Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. FAU - Gaines, Barbara A AU - Gaines BA AD - Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Electronic address: barbara.gaines@chp.edu. LA - eng GR - UL1 TR001857/TR/NCATS NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20171213 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adolescent MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Blood Transfusion MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Injury Severity Score MH - *International Normalized Ratio MH - Logistic Models MH - Male MH - Phenotype MH - Platelet Count MH - *Principal Component Analysis MH - Prognosis MH - Prospective Studies MH - *Thrombelastography MH - Wounds and Injuries/*complications/diagnosis/mortality/therapy EDAT- 2017/12/19 06:00 MHDA- 2018/09/12 06:00 CRDT- 2017/12/18 06:00 PHST- 2017/02/21 00:00 [received] PHST- 2017/07/22 00:00 [revised] PHST- 2017/09/16 00:00 [accepted] PHST- 2017/12/19 06:00 [pubmed] PHST- 2018/09/12 06:00 [medline] PHST- 2017/12/18 06:00 [entrez] AID - S0039-6060(17)30671-2 [pii] AID - 10.1016/j.surg.2017.09.031 [doi] PST - ppublish SO - Surgery. 2018 Apr;163(4):827-831. doi: 10.1016/j.surg.2017.09.031. Epub 2017 Dec 13. PMID- 29239953 OWN - NLM STAT- MEDLINE DCOM- 20181231 LR - 20181231 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 126 IP - 2 DP - 2018 Feb TI - The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients. PG - 522-529 LID - 10.1213/ANE.0000000000002708 [doi] AB - BACKGROUND: There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA. METHODS: The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals. RESULTS: Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased -3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2-11.2) mm (P < .001) and INTEM by 6.8 (4.7-9.0) mm (P < .001) in favor of the TXA group. Production of fibrinogen fragments (represented by D-dimers) was significantly lower in the TXA group compared to group C. CONCLUSIONS: Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer). FAU - Stein, Philipp AU - Stein P AD - From the Institute of Anesthesiology, University and University Hospital Zurich, Switzerland. AD - Swiss Air-Ambulance, Rega (Rettungsflugwacht/Garde Aerienne), Zurich, Switzerland. FAU - Studt, Jan-Dirk AU - Studt JD AD - Division of Hematology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Albrecht, Roland AU - Albrecht R AD - Swiss Air-Ambulance, Rega (Rettungsflugwacht/Garde Aerienne), Zurich, Switzerland. FAU - Muller, Stefan AU - Muller S AD - Schutz und Rettung Zurich, Zurich, Switzerland. FAU - von Ow, Dieter AU - von Ow D AD - Zentrale Notaufnahme Kantonsspital St.Gallen, St. Gallen, Switzerland. FAU - Fischer, Simon AU - Fischer S AD - Department of Anesthesiology, Emergency Medicine, and Pain Therapy, Cantonal Hospital of Lucerne, Lucerne, Switzerland. FAU - Seifert, Burkhardt AU - Seifert B AD - Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. FAU - Mariotti, Sergio AU - Mariotti S AD - Schutz und Rettung Zurich, Zurich, Switzerland. FAU - Spahn, Donat R AU - Spahn DR AD - From the Institute of Anesthesiology, University and University Hospital Zurich, Switzerland. FAU - Theusinger, Oliver M AU - Theusinger OM AD - From the Institute of Anesthesiology, University and University Hospital Zurich, Switzerland. LA - eng SI - ClinicalTrials.gov/NCT02354885 PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Aged MH - Antifibrinolytic Agents/*administration & dosage MH - Blood Coagulation/*drug effects/physiology MH - Emergency Medical Services/*methods/trends MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Tranexamic Acid/*administration & dosage MH - *Trauma Centers/trends EDAT- 2017/12/15 06:00 MHDA- 2019/01/01 06:00 CRDT- 2017/12/15 06:00 PHST- 2017/12/15 06:00 [pubmed] PHST- 2019/01/01 06:00 [medline] PHST- 2017/12/15 06:00 [entrez] AID - 10.1213/ANE.0000000000002708 [doi] PST - ppublish SO - Anesth Analg. 2018 Feb;126(2):522-529. doi: 10.1213/ANE.0000000000002708. PMID- 29190254 OWN - NLM STAT- MEDLINE DCOM- 20171211 LR - 20240610 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 83 IP - 6 DP - 2017 Dec TI - Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activator. PG - 1014-1022 LID - 10.1097/TA.0000000000001718 [doi] AB - BACKGROUND: Fibrinolysis shutdown (SD) is an independent risk factor for increased mortality in trauma. High levels of plasminogen activator inhibitor-1 (PAI-1) directly binding tissue plasminogen activator (t-PA) is a proposed mechanism for SD; however, patients with low PAI-1 levels present to the hospital with a rapid TEG (r-TEG) LY30 suggestive SD. We therefore hypothesized that two distinct phenotypes of SD exist, one, which is driven by t-PA inhibition, whereas another is due to an inadequate t-PA release in response to injury. METHODS: Trauma activations from our Level I center between 2014 and 2016 with blood collected within an hour of injury were analyzed with r-TEG and a modified TEG assay to quantify fibrinolysis sensitivity using exogenous t-PA (t-TEG). Using the existing r-TEG thresholds for SD (<0.9%), physiologic (LY30 0.9-2.9%), and hyperfibrinolysis (LY30 > 2.9%) patients were stratified into phenotypes. A t-TEG LY30 greater than 95th percentile of healthy volunteers (n = 140) was classified as t-PA hypersensitive and used to subdivide phenotypes. A nested cohort had t-PA and PAI-1 activity levels measured in addition to proteomic analysis of additional fibrinolytic regulators. RESULTS: This study included 398 patients (median New Injury Severity Score, 18), t-PA-Sen was present in 27% of patients. Shutdown had the highest mortality rate (20%) followed by hyperfibinolysis (16%) and physiologic (9% p = 0.020). In the non-t-PA hypersensitive cohort, SD had a fivefold increase in mortality (15%) compared with non-SD patients (3%; p = 0.003) which remained significant after adjusting for Injury Severity Score and age (p = 0.033). Overall t-PA activity (p = 0.002), PAI-1 (p < 0.001), and t-PA/PAI-1 complex levels (p = 0.006) differed between the six phenotypes, and 54% of fibrinolytic regulator proteins analyzed (n = 19) were significantly different. CONCLUSION: In conclusion, acute fibrinolysis SD is not caused by a single etiology, and is clearly associated with PAI-1 activity. The differential phenotypes require an ongoing investigation to identify the optimal resuscitation strategy for these patients. LEVEL OF EVIDENCE: Prognostic, level III. FAU - Moore, Hunter B AU - Moore HB AD - From the Department of Surgery (H.B.M., E.E.M., B.R.H., M.D., G.R.S., G.R.N., P.J.L., A.B., C.S., A.S., K.C.H.), University of Colorado; Denver Health Medical Center (E.E.M., A.G., J.C.); and University of Colorado School of Public Health (A.S.), Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Huebner, Benjamin R AU - Huebner BR FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M FAU - Stettler, Gregory R AU - Stettler GR FAU - Nunns, Geoffrey R AU - Nunns GR FAU - Lawson, Peter J AU - Lawson PJ FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chandler, James AU - Chandler J FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher AU - Silliman C FAU - Sauaia, Angela AU - Sauaia A FAU - Hansen, Kirk C AU - Hansen KC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) RN - 0 (Plasminogen Activator Inhibitor 1) SB - IM MH - Adult MH - Biomarkers/blood MH - Blood Coagulation Disorders/*blood/etiology/mortality MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Fibrinolysis/*physiology MH - Follow-Up Studies MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Phenotype MH - Plasminogen Activator Inhibitor 1/*blood MH - Prognosis MH - Prospective Studies MH - Proteomics MH - Thrombelastography MH - Wounds and Injuries/blood/*complications/diagnosis PMC - PMC5726780 MID - NIHMS909857 EDAT- 2017/12/01 06:00 MHDA- 2017/12/12 06:00 PMCR- 2018/12/01 CRDT- 2017/12/01 06:00 PHST- 2017/12/01 06:00 [entrez] PHST- 2017/12/01 06:00 [pubmed] PHST- 2017/12/12 06:00 [medline] PHST- 2018/12/01 00:00 [pmc-release] AID - 01586154-201712000-00003 [pii] AID - 10.1097/TA.0000000000001718 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Dec;83(6):1014-1022. doi: 10.1097/TA.0000000000001718. PMID- 29180179 OWN - NLM STAT- MEDLINE DCOM- 20171211 LR - 20240610 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 220 DP - 2017 Dec TI - Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation. PG - 171-175 LID - S0022-4804(17)30367-0 [pii] LID - 10.1016/j.jss.2017.05.115 [doi] AB - BACKGROUND: Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when used for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for MT. MATERIAL AND METHODS: Liver transplant patients had blood drawn before surgical incision and assayed via TEG. Preoperative TEG measurements were collected in addition to standard laboratory coagulation tests. TEG variables including R-time (reaction time), angle, maximum amplitude (MA), and LY30 (clot lysis 30 min after MA) were correlated to red blood cell units, plasma (fresh frozen plasma), cryoprecipitate, and platelets during the first 24 h after surgery and tested for their performance using a receiver-operating characteristic curve. RESULTS: Twenty-eight patients were included in the analysis with a median Model for End-Stage Liver Disease score of 17; 36% received a MT. The TEG variables associated with MT (defined as >/=10 red blood cell units/24 h) were a low MA (P < 0.001) and low angle (P = 0.014). A high international normalized ratio of prothrombin time (P = 0.003) and low platelet count (P = 0.007) were also associated with MT. MA had the highest area under the curve (0.861) followed by international normalized ratio of prothrombin time (0.803). An MA of less than 47 mm has a sensitivity of 90% and specificity of 72% to predict a MT. MA was the only coagulation variable that correlated strongly to all blood products transfused. CONCLUSIONS: TEG MA has a high predictability of MT during liver transplantation. The use of TEG preoperatively may help guide more cost effective blood bank preparation for this procedure as only a third of patients required a MT. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Lawson, Peter J AU - Lawson PJ AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. Electronic address: hunter.moore@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado; Denver Health Medical Center, Department of Surgery, Denver, Colorado. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. FAU - Pshak, Thomas J AU - Pshak TJ AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. FAU - Kam, Igal AU - Kam I AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado; Research Laboratory Bonfils Blood Center, Denver, Colorado. FAU - Nydam, Trevor L AU - Nydam TL AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170727 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - *Blood Transfusion MH - Female MH - Humans MH - *Liver Transplantation MH - Male MH - Middle Aged MH - Risk Assessment MH - *Thrombelastography PMC - PMC5726438 MID - NIHMS896175 OTO - NOTNLM OT - Coagulopathy OT - Liver transplant OT - Massive transfusion OT - TEG EDAT- 2017/11/29 06:00 MHDA- 2017/12/12 06:00 PMCR- 2018/12/01 CRDT- 2017/11/29 06:00 PHST- 2017/02/10 00:00 [received] PHST- 2017/04/27 00:00 [revised] PHST- 2017/05/25 00:00 [accepted] PHST- 2017/11/29 06:00 [entrez] PHST- 2017/11/29 06:00 [pubmed] PHST- 2017/12/12 06:00 [medline] PHST- 2018/12/01 00:00 [pmc-release] AID - S0022-4804(17)30367-0 [pii] AID - 10.1016/j.jss.2017.05.115 [doi] PST - ppublish SO - J Surg Res. 2017 Dec;220:171-175. doi: 10.1016/j.jss.2017.05.115. Epub 2017 Jul 27. PMID- 29170850 OWN - NLM STAT- MEDLINE DCOM- 20180810 LR - 20180810 IS - 1572-8773 (Electronic) IS - 0966-0844 (Linking) VI - 31 IP - 1 DP - 2018 Feb TI - Carbon monoxide inhibits hemotoxic activity of Elapidae venoms: potential role of heme. PG - 51-59 LID - 10.1007/s10534-017-0066-2 [doi] AB - Envenomation by hemotoxic enzymes continues to be a major cause of morbidity and mortality throughout the world. With regard to treatment, the gold standard to abrogate coagulopathy caused by these venoms is still the administration of antivenom; however, despite antivenom therapy, coagulopathy still occurs and recurs. Of interest, this laboratory has demonstrated in vitro and in vivo that coagulopathy inducing venom derived from snakes of the family Viperidae exposed to carbon monoxide (CO) is inhibited, potentially by an attached heme. The present investigation sought to determine if venoms derived from snakes of the Elapidae family (taipans and cobras) could also be inhibited with CO or with the metheme inducing agent, O-phenylhydroxylamine (PHA). Assessing changes in coagulation kinetics of human plasma with thrombelastography, venoms from Elapidae snakes were exposed in isolation to CO (five species) or PHA (one specie) and placed in human plasma to assess changes in procoagulant or anticoagulant activity. The procoagulant activity of two taipan venoms and anticoagulant activity of three cobra venoms were significantly inhibited by CO. The venom of the inland taipan was also inhibited by PHA. In sum, these data demonstrate indirectly that the biometal heme is likely bound to these disparate venoms as an intermediary modulatory molecule. In conclusion, CO may not just be a potential therapeutic agent to treat envenomation but also may be a potential modulator of heme as a protective mechanism for venomous snakes against injury from their own proteolytic venoms. FAU - Nielsen, Vance G AU - Nielsen VG AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. vgnielsen333@gmail.com. FAU - Frank, Nathaniel AU - Frank N AD - Mtoxins, 1111 Washington Ave, Oshkosh, WI, 54901, USA. FAU - Matika, Ryan W AU - Matika RW AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20171123 PL - Netherlands TA - Biometals JT - Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine JID - 9208478 RN - 0 (Antivenins) RN - 0 (Elapid Venoms) RN - 0 (Hydroxylamines) RN - 0 (Organometallic Compounds) RN - 0 (Solutions) RN - 0 (tricarbonyldichlororuthenium (II) dimer) RN - 282MU82Z9A (phenylhydroxylamine) RN - 42VZT0U6YR (Heme) RN - 7U1EE4V452 (Carbon Monoxide) SB - IM MH - Animals MH - Antivenins/chemistry/*pharmacology MH - Blood Coagulation/*drug effects MH - Carbon Monoxide/chemistry/*pharmacology MH - Elapid Venoms/*antagonists & inhibitors/blood MH - Elapidae/physiology MH - Heme/chemistry/*metabolism MH - Humans MH - Hydroxylamines/pharmacology MH - Kinetics MH - Organometallic Compounds/chemistry/*pharmacology MH - Solutions MH - Thrombelastography OTO - NOTNLM OT - Carbon monoxide OT - Cobra OT - Fibrinogenolysis OT - Prothrombin activator OT - Taipan EDAT- 2017/11/25 06:00 MHDA- 2018/08/11 06:00 CRDT- 2017/11/25 06:00 PHST- 2017/11/08 00:00 [received] PHST- 2017/11/17 00:00 [accepted] PHST- 2017/11/25 06:00 [pubmed] PHST- 2018/08/11 06:00 [medline] PHST- 2017/11/25 06:00 [entrez] AID - 10.1007/s10534-017-0066-2 [pii] AID - 10.1007/s10534-017-0066-2 [doi] PST - ppublish SO - Biometals. 2018 Feb;31(1):51-59. doi: 10.1007/s10534-017-0066-2. Epub 2017 Nov 23. PMID- 29162238 OWN - NLM STAT- MEDLINE DCOM- 20180926 LR - 20180926 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 48 Suppl 6 DP - 2017 Nov TI - Nanostructure in the trabecular bone of postmenopausal women: Mechanical and chemical analysis. PG - S26-S33 LID - S0020-1383(17)30791-X [pii] LID - 10.1016/S0020-1383(17)30791-X [doi] AB - The possibility of diagnosis and prediction of multiple disorders in trabecular bone through nano-biomechanics and chemical analysis are summarized. Improvements to the understating of the compositional contributors of bone mineral and organic components to mechanical competence are crucial. Viscoelastic properties and Raman characterization have been used to evaluate possible alterations of the trabecular bone associated with aging, disease, or injury. In this study, the trabecular bone of postmenopausal women has been analyzed throughout. (a) Nanomechanical characterization, by using nano-DMA: complex modulus, tan delta, loss modulus (E'), and storage modulus (E'); and (b) Raman analysis: relative presence of minerals, carbonate-to-phosphate ratio (both from the mineral components), the crosslinking and nature/secondary structure of collagen (both from the organic components). Complementary nano-morphological studies were done assessing roughness (SRa) and collagen fibrils width, on this trabecular bone. A general idea of the behavior of the viscoelastic performance can be obtained by the Tan delta (E''/E'), that achieved 0.98GPa of damping. 249nm and 0.898mum of SRa roughness and fibrils width were obtained, respectively. The relative presence of minerals, the carbonate-to-phosphate ratio, the crosslinking and the nature/secondary structure of collagen, between 700 and 1700cm(-1), were also obtained, in order to propose a study protocol for trabecular bone characterization. CI - (c) 2017 Elsevier Ltd. All rights reserved. FAU - Toledano, Manuel AU - Toledano M AD - Faculty of Dentistry, Dental Materials Section, University of Granada, Granada, Spain. FAU - Osorio, Raquel AU - Osorio R AD - Faculty of Dentistry, Dental Materials Section, University of Granada, Granada, Spain. Electronic address: rosorio@ugr.es. FAU - Guerado, Enrique AU - Guerado E AD - Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Malaga, Spain. FAU - Caso, Enrique AU - Caso E AD - Research Unit, Hospital Universitario Costa del Sol, University of Malaga, Malaga, Spain. FAU - Osorio, Estrella AU - Osorio E AD - Faculty of Dentistry, Dental Materials Section, University of Granada, Granada, Spain. LA - eng PT - Journal Article PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 9007-34-5 (Collagen) SB - IM MH - Anisotropy MH - Biomechanical Phenomena MH - Bone Density/*physiology MH - Bone Remodeling/*physiology MH - *Cancellous Bone/physiology/ultrastructure MH - Cartilage, Articular/*physiology MH - Collagen/*metabolism MH - Elasticity/physiology MH - Female MH - Humans MH - Middle Aged MH - Nanostructures/*chemistry MH - Postmenopause/*physiology MH - Spectrum Analysis, Raman MH - Stress, Mechanical MH - Viscosity OTO - NOTNLM OT - AFM OT - analysis OT - biomechanics OT - morphology OT - raman OT - roughness OT - trabecular bone OT - viscoelastic EDAT- 2017/11/23 06:00 MHDA- 2018/09/27 06:00 CRDT- 2017/11/23 06:00 PHST- 2017/11/23 06:00 [entrez] PHST- 2017/11/23 06:00 [pubmed] PHST- 2018/09/27 06:00 [medline] AID - S0020-1383(17)30791-X [pii] AID - 10.1016/S0020-1383(17)30791-X [doi] PST - ppublish SO - Injury. 2017 Nov;48 Suppl 6:S26-S33. doi: 10.1016/S0020-1383(17)30791-X. PMID- 29150842 OWN - NLM STAT- MEDLINE DCOM- 20190403 LR - 20190403 IS - 1365-2044 (Electronic) IS - 0003-2409 (Linking) VI - 73 IP - 2 DP - 2018 Feb TI - The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial. PG - 205-215 LID - 10.1111/anae.14129 [doi] AB - We have evaluated the effect of a colloid solution on acute kidney injury in paediatric cardiac surgery. A total of 195 patients were ramdomly divided into an hydroxyethyl starch group and a control group. In the starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte((R)) ) was used as the primary fluid for volume resuscitation but was limited to 30 ml.kg(-1) . In the control group, only crystalloid fluid was used during the peri-operative period. The incidence of acute kidney injury, peri-operative transfusion, clinical outcomes and laboratory data were compared. The incidence of acute kidney injury determined by Paediatric Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria were no different between the two groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no differences in clinical outcomes such as mortality, major adverse events, intensive care unit stay or duration of mechanical ventilation. Clotting time as measured using rotational thromboelastometry (ROTEM) was prolonged, and clot firmness after 10 min and maximal clot firmness were shorter in the starch group compared with the control group after sternal closure. There was no difference in transfusion between the two groups. Patients with acute kidney injury had worse clinical courses than those without acute kidney injury. We conclude that intra-operative use of 6% hydroxyethyl starch 130/0.4 up to 30 ml.kg(-1) was not associated with postoperative acute kidney injury in paediatric cardiac patients. CI - (c) 2017 The Association of Anaesthetists of Great Britain and Ireland. FAU - Oh, H-W AU - Oh HW AD - Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. FAU - Lee, J-H AU - Lee JH AD - Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. FAU - Kim, H-C AU - Kim HC AD - Department of Anaesthesiology and Pain Medicine, Dongsan Medical Centre, Keimyung University College of Medicine, Daegu, Korea. FAU - Kim, E-H AU - Kim EH AD - Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. FAU - Song, I-K AU - Song IK AD - Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea. FAU - Kim, H-S AU - Kim HS AD - Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. FAU - Kim, J-T AU - Kim JT AD - Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. LA - eng SI - ClinicalTrials.gov/NCT02599155 PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20171117 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 RN - 0 (Crystalloid Solutions) RN - 0 (Hydroxyethyl Starch Derivatives) SB - IM CIN - Anaesthesia. 2018 May;73(5):649-650. doi: 10.1111/anae.14290. PMID: 29658120 EIN - Anaesthesia. 2018 May;73(5):656. doi: 10.1111/anae.14305. PMID: 29658125 CIN - Anaesthesia. 2018 May;73(5):652. doi: 10.1111/anae.14293. PMID: 29658126 CIN - Anaesthesia. 2018 May;73(5):650-651. doi: 10.1111/anae.14291. PMID: 29658132 MH - Acute Kidney Injury/*epidemiology MH - Blood Coagulation MH - Blood Transfusion MH - Cardiac Surgical Procedures/*methods MH - Child MH - Child, Preschool MH - Critical Care/statistics & numerical data MH - Crystalloid Solutions MH - Female MH - Humans MH - Hydroxyethyl Starch Derivatives/*adverse effects MH - Incidence MH - Infant MH - Infant, Newborn MH - Length of Stay MH - Male MH - Prospective Studies MH - Resuscitation MH - Thrombelastography MH - Treatment Outcome OTO - NOTNLM OT - cardiopulmonary bypass OT - colloid OT - congenital heart disease OT - crystalloid OT - renal failure EDAT- 2017/11/19 06:00 MHDA- 2019/04/04 06:00 CRDT- 2017/11/19 06:00 PHST- 2017/10/07 00:00 [accepted] PHST- 2017/11/19 06:00 [pubmed] PHST- 2019/04/04 06:00 [medline] PHST- 2017/11/19 06:00 [entrez] AID - 10.1111/anae.14129 [doi] PST - ppublish SO - Anaesthesia. 2018 Feb;73(2):205-215. doi: 10.1111/anae.14129. Epub 2017 Nov 17. PMID- 29132583 OWN - NLM STAT- MEDLINE DCOM- 20171120 LR - 20171128 IS - 1558-0539 (Electronic) IS - 0733-8627 (Linking) VI - 36 IP - 1 DP - 2018 Feb TI - The Evolving Science of Trauma Resuscitation. PG - 85-106 LID - S0733-8627(17)30078-0 [pii] LID - 10.1016/j.emc.2017.08.009 [doi] AB - This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use. This article focuses on the tools and methods used for trauma resuscitation in the acute phase of trauma care. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Harris, Tim AU - Harris T AD - Emergency Medicine, Barts Health NHS Trust, Queen Mary University of London, London, UK. FAU - Davenport, Ross AU - Davenport R AD - Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Mak, Matthew AU - Mak M AD - Emergency Medicine, Barts Health NHS Trust, London, UK. FAU - Brohi, Karim AU - Brohi K AD - Trauma and Neuroscience, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; London's Air Ambulance, Barts Health NHS Trust, London, UK. Electronic address: k.brohi@qmul.ac.uk. LA - eng PT - Journal Article PT - Review PL - United States TA - Emerg Med Clin North Am JT - Emergency medicine clinics of North America JID - 8219565 SB - IM MH - Biomedical Research MH - Blood Coagulation Disorders/etiology/therapy MH - Brain Injuries, Traumatic/complications/therapy MH - Hemorrhage/etiology/therapy MH - Humans MH - *Resuscitation/methods MH - Shock/diagnosis/etiology/therapy MH - Wounds and Injuries/complications/*therapy OTO - NOTNLM OT - Endothelial damage OT - Hemostasis OT - Hypovolemia OT - Trauma resuscitation OT - Trauma-induced coagulopathy OT - Viscoelastic hemostatic assays EDAT- 2017/11/15 06:00 MHDA- 2017/11/29 06:00 CRDT- 2017/11/15 06:00 PHST- 2017/11/15 06:00 [entrez] PHST- 2017/11/15 06:00 [pubmed] PHST- 2017/11/29 06:00 [medline] AID - S0733-8627(17)30078-0 [pii] AID - 10.1016/j.emc.2017.08.009 [doi] PST - ppublish SO - Emerg Med Clin North Am. 2018 Feb;36(1):85-106. doi: 10.1016/j.emc.2017.08.009. PMID- 29132511 OWN - NLM STAT- MEDLINE DCOM- 20171127 LR - 20181202 IS - 1558-3171 (Electronic) IS - 0039-6109 (Linking) VI - 97 IP - 6 DP - 2017 Dec TI - Resuscitation for Hypovolemic Shock. PG - 1307-1321 LID - S0039-6109(17)30121-4 [pii] LID - 10.1016/j.suc.2017.07.011 [doi] AB - Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in hypovolemic shock should be treated with damage control resuscitation principles including limited crystalloid, whole blood or balance blood component transfusion to permissive hypotension, preventing hypothermia, and stopping bleeding as quickly as possible. CI - Published by Elsevier Inc. FAU - Kalkwarf, Kyle J AU - Kalkwarf KJ AD - Department of Surgery, University of Texas, McGovern Medical School at UTHealth, 6431 Fannin Street, MSB 4.286, Houston, TX 77030, USA. Electronic address: Kyle.Kalkwarf@gmail.com. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, University of Texas, McGovern Medical School at UTHealth, 6431 Fannin Street, MSB 4.286, Houston, TX 77030, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Surg Clin North Am JT - The Surgical clinics of North America JID - 0074243 RN - 0 (Crystalloid Solutions) RN - 0 (Hemostatics) RN - 0 (Isotonic Solutions) SB - IM MH - Blood Component Transfusion/methods MH - Blood Pressure/physiology MH - Blood Transfusion/methods MH - Crystalloid Solutions MH - Hemostatics/therapeutic use MH - Humans MH - Hypothermia/prevention & control MH - Isotonic Solutions/therapeutic use MH - Military Medicine MH - Resuscitation/*methods MH - Shock/physiopathology/*therapy MH - Thrombelastography/methods MH - Treatment Outcome MH - Wounds and Injuries/complications/physiopathology OTO - NOTNLM OT - Coagulopathy OT - Damage control resuscitation OT - Hemorrhagic shock OT - Massive transfusion OT - Trauma OT - Visoelastic hemostatic assays EDAT- 2017/11/15 06:00 MHDA- 2017/11/29 06:00 CRDT- 2017/11/15 06:00 PHST- 2017/11/15 06:00 [entrez] PHST- 2017/11/15 06:00 [pubmed] PHST- 2017/11/29 06:00 [medline] AID - S0039-6109(17)30121-4 [pii] AID - 10.1016/j.suc.2017.07.011 [doi] PST - ppublish SO - Surg Clin North Am. 2017 Dec;97(6):1307-1321. doi: 10.1016/j.suc.2017.07.011. PMID- 29112094 OWN - NLM STAT- MEDLINE DCOM- 20190301 LR - 20190301 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 84 IP - 2 DP - 2018 Feb TI - Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients: Results from a multicenter study. PG - 334-341 LID - 10.1097/TA.0000000000001735 [doi] AB - BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays, thrombelastography (TEG) and rotation thromboelastometry (ROTEM), provide fast results, which is critical in the resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European Level I Trauma Centers. METHODS: Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway. Biochemistry and clinical data including outcome and TEG parameters were recorded upon arrival. Kaolin TEG, Rapid TEG, and TEG functional fibrinogen curves were extracted, and early amplitudes A5 and A10 (amplitude at 5 and 10 minutes) were registered. Patients were stratified according to international normalized ratio of 1.2 or less or greater than 1.2, as well as transfusion requirements (nontransfused, 1-9 red blood cell units and >/=10 red blood cell units in 12 hours). RESULTS: In total, 404 patients were included, median Injury Severity Score was 13. There were strong positive correlations between A5/A10 and maximum amplitude in all investigated assays. All TEG values except rTEG maximum amplitude and kTEG maximum amplitude correlated significantly with mortality in transfused patients. Time from initiation of assay to A5 and A10 were lowest for rapid TEG and TEG functional fibrinogen compared with kaolin TEG. Rapid TEG A5 reduced time to result with greater than 50% compared with rapid TEG maximum amplitude. CONCLUSION: We found strong associations between TEG early amplitudes A5/A10 and maximum amplitude in rapid TEG, kaolin TEG, and TEG functional fibrinogen across trauma patients with coagulopathy and massive transfusion requirements. Introducing the use of early amplitudes can reduce time to diagnosis of coagulopathy and may be used in TEG monitoring of trauma patient. Further randomized controlled trials evaluating the role of TEG in guiding hemostatic resuscitation are warranted. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Laursen, Thomas H AU - Laursen TH AD - From the Section for Transfusion Medicine (T.H.L., M.A.S.M., J.S., S.R.O., P.I.J.), Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Traumatology (T.G., P.A.N.), Oslo University Hospital, Ulleval, Oslo, Norway; University of Oslo (P.A.N.), Oslo, Norway; Department of Anesthesiology, Centre of Head and Orthopedics (J.S.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery, University of Texas Health Medical School(P.I.J.), Houston, TX; Center for Systems Biology, University of Iceland(P.I.J.), Reykjavik, Iceland. FAU - Meyer, Martin A S AU - Meyer MAS FAU - Meyer, Anna Sina P AU - Meyer ASP FAU - Gaarder, Tina AU - Gaarder T FAU - Naess, Paal A AU - Naess PA FAU - Stensballe, Jakob AU - Stensballe J FAU - Ostrowski, Sisse R AU - Ostrowski SR FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/complications/*diagnosis MH - Blood Coagulation Tests MH - Denmark/epidemiology MH - *Early Diagnosis MH - Female MH - Hemorrhage/*diagnosis/epidemiology/etiology MH - Humans MH - Incidence MH - Injury Severity Score MH - Male MH - Middle Aged MH - Norway/epidemiology MH - Prognosis MH - Prospective Studies MH - Survival Rate/trends MH - Thrombelastography/*methods MH - *Trauma Centers MH - Wounds and Injuries/*complications/diagnosis EDAT- 2017/11/08 06:00 MHDA- 2019/03/02 06:00 CRDT- 2017/11/08 06:00 PHST- 2017/11/08 06:00 [pubmed] PHST- 2019/03/02 06:00 [medline] PHST- 2017/11/08 06:00 [entrez] AID - 10.1097/TA.0000000000001735 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Feb;84(2):334-341. doi: 10.1097/TA.0000000000001735. PMID- 29111420 OWN - NLM STAT- MEDLINE DCOM- 20180702 LR - 20190116 IS - 1095-8541 (Electronic) IS - 0022-5193 (Linking) VI - 437 DP - 2018 Jan 21 TI - Viscoelastic shear lag model to predict the micromechanical behavior of tendon under dynamic tensile loading. PG - 202-213 LID - S0022-5193(17)30481-2 [pii] LID - 10.1016/j.jtbi.2017.10.018 [doi] AB - Owing to its viscoelastic nature, tendon exhibits stress rate-dependent breaking and stiffness function. A Kelvin-Voigt viscoelastic shear lag model is proposed to illustrate the micromechanical behavior of the tendon under dynamic tensile conditions. Theoretical closed-form expressions are derived to predict the deformation and stress transfer between fibrils and interfibrillar matrix while tendon is dynamically stretched. The results from the analytical solutions demonstrate that how the fibril overlap length and fibril volume fraction affect the stress transfer and mechanical properties of tendon. We find that the viscoelastic property of interfibrillar matrix mainly results in collagen fibril failure under fast loading rate or creep rupture of tendon. However, discontinuous fibril model and hierarchical structure of tendon ensure relative sliding under slow loading rate, helping dissipate energy and protecting fibril from damage, which may be a key reason why regularly staggering alignment microstructure is widely selected in nature. According to the growth, injury, healing and healed process of tendon observed by many researchers, the conclusions presented in this paper agrees well with the experimental findings. Additionally, the emphasis of this paper is on micromechanical behavior of tendon, whereas this analytical viscoelastic shear lag model can be equally applicable to other soft or hard tissues, owning the similar microstructure. CI - Copyright (c) 2017 Elsevier Ltd. All rights reserved. FAU - Wu, Jiayu AU - Wu J AD - MOE Key Laboratory of Disaster Forecast and Control in Engineering, Institute of Applied Mechanics, Jinan University, Guangzhou 510632, China; School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. FAU - Yuan, Hong AU - Yuan H AD - MOE Key Laboratory of Disaster Forecast and Control in Engineering, Institute of Applied Mechanics, Jinan University, Guangzhou 510632, China. Electronic address: tyuanhong@jnu.edu.cn. FAU - Li, Longyuan AU - Li L AD - School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. FAU - Fan, Kunjie AU - Fan K AD - School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. FAU - Qian, Shanguang AU - Qian S AD - Architecture Engineering Faculty, Kunming Metallurgy College, Kumming 650033, China. FAU - Li, Bing AU - Li B AD - Blackett Laboratory, Imperial College London, South Kensington Campus, SW7 2AZ, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20171027 PL - England TA - J Theor Biol JT - Journal of theoretical biology JID - 0376342 SB - IM MH - *Algorithms MH - Animals MH - Biomechanical Phenomena/*physiology MH - Elasticity MH - Humans MH - *Models, Biological MH - Stress, Mechanical MH - Tendons/*physiology MH - Tensile Strength/physiology MH - Viscosity OTO - NOTNLM OT - Biocomposites OT - Kelvin-Voigt viscoelastic model OT - Mechanical response OT - Shear lag model OT - Tendon EDAT- 2017/11/08 06:00 MHDA- 2018/07/03 06:00 CRDT- 2017/11/08 06:00 PHST- 2017/07/13 00:00 [received] PHST- 2017/10/13 00:00 [revised] PHST- 2017/10/16 00:00 [accepted] PHST- 2017/11/08 06:00 [pubmed] PHST- 2018/07/03 06:00 [medline] PHST- 2017/11/08 06:00 [entrez] AID - S0022-5193(17)30481-2 [pii] AID - 10.1016/j.jtbi.2017.10.018 [doi] PST - ppublish SO - J Theor Biol. 2018 Jan 21;437:202-213. doi: 10.1016/j.jtbi.2017.10.018. Epub 2017 Oct 27. PMID- 29110832 OWN - NLM STAT- MEDLINE DCOM- 20180927 LR - 20210521 IS - 2173-5077 (Electronic) IS - 2173-5077 (Linking) VI - 96 IP - 1 DP - 2018 Jan TI - Thromboelastometric Profile and Acute Coagulopathy of the Polytraumatized Patient: Clinical and Prognostic Implications. PG - 41-48 LID - S0009-739X(17)30217-8 [pii] LID - 10.1016/j.ciresp.2017.09.012 [doi] AB - INTRODUCTION: About 25-35% of polytraumatized patients have a profound alteration of hemostasis on arrival at the hospital (acute traumatic coagulopathy [CAT]). Viscoelastic tests (ROTEM((R))) measure the hemostatic capacity and provide an early detection of CAT. The objectives of this study are to describe the initial thromboelastogram of these patients and to determine the prevalence of CAT according to predefined thromboelastographic profiles. METHODS: Single-center, observational, prospective study in polytraumatic patients. Initial blood and thromboelastographic test (ROTEM((R))) were made, and pre-hospital, hospital, transfusion, initial surgical/angiographic interventions, cardiac arrest and mortality data were collected. ROTEM((R))-based, patients were classified as: normal, hypercoagulable, hypocoagulable, hipocoagulable +hyperfibrinolytic and isolated hyperfibrinolysis. RESULTS: One hundred and twenty-three patients were analyzed. 32 cases (26%) with CAT: 15 patients with hypocoagulability, 9 with hyperfibrinolysis alone and 8 with hypocoagulability +hyperfibrinolysis. The CAT group, related to the normal group, presented higher ISS (23 vs. 16, P<.01), higher blood products transfusion (2.5 vs. 0; P=.001), more cardiac arrest (19 vs. 1%, P<.01), and higher mortality (34 vs. 5%, P<.01). The subgroup with hypocoagulability/hyperfibrinolysis, related to the groups with hypocoagulability or hyperfibrinolysis alone, presented a higher ISS (41 vs. 25 vs. 15, P<.01), higher angiographic procedures (62% vs. 13% vs. 0%, P<.01) and higher mortality (75% vs. 33% vs. 0%, P=.05). CONCLUSIONS: Twenty-six percent of the polytrauma patients presented early coagulopathy assessed by thromboelastography. It is associated with higher consumption of blood products and lower survival. The presence of hypocoagulability +hyperfibrinolysis is associated with greater severity and a higher requirement of blood products. CI - Copyright (c) 2017 AEC. Publicado por Elsevier Espana, S.L.U. All rights reserved. FAU - Bonet, Antonia AU - Bonet A AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. Electronic address: abonetb@bellvitgehospital.cat. FAU - Madrazo, Zoilo AU - Madrazo Z AD - Servicio de Cirugia General y Digestiva, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Koo, Maylin AU - Koo M AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Otero, Israel AU - Otero I AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Mallol, Montserrat AU - Mallol M AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Macia, Irene AU - Macia I AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Ramirez, Luciano AU - Ramirez L AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. FAU - Sabate, Antoni AU - Sabate A AD - Servicio de Anestesiologia y Reanimacion, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Espana. LA - eng LA - spa PT - Journal Article PT - Observational Study TT - Perfil tromboelastometrico y coagulopatia aguda del paciente politraumatizado: implicaciones clinicas y pronosticas. DEP - 20171028 PL - Spain TA - Cir Esp (Engl Ed) JT - Cirugia espanola JID - 101771152 SB - IM MH - Acute Disease MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*blood/epidemiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Multiple Trauma/*blood MH - Prevalence MH - Prognosis MH - Prospective Studies MH - *Thrombelastography MH - Young Adult OTO - NOTNLM OT - Coagulopathy OT - Coagulopatia OT - Politraumatizado OT - Polytraumatized OT - Thromboelastogram OT - Tromboelastograma EDAT- 2017/11/08 06:00 MHDA- 2018/09/28 06:00 CRDT- 2017/11/08 06:00 PHST- 2017/07/25 00:00 [received] PHST- 2017/09/18 00:00 [revised] PHST- 2017/09/19 00:00 [accepted] PHST- 2017/11/08 06:00 [pubmed] PHST- 2018/09/28 06:00 [medline] PHST- 2017/11/08 06:00 [entrez] AID - S0009-739X(17)30217-8 [pii] AID - 10.1016/j.ciresp.2017.09.012 [doi] PST - ppublish SO - Cir Esp (Engl Ed). 2018 Jan;96(1):41-48. doi: 10.1016/j.ciresp.2017.09.012. Epub 2017 Oct 28. PMID- 29099334 OWN - NLM STAT- MEDLINE DCOM- 20180927 LR - 20180927 IS - 1940-5596 (Electronic) IS - 1089-2532 (Linking) VI - 22 IP - 2 DP - 2018 Jun TI - Viscoelastic Monitoring to Guide Hemostatic Resuscitation in Liver Transplantation Surgery. PG - 150-163 LID - 10.1177/1089253217739121 [doi] AB - Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma. The use in these coagulopathic conditions led to its application to LT, although the mechanisms of coagulopathy in these patients are quite different. While VEM is often used during transplant surgeries in Europe and North America, evidence supporting its use is limited to a few small clinical studies. The theoretical and clinical applications of the standard and specialized VEM assays are discussed in the setting of LT and ESLD. FAU - Blaine, Kevin P AU - Blaine KP AD - 1 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. FAU - Sakai, Tetsuro AU - Sakai T AD - 2 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA. LA - eng PT - Journal Article PT - Review DEP - 20171103 PL - United States TA - Semin Cardiothorac Vasc Anesth JT - Seminars in cardiothoracic and vascular anesthesia JID - 9807630 RN - 9001-31-4 (Fibrin) SB - IM MH - Blood Coagulation MH - End Stage Liver Disease/physiopathology/surgery MH - Fibrin/physiology MH - *Hemostasis, Surgical MH - Humans MH - *Liver Transplantation MH - Resuscitation/*methods MH - *Thrombelastography MH - Whole Blood Coagulation Time OTO - NOTNLM OT - anesthesiology OT - coagulation OT - review EDAT- 2017/11/04 06:00 MHDA- 2018/09/28 06:00 CRDT- 2017/11/04 06:00 PHST- 2017/11/04 06:00 [pubmed] PHST- 2018/09/28 06:00 [medline] PHST- 2017/11/04 06:00 [entrez] AID - 10.1177/1089253217739121 [doi] PST - ppublish SO - Semin Cardiothorac Vasc Anesth. 2018 Jun;22(2):150-163. doi: 10.1177/1089253217739121. Epub 2017 Nov 3. PMID- 29088950 OWN - NLM STAT- MEDLINE DCOM- 20180726 LR - 20180726 IS - 1092-0684 (Electronic) IS - 1092-0684 (Linking) VI - 43 IP - 5 DP - 2017 Nov TI - Neurosurgical applications of viscoelastic hemostatic assays. PG - E9 LID - 10.3171/2017.8.FOCUS17447 [doi] AB - Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years. Furthermore, thromboembolic complications such as deep venous thrombosis, pulmonary embolism, and myocardial infarction are common complications of major surgery. These trends, in conjunction with a growing understanding of the hemostatic process and its contribution to the pathophysiology of disease, stress the importance of the complete evaluation of a patient's hemostatic profile in guiding management decisions. Viscoelastic hemostatic assays (VHAs), such as thromboelastography and rotational thromboelastometry, are global assessments of coagulation that account for the cellular and plasma components of coagulation. This FDA-approved technology has been available for decades and has been widely used in cardiac surgery and liver transplantation. Although VHAs were cumbersome in the past, advances in software and design have made them more accurate, reliable, and accessible to the neurosurgeon. VHAs have demonstrated utility in guiding intraoperative blood product transfusion, identifying coagulopathy in trauma, and managing postoperative thromboprophylaxis. The first half of this review aims to evaluate and assess VHAs, while the latter half seeks to appraise the evidence supporting their use in neurosurgical populations. FAU - Kvint, Svetlana AU - Kvint S AD - Departments of 1 Neurosurgery and. FAU - Schuster, James AU - Schuster J AD - Departments of 1 Neurosurgery and. FAU - Kumar, Monisha A AU - Kumar MA AD - Departments of 1 Neurosurgery and. AD - Neurology, University of Pennsylvania, Philadelphia, Pennsylvania. LA - eng PT - Journal Article PT - Review PL - United States TA - Neurosurg Focus JT - Neurosurgical focus JID - 100896471 RN - 0 (Hemostatics) SB - IM MH - Blood Coagulation Disorders/*diagnosis/therapy MH - Hemostasis/*physiology MH - Hemostatics/*therapeutic use MH - Humans MH - *Neurosurgical Procedures/methods MH - Thrombelastography/methods MH - Thromboembolism/drug therapy OTO - NOTNLM OT - AA = arachidonic acid OT - ADP = adenosine diphosphate OT - APTEM = aprotinin effect as measured by ROTEM OT - CCT = conventional coagulation test OT - CFT = clot formation time OT - CI = confidence interval OT - DAT = dual antiplatelet therapy OT - DCI = delayed cerebral ischemia OT - DOAC = direct oral anticoagulant OT - EPL = estimated percentage lysis OT - FF = functional fibrinogen OT - FFP = fresh frozen plasma OT - FIBTEM = fibrinogen component of ROTEM OT - HEPTEM = heparin effect as measured by ROTEM OT - ICH = intracerebral hemorrhage OT - INTEM = intrinsic pathway measured by ROTEM OT - LY30 = lysis at 30 minutes OT - MA = maximum amplitude OT - MCF = maximal clot firmness OT - ML = maximum lysis OT - MRTG = maximum rate of thrombus generation OT - PED = Pipeline embolization device OT - PT = prothrombin time OT - PTT = partial thromboplastin time OT - RBC = red blood cell OT - ROTEM = rotational thromboelastometry OT - RR = relative risk OT - SAH = subarachnoid hemorrhage OT - TBI = traumatic brain injury OT - TEG = thromboelastography OT - TMRTG = time to maximum rate of thrombus generation OT - TTG = total thrombus generation OT - TXA = tranexamic acid OT - VHA = viscoelastic hemostatic assay OT - assays OT - coagulation OT - hemostasis OT - hemostatic OT - rotational thromboelastometry OT - thromboelastography OT - viscoelastic EDAT- 2017/11/02 06:00 MHDA- 2018/07/27 06:00 CRDT- 2017/11/02 06:00 PHST- 2017/11/02 06:00 [entrez] PHST- 2017/11/02 06:00 [pubmed] PHST- 2018/07/27 06:00 [medline] AID - 10.3171/2017.8.FOCUS17447 [doi] PST - ppublish SO - Neurosurg Focus. 2017 Nov;43(5):E9. doi: 10.3171/2017.8.FOCUS17447. PMID- 29188703 STAT- Publisher PB - NIHR Journals Library CTI - Programme Grants for Applied Research DP - 2017 Nov BTI - Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood AB - INTRODUCTION: Dysfunction of the coagulation system, termed trauma-induced coagulopathy (TIC), is a major problem in patients who bleed after injury. Trauma haemorrhage is considered one of the leading preventable causes of death worldwide. Deaths occur early and, despite the presence of trauma teams and large transfusions of blood products, outcomes remain poor. METHODS: We conducted a multimodal programme of work to develop our understanding of coagulopathy and its optimal management. We studied the epidemiology, management and health economics of trauma haemorrhage, including the provision of care during mass casualty events. We combined systematic reviews of the literature with a national study of trauma haemorrhage, its transfusion management and associated health-care costs. We further examined several point-of-care coagulation tools for their ability to diagnose coagulopathy and assess the response to blood component therapy. We progressively implemented our findings into practice and assessed the outcomes of trauma patients presenting to our major trauma centre. To examine different approaches to the provision of blood to casualties in a mass casualty event, we constructed a discrete event model based on data from the 2005 London bombings. KEY RESULTS: Our systematic reviews found little strong evidence for the existing diagnostic tools or the practice of delivery of blood components in trauma haemorrhage. Our national study recruited 442 patients in 22 hospitals and found that the 1-year mortality rate for massive haemorrhage approached 50%. Half of these deaths occurred in the first 24 hours after injury and half of these occurred in the first 4 hours. We identified this early time window as a period when the provision of blood component therapy was often below the recommended thresholds and blood component therapy was delivered inconsistently. Studying early TIC we determined that loss of fibrinogen and excessive fibrinolysis were key derangements. We were able to determine that rotational thromboelastometry could identify early coagulopathy within 5 minutes, a large improvement on laboratory tests. We were further able to show how existing damage control resuscitation regimens with high-dose plasma do not maintain haemostatic competency during haemorrhage. In total, the estimated cost of treating a major haemorrhage patient was pound20,600 and the estimated cost of treating a massive haemorrhage patient was pound24,000. Nationally, the estimated cost of trauma haemorrhage is pound85M annually. In mass casualty situations, early results show that the only mutable factor that affects the provision of care to a large degree, in the initial phase of the response, is the level of blood stocks held in the receiving hospital. CONCLUSIONS: This multimodal programme of work has led to new understandings of the epidemiology of trauma haemorrhage and its underlying mechanisms and clinical course. We have defined diagnostic tools and trigger thresholds for identification and management and increased our understanding of how blood component and other therapeutics affect coagulopathy and when they are likely to be most effective. This diagnostic work has been taken forward at an international level to produce new personalised guidelines for the management of trauma haemorrhage. The findings have had important therapeutic implications, which have led to important changes in practice that have been incorporated into new national and international guidelines. FUNDING: The National Institute for Health Research Programme Grants for Applied Research programme. CI - Copyright (c) Queen's Printer and Controller of HMSO 2017. This work was produced by Brohi et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK FAU - Eaglestone, Simon AU - Eaglestone S AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK LA - eng PT - Review PT - Book PL - Southampton (UK) RF - 36 OAB - This research programme has led to new understandings of trauma-induced coagulopathy and identified new ways of diagnosing and treating the condition. OABL- eng OTO - NLM OT - TRAUMA OT - HAEMORRHAGE OT - COAGULOPATHY OT - TRANSFUSION OT - THROMBOELASTOMETRY OT - MASS CASUALTY EDAT- 2017/11/01 00:00 CRDT- 2017/11/01 00:00 PHST- 2017/06/01 00:00 [accepted] AID - NBK464933 [bookaccession] AID - 10.3310/pgfar05190 [doi] PMID- 29086703 OWN - NLM STAT- MEDLINE DCOM- 20190315 LR - 20190315 IS - 2212-4063 (Electronic) IS - 1871-529X (Linking) VI - 17 IP - 3 DP - 2017 TI - A Review of the Current Role of Blood Clotting Analyzers in Clinical Practice. PG - 167-179 LID - 10.2174/1871529X17666171030120851 [doi] AB - BACKGROUND: Viscoelastic tests (VETs) such as thromboelastography, rotational thromboelastography, and the Sonoclot Analyzer assess the entire process of clot formation through dissolution in real-time, and may provide additional therapeutic value to conventional laboratory coagulation tests. With the ability to obtain rapid results and identify specific coagulopathies, VETs has been examined in a variety of clinical scenarios, including cardiac surgery, trauma, obstetric emergencies, and liver transplant. CONCLUSION: This review provides a summary of clinical trials utilizing VETs in the aforementioned clinical scenarios, and suggests that VETs have demonstrated a capability to identify coagulopathies, utility in guiding algorithms to reduce the amount of transfusions, and a limited ability to predict bleeding events or mortality. CI - Copyright(c) Bentham Science Publishers; For any queries, please email at epub@benthamscience.org. FAU - Sarode, Karan AU - Sarode K AD - Paul L. Foster School of Medicine, El Paso, Texas, TX, United States. FAU - Hussain, Saad S AU - Hussain SS AD - Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States. FAU - Tyroch, Alan AU - Tyroch A AD - Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, United States. FAU - Mukherjee, Debabrata AU - Mukherjee D AD - Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States. LA - eng PT - Journal Article PT - Review PL - United Arab Emirates TA - Cardiovasc Hematol Disord Drug Targets JT - Cardiovascular & hematological disorders drug targets JID - 101269160 SB - IM MH - *Blood Coagulation MH - Blood Coagulation Disorders/blood/diagnosis MH - Blood Coagulation Tests/*instrumentation MH - Humans MH - Partial Thromboplastin Time MH - Thrombelastography OTO - NOTNLM OT - Viscoelastic tests OT - clot analyzer OT - coagulation tests. OT - coagulopathy OT - surgery OT - trauma EDAT- 2017/11/01 06:00 MHDA- 2019/03/16 06:00 CRDT- 2017/11/01 06:00 PHST- 2017/07/25 00:00 [received] PHST- 2017/10/10 00:00 [revised] PHST- 2017/10/19 00:00 [accepted] PHST- 2017/11/01 06:00 [pubmed] PHST- 2019/03/16 06:00 [medline] PHST- 2017/11/01 06:00 [entrez] AID - CHDDT-EPUB-86582 [pii] AID - 10.2174/1871529X17666171030120851 [doi] PST - ppublish SO - Cardiovasc Hematol Disord Drug Targets. 2017;17(3):167-179. doi: 10.2174/1871529X17666171030120851. PMID- 29078874 OWN - NLM STAT- MEDLINE DCOM- 20171120 LR - 20190114 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 219 DP - 2017 Nov TI - 14-Day thawed plasma retains clot enhancing properties and inhibits tPA-induced fibrinolysis. PG - 145-150 LID - S0022-4804(17)30287-1 [pii] LID - 10.1016/j.jss.2017.05.030 [doi] AB - BACKGROUND: Plasma-first resuscitation attenuates trauma-induced coagulopathy (TIC); however, the logistics of plasma-first resuscitation require thawed plasma (TP) be readily available due to the obligatory thawing time of fresh frozen plasma (FFP). The current standard is storage of TP for up to 5 days at 4 degrees C, based on factor levels at outdate, for use in patients at risk for TIC, but there remains a 2.2% outdated wastage rate. However, the multitude of plasma proteins in attenuating TIC remains unknown. We hypothesize that TP retains the ability to enhance clotting and reduce tPA-induced fibrinolysis at 14-day storage. METHODS: FFP was thawed and stored at 4 degrees C at the following intervals: 14, 10, 7, 5, 3, and 1-day prior to the experiment. Healthy volunteers underwent blood draws followed by 50% dilution with TP stored at previously mentioned intervals as well as FFP, normal saline (NS), albumin, and whole blood (WB) control. Samples underwent tPA-modified (75 ng/mL) thrombelastography (TEG) with analysis of R-time, angle, maximum amplitude (MA), and LY30. RESULTS: TEG properties did not change significantly over the thawed storage. 14-day TP retained the ability to inhibit tPA-induced hyperfibrinolysis (median LY30% 9.6%) similar to FFP (5.6%), WB (14.6%), and superior to albumin (59.3%) and NS (58.1%). 14-day TP also retained faster clot formation (median angle, 66.2 degrees ) and superior clot strength (MA, 61.5 mm) to albumin (34.8 degrees , 21.6 mm) and NS (41.6 degrees , 32.2 mm). CONCLUSIONS: TP plasma stored for 14 days retains clot-enhancing ability and resistance to clot degradation similar to FFP. A clinical trial is needed to validate these in vitro results. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Colorado, Aurora, Colorado. Electronic address: benjamin.huebner@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Shepherd-Singh, Raymond AU - Shepherd-Singh R AD - Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Pediatrics, University of Colorado, Aurora, Colorado; Bonfils Blood Center, Denver, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170512 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - *Blood Coagulation MH - Blood Coagulation Disorders/enzymology/etiology/*therapy MH - Female MH - Healthy Volunteers MH - Humans MH - Male MH - Plasma/*physiology MH - *Refrigeration MH - Thrombelastography MH - Time Factors MH - Tissue Plasminogen Activator/metabolism MH - Wounds and Injuries/complications/enzymology PMC - PMC5675137 MID - NIHMS888785 OTO - NOTNLM OT - Fresh frozen plasma OT - Hyperfibrinolysis OT - Plasma transfusion OT - Thawed plasma OT - Thrombelastography OT - Trauma-induced coagulopathy EDAT- 2017/10/29 06:00 MHDA- 2017/11/29 06:00 PMCR- 2018/11/01 CRDT- 2017/10/29 06:00 PHST- 2017/02/10 00:00 [received] PHST- 2017/03/28 00:00 [revised] PHST- 2017/05/05 00:00 [accepted] PHST- 2017/10/29 06:00 [entrez] PHST- 2017/10/29 06:00 [pubmed] PHST- 2017/11/29 06:00 [medline] PHST- 2018/11/01 00:00 [pmc-release] AID - S0022-4804(17)30287-1 [pii] AID - 10.1016/j.jss.2017.05.030 [doi] PST - ppublish SO - J Surg Res. 2017 Nov;219:145-150. doi: 10.1016/j.jss.2017.05.030. Epub 2017 May 12. PMID- 29065860 OWN - NLM STAT- MEDLINE DCOM- 20180613 LR - 20181113 IS - 1471-2253 (Electronic) IS - 1471-2253 (Linking) VI - 17 IP - 1 DP - 2017 Oct 24 TI - Assessment of Haemostasis in patients undergoing emergent neurosurgery by rotational Elastometry and standard coagulation tests: a prospective observational study. PG - 146 LID - 10.1186/s12871-017-0440-1 [doi] LID - 146 AB - BACKGROUND: Rotational elastometry (ROTEM) has been shown useful to monitor coagulation in trauma patients and in major elective surgery. In this study, we aimed to evaluate the utility of ROTEM to identify hemostatic disturbances and to predict the need for transfusion, compared with standard coagulation tests (SCTs) in patients undergoing emergent neurosurgery. METHODS: Over a four-year period, adult patients who met criteria for emergent neurosurgery lasting more than 90 min were included in the study. Blood was collected preoperatively and analyzed with SCTs (international normalized ratio [INR], fibrinogen concentration, prothrombin time [PT or Quick], partial thromboplastine time [PTT], fibrinogen concentration and platelet count), and ROTEM assays. Correlations between SCTs and ROTEM parameters as well as receiver operating characteristic curves were performed to detect a coagulopathic pattern based on standard criteria and the need for transfusing at least 3 units of packed red blood cells (PRBCs). RESULTS: In a cohort of 92 patients, 39 (42%) required >/=3 PRBCs and a coagulopathic pattern was identified in 32 patients based on SCTs and in 19 based on ROTEM. There was a strong correlation between PTT and INTEM coagulation time (R = 0.76) as well as between fibrinogen concentrations and FIBTEM maximal clot firmess (R = 0.70). The need for transfusion (>/= 3 PRBCs) was best predicted by the maximal clot firmess of EXTEM and FIBTEM (AUC of 0.72 and 0.71, respectively) and by fibrinogen concentration (AUC of 0.70). CONCLUSIONS: In patients undergoing emergent neurosurgery, ROTEM analysis provides valid markers of early coagulopathy and predictors of blood transfusion requirements. FAU - Ellenberger, Christoph AU - Ellenberger C AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. FAU - Garofano, Najia AU - Garofano N AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. FAU - Barcelos, Gleicy AU - Barcelos G AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. FAU - Diaper, John AU - Diaper J AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. FAU - Pavlovic, Gordana AU - Pavlovic G AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. FAU - Licker, Marc AU - Licker M AUID- ORCID: 0000-0002-3691-4440 AD - Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, -1211, Geneva, CH, Switzerland. marc-joseph.licker@hcuge.ch. AD - Faculty of Medicine, University of Geneva, -1211, Geneva, CH, Switzerland. marc-joseph.licker@hcuge.ch. LA - eng PT - Journal Article PT - Observational Study DEP - 20171024 PL - England TA - BMC Anesthesiol JT - BMC anesthesiology JID - 100968535 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Tests/methods MH - Female MH - Hemostasis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Neurosurgical Procedures/*methods MH - Preoperative Care/*methods MH - Prospective Studies MH - *Rotation MH - Thrombelastography/*methods PMC - PMC5655946 OTO - NOTNLM OT - Anesthesia OT - Bleeding OT - Brain injury OT - Transfusion OT - Trauma COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by the Ethics Committee of the University Hospital of Geneva (Registration N degrees CER 10-128), with a waiver for informed consent given the emergency context and the fact that ROTEM testing was routinely performed in all surgical patients at high risk of bleeding. CONSENT FOR PUBLICATION: Not applicable. No individual patient data are reported. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/10/27 06:00 MHDA- 2018/06/14 06:00 PMCR- 2017/10/24 CRDT- 2017/10/26 06:00 PHST- 2017/07/06 00:00 [received] PHST- 2017/10/19 00:00 [accepted] PHST- 2017/10/26 06:00 [entrez] PHST- 2017/10/27 06:00 [pubmed] PHST- 2018/06/14 06:00 [medline] PHST- 2017/10/24 00:00 [pmc-release] AID - 10.1186/s12871-017-0440-1 [pii] AID - 440 [pii] AID - 10.1186/s12871-017-0440-1 [doi] PST - epublish SO - BMC Anesthesiol. 2017 Oct 24;17(1):146. doi: 10.1186/s12871-017-0440-1. PMID- 29059118 OWN - NLM STAT- MEDLINE DCOM- 20180702 LR - 20180702 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) VI - 23 IP - 6 DP - 2017 Dec TI - Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. PG - 503-510 LID - 10.1097/MCC.0000000000000466 [doi] AB - PURPOSE OF REVIEW: The aim of this study was to discuss the recent developments in trauma-induced coagulopathy and the evolvement of goal-directed therapy. RECENT FINDINGS: Mortality from major trauma continues to be a worldwide problem, and massive haemorrhage remains a major cause in 40% of potentially preventable trauma deaths. Development of trauma-induced coagulopathy challenges 25-35% of the patients further increasing trauma mortality. The pathophysiology of coagulopathy in trauma reflects at least two distinct mechanisms: Acute traumatic coagulopathy, consisting of endogenous heparinization, activation of the protein C pathway, hyperfibrinolysis and platelet dysfunction, and resuscitation associated coagulopathy. Clear fluid resuscitation with crystalloids and colloids is associated with dilutional coagulopathy and poor outcome in trauma. Haemostatic resuscitation is now the backbone of trauma resuscitation using a ratio-driven strategy aiming at 1:1:1 of red blood cells, plasma and platelets while applying goal-directed therapy early and repeatedly to control trauma-induced coagulopathy. SUMMARY: Trauma resuscitation should focus on early goal-directed therapy with use of viscoelastic haemostatic assays while initially applying a ratio 1:1:1 driven transfusion therapy (with red blood cells, plasma and platelets) in order to sustain normal haemostasis and control further bleeding. FAU - Stensballe, Jakob AU - Stensballe J AD - aDepartment of Anaesthesia, Centre of Head and Orthopaedics bSection for Transfusion Medicine, Capital Region Blood Bank cTrauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark dDepartment of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Houston, Texas, USA eCentre for Systems Biology, The School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland. FAU - Henriksen, Hanne H AU - Henriksen HH FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 RN - 0 (Hemostatics) SB - IM MH - Blood Coagulation Disorders/*etiology/*therapy MH - *Early Goal-Directed Therapy MH - Hemorrhage/*etiology/*therapy MH - Hemostasis MH - Hemostatics/therapeutic use MH - Humans MH - Resuscitation/methods MH - Wounds and Injuries/*complications/physiopathology EDAT- 2017/10/24 06:00 MHDA- 2018/07/03 06:00 CRDT- 2017/10/24 06:00 PHST- 2017/10/24 06:00 [pubmed] PHST- 2018/07/03 06:00 [medline] PHST- 2017/10/24 06:00 [entrez] AID - 10.1097/MCC.0000000000000466 [doi] PST - ppublish SO - Curr Opin Crit Care. 2017 Dec;23(6):503-510. doi: 10.1097/MCC.0000000000000466. PMID- 29047413 OWN - NLM STAT- MEDLINE DCOM- 20180618 LR - 20260127 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 18 IP - 1 DP - 2017 Oct 18 TI - iTACTIC - implementing Treatment Algorithms for the Correction of Trauma-Induced Coagulopathy: study protocol for a multicentre, randomised controlled trial. PG - 486 LID - 10.1186/s13063-017-2224-9 [doi] LID - 486 AB - BACKGROUND: Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and is associated with higher mortality and morbidity. In spite of improved resuscitation strategies over the last decade, current transfusion therapy still fails to correct TIC during ongoing haemorrhage and evidence for the optimal management of bleeding trauma patients is lacking. Recent publications describe increasing the use of Viscoelastic Haemostatic Assays (VHAs) in trauma haemorrhage; however, there is insufficient evidence to support their superiority to conventional coagulation tests (CCTs). METHODS/DESIGN: This multicentre, randomised controlled study will compare the haemostatic effect of an evidence-based VHA-guided versus an optimised CCT-guided transfusion algorithm in haemorrhaging trauma patients. A total of 392 adult trauma patients will be enrolled at major trauma centres. Participants will be eligible if they present with clinical signs of haemorrhagic shock, activate the local massive haemorrhage protocol and initiate first blood transfusion. Enrolled patients will be block randomised per centre to either VHA-guided or CCT-guided transfusion therapy in addition to that therapy delivered as part of standard care, until haemostasis is achieved. Patients will be followed until discharge or 28 days. The primary endpoint is the proportion of subjects alive and free of massive transfusion (less than 10 units of red blood cells) at 24 h. Secondary outcomes include the effect of CCT- versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Surviving patients will be asked to complete a quality of life questionnaire (EuroQol EQ-5D(TM)) at day 90. DISCUSSION: CCTs have traditionally been used to detect TIC and monitor response to treatment in traumatic major haemorrhage. The use of VHAs is increasing, but limited evidence exists to support the superiority of these technologies (or comparatively) for patient-centred outcomes. This knowledge gap will be addressed by this trial. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02593877 . Registered on 15 October 2015. Trial sponsor Queen Mary University of London The contact person of the above sponsor organisation is: Dr. Sally Burtles, Director of Research Services and Business Development, Joint Research Management Office, QM Innovation Building, 5 Walden Street, London E1 2EF; phone: 020 7882 7260; Email: sponsorsrep@bartshealth.nhs.uk Trial sites Academic Medical Centre, Amsterdam, The Netherlands Kliniken der Stadt Koln gGmbH, Cologne, Germany Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark John Radcliff Hospital, Oxford, United Kingdom Oslo University Hospital, Oslo, Norway The Royal London Hospital, London, United Kingdom Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Sites that are planning to start recruitment in mid/late 2017 Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom University of Kansas Hospital (UKH), Kansas City, MO, USA Protocol version: 3.0/14.03.2017 (Additional file 1). FAU - Baksaas-Aasen, Kjersti AU - Baksaas-Aasen K AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - Gall, Lewis AU - Gall L AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Eaglestone, Simon AU - Eaglestone S AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Rourke, Claire AU - Rourke C AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. FAU - Goslings, J Carel AU - Goslings JC AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. FAU - Naess, Paal Aksel AU - Naess PA AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. FAU - van Dieren, Susan AU - van Dieren S AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. FAU - Ostrowski, Sisse Rye AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Maegele, Marc AU - Maegele M AD - Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany. FAU - Stanworth, Simon J AU - Stanworth SJ AD - NHS Blood and Transplant/Oxford University Hospital NHS Trust, John Radcliffe Hospital, Oxford, UK. AD - Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Oslo, Norway. Tinagaar@online.no. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. FAU - Johansson, Per I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. LA - eng SI - ClinicalTrials.gov/NCT02593877 PT - Journal Article PT - Randomized Controlled Trial DEP - 20171018 PL - England TA - Trials JT - Trials JID - 101263253 SB - IM MH - *Algorithms MH - Blood Coagulation MH - Blood Coagulation Disorders/blood/etiology/mortality/*therapy MH - Blood Coagulation Tests MH - Blood Transfusion/*methods/mortality MH - Clinical Decision-Making MH - Clinical Protocols MH - Decision Support Techniques MH - Europe MH - Hemorrhage/blood/etiology/mortality/*therapy MH - *Hemostasis MH - Humans MH - Kansas MH - Length of Stay MH - Quality of Life MH - Research Design MH - Surveys and Questionnaires MH - Time Factors MH - Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/blood/*complications/mortality PMC - PMC5648415 OTO - NOTNLM OT - Conventional coagulation tests OT - Haemorrhage OT - Randomised control trial OT - Transfusion OT - Trauma OT - Trauma-induced coagulopathy OT - Viscoelastic haemostatic assays COIS- AUTHORS' INFORMATION: Not applicable ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study has been approved by the respective Ethics Committees of the investigators' centers: Queen Mary University of London and John Radcliff Hospital, UK, reference number 16/LO/0004; Oslo University Hospital, Norway, reference number 2015/1601/REK sor-ost; Rigshospitalet, Denmark, reference number H-15017330; Academic Medical Centre, The Netherlands, reference number METC 2016_020#B2016333ENG; and Kliniken der Stadt Koln gGmbH, Germany, reference number 185/2015. The investigators have all obtained ethics approval before being allowed to conduct and participate in the study. The investigator is also responsible for fulfilling any conditions of approval imposed by the local Ethics Committee, such as regular reporting, study timing and so on. The timeframe required for subject or personal consultee (PC) consent/agreement is not compatible with the time sensitivity of this trial and, therefore, several approaches to obtaining informed consent/agreement will be used, all of which are consistent with the Mental Capacity Act (England; 2005) and the Declaration of Helsinki (2013). The subjects will be incapacitated at the time of eligibility (critical injury, mechanical ventilation, sedation). This study requires that the intervention to be performed rapidly, thereby necessitating that eligible patients are included in the trial very soon after hospital admission. Therefore, declaration for initial enrolment in the trial will be sought from a nominated consultee (NC), who is familiar with this study and its consenting process and is present at the trauma call. As injury is an unexpected event, it is uncommon that relatives are present at the time of hospital admission. However, if a PC for the patient is present, bearing in mind the clinical situation and their level of distress, they will be provided with brief information about the trial either verbally or in writing. If the PC objects, their wishes will be respected. If, and when, subjects regain the physical and mental capacity to give consent, information will be provided to them and written informed consent will be sought for continuation in the trial. For any patient who was included but does not regain full capacity, agreement will be sought from a PC for continuation in the trial. If a patient or PC declines to give consent/agreement for continuation at this stage, their wishes will be respected. These attempts will continue until subject consent or PC agreement is obtained. All interactions and attempts at contact with the PC and/or subject will be documented in a study consent log. In participating institutions where this is accepted according to ethics approval, patients who die before we have had the opportunity to discuss the trial and obtain consent/agreement from them or their PC, the patient will remain in the trial based on the signed declaration obtained by the NC. Should an investigator have had the opportunity to introduce themselves and discuss the trial with the PC prior to the subject's death but written agreement has not yet been obtained, then we will make a maximum of three further attempts (by any combination of telephone, Email or letter) as deemed appropriate in each individual case to contact the PC and obtain written agreement. If after these further attempts, the PC has either not been contactable or has not returned written agreement, then the subject will remain in the trial based on the NC declaration. If the PC objects to the subject remaining in the study at this stage, then their wishes will be respected. CONSENT FOR PUBLICATION: Not applicable COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/10/20 06:00 MHDA- 2018/06/19 06:00 PMCR- 2017/10/18 CRDT- 2017/10/20 06:00 PHST- 2017/05/16 00:00 [received] PHST- 2017/09/30 00:00 [accepted] PHST- 2017/10/20 06:00 [entrez] PHST- 2017/10/20 06:00 [pubmed] PHST- 2018/06/19 06:00 [medline] PHST- 2017/10/18 00:00 [pmc-release] AID - 10.1186/s13063-017-2224-9 [pii] AID - 2224 [pii] AID - 10.1186/s13063-017-2224-9 [doi] PST - epublish SO - Trials. 2017 Oct 18;18(1):486. doi: 10.1186/s13063-017-2224-9. PMID- 28982391 OWN - NLM STAT- MEDLINE DCOM- 20180822 LR - 20181202 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 25 IP - 1 DP - 2017 Oct 5 TI - The impact of early thromboelastography directed therapy in trauma resuscitation. PG - 99 LID - 10.1186/s13049-017-0443-4 [doi] LID - 99 AB - BACKGROUND: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings. METHODS: We retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation. Outcome data was compared between two groups: patients prior to thrombelastography implementation (n = 87) and patients with thrombelastography guided trauma resuscitation (n = 47). Blood product usage was compared for three time periods: first 4 h, the next 20 h, and first 24 h. RESULTS: For the first 24 h of treatment, patients with thrombelastography guided trauma resuscitation had lower packed red blood cells (p = 0.0022) and fresh frozen plasma (p = 0.0474), but higher jumbo pack platelets (p = 0.0476) utilization when compared to the patients prior to thrombelastography implementation. There was no statistical significant difference in the utilization of crystalloids for any of the three time intervals. Patients with thrombelastography guided trauma resuscitation had a shorter hospital length of stay (p = 0.0011) and intensive care unit length of stay (p = 0.0059) than the patients prior to thrombelastography implementation. Cost savings in blood products transfusion were most pronounced in patients with penetrating injuries. DISCUSSION: Using visco-elastic tests to guide blood transfusion was first used for liver transplant patients and then applied to cardiovascular surgery and trauma. Similar to other studies, this study showed using visco-elastic tests for trauma patietns corresponded to an overall reduction in the use of packed red blood cells and fresh frozen plasma during the first 24 hours of resuscitation. In addition, this study showed using visco-elastic tests corresponded to a significant reduction in both hospital and intensive care unit length of stay. CONCLUSION: This study demonstrates that Thrombelastography guided trauma resuscitation decreases the overall transfusion requirements of packed red blood cells and fresh frozen plasma. However, given the nature of under-recognized jumbo pack platelets dysfunction in the conventional laboratory parameters, jumbo pack platelets utilization is higher when following Thrombelastography directed resuscitation. The utilization of Thrombelastography corresponded to a reduction in hospital length of stay, intensive care unit length of stay and cost of transfused blood products. FAU - Mohamed, Mohamed AU - Mohamed M AUID- ORCID: 0000-0002-4511-5421 AD - Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. mo_rahman@hotmail.com. FAU - Majeske, Karl AU - Majeske K AD - School of Business Administration, Oakland University, Rochester, MI, 48309-4493, USA. FAU - Sachwani, Gul R AU - Sachwani GR AD - Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. FAU - Kennedy, Kristin AU - Kennedy K AD - Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. FAU - Salib, Mina AU - Salib M AD - Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. FAU - McCann, Michael AU - McCann M AD - Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. LA - eng PT - Journal Article DEP - 20171005 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Adult MH - Blood Coagulation MH - Blood Coagulation Disorders/blood/etiology/*therapy MH - Blood Transfusion/*methods MH - Critical Care/*methods MH - *Early Diagnosis MH - Female MH - Humans MH - Male MH - Resuscitation/*methods MH - Retrospective Studies MH - Thrombelastography/*methods MH - Wounds and Injuries/blood/*complications/therapy PMC - PMC5629752 OTO - NOTNLM OT - Coagulopathy of trauma OT - Thrombelastography OT - Trauma / critical care COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Prior to inception, this study was reviewed and approved by the Institutional Review Board (IRB) at Hurley Medical Center [#746092-1]. No patients were involved in this study and thus patient consent was not required. CONSENT FOR PUBLICATION: Not Applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/10/07 06:00 MHDA- 2018/08/23 06:00 PMCR- 2017/10/05 CRDT- 2017/10/07 06:00 PHST- 2017/04/17 00:00 [received] PHST- 2017/09/25 00:00 [accepted] PHST- 2017/10/07 06:00 [entrez] PHST- 2017/10/07 06:00 [pubmed] PHST- 2018/08/23 06:00 [medline] PHST- 2017/10/05 00:00 [pmc-release] AID - 10.1186/s13049-017-0443-4 [pii] AID - 443 [pii] AID - 10.1186/s13049-017-0443-4 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2017 Oct 5;25(1):99. doi: 10.1186/s13049-017-0443-4. PMID- 28969894 OWN - NLM STAT- MEDLINE DCOM- 20171130 LR - 20240610 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 214 IP - 6 DP - 2017 Dec TI - Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality. PG - 1041-1045 LID - S0002-9610(17)30507-X [pii] LID - 10.1016/j.amjsurg.2017.08.036 [doi] AB - INTRODUCTION: The prevalence and impact of hypercoagulability (hypo) in severely injured patients early after injury remains unclear. We hypothesize that the predominant phenotype of postinjury coagulopathy is hypercoagulability (hyper) and it is associated with increased mortality. MATERIAL AND METHODS: Blood samples from 141 healthy volunteers assayed with thrombelastography (TEG) were used to identify thresholds of hypo and hypercoagulability (above 95th/below the 5(th)percentile) in four TEG indices. These cutoffs were subsequently evaluated in severely injured trauma patients (ISS>15) from two level 1 trauma centers. RESULTS: 2540 patients with a median ISS of 25 were analyzed. Normal TEG was present in 36% of patients. Hyper was found in 38% of patients, with mixed (11%) and hypo (15%) being less common. Compared to normal coagulation patients and after controlling for age, sex, blood pressure, and injury hyper (0.013), mixed (p < 0.001) and hypo (p < 0.001) were all independent predictors of mortality. CONCLUSION: These data support the ongoing need for goal directed resuscitation in trauma patients, it appears the optimal resuscitation strategy should be targeted towards normalization of coagulation status as both early hyper and hypocoagulability are associated with increased mortality. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado, Denver, CO, USA. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Denver, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA. Electronic address: ernest.moore@dhha.org. FAU - Liras, Ioannis N AU - Liras IN AD - Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Hermann, Houston, TX, USA. FAU - Wade, Charles AU - Wade C AD - Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Hermann, Houston, TX, USA. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Colorado, Denver, CO, USA. FAU - Burlew, Clay Cothren AU - Burlew CC AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Pieracci, Fredric M AU - Pieracci FM AD - Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado, Denver, CO, USA. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Hermann, Houston, TX, USA. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20170918 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM CIN - Am J Surg. 2017 Dec;214(6):1046-1047. doi: 10.1016/j.amjsurg.2017.10.013. PMID: 29021099 MH - Adult MH - Blood Coagulation Disorders/*mortality/*therapy MH - Female MH - Humans MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Risk Factors MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*mortality/*therapy PMC - PMC5693672 MID - NIHMS910013 OTO - NOTNLM OT - Fibrinolysis OT - Hypercoagulability OT - Massive transfusion OT - Trauma OT - Trauma induced coagulopathy EDAT- 2017/10/04 06:00 MHDA- 2017/12/01 06:00 PMCR- 2018/12/01 CRDT- 2017/10/04 06:00 PHST- 2017/03/11 00:00 [received] PHST- 2017/08/02 00:00 [revised] PHST- 2017/08/28 00:00 [accepted] PHST- 2017/10/04 06:00 [pubmed] PHST- 2017/12/01 06:00 [medline] PHST- 2017/10/04 06:00 [entrez] PHST- 2018/12/01 00:00 [pmc-release] AID - S0002-9610(17)30507-X [pii] AID - 10.1016/j.amjsurg.2017.08.036 [doi] PST - ppublish SO - Am J Surg. 2017 Dec;214(6):1041-1045. doi: 10.1016/j.amjsurg.2017.08.036. Epub 2017 Sep 18. PMID- 28969328 OWN - NLM STAT- MEDLINE DCOM- 20190102 LR - 20260518 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 119 IP - 3 DP - 2017 Sep 1 TI - Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study. PG - 422-434 LID - 10.1093/bja/aex245 [doi] AB - BACKGROUND: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VE-POCT) and clinical assessment. METHODS: Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL. If Fibtem A5 determined by Rotem (R) thromboelastometry remained >15 mm, or bleeding stopped, FFP was withheld. If Fibtem A5 was 2500 mL in 40/605 (6.6%) women. RBCs were transfused in 141/605 (23.3%) patients and 11 (1.8%) received >/=4 units. At least one invasive procedure was performed in 283/605 (46.8%) women. Level 3 care was required for 10/605 (1.7%) women. No women developed clinically significant haemostatic impairment. CONCLUSIONS: Restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with targeted use of FFP based on VE-POCT. CLINICAL TRIAL REGISTRATION: ISRCTN46295339 ( http://www.isrctn.com/ISRCTN46295339 ) (accessed July 24, 2017), EudraCT 2012-005511-11 ( https://www.clinicaltrialsregister.eu/ctr-search?query=2011-005511-11 ) (accessed July 24, 2017). CI - (c) The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. FAU - Collins, P W AU - Collins PW AD - Institute of Infection and Immunity, School of Medicine Cardiff University, UK. FAU - Cannings-John, R AU - Cannings-John R AD - Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, UK. FAU - Bruynseels, D AU - Bruynseels D AD - Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, UK. FAU - Mallaiah, S AU - Mallaiah S AD - Tom Byson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK. FAU - Dick, J AU - Dick J AD - Department of Anaesthetics, University College Hospital London, UK. FAU - Elton, C AU - Elton C AD - Department of Anaesthetics, Leicester Royal Infirmary, Leicester, UK. FAU - Weeks, A AU - Weeks A AD - Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. FAU - Sanders, J AU - Sanders J AD - School of Healthcare Sciences, Cardiff University, Cardiff, UK. FAU - Aawar, N AU - Aawar N AD - Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, UK. FAU - Townson, J AU - Townson J AD - Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, UK. FAU - Hood, K AU - Hood K AD - Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, UK. FAU - Hall, J AU - Hall J AD - Department of Anaesthetics and Pain Control, School of Medicine Cardiff University, Heath Park, UK. FAU - Harding, K AU - Harding K AD - Department of Obstetrics and Gynaecology, Guys and St Thomas' Hospital, London, UK. FAU - Gauntlett, R AU - Gauntlett R AD - Department of Anaesthesia, Royal Victoria Infirmary, Newcastle, UK. FAU - Collis, R AU - Collis R AD - Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, UK. CN - OBS2 study collaborators LA - eng GR - 16/16/06/DH_/Department of Health/United Kingdom GR - HTA/16/16/06/DH_/Department of Health/United Kingdom GR - II-LA-0712-20007/DH_/Department of Health/United Kingdom GR - II-LA-0715-20008/DH_/Department of Health/United Kingdom PT - Journal Article PT - Observational Study PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM CIN - Br J Anaesth. 2017 Sep 1;119(3):352-353. doi: 10.1093/bja/aex168. PMID: 28969322 MH - Adolescent MH - Adult MH - Female MH - Humans MH - Middle Aged MH - Young Adult MH - *Blood Transfusion/methods MH - Cohort Studies MH - Double-Blind Method MH - *Plasma MH - *Postpartum Hemorrhage/therapy MH - *Thrombelastography/methods MH - Treatment Outcome OTO - NOTNLM OT - fresh frozen plasma OT - postpartum haemorrhage OT - viscoelastometric test FIR - Rees, Alexandra IR - Rees A FIR - Edey, Tracey IR - Edey T FIR - Millett, Miranda IR - Millett M FIR - Ridgway, Anouk IR - Ridgway A FIR - Jones, Rhidian IR - Jones R FIR - Leslie, David IR - Leslie D FIR - Bell, Sarah IR - Bell S FIR - MacLeod, Natalia IR - MacLeod N FIR - Kealaher, Emma IR - Kealaher E FIR - Hamlyn, Vincent IR - Hamlyn V FIR - Merrett, Laura IR - Merrett L FIR - Maybury, Helena IR - Maybury H FIR - Dickens, Joanne IR - Dickens J FIR - Peck, Katie IR - Peck K FIR - Paterson, Molly IR - Paterson M FIR - Lack, Nicki IR - Lack N FIR - Fernando, Roshan IR - Fernando R FIR - Messina, Chiara IR - Messina C FIR - Shellabear, Mikala IR - Shellabear M FIR - Mon, Wint Yu IR - Mon WY FIR - Husain, Toc IR - Husain T FIR - Patel, Selina IR - Patel S FIR - Reeve, Alexandra IR - Reeve A FIR - O'Brien, Ediri IR - O'Brien E FIR - Cunningham, Caroline IR - Cunningham C FIR - O'Keefe, Rachel IR - O'Keefe R FIR - McNamara, Helen IR - McNamara H FIR - Dower, Michelle IR - Dower M FIR - Diab, Falak IR - Diab F FIR - Holt, Siobhan IR - Holt S FIR - Houghton, Gill IR - Houghton G FIR - Kerrigan, Angela IR - Kerrigan A FIR - Scott, Jason IR - Scott J FIR - Fetherstone, Jenie IR - Fetherstone J FIR - Uddin, Zeenath IR - Uddin Z FIR - Gonkatsang, Namgyal IR - Gonkatsang N FIR - Ayuk, Paul IR - Ayuk P FIR - Fenn, Andrea IR - Fenn A FIR - Paranjothy, Shantini IR - Paranjothy S FIR - Moody, Gwenllian IR - Moody G FIR - Poile, Vincent IR - Poile V FIR - Espinasse, Aude IR - Espinasse A FIR - Evans, Judith IR - Evans J EDAT- 2017/10/04 06:00 MHDA- 2019/01/03 06:00 CRDT- 2017/10/04 06:00 PHST- 2017/07/03 00:00 [accepted] PHST- 2017/10/04 06:00 [entrez] PHST- 2017/10/04 06:00 [pubmed] PHST- 2019/01/03 06:00 [medline] AID - S0007-0912(17)53755-1 [pii] AID - 10.1093/bja/aex245 [doi] PST - ppublish SO - Br J Anaesth. 2017 Sep 1;119(3):422-434. doi: 10.1093/bja/aex245. PMID- 28964508 OWN - NLM STAT- MEDLINE DCOM- 20171211 LR - 20240610 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 162 IP - 6 DP - 2017 Dec TI - Platelet adenosine diphosphate receptor inhibition provides no advantage in predicting need for platelet transfusion or massive transfusion. PG - 1286-1294 LID - S0039-6060(17)30495-6 [pii] LID - 10.1016/j.surg.2017.07.022 [doi] AB - BACKGROUND: Thrombelastography platelet mapping is a useful assay to assess antiplatelet therapy. Inhibited response to the adenosine diphosphate receptor on platelets occurs early after injury, but recent work suggests this alteration occurs even with minor trauma. However, the utility of thrombelastography platelet mapping, specifically the percent of adenosine diphosphate receptor inhibition, in predicting outcomes and guiding platelet transfusion in trauma-induced coagulopathy remains unknown We assessed the role of percent of adenosine diphosphate-inhibition in predicting survival, requirement for massive transfusion or platelet transfusion in patients at risk for trauma-induced coagulopathy. METHODS: Thrombelastography platelet mapping was assessed in 303 trauma activation patients from 2014-2016 and in 89 healthy volunteers. Percent of adenosine diphosphate-inhibition is presented as median and interquartile range. We compared the area under the receiver operating characteristic curve of percent of adenosine diphosphate-inhibition, platelet count, and rapid thrombelastography maximum amplitude for in-hospital mortality, massive transfusion (>10 red blood cells or death/6 hours), and platelet transfusion (>0 platelet units or death/6 hour). RESULTS: Overall, 35 (11.5%) patient died, 27 (8.9%) required massive transfusion and 46, platelet transfusions (15.2%). Median percent of adenosine diphosphate-inhibition was 42.5% (interquartile range: 22.4-69.1%), compared with 4.3 % (interquartile range: 0-13.5%) in healthy volunteers (P < .0001). Patients that died, had a massive transfusion, or platelet transfusion had higher percent of adenosine diphosphate-inhibition than those that did not (P < .05 for all). However, percent of adenosine diphosphate-inhibition did not add significantly to the predictive performance of maximum amplitude or platelet count for any of the 3 outcomes, after adjustment for confounders. Subgroup analyses by severe traumatic brain injury, severe injury and requirement of red blood cells showed similar results. CONCLUSION: Adenosine diphosphate receptor inhibition did not add predictive value to predicting mortality, massive transfusion, or platelet transfusion. Thus, the role of thrombelastography platelet mapping as a solitary tool to guide platelet transfusions in trauma requires continued refinement. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO. Electronic address: ernest.moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Einersen, Peter AU - Einersen P AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Ghasabyan, Arsen AU - Ghasabyan A AD - Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO; Department of Pediatrics, University of Colorado School of Public Health, Denver, CO; Bonfils Blood Center, University of Colorado School of Public Health, Denver, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado School of Medicine, Denver, CO; Department of Health Systems, Management & Policy, University of Colorado School of Public Health, Denver, CO. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20170928 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Biomarkers) RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Adenosine Diphosphate/*blood MH - Adult MH - Aged MH - Biomarkers/blood MH - Blood Coagulation Disorders/diagnosis/etiology/mortality/*therapy MH - Case-Control Studies MH - Databases, Factual MH - Erythrocyte Transfusion/standards/*statistics & numerical data MH - Female MH - *Hospital Mortality MH - Humans MH - Male MH - Platelet Function Tests MH - Platelet Transfusion/*statistics & numerical data MH - Predictive Value of Tests MH - Prognosis MH - Risk Assessment MH - Thrombelastography MH - Wounds and Injuries/blood/*complications/mortality PMC - PMC5694384 MID - NIHMS909371 EDAT- 2017/10/02 06:00 MHDA- 2017/12/12 06:00 PMCR- 2018/12/01 CRDT- 2017/10/02 06:00 PHST- 2017/03/01 00:00 [received] PHST- 2017/07/09 00:00 [revised] PHST- 2017/07/29 00:00 [accepted] PHST- 2017/10/02 06:00 [pubmed] PHST- 2017/12/12 06:00 [medline] PHST- 2017/10/02 06:00 [entrez] PHST- 2018/12/01 00:00 [pmc-release] AID - S0039-6060(17)30495-6 [pii] AID - 10.1016/j.surg.2017.07.022 [doi] PST - ppublish SO - Surgery. 2017 Dec;162(6):1286-1294. doi: 10.1016/j.surg.2017.07.022. Epub 2017 Sep 28. PMID- 28930957 OWN - NLM STAT- MEDLINE DCOM- 20171002 LR - 20190105 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 83 IP - 4 DP - 2017 Oct TI - Clot dynamics and mortality: The MA-R ratio. PG - 628-634 LID - 10.1097/TA.0000000000001637 [doi] AB - INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging. We have developed a novel ratio utilizing TEG values to describe patients at specific risk of traumatic coagulopathy. The purpose of this study was to create a single TEG value, which would reflect both the hypercoagulability and hypocoagulability of TIC. We hypothesized that this ratio, at admission, would be indicative of TIC and predictive of both blood product transfusion volumes and subsequent mortality. METHODS: Patients admitted via the highest activation criteria at one of two Level I trauma centers were included if they received at least 1 unit of packed red blood cells in the first 24 hours of admission. The admission TEG was collected, and a ratio was calculated by dividing the MA by the R-time (MA-R). MA-R quartiles were developed, and multivariable logistic regression was utilized to determine odds of mortality. RESULTS: Three hundred thirty patients with admission TEG were included. In all patients, median age was 35 years (interquartile range, 25-54 years), Injury Severity Score (ISS) was 20 (interquartile range, 13-29), 76% were male, and 43% had penetrating trauma. The MA-R groups were based on quartiles. Multivariable analysis, controlling for mechanism of injury, ISS, and admission pH, showed that increasing ratios were associated with decreased odds of death. The lowest MA-R ratios were also significantly associated with higher ISS, higher rates of blunt injury, and higher plasma utilization without a significant difference in packed red blood cell administration. CONCLUSIONS: Patients with the lowest MA-R ratios demonstrated the highest mortality rates. This novel ratio may prove highly useful to predict at-risk patients early, when other physiologic indicators are absent. The mechanism driving this finding may rest in fibrinogen depletion, resulting in weak clot. Patients with low MA-R ratios may benefit from earlier resuscitation with cryoprecipitate, rather than the traditional use of plasma found in current massive transfusion protocols. LEVELS OF EVIDENCE: Prognostic study, Level I. FAU - Savage, Stephanie A AU - Savage SA AD - From the Indiana University School of Medicine (S.A.S., B.L.Z., T.H.P., B.L.B.), Indianapolis, Indiana; and University of Tennessee Health Sciences Center (L.J.M., M.A.C., G.H.L., A.C.M.), Memphis, Tennessee. FAU - Zarzaur, Ben L AU - Zarzaur BL FAU - Pohlman, Timothy H AU - Pohlman TH FAU - Brewer, Brian L AU - Brewer BL FAU - Magnotti, Louis J AU - Magnotti LJ FAU - Croce, Martin A AU - Croce MA FAU - Lim, Garrett H AU - Lim GH FAU - Martin, Ali C AU - Martin AC LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnostic imaging/etiology/*mortality MH - Blood Transfusion MH - Female MH - Humans MH - Injury Severity Score MH - Logistic Models MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Retrospective Studies MH - *Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*complications/*diagnostic imaging/mortality EDAT- 2017/09/21 06:00 MHDA- 2017/10/03 06:00 CRDT- 2017/09/21 06:00 PHST- 2017/09/21 06:00 [entrez] PHST- 2017/09/21 06:00 [pubmed] PHST- 2017/10/03 06:00 [medline] AID - 01586154-201710000-00010 [pii] AID - 10.1097/TA.0000000000001637 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Oct;83(4):628-634. doi: 10.1097/TA.0000000000001637. PMID- 28918481 OWN - NLM STAT- MEDLINE DCOM- 20181001 LR - 20261012 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 44 IP - 1 DP - 2018 Feb TI - Fibrinolysis in trauma: a review. PG - 35-44 LID - 10.1007/s00068-017-0833-3 [doi] AB - Fibrinolytic dysregulation is an important mechanism in traumatic coagulopathy. It is an incompletely understood process that consists of a spectrum ranging from excessive breakdown (hyperfibrinolysis) and the shutdown of fibrinolysis. Both hyperfibrinolysis and shutdown are associated with excess mortality and post-traumatic organ failure. The pathophysiology appears to relate to endothelial injury and hypoperfusion, with several molecular markers identified in playing a role. Although there are no universally accepted diagnostic tests, viscoelastic studies appear to offer the greatest potential for timely identification of patients presenting with fibrinolytic dysregulation. Treatment is multimodal, involving prompt hemorrhage control and resuscitation, with controversy surrounding the use of antifibrinolytic drug therapy. This review presents the current evidence on the pathophysiology, diagnostic challenges, as well as the management of this hemostatic dysfunction. LEVEL OF EVIDENCE: Level III. FAU - Madurska, M J AU - Madurska MJ AUID- ORCID: 0000-0001-5613-871X AD - Department of Vascular Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK. martamadurska@hotmail.com. FAU - Sachse, K A AU - Sachse KA AD - Department of Anesthesia, University of Texas Health Science Center at San Antonio, Texas, USA. FAU - Jansen, J O AU - Jansen JO AD - Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, USA. FAU - Rasmussen, T E AU - Rasmussen TE AD - US Combat Casualty Care Research Program, Fort Detrick, MD, USA. AD - The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, USA. FAU - Morrison, J J AU - Morrison JJ AUID- ORCID: 0000-0001-7462-8456 AD - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA. LA - eng PT - Journal Article PT - Review DEP - 20170916 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 0 (Antifibrinolytic Agents) RN - 0 (Biomarkers) SB - IM MH - Antifibrinolytic Agents/*therapeutic use MH - Biomarkers/blood MH - Blood Coagulation Disorders/blood/*physiopathology/therapy MH - Evidence-Based Practice MH - *Fibrinolysis MH - Humans MH - Injury Severity Score MH - Wounds and Injuries/blood/*physiopathology/therapy OTO - NOTNLM OT - Acute coagulopathy of trauma OT - Fibrinolysis shutdown OT - Hyperfibrinolysis OT - RoTEM OT - Shock OT - TEG EDAT- 2017/09/18 06:00 MHDA- 2018/10/03 06:00 CRDT- 2017/09/18 06:00 PHST- 2017/04/02 00:00 [received] PHST- 2017/09/06 00:00 [accepted] PHST- 2017/09/18 06:00 [pubmed] PHST- 2018/10/03 06:00 [medline] PHST- 2017/09/18 06:00 [entrez] AID - 10.1007/s00068-017-0833-3 [pii] AID - 10.1007/s00068-017-0833-3 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2018 Feb;44(1):35-44. doi: 10.1007/s00068-017-0833-3. Epub 2017 Sep 16. PMID- 28914713 OWN - NLM STAT- MEDLINE DCOM- 20180102 LR - 20260108 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 84 IP - 1 DP - 2018 Jan TI - The hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients. PG - 25-30 LID - 10.1097/TA.0000000000001699 [doi] AB - BACKGROUND: Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, whereas shutdown (SD) patients would have the greatest complication burden. METHODS: Severely injured patients predicted to receive a massive transfusion at 12 Level I trauma centers were randomized to one of two transfusion ratios as described in the Pragmatic, Randomized, Optimal Platelet and Plasma Ratio trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD /=3%. Univariate and multivariate analysis was performed. Logistic regression was used to adjust for age, gender, arrival physiology, shock, injury severity, center effect, and treatment arm. RESULTS: Among the 680 patients randomized, 547(80%) had admission thrombelastography (TEG) values available to determine fibrinolytic phenotypes. Compared to SD and PHYS, HF patients had higher Injury Severity Score (25 vs. 25 vs. 34), greater base deficit (-8 vs. -6 vs. -12) and were more uniformly hypocoagulable on admission by PT, PTT, and TEG values; all p <0.001. HF patients also received more red blood cells, plasma, and platelets (at 3, 6, and 24 hours); had fewer ICU-, ventilator-, and hospital-free days; and had higher 24-hour and 30-day mortality. There were no differences in complications between the three phenotypes. Multivariate logistic regression demonstrated that HF on admission was associated with a threefold higher mortality (OR 3.06, 95% CI 1.57-5.95, p = 0.001). CONCLUSIONS: Previous data have shown that both the SD and HF phenotypes are associated with increased mortality and complications in the general trauma population. However, in a large cohort of bleeding patients, HF was confirmed to be a much more lethal and resource-intense phenotype. These data suggest that further research into the understanding of SD and HF is warranted to improve outcomes in this patient population. LEVEL OF EVIDENCE: Prognostic, level II. FAU - Taylor, John R 3rd AU - Taylor JR 3rd AD - From the University of Texas Health Science Center at Houston (J.R.T., E.E.F., J.B.H., C.E.W., B.A.C.), Houston, TX; St. Michael's Hospital-University of Toronto (S.R.), Toronto, ON; University of Southern California (K.I.), Los Angeles, CA; Oregon Health and Science University (M.A.S.), Portland, OR; Medical College of Wisconsin (K.B.), Milwaukee, WI; R Adams Cowley Shock Trauma Center (T.M.S.), University of Maryland Medical Center, Baltimore, MD; University of Washington (E.B.), Seattle, WA. FAU - Fox, Erin E AU - Fox EE FAU - Holcomb, John B AU - Holcomb JB FAU - Rizoli, Sandro AU - Rizoli S FAU - Inaba, Kenji AU - Inaba K FAU - Schreiber, Martin A AU - Schreiber MA FAU - Brasel, Karen AU - Brasel K FAU - Scalea, Thomas M AU - Scalea TM FAU - Wade, Charles E AU - Wade CE FAU - Bulger, Eileen AU - Bulger E FAU - Cotton, Bryan A AU - Cotton BA CN - PROPPR Study Group LA - eng GR - U01 HL077863/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Pragmatic Clinical Trial PT - Randomized Controlled Trial PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*complications/diagnosis/mortality MH - *Blood Transfusion MH - Cohort Studies MH - Female MH - *Fibrinolysis MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Thrombelastography MH - Trauma Centers MH - Trauma Severity Indices MH - Treatment Outcome MH - Wounds and Injuries/*complications/*mortality/therapy MH - Young Adult PMC - PMC5739990 MID - NIHMS905062 COIS- Conflicts of interest: NONE EDAT- 2017/09/16 06:00 MHDA- 2018/01/03 06:00 PMCR- 2019/01/01 CRDT- 2017/09/16 06:00 PHST- 2017/09/16 06:00 [pubmed] PHST- 2018/01/03 06:00 [medline] PHST- 2017/09/16 06:00 [entrez] PHST- 2019/01/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000001699 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2018 Jan;84(1):25-30. doi: 10.1097/TA.0000000000001699. PMID- 28913856 OWN - NLM STAT- MEDLINE DCOM- 20181019 LR - 20191008 IS - 1365-3148 (Electronic) IS - 0958-7578 (Print) IS - 0958-7578 (Linking) VI - 28 IP - 3 DP - 2018 Jun TI - Multiplate and TEG platelet mapping in a population of severely injured trauma patients. PG - 224-230 LID - 10.1111/tme.12473 [doi] AB - OBJECTIVES: The objectives of this study were to compare thromboelastography platelet mapping (TEG PM) with impedance aggregometry (Multiplate, MP) in a single trauma population and relate their results clinically. BACKGROUND: Platelet function as measured by thromboelastography and impedance aggregometry demonstrates significant reductions that persist for days following traumatic injury. However, no study compares these devices and the correlation between them is not known. METHODS: In level 1 trauma patients, TEG PM and MP were conducted at their initial presentation to the emergency department. Within-device repeatability and between-device association were determined using correlation analyses. Demographic variables, Injury Severity Score, blood product transfusion, laboratory test results and mortality rate were recorded. RESULTS: Ninety-two patients were enrolled. Within-device repeatability was high for TEG PM and MP for arachidonic acid (AA) and adenosine diphosphate (ADP) activation pathways. When comparing TEG PM with MP, results correlated poorly in the ADP pathway (Spearman's rho = 0.11, P = 0.44) and moderately in the AA pathway (Spearman's rho = 0.56, P < 0.0001). TEG PM was predictive of blood product transfusion and correlated with increased base deficit, whereas MP was only predictive of mortality. CONCLUSIONS: Intra-device variability was low for TEG PM and MP, but the two point-of-care devices measuring platelet function correlate poorly with each other in injured trauma patients. Each device also had different clinical associations. CI - (c) 2017 British Blood Transfusion Society. FAU - George, M J AU - George MJ AUID- ORCID: 0000-0003-1668-821X AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Burchfield, J AU - Burchfield J AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - MacFarlane, B AU - MacFarlane B AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Wang, Y-W W AU - Wang YW AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cardenas, J C AU - Cardenas JC AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - White, N J AU - White NJ AD - Department of Emergency Medicine, University of Washington, Seattle, Washington, USA. FAU - Gill, B S AU - Gill BS AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Wade, C E AU - Wade CE AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, Texas, USA. LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States PT - Clinical Trial PT - Journal Article DEP - 20170915 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Adult MH - *Blood Component Transfusion MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Thrombelastography MH - *Trauma Severity Indices MH - Wounds and Injuries/*blood/*mortality/*therapy PMC - PMC5854506 MID - NIHMS903875 OTO - NOTNLM OT - impedance aggregometry OT - platelet function OT - thromboelastography OT - trauma EDAT- 2017/09/16 06:00 MHDA- 2018/10/20 06:00 PMCR- 2019/06/01 CRDT- 2017/09/16 06:00 PHST- 2017/06/23 00:00 [received] PHST- 2017/08/17 00:00 [revised] PHST- 2017/08/21 00:00 [accepted] PHST- 2017/09/16 06:00 [pubmed] PHST- 2018/10/20 06:00 [medline] PHST- 2017/09/16 06:00 [entrez] PHST- 2019/06/01 00:00 [pmc-release] AID - 10.1111/tme.12473 [doi] PST - ppublish SO - Transfus Med. 2018 Jun;28(3):224-230. doi: 10.1111/tme.12473. Epub 2017 Sep 15. PMID- 28899039 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200225 IS - 1524-4040 (Electronic) IS - 0148-396X (Print) IS - 0148-396X (Linking) VI - 64 IP - CN_suppl_1 DP - 2017 Sep 1 TI - The Utility of Thromboelastography for Predicting The Risk of Progression of Intracranial Hemorrhage in Traumatic Brain Injury Patients. PG - 182-187 LID - 10.1093/neuros/nyx210 [doi] FAU - Rao, Abigail AU - Rao A AD - Department of Neurological Surgery, OHSU, Portland, Oregon. FAU - Lin, Amber AU - Lin A AD - School of Public Health and Center for Policy Re-search, OHSU, Portland, Oregon. FAU - Hilliard, Cole AU - Hilliard C AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, OHSU, Portland, Oregon. FAU - Fu, Rongwei AU - Fu R AD - School of Public Health and Center for Policy Re-search, OHSU, Portland, Oregon. FAU - Lennox, Tori AU - Lennox T AD - Division of Cardio-thoracic Surgery, University of Wash-ington, Seattle, Washington. FAU - Barbosa, Ronald AU - Barbosa R AD - Trauma Services, Legacy Emanuel Hospital and Health Services, Portland, Oregon. FAU - Schreiber, Martin AU - Schreiber M AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, OHSU, Portland, Oregon. FAU - Rowell, Susan AU - Rowell S AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, OHSU, Portland, Oregon. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Neurosurgery JT - Neurosurgery JID - 7802914 PMC - PMC6433435 EDAT- 2017/09/14 06:00 MHDA- 2017/09/14 06:01 PMCR- 2018/09/01 CRDT- 2017/09/14 06:00 PHST- 2017/01/25 00:00 [received] PHST- 2017/03/30 00:00 [accepted] PHST- 2017/09/14 06:00 [entrez] PHST- 2017/09/14 06:00 [pubmed] PHST- 2017/09/14 06:01 [medline] PHST- 2018/09/01 00:00 [pmc-release] AID - 4093179 [pii] AID - nyx210 [pii] AID - 10.1093/neuros/nyx210 [doi] PST - ppublish SO - Neurosurgery. 2017 Sep 1;64(CN_suppl_1):182-187. doi: 10.1093/neuros/nyx210. PMID- 30020588 STAT- Publisher PB - Canadian Agency for Drugs and Technologies in Health CTI - CADTH Rapid Response Reports DP - 2017 Sep 8 BTI - Thromboelastography or Rotational Thromboelastography for Trauma: A Review of the Clinical and Cost-Effectiveness and Guidelines AB - The purpose of this review is to provide evidence surrounding effectiveness and cost effectiveness of Rotational Thromboelastography (ROTEG) and Thromboelastography (TEG) in trauma, and to identify relevant evidence-based guidelines. CI - Copyright (c) 2017 Canadian Agency for Drugs and Technologies in Health. FAU - MacDonald, Erika AU - MacDonald E FAU - Severn, Melissa AU - Severn M LA - eng PT - Review PT - Book PL - Ottawa (ON) EDAT- 2017/09/08 00:00 CRDT- 2017/09/08 00:00 AID - NBK513366 [bookaccession] PMID- 28857793 OWN - NLM STAT- MEDLINE DCOM- 20171207 LR - 20180430 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 125 IP - 6 DP - 2017 Dec TI - Initiation and Termination of Massive Transfusion Protocols: Current Strategies and Future Prospects. PG - 2045-2055 LID - 10.1213/ANE.0000000000002436 [doi] AB - The advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma. This is followed by an in-depth analysis of the main components within those recommendations. Societal recommendations on MTP initiation in hemorrhaging trauma patients emphasize the use of retrospectively validated massive transfusion (MT) prediction score, specifically, the Assessment of Blood Consumption and Trauma-Associated Severe Hemorrhage scores. Validation studies have shown that both scoring systems perform similarly. Both scores reliably identify patients that will not require an MT, while simultaneously overpredicting MT requirements. However, each scoring system has its unique advantages and disadvantages, and this review discusses how specific aspects of each scoring system can affect widespread applicability and statistical performance. In addition, we discuss the often overlooked topic of initiating MT in nontrauma patients and the specific tools physicians have to guide the MT initiation decision in this unique setting. Despite the serious complications that can arise with transfusion of large volumes of blood products, there is considerably less research pertinent to the topic of MTP termination. Societal recommendations on MTP termination emphasize applying clinical reasoning to identify patients who have bleeding source control and are adequately resuscitated. This review, however, focuses primarily on the recommendations presented by the Advanced Bleeding Care in Trauma's MTP guidelines that call for prompt termination of the algorithm-guided model of resuscitation and rapidly transitioning into a resuscitation model guided by laboratory test results. We also discuss the evidence in support of laboratory result-guided resuscitation and how recent literature on viscoelastic hemostatic assays, although limited, highlights the potential to achieve additional benefits from this method of resuscitation. FAU - Foster, John C AU - Foster JC AD - From the University of Florida College of Medicine, Gainesville, Florida. FAU - Sappenfield, Joshua W AU - Sappenfield JW AD - Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. FAU - Smith, Robert S AU - Smith RS AD - Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida. FAU - Kiley, Sean P AU - Kiley SP AD - Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. LA - eng PT - Journal Article PT - Review PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM MH - Blood Transfusion/*methods/standards/trends MH - *Clinical Protocols/standards MH - Forecasting MH - Hemorrhage/diagnosis/therapy MH - Humans MH - *Practice Guidelines as Topic/standards MH - Randomized Controlled Trials as Topic/methods/standards MH - Resuscitation/methods/standards/trends MH - Trauma Centers/standards/trends EDAT- 2017/09/01 06:00 MHDA- 2017/12/08 06:00 CRDT- 2017/09/01 06:00 PHST- 2017/09/01 06:00 [pubmed] PHST- 2017/12/08 06:00 [medline] PHST- 2017/09/01 06:00 [entrez] AID - 10.1213/ANE.0000000000002436 [doi] PST - ppublish SO - Anesth Analg. 2017 Dec;125(6):2045-2055. doi: 10.1213/ANE.0000000000002436. PMID- 28846577 OWN - NLM STAT- MEDLINE DCOM- 20170918 LR - 20260127 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 83 IP - 3 DP - 2017 Sep TI - Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties. PG - 373-380 LID - 10.1097/TA.0000000000001568 [doi] AB - BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused. Our hypothesis was that incorporating ROTEM measurements into DCR methods at the US Role 3 hospital at Bagram Airfield, Afghanistan would change the standard transfusion ratios of 1:1:1:1 to a product mix tailored specifically for the combat causality. METHODS: This retrospective study collected data from the Department of Defense Trauma Registry to compare transfusion practices and outcomes before and after ROTEM deployment to Bagram Airfield. Over the course of six months, 134 trauma patients received a transfusion (pre-ROTEM) and 85 received a transfusion and underwent ROTEM testing (post-ROTEM). Trauma teams received instruction on ROTEM use and interpretation, with no provision of a specific transfusion protocol, to supplement their clinical judgment and practice. RESULTS: The pre and post groups were not significantly different in terms of mortality, massive transfusion protocol activation, mean injury severity score, or coagulation measurements. Despite the difference in size, each group received an equal total number of transfusions. However, the post-ROTEM group received a significant increase in PLT and CRYO transfusions ratios, 4x and 2x, respectively. CONCLUSION: The introduction of ROTEM significantly improved adherence to DCR practices. The transfusion differences suggest that aggressive DCR without thromboelastometry data may result in reduced hemostatic support and underestimate the need for PLT and CRYO. Thus, future controlled trials should include ROTEM-guided coagulation management in trauma resuscitation. LEVEL OF EVIDENCE: Therapeutic, level IV. FAU - Prat, Nicolas J AU - Prat NJ AD - From the Coagulation and Blood Research (N.J.P., A.D.M., A.P.C.), United States Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas; French Armed Forces Institute of Biomedical Research (IRBA) (N.J.P., J.T.), Paris, France; Division of Pediatric Critical Care, Department of Pediatrics (A.D.M.), University of Texas Health Science Center, San Antonio, Texas; Northwest Surgical Specialists LLP (N.K.I.), Springfield, Oregon; and Travis Air Force Base (J.J.D.); and University of California (J.J.D.), Davis, California. FAU - Meyer, Andrew D AU - Meyer AD FAU - Ingalls, Nichole K AU - Ingalls NK FAU - Trichereau, Julie AU - Trichereau J FAU - DuBose, Joseph J AU - DuBose JJ FAU - Cap, Andrew P AU - Cap AP LA - eng GR - K23 HL124336/HL/NHLBI NIH HHS/United States PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Afghan Campaign 2001- MH - Blood Coagulation Tests MH - Blood Transfusion/*methods MH - Female MH - Hemorrhage/mortality/*therapy MH - Humans MH - Male MH - *Military Medicine MH - Registries MH - Resuscitation/*methods MH - Thrombelastography/*methods MH - Trauma Severity Indices MH - Treatment Outcome MH - United States MH - Wounds and Injuries/mortality/*therapy PMC - PMC7350930 MID - NIHMS1599876 EDAT- 2017/08/29 06:00 MHDA- 2017/09/19 06:00 PMCR- 2020/07/10 CRDT- 2017/08/29 06:00 PHST- 2017/08/29 06:00 [entrez] PHST- 2017/08/29 06:00 [pubmed] PHST- 2017/09/19 06:00 [medline] PHST- 2020/07/10 00:00 [pmc-release] AID - 01586154-201709000-00005 [pii] AID - 10.1097/TA.0000000000001568 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Sep;83(3):373-380. doi: 10.1097/TA.0000000000001568. PMID- 28844370 OWN - NLM STAT- MEDLINE DCOM- 20180604 LR - 20180604 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 31 IP - 5 DP - 2017 Oct TI - Technology: Is There Sufficient Evidence to Change Practice in Point-of-Care Management of Coagulopathy? PG - 1849-1856 LID - S1053-0770(17)30515-3 [pii] LID - 10.1053/j.jvca.2017.05.037 [doi] AB - Currently, hemostasis is one of the most widely researched topics in perioperative medicine. As investigators learn more about the complexity of coagulation, developing tests with the ability to rapidly monitor coagulation and guide targeted therapy is the key to optimizing hemostasis management. There is mounting evidence that algorithmic transfusion using point-of-care (POC) testing can reduce red cell and platelet transfusions and major bleeding after cardiac surgery. Integrating these tests during cardiac surgery and trauma management is especially important because these groups use the most blood products within a health system and the risks of transfusion are well documented. Currently, numerous POC tests are available for evaluating hemostasis. The purpose of this review is to provide a comprehensive evaluation of the current evidence surrounding the most common POC testing devices in practice for managing coagulation. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Fabbro, Michael 2nd AU - Fabbro M 2nd AD - Miller School of Medicine, University of Miami, Miami, FL. Electronic address: mxf790@miami.edu. FAU - Winkler, Anne M AU - Winkler AM AD - Instrumentation Laboratory, Bedford, MA. FAU - Levy, Jerrold H AU - Levy JH AD - Duke University Hospital, Duke University, Durham, NC. LA - eng PT - Journal Article PT - Review DEP - 20170519 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 SB - IM MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/*diagnosis/*therapy MH - Blood Transfusion/methods/standards MH - Cardiac Surgical Procedures/adverse effects/trends MH - *Disease Management MH - Hemostasis/physiology MH - Humans MH - *Point-of-Care Systems/standards MH - Randomized Controlled Trials as Topic/methods OTO - NOTNLM OT - Blood transfusion OT - Coagulation tests OT - Coagulopathy OT - Hemostasis OT - Platelet function assays OT - Point of care tests OT - Viscoelastic testing EDAT- 2017/08/29 06:00 MHDA- 2018/06/05 06:00 CRDT- 2017/08/29 06:00 PHST- 2017/03/17 00:00 [received] PHST- 2017/08/29 06:00 [pubmed] PHST- 2018/06/05 06:00 [medline] PHST- 2017/08/29 06:00 [entrez] AID - S1053-0770(17)30515-3 [pii] AID - 10.1053/j.jvca.2017.05.037 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1849-1856. doi: 10.1053/j.jvca.2017.05.037. Epub 2017 May 19. PMID- 28837538 OWN - NLM STAT- MEDLINE DCOM- 20171211 LR - 20190105 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 83 IP - 6 DP - 2017 Dec TI - Human neutrophil elastase mediates fibrinolysis shutdown through competitive degradation of plasminogen and generation of angiostatin. PG - 1053-1061 LID - 10.1097/TA.0000000000001685 [doi] AB - BACKGROUND: A subset of trauma patients undergo fibrinolysis shutdown rather than pathologic hyperfibrinolysis, contributing to organ failure. The molecular basis for fibrinolysis shutdown in trauma is incompletely understood. Elastase released from primed/activated human neutrophils (HNE) has historically been described as fibrin(ogen)olytic. However, HNE can also degrade plasminogen (PLG) to angiostatin (ANG), retaining the kringle domains but not the proteolytic function, and could thereby compete for generation of active plasmin by tissue plasminogen activator (tPA). We hypothesized that HNE can drive fibrinolysis shutdown rather than fibrinolysis. METHODS: Turbidometry was performed using light scatter (lambda = 620 nm) in a purified fibrinogen + PLG system and in healthy citrate plasma clotted with Ca/thrombin +/- tPA, +/-HNE, and +/-ANG to evaluate HNE effects on fibrinolysis, quantified by time to transition midpoint (Tm). DeltaTm from control is reported as percent of control +/-95% CI. Purified HNE coincubated with PLG or tPA was analyzed by western blot to identify cleavage products. Exogenous HNE was mixed ex vivo with healthy volunteer blood (n = 7) and used in TEG +/- tPA to evaluate effects on fibrinolysis. RESULTS: HNE did not cause measurable fibrinolysis on fibrin clots, clotted plasma, or whole blood as assessed by turbidometry or TEG in the absence of tPA. Upon tPA treatment, all three methods of evaluating fibrinolysis showed delays and decreases in fibrinolysis caused by HNE relative to control: fibrin clot turbidometry DeltaTm = 110.7% (CI 105.0-116.5%), clotted citrate plasma (n = 6 healthy volunteers) DeltaTm = 126.1% (CI 110.4-141.8%), and whole blood native TEG (n = 7 healthy volunteers) with DeltaLY30 = 28% (p = 0.043). Western blot analysis of HNE-PLG co-incubation confirmed that HNE generates angiostatin K1-3, and plasma turbidity assays treated with angiostatin K1-3 delayed fibrinolysis. CONCLUSION: HNE degrades PLG and generates angiostatin K1-3, which predominates over HNE cleavage of fibrin(ogen). These findings suggest that neutrophil release of elastase may underlie trauma-induced fibrinolytic shutdown. FAU - Barrett, Christopher D AU - Barrett CD AD - From the Koch Institute for Integrative Cancer Research (C.D.B.), Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Surgery (C.D.B.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Departments of Surgery (H.B.M., A.B., E.E.M.) and Pediatrics (C.C.S.), University of Colorado Denver, Denver, Colorado; Bonfils Blood Center (C.C.S.), Denver, Colorado; Department of Surgery (E.E.M.), Denver Health Medical Center, Denver, Colorado; Koch Institute (M.B.Y.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and Division of Acute Care Surgery and Critical Care, Department of Surgery (M.B.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. FAU - Moore, Hunter B AU - Moore HB FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC FAU - Moore, Ernest E AU - Moore EE FAU - Yaffe, Michael B AU - Yaffe MB LA - eng GR - F32 HL134244/HL/NHLBI NIH HHS/United States GR - L30 GM120751/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 86090-08-6 (Angiostatins) RN - 9001-91-6 (Plasminogen) RN - EC 3.4.21.37 (Leukocyte Elastase) SB - IM MH - Angiostatins/*blood MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Blotting, Western MH - Fibrinolysis/*physiology MH - Humans MH - Leukocyte Elastase/*blood MH - Nephelometry and Turbidimetry MH - Neutrophils/*enzymology MH - Plasminogen/*metabolism MH - Thrombelastography MH - Wounds and Injuries/blood/*complications PMC - PMC5767103 MID - NIHMS900909 COIS- No conflicts of interest are reported. EDAT- 2017/08/25 06:00 MHDA- 2017/12/12 06:00 PMCR- 2018/12/01 CRDT- 2017/08/25 06:00 PHST- 2017/08/25 06:00 [pubmed] PHST- 2017/12/12 06:00 [medline] PHST- 2017/08/25 06:00 [entrez] PHST- 2018/12/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000001685 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Dec;83(6):1053-1061. doi: 10.1097/TA.0000000000001685. PMID- 28830477 OWN - NLM STAT- MEDLINE DCOM- 20180919 LR - 20260127 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 21 IP - 1 DP - 2017 Aug 23 TI - Hyperfibrinolysis in severe isolated traumatic brain injury may occur without tissue hypoperfusion: a retrospective observational multicentre study. PG - 222 LID - 10.1186/s13054-017-1811-1 [doi] LID - 222 AB - BACKGROUND: Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although hyperfibrinolysis is observed in patients with severe isolated traumatic brain injury (TBI) on arrival at the emergency department (ED), it is unclear which factors induce hyperfibrinolysis. The present study aimed to investigate the factors associated with hyperfibrinolysis in patients with isolated severe TBI. METHODS: We conducted a multicentre retrospective review of data for adult trauma patients with an injury severity score >/= 16, and selected patients with isolated TBI (TBI group) and extra-cranial trauma (non-TBI group). The TBI group included patients with an abbreviated injury score (AIS) for the head >/= 4 and an extra-cranial AIS < 2. The non-TBI group included patients with an extra-cranial AIS >/= 3 and head AIS < 2. Hyperfibrinolysis was defined as a D-dimer level >/= 38 mg/L on arrival at the ED. We evaluated the relationships between hyperfibrinolysis and injury severity/tissue injury/tissue perfusion in TBI patients by comparing them with non-TBI patients. RESULTS: We enrolled 111 patients in the TBI group and 126 in the non-TBI group. In both groups, patients with hyperfibrinolysis had more severe injuries and received transfusion more frequently than patients without hyperfibrinolysis. Tissue injury, evaluated on the basis of lactate dehydrogenase and creatine kinase levels, was associated with hyperfibrinolysis in both groups. Among patients with TBI, the mortality rate was higher in those with hyperfibrinolysis than in those without hyperfibrinolysis. Tissue hypoperfusion, evaluated on the basis of lactate level, was associated with hyperfibrinolysis in only the non-TBI group. Although the increase in lactate level was correlated with the deterioration of coagulofibrinolytic variables (prolonged prothrombin time and activated partial thromboplastin time, decreased fibrinogen levels, and increased D-dimer levels) in the non-TBI group, no such correlation was observed in the TBI group. CONCLUSIONS: Hyperfibrinolysis is associated with tissue injury and trauma severity in TBI and non-TBI patients. However, tissue hypoperfusion is associated with hyperfibrinolysis in non-TBI patients, but not in TBI patients. Tissue hypoperfusion may not be a prerequisite for the occurrence of hyperfibrinolysis in patients with isolated TBI. FAU - Hayakawa, Mineji AU - Hayakawa M AD - Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan. mineji@dream.com. FAU - Maekawa, Kunihiko AU - Maekawa K AD - Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan. FAU - Kushimoto, Shigeki AU - Kushimoto S AD - Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. FAU - Kato, Hiroshi AU - Kato H AD - Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan. FAU - Sasaki, Junichi AU - Sasaki J AD - Department of Emergency & Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. FAU - Ogura, Hiroshi AU - Ogura H AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. FAU - Matsuoka, Tetsuya AU - Matsuoka T AD - Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan. FAU - Uejima, Toshifumi AU - Uejima T AD - Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, Osaka, Japan. FAU - Morimura, Naoto AU - Morimura N AD - Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan. FAU - Ishikura, Hiroyasu AU - Ishikura H AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. FAU - Hagiwara, Akiyoshi AU - Hagiwara A AD - Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan. FAU - Takeda, Munekazu AU - Takeda M AD - Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan. FAU - Kaneko, Naoyuki AU - Kaneko N AD - Trauma and Emergency Center, Fukaya Red Cross Hospital, Saitama, Japan. FAU - Saitoh, Daizoh AU - Saitoh D AD - Division of Traumatology, Research Institute, National Defence Medical College, Saitama, Japan. FAU - Kudo, Daisuke AU - Kudo D AD - Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. FAU - Kanemura, Takashi AU - Kanemura T AD - Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan. FAU - Shibusawa, Takayuki AU - Shibusawa T AD - Department of Emergency & Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. FAU - Furugori, Shintaro AU - Furugori S AD - Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan. FAU - Nakamura, Yoshihiko AU - Nakamura Y AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. FAU - Shiraishi, Atsushi AU - Shiraishi A AD - Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. FAU - Murata, Kiyoshi AU - Murata K AD - Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. FAU - Mayama, Gou AU - Mayama G AD - Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan. FAU - Yaguchi, Arino AU - Yaguchi A AD - Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan. FAU - Kim, Shiei AU - Kim S AD - Department of Emergency & Critical Care Medicine, Nippon Medical School, Tokyo, Japan. FAU - Takasu, Osamu AU - Takasu O AD - Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Japan. FAU - Nishiyama, Kazutaka AU - Nishiyama K AD - Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20170823 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Tests/methods MH - Brain Injuries, Traumatic/*complications MH - Female MH - Humans MH - Injury Severity Score MH - Japan MH - Male MH - Middle Aged MH - Retrospective Studies MH - Trauma Centers/organization & administration PMC - PMC5568058 OTO - NOTNLM OT - Coagulopathy OT - Disseminated intravascular coagulation OT - Hyperfibrinolysis OT - Hypoperfusion OT - Traumatic brain injury COIS- This retrospective study was conducted at 15 tertiary emergency and critical care centres in Japan and was approved by the Institutional Review Board of each hospital (Additional file 1: Table S1). No patient consent was needed because of the retrospective study design. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/08/24 06:00 MHDA- 2018/09/20 06:00 PMCR- 2017/08/23 CRDT- 2017/08/24 06:00 PHST- 2017/01/23 00:00 [received] PHST- 2017/08/07 00:00 [accepted] PHST- 2017/08/24 06:00 [entrez] PHST- 2017/08/24 06:00 [pubmed] PHST- 2018/09/20 06:00 [medline] PHST- 2017/08/23 00:00 [pmc-release] AID - 10.1186/s13054-017-1811-1 [pii] AID - 1811 [pii] AID - 10.1186/s13054-017-1811-1 [doi] PST - epublish SO - Crit Care. 2017 Aug 23;21(1):222. doi: 10.1186/s13054-017-1811-1. PMID- 28764996 OWN - NLM STAT- MEDLINE DCOM- 20171226 LR - 20260127 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 36 IP - 1 DP - 2018 Jan TI - Coagulopathy as a predictor of mortality after penetrating traumatic brain injury. PG - 38-42 LID - S0735-6757(17)30508-9 [pii] LID - 10.1016/j.ajem.2017.06.057 [doi] AB - STUDY HYPOTHESIS: Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality. METHODS: We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009-May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT>/=128s, KT>/=2.5s, angle/=3.0% or platelet count/=10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified. Blood and blood products transfused, in-hospital mortality, 24h and 90-day mortality were analysed for the period 2010-2014. Blood and blood product usage, massive transfusion protocol (MTP) activation and use of ROTEM between 2008 and 2014 were compared. RESULTS: A total of 190 MT including surgical (52.1%), gastro-intestinal bleeding (25.3%), trauma (11.6%) and obstetric haemorrhage (5.8%) episodes were identified between 2010 and 2014. The overall in-hospital mortality was 26.7% with a significant difference in 24h (p=0.04) and 90-day mortality (p=0.02) between diagnostic groups. Comparing 2008 (n=33) and 2014 (n=23), there was no significant difference in median RC, FFP and platelet units, cryoprecipitate doses and RC:FFP ratio; however there was an increase in number of patients who used cryoprecipitate (54.5% vs 87%, p=0.01). CONCLUSION: Aligned with haemostatic resuscitation, the trend continues in the form of increased use of plasma and higher RC:FFP transfusion ratios including an increase in number of patients receiving cryoprecipitate. CI - Copyright (c) 2017 Elsevier Ltd. All rights reserved. FAU - Sinha, Romi AU - Sinha R AD - Flinders University, Department of Haematology and Genetic Pathology, School of Medicine, Bedford Park, SA 5042, Australia. Electronic address: sinh0001@flinders.edu.au. FAU - Roxby, David AU - Roxby D AD - Flinders University, Department of Haematology and Genetic Pathology, School of Medicine, Bedford Park, SA 5042, Australia. LA - eng PT - Journal Article DEP - 20170608 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 MH - Adult MH - *Blood Transfusion MH - Disease-Free Survival MH - Female MH - Follow-Up Studies MH - Hemorrhage/*mortality/*therapy MH - *Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Survival Rate MH - *Tertiary Care Centers OTO - NOTNLM OT - Haemostatic resuscitation OT - Massive transfusion OT - Transfusion practice EDAT- 2017/07/10 06:00 MHDA- 2018/05/26 06:00 CRDT- 2017/07/10 06:00 PHST- 2017/02/02 00:00 [received] PHST- 2017/05/10 00:00 [revised] PHST- 2017/05/12 00:00 [accepted] PHST- 2017/07/10 06:00 [pubmed] PHST- 2018/05/26 06:00 [medline] PHST- 2017/07/10 06:00 [entrez] AID - S1473-0502(17)30095-2 [pii] AID - 10.1016/j.transci.2017.05.013 [doi] PST - ppublish SO - Transfus Apher Sci. 2017 Aug;56(4):558-562. doi: 10.1016/j.transci.2017.05.013. Epub 2017 Jun 8. PMID- 28655949 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220409 IS - 0019-5049 (Print) IS - 0976-2817 (Electronic) IS - 0019-5049 (Linking) VI - 61 IP - 6 DP - 2017 Jun TI - Peri-operative blood management. PG - 456-462 LID - 10.4103/ija.IJA_341_17 [doi] AB - Anaemia and allogeneic blood transfusions in surgical patients are associated with poor outcomes. Patient blood management (PBM) has been developed as an evidence-based clinical tool, by which clinicians can optimise anaemia, manage peri-operative bleeding, avoid unnecessary blood transfusion and improve patient outcome. This article aims to highlight the recent updates regarding evidence-based PBM in the perioperative period, following a thorough literature review involving original research articles, published guidelines and consensus documents discovered through an extensive PubMed and Medline search. PBM addresses three main pillars of the patient's journey through the pre-operative, intra-operative and post-operative periods. PBM encourages a restrictive approach to transfusion of blood products and promotes alternatives to blood transfusion to maximise clinical efficacy while minimising risks. Anaemia has been identified as an independent risk factor for poor outcomes. PBM highlights the importance of treating anaemia in the pre-operative period. Major elective surgery may be postponed until anaemia is corrected preoperatively. The intra-operative approach to PBM is a collaborative effort between the anaesthesia, surgery and transfusion laboratory teams. Use of tranexamic acid, meticulous haemostasis and cell salvage techniques play an important role during the intra-operative management of surgical and traumatic haemorrhage. Point-of-care coagulation tests with visco-elastographic methods and haemoglobin measurement ensure that the transfusion prescription is tailored to a patient. In the post-operative period, PBM highlights the need for patients to be optimised before discharge from the hospital. Implementation of the PBM has been shown to have individual health as well as economic benefits. FAU - Eeles, Alex AU - Eeles A AD - Department of Anaesthesia The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK. FAU - Baikady, Ravishankar Rao AU - Baikady RR AD - Department of Anaesthesia The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK. LA - eng PT - Journal Article PT - Review PL - India TA - Indian J Anaesth JT - Indian journal of anaesthesia JID - 0013243 PMC - PMC5474912 OTO - NOTNLM OT - Anaemia OT - iron deficiency OT - patient blood management OT - peri-operative COIS- There are no conflicts of interest. EDAT- 2017/06/29 06:00 MHDA- 2017/06/29 06:01 PMCR- 2017/06/01 CRDT- 2017/06/29 06:00 PHST- 2017/06/29 06:00 [entrez] PHST- 2017/06/29 06:00 [pubmed] PHST- 2017/06/29 06:01 [medline] PHST- 2017/06/01 00:00 [pmc-release] AID - IJA-61-456 [pii] AID - 10.4103/ija.IJA_341_17 [doi] PST - ppublish SO - Indian J Anaesth. 2017 Jun;61(6):456-462. doi: 10.4103/ija.IJA_341_17. PMID- 28650356 OWN - NLM STAT- MEDLINE DCOM- 20170913 LR - 20171214 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 266 IP - 3 DP - 2017 Sep TI - Trending Fibrinolytic Dysregulation: Fibrinolysis Shutdown in the Days After Injury Is Associated With Poor Outcome in Severely Injured Children. PG - 508-515 LID - 10.1097/SLA.0000000000002355 [doi] AB - OBJECTIVE: To trend fibrinolysis after injury and determine the influence of traumatic brain injury (TBI) and massive transfusion on fibrinolysis status. BACKGROUND: Admission fibrinolytic derangement is common in injured children and adults, and is associated with poor outcome. No studies examine fibrinolysis days after injury. METHODS: Prospective study of severely injured children at a level 1 pediatric trauma center. Rapid thromboelastography was obtained on admission and daily for up to 7 days. Standard definitions of hyperfibrinolysis (HF; LY30 >/=3), fibrinolysis shutdown (SD; LY30 30%, n = 3) was lethal. Also, 50% of massively transfused patients in hemorrhagic shock demonstrated SD physiology on admission. All with HF (fc31.2%) corrected after hemostatic resuscitation without tranexamic acid. CONCLUSIONS: Fibrinolysis shutdown is common postinjury and predicts poor outcomes. Severe TBI is associated with sustained shutdown. Empiric antifibrinolytics for children should be questioned; thromboelastography-directed selective use should be considered for documented HF. FAU - Leeper, Christine M AU - Leeper CM AD - *Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA daggerChildren's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. FAU - Neal, Matthew D AU - Neal MD FAU - McKenna, Christine J AU - McKenna CJ FAU - Gaines, Barbara A AU - Gaines BA LA - eng GR - UL1 TR000005/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Adolescent MH - Blood Coagulation Disorders/blood/diagnosis/*etiology MH - Blood Transfusion MH - Brain Injuries, Traumatic/blood/complications/mortality/therapy MH - Child MH - Child, Preschool MH - Female MH - *Fibrinolysis MH - Humans MH - Infant MH - Infant, Newborn MH - Injury Severity Score MH - Male MH - Prognosis MH - Prospective Studies MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/blood/*complications/mortality/therapy EDAT- 2017/06/27 06:00 MHDA- 2017/09/14 06:00 CRDT- 2017/06/27 06:00 PHST- 2017/06/27 06:00 [pubmed] PHST- 2017/09/14 06:00 [medline] PHST- 2017/06/27 06:00 [entrez] AID - 10.1097/SLA.0000000000002355 [doi] PST - ppublish SO - Ann Surg. 2017 Sep;266(3):508-515. doi: 10.1097/SLA.0000000000002355. PMID- 28632435 OWN - NLM STAT- MEDLINE DCOM- 20180628 LR - 20180628 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 77 IP - 6 DP - 2017 Oct TI - Relative effects of plasma, fibrinogen concentrate, and factor XIII on ROTEM coagulation profiles in an in vitro model of massive transfusion in trauma. PG - 397-405 LID - 10.1080/00365513.2017.1334128 [doi] AB - 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. FAU - Schmidt, David E AU - Schmidt DE AD - a Department of Medicine, Division of Haematology, Coagulation Unit , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden. FAU - Halmin, Marit AU - Halmin M AD - b Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden. AD - c Department of Anesthesiology and Intensive Care , Danderyd Hospital , Stockholm , Sweden. FAU - Wikman, Agneta AU - Wikman A AD - d Department of Clinical Immunology and Transfusion Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden. FAU - Ostlund, Anders AU - Ostlund A AD - e Department of Anaesthesiology and Intensive Care , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden. FAU - Agren, Anna AU - Agren A AD - a Department of Medicine, Division of Haematology, Coagulation Unit , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden. LA - eng PT - Journal Article DEP - 20170620 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) SB - IM MH - *Blood Coagulation/drug effects MH - *Blood Transfusion MH - Factor XIII/administration & dosage/*therapeutic use MH - Fibrinogen/*therapeutic use MH - Humans MH - *Models, Biological MH - Numerical Analysis, Computer-Assisted MH - Plasma/*metabolism MH - Thrombelastography MH - Whole Blood Coagulation Time MH - Wounds and Injuries/*blood/*therapy OTO - NOTNLM OT - Advanced trauma life support care OT - blood transfusion OT - factor XIII OT - fibrinogen OT - plasma OT - thromboelastography EDAT- 2017/06/21 06:00 MHDA- 2018/06/29 06:00 CRDT- 2017/06/21 06:00 PHST- 2017/06/21 06:00 [pubmed] PHST- 2018/06/29 06:00 [medline] PHST- 2017/06/21 06:00 [entrez] AID - 10.1080/00365513.2017.1334128 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2017 Oct;77(6):397-405. doi: 10.1080/00365513.2017.1334128. Epub 2017 Jun 20. PMID- 28628602 OWN - NLM STAT- MEDLINE DCOM- 20170830 LR - 20190116 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 83 IP - 1 Suppl 1 DP - 2017 Jul TI - Procoagulant activity of human mesenchymal stem cells. PG - S164-S169 LID - 10.1097/TA.0000000000001485 [doi] AB - BACKGROUND: Allogeneic mesenchymal stem cells (MSCs) show great potential for the treatment of military and civilian trauma based on their reduced immunogenicity and ability to modulate inflammation and immune function in the recipient. Although generally considered to be safe, MSCs express tissue factor (TF), a potent activator of coagulation. In the current study, we evaluated multiple MSC populations for tissue factor expression and procoagulant activity to characterize safety considerations for systemic use of MSCs in trauma patients who may have altered coagulation homeostasis. METHODS: Multiple MSC populations derived from either human adipose tissue or bone marrow were expanded in the recommended stem cell media. Stem cell identity was confirmed using a well-characterized panel of positive and negative markers. Tissue factor expression on the cell surface was evaluated by flow cytometry with anti-CD142 antibody. Effects on blood coagulation were determined by thromboelastography and calibrated automated thrombogram assays using platelet-poor plasma or whole blood. RESULTS: Mesenchymal stem cells express tissue factor on their surfaces and are procoagulant in the presence of blood or plasma. The adipose-derived MSCs (Ad-MSC) evaluated were more procoagulant and expressed more tissue factor than bone marrow MSCs (BM-MSCs), which showed a greater variability in TF expression. Bone marrow MSCs were identified that exhibited low procoagulant activity, whereas all Ad-MSCs examined exhibited high procoagulant activity. The percentage of cells in a given population expressing surface tissue factor correlates roughly with functional procoagulant activity. Mesenchymal stem cell tissue factor expression and procoagulant activity change over time in culture. CONCLUSIONS: All MSC populations are not equivalent; care should be taken to select cells for clinical use that minimize potential safety problems and maximize chance of patient benefit. Adipose-derived MSCs seem more consistently procoagulant than BM-MSCs, presenting a potential safety concern for systemic administration in coagulopathic patients. Donor variation exists between different cell populations, and culture handling conditions may also determine coagulation activity. Cells must be routinely monitored during preparation to ensure that they retain the desired characteristics before patient administration. FAU - Christy, Barbara A AU - Christy BA AD - From the Coagulation & Blood Research (B.A.C., M.C.H., R.K.M., C.D., J.A.B., K.M.R., A.P.C.), US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas; Department of Molecular Medicine (B.A.C.), University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Department of Surgery (A.P.C.), University of Texas Health Science Center at San Antonio, San Antonio, Texas. FAU - Herzig, Maryanne C AU - Herzig MC FAU - Montgomery, Robbie K AU - Montgomery RK FAU - Delavan, Christopher AU - Delavan C FAU - Bynum, James A AU - Bynum JA FAU - Reddoch, Kristin M AU - Reddoch KM FAU - Cap, Andrew P AU - Cap AP LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9035-58-9 (Thromboplastin) SB - IM MH - Adipose Tissue/cytology MH - Blood Coagulation/*physiology MH - Bone Marrow/metabolism MH - Cell Proliferation MH - Cells, Cultured MH - Flow Cytometry MH - Humans MH - *Mesenchymal Stem Cell Transplantation MH - Mesenchymal Stem Cells/*metabolism MH - Thrombelastography MH - Thromboplastin/*metabolism EDAT- 2017/06/20 06:00 MHDA- 2017/08/31 06:00 CRDT- 2017/06/20 06:00 PHST- 2017/06/20 06:00 [entrez] PHST- 2017/06/20 06:00 [pubmed] PHST- 2017/08/31 06:00 [medline] AID - 01586154-201707001-00026 [pii] AID - 10.1097/TA.0000000000001485 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Jul;83(1 Suppl 1):S164-S169. doi: 10.1097/TA.0000000000001485. PMID- 28624047 OWN - NLM STAT- MEDLINE DCOM- 20170919 LR - 20260127 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 214 DP - 2017 Jun 15 TI - Viscoelastic monitoring in pediatric trauma: a survey of pediatric trauma society members. PG - 216-220 LID - S0022-4804(17)30143-9 [pii] LID - 10.1016/j.jss.2017.03.016 [doi] AB - BACKGROUND: Viscoelastic monitoring (VEM), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in the setting of goal-directed hemostatic resuscitation has been shown to improve outcomes in adult trauma. The American College of Surgeons (ACS) Committee on Trauma recommends that "thromboelastography should be available at level I and level II trauma centers". The purpose of this study is to determine the current availability and utilization of VEM in pediatric trauma. METHODS: After IRB and Pediatric Trauma Society (PTS) approval, a survey was administered to the current members of the PTS via Survey Monkey. The survey collected demographic information, hospital and trauma program type, volume of trauma admissions, and use and/or availability of VEM for pediatric trauma patients. RESULTS: We received 107 responses representing 77 unique hospitals. Survey respondents were: 61% physicians, 29% nurses, 6% trauma program managers, and 4% nurse practitioners/physician assistants. Over half of providers worked in a free standing children's hospital. Seventy-seven percent of respondents were from hospitals that had >200 trauma admissions/year, 42% were providers at ACS level 1 pediatric trauma centers, and 62% practiced at state level 1 designated centers. VEM was available to 63% of providers, but only 31% employed VEM in pediatric trauma patients. For those who had no VEM available, over 73% would utilize this technology if it was available. Seventy-one percent of providers continue to rely on conventional coagulation assays to monitor coagulopathy in pediatric trauma patients after admission. CONCLUSIONS: While a growing body of evidence demonstrates the benefit of viscoelastic hemostatic assays in management of adult traumatic injuries, VEM during active resuscitation is infrequently used by pediatric trauma providers, even when the technology is readily available. This represents a timely and unique opportunity for quality improvement in pediatric trauma. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Russell, Robert T AU - Russell RT AD - Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: robert.russell@childrensal.org. FAU - Maizlin, Ilan I AU - Maizlin II AD - Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Vogel, Adam M AU - Vogel AM AD - Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas. LA - eng PT - Journal Article DEP - 20170331 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Child MH - Cross-Sectional Studies MH - Health Care Surveys MH - Health Services Accessibility/*statistics & numerical data MH - Humans MH - Practice Patterns, Nurses'/*statistics & numerical data MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Thrombelastography/*statistics & numerical data MH - United States MH - Wounds and Injuries/*complications OTO - NOTNLM OT - Coagulopathy OT - Pediatric OT - Trauma OT - Viscoelastic testing EDAT- 2017/06/19 06:00 MHDA- 2017/09/20 06:00 CRDT- 2017/06/19 06:00 PHST- 2017/02/08 00:00 [received] PHST- 2017/03/08 00:00 [revised] PHST- 2017/03/23 00:00 [accepted] PHST- 2017/06/19 06:00 [entrez] PHST- 2017/06/19 06:00 [pubmed] PHST- 2017/09/20 06:00 [medline] AID - S0022-4804(17)30143-9 [pii] AID - 10.1016/j.jss.2017.03.016 [doi] PST - ppublish SO - J Surg Res. 2017 Jun 15;214:216-220. doi: 10.1016/j.jss.2017.03.016. Epub 2017 Mar 31. PMID- 28602219 OWN - NLM STAT- MEDLINE DCOM- 20171003 LR - 20190114 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 217 DP - 2017 Sep TI - Tranexamic acid leads to paradoxical coagulation changes during cardiac surgery: a pilot rotational thromboelastometry study. PG - 100-112 LID - S0022-4804(17)30259-7 [pii] LID - 10.1016/j.jss.2017.05.006 [doi] AB - BACKGROUND: Tranexamic acid (TXA) is increasingly used during major surgery with the goal to reduce excessive bleeding, transfusion requirements, and reexploration. Our aim was to examine the effect of TXA on coagulation at different times during cardiac surgery using rotational thromboelastometry. MATERIALS AND METHODS: Nineteen adult males (EuroSCORE 4-5) were recruited consecutively for first-time cardiopulmonary bypass (CPB) surgery. Ten patients received TXA at anesthesia and nine received no TXA. Rotational thromboelastometry analysis occurred before anesthesia (baseline), after sternotomy, after CPB-heparinization and surgery, and after protamine administration-sternal closure. RESULTS: A median sternotomy had no effect on clot time (CT), formation, amplitude, or lysis in non-TXA patients. In contrast, TXA patients had twofold prolonged clotting time (all-tests) and approximately 30% reduced FIBTEM (A5-30) and maximum clot firmness, indicating reduced thrombin generation and lower clot fibrinogen. After CPB, CTs in both groups were prolonged, possibly linked to overheparinization. In addition, TXA patients had significantly decreased EXTEM (A5-30), suggesting lower clot strength. After protamine-sternal closure, clotting time remained prolonged in both groups, and TXA patients had a persistently 25%-33% lower FIBTEM (A5-30) and maximum clot firmness. TXA patients also had significantly reduced platelet numbers (37% from baseline), which continued Days 1 and 2. Maximum clot lysis was <10% indicating little or no hyperfibrinolysis during cardiac surgery. CONCLUSIONS: In this nonrandomized, nonblinded, observational trial, patients in the TXA group displayed prolonged CTs and clot fibrinogen (FIBTEM A5-30) after sternotomy, decreased clot strength (EXTEM) after CPB/surgery, and acute thrombocytopenia after protamine-sternal closure. There was no significant decrease in clot lysis, questioning the need for TXA in this medium-risk group. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Sharma, Rajiv AU - Sharma R AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Australia. FAU - Letson, Hayley L AU - Letson HL AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Australia. FAU - Smith, Samuel AU - Smith S AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Australia. FAU - Dobson, Geoffrey P AU - Dobson GP AD - Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Australia. Electronic address: geoffrey.dobson@jcu.edu.au. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20170508 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Aged MH - Antifibrinolytic Agents/*pharmacology/therapeutic use MH - Blood Coagulation/*drug effects MH - Cardiac Surgical Procedures/*adverse effects MH - Hemorrhage/etiology/prevention & control MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - Thrombelastography/*methods/statistics & numerical data MH - Tranexamic Acid/*pharmacology/therapeutic use OTO - NOTNLM OT - Antifibrinolytic OT - Cardiac surgery OT - Cardiopulmonary bypass OT - TXA OT - Trauma OT - coagulation EDAT- 2017/06/13 06:00 MHDA- 2017/10/04 06:00 CRDT- 2017/06/13 06:00 PHST- 2016/11/16 00:00 [received] PHST- 2017/04/19 00:00 [revised] PHST- 2017/05/01 00:00 [accepted] PHST- 2017/06/13 06:00 [pubmed] PHST- 2017/10/04 06:00 [medline] PHST- 2017/06/13 06:00 [entrez] AID - S0022-4804(17)30259-7 [pii] AID - 10.1016/j.jss.2017.05.006 [doi] PST - ppublish SO - J Surg Res. 2017 Sep;217:100-112. doi: 10.1016/j.jss.2017.05.006. Epub 2017 May 8. PMID- 28601310 OWN - NLM STAT- MEDLINE DCOM- 20170919 LR - 20240326 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 213 DP - 2017 Jun 1 TI - Hemoglobin-based oxygen carriers promote systemic hyperfibrinolysis that is both dependent and independent of plasmin. PG - 166-170 LID - S0022-4804(15)00506-5 [pii] LID - 10.1016/j.jss.2015.04.077 [doi] AB - BACKGROUND: Hyperfibrinolysis plays an integral role in the genesis of trauma-induced coagulopathy. Recent data demonstrate that red blood cell lysis promotes fibrinolysis; however, the mechanism is unclear. Hemoglobin-based oxygen carriers (HBOCs) have been developed for resuscitation and have been associated with coagulopathy. We hypothesize that replacement of whole blood (WB) using an HBOC results in a coagulopathy because of the presence of free hemoglobin. MATERIALS AND METHODS: WB was sampled from healthy donors (n = 6). The clotting profile of each citrated sample was evaluated using native thromboelastography. Serial titrations were performed using both HBOC (PolyHeme) and normal saline (NS; 5%, 25%, and 50%) and evaluated both with and without a 75-ng/mL tissue plasminogen activator (tPA) challenge. Tranexamic acid (TXA) was added to inhibit plasmin-dependent fibrinolysis. Fibrinolysis was measured and recorded as lysis at 30 min (LY30), the percentage of clot LY30 after maximal clot strength. Dilution of WB with NS or HBOC was correlated using LY30 via Spearman rho coefficients. Groups were also compared using a Friedman test and post hoc analysis with a Bonferroni adjustment. RESULTS: tPA-provoked fibrinolysis was enhanced by both HBOC (median LY30 at 5%, 25%, and 50% titrations: 11%, 21%, and 44%, respectively; Spearman = 0.94; P < 0.001) and NS (11%, 28%, and 58%, respectively; Spearman = 0.790; P < 0.001). However, HBOC also enhanced fibrinolysis without the addition of tPA (1%, 4%, 5%; Spearman = 0.735; P = 0.001) and NS did not (1%, 2%, 1%; r = 0.300; P = 0.186. Moreover, addition of TXA did not alter or inhibit this fibrinolysis (WB versus 50% HBOC: 1.8% versus 5.7%, P = 0.04). There was no significant difference in fibrinolysis of HBOC with or without TXA (50% HBOC versus 50% HBOC + TXA: 5.6% versus 5.7%, P = 0.92). In addition, the increased fibrinolysis seen with NS was reversed when TXA was present (WB versus 50% NS: 1.8% versus 1.7%, P = 1.0). CONCLUSIONS: HBOCs enhance fibrinolysis both with and without addition of tPA; moreover, this mechanism is independent of plasmin as the phenomenon persists in the presence of TXA. Our findings indicate the hemoglobin molecule or its components stimulate fibrinolysis by both tPA-dependent and innate mechanisms. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Morton, Alexander P AU - Morton AP AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. Electronic address: alexander.morton@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado; Department of Surgery-Denver Health Medical Center, Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. FAU - Peltz, Erik AU - Peltz E AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado. FAU - Silliman, Christopher AU - Silliman C AD - Department of Surgery-Trauma Research Center, University of Colorado, Denver, Colorado; Bonfils Blood Center, Denver, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20150425 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Biomarkers) RN - 0 (Blood Substitutes) RN - 0 (Hemoglobins) RN - 0 (PolyHeme) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Adult MH - Biomarkers/metabolism MH - Blood Substitutes/*adverse effects MH - Fibrinolysin/*metabolism MH - Fibrinolysis/*drug effects/physiology MH - Healthy Volunteers MH - Hemoglobins/*adverse effects MH - Humans MH - Male MH - Thrombelastography PMC - PMC5467451 MID - NIHMS684834 OTO - NOTNLM OT - Coagulopathy OT - Fibrinolysis OT - TEG OT - Thromboelastography OT - Trauma-induced coagulopathy EDAT- 2017/06/12 06:00 MHDA- 2017/09/20 06:00 PMCR- 2018/06/01 CRDT- 2017/06/12 06:00 PHST- 2015/01/03 00:00 [received] PHST- 2015/04/14 00:00 [revised] PHST- 2015/04/21 00:00 [accepted] PHST- 2017/06/12 06:00 [entrez] PHST- 2017/06/12 06:00 [pubmed] PHST- 2017/09/20 06:00 [medline] PHST- 2018/06/01 00:00 [pmc-release] AID - S0022-4804(15)00506-5 [pii] AID - 10.1016/j.jss.2015.04.077 [doi] PST - ppublish SO - J Surg Res. 2017 Jun 1;213:166-170. doi: 10.1016/j.jss.2015.04.077. Epub 2015 Apr 25. PMID- 28601210 OWN - NLM STAT- MEDLINE DCOM- 20180103 LR - 20250623 IS - 1545-1534 (Electronic) IS - 1080-6032 (Print) IS - 1080-6032 (Linking) VI - 28 IP - 2S DP - 2017 Jun TI - Tranexamic Acid Use in Prehospital Uncontrolled Hemorrhage. PG - S50-S60 LID - S1080-6032(16)30289-7 [pii] LID - 10.1016/j.wem.2016.12.006 [doi] AB - The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial in 2010 demonstrated a reduction in mortality with the use of TXA. Although this trial was a randomized, double-blinded, placebo-controlled study incorporating >20,000 patients, numerous limitations and weaknesses have been described. As a result, additional studies have followed, delineating the potential risks and benefits of TXA administration. A systematic review of the literature to date reveals a mortality benefit of early (ideally <1 hour and no later than 3 hours after injury) TXA administration in the treatment of severely injured trauma patients (systolic blood pressure <90 mm Hg, heart rate >110). Combined with abundant literature showing a reduction in bleeding in elective surgery, the most significant benefit may be administration of TXA before the patient goes into shock. Those trials that failed to show a mortality benefit of TXA in the treatment of hemorrhagic shock acknowledged that most patients received blood products before TXA administration, thus confounding the results. Although the use of prehospital TXA in the severely injured trauma patient will become more clear with the trauma studies currently underway, the current literature supports the use of prehospital TXA in this high-risk population. We recommend considering a 1 g TXA bolus en route to definitive care in high-risk patients and withholding subsequent doses until hyperfibrinolysis is confirmed by thromboelastography. CI - Copyright (c) 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Cincinnati, Cincinnati, OH (Dr Huebner). FAU - Dorlac, Warren C AU - Dorlac WC AD - University of Colorado Health, Loveland, CO and Volunteer Clinical Faculty, Department of Surgery, University of Cincinnati, Cincinnati, OH (Dr Dorlac). Electronic address: Warren.dorlac@uchealth.org. FAU - Cribari, Chris AU - Cribari C AD - University of Colorado Health, Loveland, CO (Dr Cribari). LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Systematic Review PL - United States TA - Wilderness Environ Med JT - Wilderness & environmental medicine JID - 9505185 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/*pharmacology MH - Hemorrhage/*prevention & control MH - Humans MH - Tranexamic Acid/*pharmacology PMC - PMC5567779 MID - NIHMS888783 OTO - NOTNLM OT - bleeding OT - coagulopathy OT - hemorrhagic shock OT - hyperfibrinolysis OT - tranexamic acid OT - trauma EDAT- 2017/06/12 06:00 MHDA- 2018/01/04 06:00 PMCR- 2017/08/23 CRDT- 2017/06/12 06:00 PHST- 2016/08/05 00:00 [received] PHST- 2016/11/08 00:00 [revised] PHST- 2016/12/01 00:00 [accepted] PHST- 2017/06/12 06:00 [entrez] PHST- 2017/06/12 06:00 [pubmed] PHST- 2018/01/04 06:00 [medline] PHST- 2017/08/23 00:00 [pmc-release] AID - S1080-6032(16)30289-7 [pii] AID - 10.1016/j.wem.2016.12.006 [doi] PST - ppublish SO - Wilderness Environ Med. 2017 Jun;28(2S):S50-S60. doi: 10.1016/j.wem.2016.12.006. PMID- 28598908 OWN - NLM STAT- MEDLINE DCOM- 20170918 LR - 20220408 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 83 IP - 3 DP - 2017 Sep TI - The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography. PG - 413-419 LID - 10.1097/TA.0000000000001618 [doi] AB - BACKGROUND: Venous thromboembolism (VTE) in trauma can occur in patients at low risk. Conventional coagulation tests do not predict VTE. Studies investigating thromboelastography (TEG) for VTE risk are conflicting and have not included routine surveillance to detect deep vein thrombosis (DVT). We undertook a prospective study of TEG to evaluate its utility in predicting VTE. METHODS: We conducted a prospective cohort study on all adult trauma patients admitted to our Level I trauma center from 2013 to 2015. TEG was performed immediately on arrival to the trauma bay. Hypercoagulable TEG was defined as reaction time (R) below, angle (alpha) above, or maximum amplitude (MA) above reference ranges. All patients received mechanical and/or pharmacologic prophylaxis and were followed up for DVT with our ultrasound surveillance protocol. The primary outcome was lower-extremity DVT. After bivariate analysis of variables related to DVT, those with p values of 0.100 or less were included for multivariate logistic regression. RESULTS: A total of 983 patients were evaluated with TEG on admission; of these, 684 (69.6%) received at least one surveillance ultrasound during the index admission. Lower-extremity DVT was diagnosed in 99 (14.5%) patients. Hypercoagulability based on admission TEG occurred in 582 (85.1%) patients. The lower-extremity DVT rate was higher in patients with hypercoagulable TEG than in those without hypercoagulable TEG (15.6% vs. 8%; p = 0.039). Multivariate analysis showed hypercoagulable TEG remained associated with DVT after adjustment for relevant covariates available at admission, with an odds ratio of 2.41 (95% confidence interval, 1.11-5.24; p = 0.026). CONCLUSION: Most trauma patients were hypercoagulable at admission and remained at risk of developing DVT. The rate of DVT doubled in patients with hypercoagulable TEG indices despite prophylaxis. Beyond its current clinical roles, TEG is useful for assessing DVT risk, particularly in patients otherwise perceived to be at low risk. LEVEL OF EVIDENCE: Prognostic study, level II. FAU - Brill, Jason B AU - Brill JB AD - From the Trauma Service (J.B.B., J.B., A.L.Z., J.D.W., P.R.L., M.J.S., V.B., S.R.S.), Scripps Mercy Hospital, San Diego, California. FAU - Badiee, Jayraan AU - Badiee J FAU - Zander, Ashley L AU - Zander AL FAU - Wallace, James D AU - Wallace JD FAU - Lewis, Paul R AU - Lewis PR FAU - Sise, Michael J AU - Sise MJ FAU - Bansal, Vishal AU - Bansal V FAU - Shackford, Steven R AU - Shackford SR LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Risk Factors MH - *Thrombelastography MH - Trauma Centers MH - Venous Thromboembolism/*diagnosis/diagnostic imaging MH - Wounds and Injuries/*complications EDAT- 2017/06/10 06:00 MHDA- 2017/09/19 06:00 CRDT- 2017/06/10 06:00 PHST- 2017/06/10 06:00 [pubmed] PHST- 2017/09/19 06:00 [medline] PHST- 2017/06/10 06:00 [entrez] AID - 10.1097/TA.0000000000001618 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Sep;83(3):413-419. doi: 10.1097/TA.0000000000001618. PMID- 28598883 OWN - NLM STAT- MEDLINE DCOM- 20190215 LR - 20190215 IS - 1537-1913 (Electronic) IS - 0020-5907 (Linking) VI - 55 IP - 3 DP - 2017 Summer TI - Viscoelastic Testing of Coagulation. PG - 96-108 LID - 10.1097/AIA.0000000000000155 [doi] FAU - Jones, Clinton P AU - Jones CP AD - *Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK daggerDepartment of Anaesthesia, Aintree University Hospital NHS Foundation Trust, Liverpool, UK double daggerDepartment of Anaesthesia, Queen Elizabeth Hospitals, Birmingham, UK. section signMilitary Anaesthesia, Academic Department of Military Anaesthesia, Royal Centre for Defence Medicine, Birmingham, UK parallelDepartment of Anaesthesia, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK. FAU - Keene, Damien D AU - Keene DD FAU - Nordmann, Giles R AU - Nordmann GR LA - eng PT - Journal Article PL - United States TA - Int Anesthesiol Clin JT - International anesthesiology clinics JID - 0370760 RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation MH - Elasticity MH - Fibrinogen/physiology MH - Humans MH - *Thrombelastography MH - Viscosity MH - Wounds and Injuries/blood EDAT- 2017/06/10 06:00 MHDA- 2019/02/16 06:00 CRDT- 2017/06/10 06:00 PHST- 2017/06/10 06:00 [entrez] PHST- 2017/06/10 06:00 [pubmed] PHST- 2019/02/16 06:00 [medline] AID - 00004311-201705530-00008 [pii] AID - 10.1097/AIA.0000000000000155 [doi] PST - ppublish SO - Int Anesthesiol Clin. 2017 Summer;55(3):96-108. doi: 10.1097/AIA.0000000000000155. PMID- 28587360 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 1792-0981 (Print) IS - 1792-1015 (Electronic) IS - 1792-0981 (Linking) VI - 13 IP - 6 DP - 2017 Jun TI - The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction undergoing emergent PCI. PG - 2917-2921 LID - 10.3892/etm.2017.4336 [doi] AB - The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI) was estimated. One hundred and twenty-eight patients were randomly divided into control group and observation group with 64 cases in each group. Control group adopted routine blood coagulation indexes, including prothrombin time, activated partial thromboplastin time, fibrinogen and plasma thrombin time, platelet count and platelet aggregation turbidity analysis; observation group adopted Sonoclot detection technology, including activated clotting time, coagulation rate and platelet function. Anticoagulant therapy selected was of low molecular weight heparin calcium perioperatively, intraoperative unfractionated heparin, and clopidogrel (75 mg) combined with aspirin enteric-coated tablets (100 mg) as antiplatelet drugs. The therapy was administered in accordance with blood coagulation results. The blood coagulation time, postoperative creatine kinase isoenzyme MB, cardiac troponin I and B-type natriuretic peptide levels in the observation group are significantly lower than those in the control group (P<0.05) though the operating time and specifications of the stenting did not show any significant difference (P>0.05). The incidence of recurrent myocardial infarction, microembolism, acute and subacute thrombosis and bleeding events in the observation group are significantly lower than those in the control group (P<0.05). In the control group, there is no difference in the coagulation indexes of the patients with thrombosis events or bleeding events or no event (P>0.05). Whereas, in the observation group, there is significant difference in coagulation indexes of the patients with thrombosis events or bleeding events or no event (P<0.05). In conclusion, Sonoclot detection technology instructs emergent PCI treatment in AMI patients to shorten the detection time of blood coagulation, reduce the degree of myocardial injury, reduce the incidence of perioperative thrombosis and bleeding events. Furthermore, it has great value in guiding the clinical medication of anticoagulation and antiplatelet therapy. FAU - Yang, Wu-Xiao AU - Yang WX AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. FAU - Lai, Chun-Lin AU - Lai CL AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. FAU - Chen, Fu-Heng AU - Chen FH AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. FAU - Wang, Ji-Rong AU - Wang JR AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. FAU - Ji, You-Rui AU - Ji YR AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. FAU - Wang, Dong-Xia AU - Wang DX AD - Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China. LA - eng PT - Journal Article DEP - 20170413 PL - Greece TA - Exp Ther Med JT - Experimental and therapeutic medicine JID - 101531947 PMC - PMC5450559 OTO - NOTNLM OT - Sonoclot detection technology OT - acute myocardial infarction OT - anticoagulation OT - antiplatelet EDAT- 2017/06/08 06:00 MHDA- 2017/06/08 06:01 PMCR- 2017/04/13 CRDT- 2017/06/08 06:00 PHST- 2016/09/06 00:00 [received] PHST- 2017/02/21 00:00 [accepted] PHST- 2017/06/08 06:00 [entrez] PHST- 2017/06/08 06:00 [pubmed] PHST- 2017/06/08 06:01 [medline] PHST- 2017/04/13 00:00 [pmc-release] AID - ETM-0-0-4336 [pii] AID - 10.3892/etm.2017.4336 [doi] PST - ppublish SO - Exp Ther Med. 2017 Jun;13(6):2917-2921. doi: 10.3892/etm.2017.4336. Epub 2017 Apr 13. PMID- 28584429 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220330 IS - 0972-5229 (Print) IS - 1998-359X (Electronic) IS - 0972-5229 (Linking) VI - 21 IP - 5 DP - 2017 May TI - Thromboelastography for Evaluation of Coagulopathy in Nonbleeding Patients with Sepsis at Intensive Care Unit Admission. PG - 268-273 LID - 10.4103/ijccm.IJCCM_72_17 [doi] AB - BACKGROUND: Thromboelastography (TEG) is a global test of coagulation which analyzes the whole coagulation process. TEG is popular in trauma, liver transplant, and cardiac surgeries, but studies in sepsis are limited. We have assessed the utility of TEG for evaluating coagulopathy in nonbleeding patients with sepsis. MATERIALS AND METHODS: A prospective, observational study was done in 12-bedded Intensive Care Unit (ICU) of a tertiary care hospital in North India, during May 2014-November 2014. After ethical clearance, all patients at ICU admission with sepsis were included in the study. Exclusion criteria were age <18 years, plasma/platelet transfusion before admission, patients on oral antiplatelets/anticoagulants, or with underlying hematological disorders. At admission, blood samples for TEG were analyzed by kaolin-based TEG analyzer within an hour of collecting 2.7 ml citrated blood from arterial line. TEG parameters included reaction time (R), K time (K), alpha angle (a), maximum amplitude (MA), coagulation index (CI), and lysis index (LY 30). RESULTS: In TEG, mean values of R, K, a, MA, CI, and LY30 were 6.45 +/- 2.59 (min), 1.67 +/- 0.96 (min), 66.37 +/- 10.44 ((0)), 67.08 +/- 10.33 (mm), 0.63 +/- 3.46, and 2.23 +/- 4.08 (%), respectively. In conventional coagulation assay (CCA), mean values of international normalized ratio (INR), platelet, and fibrinogen were 1.63 +/- 0.57, 153.96 +/- 99.16 (x10(3) /mm(3)), and 301.33 +/- 112.82 (mg/dl), respectively. In those with deranged INR (INR >/=1.6), 60% were normocoagulable and 20% were hypercoagulable. Similarly, 81% patients with thrombocytopenia (platelet count <1,00,000/mL) were normocoagulable. CONCLUSION: TEG could differentiate among normocoagulant, hypocoagulant, hypercoagulant states (unlike CCAs). Patients with septic shock had trend toward hypocoagulant state while those without shock had trend toward hypercoagulant state. FAU - Muzaffar, Syed Nabeel AU - Muzaffar SN AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Baronia, Arvind Kumar AU - Baronia AK AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Azim, Afzal AU - Azim A AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Verma, Anupam AU - Verma A AD - Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Gurjar, Mohan AU - Gurjar M AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Poddar, Banani AU - Poddar B AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. FAU - Singh, Ratender Kumar AU - Singh RK AD - Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. LA - eng PT - Journal Article PL - India TA - Indian J Crit Care Med JT - Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine JID - 101208863 PMC - PMC5455019 OTO - NOTNLM OT - Coagulopathy OT - sepsis OT - septic shock OT - thromboelastography COIS- There are no conflicts of interest. EDAT- 2017/06/07 06:00 MHDA- 2017/06/07 06:01 PMCR- 2017/05/01 CRDT- 2017/06/07 06:00 PHST- 2017/06/07 06:00 [entrez] PHST- 2017/06/07 06:00 [pubmed] PHST- 2017/06/07 06:01 [medline] PHST- 2017/05/01 00:00 [pmc-release] AID - IJCCM-21-268 [pii] AID - 10.4103/ijccm.IJCCM_72_17 [doi] PST - ppublish SO - Indian J Crit Care Med. 2017 May;21(5):268-273. doi: 10.4103/ijccm.IJCCM_72_17. PMID- 28583756 OWN - NLM STAT- MEDLINE DCOM- 20171003 LR - 20190114 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 217 DP - 2017 Sep TI - Thrombelastography indicates limitations of animal models of trauma-induced coagulopathy. PG - 207-212 LID - S0022-4804(17)30284-6 [pii] LID - 10.1016/j.jss.2017.05.027 [doi] AB - BACKGROUND: Thrombelastography (TEG) has been used to characterize the coagulation changes associated with injury and shock. Animal models developed to investigate trauma-induced coagulopathy (TIC) have failed to produce excessive bleeding. We hypothesize that a native TEG will demonstrate marked differences in humans compared with these experimental models, which explains the difficulties in reproducing a clinically relevant coagulopathy in animal models. METHODS: Whole blood was collected from 138 healthy human volunteers, 25 swine and 66 Sprague-Dawley rats before experimentation. Citrated native TEGs were conducted on each whole blood sample within 2 h of collection. The clot initiation (R-time, minutes), angle (degrees), maximum amplitude (MA; millimeter), and lysis 30 min after MA (LY30; percentage) were analyzed and contrasted between species with data represented as the median and 25(th) to 75(th) quartile range. Difference between species was conducted with a Kruskal-Wallis test with alpha adjusted with a Bonferroni correction for multiple comparisons (alpha = 0.016). RESULTS: Median R-time (clot initiation) was 14.65 min (IQR: 13.2-16.3 min) for humans, 5.7 min (4.9-8.8) for pigs, and 5.2 min (4.4-6) for rodents. Humans had longer R-times than both pigs (P < 0.0001) and rats (P < 0.0001); pigs were not different from rats (P = 0.4439). Angle (fibrin cross-linking) was 42.3 degrees (interquartile range [IQR]: 37.5-50.2) for humans, 71.7 degrees (64.3-75.6) for pigs, and 61.8 degrees (56.8-66.7) for rats. Humans had reduced angle compared with both pigs (P < 0.0001) and rats (P < 0.0001); pigs were not different from rats (P = 0.6052). MA (clot strength) was 55.5 mm (IQR: 52.0-59.5) for humans, 72.5 mm (70.4-75.5) for pigs, and 66.5 mm (56.5-68.6) for rats. Humans had reduced MA compared with both pigs (P < 0.0001) and rats (P < 0.0001); pigs were not different from rats (P = 0.0161). LY30 (fibrinolysis) was 1.5% (IQR: 0.975-2.5) for humans, 3.3% (1.9-4.3) for pigs, and 0.5% (0.1-1.2) for rats. Humans had a lesser LY30 than pigs (P = 0.0062) and a greater LY30 than rats (P < 0.0001), and pigs had a greater LY30 than rats (P < 0.0001). CONCLUSIONS: Humans, swine, and rodents have distinctly different coagulation systems, when evaluated by citrated native TEG. Animals are hypercoagulable with rapid clotting times and clots strengths nearly 50% stronger than humans. These coagulation differences indicate the limitations of previous models of trauma-induced coagulopathy in producing coagulation abnormalities associated with increased bleeding. The inherent hypercoagulable baseline tendencies of these animals may result in subclinical biochemical changes that are not detected by conventional TEG and should be taken into consideration when extrapolated to clinical medicine. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Stettler, Gregory R AU - Stettler GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. Electronic address: ernest.moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Lawson, Peter J AU - Lawson PJ AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Fragoso, Miguel AU - Fragoso M AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Nunns, Geoffrey R AU - Nunns GR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Surgery, University of Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado, Aurora, Colorado; Research Laboratory Bonfils Blood Center, Denver, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, Colorado. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170511 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Animals MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Humans MH - *Models, Animal MH - Rats, Sprague-Dawley MH - Swine MH - *Thrombelastography MH - Wounds and Injuries/*complications PMC - PMC5603369 MID - NIHMS876382 OTO - NOTNLM OT - Clot initiation OT - Clot strength OT - Fibrinolysis OT - Rate of clot formation OT - Thrombelastography OT - Trauma-induced coagulopathy COIS- Disclosure The authors do not have any other disclosures. EDAT- 2017/06/07 06:00 MHDA- 2017/10/04 06:00 PMCR- 2018/09/01 CRDT- 2017/06/07 06:00 PHST- 2017/02/10 00:00 [received] PHST- 2017/04/25 00:00 [revised] PHST- 2017/05/05 00:00 [accepted] PHST- 2017/06/07 06:00 [pubmed] PHST- 2017/10/04 06:00 [medline] PHST- 2017/06/07 06:00 [entrez] PHST- 2018/09/01 00:00 [pmc-release] AID - S0022-4804(17)30284-6 [pii] AID - 10.1016/j.jss.2017.05.027 [doi] PST - ppublish SO - J Surg Res. 2017 Sep;217:207-212. doi: 10.1016/j.jss.2017.05.027. Epub 2017 May 11. PMID- 28570309 OWN - NLM STAT- MEDLINE DCOM- 20191227 LR - 20191227 IS - 1559-0488 (Electronic) IS - 1559-047X (Linking) VI - 39 IP - 3 DP - 2018 Apr 20 TI - Admission Rapid Thrombelastography (rTEG(R)) Values Predict Resuscitation Volumes and Patient Outcomes After Thermal Injury. PG - 345-352 LID - 10.1097/BCR.0000000000000593 [doi] AB - In trauma, admission rapid thrombelastography (rTEG) has been shown to predict in-hospital thromboembolic events, guide treatment of coagulopathy, and identify likely to require large volume resuscitations. We sought to evaluate the use of rTEG in describing the coagulation status of major burn patients at admission and assess whether rTEG values predicted resuscitation volumes and patient outcomes. This is a retrospective study of all patients admitted to our Burn intensive care unit between January 2010 and December 2012. We excluded those with < 15% TBSA burns, < 18 years of age, and with concomitant injuries requiring admission to the Trauma intensive care unit. Previously published and validated cut points for hypocoagulable (activated clotting time >/= 128; k-time >/= 2.5; angle /= 3%) and hypercoagulable (mA >/= 65) rTEG values were used. Supra-normal burn resuscitation was defined as >/= 5.0 mL/kg/TBSA. Statistical analyses were conducted using STATA 13.1. Sixty-five patients met inclusion with a median age of 45 years, 74% male and 49% white. Median TBSA was 38% with 14% having third-degree burns. Sixty percentage of patients were hypercoagulable on admission, while 24% were hypocoagulable. rTEG values predicted increased 24-hour resuscitation volumes, as well as plasma and platelet transfusions (P < 0.05). Controlling for age, TBSA, and base deficit, admission rTEG >/= 128 predicted a 5-fold increased likelihood of supra-normal resuscitation. In addition, an angle < 60 predicted in-hospital mortality. While the majority of severely burned patients arrive hypercoagulable, one-quarter are hypocoagulable and have increased resuscitation and transfusion requirements. Moreover, those with admission activated clotting time >/= 128 are at 5-fold increased risk of supra-normal resuscitation. FAU - Huzar, Todd F AU - Huzar TF AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Martinez, Eric AU - Martinez E AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Love, Joseph AU - Love J AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - George, Tonya C AU - George TC AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Shah, Jaimin AU - Shah J AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Baer, Lisa AU - Baer L AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Cross, James M AU - Cross JM AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center Houston, TX. LA - eng PT - Journal Article PL - England TA - J Burn Care Res JT - Journal of burn care & research : official publication of the American Burn Association JID - 101262774 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*etiology/mortality/*prevention & control MH - Burns/*complications/mortality/*therapy MH - Female MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Registries MH - Resuscitation/*methods MH - Retrospective Studies MH - Texas MH - *Thrombelastography EDAT- 2017/06/02 06:00 MHDA- 2019/12/28 06:00 CRDT- 2017/06/02 06:00 PHST- 2016/02/10 00:00 [received] PHST- 2017/05/01 00:00 [accepted] PHST- 2017/06/02 06:00 [pubmed] PHST- 2019/12/28 06:00 [medline] PHST- 2017/06/02 06:00 [entrez] AID - 4796751 [pii] AID - 10.1097/BCR.0000000000000593 [doi] PST - ppublish SO - J Burn Care Res. 2018 Apr 20;39(3):345-352. doi: 10.1097/BCR.0000000000000593. PMID- 28552297 OWN - NLM STAT- MEDLINE DCOM- 20180604 LR - 20180604 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 31 IP - 5 DP - 2017 Oct TI - Comparison Between 2 Strategies of Fluid Management on Blood Loss and Transfusion Requirements During Liver Transplantation. PG - 1741-1750 LID - S1053-0770(17)30235-5 [pii] LID - 10.1053/j.jvca.2017.02.177 [doi] AB - OBJECTIVE: To compare the effects of low central venous pressure (LCVP) and transesophageal Doppler (TED)-guided fluid management on blood loss and blood transfusion during liver transplantation (LTx). DESIGN: Retrospective study. SETTING: Single institution, university hospital. PARTICIPANTS: Adult recipients of LTx. INTERVENTIONS: Two groups: control (LCVP G), n=45 with CVP maintained 40% lower than the preoperative value during the preanhepatic phase. The mean arterial pressure was kept >60 mmHg. This group was matched with the second group (TED G); n = 45, in which a TED protocol was followed maintaining the systemic vascular resistance (SVR) more than 750 dynes*s*cm(-5). Coagulation defects were corrected following thromboelastometry. MEASUREMENTS AND MAIN RESULTS: Intraoperative blood loss, blood products, perioperative creatinine, lactate, and postoperative patients' stratification according to the Acute Kidney Injury Network classification were compared. Prior to the anhepatic phase, CVP was significantly lower in LCVP G (p < 0.001). TED G tended to have less but nonsignificant, blood loss, packed red blood cells, fresh frozen plasma, and platelets and received significantly less colloid and higher norepinephrine. Lactate was significantly higher in LCVP G at the end of the anhepatic phase and end of surgery while urine output in the preanhepatic phase was significantly lower. Creatinine was significantly lower on postoperative days 1 and 3, and Acute Kidney Injury Network stages were better on postoperative day 1 in TED G. CONCLUSIONS: During LTx, TED-guided fluid management, with norepinephrine used to maintain SVR, was similar to LCVP regarding blood loss and transfusion requirements and had better impacts on kidney function and lactate. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Fayed, Nirmeen A AU - Fayed NA AD - Anesthesia and Intensive Care Department, National Liver Institute, Menoufia University, Menoufia, Egypt. Electronic address: drnirmeena@yahoo.com. FAU - Yassen, Khaled A AU - Yassen KA AD - Anesthesia and Intensive Care Department, National Liver Institute, Menoufia University, Menoufia, Egypt. FAU - Abdulla, Ayat R AU - Abdulla AR AD - Public Health and Community Department, National Liver Institute, Menoufia University, Menoufia, Egypt. LA - eng PT - Comparative Study PT - Journal Article DEP - 20170222 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 SB - IM MH - *Blood Loss, Surgical MH - Blood Transfusion/*methods MH - Central Venous Pressure/physiology MH - Female MH - Fluid Therapy/*methods MH - Humans MH - Intraoperative Care/*methods MH - Liver Transplantation/adverse effects/*methods MH - Male MH - Middle Aged MH - Retrospective Studies OTO - NOTNLM OT - blood loss OT - fluid management OT - liver transplantation EDAT- 2017/05/30 06:00 MHDA- 2018/06/05 06:00 CRDT- 2017/05/30 06:00 PHST- 2016/09/29 00:00 [received] PHST- 2017/05/30 06:00 [pubmed] PHST- 2018/06/05 06:00 [medline] PHST- 2017/05/30 06:00 [entrez] AID - S1053-0770(17)30235-5 [pii] AID - 10.1053/j.jvca.2017.02.177 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1741-1750. doi: 10.1053/j.jvca.2017.02.177. Epub 2017 Feb 22. PMID- 28550916 OWN - NLM STAT- MEDLINE DCOM- 20170913 LR - 20181231 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 212 DP - 2017 May 15 TI - Assessment of three point-of-care platelet function assays in adult trauma patients. PG - 260-269 LID - S0022-4804(17)30028-8 [pii] LID - 10.1016/j.jss.2017.01.008 [doi] AB - BACKGROUND: Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are controversial, expensive, and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. STUDY DESIGN: Prospective observational study from 2014 to 2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), Thrombelastography Platelet Mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine diphosphate assays were similarly evaluated. RESULTS: Sixty-four patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 versus 35.0 y, P < 0.001) and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 versus 53.5 P < 0.001) and VerifyNow ARU (503.5 versus 629.0, P < 0.001) were lower, whereas TEG-PM AA (51.8% versus 18.3%, P < 0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition, and VerifyNow ARU could identify AP medication use (AUC: 0.90, 0.77, and 0.90, respectively). Adenosine diphosphate assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC: 0.78, 0.89, respectively). ICH occurred in 29 patients; 12 of which had progression of their injury. ASPI AUC (AUC: 0.50) and VerifyNow ARU (AUC: 0.59) did not correlate, and TEG-PM AA percent inhibition (AUC: 0.66) minimally correlated with progression. CONCLUSIONS: Multiplate, TEG-PM, and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Connelly, Christopher Robert AU - Connelly CR AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. Electronic address: connelch@ohsu.edu. FAU - Yonge, John D AU - Yonge JD AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - McCully, Sean P AU - McCully SP AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Hart, Kyle D AU - Hart KD AD - Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Hilliard, Thomas C AU - Hilliard TC AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Lape, Diane E AU - Lape DE AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Watson, Justin J AU - Watson JJ AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Rick, Beth AU - Rick B AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Houser, Ben AU - Houser B AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Deloughery, Thomas G AU - Deloughery TG AD - Department of Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon. FAU - Schreiber, Martin A AU - Schreiber MA AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Kiraly, Laszlo N AU - Kiraly LN AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon. LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20170127 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Adult MH - Aged MH - Blood Platelet Disorders/blood/*diagnosis/etiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Function Tests MH - *Point-of-Care Systems MH - Prospective Studies MH - Sensitivity and Specificity MH - Wounds and Injuries/blood/*complications OTO - NOTNLM OT - Multiplate OT - Platelet dysfunction trauma OT - Platelet function test trauma OT - Thrombelastogram platelet mapping OT - VerifyNow EDAT- 2017/05/30 06:00 MHDA- 2017/09/14 06:00 CRDT- 2017/05/29 06:00 PHST- 2016/09/15 00:00 [received] PHST- 2017/01/05 00:00 [revised] PHST- 2017/01/18 00:00 [accepted] PHST- 2017/05/29 06:00 [entrez] PHST- 2017/05/30 06:00 [pubmed] PHST- 2017/09/14 06:00 [medline] AID - S0022-4804(17)30028-8 [pii] AID - 10.1016/j.jss.2017.01.008 [doi] PST - ppublish SO - J Surg Res. 2017 May 15;212:260-269. doi: 10.1016/j.jss.2017.01.008. Epub 2017 Jan 27. PMID- 28549445 OWN - NLM STAT- MEDLINE DCOM- 20180402 LR - 20260127 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 18 IP - 1 DP - 2017 May 26 TI - Fibrinogen Early In Severe Trauma studY (FEISTY): study protocol for a randomised controlled trial. PG - 241 LID - 10.1186/s13063-017-1980-x [doi] LID - 241 AB - BACKGROUND: Haemorrhage is a leading cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage. Early fibrinogen replacement is recommended by several international trauma guidelines using either fibrinogen concentrate (FC) or cryoprecipitate (Cryo). There is limited evidence to support one product over the other with widespread geographic and institutional variation in practice. This pilot trial is the first randomised controlled trial comparing FC to Cryo in traumatic haemorrhage. METHODS/DESIGN: The Fibrinogen Early In Severe Trauma studY (FEISTY) is an exploratory, multicentre, randomised controlled trial comparing FC to Cryo for fibrinogen supplementation in traumatic haemorrhage. This trial will utilise thromboelastometry (ROTEM(R)) to guide and dose fibrinogen supplementation. The trial will recruit 100 trauma patients at four major trauma centres in Australia. Adult trauma patients with evidence of haemorrhage will be enrolled on arrival in the trauma unit and randomised to receiving fibrinogen supplementation with either FC or Cryo. The primary outcome is the differential time to fibrinogen supplementation. There are a number of predetermined secondary outcomes including: effects of the intervention on plasma fibrinogen levels, feasibility assessments and clinical outcomes including transfusion requirements and mortality. DISCUSSION: The optimal method for replacing fibrinogen in traumatic haemorrhage is fiercely debated. In this trial the feasibility and efficacy of fibrinogen supplementation using FC will be compared to Cryo. The results of this pilot study will facilitate the design of a larger trial with sufficient power to address patient-centred outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02745041 . Registered 4 May 2016. FAU - Winearls, James AU - Winearls J AD - Gold Coast University Hospital, Southport, QLD, Australia. james.winearls@health.qld.gov.au. AD - School of Medicine, University of Queensland, St. Lucia, QLD, Australia. james.winearls@health.qld.gov.au. AD - School of Medical Sciences, Griffith University, Nathan, QLD, Australia. james.winearls@health.qld.gov.au. FAU - Wullschleger, Martin AU - Wullschleger M AD - Gold Coast University Hospital, Southport, QLD, Australia. AD - School of Medical Sciences, Griffith University, Nathan, QLD, Australia. FAU - Wake, Elizabeth AU - Wake E AD - Gold Coast University Hospital, Southport, QLD, Australia. FAU - Hurn, Catherine AU - Hurn C AD - School of Medicine, University of Queensland, St. Lucia, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Herston, QLD, Australia. FAU - Furyk, Jeremy AU - Furyk J AD - Emergency Research, Townsville Hospital, Douglas, QLD, Australia. FAU - Ryan, Glenn AU - Ryan G AD - Princess Alexandra Hospital, Woolloongabba, QLD, Australia. FAU - Trout, Melita AU - Trout M AD - Townsville Hospital, Douglas, QLD, Australia. FAU - Walsham, James AU - Walsham J AD - School of Medicine, University of Queensland, St. Lucia, QLD, Australia. AD - Intensive Care Research, Princess Alexandra Hospital, Woolloongabba, QLD, Australia. FAU - Holley, Anthony AU - Holley A AD - School of Medicine, University of Queensland, St. Lucia, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Herston, QLD, Australia. FAU - Cohen, Jeremy AU - Cohen J AD - School of Medicine, University of Queensland, St. Lucia, QLD, Australia. AD - Royal Brisbane and Women's Hospital, Herston, QLD, Australia. FAU - Shuttleworth, Megan AU - Shuttleworth M AD - Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia. FAU - Dyer, Wayne AU - Dyer W AD - Australian Red Cross Blood Service, Melbourne, VIC, Australia. FAU - Keijzers, Gerben AU - Keijzers G AD - Gold Coast University Hospital, Southport, QLD, Australia. AD - School of Medical Sciences, Griffith University, Nathan, QLD, Australia. AD - School of Medicine, Bond University, Robina, QLD, Australia. FAU - Fraser, John F AU - Fraser JF AD - Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, QLD, Australia. FAU - Presneill, Jeffrey AU - Presneill J AD - Intensive Care Unit, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia. FAU - Campbell, Don AU - Campbell D AD - Gold Coast University Hospital, Southport, QLD, Australia. LA - eng SI - ClinicalTrials.gov/NCT02745041 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20170526 PL - England TA - Trials JT - Trials JID - 101263253 RN - 0 (Hemostatics) RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Transfusion MH - Clinical Protocols MH - Factor VIII/*administration & dosage/adverse effects MH - Feasibility Studies MH - Fibrinogen/*administration & dosage/adverse effects MH - Hemorrhage/blood/diagnosis/mortality/*prevention & control MH - Hemostasis/*drug effects MH - *Hemostatic Techniques/adverse effects/mortality MH - Hemostatics/*administration & dosage/adverse effects MH - Humans MH - Pilot Projects MH - Queensland MH - Research Design MH - Time Factors MH - Treatment Outcome MH - Wounds and Injuries/blood/diagnosis/*drug therapy/mortality PMC - PMC5446750 OTO - NOTNLM OT - Cryoprecipitate OT - Fibrinogen OT - Fibrinogen concentrate OT - Haemorrhage OT - ROTEM(R) OT - Trauma EDAT- 2017/05/28 06:00 MHDA- 2018/04/03 06:00 PMCR- 2017/05/26 CRDT- 2017/05/28 06:00 PHST- 2016/11/08 00:00 [received] PHST- 2017/05/06 00:00 [accepted] PHST- 2017/05/28 06:00 [entrez] PHST- 2017/05/28 06:00 [pubmed] PHST- 2018/04/03 06:00 [medline] PHST- 2017/05/26 00:00 [pmc-release] AID - 10.1186/s13063-017-1980-x [pii] AID - 1980 [pii] AID - 10.1186/s13063-017-1980-x [doi] PST - epublish SO - Trials. 2017 May 26;18(1):241. doi: 10.1186/s13063-017-1980-x. PMID- 28542848 OWN - NLM STAT- MEDLINE DCOM- 20190221 LR - 20190221 IS - 1365-2044 (Electronic) IS - 0003-2409 (Linking) VI - 72 IP - 11 DP - 2017 Nov TI - Change of transfusion and treatment paradigm in major trauma patients. PG - 1317-1326 LID - 10.1111/anae.13920 [doi] AB - Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid. The incidence of massive transfusion (>/= 10 units of red blood cells from emergency department arrival until intensive care unit admission) was compared with the predicted incidence according to the trauma associated severe haemorrhage score. All adult (>/= 16 years) trauma patients primarily admitted to the University Hospital Zurich with an injury severity score >/= 16 were included. In 2005-2007, the observed and trauma associated severe haemorrhage score that predicted the incidence of massive transfusion were identical, whereas in 2012-2014 the observed incidence was less than half that predicted (3.7% vs. 7.5%). Compared to 2005-2007, the proportion of patients transfused with red blood cells and fresh frozen plasma was significantly lower in 2012-2014 in both the emergency department (43% vs. 17%; 31% vs. 6%, respectively), and after 24 h (53% vs. 27%; 37% vs. 16%, respectively). The use of tranexamic acid and coagulation factor XIII also increased significantly in the 2012-2014 time period. Implementation of a revised trauma management strategy, which included goal-directed coagulation management, was associated with a reduced incidence of massive transfusion and a reduction in the transfusion of red blood cells and fresh frozen plasma. CI - (c) 2017 The Association of Anaesthetists of Great Britain and Ireland. FAU - Stein, P AU - Stein P AD - Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Kaserer, A AU - Kaserer A AD - Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Sprengel, K AU - Sprengel K AD - Division of Trauma Surgery, University and University Hospital Zurich, Zurich, Switzerland. FAU - Wanner, G A AU - Wanner GA AD - Department of Orthopaedics and Traumatology, Schwarzwald-Baar Hospital, Affiliated Hospital University of Freiburg, Villingen-Schwenningen, Germany. FAU - Seifert, B AU - Seifert B AD - Department of Biostatistics, University and University Hospital Zurich, Zurich, Switzerland. FAU - Theusinger, O M AU - Theusinger OM AD - Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Spahn, D R AU - Spahn DR AD - Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. LA - eng PT - Journal Article PT - Observational Study DEP - 20170523 PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 RN - 0 (Anticoagulants) SB - IM CIN - Anaesthesia. 2017 Nov;72(11):1299-1301. doi: 10.1111/anae.14031. PMID: 28861909 MH - Adult MH - Aged MH - Anticoagulants/therapeutic use MH - Blood Transfusion/*standards MH - Clinical Protocols MH - Cohort Studies MH - Erythrocyte Transfusion MH - Female MH - Goals MH - Hemorrhage/blood/drug therapy MH - Humans MH - Incidence MH - Injury Severity Score MH - Length of Stay MH - Male MH - Middle Aged MH - Plasma MH - Retrospective Studies MH - Treatment Outcome MH - Wounds and Injuries/blood/mortality/*therapy OTO - NOTNLM OT - FFP indications OT - anaemia and coagulation OT - transfusion mortality: causes EDAT- 2017/05/26 06:00 MHDA- 2019/02/23 06:00 CRDT- 2017/05/26 06:00 PHST- 2017/04/03 00:00 [accepted] PHST- 2017/05/26 06:00 [pubmed] PHST- 2019/02/23 06:00 [medline] PHST- 2017/05/26 06:00 [entrez] AID - 10.1111/anae.13920 [doi] PST - ppublish SO - Anaesthesia. 2017 Nov;72(11):1317-1326. doi: 10.1111/anae.13920. Epub 2017 May 23. PMID- 28522144 OWN - NLM STAT- MEDLINE DCOM- 20170825 LR - 20250321 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 225 IP - 1 DP - 2017 Jul TI - Viscoelastic Tissue Plasminogen Activator Challenge Predicts Massive Transfusion in 15 Minutes. PG - 138-147 LID - 10.1016/j.jamcollsurg.2017.02.018 [doi] AB - BACKGROUND: Coagulopathy is associated with massive transfusion in trauma, yet most clinical scores to predict this end point do not incorporate coagulation assays. Previous work has identified that shock increases circulating tissue plasminogen activator (tPA). When tPA levels saturate endogenous inhibitors, systemic hyperfibrinolysis can occur. Therefore, the addition of tPA to a patient's blood sample could stratify a patients underlying degree of shock and early coagulation changes to predict progression to massive transfusion. We hypothesized that a modified thrombelastography (TEG) assay with exogenous tPA would unmask patients' impending risk for massive transfusion. STUDY DESIGN: Trauma activations were analyzed using rapid TEG and a modified TEG assay with a low and high dose of tPA. Clinical scores (shock index, assessment of blood consumption, and trauma-associated severe hemorrhage) were compared with TEG measurements to predict the need for massive transfusion using areas under the receiver operating characteristic curves. RESULTS: Three hundred and twenty-four patients were analyzed, 17% required massive transfusion. Massive transfusion patients had a median shock index of 1.2, assessment of blood consumption score of 1, and trauma-associated severe hemorrhage score of 12. Rapid TEG and tPA TEG parameters were significantly different in all massive transfusion patients compared with non-massive transfusion patients (all p < 0.02). The low-dose tPA lysis at 30 minutes had the largest the area under the receiver operating characteristic curve (0.86; 95% CI 0.79 to 0.93) for prediction of massive transfusion, similar to international normalized ratio of prothrombin time of 0.86 (95% CI 0.81 to 0.91), followed by trauma-associated severe hemorrhage score (0.83; 95% CI 0.77 to 0.89). Combing trauma-associated severe hemorrhage and tPA-TEG variables results in a positive prediction of massive transfusion in 49% of patients with a 98% negative predictive value. CONCLUSIONS: The tPA-TEG identifies trauma patients who require massive transfusion efficiently in a single assay that can be completed in a shorter time than other scoring systems, which has improved performance when combined with international normalized ratio. This new method is consistent with our understanding of the molecular events responsible for trauma-induced coagulopathy. CI - Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado School of Medicine, Aurora, CO University of Colorado School of Public Health, Aurora, CO Denver Health Medical Center, Denver, CO Bonfils Blood Center, Denver, CO. FAU - Moore, Ernest E AU - Moore EE FAU - Chapman, Michael P AU - Chapman MP FAU - Huebner, Benjamin R AU - Huebner BR FAU - Einersen, Peter M AU - Einersen PM FAU - Oushy, Solimon AU - Oushy S FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20170515 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM CIN - J Am Coll Surg. 2017 Jul;225(1):147-148. doi: 10.1016/j.jamcollsurg.2017.04.029. PMID: 28648340 MH - Adult MH - Blood Coagulation Tests MH - Blood Transfusion/*statistics & numerical data MH - Female MH - Glasgow Coma Scale MH - Hemorrhage/*etiology/mortality/*therapy MH - Humans MH - Injury Severity Score MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Risk Assessment MH - Risk Factors MH - Thrombelastography MH - Tissue Plasminogen Activator/*administration & dosage MH - Trauma Centers MH - Wounds and Injuries/*complications/mortality PMC - PMC5527680 MID - NIHMS869440 EDAT- 2017/05/20 06:00 MHDA- 2017/08/26 06:00 PMCR- 2018/07/01 CRDT- 2017/05/20 06:00 PHST- 2017/01/01 00:00 [received] PHST- 2017/01/30 00:00 [revised] PHST- 2017/02/22 00:00 [accepted] PHST- 2017/05/20 06:00 [pubmed] PHST- 2017/08/26 06:00 [medline] PHST- 2017/05/20 06:00 [entrez] PHST- 2018/07/01 00:00 [pmc-release] AID - 00019464-201707000-00028 [pii] AID - 10.1016/j.jamcollsurg.2017.02.018 [doi] PST - ppublish SO - J Am Coll Surg. 2017 Jul;225(1):138-147. doi: 10.1016/j.jamcollsurg.2017.02.018. Epub 2017 May 15. PMID- 28511450 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2249-782X (Print) IS - 0973-709X (Electronic) IS - 0973-709X (Linking) VI - 11 IP - 3 DP - 2017 Mar TI - Emergency Peripartum Hysterectomy: Indications and Outcome in a Tertiary Care Setting. PG - QC01-QC03 LID - 10.7860/JCDR/2017/19665.9347 [doi] AB - INTRODUCTION: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving procedure, mostly reserved for conditions deemed to be serious and life threatening, and not amenable to conservative methods. In the present scenario, the advent of newer medical and conservative surgical methods for controlling obstetric haemorrhage has influenced the incidence, trend and the outcomes of the procedure. AIM: To evaluate the demographic profile, indications, operative details, maternal morbidity and mortality and neonatal outcomes of women undergoing EPH. MATERIALS AND METHODS: A descriptive analysis of case records of women who underwent EPH between September 2006 to July 2014, at Guru Teg Bahadur Hospital Delhi, India was done. Data were collected from the medical records department. RESULTS: A total of 194 cases (n) were identified among 1,00712 deliveries, an incidence of 1.92 per 1000 deliveries. Majority of the women were unbooked i.e., they did not receive any form of antenatal care and were gravida 3 and above. The indications were atonic PPH in 89 (45.87%), rupture of unscarred uterus in 36 (18.56%), morbidly adhered placenta in 30 (15.46%), scar rupture in 20 (10.31%) and gangrenous uterus 19 (9.79%). The mean blood loss was around 1.6+/-0.45 litres. Approximately 14% cases underwent stepwise devascularisation prior to hysterectomy and in only 2% women, B-Lynch suture was applied. Thirteen (6.7%) cases had bladder injury and 22 (11.34%) needed re-laparotomy for hysterectomy. Around 76 (39%) women were shifted for ICU care. Nineteen (9.79%) women developed Disseminated Intravascular Coagulation (DIC). The case fatality rate was 7.2% and perinatal mortality was 30%. CONCLUSION: Atonic PPH remains the leading cause of EPH in our analysis. Surprisingly rupture of unscarred uterus was more common compared to scar rupture. Creating awareness among women to seek health services in time with facilities for early referral, teaching younger obstetricians with conservative surgical procedures like stepwise devascularisation steps and compressive sutures should be of utmost priority. FAU - Singla, Anshuja AU - Singla A AD - Assistant Professor, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. FAU - Mundhra, Rajlaxmi AU - Mundhra R AD - Ex-Senior Resident, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. FAU - Phogat, Latika AU - Phogat L AD - Ex-Senior Resident, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. FAU - Mehta, Sumita AU - Mehta S AD - Specialist, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. FAU - Rajaram, Shalini AU - Rajaram S AD - Director Professor, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. LA - eng PT - Journal Article DEP - 20170301 PL - India TA - J Clin Diagn Res JT - Journal of clinical and diagnostic research : JCDR JID - 101488993 PMC - PMC5427376 OTO - NOTNLM OT - Atonic PPH OT - Compressive sutures OT - Obstetric hysterectomy EDAT- 2017/05/18 06:00 MHDA- 2017/05/18 06:01 PMCR- 2017/03/01 CRDT- 2017/05/18 06:00 PHST- 2016/02/20 00:00 [received] PHST- 2016/09/12 00:00 [accepted] PHST- 2017/05/18 06:00 [entrez] PHST- 2017/05/18 06:00 [pubmed] PHST- 2017/05/18 06:01 [medline] PHST- 2017/03/01 00:00 [pmc-release] AID - 10.7860/JCDR/2017/19665.9347 [doi] PST - ppublish SO - J Clin Diagn Res. 2017 Mar;11(3):QC01-QC03. doi: 10.7860/JCDR/2017/19665.9347. Epub 2017 Mar 1. PMID- 28509684 OWN - NLM STAT- MEDLINE DCOM- 20180827 LR - 20180827 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 49 IP - 1 DP - 2018 Jan TI - Histone-Complexed DNA Fragments Levels are Associated with Coagulopathy, Endothelial Cell Damage, and Increased Mortality after Severe Pediatric Trauma. PG - 44-52 LID - 10.1097/SHK.0000000000000902 [doi] AB - BACKGROUND: The release of damage-associated molecular pattern molecules in the extracellular space secondary to injury has been shown to cause systemic activation of the coagulation system and endothelial cell damage. We hypothesized that pediatric trauma patients with increased levels of histone-complexed DNA fragments (hcDNA) would have evidence of coagulopathy and endothelial damage that would be associated with poor outcomes. METHODS: We conducted a prospective observational study of 149 pediatric trauma patients and 62 control patients at two level 1 pediatric trauma centers from 2013 to 2016. Blood samples were collected upon arrival and at 24 h, analyzed for hcDNA, coagulation abnormalities, endothelial damage, and clinical outcome. Platelet aggregation was assessed with impedance aggregometry (Multiplate) and coagulation parameters were assessed by measuring prothrombin time ratio in plasma and the use of viscoelastic techniques (Rotational Thromboelastometry) in whole blood. RESULTS: The median age was 8.3 years, the median injury severity score (ISS) was 20, and overall mortality was 10%. Significantly higher levels of hcDNA were found on admission in patients with severe injury (ISS > 25), coagulopathy, and/or abnormal platelet aggregation. Patients with high hcDNA levels also had significant elevations in plasma levels of syndecan-1, suggesting damage to the endothelial glycocalyx. Finally, significantly higher hcDNA levels were found in non-survivors. CONCLUSION: hcDNA is released following injury and correlates with coagulopathy, endothelial glycocalyx damage, and poor clinical outcome early after severe pediatric trauma. These results indicate that hcDNA may play an important role in development of coagulation abnormalities and endothelial glycocalyx damage in children following trauma. FAU - Russell, Robert T AU - Russell RT AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Christiaans, Sarah C AU - Christiaans SC AD - Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Nice, Tate R AU - Nice TR AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Banks, Morgan AU - Banks M AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Mortellaro, Vincent E AU - Mortellaro VE AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Morgan, Charity AU - Morgan C AD - Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Duhachek-Stapelman, Amy AU - Duhachek-Stapelman A AD - Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska. FAU - Lisco, Steven J AU - Lisco SJ AD - Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska. FAU - Kerby, Jeffrey D AU - Kerby JD AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Wagener, Brant M AU - Wagener BM AD - Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Chen, Mike K AU - Chen MK AD - Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Pittet, Jean-Francois AU - Pittet JF AD - Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. LA - eng PT - Journal Article PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Histones) RN - 9007-49-2 (DNA) SB - IM MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/*metabolism/*pathology MH - Child MH - Child, Preschool MH - DNA/*metabolism MH - Endothelial Cells/metabolism/physiology MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Histones/*metabolism MH - Humans MH - Infant MH - Injury Severity Score MH - Male MH - Prospective Studies MH - Wounds and Injuries/metabolism/pathology EDAT- 2017/05/17 06:00 MHDA- 2018/08/28 06:00 CRDT- 2017/05/17 06:00 PHST- 2017/05/17 06:00 [pubmed] PHST- 2018/08/28 06:00 [medline] PHST- 2017/05/17 06:00 [entrez] AID - 10.1097/SHK.0000000000000902 [doi] PST - ppublish SO - Shock. 2018 Jan;49(1):44-52. doi: 10.1097/SHK.0000000000000902. PMID- 28500652 OWN - NLM STAT- MEDLINE DCOM- 20171010 LR - 20181113 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 57 IP - 8 DP - 2017 Aug TI - Freeze-dried plasma enhances clot formation and inhibits fibrinolysis in the presence of tissue plasminogen activator similar to pooled liquid plasma. PG - 2007-2015 LID - 10.1111/trf.14149 [doi] AB - BACKGROUND: Systemic hyperfibrinolysis is an integral part of trauma-induced coagulopathy associated with uncontrolled bleeding. Recent data suggest that plasma-first resuscitation attenuates hyperfibrinolysis; however, the availability, transport, storage, and administration of plasma in austere environments remain challenging and have limited its use. Freeze-dried plasma (FDP) is a potential alternative due to ease of storage, longer shelf life, and efficient reconstitution. FDP potentially enhances clot formation and resists breakdown better than normal saline (NS) and albumin and similar to liquid plasma. STUDY DESIGN AND METHODS: Healthy volunteers underwent citrated blood draw followed by 50% dilution with NS, albumin, pooled plasma (PP), or pooled freeze-dried plasma (pFDP). Citrated native and tissue plasminogen activator (t-PA)-challenge (75 ng/mL) thrombelastography were done. Proteins in PP, pFDP, and albumin were analyzed by mass spectroscopy. RESULTS: pFDP and PP had superior clot-formation rates (angle) and clot strength (maximum amplitude) compared with NS and albumin in t-PA-challenge thrombelastographies (angle: pFDP, 67.9 degrees; PP, 67.8 degrees; NS, 40.6 degrees; albumin, 35.8 degrees; maximum amplitude: pFDP, 62.4 mm; PP, 63.5 mm; NS, 44.8 mm; albumin, 41.1 mm). NS and albumin dilution increased susceptibility to t-PA-induced hyperfibrinolysis compared with pFDP and PP (NS, 62.4%; albumin, 62.6%; PP, 8.5%; pFDP, 6.7%). pFDP was similar to PP in the attenuation of t-PA-induced fibrinolysis. Most proteins (97%) were conserved during the freeze-dry process, with higher levels in 12% of pFDP proteins compared with PP. CONCLUSION: pFDP enhances clot formation and attenuates hyperfibrinolysis better than NS and albumin and is a potential alternative to plasma resuscitation in the treatment of hemorrhagic shock. CI - (c) 2017 AABB. FAU - Huebner, Benjamin R AU - Huebner BR AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, Colorado. AD - Department of Surgery, Denver Health Medical Center, Aurora, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado, Aurora, Colorado. AD - Department of Surgery, Denver Health Medical Center, Aurora, Colorado. FAU - Stettler, Gregory AU - Stettler G AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M AD - Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, Colorado. FAU - Hansen, Kirk AU - Hansen K AD - Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, Colorado. FAU - Silliman, Christopher C AU - Silliman CC AD - Department of Pediatrics, University of Colorado, Aurora, Colorado. AD - Bonfils Blood Center, Denver, Colorado. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170512 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Fibrinolysis/*drug effects MH - Freeze Drying MH - Healthy Volunteers MH - Humans MH - *Plasma MH - Resuscitation/methods MH - Shock, Hemorrhagic/therapy MH - Thrombelastography/methods MH - Tissue Plasminogen Activator/*pharmacology PMC - PMC5567780 MID - NIHMS888784 COIS- CONFLICT OF INTEREST The authors have no conflicts of interest to declare. EDAT- 2017/05/14 06:00 MHDA- 2017/10/11 06:00 PMCR- 2017/08/23 CRDT- 2017/05/14 06:00 PHST- 2017/01/30 00:00 [received] PHST- 2017/03/24 00:00 [revised] PHST- 2017/03/28 00:00 [accepted] PHST- 2017/05/14 06:00 [pubmed] PHST- 2017/10/11 06:00 [medline] PHST- 2017/05/14 06:00 [entrez] PHST- 2017/08/23 00:00 [pmc-release] AID - 10.1111/trf.14149 [doi] PST - ppublish SO - Transfusion. 2017 Aug;57(8):2007-2015. doi: 10.1111/trf.14149. Epub 2017 May 12. PMID- 28497841 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 1898-018X (Electronic) IS - 1898-018X (Linking) VI - 25 IP - 2 DP - 2018 TI - Effect of fluid resuscitation with balanced solutions on platelets: In vitro simulation of 20% volume substitution. PG - 254-259 LID - 10.5603/CJ.a2017.0054 [doi] AB - BACKGROUND: Fluid resuscitation in massive bleeding may cause coagulation disorders by dilution of platelets and clotting factors or by the impact on their function. The aim of this study was to investigate the effects of balanced crystalloid and colloid solutions on platelets in vitro using complex assessment of coagulation. METHODS: The study group was comprised of 32 American Society of Anesthesiologists physical status class I male volunteers, aged 21-35 (29 +/- 4) years, weighting 59-103 (81.2 +/- 9.8) kg. Whole blood samples were diluted at a 4:1 ratio with the following fluids: balanced crystalloid (Plasmalyte(R)), 6% hydroxyethyl starch 130/0.4 (Volulyte(R)) and succinylated gelatin (Geloplasma(R)). Coagulation was as-sessed using standard morphology, rotational thromboelastometry and aggregometry. RESULTS: Dilution with all fluids caused statistically significant drop in the number of platelets (p < 0.01) but the effect did not differ between solutions (p > 0.05 for all). Other platelet parameters, such as platelet distribution width, mean platelet volume and platelet-large cell ratio were not affected by the solutions. Hemodilution had no effect on platelet function (p = 0.1). Decreased platelet component of clot strength was found for all three fluids (p < 0.05), although the effect for colloids was more pronounced. CONCLUSIONS: The effect of balanced crystalloids and colloids on platelet aggregation was insignificant, even after 20% volume substitution with the resuscitation fluids. (. FAU - Krzych, Lukasz J AU - Krzych LJ FAU - Czempik, Piotr F AU - Czempik PF AD - piotr.czempik@wp.pl. LA - eng PT - Journal Article DEP - 20170512 PL - Poland TA - Cardiol J JT - Cardiology journal JID - 101392712 RN - 0 (Crystalloid Solutions) SB - IM MH - Adult MH - Blood Coagulation/drug effects MH - Blood Platelets/*physiology MH - Body Fluids/*physiology MH - Crystalloid Solutions/*therapeutic use MH - Fluid Therapy/*methods MH - Healthy Volunteers MH - Humans MH - Male MH - Platelet Aggregation/*physiology MH - Platelet Count MH - Resuscitation/*methods MH - Shock, Hemorrhagic/blood/*therapy MH - Thrombelastography MH - Young Adult OTO - NOTNLM OT - aggregometry OT - coagulopathy OT - platelets OT - resuscitation fluids OT - rotational thromboelastometry EDAT- 2017/05/13 06:00 MHDA- 2018/12/12 06:00 CRDT- 2017/05/13 06:00 PHST- 2017/02/08 00:00 [received] PHST- 2017/05/01 00:00 [accepted] PHST- 2017/05/11 00:00 [revised] PHST- 2017/05/13 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2017/05/13 06:00 [entrez] AID - VM/OJS/J/50626 [pii] AID - 10.5603/CJ.a2017.0054 [doi] PST - ppublish SO - Cardiol J. 2018;25(2):254-259. doi: 10.5603/CJ.a2017.0054. Epub 2017 May 12. PMID- 28497494 OWN - NLM STAT- MEDLINE DCOM- 20171019 LR - 20171114 IS - 1751-553X (Electronic) IS - 1751-5521 (Linking) VI - 39 IP - 5 DP - 2017 Oct TI - Global assays of fibrinolysis. PG - 441-447 LID - 10.1111/ijlh.12688 [doi] AB - Fibrinolysis is an important and integral part of the hemostatic system. Acting as a balance to blood coagulation, the fibrinolytic system protects the body from unwanted thrombus formation and occlusion of blood vessels. As long as blood coagulation and fibrinolysis remain in equilibrium, response to injury, such as vessel damage, is appropriately regulated. However, alterations in this balance may lead to thrombosis or bleeding. A variety of methods have been proposed to assess fibrinolytic activity in blood or its components, but due to the complexity of the system, the design of a "gold standard" assay that reflects overall fibrinolysis has remained an elusive goal. In this review, we describe the most commonly used methods that have been described, such as thromboelastography (TEG and ROTEM), global fibrinolytic capacity in plasma and whole blood, plasma turbidity methods, simultaneous thrombin and plasmin generation assays, euglobulin clot lysis time and fibrin plate methods. All of these assays have strengths and limitations. We suggest that some methods may be preferable for detecting hypofibrinolytic conditions, whereas others may be better for detecting hyperfibrinolytic states. CI - (c) 2017 John Wiley & Sons Ltd. FAU - Ilich, A AU - Ilich A AUID- ORCID: 0000-0002-7669-0760 AD - Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. AD - Divisions of Internal Medicine 1, Department of Medicine, First Moscow State Medical University n.a. I.M.Sechenov, Moscow, Russia. FAU - Bokarev, I AU - Bokarev I AD - Divisions of Cardiology, Department of Medicine, First Moscow State Medical University n.a. I.M.Sechenov, Moscow, Russia. FAU - Key, N S AU - Key NS AD - Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. LA - eng PT - Journal Article PT - Review DEP - 20170512 PL - England TA - Int J Lab Hematol JT - International journal of laboratory hematology JID - 101300213 RN - EC 3.4.21.5 (Thrombin) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM CIN - Int J Lab Hematol. 2017 Dec;39(6):e140-e141. doi: 10.1111/ijlh.12710. PMID: 28722349 CIN - Int J Lab Hematol. 2017 Dec;39(6):e142-e143. doi: 10.1111/ijlh.12750. PMID: 29058381 MH - *Blood Coagulation MH - *Blood Coagulation Tests/methods/standards MH - Fibrin Clot Lysis Time MH - Fibrinolysin/biosynthesis MH - *Fibrinolysis MH - Hemostasis MH - Humans MH - Reference Values MH - Thrombelastography/methods/standards MH - Thrombin/biosynthesis OTO - NOTNLM OT - coagulation OT - euglobulin fraction OT - fibrinolysis OT - global assay OT - thromboelastography OT - turbidity assay EDAT- 2017/05/13 06:00 MHDA- 2017/10/20 06:00 CRDT- 2017/05/13 06:00 PHST- 2016/12/04 00:00 [received] PHST- 2017/03/22 00:00 [accepted] PHST- 2017/05/13 06:00 [pubmed] PHST- 2017/10/20 06:00 [medline] PHST- 2017/05/13 06:00 [entrez] AID - 10.1111/ijlh.12688 [doi] PST - ppublish SO - Int J Lab Hematol. 2017 Oct;39(5):441-447. doi: 10.1111/ijlh.12688. Epub 2017 May 12. PMID- 28480110 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2229-5097 (Print) IS - 2152-7806 (Electronic) IS - 2152-7806 (Linking) VI - 8 DP - 2017 TI - Point-of-care testing in the acute management of traumatic brain injury: Identifying the coagulopathic patient. PG - 48 LID - 10.4103/sni.sni_265_16 [doi] LID - 48 AB - BACKGROUND: The use of anticoagulants or antiplatelet medications has become increasingly common and is a well-established risk factor for worsening of hemorrhages in trauma patients. The current study addresses the need to investigate the efficacy of point-of-care tests (POC) as an adjunct to conventional coagulation testing in traumatic brain injury (TBI) patients. METHODS: A retrospective review of 190 TBI patients >18 years of age who underwent both conventional and POC testing as part of their admission coagulopathy workup was conducted. Coagulation deficiency was defined as an international normalized ratio (INR) >1.4, a reaction time (r-value) on rapid thromboelastography >50 seconds, or a VerifyNow Aspirin (VN-ASA) level of < 550 Aspirin Reaction Units. RESULTS: Among 190 patients, 91 (48%) disclosed a history of either warfarin or antiplatelet use or had documented INR >1.4. Of the 18 (9%) patients who reported warfarin use, 83% had elevated INR and 61% had elevated r-value. However, 41% of the patients without reported anticoagulant usage revealed significantly elevated r-value consistent with a post-traumatic hypocoagulable state. Of 64 (34%) patients who reported taking ASA, 51 (80%) demonstrated therapeutic VN-ASA. Interestingly, 31 of 126 (25%) patients not reporting ASA use were also noted to have therapeutic VN-ASA suggestive of platelet dysfunction. CONCLUSIONS: The coagulopathy POC panel consisting of r-TEG and VN-ASA successfully identified a subset of TBI patients with an occult coagulopathy that would have otherwise been missed. Standardization of these POC assays on admission in TBI may help guide patient resuscitation in the acute setting. FAU - Gozal, Yair M AU - Gozal YM AD - Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA. AD - Neurotrauma Center, UC Neuroscience Institute, Cincinnati, Ohio, USA. FAU - Carroll, Christopher P AU - Carroll CP AD - Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA. AD - Neurotrauma Center, UC Neuroscience Institute, Cincinnati, Ohio, USA. FAU - Krueger, Bryan M AU - Krueger BM AD - Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA. AD - Neurotrauma Center, UC Neuroscience Institute, Cincinnati, Ohio, USA. FAU - Khoury, Jane AU - Khoury J AD - Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. FAU - Andaluz, Norberto O AU - Andaluz NO AD - Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA. AD - Neurotrauma Center, UC Neuroscience Institute, Cincinnati, Ohio, USA. AD - Mayfield Clinic, Cincinnati, Ohio, USA. LA - eng PT - Journal Article DEP - 20170405 PL - United States TA - Surg Neurol Int JT - Surgical neurology international JID - 101535836 PMC - PMC5402332 OTO - NOTNLM OT - Aspirin OT - VerifyNow OT - coagulopathy OT - mild traumatic brain injury OT - thromboelastography COIS- There are no conflicts of interest. EDAT- 2017/05/10 06:00 MHDA- 2017/05/10 06:01 PMCR- 2017/04/05 CRDT- 2017/05/09 06:00 PHST- 2016/06/21 00:00 [received] PHST- 2017/01/25 00:00 [accepted] PHST- 2017/05/09 06:00 [entrez] PHST- 2017/05/10 06:00 [pubmed] PHST- 2017/05/10 06:01 [medline] PHST- 2017/04/05 00:00 [pmc-release] AID - SNI-8-48 [pii] AID - 10.4103/sni.sni_265_16 [doi] PST - epublish SO - Surg Neurol Int. 2017 Apr 5;8:48. doi: 10.4103/sni.sni_265_16. eCollection 2017. PMID- 28458760 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220317 IS - 1920-8642 (Print) IS - 1920-8642 (Linking) VI - 8 IP - 2 DP - 2017 TI - Diverse coagulopathies in a rabbit model with different abdominal injuries. PG - 141-147 LID - 10.5847/wjem.j.1920-8642.2017.02.011 [doi] AB - BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries was developed and evaluated by examining indicators of clotting and fibrinolysis. METHODS: Forty New Zealand white rabbits were randomly divided into four groups: group 1 (sham), group 2 (hemorrhage), group 3 (hemorrhage-liver injury), and group 4 (hemorrhage-liver injury/intestinal injury-peritonitis). Coagulation was detected by thromboelastography before trauma (T(0)), at 1 hour (T(1)) and 4 hours (T(2)) after trauma. RESULTS: Rabbits that suffered from hemorrhage alone did not differ in coagulation capacity compared with the sham group. The clot initiations (R times) of group 3 at T(1) and T(2) were both shorter than those of groups 1, 2, and 4 (P<0.05). In group 4, clot strength was decreased at T(1) and T(2) compared with those in groups 1, 2, and 3 (P<0.05), whereas the R time and clot polymerization were increased at T(2) (P<0.05). The clotting angle significantly decreased in group 4 compared with groups 2 and 3 at T(2) (P<0.05). CONCLUSION: This study suggests that different abdominal traumatic shock show diverse coagulopathy in the early phase. Isolated hemorrhagic shock shows no obvious effect on coagulation. In contrast, blunt hepatic injury with hemorrhage shows hypercoagulability, whereas blunt hepatic injury with hemorrhage coupled with peritonitis caused by a ruptured intestine shows a tendency toward hypocoagulability. FAU - Wu, Ruo AU - Wu R AD - Department of Emergency Medicine, Haikou People's Hospital Affiliated to Central South University, Haikou 570208, China. FAU - Peng, Luo-Gen AU - Peng LG AD - Department of Emergency Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China. FAU - Zhao, Hui-Min AU - Zhao HM AD - Department of Emergency Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China. LA - eng PT - Journal Article PL - China TA - World J Emerg Med JT - World journal of emergency medicine JID - 101549691 PMC - PMC5409236 OTO - NOTNLM OT - Coagulopathy OT - Hemorrhagic shock OT - Inflammation OT - Multiple trauma model OT - Thromboelastography COIS- Conflicts of interest: The authors declare that there are no conflicts of interest relevant to the content of the article. EDAT- 2017/05/02 06:00 MHDA- 2017/05/02 06:01 PMCR- 2017/02/01 CRDT- 2017/05/02 06:00 PHST- 2017/05/02 06:00 [entrez] PHST- 2017/05/02 06:00 [pubmed] PHST- 2017/05/02 06:01 [medline] PHST- 2017/02/01 00:00 [pmc-release] AID - WJEM-8-141 [pii] AID - 10.5847/wjem.j.1920-8642.2017.02.011 [doi] PST - ppublish SO - World J Emerg Med. 2017;8(2):141-147. doi: 10.5847/wjem.j.1920-8642.2017.02.011. PMID- 28457981 OWN - NLM STAT- MEDLINE DCOM- 20181119 LR - 20181119 IS - 2352-3026 (Electronic) IS - 2352-3026 (Linking) VI - 4 IP - 6 DP - 2017 Jun TI - Coagulation factor concentrates and point-of-care coagulation monitoring: both might be essential for optimal treatment of trauma-induced coagulopathy. PG - e246-e247 LID - S2352-3026(17)30065-0 [pii] LID - 10.1016/S2352-3026(17)30065-0 [doi] FAU - Grottke, Oliver AU - Grottke O AD - Department of Anesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany. Electronic address: ogrottke@ukaachen.de. FAU - Rossaint, Rolf AU - Rossaint R AD - Department of Anesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany. LA - eng PT - Journal Article DEP - 20170428 PL - England TA - Lancet Haematol JT - The Lancet. Haematology JID - 101643584 RN - 0 (Blood Coagulation Factors) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Coagulation Factors/pharmacology/*therapeutic use MH - Hemorrhage/*drug therapy/*etiology/physiopathology MH - Humans MH - *Point-of-Care Systems MH - Wounds and Injuries/*complications EDAT- 2017/05/02 06:00 MHDA- 2018/11/20 06:00 CRDT- 2017/05/02 06:00 PHST- 2017/04/06 00:00 [received] PHST- 2017/04/06 00:00 [accepted] PHST- 2017/05/02 06:00 [pubmed] PHST- 2018/11/20 06:00 [medline] PHST- 2017/05/02 06:00 [entrez] AID - S2352-3026(17)30065-0 [pii] AID - 10.1016/S2352-3026(17)30065-0 [doi] PST - ppublish SO - Lancet Haematol. 2017 Jun;4(6):e246-e247. doi: 10.1016/S2352-3026(17)30065-0. Epub 2017 Apr 28. PMID- 28457980 OWN - NLM STAT- MEDLINE DCOM- 20180219 LR - 20180219 IS - 2352-3026 (Electronic) IS - 2352-3026 (Linking) VI - 4 IP - 6 DP - 2017 Jun TI - Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial. PG - e258-e271 LID - S2352-3026(17)30077-7 [pii] LID - 10.1016/S2352-3026(17)30077-7 [doi] AB - BACKGROUND: Effective treatment of trauma-induced coagulopathy is important; however, the optimal therapy is still not known. We aimed to compare the efficacy of first-line therapy using fresh frozen plasma (FFP) or coagulation factor concentrates (CFC) for the reversal of trauma-induced coagulopathy, the arising transfusion requirements, and consequently the development of multiple organ failure. METHODS: This single-centre, parallel-group, open-label, randomised trial was done at the Level 1 Trauma Center in Innsbruck Medical University Hospital (Innsbruck, Austria). Patients with trauma aged 18-80 years, with an Injury Severity Score (ISS) greater than 15, bleeding signs, and plasmatic coagulopathy identified by abnormal fibrin polymerisation or prolonged coagulation time using rotational thromboelastometry (ROTEM) were eligible. Patients with injuries that were judged incompatible with survival, cardiopulmonary resuscitation on the scene, isolated brain injury, burn injury, avalanche injury, or prehospital coagulation therapy other than tranexamic acid were excluded. We used a computer-generated randomisation list, stratification for brain injury and ISS, and closed opaque envelopes to randomly allocate patients to treatment with FFP (15 mL/kg of bodyweight) or CFC (primarily fibrinogen concentrate [50 mg/kg of bodyweight]). Bleeding management began immediately after randomisation and continued until 24 h after admission to the intensive care unit. The primary clinical endpoint was multiple organ failure in the modified intention-to-treat population (excluding patients who discontinued treatment). Reversal of coagulopathy and need for massive transfusions were important secondary efficacy endpoints that were the reason for deciding the continuation or termination of the trial. This trial is registered with ClinicalTrials.gov, number NCT01545635. FINDINGS: Between March 3, 2012, and Feb 20, 2016, 100 out of 292 screened patients were included and randomly allocated to FFP (n=48) and CFC (n=52). Six patients (four in the FFP group and two in the CFC group) discontinued treatment because of overlooked exclusion criteria or a major protocol deviation with loss of follow-up. 44 patients in the FFP group and 50 patients in the CFC group were included in the final interim analysis. The study was terminated early for futility and safety reasons because of the high proportion of patients in the FFP group who required rescue therapy compared with those in the CFC group (23 [52%] in the FFP group vs two [4%] in the CFC group; odds ratio [OR] 25.34 [95% CI 5.47-240.03], p<0.0001) and increased needed for massive transfusion (13 [30%] in the FFP group vs six [12%] in the CFC group; OR 3.04 [0.95-10.87], p=0.042) in the FFP group. Multiple organ failure occurred in 29 (66%) patients in the FFP group and in 25 (50%) patients in the CFC group (OR 1.92 [95% CI 0.78-4.86], p=0.15). INTERPRETATION: Our results underline the importance of early and effective fibrinogen supplementation for severe clotting failure in multiple trauma. The available sample size in our study appears sufficient to make some conclusions that first-line CFC is superior to FFP. FUNDING: None. CI - Copyright (c) 2017 Elsevier Ltd. All rights reserved. FAU - Innerhofer, Petra AU - Innerhofer P AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: Petra.Innerhofer@tirol-kliniken.at. FAU - Fries, Dietmar AU - Fries D AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Mittermayr, Markus AU - Mittermayr M AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Innerhofer, Nicole AU - Innerhofer N AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - von Langen, Daniel AU - von Langen D AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Hell, Tobias AU - Hell T AD - Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria. FAU - Gruber, Gottfried AU - Gruber G AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Schmid, Stefan AU - Schmid S AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Friesenecker, Barbara AU - Friesenecker B AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Lorenz, Ingo H AU - Lorenz IH AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Strohle, Mathias AU - Strohle M AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Rastner, Verena AU - Rastner V AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Trubsbach, Susanne AU - Trubsbach S AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Raab, Helmut AU - Raab H AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Treml, Benedikt AU - Treml B AD - Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Wally, Dieter AU - Wally D AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Treichl, Benjamin AU - Treichl B AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. FAU - Mayr, Agnes AU - Mayr A AD - Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. FAU - Kranewitter, Christof AU - Kranewitter C AD - Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. FAU - Oswald, Elgar AU - Oswald E AD - Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. LA - eng SI - ClinicalTrials.gov/NCT01545635 PT - Journal Article PT - Randomized Controlled Trial DEP - 20170428 PL - England TA - Lancet Haematol JT - The Lancet. Haematology JID - 101643584 RN - 0 (Blood Coagulation Factors) SB - IM CIN - Lancet Haematol. 2017 Jun;4(6):e245. doi: 10.1016/S2352-3026(17)30082-0. PMID: 28583282 EIN - Lancet Haematol. 2017 Jun;4(6):e257. doi: 10.1016/S2352-3026(17)30084-4. PMID: 28583287 CIN - Lancet Haematol. 2017 Aug;4(8):e348. doi: 10.1016/S2352-3026(17)30125-4. PMID: 28754193 MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Factors/*therapeutic use MH - Female MH - Hemorrhage/*drug therapy/*etiology MH - Humans MH - Male MH - Middle Aged MH - *Plasma MH - Treatment Outcome MH - Wounds and Injuries/*complications MH - Young Adult EDAT- 2017/05/02 06:00 MHDA- 2018/02/20 06:00 CRDT- 2017/05/02 06:00 PHST- 2017/01/27 00:00 [received] PHST- 2017/03/14 00:00 [revised] PHST- 2017/03/16 00:00 [accepted] PHST- 2017/05/02 06:00 [pubmed] PHST- 2018/02/20 06:00 [medline] PHST- 2017/05/02 06:00 [entrez] AID - S2352-3026(17)30077-7 [pii] AID - 10.1016/S2352-3026(17)30077-7 [doi] PST - ppublish SO - Lancet Haematol. 2017 Jun;4(6):e258-e271. doi: 10.1016/S2352-3026(17)30077-7. Epub 2017 Apr 28. PMID- 28452886 OWN - NLM STAT- MEDLINE DCOM- 20170918 LR - 20190105 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 83 IP - 3 DP - 2017 Sep TI - Platelet transfusions reduce fibrinolysis but do not restore platelet function during trauma hemorrhage. PG - 388-397 LID - 10.1097/TA.0000000000001520 [doi] AB - BACKGROUND: Platelets play a critical role in hemostasis with aberrant function implicated in trauma-induced coagulopathy. However, the impact of massive transfusion protocols on platelet function during trauma hemorrhage is unknown. The aim of this study was to characterize the effects of platelet transfusion on platelet aggregation and fibrinolytic markers during hemostatic resuscitation. METHODS: Trauma patients enrolled into the prospective Activation of Coagulation and Inflammation in Trauma study between January 2008 and November 2015 who received at least four units of packed red blood cells (PRBCs) were included. Blood was drawn in the emergency department within 2 hours of injury and at intervals after every four units of PRBCs transfused. Platelet aggregation was assessed in whole blood with multiple electrode aggregometry. Plasma proteins were quantified by enzyme-linked immunosorbent assay. RESULTS: Of 161 patients who received four or more PRBCs as part of their initial resuscitation, 44 received 8 to 11 units and 28 received 12 units or more. At each timepoint during bleeding, platelet aggregation was similar in patients who had received a platelet transfusion compared with those who had only received other blood products (p > 0.05 for all timepoints). Platelet transfusion during the four PRBC intervals was associated with a decrease in maximum lysis on rotational thromboelastometry (start of interval, 6% [2-12] vs. end of interval, 2% [0-5]; p = 0.001), an increase in plasminogen activator inhibitor-1 (start of interval, 35.9 +/- 14.9 vs. end of interval, 66.7 +/- 22.0; p = 0.007) and a decrease in tissue plasminogen activator (start of interval, 26.2 +/- 10.5 vs. end of interval, 19.0 +/- 5.1; p = 0.04). No statistically significant changes in these parameters occurred in intervals which did not contain platelets. CONCLUSION: Current hemostatic resuscitation strategies do not appear to restore platelet aggregation during active hemorrhage. However, stored platelets may attenuate fibrinolysis by providing an additional source of plasminogen activator inhibitor-1. Further investigation into the effects of early platelet transfusion on platelet function, hemostatic, and clinical outcomes during bleeding are warranted. LEVEL OF EVIDENCE: Therapeutic, level III. FAU - Vulliamy, Paul AU - Vulliamy P AD - From the Centre for Trauma Sciences (P.V., S.G., L.S.G., K.B., R.A.D.), Queen Mary University of London, United Kingdom; and Department of Haematology (L.G.), Barts Health NHS Trust, London, United Kingdom. FAU - Gillespie, Scarlett AU - Gillespie S FAU - Gall, Lewis S AU - Gall LS FAU - Green, Laura AU - Green L FAU - Brohi, Karim AU - Brohi K FAU - Davenport, Ross A AU - Davenport RA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Fibrinolysis/*physiology MH - Hemorrhage/*therapy MH - Hemostasis/physiology MH - Humans MH - Male MH - Middle Aged MH - Platelet Aggregation MH - Platelet Function Tests MH - *Platelet Transfusion MH - Prospective Studies MH - Resuscitation/methods MH - Thrombelastography MH - Wounds and Injuries/*complications EDAT- 2017/04/30 06:00 MHDA- 2017/09/19 06:00 CRDT- 2017/04/29 06:00 PHST- 2017/04/30 06:00 [pubmed] PHST- 2017/09/19 06:00 [medline] PHST- 2017/04/29 06:00 [entrez] AID - 10.1097/TA.0000000000001520 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Sep;83(3):388-397. doi: 10.1097/TA.0000000000001520. PMID- 28431870 OWN - NLM STAT- MEDLINE DCOM- 20171006 LR - 20220408 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 35 IP - 10 DP - 2017 Oct TI - The effect of hypertonic saline and mannitol on coagulation in moderate traumatic brain injury patients. PG - 1404-1407 LID - S0735-6757(17)30286-3 [pii] LID - 10.1016/j.ajem.2017.04.020 [doi] AB - BACKGROUND: Hyperosmolar therapy, using either hypertonic saline (HTS) or mannitol (MT), is considered the treatment of choice for intracranial hypertension, a disorder characterized by high intracranial pressure (ICP). However, hyperosmolar agents have been postulated to impair coagulation and platelet function. The aim of this study was to identify whether HTS and MT could affect coagulation in moderate traumatic brain injury (TBI) patients. METHODS: In this prospective and randomized double-blind study, we included adult patients with moderate TBI. Patients were divided into two groups according to the type of hypertonic solution administered. Group A patients received 20% MT and group B patients received 3% HTS. Rotational thromboelastometry (ROTEM) parameters were used to assess coagulation and platelet function. RESULTS: ROTEM parameters included CT (clotting time), CFT (clot formation time), maximum clot firmness (MCF) measured by MCF (EXTEM and INTEM), MCF (FIBTEM) and standard coagulation tests (p>0.05). No significant differences were found between the two groups. Moreover, ROTEM parameters did not show significant changes at different time points after administration of the hyperosmolar solutions (p>0.05). Conclusions Overall, use of 3% HTS and 20% MT for the control of ICP did not significantly affect patients' coagulation function. Therefore, hyperosmotic solution is safe and does not increase the risk of intracranial rebleeding. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Wang, Haifeng AU - Wang H AD - Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China. Electronic address: hfwangjl@sina.com. FAU - Cao, Hongshi AU - Cao H AD - Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China. Electronic address: hscaoneuro@126.com. FAU - Zhang, Xiaohong AU - Zhang X AD - Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China. Electronic address: jlxiaohong@yeah.net. FAU - Ge, Liang AU - Ge L AD - Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China. Electronic address: lianggedr@sina.com. FAU - Bie, Li AU - Bie L AD - Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China; Department of Pathology and Laboratory Medicine, University of California, Irvine, USA. Electronic address: bieli@aliyun.com. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20170414 PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 RN - 0 (Diuretics, Osmotic) RN - 0 (Saline Solution, Hypertonic) RN - 3OWL53L36A (Mannitol) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Brain Injuries, Traumatic/*blood/complications/*therapy MH - Diuretics, Osmotic/*therapeutic use MH - Double-Blind Method MH - Female MH - Humans MH - Intracranial Hypertension/blood/etiology/prevention & control MH - Male MH - Mannitol/*therapeutic use MH - Middle Aged MH - Prospective Studies MH - Saline Solution, Hypertonic/*therapeutic use MH - Thrombelastography MH - Young Adult OTO - NOTNLM OT - Coagulation OT - Hypertonic saline OT - Mannitol OT - Rotational thromboelastometry EDAT- 2017/04/23 06:00 MHDA- 2017/10/07 06:00 CRDT- 2017/04/23 06:00 PHST- 2017/02/27 00:00 [received] PHST- 2017/04/10 00:00 [revised] PHST- 2017/04/13 00:00 [accepted] PHST- 2017/04/23 06:00 [pubmed] PHST- 2017/10/07 06:00 [medline] PHST- 2017/04/23 06:00 [entrez] AID - S0735-6757(17)30286-3 [pii] AID - 10.1016/j.ajem.2017.04.020 [doi] PST - ppublish SO - Am J Emerg Med. 2017 Oct;35(10):1404-1407. doi: 10.1016/j.ajem.2017.04.020. Epub 2017 Apr 14. PMID- 28411452 OWN - NLM STAT- MEDLINE DCOM- 20180403 LR - 20231028 IS - 1878-5905 (Electronic) IS - 0142-9612 (Print) IS - 0142-9612 (Linking) VI - 132 DP - 2017 Jul TI - Peptide valency plays an important role in the activity of a synthetic fibrin-crosslinking polymer. PG - 96-104 LID - S0142-9612(17)30210-7 [pii] LID - 10.1016/j.biomaterials.2017.04.002 [doi] AB - Therapeutic polymers have the potential to improve the standard of care for hemorrhage, or uncontrolled bleeding, as synthetic hemostats. PolySTAT, a fibrin-crosslinking peptide-polymer conjugate, has the capacity to rescue fibrin clot formation and improve survival in a model of acute traumatic bleeding. PolySTAT consists of a synthetic polymer backbone to which targeting fibrin-binding peptides are linked. For translation of PolySTAT, the optimal valency of peptides must be determined. Grafting of fibrin-binding peptides to the poly(hydroxyethyl methacrylate)-based backbone was controlled to produce peptide valencies ranging from 0 to 10 peptides per polymer. PolySTATs with valencies of approximately 4 or greater resulted in increased clot firmness, kinetics, and decreased breakdown as measured by thromboelastometry. A valency of approximately 4 increased clot firmness 57% and decreased clot breakdown 69% compared to phosphate-buffered saline. This trend was characterized by neutron scattering, which probed the structure of clots formed in the presence of PolySTAT. Finally, PolySTAT with valencies of 4 (100% survival; p = 0.013) and 8 (80% survival; p = 0.063) improved survival compared to an albumin control in a femoral artery injury model (20% survival). This work demonstrates tunability of hemostatic polymers and the ability of in vitro assays to predict in vivo efficacy. CI - Copyright (c) 2017 Elsevier Ltd. All rights reserved. FAU - Lamm, Robert J AU - Lamm RJ AD - Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, WA 98195, USA. FAU - Lim, Esther B AU - Lim EB AD - Department of Medicine, Division of Emergency Medicine, University of Washington, Seattle, WA 98195, USA. FAU - Weigandt, Katie M AU - Weigandt KM AD - NIST Center for Neutron Research, National Institute of Standards and Technology, Gaithersburg, MD 20899-8562, USA. FAU - Pozzo, Lilo D AU - Pozzo LD AD - Department of Chemical Engineering, University of Washington, Seattle, WA 98195, USA. FAU - White, Nathan J AU - White NJ AD - Department of Medicine, Division of Emergency Medicine, University of Washington, Seattle, WA 98195, USA. Electronic address: whiten4@uw.edu. FAU - Pun, Suzie H AU - Pun SH AD - Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, WA 98195, USA. Electronic address: spun@uw.edu. LA - eng GR - R21 EB018637/EB/NIBIB NIH HHS/United States GR - R01 HL139007/HL/NHLBI NIH HHS/United States GR - T32 EB001650/EB/NIBIB NIH HHS/United States GR - KL2 TR002317/TR/NCATS NIH HHS/United States GR - KL2 TR000421/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20170405 PL - Netherlands TA - Biomaterials JT - Biomaterials JID - 8100316 RN - 0 (Cross-Linking Reagents) RN - 0 (Peptides) RN - 0 (polySTAT) RN - 9001-31-4 (Fibrin) RN - 9012-76-4 (Chitosan) SB - IM MH - Animals MH - Blood Coagulation MH - Blood Coagulation Tests/methods MH - Chitosan/*analogs & derivatives/chemistry/therapeutic use MH - Cross-Linking Reagents/*chemistry MH - Fibrin/*chemistry MH - Hemorrhage/blood/drug therapy MH - Hemostasis MH - Humans MH - Peptides/*chemistry MH - Rats MH - Rats, Sprague-Dawley MH - Thrombelastography/methods MH - Thrombosis/drug therapy MH - Wounds and Injuries/blood/physiopathology PMC - PMC5490449 MID - NIHMS868076 OTO - NOTNLM OT - Fibrin-binding polymer OT - Ligand density OT - Peptide-polymer conjugate OT - Synthetic injectable hemostat EDAT- 2017/04/16 06:00 MHDA- 2018/04/04 06:00 PMCR- 2018/07/01 CRDT- 2017/04/16 06:00 PHST- 2016/12/11 00:00 [received] PHST- 2017/03/30 00:00 [revised] PHST- 2017/04/03 00:00 [accepted] PHST- 2017/04/16 06:00 [pubmed] PHST- 2018/04/04 06:00 [medline] PHST- 2017/04/16 06:00 [entrez] PHST- 2018/07/01 00:00 [pmc-release] AID - S0142-9612(17)30210-7 [pii] AID - 10.1016/j.biomaterials.2017.04.002 [doi] PST - ppublish SO - Biomaterials. 2017 Jul;132:96-104. doi: 10.1016/j.biomaterials.2017.04.002. Epub 2017 Apr 5. PMID- 28403868 OWN - NLM STAT- MEDLINE DCOM- 20170831 LR - 20250623 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 25 IP - 1 DP - 2017 Apr 13 TI - The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products - A systematic review and meta-analysis. PG - 39 LID - 10.1186/s13049-017-0378-9 [doi] LID - 39 AB - BACKGROUND: Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality. METHODS: PubMed and EMBASE were searched for RCTs that 1) randomised patients into receiving transfusions based on either a VHA-guided (thromboelastography [TEG] or rotational thromboelastometry [ROTEM]) algorithm (intervention group) or at the clinician's discretion and/or based on conventional coagulation tests (control group) and 2) adequately reported on the outcomes bleeding and/or transfusions and/or mortality. Data on bleeding, transfusions and mortality were extracted from each trial and included in a meta-analysis. RESULTS: Fifteen RCTs (n = 1238 patients) were included. Nine trials referred to cardiothoracic patients, one to liver transplantation, one to surgical excision of burn wounds and one to trauma. One trial was conducted with cirrhotic patients, one with patients undergoing scoliosis surgery while one trial randomised treatment in post-partum females presenting with bleeding. The amount of transfused red blood cells (RBCs), fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the VHA-guided groups, whereas no significant difference was found for platelet transfusion requirements or mortality. FAU - Fahrendorff, Mathilde AU - Fahrendorff M AUID- ORCID: 0000-0002-7646-4894 AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. mathilde.fahrendorff@regionh.dk. FAU - Oliveri, Roberto S AU - Oliveri RS AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. AD - Department of Surgery, Centre for Translational Injury Research, UT Health, University of Texas Health Science Center at Houston, Houston, TX, USA. AD - Center for Systems Biology. The School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20170413 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis MH - Blood Coagulation Tests MH - Blood Transfusion/*methods MH - Erythrocyte Transfusion MH - Hemorrhage/*blood/*therapy MH - Hemostasis MH - Humans MH - Plasma MH - Platelet Transfusion MH - Randomized Controlled Trials as Topic MH - *Thrombelastography PMC - PMC5390346 OTO - NOTNLM OT - Bleeding OT - Mortality OT - ROTEM OT - TEG OT - Thrombelastography OT - Thrombelastometry EDAT- 2017/04/14 06:00 MHDA- 2017/09/01 06:00 PMCR- 2017/04/13 CRDT- 2017/04/14 06:00 PHST- 2016/12/13 00:00 [received] PHST- 2017/03/21 00:00 [accepted] PHST- 2017/04/14 06:00 [entrez] PHST- 2017/04/14 06:00 [pubmed] PHST- 2017/09/01 06:00 [medline] PHST- 2017/04/13 00:00 [pmc-release] AID - 10.1186/s13049-017-0378-9 [pii] AID - 378 [pii] AID - 10.1186/s13049-017-0378-9 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2017 Apr 13;25(1):39. doi: 10.1186/s13049-017-0378-9. PMID- 28392864 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1918-3003 (Print) IS - 1918-3011 (Electronic) IS - 1918-3003 (Linking) VI - 9 IP - 5 DP - 2017 May TI - Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy. PG - 433-438 LID - 10.14740/jocmr3005w [doi] AB - BACKGROUND: Thromboelastography (TEG) has been utilized for the guidance of blood component therapy (BCT). We aimed to investigate the association between emergent TEG-guided BCT and clinical outcomes in patients with traumatic abdominal solid organ (liver and/or spleen) injuries. METHODS: A single center retrospective study of patients who sustained traumatic liver and/or spleen injuries receiving emergent BCT was conducted. TEG was ordered in all these patients. Patient demographics, general injury information, outcomes, BCT, and TEG parameters were analyzed and compared in patients receiving TEG-guided BCT versus those without. RESULTS: A total of 166 patients were enrolled, of whom 52% (86/166) received TEG-guided BCT. A mortality of 12% was noted among patients with TEG-guided BCT when compared with 19% of mortality in patients with non-TEG-guided BCT (P > 0.05). An average of 4 units of packed red blood cell (PRBC) was received in patients with TEG-guided BCT when compared to an average of 9 units of PRBC received in non-TEG-guided BCT patients (P < 0.01). A longer hospital length of stay (LOS, 19 +/- 16 days) was found among non-TEG-guided BCT patients when compared to the TEG-guided BCT group (14 +/- 12 days, P < 0.05). TEG-guided BCT showed as an independent factor associated with hospital LOS after other variables were adjusted (coefficiency: 5.44, 95% confidence interval: 0.69 - 10.18). CONCLUSIONS: Traumatic abdominal solid organ injury patients receiving blood transfusions might benefit from TEG-guided BCT as indicated by less blood products needed and less hospitalization stay among the cohort. FAU - Wang, Hao AU - Wang H AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Robinson, Richard D AU - Robinson RD AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Phillips, Jessica L AU - Phillips JL AD - Research Institute, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Ryon, Andrew AU - Ryon A AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Simpson, Scott AU - Simpson S AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Ford, Jonathan R AU - Ford JR AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Umejiego, Johnbosco AU - Umejiego J AD - Research Institute, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Duane, Therese M AU - Duane TM AD - Department of General Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Putty, Bradley AU - Putty B AD - Department of General Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. FAU - Zenarosa, Nestor R AU - Zenarosa NR AD - Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. LA - eng PT - Journal Article DEP - 20170401 PL - Canada TA - J Clin Med Res JT - Journal of clinical medicine research JID - 101538301 PMC - PMC5380177 OTO - NOTNLM OT - Blood component therapy OT - Thromboelastography OT - Traumatic liver and/or spleen injury EDAT- 2017/04/11 06:00 MHDA- 2017/04/11 06:01 PMCR- 2017/04/01 CRDT- 2017/04/11 06:00 PHST- 2017/03/17 00:00 [accepted] PHST- 2017/04/11 06:00 [entrez] PHST- 2017/04/11 06:00 [pubmed] PHST- 2017/04/11 06:01 [medline] PHST- 2017/04/01 00:00 [pmc-release] AID - 10.14740/jocmr3005w [doi] PST - ppublish SO - J Clin Med Res. 2017 May;9(5):433-438. doi: 10.14740/jocmr3005w. Epub 2017 Apr 1. PMID- 28380019 OWN - NLM STAT- MEDLINE DCOM- 20170905 LR - 20220408 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 12 IP - 4 DP - 2017 TI - Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest. PG - e0175257 LID - 10.1371/journal.pone.0175257 [doi] LID - e0175257 AB - It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study. We divided patients into two groups based on the presence or absence of ROSC, and performed statistical analysis utilizing patient characteristics, prehospital data, laboratory data, and ROTEM data. Seventy-five patients were enrolled. The ROSC group and non-ROSC group included 23 and 52 patients, respectively. The logistic regression analysis, utilizing significant parameters by univariate analysis, demonstrated that lactate level [odds ratio (OR) 0.880, 95% confidence interval (CI) 0.785-0.986, p = 0.028] and A30 of EXTEM test [OR 1.039, 95% CI 1.010-1.070, p = 0.009] were independent risk factors for ROSC. The cut-off values of lactate and A30 in EXTEM were 12.0 mmol/L and A 48.0 mm, respectively. We defined a positive prediction for ROSC if the patient presented lower lactate level (<12.0 mmol/L) and higher A30 of EXTEM (>/=48.0 mm) with high specificity (94.7%) and accuracy (75.0%). The present study showed that lactate level and ROTEM parameter of clot firmness were reliable predictors of ROSC in the ED for adult patients with OHCA. FAU - Koami, Hiroyuki AU - Koami H AUID- ORCID: 0000-0001-6268-4602 AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan. FAU - Sakamoto, Yuichiro AU - Sakamoto Y AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan. FAU - Sakurai, Ryota AU - Sakurai R AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Ohta, Miho AU - Ohta M AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Imahase, Hisashi AU - Imahase H AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Yahata, Mayuko AU - Yahata M AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Umeka, Mitsuru AU - Umeka M AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Miike, Toru AU - Miike T AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Nagashima, Futoshi AU - Nagashima F AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Iwamura, Takashi AU - Iwamura T AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan. FAU - Yamada, Kosuke Chris AU - Yamada KC AD - Advanced Emergency Care Center, Saga University Hospital, Saga, Japan. FAU - Inoue, Satoshi AU - Inoue S AD - Division of Trauma Surgery and Surgical Critical Care, Faculty of Medicine, Saga University, Saga, Japan. LA - eng PT - Journal Article DEP - 20170405 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Lactates) SB - IM MH - Aged MH - Aged, 80 and over MH - Blood Circulation/*physiology MH - Emergency Service, Hospital/statistics & numerical data MH - Female MH - Humans MH - Lactates/blood MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/complications/*physiopathology MH - Retrospective Studies MH - Risk Factors MH - *Thrombelastography MH - Thrombosis/etiology/physiopathology PMC - PMC5381924 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2017/04/06 06:00 MHDA- 2017/09/07 06:00 PMCR- 2017/04/05 CRDT- 2017/04/06 06:00 PHST- 2017/01/16 00:00 [received] PHST- 2017/03/22 00:00 [accepted] PHST- 2017/04/06 06:00 [entrez] PHST- 2017/04/06 06:00 [pubmed] PHST- 2017/09/07 06:00 [medline] PHST- 2017/04/05 00:00 [pmc-release] AID - PONE-D-17-01993 [pii] AID - 10.1371/journal.pone.0175257 [doi] PST - epublish SO - PLoS One. 2017 Apr 5;12(4):e0175257. doi: 10.1371/journal.pone.0175257. eCollection 2017. PMID- 28364737 OWN - NLM STAT- MEDLINE DCOM- 20180312 LR - 20180312 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 4 DP - 2017 Jun TI - Viscoelastic Testing in Trauma. PG - 375-385 LID - 10.1055/s-0037-1598057 [doi] AB - Traumatic-induced coagulopathy (TIC) is a complex condition which develops both as a response to trauma as well as to clinical care interventions. Accurate and timely diagnostics are necessary to enable therapy aimed at correction of TIC. Viscoelastic hemostatic assays (VHA) are increasingly recognized for their potential to diagnose TIC as well as for guidance of treatment. This narrative review focuses on the evidence of the use of VHAs to diagnose TIC, to monitor efficacy of treatment of TIC during bleeding and to prognosticate outcome. Pitfalls of the use of VHA are also discussed. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Wirtz, Mathijs R AU - Wirtz MR AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. AD - Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. FAU - Baumann, Holger M AU - Baumann HM AD - Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands. FAU - Klinkspoor, J Henriette AU - Klinkspoor JH AD - Laboratory for General Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands. FAU - Goslings, J Carel AU - Goslings JC AD - Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. LA - eng PT - Journal Article PT - Review DEP - 20170401 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - *Blood Coagulation MH - Blood Coagulation Disorders/*diagnosis/etiology/prevention & control MH - Blood Coagulation Tests/*methods MH - Hemostasis MH - Humans MH - Monitoring, Physiologic/methods MH - Thrombelastography/methods MH - Wounds and Injuries/blood/*complications COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2017/04/02 06:00 MHDA- 2018/03/13 06:00 CRDT- 2017/04/02 06:00 PHST- 2017/04/02 06:00 [pubmed] PHST- 2018/03/13 06:00 [medline] PHST- 2017/04/02 06:00 [entrez] AID - 10.1055/s-0037-1598057 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Jun;43(4):375-385. doi: 10.1055/s-0037-1598057. Epub 2017 Apr 1. PMID- 28359136 OWN - NLM STAT- MEDLINE DCOM- 20180312 LR - 20180312 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 4 DP - 2017 Jun TI - Point-of-Care Testing in Burn Patients. PG - 433-438 LID - 10.1055/s-0037-1599155 [doi] AB - Severe burn injury has an impact on the coagulation system, but a unique definition regarding these changes is still missing. The results of conventional coagulation assays (CCAs) measured in daily clinical practice are often interpreted as coagulopathic, which implies a bleeding tendency. However, viscoelastic coagulation assays (VCA) like Rotational Thromboelastometry (ROTEM) and Thromboelastography (TEG) depict a hypercoagulable state. Therefore, hemostatic interventions should not be indicated according to deranged CCA results, but only in case of clinically relevant bleeding plus indicative VCA results. Massive blood loss mainly results from surgical excision of burn wounds. VCAs seem to be capable of guiding target-oriented coagulation management in this context. Owing to the increased thromboembolic risk, it appears rational to individualize pharmacologic venous thromboembolism prophylaxis by using sensitive laboratory tests and drug monitoring. Studies evaluating the use of new VCA test modifications are highly warranted and may substantially improve outcome in this difficult-to-treat patient population. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Wiegele, Marion AU - Wiegele M AD - Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. FAU - Kozek-Langenecker, Sibylle AU - Kozek-Langenecker S AD - Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria. FAU - Schaden, Eva AU - Schaden E AD - Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. LA - eng PT - Journal Article PT - Review DEP - 20170330 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/*diagnosis/etiology/prevention & control MH - Blood Coagulation Tests/*methods MH - Burns/blood/*complications MH - Humans MH - Point-of-Care Systems MH - *Point-of-Care Testing MH - Thrombelastography/methods COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2017/03/31 06:00 MHDA- 2018/03/13 06:00 CRDT- 2017/03/31 06:00 PHST- 2017/03/31 06:00 [pubmed] PHST- 2018/03/13 06:00 [medline] PHST- 2017/03/31 06:00 [entrez] AID - 10.1055/s-0037-1599155 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Jun;43(4):433-438. doi: 10.1055/s-0037-1599155. Epub 2017 Mar 30. PMID- 28356162 OWN - NLM STAT- MEDLINE DCOM- 20171011 LR - 20181113 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 25 IP - 1 DP - 2017 Mar 29 TI - Blood transfusion and coagulopathy in geriatric trauma patients. PG - 33 LID - 10.1186/s13049-017-0374-0 [doi] LID - 33 AB - BACKGROUND: Trauma resuscitation has undergone a paradigm shift with new emphasis on the early use of blood products and increased proportions of plasma and platelets. However, it is unclear how this strategy is applied or how effective it is in the elderly population. The study aim is to identify differences in transfusion practices and the coagulopathy of trauma in the elderly. METHODS: Data was prospectively collected on all consecutive patients that met trauma activation criteria at a Level I trauma centre. Data fields included patient demographics, co-morbidities, injury and resuscitation data, laboratory values, thromboelastography (TEG) results, and outcome measures. Elderly patients were defined as those 55 and older. Propensity-score matched analysis was completed for patients receiving blood product transfusion. Patients were matched by gender, mechanism, injury severity score (ISS), head injury, and time from injury. RESULTS: Total of 628 patients were included, of which 142 (23%) were elderly. Elderly patients were more likely to be female (41% vs. 24%), suffer blunt mechanism of trauma (96% vs. 80%), have higher ISS scores (mean 25.4 vs. 21.6) and mortality (19% vs. 8%). Elderly patients were significantly more likely to receive a blood transfusion (42% vs. 30%), specifically for red cells and plasma. Propensity-matched analysis resulted in no difference in red cell transfusion or mortality. Despite the broad similarities between the matched cohorts, trauma coagulopathy as measured by TEG was less commonly observed in the elderly. DISCUSSION: Our results suggest that elderly trauma patients are more likely to receive blood products when admitted to a trauma centre, though this may be attributed to under-triage. The results also suggest an altered coagulopathic response to traumatic injury which is partially influenced by increased anticoagulant and antiplatelet medication use in the geriatric population. CONCLUSION: It is not clear whether the acute coagulopathy of trauma is equivalent in geriatric patients, and further study is therefore warranted. FAU - Mador, Brett AU - Mador B AD - Department of Surgery, University of Alberta, 205 - 3017 66 St NW, Edmonton, AB, T6K 4B2, Canada. Brett.mador@outlook.com. FAU - Nascimento, Bartolomeu AU - Nascimento B AD - Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H171, Toronto, ON, M4N 3M5, Canada. FAU - Hollands, Simon AU - Hollands S AD - Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. FAU - Rizoli, Sandro AU - Rizoli S AD - Department of Surgery, St. Michael's Hospital, 30 Bond Street, 3-074 Donnelly Wing, Toronto, ON, M5B 1W8, Canada. LA - eng PT - Journal Article DEP - 20170329 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Aged MH - *Blood Coagulation Disorders MH - Blood Transfusion/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Practice Patterns, Physicians' MH - Propensity Score MH - Prospective Studies MH - Trauma Centers MH - Wounds and Injuries/*blood PMC - PMC5371241 OTO - NOTNLM OT - Coagulopathy OT - Geriatric OT - Thromboelastography OT - Transfusion OT - Trauma EDAT- 2017/03/31 06:00 MHDA- 2017/10/12 06:00 PMCR- 2017/03/29 CRDT- 2017/03/31 06:00 PHST- 2016/10/18 00:00 [received] PHST- 2017/03/15 00:00 [accepted] PHST- 2017/03/31 06:00 [entrez] PHST- 2017/03/31 06:00 [pubmed] PHST- 2017/10/12 06:00 [medline] PHST- 2017/03/29 00:00 [pmc-release] AID - 10.1186/s13049-017-0374-0 [pii] AID - 374 [pii] AID - 10.1186/s13049-017-0374-0 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2017 Mar 29;25(1):33. doi: 10.1186/s13049-017-0374-0. PMID- 28346965 OWN - NLM STAT- MEDLINE DCOM- 20180312 LR - 20180312 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 4 DP - 2017 Jun TI - Point-of-Care Coagulation Tests Monitoring of Direct Oral Anticoagulants and Their Reversal Therapy: State of the Art. PG - 423-432 LID - 10.1055/s-0037-1599157 [doi] AB - Direct oral anticoagulants (DOACs) exert similar anticoagulant effects to vitamin K antagonists and are increasingly used worldwide. Nevertheless, an evidence-based approach to patients receiving DOACs when any unplanned urgent surgery or bleeding (either spontaneous or traumatic) occurs is still missing. In this review, we investigate the role of point-of-care coagulation tests when other, more specific tests are not available. Indeed, thromboelastography and activated clotting time can detect dabigatran-induced coagulopathy, while their accuracy is limited for apixaban and rivaroxaban, mostly in cases of low drug plasma concentrations. These tests can also be used to guide the reversal of DOAC-induced coagulopathy providing a quick, before-and-after picture in case of therapeutic use of hemostatic compounds. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Iapichino, Giacomo E AU - Iapichino GE AD - Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. AD - Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. FAU - Bianchi, Paolo AU - Bianchi P AD - Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. FAU - Ranucci, Marco AU - Ranucci M AD - Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. FAU - Baryshnikova, Ekaterina AU - Baryshnikova E AD - Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. LA - eng PT - Journal Article PT - Review DEP - 20170327 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Anticoagulants) SB - IM MH - Administration, Oral MH - Anticoagulants/administration & dosage/adverse effects/*therapeutic use MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/*diagnosis/etiology/prevention & control MH - Blood Coagulation Tests/*methods MH - Humans MH - Point-of-Care Systems MH - *Point-of-Care Testing MH - Thrombelastography/methods COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2017/03/28 06:00 MHDA- 2018/03/13 06:00 CRDT- 2017/03/28 06:00 PHST- 2017/03/28 06:00 [pubmed] PHST- 2018/03/13 06:00 [medline] PHST- 2017/03/28 06:00 [entrez] AID - 10.1055/s-0037-1599157 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Jun;43(4):423-432. doi: 10.1055/s-0037-1599157. Epub 2017 Mar 27. PMID- 28346963 OWN - NLM STAT- MEDLINE DCOM- 20180312 LR - 20180312 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 4 DP - 2017 Jun TI - Point-of-Care Testing in Neurosurgery. PG - 416-422 LID - 10.1055/s-0037-1599159 [doi] AB - Coagulation disorders can have a major impact on the outcome of neurosurgical patients. The central nervous system is located within the closed space of the skull, and therefore, intracranial hemorrhage can lead to intracranial hypertension. Acute brain injury has been associated with alterations of various hemostatic parameters. Point-of-care (POC) techniques such as rotational thromboelastometry are able to identify markers of coagulopathy which are not reflected by standard assessment of hemostasis (e.g., hyperfibrinolysis). In patients with acute brain injury, POC test results have been associated with important outcome parameters such as mortality and need for neurosurgical intervention. POC devices have also been used to rapidly identify and quantify the effects of antithrombotic medication. In cases of life-threatening intracranial hemorrhage, this information can be valuable when deciding over administration of prohemostatic substances or immediate neurosurgical intervention. In elective neurosurgical procedures, POC devices can provide important information when unexpected bleeding occurs or in cases of prolonged operative time with subsequent blood loss. Initial experiences with POC devices in neurosurgical care have shown promising results but further studies are needed to characterize their full potential and limitations. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Beynon, Christopher AU - Beynon C AD - Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. FAU - Wessels, Lars AU - Wessels L AD - Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. FAU - Unterberg, Andreas W AU - Unterberg AW AD - Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. LA - eng PT - Journal Article PT - Review DEP - 20170327 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Blood Coagulation MH - Blood Coagulation Tests/*methods MH - Blood Loss, Surgical/prevention & control MH - Humans MH - Intracranial Hemorrhages/*diagnosis/etiology/prevention & control MH - Neurosurgical Procedures/adverse effects/*methods MH - Point-of-Care Systems MH - *Point-of-Care Testing MH - Thrombelastography/methods COIS- Conflict of Interest: C.B. has received speaker honoraria and/or consulting fees from Bayer Healthcare, Boehringer Ingelheim, CSL Behring and research support from Roche Diagnostics. L.W. and A.W.U. declare that they have no conflict of interest. EDAT- 2017/03/28 06:00 MHDA- 2018/03/13 06:00 CRDT- 2017/03/28 06:00 PHST- 2017/03/28 06:00 [pubmed] PHST- 2018/03/13 06:00 [medline] PHST- 2017/03/28 06:00 [entrez] AID - 10.1055/s-0037-1599159 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Jun;43(4):416-422. doi: 10.1055/s-0037-1599159. Epub 2017 Mar 27. PMID- 28338491 OWN - NLM STAT- MEDLINE DCOM- 20180611 LR - 20180611 IS - 2380-0194 (Electronic) IS - 2380-0186 (Linking) VI - 30 IP - 9 DP - 2017 Nov TI - Perioperative Management of Blood Loss in Spine Surgery. PG - 383-388 LID - 10.1097/BSD.0000000000000532 [doi] AB - Spine procedures are associated with high rates of blood loss which can result in a greater need for transfusions. Repeated exposure to blood products is associated with risks and adverse reactions such as transfusion-related acute lung injury, fluid shifting, and infections. With the higher number of spine procedures and the increasing open surgery times associated with difficult procedures, excessive blood loss has become more prevalent. Perioperative methods have been established to combat the excessive blood loss and decrease the need for blood products. Preoperatively, anemia and coagulopathy screening is standard at least 4 weeks before elective procedures. Erythropoietin, iron loading or transfusions are used to decrease preoperative anemia, a predisposing factor for blood loss. Autologous predonation of blood has been shown to be ineffective and decreases preoperative hemoglobin levels. Intraoperatively, antifibrinolytics such as tranexamic acid and aminocaproic acid are used to decrease blood loss. In addition, fibrinogen concentrates, thromboelastometry, acute normovolemic hemodilution, controlled hypotension, and temperature regulation are some of the techniques used to decrease blood loss and the need for transfusions. Postoperatively, fibrin sealants, shed blood salvage, and erythropoietin or intravenous iron are used in management of blood loss, especially in instances when the patient refuses blood products. FAU - Qureshi, Rabia AU - Qureshi R AD - *Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA daggerDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD. FAU - Puvanesarajah, Varun AU - Puvanesarajah V FAU - Jain, Amit AU - Jain A FAU - Hassanzadeh, Hamid AU - Hassanzadeh H LA - eng PT - Journal Article PT - Review PL - United States TA - Clin Spine Surg JT - Clinical spine surgery JID - 101675083 SB - IM MH - *Blood Loss, Surgical MH - Humans MH - Monitoring, Physiologic MH - Orthopedic Procedures/*adverse effects MH - Perioperative Care/*methods MH - Spine/*surgery EDAT- 2017/03/25 06:00 MHDA- 2018/06/12 06:00 CRDT- 2017/03/25 06:00 PHST- 2017/03/25 06:00 [pubmed] PHST- 2018/06/12 06:00 [medline] PHST- 2017/03/25 06:00 [entrez] AID - 10.1097/BSD.0000000000000532 [doi] PST - ppublish SO - Clin Spine Surg. 2017 Nov;30(9):383-388. doi: 10.1097/BSD.0000000000000532. PMID- 28336026 OWN - NLM STAT- MEDLINE DCOM- 20171013 LR - 20181202 IS - 1878-0369 (Electronic) IS - 0001-2092 (Linking) VI - 105 IP - 4 DP - 2017 Apr TI - Viscoelastic Studies: Effective Tools for Trauma and Surgical Resuscitation Efforts. PG - 370-383 LID - S0001-2092(17)30078-9 [pii] LID - 10.1016/j.aorn.2017.01.013 [doi] AB - Trauma-induced coagulopathy (TIC) is an abrupt disruption of all hemostatic components of coagulation resulting from severe tissue injury and hypoperfusion. The effective management of TIC has remained elusive to clinicians using traditional laboratory methods, challenging efforts to improve outcomes related to uncontrolled bleeding. Recent initiatives have aimed to reduce TIC-associated morbidity and mortality, further invoking trauma experts to explore innovative modalities in the field of viscoelastic studies, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM). These tests are able to guide proper blood product administration more effectively during trauma and surgical resuscitation compared with conventional laboratory tests. Although TEG and ROTEM are similar tests, inherent differences in their features produce variation in output results. This article calls on the perioperative clinician to evaluate TEG and ROTEM tests and consider their implementation based on the benefits of their application to clinical practice. CI - Published by Elsevier Inc. FAU - Salinas, Dagoberto AU - Salinas D LA - eng PT - Journal Article PL - United States TA - AORN J JT - AORN journal JID - 0372403 SB - IM MH - Blood Coagulation Disorders/*diagnosis/etiology/therapy MH - Hemorrhage/etiology/prevention & control MH - Hemostasis MH - Humans MH - Resuscitation/methods MH - Thrombelastography/*methods MH - Wounds and Injuries/blood/*complications OTO - NOTNLM OT - massive transfusion OT - rotational thromboelastometry OT - thromboelastography OT - trauma-induced coagulopathy OT - viscoelastic studies EDAT- 2017/03/25 06:00 MHDA- 2017/10/14 06:00 CRDT- 2017/03/25 06:00 PHST- 2016/08/08 00:00 [received] PHST- 2016/09/12 00:00 [revised] PHST- 2017/01/27 00:00 [accepted] PHST- 2017/03/25 06:00 [entrez] PHST- 2017/03/25 06:00 [pubmed] PHST- 2017/10/14 06:00 [medline] AID - S0001-2092(17)30078-9 [pii] AID - 10.1016/j.aorn.2017.01.013 [doi] PST - ppublish SO - AORN J. 2017 Apr;105(4):370-383. doi: 10.1016/j.aorn.2017.01.013. PMID- 28315812 OWN - NLM STAT- MEDLINE DCOM- 20170825 LR - 20260108 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 225 IP - 1 DP - 2017 Jul TI - Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism. PG - 42-51 LID - 10.1016/j.jamcollsurg.2017.03.001 [doi] AB - BACKGROUND: Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients. STUDY DESIGN: Secondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value < 0.05 indicates significance. RESULTS: Despite similar patient demographics, VTE patients exhibited hypercoagulable thromboelastography parameters and enhanced platelet function at admission (p < 0.05). Both groups exhibited hypocoagulable thromboelastography parameters, platelet dysfunction, and suppressed clot lysis (low clot lysis at 30 minutes) 2 hours after admission (p < 0.05). The VTE patients exhibited delayed coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), alpha-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05). CONCLUSIONS: Recovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation. CI - Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - McCully, Belinda H AU - McCully BH AD - Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center, Houston, TX Division of Trauma and Critical Care, Department of Surgery, University of Washington, Seattle, WA. FAU - Connelly, Christopher R AU - Connelly CR FAU - Fair, Kelly A AU - Fair KA FAU - Holcomb, John B AU - Holcomb JB FAU - Fox, Erin E AU - Fox EE FAU - Wade, Charles E AU - Wade CE FAU - Bulger, Eileen M AU - Bulger EM FAU - Schreiber, Martin A AU - Schreiber MA CN - and the PROPPR Study Group LA - eng GR - U01 HL077863/HL/NHLBI NIH HHS/United States GR - UL1 TR000371/TR/NCATS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Pragmatic Clinical Trial PT - Randomized Controlled Trial DEP - 20170316 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 RN - 0 (Anticoagulants) SB - IM CIN - J Am Coll Surg. 2017 Jul;225(1):51-52. doi: 10.1016/j.jamcollsurg.2017.04.018. PMID: 28648347 MH - Adult MH - Anticoagulants/*therapeutic use MH - Blood Coagulation Disorders/*complications MH - Blood Coagulation Tests MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Recovery of Function MH - Thrombelastography MH - Trauma Centers MH - Venous Thromboembolism/diagnostic imaging/*drug therapy/*etiology MH - Wounds and Injuries/*complications PMC - PMC5592971 MID - NIHMS900820 EDAT- 2017/03/21 06:00 MHDA- 2017/08/26 06:00 PMCR- 2017/09/11 CRDT- 2017/03/20 06:00 PHST- 2017/01/05 00:00 [received] PHST- 2017/03/06 00:00 [revised] PHST- 2017/03/06 00:00 [accepted] PHST- 2017/03/21 06:00 [pubmed] PHST- 2017/08/26 06:00 [medline] PHST- 2017/03/20 06:00 [entrez] PHST- 2017/09/11 00:00 [pmc-release] AID - 00019464-201707000-00008 [pii] AID - 10.1016/j.jamcollsurg.2017.03.001 [doi] PST - ppublish SO - J Am Coll Surg. 2017 Jul;225(1):42-51. doi: 10.1016/j.jamcollsurg.2017.03.001. Epub 2017 Mar 16. PMID- 28302286 OWN - NLM STAT- MEDLINE DCOM- 20170418 LR - 20170418 IS - 1532-9453 (Electronic) IS - 1055-8586 (Linking) VI - 26 IP - 1 DP - 2017 Feb TI - Viscoelastic hemostatic assays in the management of the pediatric trauma patient. PG - 8-13 LID - S1055-8586(17)30004-5 [pii] LID - 10.1053/j.sempedsurg.2017.01.004 [doi] AB - Viscoelastic hemostatic assays (VHA), such as TEG and ROTEM, are whole blood tests that depict functional coagulation both numerically and graphically. The development of rapid VHA technology, which allows for the first data points to result within minutes of test initiation, has increased the utility of these tests in the treatment of trauma patients. Both adult and pediatric centers have integrated VHAs into trauma resuscitation and transfusion protocols. Literature regarding the use of VHAs for injured children is limited. Here, we discuss the mechanics and interpretation of VHAs as well as the use of VHAs in data-driven resuscitation of pediatric trauma patients. Novel research on fibrinolysis states after injury as well as hypercoagulable state diagnosed with VHAs are presented. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Leeper, Christine M AU - Leeper CM AD - Department of Surgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, 7th Floor, Faculty Pavilion, One Children's Hospital Dr, 4401 Penn Ave, Pittsburgh, Pennsylvania 15224. FAU - Gaines, Barbara A AU - Gaines BA AD - Department of Surgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, 7th Floor, Faculty Pavilion, One Children's Hospital Dr, 4401 Penn Ave, Pittsburgh, Pennsylvania 15224. Electronic address: Barbara.Gaines@chp.edu. LA - eng PT - Journal Article DEP - 20170105 PL - United States TA - Semin Pediatr Surg JT - Seminars in pediatric surgery JID - 9216162 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Blood Coagulation Tests/*methods MH - Elasticity MH - Hemostasis MH - Humans MH - Wounds and Injuries/blood/*complications OTO - NOTNLM OT - Coagulopathy OT - Pediatric OT - Thromboelastography OT - Transfusion OT - Trauma EDAT- 2017/03/18 06:00 MHDA- 2017/04/19 06:00 CRDT- 2017/03/18 06:00 PHST- 2017/03/18 06:00 [entrez] PHST- 2017/03/18 06:00 [pubmed] PHST- 2017/04/19 06:00 [medline] AID - S1055-8586(17)30004-5 [pii] AID - 10.1053/j.sempedsurg.2017.01.004 [doi] PST - ppublish SO - Semin Pediatr Surg. 2017 Feb;26(1):8-13. doi: 10.1053/j.sempedsurg.2017.01.004. Epub 2017 Jan 5. PMID- 28297730 OWN - NLM STAT- MEDLINE DCOM- 20180312 LR - 20180312 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 4 DP - 2017 Jun TI - Point-of-Care Coagulation Monitoring in Trauma Patients. PG - 367-374 LID - 10.1055/s-0037-1598062 [doi] AB - Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate-based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Stein, Philipp AU - Stein P AD - Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Kaserer, Alexander AU - Kaserer A AD - Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Spahn, Gabriela H AU - Spahn GH AD - Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland. FAU - Spahn, Donat R AU - Spahn DR AD - Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland. LA - eng PT - Journal Article PT - Review DEP - 20170315 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - *Blood Coagulation MH - Blood Coagulation Disorders/*diagnosis/etiology/prevention & control MH - Blood Coagulation Tests/*methods MH - Humans MH - *Point-of-Care Systems MH - Point-of-Care Testing MH - Wounds and Injuries/blood/*complications COIS- Disclosure The authors report no conflicts of interest in this work. EDAT- 2017/03/16 06:00 MHDA- 2018/03/13 06:00 CRDT- 2017/03/16 06:00 PHST- 2017/03/16 06:00 [pubmed] PHST- 2018/03/13 06:00 [medline] PHST- 2017/03/16 06:00 [entrez] AID - 10.1055/s-0037-1598062 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Jun;43(4):367-374. doi: 10.1055/s-0037-1598062. Epub 2017 Mar 15. PMID- 28292321 OWN - NLM STAT- MEDLINE DCOM- 20171011 LR - 20220318 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 25 IP - 1 DP - 2017 Mar 14 TI - Prothrombin time is predictive of low plasma prothrombin concentration and clinical outcome in patients with trauma hemorrhage: analyses of prospective observational cohort studies. PG - 30 LID - 10.1186/s13049-016-0332-2 [doi] LID - 30 AB - BACKGROUND: Fibrinogen and prothrombin have been suggested to become rate limiting in trauma associated coagulopathy. Administration of fibrinogen is now recommended, however, the importance of prothrombin to patient outcome is unknown. METHODS: We have utilized two trauma patient databases (database 1 n = 358 and database 2 n = 331) to investigate the relationship of plasma prothrombin concentration on clinical outcome and coagulation status. Database 1 has been used to assess the relationship of plasma prothrombin to administered packed red blood cells (PRBC), clinical outcome and coagulation biomarkers (Prothrombin Time (PT), ROTEM EXTEM Coagulation Time (CT) and Maximum Clot Firmness (MCF)). ROC analyses have been performed to investigate the ability of admission coagulation biomarkers to predict low prothrombin concentration (database 1), massive transfusion and 24 h mortality (database 1 and 2). The importance of prothrombin was further investigated in vitro by PT and ROTEM assays in the presence of a prothrombin neutralizing monoclonal antibody and following step-wise dilution. RESULTS: Patients who survived the first 24 h had higher admission prothrombin levels compared to those who died (94 vs.67 IU/dL). Patients with lower transfusion requirements within the first 24 h (10 units of PRBCs) (95 vs.62 IU/dL). Admission PT, in comparison to admission ROTEM EXTEM CT and MCF, was found to be a better predictor of prothrombin concentration <60 IU/dL (AUC 0.94 in database 1), of massive transfusion (AUC 0.92 and 0.81 in database 1 and 2 respectively) and 24 h mortality (AUC 0.90 and 0.78 in database 1 and 2, respectively). In vitro experiments supported a critical role for prothrombin in coagulation and demonstrated that PT and ROTEM EXTEM CT are sensitive methods to measure low prothrombin concentration. DISCUSSION: Our analyses suggest that prothrombin concentration at admission is predictive of mortality and transfusion and indicates that prothrombin and fibrinogen are rate limiting in coagulopathy. CONCLUSIONS: Admission PT is predictive of low prothrombin concentration and clinical outcome. PT could therefore be used as a surrogate for prothrombin concentration and further evaluation of point-of-care devices for faster PT analysis is warranted. FAU - Balendran, Clare A AU - Balendran CA AD - Personalised HealthCare and Biomarkers, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. Clare.a.balendran@astrazeneca.com. FAU - Lovgren, Ann AU - Lovgren A AD - Cardiovascular and Metabolic Diseases, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. AD - Present address: Leaflet Biotech Consulting, Jungfrudansen 8, 171 56, Solna, Sweden. FAU - Hansson, Kenny M AU - Hansson KM AD - Cardiovascular and Metabolic Diseases, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. FAU - Nelander, Karin AU - Nelander K AD - Early Clinical Development, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. FAU - Olsson, Marita AU - Olsson M AD - Early Clinical Development, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. FAU - Johansson, Karin J AU - Johansson KJ AD - Cardiovascular and Metabolic Diseases, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Fries, Dietmar AU - Fries D AD - Department of General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. FAU - Berggren, Anders AU - Berggren A AD - Early Clinical Development, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Pepparedsleden 1, Molndal, 431 83, Sweden. LA - eng PT - Journal Article PT - Observational Study DEP - 20170314 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Adult MH - Female MH - Hemorrhage/*therapy MH - Humans MH - Hypoprothrombinemias/*diagnosis MH - Male MH - Middle Aged MH - Plasma MH - *Predictive Value of Tests MH - Prospective Studies MH - *Prothrombin Time MH - Treatment Outcome MH - Young Adult PMC - PMC5348885 OTO - NOTNLM OT - Biomarker OT - Coagulopathy OT - PT OT - Prothrombin OT - ROTEM OT - Severe bleeding EDAT- 2017/03/16 06:00 MHDA- 2017/10/12 06:00 PMCR- 2017/03/14 CRDT- 2017/03/16 06:00 PHST- 2016/07/21 00:00 [received] PHST- 2016/11/18 00:00 [accepted] PHST- 2017/03/16 06:00 [entrez] PHST- 2017/03/16 06:00 [pubmed] PHST- 2017/10/12 06:00 [medline] PHST- 2017/03/14 00:00 [pmc-release] AID - 10.1186/s13049-016-0332-2 [pii] AID - 332 [pii] AID - 10.1186/s13049-016-0332-2 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2017 Mar 14;25(1):30. doi: 10.1186/s13049-016-0332-2. PMID- 28271065 OWN - NLM STAT- MEDLINE DCOM- 20170320 LR - 20181113 IS - 2314-6141 (Electronic) IS - 2314-6133 (Print) VI - 2017 DP - 2017 TI - The Reliability of the Tracheoesophageal Groove and the Ligament of Berry as Landmarks for Identifying the Recurrent Laryngeal Nerve: A Cadaveric Study and Meta-Analysis. PG - 4357591 LID - 10.1155/2017/4357591 [doi] LID - 4357591 AB - Purpose. The aim of this meta-analysis was to provide a comprehensive evidence-based assessment, supplemented by cadaveric dissections, of the value of using the Ligament of Berry and Tracheoesophageal Groove as anatomical landmarks for identifying the Recurrent Laryngeal Nerve. Methods. Seven major databases were searched to identify studies for inclusion. Eligibility was judged by two reviewers. Suitable studies were identified and extracted. MetaXL was used for analysis. All pooled prevalence rates were calculated using a random effects model. Heterogeneity among included studies was assessed using the Chi(2) test and the I(2) statistic. Results. Sixteen studies (n = 2,470 nerves), including original cadaveric data, were analyzed for the BL/RLN relationship. The RLN was most often located superficial to the BL with a pooled prevalence estimate of 78.2% of nerves, followed by deep to the BL in 14.8%. Twenty-three studies (n = 5,970 nerves) examined the RLN/TEG relationship. The RLN was located inside the TEG in 63.7% (95% CI: 55.3-77.7) of sides. Conclusions. Both the BL and TEG are landmarks that can help surgeons provide patients with complication-free procedures. Our analysis showed that the BL is a more consistent anatomical landmark than the TEG, but it is necessary to use both to prevent iatrogenic RLN injuries during thyroidectomies. FAU - Henry, Brandon Michael AU - Henry BM AUID- ORCID: 0000-0002-8047-338X AD - International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland. FAU - Sanna, Beatrice AU - Sanna B AD - Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy. FAU - Graves, Matthew J AU - Graves MJ AD - International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland. FAU - Sanna, Silvia AU - Sanna S AD - Department of Surgical Sciences, University of Cagliari, Sardinia, Italy. FAU - Vikse, Jens AU - Vikse J AD - International Evidence-Based Anatomy Working Group, Krakow, Poland; Division of Medicine, Stavanger University Hospital, Stavanger, Norway. FAU - Tomaszewska, Iwona M AU - Tomaszewska IM AUID- ORCID: 0000-0003-0952-5674 AD - Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland. FAU - Tubbs, R Shane AU - Tubbs RS AUID- ORCID: 0000-0003-1317-1047 AD - Seattle Science Foundation, Seattle, WA, USA. FAU - Tomaszewski, Krzysztof A AU - Tomaszewski KA AUID- ORCID: 0000-0001-5077-6948 AD - International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review DEP - 20170208 PL - United States TA - Biomed Res Int JT - BioMed research international JID - 101600173 SB - IM MH - Aged MH - *Anatomic Landmarks MH - Cadaver MH - Esophagus/anatomy & histology MH - Female MH - Humans MH - Ligaments/*anatomy & histology MH - Male MH - Recurrent Laryngeal Nerve/*anatomy & histology MH - Reproducibility of Results PMC - PMC5320377 COIS- The authors declare no conflict of interests. EDAT- 2017/03/09 06:00 MHDA- 2017/03/21 06:00 PMCR- 2017/02/08 CRDT- 2017/03/09 06:00 PHST- 2016/12/14 00:00 [received] PHST- 2016/12/30 00:00 [revised] PHST- 2017/01/04 00:00 [accepted] PHST- 2017/03/09 06:00 [entrez] PHST- 2017/03/09 06:00 [pubmed] PHST- 2017/03/21 06:00 [medline] PHST- 2017/02/08 00:00 [pmc-release] AID - 10.1155/2017/4357591 [doi] PST - ppublish SO - Biomed Res Int. 2017;2017:4357591. doi: 10.1155/2017/4357591. Epub 2017 Feb 8. PMID- 28257393 OWN - NLM STAT- MEDLINE DCOM- 20170719 LR - 20181010 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 82 IP - 5 DP - 2017 May TI - Potential role of platelet-leukocyte aggregation in trauma-induced coagulopathy: Ex vivo findings. PG - 921-926 LID - 10.1097/TA.0000000000001410 [doi] AB - BACKGROUND: Platelet dysfunction has been identified as an important contributor of trauma-induced coagulopathy, but the underlying mechanism still remains to be elucidated. Trauma-associated proinflammatory stimuli strongly activate leukocytes, which in turn bind activated platelets. Therefore, we investigated the role of platelet-leukocyte aggregation (PLA) as a potential feature of trauma-induced platelet dysfunction. METHODS: Whole blood from 10 healthy donors was exposed to selective and collective platelet and leukocyte agonists in order to simulate differential states of activation. PLA formation and CD11b expression as a measure of leukocyte activation were determined by flow cytometry. Platelet-mediated hemostatic function was measured by thromboelastometry (ROTEM) and impedance aggregometry (Multiplate). RESULTS: Activation of platelets and leukocytes was associated with diminished platelet-mediated hemostatic potential. Aggregation of platelets with monocytes rather than granulocytes resulted in a reduction of hemostatic function, as indicated by an impaired responsiveness in platelet aggregometry and a reduction of thromboelastometric maximum clot firmness. This finding was irrespective of CD11b expression and was not paralleled by a reduction of measurable platelet counts. CONCLUSION: PLA formation occurs primarily between monocytes and activated platelets and is associated with impaired platelet-mediated hemostatic function. PLA formation was not paralleled by a reduction in platelet complete blood counts. FAU - Zipperle, Johannes AU - Zipperle J AD - From the Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (J.Z., K.A., M.P., C.J.S., S.B., H.R., H.S.), AUVA Research Centre, Vienna; Department of Anaesthesiology and Intensive Care (M.P.), AUVA Trauma Centre, Linz, Austria; Department of Anaesthesia, Critical Care and Pain Medicine (C.J.S.), Royal Infirmary of Edinburgh, Scotland, United Kingdom; Core Facility Flow Cytometry and Surgical Research Laboratories (A.S.), Medical University of Vienna, Vienna, Austria; and Department of Anaesthesiology and Intensive Care (H.S.), AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria. FAU - Altenburger, Katrin AU - Altenburger K FAU - Ponschab, Martin AU - Ponschab M FAU - Schlimp, Christoph J AU - Schlimp CJ FAU - Spittler, Andreas AU - Spittler A FAU - Bahrami, Soheyl AU - Bahrami S FAU - Redl, Heinz AU - Redl H FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/*etiology/physiopathology MH - Flow Cytometry MH - Hemostasis/physiology MH - Humans MH - Leukocytes/*physiology MH - Monocytes/physiology MH - Platelet Aggregation/*physiology MH - Thrombelastography MH - Wounds and Injuries/*complications EDAT- 2017/03/04 06:00 MHDA- 2017/07/20 06:00 CRDT- 2017/03/04 06:00 PHST- 2017/03/04 06:00 [pubmed] PHST- 2017/07/20 06:00 [medline] PHST- 2017/03/04 06:00 [entrez] AID - 10.1097/TA.0000000000001410 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 May;82(5):921-926. doi: 10.1097/TA.0000000000001410. PMID- 29766077 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220317 IS - 2397-5776 (Electronic) IS - 2397-5776 (Linking) VI - 2 IP - 1 DP - 2017 TI - Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study. PG - e000049 LID - 10.1136/tsaco-2016-000049 [doi] LID - e000049 AB - BACKGROUND: Acute coagulopathy of trauma is associated with high mortality and extensive use of blood products. Hemostatic resuscitation, the early administration of blood products with higher ratios of procoagulant components, may improve trauma outcomes in select cases, but can also worsen outcome if inappropriately used. Evolving approaches to hemostatic resuscitation utilize viscoelastic tests to provide a more rational basis for choosing blood component therapy regimens, but these tests are logistically rigorous. We hypothesized that coagulopathy could be detected by the failure of blood clots to remain intact when subjected to a predefined impact force. METHODS: We aim to develop a point-of-injury test for coagulopathy. We created coagulopathic blood using an ex vivo normal saline (NS) dilution model and allowed blood of varying dilutions to clot, then examined the behavior of the clotted blood when subjected to a uniform gravitationally induced sheer force. RESULTS: Clots created from coagulopatic blood (diluted to /=92% sensitivity and >/=95% specificity. The automated TEG(R)6s NOAC assay may be an effective tool to identify an anticoagulant effect from NOAC therapy and facilitate care of patients with bleeding or at risk of bleeding in the event of needing emergency surgery. FAU - Bliden, Kevin P AU - Bliden KP AD - Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, USA. FAU - Chaudhary, Rahul AU - Chaudhary R AD - Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, USA. FAU - Mohammed, Nafees AU - Mohammed N AD - Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, USA. FAU - Muresan, Adina A AU - Muresan AA AD - Haemonetics Corporation, Braintree, MA, USA. FAU - Lopez-Espina, Carlos G AU - Lopez-Espina CG AD - Haemonetics Corporation, Braintree, MA, USA. FAU - Cohen, Eli AU - Cohen E AD - Coramed Technologies, Niles, IL, USA. FAU - Raviv, Gabriel AU - Raviv G AD - Coramed Technologies, Niles, IL, USA. FAU - Doubleday, Marc AU - Doubleday M AD - Haemonetics Corporation, Braintree, MA, USA. FAU - Zaman, Fowzia AU - Zaman F AD - Haemonetics Corporation, Braintree, MA, USA. FAU - Mathew, Blessy AU - Mathew B AD - Haemonetics Corporation, Braintree, MA, USA. FAU - Tantry, Udaya S AU - Tantry US AD - Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, USA. FAU - Gurbel, Paul A AU - Gurbel PA AD - Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, USA. Paul.Gurbel@inova.org. LA - eng PT - Journal Article PL - Netherlands TA - J Thromb Thrombolysis JT - Journal of thrombosis and thrombolysis JID - 9502018 RN - 0 (Anticoagulants) RN - 0 (Antithrombins) RN - 0 (Factor Xa Inhibitors) RN - 0 (Pyrazoles) RN - 0 (Pyridones) RN - 3Z9Y7UWC1J (apixaban) RN - 9NDF7JZ4M3 (Rivaroxaban) RN - I0VM4M70GC (Dabigatran) SB - IM MH - Adult MH - Anticoagulants/*therapeutic use MH - Antithrombins/therapeutic use MH - Automation MH - Dabigatran/therapeutic use MH - Drug Monitoring/instrumentation/methods/standards MH - Factor Xa Inhibitors/therapeutic use MH - Female MH - Hemorrhage/chemically induced/diagnosis MH - Humans MH - Limit of Detection MH - Male MH - Middle Aged MH - Point-of-Care Systems MH - Pyrazoles/therapeutic use MH - Pyridones/therapeutic use MH - Rivaroxaban/therapeutic use MH - Thrombelastography/instrumentation/*methods/standards OTO - NOTNLM OT - Novel oral anticoagulants (NOAC) OT - Point-of-care OT - TEG-6s OT - Thrombelastography EDAT- 2017/03/02 06:00 MHDA- 2017/04/18 06:00 CRDT- 2017/03/02 06:00 PHST- 2017/03/02 06:00 [pubmed] PHST- 2017/04/18 06:00 [medline] PHST- 2017/03/02 06:00 [entrez] AID - 10.1007/s11239-017-1477-1 [pii] AID - 10.1007/s11239-017-1477-1 [doi] PST - ppublish SO - J Thromb Thrombolysis. 2017 May;43(4):437-445. doi: 10.1007/s11239-017-1477-1. PMID- 28240645 OWN - NLM STAT- MEDLINE DCOM- 20170517 LR - 20220330 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 30 IP - 2 DP - 2017 Apr TI - Point-of-care monitoring for the management of trauma-induced bleeding. PG - 250-256 LID - 10.1097/ACO.0000000000000448 [doi] AB - PURPOSE OF REVIEW: Knowledge of trauma-induced coagulopathy has been grown in the past and point-of-care suitable devices for coagulation testing have been introduced. Methodology and clinical application of different systems for point-of-care coagulation monitoring are shown with a focus on thrombelastography as measured by TEG, rotational thromboelastometry as measured by ROTEM and impedance aggregometry as measured by the multiplate analyser and ROTEM platelet. RECENT FINDINGS: Two different methods for point-of-care coagulation assessment are available: viscoelastic tests (ROTEM, TEG) and impedance aggregometry. In different settings these methods have been evaluated in various publications pointing out the possibility of reducing transfusion requirements, transfusion-related side effects, and resulting costs. SUMMARY: Point-of-care assessment of coagulation in trauma patients appears to be at least promising. However, because published data mostly are of retrospective or observational nature only, there is a need for prospective, randomized and controlled studies. FAU - Hanke, Alexander A AU - Hanke AA AD - aKlinik fur Anasthesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover bKlinik fur Orthopadie, Diakovere Annastift cKlinik fur Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany. FAU - Horstmann, Hauke AU - Horstmann H FAU - Wilhelmi, Michaela AU - Wilhelmi M LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Blood Coagulation Tests/instrumentation/*methods MH - Blood Transfusion MH - Hemorrhage/diagnosis/etiology/*therapy MH - Humans MH - Monitoring, Physiologic/instrumentation/*methods MH - *Point-of-Care Systems MH - Wounds and Injuries/*complications/therapy EDAT- 2017/02/28 06:00 MHDA- 2017/05/18 06:00 CRDT- 2017/02/28 06:00 PHST- 2017/02/28 06:00 [pubmed] PHST- 2017/05/18 06:00 [medline] PHST- 2017/02/28 06:00 [entrez] AID - 10.1097/ACO.0000000000000448 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2017 Apr;30(2):250-256. doi: 10.1097/ACO.0000000000000448. PMID- 28236302 OWN - NLM STAT- MEDLINE DCOM- 20170504 LR - 20220410 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 57 IP - 5 DP - 2017 May TI - Pathogen inactivation treatment of plasma and platelet concentrates and their predicted functionality in massive transfusion protocols. PG - 1208-1217 LID - 10.1111/trf.14043 [doi] AB - BACKGROUND: Trauma transfusion packages for hemorrhage control consist of red blood cells, plasma, and platelets at a set ratio. Although pathogen reduction improves the transfusion safety of platelet and plasma units, there is an associated reduction in quality. This study aimed to investigate the impact of riboflavin/ultraviolet light-treated plasma or platelets in transfusion trauma packages composed of red blood cell, plasma, and platelet units in a ratio of 1:1:1 in vitro by modeling transfusion scenarios for trauma patients and assessing function by rotational thromboelastometry. STUDY DESIGN AND METHODS: Pathogen-reduced or untreated plasma and buffy coat platelet concentrate units produced in plasma were used in different combinations with red blood cells in trauma transfusion packages. After reconstitution of these packages with hemodiluted blood, the hemostatic functionality was analyzed by rotational thromboelastometry. RESULTS: Hemostatic profiles of pathogen-inactivated buffy coat platelet concentrate and plasma indicated decreased activity compared with their respective controls. Reconstitution of hemodiluted blood (hematocrit = 20%) with packages that contained treated or nontreated components resulted in increased alpha and maximum clot firmness and enhanced clot-formation time. Simulating transfusion scenarios based on 30% blood replacement with a transfusion trauma package resulted in a nonsignificant difference in rotational thromboelastometry parameters between packages containing treated and nontreated blood components (p >/= 0.05). Effects of pathogen inactivation treatment were evident when the trauma package percentage was 50% or greater and contained both pathogen inactivation-treated plasma and buffy coat platelet concentrate. CONCLUSION: Rotational thromboelastometry investigations suggest that there is relatively little impact of pathogen inactivation treatment on whole blood clot formation unless large amounts of treated components are used. CI - (c) 2017 AABB. FAU - Arbaeen, Ahmad F AU - Arbaeen AF AD - Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Faculty of Applied Medical Sciences, Department Laboratory Medicine, Umm al-Qura University, Makkah Al Mukarramah, Saudi Arabia. FAU - Schubert, Peter AU - Schubert P AD - Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Serrano, Katherine AU - Serrano K AD - Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Carter, Cedric J AU - Carter CJ AD - Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Culibrk, Brankica AU - Culibrk B AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. FAU - Devine, Dana V AU - Devine DV AD - Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. AD - Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20170224 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - TLM2976OFR (Riboflavin) SB - IM MH - Blood Component Transfusion/*methods/standards MH - Blood Platelets MH - Disinfection/*methods/standards MH - Hemodilution MH - Hemorrhage/prevention & control MH - Hemostatic Techniques MH - Humans MH - Plasma MH - *Quality Control MH - Riboflavin/adverse effects MH - Thrombelastography/*methods MH - Ultraviolet Rays/adverse effects EDAT- 2017/02/27 06:00 MHDA- 2017/05/05 06:00 CRDT- 2017/02/26 06:00 PHST- 2016/12/19 00:00 [received] PHST- 2017/01/04 00:00 [revised] PHST- 2017/01/04 00:00 [accepted] PHST- 2017/02/27 06:00 [pubmed] PHST- 2017/05/05 06:00 [medline] PHST- 2017/02/26 06:00 [entrez] AID - 10.1111/trf.14043 [doi] PST - ppublish SO - Transfusion. 2017 May;57(5):1208-1217. doi: 10.1111/trf.14043. Epub 2017 Feb 24. PMID- 28226413 OWN - NLM STAT- MEDLINE DCOM- 20180216 LR - 20250530 IS - 1600-6143 (Electronic) IS - 1600-6135 (Print) IS - 1600-6135 (Linking) VI - 17 IP - 8 DP - 2017 Aug TI - Thrombalexin: Use of a Cytotopic Anticoagulant to Reduce Thrombotic Microangiopathy in a Highly Sensitized Model of Kidney Transplantation. PG - 2055-2064 LID - 10.1111/ajt.14234 [doi] AB - Early activation of coagulation is an important factor in the initiation of innate immunity, as characterized by thrombotic microangiopathy (TMA). In transplantation, systemic anticoagulation is difficult due to bleeding. A novel "cytotopic" agent, thrombalexin (TLN), combines a cell-membrane-bound (myristoyl tail) anti-thrombin (hirudin-like peptide [HLL]), which can be perfused directly to the donor organ or cells. Thromboelastography was used to measure time to clot formation (r-time) in both rhesus and human blood, comparing TLN versus HLL (without cytotopic tail) versus negative control. Both TLN- and HLL-treated rhesus or human whole blood result in significantly prolonged r-time compared to kaolin controls. Only TLN-treated human endothelial cells and neonatal porcine islets prolonged time to clot formation. Detection of membrane-bound TLN was confirmed by immunohistochemistry and fluorescence activated cell sorter. In vivo, perfusion of a nonhuman primate kidney TLN-supplemented preservation solution in a sensitized model of transplantation demonstrated no evidence of TLN systemically. Histologically, TLN was shown to be present up to 4 days after transplantation. There was no platelet deposition, and TMA severity, as well as microvascular injury scores (glomerulitis + peritubular capillaritis), were less in the TLN-treated animals. Despite promising evidence of localized efficacy, no survival benefit was demonstrated. CI - (c) 2017 The American Society of Transplantation and the American Society of Transplant Surgeons. FAU - Manook, M AU - Manook M AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. AD - Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Kwun, J AU - Kwun J AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Burghuber, C AU - Burghuber C AD - Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria. FAU - Samy, K AU - Samy K AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Mulvihill, M AU - Mulvihill M AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Yoon, J AU - Yoon J AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Xu, H AU - Xu H AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - MacDonald, A L AU - MacDonald AL AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Freischlag, K AU - Freischlag K AUID- ORCID: 0000-0002-0234-5235 AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Curfman, V AU - Curfman V AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Branum, E AU - Branum E AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Howell, D AU - Howell D AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. FAU - Farris, A B AU - Farris AB AD - Department of Pathology, Emory University Hospital, Atlanta, GA. FAU - Smith, R A AU - Smith RA AD - MRC Centre for Transplantation, King's College, London, UK. FAU - Sacks, S AU - Sacks S AD - MRC Centre for Transplantation, King's College, London, UK. FAU - Dorling, A AU - Dorling A AD - MRC Centre for Transplantation, King's College, London, UK. FAU - Mamode, N AU - Mamode N AD - Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Knechtle, S J AU - Knechtle SJ AD - Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC. LA - eng GR - G0401591/MRC_/Medical Research Council/United Kingdom GR - U24 AI126683/AI/NIAID NIH HHS/United States GR - MR/J006742/1/MRC_/Medical Research Council/United Kingdom GR - U19 AI051731/AI/NIAID NIH HHS/United States GR - MC_PC_15031/MRC_/Medical Research Council/United Kingdom GR - G1001197/MRC_/Medical Research Council/United Kingdom GR - R24 OD010976/OD/NIH HHS/United States GR - G0600892/MRC_/Medical Research Council/United Kingdom PT - Journal Article DEP - 20170323 PL - United States TA - Am J Transplant JT - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JID - 100968638 RN - 0 (Anticoagulants) RN - 0 (Peptides) RN - 0 (thrombalexin) SB - IM EIN - Am J Transplant. 2017 Nov;17(11):2993. doi: 10.1111/ajt.14501. PMID: 29083552 MH - Animals MH - Anticoagulants/*pharmacology MH - Blood Coagulation/*drug effects MH - Humans MH - Kidney Transplantation/*adverse effects MH - Macaca mulatta MH - Male MH - Peptides/blood/*pharmacology MH - Perfusion MH - Thrombotic Microangiopathies/etiology/pathology/*prevention & control PMC - PMC5519442 MID - NIHMS855003 OTO - NOTNLM OT - alloantibody OT - animal models: nonhuman primate OT - basic (laboratory) research/science OT - coagulation and hemostasis OT - islet transplantation OT - organ perfusion and preservation OT - organ transplantation in general OT - thrombosis and thromboembolism COIS- Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. EDAT- 2017/02/23 06:00 MHDA- 2018/02/17 06:00 PMCR- 2018/08/01 CRDT- 2017/02/23 06:00 PHST- 2016/06/11 00:00 [received] PHST- 2017/01/04 00:00 [revised] PHST- 2017/01/26 00:00 [accepted] PHST- 2017/02/23 06:00 [pubmed] PHST- 2018/02/17 06:00 [medline] PHST- 2017/02/23 06:00 [entrez] PHST- 2018/08/01 00:00 [pmc-release] AID - S1600-6135(22)25089-8 [pii] AID - 10.1111/ajt.14234 [doi] PST - ppublish SO - Am J Transplant. 2017 Aug;17(8):2055-2064. doi: 10.1111/ajt.14234. Epub 2017 Mar 23. PMID- 28219085 OWN - NLM STAT- MEDLINE DCOM- 20170502 LR - 20180110 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 2 DP - 2017 Mar TI - Fibrinolysis in Trauma: "Myth," "Reality," or "Something in Between". PG - 200-212 LID - 10.1055/s-0036-1597900 [doi] AB - The emphasis on fibrinolysis as an important contributor to trauma-induced coagulopathy (TIC) has led to a debate regarding the relative clinical significance of fibrinolysis in the setting of trauma. The debate has centered on two camps. The one camp defines fibrinolysis in trauma by standard coagulation tests as well as fibrin split products, D-dimers, and plasmin/antiplasmin levels. This camp favors a more liberal use of tranexamic acid and attributes more significance to hyperfibrinolysis in TIC. The other camp favors a definition of fibrinolysis based on the viscoelastic tests (VET), rotational thromboelastometry (ROTEM), and thromboelastography (TEG). These whole blood assays define hyperfibrinolysis at a higher threshold than plasma-based tests. Therefore, this VET camp reserves antifibrinolytic treatment for patients who demonstrate severe coagulopathy associated with hyperfibrinolysis. This bimodal attribution of the clinical relevance of fibrinolysis in trauma suggests that there may be an underlying "Myth" of the concept of TIC that was historically defined by plasma-based tests and a future "Reality" of the concept of TIC that is grounded on an understanding of TIC based on a VET-defined "fibrinolytic spectrum" of TIC. This narrative review explores this "Myth" and "Reality" of fibrinolysis in TIC and proposes a direction that will allow a "Future" interpretation of TIC that incorporates both the past "Myth" and present "Reality" of fibrinolysis TIC. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Walsh, Mark AU - Walsh M AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Shreve, Jacob AU - Shreve J AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Thomas, Scott AU - Thomas S AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Moore, Ernest AU - Moore E AD - Department of Surgery, Denver General Hospital, Denver, Colorado. FAU - Moore, Hunter AU - Moore H AD - Department of Surgery, Denver General Hospital, Denver, Colorado. FAU - Hake, Daniel AU - Hake D AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Pohlman, Tim AU - Pohlman T AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Davis, Patrick AU - Davis P AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Ploplis, Victoria AU - Ploplis V AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana. FAU - Piscoya, Andres AU - Piscoya A AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Wegner, Julie AU - Wegner J AD - Department of Surgery, Midwestern University Clinic, University of Arizona, Glendale, Arizona. FAU - Bryant, John AU - Bryant J AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Crepinsek, Anton AU - Crepinsek A AD - Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana. FAU - Lantry, James AU - Lantry J AD - Department of Defense, ECMO Inpatient and Transport Programs, San Antonio Military Medicine Center/SAUSHEC, San Antonia, Texas. FAU - Sheppard, Forest AU - Sheppard F AD - Department Head, Expeditionary and Trauma Medicine, Naval Medical Research Unit, San Antonio, Texas. FAU - Castellino, Francis AU - Castellino F AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana. LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review DEP - 20170220 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Fibrinolysis/*physiology MH - Humans MH - Wounds and Injuries/*blood EDAT- 2017/02/22 06:00 MHDA- 2017/05/04 06:00 CRDT- 2017/02/21 06:00 PHST- 2017/02/22 06:00 [pubmed] PHST- 2017/05/04 06:00 [medline] PHST- 2017/02/21 06:00 [entrez] AID - 10.1055/s-0036-1597900 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Mar;43(2):200-212. doi: 10.1055/s-0036-1597900. Epub 2017 Feb 20. PMID- 28219084 OWN - NLM STAT- MEDLINE DCOM- 20170502 LR - 20170502 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 43 IP - 2 DP - 2017 Mar TI - Diagnosis and Treatment of Hyperfibrinolysis in Trauma (A European Perspective). PG - 224-234 LID - 10.1055/s-0036-1598001 [doi] AB - Fibrinolysis activation occurs almost universally after severe trauma. Systemic hyperfibrinolysis is a key component of acute traumatic coagulopathy and associated with poor clinical outcomes, although controversy exists over optimal treatment strategies. The mechanistic drivers and dynamics of fibrinolytic activation in response to injury and trauma resuscitation are currently unclear. Furthermore, therapeutic triggers are compounded by the lack of a sensitive and rapid diagnostic tool, with discrepancy between hyperfibrinolysis diagnosed by viscoelastic hemostatic assays versus biomarkers for fibrinolysis. Rotational thromboelastometry and thromboelastography appear capable of detecting the severest forms of hyperfibrinolysis but are relatively insensitive to moderate, yet clinically significant fibrinolytic activation. Rapid evaluation of the current status of the fibrinolytic system remains a challenge and therefore the decision whether to administer an antifibrinolytic agent should be based on available evidence from clinical trials. In line with current European guidelines, we recommend that all bleeding trauma patients, and in particular, severely injured patients with evidence of hemorrhagic shock, should receive early empiric tranexamic acid. This review explains our current knowledge of the pathophysiological pathways which induce hyperfibrinolysis in trauma hemorrhage, evaluates the available diagnostic modalities, and describes current treatment strategies. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Gall, Lewis S AU - Gall LS AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Brohi, Karim AU - Brohi K AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Davenport, Ross A AU - Davenport RA AD - Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. LA - eng PT - Journal Article PT - Review DEP - 20170220 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Fibrinolysis/*physiology MH - Humans MH - Wounds and Injuries/*blood/*drug therapy EDAT- 2017/02/22 06:00 MHDA- 2017/05/04 06:00 CRDT- 2017/02/21 06:00 PHST- 2017/02/22 06:00 [pubmed] PHST- 2017/05/04 06:00 [medline] PHST- 2017/02/21 06:00 [entrez] AID - 10.1055/s-0036-1598001 [doi] PST - ppublish SO - Semin Thromb Hemost. 2017 Mar;43(2):224-234. doi: 10.1055/s-0036-1598001. Epub 2017 Feb 20. PMID- 28190445 OWN - NLM STAT- MEDLINE DCOM- 20170327 LR - 20170327 IS - 0072-9752 (Print) IS - 0072-9752 (Linking) VI - 141 DP - 2017 TI - Management of neurologic complications of coagulopathies. PG - 743-764 LID - B978-0-444-63599-0.00040-5 [pii] LID - 10.1016/B978-0-444-63599-0.00040-5 [doi] AB - Coagulopathy is common in intensive care units (ICUs). Many physiologic derangements lead to dysfunctional hemostasis; these may be either congenital or acquired. The most devastating outcome of coagulopathy in the critically ill is major bleeding, defined by transfusion requirement, hemodynamic instability, or intracranial hemorrhage. ICU coagulopathy often poses complex management dilemmas, as bleeding risk must be tempered with thrombotic potential. Coagulopathy associated with intracranial hemorrhage bears directly on prognosis and outcome. There is a paucity of high-quality evidence for the management of coagulopathies in neurocritical care; however, data derived from studies of patients with intraparenchymal hemorrhage may inform treatment decisions. Coagulopathy is often broadly defined as any derangement of hemostasis resulting in either excessive bleeding or clotting, although most typically it is defined as impaired clot formation. Abnormalities in coagulation testing without overt clinical bleeding may also be considered evidence of coagulopathy. This chapter will focus on acquired conditions, such as organ failure, pharmacologic therapies, and platelet dysfunction that are associated with defective clot formation and result in, or exacerbate, intracranial hemorrhage, specifically spontaneous intraparenchymal hemorrhage and traumatic brain injury. CI - (c) 2017 Elsevier B.V. All rights reserved. FAU - Vanderwerf, J D AU - Vanderwerf JD AD - Department of Neurology, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. FAU - Kumar, M A AU - Kumar MA AD - Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Monisha.Kumar@uphs.upenn.edu. LA - eng PT - Journal Article PT - Review PL - Netherlands TA - Handb Clin Neurol JT - Handbook of clinical neurology JID - 0166161 SB - IM MH - Blood Coagulation Disorders/*complications MH - *Disease Management MH - Humans MH - *Nervous System Diseases/diagnosis/etiology/therapy OTO - NOTNLM OT - bleeding OT - blood coagulation factors OT - blood coagulation tests OT - coagulopathy OT - coagulopathy of trauma OT - hemostasis OT - intracerebral hemorrhage OT - intracranial hemorrhage OT - intraparenchymal hemorrhage OT - thrombelastography EDAT- 2017/02/14 06:00 MHDA- 2017/03/28 06:00 CRDT- 2017/02/14 06:00 PHST- 2017/02/14 06:00 [entrez] PHST- 2017/02/14 06:00 [pubmed] PHST- 2017/03/28 06:00 [medline] AID - B978-0-444-63599-0.00040-5 [pii] AID - 10.1016/B978-0-444-63599-0.00040-5 [doi] PST - ppublish SO - Handb Clin Neurol. 2017;141:743-764. doi: 10.1016/B978-0-444-63599-0.00040-5. PMID- 28153582 OWN - NLM STAT- MEDLINE DCOM- 20180403 LR - 20220321 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 43 IP - 5 DP - 2017 Aug TI - Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit. PG - 1083-1087 LID - S0305-4179(17)30031-1 [pii] LID - 10.1016/j.burns.2017.01.016 [doi] AB - INTRODUCTION: Emerging antimicrobial resistance in nosocomial bacterial isolates, limits the available treatment options for burn wound infections, among them multi-drug resistant Gram negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are major contributors to the increase in morbidity and mortality rates. MATERIAL AND METHODS: A retrospective cross-sectional study was done in the Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi. A total of 818 wound samples from patients admitted in the burn wards and Intensive Care Units (ICUs) examined between 2010-2014 (5 years period). Pseudomonas aeruginosa was found as the most common isolate (37%) followed by Klebsiella pneumoniae (15%) and Acinetobacter baumanii (12%) among Gram negative organisms while S. aureus (12%) remained the major isolates among Gram positive organisms. A significant decrease in incidence of Gram positive organisms was observed in comparison with previous study. However, resistance to ceftazidime and aminoglycosides were increased significantly in Gram negative organisms. Multi-drug resistant P. aeruginosa (MDR PA) accounted for 15.2%, multi-drug resistant A. baumanii (MDR AB) was prevalent in 13.8% and MRSA in 77.4% of burn wound infections. DISCUSSION AND CONCLUSION: Emerging bacterial drug resistance has both clinical and financial implications for the therapy of infected burn patients. Spectrum of bacterial drug resistance in an institution is important for epidemiological as well as clinical purposes. Rising frequency of MDR strains in burn patients is alarming for clinicians as it downgrades the treatment efficacy. CI - Copyright (c) 2017 Elsevier Ltd and ISBI. All rights reserved. FAU - Singh, Narendra Pal AU - Singh NP AD - Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-95, India. Electronic address: singhnanjna@yahoo.com. FAU - Rani, Mayuri AU - Rani M AD - Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-95, India. Electronic address: dr.mayurirani@gmail.com. FAU - Gupta, Kavita AU - Gupta K AD - Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-95, India. Electronic address: drkavitagupta2010@gmail.com. FAU - Sagar, Tanu AU - Sagar T AD - Department of Microbiology, All India Institute of Medical Sciences, Delhi, India. Electronic address: tanusagar18@gmail.com. FAU - Kaur, Iqbal Rajinder AU - Kaur IR AD - Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-95, India. Electronic address: iqbalrk@yahoo.com. LA - eng PT - Journal Article DEP - 20170130 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - 0 (Anti-Bacterial Agents) SB - IM CIN - Burns. 2019 Nov;45(7):1724-1725. doi: 10.1016/j.burns.2019.06.005. PMID: 31466924 MH - Anti-Bacterial Agents/pharmacology MH - Bacteria/drug effects MH - Bacterial Infections/epidemiology/*microbiology MH - Burn Units MH - Burns/*microbiology MH - Cross-Sectional Studies MH - *Drug Resistance, Bacterial MH - *Drug Resistance, Multiple, Bacterial MH - Humans MH - Microbial Sensitivity Tests MH - Retrospective Studies MH - Wound Infection/*microbiology OTO - NOTNLM OT - Antibiogram OT - Burn infections OT - Multi-drug resistant isolates OT - Therapeutic options EDAT- 2017/02/06 06:00 MHDA- 2018/04/04 06:00 CRDT- 2017/02/04 06:00 PHST- 2016/09/15 00:00 [received] PHST- 2016/12/10 00:00 [revised] PHST- 2017/01/07 00:00 [accepted] PHST- 2017/02/06 06:00 [pubmed] PHST- 2018/04/04 06:00 [medline] PHST- 2017/02/04 06:00 [entrez] AID - S0305-4179(17)30031-1 [pii] AID - 10.1016/j.burns.2017.01.016 [doi] PST - ppublish SO - Burns. 2017 Aug;43(5):1083-1087. doi: 10.1016/j.burns.2017.01.016. Epub 2017 Jan 30. PMID- 28151829 OWN - NLM STAT- MEDLINE DCOM- 20170517 LR - 20260127 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 30 IP - 2 DP - 2017 Apr TI - Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective. PG - 265-276 LID - 10.1097/ACO.0000000000000447 [doi] AB - PURPOSE OF REVIEW: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre. RECENT FINDINGS: Few topics in trauma resuscitation incite as much debate and controversy as to what constitutes the 'ideal' MHP. There is a widespread geographical and institutional variation in clinical practice. Three strategies are commonly utilized; fixed ratio major haemorrhage protocol (FRMHP), viscoelastic haemostatic assay (VHA)-guided MHP and hybrid MHP. The majority of trauma centres utilize an FRMHP and there is high-level evidence to support the use of high blood product ratios. It can be argued that the FRMHP is too simplistic to be applied to all trauma patients and that the use of VHA-guided MHP with predominant factor concentrate transfusion can allow rapid individualized interventions. In between these two strategies is a hybrid MHP, combining early FRMHP with subsequent VHA-guided transfusion. SUMMARY: There are advantages and disadvantages to each of the various MHP strategies and the evidence base to support one above another with any certainty is lacking at this time. One strategy cannot be considered superior to the other and the choice of MHP is dependent on interpretation of the current literature and local institutional logistical considerations. A number of exciting studies are currently underway that will certainly increase the evidence base and help inform clinical practice. FAU - Winearls, James AU - Winearls J AD - aGold Coast University Hospital, Southport, Queensland bSchool of Medicine, University of Queensland, Brisbane, Queensland cSchool of Medical Sciences, Griffith University, Gold Coast, Queensland dIntensive Care Unit, Gold Coast University Hospital, Southport, Queensland eNational Trauma Research Institute fThe Alfred Hospital gDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria hJoint Health Command, Australian Defence Force iBurns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland jRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia. FAU - Mitra, Biswadev AU - Mitra B FAU - Reade, Michael C AU - Reade MC LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) SB - IM MH - Australia MH - Blood Coagulation Disorders/*diagnosis/etiology/mortality/therapy MH - Blood Coagulation Factors/physiology/therapeutic use MH - Blood Coagulation Tests/*instrumentation/methods MH - Blood Transfusion/methods/*standards MH - *Clinical Protocols MH - Evidence-Based Emergency Medicine/methods MH - Fibrinolysis MH - Hemorrhage/diagnosis/etiology/mortality/*therapy MH - Humans MH - Point-of-Care Systems MH - Practice Guidelines as Topic MH - Resuscitation/methods/*standards MH - Trauma Centers/standards/trends MH - Treatment Outcome MH - Wounds and Injuries/*complications EDAT- 2017/02/06 06:00 MHDA- 2017/05/18 06:00 CRDT- 2017/02/03 06:00 PHST- 2017/02/06 06:00 [pubmed] PHST- 2017/05/18 06:00 [medline] PHST- 2017/02/03 06:00 [entrez] AID - 10.1097/ACO.0000000000000447 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2017 Apr;30(2):265-276. doi: 10.1097/ACO.0000000000000447. PMID- 28131925 OWN - NLM STAT- MEDLINE DCOM- 20170809 LR - 20181202 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 224 IP - 4 DP - 2017 Apr TI - Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents. PG - 625-632 LID - S1072-7515(17)30085-6 [pii] LID - 10.1016/j.jamcollsurg.2016.12.046 [doi] AB - BACKGROUND: Acute coagulopathy of trauma in children is of potential importance to clinical outcomes, but knowledge is limited and has only been investigated using conventional coagulation testing. The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children. STUDY DESIGN: Pediatric patients (younger than 17 years of age) who were admitted January 2010 to May 2016 and met highest-level trauma activation were included. Patients were divided into 2 groups (coagulopathy and controls) based on arrival rapid thrombelastography values. Coagulopathy was defined as the presence of any of the following on rapid thrombelastography: activated clotting time >/=128 seconds, alpha-angle /=3%. Logistic regression was used to adjust for age, sex, blood pressure, mechanism, and injury severity. RESULTS: Nine hundred and fifty-six patients met inclusion; 507 (57%) were coagulopathic and 449 (43%) were not (noncoagulopathic and control cohort). Coagulopathic patients were younger (median 14 vs 15 years) and more likely to be male (68% vs 60%) and Hispanic (38% vs 31%) (all p < 0.05). Coagulopathic patients received more RBC and plasma transfusions and had fewer ICU and ventilator-free days and higher mortality (12% vs 3%; all p < 0.05). Of these 956, 197 (21%) sustained severe brain injury-123 (62%) were coagulopathic and 74 (38%) were noncoagulopathic. The mortality difference was even greater for coagulopathic head injuries (31% vs 10%; p = 0.002). Adjusting for confounders, admission coagulopathy was an independent predictor of death, with an odds ratio of 3.67 (95% CI 1.768 to 7.632; p < 0.001). CONCLUSIONS: Almost 60% of severely injured children and adolescents arrive with evidence of acute traumatic coagulopathy. The presence of admission coagulopathy is associated with high mortality in children, especially among those with head injuries. CI - Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Liras, Ioannis N AU - Liras IN AD - Department of Surgery, McGovern Medical School, Houston, TX. FAU - Caplan, Henry W AU - Caplan HW AD - Department of Surgery, McGovern Medical School, Houston, TX. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, McGovern Medical School, Houston, TX; The Center for Translational Injury Research, Houston, TX. FAU - Cox, Charles S AU - Cox CS AD - Department of Pediatric Surgery, McGovern Medical School, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, McGovern Medical School, Houston, TX; The Center for Translational Injury Research, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu. LA - eng PT - Journal Article DEP - 20170125 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM CIN - J Am Coll Surg. 2017 Apr;224(4):632-634. doi: 10.1016/j.jamcollsurg.2017.01.022. PMID: 28343506 MH - Acute Disease MH - Adolescent MH - Blood Coagulation Disorders/diagnosis/epidemiology/*etiology MH - Case-Control Studies MH - Child MH - Child, Preschool MH - Female MH - Health Resources/statistics & numerical data MH - Humans MH - Infant MH - Infant, Newborn MH - Injury Severity Score MH - Logistic Models MH - Male MH - Odds Ratio MH - Prevalence MH - Retrospective Studies MH - Thrombelastography MH - Treatment Outcome MH - Wounds and Injuries/mortality/*physiopathology/therapy EDAT- 2017/01/31 06:00 MHDA- 2017/08/10 06:00 CRDT- 2017/01/30 06:00 PHST- 2016/12/17 00:00 [received] PHST- 2016/12/19 00:00 [accepted] PHST- 2017/01/31 06:00 [pubmed] PHST- 2017/08/10 06:00 [medline] PHST- 2017/01/30 06:00 [entrez] AID - S1072-7515(17)30085-6 [pii] AID - 10.1016/j.jamcollsurg.2016.12.046 [doi] PST - ppublish SO - J Am Coll Surg. 2017 Apr;224(4):625-632. doi: 10.1016/j.jamcollsurg.2016.12.046. Epub 2017 Jan 25. PMID- 34798696 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211128 IS - 2052-0492 (Print) IS - 2052-0492 (Electronic) IS - 2052-0492 (Linking) VI - 5 IP - 1 DP - 2017 Jan 20 TI - Monitoring the coagulation status of trauma patients with viscoelastic devices. PG - 7 LID - 10.1186/s40560-016-0198-4 [doi] LID - 7 AB - Coagulopathy is a physiological response to massive bleeding that frequently occurs after severe trauma and is an independent predictive factor for mortality. Therefore, it is very important to grasp the coagulation status of patients with severe trauma quickly and accurately in order to establish the therapeutic strategy. Judging from the description in the European guidelines, the importance of viscoelastic devices in understanding the disease condition of patients with traumatic coagulopathy has been widely recognized in Europe. In the USA, the ACS TQIP Massive Transfusion in Trauma Guidelines proposed by the American College of Surgeons in 2013 presented the test results obtained by the viscoelastic devices, TEG(R) 5000 and ROTEM(R), as the standard for transfusion or injection of blood plasma, cryoprecipitate, platelet concentrate, or anti-fibrinolytic agents in the treatment strategy for traumatic coagulopathy and hemorrhagic shock. However, some studies have reported limitations of these viscoelastic devices. A review in the Cochrane Library published in 2015 pointed out the presence of biases in the abovementioned reports in trauma patients and the absence of a quality study in this field thus far. A quality study on the relationship between traumatic coagulopathy and viscoelastic devices is needed. CI - (c) 2017. The Author(s). FAU - Sakamoto, Yuichiro AU - Sakamoto Y AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan. sakamoy@cc.saga-u.ac.jp. FAU - Koami, Hiroyuki AU - Koami H AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan. FAU - Miike, Toru AU - Miike T AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan. LA - eng PT - Journal Article PT - Review DEP - 20170120 PL - England TA - J Intensive Care JT - Journal of intensive care JID - 101627304 PMC - PMC8600748 OTO - NOTNLM OT - Abciximab OT - Activate Partial Thromboplastin Time OT - Disseminate Intravascular Coagulation OT - Injury Severity Score OT - Tranexamic Acid COIS- SY has received speaking fees from Asahi Kasei. EDAT- 2017/01/20 00:00 MHDA- 2017/01/20 00:01 PMCR- 2017/01/20 CRDT- 2021/11/20 01:00 PHST- 2016/09/01 00:00 [received] PHST- 2016/12/17 00:00 [accepted] PHST- 2021/11/20 01:00 [entrez] PHST- 2017/01/20 00:00 [pubmed] PHST- 2017/01/20 00:01 [medline] PHST- 2017/01/20 00:00 [pmc-release] AID - 10.1186/s40560-016-0198-4 [pii] AID - 198 [pii] AID - 10.1186/s40560-016-0198-4 [doi] PST - epublish SO - J Intensive Care. 2017 Jan 20;5(1):7. doi: 10.1186/s40560-016-0198-4. PMID- 28093623 OWN - NLM STAT- MEDLINE DCOM- 20180425 LR - 20260127 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 43 IP - 4 DP - 2017 Aug TI - What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan. PG - 431-438 LID - 10.1007/s00068-016-0756-4 [doi] AB - PURPOSE: The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM). METHODS: Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study. We evaluated (1) the characteristics of T-DIC, (2) the relationships between T-DIC and each parameter of the JAAM DIC criteria and (3) the diagnostic accuracies of each parameter for T-DIC by statistical measurement. RESULTS: All 72 patients (21 T-DIC and 51 control) were included in primary analysis. T-DIC was significantly related to younger age, more severe trauma scores, more cases of massive transfusions, and remarkable coagulation abnormality detected by standard coagulation tests. In the cases of T-DIC, ROTEM showed longer clotting time, lower acceleration, lower clot firmness, and inhibited fibrinolysis in EXTEM/INTEM. Within the JAAM DIC score, PT-INR >/=1.2 was the most accurate factor for T-DIC diagnosis; sensitivity 60.0%, specificity 100.0%, and accuracy 88.7%. PT-INR >/=1.2 was statistically correlated with the JAAM DIC score (p < 0.001, r = 0.709). The univariate analysis based on 1.2 of PT-INR indicated statistical differences in most categories of ROTEM, which is similar to analysis performed for the presence and absence of T-DIC. CONCLUSIONS: Among JAAM DIC criteria, the PT-INR >/=1.2 was the most accurate factor for both the diagnosis of T-DIC and the evaluation of its severity. FAU - Koami, H AU - Koami H AUID- ORCID: 0000-0001-6268-4602 AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. hkoami@cc.saga-u.ac.jp. FAU - Sakamoto, Y AU - Sakamoto Y AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Yamada, K C AU - Yamada KC AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Matsuda, T AU - Matsuda T AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Nishi, J AU - Nishi J AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Nakayama, K AU - Nakayama K AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Sakurai, R AU - Sakurai R AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Ohta, M AU - Ohta M AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Imahase, H AU - Imahase H AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Yahata, M AU - Yahata M AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Umeka, M AU - Umeka M AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Miike, T AU - Miike T AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Nagashima, F AU - Nagashima F AD - Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Iwamura, T AU - Iwamura T AD - Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. FAU - Inoue, S AU - Inoue S AD - Division of Trauma Surgery and Surgical Critical Care, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. LA - eng PT - Journal Article DEP - 20170116 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Adult MH - Age Factors MH - Aged MH - Case-Control Studies MH - Disseminated Intravascular Coagulation/*diagnosis/etiology MH - Female MH - Humans MH - Japan MH - Male MH - Middle Aged MH - Multiple Trauma/*complications MH - Practice Guidelines as Topic MH - Predictive Value of Tests MH - Retrospective Studies MH - Severity of Illness Index MH - *Thrombelastography PMC - PMC5533846 OTO - NOTNLM OT - DIC OT - JAAM DIC score OT - PT-INR OT - Thromboelastometry OT - Trauma COIS- Hiroyuki Koami, Yuichiro Sakamoto, Kosuke Chris Yamada, Tomoya Matsuda, Junpei Nishi, Kento Nakayama, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura and Satoshi Inoue have no conflict of interest. EDAT- 2017/01/18 06:00 MHDA- 2018/04/26 06:00 PMCR- 2017/01/16 CRDT- 2017/01/18 06:00 PHST- 2016/10/31 00:00 [received] PHST- 2016/12/23 00:00 [accepted] PHST- 2017/01/18 06:00 [pubmed] PHST- 2018/04/26 06:00 [medline] PHST- 2017/01/18 06:00 [entrez] PHST- 2017/01/16 00:00 [pmc-release] AID - 10.1007/s00068-016-0756-4 [pii] AID - 756 [pii] AID - 10.1007/s00068-016-0756-4 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2017 Aug;43(4):431-438. doi: 10.1007/s00068-016-0756-4. Epub 2017 Jan 16. PMID- 28088374 OWN - NLM STAT- MEDLINE DCOM- 20180201 LR - 20260127 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 48 IP - 2 DP - 2017 Feb TI - Fibrinogen in traumatic haemorrhage: A narrative review. PG - 230-242 LID - S0020-1383(16)30818-X [pii] LID - 10.1016/j.injury.2016.12.012 [doi] AB - Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Winearls, James AU - Winearls J AD - Gold Coast University Hospital, Australia; School of Medical Sciences, Griffith University, Australia; School of Medicine, University of Queensland, Australia. Electronic address: james.winearls@health.qld.gov.au. FAU - Campbell, Don AU - Campbell D AD - Gold Coast University Hospital, Australia. Electronic address: don.campbell@health.qld.gov.au. FAU - Hurn, Catherine AU - Hurn C AD - Royal Brisbane and Women's Hospital, Australia; School of Medicine, University of Queensland, Australia. Electronic address: catherine.hurn@health.qld.gov.au. FAU - Furyk, Jeremy AU - Furyk J AD - Townsville Hospital, Australia. Electronic address: jeremy.furyk@health.qld.gov.au. FAU - Ryan, Glenn AU - Ryan G AD - Princess Alexandra Hospital, Australia. Electronic address: glenn.ryan@health.qld.gov.au. FAU - Trout, Melita AU - Trout M AD - Townsville Hospital, Australia. Electronic address: melita.trout@health.qld.gov.au. FAU - Walsham, James AU - Walsham J AD - Princess Alexandra Hospital, Australia; School of Medicine, University of Queensland, Australia. Electronic address: james.walsham@health.qld.gov.au. FAU - Holley, Anthony AU - Holley A AD - Royal Brisbane and Women's Hospital, Australia; School of Medicine, University of Queensland, Australia. Electronic address: anthony.holley@health.qld.gov.au. FAU - Shuttleworth, Megan AU - Shuttleworth M AD - Menzies Health Institute Queensland, Griffith University, Australia. Electronic address: m.shuttleworth@griffith.edu.au. FAU - Dyer, Wayne AU - Dyer W AD - Australian Red Cross Blood Service, Australia. Electronic address: W.Dyer@redcrossblood.org.au. FAU - Keijzers, Gerben AU - Keijzers G AD - Gold Coast University Hospital, Australia; School of Medical Sciences, Griffith University, Australia; School of Medicine, Bond University, Australia. Electronic address: gerben.keijzers@health.qld.gov.au. FAU - Presneill, Jeff AU - Presneill J AD - Royal Melbourne Hospital, Australia. Electronic address: jeffrey.presneill@health.qld.gov.au. FAU - Fraser, John F AU - Fraser JF AD - School of Medicine, University of Queensland, Australia; The Prince Charles Hospital, Australia. Electronic address: john.fraser@health.qld.gov.au. FAU - Wullschleger, Martin AU - Wullschleger M AD - Gold Coast University Hospital, Australia; School of Medical Sciences, Griffith University, Australia. Electronic address: martin.wullschleger@health.qld.gov.au. LA - eng PT - Journal Article PT - Review DEP - 20161226 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 0 (Hemostatics) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Australia/epidemiology MH - Craniocerebral Trauma/complications/mortality/*therapy MH - Fibrinogen/*therapeutic use MH - Hemostatics/*therapeutic use MH - Humans MH - Intracranial Hemorrhage, Traumatic/complications/mortality/*therapy MH - Practice Guidelines as Topic MH - Treatment Outcome OTO - NOTNLM OT - Coagulopathy OT - Cryoprecipitate OT - Fibrinogen OT - Fibrinogen concentrate OT - Massive transfusion OT - Trauma OT - Viscoelastic haemostatic assays EDAT- 2017/01/16 06:00 MHDA- 2018/02/02 06:00 CRDT- 2017/01/16 06:00 PHST- 2016/10/06 00:00 [received] PHST- 2016/12/21 00:00 [accepted] PHST- 2017/01/16 06:00 [pubmed] PHST- 2018/02/02 06:00 [medline] PHST- 2017/01/16 06:00 [entrez] AID - S0020-1383(16)30818-X [pii] AID - 10.1016/j.injury.2016.12.012 [doi] PST - ppublish SO - Injury. 2017 Feb;48(2):230-242. doi: 10.1016/j.injury.2016.12.012. Epub 2016 Dec 26. PMID- 28085709 OWN - NLM STAT- MEDLINE DCOM- 20170517 LR - 20260127 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 30 IP - 2 DP - 2017 Apr TI - Hemotherapy algorithm for the management of trauma-induced coagulopathy: the German and European perspective. PG - 257-264 LID - 10.1097/ACO.0000000000000433 [doi] AB - PURPOSE OF REVIEW: This review presents a synopsis of best current knowledge with reference to the updated German and European guidelines and recommendations on the management of severe trauma hemorrhage and trauma-induced coagulopathy as well as a viscoelastic-based treatment algorithm based upon international expert consensus to trigger the administration of hemostatic agents and blood products. RECENT FINDINGS: Uncontrolled hemorrhage and trauma-induced coagulopathy are the major causes for preventable death after trauma and early detection and aggressive management have been associated with improved outcomes. However, best practice to treat this newly defined entity is still under debate. In the acute phase, the clinical management usually follows the 'Damage Control Resuscitation' concept, which advocates the empiric administration of blood products in predefined and fixed ratios. As an alternative, several European but also a few US trauma centers have instituted the concept of 'Goal-directed Coagulation Therapy' based upon results obtained from early point-of-care viscoelastic testing. SUMMARY: Current guidelines urge for the implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome. FAU - Maegele, Marc AU - Maegele M AD - aDepartment for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC) bInstitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Koln, Germany cDepartment for Anesthesiology and Intensive Care Medicine, Ospedali di Rimini e Riccione, AUSL della Romagna, Rimini, Italy dDepartment for Anesthesiology and Intensive Care Medicine, AUVA Trauma Hospital, Salzburg, Austria. FAU - Nardi, Giuseppe AU - Nardi G FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Hemostatics) SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/mortality/*therapy MH - Blood Coagulation Tests/instrumentation MH - Blood Transfusion/methods/*standards MH - Clinical Protocols/*standards MH - Europe MH - Evidence-Based Emergency Medicine/*methods MH - Hemorrhage/diagnosis/etiology/mortality/*therapy MH - Hemostatics/therapeutic use MH - Humans MH - Point-of-Care Systems MH - Practice Guidelines as Topic MH - Resuscitation/methods/*standards MH - Trauma Centers/standards/trends MH - Treatment Outcome MH - Wounds and Injuries/*complications EDAT- 2017/01/14 06:00 MHDA- 2017/05/18 06:00 CRDT- 2017/01/14 06:00 PHST- 2017/01/14 06:00 [pubmed] PHST- 2017/05/18 06:00 [medline] PHST- 2017/01/14 06:00 [entrez] AID - 10.1097/ACO.0000000000000433 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2017 Apr;30(2):257-264. doi: 10.1097/ACO.0000000000000433. PMID- 28062209 OWN - NLM STAT- MEDLINE DCOM- 20170417 LR - 20220330 IS - 1532-8171 (Electronic) IS - 0735-6757 (Linking) VI - 35 IP - 4 DP - 2017 Apr TI - Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients. PG - 632-636 LID - S0735-6757(16)30964-0 [pii] LID - 10.1016/j.ajem.2016.12.061 [doi] AB - PURPOSE: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC. METHODS: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards. RESULTS: A total of 54 patients were included (AC, n=27 [warfarin n=13, dabigatran n=6, aXa inhibitor n=8] vs. no AC, n=27). Baseline characteristics were similar between groups, including age (72+/-13years vs. 72+/-15; p=0.85), male gender (70% vs. 74%; p=0.76) and blunt mechanism of injury (100% vs. 100%; p=1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p=0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p<0.01). CONCLUSION: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Ali, Jawad T AU - Ali JT AD - Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: jtali@seton.org. FAU - Daley, Mitchell J AU - Daley MJ AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: mjdaley@seton.org. FAU - Vadiei, Nina AU - Vadiei N AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: nvadiei@seton.org. FAU - Enright, Zachary AU - Enright Z AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: zme07a@acu.edu. FAU - Nguyen, Joseph AU - Nguyen J AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: josephn5833@gmail.com. FAU - Ali, Sadia AU - Ali S AD - Department of Trauma Services, University Medical Center Brackenridge, United States. Electronic address: Sali@seton.org. FAU - Aydelotte, Jayson D AU - Aydelotte JD AD - Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: jdaydelotte@seton.org. FAU - Teixeira, Pedro G AU - Teixeira PG AD - Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: pgteixeira@seton.org. FAU - Coopwood, Thomas B AU - Coopwood TB AD - Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: tbcoopwoodjr@seton.org. FAU - Brown, Carlos Vr AU - Brown CV AD - Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: cvrbrown@seton.org. LA - eng PT - Journal Article DEP - 20161226 PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 RN - 0 (Anticoagulants) RN - 0 (Factor Xa Inhibitors) RN - 5Q7ZVV76EI (Warfarin) RN - I0VM4M70GC (Dabigatran) SB - IM MH - Aged MH - Aged, 80 and over MH - Anticoagulants/therapeutic use MH - Blood Coagulation Disorders/blood/complications/*diagnosis MH - Case-Control Studies MH - Cohort Studies MH - Dabigatran/therapeutic use MH - Factor Xa Inhibitors/*therapeutic use MH - Female MH - Humans MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Retrospective Studies MH - *Thrombelastography MH - Warfarin/therapeutic use MH - Wounds, Nonpenetrating/*blood/complications OTO - NOTNLM OT - Anticoagulant OT - Dabigatran OT - Rivaroxaban OT - TEG OT - Thromboelastography OT - Warfarin EDAT- 2017/01/08 06:00 MHDA- 2017/04/18 06:00 CRDT- 2017/01/08 06:00 PHST- 2016/09/20 00:00 [received] PHST- 2016/12/22 00:00 [revised] PHST- 2016/12/23 00:00 [accepted] PHST- 2017/01/08 06:00 [pubmed] PHST- 2017/04/18 06:00 [medline] PHST- 2017/01/08 06:00 [entrez] AID - S0735-6757(16)30964-0 [pii] AID - 10.1016/j.ajem.2016.12.061 [doi] PST - ppublish SO - Am J Emerg Med. 2017 Apr;35(4):632-636. doi: 10.1016/j.ajem.2016.12.061. Epub 2016 Dec 26. PMID- 28017804 OWN - NLM STAT- MEDLINE DCOM- 20170809 LR - 20170809 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 224 IP - 4 DP - 2017 Apr TI - Persistent Fibrinolysis Shutdown Is Associated with Increased Mortality in Severely Injured Trauma Patients. PG - 575-582 LID - S1072-7515(16)31709-4 [pii] LID - 10.1016/j.jamcollsurg.2016.12.018 [doi] AB - BACKGROUND: Acute fibrinolysis shutdown is associated with early mortality after trauma; however, no previous studies have investigated the incidence of persistent fibrinolysis or its association with mortality. We tested the hypothesis that persistent fibrinolysis shutdown is associated with mortality in critically ill trauma patients. STUDY DESIGN: Thromboelastography was performed on ICU admission in 181 adult trauma patients and at 1 week in a subset of 78 patients. Fibrinolysis shutdown was defined as LY30 0,6 F. Turani, A. B. Belli, S. M. Martni, V. C. Cotticelli, F. Mounajergi, R. 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Tamberg, V. Campbell, S. Mehta P235 - Use of non-invasive ventilation in infectious diseases besides classical indications A. Silva-Pinto, A. Sarmento, L. Santos P236 - The impact of fragility on noninvasive mechanical ventilation application and results in the ICU Y. Kara, F. Yyldyrym, A. Zerman, Z. Gullu, N. Boyacy, B. Basaryk Aydogan, U. Gaygysyz, K. Gonderen, G. Aryk, M. Turkoglu, M. Aydogdu, G. Aygencel, Z. Ulger, G. Gursel P237 - Effects of metabolic alkalosis on noninvasive ventilation success and ICU outcome in patients with hypercapnic respiratory failure N. Boyacy, Z. Isykdogan, O. Ozdedeoglu, Z. Gullu, M. Badoglu, U. Gaygysyz, M. Aydogdu, G. Gursel P238 - Asynchrony index and breathing patterns of acute exacerbation copd patients assisted with noninvasive pressure support ventilation and neurally adjusted ventilatory assist N. Kongpolprom, C. Sittipunt P239 - High frequency jet ventilation for severe acute hypoxemia A. Eden, Y. Kokhanovsky, S. Bursztein - De Myttenaere, R. 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Mebazaa P245 - Ultrasonographic evaluation protocol for weaning from mechanichal ventilation A. Perez-Calatayud, R. Carrillo-Esper, A. Zepeda-Mendoza, M. Diaz-Carrillo, E. Arch-Tirado P246 - Diaphragm ultrasonography: a method for weaning patients from mechanical ventilation S. Carbognin, L. Pelacani, F. Zannoni, A. Agnoli, G. Gagliardi P247 - Dorsal diaphragmatic excursion tracks transpulmonary pressure in ventilated ARDS patients: a potential non-invasive indicator of lung recruitment? R. Cho, A. Adams , S. Lunos, S. Ambur, R. Shapiro, M. Prekker P248 - Pulse oximetry in the icu patient: is the perfusion index of any value? M. Thijssen, L. Janssen, N. Foudraine P249 - Ventilation is a better assessment of respiratory status than EtCO2 C. J. Voscopoulos, J. Freeman P250 - Evaluation of the relationship between non-invasive minute ventilation and end-tidal CO2 in patients undergoing general vs spinal anesthesia C. J. Voscopoulos, J. Freeman, E. George P251 - Respiratory volume monitoring provides early warning of respiratory depression and can be used to reduce false alarms in non-intubated patients C. J. Voscopoulos, D. Eversole, J. Freeman, E. George P252 - P/i index: a predictive edi-derived weaning index during nava S. Muttini, R. Bigi, G. Villani, N. Patroniti P253 - Adequacy of ventilation in patients receiving opioids in the post anesthesia care unit: minute ventilation versus respiratory rate G. Williams, C. J. Voscopoulos, J. Freeman, E. George P254 - Comparison of regional and global expiratory time constants measured by electrical impedance tomography (EIT) A. Waldmann, S. Bohm, W. Windisch, S. Strassmann, C. Karagiannidis P255 - Electrical impedance tomography: robustness of a new pixel wise regional expiratory time constant calculation A. Waldmann, S. Bohm, W. Windisch, S. Strassmann, C. Karagiannidis P256 - Validation of regional and global expiratory time constant measurement by electrical impedance tomography in ards and obstructive pulmonary diseases C. K. Karagiannidis, A. W. Waldmann, S. B. Bohm, S. Strassmann, W. W. Windisch P257 - Transpulmonary pressure in a model with elastic recoiling lung and expanding chest wall P. Persson, S. Lundin, O. Stenqvist P258 - Lactate in pleural and abdominal effusion G. Porta, F. Numis, C. S. Serra, A. P. Pagano, M. M. Masarone, L. R. Rinaldi, A. A. Amelia, M. F. Fascione, L. A. Adinolfi, E. R. Ruggiero P259 - Outcome of patients admitted to the intensive care with pulmonary fibrosis F. Asota, K. O'Rourke, S. Ranjan, P. Morgan P260 - Sedation and analgesia practice in extra-corporeal membrane oxygenation (ECMO)-treated patients with acute respiratory distress syndrome (ARDS): a retrospective study J. W. DeBacker, E. Tamberg, L. O'Neill, L. Munshi, L. Burry, E. Fan, S. Mehta P261 - Characteristics and outcomes of patients deemed not eligible when referred for veno-venous extracorporeal membrane oxygenation (vv-ECMO) S. Poo, K. Mahendran, J. Fowles, C. Gerrard, A. Vuylsteke P262 - The SAVE SMR for veno-arterial ECMO R. Loveridge, C. Chaddock, S. Patel, V. Kakar, C. Willars, T. Hurst, C. Park, T. Best, A. Vercueil, G. Auzinger P263 - A simplified score to predict early (48 h) mortality in patients being considered for VA-ECMO A. Borgman, A. G. Proudfoot, E. Grins, K. E. Emiley, J. Schuitema, S. J. Fitch, G. Marco, J. Sturgill, M. G. Dickinson, M. Strueber, A. Khaghani, P. Wilton, S. M. Jovinge P264 - Lung function six months post extra corporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adult survivors C. Sampson, S. Harris-Fox P265 - Bicarbonate dialysis removes carbon dioxide in hypoventilated rodents. M. E. Cove, L. H. Vu, A. Sen, W. J. Federspiel, J. A. Kellum P266 - Procalcitonin as predictor of primary graft dysfunction and mortality in post-lung transplantation C. Mazo Torre, J. Riera, S. Ramirez, B. Borgatta, L. Lagunes, J. Rello P267 - New molecular biomarkers of acute respiratory distress syndrome in abdominal sepsis A. K. Kuzovlev, V. Moroz, A. Goloubev, S. Polovnikov, S. Nenchuk P268 - Tight junction's proteins claudin -5 and regulation by tnf in experimental murine lung injury model of ali/ards V. Karavana, C. Glynos, A. Asimakos, K. Pappas, C. Vrettou, M. Magkou, E. Ischaki, G. Stathopoulos, S. Zakynthinos P269 - Cell counts in endobronchial aspirate to assess airway inflammation in ARDS patients: a pilot study S. Spadaro, I. Kozhevnikova, F. Dalla Corte, S. Grasso, P. Casolari, G. Caramori, C. Volta P270 - Epidemiological and clinical profile of patients with acute respiratory distress syndrome in the surgical intensive care unit surgical, hospital JRA, Antananarivo T. Andrianjafiarinoa, T. Randriamandrato, T. Rajaonera P271 - Effect of high PEEP after recruitment maneuver on right ventricular function in ARDS. Is it good for the lung and for the heart? S. El-Dash, ELV Costa, MR Tucci, F Leleu, L Kontar, B. De Cagny, F. Brazier, D. Titeca, G. Bacari-Risal, J. Maizel, M. Amato, M. Slama P272 - Effect of recruitment maneuver on left ventricular systolic strain P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, S. El Dash, M. Slama P273 - Inhaled nitric oxide - is switching supplier cost effective? Remmington, A. Fischer, S. Squire, M. Boichat P274 - Epidemiological study of severe acute pancreatitis in Japan, comparison of the etiology and the patient outcomes on 1159 patients. H. Honzawa, H. Yasuda, T. Adati, S. Suzaki, M. Horibe, M. Sasaki, M. Sanui P275 - Extracorporeal liver support therapy. Experience in an intensive care unit R. Marinho, J. Daniel, H. Miranda, A. Marinho P276 - Accuracy of mortality prediction models in acute versus acute-on-chronic liver failure in the intensive care setting K. Milinis, M. Cooper, G. R. Williams, E. McCarron, S. Simants, I. Patanwala, I. Welters P277 - Risk of coronary artery disease in patients with chronic liver disease: a population based cohort study Y. Su P278 - 20 years of liver transplantation in Santiago de Compostela (Spain). Experience review J. Fernandez Villanueva, R. Fernandez Garda, A. Lopez Lago, E. Rodriguez Ruiz, R. Hernandez Vaquero, S. Tome Martinez de Rituerto, E. Varo Perez P279 - Diarrhea is a risk factor for liver injury and may lead to intestinal failure associated liver disease in critical illness N. Lefel, F. Schaap, D. Bergmans, S. Olde Damink, M. Van de Poll P280 - Bowel care on the intensive care unit: constipation guideline compliance and complications K. Tizard, C. Lister, L. Poole P281 - Malnutrition assessed by phase angle determines outcomes in low risk cardiac surgery patients D. Ringaitiene, D. Gineityte, V. Vicka, I. Norkiene, J. Sipylaite P282 - Preoperative fasting times in an irish hospital A. O'Loughlin, V. Maraj, J. Dowling P283 - Costs and final outcome of early x delayed feeding in a private Brazil ICU M. B. Velasco, D. M. Dalcomune, E. B. Dias, S. L. Fernandes P284 - Can ventilator derived energy expenditure measurements replace indirect calorimetry? T. Oshima, S. Graf, C. Heidegger, L. Genton, V. Karsegard, Y. Dupertuis, C. Pichard P285 - Revisiting the refeeding syndrome: results of a systematic review N. Friedli, Z. Stanga, B. Mueller, P. Schuetz P286 - Compliance with the new protocol for parenteral nutrition in our ICU L. Vandersteen, B. Stessel, S. Evers, A. Van Assche, L. Jamaer, J. Dubois P287 - Nutrition may be another treatment in the intensive care unit where less is more? R. Marinho, H. Castro, J. Moura, J. Valente, P. Martins, P. Casteloes, C. Magalhaes, S. Cabral, M. Santos, B. Oliveira, A. Salgueiro, A. Marinho P288 - Should we provide more protein to critically ill patients? R. Marinho, M. Santos, E. Lafuente, H. Castro, S. Cabral, J. Moura, P. Martins, B. Oliveira, A. Salgueiro, S. Duarte, S. Castro, M. Melo, P. Casteloes, A. Marinho P289 Protein provision in an adult intensive care unit S. Gray P290 - Prevalence and clinical outcomes of vitamin d deficiency in the medical critically ill patients in Songklanagarind hospital K. Maipang, R. Bhurayanontachai P291 - Vitamin d deficiency strongly predicts adverse medical outcome across different medical inpatient populations: results from a prospective study L. G. Gradel, P. Schutz P292 - Omega-3 fatty acids in patients undergoing cardiac surgery: a systematic review and meta-analysis P. Langlois, W. Manzanares P293 - Can 5-hydroxytriptophan prevent post-traumatic stress disorder in critically ill patients? R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P294 - Parenteral selenium in the critically ill: an updated systematic review and meta-analysis W. Manzanares, P. Langlois, M. Lemieux, G. Elke, F. Bloos, K. Reinhart, D. Heyland P295 - Probiotics in the critically ill: an updated systematic review and meta-analysis P. Langlois, M. Lemieux, I. Aramendi, D. Heyland, W. Manzanares P296 - Diabetes with hyperglycemic crisis episodes may be associated with higher risk of pancreatic cancer: a population-based cohort study Y. Su P297 - Incidence of hypoglycemia in an intensive care unit depending on insulin protocol R. Marinho, N. Babo, A. Marinho P298 - Severity of the diseases is two-dimensionally correlated to blood glucose, including blood glucose variability, especially in moderately to severely ill patients with glucose intolerance. M. Hoshino, Y. Haraguchi, S. Kajiwara, T. Mitsuhashi, T. Tsubata, M. 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Fyntanidou, S. Patsatzakis, E. Oloktsidou, K. Lolakos, E. Papapostolou, V. Grosomanidis P305 - Clinical evaluation of ICU-admitted patients who were resuscitated in the general medicine ward S. Suda , T. Ikeda, S. Ono, T. Ueno, Y. Izutani P306 - Serious game evaluation of a one-hour training basic life support session for secondary school students: new tools for future bystanders S. Gaudry, V. Desailly, P. Pasquier, PB Brun, AT Tesnieres, JD Ricard, D. Dreyfuss, A. Mignon P307 - Public and clinical staff perceptions and knowledge of CPR compared to local and national data J. C White, A. Molokhia, A. Dean, A. Stilwell, G. Friedlaender P308 Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-ventilation pediatric protocol M. Peters, S. Stipulante, A. Delfosse, AF Donneau, A. Ghuysen P309 Dantrolene versus amiodarone for resuscitation - an experimental study C. Feldmann, D. Freitag, W. Dersch, M. Irqsusi, D. Eschbach, T. Steinfeldt, H. Wulf, T. 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Ramshev P327 Hyperthermic preconditioning severely accelerates neuronal damage in the gerbil ischemic hippocampal dentate gyrus via decreasing sods expressions J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin P328 Failure in neuroprotection of remote limb ischemic post conditioning in the hippocampus of a gerbil model of transient cerebral ischemia J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin P329 Brain death and admission diagnosis in neurologic intensive care unit, a correlation? A Marudi, S Baroni, A Gaspari, E Bertellini P330 Brain magnetic resonance imaging findings in patients with septic shock G. Orhun, E. Senturk, P. E. Ozcan, S. Sencer, C. Ulusoy, E. Tuzun, F . Esen P331 Benefits of L-carnitine in valproic acid induced encephalopathy R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P332Automatic analysis of EEG reactivity in comatose patients M. Van Assen, M. M. Admiraal, M. J. Van Putten, M. Tjepkema-Cloostermans, A. F. Van Rootselaar, J. 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Sierra P342 - 5-year follow-up of patients after transplantation of organs from donors from neurocritical care V. Spatenkova, E. Pokorna, P. Suchomel P343 - Evaluation of levetiracetam pharmacokinetics after severe traumatic brain injury in neurocritical care patients at a level one trauma center N. Ebert, J. Jancik, H. Rhodes P344 - Model based time series cluster analysis to determine unique patient states in traumatic brain injury T. Bylinski, C. Hawthorne, M. Shaw, I. Piper, J. Kinsella P345 - Brain compartment monitoring capabilities from ICP to BI (bioimpedance) during HS (hypertonic saline) administration. State of art simulation outcome depending on brain swelling type A. K. Kink , I. R. Ratsep P346 - Transfusion of red blood cells in patients with traumatic brain injury admitted to Canadian trauma health centers: a multicenter cohort study A. Boutin, L. Moore, M. Chasse, R. Zarychanski, F. Lauzier, S. English, L. McIntyre, J. Lacroix, D. Griesdale, P. Lessard-Bonaventure, A. 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Leclerc P364 - A comparison of mortality scores in burns patients on the intensive care unit. O. Howarth, K. Davenport, P. Jeanrenaud, S. Raftery P365 - Clasification of pain and its treatment and an intensive care rehabiliation clinic P. MacTavish, H. Devine, J. McPeake, M. Daniel, J. Kinsella, T. Quasim P366 - Pain management adequacy in critical care areas ,the process and the barriers perceived by critical care nurses S. Alrabiee, A. Alrashid , S. Alsolamy P367 - Pain assessment in critically ill adult patients: validation of the Turkish version of the critical-care pain observation tool O. Gundogan, C. Bor, E. Akyn Korhan, K. Demirag , M. Uyar P368 - An audit of pain and sedation assessments in the intensive care unit: recommendations for clinical practice F. Frame, C. Ashton, L. Bergstrom Niska P369 - Impact of pharmaceutical care on treatment of pain and agitation in medical intensive care unit P. Dilokpattanamongkol, T. Suansanae, C. Suthisisang, S. Morakul, C. Karnjanarachata, V. Tangsujaritvijit P370 - Agitation in trauma ICU, prevention and outcome S. Mahmood, H. Al Thani, A. Almenyar P371 Correlation between percentages of ventilated patients developed vap and use of sedative agents in icu patients. A. Vakalos , V. Avramidis P372 - Improving recording of sedation events in the Emergency Department: The implementation of the SIVA International Taskforce adverse event reporting tool for procedural sedation R. Sharvill, J. Penketh P373 - Impact of sedative drug use on the length of mechanical ventilation S. E. Morton, Y. S. Chiew, C. Pretty, J. G. Chase, G. M. Shaw P374 - Co-administration of nitric oxide and sevoflurane using anaconda R. Knafelj, P. Kordis P375 - A retrospective study of the use of Dexmedetomidine in an oncological critical care setting S. Patel, V. Grover P376 - Dexmedetomidine and posttraumatic stress disorder incidence in alcohol withdrawal icu patients I. Kuchyn, K. Bielka P377 - Hemodynamic effects of dexmedetomidine in a porcine model of septic shock Z. Aidoni, V. Grosomanidis, K. Kotzampassi, G. Stavrou, B. Fyntanidou, S. Patsatzakis, C. Skourtis P378 - Ketamine for analgosedation in severe hypoxic respiratory failure S. D. Lee, K. Williams, I. D. Weltes P379 - Madness from the moon? lunar cycle and the incidence of delirium on the intensive care unit S. Berhane, C. Arrowsmith, C. Peters, S. Robert P380 - Impaired dynamic cerebral autoregulation after coronary artery bypass grafting and association with postoperative delirium J. Caldas, R. B. Panerai, T. G. Robinson, L. Camara, G. Ferreira, E. Borg-Seng-Shu, M. De Lima Oliveira, N. C. Mian, L. Santos, R. Nogueira, S. P. Zeferino, M. Jacobsen Teixeira, F. Galas, L. A. Hajjar P381 - Risk factors predicting prolonged intensive care unit length of stay after major elective surgery. P. Killeen, M. McPhail, W. Bernal, J. Maggs, J. Wendon, T. Hughes P382 - Systemic inflammatory response syndrome criteria and hospital mortality prediction in a brazilian cohort of critically ill patients L. U. Taniguchi, E. M. Siqueira, J. M. Vieira Jr, L. C. Azevedo P383 - Evaluating the efficacy of a risk predictor panel in identifying patients at elevated risk of morbidity following emergency admission A. N. Ahmad, M. Abu-Habsa, R. Bahl, E. Helme, S. Hadfield, R. Loveridge P384 - A retrospective comparison of outcomes for elective surgical patients admitted post-operatively to the critical care unit or general ward J. Shak, C. Senver, R. Howard-Griffin P385 - Effect of obesity on mortality in surgical critically ill patients. P. Wacharasint, P. Fuengfoo, N. Sukcharoen, R. Rangsin P386 - The national early warning score (news) reliably improves adverse clinical outcome prediction in community-acquired pneumonia - results from a 6 year follow-up D. Sbiti-Rohr, P. Schuetz P387 - Clinical usefulness of the charlson inverted exclamation mark s weighted index of comorbidities _as prognostic factor in patients with prolonged acute mechanical ventilation H. Na, S. Song, S. Lee, E. Jeong, K. Lee P388 - Comparison of mortality prediction scoring systems in patients with cirrhosis admitted to general intensive care unit M. Cooper, K. Milinis, G. Williams, E. McCarron, S. Simants, I. Patanwala, I. D. Welters P389 - Impact of admission source and time of admission on outcome of pediatric intensive care patients: retrospective 15 years study E. Zoumpelouli, EA Volakli, V. Chrysohoidou, S. Georgiou, K. Charisopoulou, E. Kotzapanagiotou, V. Panagiotidou, K. Manavidou, Z. Stathi, M. Sdougka P390 - Heart rate variability and outcomes prediction in critical illness N. Salahuddin, B. AlGhamdi, Q. Marashly, K. Zaza, M. Sharshir, M. Khurshid, Z. Ali, M. Malgapo, M. Jamil, A. Shafquat, M. Shoukri, M. Hijazi P391 - The incidence and outcome of hyperlactatemia in the post anaesthesia care unit T. Abe, S. Uchino, M. Takinami P392 - Correlation between arterial blood gas disturbances and arterial lactate levels during hospitalization and outcome in critically septic patients N. R. Rangel Neto, S. Oliveira, F. Q. Reis, F. A. Rocha P393 - External validation of saps 3 and mpm iii scores in 48,816 patients from 72 brazilian icus G. Moralez, K. Ebecken, L. S. Rabello, M. F. Lima, R. Hatum, F. V. De Marco, A. Alves, J. E. Pinto, M. Godoy, P. E. Brasil, F. A. Bozza, J. I. Salluh, M. Soares P394 - The frailty penalty: pre-admission functional status confounds mortality prediction models in critically ill patients J. Krinsley, G. Kang P395 - 'sooner rather than later": how delayed discharge from critical care leads to increased out of hours discharges and subsequent increase in in-hospital mortality. J. Perry, H. Hines P396 - Identifying poor outcome patient groups in a resource-constrained critical care unit K. M. Wilkinson, C. Tordoff, B. Sloan, M. C. Bellamy P397 - Effects of icu weekend admission and discharge on mortality. E. Moreira, F. Verga, M. Barbato, G. Burghi P398 - Organizational factors, outcomes and resource use in 9,946 cancer patients admitted to 70 ICUs M Soares, U. V. Silva, L. C. Azevedo, A. P. Torelly, J. M. Kahn, D. C. Angus, M. F. Knibel, P. E. Brasil, F. A. Bozza, J. I. Salluh P399 - Evaluation of oncological critically ill patients, severity score and outcome compared to not oncological in a particular hospital cti. M. B. Velasco, D. M. Dalcomune P400 - Outcomes of patients admitted to a large uk critical care department with palliative oncological diagnoses R. Marshall, T. Gilpin, A. Tridente, A. Raithatha P401 - Predictors of mortality in febrile neutropenic patients with haematological malignancies admitted to an intensive care unit of a cancer center D. Mota, B. Loureiro, J. Dias, O. Afonso, F. Coelho, A. Martins, F. Faria P402 - Patients with hematologic malignancies requiring invasive mechanical ventilation: characteristics and predictors of mortality H. Al-Dorzi, H. Al Orainni , F. AlEid, H. Tlaygeh, A. Itani, A. Hejazi, Y. Arabi P403 - Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review S. Gaudry, J. Messika, J. D. Ricard, S. Guillo, B. Pasquet, E. Dubief, D. Dreyfuss, F. Tubach P404 - Alopecia in survivors of critical illness: a qualitative study C . Battle, K. James, P. Temblett P405 - The impact of mental health on icu admission L. Davies, C. Battle, C. Lynch P406 - Cognitive impairment 5 years after ICU discharge S. Pereira, S. Cavaco, J. Fernandes, I. Moreira, E. Almeida, F. Seabra Pereira, M. Malheiro, F. Cardoso, I. Aragao, T. Cardoso P407 - Apache ii versus apache iv for octagenerians in medical icu M. Fister, R. Knafelj P408 - Outcomes of octagenarians in an indian icu P. Muraray Govind, N. Brahmananda Reddy, R. Pratheema, E. D. Arul, J. Devachandran P409 - Mortality and outcomes in elderly patients 80 years of age or older admitted to the icu M. B. Velasco , D. M. Dalcomune P410 - Octagenerians in medical icu - adding days to life or life to days? R. Knafelj, M. Fister P411 - The very elderly admitted to intensive care unit: outcomes and economic evaluation N. Chin-Yee, G. D'Egidio, K. Thavorn, D. Heyland, K. Kyeremanteng P412 - The very elderly in intensive care: relationship between acuity of illness and long-term mortality A. G. Murchison, K. Swalwell, J. Mandeville, D. Stott P413 - Acquired weakness in an oncological intensive care unit I. Guerreiro P414 - Musculoskeletal problems in intensive care unit (ICU) patients post-discharge H. Devine, P. MacTavish, J. McPeake, T. Quasim, J. Kinsella, M. Daniel P415 - Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness C. Goossens M. B. Marques, S. Derde, S. Vander Perre, T. Dufour, S. E. Thiessen, F. Guiza, T. Janssens, G. Hermans, I. Vanhorebeek, K. De Bock, G. Van den Berghe, L. Langouche P416 - Physical outcome measures for critical care patients following intensive care unit (icu) discharge H. Devine, P. MacTavish, T. Quasim, J. Kinsella, M. Daniel, J. McPeake P417 - Improving active mobilisation in a general intensive care unit B. Miles , S. Madden, H. Devine P418 - Mobilization in patients on vasoactive drugs use - a pilot study. M. Weiler, P. Marques, C. Rodrigues, M. Boeira, K. Brenner, C. Leaes, A. Machado, R. Townsend, J. Andrade P419 - Pharmacy intervention at an intensive care rehabilitation clinic P. MacTavish, J. McPeake, H. Devine, J. Kinsella, M. Daniel, R. Kishore, C. Fenlon, T. Quasim P420 - Interactive gaming is feasible and potentially increases icu patients' motivation to be engaged in rehabilitation programs T. Fiks, A. Ruijter, M. Te Raa, P. Spronk P421 - Simulation-based design of a robust stopping rule to ensure patient safety Y. S. Chiew, P. Docherty, J. Dickson, E. Moltchanova, C. Scarrot, C. Pretty, G. M. Shaw, J. G. Chase P422 - Are daily blood tests on the intensive care unit necessary? T. Hall, W. C. Ngu, J. M. Jack, P. Morgan P423 - Measuring urine output in ward patients: is it helpful? B. Avard, A. Pavli, X. Gee P424 - The incidence of pressure ulcers in an adult mixed intensive care unit in turkey C . Bor, E. Akin Korhan, K. Demirag, M. Uyar P425 - Intensivist/patient ratios in closed ICUs in Alexandria, Egypt; an overview M. Shirazy, A. Fayed P426 - Eicu (electronic intensive care unit): impact on ALOS (average length of stay) in a developing country like India S. Gupta, A. Kaushal, S. Dewan, A. Varma P427 - Predicting deterioration in general ward using early deterioration indicator E. Ghosh, L. Yang, L. Eshelman, B. Lord, E. Carlson P428 - High impact enhanced critical care outreach - the imobile service: making a difference E. Helme, R. Broderick, S. Hadfield, R. Loveridge P429 - Impact of bed availability and cognitive load on intensive care unit (ICU) bed allocation: a vignette-based trial J. Ramos, D. Forte P430 - Characteristics of critically ill patients admitted through the emergency department F. Yang, P. Hou P431 - Admission to critical care: the quantification of functional reserve J. Dudziak, J. Feeney, K. Wilkinson, K. Bauchmuller, K. Shuker, M. Faulds, A. Raithatha, D. Bryden, L. England, N. Bolton, A. Tridente P432 - Admission to critical care: the importance of frailty K. Bauchmuller, K Shuker, A Tridente, M Faulds, A Matheson, J. Gaynor, D Bryden, S South Yorkshire Hospitals Research Collaboration P433 - Development of an instrument to aid triage decisions for intensive care unit admission J. Ramos, B. Peroni, R. Daglius-Dias, L. Miranda, C. Cohen, C. Carvalho, I . Velasco, D. Forte P434 - Using selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors in critical care: a systematic review of the evidence for benefit or harm J. M. Kelly, A. Neill, G. Rubenfeld, N. Masson, A. Min P435 - Measuring adaptive coping of hospitalized patients with a severe medical condition:the sickness insight in coping questionnaire (sicq) E. Boezeman, J. Hofhuis , A. Hovingh, R. De Vries, P. Spronk P436 - Results of a national survey regarding intensive care medicine training G. Cabral-Campello, I. Aragao, T. Cardoso P437 - Work engagement among healthcare professionals in the intensive care unit M. Van Mol, M. Nijkamp, E . Kompanje P438 - Empowering the intensive care practitioners. is it a burnout ameliorating intervention? P. Ostrowski, A. Omar P439 - Icu patients suffer from circadian rhythm desynchronisation K. Kiss , B. Koves, V. Csernus, Z. Molnar P440 - Noise reduction in the ICU: feasible ? Y. Hoydonckx, S. Vanwing, B. Stessel, A. Van Assche, L. Jamaer, J. Dubois P441 - Accidental removal of invasive devices in the critical patient into the bed-washing. does the presence of professional nurse modify his incidence? V. Medo, R. Galvez, J. P. Miranda P442 - Deprivation of liberty safeguards (dols): audit of compliance in a of a 16-bed specialist cancer critical care unit. C. Stone, T. Wigmore P443 - Use of a modified cristal score to predict futility of critical care in the elderly Y. Arunan, A. Wheeler, K. Bauchmuller, D. Bryden P444 - Improvement of Referral Rate to Palliative Care for Patients with Poor Prognosis in Neurosurgical Intensive Care Unit Y. Wong, C. Poi, C. Gu P445 - Factors associated with limitation of life supporting care (lsc) in a medico-surgical intermediate care unit, and outcome of patients with lsc limitation: a monocentric, six-month study. P. Molmy, N. Van Grunderbeeck, O. Nigeon, M. Lemyze, D. Thevenin, J. Mallat P446 - Palliative care consultation and intensive care unit admission request: a cohort study J. Ramos, M. Correa, R. T. Carvalho, D. Forte P447 - Nursing and medicine together in postsurgical intensive care unit: situations of prognostic conflict at the end of life. our critical care nurses suffer with our medical activism? A. Fernandez, C. McBride P448 - End of life who may decide E. Koonthalloor, C. Walsh P449 - Correctly diagnosing death A. Webber, M. Ashe, K. Smith, P. Jeanrenaud P450 - Skin procurement performed by intensive care physicians: yes, we can. A. Marudi , S. Baroni, F. Ragusa, E. Bertellini P451 - Death analysis in pediatric intensive care patients E. A. Volakli , E. Chochliourou, M. Dimitriadou, A. Violaki, P. Mantzafleri, E. Samkinidou, O. Vrani, A. Arbouti, T. Varsami, M. Sdougka P452 - The potential impact of euthanasia on organ donation: analysis of data from belgium J. A. Bollen, T. C. Van Smaalen, W. C. De Jongh, M. M. Ten Hoopen, D. Ysebaert, L. W. Van Heurn, W. N. Van Mook P453 - Communication within an intensive care setting K. Sim, A. Fuller P454 - Development and implementation of a longitudinal communication curriculum for critical care medicine fellows A. Roze des Ordons, P. Couillard, C. Doig P455 - Staff-family conflict in a multi-ethnic intensive care unit R. V. Van Keer, R. D. Deschepper, A. F. Francke, L. H. Huyghens, J. B. Bilsen P456 - Does the source of admission to critical care affect family satisfaction? B. Nyamaizi, C. Dalrymple, A. Molokhia, A. Dobru P457 - A simple alternative to the family satisfaction survey (fs-icu) E. Marrinan, A. Ankuli, A. Molokhia P458 - A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis J. McPeake, R. Struthers, R. Crawford , H. Devine , P. Mactavish , T. Quasim P459 - Prevalence and risk factors of anxiety and depression in relatives of burn patients. P. Morelli, M. Degiovanangelo, F. Lemos, V. MArtinez, F. Verga, J. Cabrera, G. Burghi P460 - Guidance of visiting children at an adult intensive care unit (icu) A. Rutten , S. Van Ieperen, S. De Geer, M. Van Vugt, E. Der Kinderen P461 - Visiting policies in Italian pediatric ICUs: an update A. Giannini, G Miccinesi, T Marchesi, E Prandi FAU - Bateman, R M AU - Bateman RM AD - University of Western Ontario, London, Canada. ISNI: 0000 0004 1936 8884. GRID: grid.39381.30 FAU - Sharpe, M D AU - Sharpe MD AD - University of Western Ontario, London, Canada. ISNI: 0000 0004 1936 8884. GRID: grid.39381.30 FAU - Jagger, J E AU - Jagger JE AD - University of Western Ontario, London, Canada. ISNI: 0000 0004 1936 8884. GRID: grid.39381.30 FAU - Ellis, C G AU - Ellis CG FAU - Sole-Violan, J AU - Sole-Violan J AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Lopez-Rodriguez, M AU - Lopez-Rodriguez M AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Herrera-Ramos, E AU - Herrera-Ramos E AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Ruiz-Hernandez, J AU - Ruiz-Hernandez J AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Borderias, L AU - Borderias L AD - Hospital San Jorge, Huesca, Spain. ISNI: 0000 0004 1765 5935. GRID: grid.415076.1 FAU - Horcajada, J AU - Horcajada J AD - Hospital Universitari del Mar, Barcelona, Spain. ISNI: 0000 0004 1767 8811. GRID: grid.411142.3 FAU - Gonzalez-Quevedo, N AU - Gonzalez-Quevedo N AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Rajas, O AU - Rajas O AD - Hospital Universitario de la Princesa, Madrid, Spain. ISNI: 0000 0004 1767 647X. GRID: grid.411251.2 FAU - Briones, M AU - Briones M AD - Hospital Clinico y Universitario de Valencia, Valencia, Spain. GRID: grid.411308.f FAU - Rodriguez de Castro, F AU - Rodriguez de Castro F AD - Hospital Dr Negrin, Las Palmas de GC, Spain FAU - Rodriguez Gallego, C AU - Rodriguez Gallego C AD - Hospital Universitari Son Espases, Palma de Mallorca, Spain. ISNI: 0000 0004 1796 5984. GRID: grid.411164.7 FAU - Esen, F AU - Esen F AD - Medical Faculty of Istanbul, Istanbul University, Anesthesiology and Intensive Care, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Orhun, G AU - Orhun G AD - Medical Faculty of Istanbul, Istanbul University, Anesthesiology and Intensive Care, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Ergin Ozcan, P AU - Ergin Ozcan P AD - Medical Faculty of Istanbul, Istanbul University, Anesthesiology and Intensive Care, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Senturk, E AU - Senturk E AD - Medical Faculty of Istanbul, Istanbul University, Anesthesiology and Intensive Care, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Ugur Yilmaz, C AU - Ugur Yilmaz C AD - Medical Faculty of Istanbul, Physiology, Istanbul University, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Orhan, N AU - Orhan N AD - Institute of Experimental Medicine, Istanbul University, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Arican, N AU - Arican N AD - Medical Faculty of Istanbul, Forensic Medicine, Istanbul University, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Kaya, M AU - Kaya M AD - Medical Faculty of Istanbul, Physiology, Istanbul University, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Kucukerden, M AU - Kucukerden M AD - Institute of Experimental Medicine, Istanbul University, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Giris, M AU - Giris M AD - Institute of Experimental Medicine, Istanbul University, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Akcan, U AU - Akcan U AD - Institute of Experimental Medicine, Istanbul University, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Bilgic Gazioglu, S AU - Bilgic Gazioglu S AD - Institute of Experimental Medicine, Immunology, Istanbul University, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Tuzun, E AU - Tuzun E AD - Institute of Experimental Medicine, Istanbul University, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Riff, R AU - Riff R AD - Ben-Gurion University of the Negev, Beer-Sheva, Israel. ISNI: 0000 0004 1937 0511. GRID: grid.7489.2 FAU - Naamani, O AU - Naamani O AD - Ben-Gurion University of the Negev, Beer-Sheva, Israel. ISNI: 0000 0004 1937 0511. GRID: grid.7489.2 FAU - Douvdevani, A AU - Douvdevani A AD - Soroka Medical Center, Beer-Sheva, Israel. ISNI: 0000 0004 0470 8989. GRID: grid.412686.f FAU - Takegawa, R AU - Takegawa R AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Yoshida, H AU - Yoshida H AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Hirose, T AU - Hirose T AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Yamamoto, N AU - Yamamoto N AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Hagiya, H AU - Hagiya H AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ojima, M AU - Ojima M AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Akeda, Y AU - Akeda Y AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Tasaki, O AU - Tasaki O AD - Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. ISNI: 0000 0000 8902 2273. GRID: grid.174567.6 FAU - Tomono, K AU - Tomono K AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Shimazu, T AU - Shimazu T AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ono, S AU - Ono S AD - Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo Japan. GRID: grid.411909.4 FAU - Kubo, T AU - Kubo T AD - National Defense Medical College, Tokorozawa, Saitama Japan. ISNI: 0000 0004 0374 0880. GRID: grid.416614.0 FAU - Suda, S AU - Suda S AD - Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo Japan. GRID: grid.411909.4 FAU - Ueno, T AU - Ueno T AD - Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo Japan. GRID: grid.411909.4 FAU - Ikeda, T AU - Ikeda T AD - Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo Japan. GRID: grid.411909.4 FAU - Hirose, T AU - Hirose T AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ogura, H AU - Ogura H AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Takahashi, H AU - Takahashi H AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ojima, M AU - Ojima M AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Kang, J AU - Kang J AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Nakamura, Y AU - Nakamura Y AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Kojima, T AU - Kojima T AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Shimazu, T AU - Shimazu T AD - Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ikeda, T AU - Ikeda T AD - Hachiouji medical center, Tokyo medical university, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Suda, S AU - Suda S AD - Hachiouji medical center, Tokyo medical university, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Izutani, Y AU - Izutani Y AD - Hachiouji medical center, Tokyo medical university, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ueno, T AU - Ueno T AD - Hachiouji medical center, Tokyo medical university, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ono, S AU - Ono S AD - Hachiouji medical center, Tokyo medical university, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Taniguchi, T AU - Taniguchi T AD - Kanazawa University, Kanazawa, Japan. ISNI: 0000 0001 2308 3329. GRID: grid.9707.9 FAU - O, M AU - O M AD - Kanazawa University Hospital, Kanazawa, Japan. ISNI: 0000 0004 0615 9100. GRID: grid.412002.5 FAU - Dinter, C AU - Dinter C AD - ThermoFisher, Hennigsdorf, Germany FAU - Lotz, J AU - Lotz J AD - Institut fur Klinische Chemie und Laboratoriumsmedizin, Mainz, Germany FAU - Eilers, B AU - Eilers B AD - MVZ Labor Limbach Gruppe, Berlin, Germany FAU - Wissmann, C AU - Wissmann C AD - ThermoFisher, Hennigsdorf, Germany FAU - Lott, R AU - Lott R AD - Institut fur Klinische Chemie und Laboratoriumsmedizin, Mainz, Germany FAU - Meili, M M AU - Meili MM AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schuetz, P S AU - Schuetz PS AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Hawa, H AU - Hawa H AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Sharshir, M AU - Sharshir M AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Aburageila, M AU - Aburageila M AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Salahuddin, N AU - Salahuddin N AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Chantziara, V AU - Chantziara V AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Georgiou, S AU - Georgiou S AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Tsimogianni, A AU - Tsimogianni A AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Alexandropoulos, P AU - Alexandropoulos P AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Vassi, A AU - Vassi A AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Lagiou, F AU - Lagiou F AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Valta, M AU - Valta M AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Micha, G AU - Micha G AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Chinou, E AU - Chinou E AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Michaloudis, G AU - Michaloudis G AD - Saint Savvas Hospital, Athens, Greece. GRID: grid.416564.4 FAU - Kodaira, A AU - Kodaira A AD - Tokyo Medical University, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ikeda, T AU - Ikeda T AD - Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. GRID: grid.411909.4 FAU - Ono, S AU - Ono S AD - Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. GRID: grid.411909.4 FAU - Ueno, T AU - Ueno T AD - Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. GRID: grid.411909.4 FAU - Suda, S AU - Suda S AD - Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. GRID: grid.411909.4 FAU - Izutani, Y AU - Izutani Y AD - Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. GRID: grid.411909.4 FAU - Imaizumi, H AU - Imaizumi H AD - Tokyo Medical University, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - De la Torre-Prados, M V AU - De la Torre-Prados MV AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Garcia-De la Torre, A AU - Garcia-De la Torre A AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Enguix-Armada, A AU - Enguix-Armada A AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Puerto-Morlan, A AU - Puerto-Morlan A AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Perez-Valero, V AU - Perez-Valero V AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Garcia-Alcantara, A AU - Garcia-Alcantara A AD - Hospital Virgen de la Victoria, Malaga, Spain. ISNI: 0000 0000 9788 2492. GRID: grid.411062.0 FAU - Bolton, N AU - Bolton N AD - St Helens and Knowsley NHS Trust, Merseyside, UK FAU - Dudziak, J AU - Dudziak J AD - St Helens and Knowsley NHS Trust, Merseyside, UK FAU - Bonney, S AU - Bonney S AD - St Helens and Knowsley NHS Trust, Merseyside, UK FAU - Tridente, A AU - Tridente A AD - St Helens and Knowsley NHS Trust, Merseyside, UK FAU - Nee, P AU - Nee P AD - St Helens and Knowsley NHS Trust, Merseyside, UK FAU - Nicolaes, G AU - Nicolaes G AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Wiewel, M AU - Wiewel M AD - Center for Experimental and Molecular medicine, Amsterdam, Netherlands FAU - Schultz, M AU - Schultz M AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Wildhagen, K AU - Wildhagen K AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Horn, J AU - Horn J AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Schrijver, R AU - Schrijver R AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Van der Poll, T AU - Van der Poll T AD - Center for Experimental and Molecular medicine, Amsterdam, Netherlands FAU - Reutelingsperger, C AU - Reutelingsperger C AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Pillai, S AU - Pillai S AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Davies, G AU - Davies G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Mills, G AU - Mills G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Aubrey, R AU - Aubrey R AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Morris, K AU - Morris K AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Williams, P AU - Williams P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Evans, P AU - Evans P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Gayat, E G AU - Gayat EG AD - Hopital Lariboisiere, Paris, France. ISNI: 0000 0000 9725 279X. GRID: grid.411296.9 FAU - Struck, J AU - Struck J AD - Sphingotec, Berlin, Germany FAU - Cariou, A AU - Cariou A AD - Hopital Cochin, Paris, France. ISNI: 0000 0001 0274 3893. GRID: grid.411784.f FAU - Deye, N AU - Deye N AD - Hopital Lariboisiere, Paris, France. ISNI: 0000 0000 9725 279X. GRID: grid.411296.9 FAU - Guidet, B AU - Guidet B AD - Hopital Saint-Antoine, Paris, France. ISNI: 0000 0004 1937 1100. GRID: grid.412370.3 FAU - Jabert, S AU - Jabert S AD - CHRU de Montpellier, Montpellier, France. ISNI: 0000 0000 9961 060X. GRID: grid.157868.5 FAU - Launay, J AU - Launay J AD - Hopital Lariboisiere, Paris, France. ISNI: 0000 0000 9725 279X. GRID: grid.411296.9 FAU - Legrand, M AU - Legrand M AD - Hopital Saint-Louis, Paris, France. ISNI: 0000 0001 2300 6614. GRID: grid.413328.f FAU - Leone, M AU - Leone M AD - AP-HM, Marseille, France. ISNI: 0000 0001 0407 1584. GRID: grid.414336.7 FAU - Resche-Rigon, M AU - Resche-Rigon M AD - Hopital Saint-Louis, Paris, France. ISNI: 0000 0001 2300 6614. GRID: grid.413328.f FAU - Vicaut, E AU - Vicaut E AD - Hopital Lariboisiere, Paris, France. ISNI: 0000 0000 9725 279X. GRID: grid.411296.9 FAU - Vieillard-Baron, A AU - Vieillard-Baron A AD - Hopital Ambroise Pare, Paris, France. ISNI: 0000 0000 9982 5352. GRID: grid.413756.2 FAU - Mebazaa, A AU - Mebazaa A AD - Hopital Lariboisiere, Paris, France. ISNI: 0000 0000 9725 279X. GRID: grid.411296.9 FAU - Arnold, R AU - Arnold R AD - Christiana Care Health System, Newark, USA. ISNI: 0000 0004 0444 1241. GRID: grid.414316.5 FAU - Capan, M AU - Capan M AD - Christiana Care Health System, Newark, USA. ISNI: 0000 0004 0444 1241. GRID: grid.414316.5 FAU - Linder, A AU - Linder A AD - Skane University Hospital, Lund University, Lund, Sweden. ISNI: 0000 0001 0930 2361. GRID: grid.4514.4 FAU - Akesson, P AU - Akesson P AD - Skane University Hospital, Lund University, Lund, Sweden. ISNI: 0000 0001 0930 2361. GRID: grid.4514.4 FAU - Popescu, M AU - Popescu M AD - Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. ISNI: 0000 0000 9828 7548. GRID: grid.8194.4 FAU - Tomescu, D AU - Tomescu D AD - Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. ISNI: 0000 0000 9828 7548. GRID: grid.8194.4 FAU - Sprung, C L AU - Sprung CL AD - Hadassah-Hebrew University Medical Center, Jerusalem, Israel. ISNI: 0000 0001 2221 2926. GRID: grid.17788.31 FAU - Calderon Morales, R AU - Calderon Morales R AD - Hadassah-Hebrew University Medical Center, Jerusalem, Israel. ISNI: 0000 0001 2221 2926. GRID: grid.17788.31 FAU - Munteanu, G AU - Munteanu G AD - Hadassah-Hebrew University Medical Center, Jerusalem, Israel. ISNI: 0000 0001 2221 2926. GRID: grid.17788.31 FAU - Orenbuch-Harroch, E AU - Orenbuch-Harroch E AD - Hadassah-Hebrew University Medical Center, Jerusalem, Israel. ISNI: 0000 0001 2221 2926. GRID: grid.17788.31 FAU - Levin, P AU - Levin P AD - Hadassah-Hebrew University Medical Center, Jerusalem, Israel. ISNI: 0000 0001 2221 2926. GRID: grid.17788.31 FAU - Kasdan, H AU - Kasdan H AD - LeukoDx, Jerusalem, Israel FAU - Reiter, A AU - Reiter A AD - LeukoDx, Jerusalem, Israel FAU - Volker, T AU - Volker T AD - LeukoDx, Jerusalem, Israel FAU - Himmel, Y AU - Himmel Y AD - LeukoDx, Jerusalem, Israel FAU - Cohen, Y AU - Cohen Y AD - LeukoDx, Jerusalem, Israel FAU - Meissonnier, J AU - Meissonnier J AD - LeukoDx, Jerusalem, Israel FAU - Girard, L AU - Girard L AD - Abionic SA, Lausanne, Switzerland FAU - Rebeaud, F AU - Rebeaud F AD - Abionic SA, Lausanne, Switzerland FAU - Herrmann, I AU - Herrmann I AD - Swiss Federal Laboratories (Empa), St. Gallen, Switzerland FAU - Delwarde, B AU - Delwarde B AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Peronnet, E AU - Peronnet E AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Cerrato, E AU - Cerrato E AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Venet, F AU - Venet F AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Lepape, A AU - Lepape A AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Rimmele, T AU - Rimmele T AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Monneret, G AU - Monneret G AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Textoris, J AU - Textoris J AD - Pathophysiology of injury induced immunosuppression (PI3) Lab, Lyon 1 University / Hospices Civils de Lyon / bioMerieux, Lyon, France FAU - Beloborodova, N AU - Beloborodova N AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Moroz, V AU - Moroz V AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Osipov, A AU - Osipov A AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Bedova, A AU - Bedova A AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Sarshor, Y AU - Sarshor Y AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Pautova, A AU - Pautova A AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Sergeev, A AU - Sergeev A AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Chernevskaya, E AU - Chernevskaya E AD - Negovsky V.A. Research Institute of General Reanimatology, Moscow, Russia FAU - Odermatt, J AU - Odermatt J AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Bolliger, R AU - Bolliger R AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Hersberger, L AU - Hersberger L AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Ottiger, M AU - Ottiger M AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Christ-Crain, M AU - Christ-Crain M AD - University Hospital Basel, Basel, Switzerland. GRID: grid.410567.1 FAU - Mueller, B AU - Mueller B AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schuetz, P AU - Schuetz P AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Sharma, N K AU - Sharma NK AD - UNIFESP, Sao Paulo, Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b FAU - Tashima, A K AU - Tashima AK AD - UNIFESP, Sao Paulo, Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b FAU - Brunialti, M K AU - Brunialti MK AD - UNIFESP, Sao Paulo, Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b FAU - Machado, F R AU - Machado FR AD - UNIFESP, Sao Paulo, Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b FAU - Assuncao, M AU - Assuncao M AD - Albert Einstein Hospital, Sao Paulo, Brazil. ISNI: 0000 0001 0385 1941. GRID: grid.413562.7 FAU - Rigato, O AU - Rigato O AD - Sirio Libanes Hospital, Sao Paulo, Brazil FAU - Salomao, R AU - Salomao R AD - UNIFESP, Sao Paulo, Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b FAU - Cajander, S C AU - Cajander SC AD - Faculty of Medicine and Health Orebro University, Orebro, Sweden. ISNI: 0000 0001 0738 8966. GRID: grid.15895.30 FAU - Rasmussen, G AU - Rasmussen G AD - Faculty of Medicine and Health Orebro University, Orebro, Sweden. ISNI: 0000 0001 0738 8966. GRID: grid.15895.30 FAU - Tina, E AU - Tina E AD - Faculty of Medicine and Health Orebro University, Orebro, Sweden. ISNI: 0000 0001 0738 8966. GRID: grid.15895.30 FAU - Soderquist, B AU - Soderquist B AD - Faculty of Medicine and Health Orebro University, Orebro, Sweden. ISNI: 0000 0001 0738 8966. GRID: grid.15895.30 FAU - Kallman, J AU - Kallman J AD - Faculty of Medicine and Health Orebro University, Orebro, Sweden. ISNI: 0000 0001 0738 8966. GRID: grid.15895.30 FAU - Stralin, K AU - Stralin K AD - Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. ISNI: 0000 0000 9241 5705. GRID: grid.24381.3c FAU - Lange, A L AU - Lange AL AD - Faculty of Medicine and Health, Orebro, Sweden FAU - Sunden-Cullberg, J S AU - Sunden-Cullberg JS AD - Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. ISNI: 0000 0000 9241 5705. GRID: grid.24381.3c FAU - Magnuson, A M AU - Magnuson AM AD - Faculty of Medicine and Health, Orebro, Sweden FAU - Hultgren, O H AU - Hultgren OH AD - Faculty of Medicine and Health, Orebro, Sweden FAU - Davies, G AU - Davies G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Pillai, S AU - Pillai S AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Mills, G AU - Mills G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Aubrey, R AU - Aubrey R AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Morris, K AU - Morris K AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Williams, P AU - Williams P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Evans, P AU - Evans P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Pillai, S AU - Pillai S AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Davies, G AU - Davies G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Mills, G AU - Mills G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Aubrey, R AU - Aubrey R AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Morris, K AU - Morris K AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Williams, P AU - Williams P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Evans, P AU - Evans P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Pillai, S AU - Pillai S AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Davies, G AU - Davies G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Mills, G AU - Mills G AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Aubrey, R AU - Aubrey R AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Morris, K AU - Morris K AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Williams, P AU - Williams P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Evans, P AU - Evans P AD - NISCHR Haemostasis Biomarker Research Unit, Swansea, UK FAU - Van der Geest, P AU - Van der Geest P AD - Erasmus Medical Center, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Mohseni, M AU - Mohseni M AD - Erasmus Medical Center, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Linssen, J AU - Linssen J AD - University Witten/Herdecke, Witten, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - De Jonge, R AU - De Jonge R AD - Erasmus Medical Center, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Duran, S AU - Duran S AD - Maasstad Ziekenhuis, Rotterdam, Netherlands. ISNI: 0000 0004 0460 0556. GRID: grid.416213.3 FAU - Groeneveld, J AU - Groeneveld J AD - Erasmus Medical Center, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Miller, R III AU - Miller R III AD - Intermountain Healthcare, Salt Lake City, USA. ISNI: 0000 0004 0460 774X. GRID: grid.420884.2 FAU - Lopansri, B K AU - Lopansri BK AD - Intermountain Healthcare, Salt Lake City, USA. ISNI: 0000 0004 0460 774X. GRID: grid.420884.2 FAU - McHugh, L C AU - McHugh LC AD - Immunexpress, Seattle, USA FAU - Seldon, A AU - Seldon A AD - Immunexpress, Seattle, USA FAU - Burke, J P AU - Burke JP AD - Intermountain Healthcare, Salt Lake City, USA. ISNI: 0000 0004 0460 774X. GRID: grid.420884.2 FAU - Johnston, J AU - Johnston J AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Reece-Anthony, R AU - Reece-Anthony R AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Bond, A AU - Bond A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Molokhia, A AU - Molokhia A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Mcgrath, C AU - Mcgrath C AD - Wirral trust, Merseyside, UK FAU - Nsutebu, E AU - Nsutebu E AD - RLBUHT, Liverpool, UK FAU - Bank Pedersen, P AU - Bank Pedersen P AD - Department of Emergency Medicine, Odense University Hospital, Odense C, Denmark. ISNI: 0000 0004 0512 5013. GRID: grid.7143.1 FAU - Pilsgaard Henriksen, D AU - Pilsgaard Henriksen D AD - Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark. ISNI: 0000 0004 0512 5013. GRID: grid.7143.1 FAU - Mikkelsen, S AU - Mikkelsen S AD - Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark. ISNI: 0000 0004 0512 5013. GRID: grid.7143.1 FAU - Touborg Lassen, A AU - Touborg Lassen A AD - Wirral trust, Merseyside, UK FAU - Tincu, R AU - Tincu R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Cobilinschi, C AU - Cobilinschi C AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Tomescu, D AU - Tomescu D AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Ghiorghiu, Z AU - Ghiorghiu Z AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Macovei, R AU - Macovei R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Wiewel, M A AU - Wiewel MA AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Harmon, M B AU - Harmon MB AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Vught, L A AU - Van Vught LA AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Scicluna, B P AU - Scicluna BP AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Hoogendijk, A J AU - Hoogendijk AJ AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Horn, J AU - Horn J AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Zwinderman, A H AU - Zwinderman AH AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Cremer, O L AU - Cremer OL AD - University Medical Center Utrecht, Utrecht, Netherlands. ISNI: 0000000090126352. GRID: grid.7692.a FAU - Bonten, M J AU - Bonten MJ AD - University Medical Center Utrecht, Utrecht, Netherlands. ISNI: 0000000090126352. GRID: grid.7692.a FAU - Schultz, M J AU - Schultz MJ AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van der Poll, T AU - Van der Poll T AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Juffermans, N P AU - Juffermans NP AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Wiersinga, W J AU - Wiersinga WJ AD - Amsterdam Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Eren, G AU - Eren G AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Tekdos, Y AU - Tekdos Y AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Dogan, M AU - Dogan M AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Acicbe, O AU - Acicbe O AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Kaya, E AU - Kaya E AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Hergunsel, O AU - Hergunsel O AD - Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey. ISNI: 0000 0004 0419 1043. GRID: grid.414177.0 FAU - Alsolamy, S AU - Alsolamy S AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Ghamdi, G AU - Ghamdi G AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alswaidan, L AU - Alswaidan L AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alharbi, S AU - Alharbi S AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alenezi, F AU - Alenezi F AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Arabi, Y AU - Arabi Y AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Heaton, J AU - Heaton J AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Boyce, A AU - Boyce A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Nolan, L AU - Nolan L AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Johnston, J AU - Johnston J AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Dukoff-Gordon, A AU - Dukoff-Gordon A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Dean, A AU - Dean A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Molokhia, A AU - Molokhia A AD - Lewisham and Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Mann Ben Yehudah, T AU - Mann Ben Yehudah T AD - Assaf Harofeh MC, Beer Yaakov, Israel FAU - Fleischmann, C AU - Fleischmann C AD - Jena University Hopital, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Thomas-Rueddel, D AU - Thomas-Rueddel D AD - Jena University Hopital, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Haas, C AU - Haas C AD - Jena University Hopital, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Dennler, U AU - Dennler U AD - Jena University Hopital, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Reinhart, K AU - Reinhart K AD - Jena University Hopital, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Suntornlohanakul, O AU - Suntornlohanakul O AD - Prince of Songkla University, Hat Yai, Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Khwannimit, B AU - Khwannimit B AD - Division of Critical Care Medicine, Hat Yai, Thailand FAU - Breckenridge, F AU - Breckenridge F AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Puxty, A AU - Puxty A AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Szturz, P AU - Szturz P AD - University Hospital and Faculty of Medicine Ostrava University, Ostrava, Czech Republic. ISNI: 0000 0004 0609 0692. GRID: grid.412727.5 FAU - Folwarzcny, P AU - Folwarzcny P AD - University Hospital and Faculty of Medicine Ostrava University, Ostrava, Czech Republic. ISNI: 0000 0004 0609 0692. GRID: grid.412727.5 FAU - Svancara, J AU - Svancara J AD - Institute of Biostatistics and analyses, Masaryk University, Brno, Czech Republic. ISNI: 0000 0001 2194 0956. GRID: grid.10267.32 FAU - Kula, R AU - Kula R AD - University Hospital and Faculty of Medicine Ostrava University, Ostrava, Czech Republic. ISNI: 0000 0004 0609 0692. GRID: grid.412727.5 FAU - Sevcik, P AU - Sevcik P AD - University Hospital and Faculty of Medicine Ostrava University, Ostrava, Czech Republic. ISNI: 0000 0004 0609 0692. GRID: grid.412727.5 FAU - Caneva, L AU - Caneva L AD - Universita degli studi di Pavia, scuola di specialita: Anestesia e Rianimazione, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Casazza, A AU - Casazza A AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Bellazzi, E AU - Bellazzi E AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Marra, S AU - Marra S AD - Universita degli studi di Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Pagani, L AU - Pagani L AD - Universita degli studi di Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Vetere, M AU - Vetere M AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Vanzino, R AU - Vanzino R AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Ciprandi, D AU - Ciprandi D AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Preda, R AU - Preda R AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Boschi, R AU - Boschi R AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Carnevale, L AU - Carnevale L AD - UOC Anestesia e Rianimazione Ospedale Civile di Vigevano, AO Pavia, Vigevano, Italy FAU - Lopez, V AU - Lopez V AD - Hospital O'horan, Merida, Mexico FAU - Aguilar Arzapalo, M AU - Aguilar Arzapalo M AD - Hospital O'horan, Merida, Mexico FAU - Barradas, L AU - Barradas L AD - Hospital O'horan, Merida, Mexico FAU - Escalante, A AU - Escalante A AD - Hospital O'horan, Merida, Mexico FAU - Gongora, J AU - Gongora J AD - Hospital O'horan, Merida, Mexico FAU - Cetina, M AU - Cetina M AD - Hospital O'horan, Merida, Mexico FAU - Adamik, B AU - Adamik B AD - Department of Anaesthesiology and Intensive Therapy, Medical University, Wroclaw, Poland. ISNI: 0000 0001 1090 049X. GRID: grid.4495.c FAU - Jakubczyk, D AU - Jakubczyk D AD - Department of Anaesthesiology and Intensive Therapy, Medical University, Wroclaw, Poland. ISNI: 0000 0001 1090 049X. GRID: grid.4495.c FAU - Kubler, A AU - Kubler A AD - Department of Anaesthesiology and Intensive Therapy, Medical University, Wroclaw, Poland. ISNI: 0000 0001 1090 049X. GRID: grid.4495.c FAU - Radford, A AU - Radford A AD - AKPA, Waltham, USA FAU - Lee, T AU - Lee T AD - St. Paul's Hospital, Vancouver, Canada. ISNI: 0000 0000 8589 2327. GRID: grid.416553.0 FAU - Singer, J AU - Singer J AD - St. Paul's Hospital, Vancouver, Canada. ISNI: 0000 0000 8589 2327. GRID: grid.416553.0 FAU - Boyd, J AU - Boyd J AD - St. Paul's Hospital, Vancouver, Canada. ISNI: 0000 0000 8589 2327. GRID: grid.416553.0 FAU - Fineberg, D AU - Fineberg D AD - AKPA, Waltham, USA FAU - Williams, M AU - Williams M AD - AKPA, Waltham, USA FAU - Russell, J AU - Russell J AD - St. Paul's Hospital, Vancouver, Canada. ISNI: 0000 0000 8589 2327. GRID: grid.416553.0 FAU - Scarlatescu, E AU - Scarlatescu E AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Tomescu, D AU - Tomescu D AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Droc, G AU - Droc G AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Arama, S AU - Arama S AD - University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ISNI: 0000 0000 9828 7548. GRID: grid.8194.4 FAU - Muller, M AU - Muller M AD - Acedemisch Medisch Centrum, Amsterdam, Netherlands FAU - Straat, M AU - Straat M AD - Acedemisch Medisch Centrum, Amsterdam, Netherlands FAU - Zeerleder, S S AU - Zeerleder SS AD - Acedemisch Medisch Centrum, Amsterdam, Netherlands FAU - Juffermans, N P AU - Juffermans NP AD - Acedemisch Medisch Centrum, Amsterdam, Netherlands FAU - Fuchs, C F AU - Fuchs CF AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Scheer, C S AU - Scheer CS AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Wauschkuhn, S W AU - Wauschkuhn SW AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Vollmer, M V AU - Vollmer MV AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Meissner, K M AU - Meissner KM AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Kuhn, S K AU - Kuhn SK AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Hahnenkamp, K H AU - Hahnenkamp KH AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Rehberg, S R AU - Rehberg SR AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Grundling, M G AU - Grundling MG AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Yamamoto, N AU - Yamamoto N AD - Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Ojima, M AU - Ojima M AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Hamaguchi, S AU - Hamaguchi S AD - Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Hirose, T AU - Hirose T AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Akeda, Y AU - Akeda Y AD - Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Takegawa, R AU - Takegawa R AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Tasaki, O AU - Tasaki O AD - Department of Emergency Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. ISNI: 0000 0000 8902 2273. GRID: grid.174567.6 FAU - Shimazu, T AU - Shimazu T AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Tomono, K AU - Tomono K AD - Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Suita, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Gomez-Sanchez, E AU - Gomez-Sanchez E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Heredia-Rodriguez, M AU - Heredia-Rodriguez M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Alvarez-Fuente, E AU - Alvarez-Fuente E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Lorenzo-Lopez, M AU - Lorenzo-Lopez M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Gomez-Pesquera, E AU - Gomez-Pesquera E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Aragon-Camino, M AU - Aragon-Camino M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Liu-Zhu, P AU - Liu-Zhu P AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Sanchez-Lopez, A AU - Sanchez-Lopez A AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Hernandez-Lozano, A AU - Hernandez-Lozano A AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Pelaez-Jareno, M T AU - Pelaez-Jareno MT AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Tamayo, E AU - Tamayo E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Thomas-Ruddel, D O AU - Thomas-Ruddel DO AD - Jena University Hospital, Jena, Germany. ISNI: 0000 0000 8517 6224. GRID: grid.275559.9 FAU - Fleischmann, C AU - Fleischmann C AD - Jena University Hospital, Jena, Germany. ISNI: 0000 0000 8517 6224. GRID: grid.275559.9 FAU - Haas, C AU - Haas C AD - Jena University Hospital, Jena, Germany. ISNI: 0000 0000 8517 6224. GRID: grid.275559.9 FAU - Dennler, U AU - Dennler U AD - Jena University Hospital, Jena, Germany. ISNI: 0000 0000 8517 6224. GRID: grid.275559.9 FAU - Reinhart, K AU - Reinhart K AD - Jena University Hospital, Jena, Germany. ISNI: 0000 0000 8517 6224. GRID: grid.275559.9 FAU - Adora, V AU - Adora V AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Kar, A AU - Kar A AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Chakraborty, A AU - Chakraborty A AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Roy, S AU - Roy S AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Bandyopadhyay, A AU - Bandyopadhyay A AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Das, M AU - Das M AD - Medica Superspecialty Hospital, Kolkata, West Bengal India FAU - Mann Ben Yehudah, T AU - Mann Ben Yehudah T AD - Assaf Harofeh MC, Beer Yaakov, Israel FAU - BenYehudah, G AU - BenYehudah G AD - Assaf Harofeh MC, Beer Yaakov, Israel FAU - Salim, M AU - Salim M AD - DMC, Detroit, USA. ISNI: 0000 0001 0088 6903. GRID: grid.413184.b FAU - Kumar, N AU - Kumar N AD - DMC, Detroit, USA. ISNI: 0000 0001 0088 6903. GRID: grid.413184.b FAU - Arabi, L AU - Arabi L AD - DMC, Detroit, USA. ISNI: 0000 0001 0088 6903. GRID: grid.413184.b FAU - Burger, T AU - Burger T AD - DMC, Detroit, USA. ISNI: 0000 0001 0088 6903. GRID: grid.413184.b FAU - Lephart, P AU - Lephart P AD - DMC, Detroit, USA. ISNI: 0000 0001 0088 6903. GRID: grid.413184.b FAU - Toth-martin, E AU - Toth-martin E AD - Wayne State University, Detroit, USA. ISNI: 0000 0001 1456 7807. GRID: grid.254444.7 FAU - Valencia, C AU - Valencia C AD - Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium. ISNI: 0000 0004 0635 3376. GRID: grid.418170.b FAU - Hammami, N AU - Hammami N AD - Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium. ISNI: 0000 0004 0635 3376. GRID: grid.418170.b FAU - Blot, S AU - Blot S AD - Ghent University, Ghent, Belgium. ISNI: 0000 0001 2069 7798. GRID: grid.5342.0 FAU - Vincent, J L AU - Vincent JL AD - Erasme University, Brussels, Belgium FAU - Lambert, M L AU - Lambert ML AD - Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium. ISNI: 0000 0004 0635 3376. GRID: grid.418170.b FAU - Brunke, J AU - Brunke J AD - QualityLabs Bt GmbH, Nuremberg, Germany FAU - Riemann, T AU - Riemann T AD - B.Braun Melsungen AG, Melsungen, Germany. ISNI: 0000 0001 0699 8877. GRID: grid.462046.2 FAU - Roschke, I AU - Roschke I AD - Dr. Roschke medical marketing GmbH, Cologne, Germany FAU - Tincu, R AU - Tincu R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Cobilinschi, C AU - Cobilinschi C AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Tomescu, D AU - Tomescu D AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Ghiorghiu, Z AU - Ghiorghiu Z AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Macovei, R AU - Macovei R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Nimitvilai, S AU - Nimitvilai S AD - Nakhonpathom hospital, Nakhonpathom, Thailand FAU - Jintanapramote, K AU - Jintanapramote K AD - Nakhonpathom hospital, Nakhonpathom, Thailand FAU - Jarupongprapa, S AU - Jarupongprapa S AD - Nakhonpathom hospital, Nakhonpathom, Thailand FAU - Adukauskiene, D AU - Adukauskiene D AD - Lithuanian University of Health Sciences, Kaunas,, Lithuania. ISNI: 0000 0004 0432 6841. GRID: grid.45083.3a FAU - Valanciene, D AU - Valanciene D AD - Lithuanian University of Health Sciences, Kaunas,, Lithuania. ISNI: 0000 0004 0432 6841. GRID: grid.45083.3a FAU - Bose, G AU - Bose G AD - University Hospital North Midlands, Stoke-on-Trent, UK FAU - Lostarakos, V AU - Lostarakos V AD - University Hospital North Midlands, Stoke-on-Trent, UK FAU - Carr, B AU - Carr B AD - University Hospital North Midlands, Stoke-on-Trent, UK FAU - Khedher, S AU - Khedher S AD - EPS Charles-Nicolle, Bab Saadoun, Tunisia FAU - Maaoui, A AU - Maaoui A AD - EPS Charles-Nicolle, Bab Saadoun, Tunisia FAU - Ezzamouri, A AU - Ezzamouri A AD - EPS Charles-Nicolle, Bab Saadoun, Tunisia FAU - Salem, M AU - Salem M AD - EPS Charles-Nicolle, Bab Saadoun, Tunisia FAU - Chen, J AU - Chen J AD - Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan FAU - Cranendonk, D R AU - Cranendonk DR AD - Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. ISNI: 0000000084992262. GRID: grid.7177.6 FAU - Van Vught, L A AU - Van Vught LA AD - Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, Netherlands FAU - Wiewel, M A AU - Wiewel MA AD - Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, Netherlands FAU - Cremer, O L AU - Cremer OL AD - Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, Netherlands. ISNI: 0000000090126352. GRID: grid.7692.a FAU - Horn, J AU - Horn J AD - Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Bonten, M J AU - Bonten MJ AD - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands. ISNI: 0000000090126352. GRID: grid.7692.a FAU - Schultz, M J AU - Schultz MJ AD - Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van der Poll, T AU - Van der Poll T AD - Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, Netherlands FAU - Wiersinga, W J AU - Wiersinga WJ AD - Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, Netherlands FAU - Day, M AU - Day M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Penrice, G AU - Penrice G AD - NHS Greater Glasgow and Clyde, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Roy, K AU - Roy K AD - Health Protection Scotland, Glasgow, UK. ISNI: 0000 0001 2232 4338. GRID: grid.413893.4 FAU - Robertson, P AU - Robertson P AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Godbole, G AU - Godbole G AD - Public Health England, London, UK. ISNI: 0000 0001 2196 8713. GRID: grid.9004.d FAU - Jones, B AU - Jones B AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Booth, M AU - Booth M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Donaldson, L AU - Donaldson L AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kawano, Y AU - Kawano Y AD - Fukuoka University Hospital, Fukuoka, Japan. ISNI: 0000 0004 0594 9821. GRID: grid.411556.2 FAU - Ishikura, H AU - Ishikura H AD - Fukuoka University Hospital, Fukuoka, Japan. ISNI: 0000 0004 0594 9821. GRID: grid.411556.2 FAU - Al-Dorzi, H AU - Al-Dorzi H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Almutairi, M AU - Almutairi M AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alhamadi, B AU - Alhamadi B AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Crizaldo Toledo, A AU - Crizaldo Toledo A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Khan, R AU - Khan R AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Al Raiy, B AU - Al Raiy B AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Arabi, Y AU - Arabi Y AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Talaie, H AU - Talaie H AD - Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. GRID: grid.411600.2 FAU - Van Oers, J A AU - Van Oers JA AD - St. Elisabeth Hospital, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Harts, A AU - Harts A AD - St. Elisabeth Hospital, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Nieuwkoop, E AU - Nieuwkoop E AD - St. Elisabeth Hospital, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Vos, P AU - Vos P AD - St. Elisabeth Hospital, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Boussarsar, Y AU - Boussarsar Y AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Boutouta, F AU - Boutouta F AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Kamoun, S AU - Kamoun S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mezghani, I AU - Mezghani I AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Koubaji, S AU - Koubaji S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Ben Souissi, A AU - Ben Souissi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Riahi, A AU - Riahi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mebazaa, M S AU - Mebazaa MS AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Giamarellos-Bourboulis, E AU - Giamarellos-Bourboulis E AD - University of Athens, Medical School, Athens, Greece. ISNI: 0000 0001 2155 0800. GRID: grid.5216.0 FAU - Tziolos, N AU - Tziolos N AD - University of Athens, Medical School, Athens, Greece. ISNI: 0000 0001 2155 0800. GRID: grid.5216.0 FAU - Routsi, C AU - Routsi C AD - University of Athens, Medical School, Athens, Greece. ISNI: 0000 0001 2155 0800. GRID: grid.5216.0 FAU - Katsenos, C AU - Katsenos C AD - Korgialeneion Benakeion Hospital, Athens, Greece FAU - Tsangaris, I AU - Tsangaris I AD - University of Athens, Medical School, Athens, Greece. ISNI: 0000 0001 2155 0800. GRID: grid.5216.0 FAU - Pneumatikos, I AU - Pneumatikos I AD - University of Thrace, Alexandroupolis, Greece. ISNI: 0000 0001 2170 8022. GRID: grid.12284.3d FAU - Vlachogiannis, G AU - Vlachogiannis G AD - Aghios Dimitrios Hospital, Thessaloniki, Greece FAU - Theodorou, V AU - Theodorou V AD - University of Thrace, Alexandroupolis, Greece. ISNI: 0000 0001 2170 8022. GRID: grid.12284.3d FAU - Prekates, A AU - Prekates A AD - Tzaneion Hospital, Piraeus, Greece FAU - Antypa, E AU - Antypa E AD - G.Gennimatas General Hospital, Thessaloniki, Greece. GRID: grid.414012.2 FAU - Koulouras, V AU - Koulouras V AD - University of Ioannina, Ioannina, Greece. ISNI: 0000 0001 2108 7481. GRID: grid.9594.1 FAU - Kapravelos, N AU - Kapravelos N AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Gogos, C AU - Gogos C AD - University of Patras, Patras, Greece. ISNI: 0000 0004 0576 5395. GRID: grid.11047.33 FAU - Antoniadou, E AU - Antoniadou E AD - G.Gennimatas General Hospital, Thessaloniki, Greece. GRID: grid.414012.2 FAU - Mandragos, K AU - Mandragos K AD - Korgialeneion Benakeion Hospital, Athens, Greece FAU - Armaganidis, A AU - Armaganidis A AD - University of Athens, Medical School, Athens, Greece. ISNI: 0000 0001 2155 0800. GRID: grid.5216.0 FAU - Robles Caballero, A R AU - Robles Caballero AR AD - Hospital Universitario La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Civantos, B AU - Civantos B AD - Hospital Universitario La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Figueira, J C AU - Figueira JC AD - Hospital Universitario La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Lopez, J AU - Lopez J AD - Hospital Universitario La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Silva-Pinto, A AU - Silva-Pinto A AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Ceia, F AU - Ceia F AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Sarmento, A AU - Sarmento A AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Santos, L AU - Santos L AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Almekhlafi, G AU - Almekhlafi G AD - PSMMC, Riyadh, Saudi Arabia FAU - Sakr, Y AU - Sakr Y AD - UNIKLINIKUM JENA, JENA, Germany FAU - Al-Dorzi, H AU - Al-Dorzi H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Khan, R AU - Khan R AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Baharoon, S AU - Baharoon S AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Aldawood, A AU - Aldawood A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Matroud, A AU - Matroud A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alchin, J AU - Alchin J AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Al Johani, S AU - Al Johani S AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Balkhy, H AU - Balkhy H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Arabi, Y AU - Arabi Y AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alsolamy, S AU - Alsolamy S AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Yousif, S Y AU - Yousif SY AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alotabi, B O AU - Alotabi BO AD - King Fahad Medical City, Riyadh, Saudi Arabia. ISNI: 0000 0004 0593 1832. GRID: grid.415277.2 FAU - Alsaawi, A S AU - Alsaawi AS AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Ang, J AU - Ang J AD - Addenbrooke's Hospital, Cambridge, UK. ISNI: 0000 0004 0622 5016. GRID: grid.120073.7 FAU - Curran, M D AU - Curran MD AD - Addenbrooke's Hospital, Cambridge, UK. ISNI: 0000 0004 0622 5016. GRID: grid.120073.7 FAU - Enoch, D AU - Enoch D AD - Addenbrooke's Hospital, Cambridge, UK. ISNI: 0000 0004 0622 5016. GRID: grid.120073.7 FAU - Navapurkar, V AU - Navapurkar V AD - Addenbrooke's Hospital, Cambridge, UK. ISNI: 0000 0004 0622 5016. GRID: grid.120073.7 FAU - Morris, A AU - Morris A AD - University of Cambridge, Cambridge, UK. ISNI: 0000000121885934. GRID: grid.5335.0 FAU - Sharvill, R AU - Sharvill R AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Astin, J AU - Astin J AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Heredia-Rodriguez, M AU - Heredia-Rodriguez M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Gomez-Sanchez, E AU - Gomez-Sanchez E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Pelaez-Jareno, M T AU - Pelaez-Jareno MT AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Gomez-Pesquera, E AU - Gomez-Pesquera E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Lorenzo-Lopez, M AU - Lorenzo-Lopez M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Liu-Zhu, P AU - Liu-Zhu P AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Aragon-Camino, M AU - Aragon-Camino M AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Hernandez-Lozano, A AU - Hernandez-Lozano A AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Sanchez-Lopez, A AU - Sanchez-Lopez A AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Alvarez-Fuente, E AU - Alvarez-Fuente E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Tamayo, E AU - Tamayo E AD - Hospital Clinico Universitario de Valladolid, Valladolid, Spain. ISNI: 0000 0000 9274 367X. GRID: grid.411057.6 FAU - Patel, J AU - Patel J AD - Salford Royal Hospital, London, UK. ISNI: 0000 0000 8535 2371. GRID: grid.415721.4 FAU - Kruger, C AU - Kruger C AD - Salford Royal Hospital, London, UK. ISNI: 0000 0000 8535 2371. GRID: grid.415721.4 FAU - O'Neal, J AU - O'Neal J AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Rhodes, H AU - Rhodes H AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Jancik, J AU - Jancik J AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Francois, B AU - Francois B AD - CHU Dupuytren, Limoges, France. ISNI: 0000 0001 1481 5225. GRID: grid.412212.6 FAU - Laterre, P F AU - Laterre PF AD - St Luc University Hospital, Brussels, Belgium. ISNI: 0000 0004 0461 6320. GRID: grid.48769.34 FAU - Eggimann, P AU - Eggimann P AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Torres, A AU - Torres A AD - Hospital Clinic of Barcelona, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Sanchez, M AU - Sanchez M AD - Hospital Clinico San Carlos, Madrid, Spain. ISNI: 0000 0001 0671 5785. GRID: grid.411068.a FAU - Dequin, P F AU - Dequin PF AD - Universite Francois Rabelais and CHU Bretonneau, Tours, France. ISNI: 0000 0001 2182 6141. GRID: grid.12366.30 FAU - Bassi, G L AU - Bassi GL AD - Hospital Clinic of Barcelona, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Chastre, J AU - Chastre J AD - Groupe Hospitalier Pitie-Salpetriere, Paris, France. ISNI: 0000 0001 2150 9058. GRID: grid.411439.a FAU - Jafri, H S AU - Jafri HS AD - MedImmune, Gaithersburg, USA. GRID: grid.418152.b FAU - Ben Romdhane, M AU - Ben Romdhane M AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Douira, Z AU - Douira Z AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Kamoun, S AU - Kamoun S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Bousselmi, M AU - Bousselmi M AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Ben Souissi, A AU - Ben Souissi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Boussarsar, Y AU - Boussarsar Y AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Riahi, A AU - Riahi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mebazaa, M S AU - Mebazaa MS AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Vakalos, A AU - Vakalos A AD - Xanthi General Hospital, Xanthi, Greece FAU - Avramidis, V AU - Avramidis V AD - Xanthi General Hospital, Xanthi, Greece FAU - Craven, T H AU - Craven TH AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Wojcik, G AU - Wojcik G AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Kefala, K AU - Kefala K AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - McCoubrey, J AU - McCoubrey J AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Reilly, J AU - Reilly J AD - Health Protection Scotland, Glasgow, UK. ISNI: 0000 0001 2232 4338. GRID: grid.413893.4 FAU - Paterson, R AU - Paterson R AD - Western General Hospital, Edinburgh, UK. ISNI: 0000 0004 0624 9907. GRID: grid.417068.c FAU - Inverarity, D AU - Inverarity D AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Laurenson, I AU - Laurenson I AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Walsh, T S AU - Walsh TS AD - Royal Infirmary of Edinburgh, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Mongodi, S AU - Mongodi S AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Bouhemad, B AU - Bouhemad B AD - Centre Hospitalier Universitaire Dijon, Dijon, France. GRID: grid.31151.37 FAU - Orlando, A AU - Orlando A AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Stella, A AU - Stella A AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Via, G AU - Via G AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Iotti, G AU - Iotti G AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Braschi, A AU - Braschi A AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Mojoli, F AU - Mojoli F AD - Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. ISNI: 0000 0004 1762 5736. GRID: grid.8982.b FAU - Haliloglu, M AU - Haliloglu M AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Bilgili, B AU - Bilgili B AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Kasapoglu, U AU - Kasapoglu U AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Sayan, I AU - Sayan I AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Suzer Aslan, M AU - Suzer Aslan M AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Yalcin, A AU - Yalcin A AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Cinel, I AU - Cinel I AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Vakalos, A AU - Vakalos A AD - Xanthi General Hospital, Xanthi, Greece FAU - Avramidis, V AU - Avramidis V AD - Xanthi General Hospital, Xanthi, Greece FAU - Ellis, H E AU - Ellis HE AD - Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. GRID: grid.419135.b FAU - Bauchmuller, K AU - Bauchmuller K AD - Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. GRID: grid.419135.b FAU - Miller, D AU - Miller D AD - Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. GRID: grid.419135.b FAU - Temple, A AU - Temple A AD - Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. GRID: grid.419135.b FAU - Chastre, J AU - Chastre J AD - Groupe Hospitalier Pitie-Salpetriere, Paris, France. ISNI: 0000 0001 2150 9058. GRID: grid.411439.a FAU - Francois, B AU - Francois B AD - CHU Dupuytren, Limoges, France. ISNI: 0000 0001 1481 5225. GRID: grid.412212.6 FAU - Torres, A AU - Torres A AD - Hospital Clinic of Barcelona, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Luyt, C E AU - Luyt CE AD - Groupe Hospitalier Pitie-Salpetriere, Paris, France. ISNI: 0000 0001 2150 9058. GRID: grid.411439.a FAU - Sanchez, M AU - Sanchez M AD - Hospital Clinico San Carlos, Madrid, Spain. ISNI: 0000 0001 0671 5785. GRID: grid.411068.a FAU - Singer, M AU - Singer M AD - University College, London, UK FAU - Jafri, H S AU - Jafri HS AD - MedImmune, Gaithersburg, USA. GRID: grid.418152.b FAU - Nassar, Y AU - Nassar Y AD - Cairo University, Giza, Egypt. ISNI: 0000 0004 0639 9286. GRID: grid.7776.1 FAU - Ayad, M S AU - Ayad MS AD - Cairo University, Giza, Egypt. ISNI: 0000 0004 0639 9286. GRID: grid.7776.1 FAU - Trifi, A AU - Trifi A AD - University hospital Center of La Rabta, Tunis, Tunisia FAU - Abdellatif, S AU - Abdellatif S AD - University hospital Center of La Rabta, Tunis, Tunisia FAU - Daly, F AU - Daly F AD - University hospital Center of La Rabta, Tunis, Tunisia FAU - Nasri, R AU - Nasri R AD - University hospital Center of La Rabta, Tunis, Tunisia FAU - Ben Lakhal, S AU - Ben Lakhal S AD - University hospital Center of La Rabta, Tunis, Tunisia FAU - Bilgili, B AU - Bilgili B AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Haliloglu, M AU - Haliloglu M AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Gul, F AU - Gul F AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Cinel, I AU - Cinel I AD - Marmara University Pendik Teaching and Research Hospital, Istanbul, Turkey. ISNI: 0000 0001 0668 8422. GRID: grid.16477.33 FAU - Kuzovlev, A AU - Kuzovlev A AD - V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia FAU - Shabanov, A AU - Shabanov A AD - N.V. Sklifosofsky Institute of Emergency Medicine, Moscow, Russia FAU - Polovnikov, S AU - Polovnikov S AD - NN Burdenko Main Military Hospital, Moscow, Russia FAU - Moroz, V AU - Moroz V AD - V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia FAU - Kadrichu, N AU - Kadrichu N AD - Novartis Pharmaceuticals, San Carlos, USA. ISNI: 0000 0004 0439 2056. GRID: grid.418424.f FAU - Dang, T AU - Dang T AD - Novartis Pharmaceuticals, San Carlos, USA. ISNI: 0000 0004 0439 2056. GRID: grid.418424.f FAU - Corkery, K AU - Corkery K AD - Novartis Pharmaceuticals, San Carlos, USA. ISNI: 0000 0004 0439 2056. GRID: grid.418424.f FAU - Challoner, P AU - Challoner P AD - Nektar Therapeutics, San Francisco, CA USA. ISNI: 0000 0004 0410 3955. GRID: grid.476522.0 FAU - Bassi, G Li AU - Bassi GL AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Aguilera, E AU - Aguilera E AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Chiurazzi, C AU - Chiurazzi C AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Travierso, C AU - Travierso C AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Motos, A AU - Motos A AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Fernandez, L AU - Fernandez L AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Amaro, R AU - Amaro R AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Senussi, T AU - Senussi T AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Idone, F AU - Idone F AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Bobi, J AU - Bobi J AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Rigol, M AU - Rigol M AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Torres, A AU - Torres A AD - Hospital Clinic, Barcelona, Spain. ISNI: 0000 0000 9635 9413. GRID: grid.410458.c FAU - Hodiamont, C J AU - Hodiamont CJ AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Juffermans, N P AU - Juffermans NP AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Janssen, J M AU - Janssen JM AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Bouman, C S AU - Bouman CS AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Mathot, R A AU - Mathot RA AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - De Jong, M D AU - De Jong MD AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Hest, R M AU - Van Hest RM AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Payne, L AU - Payne L AD - Maine Medical Center, Portland, USA. GRID: grid.240160.1 FAU - Fraser, G L AU - Fraser GL AD - Maine Medical Center, Portland, USA. GRID: grid.240160.1 FAU - Tudor, B AU - Tudor B AD - Medical University of Vienna, Vienna, Austria. ISNI: 0000 0000 9259 8492. GRID: grid.22937.3d FAU - Lahner, M AU - Lahner M AD - Medical University of Vienna, Vienna, Austria. ISNI: 0000 0000 9259 8492. GRID: grid.22937.3d FAU - Roth, G AU - Roth G AD - Medical University of Vienna, Vienna, Austria. ISNI: 0000 0000 9259 8492. GRID: grid.22937.3d FAU - Krenn, C AU - Krenn C AD - Medical University of Vienna, Vienna, Austria. ISNI: 0000 0000 9259 8492. GRID: grid.22937.3d FAU - Talaie, H AU - Talaie H AD - Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. GRID: grid.411600.2 FAU - Jault, P AU - Jault P AD - HIA Percy, Clamart, France. ISNI: 0000 0004 1795 3756. GRID: grid.414028.b FAU - Gabard, J AU - Gabard J AD - Pherecydes Pharma, Romainville, France FAU - Leclerc, T AU - Leclerc T AD - HIA Percy, Clamart, France. ISNI: 0000 0004 1795 3756. GRID: grid.414028.b FAU - Jennes, S AU - Jennes S AD - Hopital Reine Astrid, Brussels, Belgium FAU - Que, Y AU - Que Y AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Rousseau, A AU - Rousseau A AD - CHU Liege, Liege, Belgium. ISNI: 0000 0000 8607 6858. GRID: grid.411374.4 FAU - Ravat, F AU - Ravat F AD - CH Saint Jospeh Saint Luc, Lyon, France FAU - Al-Dorzi, H AU - Al-Dorzi H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Eissa, A AU - Eissa A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Al-Harbi, S AU - Al-Harbi S AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Aldabbagh, T AU - Aldabbagh T AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Khan, R AU - Khan R AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Arabi, Y AU - Arabi Y AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Trifi, A AU - Trifi A AD - University hospital center of La Rabta, Tunis, Tunisia FAU - Abdellatif., S AU - Abdellatif. S AD - University hospital center of La Rabta, Tunis, Tunisia FAU - Daly, F AU - Daly F AD - University hospital center of La Rabta, Tunis, Tunisia FAU - Nasri, R AU - Nasri R AD - University hospital center of La Rabta, Tunis, Tunisia FAU - Ben Lakhal, S AU - Ben Lakhal S AD - University hospital center of La Rabta, Tunis, Tunisia FAU - Paramba, F AU - Paramba F AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Purayil, N AU - Purayil N AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Naushad, V AU - Naushad V AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Mohammad, O AU - Mohammad O AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Negi, V AU - Negi V AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Chandra, P AU - Chandra P AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Kleinsasser, A AU - Kleinsasser A AD - MUI, Innsbruck, Austria. ISNI: 0000 0000 8853 2677. GRID: grid.5361.1 FAU - Witrz, M R AU - Witrz MR AD - Academic Medical Centre, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Buchner-Doeven, J F AU - Buchner-Doeven JF AD - Academic Medical Centre, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Tuip-de Boer, A M AU - Tuip-de Boer AM AD - Academic Medical Centre, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Goslings, J C AU - Goslings JC AD - Academic Medical Centre, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Juffermans, N P AU - Juffermans NP AD - Academic Medical Centre, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Hezel, M AU - Van Hezel M AD - Academic Medical Center Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Straat, M AU - Straat M AD - Academic Medical Center Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Boing, A AU - Boing A AD - Academic Medical Center Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Bruggen, R AU - Van Bruggen R AD - Sanquin, Amsterdam, Netherlands. ISNI: 0000 0001 2234 6887. GRID: grid.417732.4 FAU - Juffermans, N AU - Juffermans N AD - Academic Medical Center Amsterdam, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Markopoulou, D AU - Markopoulou D AD - KAT Hospital Athens, Kifisia, Greece. ISNI: 0000 0004 0622 8129. GRID: grid.415070.7 FAU - Venetsanou, K AU - Venetsanou K AD - KAT Hospital Athens, Kifisia, Greece. ISNI: 0000 0004 0622 8129. GRID: grid.415070.7 FAU - Kaldis, V AU - Kaldis V AD - KAT Hospital Athens, Kifisia, Greece. ISNI: 0000 0004 0622 8129. GRID: grid.415070.7 FAU - Koutete, D AU - Koutete D AD - KAT Hospital Athens, Kifisia, Greece. ISNI: 0000 0004 0622 8129. GRID: grid.415070.7 FAU - Chroni, D AU - Chroni D AD - KAT Hospital Athens, Kifisia, Greece. ISNI: 0000 0004 0622 8129. GRID: grid.415070.7 FAU - Alamanos, I AU - Alamanos I AD - ICU-B, KAT Hospital Kifisia, Athens, Greece FAU - Koch, L AU - Koch L AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Jancik, J AU - Jancik J AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Rhodes, H AU - Rhodes H AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Walter, E AU - Walter E AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Maekawa, K AU - Maekawa K AD - Hokkaido University Hospital, Sapporo, Japan. ISNI: 0000 0004 0378 6088. GRID: grid.412167.7 FAU - Hayakawa, M AU - Hayakawa M AD - Hokkaido University Hospital, Sapporo, Japan. ISNI: 0000 0004 0378 6088. GRID: grid.412167.7 FAU - Kushimoto, S AU - Kushimoto S AD - Tohoku University Graduate School of Medicine, Sendai, Japan. ISNI: 0000 0001 2248 6943. GRID: grid.69566.3a FAU - Shiraishi, A AU - Shiraishi A AD - Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. GRID: grid.474906.8 FAU - Kato, H AU - Kato H AD - National Hospital Organization Disaster Medical Center, Tokyo, Japan. ISNI: 0000 0004 0569 9594. GRID: grid.416797.a FAU - Sasaki, J AU - Sasaki J AD - Keio University School of Medicine, Tokyo, Japan. ISNI: 0000 0004 1936 9959. GRID: grid.26091.3c FAU - Ogura, H AU - Ogura H AD - Osaka University Graduate School of Medicine, Osaka, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Matauoka, T AU - Matauoka T AD - Rinku General Medical Center, Osaka, Japan FAU - Uejima, T AU - Uejima T AD - Kinki University Faculty of Medicine, Osaka, Japan. ISNI: 0000 0004 1936 9967. GRID: grid.258622.9 FAU - Morimura, N AU - Morimura N AD - Yokohama City University Graduate School of Medicine, Yokohama, Japan. ISNI: 0000 0001 1033 6139. GRID: grid.268441.d FAU - Ishikura, H AU - Ishikura H AD - Faculty of Medicine, Fukuoka University, Fukuoka, Japan. ISNI: 0000 0001 0672 2176. GRID: grid.411497.e FAU - Hagiwara, A AU - Hagiwara A AD - National Center For Global Health and Medicine, Tokyo, Japan. ISNI: 0000 0004 0489 0290. GRID: grid.45203.30 FAU - Takeda, M AU - Takeda M AD - Tokyo Women's Medical University, Tokyo, Japan. ISNI: 0000 0001 0720 6587. GRID: grid.410818.4 FAU - Tarabrin, O AU - Tarabrin O AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Shcherbakow, S AU - Shcherbakow S AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Gavrychenko, D AU - Gavrychenko D AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Mazurenko, G AU - Mazurenko G AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Ivanova, V AU - Ivanova V AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Chystikov, O AU - Chystikov O AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Plourde, C AU - Plourde C AD - Hopital Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Lessard, J AU - Lessard J AD - Hopital Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Chauny, J AU - Chauny J FAU - Daoust, R AU - Daoust R AD - Hopital Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Shcherbakow, S AU - Shcherbakow S AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Tarabrin, O AU - Tarabrin O AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Gavrychenko, D AU - Gavrychenko D AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Mazurenko, G AU - Mazurenko G AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Chystikov, O AU - Chystikov O AD - Odessa National Medical University, Odessa, Ukraine. GRID: grid.445907.b FAU - Vakalos, A AU - Vakalos A AD - Xanthi General Hospital, Xanth, Greece. GRID: grid.414012.2 FAU - Avramidis, V AU - Avramidis V AD - Xanthi General Hospital, Xanth, Greece. GRID: grid.414012.2 FAU - Kropman, L AU - Kropman L AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - In het Panhuis, L AU - In het Panhuis L AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Konings, J AU - Konings J AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Huskens, D AU - Huskens D AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Schurgers, E AU - Schurgers E AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Roest, M AU - Roest M AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - De Laat, B AU - De Laat B AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Lance, M AU - Lance M AD - Maastricht UMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Durila, M AU - Durila M AD - Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. ISNI: 0000 0004 0611 0905. GRID: grid.412826.b FAU - Lukas, P AU - Lukas P AD - Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. ISNI: 0000 0004 0611 0905. GRID: grid.412826.b FAU - Astraverkhava, M AU - Astraverkhava M AD - Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. ISNI: 0000 0004 0611 0905. GRID: grid.412826.b FAU - Jonas, J AU - Jonas J AD - Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. ISNI: 0000 0004 0611 0905. GRID: grid.412826.b FAU - Budnik, I AU - Budnik I AD - Sechenov First Moscow Stat Medical University, Moscow, Russia FAU - Shenkman, B AU - Shenkman B AD - Sheba Medical Center, Tel-Hashomer, Israel. ISNI: 0000 0001 2107 2845. GRID: grid.413795.d FAU - Hayami, H AU - Hayami H AD - Yokohama Municipal Citizen's Hospital, Yokohama, Japan. ISNI: 0000 0004 0377 5418. GRID: grid.417366.1 FAU - Koide, Y AU - Koide Y AD - Hayama Heart Center, Hayama, Japan FAU - Goto, T AU - Goto T AD - Yokohama City University Hospital, Yokohama, Japan. ISNI: 0000 0004 1767 0473. GRID: grid.470126.6 FAU - Iqbal, R AU - Iqbal R AD - Institute of Ageing and Chronic Disease, Liverpool, UK FAU - Alhamdi, Y AU - Alhamdi Y AD - Institute of Infection and Global Health, Liverpool, UK FAU - Venugopal, N AU - Venugopal N AD - Institute of Ageing and Chronic Disease, Liverpool, UK FAU - Abrams, S AU - Abrams S AD - Institute of Infection and Global Health, Liverpool, UK FAU - Downey, C AU - Downey C AD - Department of Haematology, Royal Liverpool University Hospital (RLUH), Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Toh, C H AU - Toh CH AD - Institute of Infection and Global Health, Liverpool, UK FAU - Welters, I D AU - Welters ID AD - Institute of Ageing and Chronic Disease, Liverpool, UK FAU - Bombay, V B AU - Bombay VB AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Chauny, J M AU - Chauny JM AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Daoust, R D AU - Daoust RD AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Lessard, J L AU - Lessard JL AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Marquis, M M AU - Marquis MM AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Paquet, J P AU - Paquet JP AD - Hopital du Sacre-Coeur de Montreal, Montreal, Canada. ISNI: 0000 0001 2160 7387. GRID: grid.414056.2 FAU - Siemens, K AU - Siemens K AD - Evelina London Children's Hospital, London, UK FAU - Sangaran, D AU - Sangaran D AD - Evelina London Children's Hospital, London, UK FAU - Hunt, B J AU - Hunt BJ AD - St Thomas Hospital, London, UK. GRID: grid.425213.3 FAU - Durward, A AU - Durward A AD - Evelina London Children's Hospital, London, UK FAU - Nyman, A AU - Nyman A AD - Evelina London Children's Hospital, London, UK FAU - Murdoch, I A AU - Murdoch IA AD - Evelina London Children's Hospital, London, UK FAU - Tibby, S M AU - Tibby SM AD - Evelina London Children's Hospital, London, UK FAU - Ampatzidou, F AU - Ampatzidou F AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Moisidou, D AU - Moisidou D AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Dalampini, E AU - Dalampini E AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Nastou, M AU - Nastou M AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Vasilarou, E AU - Vasilarou E AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Kalaizi, V AU - Kalaizi V AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Chatzikostenoglou, H AU - Chatzikostenoglou H AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Drossos, G AU - Drossos G AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Spadaro, S AU - Spadaro S AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Fogagnolo, A AU - Fogagnolo A AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Fiore, T AU - Fiore T AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Schiavi, A AU - Schiavi A AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Fontana, V AU - Fontana V AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Taccone, F AU - Taccone F AD - Department of Intensive Care, Erasme Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium FAU - Volta, C AU - Volta C AD - Intensive Care Unit, University of Ferrara, Italy, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Chochliourou, E AU - Chochliourou E AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Volakli, E AU - Volakli E AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Violaki, A AU - Violaki A AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Samkinidou, E AU - Samkinidou E AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Evlavis, G AU - Evlavis G AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Panagiotidou, V AU - Panagiotidou V AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Sdougka, M AU - Sdougka M AD - Hippokration General Hospital Thessaloniki, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Mothukuri, R AU - Mothukuri R AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Battle, C AU - Battle C AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Guy, K AU - Guy K AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Mills, G AU - Mills G AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Evans, P AU - Evans P AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Wijesuriya, J AU - Wijesuriya J AD - Central London School of Anaesthesia and Intensive Care Medicine, London, UK FAU - Keogh, S AU - Keogh S AD - University of the Sunshine Coast, Maroochydore, Australia. ISNI: 0000 0001 1555 3415. GRID: grid.1034.6 FAU - Docherty, A AU - Docherty A AD - University of Edinburgh, Edinburgh, UK. ISNI: 0000 0004 1936 7988. GRID: grid.4305.2 FAU - O'Donnell, R AU - O'Donnell R AD - University of Edinburgh, Edinburgh, UK. ISNI: 0000 0004 1936 7988. GRID: grid.4305.2 FAU - Brunskill, S AU - Brunskill S AD - John Radcliffe Hospital, Oxford, UK. ISNI: 0000 0001 2306 7492. GRID: grid.8348.7 FAU - Trivella, M AU - Trivella M AD - John Radcliffe Hospital, Oxford, UK. ISNI: 0000 0001 2306 7492. GRID: grid.8348.7 FAU - Doree, C AU - Doree C AD - John Radcliffe Hospital, Oxford, UK. ISNI: 0000 0001 2306 7492. GRID: grid.8348.7 FAU - Holst, L AU - Holst L AD - Copenhagen University Hospital, Copenhagen, Denmark. ISNI: 0000 0004 0646 7373. GRID: grid.4973.9 FAU - Parker, M AU - Parker M AD - Peterborough NHS Trust, Peterborough, UK FAU - Gregersen, M AU - Gregersen M AD - Aarhus University, Aarhus, Denmark. ISNI: 0000 0001 1956 2722. GRID: grid.7048.b FAU - Almeida, J AU - Almeida J AD - Hospital de Sao Paulo, Sao Paulo, Brazil. GRID: grid.413463.7 FAU - Walsh, T AU - Walsh T AD - University of Edinburgh, Edinburgh, UK. ISNI: 0000 0004 1936 7988. GRID: grid.4305.2 FAU - Stanworth, S AU - Stanworth S AD - John Radcliffe Hospital, Oxford, UK. ISNI: 0000 0001 2306 7492. GRID: grid.8348.7 FAU - Moravcova, S AU - Moravcova S AD - Royal Brompton & Harefield NHS Trust, London, UK. ISNI: 0000 0004 0581 2008. GRID: grid.451052.7 FAU - Mansell, J AU - Mansell J AD - Barts Heart Centre, London, UK FAU - Rogers, A AU - Rogers A AD - Barts Heart Centre, London, UK FAU - Smith, R A AU - Smith RA AD - Barts Heart Centre, London, UK FAU - Hamilton-Davies, C AU - Hamilton-Davies C AD - Barts Heart Centre, London, UK FAU - Omar, A AU - Omar A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Allam, M AU - Allam M AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Bilala, O AU - Bilala O AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Kindawi, A AU - Kindawi A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Ewila, H AU - Ewila H AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Ampatzidou, F AU - Ampatzidou F AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Moisidou, D AU - Moisidou D AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Nastou, M AU - Nastou M AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Dalampini, E AU - Dalampini E AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Malamas, A AU - Malamas A AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Vasilarou, E AU - Vasilarou E AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Drossos, G AU - Drossos G AD - G.Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Ferreira, G AU - Ferreira G AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Caldas, J AU - Caldas J AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Fukushima, J AU - Fukushima J AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Osawa, E A AU - Osawa EA AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Arita, E AU - Arita E AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Camara, L AU - Camara L AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Zeferino, S AU - Zeferino S AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Jardim, J AU - Jardim J AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Gaioto, F AU - Gaioto F AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Dallan, L AU - Dallan L AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Jatene, F B AU - Jatene FB AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Kalil Filho, R AU - Kalil Filho R AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Galas, F AU - Galas F AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Hajjar, L A AU - Hajjar LA AD - University of Sao Paulo, Brazi, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Mitaka, C AU - Mitaka C AD - Juntendo University Hospital, Tokyo, Japan. GRID: grid.411966.d FAU - Ohnuma, T AU - Ohnuma T AD - Saitama Medical Center, Jichi Medical University, Saitama, Japan. ISNI: 0000000123090000. GRID: grid.410804.9 FAU - Murayama, T AU - Murayama T FAU - Kunimoto, F AU - Kunimoto F AD - Gunma University Hospital, Maebashi, Japan. ISNI: 0000 0004 0595 7039. GRID: grid.411887.3 FAU - Nagashima, M AU - Nagashima M AD - Yokohama City Minato Red Cross Hospital, Yokohama, Japan FAU - Takei, T AU - Takei T AD - Yokohama City Minato Red Cross Hospital, Yokohama, Japan FAU - Tomita, M AU - Tomita M AD - Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. GRID: grid.474906.8 FAU - Omar, A AU - Omar A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Mahmoud, K AU - Mahmoud K AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Hanoura, S AU - Hanoura S AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Sudarsanan, S AU - Sudarsanan S AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Sivadasan, P AU - Sivadasan P AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Othamn, H AU - Othamn H AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Shouman, Y AU - Shouman Y AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Singh, R AU - Singh R AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Al Khulaifi, A AU - Al Khulaifi A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Mandel, I AU - Mandel I AD - Research Institution for Cardiology, Tomsk, Russia FAU - Mikheev, S AU - Mikheev S AD - Research Institution for Cardiology, Tomsk, Russia FAU - Suhodolo, I AU - Suhodolo I AD - Siberian State Medical University, Tomsk, Russia. ISNI: 0000 0001 0027 1685. GRID: grid.412593.8 FAU - Kiselev, V AU - Kiselev V AD - Research Institution for Cardiology, Tomsk, Russia FAU - Svirko, Y AU - Svirko Y AD - Research Institution for Cardiology, Tomsk, Russia FAU - Podoksenov, Y AU - Podoksenov Y AD - Research Institution for Cardiology, Tomsk, Russia FAU - Jenkins, S A AU - Jenkins SA AD - The Hillingdon Hospitals NHS Foundation Trust, Middlesex, UK. ISNI: 0000 0004 0476 7073. GRID: grid.440199.1 FAU - Griffin, R AU - Griffin R AD - The Hillingdon Hospitals NHS Foundation Trust, Middlesex, UK. ISNI: 0000 0004 0476 7073. GRID: grid.440199.1 FAU - Tovar Doncel, M S AU - Tovar Doncel MS AD - University Hospital Rio Hortega, Valladolid, Spain. ISNI: 0000 0001 1842 3755. GRID: grid.411280.e FAU - Lima, A AU - Lima A AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Aldecoa, C AU - Aldecoa C AD - University Hospital Rio Hortega, Valladolid, Spain. ISNI: 0000 0001 1842 3755. GRID: grid.411280.e FAU - Ince, C AU - Ince C AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Taha, A AU - Taha A AD - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. ISNI: 0000 0004 1773 3278. GRID: grid.415670.1 FAU - Shafie, A AU - Shafie A AD - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. ISNI: 0000 0004 1773 3278. GRID: grid.415670.1 FAU - Mostafa, M AU - Mostafa M AD - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. ISNI: 0000 0004 1773 3278. GRID: grid.415670.1 FAU - Syed, N AU - Syed N AD - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. ISNI: 0000 0004 1773 3278. GRID: grid.415670.1 FAU - Hon, H AU - Hon H AD - Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. ISNI: 0000 0004 1773 3278. GRID: grid.415670.1 FAU - Righetti, F AU - Righetti F AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Colombaroli, E AU - Colombaroli E AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Castellano, G AU - Castellano G AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Righetti, F AU - Righetti F AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Colombaroli, E AU - Colombaroli E AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Hravnak, M AU - Hravnak M AD - University of Pittsburgh, Pittsburgh, USA. ISNI: 0000 0004 1936 9000. GRID: grid.21925.3d FAU - Chen, L C AU - Chen LC AD - Carnegie Mellon University, Pittsburgh, USA. ISNI: 0000 0001 2097 0344. GRID: grid.147455.6 FAU - Dubrawski, A D AU - Dubrawski AD AD - Carnegie Mellon University, Pittsburgh, USA. ISNI: 0000 0001 2097 0344. GRID: grid.147455.6 FAU - Clermont, G C AU - Clermont GC AD - University of Pittsburgh, Pittsburgh, USA. ISNI: 0000 0004 1936 9000. GRID: grid.21925.3d FAU - Pinsky, M R AU - Pinsky MR AD - University of Pittsburgh, Pittsburgh, USA. ISNI: 0000 0004 1936 9000. GRID: grid.21925.3d FAU - Gonzalez, S AU - Gonzalez S AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Macias, D AU - Macias D AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Acosta, J AU - Acosta J AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Jimenez, P AU - Jimenez P AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Loza, A AU - Loza A AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Lesmes, A AU - Lesmes A AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Lucena, F AU - Lucena F AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Leon, C AU - Leon C AD - Valme University Hospital, Seville, Spain. ISNI: 0000 0004 1768 1690. GRID: grid.412800.f FAU - Tovar Doncel, M S AU - Tovar Doncel MS AD - University Hospital Rio Hortega, Valladolid, Spain. ISNI: 0000 0001 1842 3755. GRID: grid.411280.e FAU - Ince, C AU - Ince C AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Aldecoa, C AU - Aldecoa C AD - University Hospital Rio Hortega, Valladolid, Spain. ISNI: 0000 0001 1842 3755. GRID: grid.411280.e FAU - Lima, A AU - Lima A AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Bastide, M AU - Bastide M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Richecoeur, J AU - Richecoeur J AD - CH Beauvais, Beauvais, France FAU - Frenoy, E AU - Frenoy E AD - Reanimation polyvalente, Le Havre, France FAU - Lemaire, C AU - Lemaire C AD - CH Roubaix, Roubaix, France. ISNI: 0000 0004 0608 7784. GRID: grid.477297.8 FAU - Sauneuf, B AU - Sauneuf B AD - CH Cotentin, Cherbourg, France FAU - Tamion, F AU - Tamion F AD - CHU Rouen, Rouen, France. GRID: grid.41724.34 FAU - Nseir, S AU - Nseir S AD - CHU Lille, Lille, France. ISNI: 0000 0004 0471 8845. GRID: grid.410463.4 FAU - Du Cheyron, D AU - Du Cheyron D AD - CHU Caen, Caen, France. ISNI: 0000 0004 0472 0160. GRID: grid.411149.8 FAU - Dupont, H AU - Dupont H AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Maizel, J AU - Maizel J AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Shaban, M AU - Shaban M AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Kolko, R AU - Kolko R AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Salahuddin, N AU - Salahuddin N AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Sharshir, M AU - Sharshir M AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - AbuRageila, M AU - AbuRageila M AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - AlHussain, A AU - AlHussain A AD - King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Mercado, P AU - Mercado P AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Maizel, J AU - Maizel J AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Kontar, L AU - Kontar L AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Titeca, D AU - Titeca D AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Brazier, F AU - Brazier F AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Riviere, A AU - Riviere A AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Joris, M AU - Joris M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Soupison, T AU - Soupison T AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - De Cagny, B AU - De Cagny B AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Slama, M AU - Slama M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Wagner, J AU - Wagner J AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Korner, A AU - Korner A AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Kubik, M AU - Kubik M AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Kluge, S AU - Kluge S AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Reuter, D AU - Reuter D AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Saugel, B AU - Saugel B AD - University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Colombaroli, E AU - Colombaroli E AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Righetti, F AU - Righetti F AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Castellano, G AU - Castellano G AD - Intensive Care Unit, St. Boniface Hospital, Verona, Italy FAU - Tran, T AU - Tran T AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - De Bels, D AU - De Bels D AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Cudia, A AU - Cudia A AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Strachinaru, M AU - Strachinaru M AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Ghottignies, P AU - Ghottignies P AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Devriendt, J AU - Devriendt J AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Pierrakos, C AU - Pierrakos C AD - Brugmann Hospital, Brussels, Belgium. ISNI: 0000 0004 0469 8354. GRID: grid.411371.1 FAU - Martinez Gonzalez, O AU - Martinez Gonzalez O AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Blancas, R AU - Blancas R AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Lujan, J AU - Lujan J AD - Hospital Universitario Principe de Asturias, Alcala de Henares, Spain. ISNI: 0000 0004 1765 5855. GRID: grid.411338.c FAU - Ballesteros, D AU - Ballesteros D AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Martinez Diaz, C AU - Martinez Diaz C AD - Hospital Universitario Principe de Asturias, Alcala de Henares, Spain. ISNI: 0000 0004 1765 5855. GRID: grid.411338.c FAU - Nunez, A AU - Nunez A AD - Hospital Universitario de San Carlos, Madrid, Spain. ISNI: 0000 0001 0671 5785. GRID: grid.411068.a FAU - Martin Parra, C AU - Martin Parra C AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Lopez Matamala, B AU - Lopez Matamala B AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Alonso Fernandez, M AU - Alonso Fernandez M AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Chana, M AU - Chana M AD - Hospital Universitario del Tajo, Aranjuez, Spain FAU - Huber, W AU - Huber W AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Eckmann, M AU - Eckmann M AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Elkmann, F AU - Elkmann F AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Gruber, A AU - Gruber A AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Klein, I AU - Klein I AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Schmid, R M AU - Schmid RM AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Lahmer, T AU - Lahmer T AD - Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ISNI: 0000000123222966. GRID: grid.6936.a FAU - Moller, P W AU - Moller PW AD - Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland. ISNI: 0000 0004 0479 0855. GRID: grid.411656.1 FAU - Sondergaard, S AU - Sondergaard S AD - Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden FAU - Jakob, S M AU - Jakob SM AD - Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland. ISNI: 0000 0004 0479 0855. GRID: grid.411656.1 FAU - Takala, J AU - Takala J AD - Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland. ISNI: 0000 0004 0479 0855. GRID: grid.411656.1 FAU - Berger, D AU - Berger D AD - Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland. ISNI: 0000 0004 0479 0855. GRID: grid.411656.1 FAU - Bastoni, D AU - Bastoni D AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Aya, H AU - Aya H AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Toscani, L AU - Toscani L AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Pigozzi, L AU - Pigozzi L AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Rhodes, A AU - Rhodes A AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Cecconi, M AU - Cecconi M AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Ostrowska, C AU - Ostrowska C AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Aya, H AU - Aya H AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Abbas, A AU - Abbas A AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Mellinghoff, J AU - Mellinghoff J AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Ryan, C AU - Ryan C AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Dawson, D AU - Dawson D AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Rhodes, A AU - Rhodes A AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Cecconi, M AU - Cecconi M AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Cronhjort, M AU - Cronhjort M AD - Karolinska Institutet, Stockholm, Sweden. ISNI: 0000 0004 1937 0626. GRID: grid.4714.6 FAU - Wall, O AU - Wall O AD - Karolinska Institutet, Stockholm, Sweden. ISNI: 0000 0004 1937 0626. GRID: grid.4714.6 FAU - Nyberg, E AU - Nyberg E AD - Karolinska Institutet, Stockholm, Sweden. ISNI: 0000 0004 1937 0626. GRID: grid.4714.6 FAU - Zeng, R AU - Zeng R AD - Wenzhou Medical University, Wenzhou, Zheijang China. ISNI: 0000 0001 0348 3990. GRID: grid.268099.c FAU - Svensen, C AU - Svensen C AD - Karolinska Institutet, Stockholm, Sweden. ISNI: 0000 0004 1937 0626. GRID: grid.4714.6 FAU - Martensson, J AU - Martensson J AD - Department of Intensive Care, Austin Hospital, Melbourne, VIC Australia. ISNI: 0000 0001 0162 7225. GRID: grid.414094.c FAU - Joelsson-Alm, E AU - Joelsson-Alm E AD - Karolinska Institutet, Stockholm, Sweden. ISNI: 0000 0004 1937 0626. GRID: grid.4714.6 FAU - Aguilar Arzapalo, M AU - Aguilar Arzapalo M AD - Hospital O'horan, Merida, Mexico FAU - Barradas, L AU - Barradas L AD - Hospital O'horan, Merida, Mexico FAU - Lopez, V AU - Lopez V AD - Hospital O'horan, Merida, Mexico FAU - Cetina, M AU - Cetina M AD - Hospital O'horan, Merida, Mexico FAU - Parenti, N AU - Parenti N AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Palazzi, C AU - Palazzi C AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Amidei, L A AU - Amidei LA AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Borrelli, F B AU - Borrelli FB AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Campanale, S C AU - Campanale SC AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Tagliazucchi, F T AU - Tagliazucchi FT AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Sedoni, G S AU - Sedoni GS AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Lucchesi, D L AU - Lucchesi DL AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Carella, E C AU - Carella EC AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Luciani, A L AU - Luciani AL AD - Policlinico Modena, Bologna, Italy. ISNI: 0000 0004 1769 5275. GRID: grid.413363.0 FAU - Mackovic, M AU - Mackovic M AD - Clinical Hospital Sveti Duh, Zagreb, Croatia FAU - Maric, N AU - Maric N AD - Clinical Hospital Sveti Duh, Zagreb, Croatia FAU - Bakula, M AU - Bakula M AD - Clinical Hospital Sveti Duh, Zagreb, Croatia FAU - Aya, H AU - Aya H AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Rhodes, A AU - Rhodes A AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Grounds, R M AU - Grounds RM AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Fletcher, N AU - Fletcher N AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Cecconi, M AU - Cecconi M AD - St George's Healthcare NHS Trust, London, UK. GRID: grid.451349.e FAU - Avard, B AU - Avard B AD - The Canberra Hospital, Hughes, ACT Australia. ISNI: 0000 0000 9984 5644. GRID: grid.413314.0 FAU - Zhang, P AU - Zhang P AD - Australian National University Medical School, Canberra, Australia. ISNI: 0000 0001 2180 7477. GRID: grid.1001.0 FAU - Mezidi, M AU - Mezidi M AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Charbit, J AU - Charbit J AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Ould-Chikh, M AU - Ould-Chikh M AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Deras, P AU - Deras P AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Maury, C AU - Maury C AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Martinez, O AU - Martinez O AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Capdevila, X AU - Capdevila X AD - Lapeyronie University Hospital, Montpellier, France. ISNI: 0000 0004 0638 8990. GRID: grid.411572.4 FAU - Hou, P AU - Hou P AD - Brigham and Women's Hospital, Boston, USA. ISNI: 0000 0004 0378 8294. GRID: grid.62560.37 FAU - Linde-Zwirble, W Z AU - Linde-Zwirble WZ AD - Trexin Medical, Chicago, USA FAU - Douglas, I D AU - Douglas ID AD - University of Colorado and Denver Health, Denver, USA. ISNI: 0000000107903411. GRID: grid.241116.1 FAU - Shapiro, N S AU - Shapiro NS AD - Beth Isreal Deaconess, Boston, USA FAU - Ben Souissi, A AU - Ben Souissi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mezghani, I AU - Mezghani I AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Ben Aicha, Y AU - Ben Aicha Y AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Kamoun, S AU - Kamoun S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Laribi, B AU - Laribi B AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Jeribi, B AU - Jeribi B AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Riahi, A AU - Riahi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mebazaa, M S AU - Mebazaa MS AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Pereira, C AU - Pereira C AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Antunes, R AU - Antunes R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Crivits, M AU - Crivits M AD - University Hospital, Ghent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Raes, M AU - Raes M AD - University Hospital, Ghent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Decruyenaere, J AU - Decruyenaere J AD - University Hospital, Ghent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Hoste, E AU - Hoste E AD - University Hospital, Ghent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Bagin, V AU - Bagin V AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Rudnov, V AU - Rudnov V AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Savitsky, A AU - Savitsky A AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Astafyeva, M AU - Astafyeva M AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Korobko, I AU - Korobko I AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Vein, V AU - Vein V AD - City Clinical Hospital 40, Yekaterinburg, Russia FAU - Kampmeier, T AU - Kampmeier T AD - University Hospital Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Arnemann, P AU - Arnemann P AD - University Hospital Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Hessler, M AU - Hessler M AD - University Hospital Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Wald, A AU - Wald A AD - Marienhospital Osnabruck, Osnabruck, Germany FAU - Bockbreder, K AU - Bockbreder K AD - Charite, University of Berlin, Berlin, Germany FAU - Morelli, A AU - Morelli A AD - Sapienza University of Rome, Rome, Italy. GRID: grid.7841.a FAU - Van Aken, H AU - Van Aken H AD - University Hospital Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Rehberg, S AU - Rehberg S AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Ertmer, C AU - Ertmer C AD - University Hospital Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Arnemann, P AU - Arnemann P AD - University Hospital of Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Hessler, M AU - Hessler M AD - University Hospital of Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Kampmeier, T AU - Kampmeier T AD - University Hospital of Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Rehberg, S AU - Rehberg S AD - University Hospital of Greifswald, Greifswald, Germany. ISNI: 0000 0000 9116 8976. GRID: grid.412469.c FAU - Van Aken, H AU - Van Aken H AD - University Hospital of Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Ince, C AU - Ince C AD - Erasmus MC University Hospital Rotterdam, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Ertmer, C AU - Ertmer C AD - University Hospital of Muenster, Muenster, Germany. ISNI: 0000 0004 0551 4246. GRID: grid.16149.3b FAU - Reddy, S AU - Reddy S AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Bailey, M AU - Bailey M AD - Monash University, Melbourne, Australia. ISNI: 0000 0004 1936 7857. GRID: grid.1002.3 FAU - Beasley, R AU - Beasley R AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Bellomo, R AU - Bellomo R AD - Austin Hospital, Melbourne, Australia. ISNI: 0000 0001 0162 7225. GRID: grid.414094.c FAU - Mackle, D AU - Mackle D AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Psirides, A AU - Psirides A AD - Wellington Regional Hospital, Wellington, New Zealand. ISNI: 0000 0000 8862 6892. GRID: grid.416979.4 FAU - Young, P AU - Young P AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Reddy, S AU - Reddy S AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Bailey, M AU - Bailey M AD - Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia FAU - Beasley, R AU - Beasley R AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Bellomo, R AU - Bellomo R AD - Austin Hospital, Melbourne, Australia. ISNI: 0000 0001 0162 7225. GRID: grid.414094.c FAU - Mackle, D AU - Mackle D AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Young, P AU - Young P AD - Medical Research Institute of New Zealand, Wellington, New Zealand. ISNI: 0000 0004 0445 6830. GRID: grid.415117.7 FAU - Venkatesh, H AU - Venkatesh H AD - Princess of Wales Hospital, Bridgend, UK. ISNI: 0000 0004 0648 9337. GRID: grid.415249.f FAU - Ramachandran, S AU - Ramachandran S AD - Imperial College London, London, UK. ISNI: 0000 0001 2113 8111. GRID: grid.7445.2 FAU - Basu, A AU - Basu A AD - Glan Clwyd Hospital, Bodelwyddan, UK. ISNI: 0000 0000 9831 5916. GRID: grid.415564.7 FAU - Nair, H AU - Nair H AD - Glan Clwyd Hospital, Bodelwyddan, UK. ISNI: 0000 0000 9831 5916. GRID: grid.415564.7 FAU - Egan, S AU - Egan S AD - University Hospital Galway, Galway, Ireland. ISNI: 0000 0004 0617 9371. GRID: grid.412440.7 FAU - Bates, J AU - Bates J AD - University Hospital Galway, Galway, Ireland. ISNI: 0000 0004 0617 9371. GRID: grid.412440.7 FAU - Oliveira, S AU - Oliveira S AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Rangel Neto, N R AU - Rangel Neto NR AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Reis, F Q AU - Reis FQ AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Lee, C P AU - Lee CP AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Lin, X L AU - Lin XL AD - National Neuroscience Institute, Singapore, Singapore. ISNI: 0000 0004 0636 696X. GRID: grid.276809.2 FAU - Choong, C AU - Choong C AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Eu, K M AU - Eu KM AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Sim, W Y AU - Sim WY AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Tee, K S AU - Tee KS AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Pau, J AU - Pau J AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Abisheganaden, J AU - Abisheganaden J AD - Tan Tock Seng Hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Maas, K AU - Maas K AD - Erasmus Medical Centre, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - De Geus, H AU - De Geus H AD - Erasmus Medical Centre, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Lafuente, E AU - Lafuente E AD - Centro Hospitalar Tamega e Sousa, Penafiel, Portugal. GRID: grid.466592.a FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Moura, J AU - Moura J AD - Unidade Local de Saude do Alto Minho, Viana do Castelo, Portugal FAU - Antunes, R AU - Antunes R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Doris, T E AU - Doris TE AD - South Tees NHS Trust, Middlesbrough, UK FAU - Monkhouse, D AU - Monkhouse D AD - South Tees NHS Trust, Middlesbrough, UK FAU - Shipley, T AU - Shipley T AD - South Tees NHS Trust, Middlesbrough, UK FAU - Kardasz, S AU - Kardasz S AD - South Tees NHS Trust, Middlesbrough, UK FAU - Gonzalez, I AU - Gonzalez I AD - South Tees NHS Trust, Middlesbrough, UK FAU - Stads, S AU - Stads S AD - Ikazia Hospital, Rotterdam, Netherlands. ISNI: 0000 0004 0568 7120. GRID: grid.414565.7 FAU - Groeneveld, A J AU - Groeneveld AJ AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Elsayed, I AU - Elsayed I AD - Sheffiled Teaching Hospitals, Sheffield, UK FAU - Ward, N AU - Ward N AD - Sheffiled Teaching Hospitals, Sheffield, UK FAU - Tridente, A AU - Tridente A AD - Whiston Hospital, St Helens & Knowsley, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Raithatha, A AU - Raithatha A AD - Sheffiled Teaching Hospitals, Sheffield, UK FAU - Steuber, A AU - Steuber A AD - University Hospital Duesseldorf, Dusseldorf, Germany. ISNI: 0000 0000 8922 7789. GRID: grid.14778.3d FAU - Pelletier, C AU - Pelletier C AD - University Hospital Duesseldorf, Dusseldorf, Germany. ISNI: 0000 0000 8922 7789. GRID: grid.14778.3d FAU - Schroeder, S AU - Schroeder S AD - University Hospital Duesseldorf, Dusseldorf, Germany. ISNI: 0000 0000 8922 7789. GRID: grid.14778.3d FAU - Michael, E AU - Michael E AD - University Hospital Duesseldorf, Dusseldorf, Germany. ISNI: 0000 0000 8922 7789. GRID: grid.14778.3d FAU - Slowinski, T AU - Slowinski T AD - Charite University Hospital, Berlin, Germany. ISNI: 0000 0001 2218 4662. GRID: grid.6363.0 FAU - Kindgen-Milles, D AU - Kindgen-Milles D AD - University Hospital Duesseldorf, Dusseldorf, Germany. ISNI: 0000 0000 8922 7789. GRID: grid.14778.3d FAU - Ghabina, S AU - Ghabina S AD - Royal London Hospital, London, UK. ISNI: 0000 0001 0738 5466. GRID: grid.416041.6 FAU - Turani, F AU - Turani F AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Belli, A AU - Belli A AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Busatti, S AU - Busatti S AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Barettin, G AU - Barettin G AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Candidi, F AU - Candidi F AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Gargano, F AU - Gargano F AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Barchetta, R AU - Barchetta R AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Falco, M AU - Falco M AD - Aurelia and European Hospital, Rome, Italy. GRID: grid.414645.6 FAU - Demirkiran, O AU - Demirkiran O AD - Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Kosuk, M AU - Kosuk M AD - Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Bozbay, S AU - Bozbay S AD - Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Weber, V AU - Weber V AD - Danube University Krems, Krems, Austria. ISNI: 0000 0001 2108 5830. GRID: grid.15462.34 FAU - Hartmann, J AU - Hartmann J AD - Danube University Krems, Krems, Austria. ISNI: 0000 0001 2108 5830. GRID: grid.15462.34 FAU - Harm, S AU - Harm S AD - Danube University Krems, Krems, Austria. ISNI: 0000 0001 2108 5830. GRID: grid.15462.34 FAU - Linsberger, I AU - Linsberger I AD - Danube University Krems, Krems, Austria. ISNI: 0000 0001 2108 5830. GRID: grid.15462.34 FAU - Eichhorn, T AU - Eichhorn T AD - Danube University Krems, Krems, Austria. ISNI: 0000 0001 2108 5830. GRID: grid.15462.34 FAU - Valicek, G AU - Valicek G AD - University Hospital St. Poelten, St. Poelten, Austria FAU - Miestinger, G AU - Miestinger G AD - University Hospital St. Poelten, St. Poelten, Austria FAU - Hoermann, C AU - Hoermann C AD - University Hospital St. Poelten, St. Poelten, Austria FAU - Faenza, S AU - Faenza S AD - Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy. GRID: grid.412311.4 FAU - Ricci, D AU - Ricci D AD - Department of Nephrology, Dialysis, Hypertension, Bologna, Italy FAU - Mancini, E AU - Mancini E AD - Department of Nephrology, Dialysis, Hypertension, Bologna, Italy FAU - Gemelli, C AU - Gemelli C AD - Science and Technology Park for Medicine, Mirandola, Italy FAU - Cuoghi, A AU - Cuoghi A AD - Science and Technology Park for Medicine, Mirandola, Italy FAU - Magnani, S AU - Magnani S AD - Aferetica, Bologna, Italy FAU - Atti, M AU - Atti M AD - Aferetica, Bologna, Italy FAU - Laddomada, T AU - Laddomada T AD - San Marco Hospital, Zingonia, Italy FAU - Doronzio, A AU - Doronzio A AD - San Marco Hospital, Zingonia, Italy FAU - Balicco, B AU - Balicco B AD - San Marco Hospital, Zingonia, Italy FAU - Gruda, M C AU - Gruda MC AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - O'Sullivan, P AU - O'Sullivan P AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Dan, V P AU - Dan VP AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Guliashvili, T AU - Guliashvili T AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Scheirer, A AU - Scheirer A AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Golobish, T D AU - Golobish TD AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Capponi, V J AU - Capponi VJ AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Chan, P P AU - Chan PP AD - CytoSorbents, Monmouth Junction, USA. GRID: grid.428484.6 FAU - Kogelmann, K AU - Kogelmann K AD - Klinikum Emden, Emden, Germany FAU - Druner, M AU - Druner M AD - Klinikum Emden, Emden, Germany FAU - Jarczak, D AU - Jarczak D AD - University Hospital Eppendorf, Hamburg, Germany. ISNI: 0000 0001 2180 3484. GRID: grid.13648.38 FAU - Turani, F AU - Turani F AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Belli, A B AU - Belli AB AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Martni, S M AU - Martni SM AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Cotticelli, V C AU - Cotticelli VC AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Mounajergi, F AU - Mounajergi F AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Barchetta, R AU - Barchetta R AD - Aurelia Hospital /European Hospital, Rome, Italy. GRID: grid.414077.1 FAU - Morimoto, S AU - Morimoto S AD - Fukuoka University hospital, Fukuoka, Japan. ISNI: 0000 0004 0594 9821. GRID: grid.411556.2 FAU - Ishikura, H AU - Ishikura H AD - Fukuoka University hospital, Fukuoka, Japan. ISNI: 0000 0004 0594 9821. GRID: grid.411556.2 FAU - Hussain, I AU - Hussain I AD - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Salahuddin, N AU - Salahuddin N AD - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Nadeem, A AU - Nadeem A AD - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Ghorab, K AU - Ghorab K AD - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Maghrabi, K AU - Maghrabi K AD - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Kloesel, S K AU - Kloesel SK AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Goldfuss, C AU - Goldfuss C AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Stieglitz, A AU - Stieglitz A AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Stieglitz, A S AU - Stieglitz AS AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Krstevska, L AU - Krstevska L AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Albuszies, G AU - Albuszies G AD - GPR Klinikum Ruesselsheim, Ruesselsheim, Hessen Germany FAU - Aguilar Arzapalo, M AU - Aguilar Arzapalo M AD - Hospital O'horan, Merida, Mexico FAU - Barradas, L AU - Barradas L AD - Hospital O'horan, Merida, Mexico FAU - Lopez, V AU - Lopez V AD - Hospital O'horan, Merida, Mexico FAU - Escalante, A AU - Escalante A AD - Hospital O'horan, Merida, Mexico FAU - Jimmy, G AU - Jimmy G AD - Hospital O'horan, Merida, Mexico FAU - Cetina, M AU - Cetina M AD - Hospital O'horan, Merida, Mexico FAU - Izawa, J AU - Izawa J AD - Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Iwami, T AU - Iwami T AD - Kyoto University, Kyoto, Japan. ISNI: 0000 0004 0372 2033. GRID: grid.258799.8 FAU - Uchino, S AU - Uchino S AD - Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Takinami, M AU - Takinami M AD - Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Kitamura, T AU - Kitamura T AD - Osaka University, Osaka, Japan. ISNI: 0000 0004 0373 3971. GRID: grid.136593.b FAU - Kawamura, T AU - Kawamura T AD - Kyoto University, Kyoto, Japan. ISNI: 0000 0004 0372 2033. GRID: grid.258799.8 FAU - Powell-Tuck, J G AU - Powell-Tuck JG AD - Guy's & St Thomas' NHS Foundation Trust, London, UK. GRID: grid.420545.2 FAU - Crichton, S AU - Crichton S AD - King's College, London, UK. ISNI: 0000 0001 2322 6764. GRID: grid.13097.3c FAU - Raimundo, M AU - Raimundo M AD - Hospital de Santa Maria, Lisbon, Portugal. ISNI: 0000 0001 2295 9747. GRID: grid.411265.5 FAU - Camporota, L AU - Camporota L AD - Guy's & St Thomas' NHS Foundation Trust, London, UK. GRID: grid.420545.2 FAU - Wyncoll, D AU - Wyncoll D AD - Guy's & St Thomas' NHS Foundation Trust, London, UK. GRID: grid.420545.2 FAU - Ostermann, M AU - Ostermann M AD - Guy's & St Thomas' NHS Foundation Trust, London, UK. GRID: grid.420545.2 FAU - Hana, A AU - Hana A AD - ErasmusMC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - De Geus, H R AU - De Geus HR AD - ErasmusMC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - De Geus, H R AU - De Geus HR AD - ErasmusMC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Hana, A AU - Hana A AD - ErasmusMC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Aydogdu, M AU - Aydogdu M AD - Gazi University Medical Faculty, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Boyaci, N AU - Boyaci N AD - Gazi University School of Medicine, Critical Care Fellowship Programme, Ankara, Turkey FAU - Yuksel, S AU - Yuksel S AD - Gazi University School of Medicine Biochemistry Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gursel, G AU - Gursel G AD - Gazi University Medical Faculty, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Cayci Sivri, A B AU - Cayci Sivri AB AD - Gazi University School of Medicine Biochemistry Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Meza-Marquez, J AU - Meza-Marquez J AD - Fundacion Clinica Medica Sur, Mexico City, Mexico FAU - Nava-Lopez, J AU - Nava-Lopez J AD - Fundacion Clinica Medica Sur, Mexico City, Mexico FAU - Carrillo-Esper, R AU - Carrillo-Esper R AD - Fundacion Clinica Medica Sur, Mexico City, Mexico FAU - Dardashti, A AU - Dardashti A AD - Lund University and Skane University Hospital, Lund, Sweden. GRID: grid.411843.b FAU - Grubb, A AU - Grubb A AD - Lund University and Skane University Hospital, Lund, Sweden. GRID: grid.411843.b FAU - Maizel, J AU - Maizel J AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Wetzstein, M AU - Wetzstein M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Titeca, D AU - Titeca D AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Kontar, L AU - Kontar L AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Brazier, F AU - Brazier F AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - De Cagny, B AU - De Cagny B AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Riviere, A AU - Riviere A AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Soupison, T AU - Soupison T AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Joris, M AU - Joris M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Slama, M AU - Slama M AD - Radboudumc, Nijmegen, Netherlands. ISNI: 0000 0004 0444 9382. GRID: grid.10417.33 FAU - Peters, E AU - Peters E FAU - Njimi, H AU - Njimi H AD - Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium. ISNI: 0000 0001 2348 0746. GRID: grid.4989.c FAU - Pickkers, P AU - Pickkers P AD - Radboudumc, Nijmegen, Netherlands. ISNI: 0000 0004 0444 9382. GRID: grid.10417.33 FAU - Vincent, J L AU - Vincent JL AD - Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium. ISNI: 0000 0001 2348 0746. GRID: grid.4989.c FAU - Waraich, M AU - Waraich M AD - The Royal Surrey County Hospital, Guildford, UK. ISNI: 0000 0004 0417 0648. GRID: grid.416224.7 FAU - Doyle, J AU - Doyle J AD - The Royal Surrey County Hospital, Guildford, UK. ISNI: 0000 0004 0417 0648. GRID: grid.416224.7 FAU - Samuels, T AU - Samuels T AD - The Royal Surrey County Hospital, Guildford, UK. ISNI: 0000 0004 0417 0648. GRID: grid.416224.7 FAU - Forni, L AU - Forni L AD - The Royal Surrey County Hospital, Guildford, UK. ISNI: 0000 0004 0417 0648. GRID: grid.416224.7 FAU - Desai, N AU - Desai N AD - Royal National Orthopaedic Hospital, Middlesex, UK. ISNI: 0000 0004 0417 7890. GRID: grid.416177.2 FAU - Baumber, R AU - Baumber R AD - Royal National Orthopaedic Hospital, Middlesex, UK. ISNI: 0000 0004 0417 7890. GRID: grid.416177.2 FAU - Gunning, P AU - Gunning P AD - Royal National Orthopaedic Hospital, Middlesex, UK. ISNI: 0000 0004 0417 7890. GRID: grid.416177.2 FAU - Sell, A AU - Sell A AD - Royal National Orthopaedic Hospital, Middlesex, UK. ISNI: 0000 0004 0417 7890. GRID: grid.416177.2 FAU - Lin, S AU - Lin S AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Torrence, H AU - Torrence H AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - O'Dwyer, M AU - O'Dwyer M AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Kirwan, C AU - Kirwan C AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Prowle, J AU - Prowle J AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Kim, T AU - Kim T AD - Asan medical center, Seoul, South Korea. ISNI: 0000 0001 0842 2126. GRID: grid.413967.e FAU - O'Connor, M E AU - O'Connor ME AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Hewson, R W AU - Hewson RW AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Kirwan, C J AU - Kirwan CJ AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Pearse, R M AU - Pearse RM AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Prowle, J AU - Prowle J AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Hanoura, S AU - Hanoura S AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Omar, A AU - Omar A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Othamn, H AU - Othamn H AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Sudarsanan, S AU - Sudarsanan S AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Allam, M AU - Allam M AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Maksoud, M AU - Maksoud M AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Singh, R AU - Singh R AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Al Khulaifi, A AU - Al Khulaifi A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - O'Connor, M E AU - O'Connor ME AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Hewson, R W AU - Hewson RW AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Kirwan, C J AU - Kirwan CJ AD - Barts Health NHS Trust, London, UK. ISNI: 0000 0001 0372 5777. GRID: grid.139534.9 FAU - Pearse, R M AU - Pearse RM AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Prowle, J AU - Prowle J AD - Queen Mary University of London, London, UK. ISNI: 0000 0001 2171 1133. GRID: grid.4868.2 FAU - Uzundere, O AU - Uzundere O AD - Trakya Univ, Edirne, Turkey. ISNI: 0000 0001 2342 6459. GRID: grid.411693.8 FAU - Memis, D AU - Memis D AD - Trakya Univ, Edirne, Turkey. ISNI: 0000 0001 2342 6459. GRID: grid.411693.8 FAU - Ynal, M AU - Ynal M AD - Trakya Univ, Edirne, Turkey. ISNI: 0000 0001 2342 6459. GRID: grid.411693.8 FAU - Gultekin, A AU - Gultekin A AD - Trakya Univ, Edirne, Turkey. ISNI: 0000 0001 2342 6459. GRID: grid.411693.8 FAU - Turan, N AU - Turan N AD - Trakya Univ, Edirne, Turkey. ISNI: 0000 0001 2342 6459. GRID: grid.411693.8 FAU - Aydin, M A AU - Aydin MA AD - General Directorate of Health Services, Ministry of Health, Ankara, Turkey. GRID: grid.415700.7 FAU - Basar, H AU - Basar H AD - AnkaraNKARA Research and Training Hospital, Ankara, Turkey FAU - Sencan, I AU - Sencan I AD - General Directorate of Health Services, Ministry of Health, Ankara, Turkey. GRID: grid.415700.7 FAU - Kapuagasi, A AU - Kapuagasi A AD - General Directorate of Health Services, Ministry of Health, Ankara, Turkey. GRID: grid.415700.7 FAU - Ozturk, M AU - Ozturk M AD - General Directorate of Health Services, Ministry of Health, Ankara, Turkey. GRID: grid.415700.7 FAU - Uzundurukan, Z AU - Uzundurukan Z AD - General Directorate of Health Services, Ministry of Health, Ankara, Turkey. GRID: grid.415700.7 FAU - Gokmen, D AU - Gokmen D AD - Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey. ISNI: 0000000109409118. GRID: grid.7256.6 FAU - Ozcan, A AU - Ozcan A AD - Ankara Research and Training Hospital, Ankara, Turkey. ISNI: 0000 0004 0642 6432. GRID: grid.413783.a FAU - Kaymak, C AU - Kaymak C AD - AnkaraNKARA Research and Training Hospital, Ankara, Turkey FAU - Artemenko, V A AU - Artemenko VA AD - MC Into-Sana, Odessa, Ukraine FAU - Budnyuk, A AU - Budnyuk A AD - MC Into-Sana, Odessa, Ukraine FAU - Pugh, R AU - Pugh R AD - Glan Clwyd Hospital, Rhyl, UK. ISNI: 0000 0000 9831 5916. GRID: grid.415564.7 FAU - Bhandari, S AU - Bhandari S AD - Glan Clwyd Hospital, Rhyl, UK. ISNI: 0000 0000 9831 5916. GRID: grid.415564.7 FAU - Mauri, T AU - Mauri T AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Turrini, C AU - Turrini C AD - University of Ferrara, Sant'Anna Hospital, Ferrara, Italy FAU - Langer, T AU - Langer T AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Taccone, P AU - Taccone P AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Volta, C A AU - Volta CA AD - University of Ferrara, Sant'Anna Hospital, Ferrara, Italy FAU - Marenghi, C AU - Marenghi C AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Gattinoni, L AU - Gattinoni L AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Pesenti, A AU - Pesenti A AD - Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy FAU - Sweeney, L AU - Sweeney L AD - Aerogen, Galway, Ireland FAU - O'Sullivan, A AU - O'Sullivan A AD - Aerogen, Galway, Ireland FAU - Kelly, P AU - Kelly P AD - Aerogen, Galway, Ireland FAU - Mukeria, E AU - Mukeria E AD - Aerogen, Galway, Ireland FAU - MacLoughlin, R AU - MacLoughlin R AD - Aerogen, Galway, Ireland FAU - Pfeffer, M AU - Pfeffer M AD - Kaplan Medical Centre, Rehovot, Israel FAU - Thomas, J T AU - Thomas JT AD - West Virginia University, Morgantown, West Virginia USA. ISNI: 0000 0001 2156 6140. GRID: grid.268154.c FAU - Bregman, G B AU - Bregman GB AD - Kaplan Medical Centre, Rehovot, Israel FAU - Karp, G K AU - Karp GK AD - Kaplan Medical Centre, Rehovot, Israel FAU - Kishinevsky, E K AU - Kishinevsky EK AD - Kaplan Medical Centre, Rehovot, Israel FAU - Stavi, D S AU - Stavi DS AD - Kaplan Medical Centre, Rehovot, Israel FAU - Adi, N A AU - Adi NA AD - Kaplan Medical Centre, Rehovot, Israel FAU - Poropat, T AU - Poropat T AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Knafelj, R AU - Knafelj R AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Llopart, E AU - Llopart E AD - Corporacio Sanitaria i Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain. GRID: grid.7080.f FAU - Batlle, M AU - Batlle M AD - Corporacio Sanitaria i Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain. GRID: grid.7080.f FAU - De Haro, C AU - De Haro C AD - Corporacio Sanitaria i Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain. GRID: grid.7080.f FAU - Mesquida, J AU - Mesquida J AD - Corporacio Sanitaria i Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain. GRID: grid.7080.f FAU - Artigas, A AU - Artigas A AD - Corporacio Sanitaria i Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain. GRID: grid.7080.f FAU - Pavlovic, D AU - Pavlovic D AD - Dalhousie University, Halifax, Canada. ISNI: 0000 0004 1936 8200. GRID: grid.55602.34 FAU - Lewerentz, L AU - Lewerentz L AD - Ernst-Moritz-Arndt-Universitat, Greifswald, Germany. GRID: grid.5603.0 FAU - Spassov, A AU - Spassov A AD - Ernst-Moritz-Arndt-Universitat, Greifswald, Germany. GRID: grid.5603.0 FAU - Schneider, R AU - Schneider R AD - Ernst-Moritz-Arndt-Universitat, Greifswald, Germany. GRID: grid.5603.0 FAU - De Smet, S AU - De Smet S AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - De Raedt, S AU - De Raedt S AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Derom, E AU - Derom E AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Depuydt, P AU - Depuydt P AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Oeyen, S AU - Oeyen S AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Benoit, D AU - Benoit D AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Decruyenaere, J AU - Decruyenaere J AD - Ghent University Hospital, Gent, Belgium. ISNI: 0000 0004 0626 3303. GRID: grid.410566.0 FAU - Gobatto, A AU - Gobatto A AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Besen, B AU - Besen B AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Tierno, P AU - Tierno P AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Melro, L AU - Melro L AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Mendes, P AU - Mendes P AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Cadamuro, F AU - Cadamuro F AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Park, M AU - Park M AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Malbouisson, L M AU - Malbouisson LM AD - Universidade de Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Civantos, B C AU - Civantos BC AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Lopez, J L AU - Lopez JL AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Robles, A AU - Robles A AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Figueira, J AU - Figueira J AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Yus, S AU - Yus S AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Garcia, A AU - Garcia A AD - Hospital La Paz, Madrid, Spain. ISNI: 0000 0000 8970 9163. GRID: grid.81821.32 FAU - Oglinda, A AU - Oglinda A AD - Institute of Mother and Child, Chisinau mun., Moldova FAU - Ciobanu, G AU - Ciobanu G AD - Institute of Emergency Medicine, Chisinau mun., Moldova FAU - Oglinda, C AU - Oglinda C AD - Institute of Mother and Child, Chisinau mun., Moldova FAU - Schirca, L AU - Schirca L AD - Institute of Mother and Child, Chisinau mun., Moldova FAU - Sertinean, T AU - Sertinean T AD - Institute of Mother and Child, Chisinau mun., Moldova FAU - Lupu, V AU - Lupu V AD - State University of Medicine and Pharmacy, Chisinau mun., Moldova FAU - Kelly, P AU - Kelly P AD - Aerogen, Galway, Ireland FAU - O'Sullivan, A AU - O'Sullivan A AD - Aerogen, Galway, Ireland FAU - Sweeney, L AU - Sweeney L AD - Aerogen, Galway, Ireland FAU - MacLoughlin, R AU - MacLoughlin R AD - Aerogen, Galway, Ireland FAU - O'Sullivan, A AU - O'Sullivan A AD - Aerogen, Galway, Ireland FAU - Kelly, P AU - Kelly P AD - Aerogen, Galway, Ireland FAU - Sweeney, L AU - Sweeney L AD - Aerogen, Galway, Ireland FAU - Mukeria, E AU - Mukeria E AD - Aerogen, Galway, Ireland FAU - Wolny, M AU - Wolny M AD - Aerogen, Galway, Ireland FAU - MacLoughlin, R AU - MacLoughlin R AD - Aerogen, Galway, Ireland FAU - Pagano, A AU - Pagano A AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Numis, F AU - Numis F AD - San Paolo Hospital, Naples, Italy FAU - Visone, G AU - Visone G AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Saldamarco, L AU - Saldamarco L AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Russo, T AU - Russo T AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Porta, G AU - Porta G AD - San Paolo Hospital, Naples, Italy FAU - Paladino, F AU - Paladino F AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Bell, C AU - Bell C AD - National University of Ireland, Galway, Galway City, Ireland. ISNI: 0000 0004 0488 0789. GRID: grid.6142.1 FAU - Liu, J AU - Liu J AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Debacker, J AU - Debacker J AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Lee, C AU - Lee C AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Tamberg, E AU - Tamberg E AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Campbell, V AU - Campbell V AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Mehta, S AU - Mehta S AD - Mount Sinai Hospital, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Silva-Pinto, A AU - Silva-Pinto A AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Sarmento, A AU - Sarmento A AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Santos, L AU - Santos L AD - Centro Hospitalar Sao Joao, Porto, Portugal. ISNI: 0000 0000 9375 4688. GRID: grid.414556.7 FAU - Kara, Y AU - Kara Y AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Yyldyrym, F AU - Yyldyrym F AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Zerman, A AU - Zerman A AD - Gazi University School of Medicine, Internal Medicine Critical Care Department, Ankara, Turkey FAU - Gullu, Z AU - Gullu Z AD - Gazi University School of Medicine, Internal Medicine Critical Care Department, Ankara, Turkey FAU - Boyacy, N AU - Boyacy N AD - Gazi University School of Medicine, Internal Medicine Critical Care Department, Ankara, Turkey FAU - Basaryk Aydogan, B AU - Basaryk Aydogan B AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gaygysyz, U AU - Gaygysyz U AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gonderen, K AU - Gonderen K AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Aryk, G AU - Aryk G AD - Gazi University School of Medicine, Geriatrics Department, Ankara, Turkey FAU - Turkoglu, M AU - Turkoglu M AD - Gazi University School of Medicine, Internal Medicine Critical Care Department, Ankara, Turkey FAU - Aydogdu, M AU - Aydogdu M AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Aygencel, G AU - Aygencel G AD - Gazi University School of Medicine, Internal Medicine Critical Care Department, Ankara, Turkey FAU - Ulger, Z AU - Ulger Z AD - Gazi University School of Medicine, Geriatrics Department, Ankara, Turkey FAU - Gursel, G AU - Gursel G AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Boyacy, N AU - Boyacy N AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Isykdogan, Z AU - Isykdogan Z AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Ozdedeoglu, O AU - Ozdedeoglu O AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gullu, Z AU - Gullu Z AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Badoglu, M AU - Badoglu M AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gaygysyz, U AU - Gaygysyz U AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Aydogdu, M AU - Aydogdu M AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Gursel, G AU - Gursel G AD - Gazi University School of Medicine Respiratory Medicine and Critical Care Department, Ankara, Turkey. ISNI: 0000 0001 2169 7132. GRID: grid.25769.3f FAU - Kongpolprom, N AU - Kongpolprom N AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Sittipunt, C AU - Sittipunt C AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Eden, A AU - Eden A AD - Carmel, Lady Davis Medical Center, Haifa, Israel. GRID: grid.471000.2 FAU - Kokhanovsky, Y AU - Kokhanovsky Y AD - Carmel, Lady Davis Medical Center, Haifa, Israel. GRID: grid.471000.2 FAU - Bursztein - De Myttenaere, S AU - Bursztein - De Myttenaere S AD - Carmel, Lady Davis Medical Center, Haifa, Israel. GRID: grid.471000.2 FAU - Pizov, R AU - Pizov R AD - Carmel, Lady Davis Medical Center, Haifa, Israel. GRID: grid.471000.2 FAU - Neilans, L AU - Neilans L AD - Duke University, Durham, USA. ISNI: 0000 0004 1936 7961. GRID: grid.26009.3d FAU - MacIntyre, N AU - MacIntyre N AD - Duke University, Durham, USA. ISNI: 0000 0004 1936 7961. GRID: grid.26009.3d FAU - Radosevich, M AU - Radosevich M AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Wanta, B AU - Wanta B AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Weber, V AU - Weber V AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Meyer, T AU - Meyer T AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Smischney, N AU - Smischney N AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Brown, D AU - Brown D AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Diedrich, D AU - Diedrich D AD - Mayo Clinic, Rochester, USA. ISNI: 0000 0004 0459 167X. GRID: grid.66875.3a FAU - Fuller, A AU - Fuller A AD - St Helens and Knoowsley, Prescot, UK FAU - McLindon, P AU - McLindon P AD - Royal Infirmary, Edinburgh, UK. ISNI: 0000 0001 0709 1919. GRID: grid.418716.d FAU - Sim, K AU - Sim K AD - St Helens and Knoowsley, Prescot, UK FAU - Shoaeir, M AU - Shoaeir M AD - Alexandria Universitry General Hospital, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Noeam, K AU - Noeam K AD - Alexandria Universitry General Hospital, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Mahrous, A AU - Mahrous A AD - Alexandria Universitry General Hospital, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Matsa, R AU - Matsa R AD - University Hospital North Middlands, Stoke On Trent, UK. ISNI: 0000 0004 0641 4263. GRID: grid.415598.4 FAU - Ali, A AU - Ali A AD - Alexandria Universitry General Hospital, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Dridi, C AU - Dridi C AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Koubaji, S AU - Koubaji S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Kamoun, S AU - Kamoun S AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Haddad, F AU - Haddad F AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Ben Souissi, A AU - Ben Souissi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Laribi, B AU - Laribi B AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Riahi, A AU - Riahi A AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Mebazaa, M S AU - Mebazaa MS AD - Mongi Slim University Hospital, La Marsa, Tunisia FAU - Perez-Calatayud, A AU - Perez-Calatayud A AD - Medica Sur, Mexico City, Mexico. GRID: grid.414741.3 FAU - Carrillo-Esper, R AU - Carrillo-Esper R AD - Medica Sur, Mexico City, Mexico. GRID: grid.414741.3 FAU - Zepeda-Mendoza, A AU - Zepeda-Mendoza A AD - Medica Sur, Mexico City, Mexico. GRID: grid.414741.3 FAU - Diaz-Carrillo, M AU - Diaz-Carrillo M AD - Medica Sur, Mexico City, Mexico. GRID: grid.414741.3 FAU - Arch-Tirado, E AU - Arch-Tirado E AD - Instituto Nacional de Rehabilitacion, Mexico City, Mexico. ISNI: 0000 0004 0633 2911. GRID: grid.419223.f FAU - Carbognin, S AU - Carbognin S AD - University of Padua, Padua, Italy. ISNI: 0000 0004 1757 3470. GRID: grid.5608.b FAU - Pelacani, L AU - Pelacani L AD - Sant Antony hospital, Padua, Italy FAU - Zannoni, F AU - Zannoni F AD - University of Padua, Padua, Italy. ISNI: 0000 0004 1757 3470. GRID: grid.5608.b FAU - Agnoli, A AU - Agnoli A AD - Sant Antony hospital, Padua, Italy FAU - Gagliardi, G AU - Gagliardi G AD - Sant Antony hospital, Padua, Italy FAU - Cho, R AU - Cho R AD - HCMC, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Adams, A AU - Adams A AD - HCMC, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Lunos, S AU - Lunos S AD - University of Minnesota, Minneapolis, USA. ISNI: 0000000419368657. GRID: grid.17635.36 FAU - Ambur, S AU - Ambur S AD - HCMC, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Shapiro, R AU - Shapiro R AD - HCMC, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Prekker, M AU - Prekker M AD - HCMC, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Thijssen, M AU - Thijssen M AD - Viecuri Medical Center, Venlo, Netherlands. ISNI: 0000 0004 0477 5022. GRID: grid.416856.8 FAU - Janssen, L AU - Janssen L AD - Viecuri Medical Center, Venlo, Netherlands. ISNI: 0000 0004 0477 5022. GRID: grid.416856.8 FAU - Foudraine, N AU - Foudraine N AD - Viecuri Medical Center, Venlo, Netherlands. ISNI: 0000 0004 0477 5022. GRID: grid.416856.8 FAU - Voscopoulos, C J AU - Voscopoulos CJ AD - University of Hawaii, John A. Burns School of Medicine, Honolulu, USA. ISNI: 0000 0001 2188 0957. GRID: grid.410445.0 FAU - Freeman, J AU - Freeman J AD - Respiratory Motion Inc., Waltham, USA FAU - Voscopoulos, C J AU - Voscopoulos CJ AD - University of Hawaii, John A. Burns School of Medicine, Honolulu, USA. ISNI: 0000 0001 2188 0957. GRID: grid.410445.0 FAU - Freeman, J AU - Freeman J AD - Respiratory Motion Inc., Waltham, USA FAU - George, E AU - George E AD - Massachusetts General Hospital, Boston, USA. ISNI: 0000 0004 0386 9924. GRID: grid.32224.35 FAU - Voscopoulos, C J AU - Voscopoulos CJ AD - University of Hawaii, John A. Burns School of Medicine, Honolulu, USA. ISNI: 0000 0001 2188 0957. GRID: grid.410445.0 FAU - Eversole, D AU - Eversole D AD - Respiratory Motion Inc., Waltham, USA FAU - Freeman, J AU - Freeman J AD - Respiratory Motion Inc., Waltham, USA FAU - George, E AU - George E AD - Massachusetts General Hospital, Boston, USA. ISNI: 0000 0004 0386 9924. GRID: grid.32224.35 FAU - Muttini, S AU - Muttini S AD - AO Desio e Vimercate, Vimercate, Italy FAU - Bigi, R AU - Bigi R AD - AO Desio e Vimercate, Vimercate, Italy FAU - Villani, G AU - Villani G AD - AO Crema, Crema, Italy FAU - Patroniti, N AU - Patroniti N AD - University of Milan-Bicocca, Monza, Italy. ISNI: 0000 0001 2174 1754. GRID: grid.7563.7 FAU - Williams, G AU - Williams G AD - UT Health Science Center at Houston, Houston, TX USA. ISNI: 0000 0000 9206 2401. GRID: grid.267308.8 FAU - Voscopoulos, C J AU - Voscopoulos CJ AD - University of Hawaii, John A. Burns School of Medicine, Honolulu, HI USA. ISNI: 0000 0001 2188 0957. GRID: grid.410445.0 FAU - Freeman, J AU - Freeman J AD - Respiratory Motion Inc., Waltham, MA USA FAU - George, E AU - George E AD - Massachusetts General Hospital, Boston, MA USA. ISNI: 0000 0004 0386 9924. GRID: grid.32224.35 FAU - Waldmann, A AU - Waldmann A AD - Swisstom AG, Landquart, Switzerland FAU - Bohm, S AU - Bohm S AD - Swisstom AG, Landquart, Switzerland FAU - Windisch, W AU - Windisch W AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten / Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Strassmann, S AU - Strassmann S AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten / Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Karagiannidis, C AU - Karagiannidis C AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten / Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Waldmann, A AU - Waldmann A AD - Swisstom AG, Landquart, Switzerland FAU - Bohm, S AU - Bohm S AD - Swisstom AG, Landquart, Switzerland FAU - Windisch, W AU - Windisch W AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten/ Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Strassmann, S AU - Strassmann S AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten/ Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Karagiannidis, C AU - Karagiannidis C AD - Kliniken der Stadt Koln, Pneumology and Critical Care Medicine, Witten/ Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany. ISNI: 0000 0000 9024 6397. GRID: grid.412581.b FAU - Karagiannidis, C K AU - Karagiannidis CK AD - ARDS and ECMO Center Koln-Merheim, Cologne, Germany FAU - Waldmann, A W AU - Waldmann AW AD - Swisstom, Chur, Switzerland FAU - Bohm, S B AU - Bohm SB AD - Swisstom, Chur, Switzerland FAU - Strassmann, S AU - Strassmann S AD - ARDS and ECMO Center Koln-Merheim, Cologne, Germany FAU - Windisch, W W AU - Windisch WW AD - ARDS and ECMO Center Koln-Merheim, Cologne, Germany FAU - Persson, P AU - Persson P AD - Sahlgrenska Univ Hospital, Goteborg, Sweden. ISNI: 000000009445082X. GRID: grid.1649.a FAU - Lundin, S AU - Lundin S AD - Sahlgrenska Univ Hospital, Goteborg, Sweden. ISNI: 000000009445082X. GRID: grid.1649.a FAU - Stenqvist, O AU - Stenqvist O AD - Sahlgrenska Univ Hospital, Goteborg, Sweden. ISNI: 000000009445082X. GRID: grid.1649.a FAU - Porta, G AU - Porta G AD - Second University of Naples, Naples, Italy. ISNI: 0000 0001 2200 8888. GRID: grid.9841.4 FAU - Numis, F AU - Numis F AD - San Paolo Hospital, Naples, Italy FAU - Serra, C S AU - Serra CS AD - University of Sassari, Sassari, Italy. ISNI: 0000 0001 2097 9138. GRID: grid.11450.31 FAU - Pagano, A P AU - Pagano AP AD - Cardarelli Hospital, Naples, Italy. GRID: grid.413172.2 FAU - Masarone, M M AU - Masarone MM AD - University of Saerno, Salerno, Italy FAU - Rinaldi, L R AU - Rinaldi LR AD - Second University of Naples, Naples, Italy. ISNI: 0000 0001 2200 8888. GRID: grid.9841.4 FAU - Amelia, A A AU - Amelia AA AD - Second University of Naples, Naples, Italy. ISNI: 0000 0001 2200 8888. GRID: grid.9841.4 FAU - Fascione, M F AU - Fascione MF AD - Second University of Naples, Naples, Italy. ISNI: 0000 0001 2200 8888. GRID: grid.9841.4 FAU - Adinolfi, L A AU - Adinolfi LA AD - Second University of Naples, Naples, Italy. ISNI: 0000 0001 2200 8888. GRID: grid.9841.4 FAU - Ruggiero, E R AU - Ruggiero ER AD - San Paolo Hospital, Naples, Italy FAU - Asota, F AU - Asota F AD - East Surrey Hospital, Surrey and Sussex NHS Trust, Surrey, UK FAU - O'Rourke, K AU - O'Rourke K AD - East Surrey Hospital, Surrey and Sussex NHS Trust, Surrey, UK FAU - Ranjan, S AU - Ranjan S AD - East Surrey Hospital, Surrey and Sussex NHS Trust, Surrey, UK FAU - Morgan, P AU - Morgan P AD - East Surrey Hospital, Surrey and Sussex NHS Trust, Surrey, UK FAU - DeBacker, J W AU - DeBacker JW AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Tamberg, E AU - Tamberg E AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - O'Neill, L AU - O'Neill L AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Munshi, L AU - Munshi L AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Burry, L AU - Burry L AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Fan, E AU - Fan E AD - University Health Network-Toronto General Hospital and Univeristy of Toronto, Toronto, Canada. ISNI: 0000 0001 0661 1177. GRID: grid.417184.f FAU - Mehta, S AU - Mehta S AD - Mount Sinai Hospital and University of Toronto, Toronto, Canada. ISNI: 0000 0004 0473 9881. GRID: grid.416166.2 FAU - Poo, S AU - Poo S AD - University of Cambridge, Cambridge, UK. ISNI: 0000000121885934. GRID: grid.5335.0 FAU - Mahendran, K AU - Mahendran K AD - Papworth Hospital, Cambridge, UK. ISNI: 0000 0004 0399 2308. GRID: grid.417155.3 FAU - Fowles, J AU - Fowles J AD - Papworth Hospital, Cambridge, UK. ISNI: 0000 0004 0399 2308. GRID: grid.417155.3 FAU - Gerrard, C AU - Gerrard C AD - Papworth Hospital, Cambridge, UK. ISNI: 0000 0004 0399 2308. GRID: grid.417155.3 FAU - Vuylsteke, A AU - Vuylsteke A AD - Papworth Hospital, Cambridge, UK. ISNI: 0000 0004 0399 2308. GRID: grid.417155.3 FAU - Loveridge, R AU - Loveridge R AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Chaddock, C AU - Chaddock C AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Patel, S AU - Patel S AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Kakar, V AU - Kakar V AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Willars, C AU - Willars C AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Hurst, T AU - Hurst T AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Park, C AU - Park C AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Best, T AU - Best T AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Vercueil, A AU - Vercueil A AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Auzinger, G AU - Auzinger G AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Borgman, A AU - Borgman A AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Proudfoot, A G AU - Proudfoot AG AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Grins, E AU - Grins E AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Emiley, K E AU - Emiley KE AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Schuitema, J AU - Schuitema J AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Fitch, S J AU - Fitch SJ AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Marco, G AU - Marco G AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Sturgill, J AU - Sturgill J AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Dickinson, M G AU - Dickinson MG AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Strueber, M AU - Strueber M AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Khaghani, A AU - Khaghani A AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Wilton, P AU - Wilton P AD - Meijer Heart & Vascular Institute, Grand Rapids, USA FAU - Jovinge, S M AU - Jovinge SM FAU - Sampson, C AU - Sampson C AD - Glenfield Hospital, UHL, Leicester, UK. ISNI: 0000 0004 0648 9396. GRID: grid.416025.4 FAU - Harris-Fox, S AU - Harris-Fox S AD - Glenfield Hospital, UHL, Leicester, UK. ISNI: 0000 0004 0648 9396. GRID: grid.416025.4 FAU - Cove, M E AU - Cove ME AD - National University Hospital, Singapore, Singapore. ISNI: 0000 0004 0621 9599. GRID: grid.412106.0 FAU - Vu, L H AU - Vu LH AD - National University Singapore, Singapore, Singapore. ISNI: 0000 0001 2180 6431. GRID: grid.4280.e FAU - Sen, A AU - Sen A AD - Mayo Clinic, Phoenix, AZ USA. ISNI: 0000 0000 8875 6339. GRID: grid.417468.8 FAU - Federspiel, W J AU - Federspiel WJ AD - University of Pittsburgh, Pittsburgh, PA USA. ISNI: 0000 0004 1936 9000. GRID: grid.21925.3d FAU - Kellum, J A AU - Kellum JA AD - University of Pittsburgh, Pittsburgh, PA USA. ISNI: 0000 0004 1936 9000. GRID: grid.21925.3d FAU - Mazo Torre, C AU - Mazo Torre C AD - Vall D'Hebron University Hospital, Barcelona, Spain. ISNI: 0000 0001 0675 8654. GRID: grid.411083.f FAU - Riera, J AU - Riera J AD - Vall D'Hebron University Hospital, Barcelona, Spain. ISNI: 0000 0001 0675 8654. GRID: grid.411083.f FAU - Ramirez, S AU - Ramirez S AD - Vall D'Hebron University Hospital, Barcelona, Spain. ISNI: 0000 0001 0675 8654. GRID: grid.411083.f FAU - Borgatta, B AU - Borgatta B AD - Vall D'Hebron University Hospital, Barcelona, Spain. ISNI: 0000 0001 0675 8654. GRID: grid.411083.f FAU - Lagunes, L AU - Lagunes L AD - Vall D'Hebron University Hospital, Barcelona, Spain. ISNI: 0000 0001 0675 8654. GRID: grid.411083.f FAU - Rello, J AU - Rello J AD - Universitat Autonoma de Barcelona, Barcelona, Spain. GRID: grid.7080.f FAU - Kuzovlev, A K AU - Kuzovlev AK AD - V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia FAU - Moroz, V AU - Moroz V AD - V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia FAU - Goloubev, A AU - Goloubev A AD - V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia FAU - Polovnikov, S AU - Polovnikov S AD - NN Burdenko Main Military Hospital, Moscow, Russia FAU - Nenchuk, S AU - Nenchuk S AD - NN Burdenko Main Military Hospital, Moscow, Russia FAU - Karavana, V AU - Karavana V AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Glynos, C AU - Glynos C AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Asimakos, A AU - Asimakos A AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Pappas, K AU - Pappas K AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Vrettou, C AU - Vrettou C AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Magkou, M AU - Magkou M AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Ischaki, E AU - Ischaki E AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Stathopoulos, G AU - Stathopoulos G AD - University of Patras, Rio, Achaia Greece. ISNI: 0000 0004 0576 5395. GRID: grid.11047.33 FAU - Zakynthinos, S AU - Zakynthinos S AD - George P. Livanos and Marianthi Simou Laboratories, Athens, Greece FAU - Spadaro, S AU - Spadaro S AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Kozhevnikova, I AU - Kozhevnikova I AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Dalla Corte, F AU - Dalla Corte F AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Grasso, S AU - Grasso S AD - University of Bari, Bari, Italy. ISNI: 0000 0001 0120 3326. GRID: grid.7644.1 FAU - Casolari, P AU - Casolari P AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Caramori, G AU - Caramori G AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Volta, C AU - Volta C AD - University of Ferrara, Ferrara, Italy. ISNI: 0000 0004 1757 2064. GRID: grid.8484.0 FAU - Andrianjafiarinoa, T AU - Andrianjafiarinoa T AD - CHU HJRA, Antananarivo, Madagascar FAU - Randriamandrato, T AU - Randriamandrato T AD - CHU HJRA, Antananarivo, Madagascar FAU - Rajaonera, T AU - Rajaonera T AD - CHU HJRA, Antananarivo, Madagascar FAU - El-Dash, S AU - El-Dash S AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Costa, E L V AU - Costa ELV AD - Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Tucci, M R AU - Tucci MR AD - Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Leleu, F AU - Leleu F AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Kontar, L AU - Kontar L AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - De Cagny, B AU - De Cagny B AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Brazier, F AU - Brazier F AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Titeca, D AU - Titeca D AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Bacari-Risal, G AU - Bacari-Risal G AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Maizel, J AU - Maizel J AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Amato, M AU - Amato M AD - Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Slama, M AU - Slama M AD - Reanimation medicale, Centre Hospitalier Universitaire, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Mercado, P AU - Mercado P AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Maizel, J AU - Maizel J AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Kontar, L AU - Kontar L AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Titeca, D AU - Titeca D AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Brazier, F AU - Brazier F AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Riviere, A AU - Riviere A AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Joris, M AU - Joris M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Soupison, T AU - Soupison T AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - De Cagny, B AU - De Cagny B AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - El Dash, S AU - El Dash S AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Slama, M AU - Slama M AD - CHU Amiens, Amiens, France. ISNI: 0000 0004 0593 702X. GRID: grid.134996.0 FAU - Remmington AU - Remmington AD - Royal Brompton Hospital, London, UK. GRID: grid.439338.6 FAU - Fischer, A AU - Fischer A AD - Royal Brompton Hospital, London, UK. GRID: grid.439338.6 FAU - Squire, S AU - Squire S AD - Royal Brompton Hospital, London, UK. GRID: grid.439338.6 FAU - Boichat, M AU - Boichat M AD - Royal Brompton Hospital, London, UK. GRID: grid.439338.6 FAU - Honzawa, H AU - Honzawa H AD - Musashino Red Cross Hospital, Tokyo, Japan. ISNI: 0000 0000 9887 307X. GRID: grid.416332.1 FAU - Yasuda, H AU - Yasuda H AD - Musashino Red Cross Hospital, Tokyo, Japan. ISNI: 0000 0000 9887 307X. GRID: grid.416332.1 FAU - Adati, T AU - Adati T AD - Musashino Red Cross Hospital, Tokyo, Japan. ISNI: 0000 0000 9887 307X. GRID: grid.416332.1 FAU - Suzaki, S AU - Suzaki S AD - Musashino Red Cross Hospital, Tokyo, Japan. ISNI: 0000 0000 9887 307X. GRID: grid.416332.1 FAU - Horibe, M AU - Horibe M AD - JSEPTIC Clinical Trial Group, Tokyo, Japan FAU - Sasaki, M AU - Sasaki M AD - JSEPTIC Clinical Trial Group, Tokyo, Japan FAU - Sanui, M AU - Sanui M AD - JSEPTIC Clinical Trial Group, Tokyo, Japan FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Daniel, J AU - Daniel J AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Miranda, H AU - Miranda H AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, A AU - Marinho A FAU - Milinis, K AU - Milinis K AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - Cooper, M AU - Cooper M AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Williams, G R AU - Williams GR AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - McCarron, E AU - McCarron E AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Simants, S AU - Simants S AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Patanwala, I AU - Patanwala I AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Welters, I AU - Welters I AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - Su, Y AU - Su Y AD - Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan FAU - Fernandez Villanueva, J AU - Fernandez Villanueva J AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Fernandez Garda, R AU - Fernandez Garda R AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Lopez Lago, A AU - Lopez Lago A AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Rodriguez Ruiz, E AU - Rodriguez Ruiz E AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Hernandez Vaquero, R AU - Hernandez Vaquero R AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Tome Martinez de Rituerto, S AU - Tome Martinez de Rituerto S AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Varo Perez, E AU - Varo Perez E AD - Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. ISNI: 0000 0000 8816 6945. GRID: grid.411048.8 FAU - Lefel, N AU - Lefel N AD - MUMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Schaap, F AU - Schaap F AD - MUMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Bergmans, D AU - Bergmans D AD - MUMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Olde Damink, S AU - Olde Damink S AD - MUMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Van de Poll, M AU - Van de Poll M AD - MUMC, Maastricht, Netherlands. GRID: grid.412966.e FAU - Tizard, K AU - Tizard K AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Lister, C AU - Lister C AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Poole, L AU - Poole L AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Ringaitiene, D AU - Ringaitiene D AD - Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania. ISNI: 0000 0004 0567 3159. GRID: grid.426597.b FAU - Gineityte, D AU - Gineityte D AD - Vilnius University, Faculty of Medicine, Vilnius, Lithuania FAU - Vicka, V AU - Vicka V AD - Vilnius University, Faculty of Medicine, Vilnius, Lithuania FAU - Norkiene, I AU - Norkiene I AD - Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania. ISNI: 0000 0004 0567 3159. GRID: grid.426597.b FAU - Sipylaite, J AU - Sipylaite J AD - Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania. ISNI: 0000 0004 0567 3159. GRID: grid.426597.b FAU - O'Loughlin, A AU - O'Loughlin A AD - Mercy University Hospital, Cork, Ireland. ISNI: 0000 0004 0575 9497. GRID: grid.411785.e FAU - Maraj, V AU - Maraj V AD - Mercy University Hospital, Cork, Ireland. ISNI: 0000 0004 0575 9497. GRID: grid.411785.e FAU - Dowling, J AU - Dowling J AD - Mercy University Hospital, Cork, Ireland. ISNI: 0000 0004 0575 9497. GRID: grid.411785.e FAU - Velasco, M B AU - Velasco MB AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Dalcomune, D M AU - Dalcomune DM AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Dias, E B AU - Dias EB AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Fernandes, S L AU - Fernandes SL AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Oshima, T AU - Oshima T AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Graf, S AU - Graf S AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Heidegger, C AU - Heidegger C AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Genton, L AU - Genton L AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Karsegard, V AU - Karsegard V AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Dupertuis, Y AU - Dupertuis Y AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Pichard, C AU - Pichard C AD - Geneva Universtiy Hospital, Geneva, Switzerland. ISNI: 0000 0001 0721 9812. GRID: grid.150338.c FAU - Friedli, N AU - Friedli N AD - Medical University Department, Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Stanga, Z AU - Stanga Z AD - Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Bern, Bern, Switzerland. ISNI: 0000 0004 0479 0855. GRID: grid.411656.1 FAU - Mueller, B AU - Mueller B AD - Medical University Department, Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schuetz, P AU - Schuetz P AD - Medical University Department, Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Vandersteen, L AU - Vandersteen L AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Stessel, B AU - Stessel B AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Evers, S AU - Evers S AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Van Assche, A AU - Van Assche A AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Jamaer, L AU - Jamaer L AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Dubois, J AU - Dubois J AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Castro, H AU - Castro H AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Moura, J AU - Moura J AD - Unidade Local de Saude do Alto Minho, Viana do Castelo, Portugal FAU - Valente, J AU - Valente J AD - Unidade de Saude Local de Castelo Branco, Castelo Branco, Portugal FAU - Martins, P AU - Martins P AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Casteloes, P AU - Casteloes P AD - Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. ISNI: 0000 0000 8902 4519. GRID: grid.418336.b FAU - Magalhaes, C AU - Magalhaes C AD - Centro Hospitalar do Algarve, Faro, Portugal FAU - Cabral, S AU - Cabral S AD - Instituto Portugues de Oncologia do Porto, Porto, Portugal. GRID: grid.435544.7 FAU - Santos, M AU - Santos M AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Oliveira, B AU - Oliveira B AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Salgueiro, A AU - Salgueiro A AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Santos, M AU - Santos M AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Lafuente, E AU - Lafuente E AD - Centro Hospitalar Tamega e Sousa, Penafiel, Portugal. GRID: grid.466592.a FAU - Castro, H AU - Castro H AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Cabral, S AU - Cabral S AD - Instituto Portugues de Oncologia do Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Moura, J AU - Moura J AD - Unidade Local de Saude do Alto Minho, Viana do Castelo, Portugal FAU - Martins, P AU - Martins P AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Oliveira, B AU - Oliveira B AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Salgueiro, A AU - Salgueiro A AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Duarte, S AU - Duarte S AD - Unidade de Saude Local de Castelo Branco, Castelo Branco, Portugal FAU - Castro, S AU - Castro S AD - Centro Hospitalar do Algarve, Faro, Portugal FAU - Melo, M AU - Melo M AD - Centro Hospitalar do Baixo Vouga, Aveiro, Portugal FAU - Casteloes, P AU - Casteloes P AD - Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. ISNI: 0000 0000 8902 4519. GRID: grid.418336.b FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Gray, S AU - Gray S AD - Nottingham University Hospital NHS Trust, Nottingham, UK. ISNI: 0000 0001 0440 1889. GRID: grid.240404.6 FAU - Maipang, K AU - Maipang K AD - Prince of Songkla University, Songkla, Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Bhurayanontachai, R AU - Bhurayanontachai R AD - Prince of Songkla University, Songkla, Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Gradel, L G AU - Gradel LG AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schutz, P AU - Schutz P AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Langlois, P AU - Langlois P AD - Universite de Sherbrooke, Sherbrooke, Canada. ISNI: 0000 0000 9064 6198. GRID: grid.86715.3d FAU - Manzanares, W AU - Manzanares W AD - University Hospital, Montevideo, Uruguay FAU - Tincu, R AU - Tincu R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Cobilinschi, C AU - Cobilinschi C AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Tomescu, D AU - Tomescu D AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Ghiorghiu, Z AU - Ghiorghiu Z AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Macovei, R AU - Macovei R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Manzanares, W AU - Manzanares W AD - University Hospital, Montevideo, Uruguay FAU - Langlois, P AU - Langlois P AD - Universite de Sherbrooke, Sherbrooke, Canada. ISNI: 0000 0000 9064 6198. GRID: grid.86715.3d FAU - Lemieux, M AU - Lemieux M AD - Queen's University, Kingston, Canada. ISNI: 0000 0004 1936 8331. GRID: grid.410356.5 FAU - Elke, G AU - Elke G AD - University Medical Center Schleswig-Holstein, Kiel, Germany. ISNI: 0000 0004 0646 2097. GRID: grid.412468.d FAU - Bloos, F AU - Bloos F AD - University of Jena, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Reinhart, K AU - Reinhart K AD - University of Jena, Jena, Germany. ISNI: 0000 0001 1939 2794. GRID: grid.9613.d FAU - Heyland, D AU - Heyland D AD - Queen's University, Kingston, Canada. ISNI: 0000 0004 1936 8331. GRID: grid.410356.5 FAU - Langlois, P AU - Langlois P AD - Universite de Sherbrooke, Sherbrooke, Canada. ISNI: 0000 0000 9064 6198. GRID: grid.86715.3d FAU - Lemieux, M AU - Lemieux M AD - Queen's University, Kingston, Canada. ISNI: 0000 0004 1936 8331. GRID: grid.410356.5 FAU - Aramendi, I AU - Aramendi I AD - University Hospital, Montevideo, Uruguay FAU - Heyland, D AU - Heyland D AD - Queen's University, Kingston, Canada. ISNI: 0000 0004 1936 8331. GRID: grid.410356.5 FAU - Manzanares, W AU - Manzanares W AD - University Hospital, Montevideo, Uruguay FAU - Su, Y AU - Su Y AD - Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Babo, N AU - Babo N AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Hoshino, M AU - Hoshino M AD - Aida Hospital, Fukushima, Japan FAU - Haraguchi, Y AU - Haraguchi Y AD - Keiyo Hospital, Tokyo, Japan FAU - Kajiwara, S AU - Kajiwara S AD - Aida Hospital, Fukushima, Japan FAU - Mitsuhashi, T AU - Mitsuhashi T AD - Shisei Hospital, Saitama, Japan FAU - Tsubata, T AU - Tsubata T AD - Keiyo Hospital, Tokyo, Japan FAU - Aida, M AU - Aida M AD - Aida Hospital, Fukushima, Japan FAU - Rattanapraphat, T AU - Rattanapraphat T AD - Prince of Songkla University, Hat Yai City, Songkhla Province Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Bhurayanontachai, R AU - Bhurayanontachai R AD - Prince of Songkla University, Hat Yai City, Songkhla Province Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Kongkamol, C AU - Kongkamol C AD - Prince of Songkla University, Hat Yai City, Songkhla Province Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Khwannimit, B AU - Khwannimit B AD - Prince of Songkla University, Hat Yai City, Songkhla Province Thailand. ISNI: 0000 0004 0470 1162. GRID: grid.7130.5 FAU - Marinho, R AU - Marinho R AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Santos, M AU - Santos M AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Castro, H AU - Castro H AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Lafuente, E AU - Lafuente E AD - Centro Hospitalar Tamega e Sousa, Penafiel, Portugal. GRID: grid.466592.a FAU - Salgueiro, A AU - Salgueiro A AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Cabral, S AU - Cabral S AD - Instituto Portugues de Oncologia do Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Martins, P AU - Martins P AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Moura, J AU - Moura J AD - Unidade Local de Saude do Alto Minho, Viana do Castelo, Portugal FAU - Oliveira, B AU - Oliveira B AD - Faculdade de Ciencias da Nutricao e Alimentacao da Universidade do Porto, Porto, Portugal. ISNI: 0000 0001 1503 7226. GRID: grid.5808.5 FAU - Melo, M AU - Melo M AD - Centro Hospitalar Baixo Vouga, Aveiro, Portugal FAU - Xavier, B AU - Xavier B AD - Centro Hospitalar Baixo Vouga, Aveiro, Portugal FAU - Valente, J AU - Valente J AD - Unidade de Saude Local de Castelo Branco, Castelo Branco, Portugal FAU - Magalhaes, C AU - Magalhaes C AD - Centro Hospitalar do Algarve, Faro, Portugal FAU - Casteloes, P AU - Casteloes P AD - Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. ISNI: 0000 0000 8902 4519. GRID: grid.418336.b FAU - Marinho, A AU - Marinho A AD - Centro Hospitalar do Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Moisidou, D AU - Moisidou D AD - Department of Cardiothoracic Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Ampatzidou, F AU - Ampatzidou F AD - Department of Cardiothoracic Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Koutsogiannidis, C AU - Koutsogiannidis C AD - Department of Cardiothoracic Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Moschopoulou, M AU - Moschopoulou M AD - Department of Cardiothoracic Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Drossos, G AU - Drossos G AD - Department of Cardiothoracic Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0576 574X. GRID: grid.415248.e FAU - Taskin, G AU - Taskin G AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Cakir, M AU - Cakir M AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Guler, AK AU - Guler AK AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Taskin, A AU - Taskin A AD - Ankara Mevki Military Hospital, Ankara, Turkey. GRID: grid.461837.f FAU - Ocal, N AU - Ocal N AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Ozer, S AU - Ozer S AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Yamanel, L AU - Yamanel L AD - Gulhane Military Medical Academy, Ankara, Turkey. ISNI: 0000 0001 0720 6034. GRID: grid.413460.4 FAU - Wong, J M AU - Wong JM AD - St Bartholomew's Hospital, London, UK. ISNI: 0000 0000 9244 0345. GRID: grid.416353.6 FAU - Fitton, C AU - Fitton C AD - St Bartholomew's Hospital, London, UK. ISNI: 0000 0000 9244 0345. GRID: grid.416353.6 FAU - Anwar, S AU - Anwar S AD - St Bartholomew's Hospital, London, UK. ISNI: 0000 0000 9244 0345. GRID: grid.416353.6 FAU - Stacey, S AU - Stacey S AD - St Bartholomew's Hospital, London, UK. ISNI: 0000 0000 9244 0345. GRID: grid.416353.6 FAU - Aggou, M AU - Aggou M AD - Aristotle Medical School, Thessaloniki, Greece FAU - Fyntanidou, B AU - Fyntanidou B AD - Aristotle Medical School, Thessaloniki, Greece FAU - Patsatzakis, S AU - Patsatzakis S AD - Aristotle Medical School, Thessaloniki, Greece FAU - Oloktsidou, E AU - Oloktsidou E AD - Aristotle Medical School, Thessaloniki, Greece FAU - Lolakos, K AU - Lolakos K AD - Aristotle Medical School, Thessaloniki, Greece FAU - Papapostolou, E AU - Papapostolou E AD - Aristotle Medical School, Thessaloniki, Greece FAU - Grosomanidis, V AU - Grosomanidis V AD - Aristotle Medical School, Thessaloniki, Greece FAU - Suda, S AU - Suda S AD - Tokyo Medical University Hachiosi Medical Center, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ikeda, T AU - Ikeda T AD - Tokyo Medical University Hachiosi Medical Center, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ono, S AU - Ono S AD - Tokyo Medical University Hachiosi Medical Center, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Ueno, T AU - Ueno T AD - Tokyo Medical University Hachiosi Medical Center, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Izutani, Y AU - Izutani Y AD - Tokyo Medical University Hachiosi Medical Center, Tokyo, Japan. ISNI: 0000 0001 0663 3325. GRID: grid.410793.8 FAU - Gaudry, S AU - Gaudry S AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Desailly, V AU - Desailly V AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Pasquier, P AU - Pasquier P AD - Laboratoire ILUMENS, Paris, France FAU - Brun, PB AU - Brun PB AD - Institut de Hauts de Seine, Nanterre, France FAU - Tesnieres, AT AU - Tesnieres AT AD - Laboratoire ILUMENS, Paris, France FAU - Ricard, JD AU - Ricard JD AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Dreyfuss, D AU - Dreyfuss D AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Mignon, A AU - Mignon A AD - Laboratoire ILUMENS, Paris, France FAU - White, J C AU - White JC AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Molokhia, A AU - Molokhia A AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Dean, A AU - Dean A AD - Queen Elizabeth Hospital, London, UK. GRID: grid.439484.6 FAU - Stilwell, A AU - Stilwell A AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Friedlaender, G AU - Friedlaender G AD - Minet Green Health Practice, London, UK FAU - Peters, M AU - Peters M AD - Department of Public Health, University of Liege, Liege, Belgium. ISNI: 0000 0001 0805 7253. GRID: grid.4861.b FAU - Stipulante, S AU - Stipulante S AD - Department of Public Health, University of Liege, Liege, Belgium. ISNI: 0000 0001 0805 7253. GRID: grid.4861.b FAU - Delfosse, A AU - Delfosse A AD - Department of Emergency Medicine, University Hospital of Liege, Liege, Belgium. ISNI: 0000 0000 8607 6858. GRID: grid.411374.4 FAU - Donneau, AF AU - Donneau AF AD - Department of Medical Biostatistics, University of Liege, Liege, Belgium. ISNI: 0000 0001 0805 7253. GRID: grid.4861.b FAU - Ghuysen, A AU - Ghuysen A AD - Department of Public Health, University of Liege, Liege, Belgium. ISNI: 0000 0001 0805 7253. GRID: grid.4861.b FAU - Feldmann, C AU - Feldmann C AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Freitag, D AU - Freitag D AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Dersch, W AU - Dersch W AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Irqsusi, M AU - Irqsusi M AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Eschbach, D AU - Eschbach D AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Steinfeldt, T AU - Steinfeldt T AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Wulf, H AU - Wulf H AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Wiesmann, T AU - Wiesmann T AD - University Hospital, Philipps University Marburg, Marburg, Germany. ISNI: 0000 0004 1936 9756. GRID: grid.10253.35 FAU - Kongpolprom, N AU - Kongpolprom N AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Cholkraisuwat, J AU - Cholkraisuwat J AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Beitland, S AU - Beitland S AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Nakstad, E AU - Nakstad E AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Staer-Jensen, H AU - Staer-Jensen H AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Draegni, T AU - Draegni T AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Andersen, G AU - Andersen G AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Jacobsen, D AU - Jacobsen D AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Brunborg, C AU - Brunborg C AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Waldum-Grevbo, B AU - Waldum-Grevbo B AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Sunde, K AU - Sunde K AD - Oslo University Hospital, Oslo, Norway. ISNI: 0000 0004 0389 8485. GRID: grid.55325.34 FAU - Hoyland, K AU - Hoyland K AD - William Harvey Hospital, Ashford, UK. ISNI: 0000 0004 0398 7998. GRID: grid.417122.3 FAU - Pandit, D AU - Pandit D AD - William Harvey Hospital, Ashford, UK. ISNI: 0000 0004 0398 7998. GRID: grid.417122.3 FAU - Hayakawa, K AU - Hayakawa K AD - Kansai Medical University Takii Hospital, Moriguchi, Japan. GRID: grid.410783.9 FAU - Oloktsidou, E AU - Oloktsidou E AD - Aristotle Medical School, Thessaloniki, Greece FAU - Kotzampassi, K AU - Kotzampassi K AD - Aristotle Medical School, Thessaloniki, Greece FAU - Fyntanidou, B AU - Fyntanidou B AD - Aristotle Medical School, Thessaloniki, Greece FAU - Patsatzakis, S AU - Patsatzakis S AD - Aristotle Medical School, Thessaloniki, Greece FAU - Loukipoudi, L AU - Loukipoudi L AD - Aristotle Medical School, Thessaloniki, Greece FAU - Doumaki, E AU - Doumaki E AD - Aristotle Medical School, Thessaloniki, Greece FAU - Grosomanidis, V AU - Grosomanidis V AD - Aristotle Medical School, Thessaloniki, Greece FAU - Yasuda, H AU - Yasuda H AD - Japanese Red Cross Musashino Hospital, Tokyo, Japan. ISNI: 0000 0004 1762 2623. GRID: grid.410775.0 FAU - Admiraal, M M AU - Admiraal MM AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Assen, M AU - Van Assen M AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Putten, M J AU - Van Putten MJ AD - Medisch Spectrum Twente, Enschede, Netherlands. ISNI: 0000 0004 0399 8347. GRID: grid.415214.7 FAU - Tjepkema-Cloostermans, M AU - Tjepkema-Cloostermans M AD - Medisch Spectrum Twente, Enschede, Netherlands. ISNI: 0000 0004 0399 8347. GRID: grid.415214.7 FAU - Van Rootselaar, A F AU - Van Rootselaar AF AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Horn, J AU - Horn J AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Ragusa, F AU - Ragusa F AD - University Modena, Modena, Italy. ISNI: 0000000121697570. GRID: grid.7548.e FAU - Marudi, A AU - Marudi A AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Baroni, S AU - Baroni S AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Gaspari, A AU - Gaspari A AD - University Modena, Modena, Italy. ISNI: 0000000121697570. GRID: grid.7548.e FAU - Bertellini, E AU - Bertellini E AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Taha, A AU - Taha A AD - Faculty of Medicine Alexandria University, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Abdullah, T AU - Abdullah T AD - Faculty of Medicine Alexandria University, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Abdel Monem, S AU - Abdel Monem S AD - Faculty of Medicine Alexandria University, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Alcorn, S AU - Alcorn S AD - Victoria Hospital, Kirkcaldy, UK. ISNI: 0000 0004 0624 9667. GRID: grid.416854.a FAU - McNeill, S AU - McNeill S AD - Victoria Hospital, Kirkcaldy, UK. ISNI: 0000 0004 0624 9667. GRID: grid.416854.a FAU - Russell, S AU - Russell S AD - Victoria Hospital, Kirkcaldy, UK. ISNI: 0000 0004 0624 9667. GRID: grid.416854.a FAU - Eertmans, W AU - Eertmans W AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - Genbrugge, C AU - Genbrugge C AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - Meex, I AU - Meex I AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - Dens, J AU - Dens J AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - Jans, F AU - Jans F AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - De Deyne, C AU - De Deyne C AD - Ziekenhuis Oost-Limburg, Genk, Belgium. ISNI: 0000 0004 0612 7379. GRID: grid.470040.7 FAU - Cholkraisuwat, J AU - Cholkraisuwat J AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Kongpolprom, N AU - Kongpolprom N AD - Chulalongkorn University, Bangkok, Thailand. ISNI: 0000 0001 0244 7875. GRID: grid.7922.e FAU - Avard, B AU - Avard B AD - The Canberra Hospital, Hughes, ACT Australia. ISNI: 0000 0000 9984 5644. GRID: grid.413314.0 FAU - Burns, R AU - Burns R AD - ANU Medical School, Canberra, Australia. ISNI: 0000 0001 2180 7477. GRID: grid.1001.0 FAU - Patarchi, A AU - Patarchi A AD - "Spirito Santo" Hospital, Pescara, Italy. GRID: grid.416240.5 FAU - Spina, T AU - Spina T AD - "Spirito Santo" Hospital, Pescara, Italy. GRID: grid.416240.5 FAU - Tanaka, H AU - Tanaka H AD - St Lukes International Hospital, Akashi-Chou Chuo-Ku, Japan. GRID: grid.430395.8 FAU - Otani, N AU - Otani N AD - St Lukes International Hospital, Akashi-Chou Chuo-Ku, Japan. GRID: grid.430395.8 FAU - Ode, S AU - Ode S AD - St Lukes International Hospital, Akashi-Chou Chuo-Ku, Japan. GRID: grid.430395.8 FAU - Ishimatsu, S AU - Ishimatsu S AD - St Lukes International Hospital, Akashi-Chou Chuo-Ku, Japan. GRID: grid.430395.8 FAU - Cho, J AU - Cho J AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Moon, J B AU - Moon JB AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Park, C W AU - Park CW AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Ohk, T G AU - Ohk TG AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Shin, M C AU - Shin MC AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Won, M H AU - Won MH AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Dakova, S AU - Dakova S AD - Military Medical Academy, Sofia, Bulgaria. ISNI: 0000 0004 0621 0228. GRID: grid.413126.3 FAU - Ramsheva, Z AU - Ramsheva Z AD - Military Medical Academy, Sofia, Bulgaria. ISNI: 0000 0004 0621 0228. GRID: grid.413126.3 FAU - Ramshev, K AU - Ramshev K AD - Military Medical Academy, Sofia, Bulgaria. ISNI: 0000 0004 0621 0228. GRID: grid.413126.3 FAU - Cho, J AU - Cho J AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Moon, J B AU - Moon JB AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Park, C W AU - Park CW AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Ohk, T G AU - Ohk TG AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Shin, M C AU - Shin MC AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Cho, J AU - Cho J AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Moon, J B AU - Moon JB AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Park, C W AU - Park CW AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Ohk, T G AU - Ohk TG AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Shin, M C AU - Shin MC AD - Kangwon National University, Chuncheonsi, South Korea. ISNI: 0000 0001 0707 9039. GRID: grid.412010.6 FAU - Marudi, A AU - Marudi A AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Baroni, S AU - Baroni S AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Gaspari, A AU - Gaspari A AD - University Modena, Modena, Italy. ISNI: 0000000121697570. GRID: grid.7548.e FAU - Bertellini, E AU - Bertellini E AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Orhun, G AU - Orhun G AD - Istanbul University, Medical Faculty of Istanbul, Anesthesiology and Intensive Care, Istanbul, Turkey FAU - Senturk, E AU - Senturk E AD - Istanbul University, Medical Faculty of Istanbul, Anesthesiology and Intensive Care, Istanbul, Turkey FAU - Ozcan, P E AU - Ozcan PE AD - Istanbul University, Medical Faculty of Istanbul, Anesthesiology and Intensive Care, Istanbul, Turkey FAU - Sencer, S AU - Sencer S AD - Istanbul University, Medical Faculty of Istanbul, Department of Neuroradiology, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Ulusoy, C AU - Ulusoy C AD - Istanbul University, Institute of Experimental Medicine, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Tuzun, E AU - Tuzun E AD - Istanbul University, Institute of Experimental Medicine, Neuroscience, Istanbul, Turkey. ISNI: 0000 0001 2166 6619. GRID: grid.9601.e FAU - Esen, F AU - Esen F AD - Istanbul University, Medical Faculty of Istanbul, Anesthesiology and Intensive Care, Istanbul, Turkey FAU - Tincu, R AU - Tincu R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Cobilinschi, C AU - Cobilinschi C AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Tomescu, D AU - Tomescu D AD - Fundeni Clinical Institute, Bucharest, Romania. ISNI: 0000 0004 0540 9980. GRID: grid.415180.9 FAU - Ghiorghiu, Z AU - Ghiorghiu Z AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Macovei, R AU - Macovei R AD - Bucharest Clinical Emergency Hospital, Bucharest, Romania FAU - Van Assen, M AU - Van Assen M AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Admiraal, M M AU - Admiraal MM AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Putten, M J AU - Van Putten MJ AD - Medisch Spectrum Twente, Enschede, Netherlands. ISNI: 0000 0004 0399 8347. GRID: grid.415214.7 FAU - Tjepkema-Cloostermans, M AU - Tjepkema-Cloostermans M AD - Medisch Spectrum Twente, Enschede, Netherlands. ISNI: 0000 0004 0399 8347. GRID: grid.415214.7 FAU - Van Rootselaar, A F AU - Van Rootselaar AF AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Horn, J AU - Horn J AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Fallenius, M AU - Fallenius M AD - Helsinki University Hospital, Helsinki, Finland. ISNI: 0000 0000 9950 5666. GRID: grid.15485.3d FAU - Skrifvars, M B AU - Skrifvars MB AD - Helsinki University Hospital, Helsinki, Finland. ISNI: 0000 0000 9950 5666. GRID: grid.15485.3d FAU - Reinikainen, M AU - Reinikainen M AD - North Karelia Central Hospital, Joensuu, Finland. ISNI: 0000 0004 0368 0478. GRID: grid.416446.5 FAU - Bendel, S AU - Bendel S AD - Kuopio University Hospital, Kuopio, Finland. ISNI: 0000 0004 0628 207X. GRID: grid.410705.7 FAU - Raj, R AU - Raj R AD - Helsinki University Hospital, Helsinki, Finland. ISNI: 0000 0000 9950 5666. GRID: grid.15485.3d FAU - Abu-Habsa, M AU - Abu-Habsa M AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Hymers, C AU - Hymers C AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Borowska, A AU - Borowska A AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Sivadhas, H AU - Sivadhas H AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Sahiba, S AU - Sahiba S AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Perkins, S AU - Perkins S AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Rubio, J AU - Rubio J AD - Hospital Universitario Puerta del Mar, Cadiz, Spain. ISNI: 0000 0004 1771 1175. GRID: grid.411342.1 FAU - Rubio, J A AU - Rubio JA AD - Hospital Infanta Cristina, Badajoz, Spain. ISNI: 0000 0004 1771 0842. GRID: grid.411319.f FAU - Sierra, R AU - Sierra R AD - Hospital Universitario Puerta del Mar, Cadiz, Spain. ISNI: 0000 0004 1771 1175. GRID: grid.411342.1 FAU - English, S AU - English S AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Chasse, M AU - Chasse M AD - Ulaval, Quebec City, Canada FAU - Turgeon, A AU - Turgeon A AD - Ulaval, Quebec City, Canada FAU - Lauzier, F AU - Lauzier F AD - Ulaval, Quebec City, Canada FAU - Griesdale, D AU - Griesdale D AD - UBC, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Garland, A AU - Garland A AD - UManitoba, Winnipeg, Canada FAU - Fergusson, D AU - Fergusson D AD - OHRI, Ottawa, Canada FAU - Zarychanski, R AU - Zarychanski R AD - UBC, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Tinmouth, A AU - Tinmouth A AD - OHRI, Ottawa, Canada FAU - Van Walraven, C AU - Van Walraven C AD - OHRI, Ottawa, Canada FAU - Montroy, K AU - Montroy K AD - OHRI, Ottawa, Canada FAU - Ziegler, J AU - Ziegler J AD - UManitoba, Winnipeg, Canada FAU - Dupont Chouinard, R AU - Dupont Chouinard R AD - Ulaval, Quebec City, Canada FAU - Carignan, R AU - Carignan R AD - Ulaval, Quebec City, Canada FAU - Dhaliwal, A AU - Dhaliwal A AD - UBC, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Lum, C AU - Lum C AD - OHRI, Ottawa, Canada FAU - Sinclair, J AU - Sinclair J AD - OHRI, Ottawa, Canada FAU - Pagliarello, G AU - Pagliarello G AD - OHRI, Ottawa, Canada FAU - McIntyre, L AU - McIntyre L AD - OHRI, Ottawa, Canada FAU - English, S AU - English S AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Chasse, M AU - Chasse M AD - Ulaval, Quebec City, Canada FAU - Turgeon, A AU - Turgeon A AD - Ulaval, Quebec City, Canada FAU - Lauzier, F AU - Lauzier F AD - Ulaval, Quebec City, Canada FAU - Griesdale, D AU - Griesdale D AD - UBC, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Garland, A AU - Garland A AD - UManitoba, Winnipeg, Canada FAU - Fergusson, D AU - Fergusson D AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Zarychanski, R AU - Zarychanski R AD - UManitoba, Winnipeg, Canada FAU - Tinmouth, A AU - Tinmouth A AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Van Walraven, C AU - Van Walraven C AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Montroy, K AU - Montroy K AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Ziegler, J AU - Ziegler J AD - UManitoba, Winnipeg, Canada FAU - Dupont Chouinard, R AU - Dupont Chouinard R AD - Ulaval, Quebec City, Canada FAU - Carignan, R AU - Carignan R AD - Ulaval, Quebec City, Canada FAU - Dhaliwal, A AU - Dhaliwal A AD - UBC, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Lum, C AU - Lum C AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Sinclair, J AU - Sinclair J AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Pagliarello, G AU - Pagliarello G AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - McIntyre, L AU - McIntyre L AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Groza, T AU - Groza T AD - Cliniques St Luc, Universite catholique de Louvain, Brussels, Belgium. ISNI: 0000 0001 2294 713X. GRID: grid.7942.8 FAU - Moreau, N AU - Moreau N AD - Cliniques St Luc, Universite catholique de Louvain, Brussels, Belgium. ISNI: 0000 0001 2294 713X. GRID: grid.7942.8 FAU - Castanares-Zapatero, D AU - Castanares-Zapatero D AD - Cliniques St Luc, Universite catholique de Louvain, Brussels, Belgium. ISNI: 0000 0001 2294 713X. GRID: grid.7942.8 FAU - Hantson, P AU - Hantson P AD - Cliniques St Luc, Universite catholique de Louvain, Brussels, Belgium. ISNI: 0000 0001 2294 713X. GRID: grid.7942.8 FAU - Carbonara, M AU - Carbonara M AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Ortolano, F AU - Ortolano F AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Zoerle, T AU - Zoerle T AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Magnoni, S AU - Magnoni S AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Pifferi, S AU - Pifferi S AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Conte, V AU - Conte V AD - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Stocchetti, N AU - Stocchetti N AD - Milan University, Milan, Italy. ISNI: 0000 0004 1757 2822. GRID: grid.4708.b FAU - Carteron, L AU - Carteron L AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Suys, T AU - Suys T AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Patet, C AU - Patet C AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Quintard, H AU - Quintard H AD - CHU de Nice, Nice, France. ISNI: 0000 0001 2322 4179. GRID: grid.410528.a FAU - Oddo, M AU - Oddo M AD - CHUV, Lausanne, Switzerland. ISNI: 0000 0001 0423 4662. GRID: grid.8515.9 FAU - Rubio, J A AU - Rubio JA AD - Hospital Infanta Cristina, Badajoz, Spain. ISNI: 0000 0004 1771 0842. GRID: grid.411319.f FAU - Rubio, J AU - Rubio J AD - Hospital Universitario Puerta del Mar, Cadiz, Spain. ISNI: 0000 0004 1771 1175. GRID: grid.411342.1 FAU - Sierra, R AU - Sierra R AD - Hospital Universitario Puerta del Mar, Cadiz, Spain. ISNI: 0000 0004 1771 1175. GRID: grid.411342.1 FAU - Spatenkova, V AU - Spatenkova V AD - Regional Hospital, Liberec, Czech Republic. ISNI: 0000 0004 0609 0449. GRID: grid.447961.9 FAU - Pokorna, E AU - Pokorna E AD - Institute of Experimental Medicine, Prague, Czech Republic. ISNI: 0000 0004 0404 6946. GRID: grid.424967.a FAU - Suchomel, P AU - Suchomel P AD - Regional Hospital, Liberec, Czech Republic. ISNI: 0000 0004 0609 0449. GRID: grid.447961.9 FAU - Ebert, N AU - Ebert N AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Jancik, J AU - Jancik J AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Rhodes, H AU - Rhodes H AD - Hennepin County Medical Center, Minneapolis, USA. ISNI: 0000 0000 9206 4546. GRID: grid.414021.2 FAU - Bylinski, T AU - Bylinski T AD - University of Glasgow, Glasgow, UK. ISNI: 0000 0001 2193 314X. GRID: grid.8756.c FAU - Hawthorne, C AU - Hawthorne C AD - Institute of Neurological Sciences, NHSGGC, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Shaw, M AU - Shaw M AD - Department of Clinical Physics and Bioengineering, NHSGGC, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Piper, I AU - Piper I AD - Department of Clinical Physics and Bioengineering, NHSGGC, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Kinsella, J AU - Kinsella J AD - Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow, Glasgow, UK. ISNI: 0000 0001 2193 314X. GRID: grid.8756.c FAU - Kink, A K AU - Kink AK AD - Smartimplant Ltd., Tallinn, Estonia FAU - Ratsep, I R AU - Ratsep IR AD - NEMC, Tallinn, Estonia. ISNI: 0000 0004 0631 377X. GRID: grid.454953.a FAU - Boutin, A AU - Boutin A AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Moore, L AU - Moore L AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Chasse, M AU - Chasse M AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Zarychanski, R AU - Zarychanski R AD - University of Manitoba, Winnipeg, Canada. ISNI: 0000 0004 1936 9609. GRID: grid.21613.37 FAU - Lauzier, F AU - Lauzier F AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - English, S AU - English S AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - McIntyre, L AU - McIntyre L AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Lacroix, J AU - Lacroix J AD - Universite de Montreal, Montreal, Canada. ISNI: 0000 0001 2292 3357. GRID: grid.14848.31 FAU - Griesdale, D AU - Griesdale D AD - University of British Columbia, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Lessard-Bonaventure, P AU - Lessard-Bonaventure P AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Turgeon, A F AU - Turgeon AF AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Boutin, A AU - Boutin A AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Moore, L AU - Moore L AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Green, R AU - Green R AD - Dalhousie University, Halifax, Canada. ISNI: 0000 0004 1936 8200. GRID: grid.55602.34 FAU - Lessard-Bonaventure, P AU - Lessard-Bonaventure P AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Erdogan, M AU - Erdogan M AD - Dalhousie University, Halifax, Canada. ISNI: 0000 0004 1936 8200. GRID: grid.55602.34 FAU - Butler, M AU - Butler M AD - Dalhousie University, Halifax, Canada. ISNI: 0000 0004 1936 8200. GRID: grid.55602.34 FAU - Lauzier, F AU - Lauzier F AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Chasse, M AU - Chasse M AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - English, S AU - English S AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - McIntyre, L AU - McIntyre L AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Zarychanski, R AU - Zarychanski R AD - University of Manitoba, Winnipeg, Canada. ISNI: 0000 0004 1936 9609. GRID: grid.21613.37 FAU - Lacroix, J AU - Lacroix J AD - Universite de Montreal, Montreal, Canada. ISNI: 0000 0001 2292 3357. GRID: grid.14848.31 FAU - Griesdale, D AU - Griesdale D AD - University of British Columbia, Vancouver, Canada. ISNI: 0000 0001 2288 9830. GRID: grid.17091.3e FAU - Desjardins, P AU - Desjardins P AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Fergusson, D A AU - Fergusson DA AD - Ottawa Hospital Research Institute, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Turgeon, A F AU - Turgeon AF AD - Universite Laval, Quebec, Canada. ISNI: 0000 0004 1936 8390. GRID: grid.23856.3a FAU - Goncalves, B AU - Goncalves B AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Vidal, B AU - Vidal B AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Valdez, C AU - Valdez C AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Rodrigues, A C AU - Rodrigues AC AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Miguez, L AU - Miguez L AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Moralez, G AU - Moralez G AD - Hospital Estadual Getulio Vargas, Rio de Janeiro, Brazil FAU - Hong, T AU - Hong T AD - Yonsei University College of Medicine, Seoul, South Korea. ISNI: 0000 0004 0470 5454. GRID: grid.15444.30 FAU - Kutz, A AU - Kutz A AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Hausfater, P AU - Hausfater P AD - Emergency Department, Groupe Hospitalier Pitie-Salpetriere, Paris, France. ISNI: 0000 0001 2150 9058. GRID: grid.411439.a FAU - Amin, D AU - Amin D AD - Morton Plant Hospital, Clearwater, USA. ISNI: 0000 0000 8602 0133. GRID: grid.416123.3 FAU - Struja, T AU - Struja T AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Haubitz, S AU - Haubitz S AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Huber, A AU - Huber A AD - Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Mueller, B AU - Mueller B AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schuetz, P AU - Schuetz P AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Brown, T AU - Brown T AD - Royal Cornwall Hospital Trust, Truro, UK. ISNI: 0000 0004 0474 4488. GRID: grid.412944.e FAU - Collinson, J AU - Collinson J AD - Royal Cornwall Hospital Trust, Truro, UK. ISNI: 0000 0004 0474 4488. GRID: grid.412944.e FAU - Pritchett, C AU - Pritchett C AD - Royal Cornwall Hospital Trust, Truro, UK. ISNI: 0000 0004 0474 4488. GRID: grid.412944.e FAU - Slade, T AU - Slade T AD - Royal Cornwall Hospital Trust, Truro, UK. ISNI: 0000 0004 0474 4488. GRID: grid.412944.e FAU - Le Guen, M AU - Le Guen M AD - Manchester Royal Infirmary, Manchester, UK. ISNI: 0000 0004 0641 2823. GRID: grid.419319.7 FAU - Hellings, S AU - Hellings S AD - Manchester Royal Infirmary, Manchester, UK. ISNI: 0000 0004 0641 2823. GRID: grid.419319.7 FAU - Ramsaran, R AU - Ramsaran R AD - Manchester Royal Infirmary, Manchester, UK. ISNI: 0000 0004 0641 2823. GRID: grid.419319.7 FAU - Alsheikhly, A AU - Alsheikhly A AD - Hamad Medical Corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Abe, T AU - Abe T AD - University of Tsukuba, Tsukuba Medical Center Hospital, Tsukuba, Japan. ISNI: 0000 0004 1764 0856. GRID: grid.417324.7 FAU - Kanapeckaite, L AU - Kanapeckaite L AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Abu-Habsa, M AU - Abu-Habsa M AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Bahl, R AU - Bahl R AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Russell, M Q AU - Russell MQ AD - Kent, Surrey & Sussex Air Ambulance Trust, Kent, UK FAU - Real, K J AU - Real KJ AD - Prometheus Delta-Tech, Herefordshire, UK FAU - Abu-Habsa, M AU - Abu-Habsa M AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Lyon, R M AU - Lyon RM AD - Kent, Surrey & Sussex Air Ambulance Trust, Kent, UK FAU - Oveland, N P AU - Oveland NP AD - Stavanger University Hospital, Stavanger, Norway. ISNI: 0000 0004 0627 2891. GRID: grid.412835.9 FAU - Penketh, J AU - Penketh J AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Mcdonald, M AU - Mcdonald M AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Kelly, F AU - Kelly F AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Alfafi, M AU - Alfafi M AD - Aseer Central Hospital, Abha, Saudi Arabia. ISNI: 0000 0004 0607 7156. GRID: grid.413974.c FAU - Alsolamy, S AU - Alsolamy S AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Almutairi, W AU - Almutairi W AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Alotaibi, B AU - Alotaibi B AD - King Fahad Medical City, Riyadh, Saudi Arabia. ISNI: 0000 0004 0593 1832. GRID: grid.415277.2 FAU - Van den Berg, A E AU - Van den Berg AE AD - HagaZiekenhuis, Den Haag, Netherlands. ISNI: 0000 0004 0568 6689. GRID: grid.413591.b FAU - Schriel, Y AU - Schriel Y AD - Reinier de Graaf Gasthuis, Delft, Netherlands. ISNI: 0000 0004 0624 5690. GRID: grid.415868.6 FAU - Dawson, L AU - Dawson L AD - Reinier de Graaf Gasthuis, Delft, Netherlands. ISNI: 0000 0004 0624 5690. GRID: grid.415868.6 FAU - Meynaar, I A AU - Meynaar IA AD - HagaZiekenhuis, Den Haag, Netherlands. ISNI: 0000 0004 0568 6689. GRID: grid.413591.b FAU - Talaie, H AU - Talaie H AD - Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. GRID: grid.411600.2 FAU - Silva, D AU - Silva D AD - Santa Maria University Hospital, Lisboa, Portugal. ISNI: 0000 0001 2295 9747. GRID: grid.411265.5 FAU - Fernandes, S AU - Fernandes S AD - Santa Maria University Hospital, Lisboa, Portugal. ISNI: 0000 0001 2295 9747. GRID: grid.411265.5 FAU - Gouveia, J AU - Gouveia J AD - Santa Maria University Hospital, Lisboa, Portugal. ISNI: 0000 0001 2295 9747. GRID: grid.411265.5 FAU - Santos Silva, J AU - Santos Silva J AD - Santa Maria University Hospital, Lisboa, Portugal. ISNI: 0000 0001 2295 9747. GRID: grid.411265.5 FAU - Foley, J AU - Foley J AD - St. Vincent's University Hospital, Dublin 4, Ireland. ISNI: 0000 0001 0315 8143. GRID: grid.412751.4 FAU - Kaskovagheorgescu, A AU - Kaskovagheorgescu A AD - St. Vincent's University Hospital, Dublin 4, Ireland. ISNI: 0000 0001 0315 8143. GRID: grid.412751.4 FAU - Evoy, D AU - Evoy D AD - St. Vincent's University Hospital, Dublin 4, Ireland. ISNI: 0000 0001 0315 8143. GRID: grid.412751.4 FAU - Cronin, J AU - Cronin J AD - St. Vincent's University Hospital, Dublin 4, Ireland. ISNI: 0000 0001 0315 8143. GRID: grid.412751.4 FAU - Ryan, J AU - Ryan J AD - St. Vincent's University Hospital, Dublin 4, Ireland. ISNI: 0000 0001 0315 8143. GRID: grid.412751.4 FAU - Huck, M AU - Huck M AD - Percy Military Teaching Hospital, Clamart, France FAU - Hoffmann, C AU - Hoffmann C AD - Percy Military Teaching Hospital, Clamart, France FAU - Renner, J AU - Renner J AD - Percy Military Teaching Hospital, Clamart, France FAU - Laitselart, P AU - Laitselart P AD - Percy Military Teaching Hospital, Clamart, France FAU - Donat, N AU - Donat N AD - Percy Military Teaching Hospital, Clamart, France FAU - Cirodde, A AU - Cirodde A AD - Percy Military Teaching Hospital, Clamart, France FAU - Schaal, J V AU - Schaal JV AD - Percy Military Teaching Hospital, Clamart, France FAU - Masson, Y AU - Masson Y AD - Percy Military Teaching Hospital, Clamart, France FAU - Nau, A AU - Nau A AD - Percy Military Teaching Hospital, Clamart, France FAU - Leclerc, T AU - Leclerc T AD - Percy Military Teaching Hospital, Clamart, France FAU - Howarth, O AU - Howarth O AD - Whiston Hospital, Prescot, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Davenport, K AU - Davenport K AD - Whiston Hospital, Prescot, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Jeanrenaud, P AU - Jeanrenaud P AD - Whiston Hospital, Prescot, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Raftery, S AU - Raftery S AD - Whiston Hospital, Prescot, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - MacTavish, P AU - MacTavish P AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Devine, H AU - Devine H AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - McPeake, J AU - McPeake J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Daniel, M AU - Daniel M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kinsella, J AU - Kinsella J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Quasim, T AU - Quasim T AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Alrabiee, S AU - Alrabiee S AD - King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia. ISNI: 0000 0004 1790 7311. GRID: grid.415254.3 FAU - Alrashid, A AU - Alrashid A AD - Department of Management, College of Business Administration, King Saud University, Saudi Arabia, Riyadh, Saudi Arabia. ISNI: 0000 0004 1773 5396. GRID: grid.56302.32 FAU - Alsolamy, S AU - Alsolamy S AD - King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Gundogan, O AU - Gundogan O AD - Ege University Hospital, Izmir, Turkey. ISNI: 0000 0004 0535 6364. GRID: grid.412190.f FAU - Bor, C AU - Bor C AD - Ege University Hospital, Izmir, Turkey. ISNI: 0000 0004 0535 6364. GRID: grid.412190.f FAU - Akyn Korhan, E AU - Akyn Korhan E AD - Katip Celebi University, Health Sciences Faculty, Izmir, Turkey FAU - Demirag, K AU - Demirag K AD - Ege University Hospital, Izmir, Turkey. ISNI: 0000 0004 0535 6364. GRID: grid.412190.f FAU - Uyar, M AU - Uyar M AD - Ege University Hospital, Izmir, Turkey. ISNI: 0000 0004 0535 6364. GRID: grid.412190.f FAU - Frame, F AU - Frame F AD - Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK. GRID: grid.415667.7 FAU - Ashton, C AU - Ashton C AD - Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK. GRID: grid.415667.7 FAU - Bergstrom Niska, L AU - Bergstrom Niska L AD - Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK. GRID: grid.415667.7 FAU - Dilokpattanamongkol, P AU - Dilokpattanamongkol P AD - Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Suansanae, T AU - Suansanae T AD - Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Suthisisang, C AU - Suthisisang C AD - Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Morakul, S AU - Morakul S AD - Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Karnjanarachata, C AU - Karnjanarachata C AD - Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Tangsujaritvijit, V AU - Tangsujaritvijit V AD - Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Mahmood, S AU - Mahmood S AD - Specialist Anesthesia, Doha, Qatar FAU - Al Thani, H AU - Al Thani H AD - Specialist Anesthesia, Doha, Qatar FAU - Almenyar, A AU - Almenyar A AD - Specialist Anesthesia, Doha, Qatar FAU - Vakalos, A AU - Vakalos A AD - Xanthi General Hospital, Xanthi, Greece FAU - Avramidis, V AU - Avramidis V AD - Xanthi General Hospital, Xanthi, Greece FAU - Sharvill, R AU - Sharvill R AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Penketh, J AU - Penketh J AD - Royal United Hospital, Bath, UK. ISNI: 0000 0004 0417 0728. GRID: grid.416091.b FAU - Morton, S E AU - Morton SE AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Chiew, Y S AU - Chiew YS AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Pretty, C AU - Pretty C AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Chase, J G AU - Chase JG AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Shaw, G M AU - Shaw GM AD - Christchurch Hospital, Christchurch, New Zealand. ISNI: 0000 0004 0614 1349. GRID: grid.414299.3 FAU - Knafelj, R AU - Knafelj R AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Kordis, P AU - Kordis P AD - Clinical Center Ljubljana, Ljubljana, Slovenia. ISNI: 0000 0004 0571 7705. GRID: grid.29524.38 FAU - Patel, S AU - Patel S AD - The Royal Marsden Hospital, London, UK. ISNI: 0000 0004 0417 0461. GRID: grid.424926.f FAU - Grover, V AU - Grover V AD - The Royal Marsden Hospital, London, UK. ISNI: 0000 0004 0417 0461. GRID: grid.424926.f FAU - Kuchyn, I AU - Kuchyn I AD - Bogomolets National Medical University, Kiev, Ukraine. GRID: grid.412081.e FAU - Bielka, K AU - Bielka K AD - Bogomolets National Medical University, Kiev, Ukraine. GRID: grid.412081.e FAU - Aidoni, Z AU - Aidoni Z AD - Aristotle Medical School, Thessaloniki, Greece FAU - Grosomanidis, V AU - Grosomanidis V AD - Aristotle Medical School, Thessaloniki, Greece FAU - Kotzampassi, K AU - Kotzampassi K AD - Aristotle Medical School, Thessaloniki, Greece FAU - Stavrou, G AU - Stavrou G AD - Aristotle Medical School, Thessaloniki, Greece FAU - Fyntanidou, B AU - Fyntanidou B AD - Aristotle Medical School, Thessaloniki, Greece FAU - Patsatzakis, S AU - Patsatzakis S AD - Aristotle Medical School, Thessaloniki, Greece FAU - Skourtis, C AU - Skourtis C AD - Aristotle Medical School, Thessaloniki, Greece FAU - Lee, S D AU - Lee SD AD - Royal Liverpool Intensive Care Unit, Liverpool, UK FAU - Williams, K AU - Williams K AD - Royal Liverpool Intensive Care Unit, Liverpool, UK FAU - Weltes, I D AU - Weltes ID AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - Berhane, S AU - Berhane S AD - Homerton University Hospital, London, UK. GRID: grid.439591.3 FAU - Arrowsmith, C AU - Arrowsmith C AD - Homerton University Hospital, London, UK. GRID: grid.439591.3 FAU - Peters, C AU - Peters C AD - Homerton University Hospital, London, UK. GRID: grid.439591.3 FAU - Robert, S AU - Robert S AD - Homerton University Hospital, London, UK. GRID: grid.439591.3 FAU - Caldas, J AU - Caldas J AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Panerai, R B AU - Panerai RB AD - University of Leicester, Leicester, UK. ISNI: 0000 0004 1936 8411. GRID: grid.9918.9 FAU - Robinson, T G AU - Robinson TG AD - University of Leicester, Leicester, UK. ISNI: 0000 0004 1936 8411. GRID: grid.9918.9 FAU - Camara, L AU - Camara L AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Ferreira, G AU - Ferreira G AD - University of Leicester, Leicester, UK. ISNI: 0000 0004 1936 8411. GRID: grid.9918.9 FAU - Borg-Seng-Shu, E AU - Borg-Seng-Shu E AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - De Lima Oliveira, M AU - De Lima Oliveira M AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Mian, N C AU - Mian NC AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Santos, L AU - Santos L AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Nogueira, R AU - Nogueira R AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Zeferino, S P AU - Zeferino SP AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Jacobsen Teixeira, M AU - Jacobsen Teixeira M AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Galas, F AU - Galas F AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Hajjar, L A AU - Hajjar LA AD - University of Sao Paulo, Sao Paulo, Brazil. ISNI: 0000 0004 1937 0722. GRID: grid.11899.38 FAU - Killeen, P AU - Killeen P AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - McPhail, M AU - McPhail M AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Bernal, W AU - Bernal W AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Maggs, J AU - Maggs J AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Wendon, J AU - Wendon J AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Hughes, T AU - Hughes T AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Taniguchi, L U AU - Taniguchi LU AD - Research and Education Institute, Sao Paulo, Brazil FAU - Siqueira, E M AU - Siqueira EM AD - Research and Education Institute, Sao Paulo, Brazil FAU - Vieira Jr, J M AU - Vieira Jr JM AD - Research and Education Institute, Sao Paulo, Brazil FAU - Azevedo, L C AU - Azevedo LC AD - Research and Education Institute, Sao Paulo, Brazil FAU - Ahmad, A N AU - Ahmad AN AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Abu-Habsa, M AU - Abu-Habsa M AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Bahl, R AU - Bahl R AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Helme, E AU - Helme E AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Hadfield, S AU - Hadfield S AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Loveridge, R AU - Loveridge R AD - King's College Hospital, London, UK. ISNI: 0000 0004 0391 9020. GRID: grid.46699.34 FAU - Shak, J AU - Shak J AD - Ipswich Hospital NHS Trust, England, UK, Ipswich, UK. ISNI: 0000 0004 0413 7370. GRID: grid.412930.d FAU - Senver, C AU - Senver C AD - Ipswich Hospital NHS Trust, England, UK, Ipswich, UK. ISNI: 0000 0004 0413 7370. GRID: grid.412930.d FAU - Howard-Griffin, R AU - Howard-Griffin R AD - Ipswich Hospital NHS Trust, England, UK, Ipswich, UK. ISNI: 0000 0004 0413 7370. GRID: grid.412930.d FAU - Wacharasint, P AU - Wacharasint P AD - Phramongkutklao Hospital, Bangkok, Thailand. ISNI: 0000 0004 0576 1212. GRID: grid.414965.b FAU - Fuengfoo, P AU - Fuengfoo P AD - Phramongkutklao Hospital, Bangkok, Thailand. ISNI: 0000 0004 0576 1212. GRID: grid.414965.b FAU - Sukcharoen, N AU - Sukcharoen N AD - Phramongkutklao Hospital, Bangkok, Thailand. ISNI: 0000 0004 0576 1212. GRID: grid.414965.b FAU - Rangsin, R AU - Rangsin R AD - Phramongkutklao College of Medicine, Bangkok, Thailand. ISNI: 0000 0004 1937 0490. GRID: grid.10223.32 FAU - Sbiti-Rohr, D AU - Sbiti-Rohr D AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Schuetz, P AU - Schuetz P AD - Kantonsspital Aarau, Aarau, Switzerland. ISNI: 0000 0000 8704 3732. GRID: grid.413357.7 FAU - Na, H AU - Na H AD - Pusan National University Hospital, Busan, South Korea. ISNI: 0000 0000 8611 7824. GRID: grid.412588.2 FAU - Song, S AU - Song S AD - Pusan National University Hospital, Busan, South Korea. ISNI: 0000 0000 8611 7824. GRID: grid.412588.2 FAU - Lee, S AU - Lee S AD - Pusan National University Hospital, Busan, South Korea. ISNI: 0000 0000 8611 7824. GRID: grid.412588.2 FAU - Jeong, E AU - Jeong E AD - Pusan National University Hospital, Busan, South Korea. ISNI: 0000 0000 8611 7824. GRID: grid.412588.2 FAU - Lee, K AU - Lee K AD - Pusan National University Hospital, Busan, South Korea. ISNI: 0000 0000 8611 7824. GRID: grid.412588.2 FAU - Cooper, M AU - Cooper M AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Milinis, K AU - Milinis K AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - Williams, G AU - Williams G AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - McCarron, E AU - McCarron E AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Simants, S AU - Simants S AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Patanwala, I AU - Patanwala I AD - Royal Liverpool University Hospital, Liverpool, UK. ISNI: 0000 0004 0417 2395. GRID: grid.415970.e FAU - Welters, I D AU - Welters ID AD - University of Liverpool, Liverpool, UK. ISNI: 0000 0004 1936 8470. GRID: grid.10025.36 FAU - Zoumpelouli, E AU - Zoumpelouli E AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Volakli, E A AU - Volakli EA AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Chrysohoidou, V AU - Chrysohoidou V AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Georgiou, S AU - Georgiou S AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Charisopoulou, K AU - Charisopoulou K AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Kotzapanagiotou, E AU - Kotzapanagiotou E AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Panagiotidou, V AU - Panagiotidou V AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Manavidou, K AU - Manavidou K AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Stathi, Z AU - Stathi Z AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Sdougka, M AU - Sdougka M AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Salahuddin, N AU - Salahuddin N AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - AlGhamdi, B AU - AlGhamdi B AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Marashly, Q AU - Marashly Q AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Zaza, K AU - Zaza K AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Sharshir, M AU - Sharshir M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Khurshid, M AU - Khurshid M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Ali, Z AU - Ali Z AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Malgapo, M AU - Malgapo M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Jamil, M AU - Jamil M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Shafquat, A AU - Shafquat A AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Shoukri, M AU - Shoukri M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Hijazi, M AU - Hijazi M AD - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. ISNI: 0000 0001 2191 4301. GRID: grid.415310.2 FAU - Abe, T AU - Abe T AD - The Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Uchino, S AU - Uchino S AD - The Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Takinami, M AU - Takinami M AD - The Jikei University School of Medicine, Tokyo, Japan. ISNI: 0000 0001 0661 2073. GRID: grid.411898.d FAU - Rangel Neto, N R AU - Rangel Neto NR AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Oliveira, S AU - Oliveira S AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Reis, F Q AU - Reis FQ AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Rocha, F A AU - Rocha FA AD - Albert Schweitzer State Hospital, Rio de Janeiro, Brazil FAU - Moralez, G AU - Moralez G AD - PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. ISNI: 0000 0001 2294 473X. GRID: grid.8536.8 FAU - Ebecken, K AU - Ebecken K AD - PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. ISNI: 0000 0001 2294 473X. GRID: grid.8536.8 FAU - Rabello, L S AU - Rabello LS AD - PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. ISNI: 0000 0001 2294 473X. GRID: grid.8536.8 FAU - Lima, M F AU - Lima MF AD - Hospital Esperanca Recife, Recife, Brazil FAU - Hatum, R AU - Hatum R AD - Hospital Total Cor, Rio de Janeiro, Brazil FAU - De Marco, F V AU - De Marco FV AD - Hospital viValle, Sao Jose dos Campos, Brazil FAU - Alves, A AU - Alves A AD - Hospital Rios DOr, Rio de Janeiro, Brazil FAU - Pinto, J E AU - Pinto JE AD - Hospital Norte DOr, Rio de Janeiro, Brazil FAU - Godoy, M AU - Godoy M AD - Hospital Esperanca Olinda, Olinda, Brazil FAU - Brasil, P E AU - Brasil PE AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Bozza, F A AU - Bozza FA AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Salluh, J I AU - Salluh JI AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Soares, M AU - Soares M AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Krinsley, J AU - Krinsley J AD - Stamford Hospital, Stamford, USA. ISNI: 0000 0004 0377 0318. GRID: grid.416984.6 FAU - Kang, G AU - Kang G AD - Stamford Hospital, Stamford, USA. ISNI: 0000 0004 0377 0318. GRID: grid.416984.6 FAU - Perry, J AU - Perry J AD - Darent Valley Hospital, Dartford, UK. ISNI: 0000 0004 0398 7314. GRID: grid.413475.0 FAU - Hines, H AU - Hines H AD - William Harvey Hospital, Ashford, UK. ISNI: 0000 0004 0398 7998. GRID: grid.417122.3 FAU - Wilkinson, K M AU - Wilkinson KM AD - St James's University Hospital, Leeds, UK. GRID: grid.443984.6 FAU - Tordoff, C AU - Tordoff C AD - St James's University Hospital, Leeds, UK. GRID: grid.443984.6 FAU - Sloan, B AU - Sloan B AD - St James's University Hospital, Leeds, UK. GRID: grid.443984.6 FAU - Bellamy, M C AU - Bellamy MC AD - St James's University Hospital, Leeds, UK. GRID: grid.443984.6 FAU - Moreira, E AU - Moreira E AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Verga, F AU - Verga F AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Barbato, M AU - Barbato M AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Burghi, G AU - Burghi G AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Soares, M AU - Soares M AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Silva, U V AU - Silva UV AD - Hospital de Cancer de Barretos, Barretos, Brazil. ISNI: 0000 0004 0615 7498. GRID: grid.427783.d FAU - Azevedo, L C AU - Azevedo LC AD - Hospital Sirio Libanes, Sao Paulo, Brazil. ISNI: 0000 0000 9080 8521. GRID: grid.413471.4 FAU - Torelly, A P AU - Torelly AP AD - Sta. Casa de Porto Alegre, Porto Alegre, Brazil FAU - Kahn, J M AU - Kahn JM AD - University of Pittsburgh Medical Center, Pittsburgh, USA. ISNI: 0000 0001 0650 7433. GRID: grid.412689.0 FAU - Angus, D C AU - Angus DC AD - University of Pittsburgh Medical Center, Pittsburgh, USA. ISNI: 0000 0001 0650 7433. GRID: grid.412689.0 FAU - Knibel, M F AU - Knibel MF AD - Hospital Sao Lucas, Rio de Janeiro, Brazil FAU - Brasil, P E AU - Brasil PE AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Bozza, F A AU - Bozza FA AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Salluh, J I AU - Salluh JI AD - DOr Institute for Research and Education - IDOR, Rio de Janeiro, Brazil. GRID: grid.472984.4 FAU - Velasco, M B AU - Velasco MB AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Dalcomune, D M AU - Dalcomune DM AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Marshall, R AU - Marshall R AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Gilpin, T AU - Gilpin T AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Tridente, A AU - Tridente A AD - Whiston Hospital, St Helens & Knowsley, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Raithatha, A AU - Raithatha A AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Mota, D AU - Mota D AD - Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. ISNI: 0000000106861985. GRID: grid.28911.33 FAU - Loureiro, B AU - Loureiro B AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Dias, J AU - Dias J AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Afonso, O AU - Afonso O AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Coelho, F AU - Coelho F AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Martins, A AU - Martins A AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Faria, F AU - Faria F AD - Instituto Portugues de Oncologia Francisco Gil - Porto, Porto, Portugal. ISNI: 0000 0004 0631 0608. GRID: grid.418711.a FAU - Al-Dorzi, H AU - Al-Dorzi H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Al Orainni, H AU - Al Orainni H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - AlEid, F AU - AlEid F AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Tlaygeh, H AU - Tlaygeh H AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Itani, A AU - Itani A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Hejazi, A AU - Hejazi A AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Arabi, Y AU - Arabi Y AD - King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. ISNI: 0000 0004 0608 0662. GRID: grid.412149.b FAU - Gaudry, S AU - Gaudry S AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Messika, J AU - Messika J AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Ricard, J D AU - Ricard JD AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Guillo, S AU - Guillo S AD - Hopital Bichat, Paris, France. ISNI: 0000 0000 8588 831X. GRID: grid.411119.d FAU - Pasquet, B AU - Pasquet B AD - Hopital Bichat, Paris, France. ISNI: 0000 0000 8588 831X. GRID: grid.411119.d FAU - Dubief, E AU - Dubief E AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Dreyfuss, D AU - Dreyfuss D AD - Hopital Louis Mourier, Colombes, France. ISNI: 0000 0001 0273 556X. GRID: grid.414205.6 FAU - Tubach, F AU - Tubach F AD - Hopital Bichat, Paris, France. ISNI: 0000 0000 8588 831X. GRID: grid.411119.d FAU - Battle, C AU - Battle C AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - James, K AU - James K AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Temblett, P AU - Temblett P AD - Morriston Hospital, Swansea, UK. ISNI: 0000 0004 0649 0266. GRID: grid.416122.2 FAU - Davies, L AU - Davies L AD - Abertawe Bro Morgannwg University Health Board, Swansea, UK. ISNI: 0000 0000 8959 0182. GRID: grid.419728.1 FAU - Battle, C AU - Battle C AD - Abertawe Bro Morgannwg University Health Board, Swansea, UK. ISNI: 0000 0000 8959 0182. GRID: grid.419728.1 FAU - Lynch, C AU - Lynch C AD - Abertawe Bro Morgannwg University Health Board, Swansea, UK. ISNI: 0000 0000 8959 0182. GRID: grid.419728.1 FAU - Pereira, S AU - Pereira S AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Cavaco, S AU - Cavaco S AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Fernandes, J AU - Fernandes J AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Moreira, I AU - Moreira I AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Almeida, E AU - Almeida E AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Seabra Pereira, F AU - Seabra Pereira F AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Malheiro, M AU - Malheiro M AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Cardoso, F AU - Cardoso F AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Aragao, I AU - Aragao I AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Cardoso, T AU - Cardoso T AD - Centro Hospitalar Porto, Porto, Portugal. ISNI: 0000 0004 0392 7039. GRID: grid.418340.a FAU - Fister, M AU - Fister M AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Knafelj, R AU - Knafelj R AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Muraray Govind, P AU - Muraray Govind P AD - Apollo Speciality Hospital - OMR, Chennai, India. ISNI: 0000 0004 1802 3550. GRID: grid.413839.4 FAU - Brahmananda Reddy, N AU - Brahmananda Reddy N AD - Apollo Speciality Hospital - OMR, Chennai, India. ISNI: 0000 0004 1802 3550. GRID: grid.413839.4 FAU - Pratheema, R AU - Pratheema R AD - Apollo Speciality Hospital - OMR, Chennai, India. ISNI: 0000 0004 1802 3550. GRID: grid.413839.4 FAU - Arul, E D AU - Arul ED AD - Apollo Speciality Hospital - OMR, Chennai, India. ISNI: 0000 0004 1802 3550. GRID: grid.413839.4 FAU - Devachandran, J AU - Devachandran J AD - Apollo Speciality Hospital - OMR, Chennai, India. ISNI: 0000 0004 1802 3550. GRID: grid.413839.4 FAU - Velasco, M B AU - Velasco MB AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Dalcomune, D M AU - Dalcomune DM AD - Hospital Meridional S.A., Cariacica, Brazil FAU - Knafelj, R AU - Knafelj R AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Fister, M AU - Fister M AD - Rihard Knafelj, Ljubljana, Slovenia FAU - Chin-Yee, N AU - Chin-Yee N AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - D'Egidio, G AU - D'Egidio G AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Thavorn, K AU - Thavorn K AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Heyland, D AU - Heyland D AD - Kingston General Hospital, Kingston, Canada. ISNI: 0000 0004 0633 727X. GRID: grid.415354.2 FAU - Kyeremanteng, K AU - Kyeremanteng K AD - The Ottawa Hospital, Ottawa, Canada. ISNI: 0000 0000 9606 5108. GRID: grid.412687.e FAU - Murchison, A G AU - Murchison AG AD - Milton Keynes Hospital, Milton Keynes, UK. GRID: grid.415667.7 FAU - Swalwell, K AU - Swalwell K AD - Imperial College, London, UK. ISNI: 0000 0001 2113 8111. GRID: grid.7445.2 FAU - Mandeville, J AU - Mandeville J AD - Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. ISNI: 0000 0004 0368 863X. GRID: grid.439664.a FAU - Stott, D AU - Stott D AD - Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. ISNI: 0000 0004 0368 863X. GRID: grid.439664.a FAU - Guerreiro, I AU - Guerreiro I AD - IPO -Porto, Porto, Portugal. GRID: grid.435544.7 FAU - Devine, H AU - Devine H AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - MacTavish, P AU - MacTavish P AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - McPeake, J AU - McPeake J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Quasim, T AU - Quasim T AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kinsella, J AU - Kinsella J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Daniel, M AU - Daniel M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Goossens, C AU - Goossens C AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Marques, M B AU - Marques MB FAU - Derde, S AU - Derde S AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Vander Perre, S AU - Vander Perre S AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Dufour, T AU - Dufour T AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Thiessen, S E AU - Thiessen SE AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Guiza, F AU - Guiza F AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Janssens, T AU - Janssens T AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Hermans, G AU - Hermans G AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Vanhorebeek, I AU - Vanhorebeek I AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - De Bock, K AU - De Bock K AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Van den Berghe, G AU - Van den Berghe G AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Langouche, L AU - Langouche L AD - KU Leuven, Leuven, Belgium. ISNI: 0000 0001 0668 7884. GRID: grid.5596.f FAU - Devine, H AU - Devine H AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - MacTavish, P AU - MacTavish P AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Quasim, T AU - Quasim T AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kinsella, J AU - Kinsella J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Daniel, M AU - Daniel M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - McPeake, J AU - McPeake J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Miles, B AU - Miles B AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Madden, S AU - Madden S AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Devine, H AU - Devine H AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Weiler, M AU - Weiler M AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Marques, P AU - Marques P AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Rodrigues, C AU - Rodrigues C AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Boeira, M AU - Boeira M AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Brenner, K AU - Brenner K FAU - Leaes, C AU - Leaes C AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Machado, A AU - Machado A AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Townsend, R AU - Townsend R AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - Andrade, J AU - Andrade J AD - Ernesto Dornelles Hospital, Porto Alegre, Brazil FAU - MacTavish, P AU - MacTavish P AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - McPeake, J AU - McPeake J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Devine, H AU - Devine H AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kinsella, J AU - Kinsella J AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Daniel, M AU - Daniel M AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Kishore, R AU - Kishore R AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Fenlon, C AU - Fenlon C AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Quasim, T AU - Quasim T AD - Glasgow Royal Infirmary, Glasgow, UK. ISNI: 0000 0000 9825 7840. GRID: grid.411714.6 FAU - Fiks, T AU - Fiks T AD - Gelre Ziekenhuizen, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Ruijter, A AU - Ruijter A AD - Gelre Ziekenhuizen, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Te Raa, M AU - Te Raa M AD - Gelre Ziekenhuizen, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Spronk, P AU - Spronk P AD - Gelre Ziekenhuizen, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Chiew, Y S AU - Chiew YS AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Docherty, P AU - Docherty P AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Dickson, J AU - Dickson J AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Moltchanova, E AU - Moltchanova E AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Scarrot, C AU - Scarrot C AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Pretty, C AU - Pretty C AD - University of Canterbury, Christchurch, New Zealand. ISNI: 0000 0001 2179 1970. GRID: grid.21006.35 FAU - Shaw, G M AU - Shaw GM AD - Christchurch Hospital, Christchurch, New Zealand. ISNI: 0000 0004 0614 1349. GRID: grid.414299.3 FAU - Chase, J G AU - Chase JG AD - University of Western Ontario, London, Canada. ISNI: 0000 0004 1936 8884. GRID: grid.39381.30 FAU - Hall, T AU - Hall T AD - Surrey and Sussex NHS Trust, Redhill, UK FAU - Ngu, W C AU - Ngu WC AD - Surrey and Sussex NHS Trust, Redhill, UK FAU - Jack, J M AU - Jack JM AD - Surrey and Sussex NHS Trust, Redhill, UK FAU - Morgan, P AU - Morgan P AD - Surrey and Sussex NHS Trust, Redhill, UK FAU - Avard, B AU - Avard B AD - The Canberra Hospital, Hughes, ACT Australia. ISNI: 0000 0000 9984 5644. GRID: grid.413314.0 FAU - Pavli, A AU - Pavli A AD - The Canberra Hospital, Hughes, ACT Australia. ISNI: 0000 0000 9984 5644. GRID: grid.413314.0 FAU - Gee, X AU - Gee X AD - ANU Medical School, Canberra, Australia. ISNI: 0000 0001 2180 7477. GRID: grid.1001.0 FAU - Bor, C AU - Bor C AD - Ege University School of Medicine, Izmir, Turkey. ISNI: 0000 0001 1092 2592. GRID: grid.8302.9 FAU - Akin Korhan, E AU - Akin Korhan E AD - katip Celebi University, Izmir, Turkey. ISNI: 0000 0004 0454 9420. GRID: grid.411795.f FAU - Demirag, K AU - Demirag K AD - Ege University School of Medicine, Izmir, Turkey. ISNI: 0000 0001 1092 2592. GRID: grid.8302.9 FAU - Uyar, M AU - Uyar M AD - Ege University School of Medicine, Izmir, Turkey. ISNI: 0000 0001 1092 2592. GRID: grid.8302.9 FAU - Shirazy, M AU - Shirazy M AD - Alexandria University Faculty of medicine, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Fayed, A AU - Fayed A AD - Alexandria University Faculty of medicine, Alexandria, Egypt. ISNI: 0000 0001 2260 6941. GRID: grid.7155.6 FAU - Gupta, S AU - Gupta S AD - Fortis Escorts Heart Institute, New Delhi, India. ISNI: 0000 0004 1804 7827. GRID: grid.417966.b FAU - Kaushal, A AU - Kaushal A AD - Fortis Escorts Heart Institute, New Delhi, India. ISNI: 0000 0004 1804 7827. GRID: grid.417966.b FAU - Dewan, S AU - Dewan S FAU - Varma, A AU - Varma A AD - FMRI, Gurgaon, India. ISNI: 0000 0004 4653 2037. GRID: grid.464839.4 FAU - Ghosh, E AU - Ghosh E AD - Philips Research North America, Cambridge, USA. GRID: grid.417285.d FAU - Yang, L AU - Yang L AD - Philips Research North America, Cambridge, USA. GRID: grid.417285.d FAU - Eshelman, L AU - Eshelman L AD - Philips Research North America, Cambridge, USA. GRID: grid.417285.d FAU - Lord, B AU - Lord B AD - Philips Research North America, Cambridge, USA. GRID: grid.417285.d FAU - Carlson, E AU - Carlson E AD - Philips Research North America, Cambridge, USA. GRID: grid.417285.d FAU - Helme, E AU - Helme E AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Broderick, R AU - Broderick R AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Hadfield, S AU - Hadfield S AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Loveridge, R AU - Loveridge R AD - King's College Hospital NHS Foundation Trust, London, UK. ISNI: 0000 0004 0489 4320. GRID: grid.429705.d FAU - Ramos, J AU - Ramos J AD - Hospital Sao Rafael, Salvador, Brazil. GRID: grid.413466.2 FAU - Forte, D AU - Forte D AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Yang, F AU - Yang F AD - Brigham and Women's Hospital, Boston, USA. ISNI: 0000 0004 0378 8294. GRID: grid.62560.37 FAU - Hou, P AU - Hou P AD - Brigham and Women's Hospital, Boston, USA. ISNI: 0000 0004 0378 8294. GRID: grid.62560.37 FAU - Dudziak, J AU - Dudziak J AD - St Helens and Knowsley, Liverpool, UK FAU - Feeney, J AU - Feeney J AD - St Helens and Knowsley, Liverpool, UK FAU - Wilkinson, K AU - Wilkinson K AD - St Helens and Knowsley, Liverpool, UK FAU - Bauchmuller, K AU - Bauchmuller K AD - STH, Sheffield, UK FAU - Shuker, K AU - Shuker K AD - STH, Sheffield, UK FAU - Faulds, M AU - Faulds M AD - STH, Sheffield, UK FAU - Raithatha, A AU - Raithatha A AD - STH, Sheffield, UK FAU - Bryden, D AU - Bryden D AD - STH, Sheffield, UK FAU - England, L AU - England L AD - St Helens and Knowsley, Liverpool, UK FAU - Bolton, N AU - Bolton N AD - St Helens and Knowsley, Liverpool, UK FAU - Tridente, A AU - Tridente A AD - St Helens and Knowsley, Liverpool, UK FAU - Bauchmuller, K AU - Bauchmuller K FAU - Shuker, K AU - Shuker K FAU - Tridente, A AU - Tridente A AD - Whiston Hospital, Prescot, UK. ISNI: 0000 0004 0417 1894. GRID: grid.417083.9 FAU - Faulds, M AU - Faulds M AD - Freeman Hospital, Newcastle upon Tyne, UK. ISNI: 0000 0004 0641 3308. GRID: grid.415050.5 FAU - Matheson, A AU - Matheson A AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Gaynor, J AU - Gaynor J FAU - Bryden, D AU - Bryden D CN - S South Yorkshire Hospitals Research Collaboration FAU - Ramos, J AU - Ramos J AD - Hospital Sao Rafael, Salvador, Brazil. GRID: grid.413466.2 FAU - Peroni, B AU - Peroni B AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Daglius-Dias, R AU - Daglius-Dias R AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Miranda, L AU - Miranda L AD - Hospital Nove de Julho, Sao Paulo, Brazil FAU - Cohen, C AU - Cohen C AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Carvalho, C AU - Carvalho C AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Velasco, I AU - Velasco I AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Forte, D AU - Forte D AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Kelly, J M AU - Kelly JM AD - University Hospital Coventry and Warwickshire, Coventry, UK. GRID: grid.15628.38 FAU - Neill, A AU - Neill A AD - Sunnybrook Health Sciences Centre, Toronto, Canada. ISNI: 0000 0000 9743 1587. GRID: grid.413104.3 FAU - Rubenfeld, G AU - Rubenfeld G AD - Sunnybrook Health Sciences Centre, Toronto, Canada. ISNI: 0000 0000 9743 1587. GRID: grid.413104.3 FAU - Masson, N AU - Masson N AD - NHS Scotland, Glasgow, UK. ISNI: 0000 0000 9506 6213. GRID: grid.422655.2 FAU - Min, A AU - Min A AD - Royal College of Surgeons of Ireland, Dublin, Ireland. ISNI: 0000 0004 0488 7120. GRID: grid.4912.e FAU - Boezeman, E AU - Boezeman E AD - University Leiden, Leiden, Netherlands. ISNI: 0000 0001 2312 1970. GRID: grid.5132.5 FAU - Hofhuis, J AU - Hofhuis J AD - Gelre Hospitals, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Hovingh, A AU - Hovingh A AD - Gelre Hospitals, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - De Vries, R AU - De Vries R AD - VU University Amsterdam, Amsterdam, Netherlands. ISNI: 0000 0004 1754 9227. GRID: grid.12380.38 FAU - Spronk, P AU - Spronk P AD - Gelre Hospitals, Apeldoorn, Netherlands. ISNI: 0000 0004 0370 4214. GRID: grid.415355.3 FAU - Cabral-Campello, G AU - Cabral-Campello G AD - Hospital de Santo Antonio, Oporto Hospital Center, Porto, Portugal FAU - Aragao, I AU - Aragao I AD - Hospital de Santo Antonio, Oporto Hospital Center, Porto, Portugal FAU - Cardoso, T AU - Cardoso T AD - Hospital de Santo Antonio, Oporto Hospital Center, Porto, Portugal FAU - Van Mol, M AU - Van Mol M AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Nijkamp, M AU - Nijkamp M AD - Faculty of Psychology and Educational Sciences, Heerlen, Netherlands FAU - Kompanje, E AU - Kompanje E AD - Erasmus MC, Rotterdam, Netherlands. ISNI: 000000040459992X. GRID: grid.5645.2 FAU - Ostrowski, P AU - Ostrowski P AD - University of Toronto at Scarborough, Scarborough, ON Canada. ISNI: 0000 0001 2157 2938. GRID: grid.17063.33 FAU - Omar, A AU - Omar A AD - Hamad medical corporation, Doha, Qatar. ISNI: 0000 0004 0571 546X. GRID: grid.413548.f FAU - Kiss, K AU - Kiss K AD - University of Szeged, Szeged, Hungary. ISNI: 0000 0001 1016 9625. GRID: grid.9008.1 FAU - Koves, B AU - Koves B AD - Jahn Ferenc Hospital, Budapest, Hungary FAU - Csernus, V AU - Csernus V AD - University of Pecs, Pecs, Hungary. ISNI: 0000 0001 0663 9479. GRID: grid.9679.1 FAU - Molnar, Z AU - Molnar Z AD - University of Szeged, Szeged, Hungary. ISNI: 0000 0001 1016 9625. GRID: grid.9008.1 FAU - Hoydonckx, Y AU - Hoydonckx Y AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Vanwing, S AU - Vanwing S AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Stessel, B AU - Stessel B AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Van Assche, A AU - Van Assche A AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Jamaer, L AU - Jamaer L AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Dubois, J AU - Dubois J AD - Jessa Ziekenhuis, Hasselt, Belgium. ISNI: 0000 0004 0578 1096. GRID: grid.414977.8 FAU - Medo, V AU - Medo V AD - Hospital Clinico Universidad de Chile, Santiago, Chile. GRID: grid.412248.9 FAU - Galvez, R AU - Galvez R AD - Hospital Clinico Universidad de Chile, Santiago, Chile. GRID: grid.412248.9 FAU - Miranda, J P AU - Miranda JP AD - Hospital Clinico Universidad de Chile, Santiago, Chile. GRID: grid.412248.9 FAU - Stone, C AU - Stone C AD - Royal Marsden Hospital, London, UK. ISNI: 0000 0004 0417 0461. GRID: grid.424926.f FAU - Wigmore, T AU - Wigmore T AD - Royal Marsden Hospital, London, UK. ISNI: 0000 0004 0417 0461. GRID: grid.424926.f FAU - Arunan, Y AU - Arunan Y AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Wheeler, A AU - Wheeler A AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Bauchmuller, K AU - Bauchmuller K AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Bryden, D AU - Bryden D AD - Sheffield Teaching Hospitals, Sheffield, UK. GRID: grid.419135.b FAU - Wong, Y AU - Wong Y AD - Tan Tock Seng hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Poi, C AU - Poi C FAU - Gu, C AU - Gu C AD - Tan Tock Seng hospital, Singapore, Singapore. GRID: grid.240988.f FAU - Molmy, P AU - Molmy P AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Van Grunderbeeck, N AU - Van Grunderbeeck N AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Nigeon, O AU - Nigeon O AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Lemyze, M AU - Lemyze M AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Thevenin, D AU - Thevenin D AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Mallat, J AU - Mallat J AD - Centre Hospitalier de Lens, Lens, France. ISNI: 0000 0004 0642 1236. GRID: grid.470048.f FAU - Ramos, J AU - Ramos J AD - Hospital Sao Rafael, Salvador, Brazil. GRID: grid.413466.2 FAU - Correa, M AU - Correa M AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Carvalho, R T AU - Carvalho RT AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Forte, D AU - Forte D AD - Hospital das Clinicas, Sao Paulo, Brazil. ISNI: 0000 0001 2297 2036. GRID: grid.411074.7 FAU - Fernandez, A AU - Fernandez A AD - Ntra Sra de Candelaria University Hospital, Santa Cruz de Tenerife, Spain FAU - McBride, C AU - McBride C AD - University of Texas at Austin, San Antonio, USA. ISNI: 0000 0004 1936 9924. GRID: grid.89336.37 FAU - Koonthalloor, E AU - Koonthalloor E AD - Beaumont Hospital, Dublin, Ireland. ISNI: 0000 0004 0617 6058. GRID: grid.414315.6 FAU - Walsh, C AU - Walsh C AD - Beaumont Hospital, Dublin, Ireland. ISNI: 0000 0004 0617 6058. GRID: grid.414315.6 FAU - Webber, A AU - Webber A AD - St Helens and Knowsley teaching hospitals, Liverpool, UK. GRID: grid.430747.3 FAU - Ashe, M AU - Ashe M AD - St Helens and Knowsley teaching hospitals, Liverpool, UK. GRID: grid.430747.3 FAU - Smith, K AU - Smith K AD - St Helens and Knowsley teaching hospitals, Liverpool, UK. GRID: grid.430747.3 FAU - Jeanrenaud, P AU - Jeanrenaud P AD - St Helens and Knowsley teaching hospitals, Liverpool, UK. GRID: grid.430747.3 FAU - Marudi, A AU - Marudi A AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Baroni, S AU - Baroni S AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Ragusa, F AU - Ragusa F AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Bertellini, E AU - Bertellini E AD - Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy FAU - Volakli, E A AU - Volakli EA AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Chochliourou, E AU - Chochliourou E AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Dimitriadou, M AU - Dimitriadou M AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Violaki, A AU - Violaki A AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Mantzafleri, P AU - Mantzafleri P AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Samkinidou, E AU - Samkinidou E AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Vrani, O AU - Vrani O AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Arbouti, A AU - Arbouti A AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Varsami, T AU - Varsami T AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Sdougka, M AU - Sdougka M AD - PICU, Hippokration General Hospital, Thessaloniki, Greece. ISNI: 0000 0004 0621 2899. GRID: grid.414122.0 FAU - Bollen, J A AU - Bollen JA AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Van Smaalen, T C AU - Van Smaalen TC AD - Maastricht University Medical Center, Maastricht, Netherlands. GRID: grid.412966.e FAU - De Jongh, W C AU - De Jongh WC AD - Maastricht University Medical Center, Maastricht, Netherlands. GRID: grid.412966.e FAU - Ten Hoopen, M M AU - Ten Hoopen MM AD - Maastricht University, Maastricht, Netherlands. ISNI: 0000 0001 0481 6099. GRID: grid.5012.6 FAU - Ysebaert, D AU - Ysebaert D AD - University Hospital Antwerp, Edegem, Belgium. ISNI: 0000 0004 0626 3418. GRID: grid.411414.5 FAU - Van Heurn, L W AU - Van Heurn LW AD - Academic Medical Center, Amsterdam, Netherlands. ISNI: 0000000404654431. GRID: grid.5650.6 FAU - Van Mook, W N AU - Van Mook WN AD - Maastricht University Medical Center, Maastricht, Netherlands. GRID: grid.412966.e FAU - Sim, K AU - Sim K AD - St Helens and Knoowsley, Prescot, UK FAU - Fuller, A AU - Fuller A AD - St Helens and Knoowsley, Prescot, UK FAU - Roze des Ordons, A AU - Roze des Ordons A AD - University of Calgary, Calgary, Canada. ISNI: 0000 0004 1936 7697. GRID: grid.22072.35 FAU - Couillard, P AU - Couillard P AD - University of Calgary, Calgary, Canada. ISNI: 0000 0004 1936 7697. GRID: grid.22072.35 FAU - Doig, C AU - Doig C AD - University of Calgary, Calgary, Canada. ISNI: 0000 0004 1936 7697. GRID: grid.22072.35 FAU - Van Keer, R V AU - Van Keer RV AD - Vrije Universiteit Brussel, Brussel, Belgium. ISNI: 0000 0001 2290 8069. GRID: grid.8767.e FAU - Deschepper, R D AU - Deschepper RD AD - Vrije Universiteit Brussel, Brussel, Belgium. ISNI: 0000 0001 2290 8069. GRID: grid.8767.e FAU - Francke, A F AU - Francke AF AD - EMGO+/VU University medical center, Utrecht, Netherlands. ISNI: 0000000090126352. GRID: grid.7692.a FAU - Huyghens, L H AU - Huyghens LH AD - Universitair Ziekenhuis Brussel, Brussel, Belgium. ISNI: 0000 0004 0626 3362. GRID: grid.411326.3 FAU - Bilsen, J B AU - Bilsen JB AD - Vrije Universiteit Brussel, Brussel, Belgium. ISNI: 0000 0001 2290 8069. GRID: grid.8767.e FAU - Nyamaizi, B AU - Nyamaizi B AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Dalrymple, C AU - Dalrymple C AD - Queen Elizabeth Hospital, London, UK. GRID: grid.439484.6 FAU - Molokhia, A AU - Molokhia A AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Dobru, A AU - Dobru A AD - University Hospital Lewisham, London, UK. GRID: grid.439787.6 FAU - Marrinan, E AU - Marrinan E AD - Lewisham & Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Ankuli, A AU - Ankuli A AD - Lewisham & Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - Molokhia, A AU - Molokhia A AD - Lewisham & Greenwich NHS Trust, London, UK. GRID: grid.429537.e FAU - McPeake, J AU - McPeake J AD - University of Glasgow, Glasgow, UK. ISNI: 0000 0001 2193 314X. GRID: grid.8756.c FAU - Struthers, R AU - Struthers R AD - NHS Greater Glasgow and Clyde, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Crawford, R AU - Crawford R AD - NHS Greater Glasgow and Clyde, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Devine, H AU - Devine H AD - NHS Greater Glasgow and Clyde, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Mactavish, P AU - Mactavish P AD - NHS Greater Glasgow and Clyde, Glasgow, UK. ISNI: 0000 0001 0523 9342. GRID: grid.413301.4 FAU - Quasim, T AU - Quasim T AD - University of Glasgow, Glasgow, UK. ISNI: 0000 0001 2193 314X. GRID: grid.8756.c FAU - Morelli, P AU - Morelli P AD - National Burn Unit, Montevideo, Uruguay FAU - Degiovanangelo, M AU - Degiovanangelo M AD - National Burn Unit, Montevideo, Uruguay FAU - Lemos, F AU - Lemos F AD - National Burn Unit, Montevideo, Uruguay FAU - MArtinez, V AU - MArtinez V AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Verga, F AU - Verga F AD - National Burn Unit, Montevideo, Uruguay FAU - Cabrera, J AU - Cabrera J AD - National Burn Unit, Montevideo, Uruguay FAU - Burghi, G AU - Burghi G AD - Hospital Maciel, Montevideo, Uruguay. GRID: grid.414794.b FAU - Rutten, A AU - Rutten A AD - St Elisabeth Ziekenhuis, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Van Ieperen, S AU - Van Ieperen S AD - St Elisabeth Ziekenhuis, Tilburg, Netherlands. GRID: grid.416373.4 FAU - De Geer, S AU - De Geer S AD - St Elisabeth Ziekenhuis, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Van Vugt, M AU - Van Vugt M AD - St Elisabeth Ziekenhuis, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Der Kinderen, E AU - Der Kinderen E AD - St Elisabeth Ziekenhuis, Tilburg, Netherlands. GRID: grid.416373.4 FAU - Giannini, A AU - Giannini A AD - Fondazione IRCCS Ca' Granda - Ospedale maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Miccinesi, G AU - Miccinesi G AD - Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy. ISNI: 0000 0004 1758 0566. GRID: grid.417623.5 FAU - Marchesi, T AU - Marchesi T AD - Fondazione IRCCS Ca' Granda - Ospedale maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 FAU - Prandi, E AU - Prandi E AD - Fondazione IRCCS Ca' Granda - Ospedale maggiore Policlinico, Milan, Italy. ISNI: 0000 0004 1757 8749. GRID: grid.414818.0 LA - eng PT - Conference Proceedings DEP - 20160420 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 EIN - Crit Care. 2016 Oct 24;20:347. doi: 10.1186/s13054-016-1358-6. PMID: 31268434 PMC - PMC5493079 EDAT- 2016/11/26 06:00 MHDA- 2016/11/26 06:01 PMCR- 2016/04/20 CRDT- 2016/11/26 06:00 PHST- 2016/11/26 06:00 [entrez] PHST- 2016/11/26 06:00 [pubmed] PHST- 2016/11/26 06:01 [medline] PHST- 2016/04/20 00:00 [pmc-release] AID - 10.1186/s13054-016-1208-6 [pii] AID - 1208 [pii] AID - 10.1186/s13054-016-1208-6 [doi] PST - epublish SO - Crit Care. 2016 Apr 20;20(Suppl 2):94. doi: 10.1186/s13054-016-1208-6. PMID- 27861367 OWN - NLM STAT- MEDLINE DCOM- 20170210 LR - 20210109 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 95 IP - 46 DP - 2016 Nov TI - Impact of acute kidney injury on coagulation in adult minimal change nephropathy. PG - e5366 LID - 10.1097/MD.0000000000005366 [doi] LID - e5366 AB - A hypercoagulable state exists in patients with nephrotic syndrome (NS), which more easily leads to venous thromboembolism (VTE). However, whether acute kidney injury (AKI), a common complication of NS, affects the hypercoagulable state and VTE has rarely been elucidated. In this study, we aimed to explore coagulation changes and analyze relevant influencing factors in NS-AKI patients.A total of 269 consecutive NS patients with minimal change disease (MCD) between 2011 and 2016 were included in this observational study. Ninety-one cases were in the AKI group and 178 cases in the non-AKI group. The 1:1 propensity score matching (PSM) method was applied to match the baseline information. The coagulation biomarkers were compared, and the thrombosis events were recorded. Linear correlation was performed to detect any relation between D-dimer and clinical data.The PSM method gave matched pairs of 88 MCD patients with AKI and non-AKI patients, resulting in no differences in baseline information. The D-dimer, fibrinogen, and thromboelastography parameters maximum amplitude (MA), G values of the MCD-AKI patients were significantly higher than the levels of the MCD patients without AKI (D-dimer: 1.8 [1.0, 3.3] vs 1.1 [0.6, 1.7] mg/L, P < 0.001; fibrinogen: 7.0+/-2.0 vs 6.5 +/- 1.4 g/L, P = 0.036; MA: 74.6 +/- 5.0 vs 70.5 +/- 5.3 mm, P = 0.020; G: 15.7 +/- 5.3 vs 12.5 +/- 3.3, P = 0.034). For the MCD patients, the serum creatinine, white blood cell count, and interleukin-6 levels in the patients with D-dimers >1 mg/L were significantly higher than those of patients with D-dimers 10 units of RBCs total or death in the first 6 hours or (2) >4 units of RBCs in any hour within the first 6 hours. Cutpoint analysis was then performed to determine optimal thresholds for TEG-based resuscitation. RESULTS: The ROC analysis of r-TEG yielded areas under the curve (AUC) greater than 70% for all outputs with respect to both transfusion thresholds considered, with exception of activated clotting time and lysis at 30 minutes for greater than 4 U RBC in any hour in the first 6 hours. Optimal cutpoint analysis of the resultant ROC curves was performed and for each value, the most sensitive cutpoint was identified, respectively activated clotting time of 128 seconds or longer, angle (alpha) of 65 degrees or less, maximum amplitude of 55 mm or less, and lysis at 30 minutes of 5% or greater. CONCLUSIONS: Through ROC analysis of prospective TEG data, we have identified optimal thresholds to guide hemostatic resuscitation. These thresholds should be validated in a prospective multicenter trial. LEVEL OF EVIDENCE: Therapeutic study, level V. FAU - Einersen, Peter M AU - Einersen PM AD - From the Department of Surgery (P.M.E.), University of Colorado Denver, Aurora, CO; Denver Health (E.E.M), Medical Center, Denver, CO; Department of Radiology (M.P.C.), University of Colorado Denver, Aurora, CO; Department of Surgery (H.B.M.), University of Colorado Denver, Aurora, CO; Department of Surgery (E.G.), University of Colorado Denver, Aurora, CO; Children's Hospital (C.C.S.) Colorado, Center for Cancer and Blood Disorder, Aurora, CO; Department of Surgery (A.B.), University of Colorado Denver, Aurora, CO; and School of Public Health, University of Colorado Denver (A.S.), Aurora, CO. FAU - Moore, Ernest E AU - Moore EE FAU - Chapman, Michael P AU - Chapman MP FAU - Moore, Hunter B AU - Moore HB FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Transfusion/*statistics & numerical data MH - Female MH - *Goals MH - Hemorrhage/etiology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Thrombelastography/*methods MH - Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/complications PMC - PMC5177474 MID - NIHMS822659 EDAT- 2016/11/03 06:00 MHDA- 2017/07/08 06:00 PMCR- 2018/01/01 CRDT- 2016/11/03 06:00 PHST- 2016/11/03 06:00 [pubmed] PHST- 2017/07/08 06:00 [medline] PHST- 2016/11/03 06:00 [entrez] PHST- 2018/01/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000001270 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Jan;82(1):114-119. doi: 10.1097/TA.0000000000001270. PMID- 27431334 OWN - NLM STAT- MEDLINE DCOM- 20171227 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 14 IP - 10 DP - 2016 Oct TI - Effects of an acidic environment on coagulation dynamics. PG - 2001-2010 LID - 10.1111/jth.13418 [doi] AB - Essentials Acidosis, an outcome of traumatic injury, has been linked to impaired procoagulant efficiency. In vitro model systems were used to assess coagulation dynamics at pH 7.4 and 7.0. Clot formation dynamics are slightly enhanced at pH 7.0 in blood ex vivo. Acidosis induced decreases in antithrombin efficacy offset impairments in procoagulant activity. SUMMARY: Background Disruption of hydrogen ion homeostasis is a consequence of traumatic injury often associated with clinical coagulopathy. Mechanisms by which acidification of the blood leads to aberrant coagulation require further elucidation. Objective To examine the effects of acidified conditions on coagulation dynamics using in vitro models of increasing complexity. Methods Coagulation dynamics were assessed at pH 7.4 and 7.0 as follows: (i) tissue factor (TF)-initiated coagulation proteome mixtures (+/-factor [F]XI, +/-fibrinogen/FXIII), with reaction progress monitored as thrombin generation or fibrin formation; (ii) enzyme/inhibitor reactions; and (iii) TF-dependent or independent clot dynamics in contact pathway-inhibited blood via viscoelastometry. Results Rate constants for antithrombin inhibition of FXa and thrombin were reduced by ~ 25-30% at pH 7.0. At pH 7.0 (+FXI), TF-initiated thrombin generation showed a 20% increase in maximum thrombin levels and diminished thrombin clearance rates. Viscoelastic analyses showed a 25% increase in clot time and a 25% reduction in maximum clot firmness (MCF). A similar MCF reduction was observed at pH 7.0 when fibrinogen/FXIII were reacted with thrombin. In contrast, in contact pathway-inhibited blood (n = 6) at pH 7.0, MCF values were elevated 6% (95% confidence interval [CI]: 1%-11%) in TF-initiated blood and 15% (95% CI: 1%- 29%) in the absence of TF. Clot times at pH 7.0 decreased 32% (95% CI: 15%-49%) in TF-initiated blood and 51% (95% CI: 35%-68%) in the absence of TF. Conclusions Despite reported decreased procoagulant catalysis at pH 7.0, clot formation dynamics are slightly enhanced in blood ex vivo and suppression of thrombin generation is not observed. A decrease in antithrombin reactivity is one potential mechanism contributing to these outcomes. CI - (c) 2016 International Society on Thrombosis and Haemostasis. FAU - Gissel, M AU - Gissel M AD - Department of Biochemistry, University of Vermont, Colchester, VT, USA. FAU - Brummel-Ziedins, K E AU - Brummel-Ziedins KE AD - Department of Biochemistry, University of Vermont, Colchester, VT, USA. FAU - Butenas, S AU - Butenas S AD - Department of Biochemistry, University of Vermont, Colchester, VT, USA. FAU - Pusateri, A E AU - Pusateri AE AD - US Army Medical Research and Materiel Command, Fort Detrick, MD, USA. FAU - Mann, K G AU - Mann KG AD - Haematologic Technologies, Essex Junction, VT, USA. FAU - Orfeo, T AU - Orfeo T AD - Department of Biochemistry, University of Vermont, Colchester, VT, USA. torfeo@uvm.edu. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20160912 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Ions) RN - 0 (Proteome) RN - 9000-94-6 (Antithrombin III) RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Acidosis/*blood MH - Antithrombin III/analysis MH - Blood Coagulation/*drug effects MH - Blood Coagulation Disorders MH - Blood Coagulation Tests/*methods MH - Elasticity MH - Fibrin/analysis MH - Fibrinogen/pharmacology MH - Healthy Volunteers MH - Humans MH - Hydrogen-Ion Concentration MH - Ions MH - Proteome MH - Thrombin/antagonists & inhibitors/*pharmacology MH - Thromboplastin/pharmacology MH - Time Factors MH - Viscosity OTO - NOTNLM OT - acidosis OT - blood coagulation OT - blood coagulation factor inhibitors OT - thromboelastography OT - trauma EDAT- 2016/10/28 06:00 MHDA- 2017/12/28 06:00 CRDT- 2016/07/20 06:00 PHST- 2016/03/31 00:00 [received] PHST- 2016/07/06 00:00 [accepted] PHST- 2016/10/28 06:00 [pubmed] PHST- 2017/12/28 06:00 [medline] PHST- 2016/07/20 06:00 [entrez] AID - S1538-7836(22)04978-9 [pii] AID - 10.1111/jth.13418 [doi] PST - ppublish SO - J Thromb Haemost. 2016 Oct;14(10):2001-2010. doi: 10.1111/jth.13418. Epub 2016 Sep 12. PMID- 27779597 OWN - NLM STAT- MEDLINE DCOM- 20170707 LR - 20180608 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 82 IP - 1 DP - 2017 Jan TI - Abnormalities in fibrinolysis at the time of admission are associated with deep vein thrombosis, mortality, and disability in a pediatric trauma population. PG - 27-34 LID - 10.1097/TA.0000000000001308 [doi] AB - BACKGROUND: Abnormalities in fibrinolysis are common and associated with increased mortality in injured adults. While hyperfibrinolysis (HF) and fibrinolysis shutdown (SD) are potential prognostic indicators and treatment targets in adults, these derangements are not well described in a pediatric trauma cohort. METHODS: This was a prospective analysis of highest level trauma activations in subjects aged 0 to 18 years presenting to our academic center between June 1, 2015, and July 31, 2016, with admission rapid thrombelastograph. Shutdown was defined as LY30 (lysis 30 minutes after the maximum amplitude has been reached) of 0.8% or less and HF defined as LY30 of 3.0% or greater. Variables of interest included demographics, admission vital signs and laboratory values, injuries, incidence of venous thromboembolism under our screening protocol, death, and functional disability (discharge to facility or dependence in functional independence measure category). Youden index determined optimal definition of SD, then Wilcoxon rank-sum, Kruskal-Wallis, and Fisher exact tests were performed. RESULTS: One hundred thirty-three patients are included with median age of 10 years (interquartile range [IQR], 5-13 years); male sex, 5.4%; median Injury Severity Score, 17 (IQR, 10-26); blunt mechanism, 68.4%. Youden analysis defined SD as LY30 of 0.8 or less. In total, 38.3% (n = 51) had SD on admission; 19.6% (n = 26) had HF, and 42.1% (n = 56) were normal. Mortality rate was 9.0% (n = 12), and deep vein thrombosis incidence was 10.7% (n = 13/121 surviving). Shutdown and HF were both associated with mortality (p = 0.014 and p = 0.021) and blood transfusion (p = 0.001 and p < 0.001); SD was also associated with disability (p < 0.001) and deep vein thrombosis (p = 0.002). Blunt mechanism was associated with SD, and penetrating mechanism was associated with HF (p = 0.011). Both SD (p = 0.001) and HF (p = 0.036) were associated with elevated international normalized ratio. LY30 did not differ significantly across age groups. CONCLUSIONS: Children demonstrate high rates of inhibition (SD) and overactivation (HF) of fibrinolysis after injury. Shutdown and HF are both associated with poor outcomes. Shutdown is a particularly poor prognostic indicator, accounting for the greatest percentage of death, disability, and patients requiring transfusion, as well as later development of hypercoagulable state. The addition of thrombelastograph to pediatric trauma care protocols should be considered as it contributes important prognostic and clinical information. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III. FAU - Leeper, Christine M AU - Leeper CM AD - From the Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (C.M.L., M.D.N., J.L.S.); and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania (C.M.L., C.M., B.A.G.).This article was presented at the 75th annual meeting of the American Association for the Surgery of Trauma, September 14-17, 2016, in Waikoloa, Hawaii. FAU - Neal, Matthew D AU - Neal MD FAU - McKenna, Christine AU - McKenna C FAU - Sperry, Jason L AU - Sperry JL FAU - Gaines, Barbara A AU - Gaines BA LA - eng PT - Journal Article PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Blood Coagulation Disorders/*etiology/*mortality/*physiopathology MH - Child MH - Child, Preschool MH - Disability Evaluation MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Infant MH - Infant, Newborn MH - Injury Severity Score MH - Male MH - Prospective Studies MH - Thrombelastography MH - Ultrasonography, Doppler, Duplex MH - Venous Thrombosis/*etiology/*mortality/*physiopathology MH - Wounds and Injuries/*complications/diagnostic imaging EDAT- 2016/10/26 06:00 MHDA- 2017/07/08 06:00 CRDT- 2016/10/26 06:00 PHST- 2016/10/26 06:00 [pubmed] PHST- 2017/07/08 06:00 [medline] PHST- 2016/10/26 06:00 [entrez] AID - 10.1097/TA.0000000000001308 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Jan;82(1):27-34. doi: 10.1097/TA.0000000000001308. PMID- 27779595 OWN - NLM STAT- MEDLINE DCOM- 20170705 LR - 20220330 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 82 IP - 2 DP - 2017 Feb TI - Sympathoadrenal activation and endotheliopathy are drivers of hypocoagulability and hyperfibrinolysis in trauma: A prospective observational study of 404 severely injured patients. PG - 293-301 LID - 10.1097/TA.0000000000001304 [doi] AB - BACKGROUND: One third of severely injured patients present with a laboratory-based diagnosis of coagulopathy. This study investigated clinical and biomarker profile of patients with rapid thrombelastography (rTEG) coagulopathy, hypothesizing that sympathoadrenal activation and endothelial damage were drivers of this condition. METHODS: Prospective observational study of 404 trauma patients admitted to a Level 1 US Trauma Center. Patients with admission rTEG and plasma measurements of catecholamines (adrenaline, noradrenaline) and biomarkers reflecting endothelial activation/damage (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin, nucleosomes) were included. Demography, injury type/severity, physiology, treatment, and inhospital mortality were recorded. RESULTS: Patients had a median Injury Severity Score (ISS) of 17, 73% from blunt injury. One third (35%) of the patients had rTEG coagulopathy, which was associated with higher plasma adrenaline, syndecan-1, and nucleosomes (all <0.05), higher transfusion requirements and higher early (<24 hours, 9.3% vs. 2.5%) and late (28 days, 23.8% vs. 13.4%) mortality. By adjusted linear regression analyses, high plasma adrenaline, sVE-cadherin, and syndecan-1 (reflecting sympathoadrenal activation and endothelial cell junction and glycocalyx damage) along with male sex, high ISS, low platelet count and prehospital red blood cell transfusion were independently associated with hypocoagulable rTEG, whereas prehospital plasma and sE-selectin (reflecting endothelial activation) were independently associated with more hypercoagulable rTEG. CONCLUSION: In this cohort of severely injured trauma patients, rTEG coagulopathy was associated with sympathoadrenal activation, endotheliopathy, and excess mortality. High adrenaline and biomarkers reflecting endothelial cell junction and glycocalyx damage were independently associated with hypocoagulability and hyperfibrinolysis. These findings support that sympathoadrenal activation and endotheliopathy contribute to trauma-induced coagulopathy and warrants further studies of endothelial repair management. LEVEL OF EVIDENCE: Prognostic, Level III. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - From the Section for Transfusion Medicine (S.R.O., H.H.H., J.S., M.G.-B., P.I.J.), Capital Region Blood Bank, Department of Anesthesia (J.S.), Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and Centre for Translational Injury Research (CeTIR) and Department of Surgery (J.C.C., L.A.B., B.A.C., J.B.H., C.E.W., P.I.J.), UT Health, University of Texas Health Science Center at Houston, Houston, Texas. FAU - Henriksen, Hanne H AU - Henriksen HH FAU - Stensballe, Jakob AU - Stensballe J FAU - Gybel-Brask, Mikkel AU - Gybel-Brask M FAU - Cardenas, Jessica C AU - Cardenas JC FAU - Baer, Lisa A AU - Baer LA FAU - Cotton, Bryan A AU - Cotton BA FAU - Holcomb, John B AU - Holcomb JB FAU - Wade, Charles E AU - Wade CE FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) SB - IM MH - Adrenal Glands/*innervation MH - Adult MH - Biomarkers/blood MH - Blood Coagulation Disorders/*etiology/mortality MH - Endothelium, Vascular/*pathology MH - Female MH - Fibrinolysis/*physiology MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - Sympathetic Nervous System/*physiopathology MH - Thrombelastography MH - Trauma Centers MH - Wounds, Nonpenetrating/*blood/*complications/mortality EDAT- 2016/10/26 06:00 MHDA- 2017/07/06 06:00 CRDT- 2016/10/26 06:00 PHST- 2016/10/26 06:00 [pubmed] PHST- 2017/07/06 06:00 [medline] PHST- 2016/10/26 06:00 [entrez] AID - 10.1097/TA.0000000000001304 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Feb;82(2):293-301. doi: 10.1097/TA.0000000000001304. PMID- 27779583 OWN - NLM STAT- MEDLINE DCOM- 20170705 LR - 20180713 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 82 IP - 2 DP - 2017 Feb TI - Model of trauma-induced coagulopathy including hemodilution, fibrinolysis, acidosis, and hypothermia: Impact on blood coagulation and platelet function. PG - 287-292 LID - 10.1097/TA.0000000000001282 [doi] AB - BACKGROUND: Trauma-induced coagulopathy (TIC) is commonly seen among patients with severe injury. The dynamic process of TIC is characterized by variability of the features of the disease. METHODS: A model of TIC was created. Hemodilution was produced by mixing the blood with 40% Tris/saline solution, fibrinolysis by treating the blood with 160 ng/mL tPA, acidosis by adding 1.2 mg/mL lactic acid achieving pH 7.0 to 7.1, and hypothermia by running the assay at 31 degrees C. Intact blood tested at 37 degrees C served as control. Clot formation was evaluated using rotation thromboelastometry. Platelet adhesion and aggregation were assayed at a shear rate of 1800 s(-) using Impact-R device. RESULTS: Clotting time was not affected by any of the TIC constituents used. Clotting initiation was reduced by hemodilution and further reduced by additive hypothermia. The propagation phase of blood clotting was reduced by hemodilution, further reduced by additive hypothermia, and maximally reduced if additionally combined with fibrinolysis. No effect of fibrinolysis on clot propagation was observed at 37 degrees C. Maximum clot firmness was reduced by hemodilution, further reduced by additive fibrinolysis, and maximally reduced if additionally combined with hypothermia. No effect of hypothermia on clot strength was observed in the absence of fibrinolysis. Platelet adhesion (percentage of surface coverage) and aggregation (aggregate size) under flow condition were reduced by hemodilution and further reduced by additive acidosis. Introduction of tPA to diluted blood had no effect on platelet function. CONCLUSION: The study revealed a differential effect of TIC constituents-hemodilution, hypothermia, fibrinolysis, and acidosis-on clot formation and platelet function. The effect of one factor may influence that of another factor. These data may be helpful to better understand the pathogenesis of TIC and to elaborate an individually tailored treatment strategy. LEVEL OF EVIDENCE: A new model of TIC is created. Contribution of various constituents to pathogenesis of TIC and their interactions are evaluated. FAU - Shenkman, Boris AU - Shenkman B AD - From the National Hemophilia Center (B.S., U.M.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Pathophysiology (I.B.), Sechenov First Moscow State Medical University, Moscow, Russia; Faculty of Engineering (Y.E.), Holon Institute of Technology, Holon, Israel; Amalia Biron Research Institute of Thrombosis and Hemostasis (H.H.), Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and I. Ya. Horbachevsky Ternopil State Medical University (M.A.), Ternopil, Ukraine. FAU - Budnik, Ivan AU - Budnik I FAU - Einav, Yulia AU - Einav Y FAU - Hauschner, Hagit AU - Hauschner H FAU - Andrejchin, Mykhaylo AU - Andrejchin M FAU - Martinowitz, Uriel AU - Martinowitz U LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Acidosis/*physiopathology MH - Adult MH - Blood Coagulation Disorders/*etiology/*physiopathology MH - Female MH - Fibrinolysis/*physiology MH - Hemodilution/*methods MH - Humans MH - Hypothermia/*physiopathology MH - Male MH - Middle Aged MH - Platelet Function Tests MH - Thrombelastography MH - Wounds and Injuries/*complications/*physiopathology EDAT- 2016/10/26 06:00 MHDA- 2017/07/06 06:00 CRDT- 2016/10/26 06:00 PHST- 2016/10/26 06:00 [pubmed] PHST- 2017/07/06 06:00 [medline] PHST- 2016/10/26 06:00 [entrez] AID - 10.1097/TA.0000000000001282 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2017 Feb;82(2):287-292. doi: 10.1097/TA.0000000000001282. PMID- 27775063 OWN - NLM STAT- MEDLINE DCOM- 20180430 LR - 20181113 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 6 DP - 2016 Oct 24 TI - The effect of physiological levels of South African puff adder (Bitis arietans) snake venom on blood cells: an in vitro model. PG - 35988 LID - 10.1038/srep35988 [doi] LID - 35988 AB - A significant burden of illness is caused globally by snakebites particularly by the puff adder, Bitis arietans. Presently there is no reliable and rapid method to confirm envenomation on blood chemistry; although coagulation parameters like prothrombin time, partial thromboplastin time, international normalized ratio and also serum electrolytes are tested. Here, we found that direct in vitro exposure of physiological relevant whole venom levels to human healthy blood (N = 32), caused significant physiological changes to platelet activity using a hematology analyzer, and measuring occlusion time, as well as lyses time, with the global thrombosis test (GTT). Disintegrated platelets were confirmed by scanning electron microscopy (SEM). We also confirmed the pathologic effects on erythrocytes (RBCs) (visible as eryptotic RBCs), by looking at both light microscopy and SEM. Thromboelastography showed that no clot formation in whole blood could be induced after addition of whole venom. We propose further clinical studies to investigate the use of light microscopy smears and hematology analyzer results immediately after envenomation, as a possible first-stage of clinical confirmation of envenomation. FAU - Strydom, Morne A AU - Strydom MA AD - Department of Physiology, University of Pretoria, South Africa. FAU - Bester, Janette AU - Bester J AD - Department of Physiology, University of Pretoria, South Africa. FAU - Mbotwe, Sthembile AU - Mbotwe S AD - Department of Physiology, University of Pretoria, South Africa. FAU - Pretorius, Etheresia AU - Pretorius E AD - Department of Physiology, University of Pretoria, South Africa. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20161024 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 RN - 0 (Snake Venoms) SB - IM MH - Animals MH - Blood Coagulation/drug effects MH - Blood Platelets/*drug effects/*pathology MH - Erythrocytes/*drug effects/*pathology MH - Humans MH - Microscopy, Electron, Scanning MH - Models, Theoretical MH - Snake Bites/pathology MH - Snake Venoms/*toxicity MH - *Viperidae PMC - PMC5075924 EDAT- 2016/10/25 06:00 MHDA- 2018/05/01 06:00 PMCR- 2016/10/24 CRDT- 2016/10/25 06:00 PHST- 2016/08/02 00:00 [received] PHST- 2016/10/10 00:00 [accepted] PHST- 2016/10/25 06:00 [pubmed] PHST- 2018/05/01 06:00 [medline] PHST- 2016/10/25 06:00 [entrez] PHST- 2016/10/24 00:00 [pmc-release] AID - srep35988 [pii] AID - 10.1038/srep35988 [doi] PST - epublish SO - Sci Rep. 2016 Oct 24;6:35988. doi: 10.1038/srep35988. PMID- 27765582 OWN - NLM STAT- MEDLINE DCOM- 20171031 LR - 20260127 IS - 1477-2574 (Electronic) IS - 1365-182X (Print) IS - 1365-182X (Linking) VI - 18 IP - 12 DP - 2016 Dec TI - Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid. PG - 991-999 LID - S1365-182X(16)31883-4 [pii] LID - 10.1016/j.hpb.2016.09.005 [doi] AB - BACKGROUND: Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs during liver resection. Tranexamic acid (TXA) is an antifibrinolytic agent that decreases bleeding in various settings, but has not been well studied in patients undergoing liver resection. METHODS: In this prospective, phase II trial, 18 patients undergoing major liver resection were sequentially assigned to one of three cohorts: (i) Control (no TXA); (ii) TXA Dose I - 1 g bolus followed by 1 g infusion over 8 h; (iii) TXA Dose II - 1 g bolus followed by 10 mg/kg/hr until the end of surgery. Serial blood samples were collected for thromboelastography (TEG), coagulation components and TXA concentration. RESULTS: No abnormalities in hemostatic function were identified on TEG. PAP complex levels increased to peak at 1106 mug/L (normal 0-512 mug/L) following parenchymal transection, then decreased to baseline by the morning following surgery. TXA reached stable, therapeutic concentrations early in both dosing regimens. There were no differences between patients based on TXA. CONCLUSIONS: There is no thromboelastographic evidence of hyperfibrinolysis in patients undergoing major liver resection. TXA does not influence the change in systemic fibrinolysis; it may reduce bleeding through a different mechanism of action. Registered with ClinicalTrials.gov: NCT01651182. CI - Copyright A(c) 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved. FAU - Karanicolas, Paul J AU - Karanicolas PJ AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: paul.karanicolas@sunnybrook.ca. FAU - Lin, Yulia AU - Lin Y AD - Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. FAU - Tarshis, Jordan AU - Tarshis J AD - Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada. FAU - Law, Calvin H L AU - Law CH AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Coburn, Natalie G AU - Coburn NG AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Hallet, Julie AU - Hallet J AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Nascimento, Barto AU - Nascimento B AD - Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Pawliszyn, Janusz AU - Pawliszyn J AD - Department of Chemistry, University of Waterloo, Waterloo, ON, Canada. FAU - McCluskey, Stuart A AU - McCluskey SA AD - Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. LA - eng SI - ClinicalTrials.gov/NCT01651182 PT - Clinical Trial, Phase II PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20161018 PL - England TA - HPB (Oxford) JT - HPB : the official journal of the International Hepato Pancreato Biliary Association JID - 100900921 RN - 0 (Antifibrinolytic Agents) RN - 0 (Biomarkers) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Aged MH - Antifibrinolytic Agents/*administration & dosage/adverse effects/blood MH - Biomarkers/blood MH - Blood Loss, Surgical/*prevention & control MH - Drug Monitoring/methods MH - Female MH - Fibrinolysis/*drug effects MH - Hepatectomy/*adverse effects/methods MH - Humans MH - Laparoscopy/*adverse effects MH - Male MH - Middle Aged MH - Monitoring, Intraoperative/methods MH - Ontario MH - Predictive Value of Tests MH - Prospective Studies MH - Thrombelastography MH - Time Factors MH - Tranexamic Acid/*administration & dosage/adverse effects/blood MH - Treatment Outcome PMC - PMC5144548 EDAT- 2016/10/22 06:00 MHDA- 2017/11/01 06:00 PMCR- 2016/10/18 CRDT- 2016/10/22 06:00 PHST- 2016/04/12 00:00 [received] PHST- 2016/05/19 00:00 [revised] PHST- 2016/06/21 00:00 [accepted] PHST- 2016/10/22 06:00 [pubmed] PHST- 2017/11/01 06:00 [medline] PHST- 2016/10/22 06:00 [entrez] PHST- 2016/10/18 00:00 [pmc-release] AID - S1365-182X(16)31883-4 [pii] AID - 10.1016/j.hpb.2016.09.005 [doi] PST - ppublish SO - HPB (Oxford). 2016 Dec;18(12):991-999. doi: 10.1016/j.hpb.2016.09.005. Epub 2016 Oct 18. PMID- 27506588 OWN - NLM STAT- MEDLINE DCOM- 20170324 LR - 20170324 IS - 1365-3148 (Electronic) IS - 0958-7578 (Linking) VI - 26 IP - 5 DP - 2016 Oct TI - In vitro effects of different sources of fibrinogen supplementation on clot initiation and stability in a model of dilutional coagulopathy. PG - 373-380 LID - 10.1111/tme.12333 [doi] AB - OBJECTIVES: To analyse which fibrinogen source may improve coagulation using an in vitro 33% dilutional coagulopathy model. BACKGROUND: Uncritical volume resuscitation in the context of trauma haemorrhage contributes to the iatrogenic arm of the acute trauma-induced coagulopathy through dilution and depletion of coagulation factors, with fibrinogen reaching critical levels first. MATERIALS AND METHODS: By using an experimental model of 33% dilutional coagulopathy, we have analysed which fibrinogen source may exert superior effects on improving haemocoagulative capacities and correcting depleted fibrinogen levels. As fibrinogen sources, we supplemented (i) fresh frozen plasma (FFP), (ii) fibrinogen concentrate low-dose (Fib(low) ) and (iii) fibrinogen concentrate high-dose (Fib(high) ), the latter both in the presence and absence of additional FXIII. RESULTS: The dilution was associated with decreased haemoglobin and haematocrit levels. Fibrinogen supplementation with fibrinogen-containing formulations led to increased fibrinogen levels (FFP: 172.2 +/- 17.4 mg dL(-1) ; Fib(low) : 211.5 +/- 20.61 mg dL(-1) ; Fib(high) : 255.8 +/- 21.4 mg dL(-1) ) than in a diluted-only sample (155.5 +/- 19.7 mg dL(-1) ). Extrinsically activated assay with tissue factor (EXTEM) clot formation times, alpha-angles and maximum clot firmness significantly improved in the groups of Fib(low) + FXIII (79 +/- 12.2 s; 74.3 +/- 2.4 degrees ; 62 +/- 2.3 mm), Fib(high) (70.8 +/- 10.6 s; 76.2 +/- 2.7 degrees ; 64.3 +/- 2.3 mm) and Fib(high) + FXIII (69.8 +/- 11.5 s; 77.5 +/- 2.7 degrees ; 64.33 +/- 2.5 mm) compared with the dilution groups (104.2 +/- 19 s; 69.7 +/- 2.9 degrees ; 56.5 +/- 3.1 mm). In contrast, rotational thromboelastometric trace (ROTEM) measures of samples supplemented with FFP largely remained unchanged. CONCLUSION: Fibrinogen concentrates corrected and improved haemodilution-induced changes in blood clotting in vitro. High-dose fibrinogen supplementation was associated with correction and improvement in clot dynamics and stability. CI - (c) 2016 British Blood Transfusion Society. FAU - Schafer, N AU - Schafer N AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany. FAU - Driessen, A AU - Driessen A AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. AD - Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany. FAU - Bauerfeind, U AU - Bauerfeind U AD - Institute of Transfusion Medicine Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Frohlich, M AU - Frohlich M AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. FAU - Ofir, J AU - Ofir J AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany. FAU - Sturmer, E K AU - Sturmer EK AD - The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany. FAU - Maegele, M AU - Maegele M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany. Marc.Maegele@t-online.de. LA - eng PT - Journal Article DEP - 20160809 PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation Factors/*metabolism MH - Disseminated Intravascular Coagulation/*blood/drug therapy MH - Fibrinogen/*pharmacology MH - Humans MH - Male MH - *Models, Biological MH - *Plasma MH - Wounds and Injuries/*blood/drug therapy OTO - NOTNLM OT - coagulopathy OT - factor XIII OT - fibrinogen OT - fresh frozen plasma OT - haemocoagulative capacity OT - haemorrhage OT - haemostatic potential OT - trauma-induced coagulopathy EDAT- 2016/10/21 06:00 MHDA- 2017/03/25 06:00 CRDT- 2016/08/11 06:00 PHST- 2016/04/22 00:00 [received] PHST- 2016/07/13 00:00 [revised] PHST- 2016/07/15 00:00 [accepted] PHST- 2016/10/21 06:00 [pubmed] PHST- 2017/03/25 06:00 [medline] PHST- 2016/08/11 06:00 [entrez] AID - 10.1111/tme.12333 [doi] PST - ppublish SO - Transfus Med. 2016 Oct;26(5):373-380. doi: 10.1111/tme.12333. Epub 2016 Aug 9. PMID- 27487253 OWN - NLM STAT- MEDLINE DCOM- 20170615 LR - 20260127 IS - 2168-6262 (Electronic) IS - 2168-6254 (Linking) VI - 151 IP - 10 DP - 2016 Oct 19 TI - Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial. PG - e162069 LID - 10.1001/jamasurg.2016.2069 [doi] AB - IMPORTANCE: Prophylactic enoxaparin is used to prevent venous thromboembolism (VTE) in surgical and trauma patients. However, VTE remains an important source of morbidity and mortality, potentially exacerbated by antithrombin III or anti-Factor Xa deficiencies and missed enoxaparin doses. Recent data suggest that a difference in reaction time (time to initial fibrin formation) greater than 1 minute between heparinase and standard thrombelastogram (TEG) is associated with a decreased risk of VTE. OBJECTIVE: To evaluate the effectiveness of TEG-adjusted prophylactic enoxaparin dosing among trauma and surgical patients. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial, conducted from October 2012 to May 2015, compared standard dosing (30 mg twice daily) with TEG-adjusted enoxaparin dosing (35 mg twice daily) for 185 surgical and trauma patients screened for VTE at 3 level I trauma centers in the United States. MAIN OUTCOMES AND MEASURES: The incidence of VTE, bleeding complications, anti-Factor Xa deficiency, and antithrombin III deficiency. RESULTS: Of the 185 trial participants, 89 were randomized to the control group (median age, 44.0 years; 55.1% male) and 96 to the intervention group (median age, 48.5 years; 74.0% male). Patients in the intervention group received a higher median enoxaparin dose than control patients (35 mg vs 30 mg twice daily; P < .001). Anti-Factor Xa levels in intervention patients were not higher than levels in control patients until day 6 (0.4 U/mL vs 0.21 U/mL; P < .001). Only 22 patients (11.9%) achieved a difference in reaction time greater than 1 minute, which was similar between the control and intervention groups (10.4% vs 13.5%; P = .68). The time to enoxaparin initiation was similar between the control and intervention groups (median [range] days, 1.0 [0.0-2.0] vs 1.0 [1.0-2.0]; P = .39), and the number of patients who missed at least 1 dose was also similar (43 [48.3%] vs 54 [56.3%]; P = .30). Rates of VTE (6 [6.7%] vs 6 [6.3%]; P > .99) were similar, but the difference in bleeding complications (5 [5.6%] vs 13 [13.5%]; P = .08) was not statistically significant. Antithrombin III and anti-Factor Xa deficiencies and hypercoagulable TEG parameters, including elevated coagulation index (>3), maximum amplitude (>74 mm), and G value (>12.4 dynes/cm2), were prevalent in both groups. Identified risk factors for VTE included older age (61.0 years vs 46.0 years; P = .04), higher body mass index (calculated as weight in kilograms divided by height in meters squared; 30.6 vs 27.1; P = .03), increased Acute Physiology and Chronic Health Evaluation II score (8.5 vs 7.0; P = .03), and increased percentage of missed doses per patient (14.8% vs 2.5%; P = .05). CONCLUSIONS AND RELEVANCE: The incidence of VTE was low and similar between groups; however, few patients achieved a difference in reaction time greater than 1 minute. Antithrombin III deficiencies and hypercoagulable TEG parameters were prevalent among patients with VTE. Low VTE incidence may be due to an early time to enoxaparin initiation and an overall healthier and less severely injured study population than previously reported. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00990236. FAU - Connelly, Christopher R AU - Connelly CR AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Van, Philbert Y AU - Van PY AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Hart, Kyle D AU - Hart KD AD - Department of Surgery, Oregon Health and Science University, Portland. FAU - Louis, Scott G AU - Louis SG AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Fair, Kelly A AU - Fair KA AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Erickson, Anfin S AU - Erickson AS AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Rick, Elizabeth A AU - Rick EA AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Simeon, Erika C AU - Simeon EC AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. FAU - Bulger, Eileen M AU - Bulger EM AD - Department of Surgery, University of Washington, Seattle4Harborview Medical Center, University of Washington, Seattle. FAU - Arbabi, Saman AU - Arbabi S AD - Department of Surgery, University of Washington, Seattle5Harborview Injury Prevention and Research Center, University of Washington, Seattle. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, The University of Texas Medical School, Houston. FAU - Moore, Laura J AU - Moore LJ AD - Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, The University of Texas Medical School, Houston. FAU - Schreiber, Martin A AU - Schreiber MA AD - Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland. LA - eng SI - ClinicalTrials.gov/NCT00990236 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20161019 PL - United States TA - JAMA Surg JT - JAMA surgery JID - 101589553 RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) SB - IM CIN - JAMA Surg. 2016 Oct 19;151(10):e162081. doi: 10.1001/jamasurg.2016.2081. PMID: 27486696 MH - Adult MH - Anticoagulants/*administration & dosage MH - Drug Administration Schedule MH - Enoxaparin/*administration & dosage MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - *Thrombelastography MH - Trauma Centers MH - Treatment Outcome MH - United States MH - Venous Thromboembolism/*prevention & control EDAT- 2016/10/21 06:00 MHDA- 2017/06/16 06:00 CRDT- 2016/08/04 06:00 PHST- 2016/10/21 06:00 [pubmed] PHST- 2017/06/16 06:00 [medline] PHST- 2016/08/04 06:00 [entrez] AID - 2537564 [pii] AID - 10.1001/jamasurg.2016.2069 [doi] PST - ppublish SO - JAMA Surg. 2016 Oct 19;151(10):e162069. doi: 10.1001/jamasurg.2016.2069. Epub 2016 Oct 19. PMID- 27745621 OWN - NLM STAT- MEDLINE DCOM- 20170828 LR - 20170828 IS - 1558-1365 (Electronic) IS - 1042-3699 (Linking) VI - 28 IP - 4 DP - 2016 Nov TI - Damage Control Resuscitation for Catastrophic Bleeding. PG - 553-568 LID - S1042-3699(16)30040-1 [pii] LID - 10.1016/j.coms.2016.06.010 [doi] AB - The timely recognition of shock secondary to hemorrhage from severe facial trauma or as a complication of complex oral and maxillofacial surgery presents formidable challenges. Specific hemostatic disorders are induced by hemorrhage and several extreme homeostatic imbalances may appear during or after resuscitation. Damage control resuscitation has evolved from massive transfusion to a more complex therapeutic paradigm that includes hemodynamic resuscitation, hemostatic resuscitation, and homeostatic resuscitation. Definitive control of bleeding is the principal objective of any comprehensive resuscitation scheme for hemorrhagic shock. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Andreason, Chase L AU - Andreason CL AD - Department of Oral Surgery and Hospital Dentistry, Indiana University School of Dentistry, 1121 West Michigan Street, Indianapolis, IN 46202, USA. FAU - Pohlman, Timothy H AU - Pohlman TH AD - Trauma Services, Division of General Surgery, Department of Surgery, Methodist Hospital, Indiana University Health, Suite B238, 1701 North Senate Boulevard, Indianapolis, IN 46202, USA. Electronic address: tpohlman@iuhealth.org. LA - eng PT - Journal Article PT - Review PL - United States TA - Oral Maxillofac Surg Clin North Am JT - Oral and maxillofacial surgery clinics of North America JID - 9001454 SB - IM MH - Blood Coagulation Disorders/*therapy MH - Blood Component Transfusion MH - Facial Injuries/complications/surgery MH - Hemostasis, Surgical/methods MH - Humans MH - *Oral Surgical Procedures MH - Resuscitation/*methods MH - Shock, Hemorrhagic/etiology/*therapy OTO - NOTNLM OT - Coagulopathy OT - Hemorrhage OT - Resuscitation OT - Shock OT - Thrombelastography OT - Transfusion EDAT- 2016/10/18 06:00 MHDA- 2017/08/29 06:00 CRDT- 2016/10/18 06:00 PHST- 2016/10/18 06:00 [entrez] PHST- 2016/10/18 06:00 [pubmed] PHST- 2017/08/29 06:00 [medline] AID - S1042-3699(16)30040-1 [pii] AID - 10.1016/j.coms.2016.06.010 [doi] PST - ppublish SO - Oral Maxillofac Surg Clin North Am. 2016 Nov;28(4):553-568. doi: 10.1016/j.coms.2016.06.010. PMID- 27724970 OWN - NLM STAT- MEDLINE DCOM- 20170411 LR - 20220330 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 24 IP - 1 DP - 2016 Oct 10 TI - The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine. PG - 122 LID - 122 AB - BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) >/=16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. RESULTS: The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. DISCUSSION: HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. CONCLUSIONS: The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013). FAU - Kunze-Szikszay, Nils AU - Kunze-Szikszay N AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. nkunze@gwdg.de. FAU - Krack, Lennart A AU - Krack LA AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Wildenauer, Pauline AU - Wildenauer P AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Wand, Saskia AU - Wand S AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Heyne, Tim AU - Heyne T AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Walliser, Karoline AU - Walliser K AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Spering, Christopher AU - Spering C AD - Department for Trauma Surgery and Orthopaedics, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Bauer, Martin AU - Bauer M AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Quintel, Michael AU - Quintel M AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. FAU - Roessler, Markus AU - Roessler M AD - Department for Anaesthesiology, University Medical Centre, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany. LA - eng SI - ClinicalTrials.gov/NCT01938768 PT - Journal Article PT - Observational Study DEP - 20161010 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Antifibrinolytic Agents/administration & dosage MH - Blood Coagulation/*physiology MH - Dose-Response Relationship, Drug MH - Emergency Medical Services/*methods MH - Female MH - Follow-Up Studies MH - Hemorrhage/blood/etiology/*prevention & control MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Multiple Trauma/blood/*complications MH - Prospective Studies MH - Thrombelastography/*methods MH - Tranexamic Acid/*administration & dosage MH - Young Adult PMC - PMC5057484 OTO - NOTNLM OT - Coagulopathy OT - Fibrinolysis OT - Pre-hospital care OT - Thrombelastometry OT - Tranexamic acid OT - Trauma EDAT- 2016/10/12 06:00 MHDA- 2017/04/12 06:00 PMCR- 2016/10/10 CRDT- 2016/10/12 06:00 PHST- 2016/07/12 00:00 [received] PHST- 2016/10/04 00:00 [accepted] PHST- 2016/10/12 06:00 [entrez] PHST- 2016/10/12 06:00 [pubmed] PHST- 2017/04/12 06:00 [medline] PHST- 2016/10/10 00:00 [pmc-release] AID - 10.1186/s13049-016-0314-4 [pii] AID - 314 [pii] AID - 10.1186/s13049-016-0314-4 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2016 Oct 10;24(1):122. doi: 10.1186/s13049-016-0314-4. PMID- 27724023 OWN - NLM STAT- MEDLINE DCOM- 20170322 LR - 20170817 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 77 IP - 1 DP - 2017 Feb TI - Coagulopathy in patients with acute pulmonary embolism: a pilot study of whole blood coagulation and markers of endothelial damage. PG - 19-26 AB - Whole blood coagulation and markers of endothelial damage were studied in patients with acute pulmonary embolism (PE), and evaluated in relation to PE severity. Twenty-five patients were enrolled prospectively each having viscoelastical analysis of whole blood done using thrombelastography (TEG) and Multiplate aggregometry. Fourteen of these patients were investigated for endothelial damage by ELISA measurements of Syndecan-1 (endothelial glycocalyx degradation), soluble endothelial Selectin (endothelial cell activation), soluble Thrombomodulin (endothelial cell injury) and Histone Complexed DNA fragments (endothelial cytotoxic histones). The mean values of TEG and Multiplate parameters were all within the reference levels, but a significant difference between patients with high and intermediate risk PE was observed for Ly30 (lytic activity) 1.5% [0-10] vs. 0.2% [0-2.2] p = .04, and ADP (platelet reactivity) 92 U [20-145] vs. 59 U [20-111] p = .03. A similar difference was indicated for functional fibrinogen 21 mm [17-29] vs. 18 mm [3-23] p = .05. Analysis of endothelial markers identified a significant difference in circulating levels between high and intermediate risk PE patients for Syndecan-1 118.6 ng/mL [76-133] vs. 36.3 ng/mL [11.8-102.9] p = .008. In conclusion, patients with acute PE had normal whole blood coagulation, but high risk PE patients had signs of increased activity of the haemostatic system and significantly increased level of endothelial glycocalyx degradation. FAU - Lehnert, Per AU - Lehnert P AD - a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark. FAU - Johansson, Par I AU - Johansson PI AD - b Section for Transfusion Medicine , Capital Region Blood Bank , Copenhagen , Denmark. AD - c Department of Surgery , University of Texas Health Medical School , Houston , TX , USA. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - b Section for Transfusion Medicine , Capital Region Blood Bank , Copenhagen , Denmark. FAU - Moller, Christian H AU - Moller CH AD - a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark. FAU - Bang, Lia E AU - Bang LE AD - d Department of Cardiology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark. FAU - Olsen, Peter Skov AU - Olsen PS AD - a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark. FAU - Carlsen, Jorn AU - Carlsen J AD - d Department of Cardiology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark. LA - eng PT - Journal Article DEP - 20161011 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 0 (Biomarkers) RN - 0 (E-Selectin) RN - 0 (Histones) RN - 0 (SDC1 protein, human) RN - 0 (Syndecan-1) RN - 0 (THBD protein, human) RN - 0 (Thrombomodulin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Acute Disease MH - Adult MH - Aged MH - Aged, 80 and over MH - Biomarkers/blood MH - Blood Coagulation MH - Blood Platelets/metabolism/*pathology MH - E-Selectin/blood MH - Endothelium, Vascular/chemistry/*pathology MH - Female MH - Fibrinogen/metabolism MH - Glycocalyx/chemistry/pathology MH - Histones/blood MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - Platelet Aggregation MH - Pulmonary Embolism/*blood/*diagnosis/pathology MH - Severity of Illness Index MH - Syndecan-1/*blood MH - Thrombelastography MH - Thrombomodulin/*blood OTO - NOTNLM OT - Acute disease OT - endothelial cells OT - platelet function tests OT - pulmonary embolism OT - risk OT - syndecan-1 OT - thrombelastography EDAT- 2016/10/12 06:00 MHDA- 2017/03/23 06:00 CRDT- 2016/10/12 06:00 PHST- 2016/10/12 06:00 [pubmed] PHST- 2017/03/23 06:00 [medline] PHST- 2016/10/12 06:00 [entrez] AID - 10.1080/00365513.2016.1239130 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2017 Feb;77(1):19-26. doi: 10.1080/00365513.2016.1239130. Epub 2016 Oct 11. PMID- 27722160 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220331 IS - 2297-4725 (Print) IS - 2297-475X (Electronic) IS - 2297-4725 (Linking) VI - 32 IP - 4 DP - 2016 Aug TI - Monitoring and Treatment of Coagulation Disorders in End-Stage Liver Disease. PG - 241-248 AB - BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'. PubMed was used as the basic database. RESULTS: Pathological values of standard laboratory tests (SLT) and thrombocytopenia have traditionally been regarded as indicators of a high risk for bleeding in all patients, and especially in those with ESLD. However, this approach has been challenged in recent years. The conventional approach in assessing a bleeding risk was based on pathological values of SLT. A 1.5-fold increase of INR or aPTT or platelets < 50/nl is assumed as pathological. The traditional approach of reducing the risk of excessive bleeding during an invasive procedure was to transfuse fresh frozen plasma (FFP) or platelet concentrates in order to improve hemostasis and to avoid bleeding complications. In the recent 20 years, several studies have provided us with a basis for questioning this approach. Their results indicated that SLT were not able to predict hypocoagulation and bleeding complications. Moreover, transfusion of various blood products has been associated with an increased risk for acute lung injury, transfusion-associated circulation overload, bacterial infections, and modulation of the immune system with increased numbers of nosocomial infections. Furthermore, a high volume overload, which is required to correct a hemostasis disorder if FFP are being used in ESLD patients, may increase portal venous pressure. This might significantly increase bleeding in these ESLD patients. Although the first publication about the successful use of a viscoelastic test (VET) in liver transplantation dates back to 1985, physicians are still very reluctant to use VETs (Thrombelastography and/or ROTEM) for the perioperative optimization of hemostasis. However, some very recent studies demonstrated that the use of VETs for assessing the risk of bleeding avoids futile transfusion with a similar safety profile. The implementation of ROTEM-based coagulation management and the use of coagulation factors (prothrombin complex, fibrinogen concentrate) have led to a highly significant reduction of FFP and red blood cell transfusions, without an increased incidence of thrombosis or bleeding. CONCLUSION: Patients with ESLD often show pathological values of conventional parameters used to analyze coagulation hemostasis. Without overt signs of excessive bleeding, however, they do not require coagulation treatment. The use of FFP, which is associated with fluid overload and increase in portal venous pressure, should be avoided. The preferable coagulation treatment should be based on VET-guided administration of coagulation factor concentrates. FAU - Saner, Fuat H AU - Saner FH AD - Department of General, Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany. FAU - Kirchner, Carmen AU - Kirchner C AD - Department of General, Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany. LA - eng PT - Journal Article PT - Review DEP - 20160804 PL - Switzerland TA - Visc Med JT - Visceral medicine JID - 101681546 PMC - PMC5040944 OTO - NOTNLM OT - Bleeding OT - Coagulation management OT - ESLD OT - End-stage liver disease EDAT- 2016/10/11 06:00 MHDA- 2016/10/11 06:01 PMCR- 2017/08/01 CRDT- 2016/10/11 06:00 PHST- 2016/10/11 06:00 [entrez] PHST- 2016/10/11 06:00 [pubmed] PHST- 2016/10/11 06:01 [medline] PHST- 2017/08/01 00:00 [pmc-release] AID - vis-0032-0241 [pii] AID - 10.1159/000446304 [doi] PST - ppublish SO - Visc Med. 2016 Aug;32(4):241-248. doi: 10.1159/000446304. Epub 2016 Aug 4. PMID- 27716278 OWN - NLM STAT- MEDLINE DCOM- 20170411 LR - 20250626 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 24 IP - 1 DP - 2016 Oct 3 TI - A systematic review on the rotational thrombelastometry (ROTEM(R)) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. PG - 114 LID - 114 AB - INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM(R)) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM(R) parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases. We included studies without restricting year of publication, language or geographic location. Original studies reporting the thresholds of ROTEM(R) parameters in the diagnosis or management of coagulopathy in trauma patients were included. Data on patient demographics, measures of coagulopathy, transfusion and mortality were extracted. We reported our findings according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Quality assessment and risk of bias were performed using Newcastle Ottawa Scale (NOS) and the quality assessment of diagnostic accuracy studies (QUADAS-2) tools, respectively. RESULTS: A total of 13 observational studies involving 2835 adult trauma patients met the inclusion criteria. Nine studies were prospective and four were retrospective. There were no randomized controlled trials. The quality of the included studies was moderate (mean NOS 5.92, standard deviation 0.26). Using QUADAS-2, only 1 study (7.6 %) had low risk of bias in all domains, and 9 studies (69.2 %) had low risk of applicability concerns. Outcomes from 13 studies were grouped into three categories: diagnosis of coagulopathy (n = 10), prediction of massive transfusion or transfusion guidance (n = 6) and prediction of mortality (n = 6). Overall, specific ROTEM(R) parameters measured (clot amplitude and lysis) in the extrinsically activated test (EXTEM) and the fibrin-based extrinsically activated test (FIBTEM) were consistently associated with the diagnosis of coagulopathy, increased risk of bleeding and massive transfusion, and prediction of mortality. Presence of hyperfibrinolysis by ROTEM(R) was associated with increased mortality. CONCLUSIONS: Most of the evidence indicates that abnormal EXTEM and FIBTEM clot amplitude (CA5, CA10) or maximal clot firmness (MCF) diagnose coagulopathy, and predict blood transfusion and mortality. The presence of fibrinolysis (abnormal lysis index [LI30] or maximum lysis [ML]) was also associated with mortality. ROTEM(R) thus, may be of value in the early management of trauma patients. FAU - Veigas, Precilla V AU - Veigas PV AD - Department of Surgery, St. Michael's Hospital and Institute of Medical Science, University of Toronto, 30 Bond Street, 3074 Donnelly Wing, Toronto, M5W 1B8, ON, Canada. FAU - Callum, Jeannie AU - Callum J AD - Department of Clinical Pathology, Sunnybrook Health Sciences Center and Institute of Medical Science, University of Toronto, 2075 Bayview Avenue Room B2.04, Toronto, M4N 3M5, ON, Canada. FAU - Rizoli, Sandro AU - Rizoli S AD - Departments of Surgery and Critical Care Medicine, St. Michael's Hospital and University of Toronto, 30 Bond Street, 3074 Donnelly Wing, Toronto, M5W 1B8, ON, Canada. FAU - Nascimento, Bartolomeu AU - Nascimento B AD - Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Room H1.71, Toronto, M4N 3M5, ON, Canada. FAU - da Luz, Luis Teodoro AU - da Luz LT AD - Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Room H1.71, Toronto, M4N 3M5, ON, Canada. lteoluz@yahoo.com. LA - eng PT - Journal Article PT - Systematic Review DEP - 20161003 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - *Blood Coagulation Disorders/blood/diagnosis/therapy MH - Blood Coagulation Tests MH - Blood Transfusion/*standards MH - Global Health MH - Hemostasis/*physiology MH - Humans MH - *Practice Guidelines as Topic MH - Survival Rate/trends MH - Thrombelastography/*methods MH - Wounds and Injuries/blood/*mortality/therapy PMC - PMC5048662 OTO - NOTNLM OT - Acute trauma coagulopathy OT - Bleeding OT - Threshold OT - Thromboelastometry OT - Transfusion EDAT- 2016/10/08 06:00 MHDA- 2017/04/12 06:00 PMCR- 2016/10/03 CRDT- 2016/10/08 06:00 PHST- 2016/06/02 00:00 [received] PHST- 2016/09/23 00:00 [accepted] PHST- 2016/10/08 06:00 [entrez] PHST- 2016/10/08 06:00 [pubmed] PHST- 2017/04/12 06:00 [medline] PHST- 2016/10/03 00:00 [pmc-release] AID - 10.1186/s13049-016-0308-2 [pii] AID - 308 [pii] AID - 10.1186/s13049-016-0308-2 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2016 Oct 3;24(1):114. doi: 10.1186/s13049-016-0308-2. PMID- 27692780 OWN - NLM STAT- MEDLINE DCOM- 20170313 LR - 20170817 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 42 IP - 8 DP - 2016 Dec TI - Upon admission coagulation and platelet function in patients with thermal and electrical injuries. PG - 1704-1711 LID - S0305-4179(16)30093-6 [pii] LID - 10.1016/j.burns.2016.05.001 [doi] AB - RATIONAL: There has been increased focus on hemostatic potential and function in the initial assessment of the patient with traumatic injuries, that not been extensively studied in patients with burns. We proposed to determine the hemostatic potential of patients with burns upon admission to the emergency department and contrasted their condition with that of healthy controls and patients with other traumatic injuries. In addition we assessed differences due to thermal versus electrical injury and evaluated the effect of burn size. METHODS: This is a patient based prospective observational study conducted with delayed consented. Subjects at the highest level of trauma activation upon admission to the ED had a blood sample collected for research purposes and were subsequently consented. Hemostatic potential was measured by rapid thromelastography (r-TEG((R))), thrombin generation by calibrated automated thrombogram (CAT) and platelet function by Multiplate((R)) using five activators. Burn subjects were compared to subjects with other traumatic injuries and controls. Within the burn subjects additional analysis compared mechanism (thermal vs. electrical) and burn size. Values are medians (IQR). RESULTS: Two hundred and eighty two trauma patients (with burns n=40, 14%) and 27 controls were enrolled. Upon admission, compared to controls, subjects with burns or trauma were hyper-coagulable based on r-TEG and CAT, with increased rates of clot formation and thrombin generation. There were no differences in burns compared to other traumatic injuries. The presence of hyper-coagulation did not appear to be related to the type of burn or the percentage of total body surface area involved. Employing previous defined cut points for R-TEG driven therapeutic interventions burn patients had similar rates of hyper- and hypo-coagulation noted in patients with traumatic injuries. CONCLUSION: Upon admission patients with burns are in a hyper-coagulable state similar to that of other trauma patients. Employing demonstrated cut points of hemostatic potential in trauma patients associated with increased risk of poor outcomes demonstrated the incidence in burn patients to be similar, suggesting that these values could be used in the early assessment of the patient with burns to guide treatment interventions. CI - Copyright (c) 2016 Elsevier Ltd and ISBI. All rights reserved. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. Electronic address: Charles.E.Wade@uth.tmc.edu. FAU - Baer, Lisa A AU - Baer LA AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Folkerson, Lindley E AU - Folkerson LE AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Nutall-Aurora, Kisha AU - Nutall-Aurora K AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Cotton, Bryan A AU - Cotton BA AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Cross, James M AU - Cross JM AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. FAU - Huzar, Todd AU - Huzar T AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. LA - eng PT - Journal Article PT - Observational Study DEP - 20160928 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Blood Coagulation Tests MH - Burns/blood/complications MH - Burns, Electric/*blood/complications MH - Case-Control Studies MH - Electric Injuries/*blood/complications MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Adhesiveness MH - Platelet Aggregation MH - Platelet Function Tests MH - Prospective Studies MH - Thrombelastography MH - Thrombin MH - Thrombophilia/*blood/complications MH - Wounds and Injuries/blood/complications MH - Young Adult OTO - NOTNLM OT - Burn OT - Multiplate OT - Thrombin generation OT - Trauma OT - Viscoelastometry EDAT- 2016/10/04 06:00 MHDA- 2017/03/14 06:00 CRDT- 2016/10/04 06:00 PHST- 2016/02/10 00:00 [received] PHST- 2016/04/14 00:00 [revised] PHST- 2016/05/02 00:00 [accepted] PHST- 2016/10/04 06:00 [pubmed] PHST- 2017/03/14 06:00 [medline] PHST- 2016/10/04 06:00 [entrez] AID - S0305-4179(16)30093-6 [pii] AID - 10.1016/j.burns.2016.05.001 [doi] PST - ppublish SO - Burns. 2016 Dec;42(8):1704-1711. doi: 10.1016/j.burns.2016.05.001. Epub 2016 Sep 28. PMID- 27658942 OWN - NLM STAT- MEDLINE DCOM- 20180425 LR - 20260127 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 43 IP - 4 DP - 2017 Aug TI - Algorithm for activation of coagulation support treatment in multiple injured patients--cohort study. PG - 423-430 LID - 10.1007/s00068-016-0726-x [doi] AB - BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU((R)) (TR-DGU). PATIENTS: Patients were selected for inclusion into TR-DGU according to the following criteria: polytraumatized patients with Injury severity score (ISS) >/= 18, patients with injuries to single region with AIS 5, patients with major injuries to a single region and abnormal vital signs. All patients that were dead on arrival to hospital, patients presented to hospital >24 h after the injury, and head injuries that occurred with a low energy mechanism in patients on anticoagulation drugs were excluded. MEASUREMENTS: Two groups were formed (with or without coagulopathy). Mortality, morbidity, length of mechanical ventilation, ICU and hospital stay were used as outcome and compared between the groups. A coagulopathy prediction model (CPM) was developed to identify the patients who were at high risk of coagulopathy. RESULTS: Coagulopathy was present in 51 % of patients. Severe injuries to the torso and limbs, infusion of >1000 ml of fluids in the prehospital settings, and hypotension were included into CPM. If all three criteria were present, the sensitivity of the model to predict coagulopathy was 93 %. By adding the blood gas analysis (BE 30%) on thromboelastography with platelet mapping compared with the healthy volunteers who served as controls (P < .01). Mepacrine assay showed a difference in mean fluorescent intensity for all trauma patients of 4,259 +/- 1,341 compared with controls of 3,143 +/- 709 (P = .044), correlating with greater quantities of dense granules. Neither adenosine diphosphate inhibition nor average difference in mean fluorescent intensity between traumatic brain injury and no traumatic brain injury groups were significant (P = .2). CONCLUSION: Trauma patients maintain their dense granule, contradicting the theory of platelet granule exhaustion as the etiology for platelet dysfunction in traumatic brain injury. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Bartels, Ashley N AU - Bartels AN AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. Electronic address: bartelsan@health.missouri.edu. FAU - Johnson, Cory AU - Johnson C AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. FAU - Lewis, Julie AU - Lewis J AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. FAU - Clevenger, James W AU - Clevenger JW AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. FAU - Barnes, Stephen L AU - Barnes SL AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. FAU - Hammer, Richard D AU - Hammer RD AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. FAU - Ahmad, Salman AU - Ahmad S AD - Department of Surgery, Division of Acute Care Surgery and Department of Pathology and Anatomical Sciences, University of Missouri Hospital & Clinics, Columbia, MO. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160813 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 61D2G4IYVH (Adenosine Diphosphate) RN - H0C805XYDE (Quinacrine) SB - IM CIN - Surgery. 2016 Oct;160(4):958-959. doi: 10.1016/j.surg.2016.07.020. PMID: 27531319 MH - Adenosine Diphosphate/*metabolism MH - Adult MH - Bleeding Time MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Blood Platelets/*metabolism/pathology MH - Brain Injuries, Traumatic/*blood/complications/diagnosis MH - Case-Control Studies MH - Cytoplasmic Granules/drug effects/*metabolism MH - Female MH - Flow Cytometry/methods MH - Glasgow Coma Scale MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Pilot Projects MH - Prospective Studies MH - Quinacrine/pharmacology MH - Reference Values MH - Thrombelastography/methods MH - Young Adult EDAT- 2016/08/18 06:00 MHDA- 2017/07/01 06:00 CRDT- 2016/08/18 06:00 PHST- 2016/02/23 00:00 [received] PHST- 2016/06/28 00:00 [revised] PHST- 2016/07/11 00:00 [accepted] PHST- 2016/08/18 06:00 [entrez] PHST- 2016/08/18 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - S0039-6060(16)30344-0 [pii] AID - 10.1016/j.surg.2016.07.012 [doi] PST - ppublish SO - Surgery. 2016 Oct;160(4):954-959. doi: 10.1016/j.surg.2016.07.012. Epub 2016 Aug 13. PMID- 27515056 OWN - NLM STAT- MEDLINE DCOM- 20170526 LR - 20260127 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 56 IP - 10 DP - 2016 Oct TI - The confusion continues: results from an American Association for the Surgery of Trauma survey on massive transfusion practices among United States trauma centers. PG - 2478-2486 LID - 10.1111/trf.13755 [doi] AB - BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively. A total of 123 institutions have a massive transfusion protocol (MTP); 54% report having an MTP for less than 5 years. The number of coolers and units of red blood cells, plasma, and platelets are highly variable. Tranexamic acid is part of the MTP at 64% of centers; 26% continue to use recombinant activated Factor VII. MTP activation occurs more than five times per month at 32% of centers. MTPs are utilized for nontrauma patients in 82% of institutions. Point-of-care prothrombin time, international normalized ratio, and partial thromboplastin time testing is utilized in 37% of institutions. Only 9% routinely utilize thromboelastography or rotational thromboelastometry (TEG/ROTEM) within their MTP. Just 7% use a validated scoring system to guide MTP activation. The incorporation of TEG/ROTEM into the MTP is associated with the use of a scoring system in regression analysis (p = 0.024). CONCLUSION: Most institutions regularly activate recently implemented MTPs for trauma and nontrauma indications; however, few use validated scoring systems for MTP activation. MTP content is highly variable. Few institutions use TEG, while most have incorporated tranexamic acid into their protocol. The lack of consistent practices underscores the need for outcome-based studies to guide transfusion practices. CI - (c) 2016 AABB. FAU - Etchill, Eric AU - Etchill E AUID- ORCID: 0000-0002-5381-648X AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Sperry, Jason AU - Sperry J AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Zuckerbraun, Brian AU - Zuckerbraun B AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Alarcon, Louis AU - Alarcon L AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Brown, Joshua AU - Brown J AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Schuster, Kevin AU - Schuster K AD - Yale University School of Medicine, New Haven, Connecticut. FAU - Kaplan, Lewis AU - Kaplan L AD - University of Pennsylvania Perelman School of Medicine and Philadelphia VA Medical Center, Philadelphia, Pennsylvania. FAU - Piper, Greta AU - Piper G AD - New York University Medical Center, New York, New York. FAU - Peitzman, Andrew AU - Peitzman A AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Neal, Matthew D AU - Neal MD AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. nealm2@upmc.edu. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20160811 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Hemostatics) SB - IM CIN - Transfusion. 2017 May;57(5):1322-1324. doi: 10.1111/trf.14090. PMID: 28425601 MH - Blood Transfusion/*standards MH - Health Services/standards MH - Hemorrhage/therapy MH - Hemostatics/therapeutic use MH - Humans MH - Practice Patterns, Physicians'/*standards MH - Resuscitation/methods MH - *Surveys and Questionnaires MH - Thrombelastography MH - Trauma Centers/*standards MH - United States EDAT- 2016/08/16 06:00 MHDA- 2017/05/27 06:00 CRDT- 2016/08/13 06:00 PHST- 2015/07/21 00:00 [received] PHST- 2016/04/25 00:00 [revised] PHST- 2016/04/26 00:00 [accepted] PHST- 2016/08/16 06:00 [pubmed] PHST- 2017/05/27 06:00 [medline] PHST- 2016/08/13 06:00 [entrez] AID - 10.1111/trf.13755 [doi] PST - ppublish SO - Transfusion. 2016 Oct;56(10):2478-2486. doi: 10.1111/trf.13755. Epub 2016 Aug 11. PMID- 27496751 OWN - NLM STAT- MEDLINE DCOM- 20180104 LR - 20240610 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 15 IP - 1 DP - 2017 Jan TI - Targeting factor VIII expression to platelets for hemophilia A gene therapy does not induce an apparent thrombotic risk in mice. PG - 98-109 LID - 10.1111/jth.13436 [doi] AB - Essentials Platelet-Factor (F) VIII gene therapy is a promising treatment in hemophilia A. This study aims to evaluate if platelet-FVIII expression would increase the risk for thrombosis. Targeting FVIII expression to platelets does not induce or elevate thrombosis risk. Platelets expressing FVIII are neither hyper-activated nor hyper-responsive. SUMMARY: Background Targeting factor (F) VIII expression to platelets is a promising gene therapy approach for hemophilia A, and is successful even in the presence of inhibitors. It is well known that platelets play important roles not only in hemostasis, but also in thrombosis and inflammation. Objective To evaluate whether platelet-FVIII expression might increase thrombotic risk and thereby compromise the safety of this approach. Methods In this study, platelet-FVIII-expressing transgenic mice were examined either in steady-state conditions or under prothrombotic conditions induced by inflammation or the FV Leiden mutation. Native whole blood thrombin generation assay, rotational thromboelastometry analysis and ferric chloride-induced vessel injury were used to evaluate the hemostatic properties. Various parameters associated with thrombosis risk, including D-dimer, thrombin-antithrombin complexes, fibrinogen, tissue fibrin deposition, platelet activation status and activatability, and platelet-leukocyte aggregates, were assessed. Results We generated a new line of transgenic mice that expressed 30-fold higher levels of platelet-expressed FVIII than are therapeutically required to restore hemostasis in hemophilic mice. Under both steady-state conditions and prothrombotic conditions induced by lipopolysaccharide-mediated inflammation or the FV Leiden mutation, supratherapeutic levels of platelet-expressed FVIII did not appear to be thrombogenic. Furthermore, FVIII-expressing platelets were neither hyperactivated nor hyperactivatable upon agonist activation. Conclusion We conclude that, in mice, more than 30-fold higher levels of platelet-expressed FVIII than are required for therapeutic efficacy in hemophilia A are not associated with a thrombotic predilection. CI - (c) 2016 International Society on Thrombosis and Haemostasis. FAU - Baumgartner, C K AU - Baumgartner CK AD - Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA. FAU - Mattson, J G AU - Mattson JG AD - Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA. FAU - Weiler, H AU - Weiler H AD - Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA. FAU - Shi, Q AU - Shi Q AD - Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA. AD - Medical College of Wisconsin, Milwaukee, WI, USA. AD - Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA. AD - MACC Fund Research Center, Milwaukee, WI, USA. FAU - Montgomery, R R AU - Montgomery RR AD - Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA. AD - Medical College of Wisconsin, Milwaukee, WI, USA. AD - Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA. LA - eng GR - R01 HL112614/HL/NHLBI NIH HHS/United States GR - R01 HL112641/HL/NHLBI NIH HHS/United States GR - R01 HL102035/HL/NHLBI NIH HHS/United States GR - P01 HL044612/HL/NHLBI NIH HHS/United States GR - P01 HL081588/HL/NHLBI NIH HHS/United States GR - R01 HL139847/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20161108 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Antithrombins) RN - 0 (Coagulants) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (Lipopolysaccharides) RN - 0 (factor V Leiden) RN - 0 (fibrin fragment D) RN - 113E3Z3CJJ (recombinant factor VIII SQ) RN - 839MOZ74GK (F8 protein, human) RN - 9001-24-5 (Factor V) RN - 9001-27-8 (Factor VIII) RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.5 (Thrombin) SB - IM CIN - J Thromb Haemost. 2017 Jan;15(1):96-97. doi: 10.1111/jth.13545. PMID: 27749010 MH - Animals MH - Antithrombins/metabolism MH - Blood Coagulation/genetics MH - Blood Platelets/metabolism MH - Coagulants/therapeutic use MH - Factor V/genetics MH - Factor VIII/genetics/*metabolism MH - Fibrin/metabolism MH - Fibrin Fibrinogen Degradation Products/metabolism MH - Fibrinogen/metabolism MH - Genetic Therapy/*methods MH - Hemophilia A/*genetics/*therapy MH - Hemostasis MH - Humans MH - Leukocytes/metabolism MH - Lipopolysaccharides MH - Mice MH - Mice, Inbred C57BL MH - Mice, Transgenic MH - Mutation MH - Phenotype MH - Platelet Activation MH - Thrombin/metabolism MH - Thrombosis/*genetics PMC - PMC5280575 MID - NIHMS808800 OTO - NOTNLM OT - factor VIII OT - gene therapy OT - hemophilia A OT - platelet OT - thrombosis COIS- of Conflict of Interest: The authors state that they have no conflict of interest. EDAT- 2016/08/09 06:00 MHDA- 2018/01/05 06:00 PMCR- 2018/01/01 CRDT- 2016/08/07 06:00 PHST- 2016/04/25 00:00 [received] PHST- 2016/07/12 00:00 [accepted] PHST- 2016/08/09 06:00 [pubmed] PHST- 2018/01/05 06:00 [medline] PHST- 2016/08/07 06:00 [entrez] PHST- 2018/01/01 00:00 [pmc-release] AID - S1538-7836(22)03135-X [pii] AID - 10.1111/jth.13436 [doi] PST - ppublish SO - J Thromb Haemost. 2017 Jan;15(1):98-109. doi: 10.1111/jth.13436. Epub 2016 Nov 8. PMID- 27495106 OWN - NLM STAT- MEDLINE DCOM- 20170206 LR - 20260127 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 95 IP - 31 DP - 2016 Aug TI - The thromboelastometric discrepancy between septic and trauma induced disseminated intravascular coagulation diagnosed by the scoring system from the Japanese association for acute medicine. PG - e4514 LID - 10.1097/MD.0000000000004514 [doi] LID - e4514 AB - The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM).This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome.Fifty-seven patients (30 sepsis and 27 severe trauma) were included in primary analysis. Sepsis cases were significantly older and had higher systemic inflammatory response syndrome (SIRS) scores, whereas there were no significant differences in other parameters including Acute Physiology and Chronic Health Evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score. Twenty-six patients (14 sepsis and 12 severe trauma) were diagnosed with DIC. The Septic DIC (S-DIC) group was significantly older and had higher DIC scores than the traumatic DIC (T-DIC) group. Hematologic examination revealed significantly higher CRP, fibrinogen, lower FDP, DD, and higher FDP/DD ratio were found in the S-DIC group in comparison with the T-DIC group. ROTEM findings showed that the A10, A20, and MCF in the FIBTEM test were significantly higher in the S-DIC group. However, no statistical differences were confirmed in the LI30, LI45, and ML in EXTEM test.The plasma fibrinogen level and fibrinogen based clot firmness in whole-blood test revealed statistical significance between septic and traumatic DIC patients. FAU - Koami, Hiroyuki AU - Koami H AD - Advanced Emergency Care Center, Saga University Hospital, Saga city, Saga, Japan. FAU - Sakamoto, Yuichiro AU - Sakamoto Y FAU - Sakurai, Ryota AU - Sakurai R FAU - Ohta, Miho AU - Ohta M FAU - Imahase, Hisashi AU - Imahase H FAU - Yahata, Mayuko AU - Yahata M FAU - Umeka, Mitsuru AU - Umeka M FAU - Miike, Toru AU - Miike T FAU - Nagashima, Futoshi AU - Nagashima F FAU - Iwamura, Takashi AU - Iwamura T FAU - Yamada, Kosuke Chris AU - Yamada KC FAU - Inoue, Satoshi AU - Inoue S LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (fibrin fragment D) RN - 9001-32-5 (Fibrinogen) RN - 9007-41-4 (C-Reactive Protein) SB - IM MH - Age Factors MH - Aged MH - C-Reactive Protein/analysis MH - Disseminated Intravascular Coagulation/*blood MH - Female MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinogen/analysis MH - Humans MH - Japan MH - Male MH - Retrospective Studies MH - Sepsis/*blood MH - Severity of Illness Index MH - *Thrombelastography MH - Wounds and Injuries/*blood PMC - PMC4979860 COIS- The authors have no conflicts of interest to disclose. EDAT- 2016/08/09 06:00 MHDA- 2017/02/07 06:00 PMCR- 2016/08/07 CRDT- 2016/08/07 06:00 PHST- 2016/08/07 06:00 [entrez] PHST- 2016/08/09 06:00 [pubmed] PHST- 2017/02/07 06:00 [medline] PHST- 2016/08/07 00:00 [pmc-release] AID - 00005792-201608020-00092 [pii] AID - 10.1097/MD.0000000000004514 [doi] PST - ppublish SO - Medicine (Baltimore). 2016 Aug;95(31):e4514. doi: 10.1097/MD.0000000000004514. PMID- 27492573 OWN - NLM STAT- MEDLINE DCOM- 20180306 LR - 20181107 IS - 1572-8773 (Electronic) IS - 0966-0844 (Linking) VI - 29 IP - 5 DP - 2016 Oct TI - Decreased snake venom metalloproteinase effects via inhibition of enzyme and modification of fibrinogen. PG - 913-9 LID - 10.1007/s10534-016-9963-z [doi] AB - Since the introduction of antivenom administration 120 years ago to treat venomous snake bit, it has been the gold standard for saving life and limb. However, this therapeutic approach is not always effective and not without potential life-threatening side effects. We tested a new paradigm to abrogate the plasmatic anticoagulant effects of fibrinogenolytic snake venom metalloproteinases by modification of fibrinogen with iron and carbon monoxide and by inhibiting these Zn(2+) dependent metalloproteinases directly with carbon monoxide exposure. Assessment of the fibrinogenolytic effects of venoms collected from Puff adder, Gaboon viper and Indian cobra snakes on plasmatic coagulation kinetics was performed with thrombelastography. Pretreatment of plasma with iron and carbon monoxide exposure markedly attenuated the effects of all three venoms, and direct pretreatment of each venom with carbon monoxide also significantly decreased the ability to compromise coagulation. These results demonstrated that the introduction of a transition metal (e.g., modulation of the alpha-chain of fibrinogen with iron), modulation of transition metal in heme (e.g., carbon monoxide modulation of fibrinogen-bound heme iron), and direct inhibition of transition metal containing venom enzymes (e.g., CO binding to Zn(2+) or displacing Zn(2+) from the catalytic site) significantly decreased fibrinogenolytic activity. This biometal modulation strategy to attenuate the anticoagulant effects of snake venom metalloproteinases could potentially diminish hemostatic injury in envenomed patients until antivenom can be administered. FAU - Nielsen, Vance G AU - Nielsen VG AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. vgnielsen333@gmail.com. FAU - Cerruti, Marc A AU - Cerruti MA AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. FAU - Valencia, Olivia M AU - Valencia OM AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. FAU - Amos, Quinlan AU - Amos Q AD - The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, Tucson, AZ, 85724-5114, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160804 PL - Netherlands TA - Biometals JT - Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine JID - 9208478 RN - 0 (Anticoagulants) RN - 0 (Enzyme Inhibitors) RN - 0 (Snake Venoms) RN - 7U1EE4V452 (Carbon Monoxide) RN - 9001-32-5 (Fibrinogen) RN - E1UOL152H7 (Iron) RN - EC 3.4.- (Metalloproteases) SB - IM MH - Animals MH - Anticoagulants/*pharmacology MH - Blood Coagulation/drug effects MH - Carbon Monoxide/*pharmacology MH - Enzyme Inhibitors/*pharmacology MH - Fibrinogen/*chemistry/*metabolism MH - Humans MH - Iron/*pharmacology MH - Metalloproteases/*antagonists & inhibitors/metabolism MH - Naja naja MH - Snake Venoms/*enzymology MH - Viperidae OTO - NOTNLM OT - Carbon monoxide OT - Fibrinogen OT - Iron OT - Snake venom metalloproteinase OT - Thrombelastography EDAT- 2016/08/06 06:00 MHDA- 2018/03/07 06:00 CRDT- 2016/08/06 06:00 PHST- 2016/06/21 00:00 [received] PHST- 2016/07/28 00:00 [accepted] PHST- 2016/08/06 06:00 [entrez] PHST- 2016/08/06 06:00 [pubmed] PHST- 2018/03/07 06:00 [medline] AID - 10.1007/s10534-016-9963-z [pii] AID - 10.1007/s10534-016-9963-z [doi] PST - ppublish SO - Biometals. 2016 Oct;29(5):913-9. doi: 10.1007/s10534-016-9963-z. Epub 2016 Aug 4. PMID- 27484224 OWN - NLM STAT- MEDLINE DCOM- 20180205 LR - 20260127 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 17 DP - 2016 Aug 2 TI - Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA): safety and efficacy of low-dose prostacyclin administration and blood pressure target in addition to standard therapy, as compared to standard therapy alone, in post-cardiac arrest syndrome patients: study protocol for a randomized controlled trial. PG - 378 LID - 10.1186/s13063-016-1477-z [doi] LID - 378 AB - BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery and AMI. Thus, a study is pertinent to investigate if prostacyclin infusion as a therapeutic intervention reduces endothelial damage without compromising, or even improving, the hemostatic competence in resuscitated cardiac arrest patients. Post-cardiac arrest patients frequently have a need for vasopressor therapy (catecholamines) to achieve the guideline-supported blood pressure goals. To evaluate a possible catecholamine interaction with the primary endpoints of this study, included patients will be randomized into two different blood pressure goals within guideline-recommended targets. METHODS/DESIGN: A randomized, placebo-controlled, double-blind investigator-initiated pilot trial in 40 out-of-hospital-cardiac-arrest (OHCA) patients will be conducted. Patients will be randomly assigned to either the active treatment group (48 hours of active study drug (iloprost, 1 ng/kg/min) or to the control group [placebo (saline) infusion]. Target mean blood pressure levels will be allocated 1:1 to 65 mmHg or approximately 75 mmHg, which gives four different permutations, namely: (i) iloprost/65 mHg, (ii) iloprost/75 mmHg, (iii) placebo/65 mmHg, and (iv) placebo/75 mmHg. All randomized patients will be treated in accordance with state-of-the art therapy including targeted temperature management. The primary endpoint of this study is change in biomarkers indicative of endothelial activation and damage, [soluble thrombomodulin (sTM), sE-selectin, syndecan-1, soluble vascular endothelial growth factor (sVEGF), nucleosomes] and sympathoadrenal over activation (epinephrine/norepinephrine) from baseline to 48 hours post-randomization. The secondary endpoints of this trial will include: (1) the hemostatic profile [change in functional hemostatic blood test (thrombelastography (TEG) and whole blood platelet aggregometry (multiplate)) blood cell and endothelial cell-derived microparticles]; (2) feasibility of blood pressure target intervention (target 90 %); (3) interaction of primary endpoints and blood pressure target; (4) levels of neuron-specific enolase at 48 hours post-inclusion according to blood pressure targets. DISCUSSION: The ENDO-RCA study is a pilot study trial that investigates safety and efficacy of low-dose infusion of prostacyclin administration as compared to standard therapy in post-cardiac arrest syndrome patients. TRIAL REGISTRATION: Trial registration at ClinicalTrials.gov (identifier NCT02685618 ) on 18 February 2016. FAU - Meyer, Anna Sina P AU - Meyer AS AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, 2100, Copenhagen, Denmark. annasina.pettersson@gmail.com. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Kjaergaard, Jesper AU - Kjaergaard J AD - Department of Cardiology, Rigshospitalet, 2143, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, 2100, Copenhagen, Denmark. AD - Department of Surgery, University of Texas Health Medical School, 6410 Fannin Street UPB 1100, Houston, TX, 77030, USA. FAU - Hassager, Christian AU - Hassager C AD - Department of Cardiology, Rigshospitalet, 2143, Blegdamsvej 9, 2100, Copenhagen, Denmark. LA - eng SI - ClinicalTrials.gov/NCT02685618 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20160802 PL - England TA - Trials JT - Trials JID - 101263253 RN - 0 (Biomarkers) RN - 0 (Cardiovascular Agents) RN - 0 (Catecholamines) RN - JED5K35YGL (Iloprost) SB - IM MH - Biomarkers/blood MH - Blood Pressure/*drug effects MH - *Cardiopulmonary Resuscitation/adverse effects MH - Cardiovascular Agents/*administration & dosage/adverse effects MH - Catecholamines/*administration & dosage/adverse effects MH - Clinical Protocols MH - Denmark MH - Double-Blind Method MH - Endothelium, Vascular/*drug effects/metabolism/physiopathology MH - Heart Arrest/blood/diagnosis/physiopathology/*therapy MH - Humans MH - Iloprost/*administration & dosage/adverse effects MH - Pilot Projects MH - Research Design MH - Time Factors MH - Treatment Outcome PMC - PMC4969682 OTO - NOTNLM OT - Endothelial dysfunction OT - Out-of-hospital cardiac arrest (OHCA) OT - Prostacyclin EDAT- 2016/08/04 06:00 MHDA- 2018/02/06 06:00 PMCR- 2016/08/02 CRDT- 2016/08/04 06:00 PHST- 2016/03/08 00:00 [received] PHST- 2016/07/05 00:00 [accepted] PHST- 2016/08/04 06:00 [entrez] PHST- 2016/08/04 06:00 [pubmed] PHST- 2018/02/06 06:00 [medline] PHST- 2016/08/02 00:00 [pmc-release] AID - 10.1186/s13063-016-1477-z [pii] AID - 1477 [pii] AID - 10.1186/s13063-016-1477-z [doi] PST - epublish SO - Trials. 2016 Aug 2;17:378. doi: 10.1186/s13063-016-1477-z. PMID- 27445340 OWN - NLM STAT- MEDLINE DCOM- 20170206 LR - 20170206 IS - 1472-4146 (Electronic) IS - 0021-9746 (Linking) VI - 70 IP - 2 DP - 2017 Feb TI - An in vitro study of the effects of t-PA and tranexamic acid on whole blood coagulation and fibrinolysis. PG - 154-161 LID - 10.1136/jclinpath-2016-203854 [doi] AB - AIMS: Acute traumatic coagulopathy is characterised by fibrinolysis and low fibrinogen. It is unclear how much fibrinogenolysis contributes to reduce fibrinogen levels. The study aim was to: investigate in vitro the effects of tissue-plasminogen activator (t-PA) and tranexamic acid (TXA) on coagulation and fibrinolysis. METHODS: Whole blood was spiked with varying t-PA concentrations. Clauss fibrinogen levels and thrombelastography (TEG, Haemonetics) were performed, including functional fibrinogen level (FLEV). TXA effects were assessed using four TXA concentrations. Recorded parameters from kaolin activated TEG included maximal amplitude (MA), clot strength (G), percentage lysis (LY). Plasmin-antiplasmin complex (PAP), endogenous thrombin potential (ETP), prothrombin fragment 1+2 (PF1+2), factor V and factor VIII levels were all measured. RESULTS: t-PA induced fibrinolysis: it increased PAP and LY, but decreased MA and G. t-PA induced fibrinogenolysis, with a concentration-dependant decrease in fibrinogen from 2.7 (2.6-3.1) to 0.8 (0.8-0.9) g/L with 60 nM t-PA. FLEV and fibrinogen levels were well correlated. High t-PA doses increased PF1+2, decreased ETP of 19% and FVIII of 63% but not FV. TXA had no effect on plasmin generation as evidenced by no change in PAP. It corrected LY, MA and G and partly protected fibrinogen against fibrinogenolysis: 0.03 mg/mL TXA reduced the fibrinogen fall induced by t-PA 20 nM from 43% to 14%. TXA halved the FVIII fall and increased ETP. CONCLUSIONS: t-PA induced plasminogen activation and fibrinogenolysis in a concentration-dependant manner. TXA did not affect plasmin activation but reduced fibrinogenolysis. These results suggest that TXA given early in bleeding patients may prevent fibrinogenolysis. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. FAU - Godier, Anne AU - Godier A AD - Department of Anesthesia and Critical Care, Fondation Ophtalmologique Rothschild, Paris, France. AD - Faculte de Pharmacie, INSERM UMR-S1140, Universite Paris Descartes, Paris, France. AD - Department of Thrombosis and Vascular Biology, Rayne Institute, London, UK. FAU - Parmar, Kiran AU - Parmar K AD - Department of Thrombosis and Vascular Biology, Rayne Institute, London, UK. FAU - Manandhar, Karuna AU - Manandhar K AD - Department of Thrombosis and Vascular Biology, Rayne Institute, London, UK. FAU - Hunt, Beverley J AU - Hunt BJ AD - Department of Thrombosis and Vascular Biology, Rayne Institute, London, UK. AD - Thrombosis and Haemostasis Centre, Guy's and St Thomas's NHS Foundation Trusts, and King's College, London, UK. LA - eng PT - Journal Article DEP - 20160721 PL - England TA - J Clin Pathol JT - Journal of clinical pathology JID - 0376601 RN - 0 (Antifibrinolytic Agents) RN - 0 (Fibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Antifibrinolytic Agents/*pharmacology MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests MH - Dose-Response Relationship, Drug MH - Fibrinolysis/*drug effects MH - Fibrinolytic Agents/*pharmacology MH - Humans MH - Tissue Plasminogen Activator/*pharmacology MH - Tranexamic Acid/*pharmacology OTO - NOTNLM OT - BLEEDING DISORDERS OT - COAGULATION OT - FIBRINOGEN OT - FIBRINOLYSIS OT - HAEMOSTASIS EDAT- 2016/07/23 06:00 MHDA- 2017/02/07 06:00 CRDT- 2016/07/23 06:00 PHST- 2016/05/10 00:00 [received] PHST- 2016/06/23 00:00 [revised] PHST- 2016/06/27 00:00 [accepted] PHST- 2016/07/23 06:00 [pubmed] PHST- 2017/02/07 06:00 [medline] PHST- 2016/07/23 06:00 [entrez] AID - jclinpath-2016-203854 [pii] AID - 10.1136/jclinpath-2016-203854 [doi] PST - ppublish SO - J Clin Pathol. 2017 Feb;70(2):154-161. doi: 10.1136/jclinpath-2016-203854. Epub 2016 Jul 21. PMID- 27430874 OWN - NLM STAT- MEDLINE DCOM- 20171030 LR - 20220318 IS - 1556-0961 (Electronic) IS - 1541-6933 (Print) IS - 1541-6933 (Linking) VI - 26 IP - 1 DP - 2017 Feb TI - The Role of Platelet Activation and Inflammation in Early Brain Injury Following Subarachnoid Hemorrhage. PG - 48-57 LID - 10.1007/s12028-016-0292-4 [doi] AB - BACKGROUND: Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (SAH) is an important predictor of poor functional outcome, yet the underlying mechanism is not well understood. Animal studies suggest that platelet activation and inflammation with subsequent microthrombosis and ischemia may be a mechanism of EBI. METHODS: A prospective, hypothesis-driven study of spontaneous, SAH patients and controls was conducted. Platelet activation [thromboelastography maximum amplitude (MA)] and inflammation [C-reactive protein (CRP)] were measured serially over time during the first 72 h following SAH onset. Platelet activation and inflammatory markers were compared between controls and SAH patients with mild [Hunt-Hess (HH) 1-3] versus severe (HH 4-5) EBI. The association of these biomarkers with 3-month functional outcomes was evaluated. RESULTS: We enrolled 127 patients (106 SAH; 21 controls). Platelet activation and CRP increased incrementally with worse EBI/HH grade, and both increased over 72 h (all P < 0.01). Both were higher in severe versus mild EBI (MA 68.9 vs. 64.8 mm, P = 0.001; CRP 12.5 vs. 1.5 mg/L, P = 0.003) and compared to controls (both P < 0.003). Patients with delayed cerebral ischemia (DCI) had more platelet activation (66.6 vs. 64.9 in those without DCI, P = 0.02) within 72 h of ictus. At 3 months, death or severe disability was more likely with higher levels of platelet activation (mRS4-6 OR 1.18, 95 % CI 1.05-1.32, P = 0.007) and CRP (mRS4-6 OR 1.02, 95 % CI 1.00-1.03, P = 0.041). CONCLUSIONS: Platelet activation and inflammation occur acutely after SAH and are associated with worse EBI, DCI and poor 3-month functional outcomes. These markers may provide insight into the mechanism of EBI following SAH. FAU - Frontera, Jennifer A AU - Frontera JA AD - Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave. S80, Cleveland, OH, 44195, USA. frontej@ccf.org. AD - Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. frontej@ccf.org. FAU - Provencio, J Javier AU - Provencio JJ AD - Department of Neurology and Neuroscience, Brain Immunology and Glia Center, University of Virginia, Charlottesville, VA, USA. FAU - Sehba, Fatima A AU - Sehba FA AD - Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA. FAU - McIntyre, Thomas M AU - McIntyre TM AD - Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. FAU - Nowacki, Amy S AU - Nowacki AS AD - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. FAU - Gordon, Errol AU - Gordon E AD - Department of Critical Care, Mount Sinai School of Medicine, New York, NY, USA. FAU - Weimer, Jonathan M AU - Weimer JM AD - Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave. S80, Cleveland, OH, 44195, USA. FAU - Aledort, Louis AU - Aledort L AD - Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA. LA - eng GR - R01 NS074997/NS/NINDS NIH HHS/United States PT - Journal Article PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Biomarkers MH - *Brain Injuries/blood/etiology/immunology/physiopathology MH - Female MH - Humans MH - Inflammation/*blood MH - Male MH - Middle Aged MH - *Outcome Assessment, Health Care MH - Platelet Activation/*physiology MH - Severity of Illness Index MH - *Subarachnoid Hemorrhage/blood/complications/immunology/physiopathology MH - Young Adult PMC - PMC6354928 MID - NIHMS888258 OTO - NOTNLM OT - Early brain injury OT - Inflammation OT - Microthrombosis OT - Platelet OT - SAH OT - Subarachnoid hemorrhage EDAT- 2016/07/20 06:00 MHDA- 2017/10/31 06:00 PMCR- 2019/01/31 CRDT- 2016/07/20 06:00 PHST- 2016/07/20 06:00 [pubmed] PHST- 2017/10/31 06:00 [medline] PHST- 2016/07/20 06:00 [entrez] PHST- 2019/01/31 00:00 [pmc-release] AID - 10.1007/s12028-016-0292-4 [pii] AID - 10.1007/s12028-016-0292-4 [doi] PST - ppublish SO - Neurocrit Care. 2017 Feb;26(1):48-57. doi: 10.1007/s12028-016-0292-4. PMID- 27430210 OWN - NLM STAT- MEDLINE DCOM- 20180126 LR - 20220317 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 17 IP - 1 DP - 2016 Jul 19 TI - Pilot Randomized trial of Fibrinogen in Trauma Haemorrhage (PRooF-iTH): study protocol for a randomized controlled trial. PG - 327 LID - 10.1186/s13063-016-1439-5 [doi] LID - 327 AB - BACKGROUND: Haemorrhage remains a leading cause of morbidity and mortality in trauma patients. Fibrinogen is an essential endogenous component of haemostasis and the plasma level is associated with bleeding, transfusion and outcome. Fibrinogen concentrate is widely used to correct acquired hypofibrinogenaemia, recommended by several international guidelines for the treatment of trauma patients, but evidence is lacking regarding the treatment safety and efficacy. We aim to assess the efficacy and safety of an immediate pre-emptive first-line treatment with fibrinogen concentrate in patients with trauma haemorrhage in need of haemostatic resuscitation. METHODS/DESIGN: This is a single-centre, randomized (1:1, active:placebo), placebo-controlled, double-blinded, investigator-initiated phase II trial. The trial population consists of 40 adult patients (>18 years) with traumatic, critical bleeding admitted to the Level 1 Trauma Centre at Rigshospitalet in Copenhagen, with immediate need for blood transfusion on arrival and an expected need for haemostatic resuscitation with multiple transfusions during the initial resuscitation. Patients will receive either pre-emptive administration of a bolus dose of 60-70 mg/kg fibrinogen concentrate (Riastap(R)) or placebo 0.9 % saline in equal volume to active treatment, both given as intravenous infusion blinded for the person administering the infusion. The primary end point is the change in thrombelastograph (TEG(R)) functional fibrinogen maximum amplitude in millimetres at 15 min after the intervention. The follow-up period on safety events and mortality will be until day 30. To detect a difference in the change from baseline to the 15-minute post-randomization measurement of 6-8 mm in TEG(R) functional fibrinogen maximum amplitude with a power of 0.90 and alpha of 0.05, we require 19 patients in each group. We have chosen to include 40 patients, 20 evaluable patients in each randomization group in case of attrition, in the present trial. DISCUSSION: Patients considered to be included in the trial will temporarily have a compromised consciousness because of the acute, critical bleeding related to trauma, so scientific guardians will co-sign the informed consent form. Next of kin and the patients' general practitioner or the patients will co-sign as soon as possible. This trial will test whether immediate pre-emptive fibrinogen concentrate administered to adult trauma patients as first-line treatment of trauma haemorrhage will increase the clot strength as evaluated by thrombelastography, transfusion requirements and survival in patients receiving haemostatic resuscitation according to current standard of care. TRIAL REGISTRATION: EudraCT no. 2014-003978-16 (22/1 2015); ClinicalTrials.gov: NCT02344069 . Registered on 14 January 2015. Trial protocol version 4.2 (23-12-2014). FAU - Steinmetz, Jacob AU - Steinmetz J AD - Department of Anaesthesia and Trauma Centre, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. jacob.steinmetz@regionh.dk. FAU - Sorensen, Anne Marie AU - Sorensen AM AD - Department of Anaesthesia and Trauma Centre, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Henriksen, Hanne Hee AU - Henriksen HH AD - Section for Transfusion Medicine, Capital Region Blood Bank Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Lange, Theis AU - Lange T AD - Section of Biostatistics, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen, Denmark. FAU - Larsen, Claus Falck AU - Larsen CF AD - Trauma Centre, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Department of Anaesthesia, Centre for Head and Orthopaedics and Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. LA - eng SI - EudraCT/2014-003978-16 SI - ClinicalTrials.gov/NCT02344069 PT - Clinical Trial, Phase II PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20160719 PL - England TA - Trials JT - Trials JID - 101263253 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Clinical Protocols MH - Double-Blind Method MH - Fibrinogen/*therapeutic use MH - Hemorrhage/*drug therapy MH - Humans MH - Pilot Projects MH - Thrombelastography MH - Wounds and Injuries/complications PMC - PMC4949907 OTO - NOTNLM OT - Fibrinogen OT - Haemorrhage OT - Haemostatic Resuscitation OT - Thrombelastography OT - Trauma EDAT- 2016/07/20 06:00 MHDA- 2018/01/27 06:00 PMCR- 2016/07/19 CRDT- 2016/07/20 06:00 PHST- 2015/10/03 00:00 [received] PHST- 2016/06/28 00:00 [accepted] PHST- 2016/07/20 06:00 [entrez] PHST- 2016/07/20 06:00 [pubmed] PHST- 2018/01/27 06:00 [medline] PHST- 2016/07/19 00:00 [pmc-release] AID - 10.1186/s13063-016-1439-5 [pii] AID - 1439 [pii] AID - 10.1186/s13063-016-1439-5 [doi] PST - epublish SO - Trials. 2016 Jul 19;17(1):327. doi: 10.1186/s13063-016-1439-5. PMID- 27428015 OWN - NLM STAT- MEDLINE DCOM- 20170427 LR - 20170427 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 28 IP - 3 DP - 2017 Apr TI - Recombinant human prothrombin reduced blood loss in a porcine model of dilutional coagulopathy with uncontrolled bleeding. PG - 244-253 LID - 10.1097/MBC.0000000000000590 [doi] AB - : Uncontrolled bleeding remains one of the leading causes of trauma-induced death. Treatment recommendations focus on fresh frozen plasma and blood cell transfusions, whereas plasma concentrates or single coagulation factors have been studied in recent years. The effect of recombinant human prothrombin factor II (rhFII, 8 mg/kg), activated recombinant human factor VII (rhFVIIa, 300 mug/kg), plasma-derived human fibrinogen (pdhFib) (200 mg/kg), activated prothrombin complex concentrate (aPCC, 40 IU/kg), a three-factor combination intended as a minimal PCC (8 mg/kg rhFII, 640 mug/kg recombinant human factor X (rhFX), and 12 mug/kg rhFVIIa), and vehicle were investigated in a porcine model of dilutional coagulopathy with uncontrolled bleeding. Survival time and blood loss were determined up to 120 min after induction of liver injury. Rotational thromboelastometry EXTEM coagulation time and maximum clot firmness, prothrombin time, thrombin-antithrombin complex (TAT), thrombin generation (endogenous thrombin potential, ETP) were measured at baseline, after dilution, drug administration, and end of experiment. rhFII, the three-factor combination, and aPCC significantly (P < 0.01) decreased blood loss vs. vehicle and rhFII also vs. fibrinogen (P < 0.05). Survival times increased significantly for rhFII, aPCC, rhFVIIa, and pdhFib vs. vehicle (P < 0.05), and, coagulation time, maximum clot firmness, and prothrombin time improved in all groups. TAT and ETP increased transiently for rhFII and three-factor combination, whereas persistently increased for aPCC. PdhFib and rhFVIIa did not increase TAT and ETP. rhFII decreased blood loss and improved hemostatic markers and survival. In vivo, thrombin generation (TAT) and potential to form thrombin (ETP) were transiently elevated by rhFII. Addition of rhFVIIa and rhFX to rhFII did not further improve hemostatic efficacy. FAU - Hansson, Kenny M AU - Hansson KM AD - aDepartment of Bioscience, Cardiovascular and Metabolic Disease (CVMD), Innovative Medicines unit (iMED), AstraZeneca R&D, Molndal, Sweden bDepartment of General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria cQuantitative Clinical Pharmacology, Early Clinical Development, Innovative Medicines unit (iMED), AstraZeneca R&D, Molndal, dLeaflet Biotech Consulting, Solna, Sweden. FAU - Johansson, Karin J AU - Johansson KJ FAU - Wingren, Cecilia AU - Wingren C FAU - Fries, Dietmar AU - Fries D FAU - Nelander, Karin AU - Nelander K FAU - Lovgren, Ann AU - Lovgren A LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Hemostatics) RN - 9001-26-7 (Prothrombin) SB - IM MH - Animals MH - Blood Coagulation Disorders/*blood MH - Blood Coagulation Tests/*methods MH - Disease Models, Animal MH - Hemorrhage/*blood MH - Hemostatics/*pharmacology MH - Humans MH - Prothrombin/*metabolism MH - Swine EDAT- 2016/07/19 06:00 MHDA- 2017/04/28 06:00 CRDT- 2016/07/19 06:00 PHST- 2016/07/19 06:00 [pubmed] PHST- 2017/04/28 06:00 [medline] PHST- 2016/07/19 06:00 [entrez] AID - 10.1097/MBC.0000000000000590 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2017 Apr;28(3):244-253. doi: 10.1097/MBC.0000000000000590. PMID- 27363652 OWN - NLM STAT- MEDLINE DCOM- 20170621 LR - 20220321 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 203 IP - 2 DP - 2016 Jun 15 TI - Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. PG - 424-33 LID - S0022-4804(16)00109-8 [pii] LID - 10.1016/j.jss.2016.03.008 [doi] AB - OBJECTIVES: Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are point-of-care tests (POCT). Bedside ROTEM/TEG can rapidly detect changes in blood coagulation and therefore provide a goal-directed, individualized coagulation therapy. In this meta-analysis, we aimed to determine the current evidence for or against POCT-guided algorithm in patients with severe bleeding after cardiac surgery. METHODS: We performed a meta-analysis of randomized controlled trials and observational trials retrieved from a literature search in PubMed, EMBASE, and Cochrane Library. Only trials comparing transfusion strategy guided by TEG/ROTEM with a standard of care control group undergoing cardiac surgery were included. In addition, at least one clinical outcome had to be mentioned: mortality, surgical re-exploration rate, sternal wound infection, and acute kidney injury (AKI). Also, surrogate parameters such as transfusion requirements and amount of blood loss were analyzed. The pooled treatment effects (odds ratio [OR] and 95% confidence intervals [CI]) were assessed using a fixed or random-effects model. RESULTS: The literature search retrieved a total of 17 trials (nine randomized controlled trial and eight observational trials) involving 8332 cardiac surgery patients. POCT-guided transfusion management significantly decreased the odds for patients to receive allogeneic blood products (OR 0.63, 95% CI 0.56-0.71; P < 0.00001) and the re-exploration rate due to postoperative bleeding (OR 0.56, 95% CI 0.45-0.71; P < 0.00001). Furthermore, the incidence of postoperative AKI (OR 0.77, 95% CI 0.61-0.98; P = 0.0278) and thromboembolic events (OR 0.44, 95% CI 0.28-0.70; P = 0.0006) was significantly decreased in the TEG/ROTEM group. No statistical differences were found with regard to inhospital mortality, cerebrovascular accident, or length of intensive care unit and hospital stay. CONCLUSIONS: TEG/ROTEM-based coagulation management decreases the risk of allogeneic blood product exposure after cardiac surgery. Furthermore, it results in significantly lower re-exploration rate, decreased incidence of postoperative AKI, and thromboembolic events in cardiac surgery patients. Results of this meta-analysis indicate that POCT-guided transfusion therapy is superior to the current standard of care. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Deppe, Antje-Christin AU - Deppe AC AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. Electronic address: antje-christin.deppe@uk-koeln.de. FAU - Weber, Carolyn AU - Weber C AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. FAU - Zimmermann, Julia AU - Zimmermann J AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. FAU - Kuhn, Elmar W AU - Kuhn EW AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. FAU - Slottosch, Ingo AU - Slottosch I AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. FAU - Liakopoulos, Oliver J AU - Liakopoulos OJ AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. FAU - Choi, Yeong-Hoon AU - Choi YH AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany; Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany. FAU - Wahlers, Thorsten AU - Wahlers T AD - Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. LA - eng PT - Journal Article PT - Meta-Analysis DEP - 20160326 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Algorithms MH - Blood Transfusion/*methods MH - *Cardiac Surgical Procedures MH - Clinical Decision-Making/methods MH - Decision Support Techniques MH - Humans MH - Models, Statistical MH - *Point-of-Care Systems MH - Postoperative Hemorrhage/complications/diagnosis/*therapy MH - Thrombelastography/*methods MH - Treatment Outcome OTO - NOTNLM OT - Bleeding OT - Cardiac surgery OT - Point-of-care testing OT - Thromboelastography OT - Thromboelastometry OT - Transfusion management EDAT- 2016/07/02 06:00 MHDA- 2017/06/22 06:00 CRDT- 2016/07/02 06:00 PHST- 2015/12/27 00:00 [received] PHST- 2016/02/07 00:00 [revised] PHST- 2016/03/02 00:00 [accepted] PHST- 2016/07/02 06:00 [entrez] PHST- 2016/07/02 06:00 [pubmed] PHST- 2017/06/22 06:00 [medline] AID - S0022-4804(16)00109-8 [pii] AID - 10.1016/j.jss.2016.03.008 [doi] PST - ppublish SO - J Surg Res. 2016 Jun 15;203(2):424-33. doi: 10.1016/j.jss.2016.03.008. Epub 2016 Mar 26. PMID- 27354213 OWN - NLM STAT- MEDLINE DCOM- 20170324 LR - 20181113 IS - 1502-7686 (Electronic) IS - 0036-5513 (Print) IS - 0036-5513 (Linking) VI - 76 IP - 6 DP - 2016 Oct TI - Is viscoelastic coagulation monitoring with ROTEM or TEG validated? PG - 503-7 LID - 10.1080/00365513.2016.1200136 [doi] AB - Recent years have seen increasing worldwide interest in the use of viscoelastic coagulation monitoring tests, performed using devices such as ROTEM and TEG. The use of such tests to guide haemostatic therapy may help reduce transfusion of allogeneic blood products in bleeding patients and is supported in European guidelines for managing trauma and severe perioperative bleeding. In addition, viscoelastic tests form the basis of numerous published treatment algorithms. However, some publications have stated that viscoelastic tests are not validated. A specific definition of the term validation is lacking and regulatory requirements of the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) have been fulfilled by ROTEM and TEG assays. Viscoelastic tests have been used in pivotal clinical trials, and they are approved for use in most of the world's countries. Provided that locally approved indications are adhered to, the regulatory framework for clinicians to use viscoelastic tests in routine clinical practice is in place. FAU - Solomon, Cristina AU - Solomon C AD - a Department of Anesthesiology, Perioperative Care and General Intensive Care , Paracelsus Medical University, Salzburg University Hospital , Salzburg , Austria , Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre , Vienna , Austria, and CSL Behring , Marburg , Germany ; FAU - Asmis, Lars M AU - Asmis LM AD - b Coagulation Lab and Centre for Perioperative Thrombosis and Hemostasis , Unilabs , Zurich , Switzerland ; FAU - Spahn, Donat R AU - Spahn DR AD - c Institute of Anesthesiology, University and University Hospital of Zurich , Zurich , Switzerland. LA - eng PT - Journal Article DEP - 20160629 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis MH - *Blood Coagulation Tests MH - Elasticity MH - Humans MH - Validation Studies as Topic MH - Viscosity PMC - PMC5152534 OTO - NOTNLM OT - Blood coagulation tests OT - diagnostic techniques and procedures OT - thrombelastography OT - thromboelastometry EDAT- 2016/06/30 06:00 MHDA- 2017/03/25 06:00 PMCR- 2016/12/12 CRDT- 2016/06/30 06:00 PHST- 2016/06/30 06:00 [entrez] PHST- 2016/06/30 06:00 [pubmed] PHST- 2017/03/25 06:00 [medline] PHST- 2016/12/12 00:00 [pmc-release] AID - 1200136 [pii] AID - 10.1080/00365513.2016.1200136 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2016 Oct;76(6):503-7. doi: 10.1080/00365513.2016.1200136. Epub 2016 Jun 29. PMID- 27311005 OWN - NLM STAT- MEDLINE DCOM- 20170202 LR - 20210109 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 95 IP - 24 DP - 2016 Jun TI - Relation of thromboelastography parameters to conventional coagulation tests used to evaluate the hypercoagulable state of aged fracture patients. PG - e3934 LID - 10.1097/MD.0000000000003934 [doi] LID - e3934 AB - Fractures are common among aged people, and rapid assessment of the coagulation status is important. The thromboelastography (TEG) test can give a series of coagulation parameters and has been widely used in clinics. In this research, we looked at fracture patients over 60 and compared their TEG results with those of healthy controls. Since there is a paucity of studies comparing TEG assessments with conventional coagulation tests, we aim to clarify the relationship between TEG values and the values given by conventional coagulation tests.Forty fracture patients (27 femur and 13 humerus) over 60 years old were included in the study. The change in their coagulation status was evaluated by TEG before surgery within 4 hours after the fracture. Changes in TEG parameters were analyzed compared with controls. Conventional coagulation test results for the patients, including activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, and platelets, were also acquired, and correlation analysis was done with TEG parameters, measuring similar aspects of the coagulation cascade. In addition, the sensitivity and specificity of TEG parameters for detecting raised fibrinogen levels were also analyzed.The K (time to 20 mm clot amplitude) and R (reaction time) values of aged fracture patients were lower than controls. The values for angle, maximal amplitude (MA), and coagulation index (CI) were raised compared with controls, indicating a hypercoagulable state. Correlation analysis showed that there were significant positive correlations between fibrinogen and MA/angle, between platelets and MA, and between APTT and R as well. There was significant negative correlation between fibrinogen and K. In addition, K values have better sensitivity and specificity for detecting elevated fibrinogen concentration than angle and MA values.Aged fracture patients tend to be in a hypercoagulable state, and this could be effectively reflected by a TEG test. There were correlations between TEG parameters and corresponding conventional tests. K values can better predict elevated fibrinogen levels in aged fracture patients. FAU - Liu, Chen AU - Liu C AD - Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China. FAU - Guan, Zhao AU - Guan Z FAU - Xu, Qinzhu AU - Xu Q FAU - Zhao, Lei AU - Zhao L FAU - Song, Ying AU - Song Y FAU - Wang, Hui AU - Wang H LA - eng PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R SB - IM EIN - Medicine (Baltimore). 2016 Aug 07;95(31):e5074. doi: 10.1097/01.md.0000490009.39850.74. PMID: 31265618 MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/*physiology MH - Blood Coagulation Tests MH - Female MH - Femoral Fractures/blood/*complications MH - Follow-Up Studies MH - Hemorrhage/*blood/diagnosis/etiology MH - Humans MH - Humeral Fractures/blood/*complications MH - Male MH - Middle Aged MH - Retrospective Studies MH - Thrombelastography/*methods MH - Thrombophilia/blood/complications/*diagnosis PMC - PMC4998491 COIS- The authors have no funding and conflicts of interest to disclose. EDAT- 2016/06/17 06:00 MHDA- 2017/02/06 06:00 PMCR- 2016/06/17 CRDT- 2016/06/17 06:00 PHST- 2016/06/17 06:00 [entrez] PHST- 2016/06/17 06:00 [pubmed] PHST- 2017/02/06 06:00 [medline] PHST- 2016/06/17 00:00 [pmc-release] AID - 00005792-201606140-00065 [pii] AID - 10.1097/MD.0000000000003934 [doi] PST - ppublish SO - Medicine (Baltimore). 2016 Jun;95(24):e3934. doi: 10.1097/MD.0000000000003934. PMID- 27268106 OWN - NLM STAT- MEDLINE DCOM- 20170314 LR - 20170817 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 42 IP - 7 DP - 2016 Nov TI - The influence of thermal trauma on pro- and anticoagulant activity of erythrocyte-derived microvesicles. PG - 1528-1533 LID - S0305-4179(16)30076-6 [pii] LID - 10.1016/j.burns.2016.04.013 [doi] AB - The goal of this research was to study the influence of erythrocyte-derived microvesicles on hemostasis parameters during burn. It was found that the number of microvesicles derived from washed erythrocytes of burn patients after 1 day of storage at 37 degrees C was 4.2 times bigger than the number of microvesicles derived from erythrocytes of healthy donors. Hemocoagulation properties of erythrocyte-derived microvesicles of burn patients also change: according to the results of thromboelastography their procoagulant activity increases significantly, at the same time their antithrombin and fibrinilytic activity decrease. Thus, we can conclude that hepercoagulation during burn is to a certain extent caused by the disruption of the balance between procoagulant activity of erythrocyte-derived microvesicles and their antithrombin and fibrinolytic activity. Hypercoagulation effect of erythrocyte-derived microvesicles increases during burn not just because of their changed properties but also due to their increased number after thermal trauma. CI - Copyright (c) 2016 Elsevier Ltd and ISBI. All rights reserved. FAU - Levin, Grigory AU - Levin G AD - Federal State Budgetary Institution "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia. Electronic address: levin@unn.ac.ru. FAU - Sukhareva, Ekaterina AU - Sukhareva E AD - Federal State Budgetary Institution "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia. Electronic address: ekaterina.syhareva@gmail.com. LA - eng PT - Journal Article DEP - 20160604 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - 0 (Anticoagulants) RN - 0 (Antithrombins) RN - 0 (Blood Coagulation Factors) RN - 0 (Coagulants) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Anticoagulants/*blood MH - Antithrombins MH - Blood Coagulation MH - Blood Coagulation Factors/*metabolism MH - Burns/*blood MH - Case-Control Studies MH - Cell-Derived Microparticles/*physiology MH - Coagulants/*blood MH - *Erythrocytes MH - Female MH - Humans MH - Male MH - Middle Aged MH - Thrombelastography MH - Young Adult OTO - NOTNLM OT - Antithrombin activity OT - Burns OT - Erythrocytes OT - Fibrinilysis OT - Hemostasis OT - Microvesicles EDAT- 2016/06/09 06:00 MHDA- 2017/03/16 06:00 CRDT- 2016/06/09 06:00 PHST- 2015/10/01 00:00 [received] PHST- 2016/04/18 00:00 [revised] PHST- 2016/04/18 00:00 [accepted] PHST- 2016/06/09 06:00 [pubmed] PHST- 2017/03/16 06:00 [medline] PHST- 2016/06/09 06:00 [entrez] AID - S0305-4179(16)30076-6 [pii] AID - 10.1016/j.burns.2016.04.013 [doi] PST - ppublish SO - Burns. 2016 Nov;42(7):1528-1533. doi: 10.1016/j.burns.2016.04.013. Epub 2016 Jun 4. PMID- 27264484 OWN - NLM STAT- MEDLINE DCOM- 20170602 LR - 20180208 IS - 1365-2141 (Electronic) IS - 0007-1048 (Linking) VI - 174 IP - 4 DP - 2016 Aug TI - The utility of thromboelastography in inherited and acquired bleeding disorders. PG - 503-14 LID - 10.1111/bjh.14148 [doi] AB - Thromboelastography (TEG) was first described by Hartert in 1948, and was designed to monitor viscoelastic clot strength in whole blood in real time. The current TEG method and Rotational Thromboelastometry (ROTEM) were subsequently developed from the original principles. Both of the modern methods provide data by measuring changes in the viscoelastic strength of a small sample of clotting blood in response to a constant rotational force. The important advantage of these techniques is to visually observe and quantify blood coagulation including the propagation, stabilization and dissolution phases of clot formation under low shear conditions. Analysis of the results provides detailed kinetic data on fibrin generation, clot strength and fibrinolysis. These TEG/ROTEM analyses therefore enable evaluation of global clotting function and the monitoring of haemostatic treatment in various clinical situations, not only in patients with genetic bleeding disorders, such as haemophilia, but also in patients undergoing cardiac surgery, liver transplantation or suffering from traumatic injury. Some evidence suggests that haemostatic management using TEG/ROTEM leads to a reduction in total transfusions of whole blood or clotting factors. Wider clinical application of this technology seems likely. CI - (c) 2016 John Wiley & Sons Ltd. FAU - Nogami, Keiji AU - Nogami K AD - Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20160605 PL - England TA - Br J Haematol JT - British journal of haematology JID - 0372544 SB - IM MH - Blood Coagulation Disorders/diagnosis MH - Blood Coagulation Tests MH - Hemorrhagic Disorders/*diagnosis MH - Humans MH - Monitoring, Physiologic/methods MH - Thrombelastography/*methods OTO - NOTNLM OT - bleeding disorders OT - haemophilia OT - monitoring OT - thromboelastography EDAT- 2016/06/07 06:00 MHDA- 2017/06/03 06:00 CRDT- 2016/06/07 06:00 PHST- 2016/02/05 00:00 [received] PHST- 2016/03/30 00:00 [accepted] PHST- 2016/06/07 06:00 [entrez] PHST- 2016/06/07 06:00 [pubmed] PHST- 2017/06/03 06:00 [medline] AID - 10.1111/bjh.14148 [doi] PST - ppublish SO - Br J Haematol. 2016 Aug;174(4):503-14. doi: 10.1111/bjh.14148. Epub 2016 Jun 5. PMID- 27206253 OWN - NLM STAT- MEDLINE DCOM- 20170317 LR - 20171116 IS - 1531-2291 (Electronic) IS - 0890-5339 (Linking) VI - 30 IP - 6 DP - 2016 Jun TI - Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study. PG - 299-305 LID - 10.1097/BOT.0000000000000537 [doi] AB - OBJECTIVES: To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures. DESIGN: Retrospective cohort review. SETTING: Level-2 trauma center. PATIENTS: Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation. INTERVENTION: TEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels. MAIN OUTCOME MEASUREMENT: The correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined. RESULTS: More than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) (P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures (P = 0.08). CONCLUSION: TEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. FAU - Mamczak, Christiaan N AU - Mamczak CN AD - *Beacon Orthopaedic Trauma Surgery, South Bend, IN; daggerMemorial Hospital of South Bend, South Bend, IN; double daggerIndiana University School of Medicine, South Bend, IN; section signSelf Regional Hospital, Greenwood, SC; ||General and Vascular Surgery PC, South Bend, IN; and paragraph signW. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN. FAU - Maloney, Megan AU - Maloney M FAU - Fritz, Braxton AU - Fritz B FAU - Boyer, Bryan AU - Boyer B FAU - Thomas, Scott AU - Thomas S FAU - Evans, Ed AU - Evans E FAU - Ploplis, Victoria A AU - Ploplis VA FAU - Castellino, Francis J AU - Castellino FJ FAU - McCollester, Jonathon AU - McCollester J FAU - Walsh, Mark AU - Walsh M LA - eng PT - Journal Article PL - United States TA - J Orthop Trauma JT - Journal of orthopaedic trauma JID - 8807705 SB - IM MH - Acetabulum/injuries/surgery MH - Acute Disease MH - Adolescent MH - Adult MH - Blood Component Transfusion/methods MH - Blood Transfusion/*methods MH - Cohort Studies MH - Combined Modality Therapy MH - Female MH - Follow-Up Studies MH - Fracture Fixation/adverse effects/methods MH - Fractures, Bone/diagnosis/*therapy MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Multiple Trauma/diagnosis/therapy MH - Pelvic Bones/*injuries/surgery MH - Pilot Projects MH - Resuscitation/*methods MH - Retrospective Studies MH - Risk Assessment MH - Thrombelastography/*methods MH - Transfusion Reaction MH - Trauma Centers MH - Treatment Outcome MH - Young Adult EDAT- 2016/05/21 06:00 MHDA- 2017/03/18 06:00 CRDT- 2016/05/21 06:00 PHST- 2016/05/21 06:00 [entrez] PHST- 2016/05/21 06:00 [pubmed] PHST- 2017/03/18 06:00 [medline] AID - 10.1097/BOT.0000000000000537 [doi] PST - ppublish SO - J Orthop Trauma. 2016 Jun;30(6):299-305. doi: 10.1097/BOT.0000000000000537. PMID- 27192467 OWN - NLM STAT- MEDLINE DCOM- 20170629 LR - 20180123 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 81 IP - 2 DP - 2016 Aug TI - Correlation between laboratory coagulation testing and thromboelastometry is modified during management of trauma patients. PG - 319-27 LID - 10.1097/TA.0000000000001109 [doi] AB - BACKGROUND: Thromboelastometry (ROTEM, Pentapharm GmbH, Munich, Germany) is increasingly being used to make a diagnosis of coagulopathy and to guide hemostatic therapy (HT). Although ROTEM parameters and standard laboratory test (SLT) correlated well before administration of HT, it is not known if this correlation persists after hemostatic resuscitation. METHODS: A retrospective analysis of prospectively collected data from a trauma registry (2011-2014) was performed. All patients having a ROTEM analysis were included. ROTEM parameters (clotting time and clot amplitude at 5 minutes) were determined after activation with tissue factor (EXTEM) or platelet inhibition with cytochalasin D (FIBTEM). Spearman rank correlation coefficient was calculated for the correlation between SLT and thromboelastometry parameters, and thresholds were determined with receiver operating characteristic (ROC) curve analysis for the diagnosis of an international normalized ratio (INR) greater than 1.5, fibrinogen 1.5 g/L or less, and platelet count of less than 100.10/L. RESULTS: Of the 358 patients included, 533 thromboelastometry results were obtained (335 at admission, 198 during care). Correlation between INR and EXTEM-clotting time was good at admission (r = 0.617) in the whole cohort but decreased in the subgroup of patients having an Injury Severity Score of less than 25 (r = 0.399) or a base excess of less than 6 mmol/L (r = 0.489). During care, correlation was impaired after the administration of fibrinogen concentrates in the whole cohort (r = 0.430), as well as in the subgroup of patients having an Injury Severity Score greater than 24 (r = 0.465). As well, for the diagnosis of increased INR, sensitivity and the area under the ROC curve decreased from 75% and 0.894 (no treatment) to 20% and 0.653 (fibrinogen concentrate). Areas under the ROC curve for the prediction of a fibrinogen or platelet decrease were not significantly altered regardless of the treatment group. CONCLUSIONS: A decrease in the correlation between SLTs and ROTEM parameters was observed at admission or during care, which could be in relation with injury severity, base deficit, or the administration of blood products, particularly fibrinogen concentrate. Further work will be necessary to better understand which tool is the most suitable for guiding HT. LEVEL OF EVIDENCE: Therapeutic study, level IV; diagnostic study, level IV. FAU - David, Jean-Stephane AU - David JS AD - From the Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon (M.D.); and Charles Merieux-Lyon Sud School of Medicine, University Lyon 1, Oullins (J.-S.D., M.D.); Department of Anesthesiology and Critical Care Medicine, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Benite (J.-S.D., M.L.); Intensive Care Unit, Annecy Hospital, Annecy (A.L., L.R.); Haemostasis and Thrombosis Division, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon (M.-O.G.-B.); Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, California (K.I.); and Department of Anesthesiology and Critical Care Medicine, Hopital Michallon; and INSERM U836, Grenoble (P.B.), France. FAU - Durand, Maeva AU - Durand M FAU - Levrat, Albrice AU - Levrat A FAU - Lefevre, Mathilde AU - Lefevre M FAU - Rugeri, Lucia AU - Rugeri L FAU - Geay-Baillat, Marie-Odile AU - Geay-Baillat MO FAU - Inaba, Kenji AU - Inaba K FAU - Bouzat, Pierre AU - Bouzat P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Blood Coagulation Tests MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Registries MH - Retrospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds and Injuries/complications/*therapy EDAT- 2016/05/19 06:00 MHDA- 2017/07/01 06:00 CRDT- 2016/05/19 06:00 PHST- 2016/05/19 06:00 [entrez] PHST- 2016/05/19 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 10.1097/TA.0000000000001109 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 Aug;81(2):319-27. doi: 10.1097/TA.0000000000001109. PMID- 27168561 OWN - NLM STAT- MEDLINE DCOM- 20180109 LR - 20260127 IS - 1930-613X (Electronic) IS - 0026-4075 (Linking) VI - 181 IP - 5 Suppl DP - 2016 May TI - In Trauma, Conventional ROTEM and TEG Results Are Not Interchangeable But Are Similar in Clinical Applicability. PG - 117-26 LID - 10.7205/MILMED-D-15-00166 [doi] AB - BACKGROUND: There is growing interest in viscoelastic hemostatic assays rotational thromboelastometry (ROTEM) and thromboelastography (TEG) for trauma. Despite shared features, it is unknown whether their results are interchangeable and whether one is clinically superior in predicting mortality, blood transfusion, and diagnosing early trauma coagulopathy. METHODS: We conducted a prospective observational study comparing equivalent ROTEM and TEG parameters. Severely injured patients expected to receive massive transfusion were included. Assays were performed simultaneously on admission and repeated over subsequent 12 hours. International normalized ratio >/=1.2 or fibrinogen <1 g/L defined coagulopathy. TEG used kaolin as coagulation initiator and ROTEM used tissue factor (conventional). Spearman nonparametric analysis and Bland-Altman difference mean plot revealed parameter association. Logistic regression and receiver operating characteristic curves measured predictive values. RESULTS: 33 patients (74 ROTEM, 74 TEG) were included; 79% were male, mean Injury Severity Score was 23.5 +/- 14, admission international normalized ratio was 1.33 +/- 0.4, and 63.4% received blood transfusions. Overall, parameter agreement fell outside acceptable limits, with weak or no association. Clinically, ROTEM maximum clot firmness and TEG maximum amplitude showed reasonable predictive accuracy for mortality, strong accuracy for any or massive blood transfusion, reasonable for plasma transfusion and similar poor predictive accuracy for diagnosing coagulopathy. CONCLUSIONS: ROTEM and TEG results are not interchangeable, arguably due to different coagulation triggers. Assays had similar clinical performance. CI - Reprint & Copyright (c) 2016 Association of Military Surgeons of the U.S. FAU - Rizoli, Sandro AU - Rizoli S AD - St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8. FAU - Min, Arimie AU - Min A AD - St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8. FAU - Sanchez, Adic Perez AU - Sanchez AP AD - Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5. FAU - Shek, Pang AU - Shek P AD - Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9. FAU - Grodecki, Richard AU - Grodecki R AD - Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9. FAU - Veigas, Precilla AU - Veigas P AD - St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8. FAU - Peng, Henry T AU - Peng HT AD - Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - England TA - Mil Med JT - Military medicine JID - 2984771R SB - IM MH - Adolescent MH - Adult MH - Aged MH - Blood Coagulation Tests MH - Blood Transfusion/classification MH - Clinical Laboratory Techniques/methods/standards MH - Female MH - Hemostatic Techniques/*standards MH - Humans MH - Injury Severity Score MH - Logistic Models MH - Male MH - Middle Aged MH - Ontario MH - Prospective Studies MH - Thrombelastography/*methods MH - Wounds and Injuries/blood/*physiopathology EDAT- 2016/05/12 06:00 MHDA- 2018/01/10 06:00 CRDT- 2016/05/12 06:00 PHST- 2016/05/12 06:00 [entrez] PHST- 2016/05/12 06:00 [pubmed] PHST- 2018/01/10 06:00 [medline] AID - 10.7205/MILMED-D-15-00166 [doi] PST - ppublish SO - Mil Med. 2016 May;181(5 Suppl):117-26. doi: 10.7205/MILMED-D-15-00166. PMID- 27168560 OWN - NLM STAT- MEDLINE DCOM- 20180109 LR - 20180122 IS - 1930-613X (Electronic) IS - 0026-4075 (Linking) VI - 181 IP - 5 Suppl DP - 2016 May TI - Dose Responses of Ibuprofen In Vitro on Platelet Aggregation and Coagulation in Human and Pig Blood Samples. PG - 111-6 LID - 10.7205/MILMED-D-15-00381 [doi] AB - INTRODUCTION: Ibuprofen is commonly used by warfighters in the deployed environment. This study investigated its dose effects on in vitro coagulation in human and pig blood. METHODS: Blood samples were collected from 6 normal volunteers and 6 healthy pigs and processed to make platelet-adjusted samples (100 x 10(3)/muL, common transfusion trigger in trauma). Ibuprofen was added to the samples at concentrations of 0 mug/mL (control), the concentration from the highest recommended oral dose (163 mug/mL, 1x), and 2x, 4x, 8x, 10x, 12x, 16x, and 20x. Platelet aggregation by Chrono-Log aggregometer and coagulation by rotational thrombelastogram (Rotem) were assessed at 15 minutes after the addition of ibuprofen. RESULTS: A robust inhibition of ibuprofen on arachidonic acid-induced platelet aggregation was observed at all doses tested in human or pig blood. Collagen-stimulated platelet aggregation was inhibited starting at 1x in human blood and 4x in pig blood. Rotem measurements were similarly compromised in pig and human blood starting at 16x, except clot formation time was prolonged at 1x in human blood (all p < 0.05). CONCLUSION: Ibuprofen inhibited platelet aggregation at recommended doses, and compromised coagulation at higher doses. Human blood was more sensitive to ibuprofen inhibition. Further effort is needed to investigate ibuprofen dose responses on coagulation in vivo. CI - Reprint & Copyright (c) 2016 Association of Military Surgeons of the U.S. FAU - Martini, Wenjun Z AU - Martini WZ AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. FAU - Rodriguez, Cassandra M AU - Rodriguez CM AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. FAU - Deguzman, Rodolfo AU - Deguzman R AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. FAU - Guerra, Jessica B AU - Guerra JB AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. FAU - Martin, Angela K AU - Martin AK AD - Rice University, 6100 Main Street, Houston, TX 77005. FAU - Pusateri, Anthony E AU - Pusateri AE AD - U.S. Army Medical Research and Materiel Command, Fort Detrick, 810 Schreider Street #100, Frederick, MD 21702. FAU - Cap, Andrew P AU - Cap AP AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. FAU - Dubick, Michael A AU - Dubick MA AD - U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-6315. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - Mil Med JT - Military medicine JID - 2984771R RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - WK2XYI10QM (Ibuprofen) SB - IM MH - Adult MH - Animals MH - Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/pharmacology/therapeutic use MH - Blood Coagulation/*drug effects/physiology MH - Blood Coagulation Tests/statistics & numerical data MH - Female MH - Humans MH - Ibuprofen/administration & dosage/*pharmacology/therapeutic use MH - Male MH - Platelet Aggregation/*drug effects/physiology MH - Swine EDAT- 2016/05/12 06:00 MHDA- 2018/01/10 06:00 CRDT- 2016/05/12 06:00 PHST- 2016/05/12 06:00 [entrez] PHST- 2016/05/12 06:00 [pubmed] PHST- 2018/01/10 06:00 [medline] AID - 10.7205/MILMED-D-15-00381 [doi] PST - ppublish SO - Mil Med. 2016 May;181(5 Suppl):111-6. doi: 10.7205/MILMED-D-15-00381. PMID- 27156966 OWN - NLM STAT- MEDLINE DCOM- 20170324 LR - 20170324 IS - 1473-0502 (Print) IS - 1473-0502 (Linking) VI - 55 IP - 1 DP - 2016 Aug TI - Efficacy of solvent/detergent plasma after storage at 2-8 degrees C for 5 days in comparison to other plasma products to improve factor V levels in factor V deficient plasma. PG - 114-9 LID - S1473-0502(16)30018-0 [pii] LID - 10.1016/j.transci.2016.04.015 [doi] AB - OBJECTIVES: Factor V (FV) plays an important role in coagulation. As no purified concentrate is available to restore critical FV levels, the main blood product used to replace FV is plasma. The aim of the present in vitro study was to compare the efficacy of the different available plasma products on the reversal of moderate and severe FV deficiency as assessed by ROTEM(R) and FV levels. METHODS: Five different plasma products (6 batches of each) were compared to determine their effectiveness in replacing FV in plasma moderately or severely deficient in FV. Effectiveness was measured using the ROTEM(R) EXTEM clotting time (CT) and a factor V assay. RESULTS: FFP, plasma frozen within 24 hours (FP24), Octaplas (solvent/detergent treated pooled plasma), as well as Octaplas and FP24 thawed and stored for 5 days (Octaplas TP and TP), were all used for in vitro replacement of FV. TP was significantly less effective at reversing a prolonged EXTEM CT and FV levels in FV deficient plasma than other tested products. There were no significant differences in EXTEM CT between Octaplas and Octaplas TP, while factor V activity was significantly lower in the Octaplas TP. There was no significant difference between Octaplas and FFP for EXTEM CT or FV activity. CONCLUSIONS: Octaplas and Octaplas TP appear to have an equivalent ability to improve the EXTEM CT and could be considered as a treatment alternative to FFP in patients with FV deficiency. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Cushing, Melissa M AU - Cushing MM AD - Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA. FAU - Asmis, Lars AU - Asmis L AD - Unilabs, Coagulation Lab & Centre for Perioperative Thrombosis and Haemostasis, Zurich, Switzerland. FAU - Calabia, Carmencita AU - Calabia C AD - Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA. FAU - Rand, Jacob H AU - Rand JH AD - Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA. FAU - Haas, Thorsten AU - Haas T AD - Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland. Electronic address: thorsten.haas@kispi.uzh.ch. LA - eng PT - Journal Article DEP - 20160426 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 RN - 0 (Detergents) RN - 9001-24-5 (Factor V) MH - *Blood Preservation MH - Detergents/*chemistry MH - Factor V/chemistry/*metabolism MH - Factor V Deficiency/*blood MH - Female MH - Humans MH - Male MH - Plasma/chemistry/*metabolism OTO - NOTNLM OT - Factor V OT - Fresh frozen plasma OT - Plasma OT - Thromboelastometry OT - Trauma EDAT- 2016/05/10 06:00 MHDA- 2017/03/25 06:00 CRDT- 2016/05/10 06:00 PHST- 2016/02/25 00:00 [received] PHST- 2016/03/28 00:00 [revised] PHST- 2016/04/22 00:00 [accepted] PHST- 2016/05/10 06:00 [entrez] PHST- 2016/05/10 06:00 [pubmed] PHST- 2017/03/25 06:00 [medline] AID - S1473-0502(16)30018-0 [pii] AID - 10.1016/j.transci.2016.04.015 [doi] PST - ppublish SO - Transfus Apher Sci. 2016 Aug;55(1):114-9. doi: 10.1016/j.transci.2016.04.015. Epub 2016 Apr 26. PMID- 27120319 OWN - NLM STAT- MEDLINE DCOM- 20170629 LR - 20180123 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 81 IP - 1 DP - 2016 Jul TI - Adipose tissue location and contribution to postinjury hypercoagulability. PG - 79-85 LID - 10.1097/TA.0000000000001096 [doi] AB - OBJECTIVES: Obesity is associated with a hypercoagulable state at baseline and following injury. The anatomic location of adipose deposition may influence the type of thrombotic event, with visceral adipose tissue (VAT) associated with arterial thrombosis and subcutaneous adipose tissue (SAT) predisposing to venous thrombosis. We sought to determine whether adipose tissue amount and location correlated with measures of coagulation. METHODS: All adult Level I trauma activations at our institution between January 2013 and August 2014 who underwent admission abdominal computed tomography scan and had admission rotational thromboelastometry measurements were included. Patients were excluded for history of anticoagulant use and known coagulopathy/hypercoagulable state. Admission computed tomography was used to obtain cross-sectional VAT and SAT areas at the umbilicus utilizing a novel software system; VAT and SAT measurements were associated with markers of coagulation utilizing Spearman correlation and stepwise linear regression with significance set at p < 0.05. RESULTS: Two hundred forty-two patients met inclusion and exclusion criteria. Sixty-nine percent of patients sustained blunt injury, 79% were male, mean age was 40 years, 25% were obese or morbidly obese, and mean Injury Severity Scale score was 17. Seventeen percent of patients had acute deep venous thrombosis or pulmonary embolism during hospitalization. Neither SAT nor VAT correlated with prothrombin time, international normalized ratio, or partial thromboplastin time. Subcutaneous adipose tissue correlated positively with platelet count. Visceral adipose tissue and SAT correlated negatively with clot formation time and positively with TEM fibrinogen, alpha angle, maximum clot firmness, and lysis at 30 minutes; stronger correlations and greater significance were seen between SAT and these measures except for lysis at 30 minutes. Stepwise linear regression confirmed significant relationships between SAT and clot formation time, AA, and maximum clot firmness; VAT showed a significant relationship with TEM fibrinogen. CONCLUSIONS: Increased adipose tissue correlates with relative hypercoagulability following trauma. Subcutaneous adipose tissue shows a stronger relationship with functional measures of coagulation, suggesting that SAT may be associated with hemorrhage resistance and hypercoagulability after injury. LEVEL OF EVIDENCE: Prognostic study, level IV. FAU - Winfield, Robert D AU - Winfield RD AD - From the Department of Surgery (R.D.W.), University of Kansas Medical Center; Department of Radiology (V.M.M., C.R.), Washington University School of Medicine; Department of Surgery (J.C., E.N., W-H.T., R.R., I.R.T., K.B., S.R., G.V.B.), Washington University School of Medicine; and Department of Pediatrics (P.C.S.), Washington University School of Medicine, St. Louis, Missouri. FAU - Mellnick, Vincent M AU - Mellnick VM FAU - Chamieh, Jad AU - Chamieh J FAU - Nohra, Eden AU - Nohra E FAU - Tan, Wen-Hui AU - Tan WH FAU - Ramirez, Ricardo AU - Ramirez R FAU - Raptis, Constantine AU - Raptis C FAU - Turnbull, Isaiah R AU - Turnbull IR FAU - Bochicchio, Kelly AU - Bochicchio K FAU - Reese, Stacey AU - Reese S FAU - Spinella, Philip C AU - Spinella PC FAU - Bochicchio, Grant V AU - Bochicchio GV LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Female MH - Humans MH - Injury Severity Score MH - Intra-Abdominal Fat/*diagnostic imaging MH - Male MH - Obesity/*complications MH - Subcutaneous Fat/*diagnostic imaging MH - Thrombelastography MH - Thrombophilia/*etiology MH - Tomography, X-Ray Computed MH - Wounds and Injuries/*complications EDAT- 2016/04/28 06:00 MHDA- 2017/07/01 06:00 CRDT- 2016/04/28 06:00 PHST- 2016/04/28 06:00 [entrez] PHST- 2016/04/28 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 10.1097/TA.0000000000001096 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 Jul;81(1):79-85. doi: 10.1097/TA.0000000000001096. PMID- 27100747 OWN - NLM STAT- MEDLINE DCOM- 20170619 LR - 20180302 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 56 Suppl 2 DP - 2016 Apr TI - Fibrinolytic shutdown: fascinating theory but randomized controlled trial data are needed. PG - S115-8 LID - 10.1111/trf.13490 [doi] AB - Administration of tranexamic acid (TXA) to bleeding trauma patients who are within 3 hours of injury has been shown to safely reduce mortality in bleeding trauma patients. However, some believe that thromboelastography (TEG or ROTEM) can be used to subdivide these patients into those that will benefit from TXA and those that will be harmed by it. If thromboelastography can be used in this way there could be important patient benefits. However, if the approach is misguided, patients could be denied a lifesaving treatment. I believe that rather than debate the theoretical basis of this hypothesis, it should be tested by conducting a randomized controlled trial. Bleeding trauma patients who are within 3 hours of injury should be randomly allocated to receive TXA treatment or thromboelastometry-guided TXA treatment with the risk of death and complications compared between the groups. An adequately powered clinical trial would better serve patient interest than ongoing debate. CI - (c) 2016 AABB. FAU - Roberts, Ian AU - Roberts I AD - Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK. LA - eng PT - Journal Article PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM CIN - Transfusion. 2016 Apr;56 Suppl 2:S110-4. doi: 10.1111/trf.13486. PMID: 27100746 MH - Antifibrinolytic Agents/*therapeutic use MH - Hemorrhage/drug therapy MH - Humans MH - Injury Severity Score MH - Randomized Controlled Trials as Topic MH - Tranexamic Acid/*therapeutic use EDAT- 2016/04/23 06:00 MHDA- 2017/06/20 06:00 CRDT- 2016/04/22 06:00 PHST- 2015/09/21 00:00 [received] PHST- 2015/11/05 00:00 [revised] PHST- 2015/11/05 00:00 [accepted] PHST- 2016/04/22 06:00 [entrez] PHST- 2016/04/23 06:00 [pubmed] PHST- 2017/06/20 06:00 [medline] AID - 10.1111/trf.13490 [doi] PST - ppublish SO - Transfusion. 2016 Apr;56 Suppl 2:S115-8. doi: 10.1111/trf.13490. PMID- 27072853 OWN - NLM STAT- MEDLINE DCOM- 20170824 LR - 20210703 IS - 1742-481X (Electronic) IS - 1742-4801 (Print) IS - 1742-4801 (Linking) VI - 14 IP - 1 DP - 2017 Feb TI - Clinical experience of surgically treating giant neurofibromatosis-1. PG - 271-276 LID - 10.1111/iwj.12599 [doi] AB - The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. CI - (c) 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd. FAU - Chen, Baoguo AU - Chen B AD - Department of Burn, Plastic and Aesthetic Surgery, The first hospital affiliated to the People's Literative Army Hospital, Beijing, China. FAU - Xu, Minghuo AU - Xu M AD - Department of Burn, Plastic and Aesthetic Surgery, The first hospital affiliated to the People's Literative Army Hospital, Beijing, China. FAU - Song, Huifeng AU - Song H AD - Department of Burn, Plastic and Aesthetic Surgery, The first hospital affiliated to the People's Literative Army Hospital, Beijing, China. FAU - Gao, Quanwen AU - Gao Q AD - Department of Burn, Plastic and Aesthetic Surgery, The first hospital affiliated to the People's Literative Army Hospital, Beijing, China. LA - eng PT - Journal Article DEP - 20160412 PL - England TA - Int Wound J JT - International wound journal JID - 101230907 SB - IM MH - Adult MH - Female MH - General Surgery/*methods/*standards MH - Humans MH - Male MH - Middle Aged MH - Neurofibromatoses/*surgery MH - *Practice Guidelines as Topic PMC - PMC7949877 OTO - NOTNLM OT - Clinical experience OT - Neurofibromatosis-I (NF-1) OT - Surgical treatment EDAT- 2016/04/14 06:00 MHDA- 2017/08/25 06:00 PMCR- 2016/04/12 CRDT- 2016/04/14 06:00 PHST- 2016/02/11 00:00 [received] PHST- 2016/03/10 00:00 [accepted] PHST- 2016/04/14 06:00 [pubmed] PHST- 2017/08/25 06:00 [medline] PHST- 2016/04/14 06:00 [entrez] PHST- 2016/04/12 00:00 [pmc-release] AID - IWJ12599 [pii] AID - 10.1111/iwj.12599 [doi] PST - ppublish SO - Int Wound J. 2017 Feb;14(1):271-276. doi: 10.1111/iwj.12599. Epub 2016 Apr 12. PMID- 27027558 OWN - NLM STAT- MEDLINE DCOM- 20170629 LR - 20180123 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 81 IP - 2 DP - 2016 Aug TI - Inhibition of platelet function is common following even minor injury. PG - 328-32 LID - 10.1097/TA.0000000000001057 [doi] AB - BACKGROUND: Hemorrhage remains the leading cause of preventable death following injury. Whereas significant attention has been paid to the coagulation cascade, there are fewer studies evaluating platelet dysfunction following injury. Thrombelastogram platelet mapping (TEG-PM) allows for the measurement of maximal potential clot strength and clot strength selectively caused by arachidonic acid and adenosine disphosphate receptors on the platelet. The purpose of this study was to determine the incidence and magnitude of receptor-specific platelet dysfunction following injury in patients who are not otherwise pharmacologically anticoagulated. METHODS: A retrospective study of adult trauma patients evaluated at a Level I trauma center from August 2013 to September 2014 was conducted. Platelet function was assessed using TEG-PM. Patients on any anticoagulant or antiplatelet medication were excluded. Patients were divided into those with and without radiographically evident traumatic brain injury (TBI). Demographic variables, Injury Severity Score (ISS), injury pattern, laboratory test results, and mortality were abstracted. Statistical comparisons were made using the Student's t test or Mann-Whitney U-test. RESULTS: The study includes 459 patients, 92% following blunt injury. Median ISS was 5. Patients with TBI (n = 102) were significantly older (median age, 54 years vs. 35 years), were more severely injured (median ISS, 10 vs. 4), had a longer stay and higher mortality (9% vs. 0.3%). Maximal potential clot strength was normal in all cohorts, but the arachidonic acid and adenosine diphosphate pathways were significantly inhibited (30% +/- 26% and 58% +/- 27%, respectively). There was no correlation between TEG-PM values and ISS, length of stay, or mortality. There was no difference in the TBI cohort. There were no significant differences in TEG-PM parameters in those with an ISS greater than 14. There was no significant change in TEG-PM following platelet transfusion. CONCLUSION: Marked platelet inhibition is common following minor injury. Whereas the clinical significance of this finding remains unknown, the results of this study should be factored in the overall resuscitative strategy. LEVEL OF EVIDENCE: Prognostic/epidemiogic study, level III. FAU - Sirajuddin, Sarah AU - Sirajuddin S AD - From the Center for Trauma and Critical Care (S.S., C.V., P.M., R.S., M.S., B.S.), Department of Surgery, and Department of Pathology (L.D.), The George Washington University, Washington, District of Columbia. FAU - Valdez, Carrie AU - Valdez C FAU - DePalma, Louis AU - DePalma L FAU - Maluso, Patrick AU - Maluso P FAU - Singhal, Rishi AU - Singhal R FAU - Schroeder, Mary AU - Schroeder M FAU - Sarani, Babak AU - Sarani B LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Platelet Function Tests MH - Retrospective Studies MH - Thrombelastography/*methods MH - Trauma Centers MH - Wounds and Injuries/*physiopathology EDAT- 2016/03/31 06:00 MHDA- 2017/07/01 06:00 CRDT- 2016/03/31 06:00 PHST- 2016/03/31 06:00 [entrez] PHST- 2016/03/31 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 10.1097/TA.0000000000001057 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 Aug;81(2):328-32. doi: 10.1097/TA.0000000000001057. PMID- 27008408 OWN - NLM STAT- MEDLINE DCOM- 20160728 LR - 20220318 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 11 IP - 3 DP - 2016 TI - Inducing Acute Traumatic Coagulopathy In Vitro: The Effects of Activated Protein C on Healthy Human Whole Blood. PG - e0150930 LID - 10.1371/journal.pone.0150930 [doi] LID - e0150930 AB - INTRODUCTION: Acute traumatic coagulopathy has been associated with shock and tissue injury, and may be mediated via activation of the protein C pathway. Patients with acute traumatic coagulopathy have prolonged PT and PTT, and decreased activity of factors V and VIII; they are also hypocoagulable by thromboelastometry (ROTEM) and other viscoelastic assays. To test the etiology of this phenomenon, we hypothesized that such coagulopathy could be induced in vitro in healthy human blood with the addition of activated protein C (aPC). METHODS: Whole blood was collected from 20 healthy human subjects, and was "spiked" with increasing concentrations of purified human aPC (control, 75, 300, 2000 ng/mL). PT/PTT, factor activity assays, and ROTEM were performed on each sample. Mixed effect regression modeling was performed to assess the association of aPC concentration with PT/PTT, factor activity, and ROTEM parameters. RESULTS: In all subjects, increasing concentrations of aPC produced ROTEM tracings consistent with traumatic coagulopathy. ROTEM EXTEM parameters differed significantly by aPC concentration, with stepwise prolongation of clotting time (CT) and clot formation time (CFT), decreased alpha angle (alpha), impaired early clot formation (a10 and a20), and reduced maximum clot firmness (MCF). PT and PTT were significantly prolonged at higher aPC concentrations, with corresponding significant decreases in factor V and VIII activity. CONCLUSION: A phenotype of acute traumatic coagulopathy can be induced in healthy blood by the in vitro addition of aPC alone, as evidenced by viscoelastic measures and confirmed by conventional coagulation assays and factor activity. This may lend further mechanistic insight to the etiology of coagulation abnormalities in trauma, supporting the central role of the protein C pathway. Our findings also represent a model for future investigations in the diagnosis and treatment of acute traumatic coagulopathy. FAU - Howard, Benjamin M AU - Howard BM AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. FAU - Cheung, Christopher K AU - Cheung CK AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. FAU - Kutcher, Matthew E AU - Kutcher ME AD - Department of Surgery, University of Pittsburgh Medical Center and Presbyterian University Hospital, Pittsburgh, Pennsylvania, United States of America. FAU - Miyazawa, Byron Y AU - Miyazawa BY AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. FAU - Vilardi, Ryan F AU - Vilardi RF AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. FAU - Cohen, Mitchell J AU - Cohen MJ AD - Department of Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California, United States of America. LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - 1 UM1HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20160323 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Protein C) SB - IM MH - Adult MH - Blood Coagulation Disorders/*etiology MH - Humans MH - In Vitro Techniques MH - Protein C/*administration & dosage MH - Thrombelastography PMC - PMC4805205 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2016/03/24 06:00 MHDA- 2016/07/29 06:00 PMCR- 2016/03/23 CRDT- 2016/03/24 06:00 PHST- 2015/04/24 00:00 [received] PHST- 2016/02/22 00:00 [accepted] PHST- 2016/03/24 06:00 [entrez] PHST- 2016/03/24 06:00 [pubmed] PHST- 2016/07/29 06:00 [medline] PHST- 2016/03/23 00:00 [pmc-release] AID - PONE-D-15-17926 [pii] AID - 10.1371/journal.pone.0150930 [doi] PST - epublish SO - PLoS One. 2016 Mar 23;11(3):e0150930. doi: 10.1371/journal.pone.0150930. eCollection 2016. PMID- 26997840 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20160321 LR - 20201001 IS - 0974-0333 (Print) IS - 0975-1947 (Electronic) IS - 0974-0333 (Linking) VI - 9 IP - 3 DP - 2015 Sep-Dec TI - Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. PG - 73-6 LID - 10.5005/jp-journals-10008-1188 [doi] AB - OBJECTIVE: To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs. DESIGN: Case series. SUBJECTS AND PARTICIPANTS: Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb. MAIN OUTCOME MEASURES: Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months. RESULTS: Intraocular pressure was reduced from a mean preoperative level of 26.0 +/- 1.2 (sem) mm Hg to 15.8 +/- 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 +/- 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20). CONCLUSION: Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period. How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76. FAU - Groth, Sylvia L AU - Groth SL AD - Resident, Department of Ophthalmology, University of North Carolina Chapel Hill, North Carolina, USA. FAU - Greider, Kelsi L AU - Greider KL AD - Resident Physician, Chicago Medical School, Chicago, Illinois, USA. FAU - Sponsel, William Eric AU - Sponsel WE AD - Director and Professor, WESMD Professional Association, Baptist Medical Center Biomedical Engineering, University of Texas, Texas and Vision Sciences, University of the Incarnate Word, San Antonio, Texas USA. LA - eng PT - Journal Article DEP - 20160202 PL - India TA - J Curr Glaucoma Pract JT - Journal of current glaucoma practice JID - 101492611 PMC - PMC4779944 OTO - NOTNLM OT - Bleb fibrosis OT - Glaucoma surgery OT - Glaucoma tube shunt OT - Intraocular pressure OT - Modification/revision of glaucoma tube shunt OT - Ocular hypertension OT - Viscoelastic. COIS- Source of support: Nil Conflict of interest: None EDAT- 2016/03/22 06:00 MHDA- 2016/03/22 06:01 PMCR- 2015/09/01 CRDT- 2016/03/22 06:00 PHST- 2015/09/30 00:00 [received] PHST- 2015/10/31 00:00 [accepted] PHST- 2016/03/22 06:00 [entrez] PHST- 2016/03/22 06:00 [pubmed] PHST- 2016/03/22 06:01 [medline] PHST- 2015/09/01 00:00 [pmc-release] AID - 10.5005/jp-journals-10008-1188 [doi] PST - ppublish SO - J Curr Glaucoma Pract. 2015 Sep-Dec;9(3):73-6. doi: 10.5005/jp-journals-10008-1188. Epub 2016 Feb 2. PMID- 26960340 OWN - NLM STAT- MEDLINE DCOM- 20170906 LR - 20220311 IS - 1873-5592 (Electronic) IS - 1389-4501 (Print) IS - 1389-4501 (Linking) VI - 17 IP - 8 DP - 2016 TI - Targeted Thromboelastographic (TEG) Blood Component and Pharmacologic Hemostatic Therapy in Traumatic and Acquired Coagulopathy. PG - 954-70 AB - Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy. FAU - Walsh, Mark AU - Walsh M AD - Memorial Hospital of South Bend, South Bend, Indiana 46601, USA. markwalshmd@gmail.com. FAU - Fritz, Stephanie AU - Fritz S FAU - Hake, Daniel AU - Hake D FAU - Son, Michael AU - Son M FAU - Greve, Sarah AU - Greve S FAU - Jbara, Manar AU - Jbara M FAU - Chitta, Swetha AU - Chitta S FAU - Fritz, Braxton AU - Fritz B FAU - Miller, Adam AU - Miller A FAU - Bader, Mary K AU - Bader MK FAU - McCollester, Jonathon AU - McCollester J FAU - Binz, Sophia AU - Binz S FAU - Liew-Spilger, Alyson AU - Liew-Spilger A FAU - Thomas, Scott AU - Thomas S FAU - Crepinsek, Anton AU - Crepinsek A FAU - Shariff, Faisal AU - Shariff F FAU - Ploplis, Victoria AU - Ploplis V FAU - Castellino, Francis J AU - Castellino FJ LA - eng PT - Journal Article PT - Review PL - United Arab Emirates TA - Curr Drug Targets JT - Current drug targets JID - 100960531 SB - IM MH - Blood Coagulation Disorders/*diagnosis/etiology/*therapy MH - Hemostatic Techniques MH - Humans MH - Partial Thromboplastin Time/methods MH - Platelet Count MH - Prothrombin Time/methods MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications PMC - PMC5374842 EDAT- 2016/03/11 06:00 MHDA- 2017/09/07 06:00 PMCR- 2017/03/31 CRDT- 2016/03/11 06:00 PHST- 2015/06/20 00:00 [received] PHST- 2015/10/13 00:00 [revised] PHST- 2015/12/15 00:00 [accepted] PHST- 2016/03/11 06:00 [entrez] PHST- 2016/03/11 06:00 [pubmed] PHST- 2017/09/07 06:00 [medline] PHST- 2017/03/31 00:00 [pmc-release] AID - CDT-EPUB-74316 [pii] AID - CDT-17-954 [pii] AID - 10.2174/1389450117666160310153211 [doi] PST - ppublish SO - Curr Drug Targets. 2016;17(8):954-70. doi: 10.2174/1389450117666160310153211. PMID- 26920989 OWN - NLM STAT- MEDLINE DCOM- 20160808 LR - 20181113 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 222 IP - 4 DP - 2016 Apr TI - Acute Fibrinolysis Shutdown after Injury Occurs Frequently and Increases Mortality: A Multicenter Evaluation of 2,540 Severely Injured Patients. PG - 347-55 LID - S1072-7515(16)00048-X [pii] LID - 10.1016/j.jamcollsurg.2016.01.006 [doi] AB - BACKGROUND: Fibrinolysis is a physiologic process that maintains microvascular patency by breaking down excessive fibrin clot. Hyperfibrinolysis is associated with a doubling of mortality. Fibrinolysis shutdown, an acute impairment of fibrinolysis, has been recognized as a risk factor for increased mortality. The purpose of this study was to assess the incidence and outcomes of fibrinolysis phenotypes in 2 urban trauma centers. STUDY DESIGN: Injured patients included in the analysis were admitted between 2010 and 2013, were 18 years of age or older, and had an Injury Severity Score (ISS) > 15. Admission fibrinolysis phenotypes were determined by the clot lysis at 30 minutes (LY30): shutdown /= 3%. Logistic regression was used to adjust for age, arrival blood pressure, ISS, mechanism, and facility. RESULTS: There were 2,540 patients who met inclusion criteria. Median age was 39 years (interquartile range [IQR] 26 to 55 years) and median ISS was 25 (IQR 20 to 33), with a mortality rate of 21%. Fibrinolysis shutdown was the most common phenotype (46%) followed by physiologic (36%) and hyperfibrinolysis (18%). Hyperfibrinolysis was associated with the highest death rate (34%), followed by shutdown (22%), and physiologic (14%, p < 0.001). The risk of mortality remained increased for hyperfibrinolysis (odds ratio [OR] 3.3, 95% CI 2.4 to 4.6, p < 0.0001) and shutdown (OR 1.6, 95% CI 1.3 to 2.1, p = 0.0003) compared with physiologic when adjusting for age, ISS, mechanism, head injury, and blood pressure (area under the receiver operating characteristics curve 0.82, 95% CI 0.80 to 0.84). CONCLUSIONS: Fibrinolysis shutdown is the most common phenotype on admission and is associated with increased mortality. These data provide additional evidence of distinct phenotypes of coagulation impairment and that individualized hemostatic therapy may be required. CI - Copyright (c) 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado Denver/Denver Health Medical Center, Denver, CO. Electronic address: hunter.moore@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado Denver/Denver Health Medical Center, Denver, CO. FAU - Liras, Ioannis N AU - Liras IN AD - Department of Surgery, University of Texas Health Science Center at Houston/Memorial Hermann, Houston, TX. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - Department of Surgery, University of Colorado Denver/Denver Health Medical Center, Denver, CO. FAU - Harvin, John A AU - Harvin JA AD - Department of Surgery, University of Texas Health Science Center at Houston/Memorial Hermann, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, University of Texas Health Science Center at Houston/Memorial Hermann, Houston, TX. FAU - Sauaia, Angela AU - Sauaia A AD - Department of Surgery, University of Colorado Denver/Denver Health Medical Center, Denver, CO. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, University of Texas Health Science Center at Houston/Memorial Hermann, Houston, TX. LA - eng GR - P50-GM49222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20160122 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM CIN - J Am Coll Surg. 2016 Apr;222(4):355-6. doi: 10.1016/j.jamcollsurg.2016.01.040. PMID: 27016962 MH - Acute Disease MH - Adult MH - Cohort Studies MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Kaplan-Meier Estimate MH - Logistic Models MH - Male MH - Middle Aged MH - Risk Factors MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/diagnosis/*mortality/*physiopathology MH - Young Adult PMC - PMC4834914 MID - NIHMS754128 EDAT- 2016/02/28 06:00 MHDA- 2016/08/09 06:00 PMCR- 2017/04/01 CRDT- 2016/02/28 06:00 PHST- 2016/01/05 00:00 [received] PHST- 2016/01/06 00:00 [accepted] PHST- 2016/02/28 06:00 [entrez] PHST- 2016/02/28 06:00 [pubmed] PHST- 2016/08/09 06:00 [medline] PHST- 2017/04/01 00:00 [pmc-release] AID - S1072-7515(16)00048-X [pii] AID - 10.1016/j.jamcollsurg.2016.01.006 [doi] PST - ppublish SO - J Am Coll Surg. 2016 Apr;222(4):347-55. doi: 10.1016/j.jamcollsurg.2016.01.006. Epub 2016 Jan 22. PMID- 26888580 OWN - NLM STAT- MEDLINE DCOM- 20170522 LR - 20181113 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 43 IP - 1 DP - 2017 Feb TI - Adenosine diphosphate platelet dysfunction on thromboelastogram is independently associated with increased morality in traumatic brain injury. PG - 105-111 LID - 10.1007/s00068-016-0643-z [doi] AB - PURPOSE: The purpose of this study is to determine if adenosine diphosphate (ADP) platelet dysfunction on thromboelastogram (TEG) is associated with increased in-hospital mortality in patients with head trauma. The hypothesis is that ADP dysfunction is associated with increased mortality. METHODS: This retrospective review evaluated trauma patients admitted to a level 1 trauma center from February 2011 to October 2013 who received a TEG. Patients were included if the TEG was drawn within the first 24 h of admission and the head abbreviated injury score was greater than or equal to three. Patients were categorized as severe ADP dysfunction if the degree of ADP inhibition on TEG exceeded 60 %. RESULTS: A total of 90 patients were included (no ADP dysfunction n = 37; ADP dysfunction n = 53). Initial Glasgow Coma Scale [GCS (12 +/- 4 vs. 11 +/- 5; p = 0.26)] and use of pre-injury antiplatelet agents (30 vs. 28 %; p = 0.88) were similar. Patients with ADP dysfunction on TEG had a higher in-hospital mortality rate (8 vs. 32 %; p < 0.01). ADP dysfunction was independently associated with in-hospital mortality upon fixed logistic regression (OR 6.2; 95 % CI 1.2-33) while controlling for age, gender, hypotension, pre-injury antiplatelet agents, GCS and Injury Severity Score. CONCLUSION: ADP dysfunction on TEG is associated with increased mortality in patients with traumatic brain injury. FAU - Daley, M J AU - Daley MJ AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. mjdaley@seton.org. AD - College of Pharmacy, University of Texas, Austin, TX, USA. mjdaley@seton.org. FAU - Enright, Z AU - Enright Z AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - College of Pharmacy, University of Texas, Austin, TX, USA. FAU - Nguyen, J AU - Nguyen J AD - Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - College of Pharmacy, University of Texas, Austin, TX, USA. FAU - Ali, S AU - Ali S AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. FAU - Clark, A AU - Clark A AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. FAU - Aydelotte, J D AU - Aydelotte JD AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - Dell Medical School, University of Texas, Austin, TX, USA. FAU - Teixeira, P G AU - Teixeira PG AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - Dell Medical School, University of Texas, Austin, TX, USA. FAU - Coopwood, T B AU - Coopwood TB AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - Dell Medical School, University of Texas, Austin, TX, USA. FAU - Brown, C V R AU - Brown CV AD - Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. AD - Dell Medical School, University of Texas, Austin, TX, USA. LA - eng PT - Journal Article DEP - 20160218 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 61D2G4IYVH (Adenosine Diphosphate) SB - IM MH - Adenosine Diphosphate/*blood MH - Aged MH - Blood Platelets/*physiology MH - Brain Injuries, Traumatic/*blood/*mortality MH - Female MH - Glasgow Coma Scale MH - *Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Platelet Function Tests MH - Retrospective Studies MH - *Thrombelastography OTO - NOTNLM OT - Platelet dysfunction OT - TEG OT - Thromboelastogram OT - Traumatic brain injury EDAT- 2016/02/19 06:00 MHDA- 2017/05/23 06:00 CRDT- 2016/02/19 06:00 PHST- 2015/09/24 00:00 [received] PHST- 2016/02/01 00:00 [accepted] PHST- 2016/02/19 06:00 [pubmed] PHST- 2017/05/23 06:00 [medline] PHST- 2016/02/19 06:00 [entrez] AID - 10.1007/s00068-016-0643-z [pii] AID - 10.1007/s00068-016-0643-z [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2017 Feb;43(1):105-111. doi: 10.1007/s00068-016-0643-z. Epub 2016 Feb 18. PMID- 26886005 OWN - NLM STAT- MEDLINE DCOM- 20160915 LR - 20160422 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 80 IP - 5 DP - 2016 May TI - When children become adults and adults become most hypercoagulable after trauma: An assessment of admission hypercoagulability by rapid thrombelastography and venous thromboembolic risk. PG - 778-82 LID - 10.1097/TA.0000000000000985 [doi] AB - BACKGROUND: Thrombelastography (TEG) maximal amplitude (mA) has also been shown to reflect hypercoagulability and increased venous thromboembolism (VTE) risk in adult trauma patients. Based on these previous works, we sought to identify when children become adults with respect to TEG mA values and whether this correlated with VTE risk. METHODS: We evaluated all trauma patients admitted from January 2010 to December 2013 who were highest-level activations. Age was evaluated as a continuous variable, followed by a categorical evaluation. TEG mA values were evaluated as continuous and dichotomous (hypercoagulable, mA >/= 65 mm). Logistic regression was then constructed controlling for age categories, sex, and injury severity to assess the association with TEG mA values and VTE risk. RESULTS: A total of 7,194 Level 1 trauma patients were admitted during this time frame (819 were <18 years of age). The likelihood of mA equal to or greater than 65 mm remained at 35% to 37% through age 30 years with significant increases observed at ages 31 years to 35 years (45%) and 46 years to 50 years (49%), both p < 0.01. When controlling for injury severity, race, and sex, logistic regression demonstrated that every 5-year increase in age (after age 30 years) was associated with a 16% increased likelihood of hypercoagulability at admission. Beginning with age 1 year, VTE risk remained at 1.5% or less until age 13 years where it increased to 2.3%, increasing again at age 15 years to 5.1%. Two additional significant increases were identified between ages 31 years and 35 years (5.5%) as well as 46 years and 50 years (7.6%), both p < 0.001. Logistic regression demonstrated a 3.4-fold increased risk for VTE among those aged 31 years to 50 years compared with those who are younger than 30 years. The same model noted a 2.3-fold increased risk compared with those who are older than 50 years. CONCLUSION: Beginning at age 13 years, children transition toward adult hypercoagulability, as evidenced by elevated TEG mA values and VTE risk. However, the greatest VTE risk (and highest likelihood of hypercoagulable mA) is among those adults 31 years to 50 years of age. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III. FAU - Liras, Ioannis N AU - Liras IN AD - From the Departments of Surgery (I.N.L., E.R., J.H., B.A.C.) and Pediatric Surgery (M.T.H.), The Center for Translational Injury Research (J.H., B.A.C.), and The Center for Surgical Trials and Evidence-based Practice (M.T.H., B.A.C.), The University of Texas Medical School at Houston, Houston, Texas. FAU - Rahbar, Elaheh AU - Rahbar E FAU - Harting, Matthew T AU - Harting MT FAU - Holcomb, John B AU - Holcomb JB FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article PT - Multicenter Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Adult MH - Age Distribution MH - Age Factors MH - Aged MH - Child MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Patient Admission/*statistics & numerical data MH - Prognosis MH - Retrospective Studies MH - Risk Assessment/*methods MH - Risk Factors MH - Sex Distribution MH - Thrombelastography/*methods MH - Thrombophilia/blood/complications/*diagnosis MH - United States/epidemiology MH - Venous Thromboembolism/*diagnosis/epidemiology/etiology MH - Wounds and Injuries/*complications/epidemiology MH - Young Adult EDAT- 2016/02/18 06:00 MHDA- 2016/09/16 06:00 CRDT- 2016/02/18 06:00 PHST- 2016/02/18 06:00 [entrez] PHST- 2016/02/18 06:00 [pubmed] PHST- 2016/09/16 06:00 [medline] AID - 10.1097/TA.0000000000000985 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 May;80(5):778-82. doi: 10.1097/TA.0000000000000985. PMID- 26874143 OWN - NLM STAT- MEDLINE DCOM- 20160620 LR - 20191210 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 82 IP - 2 DP - 2016 Feb TI - Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. PG - 175-80 AB - Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 +/- 289 minutes versus no APA 216 +/- 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 +/- 25.8% versus no APA 62.3 +/- 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 +/- 31% versus no APA 53.8 +/- 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity. FAU - Daley, Mitchell J AU - Daley MJ AD - Departments of Pharmaceutical Services and daggerTrauma Services, University Medical Center Brackenridge, Austin, Texas, USA. FAU - Trust, Marc D AU - Trust MD FAU - Peterson, Evan J AU - Peterson EJ FAU - Luftman, Kevin AU - Luftman K FAU - Miller, Andrew H AU - Miller AH FAU - Ali, Sadia AU - Ali S FAU - Clark, Adam AU - Clark A FAU - Aydelotte, Jayson D AU - Aydelotte JD FAU - Coopwood, Thomas B AU - Coopwood TB FAU - Brown, Carlos V R AU - Brown CV LA - eng PT - Evaluation Study PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Platelets/*drug effects/physiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/*adverse effects MH - Retrospective Studies MH - Sensitivity and Specificity MH - *Thrombelastography MH - Wounds and Injuries/*blood/physiopathology MH - Young Adult EDAT- 2016/02/15 06:00 MHDA- 2016/06/21 06:00 CRDT- 2016/02/14 06:00 PHST- 2016/02/14 06:00 [entrez] PHST- 2016/02/15 06:00 [pubmed] PHST- 2016/06/21 06:00 [medline] PST - ppublish SO - Am Surg. 2016 Feb;82(2):175-80. PMID- 26836808 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20260127 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 29 IP - 2 DP - 2016 Apr TI - Trauma-associated bleeding: management of massive transfusion. PG - 250-5 LID - 10.1097/ACO.0000000000000306 [doi] AB - PURPOSE OF REVIEW: Early treatment goals in the bleeding trauma patient have changed based on recent research findings. Trauma patients requiring a massive transfusion protocol have shown a decreased mortality based on a more aggressive and balanced approach to blood product resuscitation. This chapter will review the recent advances in managing the bleeding trauma patient. RECENT FINDINGS: Recent data have suggested a combined approach of early ratio-based blood product use, bedside viscoelastic hemostatic assays, hemostatic resuscitation, and finally goal-directed therapy to complete resuscitation. SUMMARY: There is now evidence to support the early use of a 1 : 1 : 1 blood product transfusion protocol to restore lost circulating volume, improve oxygen carrying capacity, replace diluted platelets, and replenish clotting factors in massively bleeding trauma patients. Further study is needed to determine whether prehospital initiation of blood products and pharmacological adjuncts will improve outcomes. FAU - Stephens, Christopher T AU - Stephens CT AD - aDepartment of Anesthesiology, Division of Trauma Anesthesiology bCenter for Translational Injury Research cDepartment of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Gumbert, Sam AU - Gumbert S FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) SB - IM MH - *Blood Coagulation MH - Blood Coagulation Factors/*therapeutic use MH - Blood Coagulation Tests MH - Blood Component Transfusion/*methods/standards/trends MH - Clinical Protocols MH - Hemorrhage/etiology/*therapy MH - Hemostasis MH - Humans MH - Injury Severity Score MH - Practice Guidelines as Topic MH - United States MH - Wounds and Injuries/complications/*therapy EDAT- 2016/02/03 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/02/03 06:00 PHST- 2016/02/03 06:00 [entrez] PHST- 2016/02/03 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - 10.1097/ACO.0000000000000306 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2016 Apr;29(2):250-5. doi: 10.1097/ACO.0000000000000306. PMID- 26826624 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20220330 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 208 DP - 2016 Apr 1 TI - Thrombelastography detects dabigatran at therapeutic concentrations in vitro to the same extent as gold-standard tests. PG - 14-8 LID - S0167-5273(16)30146-2 [pii] LID - 10.1016/j.ijcard.2016.01.148 [doi] AB - BACKGROUND/OBJECTIVES: Dabigatran is an oral anticoagulant approved for treatment of non-valvular atrial fibrillation, deep venous thrombosis (DVT), pulmonary embolism and prevention of DVT following orthopedic surgery. Monitoring of the dabigatran level is essential in trauma and bleeding patients but the available plasma-based assays may not sufficiently display its hemostatic effect. This study investigated the in vitro effect of different concentrations of dabigatran on whole blood thrombelastography (TEG) and its correlation to the specific but time-consuming plasma-based tests Hemoclot and Ecarin Clotting Time (ECT). METHOD: Blood was collected from 8 healthy donors (two females, six males) with a median age of 46 years and it was spiked with dabigatran to a range of plasma concentrations (0, 50, 100, 200 and 400 ng/ml) covering the therapeutic level. RESULTS: Mean TEG R at 0 ng/ml=5.963 min, 50 ng/ml=7.425 min, 100 ng/ml=8.425 min, 200 ng/ml=9.775 min, 400 ng/ml=11.813 min. A significant overall increase (p=0.001) in TEG reaction time (R) was found across increasing dabigatran concentrations i.e. 0 vs 50 vs 100 vs 200 vs 400 ng/ml (p<0.000 p=0.027 p=0.026, p=0.005, respectively). TEG R correlated strongly with Hemoclot (R(2)=0.891, p<0000) and ECT (R(2)=0.914, p<0.000) and Hemoclot and ECT were strongly inter-correlated (R(2)=0.978, p<0.000). CONCLUSION: The whole blood viscoelastic assay TEG R displayed linearity towards fixed concentrations of dabigatran and correlated strongly to the current gold-standard tests Hemoclot and ECT, for assessing dabigatran. TEG R is applicable as a rapid and precise whole blood monitoring test for dabigatran treated patients in the emergency setting. CI - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Solbeck, Sacha AU - Solbeck S AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Electronic address: sacha@solbeck.dk. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Department of Surgery, University of Texas Health Medical School, Houston, TX, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160109 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 RN - 0 (Antithrombins) RN - I0VM4M70GC (Dabigatran) SB - IM MH - Adult MH - Antithrombins/*blood/therapeutic use MH - Blood Coagulation/drug effects/physiology MH - Cardiovascular Diseases/blood/drug therapy MH - Dabigatran/*blood/therapeutic use MH - Drug Monitoring/*methods/standards MH - Female MH - Humans MH - Male MH - Middle Aged MH - Reference Standards MH - Thrombelastography/*methods/standards OTO - NOTNLM OT - Anticoagulation OT - Dabigatran OT - Ecarin clotting time OT - Thrombelastography OT - Thrombin time EDAT- 2016/01/31 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/01/31 06:00 PHST- 2015/10/09 00:00 [received] PHST- 2016/01/05 00:00 [revised] PHST- 2016/01/06 00:00 [accepted] PHST- 2016/01/31 06:00 [entrez] PHST- 2016/01/31 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - S0167-5273(16)30146-2 [pii] AID - 10.1016/j.ijcard.2016.01.148 [doi] PST - ppublish SO - Int J Cardiol. 2016 Apr 1;208:14-8. doi: 10.1016/j.ijcard.2016.01.148. Epub 2016 Jan 9. PMID- 26819521 OWN - NLM STAT- MEDLINE DCOM- 20170117 LR - 20240523 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 22 IP - 4 DP - 2016 Jan 28 TI - Hemostasis in liver transplantation: Pathophysiology, monitoring, and treatment. PG - 1541-50 LID - 10.3748/wjg.v22.i4.1541 [doi] AB - Recent findings in the pathophysiology and monitoring of hemostasis in patients with end stage liver disease have major impact on coagulation management during liver transplantation. There is increasing evidence, that the changes in both coagulation factors and platelet count regularly observed in patients with liver cirrhosis cannot be interpreted as a reliable indicator of diffuse bleeding risk. Instead, a differentiated view on hemostasis has led to the concept of a rebalanced coagulation system: While it is important to recognize that procoagulant factors are reduced in liver cirrhosis, it is also evident that synthesis of anticoagulant factors and fibrinolytic proteins produced in the liver is also diminished. Similarly, the decreased platelet count may be counterbalanced by increased platelet aggregability caused by highly active von Willebrand multimeres. The coagulation system is therefor stated to be rebalanced. While under normal "unstressed" conditions diffuse bleeding is rarely observed, however both diffuse bleeding or thrombus formation may occur when compensation mechanisms are exhausted. While most patients presenting for liver transplantation have severe cirrhosis, liver function and thus production of pro- and anticoagulant factors can be preserved especially in cholestatic liver disease. During liver transplantation, profound changes in the hemostasis system can occur. Surgical bleeding can lead to diffuse bleeding as coagulation factors and platelets are already reduced. Ischemia and tissue trauma can lead to alterations of hemostasis comparable to trauma induced coagulopathy. A further common disturbance often starting with the reperfusion of the transplanted organ is hyperfibrinolysis which can eventually precipitate complete consumption of fibrinogen and an endogenous heparinization by glycocalyx shedding. Moreover, thrombotic events in liver transplantations are not uncommon and contribute to increased mortality. Besides conventional laboratory methods, bed-side monitoring of hemostasis (e.g., thrombelastography, thrombelastometry) is often used during liver transplantation to rapidly diagnose decreases in fibrinogen and platelet count as well as hyperfibrinolysis and to guide treatment with blood products, factor concentrates, and antifibrinolytics. There is also evidence which suggests when algorithms based on bed-side hemostasis monitoring are used a reduction of blood loss, blood product use, and eventual mortality are possible. Notably, the bed-side monitoring of anticoagulant pathways and the thrombotic risk is not possible at time and thus a cautious and restrictive use of blood products is recommended. FAU - Hartmann, Matthias AU - Hartmann M AD - Matthias Hartmann, Cynthia Szalai, Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum Essen, Universitat Duisburg-Essen, D-45122 Essen, Germany. FAU - Szalai, Cynthia AU - Szalai C AD - Matthias Hartmann, Cynthia Szalai, Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum Essen, Universitat Duisburg-Essen, D-45122 Essen, Germany. FAU - Saner, Fuat H AU - Saner FH AD - Matthias Hartmann, Cynthia Szalai, Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum Essen, Universitat Duisburg-Essen, D-45122 Essen, Germany. LA - eng PT - Journal Article PT - Review PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) SB - IM MH - *Blood Coagulation/drug effects MH - Blood Coagulation Factors/*metabolism MH - Blood Coagulation Tests MH - Blood Loss, Surgical/prevention & control MH - Blood Platelets/drug effects/*metabolism MH - Blood Transfusion MH - End Stage Liver Disease/blood/diagnosis/physiopathology/*surgery MH - Hemostatics/therapeutic use MH - Humans MH - *Liver Transplantation/adverse effects MH - Point-of-Care Testing MH - Postoperative Hemorrhage/etiology/prevention & control MH - Predictive Value of Tests MH - Risk Factors MH - Thrombosis/etiology/prevention & control MH - Treatment Outcome PMC - PMC4721987 OTO - NOTNLM OT - Bed-side monitoring OT - Coagulation factors OT - Hemostasis OT - Liver transplantation OT - Thrombelastography OT - Thrombelastometry EDAT- 2016/01/29 06:00 MHDA- 2017/01/18 06:00 PMCR- 2016/01/28 CRDT- 2016/01/29 06:00 PHST- 2015/04/27 00:00 [received] PHST- 2015/09/29 00:00 [revised] PHST- 2015/11/13 00:00 [accepted] PHST- 2016/01/29 06:00 [entrez] PHST- 2016/01/29 06:00 [pubmed] PHST- 2017/01/18 06:00 [medline] PHST- 2016/01/28 00:00 [pmc-release] AID - 10.3748/wjg.v22.i4.1541 [doi] PST - ppublish SO - World J Gastroenterol. 2016 Jan 28;22(4):1541-50. doi: 10.3748/wjg.v22.i4.1541. PMID- 26796915 OWN - NLM STAT- MEDLINE DCOM- 20161220 LR - 20170808 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 140 DP - 2016 Apr TI - Hemostatic alterations during coronary artery bypass grafting. PG - 140-146 LID - S0049-3848(15)30233-4 [pii] LID - 10.1016/j.thromres.2015.12.018 [doi] AB - INTRODUCTION: The origination of blood loss after cardiac surgery is not fully explained, but is related to operation trauma and use of cardiopulmonary bypass (CPB). However, the extent of their contribution is incompletely known and might differ between distinct operation procedures. MATERIALS AND METHODS: Three groups of CABG procedures were studied: 1) off-pump coronary artery bypass surgery (OPCAB, n=11) without CPB, 2) CABG with use of CPB (CABG, n=11) and 3) CABG with use of CPB combined with aortic valve replacement (AVR, n=11). Activation of coagulation and fibrinolysis was measured at various time points by flow cytometry, platelet aggregometry, thrombelastography, the Nijmegen Hemostasis Assay, prothrombin fragment 1+2 and tissue plasminogen activator. RESULTS AND CONCLUSIONS: The use of CPB during cardiac surgery decreased platelet counts, clot strength, fibrinogen, hematocrit and albumin concentrations during the procedure. No perioperative platelet activation was observed and functional (collagen induced) platelet aggregation was transiently impaired, but recovered after surgery in all groups. Patients operated with use of CPB showed increased tissue plasminogen activator concentrations after reperfusion followed by minor and transient fibrinolysis. After all types of surgery coagulation parameters and platelet aggregation showed a rebound above preoperative levels. To conclude, no evident platelet activation, dysfunction or consumption was demonstrated. In patients using tranexamic acid the most prominent factor impairing hemostasis after CABG surgery was hemodilution associated with CPB. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Gielen, Chantal L I AU - Gielen CLI AD - Dept. of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), The Netherlands. Electronic address: c.l.i.gielen@lumc.nl. FAU - Brand, Anneke AU - Brand A AD - Sanquin Blood Bank Leiden, Leiden, The Netherlands. FAU - van Heerde, Waander L AU - van Heerde WL AD - Laboratory of Hematology, Dept. of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands. FAU - Stijnen, Theo AU - Stijnen T AD - Dept. of Medical Statistics, LUMC, Leiden, The Netherlands. FAU - Klautz, Robert J M AU - Klautz RJM AD - Dept. of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), The Netherlands. FAU - Eikenboom, Jeroen AU - Eikenboom J AD - Dept. of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20151229 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM CIN - Thromb Res. 2016 Apr;140:147-148. doi: 10.1016/j.thromres.2016.02.018. PMID: 26928139 MH - Aged MH - Aged, 80 and over MH - Blood Coagulation MH - Blood Coagulation Tests MH - Coronary Artery Bypass/*methods MH - Coronary Artery Bypass, Off-Pump/methods MH - Female MH - Hematocrit MH - *Hemostasis MH - Humans MH - Male MH - Middle Aged MH - Platelet Aggregation MH - Platelet Count OTO - NOTNLM OT - Bleeding, bleeding control OT - Blood coagulation OT - Cardiopulmonary bypass OT - Surgery, complications EDAT- 2016/01/23 06:00 MHDA- 2016/12/21 06:00 CRDT- 2016/01/23 06:00 PHST- 2015/08/14 00:00 [received] PHST- 2015/11/16 00:00 [revised] PHST- 2015/12/23 00:00 [accepted] PHST- 2016/01/23 06:00 [entrez] PHST- 2016/01/23 06:00 [pubmed] PHST- 2016/12/21 06:00 [medline] AID - S0049-3848(15)30233-4 [pii] AID - 10.1016/j.thromres.2015.12.018 [doi] PST - ppublish SO - Thromb Res. 2016 Apr;140:140-146. doi: 10.1016/j.thromres.2015.12.018. Epub 2015 Dec 29. PMID- 26784352 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20161230 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 29 IP - 2 DP - 2016 Apr TI - Coagulation management in trauma-associated coagulopathy: allogenic blood products versus coagulation factor concentrates in trauma care. PG - 245-9 LID - 10.1097/ACO.0000000000000304 [doi] AB - PURPOSE OF REVIEW: Coagulation management by transfusion of allogenic blood products and coagulation factors are competing concepts in current trauma care. RECENT FINDINGS: Rapid and adequate therapy of trauma-associated coagulopathy is crucial to survival of severely injured patients. Standard coagulation tests such as prothrombin time and activated partial thromboplastin time are commonly used, but these tests are inappropriate for monitoring and guiding therapy in trauma patients. Coagulation factor-based treatment showed promising results, but randomized trials have not yet been performed. In addition, viscoelastic tests are needed to guide therapy, although there is in fact limited evidence for these in tests in trauma care. Regarding transfusion therapy with allogenic blood products, plasma transfusion has been associated with improved survival in trauma patients following massive transfusion. In contrast, patients not requiring massive transfusion seem to be at risk for suffering complications with increasing volumes of plasma transfused. SUMMARY: The collective of trauma patients is heterogeneous. Despite the lack of evidence, there are strong arguments for individualized patient treatment with coagulation factors for some indications and to abstain from the use of fresh frozen plasma. In patients with severe trauma and major bleeding, plasma, platelets, and red blood cells should be considered to be administered at a ratio of 1 : 1 : 1. FAU - Klages, Matthias AU - Klages M AD - Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany. FAU - Zacharowski, Kai AU - Zacharowski K FAU - Weber, Christian Friedrich AU - Weber CF LA - eng PT - Comparative Study PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Blood Coagulation MH - Blood Coagulation Factors/*therapeutic use MH - Blood Coagulation Tests MH - Blood Component Transfusion/adverse effects/*methods MH - Fibrinogen/metabolism MH - Hemorrhage/diagnosis/etiology/*therapy MH - Hemostasis MH - Humans MH - Plasma MH - Transplantation, Homologous/methods MH - Wounds and Injuries/complications/*therapy EDAT- 2016/01/20 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/01/20 06:00 PHST- 2016/01/20 06:00 [entrez] PHST- 2016/01/20 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - 10.1097/ACO.0000000000000304 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2016 Apr;29(2):245-9. doi: 10.1097/ACO.0000000000000304. PMID- 26741642 OWN - NLM STAT- MEDLINE DCOM- 20170317 LR - 20170317 IS - 1531-2291 (Electronic) IS - 0890-5339 (Linking) VI - 30 IP - 6 DP - 2016 Jun TI - Can Thrombelastography Predict Venous Thromboembolic Events in Patients With Severe Extremity Trauma? PG - 294-8 LID - 10.1097/BOT.0000000000000523 [doi] AB - OBJECTIVES: An elevated maximal amplitude (mA) value with rapid thrombelastography on admission can identify general trauma patients with an increased risk of venous thromboembolic events (VTEs). We hypothesized that (1) the risk of VTE traditionally assigned to injury lies specifically in those who sustain major orthopaedic trauma and (2) an elevated admission mA value could be used to identify patients with major orthopaedic injuries at risk for VTE during initial hospital admission. DESIGN: Retrospective. SETTING: University level 1 trauma center. PATIENTS/PARTICIPANTS: Consecutive trauma patients admitted to an urban level 1 trauma center between September 2009 and February 2011 who met the criteria for level 1 trauma activation and who were between 18 and 85 years of age were included in our study group. Two groups were created, one whose extremity abbreviated injury severity score was 2 or greater (ORTHO) and the other whose extremity abbreviated injury severity score was <2 (non-ORTHO). MAIN OUTCOME MEASUREMENTS: Pulmonary emboli were confirmed by computed tomography angiography, and deep vein thromboses were confirmed by venous duplex. Univariate analyses were conducted and followed by purposeful regression analysis. RESULTS: Of note, 1818 patients met the inclusion criteria (310 ORTHO and 1508 non-ORTHO). Despite more hypocoagulable r-TEG values on arrival (alpha angle 71 vs. 73 and mA 62 vs. 64, both P < 0.05), ORTHO patients had higher rates of VTE (6.5% vs. 2.7%, P < 0.001). Stepwise regression generated 4 values to predict development of VTE (age, male gender, white race, and ORTHO). After controlling for these variables, admission mA values >/=65 (odds ratio 3.66) and >/=72 (odds ratio 6.70) were independent predictors of VTEs during hospitalization. CONCLUSIONS: Admission rapid thrombelastography mA values can identify patients with major orthopaedic trauma injuries who present with an increased risk of in-hospital deep vein thromboses and pulmonary embolism with a 3.6-fold and 6.7-fold increased risk for mA values >/=65 and >/=72, respectively. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. FAU - Gary, Joshua L AU - Gary JL AD - *Department of Orthopaedic Surgery and daggerDepartment of Surgery and the Center for Translational Injury Research (CeTIR), University of Texas Health Science Center, Houston, TX. FAU - Schneider, Prism S AU - Schneider PS FAU - Galpin, Matthew AU - Galpin M FAU - Radwan, Zayde AU - Radwan Z FAU - Munz, John W AU - Munz JW FAU - Achor, Timothy S AU - Achor TS FAU - Prasarn, Mark L AU - Prasarn ML FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article PL - United States TA - J Orthop Trauma JT - Journal of orthopaedic trauma JID - 8807705 SB - IM MH - Adult MH - Aged MH - Arm Injuries/complications/surgery MH - Cohort Studies MH - Extremities/*injuries/surgery MH - Female MH - Follow-Up Studies MH - Humans MH - Injury Severity Score MH - Leg Injuries/complications/diagnosis/surgery MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Pulmonary Embolism/*diagnosis/prevention & control MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Thrombelastography/*methods MH - Trauma Centers MH - Venous Thromboembolism/*diagnosis/prevention & control EDAT- 2016/01/08 06:00 MHDA- 2017/03/18 06:00 CRDT- 2016/01/08 06:00 PHST- 2016/01/08 06:00 [entrez] PHST- 2016/01/08 06:00 [pubmed] PHST- 2017/03/18 06:00 [medline] AID - 10.1097/BOT.0000000000000523 [doi] PST - ppublish SO - J Orthop Trauma. 2016 Jun;30(6):294-8. doi: 10.1097/BOT.0000000000000523. PMID- 29541687 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240620 IS - 2373-9878 (Print) IS - 2373-9878 (Electronic) IS - 2373-9878 (Linking) VI - 2 IP - 3 DP - 2016 TI - A Fibrin Cross-linking Polymer Enhances Clot Formation Similar to Factor Concentrates and Tranexamic Acid in an in vitro Model of Coagulopathy. PG - 403-408 LID - 10.1021/acsbiomaterials.5b00536 [doi] AB - Transfusion of blood components and factor concentrates is clinically used to replenish clotting factors and treat coagulopathy after injury when bleeding is severe. Alternatively, direct manipulation of fibrin polymerization via synthetic cross-linking agents may also improve clot formation during coagulopathic conditions as a novel way to treat coagulopathy. We recently developed a synthetic hemostatic polymer, PolySTAT, that promotes clot formation and stabilizes fibrin network structure by cross-linking fibrin monomers. In this study, we used rotational thromboelastometry (ROTEM) to monitor the effect of PolySTAT on the mechanical strength of clots during clot formation and breakdown in comparison to replacement clotting factors and antifibrinolytics under conditions of simulated trauma-induced coagulopathy (sTIC). Human recombinant activated Factor VII (rFVIIa) shortened clotting onset time and accelerated clotting rate, while tranexamic acid (TXA) eliminated clot lysis and restored maximal clot firmness.In contrast, fibrinogen and PolySTAT were both able to speed up clot formation, increase maximal firmness, and inhibit clot lysis. Furthermore, PolySTAT acted synergistically with TXA and fibrinogen, enhancing their individual effects on clot formation. Thus, manipulating fibrin clot structure by physical cross-linking with a synthetic polymer has beneficial effects on clot formation and may be a viable transfusion strategy for treatment of coagulopathy. FAU - Chan, Leslie W AU - Chan LW AD - Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15 Avenue NE, Box 355061, Seattle, WA 98195, USA. FAU - White, Nathan J AU - White NJ AD - Department of Medicine, Division of Emergency Medicine, University of Washington, Seattle, WA, 98195, USA. FAU - Pun, Suzie H AU - Pun SH AD - Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15 Avenue NE, Box 355061, Seattle, WA 98195, USA. LA - eng GR - KL2 TR000421/TR/NCATS NIH HHS/United States GR - KL2 TR002317/TR/NCATS NIH HHS/United States GR - R21 EB018637/EB/NIBIB NIH HHS/United States GR - T32 EB001650/EB/NIBIB NIH HHS/United States PT - Journal Article DEP - 20160128 PL - United States TA - ACS Biomater Sci Eng JT - ACS biomaterials science & engineering JID - 101654670 PMC - PMC5846629 MID - NIHMS924131 OTO - NOTNLM OT - Fibrin cross-linking OT - Hemostatic polymer OT - ROTEM OT - Trauma-induced coagulopathy EDAT- 2016/01/01 00:00 MHDA- 2016/01/01 00:01 PMCR- 2018/03/12 CRDT- 2018/03/16 06:00 PHST- 2018/03/16 06:00 [entrez] PHST- 2016/01/01 00:00 [pubmed] PHST- 2016/01/01 00:01 [medline] PHST- 2018/03/12 00:00 [pmc-release] AID - 10.1021/acsbiomaterials.5b00536 [doi] PST - ppublish SO - ACS Biomater Sci Eng. 2016;2(3):403-408. doi: 10.1021/acsbiomaterials.5b00536. Epub 2016 Jan 28. PMID- 29497671 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2363-9024 (Electronic) IS - 2363-9024 (Linking) VI - 2 IP - 1 DP - 2016 TI - A case of hemothorax due to traumatic bleeding managed effectively by Sonoclot(R)-guided blood transfusion. PG - 16 LID - 10.1186/s40981-016-0042-9 [doi] LID - 16 AB - A 71-year-old woman was transported to our hospital due to traumatic bleeding, and an operation was immediately performed for achieving hemostasis. We decided to perform Sonoclot(R)-guided blood transfusion. When Sonoclot signatures had returned normal values, further bleeding did not occur. We experienced the first case of traumatic bleeding managed effectively by using Sonoclot. We suggest that a Sonoclot analyzer may be useful for the management of severe coagulopathy due to traumatic bleeding like ROTEM and TEG. FAU - Edanaga, Mitsutaka AU - Edanaga M AD - Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido 060-8543 Japan. FAU - Hoshi, Tomoe AU - Hoshi T AD - Department of Anesthesia, Japanese Red Cross Kitami Hospital, Kitami, Japan. FAU - Azumaguchi, Ryu AU - Azumaguchi R AD - Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido 060-8543 Japan. FAU - Yamakage, Michiaki AU - Yamakage M AD - Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido 060-8543 Japan. LA - eng PT - Journal Article DEP - 20160802 PL - Germany TA - JA Clin Rep JT - JA clinical reports JID - 101682121 PMC - PMC5818838 OTO - NOTNLM OT - Conventional blood coagulation test OT - Sonoclot(R) analyzer OT - Traumatic bleeding EDAT- 2016/01/01 00:00 MHDA- 2016/01/01 00:01 PMCR- 2016/08/02 CRDT- 2018/03/03 06:00 PHST- 2016/06/11 00:00 [received] PHST- 2016/07/29 00:00 [accepted] PHST- 2018/03/03 06:00 [entrez] PHST- 2016/01/01 00:00 [pubmed] PHST- 2016/01/01 00:01 [medline] PHST- 2016/08/02 00:00 [pmc-release] AID - 42 [pii] AID - 10.1186/s40981-016-0042-9 [doi] PST - ppublish SO - JA Clin Rep. 2016;2(1):16. doi: 10.1186/s40981-016-0042-9. Epub 2016 Aug 2. PMID- 26720428 OWN - NLM STAT- MEDLINE DCOM- 20170515 LR - 20260127 IS - 1528-1140 (Electronic) IS - 0003-4932 (Print) IS - 0003-4932 (Linking) VI - 263 IP - 6 DP - 2016 Jun TI - Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays. PG - 1051-9 LID - 10.1097/SLA.0000000000001608 [doi] AB - BACKGROUND: Massive transfusion protocols (MTPs) have become standard of care in the management of bleeding injured patients, yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) to test the hypothesis that an MTP goal directed by the viscoelastic assay thrombelastography (TEG) improves survival compared with an MTP guided by conventional coagulation assays (CCA). METHODS: This RCT enrolled injured patients from an academic level-1 trauma center meeting criteria for MTP activation. Upon MTP activation, patients were randomized to be managed either by an MTP goal directed by TEG or by CCA (ie, international normalized ratio, fibrinogen, platelet count). Primary outcome was 28-day survival. RESULTS: One hundred eleven patients were included in an intent-to-treat analysis (TEG = 56, CCA = 55). Survival in the TEG group was significantly higher than the CCA group (log-rank P = 0.032, Wilcoxon P = 0.027); 20 deaths in the CCA group (36.4%) compared with 11 in the TEG group (19.6%) (P = 0.049). Most deaths occurred within the first 6 hours from arrival (21.8% CCA group vs 7.1% TEG group) (P = 0.032). CCA patients required similar number of red blood cell units as the TEG patients [CCA: 5.0 (2-11), TEG: 4.5 (2-8)] (P = 0.317), but more plasma units [CCA: 2.0 (0-4), TEG: 0.0 (0-3)] (P = 0.022), and more platelets units [CCA: 0.0 (0-1), TEG: 0.0 (0-0)] (P = 0.041) in the first 2 hours of resuscitation. CONCLUSIONS: Utilization of a goal-directed, TEG-guided MTP to resuscitate severely injured patients improves survival compared with an MTP guided by CCA and utilizes less plasma and platelet transfusions during the early phase of resuscitation. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - *Department of Surgery, University of Colorado, Denver, COdaggerDepartment of Surgery, Denver Health Medical Center, Denver, COdouble daggerDepartment of Pediatrics, University of Colorado, Denver, CO section signResearch Laboratory, Bonfils Blood Center, Denver, CO paragraph signColorado School of Public Health, University of Colorado, Denver, CO. FAU - Moore, Ernest E AU - Moore EE FAU - Moore, Hunter B AU - Moore HB FAU - Chapman, Michael P AU - Chapman MP FAU - Chin, Theresa L AU - Chin TL FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Wohlauer, Max V AU - Wohlauer MV FAU - Barnett, Carlton C AU - Barnett CC FAU - Bensard, Denis D AU - Bensard DD FAU - Biffl, Walter L AU - Biffl WL FAU - Burlew, Clay C AU - Burlew CC FAU - Johnson, Jeffrey L AU - Johnson JL FAU - Pieracci, Fredric M AU - Pieracci FM FAU - Jurkovich, Gregory J AU - Jurkovich GJ FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Pragmatic Clinical Trial PT - Randomized Controlled Trial PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM CIN - Ann Surg. 2016 Jun;263(6):1060-1. doi: 10.1097/SLA.0000000000001756. PMID: 27172100 MH - Adult MH - Blood Coagulation Disorders/*etiology/*therapy MH - Blood Transfusion/*standards MH - Colorado MH - Female MH - *Hemostatic Techniques MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Resuscitation/*methods MH - Survival Rate MH - Thrombelastography/*methods MH - Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/complications PMC - PMC5432433 MID - NIHMS855583 COIS- The author reports no conflicts of interest. EDAT- 2016/01/01 06:00 MHDA- 2017/05/16 06:00 PMCR- 2017/05/15 CRDT- 2016/01/01 06:00 PHST- 2016/01/01 06:00 [entrez] PHST- 2016/01/01 06:00 [pubmed] PHST- 2017/05/16 06:00 [medline] PHST- 2017/05/15 00:00 [pmc-release] AID - 10.1097/SLA.0000000000001608 [doi] PST - ppublish SO - Ann Surg. 2016 Jun;263(6):1051-9. doi: 10.1097/SLA.0000000000001608. PMID- 26718322 OWN - NLM STAT- MEDLINE DCOM- 20160801 LR - 20160309 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 56 IP - 3 DP - 2016 Mar TI - The effect of stationary versus rocked storage of whole blood on red blood cell damage and platelet function. PG - 596-604 LID - 10.1111/trf.13448 [doi] AB - BACKGROUND: Increasingly, cold-stored whole blood (WB) is being considered for the resuscitation of civilian trauma patients. It is unclear whether the WB should be agitated to enhance the function of the platelets (PLTs) or whether agitation will cause RBC damage. STUDY DESIGN AND METHODS: WB units were collected by standard procedures using a PLT-sparing inline leukoreduction filter and stored between 1 and 6 degrees C. On Storage Day 3 each unit was divided into 4 subunits that were stored under one of the following conditions for 21 days: unrocked, manually rocked once daily, continuously rocked end over end, or continuously rocked horizontally. From Day 3 to Day 10, hemolysis and the mechanical fragility index (MFI) for RBC injury were measured daily and again on Days 15 and 21 (n = 9-16 units tested each time). On Days 4 and 10, rapid thromboelastogram (rTEG) measurements were performed (n = 8-10 units tested each time). RESULTS: Hemolysis and MFI increased significantly between Day 3 and Day 21 (p < 0.0001) for all RBC rocking conditions, as well as the unrocked units. Only the manually and horizontally rocked units demonstrated higher hemolysis (on Day 21) and MFI (starting on Day 10) compared to the unrocked units. Only the alpha-angle and maximum amplitude in the end-over-end rocked units increased significantly between Day 4 and Day 10. There were no significant differences between the rocked and unrocked units on Day 10 for any rTEG variable. CONCLUSIONS: Rocking does not appear to enhance in vitro PLT activity in cold-stored WB and can lead to increased hemolysis. CI - (c) 2015 AABB. FAU - Yazer, Mark H AU - Yazer MH AD - The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania. AD - Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Glackin, Emily M AU - Glackin EM AD - Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Triulzi, Darrell J AU - Triulzi DJ AD - The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania. AD - Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Alarcon, Louis H AU - Alarcon LH AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Murdock, Alan AU - Murdock A AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Sperry, Jason AU - Sperry J AD - Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. LA - eng PT - Journal Article DEP - 20151231 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Blood Platelets/*cytology MH - Blood Preservation/*methods/*standards MH - Erythrocytes/*cytology MH - Hemolysis/physiology MH - Humans MH - Platelet Activation/physiology EDAT- 2016/01/01 06:00 MHDA- 2016/08/02 06:00 CRDT- 2016/01/01 06:00 PHST- 2015/09/02 00:00 [received] PHST- 2015/09/30 00:00 [revised] PHST- 2015/10/17 00:00 [accepted] PHST- 2016/01/01 06:00 [entrez] PHST- 2016/01/01 06:00 [pubmed] PHST- 2016/08/02 06:00 [medline] AID - 10.1111/trf.13448 [doi] PST - ppublish SO - Transfusion. 2016 Mar;56(3):596-604. doi: 10.1111/trf.13448. Epub 2015 Dec 31. PMID- 26716503 OWN - NLM STAT- MEDLINE DCOM- 20161114 LR - 20161230 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 42 IP - 2 DP - 2016 Mar TI - Indications and Risks of Fibrinogen in Surgery and Trauma. PG - 147-54 LID - 10.1055/s-0035-1564841 [doi] AB - Fibrinogen has a central role in coagulation. Following trauma and perioperatively, low fibrinogen levels have been found to be risk factors for exaggerated bleeding, transfusion needs, and adverse outcome. Conversely, treatment with exogenous fibrinogen in critically bleeding patients with low fibrinogen levels has been shown to decrease transfusion needs. Because following trauma and in many perioperative situations fibrinogen is the first coagulation "element" to become critically low, it appears reasonable to target fibrinogen in clinical coagulation algorithms aiming at early specific and goal-directed treatment. A low fibrinogen can be a low plasma concentration or a low functional fibrinogen as assessed by point-of-care techniques such as thromboelastography (TEG) or thromboelastometry (ROTEM). This review summarizes the evidence base for perioperative algorithm-based fibrinogen administration, including the exact thresholds for fibrinogen administration used in the different algorithms. Algorithm-based individualized goal-directed use of fibrinogen resulted in highly significant reduction in transfusion needs, adverse outcomes, in certain studies even mortality, and where investigated reduced costs, with high safety levels at the same time. Best evidence exists in cardiac surgery, followed by trauma, postpartum hemorrhage, and liver transplantation. The introduction of these concepts is highly demanding and requires a tremendous educational effort to familiarize all health care workers with the necessary knowledge and the skills of how to run TEG/ROTEM tests. Future research is needed to compare the efficacy, safety, and costs of different algorithms. This, however, should not prevent us from introducing these expedient point-of-care-based algorithms clinically today. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Spahn, Donat R AU - Spahn DR AD - University and University Hospital of Zurich, Institute of Anesthesiology, Zurich, Switzerland. FAU - Spahn, Gabriela H AU - Spahn GH AD - University and University Hospital of Zurich, Institute of Anesthesiology, Zurich, Switzerland. FAU - Stein, Philipp AU - Stein P AD - University and University Hospital of Zurich, Institute of Anesthesiology, Zurich, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20151230 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 9001-32-5 (Fibrinogen) SB - IM MH - *Algorithms MH - Blood Coagulation MH - *Cardiac Surgical Procedures MH - Female MH - Fibrinogen/metabolism/*therapeutic use MH - Humans MH - Male MH - Perioperative Care/*methods MH - Postpartum Hemorrhage/*drug therapy MH - Wounds and Injuries/blood/*drug therapy EDAT- 2015/12/31 06:00 MHDA- 2016/11/15 06:00 CRDT- 2015/12/31 06:00 PHST- 2015/12/31 06:00 [entrez] PHST- 2015/12/31 06:00 [pubmed] PHST- 2016/11/15 06:00 [medline] AID - 10.1055/s-0035-1564841 [doi] PST - ppublish SO - Semin Thromb Hemost. 2016 Mar;42(2):147-54. doi: 10.1055/s-0035-1564841. Epub 2015 Dec 30. PMID- 26716502 OWN - NLM STAT- MEDLINE DCOM- 20161114 LR - 20161230 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 42 IP - 2 DP - 2016 Mar TI - Use of Plasma for Acquired Coagulation Factor Deficiencies in Critical Care. PG - 95-101 LID - 10.1055/s-0035-1564830 [doi] AB - Coagulopathy in critically ill patients is common and often multifactorial. Fresh frozen plasma (FFP) is commonly used to correct this either prophylactically or therapeutically. FFP usage is mainly guided by laboratory tests of coagulation, which have been shown to have poor predictive values for bleeding. Viscoelastic tests are an attractive option to guide hemostatic therapy, but require rigorous evaluation. The past few years have seen a gradual reduction in national use of FFP potentially due to an increased awareness of risks such as transfusion-related acute lung injury, patient blood management strategies to reduce transfusion in general, and increased awareness of the lack of high-quality evidence available to support FFP use. Within critical care, FFP is administered before invasive procedures/surgery, to treat major traumatic and nontraumatic hemorrhage, disseminated intravascular coagulation, and for urgent warfarin reversal if first-line agents, such as prothrombin complex concentrate (PCC) are not available. Alternative agents such as fibrinogen concentrate and PCC need further evaluation through large-scale clinical trials. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Shah, Akshay AU - Shah A AD - Nuffied Division of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom. FAU - McKechnie, Stuart AU - McKechnie S AD - Nuffied Division of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Stanworth, Simon AU - Stanworth S AD - Oxford University Hospitals NHS Trust/NHS Blood & Transplant, John Radcliffe Hospital, Oxford, United Kingdom. LA - eng PT - Journal Article PT - Review DEP - 20151230 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Blood Coagulation Factors) SB - IM MH - *Blood Coagulation Factors MH - Blood Component Transfusion/*methods MH - Coagulation Protein Disorders/*therapy MH - Humans MH - *Plasma EDAT- 2015/12/31 06:00 MHDA- 2016/11/15 06:00 CRDT- 2015/12/31 06:00 PHST- 2015/12/31 06:00 [entrez] PHST- 2015/12/31 06:00 [pubmed] PHST- 2016/11/15 06:00 [medline] AID - 10.1055/s-0035-1564830 [doi] PST - ppublish SO - Semin Thromb Hemost. 2016 Mar;42(2):95-101. doi: 10.1055/s-0035-1564830. Epub 2015 Dec 30. PMID- 26707315 OWN - NLM STAT- MEDLINE DCOM- 20160808 LR - 20181202 IS - 1873-2623 (Electronic) IS - 0041-1345 (Linking) VI - 47 IP - 10 DP - 2015 Dec TI - Fibrinogen: A Clinical Update on Liver Transplantation. PG - 2925-8 LID - S0041-1345(15)01017-9 [pii] LID - 10.1016/j.transproceed.2015.10.025 [doi] AB - INTRODUCTION: Hemostatic and coagulation disorders related to severe liver disease may cause massive bleeding beyond what can be expected from surgical trauma in liver transplantation. Fluid resuscitation and fibrinolysis may aggravate the problem, as plasma fibrinogen decreases in all patients. The objective of this review was to update the criteria for fibrinogen replacement in liver transplantation. METHODS: A PubMed and Scopus search from 1990 to 2015 was made. The following key words were used: fibrinogen, liver transplantation, coagulation, and blood product replacement. Controlled trials and observational studies were selected on the basis of clinical relevance. RESULTS: There is a scarcity of published controlled studies on perioperative fibrinogen replacement. Most articles refer to expert opinion; therefore, criteria for the administration of fibrinogen have been empirically established. The response to cryoprecipitate or fibrinogen concentrate administration in liver transplantation has not been established. Viscoelastic platelets free tests have been reported to have a good correlation with Clauss-measured plasma fibrinogen concentration. In surgical patients, the median increase in fibrinogen plasma level per gram injected has been determined in 0.2375 g/L. Alternatively, fibrinogen replacement can be guided based on viscoelastic hemostatic assays. CONCLUSIONS: In liver transplantation, plasma fibrinogen levels are low in most patients during surgery. Fibrinogen administration to correct hypofibrinogenemia has a positive impact on surgical bleeding. However, there is a scarcity of literature about fibrinogen administration; therefore, administration should be adjusted to replace plasma fibrinogen levels in the range of normal and guided by thromboelastometry. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Sabate, A AU - Sabate A AD - Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, IDIBELL, Barcelona, Spain. Electronic address: asabatep@bellvitgehospital.cat. FAU - Dalmau, A AU - Dalmau A AD - Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, IDIBELL, Barcelona, Spain. LA - eng PT - Journal Article PT - Review PL - United States TA - Transplant Proc JT - Transplantation proceedings JID - 0243532 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Afibrinogenemia/*drug therapy/etiology/prevention & control MH - Fibrinogen/*administration & dosage/analysis MH - Hemostasis MH - Hemostasis, Surgical/*methods MH - Humans MH - Intraoperative Care/methods MH - Liver Transplantation/*methods MH - Postoperative Hemorrhage/etiology/*prevention & control MH - Thrombelastography EDAT- 2015/12/29 06:00 MHDA- 2016/08/09 06:00 CRDT- 2015/12/29 06:00 PHST- 2015/07/07 00:00 [received] PHST- 2015/09/28 00:00 [revised] PHST- 2015/10/07 00:00 [accepted] PHST- 2015/12/29 06:00 [entrez] PHST- 2015/12/29 06:00 [pubmed] PHST- 2016/08/09 06:00 [medline] AID - S0041-1345(15)01017-9 [pii] AID - 10.1016/j.transproceed.2015.10.025 [doi] PST - ppublish SO - Transplant Proc. 2015 Dec;47(10):2925-8. doi: 10.1016/j.transproceed.2015.10.025. PMID- 26683875 OWN - NLM STAT- MEDLINE DCOM- 20170126 LR - 20170126 IS - 1557-9816 (Electronic) IS - 0955-470X (Linking) VI - 30 IP - 2 DP - 2016 Apr TI - Intestinal transplantation: The anesthesia perspective. PG - 100-8 LID - S0955-470X(15)00077-4 [pii] LID - 10.1016/j.trre.2015.11.001 [doi] AB - Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis, drug interactions between anesthetic and immunosuppressive agents and venous access are some of the anesthetic considerations for this group. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Dalal, Aparna AU - Dalal A AD - Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, United States. Electronic address: aparna.dalal@mssm.edu. LA - eng PT - Journal Article PT - Review DEP - 20151114 PL - United States TA - Transplant Rev (Orlando) JT - Transplantation reviews (Orlando, Fla.) JID - 8804364 SB - IM MH - Anesthesia/*methods MH - *Graft Survival MH - Humans MH - Intestines/*transplantation MH - *Living Donors MH - *Patient Selection MH - Waiting Lists EDAT- 2015/12/20 06:00 MHDA- 2017/01/27 06:00 CRDT- 2015/12/20 06:00 PHST- 2014/08/12 00:00 [received] PHST- 2015/06/30 00:00 [revised] PHST- 2015/11/11 00:00 [accepted] PHST- 2015/12/20 06:00 [entrez] PHST- 2015/12/20 06:00 [pubmed] PHST- 2017/01/27 06:00 [medline] AID - S0955-470X(15)00077-4 [pii] AID - 10.1016/j.trre.2015.11.001 [doi] PST - ppublish SO - Transplant Rev (Orlando). 2016 Apr;30(2):100-8. doi: 10.1016/j.trre.2015.11.001. Epub 2015 Nov 14. PMID- 28352726 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2391-5463 (Print) IS - 2391-5463 (Electronic) VI - 10 IP - 1 DP - 2015 TI - Research into the Predictive Effect of TEG in the Changes of Coagulation Functions of the Patients with Traumatic Brain Hemorrhage. PG - 399-404 LID - 10.1515/med-2015-0069 [doi] AB - To analyze the predictive effect of thrombelastogram (TEG) in the changes of coagulation functions of patients with traumatic brain hemorrhage, as well as to provide a practice basis for clinical guidance. 54 cases were observed from Aug. 2013-Oct. 2014. All patients received a TEG test 1d, 3d and 7d after traumatic injury. According to the statistical analysis, the comparison among the aforementioned coagulation function parameters in each group of patients, K, alpha and Ma all had significant differences. In the comparison between different time points in the same group, there was still a significant difference. Compared to the patients, the changes of R and K reached the lowest at 1d and the highest at 3d, but there was no significant difference between two groups at 7d. The changes of alpha and Ma reached its highest at 1d and the lowest at 3d after traumatic injury, but there was no significant difference at 7d. There was some difference in changes of coagulation functions between all groups. The former was more serious and the changes of coagulation functions had certain regularity, i.e., after traumatic injury, 1d showed a hypercoagulable state; 3d showed a hypocoagulable state; the coagulation functions of 7d returned to normal. FAU - Liu, Huanqiu AU - Liu H AD - Department of Anesthesiology, the First Hospital of Jilin University, Xin Min Street 71, Chang Chun, Jilin, 130021, China. FAU - Li, Ji AU - Li J AD - Department of Anesthesiology, the First Hospital of Jilin University, Jilin, 130021 China. FAU - Yu, Jinlu AU - Yu J AD - Department of Neurosurgery, the First Hospital of Jilin University, Jilin, 130021 China. FAU - Yuan, Tong AU - Yuan T AD - Department of Anesthesiology, the First Hospital of Jilin University, Jilin, 130021 China. LA - eng PT - Journal Article DEP - 20151217 PL - Poland TA - Open Med (Wars) JT - Open medicine (Warsaw, Poland) JID - 101672167 PMC - PMC5368853 OTO - NOTNLM OT - TEG OT - coagulation functions OT - predictive effect OT - traumatic brain hemorrhage EDAT- 2015/12/17 00:00 MHDA- 2015/12/17 00:01 PMCR- 2015/12/17 CRDT- 2017/03/30 06:00 PHST- 2015/06/29 00:00 [received] PHST- 2015/10/15 00:00 [accepted] PHST- 2017/03/30 06:00 [entrez] PHST- 2015/12/17 00:00 [pubmed] PHST- 2015/12/17 00:01 [medline] PHST- 2015/12/17 00:00 [pmc-release] AID - med-2015-0069 [pii] AID - 10.1515/med-2015-0069 [doi] PST - epublish SO - Open Med (Wars). 2015 Dec 17;10(1):399-404. doi: 10.1515/med-2015-0069. eCollection 2015. PMID- 26650458 OWN - NLM STAT- MEDLINE DCOM- 20170223 LR - 20170817 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 27 IP - 6 DP - 2016 Sep TI - The effect of the perfluorocarbon emulsion Oxycyte on platelet count and function in the treatment of decompression sickness in a swine model. PG - 702-10 LID - 10.1097/MBC.0000000000000481 [doi] AB - Decompression from elevated ambient pressure is associated with platelet activation and decreased platelet counts. Standard treatment for decompression sickness (DCS) is hyperbaric oxygen therapy. Intravenous perfluorocarbon (PFC) emulsion is a nonrecompressive therapy being examined that improves mortality in animal models of DCS. However, PFC emulsions are associated with a decreased platelet count. We used a swine model of DCS to study the effect of PFC therapy on platelet count, function, and hemostasis. Castrated male swine (n = 50) were fitted with a vascular port, recovered, randomized, and compressed to 180 feet of sea water (fsw) for 31 min followed by decompression at 30 fsw/min. Animals were observed for DCS, administered 100% oxygen, and treated with either emulsified PFC Oxycyte (DCS-PFC) or isotonic saline (DCS-NS). Controls underwent the same procedures, but were not compressed (Sham-PFC and Sham-NS). Measurements of platelet count, thromboelastometry, and coagulation were obtained 1 h before compression and 1, 24, 48, 96, 168 and 192 h after treatment. No significant changes in normalized platelet counts were observed. Prothrombin time was elevated in DCS-PFC from 48 to 192 h compared with DCS-NS, and from 96 to 192 h compared with Sham-PFC. Normalized activated partial thromboplastin time was also elevated in DCS-PFC from 168 to 192 h compared with Sham-PFC. No bleeding events were noted. DCS treated with PFC (Oxycyte) does not impact platelet numbers, whole blood clotting by thromboelastometry, or clinical bleeding. Late changes in prothrombin time and activated partial thromboplastin time associated with PFC use in both DCS therapy and controls warrant further investigation. FAU - Cronin, William A AU - Cronin WA AD - Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, Maryland, USA. FAU - Senese, Angela L AU - Senese AL FAU - Arnaud, Francoise G AU - Arnaud FG FAU - Regis, David P AU - Regis DP FAU - Auker, Charles R AU - Auker CR FAU - Mahon, Richard T AU - Mahon RT LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Emulsions) RN - 0 (Fluorocarbons) RN - S88TT14065 (Oxygen) SB - IM MH - Animals MH - Blood Platelets/*drug effects/pathology MH - Decompression Sickness/blood/*drug therapy/physiopathology MH - Disease Models, Animal MH - Emulsions MH - Fluorocarbons/*pharmacology MH - Humans MH - Infusions, Intravenous MH - Male MH - Orchiectomy MH - Oxygen/*pharmacology MH - Partial Thromboplastin Time MH - Platelet Activation/*drug effects MH - Platelet Count MH - Prothrombin Time MH - Swine EDAT- 2015/12/10 06:00 MHDA- 2017/02/24 06:00 CRDT- 2015/12/10 06:00 PHST- 2015/12/10 06:00 [entrez] PHST- 2015/12/10 06:00 [pubmed] PHST- 2017/02/24 06:00 [medline] AID - 10.1097/MBC.0000000000000481 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2016 Sep;27(6):702-10. doi: 10.1097/MBC.0000000000000481. PMID- 26619853 OWN - NLM STAT- MEDLINE DCOM- 20171225 LR - 20261011 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 43 IP - 2 DP - 2017 Apr TI - Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres. PG - 201-214 LID - 10.1007/s00068-015-0608-7 [doi] AB - PURPOSE: Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres. METHODS: A web-based survey of 20 questions was developed using the open source survey application LimeSurvey((R)). It was disseminated among surgeons and anaesthetists in Germany. RESULTS: 145 Questionnaires were returned of which 106 were completed and analysed. Two-thirds of the respondents declared they worked in level I trauma centres. Only 61 % followed a treatment algorithm. Over 90 % used standard laboratory and coagulation tests for decision-making. 56.6 % declared they additionally used extended coagulation assays (TEG/ROTEM). Packed red blood cells, fresh frozen plasma, platelet concentrates, prothrombin complex concentrates, tranexamic acid, calcium, fibrinogen and vitamin K were used by more than 85 % of the respondents for the initial treatment. In all hospitals, irrespective of care level, the first blood product was administered in less than 30 min upon patient arrival (49 % <15 min, 48.1 % <30 min). New oral anticoagulants (NOACs) were identified as an increasing problem in today;s trauma care (>95 %) and 65 % of the respondents necessitated reliable tests for early risk stratification. 57.6 % necessitated interdisciplinary training programs to improve clinical skills. CONCLUSIONS: There is variation in the local infrastructure, logistics and management of trauma haemorrhage and coagulopathy across German trauma centres. More than one-third of the respondents declare they do not consistently follow a treatment algorithm. NOACs are considered as an increasing problem in acute trauma care. FAU - Albrecht, V AU - Albrecht V AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. verena.albrecht@uni-wh.de. FAU - Schafer, N AU - Schafer N AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. FAU - Sturmer, E K AU - Sturmer EK AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. FAU - Driessen, A AU - Driessen A AD - Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. FAU - Betsche, L AU - Betsche L AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. FAU - Schenk, M AU - Schenk M AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. FAU - Maegele, M AU - Maegele M AD - Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany. AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. LA - eng PT - Journal Article DEP - 20151130 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 0 (Anticoagulants) RN - 0 (Hemostatics) SB - IM MH - Anticoagulants/therapeutic use MH - Blood Coagulation Disorders/diagnosis/*therapy MH - Blood Transfusion MH - Germany/epidemiology MH - Guideline Adherence/*statistics & numerical data MH - *Health Care Surveys MH - Hemorrhage/diagnosis/*therapy MH - Hemostatics/therapeutic use MH - Humans MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Surveys and Questionnaires MH - *Trauma Centers MH - Treatment Outcome MH - Wounds and Injuries/complications/diagnosis/*therapy OTO - NOTNLM OT - Coagulopathy OT - Management OT - NOACs OT - Survey OT - Trauma haemorrhage OT - Treatment algorithm EDAT- 2015/12/02 06:00 MHDA- 2017/12/26 06:00 CRDT- 2015/12/02 06:00 PHST- 2015/08/13 00:00 [received] PHST- 2015/11/18 00:00 [accepted] PHST- 2015/12/02 06:00 [pubmed] PHST- 2017/12/26 06:00 [medline] PHST- 2015/12/02 06:00 [entrez] AID - 10.1007/s00068-015-0608-7 [pii] AID - 10.1007/s00068-015-0608-7 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2017 Apr;43(2):201-214. doi: 10.1007/s00068-015-0608-7. Epub 2015 Nov 30. PMID- 26614804 OWN - NLM STAT- MEDLINE DCOM- 20160901 LR - 20151128 IS - 2041-3033 (Electronic) IS - 0954-4119 (Linking) VI - 229 IP - 12 DP - 2015 Dec TI - Hydrogels for central nervous system therapeutic strategies. PG - 905-16 LID - 10.1177/0954411915611700 [doi] AB - The central nervous system shows a limited regenerative capacity, and injuries or diseases, such as those in the spinal, brain and retina, are a great problem since current therapies seem to be unable to achieve good results in terms of significant functional recovery. Different promising therapies have been suggested, the aim being to restore at least some of the lost functions. The current review deals with the use of hydrogels in developing advanced devices for central nervous system therapeutic strategies. Several approaches, involving cell-based therapy, delivery of bioactive molecules and nanoparticle-based drug delivery, will be first reviewed. Finally, some examples of injectable hydrogels for the delivery of bioactive molecules in central nervous system will be reported, and the key features as well as the basic principles in designing multifunctional devices will be described. CI - (c) IMechE 2015. FAU - Russo, Teresa AU - Russo T AD - Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Naples, Italy. FAU - Tunesi, Marta AU - Tunesi M AD - Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano and Unita di Ricerca Consorzio INSTM, Politecnico di Milano, Milan, Italy. FAU - Giordano, Carmen AU - Giordano C AD - Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano and Unita di Ricerca Consorzio INSTM, Politecnico di Milano, Milan, Italy. FAU - Gloria, Antonio AU - Gloria A AD - Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Naples, Italy angloria@unina.it. FAU - Ambrosio, Luigi AU - Ambrosio L AD - Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Naples, Italy. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - England TA - Proc Inst Mech Eng H JT - Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine JID - 8908934 RN - 0 (Hydrogels) SB - IM MH - Animals MH - Biomedical Research MH - *Central Nervous System/injuries/physiology MH - Central Nervous System Diseases/*therapy MH - Drug Delivery Systems MH - Humans MH - *Hydrogels/administration & dosage/chemistry/therapeutic use MH - Mice MH - *Nerve Regeneration/drug effects/physiology OTO - NOTNLM OT - Hydrogels OT - central nervous system OT - injectable materials OT - therapeutic strategies OT - viscoelastic properties EDAT- 2015/11/29 06:00 MHDA- 2016/09/02 06:00 CRDT- 2015/11/29 06:00 PHST- 2015/11/29 06:00 [entrez] PHST- 2015/11/29 06:00 [pubmed] PHST- 2016/09/02 06:00 [medline] AID - 229/12/905 [pii] AID - 10.1177/0954411915611700 [doi] PST - ppublish SO - Proc Inst Mech Eng H. 2015 Dec;229(12):905-16. doi: 10.1177/0954411915611700. PMID- 26595548 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20260127 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 29 IP - 2 DP - 2016 Apr TI - Fixed ratio versus goal-directed therapy in trauma. PG - 234-44 LID - 10.1097/ACO.0000000000000278 [doi] AB - PURPOSE OF REVIEW: This article compares the strategy of a fixed transfusion ratio of plasma and platelet concentrates to red blood cells to reconstitute 'whole blood' with the concept of individualized goal-directed coagulation therapy (GDCT). RECENT FINDINGS: Current data suggest that an early and high ratio of plasma and platelet concentrate transfusion, predominantly in a fixed 1 : 1 : 1 ratio with red blood cells, is associated with improved outcome. However, the optimal ratio is still under discussion. Moreover, storage time considerably affects the hemostatic competence of these products and no universal standard for the composition of these 'transfusion packages' has been established. Some European trauma centers instituted the concept of GDCT in trauma patients, which is based on early diagnosis of the coagulation deficit using point-of-care viscoelastic tests (VETs). These tests provide rapid information about the underlying hemostatic deficiencies, allowing targeted coagulation therapy according to the individual deficits of the patient. Treatment algorithms have been established for the administration of coagulation factor concentrates, and plasma and platelet concentrate based on VET results. SUMMARY: Individualized GDCT, guided by VET, offers several advantages over fixed ratio coagulation therapy. Studies comparing both hemostatic strategies are warranted. FAU - Schochl, Herbert AU - Schochl H AD - aLudwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna bDepartment of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria cDepartment of Trauma and Orthopedic Surgery, University Witten/Herdecke, Cologne, Germany. FAU - Maegele, Marc AU - Maegele M FAU - Voelckel, Wolfgang AU - Voelckel W LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) SB - IM MH - Blood Coagulation Factors MH - Blood Coagulation Tests MH - Erythrocyte Transfusion/*methods MH - Europe MH - Hemorrhage/etiology/*therapy MH - Hemostasis MH - Hemostatics MH - Humans MH - Plasma/cytology MH - Platelet Transfusion/*methods MH - Point-of-Care Systems MH - Trauma Centers MH - Wounds and Injuries/complications/*therapy EDAT- 2015/11/26 06:00 MHDA- 2016/12/15 06:00 CRDT- 2015/11/24 06:00 PHST- 2015/11/24 06:00 [entrez] PHST- 2015/11/26 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - 10.1097/ACO.0000000000000278 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2016 Apr;29(2):234-44. doi: 10.1097/ACO.0000000000000278. PMID- 26514413 OWN - NLM STAT- MEDLINE DCOM- 20160718 LR - 20240520 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 23 DP - 2015 Oct 29 TI - Effect of coagulation factor concentrate administration on ROTEM(R) parameters in major trauma. PG - 84 LID - 10.1186/s13049-015-0165-4 [doi] LID - 84 AB - BACKGROUND: Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated. METHODS: In this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group). RESULTS: The study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3-60.0) years, and the median injury severity score was 34.0 (25.0-44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM. CONCLUSIONS: Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s. This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria. FAU - Ponschab, Martin AU - Ponschab M AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. martin.ponschab@auva.at. FAU - Voelckel, Wolfgang AU - Voelckel W AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. Wolfgang.voelckel@auva.at. FAU - Pavelka, Michaela AU - Pavelka M AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. michela.pavelka@auva.at. FAU - Schlimp, Christoph J AU - Schlimp CJ AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. christoph.schlimp@trauma.lbg.ac.at. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. herbert.schoechl@auva.at. AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Franz Rehrl Platz 5, 5020, Salzburg, Austria. herbert.schoechl@auva.at. LA - eng PT - Journal Article PT - Observational Study DEP - 20151029 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Blood Coagulation Factors) SB - IM MH - Adult MH - Blood Coagulation Disorders MH - Blood Coagulation Factors/*administration & dosage MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Thrombelastography MH - Treatment Outcome MH - Wounds and Injuries/*blood/*therapy PMC - PMC4625604 EDAT- 2015/10/31 06:00 MHDA- 2016/07/19 06:00 PMCR- 2015/10/29 CRDT- 2015/10/31 06:00 PHST- 2015/06/23 00:00 [received] PHST- 2015/10/20 00:00 [accepted] PHST- 2015/10/31 06:00 [entrez] PHST- 2015/10/31 06:00 [pubmed] PHST- 2016/07/19 06:00 [medline] PHST- 2015/10/29 00:00 [pmc-release] AID - 10.1186/s13049-015-0165-4 [pii] AID - 165 [pii] AID - 10.1186/s13049-015-0165-4 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2015 Oct 29;23:84. doi: 10.1186/s13049-015-0165-4. PMID- 26496104 OWN - NLM STAT- MEDLINE DCOM- 20160408 LR - 20151027 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 79 IP - 5 DP - 2015 Nov TI - Platelet function in reconstituted whole blood variants: An observational study over 5 days of storage time. PG - 797-804 LID - 10.1097/TA.0000000000000852 [doi] AB - BACKGROUND: Platelet concentrates (PCs) are usually stored at room temperature under constant gentle agitation. Risk of bacterial contamination limits maximum storage time to 5 days. The objective of the study was to investigate platelet function with regard to storage time in different reconstituted whole blood (RWB) variants. METHODS: Donated apheresis PCs were stored at 22 degrees C over 5 days. To obtain RWB, apheresis PCs were mixed with plasma-free packed red blood cells (RBCs) and either prethawed fresh frozen plasma (PT) or solvent-detergent plasma (SD) [1:1:1 ratio], or with leukocyte- and platelet-depleted whole blood (LD-WB) as control. Platelet function in RWB variants was assessed by impedance aggregometry (Multiplate) on Days 0, 1, 3, and 5 following platelet donation. RESULTS: Platelet aggregometry did not reach the lower limits determined from healthy volunteers in any of the RWB variants. Platelet aggregability measured by ASPI test, ADP test, and COL test declined over storage time in all RWB variants. No differences were observed in the TRAP test. At most measurement time points, LD-RWB provided significantly higher platelet aggregability compared with SD-RWB and PT-RWB (p < 0.01). SD-RWB demonstrated higher platelet aggregability on Day 0 in the ASPI test, ADP test, and TRAP test compared with PT-RWB. CONCLUSION: Apheresis PCs stored for 5 days at 22 degrees C demonstrated reduced platelet aggregability, as measured by multiple electrode aggregometry when mixed with RBCs and plasma. As platelet aggregation in LD-RWB was superior compared with SD-RWB and PT-RWB variants, it might be possible that additives in RBCs or plasma are responsible for the observed depressed platelet function. Critical evaluation of current massive transfusion recommendations proposing early platelet transfusion is indicated. FAU - Ponschab, Martin AU - Ponschab M AD - From the Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (M.P., C.J.S., J.Z., H.R., H.S.), AUVA Research Centre; and Department of Anaesthesia, General Intensive Care and Pain Control (J.G.), Medical University of Vienna, Vienna; Red Cross Blood Transfusion Service for Upper Austria (C.G., S.S.), Linz; Department of Laboratory Medicine (J.C.), Paracelsus Medical University Salzburg; and Department of Anaesthesiology and Intensive Care (H.S.), AUVA Trauma Centre, Salzburg, Austria. FAU - Schlimp, Christoph J AU - Schlimp CJ FAU - Zipperle, Johannes AU - Zipperle J FAU - Gabriel, Christian AU - Gabriel C FAU - Sussner, Susanne AU - Sussner S FAU - Cadamuro, Janne AU - Cadamuro J FAU - Gratz, Johannes AU - Gratz J FAU - Redl, Heinz AU - Redl H FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Analysis of Variance MH - *Blood Banks MH - Blood Platelets/*physiology MH - Blood Preservation/*methods MH - Blood Safety MH - Female MH - Humans MH - Male MH - Platelet Aggregation/*physiology MH - Platelet Function Tests MH - Platelet Transfusion MH - Risk Assessment MH - Sensitivity and Specificity MH - Thrombelastography/methods MH - Time Factors MH - Trauma Severity Indices MH - Wounds and Injuries/diagnosis/therapy EDAT- 2015/10/27 06:00 MHDA- 2016/04/09 06:00 CRDT- 2015/10/27 06:00 PHST- 2015/10/27 06:00 [entrez] PHST- 2015/10/27 06:00 [pubmed] PHST- 2016/04/09 06:00 [medline] AID - 01586154-201511000-00012 [pii] AID - 10.1097/TA.0000000000000852 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Nov;79(5):797-804. doi: 10.1097/TA.0000000000000852. PMID- 26491796 OWN - NLM STAT- MEDLINE DCOM- 20160419 LR - 20220318 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 80 IP - 1 DP - 2016 Jan TI - Overwhelming tPA release, not PAI-1 degradation, is responsible for hyperfibrinolysis in severely injured trauma patients. PG - 16-23; discussion 23-5 LID - 10.1097/TA.0000000000000885 [doi] AB - BACKGROUND: Trauma-induced coagulopathy (TIC) is associated with a fourfold increased risk of mortality. Hyperfibrinolysis is a component of TIC, but its mechanism is poorly understood. Plasminogen activation inhibitor (PAI-1) degradation by activated protein C has been proposed as a mechanism for deregulation of the plasmin system in hemorrhagic shock, but in other settings of ischemia, tissue plasminogen activator (tPA) has been shown to be elevated. We hypothesized that the hyperfibrinolysis in TIC is not the result of PAI-1 degradation but is driven by an increase in tPA, with resultant loss of PAI-1 activity through complexation with tPA. METHODS: Eighty-six consecutive trauma activation patients had blood collected at the earliest time after injury and were screened for hyperfibrinolysis using thrombelastography (TEG). Twenty-five hyperfibrinolytic patients were compared with 14 healthy controls using enzyme-linked immunosorbent assays for active tPA, active PAI-1, and PAI-1/tPA complex. Blood was also subjected to TEG with exogenous tPA challenge as a functional assay for PAI-1 reserve. RESULTS: Total levels of PAI-1 (the sum of the active PAI-1 species and its covalent complex with tPA) are not significantly different between hyperfibrinolytic trauma patients and healthy controls: median, 104 pM (interquartile range [IQR], 48-201 pM) versus 115 pM (IQR, 54-202 pM). The ratio of active to complexed PAI-1, however, was two orders of magnitude lower in hyperfibrinolytic patients than in controls. Conversely, total tPA levels (active + complex) were significantly higher in hyperfibrinolytic patients than in controls: 139 pM (IQR, 68-237 pM) versus 32 pM (IQR, 16-37 pM). Hyperfibrinolytic trauma patients displayed increased sensitivity to exogenous challenge with tPA (median LY30 of 66.8% compared with 9.6% for controls). CONCLUSION: Depletion of PAI-1 in TIC is driven by an increase in tPA, not PAI-1 degradation. The tPA-challenged TEG, based on this principle, is a functional test for PAI-1 reserves. Exploration of the mechanism of up-regulation of tPA is critical to an understanding of hyperfibrinolysis in trauma. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level II. FAU - Chapman, Michael P AU - Chapman MP AD - From the Department of Surgery (M.P.C., E.E.M, H.B.M, E.G., F.G.S., J.G.C., S.M., A.G., T.L.C., A.S., A.B., C.C.S.), University of Colorado-Denver; Department of Surgery, Denver Health Medical Center (M.P.C., E.E.M., H.B.M. E.G., J.G.C. A.G., T.L.C., A.S.); Department of Surgery, Georgia Regents University (M.P.C.); Department of Hematology and Oncology (C.C.S.), Children's Hospital Colorado; and Bonfils Blood Center (C.C.S.), Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Moore, Hunter B AU - Moore HB FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Gamboni, Fabia AU - Gamboni F FAU - Chandler, James G AU - Chandler JG FAU - Mitra, Sanchayita AU - Mitra S FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chin, Theresa L AU - Chin TL FAU - Sauaia, Angela AU - Sauaia A FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UMHL120877/PHS HHS/United States GR - T32GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Plasminogen Activator Inhibitor 1) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Blood Coagulation Disorders/physiopathology MH - Case-Control Studies MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Plasminogen Activator Inhibitor 1/*blood MH - Thrombelastography MH - Tissue Plasminogen Activator/*blood MH - Wounds and Injuries/*blood PMC - PMC4688194 MID - NIHMS730539 EDAT- 2015/10/23 06:00 MHDA- 2016/04/20 06:00 PMCR- 2017/01/01 CRDT- 2015/10/23 06:00 PHST- 2015/10/23 06:00 [entrez] PHST- 2015/10/23 06:00 [pubmed] PHST- 2016/04/20 06:00 [medline] PHST- 2017/01/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000000885 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 Jan;80(1):16-23; discussion 23-5. doi: 10.1097/TA.0000000000000885. PMID- 26488324 OWN - NLM STAT- MEDLINE DCOM- 20160505 LR - 20181113 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 79 IP - 6 DP - 2015 Dec TI - The "Death Diamond": Rapid thrombelastography identifies lethal hyperfibrinolysis. PG - 925-9 LID - 10.1097/TA.0000000000000871 [doi] AB - BACKGROUND: Postinjury hyperfibrinolysis (HF), defined as LY30 of 3% or greater on rapid thrombelastography (rTEG), is associated with high mortality and large use of blood products. We observed that some cases of HF are reversible and are associated with patients who respond to hemostatic resuscitation; however, other cases of severe HF seem to be associated with these patients' inevitable demise. We therefore sought to define this unsurvivable subtype of HF as a recognizable rTEG tracing pattern. METHODS: We queried our trauma registry for patients who either died or spent at least 1 day in the intensive care unit, received at least 1 U of packed red blood cells, and had an admission rTEG. Within this group of 572 patients, we identified 42 pairs of nonsurvivors and survivors who matched on age, sex, injury mechanism, and New Injury Severity Score (NISS). We inspected the rTEG tracings to ascertain if any pattern was found exclusively within the nonsurviving group and applied these findings to the cohort of 572 patients to assess the predictive value for mortality. RESULTS: Within the matched group, 17% of the patients developed HF. Within the HF subgroup, a unique rTEG pattern was present in 14 HF patients who died and in none of the survivors. This pattern was a "diamond-shaped" tracing with a short time to maximum amplitude of 14 minutes or shorter and complete lysis before the LY30 point. When these criteria are applied to the 572 unmatched patients, this pattern had a 100% positive predictive value for mortality. CONCLUSION: Patients displaying the "death diamond" pattern on their admission rTEG are at higher risk for mortality. Given the volume of blood products and other resources that these patients consume, this thrombelastography pattern may represent an objective criterion to discontinue efforts at hemostatic resuscitation. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III. FAU - Chapman, Michael P AU - Chapman MP AD - From the Department of Surgery (M.P.C., E.E.M., J.C., C.D.F., H.B.M., E.G., A.P.M., A.G., C.C.S., A.B., A.S.), University of Colorado Denver; Department of Surgery, Denver Health Medical Center (M.P.C., E.E.M., J.C., C.D.F., H.B.M., E.G., A.P.M., A.G.), Denver; and Bonfils Blood Center (C.C.S.), and Department of Hematology and Oncology (C.C.S.), Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, Georgia Regents University (M.P.C.), Augusta, Georgia. FAU - Moore, Ernest E AU - Moore EE FAU - Moore, Hunter B AU - Moore HB FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Morton, Alexander P AU - Morton AP FAU - Chandler, James AU - Chandler J FAU - Fleming, Courtney D AU - Fleming CD FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UMHL120877/PHS HHS/United States GR - T32GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*blood/mortality/physiopathology MH - Critical Care MH - Erythrocyte Transfusion MH - Female MH - Fibrinolysis/physiology MH - Humans MH - Incidence MH - Injury Severity Score MH - Male MH - Registries MH - Retrospective Studies MH - Survival Analysis MH - *Thrombelastography PMC - PMC4684985 MID - NIHMS723096 EDAT- 2015/10/22 06:00 MHDA- 2016/05/06 06:00 PMCR- 2016/12/01 CRDT- 2015/10/22 06:00 PHST- 2015/10/22 06:00 [entrez] PHST- 2015/10/22 06:00 [pubmed] PHST- 2016/05/06 06:00 [medline] PHST- 2016/12/01 00:00 [pmc-release] AID - 10.1097/TA.0000000000000871 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Dec;79(6):925-9. doi: 10.1097/TA.0000000000000871. PMID- 26488322 OWN - NLM STAT- MEDLINE DCOM- 20160505 LR - 20151219 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 79 IP - 6 DP - 2015 Dec TI - A new kid on the block: Outcomes with Kcentra 1 year after approval. PG - 1004-8 LID - 10.1097/TA.0000000000000868 [doi] AB - BACKGROUND: As the population ages, more trauma patients are admitted with coagulopathy. Fresh frozen plasma is effective in reversing coagulopathy caused by warfarin; however, it is not appropriate for all patients. Prothrombin complex concentrates (PCCs) are an alternative for patients who require emergent reversal, minimal-volume administration and who have a supratherapeutic international normalized ratio (INR). A four-factor PCC initially approved in Europe is now available in the United States. We sought to review our experience with Kcentra (4F-PCC) in the first year following Food and Drug Administration approval. METHODS: All trauma patients admitted to an academic Level 1 trauma center between July 15, 2013, and July 15, 2014, who received 4F-PCC for reversal of warfarin-induced coagulopathy were reviewed. 4F-PCC was given as per protocol. Univariate analysis was performed to examine patient demographics, injury characteristics, coagulation studies, 4F-PCC dose, vitamin K use, transfusions, response to reversal, duration of reversal, complications, and mortality. RESULTS: Twenty-six patients met study criteria. Of these patients, 34.6% were reversed because of intracranial hemorrhage. The mean INR decreased from 5.7 +/- 6.1 (range, 1.6-30) to 1.5 +/- 0.4 (range, 1.2-2.6) after 4F-PCC administration. One patient (3.8%) received concurrent fresh frozen plasma. For patients with an initial INR greater than 5.0, the mean INR decreased from 12.0 +/- 8.2 to 1.6 +/- 0.5. Forty-eight hours following 4F-PCC administration, mean INR for all patients remained 1.4 +/- 0.4 (range, 1.0-2.6). Of the patients, 80.8% received vitamin K over this period. Fourteen patients had a pre-4F-PCC thromboelastogram; four were hypocoagulable. Two patients had repeat thromboelastograms after 4F-PCC was given, which demonstrated normal coagulation. Of the patients with intracranial hemorrhage, 66.7% showed radiographic progression of the initial insult on post-4F-PCC head computed tomography, while only 11.1% progressed clinically. In-hospital mortality was 0%. There were no thromboembolic complications. CONCLUSION: 4F-PCC effectively reverses elevated INRs in trauma patients with warfarin-induced coagulopathy, with results lasting more than 48 hours after administration. LEVEL OF EVIDENCE: Therapeutic study, level V. FAU - Berndtson, Allison E AU - Berndtson AE AD - From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (A.E.B., L.K., L.N.G., A.M.S., R.C.), Department of Pharmacy (W.-T.H., K.B.), and Division of Neurosurgery (D.W.), University of California, San Diego, La Jolla, California. FAU - Huang, Wan-Ting AU - Huang WT FAU - Box, Kevin AU - Box K FAU - Kobayashi, Leslie AU - Kobayashi L FAU - Godat, Laura N AU - Godat LN FAU - Smith, Alan M AU - Smith AM FAU - Weingarten, David AU - Weingarten D FAU - Coimbra, Raul AU - Coimbra R LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 5Q7ZVV76EI (Warfarin) SB - IM MH - Aged MH - Blood Coagulation Disorders/*chemically induced/*drug therapy MH - Blood Coagulation Factors/administration & dosage/adverse effects/*therapeutic use MH - Drug Approval MH - Female MH - Humans MH - International Normalized Ratio MH - Male MH - Retrospective Studies MH - Thrombelastography MH - Time Factors MH - Trauma Centers MH - Trauma Severity Indices MH - Warfarin/*adverse effects EDAT- 2015/10/22 06:00 MHDA- 2016/05/06 06:00 CRDT- 2015/10/22 06:00 PHST- 2015/10/22 06:00 [entrez] PHST- 2015/10/22 06:00 [pubmed] PHST- 2016/05/06 06:00 [medline] AID - 10.1097/TA.0000000000000868 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Dec;79(6):1004-8. doi: 10.1097/TA.0000000000000868. PMID- 26469100 OWN - NLM STAT- MEDLINE DCOM- 20151123 LR - 20181023 IS - 1899-5276 (Print) IS - 1899-5276 (Linking) VI - 24 IP - 4 DP - 2015 Jul-Aug TI - Pre-Hospital Induced Hypothermia Improves Outcomes in a Pig Model of Traumatic Hemorrhagic Shock. PG - 571-8 LID - 10.17219/acem/29044 [doi] AB - BACKGROUND: Extensive preclinical evidence suggests that induced hypothermia can protect tissues from ischemia-reperfusion injury, reduce organ damage, and improve survival in the advanced stages of shock. OBJECTIVES: We assessed the effects of induced hypothermia on the hemodynamic parameters and coagulation capacity during hemorrhagic shock (HS) and fluid resuscitation, in a pig model of HS with multiple intestinal perforations. MATERIAL AND METHODS: Pigs (n=16) were randomized into 2 groups: a hypothermia (HT) group (n=8, 34 degrees C) and a normothermia (NT) group (n=8, 38 degrees C). Hypothermia to 34 degrees C was induced with a cold blanket at the pre-hospital stage. Traumatic HS shock was induced using multiple intestinal perforations. Pulse indicator continuous cardiac output (PiCCO) was used to monitor hemodynamic changes. Coagulation capacity was measured using thromboelastography (TEG) at baseline as well as during resuscitation periods. Survival was documented for 72 h post-trauma. RESULTS: Mortality in the hypothermic HS group was low, but there were no significant differences in mortality between the groups (mortality=2/8 HT vs. 5/8 NT, p=0.137). During hypothermia, the heart rate, extravascular lung water index (EVLWI), oxygen uptake index (VO2), and oxygen delivery index (DO2) in the HT group were significantly lower than those in the NT group. There were no significant differences between the 2 groups in the other hemodynamic indices or prothrombin time. Analyses of thromboelastometry at 34 degrees C during hypothermia showed significant differences for reaction time (R) and alpha angle, but not for maximal amplitude (MA). CONCLUSIONS: Rewarming reversed the coagulation changes induced by hypothermia. Induced mild hypothermia (34 degrees C) in the pre-hospital stage affects hemodynamic parameters and the coagulation system but does not worsen outcomes in a pig HS model. The hypothermia-induced coagulation changes were reversed during rewarming without evidence of harmful effects. Our results suggest that pre-hospital induced hypothermia can be performed carefully following major trauma. FAU - Zhou, Bo AU - Zhou B AD - Department of Nursing, Huangshan Vocational Technical College and Jinling Hospital, China. FAU - Wang, Gang AU - Wang G AD - Research Institute of General Surgery, Jinling Hospital, China. FAU - Peng, Nanhai AU - Peng N AD - Research Institute of General Surgery, Jinling Hospital, China. FAU - He, Xiandi AU - He X AD - ICU, First Affiliated Hospital of Bengbu Medical College, China. FAU - Guan, Xiaoxiang AU - Guan X AD - Department of Oncology, Jinling Hospital, China. FAU - Liu, Yun AU - Liu Y AD - Department of Nursing, Jinling Hospital, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Poland TA - Adv Clin Exp Med JT - Advances in clinical and experimental medicine : official organ Wroclaw Medical University JID - 101138582 SB - IM MH - Animals MH - Blood Coagulation MH - Blood Coagulation Tests MH - Disease Models, Animal MH - Emergency Medical Services/*methods MH - Female MH - *Fluid Therapy MH - Hemodynamics MH - Humans MH - *Hypothermia, Induced MH - Recovery of Function MH - Rewarming MH - Shock, Hemorrhagic/blood/diagnosis/physiopathology/*therapy MH - Swine MH - Time Factors EDAT- 2015/10/16 06:00 MHDA- 2015/12/15 06:00 CRDT- 2015/10/16 06:00 PHST- 2015/10/16 06:00 [entrez] PHST- 2015/10/16 06:00 [pubmed] PHST- 2015/12/15 06:00 [medline] AID - 10.17219/acem/29044 [doi] PST - ppublish SO - Adv Clin Exp Med. 2015 Jul-Aug;24(4):571-8. doi: 10.17219/acem/29044. PMID- 26442265 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20151007 LR - 20200930 IS - 2296-858X (Print) IS - 2296-858X (Electronic) IS - 2296-858X (Linking) VI - 2 DP - 2015 TI - Viscoelastic Methods of Blood Clotting Assessment - A Multidisciplinary Review. PG - 62 LID - 10.3389/fmed.2015.00062 [doi] LID - 62 AB - Viscoelastic methods (VEM) made available the bedside assessment of blood clotting. Unlike standard laboratory tests, the results are based on the whole blood coagulation and are available in real time at a much faster turnaround time. In combination with our new knowledge about pathophysiology of the trauma-induced coagulopathy, the goal-oriented treatment protocols have been recently proposed for the initial management of bleeding in trauma victims. Additionally, the utility of viscoelastic monitoring devices has been proved even outside this setting in cardiosurgical patients or those undergoing liver transplantation. Many other situations were described in literature showing the potential use of bedside analysis of coagulation for the management of bleeding or critically ill patients. In the near future, we may expect further improvement in current bedside diagnostic tools enabling not only the assessment of secondary hemostasis but also the platelet aggregation. More sensitive assays for new anticoagulants are underway. Aim of this review is to offer the reader a multidisciplinary overview of VEM and their potential use in anesthesiology and critical care. FAU - Benes, Jan AU - Benes J AD - Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Teaching Hospital in Plzen, Charles University in Prague , Plzen , Czech Republic ; Faculty of Medicine in Plzen, Biomedical Centre, Charles University in Prague , Plzen , Czech Republic. FAU - Zatloukal, Jan AU - Zatloukal J AD - Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Teaching Hospital in Plzen, Charles University in Prague , Plzen , Czech Republic. FAU - Kletecka, Jakub AU - Kletecka J AD - Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Teaching Hospital in Plzen, Charles University in Prague , Plzen , Czech Republic. LA - eng PT - Journal Article PT - Review DEP - 20150914 PL - Switzerland TA - Front Med (Lausanne) JT - Frontiers in medicine JID - 101648047 PMC - PMC4568412 OTO - NOTNLM OT - coagulation OT - point-of-care testing OT - thrombosis OT - transfusion OT - trauma-induced coagulopathy OT - viscoelastic methods EDAT- 2015/10/07 06:00 MHDA- 2015/10/07 06:01 PMCR- 2015/09/14 CRDT- 2015/10/07 06:00 PHST- 2015/05/12 00:00 [received] PHST- 2015/08/17 00:00 [accepted] PHST- 2015/10/07 06:00 [entrez] PHST- 2015/10/07 06:00 [pubmed] PHST- 2015/10/07 06:01 [medline] PHST- 2015/09/14 00:00 [pmc-release] AID - 10.3389/fmed.2015.00062 [doi] PST - epublish SO - Front Med (Lausanne). 2015 Sep 14;2:62. doi: 10.3389/fmed.2015.00062. eCollection 2015. PMID- 26428070 OWN - NLM STAT- MEDLINE DCOM- 20160718 LR - 20260518 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 23 DP - 2015 Oct 1 TI - Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres. PG - 74 LID - 10.1186/s13049-015-0147-6 [doi] LID - 74 AB - BACKGROUND: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis. METHODS: For assessing management practices across six European level I trauma centres with academic interest and research in the field of coagulopathy an online survey was conducted addressing local management practice for bleeding trauma patients including algorithms for detection, management and monitoring coagulation disorders and immediate interventions. Each centre provided their locally applied massive transfusion protocol. RESULTS: All participating trauma centres have developed and implemented a local algorithm and protocol for the bleeding trauma patient. These are uniformly activated by clinical triggers and deactivated once the bleeding has stopped according to clinical assessment in combination with laboratory signs of achieved haemostasis. The severity of coagulopathy and shock is mostly assessed via standard coagulation tests and partially used extended viscoelastic tests. All centres have implemented the immediate use of tranexamic acid. Initial resuscitation is started either pre-hospital or after hospital admission by using transfusion packages with pre-fixed universal blood product combinations and ratios following the concept of "damage control resuscitation" at which applied ratios substantially vary. Two centres initially start with transfusion packages but with viscoelastic tests running in parallel to quickly allow a shift towards a viscoelastic test-guided therapy. CONCLUSION: Diversity in the management of bleeding trauma patients such as pre-hospital blood administration and routinely performed viscoelastic tests exists even among level I trauma centres. The paucity of consensus among these centres highlights the need for further primary research followed by clinical trials to improve the evidence for sophisticated guidelines and strategies. FAU - Schafer, Nadine AU - Schafer N AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. FAU - Driessen, Arne AU - Driessen A AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. AD - Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. FAU - Frohlich, Matthias AU - Frohlich M AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. AD - Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. FAU - Sturmer, Ewa K AU - Sturmer EK AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. FAU - Maegele, Marc AU - Maegele M AD - Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. marc.maegele@t-online.de. AD - Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany. marc.maegele@t-online.de. CN - TACTIC partners LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20151001 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Algorithms MH - Blood Coagulation Disorders/etiology/therapy MH - Blood Transfusion/standards MH - *Clinical Protocols MH - Europe MH - Hemorrhage/*diagnosis/*therapy MH - *Hemostasis MH - Humans MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Resuscitation/standards MH - Surveys and Questionnaires MH - Trauma Centers/*standards PMC - PMC4590713 FIR - Johansson, Par I IR - Johansson PI FIR - Ostrowski, Sisse R IR - Ostrowski SR FIR - Stensballe, Jakob IR - Stensballe J FIR - Goslings, J Carel IR - Goslings JC FIR - Juffermans, Nicole IR - Juffermans N FIR - Balvers, Kirsten IR - Balvers K FIR - Neble, Sylvie IR - Neble S FIR - van Dieren, Susan IR - van Dieren S FIR - Gaarder, Christine IR - Gaarder C FIR - Naess, Pal A IR - Naess PA FIR - Kolstadbraten, Knut Magne IR - Kolstadbraten KM FIR - Brohi, Karim IR - Brohi K FIR - Eaglestone, Simon IR - Eaglestone S FIR - Rourke, Claire IR - Rourke C FIR - Campbell, Helen IR - Campbell H FIR - Curry, Nicola IR - Curry N FIR - Stanworth, Simon IR - Stanworth S FIR - Harrison, Michael IR - Harrison M FIR - Buchanan, James IR - Buchanan J FIR - Soyel, Hamit IR - Soyel H FIR - Gall, Lewis IR - Gall L FIR - Maegele, Marc IR - Maegele M FIR - Sturmer, Ewa K IR - Sturmer EK FIR - Schafer, Nadine IR - Schafer N FIR - Driessen, Arne IR - Driessen A FIR - Orr, Adrian IR - Orr A FIR - Char, Ahmed IR - Char A FIR - Gorlinger, Klaus IR - Gorlinger K FIR - Schubert, Axel IR - Schubert A EDAT- 2015/10/03 06:00 MHDA- 2016/07/19 06:00 PMCR- 2015/10/01 CRDT- 2015/10/03 06:00 PHST- 2015/07/08 00:00 [received] PHST- 2015/09/07 00:00 [accepted] PHST- 2015/10/03 06:00 [entrez] PHST- 2015/10/03 06:00 [pubmed] PHST- 2016/07/19 06:00 [medline] PHST- 2015/10/01 00:00 [pmc-release] AID - 10.1186/s13049-015-0147-6 [pii] AID - 147 [pii] AID - 10.1186/s13049-015-0147-6 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2015 Oct 1;23:74. doi: 10.1186/s13049-015-0147-6. PMID- 26425342 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20151001 LR - 20220321 IS - 2047-0525 (Print) IS - 2047-0525 (Electronic) IS - 2047-0525 (Linking) VI - 4 DP - 2015 TI - Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery. PG - 9 LID - 10.1186/s13741-015-0019-7 [doi] LID - 9 AB - BACKGROUND: The European Medicines Agency does not recommend the use of hydroxyethyl starch-based volume replacement solutions in critically ill patients due to an increased risk of renal failure. However, this recommendation is questionable for its perioperative use. Several recent randomised controlled studies do not indicate a risk for renal failure-not even after high-risk surgery. Human albumin is used in our neurointensive care unit as a part of the "Lund concept" of brain injury resuscitation, and albumin has been introduced in elective neurosurgery instead of starch. The aim of our prospective unblinded observational cohort study was to compare the degree of dilutive coagulopathy after albumin and starch intra-operative fluid therapy. METHODS: Thirty-nine patients undergoing elective brain tumour surgery with craniotomy received either 130/0.42 hydroxyethyl starch or 5 % albumin infusions. The first 18 patients received starch, whereas the rest received albumin. Rotational thromboelastometry with ROTEM and platelet aggregometry with Multiplate were performed before surgery, after the first and second consecutive colloid infusions (250/500 ml albumin or 500/1000 ml starch) and at the end of surgery. RESULTS: Both intra- and inter-group comparisons showed more deranged ROTEM parameters after the higher doses of starch. Multiplate detected changes only in the albumin group after 500-ml infusion. Blood los did not differ between groups, nor did haemoglobin preoperatively or at end of surgery. Lower volumes of albumin were required to maintain stable intra-operative haemodynamic parameters; 250/500 ml albumin corresponded to 500/1000 ml starch. CONCLUSIONS: Hydroxyethyl starch affected coagulation at lower volumes, with a more prominent effect on clot structure at the end of surgery, corroborating previous research. Only albumin decreased platelet aggregation, and 5 % albumin had a more potential volume effect than 130/0.42 hydroxyethyl starch. FAU - Li, N AU - Li N AD - Department of Medicine, Vaxjo County Hospital, Vaxjo, Sweden. FAU - Statkevicius, S AU - Statkevicius S AD - Department of Anaesthesia and Intensive Care, Lund University and Skane University Hospital, Lund, S-22185 Sweden. FAU - Asgeirsson, B AU - Asgeirsson B AD - Department of Anaesthesia and Intensive Care, Lund University and Skane University Hospital, Lund, S-22185 Sweden. FAU - Schott, U AU - Schott U AD - Department of Anaesthesia and Intensive Care, Lund University and Skane University Hospital, Lund, S-22185 Sweden. LA - eng PT - Journal Article DEP - 20150929 PL - England TA - Perioper Med (Lond) JT - Perioperative medicine (London, England) JID - 101609072 PMC - PMC4589068 OTO - NOTNLM OT - Albumin OT - Hydroxyethyl starch OT - Neurosurgery OT - Platelet aggregation OT - Thromboelastography EDAT- 2015/10/02 06:00 MHDA- 2015/10/02 06:01 PMCR- 2015/09/29 CRDT- 2015/10/02 06:00 PHST- 2015/04/20 00:00 [received] PHST- 2015/09/22 00:00 [accepted] PHST- 2015/10/02 06:00 [entrez] PHST- 2015/10/02 06:00 [pubmed] PHST- 2015/10/02 06:01 [medline] PHST- 2015/09/29 00:00 [pmc-release] AID - 19 [pii] AID - 10.1186/s13741-015-0019-7 [doi] PST - epublish SO - Perioper Med (Lond). 2015 Sep 29;4:9. doi: 10.1186/s13741-015-0019-7. eCollection 2015. PMID- 26411212 OWN - NLM STAT- MEDLINE DCOM- 20151030 LR - 20200923 IS - 0390-6663 (Print) IS - 0390-6663 (Linking) VI - 42 IP - 4 DP - 2015 TI - Detecting coagulability status by thromboelastography in women with the history of preeclampsia and inherited thrombophilia. PG - 462-8 AB - OBJECTIVE: To assign tendency to thrombosis in patients with preeclampsia and inherited thrombophilia using thromboelastography (TEG), and therefore to evaluate possible relationship between thrombophilia and preeclampsia. MATERIALS AND METHODS: Kinetics of clot formation was assessed with TEG analyzer in 49 patients with severe preeclampsia, 54 cases with previous diagnosis of inherited thrombophilia, and 31 controls. RESULTS: 'r, 'k', TMA, coagulation index (CI) parameters were found statistically discrete between patients with inherited thrombophilia and controls. The difference between preeclampsia and control groups was not statistically significant. The difference in a angle was statistically significant between thrombophilics and preeclamptics (p = 0.01), and between thrombophilics and controls (p = 0.004). CI was found statistically lower in thrombophilia group than control group (p = 0.006). Particularly, clot lysis time (CLT) was measured to shorten in preeclampsia when compared with controls and patients with thrombophilia (p = 0.032, p = 0.028, respectively). CONCLUSIONS: Not only the inherited thrombophilia group but also preeclampsia group demonstrated elongated clot initiation patterns when compared to the controls. Moreover, apart from the patients with inherited thrombophilia, preeclamptics exposed shorter CLT values indicating a possible increment in clot turn over, which eventually results in increased depletion of coagulation substrates, and thus, increased frequencies of oxidative cycle injury. FAU - Bulbul, M AU - Bulbul M FAU - Atalay, M A AU - Atalay MA FAU - Cetinkaya Demir, B AU - Cetinkaya Demir B FAU - Turker, G AU - Turker G FAU - Esmer, A AU - Esmer A LA - eng PT - Evaluation Study PT - Journal Article PL - Singapore TA - Clin Exp Obstet Gynecol JT - Clinical and experimental obstetrics & gynecology JID - 7802110 RN - Thrombophilia, hereditary SB - IM MH - Adult MH - Case-Control Studies MH - Female MH - Humans MH - Pre-Eclampsia/*blood MH - Predictive Value of Tests MH - Pregnancy MH - Prenatal Diagnosis MH - *Thrombelastography MH - Thrombophilia/*blood EDAT- 2015/09/29 06:00 MHDA- 2015/10/31 06:00 CRDT- 2015/09/29 06:00 PHST- 2015/09/29 06:00 [entrez] PHST- 2015/09/29 06:00 [pubmed] PHST- 2015/10/31 06:00 [medline] PST - ppublish SO - Clin Exp Obstet Gynecol. 2015;42(4):462-8. PMID- 26384835 OWN - NLM STAT- Publisher LR - 20230815 IS - 1743-9159 (Electronic) IS - 1743-9159 (Linking) VI - 33 IP - Pt B DP - 2016 Sep TI - Thromboelastography and Rotational Thromboelastometry use in trauma. PG - 196-201 LID - S1743-9191(15)01223-6 [pii] LID - 10.1016/j.ijsu.2015.09.036 [doi] AB - The appropriate resuscitation of patients in hemorrhagic shock is critical to improving survival. Current strategies for massive transfusions utilize fixed ratio protocols to rapidly deliver plasma and platelets to the patient. However, there is some concern that these larger volumes of transfusions can lead to untoward effects. Efforts are ongoing to provide patient-specific transfusion therapy in order to avoid excess transfusions. Thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) are two viscoelastic analyzers capable of providing Viscoelastic testing. CI - Copyright (c) 2015 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved. FAU - Abdelfattah, Kareem AU - Abdelfattah K AD - Department of Surgery, University of Texas Southwestern, Dallas, TX, USA. FAU - Cripps, Michael W AU - Cripps MW AD - Department of Surgery, University of Texas Southwestern, Dallas, TX, USA. Electronic address: Michael.Cripps@utsouthwestern.edu. LA - eng PT - Journal Article PT - Review DEP - 20150916 PL - United States TA - Int J Surg JT - International journal of surgery (London, England) JID - 101228232 OTO - NOTNLM OT - Coagulopathy OT - Massive transfusion OT - Rotational thromboelastometry OT - Thromboelastography EDAT- 2015/09/20 06:00 MHDA- 2015/09/20 06:00 CRDT- 2015/09/20 06:00 PHST- 2015/07/14 00:00 [received] PHST- 2015/08/21 00:00 [revised] PHST- 2015/09/02 00:00 [accepted] PHST- 2015/09/20 06:00 [entrez] PHST- 2015/09/20 06:00 [pubmed] PHST- 2015/09/20 06:00 [medline] AID - S1743-9191(15)01223-6 [pii] AID - 10.1016/j.ijsu.2015.09.036 [doi] PST - ppublish SO - Int J Surg. 2016 Sep;33(Pt B):196-201. doi: 10.1016/j.ijsu.2015.09.036. Epub 2015 Sep 16. PMID- 26362487 OWN - NLM STAT- MEDLINE DCOM- 20160809 LR - 20151023 IS - 1873-1570 (Electronic) IS - 0300-9572 (Linking) VI - 96 DP - 2015 Nov TI - The effect of targeted temperature management on coagulation parameters and bleeding events after out-of-hospital cardiac arrest of presumed cardiac cause. PG - 260-7 LID - S0300-9572(15)00391-3 [pii] LID - 10.1016/j.resuscitation.2015.08.018 [doi] AB - 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 degrees 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 degrees 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 degrees C was associated with impaired hemostasis or increased the frequency of adverse bleeding and thrombotic events compared to TTM at 36 degrees C. We found that TTM at either temperature can safely be applied in the postresuscitation phase after acute myocardial infarction and primary PCI. CI - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Jacob, Marrit AU - Jacob M AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Hassager, Christian AU - Hassager C AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Bro-Jeppesen, John AU - Bro-Jeppesen J AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Thomsen, Jakob Hartvig AU - Thomsen JH AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Wanscher, Michael AU - Wanscher M AD - Department of Cardiothoracic Anaesthesia, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Winther-Jensen, Matilde AU - Winther-Jensen M AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. FAU - Kjaergaard, Jesper AU - Kjaergaard J AD - Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. Electronic address: jesper.kjaergaard.05@regionh.dk. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20150908 PL - Ireland TA - Resuscitation JT - Resuscitation JID - 0332173 SB - IM MH - Blood Coagulation/*physiology MH - Body Temperature/*physiology MH - Coma/blood/etiology/*therapy MH - Coronary Artery Disease/*complications/surgery MH - Coronary Thrombosis/blood/*prevention & control MH - Female MH - Follow-Up Studies MH - Humans MH - Hypothermia, Induced/*methods MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/blood/complications/*therapy MH - Percutaneous Coronary Intervention MH - Prognosis MH - Retrospective Studies OTO - NOTNLM OT - Bleeding OT - Cardiac arrest OT - Hypothermia OT - Stent thrombosis OT - Targeted temperature management OT - Thrombelastography EDAT- 2015/09/13 06:00 MHDA- 2016/08/10 06:00 CRDT- 2015/09/13 06:00 PHST- 2015/05/01 00:00 [received] PHST- 2015/08/19 00:00 [revised] PHST- 2015/08/23 00:00 [accepted] PHST- 2015/09/13 06:00 [entrez] PHST- 2015/09/13 06:00 [pubmed] PHST- 2016/08/10 06:00 [medline] AID - S0300-9572(15)00391-3 [pii] AID - 10.1016/j.resuscitation.2015.08.018 [doi] PST - ppublish SO - Resuscitation. 2015 Nov;96:260-7. doi: 10.1016/j.resuscitation.2015.08.018. Epub 2015 Sep 8. PMID- 26333113 OWN - NLM STAT- MEDLINE DCOM- 20160916 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 13 IP - 11 DP - 2015 Nov TI - A critical appraisal of point-of-care coagulation testing in critically ill patients. PG - 1960-7 LID - 10.1111/jth.13126 [doi] AB - Derangement of the coagulation system is a common phenomenon in critically ill patients, who may present with severe bleeding and/or conditions associated with a prothrombotic state. Monitoring of this coagulopathy can be performed with conventional coagulation assays; however, point-of-care tests have become increasingly attractive, because not only do they yield a more rapid result than clinical laboratory testing, but they may also provide a more complete picture of the condition of the hemostatic system. There are many potential areas of study and applications of point-of-care hemostatic testing in critical care, including patients who present with massive blood loss, patients with a hypercoagulable state (such as in disseminated intravascular coagulation), and monitoring of antiplatelet treatment for acute arterial thrombosis, mostly acute coronary syndromes. However, the limitations of near-patient hemostatic testing has not been fully appreciated, and are discussed here. The currently available evidence indicates that point-of-care tests may be applied to guide appropriate blood product transfusion and the use of hemostatic agents to correct the hemostatic defect or to ameliorate antithrombotic treatment. Disappointingly, however, only in cardiac surgery is there adequate evidence to show that application of near-patient thromboelastography leads to an improvement in clinically relevant outcomes, such as reductions in bleeding-related morbidity and mortality, and cost-effectiveness. More research is required to validate the utility and cost-effectiveness of near-patient hemostatic testing in other areas, especially in traumatic bleeding and postpartum hemorrhage. CI - (c) 2015 International Society on Thrombosis and Haemostasis. FAU - Levi, M AU - Levi M AD - Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Hunt, B J AU - Hunt BJ AD - Thrombosis & Haemostasis, Kings College University & Consultant in Haematology, Lupus & Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK. LA - eng PT - Journal Article PT - Review DEP - 20150922 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Anticoagulants) SB - IM MH - Anticoagulants/adverse effects/blood/therapeutic use MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - *Blood Coagulation Tests/economics/methods MH - Blood Loss, Surgical MH - Blood Transfusion MH - Cost-Benefit Analysis MH - Critical Care/economics/*methods MH - *Critical Illness MH - Disease Management MH - Drug Monitoring/methods MH - Hemorrhage/blood/chemically induced/etiology/therapy MH - Humans MH - Platelet Function Tests MH - *Point-of-Care Systems/economics MH - Postoperative Hemorrhage/blood/therapy MH - Randomized Controlled Trials as Topic MH - Thrombelastography/economics MH - Wounds and Injuries/blood/complications/therapy OTO - NOTNLM OT - critical care OT - hemorrhage OT - platelet aggregation inhibitors OT - point-of-care systems OT - thoracic surgery OT - thrombosis EDAT- 2015/09/04 06:00 MHDA- 2016/09/17 06:00 CRDT- 2015/09/03 06:00 PHST- 2015/05/25 00:00 [received] PHST- 2015/08/22 00:00 [accepted] PHST- 2015/09/03 06:00 [entrez] PHST- 2015/09/04 06:00 [pubmed] PHST- 2016/09/17 06:00 [medline] AID - S1538-7836(22)08687-1 [pii] AID - 10.1111/jth.13126 [doi] PST - ppublish SO - J Thromb Haemost. 2015 Nov;13(11):1960-7. doi: 10.1111/jth.13126. Epub 2015 Sep 22. PMID- 26327200 OWN - NLM STAT- MEDLINE DCOM- 20160203 LR - 20181113 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 43 IP - 11 DP - 2015 Nov TI - Asphyxia by Drowning Induces Massive Bleeding Due To Hyperfibrinolytic Disseminated Intravascular Coagulation. PG - 2394-402 LID - 10.1097/CCM.0000000000001273 [doi] AB - OBJECTIVE: To date, no study has systematically investigated the impact of drowning-induced asphyxia on hemostasis. Our objective was to test the hypothesis that asphyxia induces bleeding by hyperfibrinolytic disseminated intravascular coagulation. DESIGN: Observational study. SETTING: A 2,100-bed tertiary care facility in Vienna, Austria, Europe. PATIENTS: All cases of drowning-induced asphyxia (n=49) were compared with other patients with cardiopulmonary resuscitation (n=116) and to patients with acute promyelocytic leukemia (n=83). Six drowning victims were investigated prospectively. To study the mechanism, a forearm-ischemia model was used in 20 volunteers to investigate whether hypoxia releases tissue plasminogen activator. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eighty percent of patients with drowning-induced asphyxia developed overt disseminated intravascular coagulation within 24 hours. When compared with nondrowning cardiac arrest patients, drowning patients had a 13 times higher prevalence of overt disseminated intravascular coagulation at admission (55% vs 4%; p<0.001). Despite comparable disseminated intravascular coagulation scores, acute promyelocytic leukemia patients had higher fibrinogen but lower d-dimer levels and platelet counts than drowning patients (p<0.001). Drowning victims had a three-fold longer activated partial thromboplastin time (124 s; p<0.001) than both nondrowning cardiac arrest and acute promyelocytic leukemia patients. Hyperfibrinolysis was reflected by up to 1,000-fold increased d-dimer levels, greater than 5-fold elevated plasmin antiplasmin levels, and a complete absence of thrombelastometric clotting patterns, which was reversed by antifibrinolytics and heparinase. Thirty minutes of forearm-ischemia increased tissue plasminogen activator 31-fold (p<0.001). CONCLUSIONS: The vast majority of drowning patients develops overt hyperfibrinolytic disseminated intravascular coagulation, partly caused by hypoxia induced tissue plasminogen activator release. Antifibrinolytics and heparinase partially reverse the abnormal clotting patterns. Severe activated partial thromboplastin time prolongation may be a marker of combined hyperfibrinolytic afibrinogenemia and autoheparinization in drowning-related asphyxia. FAU - Schwameis, Michael AU - Schwameis M AD - 1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. 2Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. 3Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria. 4Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Salzburg, Austria. FAU - Schober, Andreas AU - Schober A FAU - Schorgenhofer, Christian AU - Schorgenhofer C FAU - Sperr, Wolfgang Reinhard AU - Sperr WR FAU - Schochl, Herbert AU - Schochl H FAU - Janata-Schwatczek, Karin AU - Janata-Schwatczek K FAU - Kurkciyan, Erol Istepan AU - Kurkciyan EI FAU - Sterz, Fritz AU - Sterz F FAU - Jilma, Bernd AU - Jilma B LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 SB - IM MH - Adult MH - Asphyxia/*complications/mortality/physiopathology MH - Case-Control Studies MH - Cohort Studies MH - Disseminated Intravascular Coagulation/*etiology/mortality/physiopathology MH - Drowning/*physiopathology MH - Female MH - Fibrinolysis/*physiology MH - Follow-Up Studies MH - Hemorrhage/*etiology/mortality/physiopathology MH - Hospitals, University MH - Humans MH - Kaplan-Meier Estimate MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Retrospective Studies MH - Risk Assessment MH - Severity of Illness Index MH - Survival Rate MH - Thrombelastography PMC - PMC4603369 COIS- Dr. Schochl served as a board member for, consulted for, and received support for travel from CSL Behring, TEM International. His institution received grant support from CSL Behring, TEM International and has patents with Endothelial-coated microbeads. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2015/09/04 06:00 MHDA- 2016/02/04 06:00 PMCR- 2015/10/13 CRDT- 2015/09/02 06:00 PHST- 2015/09/02 06:00 [entrez] PHST- 2015/09/04 06:00 [pubmed] PHST- 2016/02/04 06:00 [medline] PHST- 2015/10/13 00:00 [pmc-release] AID - 10.1097/CCM.0000000000001273 [doi] PST - ppublish SO - Crit Care Med. 2015 Nov;43(11):2394-402. doi: 10.1097/CCM.0000000000001273. PMID- 26315261 OWN - NLM STAT- MEDLINE DCOM- 20160622 LR - 20150921 IS - 1742-6723 (Electronic) IS - 1742-6723 (Linking) VI - 27 IP - 5 DP - 2015 Oct TI - Assessing the damage control resuscitation: development, drivers and direction. PG - 485-7 LID - 10.1111/1742-6723.12456 [doi] AB - Damage control resuscitation (DCR) has become a more widely adopted acute management strategy over the past decade. A cornerstone of this strategy is the performance of an initial limited surgical intervention for the control of active bleeding and contamination. This technique is indicated where significant physiological compromise exists and immediate surgical intervention is required. This damage control surgery itself is completed judiciously to allow a period of resuscitative stabilisation before later definitive surgical solutions. This discussion describes the three further principles of DCR and then explores the rationale and drivers behind the development of this approach. CI - (c) 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. FAU - Quinn, David AU - Quinn D AUID- ORCID: 0000-0002-6338-5265 AD - Emergency Department, Gosford District Hospital, Gosford, New South Wales, Australia. FAU - Frith, Daniel AU - Frith D AD - Trauma Sciences, Queen Mary University of London, London, UK. LA - eng PT - Journal Article DEP - 20150828 PL - Australia TA - Emerg Med Australas JT - Emergency medicine Australasia : EMA JID - 101199824 SB - IM MH - Biomedical Research MH - Humans MH - Military Medicine/methods MH - Resuscitation/*methods MH - Shock, Hemorrhagic/surgery/therapy MH - Wounds and Injuries/*surgery OTO - NOTNLM OT - damage control resuscitation OT - haemorrhage OT - permissive hypotension OT - viscoelastic testing EDAT- 2015/09/01 06:00 MHDA- 2016/06/23 06:00 CRDT- 2015/08/29 06:00 PHST- 2015/07/15 00:00 [accepted] PHST- 2015/08/29 06:00 [entrez] PHST- 2015/09/01 06:00 [pubmed] PHST- 2016/06/23 06:00 [medline] AID - 10.1111/1742-6723.12456 [doi] PST - ppublish SO - Emerg Med Australas. 2015 Oct;27(5):485-7. doi: 10.1111/1742-6723.12456. Epub 2015 Aug 28. PMID- 26301095 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20150824 LR - 20200930 IS - 2052-1839 (Print) IS - 2052-1839 (Electronic) IS - 2052-1839 (Linking) VI - 15 DP - 2015 TI - Detection of coagulopathy in paediatric heart surgery [DECISION study]: study protocol. PG - 11 LID - 10.1186/s12878-015-0030-8 [doi] LID - 11 AB - BACKGROUND: Each year in the UK, approximately 3000 children undergo major cardiac surgery requiring cardiopulmonary bypass. Approximately 40 % of these experience excessive bleeding necessitating red cell transfusion or treatment with other blood components. A further 40 % receive blood components because of the perception by clinicians that the risk of bleeding is high. Excessive bleeding and treatment with red cell transfusion or blood components are associated with post-operative complications such as infection and renal injury and are independently associated with increased morbidity and mortality. Abnormalities in blood coagulation are a major cause of excessive bleeding after cardiac surgery in children. However, the extent of these abnormalities varies between children and their characteristics may change rapidly during surgery. In adults undergoing cardiac surgery, rapid testing of blood coagulation using techniques such as thromboelastometry may assist the selection of appropriate blood component treatments. In some sub-groups of adults, this improves clinical outcomes. Rapid testing of blood coagulation in children undergoing cardiac surgery has not been evaluated fully. METHODS/DESIGN: The DECISION study is a prospective, single-centre, observational study that aims to assess the utility of rapid testing of blood coagulation in children undergoing cardiac surgery. This will be achieved by testing blood samples from 200 children obtained immediately before, and after cardiac surgery. The blood samples will be analysed in parallel using thromboelastometry and reference laboratory tests of blood coagulation. The primary clinical outcome will be clinical concern about bleeding, defined as a composite of either excessive blood loss or the use of a pro-haemostatic treatment outside of standard treatment protocols because of perceived high risk of excessive bleeding. The reference laboratory test results will be used to describe the patterns of abnormalities in blood coagulation in children and will be compared to the thromboelastometry test results to determine the diagnostic accuracy of the thromboelastometry tests. We will estimate how well the reference and thromboelastometry test results predict clinical concern about bleeding. DISCUSSION: The DECISION study will identify the most useful thromboeastometry tests of blood coagulation for the prediction of excessive bleeding in children after cardiac surgery and will inform the design of future randomised controlled trials. TRIAL REGISTRATION: The trail was registered as ISRCTN55439761 on 23(rd) April 2015. FAU - Underwood, Wendy AU - Underwood W AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - Rogers, Chris A AU - Rogers CA AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - Plummer, Zoe AU - Plummer Z AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - C Reeves, Barnaby AU - C Reeves B AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - Caputo, Massimo AU - Caputo M AD - The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. FAU - Murphy, Peter AU - Murphy P AD - Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. FAU - Sheehan, Karen AU - Sheehan K AD - Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. FAU - Harris, Jessica AU - Harris J AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - Culliford, Lucy AU - Culliford L AD - Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. FAU - Mumford, Andrew AU - Mumford A AD - School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK. LA - eng PT - Journal Article DEP - 20150819 PL - England TA - BMC Hematol JT - BMC hematology JID - 101609487 PMC - PMC4543490 OTO - NOTNLM OT - Cardiopulmonary bypass OT - Coaugulation OT - Heart surgery OT - Paediatric OT - Rotational TEM OT - Thromboelastometry EDAT- 2015/08/25 06:00 MHDA- 2015/08/25 06:01 PMCR- 2015/08/19 CRDT- 2015/08/25 06:00 PHST- 2015/02/17 00:00 [received] PHST- 2015/06/23 00:00 [accepted] PHST- 2015/08/25 06:00 [entrez] PHST- 2015/08/25 06:00 [pubmed] PHST- 2015/08/25 06:01 [medline] PHST- 2015/08/19 00:00 [pmc-release] AID - 30 [pii] AID - 10.1186/s12878-015-0030-8 [doi] PST - epublish SO - BMC Hematol. 2015 Aug 19;15:11. doi: 10.1186/s12878-015-0030-8. eCollection 2015. PMID- 26273234 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 1555-4155 (Print) IS - 1878-058X (Electronic) IS - 1555-4155 (Linking) VI - 11 IP - 7 DP - 2015 Jul-Aug TI - Thromboelastography: A Practice Summary for Nurse Practitioners Treating Hemorrhage. PG - 702-709 AB - Nurse practitioners may manage patients with coagulopathic bleeding which can lead to life-threatening hemorrhage. Routine plasma-based tests such as prothrombin time and activated partial thromboplastin time are inadequate in diagnosing hemorrhagic coagulopathy. Indiscriminate administration of fresh frozen plasma, platelets or cryoprecipitate for coagulopathic states can be extremely dangerous. The qualitative analysis that thromboelastography provides can facilitate the administration of the right blood product, at the right time, thereby permitting the application of goal-directed therapy for coagulopathic intervention application and patient survival. FAU - Bose, Eliezer AU - Bose E AD - School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA. FAU - Hravnak, Marilyn AU - Hravnak M AD - School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA. LA - eng GR - R01 NR013912/NR/NINR NIH HHS/United States PT - Journal Article PL - United States TA - J Nurse Pract JT - The journal for nurse practitioners : JNP JID - 101264817 PMC - PMC4528385 MID - NIHMS692719 OTO - NOTNLM OT - Thromboelastography OT - coagulopathy OT - fibrinolysis OT - hemorrhage OT - thromboelastogram OT - thromboelastometry OT - trauma OT - viscoelastic testing EDAT- 2015/08/15 06:00 MHDA- 2015/08/15 06:01 PMCR- 2016/07/01 CRDT- 2015/08/15 06:00 PHST- 2015/08/15 06:00 [entrez] PHST- 2015/08/15 06:00 [pubmed] PHST- 2015/08/15 06:01 [medline] PHST- 2016/07/01 00:00 [pmc-release] AID - 10.1016/j.nurpra.2015.05.006 [doi] PST - ppublish SO - J Nurse Pract. 2015 Jul-Aug;11(7):702-709. doi: 10.1016/j.nurpra.2015.05.006. PMID- 26263433 OWN - NLM STAT- MEDLINE DCOM- 20160718 LR - 20151020 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 44 IP - 5 DP - 2015 Nov TI - Trauma, Time, and Transfusions: A Longitudinal Analysis of Coagulation Markers in Severely Injured Trauma Patients Receiving Modified Whole Blood or Component Blood Products. PG - 417-25 LID - 10.1097/SHK.0000000000000449 [doi] AB - OBJECTIVE: The current study leveraged data from the Early Whole Blood (EWB) trial to explore the effects of modified whole blood (mWB) versus component (COMP) transfusions on coagulation parameters over time using longitudinal statistical methods. STUDY DESIGN AND METHODS: The EWB study was a single-center randomized controlled trial, approved by the local IRB. Adult patients at highest-level trauma activations were randomized into mWB or COMP groups. Coagulation status was evaluated (at times 0, 3, 6, 12, and 24 h postadmission) using thrombelastography, platelet aggregometry, and calibrated automated thrombograms. Longitudinal statistical analyses with generalized estimating equations (GEE) were used to evaluate the effects of group, time, transfusion types, and their respective interactions on changes in measured coagulation markers. RESULTS: A total of 59 patients were enrolled and adhered to protocol in the EWB trial, 25 in the mWB group, and 34 in the COMP group. Patients in both the mWB and COMP groups demonstrated a significant decline in their thrombelastography parameters during the first 3-6 h, specifically K-time, alpha-angle, maximum amplitude, G, and LY30. Patients receiving mWB exhibited improved thrombin potential than those receiving COMP. Platelet count and function declined over time in both mWB and COMP groups; however, platelet aggregation in response to ristocetin in the mWB group was significantly improved at 12 h compared with the COMP group. The longitudinal GEE model revealed significant group-time interactive effects on the changes in coagulation markers and significant effect of platelet transfusions on improvements in coagulation profile. CONCLUSIONS: We observed significant interactive group-time effects, indicating that the types of transfusion as well as the time of transfusion significantly affect the patient's coagulation status. Our pilot data suggest that there is an improvement in platelet function with mWB, but further studies are needed. Regardless, platelet transfusions were associated with improvements in coagulation over time in both the groups. FAU - Rahbar, Elaheh AU - Rahbar E AD - *Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center, Houston, Texas daggerDepartment of Biomedical Engineering, Wake Forest University, Winston-Salem, North Carolina double daggerDepartment of Surgery, University of California San Francisco, San Francisco, California. FAU - Cardenas, Jessica C AU - Cardenas JC FAU - Matijevic, Nena AU - Matijevic N FAU - Del Junco, Deborah AU - Del Junco D FAU - Podbielski, Jeanette AU - Podbielski J FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Cotton, Bryan A AU - Cotton BA FAU - Holcomb, John B AU - Holcomb JB FAU - Wade, Charles E AU - Wade CE CN - Early Whole Blood Investigators LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Blood Coagulation Factors) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Factors/metabolism MH - Blood Component Transfusion/methods MH - Blood Transfusion/*methods MH - Female MH - Hemostasis/physiology MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Pilot Projects MH - Platelet Function Tests/methods MH - Thrombelastography/methods MH - Thrombin/biosynthesis MH - Trauma Severity Indices MH - Wounds and Injuries/blood/*therapy EDAT- 2015/08/12 06:00 MHDA- 2016/07/19 06:00 CRDT- 2015/08/12 06:00 PHST- 2015/08/12 06:00 [entrez] PHST- 2015/08/12 06:00 [pubmed] PHST- 2016/07/19 06:00 [medline] AID - 10.1097/SHK.0000000000000449 [doi] PST - ppublish SO - Shock. 2015 Nov;44(5):417-25. doi: 10.1097/SHK.0000000000000449. PMID- 26256459 OWN - NLM STAT- MEDLINE DCOM- 20160804 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 13 IP - 10 DP - 2015 Oct TI - Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue-type plasminogen activator in trauma patients. PG - 1878-87 LID - 10.1111/jth.13067 [doi] AB - BACKGROUND: Systemic hyperfibrinolysis is a lethal phenotype of trauma-induced coagulopathy. Its pathogenesis is poorly understood. Recent studies have support a central role of platelets in hemostasis and in fibrinolysis regulation, implying that platelet impairment is integral to the development of postinjury systemic hyperfibrinolysis. OBJECTIVE: The objective of this study was to identify if platelet function is associated with blood clot sensitivity to fibrinolysis. We hypothesize that platelet impairment of the ADP pathway correlates with fibrinolysis sensitivity in trauma patients. METHODS: A prospective observational study of patients meeting the criteria for the highest level of activation at an urban trauma center was performed. Viscoelastic parameters associated with platelet function (maximum amplitude [MA]) were measured with native thrombelastography (TEG), and TEG platelet mapping of the ADP pathway (ADP-MA). The contribution of fibrinogen to clotting was measured with TEG (angle) and the TEG functional fibrinogen (FF) assay (FF-MA). Another TEG assay containing tissue-type plasminogen activator (t-PA) (75 ng mL(-1) ) was used to assess clot sensitivity to an exogenous fibrinolytic stimulus by use of the TEG lysis at 30 min (LY30) variable. Multivariate linear regression was used to identify which TEG variable correlated with t-PA-LY30 (quantification of fibrinolysis sensitivity). RESULTS: Fifty-eight trauma patients were included in the analysis, with a median injury severity score of 17 and a base deficit of 6 mEq L(-1) . TEG parameters that significantly predicted t-PA-LY30 were related to platelet function (ADP-MA, P = 0.001; MA, P < 0.001) but not to fibrinogen (FF-MA, P = 0.773; angle, P = 0.083). Clinical predictors of platelet ADP impairment included calcium level (P = 0.001), base deficit (P = 0.001), and injury severity (P = 0.001). RESULTS AND CONCLUSIONS: Platelet impairment of the ADP pathway is associated with increased sensitivity to t-PA. ADP pathway inhibition in platelets may be an early step in the pathogenesis of systemic hyperfibrinolysis. CI - (c) 2015 International Society on Thrombosis and Haemostasis. FAU - Moore, H B AU - Moore HB AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - Moore, E E AU - Moore EE AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - Chapman, M P AU - Chapman MP AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - Gonzalez, E AU - Gonzalez E AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - Slaughter, A L AU - Slaughter AL AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - Morton, A P AU - Morton AP AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Denver Health Medical Center, Denver, CO, USA. FAU - D'Alessandro, A AU - D'Alessandro A AD - Department of Surgery, University of Colorado, Aurora, CO, USA. FAU - Hansen, K C AU - Hansen KC AD - Department of Surgery, University of Colorado, Aurora, CO, USA. FAU - Sauaia, A AU - Sauaia A AD - Department of Surgery, University of Colorado, Aurora, CO, USA. FAU - Banerjee, A AU - Banerjee A AD - Department of Surgery, University of Colorado, Aurora, CO, USA. FAU - Silliman, C C AU - Silliman CC AD - Department of Surgery, University of Colorado, Aurora, CO, USA. AD - Bonfils Blood Center, Denver, CO, USA. LA - eng GR - UM1HL120877/HL/NHLBI NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50-GM0492221/GM/NIGMS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20150922 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Biomarkers) RN - 0 (Fibrinolytic Agents) RN - 61D2G4IYVH (Adenosine Diphosphate) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - SY7Q814VUP (Calcium) SB - IM MH - Adenosine Diphosphate/blood MH - Adult MH - Biomarkers/blood MH - Blood Platelets/*drug effects/metabolism MH - Blood Viscosity MH - Calcium/blood MH - Elasticity MH - Female MH - Fibrinogen/*metabolism MH - Fibrinolysis/*drug effects MH - Fibrinolytic Agents/*therapeutic use MH - Humans MH - Injury Severity Score MH - Linear Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Patient Selection MH - *Platelet Function Tests MH - Predictive Value of Tests MH - Prospective Studies MH - Thrombolytic Therapy/*methods MH - Tissue Plasminogen Activator/*therapeutic use MH - Treatment Outcome MH - Wounds and Injuries/blood/diagnosis/*drug therapy PMC - PMC4838414 MID - NIHMS774631 OTO - NOTNLM OT - blood platelet disorder OT - fibrinogen OT - fibrinolysis OT - platelet function tests OT - trauma COIS- Disclosure of Conflict of Interests M. P. Chapman reports receiving non-financial support from Haemonetics LLC, TEM Gmbh and Barkey Gmbh, outside the submitted work. In addition, M. P. Chapman has a pending patent on Methodologies and Reagents for Detecting Fibrinolysis and Hyperfibrinolysis. A. Sauaia reports receiving grants from the Department of Defense, during the conduct of the study, as well as other support from the American Association for the Surgery of Trauma outside the submitted work. E. Gonzalez and H. B. Moore have a pending patent on the Identification of Novel Disease States Using Viscoelastic Analysis in the Presence of a Thrombolytic Agent. The other authors state that they have no conflict of interest. EDAT- 2015/08/11 06:00 MHDA- 2016/08/05 06:00 PMCR- 2016/10/01 CRDT- 2015/08/11 06:00 PHST- 2015/04/23 00:00 [received] PHST- 2015/07/22 00:00 [accepted] PHST- 2015/08/11 06:00 [entrez] PHST- 2015/08/11 06:00 [pubmed] PHST- 2016/08/05 06:00 [medline] PHST- 2016/10/01 00:00 [pmc-release] AID - S1538-7836(22)08412-4 [pii] AID - 10.1111/jth.13067 [doi] PST - ppublish SO - J Thromb Haemost. 2015 Oct;13(10):1878-87. doi: 10.1111/jth.13067. Epub 2015 Sep 22. PMID- 26251606 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20150807 LR - 20220330 IS - 1176-6336 (Print) IS - 1178-203X (Electronic) IS - 1176-6336 (Linking) VI - 11 DP - 2015 TI - Massive hemorrhage management-a best evidence topic report. PG - 1107-11 LID - 10.2147/TCRM.S88878 [doi] AB - INTRODUCTION: Massive hemorrhage remains a major cause of potentially preventable deaths. Better control of bleeding could improve survival rates by 10%-20%. Transfusion intervention concepts have been formulated in order to minimize acute traumatic coagulopathy. These interventions still have not been standardized and vary among medical centers. MATERIALS AND METHODS: Based on a literature search using free term keywords and Medical Subject Heading (MeSH) index, we analyzed published articles addressing massive hemorrhage, component therapy, fresh whole blood, and fibrinogen from the year 2000 onward, in journals with impact factor >1.000, in Medline, PubMed, and Google Scholar. The evidence was grouped into topics including laboratory testing and transfusion interventions/viscoelastic assays vs standard laboratory tests, the effect of component therapy on patient outcome, the effect of warm fresh whole blood on patient outcome, and the effects of fibrinogen in severe bleeding. The obtained information was compared, evaluated, confronted, and was focused on to present an adequate and individual-based massive hemorrhage management approach. RESULTS: Viscoelastic whole-blood assays are superior to standard coagulation blood tests for the identification of coagulopathy and for guiding decisions on appropriate therapy in patients with severe bleeding. Replacement of plasma, red blood cells, platelets, and fibrinogen in a ratio of 1:1:1:1 has appeared to be the best substitution for lost whole blood. There is no evidence that cryoprecipitate improves the outcome of patients with severe hemorrhage. Current literature promotes the transfusion of warm fresh whole blood, which seems to be superior to the component therapy in certain clinical situations. Some authors recommend that fibrinogen and other coagulation factors be administered according to the viscoelastic attributes of the blood clot. CONCLUSION: This best-evidence topic report brings comprehensive information about massive hemorrhage management. FAU - Vymazal, Tomas AU - Vymazal T AD - Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine Charles University, University Hospital Motol, Prague, Czech Republic. LA - eng PT - Journal Article PT - Review DEP - 20150727 PL - New Zealand TA - Ther Clin Risk Manag JT - Therapeutics and clinical risk management JID - 101253281 PMC - PMC4524472 OTO - NOTNLM OT - coagulopathy OT - fibrinogen OT - transfusion OT - viscoelastic assay EDAT- 2015/08/08 06:00 MHDA- 2015/08/08 06:01 PMCR- 2015/07/27 CRDT- 2015/08/08 06:00 PHST- 2015/08/08 06:00 [entrez] PHST- 2015/08/08 06:00 [pubmed] PHST- 2015/08/08 06:01 [medline] PHST- 2015/07/27 00:00 [pmc-release] AID - tcrm-11-1107 [pii] AID - 10.2147/TCRM.S88878 [doi] PST - epublish SO - Ther Clin Risk Manag. 2015 Jul 27;11:1107-11. doi: 10.2147/TCRM.S88878. eCollection 2015. PMID- 26215747 OWN - NLM STAT- MEDLINE DCOM- 20160421 LR - 20250711 IS - 2046-4924 (Electronic) IS - 1366-5278 (Print) IS - 1366-5278 (Linking) VI - 19 IP - 58 DP - 2015 Jul TI - Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis. PG - 1-228, v-vi LID - 10.3310/hta19580 [doi] AB - BACKGROUND: Patients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM(R) Delta, TEM International GmbH, Munich, Germany; www.rotem.de), TEG (TEG(R) 5000 analyser, Haemonetics Corporation, Niles, IL, USA; www.haemonetics.com) and Sonoclot (Sonoclot(R) coagulation and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care viscoelastic (VE) devices that use thromboelastometry to test for haemostasis in whole blood. They have a number of proposed advantages over standard laboratory tests (SLTs): they provide a result much quicker, are able to identify what part of the clotting process is disrupted, and provide information on clot formation over time and fibrinolysis. OBJECTIVES: This assessment aimed to assess the clinical effectiveness and cost-effectiveness of VE devices to assist with the diagnosis, management and monitoring of haemostasis disorders during and after cardiac surgery, trauma-induced coagulopathy and post-partum haemorrhage (PPH). METHODS: Sixteen databases were searched to December 2013: MEDLINE (OvidSP), MEDLINE In-Process and Other Non-Indexed Citations and Daily Update (OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (SCI) (Web of Science), Conference Proceedings Citation Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, Latin American and Caribbean Health Sciences Literature (LILACS), International Network of Agencies for Health Technology Assessment (INAHTA), National Institute for Health Research (NIHR) HTA programme, Aggressive Research Intelligence Facility (ARIF), Medion, and the International Prospective Register of Systematic Reviews (PROSPERO). Randomised controlled trials (RCTs) were assessed for quality using the Cochrane Risk of Bias tool. Prediction studies were assessed using QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using random-effects models. Continuous data were summarised narratively. For prediction studies, the odds ratio (OR) was selected as the primary effect estimate. The health-economic analysis considered the costs and quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs in cardiac surgery and trauma patients. A decision tree was used to take into account short-term complications and longer-term side effects from transfusion. The model assumed a 1-year time horizon. RESULTS: Thirty-one studies (39 publications) were included in the clinical effectiveness review. Eleven RCTs (n=1089) assessed VE devices in patients undergoing cardiac surgery; six assessed thromboelastography (TEG) and five assessed ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95% confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion (RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing groups compared with control. There were no significant differences between groups in terms of other blood products transfused. Continuous data on blood product use supported these findings. Clinical outcomes did not differ significantly between groups. There were no apparent differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot. There were no data on the clinical effectiveness of VE devices in trauma patients or women with PPH. VE testing was cost-saving and more effective than SLTs. For the cardiac surgery model, the cost-saving was pound43 for ROTEM, pound79 for TEG and pound132 for Sonoclot. For the trauma population, the cost-savings owing to VE testing were more substantial, amounting to per-patient savings of pound688 for ROTEM compared with SLTs, pound721 for TEG, and pound818 for Sonoclot. This finding was entirely dependent on material costs, which are slightly higher for ROTEM. VE testing remained cost-saving following various scenario analyses. CONCLUSIONS: VE testing is cost-saving and more effective than SLTs, in both patients undergoing cardiac surgery and trauma patients. However, there were no data on the clinical effectiveness of Sonoclot or of VE devices in trauma patients. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005623. FUNDING: The NIHR Health Technology Assessment programme. FAU - Whiting, Penny AU - Whiting P AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Al, Maiwenn AU - Al M AD - Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands. FAU - Westwood, Marie AU - Westwood M AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Ramos, Isaac Corro AU - Ramos IC AD - Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands. FAU - Ryder, Steve AU - Ryder S AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Armstrong, Nigel AU - Armstrong N AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Misso, Kate AU - Misso K AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Ross, Janine AU - Ross J AD - Kleijnen Systematic Reviews Ltd, York, UK. FAU - Severens, Johan AU - Severens J AD - Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands. FAU - Kleijnen, Jos AU - Kleijnen J AD - School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Systematic Review PL - England TA - Health Technol Assess JT - Health technology assessment (Winchester, England) JID - 9706284 SB - IM MH - Blood Coagulation Disorders/*diagnosis/physiopathology MH - Cost-Benefit Analysis MH - Hemostasis/*physiology MH - Humans MH - Point-of-Care Testing/*economics MH - Thrombelastography/*economics/*methods PMC - PMC4781169 EDAT- 2015/07/29 06:00 MHDA- 2016/04/22 06:00 PMCR- 2016/03/07 CRDT- 2015/07/29 06:00 PHST- 2015/07/29 06:00 [entrez] PHST- 2015/07/29 06:00 [pubmed] PHST- 2016/04/22 06:00 [medline] PHST- 2016/03/07 00:00 [pmc-release] AID - 10.3310/hta19580 [doi] PST - ppublish SO - Health Technol Assess. 2015 Jul;19(58):1-228, v-vi. doi: 10.3310/hta19580. PMID- 26209572 OWN - NLM STAT- MEDLINE DCOM- 20151102 LR - 20150813 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 158 IP - 3 DP - 2015 Sep TI - Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism. PG - 618-26 LID - S0039-6060(15)00480-8 [pii] LID - 10.1016/j.surg.2015.06.014 [doi] AB - BACKGROUND: Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable state would be associated with increased TE events. METHODS: This was a 14-month, prospective, observational trial evaluating serial rapid thrombelastography (rTEG) at 3 American College of Surgeons-verified, level 1 trauma centers. Inclusion criteria were highest-level trauma activation and arrival within 6 hours of injury. Exclusion criteria were <18 years of age, incarcerated, and burns>20% total body surface area. Serial rTEG (activated clotting time, k-time, alpha-angle, MA, lysis) and traditional coagulation testing (prothrombin time, partial thromboplastin time, fibrinogen and platelet count) were obtained at admission and then at 3, 6, 12, 24, 48, 72, 96, and 120 hours. Thromboembolic complications were defined as the development of deep-vein thrombosis, pulmonary embolism, acute myocardial infarction, or ischemic stroke during hospitalization. Patients were stratified into splenectomy versus nonsplenectomy cohorts. Univariate analysis was then conducted followed by longitudinal analysis using generalized estimating equations to evaluate the effects of time, splenectomy, and group-time interactions on changes in rTEG and traditional coagulation testing. We used an adjusted generalized estimating equation model to control for age, sex, ISS, admission blood pressure, base deficit, and hemoglobin. RESULTS: A total of 1,242 patients were enrolled; 795 had serial rTEG data. Of these, 605 had serial values >24 hours and made up the study population. Splenectomy patients were younger, more hypotensive, and in shock on arrival. Although there was no difference in 24-hour or 30-day mortality, splenectomy patients were more likely to develop TE events. Using the GEE model, we found that alpha-angle and MA in splenectomy patients were lesser (more hypocoagulable) within the first 6 hours; however, they became substantially greater (more hypercoagulable) at 48, 72, 96, and 120 hours; all P < .05. In addition, platelet counts were greater in the splenectomy group beginning at 72 hours and continuing through 120 hours; P < .05. CONCLUSION: This multicenter, prospective study demonstrates that patients undergoing splenectomy have a more hypercoagulable state than other trauma patients. This hypercoagulable state (identified by greater alpha-angle and mA values) begins at approximately 48 hours after injury and continues through at least day 5. Moreover, this hypercoagulable state is associated with increased risk of TE complications. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Pommerening, Matthew J AU - Pommerening MJ AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Rahbar, Elaheh AU - Rahbar E AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Minei, Kristin AU - Minei K AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Schreiber, Martin A AU - Schreiber MA AD - Oregon Health & Science University, Portland, OR. FAU - Cohen, Mitchell J AU - Cohen MJ AD - The University of California, San Francisco, CA. FAU - Underwood, Samantha J AU - Underwood SJ AD - Oregon Health & Science University, Portland, OR. FAU - Nelson, Mary AU - Nelson M AD - The University of California, San Francisco, CA. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20150721 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Aged MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Postoperative Complications/diagnosis/*etiology MH - Prospective Studies MH - Risk Factors MH - Spleen/*injuries/surgery MH - *Splenectomy MH - Thrombelastography MH - Thromboembolism/diagnosis/*etiology MH - Thrombophilia/diagnosis/*etiology MH - Time Factors MH - Treatment Outcome EDAT- 2015/07/26 06:00 MHDA- 2015/11/03 06:00 CRDT- 2015/07/26 06:00 PHST- 2015/01/02 00:00 [received] PHST- 2015/05/29 00:00 [revised] PHST- 2015/06/13 00:00 [accepted] PHST- 2015/07/26 06:00 [entrez] PHST- 2015/07/26 06:00 [pubmed] PHST- 2015/11/03 06:00 [medline] AID - S0039-6060(15)00480-8 [pii] AID - 10.1016/j.surg.2015.06.014 [doi] PST - ppublish SO - Surgery. 2015 Sep;158(3):618-26. doi: 10.1016/j.surg.2015.06.014. Epub 2015 Jul 21. PMID- 26180038 OWN - NLM STAT- MEDLINE DCOM- 20170629 LR - 20170629 IS - 1525-1489 (Electronic) IS - 0885-0666 (Linking) VI - 31 IP - 9 DP - 2016 Oct TI - Damage Control and the Open Abdomen: Challenges for the Nonsurgical Intensivist. PG - 567-76 LID - 10.1177/0885066615594352 [doi] AB - BACKGROUND: As strategies in acute care surgery focus on damage control to restore physiology, intensivists spanning all disciplines care for an increasing number of patients requiring massive transfusion, temporary abdominal closures, and their sequelae. OBJECTIVE: To equip the nonsurgical intensivist with evidence-based management principles for patients with an open abdomen after damage control surgery. DATA SOURCE: Search of PubMed database and manual review of bibliographies from selected articles. DATA SYNTHESIS AND CONCLUSIONS: Temporary abdominal closure improves outcomes in patients with abdominal compartment syndrome, hemorrhagic shock, and intra-abdominal sepsis but creates new challenges with electrolyte derangement, hypovolemia, malnutrition, enteric fistulas, and loss of abdominal wall domain. Intensive care of such patients mandates attention to resuscitation, sepsis control, and expedient abdominal closure. CI - (c) The Author(s) 2015. FAU - Griggs, Cornelia AU - Griggs C AD - Massachusetts General Hospital, Boston, MA, USA cgriggs@partners.org. FAU - Butler, Kathryn AU - Butler K AD - Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA. LA - eng PT - Journal Article PT - Review DEP - 20150714 PL - United States TA - J Intensive Care Med JT - Journal of intensive care medicine JID - 8610344 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Abdominal Injuries/complications/*surgery MH - Abdominal Wound Closure Techniques MH - Antifibrinolytic Agents/therapeutic use MH - Blood Transfusion/*methods MH - *Critical Care MH - Evidence-Based Emergency Medicine MH - Fasciotomy/*methods MH - Humans MH - Intra-Abdominal Hypertension/*therapy MH - Practice Guidelines as Topic MH - Shock, Hemorrhagic/diagnostic imaging/*therapy MH - *Thrombelastography MH - Tranexamic Acid/therapeutic use OTO - NOTNLM OT - abdominal compartment syndrome OT - damage control surgery OT - enteroatmospheric fistula OT - open abdomen EDAT- 2015/07/17 06:00 MHDA- 2017/07/01 06:00 CRDT- 2015/07/17 06:00 PHST- 2015/01/06 00:00 [received] PHST- 2015/06/10 00:00 [accepted] PHST- 2015/07/17 06:00 [entrez] PHST- 2015/07/17 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 0885066615594352 [pii] AID - 10.1177/0885066615594352 [doi] PST - ppublish SO - J Intensive Care Med. 2016 Oct;31(9):567-76. doi: 10.1177/0885066615594352. Epub 2015 Jul 14. PMID- 26179747 OWN - NLM STAT- MEDLINE DCOM- 20160310 LR - 20260518 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 23 DP - 2015 Jul 16 TI - Factors that may improve outcomes of early traumatic brain injury care: prospective multicenter study in Austria. PG - 53 LID - 10.1186/s13049-015-0133-z [doi] LID - 53 AB - BACKGROUND: Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect. METHODS: 14 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale score < 13 and/or AIS head > 2 within 48 h after the accident, were enrolled. Data were collected in 2 phases: in the first phase data of 408 patients were analyzed. Based on this, a set of recommendations expected to improve outcomes was developed by the study group and implemented in participating centers. Recommendations included time factors (transport to appropriate trauma center, avoiding secondary transfer), adequate treatment strategies (prehospital fluid and airway management, anesthesia, ventilation), monitoring (pulse oximetry and blood pressure monitoring in all patients, capnography in ventilated patients) for prehospital treatment. In the emergency department focus was on first CT scan as soon as possible, short interval between CT scan and surgery and early use of thrombelastometry to optimize coagulation. Following implementation of these recommendations, data on 325 patients were collected and analyzed in phase 2. Final analysis investigated the impact of the recommendations on patient outcomes. RESULTS: Patients in both data collection phases showed comparable demographic and injury severity characteristics. Treatment changes, especially in terms of fluid management, monitoring and normoventilation as well as thrombelastometry measurements were implemented successfully in phase 2, and led to significant improvement of patient outcomes. Hospital mortality was reduced from 31 % to 23 %. We found a lower rate of unfavorable outcomes, a significant increase in unexpected survivors and more patients with unexpected favorable outcomes as well. CONCLUSIONS: The results of this study clearly demonstrate that the outcomes of TBI patients can be improved with appropriate early care. FAU - Brazinova, Alexandra AU - Brazinova A AD - International Neurotrauma Research Organization (INRO), Molker Gasse 4/3, 1080, Vienna, Austria. abrazinova@igeh.org. AD - Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Univerzitne nam.1, 91843, Trnava, Slovak Republic. abrazinova@igeh.org. FAU - Majdan, Marek AU - Majdan M AD - International Neurotrauma Research Organization (INRO), Molker Gasse 4/3, 1080, Vienna, Austria. mmajdan@igeh.org. AD - Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Univerzitne nam.1, 91843, Trnava, Slovak Republic. mmajdan@igeh.org. FAU - Leitgeb, Johannes AU - Leitgeb J AD - Department of Traumatology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. johannes.leitgeb@meduniwien.ac.at. FAU - Trimmel, Helmut AU - Trimmel H AD - Department of Anesthesiology, Intensive Care and Emergency Medicine, Wiener Neustadt Regional Hospital, Corvinusring 3-5, 2700, Wiener Neustadt, Austria. Helmut.Trimmel@wienerneustadt.lknoe.at. FAU - Mauritz, Walter AU - Mauritz W AD - International Neurotrauma Research Organization (INRO), Molker Gasse 4/3, 1080, Vienna, Austria. walter.mauritz@auva.at. AD - Department of Anesthesiology and Intensive Care Medicine, Trauma Hospital 'Lorenz Boehler", Donaueschingenstrasse 13, 1200, Vienna, Austria. walter.mauritz@auva.at. CN - Austrian Working Group on Improvement of Early TBI Care LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20150716 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Adult MH - Austria/epidemiology MH - Brain Injuries/mortality/physiopathology/*therapy MH - Emergency Medical Services/*methods MH - Female MH - Follow-Up Studies MH - Glasgow Coma Scale MH - Hospital Mortality/trends MH - Humans MH - Male MH - Middle Aged MH - Monitoring, Physiologic MH - Prospective Studies MH - *Trauma Centers MH - Young Adult PMC - PMC4504095 FIR - Brazinova, Alexandra IR - Brazinova A FIR - Majdan, Marek IR - Majdan M FIR - Leitgeb, Johannes IR - Leitgeb J FIR - Mauritz, Walter IR - Mauritz W FIR - Liedler, Andreas IR - Liedler A FIR - Schmied, Harald IR - Schmied H FIR - Folie, Reinhard IR - Folie R FIR - Germann, Reinhard IR - Germann R FIR - Graber, Jurgen IR - Graber J FIR - Michaeli, Kristina IR - Michaeli K FIR - Oswald, Rene Florian IR - Oswald RF FIR - Waltensdorfer, Andreas IR - Waltensdorfer A FIR - Haidacher, Thomas IR - Haidacher T FIR - Menner, Johannes IR - Menner J FIR - Hublauer, Anna IR - Hublauer A FIR - Nodl, Elisabeth IR - Nodl E FIR - Freund, Christian IR - Freund C FIR - Stadlbauer, Karl-Heinz IR - Stadlbauer KH FIR - Oher, Michel IR - Oher M FIR - Zechner, Annemarie IR - Zechner A FIR - Gruber, Franz IR - Gruber F FIR - Mitterndorfer, Walter IR - Mitterndorfer W FIR - Rathmaier, Sandra IR - Rathmaier S FIR - Bauer, Norbert IR - Bauer N FIR - Hohenauer, Peter IR - Hohenauer P FIR - Lanner, Josef IR - Lanner J FIR - Voelckel, Wolfgang IR - Voelckel W FIR - Mirth, Claudia IR - Mirth C FIR - Artmann, Hubert IR - Artmann H FIR - Cudrigh, Bettina IR - Cudrigh B FIR - Csomor, Daniel IR - Csomor D FIR - Herzer, Gunther IR - Herzer G FIR - Hofinger, Andreas IR - Hofinger A FIR - Trimmel, Helmut IR - Trimmel H FIR - Lorenz, Veit IR - Lorenz V FIR - Steltzer, Heinz IR - Steltzer H FIR - Mauritz, Walter IR - Mauritz W EDAT- 2015/07/17 06:00 MHDA- 2016/03/11 06:00 PMCR- 2015/07/16 CRDT- 2015/07/17 06:00 PHST- 2015/02/12 00:00 [received] PHST- 2015/07/06 00:00 [accepted] PHST- 2015/07/17 06:00 [entrez] PHST- 2015/07/17 06:00 [pubmed] PHST- 2016/03/11 06:00 [medline] PHST- 2015/07/16 00:00 [pmc-release] AID - 10.1186/s13049-015-0133-z [pii] AID - 133 [pii] AID - 10.1186/s13049-015-0133-z [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2015 Jul 16;23:53. doi: 10.1186/s13049-015-0133-z. PMID- 26151526 OWN - NLM STAT- MEDLINE DCOM- 20150925 LR - 20260304 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 78 IP - 6 DP - 2015 Jun TI - 2014 Consensus conference on viscoelastic test-based transfusion guidelines for early trauma resuscitation: Report of the panel. PG - 1220-9 LID - 10.1097/TA.0000000000000657 [doi] AB - There has been an increased interest in the use of viscoelastic testing to guide blood product replacement during the acute resuscitation of the injured patient. Currently, no uniformly accepted guidelines exist for how this technology should be integrated into clinical care. In September 2014, an international multidisciplinary group of leaders in the field of trauma coagulopathy and resuscitation was assembled for a 2-day consensus conference in Philadelphia, Pennsylvania. This panel included trauma surgeons, hematologists, blood bank specialists, anesthesiologists, and the lay public.Nine questions regarding the impact of viscoelastic testing in the early resuscitation of trauma patients were developed before the conference by panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival-when conventional laboratory results are not available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a two-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen, platelets, plasma, and prothrombin complex concentrates. This report summarizes the findings and recommendations of this consensus conference. FAU - Inaba, Kenji AU - Inaba K AD - From the Division of Trauma and Surgical Critical Care (K.I.), University of Southern California, Los Angeles, California; Departments of Surgery and Critical Care Medicine, St. Michael's Hospital, and University of Toronto (S.R.); Department of Surgery, Sunnybrook Health Sciences Center and Institute of Medical Science, University of Toronto (P.V.); and Department of Clinical Pathology, Sunnybrook Health Sciences Center Toronto, and Department of Laboratory Medicine and Pathobiology, University of Toronto (J.C.), Toronto, Ontario, Canada; Centre for Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London (R.D.), London, United Kingdom; Department of Laboratory Medicine (J.H.), School of Medicine, University of Washington, Seattle, Washington; and Department of Traumatology and Orthopedic Surgery (M.M.), Institute for Research in Operative Medicine (IFOM), Private University Witten/Herdecke Ostmerheimserstr, Koln, Germany. FAU - Rizoli, Sandro AU - Rizoli S FAU - Veigas, Precilla V AU - Veigas PV FAU - Callum, Jeannie AU - Callum J FAU - Davenport, Ross AU - Davenport R FAU - Hess, John AU - Hess J FAU - Maegele, Marc AU - Maegele M CN - Viscoelastic Testing in Trauma Consensus Panel LA - eng PT - Consensus Statement PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/*diagnosis/etiology/*therapy MH - *Blood Coagulation Tests MH - *Blood Transfusion MH - Blood Viscosity MH - Early Diagnosis MH - Humans MH - *Resuscitation MH - Wounds and Injuries/complications/*therapy EDAT- 2015/07/08 06:00 MHDA- 2015/09/26 06:00 CRDT- 2015/07/08 06:00 PHST- 2015/07/08 06:00 [entrez] PHST- 2015/07/08 06:00 [pubmed] PHST- 2015/09/26 06:00 [medline] AID - 01586154-201506000-00023 [pii] AID - 10.1097/TA.0000000000000657 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Jun;78(6):1220-9. doi: 10.1097/TA.0000000000000657. PMID- 26149052 OWN - NLM STAT- MEDLINE DCOM- 20160404 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 13 Suppl 1 IP - 0 1 DP - 2015 Jun TI - TACTIC: Trans-Agency Consortium for Trauma-Induced Coagulopathy. PG - S63-71 LID - 10.1111/jth.12981 [doi] AB - Trauma-induced coagulopathy (TIC) includes heterogeneous coagulopathic syndromes with different underlying causes, and treatment is challenged by limited diagnostic tests to discriminate between these entities in the acute setting. We provide an overview of progress in understanding the mechanisms of TIC and the context for several of the hypotheses that will be tested in 'TACTIC'. Although connected to ongoing clinical trials in trauma, TACTIC itself has no intent to conduct clinical trials. We do anticipate that 'early translation' of promising results will occur. Functions anticipated at this early translational level include: (i) basic science groundwork for future therapeutic candidates; (ii) development of acute coagulopathy scoring systems; (iii) coagulation factor composition-based computational analysis; (iv) characterization of novel analytes including tissue factor, polyphosphates, histones, meizothrombin and alpha-thrombin-antithrombin complexes, factor XIa, platelet and endothelial markers of activation, signatures of protein C activation and fibrinolysis markers; and (v) assessment of viscoelastic tests and new point-of-care methods. CI - (c) 2015 International Society on Thrombosis and Haemostasis. FAU - Mann, K G AU - Mann KG AD - Department of Biochemistry, University of Vermont, Colchester, VT, USA. FAU - Freeman, K AU - Freeman K AD - Department of Surgery, University of Vermont, Burlington, VT, USA. LA - eng GR - K08 GM098795/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 SB - IM MH - Animals MH - *Blood Coagulation MH - Blood Coagulation Disorders/blood/*etiology/therapy MH - *Cooperative Behavior MH - Humans MH - *Interinstitutional Relations MH - Translational Research, Biomedical/*organization & administration MH - Wounds and Injuries/blood/*complications/therapy PMC - PMC4498273 MID - NIHMS683203 OTO - NOTNLM OT - blood coagulation disorders OT - endothelium OT - hemorrhage OT - platelets OT - thrombin OT - trauma EDAT- 2015/07/08 06:00 MHDA- 2016/04/05 06:00 PMCR- 2016/06/01 CRDT- 2015/07/08 06:00 PHST- 2015/07/08 06:00 [entrez] PHST- 2015/07/08 06:00 [pubmed] PHST- 2016/04/05 06:00 [medline] PHST- 2016/06/01 00:00 [pmc-release] AID - S1538-7836(22)04259-3 [pii] AID - 10.1111/jth.12981 [doi] PST - ppublish SO - J Thromb Haemost. 2015 Jun;13 Suppl 1(0 1):S63-71. doi: 10.1111/jth.12981. PMID- 26140884 OWN - NLM STAT- MEDLINE DCOM- 20150914 LR - 20150704 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 81 IP - 7 DP - 2015 Jul TI - Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism. PG - 663-8 AB - We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score >/= 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 +/- 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients. FAU - Allen, Casey J AU - Allen CJ AD - Divisions of Trauma and Surgical Critical Care, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. FAU - Murray, Clark R AU - Murray CR FAU - Meizoso, Jonathan P AU - Meizoso JP FAU - Ray, Juliet J AU - Ray JJ FAU - Teisch, Laura F AU - Teisch LF FAU - Ruiz, Xiomara D AU - Ruiz XD FAU - Hanna, Mena M AU - Hanna MM FAU - Guarch, Gerardo A AU - Guarch GA FAU - Manning, Ronald J AU - Manning RJ FAU - Livingstone, Alan S AU - Livingstone AS FAU - Ginzburg, Enrique AU - Ginzburg E FAU - Schulman, Carl I AU - Schulman CI FAU - Namias, Nicholas AU - Namias N FAU - Proctor, Kenneth G AU - Proctor KG LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Aged MH - Blood Coagulation/*physiology MH - Blood Platelets/physiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/therapeutic use MH - Prospective Studies MH - Risk Assessment MH - Thrombelastography MH - Venous Thromboembolism/*blood/*prevention & control MH - Wounds and Injuries/*blood EDAT- 2015/07/05 06:00 MHDA- 2015/09/15 06:00 CRDT- 2015/07/05 06:00 PHST- 2015/07/05 06:00 [entrez] PHST- 2015/07/05 06:00 [pubmed] PHST- 2015/09/15 06:00 [medline] PST - ppublish SO - Am Surg. 2015 Jul;81(7):663-8. PMID- 26091324 OWN - NLM STAT- MEDLINE DCOM- 20150903 LR - 20181113 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 79 IP - 1 DP - 2015 Jul TI - All the bang without the bucks: Defining essential point-of-care testing for traumatic coagulopathy. PG - 117-24; discussion 124 LID - 10.1097/TA.0000000000000691 [doi] AB - BACKGROUND: Rapid assessment and treatment of coagulopathy reduces postinjury morbidity and mortality. Although thrombelastography (TEG) may be more accurate and efficient than conventional coagulation tests, it requires significant financial and personnel investments. We hypothesized that point-of-care international normalized ratio (POC INR) may provide a rapid and accurate alternative to TEG. METHODS: A retrospective review of sequential trauma patients who underwent both POC INR and rapid TEG (r-TEG) testing upon presentation to a Level I trauma center from July 2012 to December 2013 was performed. POC INR was compared with r-TEG values (R value, K time, alpha angle, maximum amplitude, percent clot lysis in 30 minutes) and transfusion requirements. Vital signs, admission laboratory values, and injury severity were analyzed. POC INR and venous blood gas testing was performed in the emergency department. All results and Pearson correlations noted were significant if p < 0.05. RESULTS: We identified 628 trauma patients with concomitant r-TEG and POC INR testing. Median Injury Severity Score (ISS) was 13, 20% arrived in shock (base value < -5), 21% were transfused, and 11% died. POC INR correlated with all r-TEG values, with stronger correlations for patients in shock. POC INR and r-TEG had similar correlations with blood products transfused at 4 hours and 24 hours, but only POC INR predicted substantial bleeding and massive transfusion. POC INR also correlated strongly with standard INR testing. POC INR test duration was less than 1 minute, compared with at least 30 minutes for r-TEG. Total cohort charges for POC INR were estimated at $21,980 versus $396,896 for r-TEG. CONCLUSION: POC INR testing is faster and cheaper than r-TEG. In addition, POC INR correlates not only with r-TEG values but also with acute blood product transfusions. POC INR provides a practical alternative for rapid coagulopathy assessment in the trauma patient at institutions that lack TEG capability. LEVEL OF EVIDENCE: Diagnostic study, level III. Therapeutic/care management study, level IV. FAU - Goodman, Michael D AU - Goodman MD AD - From the Division of Trauma and Surgical Critical Care, Department of Surgery, and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio. FAU - Makley, Amy T AU - Makley AT FAU - Hanseman, Dennis J AU - Hanseman DJ FAU - Pritts, Timothy A AU - Pritts TA FAU - Robinson, Bryce R H AU - Robinson BR LA - eng GR - UL1 TR000077/TR/NCATS NIH HHS/United States PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Female MH - Humans MH - Injury Severity Score MH - *International Normalized Ratio MH - Logistic Models MH - Male MH - Middle Aged MH - *Point-of-Care Systems MH - Retrospective Studies MH - Sensitivity and Specificity MH - *Thrombelastography MH - Wounds and Injuries/complications PMC - PMC5558264 MID - NIHMS889448 COIS- DISCLOSURE The authors declare no conflicts of interest. EDAT- 2015/06/20 06:00 MHDA- 2015/09/04 06:00 PMCR- 2017/08/16 CRDT- 2015/06/20 06:00 PHST- 2015/06/20 06:00 [entrez] PHST- 2015/06/20 06:00 [pubmed] PHST- 2015/09/04 06:00 [medline] PHST- 2017/08/16 00:00 [pmc-release] AID - 01586154-201507000-00018 [pii] AID - 10.1097/TA.0000000000000691 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Jul;79(1):117-24; discussion 124. doi: 10.1097/TA.0000000000000691. PMID- 26070849 OWN - NLM STAT- MEDLINE DCOM- 20151102 LR - 20150813 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 158 IP - 3 DP - 2015 Sep TI - Prevalence and impact of admission hyperfibrinolysis in severely injured pediatric trauma patients. PG - 812-8 LID - S0039-6060(15)00372-4 [pii] LID - 10.1016/j.surg.2015.05.004 [doi] AB - INTRODUCTION: Hyperfibrinolysis (HF) on admission is associated with increased mortality in adult patients with trauma. Several studies have demonstrated that 9% of severely injured adults present to the emergency department (ED) with HF. Our aim was to (1) define HF in pediatric patients and develop a relevant cut-point for therapeutic intervention (if any); (2) identify the prevalence of HF in severely injured pediatric patients; and (3) determine whether HF on admission is as lethal a phenomenon as it is in adults. METHODS: After approval from the institutional review board (Committee for the Protection of Human Subjects), we identified all pediatric trauma admissions (patients /=3% where mortality doubled from 9 to 20%. We began by identifying a relevant inflection point to define HF and its prevalence, followed by univariate analysis to compare HF and non-HF patients. Finally, a purposeful logistic regression model was developed to evaluate clinically relevant predictors of mortality in severely injured pediatric patients. RESULTS: A total of 819 patients met study criteria. LY-30 values were plotted against mortality. A distinct inflection point was noted at >/=3%, where mortality doubled from 6 to 14%. Of note, mortality continued to increase as the amount of lysis increased, with a 100% mortality demonstrated at a LY-30 >/=30% (compared with 77% in adults). Using LY-30 >/=3%, we stratified patients into HF (n = 197) and non-HF (n = 622) groups, with prevalence on admission of 24%. With the exception of HF patients being younger (median age 11 vs 15 years; P < .001), there were no differences in demographics, scene vitals, or Injury Severity Scores between the groups. On arrival to the ED, HF patients had a lesser systolic blood pressure (median 118 vs 124 mm Hg) and lesser hemoglobin (median 12.2 vs 12.7 g/dL); both P < .001). Controlling for age, arrival vital signs, admission hemoglobin, and Injury Severity Score, we found that logistic regression identified admission LY30 >/=3% (odds ratio 6.2, 95% confidence interval 2.47-16.27) as an independent predictor of mortality. CONCLUSION: Similar to adults, admission HF appears to reach a critical threshold at a LY30 >/=3% in pediatric patients. Admission HF in pediatric patients occurs more frequently than in adults (24 vs 9%) but is associated similarly with a substantial increase in mortality (6-14%). When controlling for additional factors, we found that admission LY-30 >/=3% has an odds ratio of 6.2 (P < .001) for mortality among severely injured pediatric patients. HF on admission may serve to identify rapidly those injured children and adolescents likely to benefit from hemostatic resuscitation efforts and to guide antifibrinolytic therapy. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Liras, Ioannis N AU - Liras IN AD - Department of Surgery and Center for Translational Injury Research, The University of Texas Medical School at Houston, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery and Center for Translational Injury Research, The University of Texas Medical School at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice, The University of Texas Medical School at Houston, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Department of Surgery and Center for Translational Injury Research, The University of Texas Medical School at Houston, Houston, TX. FAU - Harting, Matthew T AU - Harting MT AD - Center for Surgical Trials and Evidence-based Practice, The University of Texas Medical School at Houston, Houston, TX; Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, TX. LA - eng PT - Journal Article DEP - 20150610 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adolescent MH - Blood Coagulation Disorders/diagnosis/epidemiology/*etiology MH - Child MH - Child, Preschool MH - Female MH - Fibrinolysis MH - Humans MH - Infant MH - Infant, Newborn MH - Injury Severity Score MH - Logistic Models MH - Male MH - Prevalence MH - Prognosis MH - Retrospective Studies MH - Thrombelastography MH - Wounds and Injuries/*complications/mortality EDAT- 2015/06/14 06:00 MHDA- 2015/11/03 06:00 CRDT- 2015/06/14 06:00 PHST- 2015/01/03 00:00 [received] PHST- 2015/04/10 00:00 [revised] PHST- 2015/05/13 00:00 [accepted] PHST- 2015/06/14 06:00 [entrez] PHST- 2015/06/14 06:00 [pubmed] PHST- 2015/11/03 06:00 [medline] AID - S0039-6060(15)00372-4 [pii] AID - 10.1016/j.surg.2015.05.004 [doi] PST - ppublish SO - Surgery. 2015 Sep;158(3):812-8. doi: 10.1016/j.surg.2015.05.004. Epub 2015 Jun 10. PMID- 26067457 OWN - NLM STAT- MEDLINE DCOM- 20151102 LR - 20220311 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 158 IP - 3 DP - 2015 Sep TI - Predicting progressive hemorrhagic injury from isolated traumatic brain injury and coagulation. PG - 655-61 LID - S0039-6060(15)00357-8 [pii] LID - 10.1016/j.surg.2015.02.029 [doi] AB - BACKGROUND: Progressive hemorrhagic injury (PHI) in traumatic brain injury (TBI) patients is associated with poor outcomes. Early prediction of PHI is difficult yet vital. We hypothesize that TBI subtype and coagulation would be predictors of PHI. METHODS: This was a retrospective analysis of highest level activation adult trauma patients with evidence of TBI (head Abbreviated Injury Scale >/=3). Coagulopathy was determined using rapid thrombelastography (r-TEG), complete blood counts, and conventional coagulation tests obtained on arrival. Patients were dichotomized into PHI and stable groups based on head computerized CT. Subtypes of TBI included subdural hematoma, intraparenchymal contusions (IPC), subarachnoid hemorrhage, epidural hematoma, and combined. Data are reported as median values with interquartile range (IQR). Multivariate logistic regression was used to assess the effect of subtype and coagulation on PHI. RESULTS: We included 279 isolated TBI patients who met study criteria. There were 157 patients (56%) who experienced PHI; 122 (44%) were stable on repeat CT. Patients with PHI were older, had fewer hospital-free days, and higher mortality (all P < .001). No differences were noted in r-TEG parameters between groups; however, coagulopathy and age were independent predictors of progression in all subtypes (odds ratio [OR], 1.81; 95% CI, 1.09-3.01 [P = .021]; OR, 1.02, 95% CI, 1.01-1.04 [P = .006]). Controlling for age, Glasgow Coma Scale score, and coagulopathy, patients with IPC were more likely to experience PHI (OR, 4.49; 95% CI, 2.24-8.98; P < .0001). CONCLUSION: This study demonstrates that older patients with coagulation abnormalities and IPC on admission are more likely to experience PHI, identifying a target population for earlier therapies. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Folkerson, Lindley E AU - Folkerson LE AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. Electronic address: Lindley.E.Folkerson@uth.tmc.edu. FAU - Sloan, Duncan AU - Sloan D AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. FAU - Tomasek, Jeffrey S AU - Tomasek JS AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150609 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*complications/diagnosis MH - Brain Injuries/*complications/diagnosis MH - Female MH - Humans MH - Intracranial Hemorrhage, Traumatic/*diagnosis/etiology MH - Logistic Models MH - Male MH - Middle Aged MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Thrombelastography MH - Young Adult EDAT- 2015/06/13 06:00 MHDA- 2015/11/03 06:00 CRDT- 2015/06/13 06:00 PHST- 2015/01/02 00:00 [received] PHST- 2015/02/17 00:00 [revised] PHST- 2015/02/19 00:00 [accepted] PHST- 2015/06/13 06:00 [entrez] PHST- 2015/06/13 06:00 [pubmed] PHST- 2015/11/03 06:00 [medline] AID - S0039-6060(15)00357-8 [pii] AID - 10.1016/j.surg.2015.02.029 [doi] PST - ppublish SO - Surgery. 2015 Sep;158(3):655-61. doi: 10.1016/j.surg.2015.02.029. Epub 2015 Jun 9. PMID- 26054337 OWN - NLM STAT- MEDLINE DCOM- 20160624 LR - 20220330 IS - 1471-2253 (Electronic) IS - 1471-2253 (Linking) VI - 15 DP - 2015 Jun 9 TI - Prophylactic plasma and platelet transfusion in the critically Ill patient: just useless and expensive or even harmful? PG - 86 LID - 10.1186/s12871-015-0074-0 [doi] LID - 86 AB - It is still common practice to correct abnormal standard laboratory test results, such as increased INR or low platelet count, prior to invasive interventions, such as tracheostomy, central venous catheter insertion or liver biopsy, in critically ill patients. Data suggest that 30-90 % of plasma transfused for these indications is unnecessary and puts the patient at risk. Plasma transfusion is associated with a high risk of transfusion-associated adverse events such as transfusion-associated circulatory overload (TACO), transfusion-related lung injury (TRALI), transfusion-related immunomodulation (TRIM), and anaphylaxis/allergic reactions. Therefore, the avoidance of inappropriate plasma transfusion bears a high potential of improving patient outcomes. The prospective study by Durila et al., published recently in BMC Anesthesiology, provides evidence that tracheostomies can be performed without prophylactic plasma transfusion and bleeding complications in critically ill patients despite increased INR in case of normal thromboelastometry (ROTEM) results. Thromboelastometry-based restrictive transfusion management helped avoid unnecessary plasma and platelet transfusion, and should reduce the incidence of transfusion-related adverse events and transfusion-associated hospital costs. Therefore, the authors believe that thromboelastometry-based strategies should be implemented to optimize patient blood management in perioperative medicine. FAU - Gorlinger, Klaus AU - Gorlinger K AD - Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany. klaus@goerlinger.net. AD - Tem International GmbH, Munich, Germany. klaus@goerlinger.net. FAU - Saner, Fuat H AU - Saner FH AD - Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany. fuat.saner@uni-due.de. LA - eng PT - Journal Article PT - Review DEP - 20150609 PL - England TA - BMC Anesthesiol JT - BMC anesthesiology JID - 100968535 SB - IM MH - Critical Illness/*economics/*therapy MH - Humans MH - *Plasma MH - Platelet Transfusion/*adverse effects/*economics MH - Pre-Exposure Prophylaxis/economics/methods MH - Thrombelastography/economics/methods PMC - PMC4556318 EDAT- 2015/06/10 06:00 MHDA- 2016/06/25 06:00 PMCR- 2015/06/09 CRDT- 2015/06/10 06:00 PHST- 2015/06/01 00:00 [received] PHST- 2015/06/01 00:00 [accepted] PHST- 2015/06/10 06:00 [entrez] PHST- 2015/06/10 06:00 [pubmed] PHST- 2016/06/25 06:00 [medline] PHST- 2015/06/09 00:00 [pmc-release] AID - 10.1186/s12871-015-0074-0 [pii] AID - 74 [pii] AID - 10.1186/s12871-015-0074-0 [doi] PST - epublish SO - BMC Anesthesiol. 2015 Jun 9;15:86. doi: 10.1186/s12871-015-0074-0. PMID- 26038165 OWN - NLM STAT- MEDLINE DCOM- 20160405 LR - 20181113 IS - 1863-9941 (Electronic) IS - 1863-9933 (Print) IS - 1863-9933 (Linking) VI - 41 IP - 1 DP - 2015 Feb TI - Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early. PG - 49-56 LID - 10.1007/s00068-014-0400-0 [doi] AB - PURPOSE: Viscoelastic hemostatic assays are emerging as the standard-of-care in the early detection of post-injury coagulopathy. TEG and ROTEM are most commonly used. Although similar in technique, each uses different reagents, which may affect their sensitivity to detect fibrinolysis. Therefore, the purpose of this study is to determine the ability of each device to detect fibrinolysis. METHODS: TEG (Rapid, Kaolin, Functional Fibrinogen) and ROTEM (EXTEM, INTEM, FIBTEM) were run simultaneously on normal blood as well as blood containing tPA from healthy volunteers (n = 10). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and ROTEM assays, respectively. RESULTS: TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable. CONCLUSIONS: TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding trauma patients in order to provide timely antifibrinolytic therapy. FAU - Harr, J N AU - Harr JN AD - Department of Surgery, University of Colorado Denver, Aurora, CO, USA, jeffrey.harr@ucdenver.edu. FAU - Moore, E E AU - Moore EE FAU - Chin, T L AU - Chin TL FAU - Chapman, M P AU - Chapman MP FAU - Ghasabyan, A AU - Ghasabyan A FAU - Stringham, J R AU - Stringham JR FAU - Banerjee, A AU - Banerjee A FAU - Silliman, C C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20140404 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis/physiopathology MH - Blood Pressure MH - Critical Care MH - Early Diagnosis MH - Fibrinolysis MH - Humans MH - Point-of-Care Systems MH - Sensitivity and Specificity MH - Shock, Hemorrhagic/blood/*prevention & control MH - *Thrombelastography/instrumentation MH - Wounds and Injuries/blood/*complications/physiopathology PMC - PMC5810948 MID - NIHMS936258 COIS- Conflict of interest J. N. Harr, E. E. Moore, T. L. Chin, M. P. Chapman, A. Ghasabyan, J. R. Stringham, A. Banerjee, and C. C. Silliman report no conflict of interest. EDAT- 2015/06/04 06:00 MHDA- 2016/04/06 06:00 PMCR- 2018/02/13 CRDT- 2015/06/04 06:00 PHST- 2014/01/04 00:00 [received] PHST- 2014/03/23 00:00 [accepted] PHST- 2015/06/04 06:00 [entrez] PHST- 2015/06/04 06:00 [pubmed] PHST- 2016/04/06 06:00 [medline] PHST- 2018/02/13 00:00 [pmc-release] AID - 10.1007/s00068-014-0400-0 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2015 Feb;41(1):49-56. doi: 10.1007/s00068-014-0400-0. Epub 2014 Apr 4. PMID- 26019707 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20150528 LR - 20201001 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 42 IP - 2 DP - 2015 Mar TI - Point of care and factor concentrate-based coagulation algorithms. PG - 115-21 LID - 10.1159/000381320 [doi] AB - In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving. FAU - Theusinger, Oliver M AU - Theusinger OM AD - Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland. FAU - Stein, Philipp AU - Stein P AD - Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland. FAU - Levy, Jerrold H AU - Levy JH AD - Cardiothoracic ICU, Duke University School of Medicine, Durham, NC, USA. LA - eng PT - Journal Article PT - Review DEP - 20150320 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC4439774 OTO - NOTNLM OT - Bleeding OT - Cardiac surgery OT - Goal-directed transfusions OT - POC OT - Patient blood management OT - Point of care devices OT - ROTEM(R) OT - Thrombelastometry OT - Transfusion management OT - Trauma EDAT- 2015/05/29 06:00 MHDA- 2015/05/29 06:01 PMCR- 2015/03/20 CRDT- 2015/05/29 06:00 PHST- 2014/12/29 00:00 [received] PHST- 2015/03/03 00:00 [accepted] PHST- 2015/05/29 06:00 [entrez] PHST- 2015/05/29 06:00 [pubmed] PHST- 2015/05/29 06:01 [medline] PHST- 2015/03/20 00:00 [pmc-release] AID - tmh-0042-0115 [pii] AID - 10.1159/000381320 [doi] PST - ppublish SO - Transfus Med Hemother. 2015 Mar;42(2):115-21. doi: 10.1159/000381320. Epub 2015 Mar 20. PMID- 26002266 OWN - NLM STAT- MEDLINE DCOM- 20150818 LR - 20181113 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 78 IP - 6 Suppl 1 DP - 2015 Jun TI - Postinjury fibrinolysis shutdown: Rationale for selective tranexamic acid. PG - S65-9 LID - 10.1097/TA.0000000000000634 [doi] AB - Postinjury systemic fibrinolysis has been recognized as a biologic process for more than 200 years, but the specific mechanisms of regulation and their clinical implications remain to be elucidated. By the 1950s, the plasminogen-plasmin-antiplasmin system was established as critical in preserving microvascular patency during blood clotting to maintain hemostasis. The challenges in modulating systemic fibrinolysis became evident soon thereafter. In the 1960s systemic fibrinolysis was identified by thrombelastography (TEG) during the anhepatic phase of liver transplantation, prompting the recommendation for intraoperative antifibrinolytics. But the administration of antifibrinolytic was associated with fatal postoperative pulmonary emboli. During the same period, there was experimental evidence that antifibrinolytics prevented irreversible hemorrhagic shock. More recently, a randomized trial indicated that plasmin inhibition during coronary artery bypass grafting was associated with increased mortality. The interest in antifibrinolytic therapy for trauma induced coagulopathy (TIC) is a relatively recent event, largely driven by the increasing use of viscoelastic hemostatic assays. The CRASH-2 trial, published in 2010, stimulated worldwide enthusiasm for tranexamic acid (TXA). However, the limitations of this study were soon acknowledged, raising concern for the unbridled use of TXA. Most recently, the documentation of fibrinolysis shutdown soon after injury has highlighted the potential adverse effects due to the untimely administration of TXA. A recent retrospective analysis in severely injured patients supports this hypothesis. But final clarity of this volatile topic awaits the completion of the current ongoing randomized clinical trials throughout the world. FAU - Moore, Ernest E AU - Moore EE AD - From the Departments of Surgery (E.E.M., H.B.M., E.G., M.P.C., K.C.H., A.S., A.B.) and Pediatrics (C.C.S.), University of Colorado Denver, Aurora; Department of Surgery (E.E.M., H.B.M., E.G., M.P.C., A.S.), Denver Health Medical Center; and Bonfils Blood Center (C.C.S.), Denver, Colorado. FAU - Moore, Hunter B AU - Moore HB FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Chapman, Michael P AU - Chapman MP FAU - Hansen, Kirk C AU - Hansen KC FAU - Sauaia, Angela AU - Sauaia A FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - P50-GM049222/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - UMIHL120877/PHS HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 0 (Plasminogen Activator Inhibitor 1) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM MH - Antifibrinolytic Agents/*therapeutic use MH - Blood Component Transfusion MH - Fibrinolysin/metabolism MH - Fibrinolysis/*physiology MH - Humans MH - Plasminogen Activator Inhibitor 1/metabolism MH - Tranexamic Acid/*therapeutic use MH - Wounds and Injuries/*physiopathology PMC - PMC4443855 MID - NIHMS666574 EDAT- 2015/05/24 06:00 MHDA- 2015/08/19 06:00 PMCR- 2016/06/01 CRDT- 2015/05/24 06:00 PHST- 2015/05/24 06:00 [entrez] PHST- 2015/05/24 06:00 [pubmed] PHST- 2015/08/19 06:00 [medline] PHST- 2016/06/01 00:00 [pmc-release] AID - 01586154-201506001-00011 [pii] AID - 10.1097/TA.0000000000000634 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S65-9. doi: 10.1097/TA.0000000000000634. PMID- 26002263 OWN - NLM STAT- MEDLINE DCOM- 20150818 LR - 20220318 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 78 IP - 6 Suppl 1 DP - 2015 Jun TI - Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program. PG - S48-53 LID - 10.1097/TA.0000000000000641 [doi] AB - BACKGROUND: Massive transfusion protocols (MTPs) have been developed to implement damage control resuscitation (DCR) principles. A survey of MTP policies from American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) participants was performed to establish which MTP activation, hemostatic resuscitation, and monitoring aspects of DCR are included in the MTP guidelines. METHODS: On October 10, 2013, ACS-TQIP administration administered a cross-sectional electronic survey to 187 ACS-TQIP participants. RESULTS: Seventy-one percent (132 of 187) of responses were analyzed, with 62% designated as Level I and 38% designated as Level II ACS-TQIP trauma centers. Sixty-nine percent of sites indicated that they have plasma immediately available for MTP activation. By policy, in the first group of blood products administered, 88% of sites target high (>/=1:2) plasma-to-red blood cell (RBC) ratios and 10% target low ratios. Likewise, 79% of sites target high platelet-to-RBC ratios and 16% target low ratios. Eighteen percent of sites reported incorporating point-of-care thromboelastogram into MTP policies. The most common intravenous hemostatic adjunct incorporated into MTPs was tranexamic acid (49%). Thirty-four percent of sites reported that some or all of their emergency medical service agencies have the ability to administer blood products or hemostatic agents during prehospital transport. There were minimal differences in MTP policies or capabilities between Level I and II sites. CONCLUSION: The majority of ACS-TQIP participants reported having MTPs that support the use of DCR principles including high plasma-to-RBC and platelet-to-RBC ratios. Immediate availability of plasma and product use by emergency medical services are becoming increasingly common, whereas the incorporation of point-of-care thromboelastogram into MTP policies remains low. FAU - Camazine, Maraya N AU - Camazine MN AD - From the Divisions of Critical Care (M.N.C., R.A.J., P.C.S.) and Emergency Medicine (J.A.H.), Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri; Department of Surgery (M.R.H.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Pediatrics (J.C.L.), Nationwide Children's Hospital, Columbus, Ohio; Shock Trauma Center (R.A.K.), University of Maryland, Baltimore, Maryland; Department of Surgery (G.V.B.), Washington University in St. Louis, St. Louis, Missouri; Department of Surgery (A.B.N.), Sunnybrook Health Sciences Center and the University of Toronto, Toronto, Ontario, Canada; and Department of Surgery (H.M.C.), University of California, Los Angeles, Los Angeles, California. FAU - Hemmila, Mark R AU - Hemmila MR FAU - Leonard, Julie C AU - Leonard JC FAU - Jacobs, Rachel A AU - Jacobs RA FAU - Horst, Jennifer A AU - Horst JA FAU - Kozar, Rosemary A AU - Kozar RA FAU - Bochicchio, Grant V AU - Bochicchio GV FAU - Nathens, Avery B AU - Nathens AB FAU - Cryer, Henry M AU - Cryer HM FAU - Spinella, Philip C AU - Spinella PC LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 0 (Hemostatics) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/administration & dosage MH - Blood Transfusion/*standards MH - *Clinical Protocols MH - Hemostatics/administration & dosage MH - Humans MH - Organizational Policy MH - Point-of-Care Systems MH - Quality Improvement MH - Thrombelastography MH - Tranexamic Acid/administration & dosage MH - Trauma Centers/*organization & administration EDAT- 2015/05/24 06:00 MHDA- 2015/08/19 06:00 CRDT- 2015/05/24 06:00 PHST- 2015/05/24 06:00 [entrez] PHST- 2015/05/24 06:00 [pubmed] PHST- 2015/08/19 06:00 [medline] AID - 01586154-201506001-00008 [pii] AID - 10.1097/TA.0000000000000641 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S48-53. doi: 10.1097/TA.0000000000000641. PMID- 26002262 OWN - NLM STAT- MEDLINE DCOM- 20150818 LR - 20181113 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 78 IP - 6 Suppl 1 DP - 2015 Jun TI - Acute blood loss during burn and soft tissue excisions: An observational study of blood product resuscitation practices and focused review. PG - S39-47 LID - 10.1097/TA.0000000000000627 [doi] AB - BACKGROUND: Many military and civilian centers have shifted to a damage-control resuscitation approach, focused on providing oxygen-carrying capacity while simultaneously mitigating coagulopathy with a balanced ratio of platelets and plasma to red blood cells. It is unclear to what degree this strategy is used during burn or soft tissue excision. Here, we characterized blood product transfusion during burn and soft tissue surgery and reviewed the published literature regarding intraoperative coagulation changes. We hypothesized that blood product resuscitation during burn and soft tissue excision is not hemostatic and would be insufficient to address hemorrhage-induced coagulopathy. METHODS: Consented adult patients were enrolled into an institutional review board-approved prospective observational study. Number, component type, volume, and age of the blood products transfused were recorded during burn excision/grafting or soft tissue debridement. Component bags (packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate) were collected, and the remaining sample was harvested from the bag and tubing. Aliquots of 1/1,000th the original volume of each blood product were obtained and combined, producing an amalgam sample containing the same ratio of product transfused. Platelet count, rotational thromboelastometry, and impedance aggregometry were measured. Significance was set at p < 0.05. RESULTS: Amalgamated transfusate samples produced abnormally weak clots (p 72 mm or an angle>74 degrees on the thromboelastograph and a maximum amplitude<54 mm or an angle<47 degrees , respectively. In vitro thrombotic tendency was more common than bleeding tendency and this was not different between the critically ill trauma and non-trauma patients (59% versus 67% with thrombotic tendency, P=0.461; 11% versus 10% with bleeding tendency, respectively, P=0.999). Thrombocytopenia (<150x10(9)/l) and low fibrinogen concentrations (<2 g/l) were the only two factors associated with an increased in vitro bleeding tendency (both P=0.001) and thrombocytopenia was the only factor associated with a lower risk of in vitro thrombotic tendency (21% versus 75%, P=0.001). Platelet counts (Pearson's correlation coefficient [r]: 0.59, P=0.001) and fibrinogen concentrations (r 0.61, P=0.001) both had a relatively linear association with maximum amplitude of the thromboelastograph. Prolonged International Normalized Ratio (>1.5) and activated Partial Thromboplastin Time (>40 seconds) were, however, not significantly associated with an increased in vitro thrombotic or bleeding tendency. In conclusion, in vitro thrombotic tendency was more common than bleeding tendency in critically ill trauma and non-trauma patients. Platelet counts and fibrinogen concentrations were better predictors of increased in vitro thrombotic and bleeding risks than International Normalized Ratio or activated Partial Thromboplastin Time. FAU - Ho, K M AU - Ho KM AD - Department of Intensive Care Medicine, Royal Perth Hospital and School of Population Health, University of Western Australia, Perth, Western Australia. FAU - Duff, O C AU - Duff OC AD - Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Anaesth Intensive Care JT - Anaesthesia and intensive care JID - 0342017 SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/*diagnosis MH - Blood Coagulation Tests/methods/statistics & numerical data MH - Critical Care/*methods MH - Critical Illness MH - Female MH - Hemorrhage/blood/*diagnosis MH - Humans MH - In Vitro Techniques MH - Male MH - Middle Aged MH - Odds Ratio MH - Predictive Value of Tests MH - Prospective Studies MH - Reproducibility of Results MH - Risk MH - Thrombelastography/methods MH - Thrombocytopenia/diagnosis MH - Thrombosis/blood/*diagnosis MH - Wounds and Injuries/blood MH - Young Adult OTO - NOTNLM OT - assessment OT - bleeding OT - coagulation OT - injury OT - thrombosis EDAT- 2015/05/07 06:00 MHDA- 2015/06/19 06:00 CRDT- 2015/05/07 06:00 PHST- 2015/05/07 06:00 [entrez] PHST- 2015/05/07 06:00 [pubmed] PHST- 2015/06/19 06:00 [medline] AID - 20140747 [pii] AID - 10.1177/0310057X1504300306 [doi] PST - ppublish SO - Anaesth Intensive Care. 2015 May;43(3):317-22. doi: 10.1177/0310057X1504300306. PMID- 25909415 OWN - NLM STAT- MEDLINE DCOM- 20150707 LR - 20151119 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 78 IP - 5 DP - 2015 May TI - Acute traumatic coagulopathy: Whole blood thrombelastography measures the tip of the iceberg. PG - 955-61 LID - 10.1097/TA.0000000000000586 [doi] AB - BACKGROUND: Thrombelastography (TEG) is suggested as an optimal instrument for the identification of acute traumatic coagulopathy-induced alterations in coagulation status. Patient whole blood (WB) used in TEG analysis is generally collected from a large blood vessel containing representative systemic blood, often close to 40% hematocrit (Hct). Trauma patients often exhibit bleeding from the microvasculature. This study examines early coagulation function changes at the simulated microvascular level based on altered Hct and pH in vitro through TEG analyses of normal donor blood. METHODS: Anticoagulated normophysiologic fresh human blood was centrifuged. Individual component effects on coagulation were investigated through variable recombination groups: platelet-rich plasma (PRP), platelet-poor plasma (PPP), and red blood cells (RBCs), which were compared with WB. Acute traumatic coagulopathy-induced acidic microvascular environment was simulated and investigated using tissue factor-activated TEG analysis of variable Hct (40%, 30%, 20%, and 0%) samples and variable [H]. Incremental replacement of RBC with either PPP or normal saline (NS) simulated resuscitation in vitro was also conducted under similar conditions. RESULTS: Only acidified PRP reflected loss of clot strength. Acidified PRP and PPP were delayed equally in clot time. In all groups, inclusion of RBCs normalized clot time. RBC replacement with PPP significantly delayed clot time when samples were acid-challenged, signifying greater acid effect in low Hct microvascular beds. NS simulated resuscitation incurred even greater clotting delays. CONCLUSION: Acidemia-induced coagulopathy at the level of the capillary Hct (1) is more severe than at higher Hct levels (larger blood vessels), (2) shows that simulated resuscitation with NS causes greater increases in clot time and decreases in clot strength beyond that which occurs with plasma replacement, and (3) may not accurately be portrayed through common TEG practice of testing systemic WB of greater than 30% Hct. FAU - Campbell, James Eric AU - Campbell JE AD - From the Joint Inflammation Modulation of Trauma Program (J.E.C.), Tri-Services Research Laboratories; and Coagulation and Blood Research Program (J.K.A., A.P.C.), US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas. FAU - Aden, James Keith AU - Aden JK FAU - Cap, Andrew Peter AU - Cap AP LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Biomarkers/blood MH - *Blood Coagulation MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Blood Donors MH - Healthy Volunteers MH - Humans MH - Male MH - Predictive Value of Tests MH - Thrombelastography/*methods MH - Trauma Severity Indices MH - Wounds and Injuries/blood/*complications/diagnosis EDAT- 2015/04/25 06:00 MHDA- 2015/07/08 06:00 CRDT- 2015/04/25 06:00 PHST- 2015/04/25 06:00 [entrez] PHST- 2015/04/25 06:00 [pubmed] PHST- 2015/07/08 06:00 [medline] AID - 01586154-201505000-00009 [pii] AID - 10.1097/TA.0000000000000586 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 May;78(5):955-61. doi: 10.1097/TA.0000000000000586. PMID- 25909408 OWN - NLM STAT- MEDLINE DCOM- 20150707 LR - 20220408 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 78 IP - 5 DP - 2015 May TI - The impact of tranexamic acid on mortality in injured patients with hyperfibrinolysis. PG - 905-9; discussion 909-11 LID - 10.1097/TA.0000000000000612 [doi] AB - BACKGROUND: In 2011, supported by data from two separate trauma centers, we implemented a protocol to administer tranexamic acid (TXA) in trauma patients with evidence of hyperfibrinolysis (HF) on admission. The purpose of this study was to examine whether the use of TXA in patients with HF determined by admission rapid thrombelastography was associated with improved survival. METHODS: Following institutional review board approval, we evaluated all trauma patients 16 years or older admitted between September 2009 and September 2013. HF was defined as LY-30 of 3% or greater. Patients with LY-30 less than 3.0% were excluded. Patients were divided into those who received TXA (TXA group) and those who did not (no-TXA group). After univariate analyses, a purposeful, logistic regression model was developed a priori to evaluate the impact of TXA on mortality (controlling for age, sex, Injury Severity Score (ISS), arrival physiology, and base deficit). RESULTS: A total of 1,032 patients met study criteria. Ninety-eight (10%) received TXA, and 934 (90%) did not. TXA patients were older (median age, 37 years vs. 32 years), were more severely injured (median ISS, 29 vs. 14), had a lower blood pressure (median systolic blood pressure 103 mm Hg vs. 125 mm Hg), and were more likely to be in shock (median, base excess, -5 mmol/dL vs. -2 mmol/dL), all p < 0.05. Twenty-three percent of the patients had a repeat thrombelastography within 6 hours; 8.8% of the TXA patients had LY-30 of 3% or greater on repeat rapid thrombelastography (vs. 10.1% in the no-TXA group, p = 0.679). Unadjusted in-hospital mortality was higher in the TXA group (40% vs. 17%, p < 0.001). There were no differences in venous thromboembolism (3.3% vs. 3.8%). Logistic regression failed to find a difference in in-hospital mortality among those receiving TXA (odds ratio, 0.74; 95% confidence interval, 0.38-1.40; p 0.80). CONCLUSION: In the current study, the use of TXA was not associated with a reduction in mortality. Further studies are needed to better define who will benefit from an administration of TXA. LEVEL OF EVIDENCE: Therapeutic study, level IV. FAU - Harvin, John A AU - Harvin JA AD - From the University of Texas Medical School at Houston, Houston, Texas. FAU - Peirce, Charles A AU - Peirce CA FAU - Mims, Mark M AU - Mims MM FAU - Hudson, Jessica A AU - Hudson JA FAU - Podbielski, Jeanette M AU - Podbielski JM FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Adult MH - Antifibrinolytic Agents/administration & dosage MH - Dose-Response Relationship, Drug MH - Female MH - Follow-Up Studies MH - Hospital Mortality/trends MH - Humans MH - Infusions, Intravenous MH - Injury Severity Score MH - Male MH - Middle Aged MH - Odds Ratio MH - Retrospective Studies MH - Thrombelastography MH - Thrombophilia/*complications/drug therapy/mortality MH - Tomography, X-Ray Computed MH - Tranexamic Acid/*administration & dosage MH - Trauma Centers MH - Treatment Outcome MH - Ultrasonography, Doppler MH - United States/epidemiology MH - Venous Thromboembolism/diagnosis/epidemiology/*prevention & control MH - Wounds and Injuries/*complications/diagnosis/mortality MH - Young Adult EDAT- 2015/04/25 06:00 MHDA- 2015/07/08 06:00 CRDT- 2015/04/25 06:00 PHST- 2015/04/25 06:00 [entrez] PHST- 2015/04/25 06:00 [pubmed] PHST- 2015/07/08 06:00 [medline] AID - 01586154-201505000-00002 [pii] AID - 10.1097/TA.0000000000000612 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 May;78(5):905-9; discussion 909-11. doi: 10.1097/TA.0000000000000612. PMID- 25907781 OWN - NLM STAT- MEDLINE DCOM- 20160212 LR - 20250917 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 19 IP - 1 DP - 2015 Apr 24 TI - Association between biomarkers of endothelial injury and hypocoagulability in patients with severe sepsis: a prospective study. PG - 191 LID - 10.1186/s13054-015-0918-5 [doi] LID - 191 AB - INTRODUCTION: Patients with severe sepsis often present with concurrent coagulopathy, microcirculatory failure and evidence of vascular endothelial activation and damage. Given the critical role of the endothelium in balancing hemostasis, we investigated single-point associations between whole blood coagulopathy by thrombelastography (TEG) and plasma/serum markers of endothelial activation and damage in patients with severe sepsis. METHODS: A post-hoc multicenter prospective observational study in a subgroup of 184 patients from the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial. Study patients were admitted to two Danish intensive care units. Inclusion criteria were severe sepsis, pre-intervention whole blood TEG measurement and a plasma/serum research sample available from baseline (pre-intervention) for analysis of endothelial-derived biomarkers. Endothelial-derived biomarkers were measured in plasma/serum by enzyme-linked immunosorbent assay (syndecan-1, thrombomodulin, protein C (PC), tissue-type plasminogen activator and plasminogen activator inhibitor-1). Pre-intervention TEG, functional fibrinogen (FF) and laboratory and clinical data, including mortality, were retrieved from the trial database. RESULTS: Most patients presented with septic shock (86%) and pulmonary (60%) or abdominal (30%) focus of infection. The median (IQR) age was 67 years (59 to 75), and 55% were males. The median SOFA and SAPS II scores were 8 (6 to 10) and 56 (41 to 68), respectively, with 7-, 28- and 90-day mortality rates being 21%, 39% and 53%, respectively. Pre-intervention (before treatment with different fluids), TEG reaction (R)-time, angle and maximum amplitude (MA) and FF MA all correlated with syndecan-1, thrombomodulin and PC levels. By multivariate linear regression analyses, higher syndecan-1 and lower PC were independently associated with TEG and FF hypocoagulability at the same time-point: 100 ng/ml higher syndecan-1 predicted 0.64 minutes higher R-time (SE 0.25), 1.78 mm lower TEG MA (SE 0.87) and 0.84 mm lower FF MA (SE 0.42; all P < 0.05), and 10% lower protein C predicted 1.24 mm lower TEG MA (SE 0.31). CONCLUSIONS: In our cohort of patients with severe sepsis, higher circulating levels of biomarkers of mainly endothelial damage were independently associated with hypocoagulability assessed by TEG and FF. Endothelial damage is intimately linked to coagulopathy in severe sepsis. TRIAL REGISTRATION: Clinicaltrials.gov number: NCT00962156. Registered 13 July 2009. FAU - Ostrowski, Sisse Rye AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. sisse.ostrowski@gmail.com. FAU - Haase, Nicolai AU - Haase N AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, DK-2100, Copenhagen, Denmark. nicolai.rosenkrantz.segelcke.haase@regionh.dk. FAU - Muller, Rasmus Beier AU - Muller RB AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, DK-2100, Copenhagen, Denmark. rasmus.muller@regionh.dk. FAU - Moller, Morten Hylander AU - Moller MH AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, DK-2100, Copenhagen, Denmark. mortenhylander@gmail.com. FAU - Pott, Frank Christian AU - Pott FC AD - Department of Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. frank.christian.pott@regionh.dk. FAU - Perner, Anders AU - Perner A AD - Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, DK-2100, Copenhagen, Denmark. anders.perner@regionh.dk. FAU - Johansson, Par Ingemar AU - Johansson PI AD - Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, 6410 Fannin Street UPB 1100, Houston, TX, 77030, USA. per.johansson@regionh.dk. LA - eng SI - ClinicalTrials.gov/NCT00962156 PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20150424 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Biomarkers) SB - IM MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - Biomarkers/blood MH - *Blood Coagulation Disorders/blood/diagnosis/epidemiology MH - *Endothelium, Vascular/metabolism/pathology MH - Prospective Studies MH - *Sepsis/blood/diagnosis/epidemiology MH - Thrombelastography/methods PMC - PMC4423170 EDAT- 2015/04/25 06:00 MHDA- 2016/02/13 06:00 PMCR- 2015/04/24 CRDT- 2015/04/25 06:00 PHST- 2015/02/27 00:00 [received] PHST- 2015/04/10 00:00 [accepted] PHST- 2015/04/25 06:00 [entrez] PHST- 2015/04/25 06:00 [pubmed] PHST- 2016/02/13 06:00 [medline] PHST- 2015/04/24 00:00 [pmc-release] AID - 10.1186/s13054-015-0918-5 [pii] AID - 918 [pii] AID - 10.1186/s13054-015-0918-5 [doi] PST - epublish SO - Crit Care. 2015 Apr 24;19(1):191. doi: 10.1186/s13054-015-0918-5. PMID- 25892117 OWN - NLM STAT- MEDLINE DCOM- 20160325 LR - 20150625 IS - 1502-7686 (Electronic) IS - 0036-5513 (Linking) VI - 75 IP - 5 DP - 2015 Sep TI - Evaluation of fibrinogen concentrates and prothrombin complex concentrates on coagulation changes in a hypothermic in vitro model using thromboelastometry and thromboelastography. PG - 407-14 LID - 10.3109/00365513.2015.1031694 [doi] AB - BACKGROUND: Hypothermic coagulopathy is very challenging in bleeding trauma patients. Therefore, we decided to evaluate the efficacy of fibrinogen and prothrombin complex in 30 degrees C hypothermia in vitro to investigate if higher levels of fibrinogen and prothrombin complex concentrate can compensate for the hypothermic effect on coagulation as measured by thromboelastometry/thromboelastography. METHODS: Blood samples were obtained from 12 healthy volunteers (six men and six women) in our study. Measurements were performed at 37 degrees C and 30 degrees C simultaneously, then at 30 degrees C with adding fibrinogen and prothrombin complex and in the last step samples with added coagulation factors were warmed back to 37 degrees C. RESULTS: We found that 30 degrees C hypothermic coagulopathy can be detected both by thromboelastometry and thromboelastography. Hypothermic coagulopathy can be restored by fibrinogen to the point where the results do not significantly differ from 37 degrees C values (p > 0.05). After warming the sample with fibrinogen to 37 degrees C, the thrombodynamic potential index was not significantly different from baseline (p > 0.05), although there was a trend to prothrombotic status. The addition of prothrombin complex concentrate to 30 degrees C hypothermic sample was not able to correct hypothermic coagulopathy in vitro. CONCLUSIONS: Coagulopathy caused by the 30 degrees C hypothermia in vitro model can be corrected by fibrinogen concentrate compared to prothrombin complex concentrate. In spite of a tendency to prothrombotic status, this was not significant with the use of the recommended dose of fibrinogen even after warming the blood to 37 degrees C. However, measurement performed at 37 degrees C seems to be safer than at 30 degrees C. FAU - Durila, Miroslav AU - Durila M AD - Department of Anaesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University in Prague, Motol University Hospital , Prague , Czech Republic. FAU - Lukas, Pavel AU - Lukas P FAU - Astraverkhava, Marta AU - Astraverkhava M FAU - Vymazal, Tomas AU - Vymazal T LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20150418 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Blood Coagulation Factors/*pharmacology MH - Female MH - Fibrinogen/*pharmacology MH - Humans MH - *Hypothermia, Induced MH - Male MH - *Models, Biological MH - Rotation MH - Thrombelastography/*methods OTO - NOTNLM OT - Thromboelastometry OT - coagulation OT - fibrinogen OT - hypothermia OT - temperature OT - thromboelastography OT - thrombosis EDAT- 2015/04/22 06:00 MHDA- 2016/03/26 06:00 CRDT- 2015/04/21 06:00 PHST- 2015/04/21 06:00 [entrez] PHST- 2015/04/22 06:00 [pubmed] PHST- 2016/03/26 06:00 [medline] AID - 10.3109/00365513.2015.1031694 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2015 Sep;75(5):407-14. doi: 10.3109/00365513.2015.1031694. Epub 2015 Apr 18. PMID- 25888054 OWN - NLM STAT- MEDLINE DCOM- 20160129 LR - 20181113 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 23 DP - 2015 Feb 15 TI - Transfusion therapy in paediatric trauma patients: a review of the literature. PG - 21 LID - 10.1186/s13049-015-0097-z [doi] LID - 21 AB - Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT).Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. Determining the triggers for MTP activation in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted. FAU - Nystrup, Kristin Bronnum AU - Nystrup KB AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. kristinnystrup@gmail.com. AD - Department of Paediatrics, Naestved Hospital, Ringstedgade 61, Naestved, DK-4700, Denmark. kristinnystrup@gmail.com. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. jakob.stensballe@regionh.dk. AD - Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. jakob.stensballe@regionh.dk. FAU - Bottger, Morten AU - Bottger M AD - Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. morten.boettger@regionh.dk. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. per.johansson@regionh.dk. AD - Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Houston, TX, USA. per.johansson@regionh.dk. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. sisse.ostrowski@gmail.com. LA - eng PT - Journal Article PT - Review DEP - 20150215 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Blood Coagulation Disorders/etiology/*therapy MH - *Blood Transfusion MH - Child MH - Hemorrhage/etiology/*therapy MH - Humans MH - Transfusion Reaction MH - Wounds and Injuries/complications/*therapy PMC - PMC4336766 EDAT- 2015/04/19 06:00 MHDA- 2016/01/30 06:00 PMCR- 2015/02/15 CRDT- 2015/04/19 06:00 PHST- 2013/11/30 00:00 [received] PHST- 2015/01/20 00:00 [accepted] PHST- 2015/04/19 06:00 [entrez] PHST- 2015/04/19 06:00 [pubmed] PHST- 2016/01/30 06:00 [medline] PHST- 2015/02/15 00:00 [pmc-release] AID - 10.1186/s13049-015-0097-z [pii] AID - 97 [pii] AID - 10.1186/s13049-015-0097-z [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2015 Feb 15;23:21. doi: 10.1186/s13049-015-0097-z. PMID- 25888032 OWN - NLM STAT- MEDLINE DCOM- 20151201 LR - 20260317 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 19 IP - 1 DP - 2015 Mar 23 TI - Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. PG - 97 LID - 10.1186/s13054-015-0823-y [doi] LID - 97 AB - INTRODUCTION: The purpose of this study was to re-evaluate the findings of a smaller cohort study on the functional definition and characteristics of acute traumatic coagulopathy (ATC). We also aimed to identify the threshold values for the most accurate identification of ATC and prediction of massive transfusion (MT) using rotational thromboelastometry (ROTEM) assays. METHODS: In this prospective international multicentre cohort study, adult trauma patients who met the local criteria for full trauma team activation from four major trauma centres were included. Blood was collected on arrival to the emergency department and analyzed with laboratory international normalized ratio (INR), fibrinogen concentration and two ROTEM assays (EXTEM and FIBTEM). ATC was defined as laboratory INR >1.2. Transfusion requirements of >/=10 units of packed red blood cells within 24 hours were defined as MT. Performance of the tests were evaluated by receiver operating characteristic curves, and calculation of area under the curve (AUC). Optimal cutoff points were estimated based on Youden index. RESULTS: In total, 808 patients were included in the study. Among the ROTEM parameters, the largest AUCs were found for the clot amplitude (CA) 5 value in both the EXTEM and FIBTEM assays. EXTEM CA5 threshold value of 3 days) using bivariate and multivariable analysis. RESULTS: A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26%) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43% early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity >/= 3. Higher Injury Severity Score, severe chest and head trauma (AIS >/= 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE. CONCLUSIONS: Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury. CI - Copyright (c) 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Coleman, Jamie J AU - Coleman JJ AD - Department of Surgery, Indiana University, Indianapolis, IN. Electronic address: jcoleman6@iuhealth.org. FAU - Zarzaur, Ben L AU - Zarzaur BL AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - Katona, Chad W AU - Katona CW AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - Plummer, Zachary J AU - Plummer ZJ AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - Johnson, Laura S AU - Johnson LS AD - Department of Surgery, MedStar Washington Hospital Center, Washington, DC. FAU - Fecher, Alison AU - Fecher A AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - O'Rear, Jamie M AU - O'Rear JM AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - Feliciano, David V AU - Feliciano DV AD - Department of Surgery, Indiana University, Indianapolis, IN. FAU - Rozycki, Grace S AU - Rozycki GS AD - Department of Surgery, Indiana University, Indianapolis, IN. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20150106 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM CIN - J Am Coll Surg. 2015 Apr;220(4):736-7. doi: 10.1016/j.jamcollsurg.2015.01.045. PMID: 25797760 MH - Female MH - Humans MH - Male MH - Middle Aged MH - Morbidity/trends MH - Patient Admission/*statistics & numerical data MH - Prognosis MH - Pulmonary Embolism/diagnosis/epidemiology/*etiology MH - *Registries MH - Risk Assessment/*methods MH - Risk Factors MH - Survival Rate/trends MH - Thrombelastography MH - Time Factors MH - Trauma Centers/*statistics & numerical data MH - Trauma Severity Indices MH - United States/epidemiology MH - Venous Thrombosis/diagnosis/epidemiology/etiology MH - Wounds and Injuries/*complications/diagnosis EDAT- 2015/03/01 06:00 MHDA- 2015/05/27 06:00 CRDT- 2015/03/01 06:00 PHST- 2014/12/16 00:00 [received] PHST- 2014/12/17 00:00 [accepted] PHST- 2015/03/01 06:00 [entrez] PHST- 2015/03/01 06:00 [pubmed] PHST- 2015/05/27 06:00 [medline] AID - S1072-7515(15)00002-2 [pii] AID - 10.1016/j.jamcollsurg.2014.12.032 [doi] PST - ppublish SO - J Am Coll Surg. 2015 Apr;220(4):731-6. doi: 10.1016/j.jamcollsurg.2014.12.032. Epub 2015 Jan 6. PMID- 25708032 OWN - NLM STAT- MEDLINE DCOM- 20151127 LR - 20200225 IS - 1757-7861 (Electronic) IS - 1757-7853 (Print) IS - 1757-7853 (Linking) VI - 7 IP - 1 DP - 2015 Feb TI - Thromboelastography predictive of death in trauma patients. PG - 26-30 LID - 10.1111/os.12158 [doi] AB - OBJECTIVES: To determine if thromboelastography (TEG) is predictive of patient outcomes following traumatic injury. METHODS: A retrospective review of 131 patients with pelvic trauma admitted to a Level II trauma center was conducted over four years from 1 January 2009 to 31 December 2012. Patients were identified retrospectively from a prospectively collected database of acute pelvic trauma (n = 372). Eligible patients were identified from billing/coding data as having fractures of the acetabulum, iliac wing or sacral alae. Patients with incomplete TEG data were excluded (n = 241), as were patients with pathological fractures. TEG clotting variables and traditional clotting variables were recorded. RESULTS: Evaluation of TEG data revealed 41 patients with abnormal clotting times (TEG R). TEG R > 6 was an independent risk factor for death (OR, 16; 95%CI 5.4-53; P = 0.0001). The death rate was 52% in patients with TEG R values >/=6 (n = 13/25). There was no significant association between traditional clotting markers and death rate. CONCLUSIONS: TEG reaction time value, representing the time of initial clot formation, was the only hematologic marker predictive of mortality in patients with pelvic trauma. Delay in reaction time was associated with a significantly increased death rate, independent of injury severity. The death rate association was not observed with traditional markers of clotting. Future prospective studies may be warranted to determine the presentation and significance of TEG abnormalities when resuscitating patients with orthopaedic trauma. CI - (c) 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd. FAU - Kane, Ian AU - Kane I AD - New York Medical College, Valhalla, New York, USA; Rothman Institute of Orthopedics, Jefferson University Hospital, Philadelphia, Pennsylvania, USA. FAU - Ong, Alvin AU - Ong A FAU - Orozco, Fabio R AU - Orozco FR FAU - Post, Zachary D AU - Post ZD FAU - Austin, Luke S AU - Austin LS FAU - Radcliff, Kris E AU - Radcliff KE LA - eng PT - Journal Article PL - Australia TA - Orthop Surg JT - Orthopaedic surgery JID - 101501666 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/diagnosis/*etiology/mortality MH - Female MH - Fractures, Bone/complications/*mortality MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Pelvic Bones/*injuries MH - Retrospective Studies MH - *Thrombelastography PMC - PMC6583160 OTO - NOTNLM OT - Coagulopathy OT - Mortality OT - Thromboelastography EDAT- 2015/02/25 06:00 MHDA- 2015/12/15 06:00 PMCR- 2015/02/23 CRDT- 2015/02/25 06:00 PHST- 2014/06/15 00:00 [received] PHST- 2014/11/03 00:00 [accepted] PHST- 2015/02/25 06:00 [entrez] PHST- 2015/02/25 06:00 [pubmed] PHST- 2015/12/15 06:00 [medline] PHST- 2015/02/23 00:00 [pmc-release] AID - OS12158 [pii] AID - 10.1111/os.12158 [doi] PST - ppublish SO - Orthop Surg. 2015 Feb;7(1):26-30. doi: 10.1111/os.12158. PMID- 25705417 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20150223 LR - 20240512 IS - 2052-0492 (Print) IS - 2052-0492 (Electronic) IS - 2052-0492 (Linking) VI - 2 IP - 1 DP - 2014 TI - Role of prothrombin complex concentrate in perioperative coagulation therapy. PG - 60 LID - 10.1186/s40560-014-0060-5 [doi] LID - 60 AB - Prothrombin complex concentrate (PCC) is a term to describe pharmacological products that contain lyophilized, human plasma-derived vitamin K-dependent factors (F), FII, FVII, FIX, FX, and various amounts of proteins C and S. PCCs can be rapidly reconstituted in a small volume (20 ml for about 500 international units (IU)) at bedside and administered regardless of the patient's blood type. PCCs are categorized as 4-factor PCC if they contain therapeutic amounts of FVII, and 3-factor PCC when FVII content is low. In addition, activated PCC which contains activated FVII and FX with prothrombin is available for factor VIII bypassing therapy in hemophilia patients with inhibitors. Currently, 4-factor PCC is approved for the management of bleeding in patients taking warfarin, but there has been increasing use of various PCCs in the treatment of acquired perioperative coagulopathy unrelated to warfarin therapy and in the management of bleeding due to novel oral anticoagulants. There is also an ongoing controversy about plasma transfusion and its potential hazards including transfusion-related lung injury (TRALI). Early fixed ratio plasma transfusion has been implemented in many trauma centers in the USA, whereas fibrinogen concentrate and PCC are preferred over plasma transfusion in some European centers. In this review, the rationales for including PCCs in the perioperative hemostatic management will be discussed in conjunction with plasma transfusion. FAU - Tanaka, Kenichi A AU - Tanaka KA AD - Department of Anesthesiology, Cardiothoracic Anesthesia Division, University of Maryland, Suite S8D12, 22 South Greene Street, Baltimore, MD 21201 USA. FAU - Mazzeffi, Michael AU - Mazzeffi M AD - Department of Anesthesiology, Cardiothoracic Anesthesia Division, University of Maryland, Suite S8D12, 22 South Greene Street, Baltimore, MD 21201 USA. FAU - Durila, Miroslav AU - Durila M AD - Department of Anesthesiology and Critical Care Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic. LA - eng PT - Journal Article PT - Review DEP - 20141029 PL - England TA - J Intensive Care JT - Journal of intensive care JID - 101627304 PMC - PMC4336276 OTO - NOTNLM OT - Coagulation OT - Factor eight bypassing agent OT - Fresh frozen plasma OT - Prothrombin complex concentrate OT - Recombinant activated factor VII OT - Thromboelastometry EDAT- 2015/02/24 06:00 MHDA- 2015/02/24 06:01 PMCR- 2014/10/29 CRDT- 2015/02/24 06:00 PHST- 2014/09/03 00:00 [received] PHST- 2014/10/17 00:00 [accepted] PHST- 2015/02/24 06:00 [entrez] PHST- 2015/02/24 06:00 [pubmed] PHST- 2015/02/24 06:01 [medline] PHST- 2014/10/29 00:00 [pmc-release] AID - 60 [pii] AID - 10.1186/s40560-014-0060-5 [doi] PST - epublish SO - J Intensive Care. 2014 Oct 29;2(1):60. doi: 10.1186/s40560-014-0060-5. eCollection 2014. PMID- 25697747 OWN - NLM STAT- MEDLINE DCOM- 20160211 LR - 20181113 IS - 1420-908X (Electronic) IS - 1023-3830 (Linking) VI - 64 IP - 3-4 DP - 2015 Apr TI - Circulating levels of platelet alpha-granule cytokines in trauma patients. PG - 235-41 LID - 10.1007/s00011-015-0802-4 [doi] AB - OBJECTIVE AND DESIGN: To elucidate whether platelets differentiate cytokine release following trauma, we prospectively measured three major platelet-derived cytokines in 213 trauma patients on hospital arrival. METHODS: We measured plasma levels of the anti-inflammatory beta-thromboglobulins (betaTGs), transforming growth factor-beta1 (TGFbeta1) and the pro-inflammatory platelet factor 4 (PF4) cytokines. We also measured soluble glycoprotein VI (sGPVI), procoagulant platelet microparticles (PMPs) and white blood cell (WBC) counts, and evaluated in vitro platelet function in primary and secondary haemostasis by aggregometry and thromboelastometry, respectively. We evaluated associations of each cytokine by multivariate regression including injury severity score (ISS), WBC counts, sGPVI and platelet counts as explanatory variables. RESULTS: Severely injured patients (ISS > 15) had higher levels of betaTGs and TGFbeta1 (both p < 0.01) but lower levels of PF4 (p = 0.02). GPVI and PMPs levels correlated with TGFbeta1 and PF4 whereas we found no significant association between cytokine levels and measures of haemostasis. By multivariate regression, a high WBC count was associated with high levels of TGFbeta1 (p = 0.01) and betaTGs (p < 0.01) but with low levels of PF4 (p = 0.03). CONCLUSION: Severely injured patients had higher levels of betaTGs and TGFbeta1 but lower levels of the PF4; a high WBC count predicted this anti-inflammatory profile of platelet cytokines. FAU - Windelov, N A AU - Windelov NA AD - Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark, nis.windelov@gmail.com. FAU - Ostrowski, S R AU - Ostrowski SR FAU - Johansson, P I AU - Johansson PI FAU - Wanscher, M AU - Wanscher M FAU - Larsen, C F AU - Larsen CF FAU - Sorensen, A M AU - Sorensen AM FAU - Rasmussen, L S AU - Rasmussen LS LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20150220 PL - Switzerland TA - Inflamm Res JT - Inflammation research : official journal of the European Histamine Research Society ... [et al.] JID - 9508160 RN - 0 (Platelet Membrane Glycoproteins) RN - 0 (Transforming Growth Factor beta1) RN - 0 (beta-Thromboglobulin) RN - 0 (platelet membrane glycoprotein VI) RN - 37270-94-3 (Platelet Factor 4) SB - IM MH - Adult MH - Female MH - Humans MH - Leukocyte Count MH - Male MH - Middle Aged MH - Platelet Factor 4/*blood MH - Platelet Membrane Glycoproteins/metabolism MH - Regression Analysis MH - Retrospective Studies MH - Severity of Illness Index MH - Transforming Growth Factor beta1/*blood MH - Wounds and Injuries/*blood/pathology MH - beta-Thromboglobulin/*metabolism EDAT- 2015/02/24 06:00 MHDA- 2016/02/13 06:00 CRDT- 2015/02/21 06:00 PHST- 2014/05/28 00:00 [received] PHST- 2015/02/11 00:00 [accepted] PHST- 2015/02/09 00:00 [revised] PHST- 2015/02/21 06:00 [entrez] PHST- 2015/02/24 06:00 [pubmed] PHST- 2016/02/13 06:00 [medline] AID - 10.1007/s00011-015-0802-4 [doi] PST - ppublish SO - Inflamm Res. 2015 Apr;64(3-4):235-41. doi: 10.1007/s00011-015-0802-4. Epub 2015 Feb 20. PMID- 25686465 OWN - NLM STAT- MEDLINE DCOM- 20150630 LR - 20250711 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 2015 IP - 2 DP - 2015 Feb 16 TI - Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding. PG - CD010438 LID - 10.1002/14651858.CD010438.pub2 [doi] LID - CD010438 AB - BACKGROUND: Trauma-induced coagulopathy (TIC) is a disorder of the blood clotting process that occurs soon after trauma injury. A diagnosis of TIC on admission is associated with increased mortality rates, increased burdens of transfusion, greater risks of complications and longer stays in critical care. Current diagnostic testing follows local hospital processes and normally involves conventional coagulation tests including prothrombin time ratio/international normalized ratio (PTr/INR), activated partial prothrombin time and full blood count. In some centres, thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are standard tests, but in the UK they are more commonly used in research settings. OBJECTIVES: The objective was to determine the diagnostic accuracy of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for TIC in adult trauma patients with bleeding, using a reference standard of prothrombin time ratio and/or the international normalized ratio. SEARCH METHODS: We ran the search on 4 March 2013. Searches ran from 1970 to current. We searched The Cochrane Library, MEDLINE (OvidSP), EMBASE Classic and EMBASE, eleven other databases, the web, and clinical trials registers. The Cochrane Injuries Group's specialised register was not searched for this review as it does not contain diagnostic test accuracy studies. We also screened reference lists, conducted forward citation searches and contacted authors. SELECTION CRITERIA: We included all cross-sectional studies investigating the diagnostic test accuracy of TEG and ROTEM in patients with clinically suspected TIC, as well as case-control studies. Participants were adult trauma patients in both military and civilian settings. TIC was defined as a PTr/INR reading of 1.2 or greater, or 1.5 or greater. DATA COLLECTION AND ANALYSIS: We piloted and performed all review stages in duplicate, including quality assessment using the QUADAS-2 tool, adhering to guidance in the Cochrane Handbook for Diagnostic Test Accuracy Reviews. We analysed sensitivity and specificity of included studies narratively as there were insufficient studies to perform a meta-analysis. MAIN RESULTS: Three studies were included in the final analysis. All three studies used ROTEM as the test of global haemostatic function, and none of the studies used TEG. Tissue factor-activated assay EXTEM clot amplitude (CA) was the focus of the accuracy measurements in blood samples taken near to the point of admission. These CAs were not taken at a uniform time after the start of the coagulopathic trace; the time varied from five minutes, to ten minutes and fifteen minutes. The three included studies were conducted in the UK, France and Afghanistan in both civilian and military trauma settings. In two studies, median Injury Severity Scores were 12, inter-quartile range (IQR) 4 to 24; and 22, IQR 12 to 34; and in one study the median New Injury Severity Score was 34, IQR 17 to 43.There were insufficient included studies examining each of the three ROTEM CAs at 5, 10 and 15 minutes to make meta-analysis and investigation of heterogeneity valid. The results of the included studies are thus reported narratively and illustrated by a forest plot and results plotted on the receiver operating characteristic (ROC) plane.For CA5 the accuracy results were sensitivity 70% (95% CI 47% to 87%) and specificity 86% (95% CI 82% to 90%) for one study, and sensitivity 96% (95% CI 88% to 100%) and specificity 58% (95% CI 44% to 72%) for the other.For CA10 the accuracy results were sensitivity 100% (95% CI 94% to 100%) and specificity 70% (95% CI 56% to 82%).For CA15 the accuracy results were sensitivity 88% (95% CI 69% to 97%) and specificity 100% (95% CI 94% to 100%).No uninterpretable ROTEM study results were mentioned in any of the included studies.Risk of bias and concerns around applicability of findings was low across all studies for the patient and flow and timing domains. However, risk of bias and concerns around applicability of findings for the index test domain was either high or unclear, and the risk of bias for the reference standard domain was high. This raised concerns around the interpretation of the sensitivity and specificity results of the included studies, which may be misleading. AUTHORS' CONCLUSIONS: We found no evidence on the accuracy of TEG and very little evidence on the accuracy of ROTEM. The value of accuracy estimates are considerably undermined by the small number of included studies, and concerns about risk of bias relating to the index test and the reference standard. We are unable to offer advice on the use of global measures of haemostatic function for trauma based on the evidence on test accuracy identified in this systematic review. This evidence strongly suggests that at present these tests should only be used for research. We consider more thoroughly what this research could be in the Discussion section. FAU - Hunt, Harriet AU - Hunt H AD - Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK. H.A.Hunt@exeter.ac.uk. FAU - Stanworth, Simon AU - Stanworth S FAU - Curry, Nicola AU - Curry N FAU - Woolley, Tom AU - Woolley T FAU - Cooper, Chris AU - Cooper C FAU - Ukoumunne, Obioha AU - Ukoumunne O FAU - Zhelev, Zhivko AU - Zhelev Z FAU - Hyde, Chris AU - Hyde C LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20150216 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - doi: 10.1002/14651858.CD010438 MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Cross-Sectional Studies MH - Hemorrhage/*blood/etiology MH - Humans MH - Thrombelastography/*methods/standards MH - Wounds and Injuries/blood/*complications PMC - PMC7083579 COIS- Harriet Hunt: none known.
 Simon Stanworth: a member of the research team for included study Davenport 2011a, and excluded study Davenport 2009, but not involved in screening, quality assessment or analysis of those studies within this review.
 Nicola Curry: a member of the research team for excluded study Rourke 2012 but not involved in screening of that study within this review.
 Tom Woolley: a member of the research team for included study Woolley 2012, but not involved in screening, quality assessment or analysis of that study within this review.
 Chris Cooper: none known
 Obioha Ukoumunne: none known
 Zhivko Zhelev: none known
 Chris Hyde: CH was an employee of NHS Blood and Transplant when this review was commenced. This arrangement ended in 2009. EDAT- 2015/02/17 06:00 MHDA- 2015/07/01 06:00 PMCR- 2016/02/16 CRDT- 2015/02/17 06:00 PHST- 2015/02/17 06:00 [entrez] PHST- 2015/02/17 06:00 [pubmed] PHST- 2015/07/01 06:00 [medline] PHST- 2016/02/16 00:00 [pmc-release] AID - CD010438.pub2 [pii] AID - 10.1002/14651858.CD010438.pub2 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2015 Feb 16;2015(2):CD010438. doi: 10.1002/14651858.CD010438.pub2. PMID- 25674987 OWN - NLM STAT- MEDLINE DCOM- 20151123 LR - 20150303 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 28 IP - 2 DP - 2015 Apr TI - Factor concentrates in trauma. PG - 217-26 LID - 10.1097/ACO.0000000000000167 [doi] AB - PURPOSE OF REVIEW: Recent advances in the understanding of transfusion practices during hemorrhagic shock in trauma have led to early administration of thawed plasma in increased ratios to packed red blood cells and have improved survival in the most severely injured patients. As an appreciation for the sequelae of massive transfusion continues to mature, it is becoming apparent that a more targeted approach to coagulation deficiencies may offer an advantage. RECENT FINDINGS: Factor concentrate therapy offers the advantage of smaller volumes of resuscitative fluids directed at specific phases of coagulation identified by alternative laboratory assays (e.g., viscoelastic testing). Case reports, animal studies, and retrospective reviews offer encouraging data on the ability of factor concentrates to reverse coagulopathy and reduce blood product usage. SUMMARY: The use of factor concentrates to target specific phases of coagulation may offer benefit over blood product ratio-driven transfusion. The outcome benefit of factor concentrates, however, has not yet been demonstrated in well powered prospective trials. FAU - Tobin, Joshua M AU - Tobin JM AD - aDepartment of Anesthesiology, Keck Medicine, University of Southern California, Los Angeles, California bDepartment of Anesthesiology, University of Maryland, Baltimore, Maryland cDepartment of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. FAU - Tanaka, Kenichi A AU - Tanaka KA FAU - Smith, Charles E AU - Smith CE LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Blood Coagulation Factors) SB - IM MH - Blood Coagulation/drug effects MH - Blood Coagulation Factors/*therapeutic use MH - Blood Transfusion MH - Humans MH - Wounds and Injuries/blood/physiopathology/*therapy EDAT- 2015/02/13 06:00 MHDA- 2015/12/15 06:00 CRDT- 2015/02/13 06:00 PHST- 2015/02/13 06:00 [entrez] PHST- 2015/02/13 06:00 [pubmed] PHST- 2015/12/15 06:00 [medline] AID - 10.1097/ACO.0000000000000167 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2015 Apr;28(2):217-26. doi: 10.1097/ACO.0000000000000167. PMID- 25656632 OWN - NLM STAT- MEDLINE DCOM- 20160229 LR - 20150602 IS - 1744-9987 (Electronic) IS - 1744-9979 (Linking) VI - 19 IP - 3 DP - 2015 Jun TI - Safety and efficacy of citrate anti-coagulation continuous renal replacement therapies in post-cardiac surgery patients with liver dysfunction. PG - 272-8 LID - 10.1111/1744-9987.12280 [doi] AB - The study's aim was to examine safety and efficiency of citrate anticoagulated continuous renal replacement therapies (CRRT) in cardiac surgery patients with acute kidney injury and associated liver dysfunction. The study was conducted on critical ICU patients, hospitalized after cardiac surgery, who developed renal and liver acute failures due to low-flow syndrome. CRRT in continuous veno-venous hemodiafiltration with regional citrate anticoagulation (RCA) was prescribed to address renal failure and avoid bleeding-risk. Patient Ca(++) was measured to monitor RCA safety, while thromboelastography (TEG) and circuit Ca(++) were used to verify efficacy. CRRT effectiveness was evaluated through creatinine and urea levels, while liver function was monitored through bilirubin, aspartate aminotransferase, glutamic oxaloacetic transaminase (AST GOT) and gamma glutamyl transferase (GT) levels. The study did not require ethical approval. Hepatic and renal failures were confirmed by baseline levels (total bilirubin=3.1 +/- 3.37 mg/dL, AST GOT=153 +/- 147 U/L and gamma GT=93.3 +/- 86 IU/L, creatinine=1.97 +/- 0.88 and blood urea nitrogen [BUN] 98.13 +/- 71.34) assessed in 15 patients. During treatment, Ca(++) (patient and circuit) remained stable and within range for the whole therapy thanks to low citrate dose (2.8 +/- 0.3 mmol/L of blood), while hepatic markers did not show any significant changes the therapy, although treatment with citrate is contraindicated in patients with hepatic failure. RCA quality was confirmed by TEG values, which showed an anticoagulated circuit with no effects on patients. These results involved a high filter lifespan (49.76 +/- 22.10 h) and with an effective creatinine and BUN clearance. No episodes of citrate intoxication were reported (total/ionized calcium ratio remained stable and physiologic). RCA during CRRT with dilute solutions proved both effective and safe, even in patients with acute liver failure. CI - (c) 2015 The Authors. Therapeutic Apheresis and Dialysis (c) 2015 International Society for Apheresis. FAU - De Vico, Pasquale AU - De Vico P AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Messino, Valentina AU - Messino V AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Tartaglione, Alessandra AU - Tartaglione A AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Beccaris, Camilla AU - Beccaris C AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Buonomo, Chiara AU - Buonomo C AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Talarico, Daniela AU - Talarico D AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Prati, Paolo AU - Prati P AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Sabato, Alessandro Fabrizio AU - Sabato AF AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. FAU - Colella, Dionisio Fernando AU - Colella DF AD - Department of Emergency, Critical Care Medicine and Anesthesiology, Intensive Care Unit, Policlinico Tor Vergata, Rome, Italy. LA - eng PT - Journal Article DEP - 20150206 PL - Australia TA - Ther Apher Dial JT - Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy JID - 101181252 RN - 0 (Anticoagulants) RN - 0 (Citrates) SB - IM MH - Acute Kidney Injury/diagnosis/etiology/therapy MH - Aged MH - Aged, 80 and over MH - Anticoagulants/*administration & dosage/adverse effects MH - Cardiac Surgical Procedures/methods MH - Citrates/*administration & dosage/adverse effects MH - Female MH - Hemodiafiltration/*methods MH - Hemorrhage/*chemically induced/epidemiology MH - Hospitalization MH - Humans MH - Intensive Care Units MH - Liver Diseases/diagnosis/etiology/physiopathology MH - Male MH - Middle Aged OTO - NOTNLM OT - Anticoagulation OT - Citrate OT - Continuous renal replacement OT - Liver dysfunction OT - Regional citrate anticoagulation OT - Thromboelastography EDAT- 2015/02/07 06:00 MHDA- 2016/03/02 06:00 CRDT- 2015/02/07 06:00 PHST- 2015/02/07 06:00 [entrez] PHST- 2015/02/07 06:00 [pubmed] PHST- 2016/03/02 06:00 [medline] AID - 10.1111/1744-9987.12280 [doi] PST - ppublish SO - Ther Apher Dial. 2015 Jun;19(3):272-8. doi: 10.1111/1744-9987.12280. Epub 2015 Feb 6. PMID- 25655040 OWN - NLM STAT- MEDLINE DCOM- 20151117 LR - 20230124 IS - 1600-6143 (Electronic) IS - 1600-6135 (Linking) VI - 15 IP - 3 DP - 2015 Mar TI - Coagulation profiles of unexpected DCDD donors do not indicate a role for exogenous fibrinolysis. PG - 764-71 LID - 10.1111/ajt.13058 [doi] AB - It has been suggested that vascular stasis during cardio-circulatory arrest leads to the formation of microvascular thrombi and the viability of organs arising from donation after circulatory determination of death (DCDD) donors may be improved through the application of fibrinolytic therapy. Our aim was to comprehensively study the coagulation profiles of Maastricht category II DCDD donors in order to determine the presence of coagulation abnormalities that could benefit from fibrinolytic therapy. Whole blood from potential DCDD donors suffering out-of-hospital cardiac arrest was sampled after declaration of death in the emergency department, and rotational thromboelastomeric analysis was performed. Between July 2012 and December 2013, samples from 33 potential DCDD donors were analyzed. All patients demonstrated hyperfibrinolysis (HF), as reflected by maximum clot lysis of 98-100% in all cases, indicating that there is no role for additional fibrinolytic therapy in this setting. As well, we observed correlations between thromboelastomeric lysis parameters and maximum hepatic transaminase levels measured in potential donors and renal artery flows measured during ex situ hypothermic oxygenated machine perfusion, indicating that further studies on the utility of thromboelastometry to evaluate organ injury and perhaps even viability in unexpected DCDD may be warranted. CI - (c) Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons. FAU - Vendrell, M AU - Vendrell M AD - Anesthesiology, Hospital Clinic, University of Barcelona, Barcelona, Spain. FAU - Hessheimer, A J AU - Hessheimer AJ FAU - Ruiz, A AU - Ruiz A FAU - de Sousa, E AU - de Sousa E FAU - Paredes, D AU - Paredes D FAU - Rodriguez, C AU - Rodriguez C FAU - Saavedra, S AU - Saavedra S FAU - Fuster, J AU - Fuster J FAU - Alcaraz, A AU - Alcaraz A FAU - Oppenheimer, F AU - Oppenheimer F FAU - Taura, P AU - Taura P FAU - Garcia-Valdecasas, J C AU - Garcia-Valdecasas JC FAU - Fondevila, C AU - Fondevila C LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150205 PL - United States TA - Am J Transplant JT - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JID - 100968638 SB - IM MH - Blood Circulation MH - *Blood Coagulation MH - Female MH - *Fibrinolysis MH - Humans MH - Male MH - Middle Aged MH - *Organ Transplantation MH - *Tissue Donors MH - Treatment Outcome OTO - NOTNLM OT - Clinical research/practice OT - donors and donation: donation after circulatory death (DCD) OT - kidney transplantation/nephrology OT - liver transplantation/hepatology OT - organ acceptance OT - organ procurement OT - organ procurement and allocation OT - thrombolytic therapy/thrombolysis EDAT- 2015/02/07 06:00 MHDA- 2015/11/18 06:00 CRDT- 2015/02/07 06:00 PHST- 2014/08/06 00:00 [received] PHST- 2014/10/08 00:00 [revised] PHST- 2014/10/11 00:00 [accepted] PHST- 2015/02/07 06:00 [entrez] PHST- 2015/02/07 06:00 [pubmed] PHST- 2015/11/18 06:00 [medline] AID - S1600-6135(22)00138-1 [pii] AID - 10.1111/ajt.13058 [doi] PST - ppublish SO - Am J Transplant. 2015 Mar;15(3):764-71. doi: 10.1111/ajt.13058. Epub 2015 Feb 5. PMID- 25643013 OWN - NLM STAT- MEDLINE DCOM- 20160425 LR - 20181113 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 44 Suppl 1 IP - 0 1 DP - 2015 Aug TI - Clot Formation Is Associated With Fibrinogen and Platelet Forces in a Cohort of Severely Injured Emergency Department Trauma Patients. PG - 39-44 LID - 10.1097/SHK.0000000000000342 [doi] AB - INTRODUCTION: Anticoagulation, fibrinogen consumption, fibrinolytic activation, and platelet dysfunction all interact to produce different clot formation responses after trauma. However, the relative contributions of these coagulation components to overall clot formation remain poorly defined. We examined for sources of heterogeneity in clot formation responses after trauma. METHODS: Blood was sampled in the emergency department from patients meeting trauma team activation criteria at an urban trauma center. Plasma prothrombin time of 18 s or longer was used to define traumatic coagulopathy. Mean kaolin-activated thrombelastography (TEG) parameters were calculated and tested for heterogeneity using analysis of means. Discriminant analysis and forward stepwise variable selection with linear regression were used to determine if prothrombin time, fibrinogen, platelet contractile force (PCF), and D-dimer concentration, representing key mechanistic components of coagulopathy, each contribute to heterogeneous TEG responses after trauma. RESULTS: Of 95 subjects, 16% met criteria for coagulopathy. Coagulopathic subjects were more severely injured with greater shock and received more blood products in the first 8 h compared with noncoagulopathic subjects. Mean (SD) TEG maximal amplitude (MA) was significantly decreased in the coagulopathic group (57.5 [SD, 4.7] mm vs. 62.7 [SD, 4.7], t test P < 0.001). The MA also exceeded the ANOM predicted upper decision limit for the noncoagulopathic group and the lower decision limit for the coagulopathic group at alpha = 0.05, suggesting significant heterogeneity from the overall cohort mean. Fibrinogen and PCF best discriminated TEG MA using discriminant analysis. Fibrinogen, PCF, and D-dimer were primary covariates for TEG MA using regression analysis. CONCLUSIONS: Heterogeneity in TEG-based clot formation in emergency department trauma patients was linked to changes in MA. Individual parameters representing fibrin polymerization, PCFs, and fibrinolysis were primarily associated with TEG MA after trauma and should be the focus of early hemostatic therapies. FAU - White, Nathan J AU - White NJ AD - *Division of Emergency Medicine, University of Washington, and Puget Sound Blood Center Research Institute, Seattle, WA; daggerCoagulation Advancement Laboratory, Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA; double daggerDepartment of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; section signPharmacotherapy & Outcomes Science and Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA; ||Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA; paragraph signUS Army Medical Research and Materiel Command, Fort Detrick, MD; #Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan. FAU - Newton, Jason C AU - Newton JC FAU - Martin, Erika J AU - Martin EJ FAU - Mohammed, Bassem M AU - Mohammed BM FAU - Contaifer, Daniel Jr AU - Contaifer D Jr FAU - Bostic, Jessica L AU - Bostic JL FAU - Brophy, Gretchen M AU - Brophy GM FAU - Spiess, Bruce D AU - Spiess BD FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Ward, Kevin R AU - Ward KR FAU - Brophy, Donald F AU - Brophy DF LA - eng GR - KL2 TR000421/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (fibrin fragment D) RN - 24H4NWX5CO (Kaolin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - *Blood Coagulation MH - Blood Coagulation Tests MH - Blood Platelets/*cytology MH - Cross-Sectional Studies MH - Discriminant Analysis MH - Emergency Medicine MH - Emergency Service, Hospital MH - Fibrin Fibrinogen Degradation Products/chemistry MH - Fibrinogen/*chemistry MH - Humans MH - Kaolin/chemistry MH - Middle Aged MH - Prospective Studies MH - Prothrombin Time MH - Regression Analysis MH - Thrombelastography MH - Time Factors MH - Wounds and Injuries/*blood/therapy MH - Young Adult PMC - PMC4504845 MID - NIHMS656809 EDAT- 2015/02/03 06:00 MHDA- 2016/04/26 06:00 PMCR- 2016/08/01 CRDT- 2015/02/03 06:00 PHST- 2015/02/03 06:00 [entrez] PHST- 2015/02/03 06:00 [pubmed] PHST- 2016/04/26 06:00 [medline] PHST- 2016/08/01 00:00 [pmc-release] AID - 10.1097/SHK.0000000000000342 [doi] PST - ppublish SO - Shock. 2015 Aug;44 Suppl 1(0 1):39-44. doi: 10.1097/SHK.0000000000000342. PMID- 25616490 OWN - NLM STAT- MEDLINE DCOM- 20161221 LR - 20161230 IS - 1938-2723 (Electronic) IS - 1076-0296 (Linking) VI - 22 IP - 4 DP - 2016 May TI - Effects of Hyperbaric and Decompression Stress on Blood Coagulation and Fibrinolysis: Comparison of Thromboelastography and Thromboelastometry. PG - 327-39 LID - 10.1177/1076029614568712 [doi] AB - Hyperbaric and decompression stress from diving impairs blood coagulation and fibrinolysis. We hypothesized that thromboelastography (TEG) and rotational thromboelastometry (ROTEM) were suitable to characterize the effects of stress on global hemostatic profiles. We thus conducted a comparative study of the hyperbaric effects on human coagulation using TEG and ROTEM. Maximum clot strength (maximum amplitude [MA]) and clot lysis (lysis index at time 30 minutes [LI30]) were reduced as indicated by TEG MA and EXTEM LI30, respectively. The relative changes in coagulation and fibrinolysis by the hyperbaric effects of diving were indicated by reduced TEG reaction time R at 5 hours, MA at 24 hours postdive, and reduced EXTEM coagulation time at 15 minutes postdive as well as decreased fibrinolysis (EXTEM LI30) at all postdiving time points investigated. Comparison of the parameter values and the diving-induced changes in each parameter between TEG and ROTEM showed both differences and correlations. The discrepancies between the 2 systems may be due to the different assay reagents used. Future studies will seek to further elucidate the changes in blood coagulation and fibrinolysis following varying levels of hyperbaric and decompression stress. CI - (c) The Author(s) 2015. FAU - Peng, Henry T AU - Peng HT AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada henry.peng@drdc-rddc.gc.ca. FAU - Cameron, Bruce A AU - Cameron BA AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. FAU - Rhind, Shawn G AU - Rhind SG AD - Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada. LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150123 PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 SB - IM MH - Adolescent MH - Adult MH - Decompression Sickness/*blood/etiology MH - Diving/*adverse effects MH - Female MH - *Fibrinolysis MH - Humans MH - Male MH - Middle Aged MH - *Thrombelastography OTO - NOTNLM OT - blood coagulation OT - decompression stress OT - thromboelastography OT - thromboelastometry EDAT- 2015/01/27 06:00 MHDA- 2016/12/22 06:00 CRDT- 2015/01/25 06:00 PHST- 2015/01/25 06:00 [entrez] PHST- 2015/01/27 06:00 [pubmed] PHST- 2016/12/22 06:00 [medline] AID - 1076029614568712 [pii] AID - 10.1177/1076029614568712 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2016 May;22(4):327-39. doi: 10.1177/1076029614568712. Epub 2015 Jan 23. PMID- 25590525 OWN - NLM STAT- MEDLINE DCOM- 20151020 LR - 20220317 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 41 IP - 1 DP - 2015 Feb TI - Hypercoagulability and venous thromboembolism in burn patients. PG - 43-8 LID - 10.1055/s-0034-1398380 [doi] AB - To our knowledge, this is the first comprehensive review on the subject of venous thromboembolism (VTE) and hypercoagulability in burn patients. Specific changes in coagulability are reviewed using data from thromboelastography and other techniques. Disseminated intravascular coagulation in burn patients is discussed. The incidence and risk factors associated with VTE in burn patients are then examined, followed by the use of low-molecular-weight heparin thromboprophylaxis and monitoring techniques using antifactor Xa levels. The need for large, prospective trials in burn patients is highlighted, especially in the areas of VTE incidence and safe, effective thromboprophylaxis. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Meizoso, Jonathan P AU - Meizoso JP AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Ray, Juliet J AU - Ray JJ AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Allen, Casey J AU - Allen CJ AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Van Haren, Robert M AU - Van Haren RM AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Ruiz, Gabriel AU - Ruiz G AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Namias, Nicholas AU - Namias N AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Schulman, Carl I AU - Schulman CI AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Pizano, Louis R AU - Pizano LR AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. FAU - Proctor, Kenneth G AU - Proctor KG AD - Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review DEP - 20150115 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 SB - IM MH - Burns/*blood MH - Humans MH - Risk Factors MH - Thrombelastography/methods MH - Thrombophilia/*blood/*etiology MH - Venous Thromboembolism/*blood/*etiology EDAT- 2015/01/16 06:00 MHDA- 2015/10/21 06:00 CRDT- 2015/01/16 06:00 PHST- 2015/01/16 06:00 [entrez] PHST- 2015/01/16 06:00 [pubmed] PHST- 2015/10/21 06:00 [medline] AID - 10.1055/s-0034-1398380 [doi] PST - ppublish SO - Semin Thromb Hemost. 2015 Feb;41(1):43-8. doi: 10.1055/s-0034-1398380. Epub 2015 Jan 15. PMID- 25590183 OWN - NLM STAT- MEDLINE DCOM- 20160407 LR - 20220409 IS - 1438-8812 (Electronic) IS - 0013-726X (Linking) VI - 47 IP - 7 DP - 2015 Jul TI - Effects of a hemostatic powder hemospray on coagulation and clot formation. PG - 638-45 LID - 10.1055/s-0034-1391353 [doi] AB - BACKGROUND AND STUDY AIMS: Hemospray (Cook Medical Inc., Winston-Salem, North Carolina, USA) is a novel, hemostatic, powder spray that has been developed for gastrointestinal use. The powder is thought to achieve hemostasis by concentrating clotting factors and forming a mechanical plug on the injured blood vessel. However, no detailed studies on the hemostatic mode of action have been performed. The aim of this study was to examine the effects of Hemospray on coagulation and clot formation both in vitro and in vivo. MATERIALS AND METHODS: Recalcification time, thromboelastometry using EXTEM and INTEM assays, and plasma coagulation tests (activated partial thromboplastin time and prothrombin time) were carried out on blood samples mixed with Hemospray, and compared with talcum powder (negative control) and kaolin (positive control) at 1 mg/mL and 10 mg/mL. Scanning electron microscopy (SEM) and light microscopy were performed on in vitro thrombi and on gastric thrombi from an animal model of gastrointestinal hemorrhage treated with Hemospray. RESULTS: The median recalcification time of whole blood was 187.5 seconds. The addition of 1 mg/mL and 10 mg/mL Hemospray significantly shortened this time (median 60 and 45 seconds, respectively; P < 0.05). The median clotting time of whole blood, measured using the INTEM assay, was 160 seconds (interquartile range [IQR] 159 - 176.5) and this was also significantly reduced by the addition of Hemospray (91 seconds [IQR 84 - 102]; P = 0.005). The plasma prothrombin time of 11.6 seconds was significantly reduced by Hemospray (9.5 seconds; P = 0.011). SEM of in vivo clots demonstrated that Hemospray rapidly interacted with whole blood, forming one confluent mass over the bleeding site. In sufficient amounts, Hemospray was able to deform and pack erythrocytes. CONCLUSIONS: Hemospray covered the bleeding site and enhanced clot formation in vivo, and shortened coagulation time in vitro. Elaboration of these unique properties in clinical practice will help to optimize future endoscopic hemostasis with Hemospray. CI - (c) Georg Thieme Verlag KG Stuttgart . New York. FAU - Holster, I Lisanne AU - Holster IL AD - Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - van Beusekom, Heleen M M AU - van Beusekom HM AD - Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - Kuipers, Ernst J AU - Kuipers EJ AD - Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - Leebeek, Frank W G AU - Leebeek FW AD - Department of Hematology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - de Maat, Moniek P M AU - de Maat MP AD - Department of Hematology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - Tjwa, Eric T T L AU - Tjwa ET AD - Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150115 PL - Germany TA - Endoscopy JT - Endoscopy JID - 0215166 RN - 0 (Hemostatics) RN - 0 (Minerals) RN - 0 (hemospray) SB - IM CIN - Endoscopy. 2015 Jul;47(7):664. PMID: 26334059 MH - Adult MH - Animals MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests MH - Female MH - Gastrointestinal Hemorrhage/*drug therapy MH - Hemostatics/*pharmacology/therapeutic use MH - Humans MH - Male MH - Microscopy, Electron, Scanning MH - Minerals/*pharmacology/therapeutic use MH - Sus scrofa MH - Thrombelastography EDAT- 2015/01/16 06:00 MHDA- 2016/04/08 06:00 CRDT- 2015/01/16 06:00 PHST- 2015/01/16 06:00 [entrez] PHST- 2015/01/16 06:00 [pubmed] PHST- 2016/04/08 06:00 [medline] AID - 10.1055/s-0034-1391353 [doi] PST - ppublish SO - Endoscopy. 2015 Jul;47(7):638-45. doi: 10.1055/s-0034-1391353. Epub 2015 Jan 15. PMID- 25587242 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240322 IS - 1523-3855 (Print) IS - 2167-6275 (Electronic) IS - 1523-3855 (Linking) VI - 4 IP - 3 DP - 2014 Sep 1 TI - Trauma-Induced Coagulopathy. PG - 189-199 AB - Trauma is the leading cause of death among people under the age of 44. Hemorrhage is a major contributor to deaths related to trauma in the first 48 h. Accordingly, the management of these patients is a time-sensitive and critical affair that anesthesiologists responsible for surgical resuscitation will face. Coagulopathy associated with trauma exists in one-third of all severely injured patients upon presentation to the hospital. Trauma patients presenting with coagulopathy have significantly higher mortality. This trauma-induced coagulopathy (TIC) must be managed adroitly in the resuscitation of these patients. Recent advancements in our understanding of TIC have led to new protocols and therapy guidelines. Anesthesiologists must be aware of these to effectively manage this form of shock. TIC driven by a combination of endogenous biological processes, as well as iatrogenic causes, can ultimately lead to the lethal triad of hypothermia, acidemia, and coagulopathy. Providers should understand how to promptly diagnose TIC and be aware of the early indicators of massive transfusion. The use of common laboratory studies and patient vital signs serve as our current guide, but the importance of each is still under debate. Thromboelastography is a tool used often in the diagnosis of TIC and can be used to guide blood product transfusion. Certain pharmaceutical strategies and non-transfusion strategies also exist, which aid in the management of hemorrhagic shock. Damage control surgery, rewarming, tranexamic acid, and 1:1:1 transfusion protocols are promising methods used to treat the critically wounded. Though protocols have been developed, controversies still exist on the optimal resuscitation strategy. FAU - Simmons, Jeffrey W AU - Simmons JW AD - Trauma Section, Medical Simulation, Department of Anesthesiology, University of Alabama at Birmingham, 804 Jefferson Tower, 619 South 19th Street, Birmingham, AL 35249-6810, USA. FAU - Pittet, Jean-Francois AU - Pittet JF AD - Critical Care Division, Department of Anesthesiology, University of Alabama at Birmingham, 804 Jefferson Tower, 619 South 19th Street, Birmingham, AL 35249-6810, USA. FAU - Pierce, Bert AU - Pierce B AD - Department of Anesthesiology, University of Alabama at Birmingham, 804 Jefferson Tower, 619 South 19th Street, Birmingham, AL 35249-6810, USA. LA - eng GR - R01 GM086416/GM/NIGMS NIH HHS/United States PT - Journal Article PL - United States TA - Curr Anesthesiol Rep JT - Current anesthesiology reports JID - 100888957 PMC - PMC4288848 MID - NIHMS644565 OTO - NOTNLM OT - Coagulopathy OT - Hemorrhage OT - Pathogenesis OT - Resuscitation OT - Shock OT - Trauma COIS- Conflict of Interest Jeffrey W. Simmons, Jean-Francois Pittet, and Bert Pierce declare that they have no conflict of interest. EDAT- 2015/01/15 06:00 MHDA- 2015/01/15 06:01 PMCR- 2015/09/01 CRDT- 2015/01/15 06:00 PHST- 2015/01/15 06:00 [entrez] PHST- 2015/01/15 06:00 [pubmed] PHST- 2015/01/15 06:01 [medline] PHST- 2015/09/01 00:00 [pmc-release] AID - 10.1007/s40140-014-0063-8 [doi] PST - ppublish SO - Curr Anesthesiol Rep. 2014 Sep 1;4(3):189-199. doi: 10.1007/s40140-014-0063-8. PMID- 25577141 OWN - NLM STAT- MEDLINE DCOM- 20150429 LR - 20181113 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 194 IP - 1 DP - 2015 Mar TI - Thrombelastographic pattern recognition in renal disease and trauma. PG - 1-7 LID - S0022-4804(14)01126-3 [pii] LID - 10.1016/j.jss.2014.12.012 [doi] AB - BACKGROUND: Thrombelastography (TEG) is a viscoelastic hemostatic assay. We have observed that end-stage renal disease (ESRD) and trauma-induced coagulopathy (TIC) produce distinctive TEG tracings. We hypothesized that rigorously definable TEG patterns could discriminate between healthy controls and patients with ESRD and TIC. METHODS: TEG was performed on blood from ESRD patients (n = 54) and blood from trauma patients requiring a massive blood transfusion (n = 16). Plots of independent TEG parameters were analyzed for patterns coupled to disease state, compared with controls. Decision trees for taxonomic classification were then built using the "R-Project" statistical software. RESULTS: Minimally overlapping clusters of TEG results were observed for the three patient groups when coordinate pairs of maximum amplitude (MA) and TEG-activated clotting time (ACT) were plotted on orthogonal axes. Based on these groupings, a taxonomical classification tree was constructed using MA and TEG ACT. Branch points were set at an ACT of 103 s, and these branches subdivided for MA at 60.8 mm for the high ACT branch and 72.6 mm for the low ACT branch, providing a correct classification rate of 93.4%. CONCLUSIONS: ESRD and TIC demonstrate distinct TEG patterns. The coagulopathy of ESRD is typified by a prolonged enzymatic phase of clot formation, with normal-to-elevated final clot strength. Conversely, TIC is typified by prolonged clot formation and weakened clot strength. Our taxonomic categorization constitutes a rigorous system for the algorithmic interpretation of TEG based on cluster analysis. This will form the basis for clinical decision support software for viscoelastic hemostatic assays. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Chapman, Michael P AU - Chapman MP AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. Electronic address: michael.chapman@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. FAU - Burneikis, Dominykas AU - Burneikis D AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Anderson, Kelsey C AU - Anderson KC AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Ramos, Christopher R AU - Ramos CR AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. FAU - Banerjee, Anirban AU - Banerjee A AD - Department of Surgery, University of Colorado-Denver, Aurora, Colorado. LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UMHL120877/PHS HHS/United States GR - T32GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20141210 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 SB - IM MH - Cluster Analysis MH - Humans MH - Kidney Failure, Chronic/*blood MH - *Thrombelastography MH - Whole Blood Coagulation Time MH - Wounds and Injuries/*blood PMC - PMC4346387 MID - NIHMS654254 OTO - NOTNLM OT - Classification tree analysis OT - Coagulopathy OT - Hemodialysis OT - Hypercoagulability OT - Machine learning OT - Pattern recognition OT - Renal disease OT - Taxonomy OT - Thrombelastography OT - Trauma OT - Trauma-induced coagulopathy OT - Viscoelastic hemostatic assay COIS- Conflict of Interest Statement: We receive research support from the Haemonetics Corporation, Niles, IL EDAT- 2015/01/13 06:00 MHDA- 2015/04/30 06:00 PMCR- 2016/03/01 CRDT- 2015/01/12 06:00 PHST- 2014/01/04 00:00 [received] PHST- 2014/12/02 00:00 [revised] PHST- 2014/12/04 00:00 [accepted] PHST- 2015/01/12 06:00 [entrez] PHST- 2015/01/13 06:00 [pubmed] PHST- 2015/04/30 06:00 [medline] PHST- 2016/03/01 00:00 [pmc-release] AID - S0022-4804(14)01126-3 [pii] AID - 10.1016/j.jss.2014.12.012 [doi] PST - ppublish SO - J Surg Res. 2015 Mar;194(1):1-7. doi: 10.1016/j.jss.2014.12.012. Epub 2014 Dec 10. PMID- 25571924 OWN - NLM STAT- MEDLINE DCOM- 20160129 LR - 20181113 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 23 DP - 2015 Jan 9 TI - Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios: a thrombelastometry study. PG - 2 LID - 10.1186/s13049-014-0080-0 [doi] LID - 2 AB - INTRODUCTION: Different transfusion ratio concepts of packed red blood cells (pRBCs), fresh frozen plasma (FFP) and platelets (PLTs) have been implemented in trauma care, but the optimal ratios are still discussed. In this study the hemostatic potential of two predefined ratios was assessed by using an in vitro thrombelastometric approach. Furthermore, age effects of reconstituted blood were analyzed. METHODS: Whole blood (WB) of voluntary donors was separated into pRBCs, FFP and PLTs and reconstituted into the ratios 1:1:1 and 3:1:1 at day 1, 4, 14, and 24. Standard blood count, electrolytes and coagulation proteins were quantified. The functional coagulation in ratio- and age-specific groups was evaluated using rotational thromboelastometry (ROTEM). RESULTS: Several coagulation factors reduced significantly in the 3:1:1 ratio and were consistent with increased INR, decelerated clot formation times and A10 (amplitude 10 minutes after clotting time (CT)), flattened alpha-angle during the EXTEM and diminished MCF for distinct time points during the INTEM, FIBTEM and APTEM assays. With rising age of pRBCs the pH, sodium and potassium reached non-physiological levels. CONCLUSION: Under standardized in vitro conditions the higher amount of pRBCs in the 3:1:1 ratio diluted coagulation factors significantly on the expense of its functional coagulation capacity as revealed by ROTEM results. Thus, the coagulation functionality of the 1:1:1 ratio predominated. FAU - Driessen, Arne AU - Driessen A AD - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@uni-wh.de. AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@uni-wh.de. FAU - Schafer, Nadine AU - Schafer N AD - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. nadine.schaefer@uni-wh.de. FAU - Bauerfeind, Ursula AU - Bauerfeind U AD - Institute of Transfusion Medicine Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Cologne (Germany), Ostmerheimer Str. 200, D-51109, Cologne, Germany. bauerfeindu@kliniken-koeln.de. FAU - Kaske, Sigune AU - Kaske S AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. sigune.peiniger@web.de. FAU - Fromm-Dornieden, Carolin AU - Fromm-Dornieden C AD - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. carolin.fromm-dornieden@uni-wh.de. FAU - Stuermer, Ewa K AU - Stuermer EK AD - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. ewa.stuermer@uni-wh.de. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. marc.maegele@t-online.de. LA - eng PT - Journal Article DEP - 20150109 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Blood Coagulation Tests MH - Blood Platelets/physiology MH - Blood Transfusion/*methods MH - Erythrocytes/physiology MH - Humans MH - In Vitro Techniques MH - International Normalized Ratio MH - Plasma/physiology MH - *Thrombelastography PMC - PMC4296528 EDAT- 2015/01/13 06:00 MHDA- 2016/01/30 06:00 PMCR- 2015/01/09 CRDT- 2015/01/10 06:00 PHST- 2014/09/09 00:00 [received] PHST- 2014/12/16 00:00 [accepted] PHST- 2015/01/10 06:00 [entrez] PHST- 2015/01/13 06:00 [pubmed] PHST- 2016/01/30 06:00 [medline] PHST- 2015/01/09 00:00 [pmc-release] AID - s13049-014-0080-0 [pii] AID - 80 [pii] AID - 10.1186/s13049-014-0080-0 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2015 Jan 9;23:2. doi: 10.1186/s13049-014-0080-0. PMID- 25553671 OWN - NLM STAT- MEDLINE DCOM- 20150921 LR - 20220318 IS - 1873-2380 (Electronic) IS - 0021-9290 (Linking) VI - 48 IP - 3 DP - 2015 Feb 5 TI - Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel. PG - 449-55 LID - S0021-9290(14)00683-6 [pii] LID - 10.1016/j.jbiomech.2014.12.029 [doi] AB - Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0 degrees and 30 degrees flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures. CI - Copyright (c) 2014 Elsevier Ltd. All rights reserved. FAU - Kociolek, Aaron M AU - Kociolek AM AD - Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. FAU - Tat, Jimmy AU - Tat J AD - Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. FAU - Keir, Peter J AU - Keir PJ AD - Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. Electronic address: pjkeir@mcmaster.ca. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141216 PL - United States TA - J Biomech JT - Journal of biomechanics JID - 0157375 SB - IM MH - Adult MH - Aged MH - Cadaver MH - Carpal Tunnel Syndrome/*physiopathology MH - Connective Tissue/*physiopathology MH - Fibrosis MH - Fingers MH - Friction MH - Humans MH - Middle Aged MH - Range of Motion, Articular MH - Risk Factors MH - Tendons/*physiopathology MH - Wrist Joint/*physiopathology OTO - NOTNLM OT - Carpal tunnel OT - Gliding resistance OT - Subsynovial connective tissue OT - Tendon OT - Viscoelastic EDAT- 2015/01/03 06:00 MHDA- 2015/09/22 06:00 CRDT- 2015/01/03 06:00 PHST- 2014/07/28 00:00 [received] PHST- 2014/11/16 00:00 [revised] PHST- 2014/12/08 00:00 [accepted] PHST- 2015/01/03 06:00 [entrez] PHST- 2015/01/03 06:00 [pubmed] PHST- 2015/09/22 06:00 [medline] AID - S0021-9290(14)00683-6 [pii] AID - 10.1016/j.jbiomech.2014.12.029 [doi] PST - ppublish SO - J Biomech. 2015 Feb 5;48(3):449-55. doi: 10.1016/j.jbiomech.2014.12.029. Epub 2014 Dec 16. PMID- 25546432 OWN - NLM STAT- MEDLINE DCOM- 20150908 LR - 20181113 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 9 IP - 12 DP - 2014 TI - Platelet activation after presyncope by lower body negative pressure in humans. PG - e116174 LID - 10.1371/journal.pone.0116174 [doi] LID - e116174 AB - Central hypovolemia elevates hemostatic activity which is essential for preventing exsanguination after trauma, but platelet activation to central hypovolemia has not been described. We hypothesized that central hypovolemia induced by lower body negative pressure (LBNP) activates platelets. Eight healthy subjects were exposed to progressive central hypovolemia by LBNP until presyncope. At baseline and 5 min after presyncope, hemostatic activity of venous blood was evaluated by flow cytometry, thrombelastography, and plasma markers of coagulation and fibrinolysis. Cell counts were also determined. Flow cytometry revealed that LBNP increased mean fluorescence intensity of PAC-1 by 1959+/-455 units (P<0.001) and percent of fluorescence-positive platelets by 27+/-18%-points (P = 0.013). Thrombelastography demonstrated that coagulation was accelerated (R-time decreased by 0.8+/-0.4 min (P = 0.001)) and that clot lysis increased (LY60 by 6.0+/-5.8%-points (P = 0.034)). Plasma coagulation factor VIII and von Willebrand factor ristocetin cofactor activity increased (P = 0.011 and P = 0.024, respectively), demonstrating increased coagulation activity, while von Willebrand factor antigen was unchanged. Plasma protein C activity and tissue-type plasminogen activator increased (P = 0.007 and P = 0.017, respectively), and D-dimer increased by 0.03+/-0.02 mg l(-1) (P = 0.031), demonstrating increased fibrinolytic activity. Plasma prothrombin time and activated partial thromboplastin time were unchanged. Platelet count increased by 15+/-13% (P = 0.014) and red blood cells by 9+/-4% (P = 0.002). In humans, LBNP-induced presyncope activates platelets, as evidenced by increased exposure of active glycoprotein IIb/IIIa, accelerates coagulation. LBNP activates fibrinolysis, similar to hemorrhage, but does not alter coagulation screening tests, such as prothrombin time and activated partial thromboplastin time. LBNP results in increased platelet counts, but also in hemoconcentration. FAU - Zaar, Morten AU - Zaar M AD - University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America. FAU - Fedyk, Chriselda G AU - Fedyk CG AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Pidcoke, Heather F AU - Pidcoke HF AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Scherer, Michael R AU - Scherer MR AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Ryan, Kathy L AU - Ryan KL AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Rickards, Caroline A AU - Rickards CA AD - University of North Texas Health Science Center Fort Worth, Fort Worth, Texas, United States of America. FAU - Hinojosa-Laborde, Carmen AU - Hinojosa-Laborde C AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Convertino, Victor A AU - Convertino VA AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. FAU - Cap, Andrew P AU - Cap AP AD - United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America. LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20141229 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Biomarkers) RN - 0 (Hormones) RN - EC 3.4.23.15 (Renin) SB - IM MH - Adult MH - Biomarkers/blood MH - Blood Coagulation MH - Female MH - Flow Cytometry MH - Hormones/blood MH - Humans MH - *Lower Body Negative Pressure MH - Male MH - *Platelet Activation MH - Renin/blood MH - Syncope/*blood MH - Thrombelastography PMC - PMC4278859 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2014/12/30 06:00 MHDA- 2015/09/09 06:00 PMCR- 2014/12/29 CRDT- 2014/12/30 06:00 PHST- 2014/09/08 00:00 [received] PHST- 2014/12/04 00:00 [accepted] PHST- 2014/12/30 06:00 [entrez] PHST- 2014/12/30 06:00 [pubmed] PHST- 2015/09/09 06:00 [medline] PHST- 2014/12/29 00:00 [pmc-release] AID - PONE-D-14-40313 [pii] AID - 10.1371/journal.pone.0116174 [doi] PST - epublish SO - PLoS One. 2014 Dec 29;9(12):e116174. doi: 10.1371/journal.pone.0116174. eCollection 2014. PMID- 25545751 OWN - NLM STAT- MEDLINE DCOM- 20150415 LR - 20220330 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 120 IP - 3 DP - 2015 Mar TI - Changes in coagulation in standard laboratory tests and ROTEM in trauma patients between on-scene and arrival in the emergency department. PG - 627-635 LID - 10.1213/ANE.0000000000000561 [doi] AB - BACKGROUND: When trauma patients arrive in the emergency department (ED), coagulopathy frequently is present. The time course, however, in which this coagulopathy develops is poorly understood. No study has fully evaluated the coagulation status, including thromboelastometry on-scene and at hospital arrival. We hypothesized that measured coagulation variables might change when measured at the scene of injury and upon arrival to the ED. METHODS: We performed a prospective, single-center, observational study investigating coagulation status in 50 trauma patients on-scene and at arrival in the ED. Measurements included arterial blood gases, ROTEM(R), protein S100, protein C activity, protein S, Quick value, international normalized ratio, activated partial thromboplastin time, D-dimer, coagulation factor V (FV), coagulation factor XIII (FXIII), fibrinogen, hemoglobin, hematocrit, platelets, and volume and blood products being administered during the first 24 hours. RESULTS: Significant changes between on-scene and the ED were observed for the following values: partial venous oxygen pressure increased and sodium, glucose, and lactate decreased. For EXTEM, INTEM, and APTEM, clotting time and clot formation time increased significantly, whereas maximal clot firmness and angle alpha decreased significantly (all P /= 11.7 dynes/cm(2) and hypocoagulability as a G value of <5.0 dynes/cm(2). ROTEM was performed on admission and 24 hours later. RESULTS: A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. CONCLUSIONS: The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants. FAU - Muller, Marcella C A AU - Muller MC AD - Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.c.muller@amc.uva.nl. FAU - Balvers, Kirsten AU - Balvers K AD - Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.balvers@amc.uva.nl. AD - Department of Surgery, Trauma Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.balvers@amc.uva.nl. FAU - Binnekade, Jan M AU - Binnekade JM AD - Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.m.binnekade@amc.uva.nl. FAU - Curry, Nicola AU - Curry N AD - National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9BQ, UK. Nicola.Curry@ouh.nhs.uk. FAU - Stanworth, Simon AU - Stanworth S AD - National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9BQ, UK. Simon.stanworth@NHSBT.NHS.UK. FAU - Gaarder, Christine AU - Gaarder C AD - Department of Traumatology, Oslo University Hospital, Ullevaal, Nydalen, N-0424, Oslo, Norway. tinagaar@online.no. FAU - Kolstadbraaten, Knut M AU - Kolstadbraaten KM AD - Department of Traumatology, Oslo University Hospital, Ullevaal, Nydalen, N-0424, Oslo, Norway. KKOLSTAD@ous-hf.no. FAU - Rourke, Claire AU - Rourke C AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, Turner Street, London, E1 2AD, UK. Claire.Rourke@bartshealth.nhs.uk. FAU - Brohi, Karim AU - Brohi K AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, Turner Street, London, E1 2AD, UK. karimbrohi@gmail.com. FAU - Goslings, J Carel AU - Goslings JC AD - Department of Surgery, Trauma Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.c.goslings@amc.uva.nl. FAU - Juffermans, Nicole P AU - Juffermans NP AD - Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. n.p.juffermans@amc.uva.nl. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20141225 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 SB - IM MH - Adult MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Multiple Organ Failure/*blood/*diagnosis/epidemiology MH - Multiple Trauma/*blood/*diagnosis/epidemiology MH - Prospective Studies MH - Thrombelastography/*methods PMC - PMC4305250 EDAT- 2014/12/30 06:00 MHDA- 2015/10/20 06:00 PMCR- 2014/12/25 CRDT- 2014/12/26 06:00 PHST- 2014/07/23 00:00 [received] PHST- 2014/11/25 00:00 [accepted] PHST- 2014/12/26 06:00 [entrez] PHST- 2014/12/30 06:00 [pubmed] PHST- 2015/10/20 06:00 [medline] PHST- 2014/12/25 00:00 [pmc-release] AID - s13054-014-0687-6 [pii] AID - 687 [pii] AID - 10.1186/s13054-014-0687-6 [doi] PST - epublish SO - Crit Care. 2014 Dec 25;18(6):687. doi: 10.1186/s13054-014-0687-6. PMID- 25539200 OWN - NLM STAT- MEDLINE DCOM- 20150303 LR - 20181113 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 78 IP - 1 DP - 2015 Jan TI - Obesity and clotting: Body mass index independently contributes to hypercoagulability after injury. PG - 30-6; discussion 37-8 LID - 10.1097/TA.0000000000000490 [doi] AB - BACKGROUND: Although obese patients have high thrombosis rates following injury, the role of obesity in coagulation after trauma remains unknown. We hypothesized that body mass index (BMI) is independently associated with increased measures of hypercoagulability longitudinally after injury. METHODS: Data were prospectively collected for 377 consecutive highest-level trauma activation patients with a BMI of 18.5 kg/m(2) or greater. Standard coagulation measures, citrated kaolin and functional fibrinogen thromboelastography, as well as clotting factors were measured at 0 hour to 120 hours. BMI categories were defined as normal weight (18.5-24.99 kg/m(2)), overweight (25-29.99 kg/m(2)), and obese (>/=30 kg/m(2)). RESULTS: The 377 patients were mostly male (81%) and had blunt injury (61%), with a median BMI of 25.8 kg/m(2). Of the patients, 42% were normal weight (median BMI, 22.5 kg/m(2)). There were no differences in age, sex, Injury Severity Score (ISS), or base deficit between groups. There were no differences in admission international normalized ratio/partial thromboplastin time or factors II, V, VII, VIII, and X; antithrombin III; or protein C. However, obese patients had higher admission platelet counts (303 x 10(9)/L vs. 269 x 10(9)/L, p = 0.004), lower D-dimer (1.88 mug/mL vs. 4.00 mug/mL, p = 0.004), and a trend toward higher factor IX (134% vs. 119% activity, p = 0.042) compared with normal weight patients. Measured by thromboelastography, clot strength (maximum amplitude) and functional fibrinogen level (FLEV) were also higher on admission for obese patients (maximum amplitude, 65.7 mm vs. 63.4 mm, p = 0.016; FLEV, 407 mg/dL vs. 351 mg/dL, p = 0.008). In multiple linear regression, the relationship of BMI to clot strength, FLEV, and factor IX persisted through 24 hours. Similarly, the relationship of BMI and platelet count persisted through 120 hours (all p < 0.05). In multiple logistic regression, for every 5-kg/m(2) increase in BMI, there was an 85% increase in odds of thromboembolic complication (odds ratio, 1.85; 95% confidence interval, 1.13-3.08; p = 0.017). CONCLUSION: Obese trauma patients are hypercoagulable compared with their similarly injured normal-weight counterparts, which persists longitudinally after injury. The significance of this hypercoagulability requires elucidation for guidance of anticoagulation in this at-risk group. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - From the Department of Surgery, San Francisco General Hospital and the University of California, San Francisco, San Francisco, California. FAU - Howard, Benjamin AU - Howard B FAU - Kunitake, Ryan AU - Kunitake R FAU - Redick, Brittney AU - Redick B FAU - Nelson, Mary AU - Nelson M FAU - Cohen, Mitchell Jay AU - Cohen MJ FAU - Callcut, Rachael AU - Callcut R LA - eng GR - T32 GM-008258-25/GM/NIGMS NIH HHS/United States GR - T32 GM008258/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - K08 GM085689/GM/NIGMS NIH HHS/United States GR - UL1 TR000371/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM CIN - J Vasc Nurs. 2018 Dec;36(4):216-217. doi: 10.1016/j.jvn.2018.10.001. PMID: 30458945 MH - Adult MH - Blood Coagulation Tests MH - *Body Mass Index MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Obesity/*complications MH - Prospective Studies MH - Thrombophilia/*etiology MH - Wounds and Injuries/*complications PMC - PMC4279446 MID - NIHMS645659 COIS- Conflicts of interest: None EDAT- 2014/12/30 06:00 MHDA- 2015/03/04 06:00 PMCR- 2016/01/01 CRDT- 2014/12/25 06:00 PHST- 2014/12/25 06:00 [entrez] PHST- 2014/12/30 06:00 [pubmed] PHST- 2015/03/04 06:00 [medline] PHST- 2016/01/01 00:00 [pmc-release] AID - 01586154-201501000-00004 [pii] AID - 10.1097/TA.0000000000000490 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2015 Jan;78(1):30-6; discussion 37-8. doi: 10.1097/TA.0000000000000490. PMID- 25538517 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20141224 LR - 20200928 IS - 1658-354X (Print) IS - 0975-3125 (Electronic) VI - 8 IP - Suppl 1 DP - 2014 Nov TI - Critical care issues in solid organ injury: Review and experience in a tertiary trauma center. PG - S29-35 LID - 10.4103/1658-354X.144065 [doi] AB - BACKGROUND AND AIM: Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. MATERIALS AND METHODS: Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center. RESULTS: Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. CONCLUSIONS: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury. FAU - Sawhney, Chhavi AU - Sawhney C AD - Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India. FAU - Kaur, Manpreet AU - Kaur M AD - Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India. FAU - Gupta, Babita AU - Gupta B AD - Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India. FAU - Singh, P M AU - Singh PM AD - Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India. FAU - Gupta, Amit AU - Gupta A AD - Department of Surgery, All India Institute of Medical Sciences, New Delhi, India. FAU - Kumar, Subodh AU - Kumar S AD - Department of Surgery, All India Institute of Medical Sciences, New Delhi, India. FAU - Misra, M C AU - Misra MC AD - Department of Surgery, All India Institute of Medical Sciences, New Delhi, India. LA - eng PT - Journal Article PL - India TA - Saudi J Anaesth JT - Saudi journal of anaesthesia JID - 101500601 PMC - PMC4268524 OTO - NOTNLM OT - Critical care OT - deadly triad OT - hepatic injury OT - liver trauma OT - solid organ injury OT - splenic trauma COIS- Conflict of Interest: None declared. EDAT- 2014/12/30 06:00 MHDA- 2014/12/30 06:01 PMCR- 2014/11/01 CRDT- 2014/12/25 06:00 PHST- 2014/12/25 06:00 [entrez] PHST- 2014/12/30 06:00 [pubmed] PHST- 2014/12/30 06:01 [medline] PHST- 2014/11/01 00:00 [pmc-release] AID - SJA-8-29 [pii] AID - 10.4103/1658-354X.144065 [doi] PST - ppublish SO - Saudi J Anaesth. 2014 Nov;8(Suppl 1):S29-35. doi: 10.4103/1658-354X.144065. PMID- 25535424 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20141223 LR - 20240510 IS - 0019-5049 (Print) IS - 0976-2817 (Electronic) IS - 0019-5049 (Linking) VI - 58 IP - 5 DP - 2014 Sep TI - Transfusion practices in trauma. PG - 609-15 LID - 10.4103/0019-5049.144668 [doi] AB - Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. FAU - Ramakrishnan, V Trichur AU - Ramakrishnan VT AD - Department of Emergency Medicine, Sri Ramachandra Medical College Research Institute, Porur, Chennai, Tamil Nadu, India. FAU - Cattamanchi, Srihari AU - Cattamanchi S AD - Masters in Public Health (MPH) Candidate - May 2015, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. LA - eng PT - Journal Article PT - Review PL - India TA - Indian J Anaesth JT - Indian journal of anaesthesia JID - 0013243 PMC - PMC4260308 OTO - NOTNLM OT - Blood transfusion OT - damage control resuscitation OT - massive transfusion protocol OT - packed red blood cells OT - plasma OT - platelets OT - trauma resuscitation COIS- Conflict of Interest: None declared EDAT- 2014/12/24 06:00 MHDA- 2014/12/24 06:01 PMCR- 2014/09/01 CRDT- 2014/12/24 06:00 PHST- 2014/12/24 06:00 [entrez] PHST- 2014/12/24 06:00 [pubmed] PHST- 2014/12/24 06:01 [medline] PHST- 2014/09/01 00:00 [pmc-release] AID - IJA-58-609 [pii] AID - 10.4103/0019-5049.144668 [doi] PST - ppublish SO - Indian J Anaesth. 2014 Sep;58(5):609-15. doi: 10.4103/0019-5049.144668. PMID- 25510409 OWN - NLM STAT- MEDLINE DCOM- 20160112 LR - 20240510 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 22 DP - 2014 Dec 16 TI - Correction of hypothermic and dilutional coagulopathy with concentrates of fibrinogen and factor XIII: an in vitro study with ROTEM. PG - 73 LID - 10.1186/s13049-014-0073-z [doi] LID - 73 AB - BACKGROUND: Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia. METHODS: Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33 degrees C or 37 degrees C with ROTEM EXTEM and FIBTEM reagents. Clotting time (CT), clot formation time (CFT), alpha angle (AA) and maximal clot formation (MCF) were recorded. RESULTS: Fibrinogen with or without factor XIII improved all ROTEM parameters in either solution irrespective of temperature, with the exception of EXTEM-AA and EXTEM-CFT in HES haemodilution. Fibrinogen increased FIBTEM-MCF more in the samples diluted with RAc than HES, particularly in presence of factor XIII. CONCLUSIONS: Fibrinogen improved in vitro haemodilution-induced coagulopathy at both 33 degrees C and 37 degrees C, though more efficiently after crystalloid than HES haemodilution. Factor XIII had an additional effect on FIBTEM-MCF, but only after crystalloid dilution. FAU - Winstedt, Dag AU - Winstedt D AD - Faculty of Medicine, Lund University, Lund, Sweden. dag.winstedt@med.lu.se. AD - Department of Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, 221 85, Sweden. dag.winstedt@med.lu.se. FAU - Thomas, Owain D AU - Thomas OD AD - Faculty of Medicine, Lund University, Lund, Sweden. odt@cantab.net. AD - Department of Paediatric Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, 221 85, Sweden. odt@cantab.net. FAU - Nilsson, Fredrik AU - Nilsson F AD - Research and Development Centre, Skane, Skane University Hospital Lund, Lund, 221 85, Sweden. fredrik.x.nilsson@skane.se. FAU - Olanders, Knut AU - Olanders K AD - Faculty of Medicine, Lund University, Lund, Sweden. knut.olanders@skane.se. AD - Department of Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, 221 85, Sweden. knut.olanders@skane.se. FAU - Schott, Ulf AU - Schott U AD - Faculty of Medicine, Lund University, Lund, Sweden. ulf.schott@skane.se. AD - Department of Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, 221 85, Sweden. ulf.schott@skane.se. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141216 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Hydroxyethyl Starch Derivatives) RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*blood/drug therapy/etiology MH - Blood Coagulation Tests MH - Factor XIII/*metabolism MH - Female MH - Fibrinogen/*metabolism MH - Healthy Volunteers MH - Humans MH - Hydroxyethyl Starch Derivatives/pharmacology MH - Hypothermia/blood/*complications MH - Male MH - Middle Aged MH - Thrombelastography/*methods PMC - PMC4272532 EDAT- 2014/12/17 06:00 MHDA- 2016/01/13 06:00 PMCR- 2014/12/16 CRDT- 2014/12/17 06:00 PHST- 2014/09/10 00:00 [received] PHST- 2014/11/26 00:00 [accepted] PHST- 2014/12/17 06:00 [entrez] PHST- 2014/12/17 06:00 [pubmed] PHST- 2016/01/13 06:00 [medline] PHST- 2014/12/16 00:00 [pmc-release] AID - s13049-014-0073-z [pii] AID - 73 [pii] AID - 10.1186/s13049-014-0073-z [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2014 Dec 16;22:73. doi: 10.1186/s13049-014-0073-z. PMID- 25510310 OWN - NLM STAT- MEDLINE DCOM- 20150702 LR - 20220317 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 194 IP - 2 DP - 2015 Apr TI - Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays. PG - 581-590 LID - S0022-4804(14)01057-9 [pii] LID - 10.1016/j.jss.2014.11.021 [doi] AB - BACKGROUND: Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method. MATERIALS AND METHODS: Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h. RESULTS: A total of 182 patients with an Injury Severity Score of 17 (9-26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both rho = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (rho = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm. CONCLUSIONS: The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Meyer, Martin A S AU - Meyer MAS AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. Electronic address: martin.as.meyer@gmail.com. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Sorensen, Anne Marie AU - Sorensen AM AD - Trauma Centre, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Denmark. FAU - Meyer, Anna Sina P AU - Meyer ASP AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Trauma Centre, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Denmark. LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20141120 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Transfusion MH - Fibrinogen/*analysis MH - Humans MH - Middle Aged MH - Odds Ratio MH - Prospective Studies MH - Regression Analysis MH - Thrombelastography/*methods MH - Wounds and Injuries/*blood/therapy OTO - NOTNLM OT - Bleeding OT - FF OT - FIBTEM OT - Fibrinogen OT - Hemostasis OT - Transfusion OT - Trauma EDAT- 2014/12/17 06:00 MHDA- 2015/07/03 06:00 CRDT- 2014/12/17 06:00 PHST- 2014/07/07 00:00 [received] PHST- 2014/10/11 00:00 [revised] PHST- 2014/11/13 00:00 [accepted] PHST- 2014/12/17 06:00 [entrez] PHST- 2014/12/17 06:00 [pubmed] PHST- 2015/07/03 06:00 [medline] AID - S0022-4804(14)01057-9 [pii] AID - 10.1016/j.jss.2014.11.021 [doi] PST - ppublish SO - J Surg Res. 2015 Apr;194(2):581-590. doi: 10.1016/j.jss.2014.11.021. Epub 2014 Nov 20. PMID- 25506124 OWN - NLM STAT- Publisher LR - 20191120 IS - 0737-6146 (Print) IS - 1878-0415 (Electronic) IS - 0737-6146 (Linking) VI - 32 IP - 1 DP - 2014 TI - Practical understanding of hemostasis and approach to the bleeding patient in the OR. PG - 1-21 FAU - Pierce, Albert AU - Pierce A AD - Department of Anesthesiology, University of Alabama at Birmingham. FAU - Pittet, Jean-Francois AU - Pittet JF AD - Department of Anesthesiology, University of Alabama at Birmingham. LA - eng GR - R01 GM086416/GM/NIGMS NIH HHS/United States PT - Journal Article PL - United States TA - Adv Anesth JT - Advances in anesthesia JID - 8409340 PMC - PMC4260414 MID - NIHMS630758 OTO - NOTNLM OT - Bleeding OT - coagulation OT - coagulopathy OT - damage control resuscitation OT - inflammation OT - massive hemorrhage OT - trauma OT - viscoelastic EDAT- 2014/12/17 06:00 MHDA- 2014/12/17 06:00 PMCR- 2015/01/01 CRDT- 2014/12/16 06:00 PHST- 2014/12/16 06:00 [entrez] PHST- 2014/12/17 06:00 [pubmed] PHST- 2014/12/17 06:00 [medline] PHST- 2015/01/01 00:00 [pmc-release] AID - 10.1016/j.aan.2014.08.009 [doi] PST - ppublish SO - Adv Anesth. 2014;32(1):1-21. doi: 10.1016/j.aan.2014.08.009. PMID- 25494419 OWN - NLM STAT- Publisher LR - 20191120 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 77 IP - 5 DP - 2014 Nov TI - Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients. PG - 692-700 AB - BACKGROUND: Following activation, platelets release small vesicles called platelet-derived microparticles (PMPs). PMPs accelerate thrombin generation and thus clot formation at sites of injury by exposing the procoagulant membrane phospholipid phosphatidylserine (PS). The role of PMPs in coagulopathy and hemorrhage following trauma remains elusive. We hypothesized that low levels of PS-positive PMPs (PS + PMPs) would be associated with impaired clot formation. METHODS: This is a prospective observational study of 210 trauma patients admitted directly to a Level 1 trauma center. Plasma levels of PS + PMPs were determined by flow cytometry. Coagulation status was assessed by rotational thrombelastometry, and impaired clot formation was defined by an alpha angle less than 63 degrees using the tissue factor-based EXTEM reagent. Transfusion requirement was assessed by number of units of red blood cells (RBCs) transfused within 24 hours of admission; platelet aggregation capacity was evaluated by the Multiplate assay; and injury severity was determined by the Injury Severity Score (ISS). RESULTS: The median ISS was 17, and blood samples were obtained after a median of 65 minutes following injury. Significantly lower levels of PS + PMPs were found in patients with impaired clot formation (p < 0.001). A low level of PS + PMPs was associated with a higher number of RBCs transfused during the initial 24 hours after admission (p < 0.03) when corrected for risk factors, for example, platelet count, hemoglobin level, and ISS. Platelet aggregation and PS + PMPs did not correlate significantly. CONCLUSION: Low levels of PMPs were associated with impaired clot formation in trauma patients at admission and also with the number of RBC transfusions. This suggests that PMPs may play an important and not previously investigated role in trauma-induced coagulopathy. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Windelov, Nis Agerlin AU - Windelov NA AD - From the Department of Anesthesia (N.A.W., A.M.S., L.S.R.), Center of Head and Orthopedics; Section for Transfusion Medicine (P.I.J., S.R.O.), Capital Region Blood Bank; Trauma Center (A.M.S., C.F.L.), Center of Head and Orthopedics; Department of Intensive Care (A.P.), Abdominal Center; and Department of Cardiothoracic Anesthesia and Intensive Care (M.W.), The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark; and Department of Surgery (P.I.J.), Center for Translational Injury Research, University of Texas Medical School at Houston, Houston, Texas. FAU - Johansson, Par Ingemar AU - Johansson PI FAU - Sorensen, Anne Marie AU - Sorensen AM FAU - Perner, Anders AU - Perner A FAU - Wanscher, Michael AU - Wanscher M FAU - Larsen, Claus Falck AU - Larsen CF FAU - Ostrowski, Sisse Rye AU - Ostrowski SR FAU - Rasmussen, Lars Simon AU - Rasmussen LS LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 EDAT- 2014/12/11 06:00 MHDA- 2014/12/11 06:00 CRDT- 2014/12/11 06:00 PHST- 2014/12/11 06:00 [entrez] PHST- 2014/12/11 06:00 [pubmed] PHST- 2014/12/11 06:00 [medline] AID - 01586154-201411000-00007 [pii] AID - 10.1097/TA.0000000000000437 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Nov;77(5):692-700. doi: 10.1097/TA.0000000000000437. PMID- 25489274 OWN - NLM STAT- MEDLINE DCOM- 20150706 LR - 20181113 IS - 1471-2253 (Print) IS - 1471-2253 (Electronic) IS - 1471-2253 (Linking) VI - 14 DP - 2014 TI - Administration of fibrinogen concentrate for refractory bleeding in massively transfused, non-trauma patients with coagulopathy: a retrospective study with comparator group. PG - 109 LID - 10.1186/1471-2253-14-109 [doi] LID - 109 AB - BACKGROUND: This retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy. METHODS: Over a 3-years period, all patients for whom a massive transfusion protocol was activated and had received >/= 4 units of allogeneic blood components within a /= 2 g/L within 24 h after FBNc administration. RESULTS: Seventy-one patients received 2 [2,4] g of FBNc (FBNc group) and 72 did not (comparator group). FBNc was administered after transfusing 5 [5,9] blood component units, 3 [2,6] hours after massive transfusion protocol activation. Linear regression analysis showed that SOFA (AOR 0.75 [95% CI:0.08-1.43]) and admission fibrinogen level (AOR -2.7 [95% CI:-4.68 - -0.78]), but not FBNc administration, were independently associated with total transfused units. There was a significant inverse relation between both admission and target fibrinogen levels, and total transfused components. Logistic regression showed a direct relationship between admission fibrinogen level and achieving a target level >/= 2 g/L (AOR 3.29 [95% CI;1.95-5.56]). No thromboembolic events associated with FBNc were observed. CONCLUSIONS: In massively transfused, non-trauma patients with coagulopathy and refractory bleeding, late administration of low FBNc dosage was not associated with decreased blood transfusion or increased post-infusion fibrinogen level. Given that both fibrinogen upon admission and target fibrinogen levels were associated with decreased blood transfusion, earlier administration and higher doses of FBNc could be needed. FAU - Leal-Noval, Santiago R AU - Leal-Noval SR AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Casado, Manuel AU - Casado M AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Arellano-Orden, Victoria AU - Arellano-Orden V AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Dusseck, Reginald AU - Dusseck R AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Bautista-Paloma, Javier AU - Bautista-Paloma J AD - Pharmacy Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Munoz, Manuel AU - Munoz M AD - Transfusion Medicine, University of Malaga, Malaga, Spain. FAU - Naranjo-Izorieta, Jose AU - Naranjo-Izorieta J AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Moreno, Antonio Puppo AU - Moreno AP AD - Critical Care Division, Hospital Universitario "Virgen del Rocio" and Instituto de Biomedicina IBIS, Avenida Manuel Siurot s/n, 41013 Seville, Spain. FAU - Cayuela, Aurelio AU - Cayuela A AD - Statistics and Design Division, Hospital del Valme, Seville, Spain. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141126 PL - England TA - BMC Anesthesiol JT - BMC anesthesiology JID - 100968535 RN - 0 (Coagulants) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*therapy MH - Blood Transfusion/*methods MH - Coagulants/administration & dosage/therapeutic use MH - Female MH - Fibrinogen/administration & dosage/*therapeutic use MH - Hemorrhage/*therapy MH - Humans MH - Linear Models MH - Male MH - Middle Aged MH - Retrospective Studies MH - Time Factors MH - Treatment Outcome PMC - PMC4258800 OTO - NOTNLM OT - Anaemia OT - Bleeding OT - Clauss method OT - FIBTEM OT - Fibrinogen concentrate OT - Goal directed therapy OT - Massive transfusion protocol OT - ROTEM OT - TEG OT - Thromboelastography OT - Thromboelastometry OT - Transfusion EDAT- 2014/12/10 06:00 MHDA- 2015/07/07 06:00 PMCR- 2014/11/26 CRDT- 2014/12/10 06:00 PHST- 2014/08/25 00:00 [received] PHST- 2014/11/12 00:00 [accepted] PHST- 2014/12/10 06:00 [entrez] PHST- 2014/12/10 06:00 [pubmed] PHST- 2015/07/07 06:00 [medline] PHST- 2014/11/26 00:00 [pmc-release] AID - 321 [pii] AID - 10.1186/1471-2253-14-109 [doi] PST - epublish SO - BMC Anesthesiol. 2014 Nov 26;14:109. doi: 10.1186/1471-2253-14-109. eCollection 2014. PMID- 25458237 OWN - NLM STAT- MEDLINE DCOM- 20150204 LR - 20141203 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 219 IP - 6 DP - 2014 Dec TI - Early diagnosis of clinically significant hyperfibrinolysis using thrombelastography velocity curves. PG - 1157-66 LID - S1072-7515(14)01714-1 [pii] LID - 10.1016/j.jamcollsurg.2014.07.943 [doi] AB - BACKGROUND: Clot lysis values (LY30) determined by rapid thrombelastography (rTEG) predict postinjury transfusion needs and mortality risk. However, the first derivative velocity curve values generated by rTEG measuring lysis-maximum rate of lysis (MRL) and total lysis (TL)-have not been evaluated. Although recent data support use of antifibrinolytics in trauma, the population that would benefit remains poorly defined. The purpose of this study was to determine if velocity curves more accurately predict large volume transfusions and early mortality than conventional rTEG values. STUDY DESIGN: Conventional and velocity curve admission rTEG values of adult trauma patients were retrospectively evaluated for their ability to predict early transfusion of RBC and plasma, substantial bleeding, massive transfusion, and mortality. Patient outcomes were compared according to hyperfibrinolysis diagnosed by velocity curve values and the conventional LY30 cutoff. RESULTS: There were 1,625 patients included. Clot lysis values predicted early transfusion of RBC (p = 0.003), but not plasma (p = 0.298), within 3 hours of arrival. With respect to velocity curves, MRL and TL predicted both early RBC and plasma transfusion (p < 0.05). All 3 parameters predicted massive transfusion, but only MRL and TL predicted substantial bleeding (odds ratio [OR] 3.1 and 2.9, respectively). In addition, MRL was a stronger predictor of 24-hour and 30-day mortality (p < 0.001) and was also available earlier after arrival than LY30 (p < 0.001). CONCLUSIONS: Velocity curve measures of fibrinolysis are stronger predictors of early transfusion of blood components, bleeding, and mortality after trauma compared with conventional rTEG values. In addition, the MRL is more rapidly available after arrival, which may facilitate earlier diagnosis and treatment of clinically significant hyperfibrinolysis. CI - Copyright (c) 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Pommerening, Matthew J AU - Pommerening MJ AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Goodman, Michael D AU - Goodman MD AD - Department of Surgery, University of Cincinnati, Cincinnati, OH. FAU - Farley, Danny L AU - Farley DL AD - Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Podbielski, Jeanette AU - Podbielski J AD - Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu. LA - eng PT - Journal Article DEP - 20141008 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM MH - Adult MH - Blood Component Transfusion MH - Blood Transfusion MH - Early Diagnosis MH - Female MH - Fibrin Clot Lysis Time MH - Fibrinolysis/*physiology MH - Forecasting MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Thrombelastography MH - Wounds and Injuries/complications/mortality EDAT- 2014/12/03 06:00 MHDA- 2015/02/05 06:00 CRDT- 2014/12/03 06:00 PHST- 2014/05/22 00:00 [received] PHST- 2014/07/29 00:00 [revised] PHST- 2014/07/29 00:00 [accepted] PHST- 2014/12/03 06:00 [entrez] PHST- 2014/12/03 06:00 [pubmed] PHST- 2015/02/05 06:00 [medline] AID - S1072-7515(14)01714-1 [pii] AID - 10.1016/j.jamcollsurg.2014.07.943 [doi] PST - ppublish SO - J Am Coll Surg. 2014 Dec;219(6):1157-66. doi: 10.1016/j.jamcollsurg.2014.07.943. Epub 2014 Oct 8. PMID- 25449666 OWN - NLM STAT- MEDLINE DCOM- 20161230 LR - 20161231 IS - 1578-6749 (Electronic) IS - 0210-5691 (Linking) VI - 39 IP - 3 DP - 2015 Apr TI - Innovation and new trends in critical trauma disease. PG - 179-88 LID - S0210-5691(14)00212-5 [pii] LID - 10.1016/j.medin.2014.09.003 [doi] AB - The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems. CI - Copyright (c) 2014 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved. FAU - Chico-Fernandez, M AU - Chico-Fernandez M AD - UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. Grupo de Trabajo de Trauma y Neurocriticos de la SEMICYUC. Electronic address: murgchico@yahoo.es. FAU - Terceros-Almanza, L L AU - Terceros-Almanza LL AD - UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. Grupo de Trabajo de Trauma y Neurocriticos de la SEMICYUC. FAU - Mudarra-Reche, C C AU - Mudarra-Reche CC AD - UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Espana. Grupo de Trabajo de Trauma y Neurocriticos de la SEMICYUC. LA - eng LA - spa PT - Journal Article DEP - 20141108 PL - Spain TA - Med Intensiva JT - Medicina intensiva JID - 9207689 SB - IM MH - Balloon Occlusion/instrumentation MH - Critical Care/methods/trends MH - Disaster Medicine/*trends MH - Disease Management MH - Fluid Therapy MH - Heart Arrest/therapy MH - Hemostatic Techniques/instrumentation MH - Humans MH - Infusions, Intraosseous/instrumentation MH - Mass Casualty Incidents MH - Military Medicine MH - Patient Care Team MH - Patient Simulation MH - Resuscitation/methods MH - *Therapies, Investigational MH - Thoracotomy MH - Thrombelastography MH - Traumatology/*trends MH - Wounds and Injuries/*therapy OTO - NOTNLM OT - ICU OT - Injury OT - Innovacion OT - Innovation OT - Intensive care medicine OT - Medicina Intensiva OT - Trauma OT - UCI EDAT- 2014/12/03 06:00 MHDA- 2016/12/31 06:00 CRDT- 2014/12/03 06:00 PHST- 2014/07/21 00:00 [received] PHST- 2014/09/05 00:00 [revised] PHST- 2014/09/17 00:00 [accepted] PHST- 2014/12/03 06:00 [entrez] PHST- 2014/12/03 06:00 [pubmed] PHST- 2016/12/31 06:00 [medline] AID - S0210-5691(14)00212-5 [pii] AID - 10.1016/j.medin.2014.09.003 [doi] PST - ppublish SO - Med Intensiva. 2015 Apr;39(3):179-88. doi: 10.1016/j.medin.2014.09.003. Epub 2014 Nov 8. PMID- 25447807 OWN - NLM STAT- MEDLINE DCOM- 20151117 LR - 20250529 IS - 1432-1238 (Electronic) IS - 0342-4642 (Linking) VI - 41 IP - 2 DP - 2015 Feb TI - Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. PG - 239-47 LID - 10.1007/s00134-014-3584-1 [doi] AB - OBJECTIVE: To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage. BACKGROUND: Severe hemorrhage remains a leading cause of mortality in trauma. Damage control resuscitation strategies target trauma-induced coagulopathy (TIC) with the early delivery of high-dose blood components such as fresh frozen plasma (FFP) and platelet transfusions. However, the ability of these products to correct TIC during hemorrhage and resuscitation is unknown. METHODS: This was an international prospective cohort study of bleeding trauma patients at three major trauma centers. A blood sample was drawn immediately on arrival and after 4, 8 and 12 packed red blood cell (PRBC) transfusions. FFP, platelet and cryoprecipitate use was recorded during these intervals. Samples were analyzed for functional coagulation and procoagulant factor levels. RESULTS: One hundred six patients who received at least four PRBC units were included. Thirty-four patients (32 %) required a massive transfusion. On admission 40 % of patients were coagulopathic (ROTEM CA5 /=60 years. Outcomes were correlated with antithrombotic-agent status, coagulation test results, admission neurologic function, and CT-based cerebral atrophy dimensions. RESULTS: Of 198 consecutive patients, 36% were antithrombotic-negative and 64% antithrombotic-positive. ASA patients had higher arachidonic acid inhibition (p = 0.04) and warfarin patients had higher INR (p<0.001), compared to antithrombotic-negative patients. Antithrombotic-positive intracranial hemorrhage rate (38.9%) was similar to the antithrombotic-negative rate (31.9%; p = 0.3285). Coagulopathy was not present on the ten standard coagulation, thromboelastography, and platelet mapping tests with intracranial hemorrhage and results were similar to those without hemorrhage (p>/=0.1354). Hemorrhagic-neurologic complication (intracranial hemorrhage progression, need for craniotomy, neurologic deterioration, or death) rates were similar for antithrombotic-negative (6.9%) and antithrombotic-positive (8.7%; p = 0.6574) patients. The hemorrhagic-neurologic complication rate was increased when admission major neurologic dysfunction was present (63.2% versus 2.2%; RR = 28.3; p<0.001). Age correlated inversely with brain parenchymal width (p<0.001) and positively with lateral ventricular width (p = 0.047) and cortical atrophy (p<0.001). Intracranial hemorrhage correlated with cortical atrophy (p<0.001) and ventricular width (p<0.001). CONCLUSIONS: Intracranial hemorrhage is not associated with antithrombotic agent use. Intracranial hemorrhage patients have no demonstrable coagulopathy. The association of preinjury brain atrophy with acute intracranial hemorrhage is a novel finding. Contrary to antithrombotic agent status, admission neurologic abnormality is a predictor of adverse post-admission outcomes. Study findings indicate that effective hemostasis is maintained with antithrombotic therapy. FAU - Dunham, C Michael AU - Dunham CM AD - Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America. FAU - Hoffman, David A AU - Hoffman DA AD - Division of Cardiology, St. Elizabeth Health Center, Youngstown, Ohio, United States of America. FAU - Huang, Gregory S AU - Huang GS AD - Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America. FAU - Omert, Laurel A AU - Omert LA AD - CSL Behring, King of Prussia, Pennsylvania, United States of America. FAU - Gemmel, David J AU - Gemmel DJ AD - Medical Education and Statistics, St. Elizabeth Health Center, Youngstown, Ohio, United States of America. FAU - Merrell, Renee AU - Merrell R AD - Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America. LA - eng PT - Comparative Study PT - Journal Article DEP - 20141003 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Anticoagulants) RN - 0 (Fibrinolytic Agents) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Aged MH - Anticoagulants/*pharmacology MH - Atrophy/*complications/*physiopathology MH - Brain Injuries/*complications/drug therapy MH - Female MH - Fibrinolytic Agents/*pharmacology MH - Follow-Up Studies MH - Glasgow Coma Scale MH - Humans MH - Injury Severity Score MH - Intracranial Hemorrhage, Traumatic/*etiology MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/*pharmacology MH - Prognosis MH - Retrospective Studies PMC - PMC4184859 COIS- Competing Interests: Dr. Omert is a former employee of the Haemonetics Corporation and a current employee of CSL Behring. Dr. Hoffman is on the advisory boards of CardioDX and AstraZeneca. The authors declare that these affiliations have not caused any bias in conception and design of the study, data interpretation, content of the original submitted manuscript, or any statement in the revised manuscript. EDAT- 2014/10/04 06:00 MHDA- 2016/01/20 06:00 PMCR- 2014/10/03 CRDT- 2014/10/04 06:00 PHST- 2014/06/10 00:00 [received] PHST- 2014/09/01 00:00 [accepted] PHST- 2014/10/04 06:00 [entrez] PHST- 2014/10/04 06:00 [pubmed] PHST- 2016/01/20 06:00 [medline] PHST- 2014/10/03 00:00 [pmc-release] AID - PONE-D-14-25639 [pii] AID - 10.1371/journal.pone.0109473 [doi] PST - epublish SO - PLoS One. 2014 Oct 3;9(10):e109473. doi: 10.1371/journal.pone.0109473. eCollection 2014. PMID- 25264646 OWN - NLM STAT- MEDLINE DCOM- 20141201 LR - 20140930 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 80 IP - 10 DP - 2014 Oct TI - Defining early trauma-induced coagulopathy using thromboelastography. PG - 994-8 AB - Early trauma-induced coagulopathy (ETIC) is abnormal coagulation detected on presentation, but a clear description is lacking. We used thromboelastography (TEG) to characterize ETIC. Data were prospectively collected on high-acuity trauma activations at an urban Level I trauma center between July 2012 and May 2013. Patients with admission TEG before any blood transfusion were stratified by Injury Severity Score (ISS): mild (less than 16), moderate (16 to 24), severe (25 or greater). TEG parameters were compared between groups. ETIC was defined as any abnormality detected on TEG. Fifty-two patients were included; mean age was 49 years and mean time to the emergency department was 26 minutes. Mean ISS for the cohort was 17 with 28 patients in mild, eight in moderate, and 16 in severe. Glasgow Coma Score was lower and head Abbreviated Injury Scale was higher in severe (P < 0.001). Forty-three (83%) patients had an abnormal TEG. Shortened reaction (R) time was noted in 42 patients. There were no differences in any TEG parameters between the injury severity groups. Hyperfibrinolysis was detected in four (8%) patients. ETIC was present in over 80 per cent of high-acuity trauma activations irrespective of injury severity and characterized primarily by shortened R time, indicating ETIC is initially described by a hypercoagulable state as a result of thrombin generation. FAU - Liou, Douglas Z AU - Liou DZ AD - Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA. FAU - Shafi, Hedyeh AU - Shafi H FAU - Bloom, Matthew B AU - Bloom MB FAU - Chung, Rex AU - Chung R FAU - Ley, Eric J AU - Ley EJ FAU - Salim, Ali AU - Salim A FAU - Tcherniantchouk, Oxana AU - Tcherniantchouk O FAU - Margulies, Daniel R AU - Margulies DR LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - *Thrombelastography MH - Wounds and Injuries/*complications EDAT- 2014/09/30 06:00 MHDA- 2014/12/15 06:00 CRDT- 2014/09/30 06:00 PHST- 2014/09/30 06:00 [entrez] PHST- 2014/09/30 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] PST - ppublish SO - Am Surg. 2014 Oct;80(10):994-8. PMID- 25261079 OWN - NLM STAT- MEDLINE DCOM- 20150529 LR - 20250728 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 18 IP - 5 DP - 2014 Sep 27 TI - Effect of thromboelastography (TEG(R)) and rotational thromboelastometry (ROTEM(R)) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. PG - 518 LID - 10.1186/s13054-014-0518-9 [doi] LID - 518 AB - INTRODUCTION: The understanding of coagulopathies in trauma has increased interest in thromboelastography (TEG(R)) and thromboelastometry (ROTEM(R)), which promptly evaluate the entire clotting process and may guide blood product therapy. Our objective was to review the evidence for their role in diagnosing early coagulopathies, guiding blood transfusion, and reducing mortality in injured patients. METHODS: We considered observational studies and randomized controlled trials (MEDLINE, EMBASE, and Cochrane databases) to February 2014 that examined TEG(R)/ROTEM(R) in adult trauma patients. We extracted data on demographics, diagnosis of early coagulopathies, blood transfusion, and mortality. We assessed methodologic quality by using the Newcastle-Ottawa scale (NOS) for observational studies and QUADAS-2 tool for diagnostic accuracy studies. RESULTS: Fifty-five studies (12,489 patients) met inclusion criteria, including 38 prospective cohort studies, 15 retrospective cohort studies, two before-after studies, and no randomized trials. Methodologic quality was moderate (mean NOS score, 6.07; standard deviation, 0.49). With QUADAS-2, only three of 47 studies (6.4%) had a low risk of bias in all domains (patient selection, index test, reference standard and flow and timing); 37 of 47 studies (78.8%) had low concerns regarding applicability. Studies investigated TEG(R)/ROTEM(R) for diagnosis of early coagulopathies (n = 40) or for associations with blood-product transfusion (n = 25) or mortality (n = 24). Most (n = 52) were single-center studies. Techniques examined included rapid TEG(R) (n =12), ROTEM(R) (n = 18), TEG(R) (n = 23), or both TEG(R) and rapid TEG(R) (n = 2). Many TEG(R)/ROTEM(R) measurements were associated with early coagulopathies, including some (hypercoagulability, hyperfibrinolysis, platelet dysfunction) not assessed by routine screening coagulation tests. Standard measures of diagnostic accuracy were inconsistently reported. Many abnormalities predicted the need for massive transfusion and death, but predictive performance was not consistently superior to routine tests. One observational study suggested that a ROTEM(R)-based transfusion algorithm reduced blood-product transfusion, but TEG(R)/ROTEM(R)-based resuscitation was not associated with lower mortality in most studies. CONCLUSIONS: Limited evidence from observational data suggest that TEG(R)/ROTEM(R) tests diagnose early trauma coagulopathy and may predict blood-product transfusion and mortality in trauma. Effects on blood-product transfusion, mortality, and other patient-important outcomes remain unproven in randomized trials. FAU - Da Luz, Luis Teodoro AU - Da Luz LT FAU - Nascimento, Bartolomeu AU - Nascimento B FAU - Shankarakutty, Ajith Kumar AU - Shankarakutty AK FAU - Rizoli, Sandro AU - Rizoli S FAU - Adhikari, Neill Kj AU - Adhikari NK LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20140927 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 SB - IM CIN - Crit Care. 2014 Nov 24;18(6):637. doi: 10.1186/s13054-014-0637-3. PMID: 25672839 MH - Blood Coagulation Disorders/*diagnosis/*therapy MH - *Blood Transfusion MH - Humans MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications/mortality PMC - PMC4206701 EDAT- 2014/09/28 06:00 MHDA- 2015/05/30 06:00 PMCR- 2014/09/27 CRDT- 2014/09/28 06:00 PHST- 2013/11/03 00:00 [received] PHST- 2014/08/29 00:00 [accepted] PHST- 2014/09/28 06:00 [entrez] PHST- 2014/09/28 06:00 [pubmed] PHST- 2015/05/30 06:00 [medline] PHST- 2014/09/27 00:00 [pmc-release] AID - s13054-014-0518-9 [pii] AID - 518 [pii] AID - 10.1186/s13054-014-0518-9 [doi] PST - epublish SO - Crit Care. 2014 Sep 27;18(5):518. doi: 10.1186/s13054-014-0518-9. PMID- 25243020 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20140922 LR - 20220311 IS - 1752-2897 (Print) IS - 1752-2897 (Electronic) IS - 1752-2897 (Linking) VI - 8 DP - 2014 TI - Vagus nerve stimulation improves coagulopathy in hemorrhagic shock: a thromboelastometric animal model study. PG - 15 LID - 10.1186/1752-2897-8-15 [doi] AB - INTRODUCTION: Inflammation plays a major role in the multifactorial process of trauma associated coagulopathy. The vagus nerve regulates the cholinergic anti-inflammatory pathway. We hypothesized that efferent vagus nerve stimulation (VNS) can improve coagulopathy by modulating the inflammatory response to hemorrhage. METHODS: Wistar rats (n = 24) were divided in 3 groups: Group (G1) Sham hemorrhagic shock (HS); (G2) HS w/o VNS; (G3) HS followed by division of the vagus nerves and VNS of the distal stumps. Hemorrhage (45% of baseline MAPx15 minutes) was followed by normotensive resuscitation with LR. Vagus nerves were stimulated (3.5 mA, 5 Hz) for 30 sec 7 times. Samples were obtained at baseline and at 60 minutes for thromboelastometry (Rotem(R)) and cytokine assays (IL-1 and IL-10). ANOVA was used for statistical analysis; significance was set at p < 0.05. RESULTS: Maximum clot firmness (MCF) significantly decreased in G2 after HS (71.5 +/- 1.5 vs. 64 +/- 1.6) (p < 0.05). MCF significantly increased in G3 compared to baseline (67.3 +/- 2.7 vs. 71.5 +/- 1.2) (p < 0.05). G3 also showed significant improvement in Alfa angle, and Clot Formation Time (CFT) compared to baseline. IL-1 increased significantly in group 2 and decrease in group 3, while IL-10 increased in group 3 (p < 0.05). CONCLUSIONS: Electrical stimulation of efferent vagus nerves, during resuscitation (G3), decreases inflammatory response to hemorrhage and improves coagulation. FAU - Rezende-Neto, Joao B AU - Rezende-Neto JB AD - Department of General Surgery, St. Michael's Hospital - University of Toronto, Toronto, ON, Canada. FAU - Alves, Roger Lage AU - Alves RL AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Carvalho, Mario Jr AU - Carvalho M Jr AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Almeida, Thiago AU - Almeida T AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Trant, Cyntia AU - Trant C AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Kushmerick, Christopher AU - Kushmerick C AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Andrade, Marcus AU - Andrade M AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Rizoli, Sandro B AU - Rizoli SB AD - Department of General Surgery, St. Michael's Hospital - University of Toronto, Toronto, ON, Canada. FAU - Cunha-Melo, Jose AU - Cunha-Melo J AD - Federal University of Minas Gerais, Belo Horizonte, Brazil. LA - eng PT - Journal Article DEP - 20140917 PL - England TA - J Trauma Manag Outcomes JT - Journal of trauma management & outcomes JID - 101294910 PMC - PMC4169132 OTO - NOTNLM OT - Coagulopathy OT - Cytokines OT - Hemorrhage OT - Resuscitation OT - Shock OT - Thromboelastometry OT - Trauma OT - Vagal nerve EDAT- 2014/09/23 06:00 MHDA- 2014/09/23 06:01 PMCR- 2014/09/17 CRDT- 2014/09/23 06:00 PHST- 2014/07/14 00:00 [received] PHST- 2014/09/12 00:00 [accepted] PHST- 2014/09/23 06:00 [entrez] PHST- 2014/09/23 06:00 [pubmed] PHST- 2014/09/23 06:01 [medline] PHST- 2014/09/17 00:00 [pmc-release] AID - 1752-2897-8-15 [pii] AID - 10.1186/1752-2897-8-15 [doi] PST - epublish SO - J Trauma Manag Outcomes. 2014 Sep 17;8:15. doi: 10.1186/1752-2897-8-15. eCollection 2014. PMID- 25183582 OWN - NLM STAT- MEDLINE DCOM- 20141031 LR - 20160525 IS - 2049-4408 (Electronic) IS - 2049-4394 (Linking) VI - 96-B IP - 9 DP - 2014 Sep TI - Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy. PG - 1143-54 LID - 10.1302/0301-620X.96B9.33914 [doi] AB - Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy. This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation. CI - (c)2014 The British Editorial Society of Bone & Joint Surgery. FAU - Mauffrey, C AU - Mauffrey C AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Cuellar, D O 3rd AU - Cuellar DO 3rd AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Pieracci, F AU - Pieracci F AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Hak, D J AU - Hak DJ AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Hammerberg, E M AU - Hammerberg EM AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Stahel, P F AU - Stahel PF AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Burlew, C C AU - Burlew CC AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. FAU - Moore, E E AU - Moore EE AD - Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA. LA - eng PT - Journal Article PT - Review PL - England TA - Bone Joint J JT - The bone & joint journal JID - 101599229 SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/*therapy MH - Blood Transfusion MH - Fracture Fixation MH - Fractures, Bone/*complications/diagnosis/surgery MH - Hemorrhage/etiology/*therapy MH - *Hemostatic Techniques MH - Humans MH - Pelvic Bones/*injuries/surgery MH - Resuscitation/methods MH - Thrombelastography OTO - NOTNLM OT - Angio-embolisation OT - Bleeding pelvic fractures OT - Haemodynamic instability OT - Massive transfusion protocol OT - Pelvic fracture OT - Pelvic packing OT - TIC OT - Trauma-induced coagulopathy EDAT- 2014/09/04 06:00 MHDA- 2014/11/02 06:00 CRDT- 2014/09/04 06:00 PHST- 2014/09/04 06:00 [entrez] PHST- 2014/09/04 06:00 [pubmed] PHST- 2014/11/02 06:00 [medline] AID - 96-B/9/1143 [pii] AID - 10.1302/0301-620X.96B9.33914 [doi] PST - ppublish SO - Bone Joint J. 2014 Sep;96-B(9):1143-54. doi: 10.1302/0301-620X.96B9.33914. PMID- 25180602 OWN - NLM STAT- MEDLINE DCOM- 20150209 LR - 20221109 IS - 1558-8238 (Electronic) IS - 0021-9738 (Print) IS - 0021-9738 (Linking) VI - 124 IP - 10 DP - 2014 Oct TI - Plasma fibronectin supports hemostasis and regulates thrombosis. PG - 4281-93 LID - 74630 [pii] LID - 10.1172/JCI74630 [doi] AB - Plasma fibronectin (pFn) has long been suspected to be involved in hemostasis; however, direct evidence has been lacking. Here, we demonstrated that pFn is vital to control bleeding in fibrinogen-deficient mice and in WT mice given anticoagulants. At the site of vessel injury, pFn was rapidly deposited and initiated hemostasis, even before platelet accumulation, which is considered the first wave of hemostasis. This pFn deposition was independent of fibrinogen, von Willebrand factor, beta3 integrin, and platelets. Confocal and scanning electron microscopy revealed pFn integration into fibrin, which increased fibrin fiber diameter and enhanced the mechanical strength of clots, as determined by thromboelastography. Interestingly, pFn promoted platelet aggregation when linked with fibrin but inhibited this process when fibrin was absent. Therefore, pFn may gradually switch from supporting hemostasis to inhibiting thrombosis and vessel occlusion following the fibrin gradient that decreases farther from the injured endothelium. Our data indicate that pFn is a supportive factor in hemostasis, which is vital under both genetic and therapeutic conditions of coagulation deficiency. By interacting with fibrin and platelet beta3 integrin, pFn plays a self-limiting regulatory role in thrombosis, suggesting pFn transfusion may be a potential therapy for bleeding disorders, particularly in association with anticoagulant therapy. FAU - Wang, Yiming AU - Wang Y FAU - Reheman, Adili AU - Reheman A FAU - Spring, Christopher M AU - Spring CM FAU - Kalantari, Jalil AU - Kalantari J FAU - Marshall, Alexandra H AU - Marshall AH FAU - Wolberg, Alisa S AU - Wolberg AS FAU - Gross, Peter L AU - Gross PL FAU - Weitz, Jeffrey I AU - Weitz JI FAU - Rand, Margaret L AU - Rand ML FAU - Mosher, Deane F AU - Mosher DF FAU - Freedman, John AU - Freedman J FAU - Ni, Heyu AU - Ni H LA - eng GR - MOP 119540/Canadian Institutes of Health Research/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140902 PL - United States TA - J Clin Invest JT - The Journal of clinical investigation JID - 7802877 RN - 0 (Fibronectins) RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Animals MH - Blood Coagulation MH - Blood Platelets/physiology MH - Female MH - Fibrin/chemistry MH - Fibrinogen/metabolism MH - Fibronectins/*blood MH - *Hemostasis MH - Homeostasis MH - Humans MH - Male MH - Mice MH - Mice, Knockout MH - Mice, Transgenic MH - Microscopy, Confocal MH - Microscopy, Electron, Scanning MH - Thrombosis/*blood MH - Treatment Outcome PMC - PMC4191008 EDAT- 2014/09/03 06:00 MHDA- 2015/02/11 06:00 PMCR- 2015/01/01 CRDT- 2014/09/03 06:00 PHST- 2014/03/07 00:00 [received] PHST- 2014/07/24 00:00 [accepted] PHST- 2014/09/03 06:00 [entrez] PHST- 2014/09/03 06:00 [pubmed] PHST- 2015/02/11 06:00 [medline] PHST- 2015/01/01 00:00 [pmc-release] AID - 74630 [pii] AID - 10.1172/JCI74630 [doi] PST - ppublish SO - J Clin Invest. 2014 Oct;124(10):4281-93. doi: 10.1172/JCI74630. Epub 2014 Sep 2. PMID- 25168942 OWN - NLM STAT- MEDLINE DCOM- 20150512 LR - 20140829 IS - 1557-9832 (Electronic) IS - 0272-2712 (Linking) VI - 34 IP - 3 DP - 2014 Sep TI - Management of anticoagulation agents in trauma patients. PG - 563-74 LID - S0272-2712(14)00057-2 [pii] LID - 10.1016/j.cll.2014.06.013 [doi] AB - A lack of consensus on anticoagulant reversal during acute trauma is compounded by an aging population and the expanding spectrum of new anticoagulation agents. Developments in laboratory assays and transfusion medicine, including thromboelastography, recombinant factors, and factor concentrates, have revolutionized care for anticoagulated trauma patients. Accordingly, clinicians must be fully aware of drug mechanisms, assays to determine drug activity, and appropriate reversal strategies for patients on anticoagulants. Drugs include vitamin K antagonists, direct thrombin inhibitors, direct factor Xa inhibitors, low molecular weight heparin, and antiplatelet agents. This article discusses the appropriate assessment and management of trauma patients receiving these agents. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - McCoy, C Cameron AU - McCoy CC AD - Department of Surgery, Duke University Medical Center, Duke University, Box 3443, Room 3581, White Zone, Duke South, Durham, NC 27710, USA. Electronic address: Christopher.mccoy@dm.duke.edu. FAU - Lawson, Jeffrey H AU - Lawson JH AD - Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Duke University, Box 2622, Room 481 MSRB 1 Research Drive, Durham, NC 27710, USA. FAU - Shapiro, Mark L AU - Shapiro ML AD - Division of Trauma & Critical Care, Department of Surgery, Duke University Medical Center, Duke University, 1557 F Duke South, Blue Zone Box 2837, Durham, NC 27710, USA. LA - eng PT - Journal Article PT - Review DEP - 20140719 PL - United States TA - Clin Lab Med JT - Clinics in laboratory medicine JID - 8100174 RN - 0 (Anticoagulants) SB - IM MH - Administration, Oral MH - Animals MH - Anticoagulants/administration & dosage/*adverse effects MH - Drug Monitoring MH - Emergency Treatment MH - Hemorrhage/*chemically induced/etiology MH - Humans MH - Wounds and Injuries/*physiopathology OTO - NOTNLM OT - Anticoagulation OT - Hemorrhage OT - Hemostasis OT - Thromboelastography OT - Trauma EDAT- 2014/08/30 06:00 MHDA- 2015/05/13 06:00 CRDT- 2014/08/30 06:00 PHST- 2014/08/30 06:00 [entrez] PHST- 2014/08/30 06:00 [pubmed] PHST- 2015/05/13 06:00 [medline] AID - S0272-2712(14)00057-2 [pii] AID - 10.1016/j.cll.2014.06.013 [doi] PST - ppublish SO - Clin Lab Med. 2014 Sep;34(3):563-74. doi: 10.1016/j.cll.2014.06.013. Epub 2014 Jul 19. PMID- 25156858 OWN - NLM STAT- MEDLINE DCOM- 20150720 LR - 20220309 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 176 IP - 3 DP - 2014 Oct 20 TI - Monitoring of dabigatran anticoagulation and its reversal in vitro by thrombelastography. PG - 794-9 LID - S0167-5273(14)01294-7 [pii] LID - 10.1016/j.ijcard.2014.07.084 [doi] AB - BACKGROUND: Dabigatran etexilate, a pro-drug of a direct thrombin inhibitor, was approved a few years ago for non-valvular atrial fibrillation and deep venous thrombosis. Rapid monitoring of the dabigatran level is essential in trauma and bleeding patients but the traditional plasma-based assays may not sufficiently display the effect. Furthermore, no antidote exists and reversal of the anticoagulant effect is impossible or difficult. The present study investigated the in vitro effect of dabigatran on whole blood thromboelastography (TEG) and its reversal by recombinant activated factor VII and prothrombin complex concentrate. METHODS: Blood was collected from 10 healthy donors and spiked in vitro with therapeutic doses of dabigatran to a plasma concentration of 200 ng/ml, followed by therapeutic doses of recombinant activated factor VII (corresponding to 100 mug/kg) and prothrombin complex concentrate (corresponding to 50 IE/kg) and evaluated by TEG. RESULTS: Compared to baseline, dabigatran changed all TEG parameters in a hypocoagulable direction corresponding to increased R time and time to maximum rate of thrombus generation, reduced angle, A5, A10, maximum amplitude and maximum rate of thrombin formation. Recombinant activated factor VII had a procoagulant effect on the majority of the investigated TEG parameters when added to dabigatran spiked samples. Prothrombin complex concentrate appeared not to have a procoagulant effect on TEG even when the heparin content in the formulation was neutralized by heparinase. CONCLUSIONS: TEG displays the presence of dabigatran in whole blood in vitro and the anticoagulant effect of dabigatran is partly reversed by spiking with recombinant activated factor VII. CI - Copyright (c) 2014 Elsevier Ireland Ltd. All rights reserved. FAU - Solbeck, Sacha AU - Solbeck S AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Electronic address: sacha@solbeck.dk. FAU - Meyer, Martin A S AU - Meyer MA AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. FAU - Meyer, Anna Sina P AU - Meyer AS AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. FAU - Cotton, Bryan A AU - Cotton BA AD - The Center for Translational Injury Research (CeTIR), University of Texas Health Science Center, Houston, TX, United States; The Department of Surgery, University of Texas Health Science Center, Houston, TX, United States. FAU - Stensballe, Jakob AU - Stensballe J AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. FAU - Schott, Ulf AU - Schott U AD - Skane University Hospital, Lund, Skane, Sweden. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140804 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 RN - 0 (Anticoagulants) RN - 0 (Benzimidazoles) RN - 11P2JDE17B (beta-Alanine) RN - I0VM4M70GC (Dabigatran) SB - IM CIN - Blood Transfus. 2016 Sep;14(5):481-6. doi: 10.2450/2016.0205-15. PMID: 27177413 MH - Adult MH - Aged MH - Anticoagulants/*blood/*pharmacology MH - Benzimidazoles/*blood/*pharmacology MH - Blood Coagulation/drug effects/physiology MH - Dabigatran MH - Drug Monitoring/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Thrombelastography/*methods MH - Young Adult MH - beta-Alanine/*analogs & derivatives/blood/pharmacology OTO - NOTNLM OT - Activated recombinant factor VII OT - Anticoagulation OT - Atrial fibrillation OT - Dabigatran OT - Prothrombin complex concentrate OT - Thromboelastography EDAT- 2014/08/27 06:00 MHDA- 2015/07/21 06:00 CRDT- 2014/08/27 06:00 PHST- 2013/11/13 00:00 [received] PHST- 2014/06/26 00:00 [revised] PHST- 2014/07/26 00:00 [accepted] PHST- 2014/08/27 06:00 [entrez] PHST- 2014/08/27 06:00 [pubmed] PHST- 2015/07/21 06:00 [medline] AID - S0167-5273(14)01294-7 [pii] AID - 10.1016/j.ijcard.2014.07.084 [doi] PST - ppublish SO - Int J Cardiol. 2014 Oct 20;176(3):794-9. doi: 10.1016/j.ijcard.2014.07.084. Epub 2014 Aug 4. PMID- 25127903 OWN - NLM STAT- MEDLINE DCOM- 20160125 LR - 20211021 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 22 IP - 1 DP - 2015 Feb TI - Thromboelastography defines late hypercoagulability after TBI: a pilot study. PG - 45-51 LID - 10.1007/s12028-014-0051-3 [doi] AB - INTRODUCTION: Traumatic brain injury (TBI) is associated with a hypercoagulable state, the mechanism and duration of which remain unclear. We sought to determine whether thromboelastography (TEG) analysis could identify the hypercoagulable state after TBI, as defined by elevations in maximal amplitude (MA), thrombus generation (TG), G value (G), and alpha angle (alphaA). METHODS: Patients with moderate-severe TBI, defined primarily as a GCS <12, admitted between 1/2012 and 8/2013 were eligible for enrolment in this prospective cohort study. TEG profiles were obtained between 0-24 h (T1), 24-48 h (T2), 48-72 h (T3), 72-96 h (T4), and 96-120 h (T5) after admission. Early TEG was defined as 0-48 h, and late TEG was defined as >48 h. RESULTS: Twenty five patients (80 % men) and 7 age- and sex-matched control subjects were studied. Median age was 38 years (range 18-85). Early MA was [63.6 mm (60.5, 67.4)] versus late MA [69.9 mm (65.2,73.9); p = 0.02], early TG was [763.3 mm/min (712.8, 816.2)] versus late TG [835.9 mm/min (791.2,888.3); p = 0.02], and early G was [8.8 d/cm(2) (7.7,10.4)] versus late G [11.6 d/cm(2) (9.4,14.1); p = 0.02]. Study patients had higher MA (p = 0.02), TG (p = 0.03), and G (p = 0.02) values at T5 compared to controls. There was a linear increase per day of MA by 2.6 mm (p = 0.001), TG 31.9 mm/min (p 10 mg/dL). These patients were primarily male (87% vs. 79%), were bluntly injured (77% vs. 59%), and had lower median Glasgow Coma Scale (GCS) score (9.5 vs. 14, all p < 0.05) than the EtOH-negative patients. There were no notable differences in pH (7.29 vs. 7.31, p = nonsignificant) or injury severity (median Injury Severity Score [ISS], 11 vs. 14; p = nonsignificant) between the groups. The alcohol-positive patients had a prolonged TEG citrated kaolin R-time (reaction time), or time to initial clot formation (5.91 minutes vs. 4.43 minutes, p = 0.013), prolonged K-time (kinetics time), or time to fixed level of clot strength (1.77 minutes vs. 1.43 minutes, p = 0.036), and decreased alpha angle (66.5 degrees vs. 70.2 degrees, p = 0.001). In multiple linear regression, for every 10-mg/dL increase in EtOH, R-time was prolonged by 3.84 seconds (p = 0.015), and alpha angle decreased by 0.11 degrees (p = 0.013). However, in multiple logistic regression analyses, EtOH was a negative predictor of coagulopathy by international normalized ratio (>1.3) and was not predictive of transfusion requirements or early or late mortality. CONCLUSION: Patients with elevated EtOH present with impaired clot formation as assayed by TEG, but this does not correlate with standard measures of coagulopathy or with outcome. Reliance on TEG for determining coagulopathy in intoxicated trauma patients may lead to a misperceived hypocoagulable state and inappropriate transfusion. TEG appears to be affected by EtOH in a previously unreported way, warranting further investigation. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III. FAU - Howard, Benjamin M AU - Howard BM AD - From the Department of Surgery, San Francisco General Hospital and the University of California, San Francisco, San Francisco, California. FAU - Kornblith, Lucy Z AU - Kornblith LZ FAU - Redick, Brittney J AU - Redick BJ FAU - Vilardi, Ryan F AU - Vilardi RF FAU - Balhotra, Kimen S AU - Balhotra KS FAU - Crane, Jeremy M AU - Crane JM FAU - Forde, Melissa R AU - Forde MR FAU - Nelson, Mary F AU - Nelson MF FAU - Callcut, Rachael A AU - Callcut RA FAU - Cohen, Mitchell Jay AU - Cohen MJ LA - eng GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - GM-085689/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 3K9958V90M (Ethanol) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/*drug effects MH - Ethanol/blood/*pharmacology MH - Female MH - Glasgow Coma Scale MH - Humans MH - Male MH - Middle Aged MH - Thrombelastography/*drug effects MH - Wounds and Injuries/*blood MH - Young Adult EDAT- 2014/08/08 06:00 MHDA- 2015/02/07 06:00 CRDT- 2014/08/08 06:00 PHST- 2014/08/08 06:00 [entrez] PHST- 2014/08/08 06:00 [pubmed] PHST- 2015/02/07 06:00 [medline] AID - 10.1097/TA.0000000000000357 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Dec;77(6):865-71; discussion 871-2. doi: 10.1097/TA.0000000000000357. PMID- 25092093 OWN - NLM STAT- MEDLINE DCOM- 20150511 LR - 20140805 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 49 IP - 8 DP - 2014 Aug TI - Trauma induced hypercoagulablity in pediatric patients. PG - 1295-9 LID - S0022-3468(13)00911-1 [pii] LID - 10.1016/j.jpedsurg.2013.11.050 [doi] AB - PURPOSE: Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response. METHODS: A prospective observational study was conducted in hospitalized patients (age 8months to 14years) admitted for trauma or elective surgery. Informed consent was obtained from the parents and informed assent was obtained in patients 7years of age or older. Coagulation changes were evaluated on fresh whole blood using thromboelastography (TEG) and on stored plasma using assays for special clotting factors. RESULTS: Forty three patients (22 trauma, median injury severity score =9; and 21 uninjured controls) were evaluated. For trauma vs control, prothrombin time (PT) was higher by about 10% (p<0.001), but activated partial thromboplastin time was not altered. TEG clotting time (R;p=0.005) and fibrin cross-linking were markedly accelerated (K time, alpha angle; p<0.001) relative to the control patients. d-Dimer, Prothrombin Fragment 1+2, and Plasminogen Activator Inhibitor-1 were all elevated, whereas Protein S activity was reduced (all p<0.01). Importantly, a large fraction of TEG values and clotting factor assays in the pediatric control group were outside the published reference ranges for adults. CONCLUSION: A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Ryan, Mark L AU - Ryan ML AD - Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Van Haren, Robert M AU - Van Haren RM AD - Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Thorson, Chad M AU - Thorson CM AD - Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Andrews, David M AU - Andrews DM AD - Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Perez, Eduardo A AU - Perez EA AD - Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Neville, Holly L AU - Neville HL AD - Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Sola, Juan E AU - Sola JE AD - Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. FAU - Proctor, Kenneth G AU - Proctor KG AD - Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA. Electronic address: kproctor@miami.edu. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20131116 PL - United States TA - J Pediatr Surg JT - Journal of pediatric surgery JID - 0052631 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - Female MH - Florida/epidemiology MH - Follow-Up Studies MH - Humans MH - Incidence MH - Infant MH - Male MH - Prospective Studies MH - Prothrombin Time MH - Thrombelastography MH - Thrombophilia/blood/epidemiology/*etiology MH - Wounds and Injuries/*complications OTO - NOTNLM OT - Coagulation OT - Pediatric OT - Thromboelastography OT - Trauma EDAT- 2014/08/06 06:00 MHDA- 2015/05/12 06:00 CRDT- 2014/08/06 06:00 PHST- 2013/08/30 00:00 [received] PHST- 2013/10/13 00:00 [revised] PHST- 2013/11/07 00:00 [accepted] PHST- 2014/08/06 06:00 [entrez] PHST- 2014/08/06 06:00 [pubmed] PHST- 2015/05/12 06:00 [medline] AID - S0022-3468(13)00911-1 [pii] AID - 10.1016/j.jpedsurg.2013.11.050 [doi] PST - ppublish SO - J Pediatr Surg. 2014 Aug;49(8):1295-9. doi: 10.1016/j.jpedsurg.2013.11.050. Epub 2013 Nov 16. PMID- 25086657 OWN - NLM STAT- MEDLINE DCOM- 20160509 LR - 20240610 IS - 1879-2472 (Electronic) IS - 0049-3848 (Print) IS - 0049-3848 (Linking) VI - 134 IP - 3 DP - 2014 Sep TI - Cellular microparticle and thrombogram phenotypes in the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study: correlation with coagulopathy. PG - 652-8 LID - S0049-3848(14)00400-9 [pii] LID - 10.1016/j.thromres.2014.07.023 [doi] AB - BACKGROUND: Trauma-induced coagulopathy following severe injury is associated with increased bleeding and mortality. Injury may result in alteration of cellular phenotypes and release of cell-derived microparticles (MP). Circulating MPs are procoagulant and support thrombin generation (TG) and clotting. We evaluated MP and TG phenotypes in severely injured patients at admission, in relation to coagulopathy and bleeding. METHODS: As part of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, research blood samples were obtained from 180 trauma patients requiring transfusions at 5 participating centers. Twenty five healthy controls and 40 minimally injured patients were analyzed for comparisons. Laboratory criteria for coagulopathy was activated partial thromboplastin time (APTT) >/= 35 sec. Samples were analyzed by Calibrated Automated Thrombogram to assess TG, and by flow cytometry for MP phenotypes [platelet (PMP), erythrocyte (RMP), leukocyte (LMP), endothelial (EMP), tissue factor (TFMP), and Annexin V positive (AVMP)]. RESULTS: 21.7% of patients were coagulopathic with the median (IQR) APTT of 44 sec (37, 53), and an Injury Severity Score of 26 (17, 35). Compared to controls, patients had elevated EMP, RMP, LMP, and TFMP (all p<0.001), and enhanced TG (p<0.0001). However, coagulopathic PROMMTT patients had significantly lower PMP, TFMP, and TG, higher substantial bleeding, and higher mortality compared to non-coagulopathic patients (all p<0.001). CONCLUSIONS: Cellular activation and enhanced TG are predominant after trauma and independent of injury severity. Coagulopathy was associated with lower thrombin peak and rate compared to non-coagulopathic patients, while lower levels of TF-bearing PMPs were associated with substantial bleeding. CI - Copyright (c) 2014 Elsevier Ltd. All rights reserved. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Nena.Matijevic@uth.tmc.edu. FAU - Wang, Yao-Wei W AU - Wang YW AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Yao-Wei.W.Wang@uth.tmc.edu. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Charles.E.Wade@uth.tmc.edu. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: John.Holcomb@uth.tmc.edu. FAU - Cotton, Bryan A AU - Cotton BA AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Bryan.A.Cotton@uth.tmc.edu. FAU - Schreiber, Martin A AU - Schreiber MA AD - Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Rd SW, Mail Code L-611, Portland, OR 97035, USA. Electronic address: schreibm@ohsu.edu. FAU - Muskat, Peter AU - Muskat P AD - Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 222 Piedmont Ave., Suite 7000, Cincinnati, OH 45219, USA. Electronic address: muskatp@ucmail.uc.edu. FAU - Fox, Erin E AU - Fox EE AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Erin.E.Fox@uth.tmc.edu. FAU - Del Junco, Deborah J AU - Del Junco DJ AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Deborah.J.deljunco@uth.tmc.edu. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Jessica.C.Cardenas@uth.tmc.edu. FAU - Rahbar, Mohammad H AU - Rahbar MH AD - Division of Clinical and Translational Sciences, Department of Internal Medicine, Medical School, Biostatistics/Epidemiology/Research Design Core,Center for Clinical and Translational Sciences and Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1100 Fannin St. UPB 1100.21, Houston, TX 77030, USA. Electronic address: Mohammad.H.Rahbar@uth.tmc.edu. FAU - Cohen, Mitchell Jay AU - Cohen MJ AD - Division of General Surgery, Department of Surgery, School of Medicine, University of California San Francisco, 1001 Potrero Ave. Room 3C-38, San Francisco, CA 94110, USA. Electronic address: mcohen@sfghsurg.ucsf.edu. CN - PROMMTT Study Group LA - eng GR - T32 GM008792/GM/NIGMS NIH HHS/United States GR - UL1 RR024148/RR/NCRR NIH HHS/United States GR - UL1 TR000371/TR/NCATS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20140722 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 RN - 0 (Biomarkers) RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Biomarkers/blood MH - *Blood Coagulation MH - Blood Coagulation Disorders/blood/diagnosis/*etiology/mortality/therapy MH - Blood Transfusion MH - Cell-Derived Microparticles/*metabolism MH - Female MH - Hemorrhage/blood/diagnosis/*etiology/mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Phenotype MH - Predictive Value of Tests MH - Prospective Studies MH - Risk Factors MH - Thrombelastography MH - Thrombin/*metabolism MH - Thromboplastin/metabolism MH - United States MH - Wounds and Injuries/*complications/diagnosis/mortality MH - Young Adult PMC - PMC4160305 MID - NIHMS616158 OTO - NOTNLM OT - Blood coagulation OT - Cell-derived microparticles OT - Hemorrhage OT - Thrombin OT - Trauma COIS- Conflict of Interest Disclosures: The authors have no conflicts of interest to declare. EDAT- 2014/08/05 06:00 MHDA- 2016/05/10 06:00 PMCR- 2015/09/01 CRDT- 2014/08/04 06:00 PHST- 2014/05/09 00:00 [received] PHST- 2014/06/26 00:00 [revised] PHST- 2014/07/08 00:00 [accepted] PHST- 2014/08/04 06:00 [entrez] PHST- 2014/08/05 06:00 [pubmed] PHST- 2016/05/10 06:00 [medline] PHST- 2015/09/01 00:00 [pmc-release] AID - S0049-3848(14)00400-9 [pii] AID - 10.1016/j.thromres.2014.07.023 [doi] PST - ppublish SO - Thromb Res. 2014 Sep;134(3):652-8. doi: 10.1016/j.thromres.2014.07.023. Epub 2014 Jul 22. PMID- 25082123 OWN - NLM STAT- MEDLINE DCOM- 20151028 LR - 20161020 IS - 1024-2708 (Print) IS - 1024-2708 (Linking) VI - 21 IP - 1 DP - 2015 Feb TI - Use of viscoelastic haemostatic assay in emergency and elective surgery. PG - 45-51 LID - 10.12809/hkmj134147 [doi] AB - OBJECTIVES: To review the current evidence for the use of viscoelastic haemostatic assays in different surgical settings including trauma, cardiac surgery, liver transplantation, as well as the monitoring of antiplatelet agents and anticoagulants prior to surgery. DATA SOURCES: PubMed database. STUDY SELECTION: Key words for the literature search were "thromboelastography" or "ROTEM" in combination with "trauma", "antiplatelet", "cardiac surgery", "liver transplantation" or "anticoagulants". DATA EXTRACTION: Original and major review articles related to the use of viscoelastic haemostatic assays. DATA SYNTHESIS: Haemostatic function is a critical factor determining patient outcomes in emergency or elective surgery. The increasing use of antiplatelet agents and anticoagulants has potentially increased the risks of haemorrhages and the need for transfusion. Conventional coagulation tests have limitations in detecting haemostatic dysfunctions in subgroups of patients and are largely ineffective in diagnosing hyperfibrinolysis. The viscoelastic haemostatic assays are potentially useful point-of-care tools that provide information on clot formation, clot strength, and fibrinolysis, as well as to guide goal-directed transfusion and antifibrinolytic therapy. They may also be used to monitor antiplatelet and anticoagulant therapy. However, standardisation of techniques and reference ranges is required before these tests can be widely used in different clinical settings. CONCLUSIONS: Viscoelastic haemostatic assays, as compared with conventional coagulation tests, are better for detecting coagulopathy and are the only tests that can provide rapid diagnosis of hyperfibrinolysis. Goal-directed administration of blood products based on the results of viscoelastic haemostatic assays was associated with reduction in allogeneic blood product transfusions in trauma, cardiac surgery, and liver transplantation cases. However, there is currently no evidence to support the routine use of viscoelastic haemostatic assays for monitoring platelet function prior to surgery. FAU - Yeung, Maximus C F AU - Yeung MC AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. FAU - Tong, Steven Y T AU - Tong SY AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. FAU - Tong, Paul Y W AU - Tong PY AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. FAU - Cheung, Billy H H AU - Cheung BH AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. FAU - Ng, Joanne Y W AU - Ng JY AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. FAU - Leung, Gilberto K K AU - Leung GK AD - Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. LA - eng PT - Journal Article PT - Review DEP - 20140801 PL - China TA - Hong Kong Med J JT - Hong Kong medical journal = Xianggang yi xue za zhi JID - 9512509 RN - 0 (Anticoagulants) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Viscoelastic Substances) SB - IM MH - Anticoagulants/blood MH - Elective Surgical Procedures MH - Hemorrhagic Disorders/diagnosis MH - Hemostasis, Surgical/*methods MH - Humans MH - Platelet Aggregation Inhibitors/blood MH - Preoperative Care/methods MH - Surgical Procedures, Operative/*methods MH - Thrombelastography/*methods MH - *Viscoelastic Substances OTO - NOTNLM OT - Anticoagulants OT - Liver transplantation OT - Thoracic surgery OT - Thrombelastography OT - Wounds and injuries EDAT- 2014/08/02 06:00 MHDA- 2015/10/29 06:00 CRDT- 2014/08/02 06:00 PHST- 2014/08/02 06:00 [entrez] PHST- 2014/08/02 06:00 [pubmed] PHST- 2015/10/29 06:00 [medline] AID - 10.12809/hkmj134147 [doi] PST - ppublish SO - Hong Kong Med J. 2015 Feb;21(1):45-51. doi: 10.12809/hkmj134147. Epub 2014 Aug 1. PMID- 25072794 OWN - NLM STAT- MEDLINE DCOM- 20150812 LR - 20211021 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 43 IP - 1 DP - 2015 Jan TI - Hemolysis exacerbates hyperfibrinolysis, whereas platelolysis shuts down fibrinolysis: evolving concepts of the spectrum of fibrinolysis in response to severe injury. PG - 39-46 LID - 10.1097/SHK.0000000000000245 [doi] AB - INTRODUCTION: We have recently identified a spectrum of fibrinolysis in response to injury, in which there is increased mortality in patients who have either excessive fibrinolysis (hyperfibrinolysis [HF]) or impaired fibrinolysis (shutdown). The regulation of the fibrinolytic system after trauma remains poorly understood. Our group's previous proteomic and metabolomic work identified elevated red blood cell (RBC) degradation products in trauma patients manifesting HF. We therefore hypothesized that hemolysis was contributory to the pathogenesis of HF. Given the central role of platelets in the cell-based model of coagulation, we further investigated the potential role of platelet lysis in mediation of the fibrinolytic system. METHODS: Red blood cells from healthy donors were frozen in liquid nitrogen and vortexed to create mechanical membrane disruption. Platelets were prepared in a similar fashion. Assays were performed with citrated whole blood mixed ex vivo with either RBC or platelet lysates. Tissue plasminogen activator (tPA) was then added to promote fibrinolysis, mimicking the tPA release from ischemic endothelium during hemorrhagic shock. The degree of fibrinolysis was evaluated with thromboelastography. To identify the mediators of the fibrinolysis system present in RBC and platelet lysates, these lysates were passed over immobilized tPA and plasminogen affinity columns to capture protein-binding partners from RBC or platelet lysates. RESULTS: The addition of 75 ng/mL of tPA to whole blood increased fibrinolysis from median 30-min lysis of 1.4% (interquartile range [IQR], 0.9%-2.0%) to 8.9% (IQR, 6.5%-11.5%). Red blood cell lysate with tPA increased fibrinolysis to 20.1% (IQR, 12.5%-33.7%), which was nearly three times as much lysis as tPA alone (P < 0.001). Conversely, the addition of platelet lysate decreased tPA-mediated fibrinolysis to 0.35% (IQR, 0.2%-0.8%; P < 0.001). Affinity chromatography coupled with tandem mass spectrometry identified a number of proteins not previously associated with regulation of fibrinolysis and trauma. CONCLUSION: Red blood cell lysate is a potent enhancer of fibrinolysis, whereas platelet lysate inhibits fibrinolysis. Intracellular proteins from circulating blood cells contain proteins that interact with the two key proteins of tPA-mediated fibrinolysis. Understanding the effect of tissue injury and shock on the lysis of circulating cells may provide insight to comprehending the spectrum of fibrinolysis in response to trauma. FAU - Moore, Hunter B AU - Moore HB AD - *University of Colorado, Aurora, Colorado, daggerDenver Health Medical Center, Denver, Colorado; and double daggerBonfils Blood Center, Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Hansen, Kirk C AU - Hansen KC FAU - Dzieciatkowska, Monika AU - Dzieciatkowska M FAU - Chapman, Michael P AU - Chapman MP FAU - Sauaia, Angela AU - Sauaia A FAU - West, Bernadette AU - West B FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50-GM0492221/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Aged MH - Blood Platelets/*metabolism/pathology MH - Erythrocytes/*metabolism/pathology MH - *Fibrinolysis MH - *Hemolysis MH - Humans MH - Male MH - Middle Aged MH - Tissue Plasminogen Activator/*blood MH - Wounds and Injuries/*blood/mortality/pathology PMC - PMC4373619 MID - NIHMS670284 COIS- The authors have no conflicts of interest. EDAT- 2014/07/30 06:00 MHDA- 2015/08/13 06:00 PMCR- 2015/03/25 CRDT- 2014/07/30 06:00 PHST- 2014/07/30 06:00 [entrez] PHST- 2014/07/30 06:00 [pubmed] PHST- 2015/08/13 06:00 [medline] PHST- 2015/03/25 00:00 [pmc-release] AID - 10.1097/SHK.0000000000000245 [doi] PST - ppublish SO - Shock. 2015 Jan;43(1):39-46. doi: 10.1097/SHK.0000000000000245. PMID- 25058249 OWN - NLM STAT- MEDLINE DCOM- 20140926 LR - 20140725 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 77 IP - 2 DP - 2014 Aug TI - Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients? PG - 243-50 LID - 10.1097/TA.0000000000000307 [doi] AB - BACKGROUND: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants. We test the hypothesis that TBI associated with polytrauma results in a higher rate of VTE than polytrauma without TBI. METHODS: From August 2011 to June 2013, a prospective observational trial with informed consent was performed in 148 intensive care unit (ICU) patients with a Greenfield Risk Assessment Profile score of 10 or greater. RESULTS: Demographics, Greenfield Risk Assessment Profile scores, the incidence of polytrauma, and mortality were similar, but TBI patients had worse Injury Severity Scores (ISS) (32 vs. 22), longer ICU lengths of stay (21 days vs. 12 days), more hypercoagulable thromboelastogram values on admission (94% vs. 79%), more received unfractionated heparin prophylaxis (65% vs. 36%), and the prophylaxis start date was more than a day later (all p < 0.05). Nevertheless, the VTE rate with TBI was similar to that without TBI (25% vs. 26%, p = 0.507). Furthermore, VTE occurred at similar time points after ICU admission with and without TBI. In both groups, about 30% of the VTEs were detected within 2 days of ICU admission and 50% of the VTEs occurred within 10 days of admission despite chemical and mechanical thromboprophylaxis. CONCLUSION: In complex polytrauma patients who survived to ICU admission and who were prescreened for high VTE risk, TBI did not further increase the risk for VTE. The most likely explanation is that no single risk factor is necessary or sufficient for VTE development, especially in those who routinely receive chemical and mechanical thromboprophylaxis. LEVEL OF EVIDENCE: Epidemiologic study, level III. FAU - Valle, Evan J AU - Valle EJ AD - From the Dewitt-Daughtry Family Department of Surgery, Divisions of Trauma and Surgical Critical Care, and Department of Neurosurgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida. FAU - Van Haren, Robert M AU - Van Haren RM FAU - Allen, Casey J AU - Allen CJ FAU - Jouria, Jassin M AU - Jouria JM FAU - Bullock, M Ross AU - Bullock MR FAU - Schulman, Carl I AU - Schulman CI FAU - Namias, Nicholas AU - Namias N FAU - Livingstone, Alan S AU - Livingstone AS FAU - Proctor, Kenneth G AU - Proctor KG LA - eng PT - Journal Article PT - Observational Study PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 9005-49-6 (Heparin) SB - IM MH - Blood Coagulation Tests MH - Brain Injuries/*complications MH - Female MH - Heparin/therapeutic use MH - Humans MH - Injury Severity Score MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Multiple Trauma/*complications MH - Prospective Studies MH - Risk Factors MH - Venous Thromboembolism/*etiology/prevention & control EDAT- 2014/07/25 06:00 MHDA- 2014/09/27 06:00 CRDT- 2014/07/25 06:00 PHST- 2014/07/25 06:00 [entrez] PHST- 2014/07/25 06:00 [pubmed] PHST- 2014/09/27 06:00 [medline] AID - 01586154-201408000-00010 [pii] AID - 10.1097/TA.0000000000000307 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Aug;77(2):243-50. doi: 10.1097/TA.0000000000000307. PMID- 25052157 OWN - NLM STAT- MEDLINE DCOM- 20160125 LR - 20220318 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 22 IP - 1 DP - 2015 Feb TI - Traumatic brain injury associated coagulopathy. PG - 34-44 LID - 10.1007/s12028-014-0026-4 [doi] AB - BACKGROUND: The presence of coagulopathy is common after severe trauma. The aim of this study was to identify whether isolated severe traumatic brain injury (TBI) is an independent risk factor for coagulopathy. METHODS: Prospective observational cohort of adult patients admitted to a Level I Trauma Center within 6 h of injury. Patients were categorized according to the abbreviated injury scale (AIS): Group 1-isolated severe TBI (AIS head >/= 3 + AIS non-head < 3); Group 2-severe multisystem trauma associated with severe TBI (AIS head >/= 3 + AIS non-head >/= 3); Group 3-severe multisystem trauma without TBI (AIS head < 3 + AIS non-head >/= 3). Primary outcome was the development of coagulopathy. Secondary outcome was in-hospital mortality. RESULTS: Three hundred and forty five patients were included (Group 1 = 48 patients, Group 2 = 137, and Group 3 = 160). Group 1 patients had the lowest incidence of coagulopathy and disseminated intravascular coagulopathy, and in general presented with better coagulation profile measured by either classic coagulation tests, thromboelastography or clotting factors. Isolated severe TBI was not an independent risk factor for the development of coagulopathy (OR 1.06; 0.35-3.22 CI, p = 0.92), however, isolated severe TBI patients who developed coagulopathy had higher mortality rates than isolated severe TBI patients without coagulopathy (66 vs. 16.6 %, p < 0.05). The presence of coagulopathy (OR 5.61; 2.65-11.86 CI, p < 0.0001) and isolated severe TBI (OR 11.51; 3.9-34.2 CI, p < 0.0001) were independent risk factors for in-hospital mortality. CONCLUSION: Isolated severe TBI is not an independent risk factor for the development of coagulopathy. However, severe TBI patients who develop coagulopathy have extremely high mortality rates. FAU - de Oliveira Manoel, Airton Leonardo AU - de Oliveira Manoel AL AD - Trauma & Neurosurgical Intensive Care Unit, St. Michael's Hospital-University of Toronto, 30 Bond Street Donnelly Wing, Room 3-074B, Toronto, ON, M4N 3M5, Canada, airtonleo.manoel@gmail.com. FAU - Neto, Antonio Capone AU - Neto AC FAU - Veigas, Precilla V AU - Veigas PV FAU - Rizoli, Sandro AU - Rizoli S LA - eng GR - Canadian Institutes of Health Research/Canada PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Adolescent MH - Adult MH - Blood Coagulation Disorders/diagnosis/*epidemiology/mortality MH - Brain Injuries/*epidemiology/mortality MH - Comorbidity MH - Female MH - Humans MH - Male MH - Middle Aged MH - Risk Factors MH - Severity of Illness Index MH - Young Adult EDAT- 2014/07/24 06:00 MHDA- 2016/01/26 06:00 CRDT- 2014/07/24 06:00 PHST- 2014/07/24 06:00 [entrez] PHST- 2014/07/24 06:00 [pubmed] PHST- 2016/01/26 06:00 [medline] AID - 10.1007/s12028-014-0026-4 [doi] PST - ppublish SO - Neurocrit Care. 2015 Feb;22(1):34-44. doi: 10.1007/s12028-014-0026-4. PMID- 25051384 OWN - NLM STAT- MEDLINE DCOM- 20150206 LR - 20220330 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 77 IP - 6 DP - 2014 Dec TI - Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. PG - 811-7; discussion 817 LID - 10.1097/TA.0000000000000341 [doi] AB - BACKGROUND: Fibrinolysis is a physiologic process maintaining patency of the microvasculature. Maladaptive overactivation of this essential function (hyperfibrinolysis) is proposed as a pathologic mechanism of trauma-induced coagulopathy. Conversely, the shutdown of fibrinolysis has also been observed as a pathologic phenomenon. We hypothesize that there is a level of fibrinolysis between these two extremes that have a survival benefit for the severely injured patients. METHODS: Thrombelastography and clinical data were prospectively collected on trauma patients admitted to our Level I trauma center from 2010 to 2013. Patients with an Injury Severity Score (ISS) of 15 or greater were evaluated. The percentage of fibrinolysis at 30 minutes by thrombelastography was used to stratify three groups as follows: hyperfibrinolysis (>/=3%), physiologic (0.081-2.9%), and shutdown (0-0.08%). The threshold for hyperfibrinolysis was based on existing literature. The remaining groups were established on a cutoff of 0.8%, determined by the highest point of specificity and sensitivity for mortality on a receiver operating characteristic curve. RESULTS: One hundred eighty patients were included in the study. The median age was 42 years (interquartile range [IQR], 28-55 years), 70% were male, and 21% had penetrating injuries. The median ISS was 29 (IQR, 22-36), and the median base deficit was 9 mEq/L (IQR, 6-13 mEq/L). Distribution of fibrinolysis was as follows: shutdown, 64% (115 of 180); physiologic, 18% (32 of 180); and hyperfibrinolysis, 18% (33 of 180). Mortality rates were lower for the physiologic group (3%) compared with the hyperfibrinolysis (44%) and shutdown (17%) groups (p = 0.001). CONCLUSION: We have identified a U-shaped distribution of death related to the fibrinolysis system in response to major trauma, with a nadir in mortality, with level of fibrinolysis after 30 minutes between 0.81% and 2.9%. Exogenous inhibition of the fibrinolysis system in severely injured patients requires careful selection, as it may have an adverse affect on survival. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Moore, Hunter B AU - Moore HB AD - From the Departments of Surgery (H.B.M., E.E.M., E.G., M.P.C., T.L.C., A.B., A.S.) and Pediatrics (C.C.S.), University of Colorado Denver; Department of Surgery (E.E.M.), Denver Health Medical Center; and Bonfils Blood Center (C.C.S.), Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Chapman, Michael P AU - Chapman MP FAU - Chin, Theresa L AU - Chin TL FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - UM1HL120877/HL/NHLBI NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - P50-GM0492221/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography MH - Wounds and Injuries/mortality/pathology/*physiopathology PMC - PMC4370273 MID - NIHMS670283 EDAT- 2014/07/23 06:00 MHDA- 2015/02/07 06:00 PMCR- 2015/03/23 CRDT- 2014/07/23 06:00 PHST- 2014/07/23 06:00 [entrez] PHST- 2014/07/23 06:00 [pubmed] PHST- 2015/02/07 06:00 [medline] PHST- 2015/03/23 00:00 [pmc-release] AID - 10.1097/TA.0000000000000341 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Dec;77(6):811-7; discussion 817. doi: 10.1097/TA.0000000000000341. PMID- 24979715 OWN - NLM STAT- MEDLINE DCOM- 20150330 LR - 20220409 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) VI - 20 IP - 4 DP - 2014 Aug TI - Optimal fluid resuscitation in trauma: type, timing, and total. PG - 366-72 LID - 10.1097/MCC.0000000000000104 [doi] AB - PURPOSE OF REVIEW: This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. RECENT FINDINGS: In the prehospital arena, intravenous fluids have been associated with worse patient outcomes due to increased coagulopathy and time to definitive care. Once in the trauma bay, damage control resuscitation principles apply to the severely injured patient. Large volume crystalloid infusion increases mortality. The best patient outcomes have been found with transfusion of blood products in a ratio that closely mimics whole blood. Thrombelastography is a useful adjunct in resuscitation and can help guide the judicious use of blood products. New technology can help providers ascertain when a patient is appropriately resuscitated by determining adequate global and regional perfusion. SUMMARY: During the resuscitation of the acutely injured patient, crystalloids should be limited in favor of blood components. Damage control principles apply until definitive hemostasis is obtained, at which point the focus should change to targeted resuscitation using traditional global endpoints of resuscitation in conjunction with determinants of regional perfusion. FAU - Feinman, Marcie AU - Feinman M AD - aDepartment of Surgery, Johns Hopkins Medicine, Baltimore, Maryland bDepartment of Surgery and The Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas, USA. FAU - Cotton, Bryan A AU - Cotton BA FAU - Haut, Elliott R AU - Haut ER LA - eng GR - U01HL077863-07/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 RN - 0 (Crystalloid Solutions) RN - 0 (Isotonic Solutions) SB - IM MH - Crystalloid Solutions MH - *Fluid Therapy MH - Humans MH - Infusions, Intravenous MH - Intensive Care Units MH - Isotonic Solutions/adverse effects/therapeutic use MH - Length of Stay MH - *Platelet Transfusion MH - *Resuscitation MH - Thrombelastography MH - Wounds and Injuries/mortality/*therapy EDAT- 2014/07/01 06:00 MHDA- 2015/03/31 06:00 CRDT- 2014/07/01 06:00 PHST- 2014/07/01 06:00 [entrez] PHST- 2014/07/01 06:00 [pubmed] PHST- 2015/03/31 06:00 [medline] AID - 10.1097/MCC.0000000000000104 [doi] PST - ppublish SO - Curr Opin Crit Care. 2014 Aug;20(4):366-72. doi: 10.1097/MCC.0000000000000104. PMID- 24977757 OWN - NLM STAT- MEDLINE DCOM- 20140905 LR - 20140701 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 77 IP - 1 DP - 2014 Jul TI - Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions. PG - 67-72; discussion 72 LID - 10.1097/TA.0000000000000255 [doi] AB - BACKGROUND: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury has been associated with coagulopathy out of proportion to other body regions. We hypothesized that injury severity and shock determine coagulopathy independent of body region injured. METHODS: We performed a prospective, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 3 for each body region. Patients were grouped according to their dominant AIS region of injury. Dominant region of injury was defined as the single region with the highest AIS score. Patients with two or more regions with the same greatest AIS score and patients without a region with an AIS score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6. RESULTS: Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59%), were male (75%), experienced blunt trauma (71%), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions. CONCLUSION: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy. LEVEL OF EVIDENCE: Epidemiologic study, level III. FAU - Lee, Tim H AU - Lee TH AD - From the Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon. FAU - Hampton, David A AU - Hampton DA FAU - Diggs, Brian S AU - Diggs BS FAU - McCully, Sean P AU - McCully SP FAU - Kutcher, Matt AU - Kutcher M FAU - Redick, Britt J AU - Redick BJ FAU - Podbielski, Jeannette AU - Podbielski J FAU - Cotton, Bryan A AU - Cotton BA FAU - Cohen, Mitchell AU - Cohen M FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - *Abbreviated Injury Scale MH - Blood Coagulation Disorders/epidemiology/*etiology MH - Blood Coagulation Tests MH - Brain Injuries/*complications MH - Female MH - Glasgow Coma Scale MH - Humans MH - Injury Severity Score MH - Male MH - Multiple Trauma MH - Prospective Studies MH - Risk Factors MH - Shock/complications MH - Thrombelastography EDAT- 2014/07/01 06:00 MHDA- 2014/09/06 06:00 CRDT- 2014/07/01 06:00 PHST- 2014/07/01 06:00 [entrez] PHST- 2014/07/01 06:00 [pubmed] PHST- 2014/09/06 06:00 [medline] AID - 01586154-201407000-00011 [pii] AID - 10.1097/TA.0000000000000255 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Jul;77(1):67-72; discussion 72. doi: 10.1097/TA.0000000000000255. PMID- 24962188 OWN - NLM STAT- MEDLINE DCOM- 20141121 LR - 20211021 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 156 IP - 3 DP - 2014 Sep TI - A principal component analysis of postinjury viscoelastic assays: clotting factor depletion versus fibrinolysis. PG - 570-7 LID - S0039-6060(14)00200-1 [pii] LID - 10.1016/j.surg.2014.04.030 [doi] AB - INTRODUCTION: The mechanisms driving trauma-induced coagulopathy (TIC) remain to be defined, and its therapy demands an orchestrated replacement of specific blood products. Thrombelastography (TEG) is a tool to guide the TIC multicomponent therapy. Principal component analysis (PCA) is a statistical approach that identifies variable clusters; thus, we hypothesize that PCA can identify specific combinations of TEG-generated values that reflect TIC mechanisms. METHODS: Adult trauma patients admitted from September 2010 to October 2013 for whom a massive transfusion protocol was activated were included. Rapid TEG values obtained within the first 6 hours after injury were included in the PCA. PCA components with an eigenvalue >1 were retained, and, within components, variable loadings (equivalent to correlation coefficients) >|60| were considered significant. Component scorings for each patient were calculated and clinical characteristics of patients with high and low scores were compared. RESULTS: Of 98 enrolled patients, 67% were male and 70% suffered blunt trauma. Median age was 41 years (interquartile range 28-55) and median Injury Severity Score was 31.5 (interquartile range 24-43). PCA identified three principal components (PCs) that together explained 93% of the overall variance. PC1 reflected global coagulopathy with depletion of platelets and fibrinogen whereas PC3 indicated hyperfibrinolysis. PC2 may represent endogenous anticoagulants such as the activation of protein C. CONCLUSION: PCA suggests depletion coagulopathy is independent from fibrinolytic coagulopathy. Furthermore, the distribution of mortality suggests that low levels of fibrinolysis may be beneficial in a select group of injured patients. These data underscore the potential of risk for concurrent presumptive treatment for preserved depletion coagulopathy and possible fibrinolysis. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Chin, Theresa L AU - Chin TL AD - University of Colorado Denver, Denver, CO. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado Denver, Denver, CO; Denver Health Medical Center, Denver, CO. Electronic address: ernest.moore@dhha.org. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado Denver, Denver, CO. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - University of Colorado Denver, Denver, CO. FAU - Chapman, Michael P AU - Chapman MP AD - University of Colorado Denver, Denver, CO. FAU - Stringham, John R AU - Stringham JR AD - University of Colorado Denver, Denver, CO. FAU - Ramos, Christopher R AU - Ramos CR AD - University of Colorado Denver, Denver, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - University of Colorado Denver, Denver, CO. FAU - Sauaia, Angela AU - Sauaia A AD - University of Colorado Denver, Denver, CO. LA - eng GR - UM1HL120877/HL/NHLBI NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20140621 PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Blood Coagulation Factors) SB - IM MH - Adult MH - Blood Coagulation Disorders/*blood/*etiology/therapy MH - Blood Coagulation Factors/*metabolism MH - Blood Component Transfusion MH - Female MH - *Fibrinolysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Principal Component Analysis MH - Resuscitation MH - Thrombelastography/*methods/statistics & numerical data MH - Wounds and Injuries/*blood/*complications PMC - PMC4150833 MID - NIHMS588739 EDAT- 2014/06/26 06:00 MHDA- 2014/12/15 06:00 PMCR- 2015/09/01 CRDT- 2014/06/26 06:00 PHST- 2014/01/29 00:00 [received] PHST- 2014/04/15 00:00 [accepted] PHST- 2014/06/26 06:00 [entrez] PHST- 2014/06/26 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] PHST- 2015/09/01 00:00 [pmc-release] AID - S0039-6060(14)00200-1 [pii] AID - 10.1016/j.surg.2014.04.030 [doi] PST - ppublish SO - Surgery. 2014 Sep;156(3):570-7. doi: 10.1016/j.surg.2014.04.030. Epub 2014 Jun 21. PMID- 24957146 OWN - NLM STAT- MEDLINE DCOM- 20150427 LR - 20211021 IS - 1528-0020 (Electronic) IS - 0006-4971 (Print) IS - 0006-4971 (Linking) VI - 124 IP - 7 DP - 2014 Aug 14 TI - The endothelial protein C receptor enhances hemostasis of FVIIa administration in hemophilic mice in vivo. PG - 1157-65 LID - 10.1182/blood-2014-04-567297 [doi] AB - Recombinant activated human factor VII (rhFVIIa) is an established hemostatic agent in hemophilia, but its mechanism of action remains unclear. Although tissue factor (TF) is its natural receptor, rhFVIIa also interacts with the endothelial protein C receptor (EPCR) through its gamma-carboxyglutamic acid (Gla) domain, with unknown hemostatic consequences in vivo. Here, we study whether EPCR facilitates rhFVIIa hemostasis in hemophilia using a mouse model system. Mouse activated FVII (mFVIIa) is functionally homologous to rhFVIIa, but binds poorly to mouse EPCR (mEPCR). We modified mFVIIa to gain mEPCR binding using 3 amino acid changes in its Gla domain (L4F/L8M/W9R). The resulting molecule mFVIIa-FMR specifically bound mEPCR in vitro and in vivo and was identical to mFVIIa with respect to TF affinity and procoagulant functions. In macrovascular injury models, hemophilic mice administered mFVIIa-FMR exhibited superior hemostatic activity compared with mFVIIa. This was abolished by blocking mEPCR and was absent in ex vivo whole blood coagulation assays, implicating a specific mFVIIa-FMR and endothelial mEPCR interaction. Because mFVIIa-FMR models the TF-dependent and EPCR binding properties of rhFVIIa, our data unmask a novel contribution of EPCR on the action of rhFVIIa administration in hemophilia, prompting the rational design of improved and safer rhFVIIa therapeutics. CI - (c) 2014 by The American Society of Hematology. FAU - Pavani, Giulia AU - Pavani G AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; and. FAU - Ivanciu, Lacramioara AU - Ivanciu L AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; and. FAU - Faella, Armida AU - Faella A AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; and. FAU - Marcos-Contreras, Oscar A AU - Marcos-Contreras OA AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; and. FAU - Margaritis, Paris AU - Margaritis P AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; and The University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140623 PL - United States TA - Blood JT - Blood JID - 7603509 RN - 0 (Amino Acids) RN - 0 (Blood Coagulation Factors) RN - 0 (Receptors, Cell Surface) RN - 0 (Recombinant Proteins) RN - 0 (activated protein C receptor) RN - 53445-96-8 (1-Carboxyglutamic Acid) RN - 9035-58-9 (Thromboplastin) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - 1-Carboxyglutamic Acid/metabolism MH - Amino Acids/genetics/metabolism MH - Animals MH - Binding Sites/genetics MH - Binding, Competitive MH - Blood Coagulation/drug effects MH - Blood Coagulation Factors/genetics/*metabolism MH - CHO Cells MH - Cricetinae MH - Cricetulus MH - Factor VIIa/administration & dosage/genetics/*pharmacology MH - Hemophilia A/blood/*drug therapy MH - Hemostasis/*drug effects MH - Humans MH - Kinetics MH - Male MH - Mice, Inbred C57BL MH - Protein Binding MH - Receptors, Cell Surface/genetics/*metabolism MH - Recombinant Proteins/administration & dosage/genetics/pharmacology MH - Thrombelastography MH - Thromboplastin/metabolism PMC - PMC4133488 EDAT- 2014/06/25 06:00 MHDA- 2015/04/29 06:00 PMCR- 2014/08/14 CRDT- 2014/06/25 06:00 PHST- 2014/06/25 06:00 [entrez] PHST- 2014/06/25 06:00 [pubmed] PHST- 2015/04/29 06:00 [medline] PHST- 2014/08/14 00:00 [pmc-release] AID - S0006-4971(20)39846-3 [pii] AID - 2014/567297 [pii] AID - 10.1182/blood-2014-04-567297 [doi] PST - ppublish SO - Blood. 2014 Aug 14;124(7):1157-65. doi: 10.1182/blood-2014-04-567297. Epub 2014 Jun 23. PMID- 24953269 OWN - NLM STAT- MEDLINE DCOM- 20140926 LR - 20140714 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 156 IP - 2 DP - 2014 Aug TI - Hypercoagulability after injury in premenopausal females: a prospective, multicenter study. PG - 439-47 LID - S0039-6060(14)00188-3 [pii] LID - 10.1016/j.surg.2014.04.018 [doi] AB - BACKGROUND: Recent studies suggest there are gender-specific differences in injury response that may be related to coagulation. The objective of this study was to test the hypothesis that rapid thrombelastography (rTEG) coagulation profiles differ by gender. METHODS: Adult trauma patients were prospectively followed at 3 level 1 trauma centers over a 14-month period. rTEG was obtained upon arrival and serially at several time points during the hospital stay. Female patients were stratified into premenopausal (50 years) age groups with age-matched male cohorts. Values were analyzed using a repeated-measures multilevel linear model to evaluate the effect of gender on coagulation. RESULTS: A total of 795 patients had serial rTEG data (24% female and 76% male). Compared with age-matched males, premenopausal females were more hypercoagulable by rTEG on admission (P < .001) and for the first 12 hours after arrival. Gender was an effect modifier for alpha angle (P = .02) and maximum amplitude (P = .04). Controlling for Injury Severity Score and mechanism of injury, age-matched males had a >4-fold increased risk of hypercoagulable complications than premenopausal females (odds ratio, 4.7; P = .038). CONCLUSION: This prospective, multicenter study demonstrates that premenopausal females are relatively hypercoagulable compared with age-matched males early after injury. However, this did not translate into higher thromboembolic complications. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Pommerening, Matthew J AU - Pommerening MJ AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Schwartz, Diane A AU - Schwartz DA AD - Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MA. FAU - Cohen, Mitchell J AU - Cohen MJ AD - The University of California, San Francisco, CA. FAU - Schreiber, Martin A AU - Schreiber MA AD - Oregon Health & Science University, Portland, OR. FAU - del Junco, Deborah J AU - del Junco DJ AD - The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Camp, Elizabeth A AU - Camp EA AD - The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Wade, Charles E AU - Wade CE AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Holcomb, John B AU - Holcomb JB AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center, Houston, TX; The Center for Translational Injury Research, The University of Texas Health Science Center, Houston, TX. Electronic address: bryan.a.cotton@uth.tmc.edu. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20140619 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Female MH - Humans MH - Injury Severity Score MH - Linear Models MH - Male MH - Middle Aged MH - Premenopause/*blood MH - Prospective Studies MH - Sex Characteristics MH - Thrombelastography MH - Thrombophilia/*blood/*etiology MH - Time Factors MH - Trauma Centers MH - Wounds and Injuries/*blood/*complications MH - Wounds, Nonpenetrating/blood/complications EDAT- 2014/06/24 06:00 MHDA- 2014/09/27 06:00 CRDT- 2014/06/24 06:00 PHST- 2014/01/05 00:00 [received] PHST- 2014/04/14 00:00 [accepted] PHST- 2014/06/24 06:00 [entrez] PHST- 2014/06/24 06:00 [pubmed] PHST- 2014/09/27 06:00 [medline] AID - S0039-6060(14)00188-3 [pii] AID - 10.1016/j.surg.2014.04.018 [doi] PST - ppublish SO - Surgery. 2014 Aug;156(2):439-47. doi: 10.1016/j.surg.2014.04.018. Epub 2014 Jun 19. PMID- 24921658 OWN - NLM STAT- MEDLINE DCOM- 20150129 LR - 20220318 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 9 IP - 6 DP - 2014 TI - Comparative response of platelet fV and plasma fV to activated protein C and relevance to a model of acute traumatic coagulopathy. PG - e99181 LID - 10.1371/journal.pone.0099181 [doi] LID - e99181 AB - BACKGROUND: Acute traumatic coagulopathy (ATC) has been linked to an increase in activated protein C (aPC) from 40 pM in healthy individuals to 175 pM. aPC exerts its activity primarily through cleavage of active coagulation factor Va (fVa). Platelets reportedly possess fVa which is more resistant to aPC cleavage than plasma fVa; this work examines the hypothesis that normal platelets are sufficient to maintain coagulation in the presence of elevated aPC. METHODS: Coagulation responses of normal plasma, fV deficient plasma (fVdp), and isolated normal platelets in fVdp were conducted: prothrombin (PT) tests, turbidimetry, and thromboelastography (TEG), including the dose response of aPC on the samples. RESULTS: PT and turbidimetric assays demonstrate that normal plasma is resistant to aPC at doses much higher than those found in ATC. Additionally, an average physiological number of washed normal platelets (200,000 platelets/mm3) was sufficient to eliminate the anti-coagulant effects of aPC up to 10 nM, nearly two orders of magnitude above the ATC concentration and even the steady-state pharmacological concentration of human recombinant aPC, as measured by TEG. aPC also demonstrated no significant effect on clot lysis in normal plasma samples with or without platelets. CONCLUSIONS: Although platelet fVa shows slightly superior resistance to aPC's effects compared to plasma fVa in static models, neither fVa is sufficiently cleaved in simulations of ATC or pharmacologically-delivered aPC to diminish coagulation parameters. aPC is likely a correlative indicator of ATC or may play a cooperative role with other activity altering products generated in ATC. FAU - Campbell, James E AU - Campbell JE AD - United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America. FAU - Meledeo, Michael Adam AU - Meledeo MA AD - United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America. FAU - Cap, Andrew P AU - Cap AP AD - United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20140612 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Anticoagulants) RN - 0 (Antigens, CD) RN - 0 (Endothelial Protein C Receptor) RN - 0 (PROCR protein, human) RN - 0 (Phospholipids) RN - 0 (Protein C) RN - 0 (Receptors, Cell Surface) RN - 65522-14-7 (Factor Va) RN - 9001-24-5 (Factor V) RN - 9001-27-8 (Factor VIII) RN - 9001-31-4 (Fibrin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Acute Disease MH - Anticoagulants/pharmacology MH - Antigens, CD/metabolism MH - Blood Coagulation Disorders/*blood MH - Blood Platelets/*metabolism MH - Endothelial Protein C Receptor MH - Factor V/*metabolism MH - Factor VIII/metabolism MH - Factor Va/metabolism MH - Fibrin/metabolism MH - Fibrinolysis/drug effects MH - Humans MH - International Normalized Ratio MH - *Models, Biological MH - Nephelometry and Turbidimetry MH - Phospholipids/metabolism MH - Protein C/*metabolism MH - Proteolysis/drug effects MH - Prothrombin Time MH - Receptors, Cell Surface/metabolism MH - Solubility MH - Thrombelastography MH - Tissue Plasminogen Activator/metabolism PMC - PMC4055642 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2014/06/13 06:00 MHDA- 2015/01/30 06:00 PMCR- 2014/06/12 CRDT- 2014/06/13 06:00 PHST- 2014/02/21 00:00 [received] PHST- 2014/05/12 00:00 [accepted] PHST- 2014/06/13 06:00 [entrez] PHST- 2014/06/13 06:00 [pubmed] PHST- 2015/01/30 06:00 [medline] PHST- 2014/06/12 00:00 [pmc-release] AID - PONE-D-14-08289 [pii] AID - 10.1371/journal.pone.0099181 [doi] PST - epublish SO - PLoS One. 2014 Jun 12;9(6):e99181. doi: 10.1371/journal.pone.0099181. eCollection 2014. PMID- 24889805 OWN - NLM STAT- MEDLINE DCOM- 20150212 LR - 20140603 IS - 1365-3148 (Electronic) IS - 0958-7578 (Linking) VI - 24 IP - 3 DP - 2014 Jun TI - State of the art: massive transfusion. PG - 138-44 LID - 10.1111/tme.12125 [doi] AB - The aim of this article was to review recent developments in the resuscitation of both trauma and non-trauma patients in haemorrhagic shock. Strategies for the resuscitation of massively haemorrhaging patients and the use of massive transfusion protocols (MTPs) have been a major focus of the trauma literature over the past several years. The application of haemostatic resuscitation practices and MTPs to non-trauma populations has long been in practice, but has only recently been the subject of active research. Medline and PubMed were reviewed for 'massive transfusion' (MT) from 2012 to present. Non-English and paediatric articles were excluded. Articles were systematically reviewed for their relevance to MT. There were eight major areas of development identified. In recent MT literature, there was an increased focus on massively haemorrhaging non-trauma patients, the role of acute traumatic coagulopathy, the use of thromboelastography (TEG), and the impact of MTPs on blood product waste and efficiency of product delivery. Other developments included additional MT prediction tools and The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. There was also interest in re-evaluating the clinical relevance of the current MT definition and identifying new foci for MT. These recent developments reflect efforts to better understand and manage non-traumatic haemorrhage and to address prior limitations in the trauma literature. Inevitably, new questions have been raised, which will likely direct ongoing and future research in MT. CI - (c) 2014 The Authors. Transfusion Medicine (c) 2014 British Blood Transfusion Society. FAU - McDaniel, L M AU - McDaniel LM AD - University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. FAU - Etchill, E W AU - Etchill EW FAU - Raval, J S AU - Raval JS FAU - Neal, M D AU - Neal MD LA - eng PT - Journal Article PT - Review PL - England TA - Transfus Med JT - Transfusion medicine (Oxford, England) JID - 9301182 SB - IM MH - Blood Transfusion/*methods/*trends MH - Humans MH - MEDLINE MH - Shock, Hemorrhagic/*therapy MH - Wounds and Injuries/*therapy OTO - NOTNLM OT - haemorrhage OT - massive transfusion OT - massive transfusion protocol OT - non-trauma OT - resuscitation OT - trauma EDAT- 2014/06/04 06:00 MHDA- 2015/02/13 06:00 CRDT- 2014/06/04 06:00 PHST- 2014/01/20 00:00 [received] PHST- 2014/03/17 00:00 [revised] PHST- 2014/04/25 00:00 [accepted] PHST- 2014/06/04 06:00 [entrez] PHST- 2014/06/04 06:00 [pubmed] PHST- 2015/02/13 06:00 [medline] AID - 10.1111/tme.12125 [doi] PST - ppublish SO - Transfus Med. 2014 Jun;24(3):138-44. doi: 10.1111/tme.12125. PMID- 24882760 OWN - NLM STAT- MEDLINE DCOM- 20141121 LR - 20240611 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 156 IP - 3 DP - 2014 Sep TI - Activated clotting time of thrombelastography (T-ACT) predicts early postinjury blood component transfusion beyond plasma. PG - 564-9 LID - S0039-6060(14)00187-1 [pii] LID - 10.1016/j.surg.2014.04.017 [doi] AB - INTRODUCTION: Rapid thrombelastography (rTEG) has been advocated as a point-of-care test to manage trauma-induced coagulopathy. rTEG activated clotting time (T-ACT) results become available much sooner than other rTEG values, thus offering an attractive tool to guide blood component transfusion in a hemorrhagic shock. We hypothesize that patients with a prolonged T-ACT require replacement of platelets (Plts) and cryoprecipitate (Cryo) in addition to plasma to correct trauma-induced coagulopathy. METHODS: A prospective trauma registry was reviewed for patients with an r-TEG available within 3 hours of injury. Blood was collected via a standardized protocol for rTEG. Patients were stratified into quartiles: low (T-ACT <113 seconds), mild (T-ACT 113-120 seconds), moderate (T-ACT 121-140 seconds), and severe (T-ACT >140 seconds). Transfusion requirements were evaluated during the first 6 hours after injury. RESULTS: A total of 114 patients were included. Median age was 39 years, injury severity score 20, base-deficit 10, and mortality rate 13%. T-ACT cohorts had similar age (P = .11), injury severity score (P = .55), and base deficit (P = .38). An T-ACT >140 seconds predicted a lower angle (median 57 vs 70, P < .000) and maximum amplitude (46 vs 60, P = .002), and patients received more Cryo (0.5 vs 0, P 140 seconds are polycoagulopathic and may benefit from early Cryo and Plts. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Moore, Hunter B AU - Moore HB AD - University of Colorado, Aurora, CO. Electronic address: hunter.moore@ucdenver.edu. FAU - Moore, Ernest E AU - Moore EE AD - University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO. FAU - Chin, Theresa L AU - Chin TL AD - University of Colorado, Aurora, CO. FAU - Gonzalez, Eduardo AU - Gonzalez E AD - University of Colorado, Aurora, CO. FAU - Chapman, Michael P AU - Chapman MP AD - University of Colorado, Aurora, CO. FAU - Walker, Carson B AU - Walker CB AD - University of Colorado, Aurora, CO. FAU - Sauaia, Angela AU - Sauaia A AD - University of Colorado, Aurora, CO. FAU - Banerjee, Anirban AU - Banerjee A AD - University of Colorado, Aurora, CO. LA - eng GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - 1UM 1HL120877/HL/NHLBI NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - P50-GM049222/GM/NIGMS NIH HHS/United States GR - UM1 HL120877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20140602 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Blood Coagulation Disorders/*blood/etiology/*therapy MH - Blood Component Transfusion/*methods MH - Female MH - Humans MH - Male MH - Plasma MH - Platelet Transfusion MH - Point-of-Care Systems MH - Prospective Studies MH - Resuscitation MH - Thrombelastography/*methods MH - Time Factors MH - Wounds and Injuries/complications PMC - PMC4150844 MID - NIHMS618115 EDAT- 2014/06/03 06:00 MHDA- 2014/12/15 06:00 PMCR- 2014/09/02 CRDT- 2014/06/03 06:00 PHST- 2014/01/07 00:00 [received] PHST- 2014/04/14 00:00 [accepted] PHST- 2014/06/03 06:00 [entrez] PHST- 2014/06/03 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] PHST- 2014/09/02 00:00 [pmc-release] AID - S0039-6060(14)00187-1 [pii] AID - 10.1016/j.surg.2014.04.017 [doi] PST - ppublish SO - Surgery. 2014 Sep;156(3):564-9. doi: 10.1016/j.surg.2014.04.017. Epub 2014 Jun 2. PMID- 24866407 OWN - NLM STAT- MEDLINE DCOM- 20141124 LR - 20140924 IS - 1528-1175 (Electronic) IS - 0003-3022 (Linking) VI - 121 IP - 4 DP - 2014 Oct TI - Fibrinogen concentrate does not suppress endogenous fibrinogen synthesis in a 24-hour porcine trauma model. PG - 753-64 LID - 10.1097/ALN.0000000000000315 [doi] AB - BACKGROUND: Fibrinogen concentrate may reduce blood loss after trauma. However, its effect on endogenous fibrinogen synthesis is unknown. The authors investigated the effect of exogenous human fibrinogen on endogenous fibrinogen metabolism in a 24-h porcine trauma model. METHODS: Coagulopathy was induced in 20 German Landrace pigs by hemodilution and blunt liver injury. Animals were randomized to receive fibrinogen concentrate (100 mg/kg; infusion beginning 20 min postinjury and lasting approximately 10 min) or saline. Fibrinogen concentration, thromboelastometry, and quantitative reverse transcriptase polymerase chain reaction of fibrinogen genes in liver tissue samples were recorded. Internal organs were examined histologically for emboli. RESULTS: Coagulation parameters were impaired and plasma fibrinogen concentrations were reduced before starting infusion of fibrinogen concentrate/saline. Twenty minutes after starting infusion, exogenous fibrinogen supplementation had increased plasma fibrinogen concentration versus controls (171 +/- 19 vs. 63 +/- 10 mg/dl [mean +/- SD for Multifibren U]; 185 +/- 30 vs. 41 +/- 4 mg/dl [Thrombin reagent]; P < 0.05 for both comparisons). The between-group difference in plasma fibrinogen concentration diminished thereafter, with maximum concentrations in both groups observed at approximately 24 h, that is, during the acute-phase reaction after trauma. Fibrinogen supplementation did not down-regulate endogenous fibrinogen synthesis (no between-group differences in fibrinogen messenger RNA). Total postinjury blood loss was significantly lower in the fibrinogen group (1,062 +/- 216 vs. 1,643 +/- 244 ml; P < 0.001). No signs of thromboembolism were observed. CONCLUSIONS: Administration of human fibrinogen concentrate did not down-regulate endogenous porcine fibrinogen synthesis. The effect on plasma fibrinogen concentration was most pronounced at 20 min but nonsignificant at approximately 24 h. FAU - Zentai, Christian AU - Zentai C AD - From the Department of Anesthesiology (C.Z., J.S., R.R., O.G.), Institute for Laboratory Animal Science (C.Z.), and Department of Pathology (T.B., M.R.), RWTH Aachen University Hospital, Aachen, Germany. FAU - Braunschweig, Till AU - Braunschweig T FAU - Schnabel, Jonas AU - Schnabel J FAU - Rose, Michael AU - Rose M FAU - Rossaint, Rolf AU - Rossaint R FAU - Grottke, Oliver AU - Grottke O LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesthesiology JT - Anesthesiology JID - 1300217 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Animals MH - *Disease Models, Animal MH - Fibrinogen/antagonists & inhibitors/*biosynthesis/*pharmacology MH - Humans MH - Liver/drug effects/*injuries/*metabolism MH - Male MH - Random Allocation MH - Swine MH - Time Factors MH - Wounds, Nonpenetrating/*metabolism EDAT- 2014/05/29 06:00 MHDA- 2014/12/15 06:00 CRDT- 2014/05/29 06:00 PHST- 2014/05/29 06:00 [entrez] PHST- 2014/05/29 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] AID - 10.1097/ALN.0000000000000315 [doi] PST - ppublish SO - Anesthesiology. 2014 Oct;121(4):753-64. doi: 10.1097/ALN.0000000000000315. PMID- 24843206 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20140624 LR - 20211021 IS - 0377-1237 (Print) IS - 0377-1237 (Linking) VI - 70 IP - 2 DP - 2014 Apr TI - The challenge in management of hemorrhagic shock in trauma. PG - 163-9 LID - 10.1016/j.mjafi.2014.03.001 [doi] AB - Transfusion and resuscitation practices in trauma have undergone a sea change over the past decade. New understanding of transfusion physiology and experiences in military trauma over the last decade has identified key factors taken as challenges in trauma. The most important challenge remains acute traumatic coagulopathy (ATC) which sets in early after a trauma and spirals the patient into shock and continued bleeding. World wide trauma is the leading cause of mortality. More than 6 million deaths occur due to trauma out of which 20% are due to uncontrollable bleeding. Out of the hospital admissions in trauma 20% develop coagulopathy. Mortality is three to four times higher in a patient with coagulopathy and thus prevention and correction of coagulopathy is the central goal of the management of hemorrhagic shock in trauma. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy, This article looks at the importance of acute traumatic coagulopathy, its etiology, diagnosis, effects and resuscitation strategies to prevent it and to see the background behind this shift. FAU - Jacob, Mathews AU - Jacob M AD - Associate Professor, Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune 411040, India. FAU - Kumar, Praveen AU - Kumar P AD - Resident, Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune 411040, India. LA - eng PT - Journal Article PT - Review DEP - 20140413 PL - India TA - Med J Armed Forces India JT - Medical journal, Armed Forces India JID - 7602492 PMC - PMC4017195 OTO - NOTNLM OT - Acute traumatic coagulopathy OT - Damage control resuscitation OT - Haemorrhagic shock OT - Hemostatic resuscitation OT - Thromboelastography EDAT- 2014/05/21 06:00 MHDA- 2014/05/21 06:01 PMCR- 2015/04/01 CRDT- 2014/05/21 06:00 PHST- 2013/09/29 00:00 [received] PHST- 2014/03/02 00:00 [accepted] PHST- 2014/05/21 06:00 [entrez] PHST- 2014/05/21 06:00 [pubmed] PHST- 2014/05/21 06:01 [medline] PHST- 2015/04/01 00:00 [pmc-release] AID - S0377-1237(14)00040-9 [pii] AID - 10.1016/j.mjafi.2014.03.001 [doi] PST - ppublish SO - Med J Armed Forces India. 2014 Apr;70(2):163-9. doi: 10.1016/j.mjafi.2014.03.001. Epub 2014 Apr 13. PMID- 24827574 OWN - NLM STAT- MEDLINE DCOM- 20140904 LR - 20211021 IS - 2769-6677 (Electronic) IS - 1559-6109 (Print) IS - 1559-6109 (Linking) VI - 53 IP - 3 DP - 2014 May TI - Blood-banking techniques for plateletpheresis in swine. PG - 307-16 AB - During the past several years, trauma resuscitation in human patients has evolved from decreased use of crystalloids to increased use of blood products. Of high interest is the role of platelets in trauma resuscitation. Because conducting prehos- pital resuscitation in human trauma patients is very difficult, swine are often the animal model of choice for such studies because their coagulation and hemodynamic systems are similar to those in humans. However, consistent production of sufficient swine platelets for such studies has not previously been achieved. We developed a method for producing swine platelets by using standard human techniques and equipment. We assessed pH, pO2, pCO2, lactate, thromboelastography, and platelet aggregation over 5 d of storage to determine whether the swine platelet product met the American Association of Blood Banks (AABB) standards for transfusion. Swine platelets met AABB standards at 24 h but not at later time points. In addition, we fluorescently labeled nonautologous platelets and then measured their percentage recovery over 5 h (the time used in subsequent experimental studies) when transfused into a recipient pig. We showed that 80% of the platelets stored for 24 h remained in the circulation and increased the recipient pigs' thromboelastographic responses, indicating that the platelets were viable and active. Therefore, swine platelets stored for 24 h by using standard human products met the AABB criteria and were functional. FAU - Sondeen, Jill L AU - Sondeen JL AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. jill.l.sondeen.vol@mail.mil. FAU - Prince, Malcolm D AU - Prince MD AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - Polykratis, Irene A AU - Polykratis IA AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - Hernandez, Orlando AU - Hernandez O AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - Torres-Mendoza, Jaime AU - Torres-Mendoza J AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - De Guzman, Rodolfo AU - De Guzman R AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - Aden, James K AU - Aden JK AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. FAU - Dubick, Michael A AU - Dubick MA AD - US Army Institute of Surgical Research, San Antonio, Texas, USA. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Am Assoc Lab Anim Sci JT - Journal of the American Association for Laboratory Animal Science : JAALAS JID - 101269489 SB - IM MH - Animals MH - Blood Banks MH - Blood Coagulation MH - Blood Platelets/*physiology MH - Humans MH - Male MH - Models, Animal MH - Platelet Transfusion MH - *Plateletpheresis MH - *Swine MH - Thrombelastography PMC - PMC4128570 EDAT- 2014/05/16 06:00 MHDA- 2014/09/05 06:00 PMCR- 2014/11/01 CRDT- 2014/05/16 06:00 PHST- 2014/05/16 06:00 [entrez] PHST- 2014/05/16 06:00 [pubmed] PHST- 2014/09/05 06:00 [medline] PHST- 2014/11/01 00:00 [pmc-release] AID - 2014000307 [pii] PST - ppublish SO - J Am Assoc Lab Anim Sci. 2014 May;53(3):307-16. PMID- 24786172 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231120 IS - 1799-7267 (Electronic) IS - 1457-4969 (Print) IS - 1457-4969 (Linking) VI - 103 IP - 2 DP - 2014 Jun TI - Trauma-Induced Coagulopathy: An Institution's 35 Year Perspective on Practice and Research. PG - 89-103 AB - INTRODUCTION: Injury is the second leading cause of death worldwide, and as much as 40% of injury-related mortality is attributed to uncontrollable hemorrhage. This persists despite establishment of regionalized trauma systems and advances in the management of severely injured patients. Trauma-induced coagulopathy has been identified as the most common preventable cause of postinjury mortality. METHODS: A review of the current literature was performed by collecting PUBMED references related to trauma-induced coagulopathy. Data were then critically analyzed and summarized based on the authors' clinical and research perspective, as well as that reported by other institutions and researchers interested in trauma-induced coagulopathy. A particular focus was placed on those aspects of coagulopathy in which agreement among clinical and basic scientists is currently lacking; these include, pathophysiology, the role of blood components and factor therapy, and goal-directed assessment and management. RESULTS: Trauma-induced coagulopathy has been recognized in approximately one-third of trauma patients. There is a vast range of severity, and the emergence of viscoelastic assays, such as thrombelastography and rotational thromboelastogram, has refined its diagnosis and management, particularly through the establishment of goal-directed massive transfusion protocols. Despite advancements in the diagnosis and management of trauma-induced coagulopathy, much remains to be understood regarding its pathophysiology. The cell-based model of hemostasis has allowed for characterization of endothelial dysfunction, impaired thrombin generation, platelet dysfunction, fibrinolysis, endogenous anticoagulants such as protein-C, and antifibrinolytic proteins. These concepts collectively compose the contemporary, but still partial, understanding of trauma-induced coagulopathy. CONCLUSION: Trauma-induced coagulopathy is a complex pathophysiological condition, of which some mechanisms have been characterized, but much remains to be understood in order to translate this knowledge into improved outcomes for the injured patient. CI - (c) The Finnish Surgical Society 2014. FAU - Gonzalez, E AU - Gonzalez E AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Moore, E E AU - Moore EE AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA Department of Surgery, Denver Health Medical Center, Denver, CO, USA Ernest.Moore@dhha.org. FAU - Moore, H B AU - Moore HB AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA Department of Surgery, Denver Health Medical Center, Denver, CO, USA. FAU - Chapman, M P AU - Chapman MP AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA. FAU - Silliman, C C AU - Silliman CC AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA Department of Pediatrics, University of Colorado, Denver, CO, USA Department of Research, Bonfils Blood Center, Denver, CO, USA. FAU - Banerjee, A AU - Banerjee A AD - Trauma Research Center, Department of Surgery, University of Colorado, Denver, CO, USA. LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States PT - Journal Article PT - Review DEP - 20140430 PL - England TA - Scand J Surg JT - Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society JID - 101144297 PMC - PMC4214916 MID - NIHMS616002 OTO - NOTNLM OT - Coagulopathy OT - ROTEM OT - fibrinolysis OT - hemorrhage OT - thrombelastography OT - transfusion OT - trauma COIS- DECLARATION OF CONFLICTING INTERESTS None. EDAT- 2014/05/03 06:00 MHDA- 2014/05/03 06:01 PMCR- 2015/10/30 CRDT- 2014/05/03 06:00 PHST- 2014/05/03 06:00 [entrez] PHST- 2014/05/03 06:00 [pubmed] PHST- 2014/05/03 06:01 [medline] PHST- 2015/10/30 00:00 [pmc-release] AID - 1457496914531927 [pii] AID - 10.1177/1457496914531927 [doi] PST - ppublish SO - Scand J Surg. 2014 Jun;103(2):89-103. doi: 10.1177/1457496914531927. Epub 2014 Apr 30. PMID- 24747445 OWN - NLM STAT- MEDLINE DCOM- 20140610 LR - 20231120 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 76 IP - 5 DP - 2014 May TI - Traumatic brain injury causes platelet adenosine diphosphate and arachidonic acid receptor inhibition independent of hemorrhagic shock in humans and rats. PG - 1169-76 LID - 10.1097/TA.0000000000000216 [doi] AB - BACKGROUND: Coagulopathy in traumatic brain injury (CTBI) is a well-established phenomenon, but its mechanism is poorly understood. Various studies implicate protein C activation related to the global insult of hemorrhagic shock or brain tissue factor release with resultant platelet dysfunction and depletion of coagulation factors. We hypothesized that the platelet dysfunction of CTBI is a distinct phenomenon from the coagulopathy following hemorrhagic shock. METHODS: We used thrombelastography with platelet mapping as a measure of platelet function, assessing the degree of inhibition of the adenosine diphosphate (ADP) and arachidonic acid (AA) receptor pathways. First, we studied the early effect of TBI on platelet inhibition by performing thrombelastography with platelet mapping on rats. We then conducted an analysis of admission blood samples from trauma patients with isolated head injury (n = 70). Patients in shock or on clopidogrel or aspirin were excluded. RESULTS: In rats, ADP receptor inhibition at 15 minutes after injury was 77.6% +/- 6.7% versus 39.0% +/- 5.3% for controls (p < 0.0001). Humans with severe TBI (Glasgow Coma Scale [GCS] score /=16 showed that patients in the goal-directed group had significantly fewer consumption of total blood products than patients in the control group (7[6.1, 47.0]U vs 37.6[14.5, 89.9]U, p = 0.015). No differences were found in mortality at 28d, length of stay in intensive care unit and hospital between the two groups. CONCLUSIONS: Goal-directed transfusion protocol via standard TEG was achievable in patients with abdominal trauma. The novel protocol, compared to conventional transfusion management, has the potential to decrease blood product utilization and prevent exacerbation of coagulation function. FAU - Yin, Jianyi AU - Yin J AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Zhao, Zhenguo AU - Zhao Z AD - Department of General Surgery, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China. FAU - Li, Yousheng AU - Li Y AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Wang, Jian AU - Wang J AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Yao, Danhua AU - Yao D AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Zhang, Shaoyi AU - Zhang S AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Yu, Wenkui AU - Yu W AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Li, Ning AU - Li N AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. FAU - Li, Jieshou AU - Li J AD - Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. LA - eng PT - Journal Article DEP - 20140415 PL - England TA - World J Emerg Surg JT - World journal of emergency surgery : WJES JID - 101266603 PMC - PMC3999505 OTO - NOTNLM OT - Abdominal trauma OT - Thrombelastography OT - Transfusion OT - Trauma-induced coagulopathy EDAT- 2014/04/16 06:00 MHDA- 2014/04/16 06:01 PMCR- 2014/04/15 CRDT- 2014/04/16 06:00 PHST- 2014/01/28 00:00 [received] PHST- 2014/04/10 00:00 [accepted] PHST- 2014/04/16 06:00 [entrez] PHST- 2014/04/16 06:00 [pubmed] PHST- 2014/04/16 06:01 [medline] PHST- 2014/04/15 00:00 [pmc-release] AID - 1749-7922-9-28 [pii] AID - 10.1186/1749-7922-9-28 [doi] PST - epublish SO - World J Emerg Surg. 2014 Apr 15;9:28. doi: 10.1186/1749-7922-9-28. eCollection 2014. PMID- 24695847 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20140403 LR - 20211021 IS - 2090-441X (Print) IS - 2090-4428 (Electronic) IS - 2090-441X (Linking) VI - 2014 DP - 2014 TI - Evaluation of the utility of thromboelastography in a tertiary trauma care centre. PG - 849626 LID - 10.1155/2014/849626 [doi] LID - 849626 AB - Background. Thromboelastography (TEG) unlike conventional coagulation assays evaluates the dynamic interaction of clotting factors and platelets indicating an overall clot quality. Literature assessing the efficacy of TEG in identifying trauma associated bleeding is lacking. Aim. To compare TEG with conventional plasma based coagulation tests and assess whether TEG can serve as a screening test or replace the conventional routine test. Materials. Retrospective data was collected for 150 severe trauma patients. Patients with known evidence of severe comorbidities, which may influence the outcome, were excluded. Detailed evaluation of the patient's clinical and laboratory records was conducted. Diagnostic characteristics such as sensitivity, specificity, and accuracy were calculated. Results. Fifty-one patients were defined as coagulopathic by the conventional coagulation test, 30 by the laboratory established range for TEG indices and 105 by manufactures range. Specificity and sensitivity for the laboratory established range for TEG were 29.4% and 84.8%; for manufactures range sensitivity was 74.5%, specificity was 32.3%. Conclusion. We observed that conventional coagulation assays are the most sensitive tests for diagnosis of coagulopathy due to trauma. However in emergency trauma situations, where immediate corrective measures need to be taken, coagulation parameters and conventional coagulation tests may cause delay. TEG can give highly specific results depicting the underlying coagulopathy. FAU - Subramanian, Arulselvi AU - Subramanian A AD - Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi 110029, India. FAU - Albert, Venencia AU - Albert V AD - Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi 110029, India. FAU - Agrawal, Deepak AU - Agrawal D AD - Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi 110029, India. FAU - Saxena, Renu AU - Saxena R AD - Department of Haematology, AIIMS, New Delhi 110029, India. FAU - Pandey, Ravindra Mohan AU - Pandey RM AD - Department of Biostatistics, AIIMS, New Delhi 110029, India. LA - eng PT - Journal Article DEP - 20140212 PL - Egypt TA - ISRN Hematol JT - ISRN hematology JID - 101567023 PMC - PMC3947774 EDAT- 2014/04/04 06:00 MHDA- 2014/04/04 06:01 PMCR- 2014/02/12 CRDT- 2014/04/04 06:00 PHST- 2013/11/17 00:00 [received] PHST- 2013/12/15 00:00 [accepted] PHST- 2014/04/04 06:00 [entrez] PHST- 2014/04/04 06:00 [pubmed] PHST- 2014/04/04 06:01 [medline] PHST- 2014/02/12 00:00 [pmc-release] AID - 10.1155/2014/849626 [doi] PST - epublish SO - ISRN Hematol. 2014 Feb 12;2014:849626. doi: 10.1155/2014/849626. eCollection 2014. PMID- 24667614 OWN - NLM STAT- MEDLINE DCOM- 20150209 LR - 20140614 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 42 IP - 1 DP - 2014 Jul TI - Establishment of methods for performing thrombelastography and calibrated automated thrombography in rats. PG - 27-30 LID - 10.1097/SHK.0000000000000163 [doi] AB - Rodent models of hemorrhagic shock are paramount to our understanding of the pathophysiology of this disease, the effects on coagulation and in exploring the utility of resuscitative methods for managing patients in shock. These models usually require serial blood sampling during experimentation. The lack of standardized practices for these experimental models has resulted in technical variability, discordance in the literature, and incomparable results on blood coagulation analysis between researchers, hindering substantial progress in the field of hemorrhagic shock. The aim of this study was to define the effects of cardiac puncture versus arterial catheterization on coagulation in a rat model to provide data supporting standardization of one practice over another. Blood was collected from anesthetized rats via cardiac puncture or femoral artery catheterization and hemostatic potential analyzed by thrombelastography and calibrated automated thrombography. Our data show that blood collected via cardiac puncture demonstrated hypercoagulability as indicated by faster rates of clot formation and thrombin generation, increased overall clot strength, and a greater thrombin-generating capacity when compared with blood collected via femoral artery catheter. We conclude that blood collection methods have a profound effect on hemostatic potential, and standardization of these practices is necessary to define the effects of shock on coagulation in rodents. FAU - Huby, Maria del Pilar AU - Huby Mdel P AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas. FAU - Cardenas, Jessica C AU - Cardenas JC FAU - Baer, Lisa A AU - Baer LA FAU - Pawelczyk, Nick S AU - Pawelczyk NS FAU - Salsbury, John R AU - Salsbury JR FAU - Wang, Yao-Wei W AU - Wang YW FAU - Matijevic, Nena AU - Matijevic N FAU - Holcomb, John B AU - Holcomb JB FAU - Wade, Charles E AU - Wade CE LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Animals MH - Blood Coagulation Tests/methods MH - Blood Specimen Collection/*methods/standards MH - Cardiac Catheterization/methods MH - *Disease Models, Animal MH - Femoral Artery MH - Hemostasis/physiology MH - Humans MH - Male MH - Punctures/methods MH - Rats, Sprague-Dawley MH - Reference Values MH - Reproducibility of Results MH - Shock, Hemorrhagic/*blood MH - Thrombelastography/*methods MH - Thrombin/biosynthesis EDAT- 2014/03/29 06:00 MHDA- 2015/02/11 06:00 CRDT- 2014/03/27 06:00 PHST- 2014/03/27 06:00 [entrez] PHST- 2014/03/29 06:00 [pubmed] PHST- 2015/02/11 06:00 [medline] AID - 10.1097/SHK.0000000000000163 [doi] PST - ppublish SO - Shock. 2014 Jul;42(1):27-30. doi: 10.1097/SHK.0000000000000163. PMID- 24662855 OWN - NLM STAT- MEDLINE DCOM- 20140513 LR - 20140325 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 76 IP - 4 DP - 2014 Apr TI - Thromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial. PG - 937-42; discussion 942-3 LID - 10.1097/TA.0000000000000165 [doi] AB - BACKGROUND: The incidence of deep venous thrombosis (DVT) remains high in general surgery and trauma patients despite widespread prophylaxis with enoxaparin. A recent study demonstrated decreased incidence of DVT if patients on enoxaparin had a change in R time (DeltaR) of greater than 1 minute when heparinase-activated thromboelastography (TEG) was compared with normal TEG. We hypothesized that using DeltaR-guided dosing would result in decreased DVT rates. METHODS: A prospective, randomized controlled trial was performed at a Level 1 trauma center. Both trauma and general surgery patients were included. Upon enrollment, demographic data including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were obtained. Enrolled patients were randomized to standard (30 mg twice a day) or TEG-guided dosing. Dose-adjusted patients underwent daily enoxaparin titration to achieve an DeltaR of 1 minute to 2 minutes. Venous thromboembolism screening was performed per institutional protocol. Antithrombin III (AT-III) and anti-Xa levels were drawn at peak enoxaparin concentrations. RESULTS: A total of 87 patients were enrolled. There was no difference in demographic data between the groups. No pulmonary emboli were identified. The control group had a DVT rate of 16%, while the experimental group had a rate of 14% (p = nonsignificant). The experimental group's median enoxaparin dosage, 50 mg twice a day, was significantly higher than that of the control (p < 0.01). TEG DeltaR was not different between the control and experimental groups. Beginning at Day 3, anti-Xa levels were higher in the experimental group (p < 0.05). There was no difference in AT-III activity between the two groups; 67% of the patients demonstrated AT-III deficiency. CONCLUSION: TEG adjusted enoxaparin dosing led to significant increases in anti-Xa activity, which did not correlate with a decreased DVT rate. Failure to reduce the DVT rate and increase DeltaR despite increased dosing and increased anti-Xa activity is consistent with the high rate of AT-III deficiency detected in this study cohort. These data suggest that the future of DVT prevention may not lie in the optimization of low molecular weight heparin therapy but rather in compounds that increase antithrombin directly or operate independently of the AT-III pathway. LEVEL OF EVIDENCE: Therapeutic study, level III. FAU - Louis, Scott G AU - Louis SG AD - From the Department of Surgery, Division of Trauma and Acute Care Surgery, Trauma Research Institute of Oregon (TRIO) (S.G.L., P.Y.V., G.M.R., J.S.B., N.R.K., S.U., J.D., M.S.), Oregon Health and Science University, Portland, Oregon; and Department of Surgery, University of Miami School of Medicine (E.G.), Miami, Florida. FAU - Van, Philbert Y AU - Van PY FAU - Riha, Gordon M AU - Riha GM FAU - Barton, Jeffrey S AU - Barton JS FAU - Kunio, Nicholas R AU - Kunio NR FAU - Underwood, Samantha J AU - Underwood SJ FAU - Differding, Jerome A AU - Differding JA FAU - Rick, Elizabeth AU - Rick E FAU - Ginzburg, Enrique AU - Ginzburg E FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Enoxaparin) RN - 0 (Fibrinolytic Agents) RN - EC 3.4.21.6 (Factor Xa) SB - IM MH - *Blood Coagulation MH - Dose-Response Relationship, Drug MH - Enoxaparin/*administration & dosage MH - Factor Xa/metabolism MH - Female MH - Fibrinolytic Agents/administration & dosage MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Monitoring, Physiologic/*methods MH - Pilot Projects MH - Prospective Studies MH - Thrombelastography/*methods MH - Treatment Outcome MH - Venous Thrombosis/blood/*prevention & control EDAT- 2014/03/26 06:00 MHDA- 2014/05/14 06:00 CRDT- 2014/03/26 06:00 PHST- 2014/03/26 06:00 [entrez] PHST- 2014/03/26 06:00 [pubmed] PHST- 2014/05/14 06:00 [medline] AID - 01586154-201404000-00005 [pii] AID - 10.1097/TA.0000000000000165 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Apr;76(4):937-42; discussion 942-3. doi: 10.1097/TA.0000000000000165. PMID- 24631124 OWN - NLM STAT- MEDLINE DCOM- 20160108 LR - 20161020 IS - 1878-1861 (Electronic) IS - 1878-1861 (Linking) VI - 18 IP - 2 DP - 2015 Mar TI - Relationship between viscosity of the ankle joint complex and functional ankle instability for inversion ankle sprain patients. PG - 128-32 LID - S1440-2440(14)00040-1 [pii] LID - 10.1016/j.jsams.2014.02.009 [doi] AB - OBJECTIVES: Measurement of viscosity of the ankle joint complex is a novel method to assess mechanical ankle instability. In order to further investigate the clinical significance of the method, this study intended to investigate the relationship between ankle viscosity and severity of functional ankle instability. DESIGN: Cross-sectional study. METHODS: 15 participants with unilateral inversion ankle sprain and 15 controls were recruited. Their ankles were further classified into stable and unstable ankles. Ankle viscosity was measured by an instrumental anterior drawer test. Severity of functional ankle instability was measured by the Cumberland Ankle Instability Tool. Unstable ankles were compared with stable ankles. Injured ankles were compared with uninjured ankles of both groups. The spearman's rank correlation coefficient was applied to determine the relationship between ankle viscosity and severity of functional ankle instability in unstable ankles. RESULTS: There was a moderate relationship between ankle viscosity and severity of functional ankle instability (r=-0.64, p<0.0001). Unstable ankles exhibited significantly lower viscosity (p<0.005) and more severe functional ankle instability (p<0.0001) than stable ankles. Injured ankles exhibited significantly lower viscosity and more severe functional ankle instability than uninjured ankles (p<0.0001). CONCLUSIONS: There was a moderate relationship between ankle viscosity and severity of functional ankle instability. This finding suggested that, severity of functional ankle instability may be partially attributed to mechanical insufficiencies such as the degenerative changes in ankle viscosity following the inversion ankle sprain. In clinical application, measurement of ankle viscosity could be a useful tool to evaluate severity of chronic ankle instability. CI - Copyright (c) 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. FAU - Lin, Che-Yu AU - Lin CY AD - Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan. FAU - Kang, Jiunn-Horng AU - Kang JH AD - Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University, Taipei, Taiwan. FAU - Wang, Chung-Li AU - Wang CL AD - Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan. FAU - Shau, Yio-Wha AU - Shau YW AD - Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan; Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan. Electronic address: richardyiowhashau@gmail.com. LA - eng PT - Journal Article DEP - 20140223 PL - Australia TA - J Sci Med Sport JT - Journal of science and medicine in sport JID - 9812598 SB - IM MH - Adult MH - Ankle Injuries/*physiopathology MH - Ankle Joint/*physiopathology MH - Cross-Sectional Studies MH - Female MH - Humans MH - Joint Instability/physiopathology MH - Male MH - Viscosity MH - Young Adult OTO - NOTNLM OT - Anterior drawer test OT - Functional ankle instability OT - Mechanical ankle instability OT - Stress relaxation OT - Viscoelastic properties EDAT- 2014/03/19 06:00 MHDA- 2016/01/09 06:00 CRDT- 2014/03/18 06:00 PHST- 2013/09/14 00:00 [received] PHST- 2014/02/07 00:00 [revised] PHST- 2014/02/12 00:00 [accepted] PHST- 2014/03/18 06:00 [entrez] PHST- 2014/03/19 06:00 [pubmed] PHST- 2016/01/09 06:00 [medline] AID - S1440-2440(14)00040-1 [pii] AID - 10.1016/j.jsams.2014.02.009 [doi] PST - ppublish SO - J Sci Med Sport. 2015 Mar;18(2):128-32. doi: 10.1016/j.jsams.2014.02.009. Epub 2014 Feb 23. PMID- 24630907 OWN - NLM STAT- MEDLINE DCOM- 20140626 LR - 20140923 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 207 IP - 5 DP - 2014 May TI - A predictive model of early mortality in trauma patients. PG - 642-7; discussion 647 LID - S0002-9610(14)00066-X [pii] LID - 10.1016/j.amjsurg.2013.12.009 [doi] AB - BACKGROUND: Rapid thrombelastography (rTEG) is a real-time whole-blood viscoelastic coagulation assay. We hypothesized that admission rTEG and clinical data are independent predictors of trauma-related mortality. METHODS: Prospective observational data (patient demographics, admission vital signs, laboratory studies, and injury characteristics) from trauma patients enrolled within 6 hours of injury were collected. Mann-Whitney U test and analysis of variance test assessed significance (P 1.5, Ly30 >8%, and penetrating injury (P < .05). This 5-variable model's area under the receiver operator characteristic curve was .88. The Hosmer-Lemeshow goodness-of-fit test was .90. CONCLUSIONS: This 5-variable model provides a rapid prediction of 24-hour mortality. The inclusion of rTEG Ly30 demonstrates the association of fibrinolysis with outcome and may support the early use of antifibrinolytic therapies. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Hampton, David A AU - Hampton DA AD - Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Electronic address: hampton@ohsu.edu. FAU - Lee, Tim H AU - Lee TH AD - Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. FAU - Diggs, Brian S AU - Diggs BS AD - Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. FAU - McCully, Sean P AU - McCully SP AD - Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. FAU - Schreiber, Martin A AU - Schreiber MA AD - Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study DEP - 20140131 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM CIN - Am J Surg. 2014 Aug;208(2):316. doi: 10.1016/j.amjsurg.2014.03.002. PMID: 24933667 CIN - Expert Rev Med Devices. 2014 Sep;11(5):435-8. doi: 10.1586/17434440.2014.940313. PMID: 25035047 MH - Adult MH - *Decision Support Techniques MH - Humans MH - Logistic Models MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - ROC Curve MH - Risk Assessment MH - *Thrombelastography MH - Wounds and Injuries/blood/*mortality OTO - NOTNLM OT - Model OT - Mortality OT - Thrombelastography OT - Trauma EDAT- 2014/03/19 06:00 MHDA- 2014/06/27 06:00 CRDT- 2014/03/18 06:00 PHST- 2013/11/02 00:00 [received] PHST- 2013/12/16 00:00 [revised] PHST- 2013/12/16 00:00 [accepted] PHST- 2014/03/18 06:00 [entrez] PHST- 2014/03/19 06:00 [pubmed] PHST- 2014/06/27 06:00 [medline] AID - S0002-9610(14)00066-X [pii] AID - 10.1016/j.amjsurg.2013.12.009 [doi] PST - ppublish SO - Am J Surg. 2014 May;207(5):642-7; discussion 647. doi: 10.1016/j.amjsurg.2013.12.009. Epub 2014 Jan 31. PMID- 24607758 OWN - NLM STAT- MEDLINE DCOM- 20141209 LR - 20140428 IS - 1878-0180 (Electronic) IS - 1878-0180 (Linking) VI - 34 DP - 2014 Jun TI - Viscoelastic shock wave in ballistic gelatin behind soft body armor. PG - 199-207 LID - S1751-6161(14)00043-5 [pii] LID - 10.1016/j.jmbbm.2014.02.011 [doi] AB - Ballistic gelatins are widely used as a surrogate of biological tissue in blunt trauma tests. Non-penetration impact tests of handgun bullets on the 10wt% ballistic gelatin block behind soft armor were carried out in which a high-speed camera recorded the crater׳s movement and pressure sensors imbedded in the gelatin block recorded the pressure waves at different locations. The observed shock wave attenuation indicates the necessity of considering the gelatin׳s viscoelasticity. A three-element viscoelastic constitutive model was adopted, in which the relevant parameters were obtained via fitting the damping free oscillations at the beginning of the creep-mode of rheological measurement, and by examining the data of published split Hopkinson pressure bar (SHPB) experiments. The viscoelastic model is determined by a retardation time of 5.5x10(-5)s for high oscillation frequencies and a stress relaxation time of 2.0-4.5x10(-7)s for shock wave attenuation. Using the characteristic-line method and the spherical wave assumption, the propagation of impact pressure wave front and the subsequent unloading profile can be simulated using the experimental velocity boundary condition. The established viscoelastic model considerably improves the prediction of shock wave attenuation in the ballistic gelatin. CI - Copyright (c) 2014 Elsevier Ltd. All rights reserved. FAU - Liu, Li AU - Liu L AD - State Key Lab of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, P.R. China. FAU - Fan, Yurun AU - Fan Y AD - State Key Lab of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, P.R. China. Electronic address: yurunfan@zju.edu.cn. FAU - Li, Wei AU - Li W AD - State Key Lab of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, P.R. China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140218 PL - Netherlands TA - J Mech Behav Biomed Mater JT - Journal of the mechanical behavior of biomedical materials JID - 101322406 RN - 9000-70-8 (Gelatin) SB - IM MH - Elasticity MH - *Gelatin MH - *Materials Testing MH - *Protective Clothing MH - Viscosity OTO - NOTNLM OT - Ballistic gelatin OT - Blunt impact OT - Spherical wave OT - Viscoelastic wave EDAT- 2014/03/13 06:00 MHDA- 2014/12/15 06:00 CRDT- 2014/03/11 06:00 PHST- 2013/11/12 00:00 [received] PHST- 2014/02/04 00:00 [revised] PHST- 2014/02/05 00:00 [accepted] PHST- 2014/03/11 06:00 [entrez] PHST- 2014/03/13 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] AID - S1751-6161(14)00043-5 [pii] AID - 10.1016/j.jmbbm.2014.02.011 [doi] PST - ppublish SO - J Mech Behav Biomed Mater. 2014 Jun;34:199-207. doi: 10.1016/j.jmbbm.2014.02.011. Epub 2014 Feb 18. PMID- 24602482 OWN - NLM STAT- MEDLINE DCOM- 20140905 LR - 20140712 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 190 IP - 2 DP - 2014 Aug TI - In vitro efficacy of RiaSTAP after rapid reconstitution. PG - 655-61 LID - S0022-4804(14)00101-2 [pii] LID - 10.1016/j.jss.2014.01.055 [doi] AB - BACKGROUND: Fibrinogen is the first coagulation factor to reach critical levels during hemorrhage. Consequently, reestablishing normal fibrinogen levels is necessary to achieve adequate hemostasis. Fibrinogen is supplemented through administration of fresh frozen plasma, cryoprecipitate, or human fibrinogen concentrate, RiaSTAP. RiaSTAP is potentially the most advantageous fibrinogen replacement product because it offers the highest fibrinogen concentration, lowest volume, and most consistent dose. Unfortunately, RiaSTAP is limited by a protocol reconstitution time of 15 min. Conversely, physicians in emergency settings frequently resort to a forceful and rapid reconstitution, which causes foaming and possible protein loss and/or damage. This study aims to address the in vitro effectiveness of protocol-reconstituted RiaSTAP versus rapidly reconstituted RiaSTAP versus cryoprecipitate. METHODS: Three fibrinogen treatments were prepared: protocol-reconstituted RiaSTAP, rapidly reconstituted RiaSTAP, and thawed cryoprecipitate. Each treatment was added in theoretical doses of 0-600 mg/dL to fibrinogen-depleted plasma (normal fibrinogen level is 150-450 mg/dL). Samples were generated in triplicate, and each sample was subjected to rapid thrombelastography and Clauss assays. The rapid thrombelastography assay measures the hemostatic potential of a blood and/or plasma sample. The maximum amplitude (MA) parameter indicates overall clot strength and is a reflection of fibrinogen efficacy. The Clauss assay measures the time to clot formation in response to a known concentration of thrombin, and the amount of functional fibrinogen is then determined from a standard curve. RESULTS: For all fibrinogen treatments, increasing fibrinogen dose resulted in an increase in MA. There was no significant difference in MA between both RiaSTAP reconstitutions (slope of RiaSTAP [protocol], 10.85 mm/[100 mg/dL] and slope of RiaSTAP [rapid], 10.54 mm/[100 mg/dL]). However, both protocol-reconstituted RiaSTAP and rapidly reconstituted RiaSTAP have higher MA values than cryoprecipitate in doses of >/=100 mg/dL. Moreover, each replicate of cryoprecipitate showed a higher variance in fibrinogen efficacy (coefficient of variance [CV] = 44.7%) at a fibrinogen dose of 300 mg/dL. RiaSTAP, however, showed a lower variance in fibrinogen efficacy for both reconstitutions (RiaSTAP [protocol], CV = 3.3% and RiaSTAP [rapid], CV = 2.7%), indicating a consistent fibrinogen dose. CONCLUSIONS: RiaSTAP (either reconstitution method) has greater hemostatic potential and less variability in fibrinogen concentration compared with cryoprecipitate. Rapidly reconstituted RiaSTAP does not compromise hemostatic potential and can be used to potentially facilitate hemostasis in rapidly bleeding patients. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Karri, Jay V AU - Karri JV AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas. FAU - Cardenas, Jessica C AU - Cardenas JC AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas. FAU - Johansson, Par I AU - Johansson PI AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas. FAU - Cotton, Bryan A AU - Cotton BA AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. FAU - Wade, Charles E AU - Wade CE AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: John.Holcomb@uth.tmc.edu. LA - eng PT - Journal Article DEP - 20140206 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Factor VIII MH - Fibrinogen/chemistry/*therapeutic use MH - *Hemostasis MH - *Hemostatic Techniques MH - Humans MH - Solubility OTO - NOTNLM OT - Cryoprecipitate OT - Fibrinogen OT - Resuscitation OT - RiaSTAP OT - Trauma EDAT- 2014/03/08 06:00 MHDA- 2014/09/06 06:00 CRDT- 2014/03/08 06:00 PHST- 2013/12/09 00:00 [received] PHST- 2014/01/22 00:00 [revised] PHST- 2014/01/31 00:00 [accepted] PHST- 2014/03/08 06:00 [entrez] PHST- 2014/03/08 06:00 [pubmed] PHST- 2014/09/06 06:00 [medline] AID - S0022-4804(14)00101-2 [pii] AID - 10.1016/j.jss.2014.01.055 [doi] PST - ppublish SO - J Surg Res. 2014 Aug;190(2):655-61. doi: 10.1016/j.jss.2014.01.055. Epub 2014 Feb 6. PMID- 24556653 OWN - NLM STAT- MEDLINE DCOM- 20141028 LR - 20151119 IS - 1945-2810 (Electronic) IS - 0888-0395 (Linking) VI - 46 IP - 2 DP - 2014 Apr TI - Utility of thromboelastography in traumatic brain injury and the neuroscience intensive care unit. PG - 66-70 LID - 10.1097/JNN.0000000000000045 [doi] FAU - Figueroa, Stephen A AU - Figueroa SA AD - Questions or comments about this article may be directed to Stephen A. Figueroa, MD, at stephen.figueroa@utsouthwestern.edu. He is an Assistant Professor of Neurology and Neurotherapeutics at University of Texas Southwestern, Dallas, TX. Karen Merriman-Noesges, MSN RN APRN ACPN-BC, is a Nurse Practioner at University of Texas Southwestern, Dallas, TX. FAU - Merriman-Noesges, Karen AU - Merriman-Noesges K LA - eng PT - Journal Article PT - Review PL - United States TA - J Neurosci Nurs JT - The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses JID - 8603596 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis/nursing MH - Brain Injuries/blood/*diagnosis/nursing MH - Critical Care/*methods MH - Critical Care Nursing/*methods MH - Humans MH - *Nurse Practitioners MH - Thrombelastography/*methods EDAT- 2014/02/22 06:00 MHDA- 2014/10/29 06:00 CRDT- 2014/02/22 06:00 PHST- 2014/02/22 06:00 [entrez] PHST- 2014/02/22 06:00 [pubmed] PHST- 2014/10/29 06:00 [medline] AID - 01376517-201404000-00002 [pii] AID - 10.1097/JNN.0000000000000045 [doi] PST - ppublish SO - J Neurosci Nurs. 2014 Apr;46(2):66-70. doi: 10.1097/JNN.0000000000000045. PMID- 24553534 OWN - NLM STAT- MEDLINE DCOM- 20140501 LR - 20140220 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 76 IP - 3 DP - 2014 Mar TI - Thrombelastography and rotational thromboelastometry early amplitudes in 182 trauma patients with clinical suspicion of severe injury. PG - 682-90 LID - 10.1097/TA.0000000000000134 [doi] AB - BACKGROUND: Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC). METHODS: This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational thromboelastometry (ROTEM) parameters were recorded upon arrival. Citrated kaolin (CK), rapid TEG (rTEG), and functional fibrinogen curves were extracted, and early amplitudes A5 and A10 were registered. Patients were stratified according to international normalized ratio of 1.2 or less and international normalized ratio greater than 1.2 (TIC patients) as well as transfusion needs (no red blood cells [RBCs], 1-9 RBCs, and >/=10 RBC in 6 hours). Correlations were analyzed by Spearman's correlation. RESULTS: TIC patients had lower amplitudes than non-TIC patients in ROTEM/TEG as follows: EXTEM, INTEM, and FIBTEM: A5, A10, and maximum clot firmness (MCF); rTEG: A10; CK: maximum amplitude (MA); and functional fibrinogen: A5, A10, and MA (p < 0.05). Furthermore, A5 and A10 had a strong correlation with MA/MCF (rho > 0.7 and p < 0.01). The A10 amplitudes were significantly lower in patients transfused with 10 or more units of RBC compared with nontransfused patients (p < 0.02). Fibrinogen concentration and platelet count had moderate correlation with A10 compared with A5 and MA/MCF (0.3 < rho < 0.7 and p < 0.01). Time (median [interquartile range], in minutes) to obtain a reading was faster for A10 than MA/MCF (p < 0.001) (CK, 16 [15-17] vs. 27 [25-30]; rTEG, 11 [11-11] vs. 18 [17-20]; EXTEM, 11 [11-11] vs. 29 [26-31]; and INTEM 13[12-13] vs. 25 [22-29]). CONCLUSION: Early amplitudes were lower in TIC patients, had significant correlations with MA/MCF, and differentiated between nontransfused and patients receiving one to nine RBC units or 10 or more RBC units within 6 hours. A10's superior correlation with platelet count and fibrinogen concentration suggests that A10 reflects a more dynamic part of the hemostatic process rather than MA/MCF. Early amplitudes may translate into earlier goal-directed transfusion therapy and may allow refinement of existing transfusion algorithms. LEVEL OF EVIDENCE: Prognostic and diagnostic study, level III. FAU - Meyer, Anna Sina P AU - Meyer AS AD - From the Section for Transfusion Medicine (A.S.P.M., M.A.S.M., M.B.H., S.R.O., P.I.J.), Capital Region Blood Bank, The Trauma Centre (A.M.S.), Centre of Head and Orthopaedics, and Department of Anaesthesia (A.M.S., L.S.R.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery (A.S.P.M., M.A.S.M., J.H.B., B.A.C., C.E.W., P.I.J.), Center for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Houston, Texas. FAU - Meyer, Martin A S AU - Meyer MA FAU - Sorensen, Anne Marie AU - Sorensen AM FAU - Rasmussen, Lars S AU - Rasmussen LS FAU - Hansen, Morten B AU - Hansen MB FAU - Holcomb, John B AU - Holcomb JB FAU - Cotton, Bryan A AU - Cotton BA FAU - Wade, Charles E AU - Wade CE FAU - Ostrowski, Sisse R AU - Ostrowski SR FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/diagnosis/etiology MH - Erythrocyte Transfusion/statistics & numerical data MH - Female MH - Hemostasis MH - Humans MH - International Normalized Ratio/statistics & numerical data MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography/*statistics & numerical data MH - Time Factors MH - Trauma Centers/statistics & numerical data MH - Wounds and Injuries/*blood/complications/diagnosis EDAT- 2014/02/21 06:00 MHDA- 2014/05/03 06:00 CRDT- 2014/02/21 06:00 PHST- 2014/02/21 06:00 [entrez] PHST- 2014/02/21 06:00 [pubmed] PHST- 2014/05/03 06:00 [medline] AID - 01586154-201403000-00015 [pii] AID - 10.1097/TA.0000000000000134 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Mar;76(3):682-90. doi: 10.1097/TA.0000000000000134. PMID- 24553520 OWN - NLM STAT- MEDLINE DCOM- 20140501 LR - 20250529 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 76 IP - 3 DP - 2014 Mar TI - Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. PG - 561-7; discussion 567-8 LID - 10.1097/TA.0000000000000146 [doi] AB - BACKGROUND: Trauma hemorrhage continues to carry a high mortality rate despite changes in modern practice. Traditional approaches to the massively bleeding patient have been shown to result in persistent coagulopathy, bleeding, and poor outcomes. Hemostatic (or damage control) resuscitation developed from the discovery of acute traumatic coagulopathy and increased recognition of the negative consequences of dilutional coagulopathy. These strategies concentrate on early delivery of coagulation therapy combined with permissive hypotension. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion during acute hemorrhage has not been studied. METHODS: This is a prospective cohort study of ROTEM and lactate measurements taken from trauma patients recruited to the multicenter Activation of Coagulation and Inflammation in Trauma (ACIT) study. A blood sample is taken on arrival and during the acute bleeding phase after administration of every 4 U of packed red blood cells (PRBCs), up to 12 U. The quantity of blood products administered within each interval is recorded. RESULTS: Of the 106 study patients receiving at least 4 U of PRBC, 27 received 8 U to 11 U of PRBC and 31 received more than 12 U of PRBC. Average admission lactate was 6.2 mEq/L. Patients with high lactate (>/=5 mEq/L) on admission did not clear lactate until hemorrhage control was achieved, and no further PRBC units were required. On admission, 43% of the patients were coagulopathic (clot amplitude at 5 minutes /= 1.3) had significantly lower admission %MA(FF) than noncoagulopathic patients (24.7% vs. 31.2%, p < 0.05). Patients requiring plasma transfusion had a significantly lower admission %MA(FF) (26.6% vs. 30.6%, p < 0.05). Higher admission %MA(FF) was predictive of reduced mortality (hazard ratio, 0.815, p < 0.001). %MA(platelets) was higher than %MA(FF) at all time points, decreased over time, and stabilized at 72 hours (69.4% at 0 hour, 56.2% at 72 hours). In contrast, %MA(FF) increased over time and stabilized at 72 hours (30.6% at 0 hour, 43.8% at 72 hours). CONCLUSION: FF TEG affords differentiation of fibrin- versus platelet-based clot dynamics. Coagulopathy and plasma transfusion were associated with a lower %MA(FF). Despite this importance of fibrinogen, platelets had a greater contribution to clot strength at all time points after injury. This suggests that attention to these relative contributions should guide resuscitation and thromboprophylaxis and that antiplatelet therapy may be of underrecognized importance to thromboprophylaxis after trauma. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Kornblith, Lucy Z AU - Kornblith LZ AD - From the Department of Surgery, San Francisco General Hospital, University of California, San Francisco, San Francisco, California. FAU - Kutcher, Matthew E AU - Kutcher ME FAU - Redick, Brittney J AU - Redick BJ FAU - Calfee, Carolyn S AU - Calfee CS FAU - Vilardi, Ryan F AU - Vilardi RF FAU - Cohen, Mitchell Jay AU - Cohen MJ LA - eng GR - NIH GM-085689/GM/NIGMS NIH HHS/United States GR - K08 CA092013/CA/NCI NIH HHS/United States GR - HL110969/HL/NHLBI NIH HHS/United States GR - NIH HL090833/HL/NHLBI NIH HHS/United States GR - K08 GM085689/GM/NIGMS NIH HHS/United States GR - NIH T32 GM-08258-20/GM/NIGMS NIH HHS/United States GR - NIH T32 GM-008258-25/GM/NIGMS NIH HHS/United States GR - K23 HL090833/HL/NHLBI NIH HHS/United States GR - R01 HL110969/HL/NHLBI NIH HHS/United States GR - T32 GM008258/GM/NIGMS NIH HHS/United States GR - L30 GM099113/GM/NIGMS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Platelet Aggregation Inhibitors) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/mortality/therapy MH - Blood Coagulation Tests MH - Blood Component Transfusion/methods MH - Blood Platelets/physiology MH - Female MH - Fibrin Clot Lysis Time MH - Fibrinogen/metabolism MH - Humans MH - Injury Severity Score MH - Linear Models MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/therapeutic use MH - Proportional Hazards Models MH - Prospective Studies MH - Resuscitation/*methods MH - Risk Assessment MH - Sampling Studies MH - Survival Rate MH - Thrombelastography/*methods MH - Thrombin Time MH - Thrombosis/*prevention & control MH - Trauma Centers MH - Wounds and Injuries/*blood/diagnosis/mortality/therapy MH - Young Adult PMC - PMC4238905 MID - NIHMS641357 COIS- Conflicts of interest: None EDAT- 2014/01/25 06:00 MHDA- 2014/04/08 06:00 PMCR- 2015/02/01 CRDT- 2014/01/25 06:00 PHST- 2014/01/25 06:00 [entrez] PHST- 2014/01/25 06:00 [pubmed] PHST- 2014/04/08 06:00 [medline] PHST- 2015/02/01 00:00 [pmc-release] AID - 01586154-201402000-00001 [pii] AID - 10.1097/TA.0000000000000108 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Feb;76(2):255-6; discussion 262-3. doi: 10.1097/TA.0000000000000108. PMID- 24415744 OWN - NLM STAT- MEDLINE DCOM- 20150630 LR - 20211021 IS - 1554-6179 (Electronic) IS - 1539-4182 (Print) IS - 1539-4182 (Linking) VI - 12 IP - 1-2 DP - 2014 Sep TI - Low incidence of hyperfibrinolysis and thromboembolism in 195 primary liver transplantations transfused with solvent/detergent-treated plasma. PG - 27-32 LID - 10.3121/cmr.2013.1168 [doi] AB - BACKGROUND: Liver transplantation regularly requires transfusion of red blood cells (RBCs), plasma, and platelets. Compared to fresh frozen plasma (FFP) from single blood donors, solvent/detergent-treated plasma (SD-plasma) pooled from several hundred blood donors has advantages with respect to pathogen reduction, standardized content of plasma proteins, and significantly reduced risk of transfusion related lung injury and allergic/immunologic adverse reactions. However, SD-plasma has been suspected to increase the incidence of hyperfibrinolysis and thromboembolic events. STUDY DESIGN AND METHODS: We investigated the transfusion practices, hyperfibrinolysis parameters, and thrombosis outcomes in 195 consecutive adult primary liver transplants in our center using SD-plasma (Octaplas) as the exclusive source of plasma. RESULTS: Perioperatively, median (interquartile range) 4 (1 to 9) RBC-units, 10 (4 to 18) plasma-bags, and 0 (0 to 2) platelet-units were transfused. Hyperfibrinolysis defined as LY30 /= 10 received serial venous duplex ultrasound examinations and blood samples for coagulation analysis at admission to the ICU and weekly thereafter. RESULTS: Six hundred seventy-eight patients were screened and 121 were enrolled; 76% blunt injury, Injury Severity Score (ISS) 27, 13% mortality. Thromboprophylaxis was administered to 90% of the patients and was started a median of 2 days after hospital admission. VTE was detected in 28% (n = 34) of the patients (27 deep vein thrombosis and 7 pulmonary emboli) and occurred a median 10 days after admission. Twenty-nine percent (n = 10) of VTE occurred within 2 days of admission. Most variables were similar between those with and without VTE, but the VTE group received more operations (3 (2) vs. 2 (2), p = 0.044), had increased ICU days (25 (34) days vs. 15 (18) days, p = 0.004), and was more likely to have abdominal injury with Abbreviated Injury Scale (AIS) score > 2 (59% vs. 39%, p = 0.050). Upon ICU admission, standard coagulation markers were within normal limits, while TEG demonstrated hypercoagulability, but neither was associated with VTE. Repeat TEG one week after admission (n = 58) remained hypercoagulable but transitioned to a different pattern with increased clot strength. TXA was associated with reduced fibrinolysis on initial TEG (p < 0.05) but was not associated with VTE. CONCLUSION: Trauma ICU patients with RAP >/= 10 are hypercoagulable at admission to ICU and remain so during recovery. They have a >/= 25% rate of VTE, despite thromboprophylaxis. TXA is associated with reduced fibrinolysis but does not increase VTE rates. Neither TEG nor standard coagulation markers (measured on ICU admission) stratify high-risk patients who develop VTE from those who do not. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Van Haren, Robert M AU - Van Haren RM AD - From the Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida. FAU - Valle, Evan J AU - Valle EJ FAU - Thorson, Chad M AU - Thorson CM FAU - Jouria, Jassin M AU - Jouria JM FAU - Busko, Alexander M AU - Busko AM FAU - Guarch, Gerardo A AU - Guarch GA FAU - Namias, Nicholas AU - Namias N FAU - Livingstone, Alan S AU - Livingstone AS FAU - Proctor, Kenneth G AU - Proctor KG LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Anticoagulants) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Anticoagulants/therapeutic use MH - Blood Coagulation Tests MH - Cohort Studies MH - Critical Care MH - Female MH - Follow-Up Studies MH - Hospital Mortality MH - Humans MH - *Intensive Care Units MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio MH - Risk Assessment MH - Severity of Illness Index MH - Survival Analysis MH - Thrombelastography/methods MH - Thrombophilia/complications/*diagnosis MH - Trauma Centers MH - Trauma Severity Indices MH - Treatment Outcome MH - Ultrasonography, Doppler, Duplex MH - Venous Thromboembolism/*diagnosis/drug therapy/etiology/*mortality MH - Wounds and Injuries/*diagnosis/mortality/therapy MH - Young Adult EDAT- 2014/01/09 06:00 MHDA- 2014/04/08 06:00 CRDT- 2014/01/09 06:00 PHST- 2014/01/09 06:00 [entrez] PHST- 2014/01/09 06:00 [pubmed] PHST- 2014/04/08 06:00 [medline] AID - 10.1097/TA.0b013e3182a9d11d [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2014 Feb;76(2):443-9. doi: 10.1097/TA.0b013e3182a9d11d. PMID- 24365883 OWN - NLM STAT- MEDLINE DCOM- 20141209 LR - 20140416 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 41 Suppl 1 DP - 2014 May TI - Prehospital coagulation monitoring of resuscitation with point-of-care devices. PG - 26-9 LID - 10.1097/SHK.0000000000000108 [doi] AB - A variety of point-of-care monitors for the measurement of hematocrit, hemoglobin, blood gas with electrolytes, and lactate can be used also in the prehospital setting for optimizing and individualizing trauma resuscitation. Point-of-care coagulation testing with activated prothrombin test, prothrombin test, and activated coagulation/clotting time tests is available for prehospital use. Although robust, battery driven, and easy to handle, many devices lack documentation for use in prehospital care. Some of the devices correspond poorly to corresponding laboratory analyses in acute trauma coagulopathy and at lower hematocrits. In trauma, viscoelastic tests such as rotational thromboelastometry and thromboelastography can rapidly detect acute trauma coagulopathy and give an overall dynamic picture of the hemostatic system and the interaction between its different components: coagulation activation, fibrin polymerization, fibrin platelet interactions within the clot, and fibrinolysis. Rotational thromboelastometry is shock resistant and has the potential to be used outside the hospital setting to guide individualized coagulation factor and blood component therapies. Sonoclot and Rheorox are two small viscoelastic instruments with one-channel options, but with less documentation. The point-of-care market for coagulation tests is quickly expanding, and new devices are introduced all the time. Still they should be better adopted to prehospital conditions, small, robust, battery charged, and rapid and use small sample volumes and whole blood. FAU - Schott, Ulf AU - Schott U AD - Department of Anaesthesia and Intensive Care, Skane University Hospital, and Lund University, Lund, Sweden. LA - eng PT - Journal Article PT - Review PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Hemoglobins) RN - 0 (Lactates) RN - S88TT14065 (Oxygen) SB - IM MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/diagnosis MH - Blood Platelet Disorders MH - Elasticity MH - Hematocrit MH - Hemoglobins MH - Humans MH - Lactates MH - Monitoring, Physiologic/methods MH - Oxygen/chemistry MH - Point-of-Care Systems MH - Resuscitation/*methods MH - Thrombelastography MH - Treatment Outcome MH - Viscosity EDAT- 2013/12/25 06:00 MHDA- 2014/12/15 06:00 CRDT- 2013/12/25 06:00 PHST- 2013/12/25 06:00 [entrez] PHST- 2013/12/25 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] AID - 10.1097/SHK.0000000000000108 [doi] PST - ppublish SO - Shock. 2014 May;41 Suppl 1:26-9. doi: 10.1097/SHK.0000000000000108. PMID- 24351527 OWN - NLM STAT- MEDLINE DCOM- 20140730 LR - 20211021 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 41 IP - 1 DP - 2014 Jan TI - Postinjury hyperfibrinogenemia compromises efficacy of heparin-based venous thromboembolism prophylaxis. PG - 33-9 LID - 10.1097/SHK.0000000000000067 [doi] AB - BACKGROUND: Venous thromboembolism (VTE) prophylaxis remains debated following trauma, and recommendations have not been established. Although hyperfibrinogenemia is a marker of proinflammatory states, it also contributes to thrombus formation. Postinjury hyperfibrinogenemia is common, but the effect of hyperfibrinogenemia on VTE prophylaxis has not been fully elucidated. Therefore, we hypothesized that heparin is less effective for VTE prophylaxis following severe injury due to hyperfibrinogenemia. METHODS: In vitro studies evaluated thromboelastography (TEG) parameters in 10 healthy volunteers after the addition of fibrinogen concentrate and heparin. Data from a recent randomized controlled trial, conducted at an academic level I trauma center surgical intensive care unit, were reviewed. Critically injured patients were randomized to standard VTE prophylaxis (5,000 U low-molecular-weight heparin daily) or TEG-guided prophylaxis (up to 10,000 U low-molecular-weight heparin daily) and were followed up for 5 days. Analysis was performed to evaluate the relationship between fibrinogen levels, measures of anticoagulation, and TEG parameters. RESULTS: In vitro studies revealed increased fibrinogen reversed the effects of heparin as measured by TEG. Fifty patients were enrolled in the clinical study with 25 in each arm. Thromboelastography parameters, fibrinogen, platelet count, and anti-Xa levels did not differ between groups despite treatment provided. Fibrinogen levels increased over the 5-day study period (597 +/- 24.0 to 689.3 +/- 25.0), as well as clot strength (9.8 +/- 0.4 to 14.5 +/- 0.6), which had a significant correlation coefficient (P < 0.01). Moreover, there was a moderate inverse correlation between fibrinogen level and the effect of heparin (RF), which was significant on study days 1 and 3, implicating hyperfibrinogenemia in heparin resistance. CONCLUSIONS: Hypercoagulability and heparin resistance are common following trauma. The preclinical and clinical relationships between fibrinogen levels and hypercoagulability implicate hyperfibrinogenemia as a potential factor in heparin resistance. FAU - Harr, Jeffrey N AU - Harr JN AD - *Department of Surgery, University of Colorado Denver, Aurora; daggerDepartment of Surgery, Denver Health Medical Center, Denver; double daggerTrauma Research Center and section signDepartment of Pediatrics, University of Colorado Denver, Aurora; and parallelResearch Department, Bonfils Blood Center, Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Chin, Theresa L AU - Chin TL FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Wohlauer, Max V AU - Wohlauer MV FAU - Sauaia, Angela AU - Sauaia A FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - UL1 TR001082/TR/NCATS NIH HHS/United States PT - Clinical Trial, Phase II PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Anticoagulants/administration & dosage/antagonists & inhibitors/*therapeutic use MH - Blood Coagulation/drug effects MH - Dose-Response Relationship, Drug MH - Female MH - Fibrinogen/*metabolism/pharmacology MH - Heparin, Low-Molecular-Weight/administration & dosage/antagonists & inhibitors/*therapeutic use MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Thrombelastography/methods MH - Treatment Outcome MH - Venous Thromboembolism/blood/*etiology/*prevention & control MH - Wounds and Injuries/blood/*complications MH - Young Adult PMC - PMC3902785 MID - NIHMS542931 COIS- Conflicts of Interest There are no conflicts of interest reported by any authors. EDAT- 2013/12/20 06:00 MHDA- 2014/07/31 06:00 PMCR- 2015/01/01 CRDT- 2013/12/20 06:00 PHST- 2013/12/20 06:00 [entrez] PHST- 2013/12/20 06:00 [pubmed] PHST- 2014/07/31 06:00 [medline] PHST- 2015/01/01 00:00 [pmc-release] AID - 00024382-201401000-00005 [pii] AID - 10.1097/SHK.0000000000000067 [doi] PST - ppublish SO - Shock. 2014 Jan;41(1):33-9. doi: 10.1097/SHK.0000000000000067. PMID- 24335401 OWN - NLM STAT- MEDLINE DCOM- 20140210 LR - 20220330 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 111 Suppl 1 DP - 2013 Dec TI - Update on massive transfusion. PG - i71-82 LID - 10.1093/bja/aet376 [doi] AB - Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively bleeding patients, regardless of aetiology (trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel. In MT patients, it is crucial to practice damage control resuscitation and to administer blood products early in the resuscitation. Trauma patients are often admitted with early trauma-induced coagulopathy (ETIC), which is associated with mortality; the aetiology of ETIC is likely multifactorial. Current data support that trauma patients treated with higher ratios of plasma and platelet to red blood cell transfusions have improved outcomes, but further clinical investigation is needed. Additionally, tranexamic acid has been shown to decrease the mortality in trauma patients requiring MT. Greater use of cryoprecipitate or fibrinogen concentrate might be beneficial in MT patients from obstetrical causes. The risks and benefits for other therapies (prothrombin complex concentrate, recombinant activated factor VII, or whole blood) are not clearly defined in MT patients. Throughout the resuscitation, the patient should be closely monitored and both metabolic and coagulation abnormalities corrected. Further studies are needed to clarify the optimal ratios of blood products, treatment based on underlying clinical disorder, use of alternative therapies, and integration of laboratory testing results in the management of massively bleeding patients. FAU - Pham, H P AU - Pham HP AD - New York Blood Center, New York, NY, USA. FAU - Shaz, B H AU - Shaz BH LA - eng PT - Journal Article PT - Review PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Blood Coagulation Disorders/etiology MH - Blood Coagulation Factors/therapeutic use MH - *Blood Transfusion MH - Hemorrhage/blood/physiopathology/*therapy MH - Humans MH - Thrombelastography MH - Tranexamic Acid/therapeutic use OTO - NOTNLM OT - massive transfusion OT - massive transfusion protocol OT - paediatric transfusion protocol OT - transfusion management EDAT- 2013/12/18 06:00 MHDA- 2014/02/11 06:00 CRDT- 2013/12/17 06:00 PHST- 2013/12/17 06:00 [entrez] PHST- 2013/12/18 06:00 [pubmed] PHST- 2014/02/11 06:00 [medline] AID - S0007-0912(17)30932-7 [pii] AID - 10.1093/bja/aet376 [doi] PST - ppublish SO - Br J Anaesth. 2013 Dec;111 Suppl 1:i71-82. doi: 10.1093/bja/aet376. PMID- 24331944 OWN - NLM STAT- MEDLINE DCOM- 20140902 LR - 20211021 IS - 1557-8615 (Electronic) IS - 0883-9441 (Print) IS - 0883-9441 (Linking) VI - 29 IP - 1 DP - 2014 Feb TI - Thrombin generation and fibrin clot formation under hypothermic conditions: an in vitro evaluation of tissue factor initiated whole blood coagulation. PG - 24-30 LID - S0883-9441(13)00390-0 [pii] LID - 10.1016/j.jcrc.2013.10.010 [doi] AB - BACKGROUND: Despite trauma-induced hypothermic coagulopathy being familiar in the clinical setting, empirical experimentation concerning this phenomenon is lacking. In this study, we investigated the effects of hypothermia on thrombin generation, clot formation, and global hemostatic functions in an in vitro environment using a whole blood model and thromboelastography, which can recapitulate hypothermia. METHODS: Blood was collected from healthy individuals through venipuncture and treated with corn trypsin inhibitor, to block the contact pathway. Coagulation was initiated with 5pM tissue factor at temperatures 37 degrees C, 32 degrees C, and 27 degrees C. Reactions were quenched over time, with soluble and insoluble components analyzed for thrombin generation, fibrinogen consumption, factor (f)XIII activation, and fibrin deposition. Global coagulation potential was evaluated through thromboelastography. RESULTS: Data showed that thrombin generation in samples at 37 degrees C and 32 degrees C had comparable rates, whereas 27 degrees C had a much lower rate (39.2 +/- 1.1 and 43 +/- 2.4 nM/min vs 28.6 +/- 4.4 nM/min, respectively). Fibrinogen consumption and fXIII activation were highest at 37 degrees C, followed by 32 degrees C and 27 degrees C. Fibrin formation as seen through clot weights also followed this trend. Thromboelastography data showed that clot formation was fastest in samples at 37 degrees C and lowest at 27 degrees C. Maximum clot strength was similar for each temperature. Also, percent lysis of clots was highest at 37 degrees C followed by 32 degrees C and then 27 degrees C. CONCLUSIONS: Induced hypothermic conditions directly affect the rate of thrombin generation and clot formation, whereas global clot stability remains intact. CI - (c) 2013. FAU - Whelihan, Matthew F AU - Whelihan MF AD - Departments of Biochemistry and Surgery, College of Medicine, University of Vermont, Burlington, VT. Electronic address: Matthew.whelihan@uvm.edu. FAU - Kiankhooy, Armin AU - Kiankhooy A AD - Departments of Biochemistry and Surgery, College of Medicine, University of Vermont, Burlington, VT. Electronic address: Armin.Kiankhooy@vtmednet.org. FAU - Brummel-Ziedins, Kathleen E AU - Brummel-Ziedins KE AD - Departments of Biochemistry and Surgery, College of Medicine, University of Vermont, Burlington, VT. Electronic address: Kathleen.brummel@uvm.edu. LA - eng GR - T32 HL007594/HL/NHLBI NIH HHS/United States GR - T32 HL007149/HL/NHLBI NIH HHS/United States GR - P01 HL046703/HL/NHLBI NIH HHS/United States GR - T32HL07594-22/HL/NHLBI NIH HHS/United States GR - HL46703/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20131029 PL - United States TA - J Crit Care JT - Journal of critical care JID - 8610642 RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Tests MH - Factor XIII/metabolism MH - Female MH - Fibrin/*biosynthesis MH - Fibrinogen/metabolism MH - Humans MH - Hypothermia/blood/*metabolism MH - In Vitro Techniques MH - Male MH - Middle Aged MH - Temperature MH - Thrombelastography MH - Thrombin/*biosynthesis PMC - PMC4355959 MID - NIHMS543941 OTO - NOTNLM OT - Fibrin formation OT - Hypothermia OT - Lysis OT - Thrombin generation OT - Trauma EDAT- 2013/12/18 06:00 MHDA- 2014/09/03 06:00 PMCR- 2015/03/11 CRDT- 2013/12/17 06:00 PHST- 2012/05/30 00:00 [received] PHST- 2013/09/06 00:00 [revised] PHST- 2013/10/20 00:00 [accepted] PHST- 2013/12/17 06:00 [entrez] PHST- 2013/12/18 06:00 [pubmed] PHST- 2014/09/03 06:00 [medline] PHST- 2015/03/11 00:00 [pmc-release] AID - S0883-9441(13)00390-0 [pii] AID - 10.1016/j.jcrc.2013.10.010 [doi] PST - ppublish SO - J Crit Care. 2014 Feb;29(1):24-30. doi: 10.1016/j.jcrc.2013.10.010. Epub 2013 Oct 29. PMID- 26037972 OWN - NLM STAT- MEDLINE DCOM- 20160405 LR - 20181113 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 41 IP - 3 DP - 2015 Jun TI - The pathophysiology, diagnosis and treatment of the acute coagulopathy of trauma and shock: a literature review. PG - 259-72 LID - 10.1007/s00068-013-0360-9 [doi] AB - BACKGROUND: The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the diagnosis of trauma-associated coagulopathy and subsequent interventions. METHODS: Review of the literature. RESULTS: The standard laboratory tests, including prothrombin time and activated partial thromboplastin time, are unreliable and describe only an isolated fragment of the complex coagulation pathways. Additionally, thromboelastography and thromboelastometry operate in a non-linear regime which implies that clot formation is the product of both the clotting process and the effect of the measurement. The assessment of the clot microstructure using a scanning electron microscope has resulted in a subjective analysis of a clot structure, showing also poor correlation between the coagulation pathways and clot development. The fractal dimension provides information on the structure and quality of the initial clot, which subsequently acts as a template for how the mature clot will behave. However, these data require further verification in an in vivo setting. At present, the treatment of the coagulopathy is delivered by empirically administered massive transfusion protocols, which lack a specific target for replacement therapy. CONCLUSIONS: There is enough evidence to demonstrate that we urgently need a robust test, which would determine and quantify both the rate and the extent of coagulation abnormalities. This could help to tailor the treatment of coagulopathy according to the patient's needs. FAU - Kaczynski, J AU - Kaczynski J AD - General and Vascular Surgery Departments, Regional Trauma Centre, Morriston Hospital, ABM University Health Board, Swansea, SA6 6NL, UK, Jakub.Kaczynski@hotmail.co.uk. FAU - Wilczynska, M AU - Wilczynska M FAU - Fligelstone, L AU - Fligelstone L FAU - Hilton, J AU - Hilton J LA - eng PT - Journal Article PT - Review DEP - 20131212 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis/physiopathology MH - Blood Coagulation Tests/methods MH - Blood Transfusion/methods MH - Clinical Protocols MH - Early Diagnosis MH - Fluid Therapy/methods MH - Humans MH - Partial Thromboplastin Time MH - Practice Guidelines as Topic MH - Prothrombin Time MH - Shock/blood/*etiology/physiopathology MH - Thrombelastography/methods MH - Wounds and Injuries/blood/*complications/physiopathology EDAT- 2013/12/12 00:00 MHDA- 2016/04/06 06:00 CRDT- 2015/06/04 06:00 PHST- 2013/02/10 00:00 [received] PHST- 2013/12/01 00:00 [accepted] PHST- 2015/06/04 06:00 [entrez] PHST- 2013/12/12 00:00 [pubmed] PHST- 2016/04/06 06:00 [medline] AID - 10.1007/s00068-013-0360-9 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2015 Jun;41(3):259-72. doi: 10.1007/s00068-013-0360-9. Epub 2013 Dec 12. PMID- 24319247 OWN - NLM STAT- MEDLINE DCOM- 20140722 LR - 20220408 IS - 1520-4383 (Electronic) IS - 1520-4383 (Linking) VI - 2013 DP - 2013 TI - Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective. PG - 656-9 LID - 10.1182/asheducation-2013.1.656 [doi] AB - Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured. FAU - Holcomb, John B AU - Holcomb JB AD - 1Center for Translational Injury Research, Department of Surgery, and Texas Trauma Institute, University of Texas Medical School, Houston, TX; and. FAU - Pati, Shibani AU - Pati S LA - eng PT - Journal Article PT - Review PL - United States TA - Hematology Am Soc Hematol Educ Program JT - Hematology. American Society of Hematology. Education Program JID - 100890099 RN - 0 (Antifibrinolytic Agents) SB - IM MH - Adolescent MH - Adult MH - Antifibrinolytic Agents/therapeutic use MH - Blood Component Transfusion/*methods MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Male MH - Middle Aged MH - *Plasma MH - Resuscitation/*methods MH - Wounds and Injuries/mortality/*therapy EDAT- 2013/12/10 06:00 MHDA- 2014/07/23 06:00 CRDT- 2013/12/10 06:00 PHST- 2013/12/10 06:00 [entrez] PHST- 2013/12/10 06:00 [pubmed] PHST- 2014/07/23 06:00 [medline] AID - 2013/1/656 [pii] AID - 10.1182/asheducation-2013.1.656 [doi] PST - ppublish SO - Hematology Am Soc Hematol Educ Program. 2013;2013:656-9. doi: 10.1182/asheducation-2013.1.656. PMID- 24317351 OWN - NLM STAT- MEDLINE DCOM- 20141016 LR - 20140217 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 41 IP - 3 DP - 2014 Mar TI - Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients. PG - 200-7 LID - 10.1097/SHK.0000000000000109 [doi] AB - INTRODUCTION: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. METHODS: Injured patients meeting our level I trauma center's highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. RESULTS: A total of 118 patients were enrolled: 26.3% (n = 31) were hypercoagulable, 55.9% (n = 66) had a normal TEG profile, and 17.8% (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un-cross-matched blood (11.1% for hypercoagulable vs. 20.4% for normal vs. 45.7% for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0% vs. 5.5% vs. 27.8%, adjusted P < 0.001) and 7-day mortality (0.0% vs. 5.5% vs. 36.1%, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0% vs. 1.8% vs. 25.0%, adjusted P < 0.001). CONCLUSIONS: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted. FAU - Branco, Bernardino C AU - Branco BC AD - *Department of Surgery, University of Arizona, Tucson, Arizona; daggerDivision of Trauma and Surgical Critical Care and double daggerDepartment of Pathology, University of Southern California, Los Angeles, California; section signDepartment of Anesthesiology & Critical Care, Lyon-Sud Hospital, Hospital Civils de Lyon (HCL) and Claude Bernard University, Lyon, France; parallelLudwig Boltzmann Institute of Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria; and paragraph signDivision of Trauma, Critical Care and Emergency Surgery, University of Arizona, Tucson, Arizona. FAU - Inaba, Kenji AU - Inaba K FAU - Ives, Crystal AU - Ives C FAU - Okoye, Obi AU - Okoye O FAU - Shulman, Ira AU - Shulman I FAU - David, Jean-Stephane AU - David JS FAU - Schochl, Herbert AU - Schochl H FAU - Rhee, Peter AU - Rhee P FAU - Demetriades, Demetrios AU - Demetriades D LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Child MH - Female MH - *Hemorrhage/blood/mortality/therapy MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Survival Rate MH - *Thrombelastography MH - *Thrombophilia/blood/mortality/therapy MH - *Wounds and Injuries/blood/mortality/therapy EDAT- 2013/12/10 06:00 MHDA- 2014/10/17 06:00 CRDT- 2013/12/10 06:00 PHST- 2013/12/10 06:00 [entrez] PHST- 2013/12/10 06:00 [pubmed] PHST- 2014/10/17 06:00 [medline] AID - 10.1097/SHK.0000000000000109 [doi] PST - ppublish SO - Shock. 2014 Mar;41(3):200-7. doi: 10.1097/SHK.0000000000000109. PMID- 24281819 OWN - NLM STAT- MEDLINE DCOM- 20150918 LR - 20261011 IS - 2035-5114 (Electronic) IS - 2035-5114 (Linking) VI - 98 IP - 1 DP - 2014 Jun TI - Perioperative coagulopathy monitoring. PG - 1-8 LID - 10.1007/s12306-013-0307-7 [doi] AB - Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), "Point-of-care" coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery. FAU - Jakoi, A AU - Jakoi A AD - Department of Orthopaedic Surgery, Drexel University, Philadelphia, PA, USA, ajakoi22@gmail.com. FAU - Kumar, N AU - Kumar N FAU - Vaccaro, A AU - Vaccaro A FAU - Radcliff, K AU - Radcliff K LA - eng PT - Journal Article PT - Review DEP - 20131127 PL - Italy TA - Musculoskelet Surg JT - Musculoskeletal surgery JID - 101498346 RN - 0 (Anticoagulants) RN - 0 (Blood Coagulation Factors) SB - IM MH - Anticoagulants/adverse effects/therapeutic use MH - Blood Coagulation/physiology MH - Blood Coagulation Factors/physiology MH - *Blood Coagulation Tests/economics/methods MH - Blood Loss, Surgical/prevention & control MH - Clinical Trials as Topic MH - Elasticity MH - Hemorrhagic Disorders/diagnosis MH - Humans MH - Intraoperative Complications/*prevention & control MH - *Orthopedic Procedures MH - Perioperative Care/*methods MH - Point-of-Care Systems MH - Postoperative Complications/*prevention & control MH - Postoperative Hemorrhage/prevention & control MH - Practice Guidelines as Topic MH - Thromboembolism/prevention & control MH - Thrombophilia/diagnosis MH - Viscosity EDAT- 2013/11/28 06:00 MHDA- 2015/09/19 06:00 CRDT- 2013/11/28 06:00 PHST- 2013/11/03 00:00 [received] PHST- 2013/11/07 00:00 [accepted] PHST- 2013/11/28 06:00 [entrez] PHST- 2013/11/28 06:00 [pubmed] PHST- 2015/09/19 06:00 [medline] AID - 10.1007/s12306-013-0307-7 [doi] PST - ppublish SO - Musculoskelet Surg. 2014 Jun;98(1):1-8. doi: 10.1007/s12306-013-0307-7. Epub 2013 Nov 27. PMID- 24280690 OWN - NLM STAT- MEDLINE DCOM- 20141016 LR - 20260323 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 41 IP - 3 DP - 2014 Mar TI - Plasma colloid osmotic pressure is an early indicator of injury and hemorrhagic shock. PG - 181-7 LID - 10.1097/SHK.0000000000000101 [doi] AB - OBJECTIVE: Hemorrhagic shock is the leading cause of traumatic deaths; many could be potentially prevented with appropriate resuscitation. However, to initiate resuscitation, one must identify patients with hemorrhagic shock early. In this article, we determined the associations between plasma colloid osmotic pressure (COP) and clinical outcomes in severely injured trauma patients. METHODS: Plasma samples were collected from 104 trauma patients upon admission to the emergency department and 10 healthy volunteers to serve as control subjects. Plasma osmolality, COP, and serum protein were measured and correlated to clinical data. Thrombelastography and impedance aggregometry were performed to assess coagulopathy. Commercial enzyme-linked immunosorbent assays were used to quantify syndecan 1. RESULTS: Plasma COP was significantly reduced in trauma patients compared to control subjects 17.7 +/- 2.6 vs. 20.7 +/- 2.1 mmHg (P < 0.05) and strongly correlated to serum protein values (R = 0.7). We divided our cohort into low (COP 16.5 mmHg) subgroups, illustrating significantly higher Injury Severity Score scores in patients with low COP (21 vs. 10, P = 0.007), despite no differences in vital signs. Patients with low COP received more red blood cells, plasma, and platelets (4 vs. 0 total units, P = 0.0005) within 24 h of admission. Syndecan 1 levels were significantly higher (184 vs. 52 ng/mL, P = 0.027) in patients with low COP. CONCLUSIONS: Reduced plasma COP and serum protein in trauma patients are indicative of injury severity. In the absence of significant alterations in vital signs, plasma COP levels were associated with increased requirements for blood products and increased syndecan 1 shedding. We believe that plasma COP provides new insight in guiding resuscitation. FAU - Rahbar, Elaheh AU - Rahbar E AD - Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center, Houston, Texas. FAU - Baer, Lisa A AU - Baer LA FAU - Cotton, Bryan A AU - Cotton BA FAU - Holcomb, John B AU - Holcomb JB FAU - Wade, Charles E AU - Wade CE LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Biomarkers) RN - 0 (Blood Proteins) SB - IM MH - Adolescent MH - Adult MH - Biomarkers/blood MH - Blood Proteins/*metabolism MH - Cohort Studies MH - Disseminated Intravascular Coagulation/blood/pathology/therapy MH - Female MH - Humans MH - Male MH - Osmolar Concentration MH - *Osmotic Pressure MH - *Plasma MH - Resuscitation MH - Shock, Hemorrhagic/*blood/pathology/therapy MH - Thrombelastography MH - *Trauma Severity Indices EDAT- 2013/11/28 06:00 MHDA- 2014/10/17 06:00 CRDT- 2013/11/28 06:00 PHST- 2013/11/28 06:00 [entrez] PHST- 2013/11/28 06:00 [pubmed] PHST- 2014/10/17 06:00 [medline] AID - 10.1097/SHK.0000000000000101 [doi] PST - ppublish SO - Shock. 2014 Mar;41(3):181-7. doi: 10.1097/SHK.0000000000000101. PMID- 24269787 OWN - NLM STAT- MEDLINE DCOM- 20140520 LR - 20170609 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 210 IP - 4 DP - 2014 Apr TI - Transfusion ratios for postpartum hemodilutional coagulopathy: an in vitro thromboelastographic model. PG - 323.e1-323.e7 LID - S0002-9378(13)02041-3 [pii] LID - 10.1016/j.ajog.2013.11.029 [doi] AB - OBJECTIVE: A 1:1:1 ratio of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT) has been advocated for trauma hemorrhage, but the effectiveness of this ratio for postpartum hemorrhage is unknown. We created an in vitro hemodilutional model to investigate this strategy. STUDY DESIGN: Blood from 20 parturients at term was diluted 50% with 0.9% normal saline. Diluted samples were reconstituted with 1:1 PRBC:FFP or 3:1 PRBC:FFP. In 10 samples, PLT were also added. Baseline, diluted, and reconstituted sample thromboelastographic values were compared. RESULTS: Maximum amplitude (MA) was lower compared to baseline values in both groups after 50% dilution with normal saline (P < .001) and remained lower than baseline despite reconstitution with 3:1:0 or 1:1:0 PRBC:FFP:PLT (P < .0001) or 3:1:1 PRBC:FFP:PLT (P < .01). MA approached baseline (P = not significant) in the samples with 1:1:1 PRBC:FFP:PLT. CONCLUSION: The addition of PLT to 1:1 PRBC:FFP optimized MA in this in vitro hemodilutional model of postpartum hemorrhage. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Farber, Michaela Kristina AU - Farber MK AD - Department of Anesthesiology and Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. FAU - Sadana, Neeti AU - Sadana N AD - Department of Anesthesiology, Tufts University School of Medicine, Boston, MA. FAU - Kaufman, Richard Max AU - Kaufman RM AD - Department of Pathology, Brigham and Women's Hospital, Boston, MA. FAU - Liu, Xiaoxia AU - Liu X AD - Department of Anesthesiology and Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. FAU - Kodali, Bhavani Shankar AU - Kodali BS AD - Department of Anesthesiology and Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131119 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - IM MH - Adolescent MH - Adult MH - Blood Transfusion/*methods MH - Erythrocyte Count MH - Female MH - Hemodilution MH - Humans MH - In Vitro Techniques MH - *Models, Biological MH - Platelet Count MH - Postpartum Hemorrhage/*blood/*therapy MH - Pregnancy MH - Thrombelastography MH - Young Adult OTO - NOTNLM OT - dilutional coagulopathy OT - postpartum hemorrhage OT - thromboelastography OT - transfusion ratios EDAT- 2013/11/26 06:00 MHDA- 2014/05/21 06:00 CRDT- 2013/11/26 06:00 PHST- 2013/07/21 00:00 [received] PHST- 2013/10/28 00:00 [revised] PHST- 2013/11/18 00:00 [accepted] PHST- 2013/11/26 06:00 [entrez] PHST- 2013/11/26 06:00 [pubmed] PHST- 2014/05/21 06:00 [medline] AID - S0002-9378(13)02041-3 [pii] AID - 10.1016/j.ajog.2013.11.029 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2014 Apr;210(4):323.e1-323.e7. doi: 10.1016/j.ajog.2013.11.029. Epub 2013 Nov 19. PMID- 24268874 OWN - NLM STAT- MEDLINE DCOM- 20140816 LR - 20190318 IS - 1873-5711 (Electronic) IS - 1050-6411 (Linking) VI - 24 IP - 1 DP - 2014 Feb TI - The effects of isometric and isotonic training on hamstring stiffness and anterior cruciate ligament loading mechanisms. PG - 98-103 LID - S1050-6411(13)00242-3 [pii] LID - 10.1016/j.jelekin.2013.10.010 [doi] AB - Greater hamstring musculotendinous stiffness is associated with lesser ACL loading mechanisms. Stiffness is enhanced via training, but previous investigations evaluated tendon rather than musculotendinous stiffness, and none involved the hamstrings. We evaluated the effects of isometric and isotonic training on hamstring stiffness and ACL loading mechanisms. Thirty-six healthy volunteers were randomly assigned to isometric, isotonic, and control groups. Isometric and isotonic groups completed 6 weeks of training designed to enhance hamstring stiffness. Stiffness, anterior tibial translation, and landing biomechanics were measured prior to and following the interventions. Hamstring stiffness increased significantly with isometric training (15.7%; p=0.006), but not in the isotonic (13.5%; p=0.089) or control (0.4%; p=0.942) groups. ACL loading mechanisms changed in manners consistent with lesser loading, but these changes were not statistically significant. These findings suggest that isometric training may be an important addition to ACL injury prevention programs. The lack of significant changes in ACL loading mechanisms and effects of isotonic training were likely due to the small sample sizes per group and limited intervention duration. Future research using larger sample sizes and longer interventions is necessary to determine the effects of enhancing hamstring stiffness on ACL loading and injury risk. CI - Copyright (c) 2013 Elsevier Ltd. All rights reserved. FAU - Blackburn, J Troy AU - Blackburn JT AD - Neuromuscular Research Laboratory, University of North Carolina, Chapel Hill, NC, USA. Electronic address: troyb@email.unc.edu. FAU - Norcross, Marc F AU - Norcross MF AD - Department of Nutrition and Exercise Sciences, Oregon State University, Corvallis, OR, USA. LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20131106 PL - England TA - J Electromyogr Kinesiol JT - Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology JID - 9109125 SB - IM MH - Adult MH - Anterior Cruciate Ligament/*physiology MH - Elasticity MH - Female MH - Healthy Volunteers MH - Humans MH - Isometric Contraction/*physiology MH - Male MH - Muscle Strength/physiology MH - Muscle, Skeletal/*physiology MH - *Resistance Training MH - Single-Blind Method MH - Tendons/physiology MH - Thigh MH - Weight-Bearing/physiology OTO - NOTNLM OT - ACL OT - Muscle OT - Neuromechanics OT - Neuromuscular OT - Viscoelastic EDAT- 2013/11/26 06:00 MHDA- 2014/08/17 06:00 CRDT- 2013/11/26 06:00 PHST- 2013/05/17 00:00 [received] PHST- 2013/10/18 00:00 [accepted] PHST- 2013/11/26 06:00 [entrez] PHST- 2013/11/26 06:00 [pubmed] PHST- 2014/08/17 06:00 [medline] AID - S1050-6411(13)00242-3 [pii] AID - 10.1016/j.jelekin.2013.10.010 [doi] PST - ppublish SO - J Electromyogr Kinesiol. 2014 Feb;24(1):98-103. doi: 10.1016/j.jelekin.2013.10.010. Epub 2013 Nov 6. PMID- 24256667 OWN - NLM STAT- MEDLINE DCOM- 20140116 LR - 20220317 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 75 IP - 6 DP - 2013 Dec TI - Fibrinolysis greater than 3% is the critical value for initiation of antifibrinolytic therapy. PG - 961-7; discussion 967 LID - 10.1097/TA.0b013e3182aa9c9f [doi] AB - BACKGROUND: The acute coagulopathy of trauma is present in up to one third of patients by the time of admission, and the recent CRASH-2 and MATTERs trials have focused worldwide attention on hyperfibrinolysis as a component of acute coagulopathy of trauma. Thromboelastography (TEG) is a powerful tool for analyzing fibrinolyis, but a clinically relevant threshold for defining hyperfibrinolysis has yet to be determined. Recent data suggest that the accepted normal upper bound of 7.5% for 30-minute fibrinolysis (LY30) by TEG is inappropriate in severe trauma, as the risk of death rises at much lower levels of clot lysis. We wished to determine the validity of this hypothesis and establish a threshold value to treat fibrinolysis, based on prediction of massive transfusion requirement and risk of mortality. METHODS: Patients with uncontrolled hemorrhage, meeting the massive transfusion protocol (MTP) criteria at admission (n = 73), represent the most severely injured trauma population at our center (median Injury Severity Score [ISS], 30; interquartile range, 20-38). Citrated kaolin TEG was performed at admission blood samples from this population, stratified by LY30, and evaluated for transfusion requirement and 28-day mortality. The same analysis was conducted on available field blood samples from all non-MTP trauma patients (n = 216) in the same period. These represent the general trauma population. RESULTS: Within the MTP-activating population, the cohort of patients with LY30 of 3% or greater was shown to be at much higher risk for requiring a massive transfusion (90.9% vs. 30.5%, p = 0.0008) and dying of hemorrhage (45.5% vs. 4.8%, p = 0.0014) than those with LY30 less than 3%. Similar trends were seen in the general trauma population. CONCLUSION: LY30 of 3% or greater defines clinically relevant hyperfibrinolysis and strongly predicts the requirement for massive transfusion and an increased risk of mortality in trauma patients presenting with uncontrolled hemorrhage. This threshold value for LY30 represents a critical indication for the treatment of fibrinolysis. LEVEL OF EVIDENCE: Prognostic study, level III. FAU - Chapman, Michael P AU - Chapman MP AD - From the Department of Surgery (M.P.C., C.R.R., J.N.H., T.L.C., J.R.S., A.S., A.B.), University of Colorado-Denver; Denver Health Medical Center (M.P.C., E.E.M., C.R.R., A.G., J.N.H., T.L.C., J.R.S., A.S.); Medical College of Georgia (M.P.C.); and Bonfils Blood Center (C.C.S.), Denver, Colorado. FAU - Moore, Ernest E AU - Moore EE FAU - Ramos, Christopher R AU - Ramos CR FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Harr, Jeffrey N AU - Harr JN FAU - Chin, Theresa L AU - Chin TL FAU - Stringham, John R AU - Stringham JR FAU - Sauaia, Angela AU - Sauaia A FAU - Silliman, Christopher C AU - Silliman CC FAU - Banerjee, Anirban AU - Banerjee A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) SB - IM MH - Adult MH - Antifibrinolytic Agents/*administration & dosage MH - Blood Coagulation Disorders/*blood/etiology/therapy MH - Blood Transfusion MH - Dose-Response Relationship, Drug MH - Female MH - Fibrinolysis/*drug effects MH - Follow-Up Studies MH - Humans MH - Injury Severity Score MH - Male MH - Prognosis MH - Retrospective Studies MH - Thrombelastography MH - Time Factors MH - Treatment Outcome MH - Wounds and Injuries/blood/*complications PMC - PMC4072127 MID - NIHMS593557 EDAT- 2013/11/22 06:00 MHDA- 2014/01/17 06:00 PMCR- 2014/06/26 CRDT- 2013/11/22 06:00 PHST- 2013/11/22 06:00 [entrez] PHST- 2013/11/22 06:00 [pubmed] PHST- 2014/01/17 06:00 [medline] PHST- 2014/06/26 00:00 [pmc-release] AID - 01586154-201312000-00006 [pii] AID - 10.1097/TA.0b013e3182aa9c9f [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Dec;75(6):961-7; discussion 967. doi: 10.1097/TA.0b013e3182aa9c9f. PMID- 24256665 OWN - NLM STAT- MEDLINE DCOM- 20140116 LR - 20131122 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 75 IP - 6 DP - 2013 Dec TI - The International Normalized Ratio overestimates coagulopathy in stable trauma and surgical patients. PG - 947-53 LID - 10.1097/TA.0b013e3182a9676c [doi] AB - BACKGROUND: The international normalized ratio (INR) was developed to assess adequacy of Coumadin dosing. Its use has been generalized to guide fresh frozen plasma (FFP) therapy in stable patients. Thrombelastography (TEG) is a whole-blood assay measuring the viscoelastic properties of the clot in near real time. This study hypothesized that INR does not reflect coagulopathy and should not be used to guide FFP therapy in stable trauma and surgical patients. METHODS: Prospective observational data were collected from stable trauma and surgical patients (n = 106) who received FFP transfusions. Pretransfusion and posttransfusion blood samples were obtained to assess complete blood count, standard coagulation parameters (INR, partial thromboplastin time, fibrinogen and D-dimer), soluble clotting factors (II, V, VII, VIII, IX, X, XI, XII, proteins C and S) and TEG. Data were analyzed using a Mann-Whitney U-test. Significance was defined as p < 0.05. RESULTS: A total of 262 U of FFP were transfused, with 78% of 106 patients receiving two or more units. Despite a reduction in INR, median TEG values remained within normal limits, while clotting factor levels retained adequate function to produce normal clotting before and following FFP transfusion. CONCLUSION: The use of FFP in this population did not affect coagulation status in a clinically relevant manner based on TEG values and coagulation factor function. INR is not a predictor of coagulopathy and should not be used to guide coagulation factor replacement in stable trauma and surgical patients. LEVEL OF EVIDENCE: Diagnostic study, level III. FAU - McCully, Sean P AU - McCully SP AD - From the Trauma Research Institute of Oregon (TRIO) (S.P.M., L.J.F., N.R.K., T.L.G., K.M.W., J.A.D., M.A.S.), Department of Hematology and Medical Oncology (T.G.D.), Oregon Health & Science University, Portland, Oregon. FAU - Fabricant, Loic J AU - Fabricant LJ FAU - Kunio, Nicholas R AU - Kunio NR FAU - Groat, Tahnee L AU - Groat TL FAU - Watson, Katherine M AU - Watson KM FAU - Differding, Jerome A AU - Differding JA FAU - Deloughery, Thomas G AU - Deloughery TG FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Blood Coagulation MH - Blood Coagulation Disorders/blood/*classification/etiology MH - Female MH - Follow-Up Studies MH - Humans MH - *International Normalized Ratio MH - Male MH - Middle Aged MH - Postoperative Complications/blood/*classification/etiology MH - Prospective Studies MH - Thrombelastography MH - Wounds and Injuries/blood/*complications MH - Young Adult EDAT- 2013/11/22 06:00 MHDA- 2014/01/17 06:00 CRDT- 2013/11/22 06:00 PHST- 2013/11/22 06:00 [entrez] PHST- 2013/11/22 06:00 [pubmed] PHST- 2014/01/17 06:00 [medline] AID - 01586154-201312000-00004 [pii] AID - 10.1097/TA.0b013e3182a9676c [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Dec;75(6):947-53. doi: 10.1097/TA.0b013e3182a9676c. PMID- 24247318 OWN - NLM STAT- MEDLINE DCOM- 20141022 LR - 20161125 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 25 IP - 1 DP - 2014 Jan TI - Effects of recombinant activated factor VIIa on abdominal trauma patients. PG - 33-8 LID - 10.1097/MBC.0000000000000021 [doi] AB - Recombinant activated factor VIIa (rFVIIa) has been highlighted by correcting uncontrollable traumatic haemorrhage. Compared with routine coagulation tests, thromboelastography (TEG) can evaluate the coagulation function of trauma patients more rapidly, accurately and comprehensively, and can also diagnose trauma-associated coagulopathy (TAC) in an early stage. Thirty-eight cases conforming to rFVIIa indications were screened according to TEG results and divided into an rFVIIa group (n = 20) and a nonrFVIIa group (n = 18). Their coagulopathy was goal-directedly corrected under the guidance of TEG. The parameters examined by routine coagulation tests and TEG were compared. The blood components transfused in the two groups were also calculated. When rFVIIa was administered by an average dose of 52.3 mug/kg (24.0-95.6 mug/kg), blood coagulation function was significantly improved in 48 h. Compared with the nonrFVIIa group, the treatment group experienced decreased R time. Moreover, significant fewer red blood cells, platelet and fresh frozen plasma were transfused in the rFVIIa group. All patients underwent daily bedside vascular ultrasound screening within a week after haemostatic treatment, of which no thromboembolic events occurred. TEG can sensitively detect TAC. rFVIIa administered goal-directedly guided by TEG is more effectively in correcting TAC and decreasing the amount of blood product transfusion. FAU - Yao, Danhua AU - Yao D AD - Department of Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China. FAU - Li, Yousheng AU - Li Y FAU - Wang, Jian AU - Wang J FAU - Yu, Wenkui AU - Yu W FAU - Li, Ning AU - Li N FAU - Li, Jieshou AU - Li J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Recombinant Proteins) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Abdominal Injuries/blood/*drug therapy MH - Adolescent MH - Adult MH - Blood Coagulation Disorders/drug therapy MH - Factor VIIa/*administration & dosage MH - Female MH - Hemorrhage/blood/drug therapy/etiology MH - Humans MH - Male MH - Middle Aged MH - Recombinant Proteins/administration & dosage MH - Retrospective Studies MH - Thrombelastography/methods MH - Young Adult EDAT- 2013/11/20 06:00 MHDA- 2014/10/23 06:00 CRDT- 2013/11/20 06:00 PHST- 2013/11/20 06:00 [entrez] PHST- 2013/11/20 06:00 [pubmed] PHST- 2014/10/23 06:00 [medline] AID - 10.1097/MBC.0000000000000021 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2014 Jan;25(1):33-8. doi: 10.1097/MBC.0000000000000021. PMID- 24240827 OWN - NLM STAT- MEDLINE DCOM- 20140812 LR - 20260128 IS - 1531-7072 (Electronic) IS - 1070-5295 (Linking) VI - 19 IP - 6 DP - 2013 Dec TI - Rotational thromboelastometry-guided trauma resuscitation. PG - 605-12 LID - 10.1097/MCC.0000000000000021 [doi] AB - PURPOSE OF REVIEW: Haemorrhage from major trauma is a significant cause of death worldwide. The UK Defence Medical Service (UK-DMS) has had significant experience in managing severely injured and shocked trauma casualties over the last decade. This has led to the integration of rotational thromboelastometry (ROTEM) into damage control resuscitation delivered at Camp Bastion Field Hospital in Afghanistan. This review aims to describe the rationale for its use and how its use has evolved by UK-DMS. RECENT FINDINGS: Although there is reasonable evidence showing its benefit in cardiac and liver surgery, evidence for its use in trauma is limited. More recent studies and meta-analyses have demonstrated a reduced rate of transfusion and blood loss, but no benefit on mortality. Despite this, there is a growing body of opinion supporting ROTEM use in trauma with European guidelines supporting its use where available. Recent UK-DMS experience has shown that it is a fast, reliable and robust means of identifying transfusion requirements. SUMMARY: ROTEM provides a means to rapidly assess coagulation in trauma casualties, allowing targeted use of blood products. It provides information on clot initiation strength and breakdown. However, its use in trauma has still to be fully evaluated. FAU - Keene, Damian D AU - Keene DD AD - Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK. FAU - Nordmann, Giles R AU - Nordmann GR FAU - Woolley, Tom AU - Woolley T LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM MH - Afghan Campaign 2001- MH - Blood Transfusion/methods MH - Female MH - Hemorrhage/etiology/mortality/*therapy MH - Humans MH - Male MH - *Military Personnel MH - *Point-of-Care Systems/trends MH - Resuscitation/*methods MH - *Thrombelastography/methods/trends MH - United Kingdom MH - Wounds and Injuries/complications/mortality/*therapy EDAT- 2013/11/19 06:00 MHDA- 2014/08/13 06:00 CRDT- 2013/11/19 06:00 PHST- 2013/11/19 06:00 [entrez] PHST- 2013/11/19 06:00 [pubmed] PHST- 2014/08/13 06:00 [medline] AID - 00075198-201312000-00014 [pii] AID - 10.1097/MCC.0000000000000021 [doi] PST - ppublish SO - Curr Opin Crit Care. 2013 Dec;19(6):605-12. doi: 10.1097/MCC.0000000000000021. PMID- 24227563 OWN - NLM STAT- MEDLINE DCOM- 20160422 LR - 20220603 IS - 1553-9768 (Print) IS - 1553-9768 (Linking) VI - 13 IP - 4 DP - 2013 Winter TI - Point-of-Care Coagulation Testing for Trauma Patients in a Military Setting: A Prospective Study. PG - 59-62 LID - 6OJ3-UGS5 [pii] LID - 10.55460/6OJ3-UGS5 [doi] AB - BACKGROUND AND OBJECTIVE: Almost 50% of military trauma patients who need transfusions develop a coagulopathy. Immediately treating this coagulopathy improves the patient?s prognosis. Field military hospitals often lack laboratory devices needed to diagnose a clinically significant coagulopathy and have limited blood product resources such as plasma. Point-of-care (POC) devices for the measurement of prothrombin time (PT) are available and have been tested in a variety of situations, including hemorrhagic surgery. The authors compared a POC device, the Coaguchek XS Pro (F. Hoffmann-La Roche Ltd., Basel, Switzerland), with laboratory measures for determining the PT in military trauma patients in a field hospital. METHODS: This single-center prospective study was designed to compare POC coagulation monitoring with traditional laboratory testing. It was conducted at the French military hospital located at Kabul International Airport. All patients with trauma injuries resulting from war operations were included. A blood sample was drawn immediately on admission. PT was determined both in the laboratory and with use of the Coaguchek XS pro. RESULTS: Forty patients with war trauma were enrolled during a 3-month period. The authors recorded 69 measurements. The two methods were correlated with a correlation coefficient of 0.78 (p < .001). The Bland-Altman plot showed a mean difference of 5.8% (95% confidence interval ?14.9% to 26.6%). Using a PT cutoff of 60%, POC had a sensitivity of 77.1% and a specificity of 94.1%. RESULTS from POC PT measurement were available within a mean of 25.8 minutes before laboratory measures. CONCLUSIONS: The Coaguchek XS Pro device can be used successfully in an austere environment without compromising its performance. CI - 2013. FAU - Cotte, Jean AU - Cotte J FAU - d'Aranda, Erwan AU - d'Aranda E FAU - Chauvin, Vincent AU - Chauvin V FAU - Kaiser, Eric AU - Kaiser E FAU - Meaudre, Eric AU - Meaudre E LA - eng PT - Journal Article PL - United States TA - J Spec Oper Med JT - Journal of special operations medicine : a peer reviewed journal for SOF medical professionals JID - 101158402 SB - IM MH - Blood Coagulation MH - Humans MH - *International Normalized Ratio MH - Military Personnel MH - *Point-of-Care Systems MH - Prospective Studies EDAT- 2013/11/15 06:00 MHDA- 2016/04/23 06:00 CRDT- 2013/11/15 06:00 PHST- 2013/12/01 00:00 [accepted] PHST- 2013/11/15 06:00 [entrez] PHST- 2013/11/15 06:00 [pubmed] PHST- 2016/04/23 06:00 [medline] AID - 6OJ3-UGS5 [pii] AID - 10.55460/6OJ3-UGS5 [doi] PST - ppublish SO - J Spec Oper Med. 2013 Winter;13(4):59-62. doi: 10.55460/6OJ3-UGS5. PMID- 24220042 OWN - NLM STAT- MEDLINE DCOM- 20140603 LR - 20181202 IS - 1879-1271 (Electronic) IS - 0268-0033 (Linking) VI - 29 IP - 1 DP - 2014 Jan TI - Geometric and architectural contributions to hamstring musculotendinous stiffness. PG - 105-10 LID - S0268-0033(13)00230-1 [pii] LID - 10.1016/j.clinbiomech.2013.10.011 [doi] AB - BACKGROUND: Greater hamstring musculotendinous stiffness is associated with lesser anterior cruciate ligament loading mechanisms during both controlled joint perturbations and dynamic tasks, suggesting a potential protective mechanism. Additionally, lesser hamstring stiffness has been reported in females, potentially contributing to their greater risk of anterior cruciate ligament injury. However, the factors which contribute to high vs. low stiffness are unclear. Muscle geometry and architecture influence force production and may, therefore, influence stiffness. The purpose of this investigation was to evaluate the contributions of geometric and architectural muscle characteristics to hamstring stiffness. METHODS: Thirty healthy individuals (15 males, 15 females) volunteered for participation. Biceps femoris long head cross-sectional area, pennation angle, fiber length, tendon stiffness, and posterior thigh fat thickness were assessed via ultrasound imaging, and strength was measured via isometric contraction. Stiffness was assessed via the damped oscillatory technique. FINDINGS: Following normalization to anthropometric factors, only strength (r=0.535) and posterior thigh fat thickness (Spearman rho=-0.305) were correlated with stiffness. Normalized tendon stiffness (0.06 vs. 0.10N/m.kg(-1)) and strength (7.1 vs. 10.0N.kg(-1)) were greater in males, while posterior thigh fat thickness (10.4 vs. 5.0mm) was greater in females. INTERPRETATION: Greater posterior thigh fat thickness may influence stiffness by contributing to greater intramuscular fat and shank segment mass, and lesser muscle per unit mass in the thigh segment. These findings suggest that training designed to increase hamstring strength and decrease fat mass may be beneficial for anterior cruciate ligament injury prevention. CI - (c) 2013. FAU - Blackburn, J Troy AU - Blackburn JT AD - Neuromuscular Research Laboratory, University of North Carolina, Chapel Hill, NC, USA; Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA; Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA; Program in Human Movement Science, University of North Carolina, Chapel Hill, NC, USA. Electronic address: troyb@email.unc.edu. FAU - Pamukoff, Derek N AU - Pamukoff DN AD - Neuromuscular Research Laboratory, University of North Carolina, Chapel Hill, NC, USA; Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA; Program in Human Movement Science, University of North Carolina, Chapel Hill, NC, USA. LA - eng PT - Journal Article DEP - 20131024 PL - England TA - Clin Biomech (Bristol) JT - Clinical biomechanics (Bristol, Avon) JID - 8611877 SB - IM MH - Adipose Tissue/diagnostic imaging MH - Adult MH - Anterior Cruciate Ligament/anatomy & histology/diagnostic imaging/*physiology MH - Anterior Cruciate Ligament Injuries MH - Elasticity Imaging Techniques MH - Female MH - Humans MH - Male MH - Muscle Strength/*physiology MH - Muscle, Skeletal/anatomy & histology/diagnostic imaging/*physiology MH - Sex Factors MH - Tendons/physiology MH - Thigh MH - Young Adult OTO - NOTNLM OT - ACL OT - Muscle OT - Neuromechanics OT - Neuromuscular OT - Viscoelastic EDAT- 2013/11/14 06:00 MHDA- 2014/06/04 06:00 CRDT- 2013/11/14 06:00 PHST- 2013/08/29 00:00 [received] PHST- 2013/10/14 00:00 [revised] PHST- 2013/10/15 00:00 [accepted] PHST- 2013/11/14 06:00 [entrez] PHST- 2013/11/14 06:00 [pubmed] PHST- 2014/06/04 06:00 [medline] AID - S0268-0033(13)00230-1 [pii] AID - 10.1016/j.clinbiomech.2013.10.011 [doi] PST - ppublish SO - Clin Biomech (Bristol). 2014 Jan;29(1):105-10. doi: 10.1016/j.clinbiomech.2013.10.011. Epub 2013 Oct 24. PMID- 24204130 OWN - NLM STAT- MEDLINE DCOM- 20140321 LR - 20211021 IS - 1178-1998 (Electronic) IS - 1176-9092 (Print) IS - 1176-9092 (Linking) VI - 8 DP - 2013 TI - Predicting hemorrhage and obstruction in the elderly population using thromboelastographic indices. PG - 1405-12 LID - 10.2147/CIA.S49478 [doi] AB - OBJECTIVE: To estimate the value of the different thromboelastogram indices for predicting hemorrhage and vascular obstruction in an elderly population. METHODS: This was a prospective cohort study of patients 65 years and older without hemato-logic disorders who received thromboelastography (TEG) examination at the Chinese People's Liberation Army General Hospital from January 2007 to December 2010. Detailed information was collected at recruitment including their TEG test results. Subjects were then followed during outpatient visits and hospitalization. The primary outcome measures were hemorrhage and vascular obstruction. Receiver-operating characteristics (ROC) curves were used to compare the predictive value of the four TEG indices, reaction time (R), clot formation time (K), maximal amplitude (MA), alpha angle (ANGLE) and their combination for predicting hemorrhage and vascular obstruction. The maximal Youden's index was used to estimate optimal cut-off values for the indices. Areas under the ROC curves were used to estimate overall predictive accuracies. RESULTS: A total of 403 elderly patients met inclusion criteria and were included: 373 male and 30 females with mean age 83.0 +/- 7.3 years and range of 65-103 years. Hemorrhage occurred in 25 (6.2%) patients and vascular obstruction in 78 (19.4%) patients during the 2-year follow up. The currently recommended TEG cut-off values were poorly predictive of vascular obstruction and modestly predictive of hemorrhage. Based on maximal Youden's, the optimal cutoffs of the TEG indices for predicting vascular obstruction were: R = 7, K = 1.5, MA = 63.5, and ANGLE = 67.1. A combination of all four showed the best predictive value (area under the ROC curve of 0.60, sensitivity 85.9%, and specificity 34.7%). The optimal cut-off values for predicting hemorrhage were: R = 7.8, K = 2.3, MA = 50.5, ANGLE = 53.7. A combination of R and MA was also most predictive of hemorrhage (area under ROC curve 0.66, sensitivity 60%, and specificity 71.7%). CONCLUSION: The currently adopted cut-off values for TEG indices are poorly and modestly predictive of hemorrhage and obstruction, respectively, in the elderly population. Optimal cutoff values determined by ROC curve analysis improved the prediction of vascular obstruction and hemorrhage. FAU - Zheng, Qiwen AU - Zheng Q AD - Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China. FAU - Fu, Shuhong AU - Fu S FAU - Chen, Dafang AU - Chen D FAU - Li, Xiaoxia AU - Li X FAU - Li, Yuru AU - Li Y FAU - Li, Yanyan AU - Li Y FAU - Yu, Jihong AU - Yu J FAU - Gong, Meiliang AU - Gong M FAU - Bai, Jie AU - Bai J LA - eng PT - Journal Article DEP - 20131017 PL - New Zealand TA - Clin Interv Aging JT - Clinical interventions in aging JID - 101273480 SB - IM MH - Aged MH - Aged, 80 and over MH - China/epidemiology MH - Factor Analysis, Statistical MH - Female MH - Hemorrhage/*epidemiology MH - Humans MH - Male MH - Postoperative Complications MH - *Predictive Value of Tests MH - ROC Curve MH - Sensitivity and Specificity MH - *Thrombelastography MH - Venous Thromboembolism/*epidemiology MH - Wounds and Injuries PMC - PMC3804517 OTO - NOTNLM OT - ROC curve OT - TEG OT - elderly OT - hemorrhage OT - obstruction OT - prediction OT - thromboelastography EDAT- 2013/11/10 06:00 MHDA- 2014/03/22 06:00 PMCR- 2013/10/17 CRDT- 2013/11/09 06:00 PHST- 2013/11/09 06:00 [entrez] PHST- 2013/11/10 06:00 [pubmed] PHST- 2014/03/22 06:00 [medline] PHST- 2013/10/17 00:00 [pmc-release] AID - cia-8-1405 [pii] AID - 10.2147/CIA.S49478 [doi] PST - ppublish SO - Clin Interv Aging. 2013;8:1405-12. doi: 10.2147/CIA.S49478. Epub 2013 Oct 17. PMID- 24169144 OWN - NLM STAT- MEDLINE DCOM- 20140421 LR - 20161125 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 187 IP - 1 DP - 2014 Mar TI - A totally recombinant human fibrin sealant. PG - 334-42 LID - S0022-4804(13)00912-8 [pii] LID - 10.1016/j.jss.2013.09.039 [doi] AB - BACKGROUND: Applications of plasma-derived human fibrin sealants (pdhFS) have been limited because of cost, limited supply of pathogen-screened plasma, the need for bioengineering improvements, and regulatory issues associated with federal approval. We describe a totally recombinant human fibrin sealant (rhFS), which may engender an abundant, safe, and cost-effective supply of efficacious fibrin sealant. MATERIALS AND METHODS: A first-generation rhFS made from recombinant human fibrinogen (rhFI; produced in the milk of transgenic cows), activated recombinant human factor XIII (rhFXIIIa; produced in yeast), and recombinant human thrombin (rhFIIa; purchased, made in animal cell culture) was formulated using thromboelastography (TEG). The hemostatic efficacy of rhFS versus commercial pdhFS was compared in a nonlethal porcine hepatic wedge excision model. RESULTS: The maximal clot strength of rhFS measured in vitro by TEG was not statistically different than that of pdhFS. TEG analysis also showed that the rhFS gained strength more quickly as reflected by a steeper alpha angle; however, the rhFS achieved this clot strength with a 5-fold lower factor I content than the pdhFS. When these fibrin sealants were studied in a porcine hepatic wedge excision model, the hemostatic scores of the rhFS were equivalent or better than that of the pdhFS. CONCLUSIONS: The bioengineered rhFS had equivalent or better hemostatic efficacy than the pdhFS in a nonlethal hemorrhage model, despite the factor I concentration in the rhFS being about one-fifth that in the pdhFS. Because the rhFS is amenable to large-scale production, the rhFS has the potential to be more economical and abundant than the pdhFS, while having a decreased risk of blood-borne pathogen transmission. CI - Published by Elsevier Inc. FAU - Carlson, Mark A AU - Carlson MA AD - Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. Electronic address: macarlso@unmc.edu. FAU - Calcaterra, Jennifer AU - Calcaterra J AD - Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska. FAU - Johanning, Jason M AU - Johanning JM AD - Department of Vascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. FAU - Pipinos, Iraklis I AU - Pipinos II AD - Department of Vascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. FAU - Cordes, Crystal M AU - Cordes CM AD - Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, Nebraska. FAU - Velander, William H AU - Velander WH AD - Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20131002 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Fibrin Tissue Adhesive) RN - 0 (Recombinant Proteins) RN - 9001-32-5 (Fibrinogen) RN - EC 2.3.2.13 (Factor XIIIa) RN - EC 3.4.21.5 (Thrombin) RN - SCK81AMR7R (recombinant human thrombin) SB - IM MH - Animals MH - Animals, Genetically Modified MH - Cattle MH - Cells, Cultured MH - Disease Models, Animal MH - Factor XIIIa/genetics/pharmacology MH - Fibrin Tissue Adhesive/*pharmacology MH - Fibrinogen/genetics/pharmacology MH - Hemorrhage/*drug therapy MH - Hemostasis MH - Humans MH - Lacerations/*drug therapy MH - Liver/drug effects/*injuries MH - Male MH - Recombinant Proteins/genetics/*pharmacology MH - Sus scrofa MH - Thrombelastography MH - Thrombin/genetics/pharmacology MH - Yeasts OTO - NOTNLM OT - Factor XIII OT - Fibrin sealant OT - Fibrinogen OT - Hemorrhage OT - Hemostasis OT - Human OT - Recombinant OT - Swine OT - Thrombin EDAT- 2013/10/31 06:00 MHDA- 2014/04/22 06:00 CRDT- 2013/10/31 06:00 PHST- 2013/06/10 00:00 [received] PHST- 2013/09/25 00:00 [revised] PHST- 2013/09/26 00:00 [accepted] PHST- 2013/10/31 06:00 [entrez] PHST- 2013/10/31 06:00 [pubmed] PHST- 2014/04/22 06:00 [medline] AID - S0022-4804(13)00912-8 [pii] AID - 10.1016/j.jss.2013.09.039 [doi] PST - ppublish SO - J Surg Res. 2014 Mar;187(1):334-42. doi: 10.1016/j.jss.2013.09.039. Epub 2013 Oct 2. PMID- 24142816 OWN - NLM STAT- MEDLINE DCOM- 20141204 LR - 20221207 IS - 1098-2752 (Electronic) IS - 0738-1085 (Linking) VI - 34 IP - 4 DP - 2014 May TI - Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery? PG - 253-60 LID - 10.1002/micr.22199 [doi] AB - Thrombotic occlusion of the microvascular pedicle is the major reason for flap loss. Thus, identifying patients who are at risk for such events is paramount. Rotational thromboelastometry (RTE) is widely used to detect coagulopathy and hypercoagulable states. The aim of our study was to assess its diagnostic value in reconstructive microsurgery. In all 181 patients undergoing free tissue transfer at our department between February 2010 and November 2011 preoperative RTE was performed. In addition, coagulation values as well as patient's demographic data, cause and localization of defect, type of flap and surgical revisions were recorded. The majority of patients was male (59.6%) with traumatic (59.7%) defects located on the lower extremity (60.3%). ALT was the most often used flap (35.9%). Preoperatively, 36.5% of patients had a hypercoagulable RTE (higher than physiological RTE values; intrinsic (ICPT) or extrinsic (ECPT) mean clot firmness (MCF) >72mm or functional fibrinogen (ICF) MCF >25mm). A total of 28 primary thrombosis of the microvascular pedicle occurred, 11 of those in-patients with a hypercoagulable state. Total flap loss rate because ofthrombosis was 7.7% (n = 14). Both a hypercoagulable RTE assay and a functional fibrinogen to platelet ratio (FPR) of >43 (MCF value of ICF divided by the MCF value of ICPT) were significant predictors of thrombotic flap loss when performing multivariate binary logistic regression, co-factoring for age, sex, and comorbidities (p = 0.036 and 0.003, respectively). RTE seems to be able to identify patients that are prone to thrombotic complications and might be used as a screening tool. CI - Copyright (c) 2013 Wiley Periodicals, Inc. FAU - Kolbenschlag, Jonas AU - Kolbenschlag J AD - BG University Clinic Bergmannsheil, Department of Plastic Surgery, Burn Center, Bochum, Germany. FAU - Daigeler, Adrien AU - Daigeler A FAU - Lauer, Sarah AU - Lauer S FAU - Wittenberg, Gerhard AU - Wittenberg G FAU - Fischer, Sebastian AU - Fischer S FAU - Kapalschinski, Nicolai AU - Kapalschinski N FAU - Lehnhardt, Marcus AU - Lehnhardt M FAU - Goertz, Ole AU - Goertz O LA - eng PT - Journal Article DEP - 20131021 PL - United States TA - Microsurgery JT - Microsurgery JID - 8309230 SB - IM MH - Female MH - Free Tissue Flaps/*blood supply MH - Humans MH - Male MH - Microsurgery/*adverse effects MH - Middle Aged MH - Predictive Value of Tests MH - Plastic Surgery Procedures/*methods MH - Retrospective Studies MH - Thrombelastography/*methods MH - Thrombosis/*diagnosis/*etiology EDAT- 2013/10/22 06:00 MHDA- 2014/12/15 06:00 CRDT- 2013/10/22 06:00 PHST- 2013/05/14 00:00 [received] PHST- 2013/10/03 00:00 [revised] PHST- 2013/10/04 00:00 [accepted] PHST- 2013/10/22 06:00 [entrez] PHST- 2013/10/22 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] AID - 10.1002/micr.22199 [doi] PST - ppublish SO - Microsurgery. 2014 May;34(4):253-60. doi: 10.1002/micr.22199. Epub 2013 Oct 21. PMID- 24123050 OWN - NLM STAT- MEDLINE DCOM- 20140502 LR - 20220331 IS - 1096-8652 (Electronic) IS - 0361-8609 (Linking) VI - 89 IP - 2 DP - 2014 Feb TI - TEG and ROTEM: technology and clinical applications. PG - 228-32 LID - 10.1002/ajh.23599 [doi] AB - Initially described in 1948 by Hertert thromboelastography (TEG) provides a real-time assessment of viscoelastic clot strength in whole blood. Rotational thromboelastometry (ROTEM) evolved from TEG technology and both devices generate output by transducing changes in the viscoelastic strength of a small sample of clotting blood (300 microl) to which a constant rotational force is applied. These point of care devices allow visual assessment of blood coagulation from clot formation, through propagation, and stabilization, until clot dissolution. Computer analysis of the output allows sophisticated clot formation/dissolution kinetics and clot strength data to be generated. Activation of clot formation can be initiated with both intrinsic (kaolin, ellagic acid) and extrinsic (tissue factor) activators. In addition, the independent contributions of platelets and fibrinogen to final clot strength can be assessed using added platelet inhibitors (abciximab and cytochalasin D). Increasingly, ROTEM and TEG analysis is being incorporated in vertical algorithms to diagnose and treat bleeding in high-risk populations such as those undergoing cardiac surgery or suffering from blunt trauma. Some evidence suggests these algorithms might reduce transfusions, but further study is needed to assess patient outcomes. CI - Copyright (c) 2013 Wiley Periodicals, Inc. FAU - Whiting, David AU - Whiting D AD - Division of Cardiac Anesthesia, Department of Anaesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts. FAU - DiNardo, James A AU - DiNardo JA LA - eng PT - Journal Article PT - Review PL - United States TA - Am J Hematol JT - American journal of hematology JID - 7610369 SB - IM MH - Humans MH - Thrombelastography/instrumentation/*methods EDAT- 2013/10/15 06:00 MHDA- 2014/05/03 06:00 CRDT- 2013/10/15 06:00 PHST- 2013/06/06 00:00 [received] PHST- 2013/09/23 00:00 [revised] PHST- 2013/09/23 00:00 [accepted] PHST- 2013/10/15 06:00 [entrez] PHST- 2013/10/15 06:00 [pubmed] PHST- 2014/05/03 06:00 [medline] AID - 10.1002/ajh.23599 [doi] PST - ppublish SO - Am J Hematol. 2014 Feb;89(2):228-32. doi: 10.1002/ajh.23599. PMID- 24117955 OWN - NLM STAT- MEDLINE DCOM- 20140701 LR - 20220331 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 54 IP - 5 DP - 2014 May TI - Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy. PG - 1389-405; quiz 1388 LID - 10.1111/trf.12431 [doi] AB - Fibrinogen plays a critical role in achieving and maintaining hemostasis and is fundamental to effective clot formation. There is increasing awareness of the important role of fibrinogen as a key target for the treatment and prevention of acquired bleeding. Fibrinogen is the first coagulation factor to fall to critically low levels (<1.0 g/L) during major hemorrhage (normal plasma fibrinogen levels range from 2.0 to 4.5 g/L), and current guidelines recommend maintaining the plasma fibrinogen level above 1.5 g/L. Fibrinogen supplementation can be achieved using plasma or cryoprecipitate; however, there are a number of safety concerns associated with these allogeneic blood products and there is a lack of high-quality evidence to support their use. Additionally, there is sometimes a long delay associated with the preparation of frozen products for infusion. Fibrinogen concentrate provides a promising alternative to allogeneic blood products and has a number of advantages: it allows a standardized dose of fibrinogen to be rapidly administered in a small volume, has a very good safety profile, and is virally inactivated as standard. Administration of fibrinogen concentrate, often guided by point-of-care viscoelastic testing to allow individualized dosing, has been successfully used as hemostatic therapy in a range of clinical settings, including cardiovascular surgery, postpartum hemorrhage, and trauma. Results show that fibrinogen concentrate is associated with a reduction or even total avoidance of allogeneic blood product transfusion. Fibrinogen concentrate represents an important option for the treatment of coagulopathic bleeding; further studies are needed to determine precise dosing strategies and thresholds for fibrinogen supplementation. CI - (c) 2013 American Association of Blood Banks. FAU - Levy, Jerrold H AU - Levy JH AD - Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina. FAU - Welsby, Ian AU - Welsby I FAU - Goodnough, Lawrence T AU - Goodnough LT LA - eng PT - Journal Article PT - Review DEP - 20131009 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (cryoprecipitate coagulum) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Transfusion. 2014 May;54(5):1442-3. doi: 10.1111/trf.12563. PMID: 24819078 CIN - Transfusion. 2014 May;54(5):1443-4. doi: 10.1111/trf.12604. PMID: 24819079 MH - Factor VIII/therapeutic use MH - Fibrinogen/administration & dosage/analysis/physiology/*therapeutic use MH - Hemorrhage/blood/*drug therapy/prevention & control MH - Hemostasis MH - Humans MH - Orthopedic Procedures MH - Plasma MH - Wounds and Injuries/drug therapy EDAT- 2013/10/15 06:00 MHDA- 2014/07/02 06:00 CRDT- 2013/10/15 06:00 PHST- 2013/05/03 00:00 [received] PHST- 2013/08/14 00:00 [revised] PHST- 2013/08/14 00:00 [accepted] PHST- 2013/10/15 06:00 [entrez] PHST- 2013/10/15 06:00 [pubmed] PHST- 2014/07/02 06:00 [medline] AID - 10.1111/trf.12431 [doi] PST - ppublish SO - Transfusion. 2014 May;54(5):1389-405; quiz 1388. doi: 10.1111/trf.12431. Epub 2013 Oct 9. PMID- 24112665 OWN - NLM STAT- MEDLINE DCOM- 20140130 LR - 20211021 IS - 1879-1883 (Electronic) IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 206 IP - 6 DP - 2013 Dec TI - Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation. PG - 917-22; discussion 922-3 LID - S0002-9610(13)00485-6 [pii] LID - 10.1016/j.amjsurg.2013.07.024 [doi] AB - BACKGROUND: The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown. METHODS: Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours. RESULTS: Forty-two of 304 patients (13.8%) identified underwent multiple postinjury thromboelastographic studies. Age (P = .45), gender (P = .45), and solid organ injury grade (P = .71) were similar between TEG and non-TEG patients. TEG patients had higher Injury Severity Scores compared with non-TEG patients (33.2 vs 18.3, respectively, P < .01). Among the TEG patients, the shear elastic modulus strength and maximum amplitude values began in the normal range within the first 12-hour interval after injury, increased linearly, and crossed into the hypercoagulable range at 48 hours (15.1 +/- 1.9 Kd/cs and 57.6 +/- 1.6 mm, respectively; P < .01, analysis of variance). CONCLUSIONS: Patients sustaining blunt abdominal solid organ injuries transition to a hypercoagulable state approximately 48 hours after injury. In the absence of contraindications, pharmacoprophylaxis should be considered before this time for effective venous thromboembolism prevention. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Chapman, Brandon C AU - Chapman BC AD - Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock Street MC0206, Denver, CO 80206, USA. FAU - Moore, Ernest E AU - Moore EE FAU - Barnett, Carlton AU - Barnett C FAU - Stovall, Robert T AU - Stovall RT FAU - Biffl, Walter L AU - Biffl WL FAU - Burlew, Clay C AU - Burlew CC FAU - Bensard, Denis D AU - Bensard DD FAU - Jurkovich, Gregory J AU - Jurkovich GJ FAU - Pieracci, Fredric M AU - Pieracci FM LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Comparative Study PT - Journal Article DEP - 20131007 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Abdominal Injuries/blood/*complications/diagnosis MH - Adult MH - Blood Coagulation MH - Blood Transfusion/*methods MH - Female MH - Follow-Up Studies MH - Humans MH - Injury Severity Score MH - Male MH - Retrospective Studies MH - Thrombelastography MH - Thrombophilia/blood/etiology/*prevention & control MH - Time Factors MH - Wounds, Nonpenetrating/blood/*complications/diagnosis PMC - PMC4091755 MID - NIHMS596199 OTO - NOTNLM OT - Blunt solid organ injury OT - Hypercoagulable OT - Trauma COIS- The authors declare no conflicts of interest. EDAT- 2013/10/12 06:00 MHDA- 2014/01/31 06:00 PMCR- 2014/07/10 CRDT- 2013/10/12 06:00 PHST- 2013/03/16 00:00 [received] PHST- 2013/07/27 00:00 [revised] PHST- 2013/07/31 00:00 [accepted] PHST- 2013/10/12 06:00 [entrez] PHST- 2013/10/12 06:00 [pubmed] PHST- 2014/01/31 06:00 [medline] PHST- 2014/07/10 00:00 [pmc-release] AID - S0002-9610(13)00485-6 [pii] AID - 10.1016/j.amjsurg.2013.07.024 [doi] PST - ppublish SO - Am J Surg. 2013 Dec;206(6):917-22; discussion 922-3. doi: 10.1016/j.amjsurg.2013.07.024. Epub 2013 Oct 7. PMID- 24104413 OWN - NLM STAT- MEDLINE DCOM- 20140403 LR - 20131009 IS - 1531-7048 (Electronic) IS - 1065-6251 (Linking) VI - 20 IP - 6 DP - 2013 Nov TI - Massive transfusion: blood component ratios. PG - 521-5 LID - 10.1097/MOH.0b013e3283653982 [doi] AB - PURPOSE OF REVIEW: This review will address recent developments in the transfusion management of massively transfused trauma patients, focusing on the use of fixed blood component ratios in massive transfusion protocols. RECENT FINDINGS: The majority of trauma centers have migrated from laboratory-based transfusion protocols to massive transfusion protocols with fixed blood component ratios. These protocols with red blood cell : plasma : platelet ratio of 1 : 1 : 1 are associated with improved survival in severely injured patients. However, alternate ratios have also demonstrated improved survival. Thus, the optimal ratio has not been determined. In addition, the use of medications, such as antifibrinolytics, and point of care testing, such as thromboelastography, are increasingly being used as part of massive transfusion protocols to adjust transfusion therapy and decrease bleeding. However, their optimal integration has yet to be determined. SUMMARY: Massive transfusion protocols with fixed ratios of red blood cells to plasma and platelets have improved survival in both civilian and military trauma patients. Continued studies of ratios as well as integration of other therapies and testing are ongoing in order to continue to improve patient outcome. FAU - Lal, Devika S AU - Lal DS AD - New York Blood Center, New York, New York, USA. FAU - Shaz, Beth H AU - Shaz BH LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Hematol JT - Current opinion in hematology JID - 9430802 SB - IM MH - Blood Component Transfusion/*methods MH - Clinical Protocols MH - Hemorrhagic Disorders/*therapy MH - Humans MH - Wounds and Injuries/*therapy EDAT- 2013/10/10 06:00 MHDA- 2014/04/04 06:00 CRDT- 2013/10/10 06:00 PHST- 2013/10/10 06:00 [entrez] PHST- 2013/10/10 06:00 [pubmed] PHST- 2014/04/04 06:00 [medline] AID - 00062752-201311000-00007 [pii] AID - 10.1097/MOH.0b013e3283653982 [doi] PST - ppublish SO - Curr Opin Hematol. 2013 Nov;20(6):521-5. doi: 10.1097/MOH.0b013e3283653982. PMID- 24103457 OWN - NLM STAT- MEDLINE DCOM- 20140724 LR - 20211021 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 21 DP - 2013 Oct 8 TI - Impact of fibrinogen concentrate alone or with prothrombin complex concentrate (+/- fresh frozen plasma) on plasma fibrinogen level and fibrin-based clot strength (FIBTEM) in major trauma: a retrospective study. PG - 74 LID - 10.1186/1757-7241-21-74 [doi] AB - BACKGROUND: Low plasma fibrinogen concentration is a predictor of poor outcome in major trauma patients. The role of fibrinogen concentrate for rapidly increasing fibrinogen plasma levels in severe trauma is not well defined. METHODS: In this retrospective study we included severe trauma patients treated with fibrinogen concentrate alone (FC group), fibrinogen concentrate with prothrombin complex concentrate (FC-PCC group) or fibrinogen concentrate with PCC and fresh frozen plasma (FC-PCC-FFP group). PCC was generally administered as the second step of intraoperative therapy, while FFP was only administered as a third step. All patients received >/=1 g fibrinogen concentrate within 24 hours. Plasma fibrinogen concentration and ROTEM parameters upon emergency room (ER) admission, intensive care unit (ICU) admission, and after 24 hours were analysed. RESULTS: Among 157 patients fulfilling the inclusion criteria, 83% were male; mean age was 44 years and median injury severity score (ISS) was 29. Standard coagulation tests reflected increasing severity of coagulopathy with increasing complexity of haemostatic therapy (highest severity in the FC-PCC-FFP group; p < 0.0001). Total 24-hour fibrinogen concentrate dose also increased with complexity of haemostatic therapy. Plasma fibrinogen concentration was maintained, with no significant difference between ER admission and ICU admission in all patient groups. FIBTEM clot firmness at 10 minutes (CA10) was similarly maintained, albeit with a small increase in the FC-PCC group. Fibrinogen concentration and FIBTEM CA10 were within the normal range in all groups at 24 hours. The ratio of fibrinogen concentrate to red blood cells (g:U) ranged between 0.7:1.0 and 1.0:1.0. CONCLUSION: Fibrinogen concentrate therapy maintained fibrinogen concentration and FIBTEM CA10 during the initial phase of trauma care until ICU admission. After 24 hours, these parameters were comparable between the three groups and within the normal range for each of them. Further studies are warranted to investigate the effect of fibrinogen concentrate on clinical outcomes. FAU - Schlimp, Christoph J AU - Schlimp CJ AD - Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria. herbert.schoechl@auva.at. FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Inaba, Kenji AU - Inaba K FAU - Maegele, Marc AU - Maegele M FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131008 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Afibrinogenemia/*drug therapy MH - Austria MH - Blood Coagulation MH - Blood Coagulation Factors/*administration & dosage MH - Female MH - Fibrinogen/*administration & dosage/*analysis MH - Hospitalization MH - Humans MH - Male MH - Medical Audit MH - Middle Aged MH - Plasma/*chemistry MH - Retrospective Studies MH - Wounds and Injuries/*blood/pathology PMC - PMC3852540 EDAT- 2013/10/10 06:00 MHDA- 2014/07/25 06:00 PMCR- 2013/10/08 CRDT- 2013/10/10 06:00 PHST- 2013/07/18 00:00 [received] PHST- 2013/10/04 00:00 [accepted] PHST- 2013/10/10 06:00 [entrez] PHST- 2013/10/10 06:00 [pubmed] PHST- 2014/07/25 06:00 [medline] PHST- 2013/10/08 00:00 [pmc-release] AID - 1757-7241-21-74 [pii] AID - 10.1186/1757-7241-21-74 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2013 Oct 8;21:74. doi: 10.1186/1757-7241-21-74. PMID- 23971232 OWN - NLM STAT- MEDLINE DCOM- 20130924 LR - 20130826 IS - 0094-6354 (Print) IS - 0094-6354 (Linking) VI - 81 IP - 2 DP - 2013 Apr TI - Thromboelastography-guided transfusion Therapy in the trauma patient. PG - 127-32 AB - This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. The leading cause of death worldwide results from trauma. Hemorrhage is responsible for 30% to 40% of trauma mortality and accounts for almost 50% of the deaths occurring in the initial 24 hours following the traumatic incident. On admission, 25% to 35% of trauma patients present with coagulopathy, which is associated with a sevenfold increase in morbidity and mortality. The literature supports that routine plasma-based routine coagulation tests, such as prothrombin time, activated partial thromboplastin time, and international normalized ratio, are inadequate for monitoring coagulopathy and guided transfusion therapy in trauma patients. A potential solution is incorporating the use of the TEG assay into the care of trauma patients to render evidence-based therapy for patients requiring massive blood transfusions. Analysis with TEG provides a complete picture of hemostasis, which is far superior to isolated, static conventional tests. The result is a fast, well-designed, and precise diagnosis enabling more cost-effective treatment, improved clinical outcome, accurate use of blood products, and pharmaceutical therapies at the point of care. FAU - Brazzel, Charice AU - Brazzel C AD - Sheridan Healthcare, Kendall Regional Medical Center, Miami, Florida, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - AANA J JT - AANA journal JID - 0431420 MH - Blood Transfusion/*methods MH - Evidence-Based Practice MH - Hemorrhage/mortality/*therapy MH - Hemostasis MH - Humans MH - *Nurse Anesthetists MH - Thrombelastography/*methods MH - Wounds and Injuries/mortality/*therapy EDAT- 2013/08/27 06:00 MHDA- 2013/09/26 06:00 CRDT- 2013/08/27 06:00 PHST- 2013/08/27 06:00 [entrez] PHST- 2013/08/27 06:00 [pubmed] PHST- 2013/09/26 06:00 [medline] PST - ppublish SO - AANA J. 2013 Apr;81(2):127-32. PMID- 23910535 OWN - NLM STAT- MEDLINE DCOM- 20140311 LR - 20130805 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 27 IP - 4 Suppl DP - 2013 Aug TI - Management of hemorrhage in trauma. PG - S35-43 LID - S1053-0770(13)00290-5 [pii] LID - 10.1053/j.jvca.2013.05.015 [doi] AB - Hemorrhage remains one of the leading causes of trauma-related deaths. Uncontrolled diffuse microvascular bleeding in the course of initial care is common, potentially resulting in exsanguination. Early and aggressive hemostatic intervention increases survival and reduces the incidence of massive transfusion. Thus, timely diagnosis of the underlying coagulation disorders is mandatory. It has been shown that standard coagulation tests do not sufficiently characterize trauma-induced coagulopathy (TIC). This has led to increasing interest in alternatives, such as the viscoelastic test, to diagnose TIC and to provide the basis for a goal-directed hemostatic therapy. The concept of damage control resuscitation (DCR) has been introduced widely in trauma patients with severe bleeding. This strategy addresses important confounders of the coagulation process such as hemodilution, hypothermia, and acidosis; DCR is based on a damage control surgical approach, permissive hypotension, and improvement of hemostatic competence. Many studies have shown benefit in mortality when using high ratios of fresh frozen plasma (FFP) to red blood cells (RBC) as early treatment. However, there is increased awareness that coagulation factor concentrate could be beneficial in the treatment of trauma-induced coagulopathy. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria. Herbert.schoechl@auva.at FAU - Grassetto, Alberto AU - Grassetto A FAU - Schlimp, Christoph J AU - Schlimp CJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 RN - 0 (Coagulants) SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Coagulation Tests/methods MH - Coagulants/administration & dosage MH - Fluid Therapy/methods MH - Hemorrhage/*etiology/*therapy MH - *Hemostatic Techniques MH - Humans MH - Hypotension, Controlled/methods MH - Monitoring, Physiologic/methods MH - Wounds and Injuries/*complications OTO - NOTNLM OT - bleeding OT - coagulation tests OT - coagulopathy OT - damage control resuscitation OT - goal-directed therapy OT - hemorrhage OT - permissive hypotension OT - transfusion OT - trauma EDAT- 2013/08/09 06:00 MHDA- 2014/03/13 06:00 CRDT- 2013/08/06 06:00 PHST- 2013/08/06 06:00 [entrez] PHST- 2013/08/09 06:00 [pubmed] PHST- 2014/03/13 06:00 [medline] AID - S1053-0770(13)00290-5 [pii] AID - 10.1053/j.jvca.2013.05.015 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2013 Aug;27(4 Suppl):S35-43. doi: 10.1053/j.jvca.2013.05.015. PMID- 23857437 OWN - NLM STAT- MEDLINE DCOM- 20150406 LR - 20151119 IS - 1827-1596 (Electronic) IS - 0375-9393 (Linking) VI - 80 IP - 1 DP - 2014 Jan TI - Role of fibrinogen in massive injury. PG - 89-95 AB - Coagulation is a complex cascade whose intact functioning is essential in helping control hemorrhage after injury. While traditionally ascribed to the combined effects of acidosis, hypothermia, factor consumption and factor dilution, coagulopathy is also directly related to injury as well as hypofibrinogenemia and hyperfibrinolysis. Low fibrinogen concentration is readily determined with standard laboratory profiling, but direct analysis of hyperfibrinolysis relies on either thromboelastography or rotational thromboelastometry. Both conditions offer opportunities for therapeutic intervention, and inhibition or abrogation of hyperfibrinolysis in particular may significantly improve survival in patients with injury and massive hemorrhage. Herein, we explore the underpinnings of trauma associated coagulopathy, the basic science behind the role of fibrinogen in acute traumatic coagulopathy, and the rationale behind and the data derived from management of hypofibrinogenemia as well as hyperfibrinolysis. FAU - Maung, A A AU - Maung AA AD - Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA - lewis.kaplan@yale.edu. FAU - Kaplan, L J AU - Kaplan LJ LA - eng PT - Journal Article PT - Review DEP - 20130715 PL - Italy TA - Minerva Anestesiol JT - Minerva anestesiologica JID - 0375272 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-31-4 (Fibrin) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Afibrinogenemia/blood/congenital/etiology MH - Animals MH - Antifibrinolytic Agents/pharmacology/therapeutic use MH - Blood Component Transfusion MH - Fibrin/biosynthesis MH - Fibrinogen/*physiology/therapeutic use MH - Fibrinolysis/drug effects MH - Hemorrhage/*blood/etiology/therapy MH - Hemostasis/*physiology MH - Hemostatic Techniques MH - Humans MH - Multicenter Studies as Topic MH - Plasma MH - Randomized Controlled Trials as Topic MH - Tranexamic Acid/therapeutic use MH - Wounds and Injuries/blood/complications/*physiopathology EDAT- 2013/07/17 06:00 MHDA- 2015/04/07 06:00 CRDT- 2013/07/17 06:00 PHST- 2013/07/17 06:00 [entrez] PHST- 2013/07/17 06:00 [pubmed] PHST- 2015/04/07 06:00 [medline] AID - R02Y9999N00A0667 [pii] PST - ppublish SO - Minerva Anestesiol. 2014 Jan;80(1):89-95. Epub 2013 Jul 15. PMID- 23856126 OWN - NLM STAT- MEDLINE DCOM- 20140107 LR - 20211021 IS - 1095-8673 (Electronic) IS - 0022-4804 (Print) IS - 0022-4804 (Linking) VI - 185 IP - 2 DP - 2013 Dec TI - Hypercoagulability in response to elevated body temperature and central hypovolemia. PG - e93-100 LID - S0022-4804(13)00601-X [pii] LID - 10.1016/j.jss.2013.06.012 [doi] AB - BACKGROUND: Coagulation abnormalities contribute to poor outcomes in critically ill patients. In trauma patients exposed to a hot environment, a systemic inflammatory response syndrome, elevated body temperature, and reduced central blood volume occur in parallel with changes in hemostasis and endothelial damage. The objective of this study was to evaluate whether experimentally elevated body temperature and reduced central blood volume (CBV) per se affects hemostasis and endothelial activation. METHODS: Eleven healthy volunteers were subjected to heat stress, sufficient to elevate core temperature, and progressive reductions in CBV by lower body negative pressure (LBNP). Changes in hemostasis were evaluated by whole blood haemostatic assays, standard hematologic tests and by plasma biomarkers of coagulation and endothelial activation/disruption. RESULTS: Elevated body temperature and decreased CBV resulted in coagulation activation evidenced by shortened activated partial tromboplastin time (-9% [IQR -7; -4]), thrombelastography: reduced reaction time (-15% [-24; -4]) and increased maximum amplitude (+4% (2; 6)), all P < 0.05. Increased fibrinolysis was documented by elevation of D-dimer (+53% (12; 59), P = 0.016). Plasma adrenaline and noradrenaline increased 198% (83; 346) and 234% (174; 363) respectively (P = 0.006 and P = 0.003). CONCLUSIONS: This experiment revealed emerging hypercoagulability in response to elevated body temperature and decreased CBV, whereas no effect on the endothelium was observed. We hypothesize that elevated body temperature and reduced CBV contributes to hypercoagulability, possibly due to moderate sympathetic activation, in critically ill patients and speculate that normalization of body temperature and CBV may attenuate this hypercoagulable response. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Meyer, Martin A S AU - Meyer MA AD - Section for Transfusion Medicine, Capital Regional Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: martin.as.meyer@gmail.com. FAU - Ostrowski, Sisse R AU - Ostrowski SR FAU - Overgaard, Anders AU - Overgaard A FAU - Ganio, Matthew S AU - Ganio MS FAU - Secher, Niels H AU - Secher NH FAU - Crandall, Craig G AU - Crandall CG FAU - Johansson, Par I AU - Johansson PI LA - eng GR - R01 HL061388/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20130629 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 0 (Catecholamines) SB - IM MH - Adult MH - Blood Pressure/physiology MH - Body Temperature/*physiology MH - Catecholamines/blood MH - Endothelium, Vascular/immunology/physiopathology MH - Fever/*blood/immunology/physiopathology MH - Healthy Volunteers MH - Heart Rate/physiology MH - Hemostasis/physiology MH - Humans MH - Hypovolemia/*blood/immunology/physiopathology MH - Inflammation/blood/immunology/physiopathology MH - Lower Body Negative Pressure MH - Male MH - Platelet Aggregation/physiology MH - Thrombelastography MH - Thrombophilia/*blood/immunology/physiopathology MH - Young Adult PMC - PMC4961036 MID - NIHMS804453 OTO - NOTNLM OT - Catecholamines OT - Central blood volume OT - Hyperthermia OT - Hypovolemia OT - LBNP OT - SIRS OT - Sepsis OT - TEG OT - Trauma EDAT- 2013/07/17 06:00 MHDA- 2014/01/08 06:00 PMCR- 2016/07/26 CRDT- 2013/07/17 06:00 PHST- 2012/12/20 00:00 [received] PHST- 2013/05/20 00:00 [revised] PHST- 2013/06/06 00:00 [accepted] PHST- 2013/07/17 06:00 [entrez] PHST- 2013/07/17 06:00 [pubmed] PHST- 2014/01/08 06:00 [medline] PHST- 2016/07/26 00:00 [pmc-release] AID - S0022-4804(13)00601-X [pii] AID - 10.1016/j.jss.2013.06.012 [doi] PST - ppublish SO - J Surg Res. 2013 Dec;185(2):e93-100. doi: 10.1016/j.jss.2013.06.012. Epub 2013 Jun 29. PMID- 23845632 OWN - NLM STAT- MEDLINE DCOM- 20140314 LR - 20220318 IS - 1531-5037 (Electronic) IS - 0022-3468 (Linking) VI - 48 IP - 6 DP - 2013 Jun TI - Admission rapid thrombelastography delivers real-time "actionable" data in pediatric trauma. PG - 1371-6 LID - S0022-3468(13)00298-4 [pii] LID - 10.1016/j.jpedsurg.2013.03.036 [doi] AB - PURPOSE: Admission rapid thrombelastography (rTEG) is a "real-time" clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown. METHODS: Severely injured patients (age 1 mug/mL). CONCLUSIONS: The new ReoRox ReoLyse test provides more information on fibrinolysis compared to the ReoRox Fib1 program. Neither ReoRox nor ROTEM could detect lower degrees of fibrinolysis. ReoRox is a valuable alternative to ROTEM to study high degrees of fibrinolysis and should be evaluated in clinical situations with increased fibrinolysis and during therapeutic thrombolysis. FAU - Nilsson, Caroline U AU - Nilsson CU AD - Department of Anaesthesia and Intensive Care, Lund University. FAU - Tynngard, Nahreen AU - Tynngard N FAU - Reinstrup, Peter AU - Reinstrup P FAU - Engstrom, Martin AU - Engstrom M LA - eng PT - Comparative Study PT - Journal Article DEP - 20130614 PL - England TA - Scand J Clin Lab Invest JT - Scandinavian journal of clinical and laboratory investigation JID - 0404375 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Blood Coagulation MH - Blood Viscosity MH - Female MH - *Fibrinolysis MH - Humans MH - Male MH - Middle Aged MH - Thrombelastography/instrumentation/*methods MH - Tissue Plasminogen Activator/physiology MH - Young Adult EDAT- 2013/06/19 06:00 MHDA- 2014/04/02 06:00 CRDT- 2013/06/18 06:00 PHST- 2013/06/18 06:00 [entrez] PHST- 2013/06/19 06:00 [pubmed] PHST- 2014/04/02 06:00 [medline] AID - 10.3109/00365513.2013.801509 [doi] PST - ppublish SO - Scand J Clin Lab Invest. 2013 Sep;73(6):457-65. doi: 10.3109/00365513.2013.801509. Epub 2013 Jun 14. PMID- 23734991 OWN - NLM STAT- MEDLINE DCOM- 20140220 LR - 20260317 IS - 1545-0066 (Electronic) IS - 1090-3127 (Linking) VI - 17 IP - 3 DP - 2013 Jul-Sep TI - Stability of tranexamic acid after 12-week storage at temperatures from -20 degrees c to 50 degrees c. PG - 394-400 LID - 10.3109/10903127.2013.792891 [doi] AB - BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic agent that reduces blood loss during surgery, decreases mortality in civilian and military trauma populations, was adopted for prehospital use by the British military, and is now issued to U.S. Special Operations Forces for use on the battlefield. OBJECTIVE: This study tested whether storage of TXA ampoules at four temperatures (-20 degrees C, 4 degrees C, 22 degrees C, or 50 degrees C) for 1, 2, 4, and 12 weeks would result in chemical degradation and the loss of activity to block streptokinase-induced fibrinolysis in human plasma. METHODS: For each temperature and storage duration, normal plasma, plasma plus streptokinase (SK) (50 units/mL), and plasma + SK + TXA (0.2 mug/mL, n = 4) were tested for D-dimer (DD), for fibrin degradation products (FDP), by thromboelastography (to measure the units/mL of SK needed to get 100% fibrinolysis at 60 minutes [LY60]), and by high-performance liquid chromatography (HPLC). The results were similar for all temperatures and storage durations, and were therefore combined. RESULTS: Streptokinase led to a rise in LY60, DD, and FDP that was significantly (p < 0.05) attenuated with TXA. The results in the three test conditions were LY60: 0.00% +/- 0.00%, 70.52% +/- 4.7%, 0.02% +/- 0.01%; DD: 0.23 +/- 0.1, 205.05 +/- 101.59, 0.31 +/- 0.01 mg/L; and FDP: <10, >40, and <10 mug/mL, respectively. The HPLC results showed no chemical breakdown of TXA. All TXA glass ampoules at -20 degrees C were cracked by week 1. CONCLUSIONS: Except for the finding that TXA ampoules cracked when frozen, this study indicated that the drug remains effective when stored under conditions likely to be encountered in the prehospital environment and outside the manufacturer's recommended temperature range for at least 12 weeks. FAU - de Guzman, Rodolfo AU - de Guzman R AD - U.S. Army Institute of Surgical Research, San Antonio, TX 78234, USA. FAU - Polykratis, I Amy AU - Polykratis IA FAU - Sondeen, Jill L AU - Sondeen JL FAU - Darlington, Daniel N AU - Darlington DN FAU - Cap, Andrew P AU - Cap AP FAU - Dubick, Michael A AU - Dubick MA LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - Prehosp Emerg Care JT - Prehospital emergency care JID - 9703530 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Antifibrinolytic Agents/*chemistry MH - Chromatography, High Pressure Liquid MH - *Drug Stability MH - *Drug Storage MH - Feasibility Studies MH - Humans MH - In Vitro Techniques MH - *Temperature MH - Thrombelastography MH - Tranexamic Acid/*chemistry EDAT- 2013/06/06 06:00 MHDA- 2014/02/22 06:00 CRDT- 2013/06/06 06:00 PHST- 2013/06/06 06:00 [entrez] PHST- 2013/06/06 06:00 [pubmed] PHST- 2014/02/22 06:00 [medline] AID - 10.3109/10903127.2013.792891 [doi] PST - ppublish SO - Prehosp Emerg Care. 2013 Jul-Sep;17(3):394-400. doi: 10.3109/10903127.2013.792891. PMID- 23717233 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20130530 LR - 20220408 IS - 1658-354X (Print) IS - 0975-3125 (Electronic) VI - 7 IP - 1 DP - 2013 Jan TI - Assessment of hemostatic changes after crystalloid and colloid fluid preloading in trauma patients using standard coagulation parameters and thromboelastography. PG - 48-56 LID - 10.4103/1658-354X.109809 [doi] AB - BACKGROUND: The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of in vivo hemodilution with various fluid preparations (4% gelatin, 6% hydoxyethyl starch (HES), Ringer's lactate, 0.9% normal saline) on coagulation using standard coagulation parameters and real-time thromboelastography (TEG) in patients undergoing elective surgery post trauma. METHODS: In a randomized, double-blind study, 100 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective surgeries were allocated into four groups of 25 each according to the type of fluid infused. Group G (4% gelatin), Group N (0.9% normal saline), Group R (Ringer's lactate), and Group H (6% HES) received preloading with 1 L of fluid according to the group. The coagulation status of the patients was assessed during perioperative period (before surgery, after fluid preloading, and at the end of the surgery) using both conventional coagulation analysis and TEG. STATISTICAL ANALYSIS: Analysis of variance (ANOVA), post hoc and Pearson Chi-square test were used. RESULTS: In all the patients preloaded with gelatin, there was a significant increase in prothrombin time index (PTI; 14.88+/-0.90 vs. 13.78+/-3.01, P<0.001) and international normalized ratio (INR; 1.12+/-0.09 vs. 1.09+/-0.19, P<0.05) compared to the baseline value. An increase was observed in these parameters in the postoperative period also. In the HES group, there was statistically significant increase in PT time (15.70+/-1.51 vs. 13.74+/-0.75, P=0.01) and INR (1.20+/-0.15 vs. 1.03+/-0.17, P<0.001) as compared to the baseline. In the intergroup comparisons, the patients preloaded with HES had a significant increase in INR (1.20+/-0.15 vs. 1.12+/-0.09, P=0.04) and reaction time (R time; 6.84+/-2.55 min vs. 4.79+/-1.77 min, P=0.02) as compared to the gelatin group. The fall in coagulation time (k time; 2.16+/-0.98 vs. 3.94+/-2.6, P=0.02), rise in maximum amplitude (MA; 61.94+/-14.08 vs. 50.11+/-14.10, P=0.04), and rise in A20 (56.17+/-14.66 vs. 43.11+/-14.24, P=0.05) were more in patients preloaded with RL as compared to the HES group. 100% patients in the gelatin group, 84.2% patients in the NS group, 94.4% patients in the RL group, and 66.7% patients in the HES group had hypocoagulable (R time > 14 min) state in the postoperative period. CONCLUSION: Crystalloids are optimal volume expanders in trauma, with RL having beneficial effects on coagulation system (decrease in k time and increase in MA and A20). Among the colloids, HES 6% (130/0.4) affects coagulation parameters (increase in PTI, INR, R time, k time) more than gelatin. Trial registration (protocol number-IEC/NP-189/2011). FAU - Sawhney, Chhavi AU - Sawhney C AD - Department of Anaesthesia and Critical Care, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. FAU - Subramanian, Arulselvi AU - Subramanian A FAU - Kaur, Manpreet AU - Kaur M FAU - Anjum, Ajaz AU - Anjum A FAU - Albert, Venencia AU - Albert V FAU - Soni, Kapil Dev AU - Soni KD FAU - Kumar, Ajit AU - Kumar A LA - eng PT - Journal Article PL - India TA - Saudi J Anaesth JT - Saudi journal of anaesthesia JID - 101500601 PMC - PMC3657925 OTO - NOTNLM OT - Colloids OT - crystalloids OT - thromboelastography OT - trauma COIS- Conflict of Interest: None declared EDAT- 2013/05/30 06:00 MHDA- 2013/05/30 06:01 PMCR- 2013/01/01 CRDT- 2013/05/30 06:00 PHST- 2013/05/30 06:00 [entrez] PHST- 2013/05/30 06:00 [pubmed] PHST- 2013/05/30 06:01 [medline] PHST- 2013/01/01 00:00 [pmc-release] AID - SJA-7-48 [pii] AID - 10.4103/1658-354X.109809 [doi] PST - ppublish SO - Saudi J Anaesth. 2013 Jan;7(1):48-56. doi: 10.4103/1658-354X.109809. PMID- 23696866 OWN - NLM STAT- MEDLINE DCOM- 20131125 LR - 20211021 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 8 IP - 5 DP - 2013 TI - Thrombin generation capacity of prothrombin complex concentrate in an in vitro dilutional model. PG - e64100 LID - 10.1371/journal.pone.0064100 [doi] LID - e64100 AB - BACKGROUND: The use of PCC for the treatment of trauma-induced coagulopathy potentially increase the risk of thromboembolism and disseminated intravascular coagulation, which is addressed to an imbalance of both pro- and anticoagulants. As PCCs differ in composition, we used an in vitro dilutional approach to assess the overall thrombin generation of five different PCCs through various laboratory assays. METHODS: The vitamin K-dependent coagulation factors, heparin, and antithrombin were assessed in five commercially available PCCs. The procoagulant potential of the PCCs was assessed in plasma and whole blood from 4 healthy donors by means of classical coagulation assays, thrombin generation assay and thromboelastometry. In order to reflect coagulopathy, whole blood was diluted to 80, 60, 40, and 20% with Ringer's lactate solution. RESULTS: The five different PCCs were characterised by comparable levels of factors II, VII, IX and X (all around 20-30 IU/mL), whereas the heparin (0 to 17.6 IU/mL) and antithrombin (0.06 to 1.29 IU/mL) levels were remarkably different between manufactures. In vitro dilution of blood induced a prolongation of the PT and aPTT, and attenuation of thrombin generation and ExTem induced thromboelastometry. Overall, non- or low-heparin containing PCCs restored the in vitro dilutional coagulopathy, whereas PCCs containing heparin have an anticoagulant effect. The thrombin generation assay showed to be the most sensitive method for assessment of PCC effects. CONCLUSIONS: This study shows that most available PCCs are not balanced regarding their pro- and anticoagulants. The effect of measured differences in thrombin generation among different PCCs requires further investigations to elaborate the clinical meaning of this finding in the treatment of trauma induced coagulopathy. FAU - Grottke, Oliver AU - Grottke O AD - Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Rossaint, Rolf AU - Rossaint R FAU - Henskens, Yvonne AU - Henskens Y FAU - van Oerle, Rene AU - van Oerle R FAU - Ten Cate, Hugo AU - Ten Cate H FAU - Spronk, Henri M H AU - Spronk HM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130517 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Coagulation MH - Blood Coagulation Disorders/etiology MH - Blood Coagulation Factors/*metabolism MH - Blood Coagulation Tests MH - Hemostasis MH - Humans MH - Thrombin/*biosynthesis MH - Wounds and Injuries/complications PMC - PMC3656958 COIS- Competing Interests: Oliver Grottke has received research funding from Novo Nordisk, Biotest, CSL Behring, Nycomed and honoraria for consultancy from Bayer Healthcare and Boehringer Ingelheim. Rolf Rossaint has received honoraria for lectures and consultancy from CSL Behring and Novo Nordisk. Hugo ten Cate has received speaker fees from Bayer, Boehringer Ingelheim, GlaxoSmithKline and Leo Pharma. There are no further patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. EDAT- 2013/05/23 06:00 MHDA- 2013/12/16 06:00 PMCR- 2013/05/17 CRDT- 2013/05/23 06:00 PHST- 2012/12/20 00:00 [received] PHST- 2013/04/08 00:00 [accepted] PHST- 2013/05/23 06:00 [entrez] PHST- 2013/05/23 06:00 [pubmed] PHST- 2013/12/16 06:00 [medline] PHST- 2013/05/17 00:00 [pmc-release] AID - PONE-D-12-40774 [pii] AID - 10.1371/journal.pone.0064100 [doi] PST - epublish SO - PLoS One. 2013 May 17;8(5):e64100. doi: 10.1371/journal.pone.0064100. Print 2013. PMID- 23694891 OWN - NLM STAT- MEDLINE DCOM- 20130722 LR - 20130925 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 6 DP - 2013 Jun TI - Practical application of point-of-care coagulation testing to guide treatment decisions in trauma. PG - 1587-98 LID - 10.1097/TA.0b013e31828c3171 [doi] FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria. herbert.schoechl@auva.at FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Grassetto, Alberto AU - Grassetto A FAU - Schlimp, Christoph J AU - Schlimp CJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/therapy MH - *Blood Coagulation Tests MH - Humans MH - *Point-of-Care Systems MH - Wounds and Injuries/complications/*diagnosis/therapy EDAT- 2013/05/23 06:00 MHDA- 2013/07/23 06:00 CRDT- 2013/05/23 06:00 PHST- 2013/05/23 06:00 [entrez] PHST- 2013/05/23 06:00 [pubmed] PHST- 2013/07/23 06:00 [medline] AID - 01586154-201306000-00031 [pii] AID - 10.1097/TA.0b013e31828c3171 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Jun;74(6):1587-98. doi: 10.1097/TA.0b013e31828c3171. PMID- 23694890 OWN - NLM STAT- MEDLINE DCOM- 20130722 LR - 20220408 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 6 DP - 2013 Jun TI - Tranexamic acid in trauma: how should we use it? PG - 1575-86 LID - 10.1097/TA.0b013e318292cc54 [doi] FAU - Napolitano, Lena M AU - Napolitano LM AD - Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109-5033, USA. lenan@umich.edu FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Cotton, Bryan A AU - Cotton BA FAU - Schreiber, Martin A AU - Schreiber MA FAU - Moore, Ernest E AU - Moore EE LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) SB - IM CIN - J Trauma Acute Care Surg. 2013 Oct;75(4):743. doi: 10.1097/TA.0b013e3182a53873. PMID: 24064892 CIN - J Trauma Acute Care Surg. 2013 Oct;75(4):743-4. doi: 10.1097/01.ta.0000436141.01515.9a. PMID: 24064893 MH - Antifibrinolytic Agents/*therapeutic use MH - Hemorrhage/drug therapy MH - Humans MH - Thrombelastography MH - Tranexamic Acid/*therapeutic use MH - Treatment Outcome MH - Wounds and Injuries/*drug therapy EDAT- 2013/05/23 06:00 MHDA- 2013/07/23 06:00 CRDT- 2013/05/23 06:00 PHST- 2013/05/23 06:00 [entrez] PHST- 2013/05/23 06:00 [pubmed] PHST- 2013/07/23 06:00 [medline] AID - 01586154-201306000-00030 [pii] AID - 10.1097/TA.0b013e318292cc54 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Jun;74(6):1575-86. doi: 10.1097/TA.0b013e318292cc54. PMID- 23624773 OWN - NLM STAT- MEDLINE DCOM- 20140102 LR - 20130429 IS - 1473-5695 (Electronic) IS - 0969-9546 (Linking) VI - 20 IP - 3 DP - 2013 Jun TI - Rotational thrombolelastometry produces potentially clinical useful results within 10 min in bleeding emergency department patients: the DEUCE study. PG - 160-6 LID - 10.1097/MEJ.0b013e3283561261 [doi] AB - OBJECTIVES AND BACKGROUND: For the first time in the Emergency Department (ED), to assess the use of rotational thromboelastometry (ROTEM) in patients presenting with all-cause haemodynamic shock, specifically (a) to establish whether a 5- min (A5) or a 10-min result (A10) is accurate compared with a final maximum clot firmness (MCF) result; (b) to compare time to A10 and formal laboratory coagulation result; (c) to assess whether bleeding ED trauma, gastrointestinal and aortic aneurysm patients are coagulopathic according to ROTEM; and (d) to compare ROTEM results with formal laboratory coagulation parameters. METHODS: Patients presenting to the ED in haemodynamic shock were recruited. A citrated coagulation sample was taken and once a ROTEM researcher arrived in the ED, was subjected to ROTEM analysis. RESULTS: Between 28 September 2010 and 31 August 2011, 40 patients were recruited (15 gastrointestinal bleeds, 20 major trauma cases and five ruptured abdominal aortic aneurysms). A10 and MCF correlated well (kappa=0.98); A5 and MCF correlated less well (kappa=0.91). The mean time to result (SD) was 57 (28) min for the formal laboratory coagulation result and 50 (45) min for the ROTEM A10 result (including delay to start of analysis). Seven patients were coagulopathic on ROTEM. CONCLUSION: Eighteen percent of bleeding ED patients are coagulopathic using ROTEM including 25% of trauma patients. A 10-min ROTEM clot firmness (A10) is an excellent surrogate for MCF and allows a result to be obtained earlier than formal laboratory results and potentially within 10 min of the patient arriving in the ED. FAU - Reed, Matthew J AU - Reed MJ AD - Emergency Medicine Research Group Edinburgh EMeRGE, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. mattreed1@hotmail.com FAU - Nimmo, Alastair F AU - Nimmo AF FAU - McGee, Danny AU - McGee D FAU - Manson, Lynn AU - Manson L FAU - Neffendorf, Alice E AU - Neffendorf AE FAU - Moir, Linzi AU - Moir L FAU - Donaldson, Lucienne S AU - Donaldson LS LA - eng PT - Journal Article PL - England TA - Eur J Emerg Med JT - European journal of emergency medicine : official journal of the European Society for Emergency Medicine JID - 9442482 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Point-of-Care Systems MH - Prospective Studies MH - Reproducibility of Results MH - Shock/physiopathology/*therapy MH - Thrombelastography/*methods MH - Treatment Outcome MH - Young Adult EDAT- 2013/04/30 06:00 MHDA- 2014/01/03 06:00 CRDT- 2013/04/30 06:00 PHST- 2013/04/30 06:00 [entrez] PHST- 2013/04/30 06:00 [pubmed] PHST- 2014/01/03 06:00 [medline] AID - 00063110-201306000-00003 [pii] AID - 10.1097/MEJ.0b013e3283561261 [doi] PST - ppublish SO - Eur J Emerg Med. 2013 Jun;20(3):160-6. doi: 10.1097/MEJ.0b013e3283561261. PMID- 23614333 OWN - NLM STAT- MEDLINE DCOM- 20140203 LR - 20131210 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 53 IP - 12 DP - 2013 Dec TI - Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets. PG - 3088-99 LID - 10.1111/trf.12214 [doi] AB - BACKGROUND: Hemorrhage accounts for most preventable trauma deaths, but still the optimal strategy for hemostatic resuscitation remains debated. STUDY DESIGN AND METHODS: This was a prospective study of adult trauma patients admitted to a Level I trauma center. Demography, Injury Severity Score (ISS), transfusion therapy, and mortality were registered. Hemostatic resuscitation was based on a massive transfusion protocol encompassing transfusion packages and thromboelastography (TEG)-guided therapy. RESULTS: A total of 182 patients were included (75% males, median age 43 years, ISS of 17, 92% with blunt trauma). Overall 28-day mortality was 12% with causes of death being exsanguinations (14%), traumatic brain injury (72%, two-thirds expiring within 24 hr), and other (14%). One-fourth, 16 and 15% of the patients, received red blood cells (RBCs), plasma, or platelets (PLTs) within 2 hours from admission and 68, 71, and 75%, respectively, of patients transfused within 24 hours received the respective blood products within the first 2 hours. In patients transfused within 24 hours, the median number of blood products at 2 hours was 5 units of RBCs, 5 units of plasma, and 2 units of PLT concentrates. Nonsurvivors had lower clot strength by kaolin-activated TEG and TEG functional fibrinogen and lower kaolin-tissue factor-activated TEG alpha-angle and lysis after 30 minutes compared to survivors. None of the TEG variables were independent predictors of massive transfusion or mortality. CONCLUSION: Three-fourths of the patients transfused with plasma or PLTs within 24 hours received these in the first 2 hours. Hemorrhage caused 14% of the deaths. We introduced transfusion packages and early TEG-directed hemostatic resuscitation at our hospital 10 years ago and this may have contributed to reducing hemorrhagic trauma deaths. CI - (c) 2013 American Association of Blood Banks. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, the Department of Anesthesia and TraumaCenter 3193, Centre for Head and Orthopedic, and the Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, CeTIR, University of Texas Medical School at Houston, Houston, Texas. FAU - Sorensen, Anne Marie AU - Sorensen AM FAU - Larsen, Claus F AU - Larsen CF FAU - Windelov, Nis A AU - Windelov NA FAU - Stensballe, Jakob AU - Stensballe J FAU - Perner, Anders AU - Perner A FAU - Rasmussen, Lars S AU - Rasmussen LS FAU - Ostrowski, Sisse R AU - Ostrowski SR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130425 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Adult MH - Aged MH - Blood Component Transfusion/*methods MH - Female MH - Hemorrhage/mortality/therapy MH - Humans MH - Male MH - Middle Aged MH - Plasma MH - Platelet Transfusion/*methods MH - Prospective Studies MH - Resuscitation/*methods MH - Thrombelastography/*methods MH - Trauma Centers/statistics & numerical data MH - Wounds and Injuries EDAT- 2013/04/26 06:00 MHDA- 2014/02/04 06:00 CRDT- 2013/04/26 06:00 PHST- 2012/11/15 00:00 [received] PHST- 2013/02/21 00:00 [revised] PHST- 2013/03/01 00:00 [accepted] PHST- 2013/04/26 06:00 [entrez] PHST- 2013/04/26 06:00 [pubmed] PHST- 2014/02/04 06:00 [medline] AID - 10.1111/trf.12214 [doi] PST - ppublish SO - Transfusion. 2013 Dec;53(12):3088-99. doi: 10.1111/trf.12214. Epub 2013 Apr 25. PMID- 23590923 OWN - NLM STAT- MEDLINE DCOM- 20140122 LR - 20140725 IS - 1878-1608 (Electronic) IS - 1753-3740 (Linking) VI - 27 IP - 1 DP - 2013 Mar TI - Emerging haemostatic agents and patient blood management. PG - 141-60 LID - S1521-6896(13)00020-7 [pii] LID - 10.1016/j.bpa.2013.02.004 [doi] AB - The transfusion of allogeneic blood products has been considered as a life-saving procedure for patients suffering from major traumatic injury and those who are undergoing major surgery. The safety of blood products has improved in terms of infectious complications over the last three decades due to advanced donor screening procedures and tests. Nevertheless, non-infectious complications including a blood-type mismatch, volume overload and immunologic and non-immunologic reactions to blood products can adversely affect clinical outcomes. It is thus important to implement a patient-specific strategy in diagnosing bleeding cause(s) and optimising haemostatic therapy. This strategy is an integral part of patient blood management applicable to many perioperative patients. Recent advances in the haemostatic management and transfusion include better understanding of the pathomechanisms of coagulopathy, availability of point-of-care coagulation monitoring and introductions of pathogen-inactivated plasma and factor concentrates as well as recombinant coagulation factors. Understanding the indications and limitations of conventional haemostatic therapy, and potential indications and complications relating to emerging haemostatic agents, is important for perioperative physicians. In this article, we discuss current issues related to allogeneic plasma products and emerging biological haemostatic agents and techniques. Further, we review the mechanisms of action and available preclinical or clinical data for each therapeutic agent. CI - Copyright (c) 2013 Elsevier Ltd. All rights reserved. FAU - Tanaka, Kenichi A AU - Tanaka KA AD - Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH C-215, Pittsburgh, PA 15213, USA. tanakak@upmc.edu FAU - Kor, Daryl J AU - Kor DJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Netherlands TA - Best Pract Res Clin Anaesthesiol JT - Best practice & research. Clinical anaesthesiology JID - 101121446 RN - 0 (Hemostatics) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Plasma, artificial FSB-FSP) SB - IM EIN - Best Pract Res Clin Anaesthesiol. 2013 Jun;27(2):289 MH - Animals MH - Blood Transfusion/methods/*trends MH - Disease Management MH - Hemorrhage/blood/*therapy MH - Hemostatics/*therapeutic use MH - Humans MH - Isotonic Solutions/therapeutic use MH - Plasma Substitutes/therapeutic use MH - Platelet Transfusion/methods/trends EDAT- 2013/04/18 06:00 MHDA- 2014/01/23 06:00 CRDT- 2013/04/18 06:00 PHST- 2013/02/11 00:00 [received] PHST- 2013/02/20 00:00 [accepted] PHST- 2013/04/18 06:00 [entrez] PHST- 2013/04/18 06:00 [pubmed] PHST- 2014/01/23 06:00 [medline] AID - S1521-6896(13)00020-7 [pii] AID - 10.1016/j.bpa.2013.02.004 [doi] PST - ppublish SO - Best Pract Res Clin Anaesthesiol. 2013 Mar;27(1):141-60. doi: 10.1016/j.bpa.2013.02.004. PMID- 23587157 OWN - NLM STAT- MEDLINE DCOM- 20140128 LR - 20220330 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 21 DP - 2013 Apr 16 TI - Thrombelastography (TEG(R)): practical considerations on its clinical use in trauma resuscitation. PG - 29 LID - 10.1186/1757-7241-21-29 [doi] AB - BACKGROUND: Thrombelastography is a laboratorial test that measures viscoelastic changes of the entire clotting process. There is growing interest in its clinical use in trauma resuscitation, particularly for managing acute coagulopathy of trauma and assisting decision making concerning transfusion. This review focuses on the clinical use of thrombelastography in trauma, with practical points to consider on its use in civilian and military settings. METHODS: A search in the literature using the terms "thrombelastography AND trauma" was performed in PUBMED database. We focused the review on the main clinical aspects of this viscoelastic method in diagnosing and treating patients with acute coagulopathy of trauma during initial resuscitation. RESULTS: Thrombelastography is not a substitute for conventional laboratorial tests such as INR and aPTT but offers additional information and may guide blood transfusion. Thrombelastography can be used as a point of care test but requires multiple daily calibrations, should be performed by trained personnel and its technique requires standardization. While useful partial results may be available in minutes, the whole test may take as long as other conventional tests. The most important data provided by thrombelastography are clot strength and fibrinolysis. Clot strength measure can establish whether the bleeding is due to coagulopathy or not, and is the key information in thrombelastography-based transfusion algorithms. Thrombelastography is among the few tests that diagnose and quantify fibrinolysis and thus guide the use of anti-fibrinolytic drugs and blood products such as cryoprecipitate and fibrinogen concentrate. It may also diagnose platelet dysfunction and hypercoagulability and potentially prevent inappropriate transfusions of hemostatic blood products to non-coagulopathic patients. CONCLUSIONS: Thrombelastography has characteristics of an ideal coagulation test for use in early trauma resuscitation. It has limitations, but may prove useful as an additional test. Future studies should evaluate its potential to guide blood transfusion and the understanding of the mechanisms of trauma coagulopathy. FAU - da Luz, Luis Teodoro AU - da Luz LT AD - Department of Critical Care Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada. FAU - Nascimento, Bartolomeu AU - Nascimento B FAU - Rizoli, Sandro AU - Rizoli S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20130416 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Algorithms MH - Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Platelets/physiology MH - Fibrinolysis MH - Humans MH - Point-of-Care Systems MH - *Thrombelastography/methods MH - Thrombophilia/diagnosis/physiopathology MH - Wounds and Injuries/complications/*therapy PMC - PMC3637505 EDAT- 2013/04/17 06:00 MHDA- 2014/01/29 06:00 PMCR- 2013/04/16 CRDT- 2013/04/17 06:00 PHST- 2013/01/17 00:00 [received] PHST- 2013/04/07 00:00 [accepted] PHST- 2013/04/17 06:00 [entrez] PHST- 2013/04/17 06:00 [pubmed] PHST- 2014/01/29 06:00 [medline] PHST- 2013/04/16 00:00 [pmc-release] AID - 1757-7241-21-29 [pii] AID - 10.1186/1757-7241-21-29 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2013 Apr 16;21:29. doi: 10.1186/1757-7241-21-29. PMID- 23531394 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20130328 LR - 20220311 IS - 1749-7922 (Print) IS - 1749-7922 (Electronic) IS - 1749-7922 (Linking) VI - 7 Suppl 1 IP - Suppl 1 DP - 2012 Aug 22 TI - TEG(R) and ROTEM(R) in trauma: similar test but different results? PG - S3 LID - 10.1186/1749-7922-7-S1-S3 [doi] AB - INTRODUCTION: Transfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG(R)) and rotational thromboelastometry (ROTEM(R)) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients. METHODS: PUBMED database was reviewed using the keywords "thromboelastography" and "compare", between 2000 and 2011. Original studies directly comparing TEG(R) with ROTEM(R) in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords "thromboelastography" and "trauma" in the PUBMED database. RESULTS: Only 4 studies directly compared TEG(R) with ROTEM(R). One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity. CONCLUSION: Both tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma. FAU - Sankarankutty, Ajith AU - Sankarankutty A AD - Departments of Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada. Sandro.Rizoli@sunnybrook.ca. FAU - Nascimento, Bartolomeu AU - Nascimento B FAU - Teodoro da Luz, Luis AU - Teodoro da Luz L FAU - Rizoli, Sandro AU - Rizoli S LA - eng PT - Journal Article DEP - 20120822 PL - England TA - World J Emerg Surg JT - World journal of emergency surgery : WJES JID - 101266603 PMC - PMC3424963 EDAT- 2013/03/28 06:00 MHDA- 2013/03/28 06:01 PMCR- 2012/08/22 CRDT- 2013/03/28 06:00 PHST- 2013/03/28 06:00 [entrez] PHST- 2013/03/28 06:00 [pubmed] PHST- 2013/03/28 06:01 [medline] PHST- 2012/08/22 00:00 [pmc-release] AID - 1749-7922-7-S1-S3 [pii] AID - 10.1186/1749-7922-7-S1-S3 [doi] PST - ppublish SO - World J Emerg Surg. 2012 Aug 22;7 Suppl 1(Suppl 1):S3. doi: 10.1186/1749-7922-7-S1-S3. Epub 2012 Aug 22. PMID- 23523146 OWN - NLM STAT- MEDLINE DCOM- 20130613 LR - 20220318 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 205 IP - 5 DP - 2013 May TI - Correlation of conventional thrombelastography and rapid thrombelastography in trauma. PG - 521-7; discussion 527 LID - S0002-9610(13)00117-7 [pii] LID - 10.1016/j.amjsurg.2013.01.016 [doi] AB - BACKGROUND: Conventional thrombelastography has been in use for over 6 decades and provides a functional assay of coagulation. Rapid thrombelastography was developed to provide more rapid comprehensive analysis of coagulation status in an emergency setting. The purpose of this study was to determine the correlation of rapid thrombelastographic values with conventional thrombelastographic values in trauma patients. METHODS: We performed a prospective study on trauma patients at a university level 1 trauma center. Conventional thrombelastography and rapid thrombelastography were performed on 190 consecutive major trauma patients upon admission between 2010 and 2012. Conventional thrombelastographic and rapid thrombelastographic parameters were analyzed using bivariate analysis with Pearson correlation. Group comparisons were performed using the Mann-Whitney U test. RESULTS: Patients were predominantly male (71.6%, P < .05) with a median Injury Severity Score of 17 (range 10 to 29) and a median age of 43 years (range 29 to 53 years). There were significantly more patients with blunt trauma than penetrating trauma (72% vs 28%, P < .05). There was a strong correlation between the rapid thrombelastographic and conventional thrombelastographic maximal amplitude value, which represents platelet function (r = .80). There was a moderate correlation between the G (overall clot strength, r = .70), k (speed of clot formation, r = .66), and alpha-angle (r = .38), which reflects the degree of fibrin cross-linking. Lysis at 30 minutes correlated poorly (r = .19). CONCLUSIONS: Overall, there is a strong correlation between rapid thrombelastography and conventional thrombelastography in terms of overall clot strength and platelet function. There is a moderate correlation in assessing the degree of fibrin cross-linking and a poor correlation in evaluating thrombolysis. These correlations should be considered when evaluating coagulation status using rapid thrombelastography. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Lee, Tim H AU - Lee TH AD - Department of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR 97239-3098, USA. FAU - McCully, Belinda H AU - McCully BH FAU - Underwood, Samantha J AU - Underwood SJ FAU - Cotton, Bryan A AU - Cotton BA FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130320 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Statistics, Nonparametric MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications EDAT- 2013/03/26 06:00 MHDA- 2013/06/14 06:00 CRDT- 2013/03/26 06:00 PHST- 2012/10/29 00:00 [received] PHST- 2013/01/14 00:00 [revised] PHST- 2013/01/17 00:00 [accepted] PHST- 2013/03/26 06:00 [entrez] PHST- 2013/03/26 06:00 [pubmed] PHST- 2013/06/14 06:00 [medline] AID - S0002-9610(13)00117-7 [pii] AID - 10.1016/j.amjsurg.2013.01.016 [doi] PST - ppublish SO - Am J Surg. 2013 May;205(5):521-7; discussion 527. doi: 10.1016/j.amjsurg.2013.01.016. Epub 2013 Mar 20. PMID- 23515053 OWN - NLM STAT- MEDLINE DCOM- 20140422 LR - 20151119 IS - 1523-1755 (Electronic) IS - 0085-2538 (Linking) VI - 84 IP - 1 DP - 2013 Jul TI - Hemostasis in patients with acute kidney injury secondary to acute liver failure. PG - 158-63 LID - 10.1038/ki.2013.92 [doi] AB - Acute kidney injury (AKI) occurs in over half of patients with acute liver failure. Despite prolonged prothrombin times and thrombocytopenia, continuous renal replacement therapy circuits frequently develop clots during patient treatment. Here we assessed factors contributing to this by measuring coagulation parameters (standard coagulation tests, pro- and anticoagulant factors, thromboelastography, and thrombin generation) in 20 consecutive patients with acute liver failure; mean age 42 years. Within 48 h, 10 had developed stage 3 AKI and 9 required continuous renal replacement therapy, of whom 2 had frequent circuit clots. The patients with stage 3 AKI were found to have significantly lower platelet counts and levels of factor V and the natural anticoagulants antithrombin, Protein C and Protein S, but increased extrinsic pathway activation and von Willebrand factor levels. Tissue factor levels were greater in those with stage 3 AKI, as was microparticle activity. Although patients with acute liver failure and advanced AKI requiring continuous renal replacement therapy have an even more marked thrombocytopenia and more prolonged extrinsic pathway activation, this was not associated with increased bleeding. Thus, more frequent circuit clots during continuous renal replacement therapy appear to be due to a combination of increased tissue factor and microparticle release, endothelial activation, and reduction in natural anticoagulants. FAU - Agarwal, Banwari AU - Agarwal B AD - Intensive Care Unit, Royal Free Hospital, London, UK. FAU - Gatt, Alex AU - Gatt A FAU - Riddell, Anne AU - Riddell A FAU - Wright, Gavin AU - Wright G FAU - Chowdary, Pratima AU - Chowdary P FAU - Jalan, Rajiv AU - Jalan R FAU - Burroughs, Andrew K AU - Burroughs AK FAU - Davenport, Andrew AU - Davenport A LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130320 PL - United States TA - Kidney Int JT - Kidney international JID - 0323470 RN - 0 (Biomarkers) RN - 0 (Blood Coagulation Factors) RN - EC 3.4.21.5 (Thrombin) SB - IM CIN - Kidney Int. 2013 Jul;84(1):22-4. doi: 10.1038/ki.2013.121. PMID: 23812363 MH - Acute Kidney Injury/*blood/*etiology/therapy MH - Adult MH - Analysis of Variance MH - Biomarkers/blood MH - Blood Coagulation MH - Blood Coagulation Factors/analysis MH - Blood Coagulation Tests MH - Chi-Square Distribution MH - Female MH - *Hemostasis MH - Humans MH - Liver Failure, Acute/*blood/*complications MH - Male MH - Middle Aged MH - Platelet Count MH - Predictive Value of Tests MH - Renal Replacement Therapy/adverse effects MH - Risk Factors MH - Severity of Illness Index MH - Thrombin/analysis MH - Thrombocytopenia/blood/etiology MH - Thrombosis/blood/etiology MH - Time Factors EDAT- 2013/03/22 06:00 MHDA- 2014/04/23 06:00 CRDT- 2013/03/22 06:00 PHST- 2012/10/27 00:00 [received] PHST- 2013/01/05 00:00 [revised] PHST- 2013/01/10 00:00 [accepted] PHST- 2013/03/22 06:00 [entrez] PHST- 2013/03/22 06:00 [pubmed] PHST- 2014/04/23 06:00 [medline] AID - S0085-2538(15)55933-4 [pii] AID - 10.1038/ki.2013.92 [doi] PST - ppublish SO - Kidney Int. 2013 Jul;84(1):158-63. doi: 10.1038/ki.2013.92. Epub 2013 Mar 20. PMID- 23494019 OWN - NLM STAT- MEDLINE DCOM- 20131118 LR - 20220321 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 109 IP - 5 DP - 2013 May TI - A novel coagulation assay incorporating adherent endothelial cells in thromboelastometry. PG - 869-77 LID - 10.1160/TH12-10-0767 [doi] AB - Following vascular injury or activation, endothelial cells (ECs) participate in the modulation of haemostasis and fibrinolysis. Viscoelastic tests (VETs) are a potent bedside monitoring tool that reports haemostatic parameters in real time. However, VETs neglect the influence of the surrounding endothelium. Our aim was therefore to establish an assay that incorporates ECs in a whole blood VET and to assess the impact of ECs on coagulation parameters. Outgrowth endothelial cells (OECs) and human umbilical vein endothelial cells (HUVECs) were seeded onto microbeads to create transferable EC-microcarriers. Microbeads were then added to citrated whole blood in the measurement cup of a thromboelastometry device (ROTEM). After the addition of CaCl2 (star-TEM(R)) to the blood sample (NATEM assay), standard ROTEM parameters were analysed. Scanning electron microscopy (SEM) was carried out to visualise the interactions of the beads, whole blood components and the ROTEM pin after clotting. SEM showed that the added microbeads were effectively incorporated into the final blood clot. In the presence of activated ECs, the clotting time (CT) of the blood was shortened fourfold compared to that in uncoated control beads. A significant reduction in CT was also observed in the presence of unstimulated ECs. Interestingly, CT was also reduced by the addition of purified EC culture supernatant. CT shortening was prevented by incubating the supernatant with an inhibiting antibody against tissue factor (TF). Our findings demonstrate that ECs can be incorporated into a ROTEM assay via coated microbeads, and whole blood clotting initiation is accelerated by non-activated and activated ECs. FAU - Zipperle, J AU - Zipperle J AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Donaueschingenstrasse 13, Vienna, Austria. FAU - Schlimp, C J AU - Schlimp CJ FAU - Holnthoner, W AU - Holnthoner W FAU - Husa, A-M AU - Husa AM FAU - Nurnberger, S AU - Nurnberger S FAU - Redl, H AU - Redl H FAU - Schochl, H AU - Schochl H LA - eng PT - Journal Article PT - Validation Study DEP - 20130314 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Culture Media, Conditioned) RN - 9035-58-9 (Thromboplastin) SB - IM MH - *Blood Coagulation MH - *Cell Adhesion MH - Cells, Cultured MH - Culture Media, Conditioned/metabolism MH - Human Umbilical Vein Endothelial Cells/*metabolism MH - Humans MH - Microscopy, Electron, Scanning MH - Microspheres MH - Predictive Value of Tests MH - Reproducibility of Results MH - Thrombelastography/instrumentation/*methods MH - Thromboplastin/metabolism EDAT- 2013/03/16 06:00 MHDA- 2013/11/19 06:00 CRDT- 2013/03/16 06:00 PHST- 2012/10/23 00:00 [received] PHST- 2013/02/05 00:00 [accepted] PHST- 2013/03/16 06:00 [entrez] PHST- 2013/03/16 06:00 [pubmed] PHST- 2013/11/19 06:00 [medline] AID - 12-10-0767 [pii] AID - 10.1160/TH12-10-0767 [doi] PST - ppublish SO - Thromb Haemost. 2013 May;109(5):869-77. doi: 10.1160/TH12-10-0767. Epub 2013 Mar 14. PMID- 23446185 OWN - NLM STAT- MEDLINE DCOM- 20130814 LR - 20130228 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 26 IP - 2 DP - 2013 Apr TI - Logistics of transfusion support for patients with massive hemorrhage. PG - 208-14 LID - 10.1097/ACO.0b013e32835d6f8f [doi] AB - PURPOSE OF REVIEW: Traditionally, trauma resuscitation protocols have advocated sequential administration of therapeutic components, beginning with crystalloid solutions infused to replace lost intravascular volume. However, rapid restoration of the components of blood is essential for ensuring adequate tissue perfusion and for preventing acidosis, coagulopathy, and hypothermia, referred to as the 'lethal triad' in trauma settings. The review summarizes practical approaches for transfusion support of patients with massive hemorrhage. RECENT FINDINGS: Massive transfusion protocols for blood transfusion support are reviewed, including practical considerations from our own. We maintain an inventory of thawed, previously frozen plasma (four units each of blood group O and A), which can be issued immediately for patients in whom the blood type is known. As frozen plasma requires 45 min to thaw, liquid AB plasma (26 day outdate) functions as an excellent alternative, particularly for patients with unknown or blood group B or AB types. SUMMARY: Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions to optimize patients' coagulation, reduce exposure to blood products, and to improve patient outcomes. Future studies are needed to understand and demonstrate improved patient outcomes. FAU - Goodnough, Lawrence T AU - Goodnough LT AD - Department of Pathology, Stanford University, Stanford, California, USA. ltgoodno@stanford.edu FAU - Spain, David A AU - Spain DA FAU - Maggio, Paul AU - Maggio P LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Blood Coagulation Disorders/therapy MH - *Blood Transfusion MH - Hemorrhage/*therapy MH - Humans MH - Point-of-Care Systems MH - Thrombelastography EDAT- 2013/03/01 06:00 MHDA- 2013/08/15 06:00 CRDT- 2013/03/01 06:00 PHST- 2013/03/01 06:00 [entrez] PHST- 2013/03/01 06:00 [pubmed] PHST- 2013/08/15 06:00 [medline] AID - 00001503-201304000-00019 [pii] AID - 10.1097/ACO.0b013e32835d6f8f [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2013 Apr;26(2):208-14. doi: 10.1097/ACO.0b013e32835d6f8f. PMID- 23425732 OWN - NLM STAT- MEDLINE DCOM- 20130708 LR - 20220310 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 74 IP - 3 DP - 2013 Mar TI - Platelets are dominant contributors to hypercoagulability after injury. PG - 756-62; discussion 762-5 LID - 10.1097/TA.0b013e3182826d7e [doi] AB - BACKGROUND: Venous thromboembolic (VTE) disease has a high incidence following trauma, but debate remains regarding optimal prophylaxis. Thrombelastography (TEG) has been suggested to be optimal in guiding prophylaxis. Thus, we designed a phase II randomized controlled trial to test the hypothesis that TEG-guided prophylaxis with escalating low-molecular weight heparin (LMWH), followed by antiplatelet therapy would reduce VTE incidence. METHODS: Surgical intensive care unit trauma patients (n = 50) were randomized to receive 5,000 IU of LMWH daily (control) or to TEG-guided prophylaxis, up to 5,000 IU twice daily with the addition of aspirin, and were followed up for 5 days. In vitro studies were also conducted in which apheresis platelets were added to blood from healthy volunteers (n = 10). RESULTS: Control (n = 25) and TEG-guided prophylaxis (n = 25) groups were similar in age, body mass index, Injury Severity Score, and male sex. Fibrinogen levels and platelet counts did not differ, and increased LMWH did not affect clot strength between the control and study groups. The correlation of clot strength (G value) with fibrinogen was stronger on Days 1 and 2 but was superseded by platelet count on Days 3, 4, and 5. There was also a trend in increased platelet contribution to clot strength in patients receiving increased LMWH. In vitro studies demonstrated apheresis platelets significantly increased clot strength (7.19 +/- 0.35 to 10.34 +/- 0.29), as well as thrombus generation (713.86 +/- 12.19 to 814.42 +/- 7.97) and fibrin production (274.03 +/- 15.82 to 427.95 +/- 16.58). CONCLUSION: Increased LMWH seemed to increase platelet contribution to clot strength early in the study but failed to affect the overall rise clot strength. Over time, platelet count had the strongest correlation with clot strength, and in vitro studies demonstrated that increased platelet counts increase fibrin production and thrombus generation. In sum, these data suggest an important role for antiplatelet therapy in VTE prophylaxis following trauma, particularly after 48 hours. LEVEL OF EVIDENCE: Therapeutic study, level III. FAU - Harr, Jeffrey N AU - Harr JN AD - Department of Surgery, University of Colorado Denver, Aurora, Colorado, USA. FAU - Moore, Ernest E AU - Moore EE FAU - Chin, Theresa L AU - Chin TL FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Wohlauer, Max V AU - Wohlauer MV FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Clinical Trial, Phase II PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Adult MH - Anticoagulants/administration & dosage MH - *Blood Coagulation MH - Blood Platelets/*physiology MH - Dose-Response Relationship, Drug MH - Female MH - Follow-Up Studies MH - Heparin, Low-Molecular-Weight/*administration & dosage MH - Humans MH - Injury Severity Score MH - Male MH - Platelet Aggregation Inhibitors/*administration & dosage MH - Platelet Count MH - Prognosis MH - Prospective Studies MH - Thrombelastography MH - Thrombophilia/*blood/complications/drug therapy MH - Thrombosis/blood/*etiology/prevention & control MH - Wounds and Injuries/blood/*complications/diagnosis PMC - PMC3736746 MID - NIHMS481315 EDAT- 2013/02/22 06:00 MHDA- 2013/07/09 06:00 PMCR- 2013/08/07 CRDT- 2013/02/22 06:00 PHST- 2013/02/22 06:00 [entrez] PHST- 2013/02/22 06:00 [pubmed] PHST- 2013/07/09 06:00 [medline] PHST- 2013/08/07 00:00 [pmc-release] AID - 01586154-201303000-00007 [pii] AID - 10.1097/TA.0b013e3182826d7e [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Mar;74(3):756-62; discussion 762-5. doi: 10.1097/TA.0b013e3182826d7e. PMID- 23411504 OWN - NLM STAT- MEDLINE DCOM- 20140117 LR - 20130620 IS - 1477-111X (Electronic) IS - 0267-6591 (Linking) VI - 28 IP - 4 DP - 2013 Jul TI - Mini-extracorporeal circulation minimizes coagulation abnormalities and ameliorates pulmonary outcome in coronary artery bypass grafting surgery. PG - 298-305 LID - 10.1177/0267659113478322 [doi] AB - Hemostasis is impaired during CABG and coagulation abnormalities often result in clinically relevant organ dysfunctions, eventually increasing morbidity and mortality rates. Fifteen consecutive patients with coronary artery disease submitted to conventional extracorporeal circulation (cECC) have been compared with 15 matched patients, using mini-ECC (MECC). Postoperative lung function was evaluated according to gas exchange, intubation time and lung injury score. In the MECC group, thrombin-antithrombin complex levels (TaTc), prothrombin fragments (PF1+2) formation and thromboelastography (TEG) clotting times were lower compared to the cECC group (p=0.002 and p<0.001, respectively) whereas postoperative blood loss was higher in the cECC group (p=0.030) and more patients required blood transfusion (p=0.020). In the MECC group, postoperative gas exchange values were better, intubation time shorter and lung injury score lower (p<0.001 for all comparisons). Our study suggests that MECC induces less coagulation disorders, leading to lower postoperative blood loss and better postoperative lung function. This approach may be advantageous in high-risk patients. FAU - Zeitani, J AU - Zeitani J AD - Department of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy. FAU - Buccisano, F AU - Buccisano F FAU - Nardella, S AU - Nardella S FAU - Flaminio, M AU - Flaminio M FAU - Prati, P AU - Prati P FAU - Chiariello, G AU - Chiariello G FAU - Venditti, A AU - Venditti A FAU - Chiariello, L AU - Chiariello L LA - eng PT - Journal Article DEP - 20130214 PL - England TA - Perfusion JT - Perfusion JID - 8700166 SB - IM MH - Aged MH - *Blood Coagulation MH - Coronary Artery Bypass/*adverse effects/*instrumentation MH - Extracorporeal Circulation/*adverse effects/*instrumentation MH - Female MH - Humans MH - Lung/physiology/*physiopathology MH - Male MH - Middle Aged MH - Thrombelastography OTO - NOTNLM OT - coronary artery bypass graft surgery OT - inflammatory response OT - minimal extracorporeal circulation OT - thromboelastography EDAT- 2013/02/16 06:00 MHDA- 2014/01/18 06:00 CRDT- 2013/02/16 06:00 PHST- 2013/02/16 06:00 [entrez] PHST- 2013/02/16 06:00 [pubmed] PHST- 2014/01/18 06:00 [medline] AID - 0267659113478322 [pii] AID - 10.1177/0267659113478322 [doi] PST - ppublish SO - Perfusion. 2013 Jul;28(4):298-305. doi: 10.1177/0267659113478322. Epub 2013 Feb 14. PMID- 23406662 OWN - NLM STAT- MEDLINE DCOM- 20131113 LR - 20181203 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 24 IP - 5 DP - 2013 Jul TI - Influence of resuscitation fluids, fresh frozen plasma and antifibrinolytics on fibrinolysis in a thrombelastography-based, in-vitro, whole-blood model. PG - 489-97 LID - 10.1097/MBC.0b013e32835e4246 [doi] AB - Hyperfibrinolysis has been identified as a mechanism of trauma coagulopathy associated with poor outcome. The aim of the study was to create a trauma coagulopathy model (TCM) with a hyperfibrinolysis thrombelastography (TEG) pattern similar to injured patients and test the effects of different resuscitation fluids and antifibrinolytics on fibrinolysis. TCM was established from whole blood by either 15% dilution with isotonic saline, lactated Ringer's, Plasma-Lyte, 5% albumin, Voluven, Hextend, 6% dextran in isotonic saline or 30% dilution with lactated Ringer's plus Voluven and supplementation with tissue factor and tissue plasminogen activator (tPA). These combinations resulted in a TCM that could then be 'treated' with tranexamic acid (TXA) or 6-aminocaproic acid (ACA). Clot formation was evaluated by TEG. Whole-blood dilution by 15% with crystalloids and albumin in the presence of tissue factor plus tPA resulted in an abnormal TEG pattern and increased fibrinolysis, as did dilution with synthetic colloids. TXA 1 mug/ml or ACA 10 mug/ml were sufficient to suppress fibrinolysis when TCM was diluted 15% with lactated Ringer's, but 3 mug/ml of TXA or 30 mug/ml of ACA were needed for fibrinolysis inhibition induced by simultaneous euvolemic dilution with lactated Ringer's plus Voluven by 30%. A total of 15% dilution of whole blood in the presence of tissue factor plus tPA results in a hyperfibrinolysis TEG pattern similar to that observed in severely injured patients. Synthetic colloids worsen TEG variables with a further increase of fibrinolysis. Low concentrations of TXA or ACA reversed hyperfibrinolysis, but the efficient concentrations were dependent on the degree of fibrinolysis and whole-blood dilution. FAU - Kostousov, Vadim AU - Kostousov V AD - Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. FAU - Wang, Yao-Wei W AU - Wang YW FAU - Cotton, Bryan A AU - Cotton BA FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB FAU - Matijevic, Nena AU - Matijevic N LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Antifibrinolytic Agents) RN - 0 (Colloids) RN - 0 (Crystalloid Solutions) RN - 0 (Isotonic Solutions) RN - 0 (Pharmaceutical Solutions) RN - 6T84R30KC1 (Tranexamic Acid) RN - U6F3787206 (Aminocaproic Acid) SB - IM MH - Aminocaproic Acid/pharmacology MH - Antifibrinolytic Agents/*pharmacology MH - Blood Coagulation Disorders/etiology MH - Colloids MH - Crystalloid Solutions MH - Female MH - Fibrinolysis/*drug effects MH - Humans MH - In Vitro Techniques MH - Isotonic Solutions/*pharmacology MH - Male MH - Models, Biological MH - Pharmaceutical Solutions/pharmacology MH - *Plasma MH - *Thrombelastography MH - Tranexamic Acid/pharmacology MH - Wounds and Injuries/*complications EDAT- 2013/02/15 06:00 MHDA- 2013/11/14 06:00 CRDT- 2013/02/15 06:00 PHST- 2013/02/15 06:00 [entrez] PHST- 2013/02/15 06:00 [pubmed] PHST- 2013/11/14 06:00 [medline] AID - 10.1097/MBC.0b013e32835e4246 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2013 Jul;24(5):489-97. doi: 10.1097/MBC.0b013e32835e4246. PMID- 23392364 OWN - NLM STAT- MEDLINE DCOM- 20130826 LR - 20230815 IS - 1529-7535 (Print) IS - 1529-7535 (Linking) VI - 14 IP - 3 DP - 2013 Mar TI - Coagulation assessment in children with diabetic ketoacidosis. PG - 256-60 LID - 10.1097/PCC.0b013e318271fcb7 [doi] AB - OBJECTIVES: To assess potential hypercoagulability during diabetic ketoacidosis in children. DESIGN: A prospective, controlled pilot study. SETTING: University-affiliated pediatric critical care unit and emergency department in a tertiary care children's hospital. PATIENTS: Children (1-18 years) admitted with an episode of diabetic ketoacidosis and healthy children as controls. All patients with diabetic ketoacidosis managed according to a preestablished protocol. INTERVENTIONS: Thromboelastography was performed using citrated whole-blood samples drawn at the time of admission and upon biochemical and clinical resolution of diabetic ketoacidosis. Citrated whole-blood samples drawn from healthy nondiabetic children acted as control samples. MEASUREMENTS AND MAIN RESULTS: Fifteen patients (11.7 +/- 4.1 years) in the diabetic ketoacidosis group and 20 patients (8.9 +/- 4.5 years; p = 0.06) in the control group completed the study. Values for standard thromboelastography parameters (R and K time, alpha angle, maximum amplitude, coagulation index, and Ly30) in the diabetic ketoacidosis group, both on admission and resolution, were within the control range; thromboelastography profiles of diabetic ketoacidosis patients on admission were not significantly different from profiles obtained upon diabetic ketoacidosis resolution. The mean alpha-angle was significantly higher in known diabetic patients compared with newly diagnosed diabetics on admission; however, it still remained within the control normal range. CONCLUSIONS: Thromboelastographic assay results do not reflect a hypercoagulable state in this group of children with diabetic ketoacidosis. Further investigation is required to examine the potential role of injured endothelium in the suspected hypercoagulability during diabetic ketoacidosis. FAU - Tran, Thai Hoa AU - Tran TH AD - Critical Care Unit, Department of Paediatrics, Children's Hospital, University of Western Ontario, London, Ontario, Canada. FAU - Al-Harfi, Ibrahim AU - Al-Harfi I FAU - Harle, Christopher C AU - Harle CC FAU - Kahr, Walter H A AU - Kahr WH FAU - Morrison, Gavin C AU - Morrison GC FAU - Kornecki, Alik AU - Kornecki A LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Pediatr Crit Care Med JT - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JID - 100954653 SB - IM CIN - Pediatr Crit Care Med. 2013 Mar;14(3):325-6. doi: 10.1097/PCC.0b013e31827d0e70. PMID: 23462354 MH - Adolescent MH - Case-Control Studies MH - Child MH - Child, Preschool MH - Diabetic Ketoacidosis/*complications MH - Female MH - Humans MH - Infant MH - Male MH - Pilot Projects MH - Prospective Studies MH - *Thrombelastography MH - Thrombophilia/*diagnosis/etiology EDAT- 2013/02/09 06:00 MHDA- 2013/08/27 06:00 CRDT- 2013/02/09 06:00 PHST- 2013/02/09 06:00 [entrez] PHST- 2013/02/09 06:00 [pubmed] PHST- 2013/08/27 06:00 [medline] AID - 10.1097/PCC.0b013e318271fcb7 [doi] PST - ppublish SO - Pediatr Crit Care Med. 2013 Mar;14(3):256-60. doi: 10.1097/PCC.0b013e318271fcb7. PMID- 23385320 OWN - NLM STAT- MEDLINE DCOM- 20130814 LR - 20131121 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 26 IP - 2 DP - 2013 Apr TI - Potential value of protocols in substantially bleeding trauma patients. PG - 215-20 LID - 10.1097/ACO.0b013e32835e8c9b [doi] AB - PURPOSE OF REVIEW: Early identification of shock and coagulopathy coupled with damage control resuscitation are central tenets of early trauma management. In traumatic injury, haemorrhage is responsible for almost 50% of deaths occurring within the first 24 h of injury and up to 80% of intraoperative trauma mortalities. Immediate haemorrhagic mortality constitutes the largest group of potentially preventable deaths in the initial 24-h period. This review will discuss the recent changes and advancement of early traumatic coagulopathy and the important role of substantial bleeding protocols (SBPs). RECENT FINDINGS: Ho et al. examined survivor bias and determined when accounting for survivor bias improved survival outcome with higher fresh frozen plasma: red blood cell ratios. The PROMMTT study, a 10-centre observation trial, highlighted the variable nature of infusion, the importance of time and improved outcomes with higher product ratios. SUMMARY: An SBP addresses the organizational issues necessary to respond to massive blood loss in an immediate and sustained manner. It reduces provider variability, facilitates staff communication and compliance, and simplifies the administration of predefined ratios of blood components. A transfusion subcommittee should be formed to directly address the complex issues of implementing a SBP system. FAU - Holcomb, John B AU - Holcomb JB AD - Division of Acute Care Surgery, Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas, USA. John.Holcomb@uth.tmc.edu FAU - Gumbert, Sam AU - Gumbert S LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 6T84R30KC1 (Tranexamic Acid) SB - IM MH - Blood Coagulation Disorders/*therapy MH - Blood Coagulation Tests MH - *Clinical Protocols MH - Hemorrhage/*therapy MH - Humans MH - Thrombelastography MH - Tranexamic Acid/therapeutic use MH - Wounds and Injuries/*complications EDAT- 2013/02/07 06:00 MHDA- 2013/08/15 06:00 CRDT- 2013/02/07 06:00 PHST- 2013/02/07 06:00 [entrez] PHST- 2013/02/07 06:00 [pubmed] PHST- 2013/08/15 06:00 [medline] AID - 10.1097/ACO.0b013e32835e8c9b [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2013 Apr;26(2):215-20. doi: 10.1097/ACO.0b013e32835e8c9b. PMID- 23354242 OWN - NLM STAT- MEDLINE DCOM- 20130405 LR - 20131121 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 2 DP - 2013 Feb TI - Recombinant tissue-type plasminogen activator-evoked hyperfibrinolysis is enhanced by acidosis and inhibited by hypothermia but still can be blocked by tranexamic acid. PG - 482-8 LID - 10.1097/TA.0b013e318280dec1 [doi] AB - BACKGROUND: Hypothermia and acidosis have been suggested as key initiators of trauma-induced coagulopathy, and severe bleeding caused by hyperfibrinolysis (HF) predicts mortality. We tested in vitro (1) whether clinically relevant grades of hypothermia, acidosis, and their combination impact on recombinant tissue-type plasminogen activator (r-tPA)-evoked HF and assessed (2) the efficacy of tranexamic acid (TA) in inhibiting fibrinolysis under such conditions. METHODS: To assess the effects of r-tPA-evoked HF, venous blood (3,000 muL) from healthy volunteers was incubated with r-tPA (final concentration, 100 ng/mL) or saline (control) for 30 minutes at the final measurement temperature. Before thromboelastometric measurements, samples were acidified (addition of 40 muL of 0.5 or 1N hydrochloric acid, respectively) to achieve a pH (alpha-stat) of approximately 7.1 or 6.9, respectively. To assess effects of hypothermia, tests were performed at blood/thromboelastometer temperatures of 33 degrees C and 37 degrees C, respectively. Coagulation was analyzed using rotational thromboelastometry (ROTEM), particularly assessing the Clot Lysis Index (CLI) after 45 minutes (CLI45) in extrinsically activated assays (EXTEM). RESULTS: Addition of r-tPA evoked fibrinolysis (CLI45: median, 64; 25th/75th percentile, 48/80) compared with saline controls (CLI45: median, 93; 25th/75th percentile, 91/96). Moderate acidosis (pH [mean +/- SD], 7.12 +/- 0.03) did not affect r-tPA-induced fibrinolysis. However, severe acidosis (pH, 6.91 +/- 0.02) significantly aggravated r-tPA-induced fibrinolysis (CLI45: median, 49; 25th/75th percentile, 26/71; p = 0.0039) compared with fibrinolysis with normal pH and normothermia (median, 77; 25th/75th percentile, 65.5/83). In contrast, hypothermia (33 degrees C) at normal pH (median +/- SD, 7.37 +/- 0.02) markedly mitigated fibrinolysis (CLI45: median, 94; 25th/75th percentile, 88/96; p = 0.0156) compared with normothermia (CLI45: median, 64; 25th/75th percentile, 48/80). TA (final concentration, 0.33 mg/mL) abolished r-tPA-evoked fibrinolysis even during severe acidosis (CLI45: median, 92; 25th/75th percentile, 86.5/94; p = 0.0039). CONCLUSION: Severe acidosis significantly increases r-tPA-evoked fibrinolysis, whereas hypothermia markedly mitigates HF. The latter finding may imply that rapid rewarming of trauma patients might aggravate fibrinolysis. TA reliably abolished fibrinolysis also under these conditions, supporting its role in trauma-induced coagulopathy. FAU - Dirkmann, Daniel AU - Dirkmann D AD - Klinik fur Anasthesiologie und Intensivmedizin, Universitat Duisburg-Essen and Universitatsklinikum Essen, Germany. Daniel.Dirkmann@uni-duisburg-essen.de FAU - Radu-Berlemann, Julia AU - Radu-Berlemann J FAU - Gorlinger, Klaus AU - Gorlinger K FAU - Peters, Jurgen AU - Peters J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Fibrinolytic Agents) RN - 0 (Recombinant Proteins) RN - 6T84R30KC1 (Tranexamic Acid) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Acidosis/*complications MH - Adult MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/chemically induced/drug therapy/*etiology MH - Female MH - Fibrinolytic Agents/adverse effects/*therapeutic use MH - Humans MH - *Hypothermia, Induced MH - Male MH - Recombinant Proteins/adverse effects/therapeutic use MH - Thrombelastography MH - Tissue Plasminogen Activator/adverse effects/*therapeutic use MH - Tranexamic Acid/*therapeutic use MH - Wounds and Injuries/*complications/drug therapy EDAT- 2013/01/29 06:00 MHDA- 2013/04/06 06:00 CRDT- 2013/01/29 06:00 PHST- 2013/01/29 06:00 [entrez] PHST- 2013/01/29 06:00 [pubmed] PHST- 2013/04/06 06:00 [medline] AID - 01586154-201302000-00020 [pii] AID - 10.1097/TA.0b013e318280dec1 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Feb;74(2):482-8. doi: 10.1097/TA.0b013e318280dec1. PMID- 23354228 OWN - NLM STAT- MEDLINE DCOM- 20130405 LR - 20220318 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 2 DP - 2013 Feb TI - TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients. PG - 378-85; discussion 385-6 LID - 10.1097/TA.0b013e31827e20e0 [doi] AB - BACKGROUND: For nearly a decade, our center performed thromboelastograms (TEGs) to analyze coagulation profiles, allowing rapid data-driven blood component therapy. After consensus recommendations for massive transfusion protocols (MTPs), we implemented an MTP in October 2009 with 1:1:1 ratio of blood (red blood cells [RBC]), plasma (fresh-frozen plasma [FFP]), and platelets. We hypothesized that TEG-directed resuscitation is equivalent to MTP resuscitation. METHODS: All patients receiving 6 units (U) or more of RBC in the first 24 hours for 21 months before and after MTP initiation in an urban Level I trauma center were examined. Demographics, mechanism of injury (MOI), Injury Severity Score (ISS), 24-hour volume of RBC, FFP, platelets, crystalloid, and 30-day mortality were compared, excluding patients with traumatic brain injuries. Variables were analyzed using Student's t-test and chi2 or Fisher's exact test. RESULTS: For the preMTP group, there were 165 patients. In the MTP group, there were 124 patients. There were no significant differences in ISS, age, or sex. PreMTP patients with 6U or more RBC had significantly more penetrating MOI (p = 0.017), whereas preMTP patients with 10U or more RBC had similar MOIs. All patients received less crystalloid after MTP adoption (p < 0.001). There was no difference in volume of blood products or mortality in patients receiving 6U or more RBC. Blunt trauma MTP patients who received 10U or more RBC received more FFP (p = 0.02), with no change in mortality. Penetrating trauma patients who received 10U or more RBC received a similar volume of FFP; however, mortality increased from 54.1% for MTP versus 33.3% preMTP (p = 0.04). CONCLUSION: TEG-directed resuscitation is equivalent to standardized MTP for patients receiving 6U or more RBC and for blunt MOI patients receiving 10U or more RBC. MTP therapy worsened mortality in penetrating MOI patients receiving 10U or more RBC, indicating a continued need for TEG-directed therapy. A 1:1:1 strategy may not be adequate in all patients. LEVEL OF EVIDENCE: Therapeutic study, level IV. FAU - Tapia, Nicole M AU - Tapia NM AD - Baylor College of Medicine, Houston, Texas, USA. nmtapia@bcm.edu FAU - Chang, Alex AU - Chang A FAU - Norman, Michael AU - Norman M FAU - Welsh, Francis AU - Welsh F FAU - Scott, Bradford AU - Scott B FAU - Wall, Matthew J Jr AU - Wall MJ Jr FAU - Mattox, Kenneth L AU - Mattox KL FAU - Suliburk, James AU - Suliburk J LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Transfusion/*methods MH - Clinical Protocols MH - Erythrocyte Transfusion/methods MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Platelet Transfusion/methods MH - Resuscitation/*methods MH - Retrospective Studies MH - *Thrombelastography/methods MH - Wounds, Penetrating/*therapy EDAT- 2013/01/29 06:00 MHDA- 2013/04/06 06:00 CRDT- 2013/01/29 06:00 PHST- 2013/01/29 06:00 [entrez] PHST- 2013/01/29 06:00 [pubmed] PHST- 2013/04/06 06:00 [medline] AID - 01586154-201302000-00006 [pii] AID - 10.1097/TA.0b013e31827e20e0 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Feb;74(2):378-85; discussion 385-6. doi: 10.1097/TA.0b013e31827e20e0. PMID- 23354227 OWN - NLM STAT- MEDLINE DCOM- 20130405 LR - 20130925 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 2 DP - 2013 Feb TI - Cryopreserved deglycerolized blood is safe and achieves superior tissue oxygenation compared with refrigerated red blood cells: a prospective randomized pilot study. PG - 371-6; discussion 376-7 LID - 10.1097/TA.0b013e31827e1d40 [doi] AB - BACKGROUND: During preservation, donated liquid red blood cells (RBCs) experience multiple functional and structural changes known as the storage lesion. Increased RBC age is associated with increased infection rates, organ failure, and mortality. METHODS: This prospective, randomized, double-blinded pilot study enrolled stable trauma patients who required RBC transfusion. Patients were randomly assigned to receive standard or cryopreserved RBCs. Continuous tissue oxygenation (StO2) monitoring was performed during the peritransfusion period. Hematocrit and thrombelastography before and after transfusion were evaluated. Patients were monitored for transfusion reactions and clinical outcomes. RESULTS: Fifty-seven patients were randomized, and groups were well matched for demographics and Injury Severity Score (ISS). No statistically significant differences were noted in hematocrit change, thrombelastography parameters, transfusion reactions, or clinical outcomes. StO2 was found to be higher in the cryopreserved group. CONCLUSION: Cryopreserved RBCs are equally safe and efficacious to refrigerated RBCs. This storage technique extends the life span of RBCs to 10 years, potentially preserving a precious resource and preventing the storage lesion. StO2 was superior in patients receiving cryopreserved RBCs. This finding has the potential to drive a paradigm shift in transfusion practices. LEVEL OF EVIDENCE: Therapeutic study, level II. FAU - Fabricant, Loic AU - Fabricant L AD - Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA. fabrican@ohsu.edu FAU - Kiraly, Laszlo AU - Kiraly L FAU - Wiles, Connor AU - Wiles C FAU - Differding, Jerome AU - Differding J FAU - Underwood, Samantha AU - Underwood S FAU - Deloughery, Thomas AU - Deloughery T FAU - Schreiber, Martin AU - Schreiber M LA - eng PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Aged MH - Blood Preservation/*methods MH - Cold Temperature MH - *Cryopreservation MH - Double-Blind Method MH - Erythrocyte Transfusion/*methods MH - Female MH - Hematocrit MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Pilot Projects MH - Prospective Studies MH - Thrombelastography MH - Treatment Outcome MH - Wounds and Injuries/blood/therapy EDAT- 2013/01/29 06:00 MHDA- 2013/04/06 06:00 CRDT- 2013/01/29 06:00 PHST- 2013/01/29 06:00 [entrez] PHST- 2013/01/29 06:00 [pubmed] PHST- 2013/04/06 06:00 [medline] AID - 01586154-201302000-00005 [pii] AID - 10.1097/TA.0b013e31827e1d40 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Feb;74(2):371-6; discussion 376-7. doi: 10.1097/TA.0b013e31827e1d40. PMID- 23351534 OWN - NLM STAT- MEDLINE DCOM- 20130805 LR - 20130128 IS - 1932-2275 (Print) IS - 1932-2275 (Linking) VI - 31 IP - 1 DP - 2013 Mar TI - Point of care devices for assessing bleeding and coagulation in the trauma patient. PG - 55-65 LID - S1932-2275(12)00142-5 [pii] LID - 10.1016/j.anclin.2012.10.006 [doi] AB - Severe trauma is associated with bleeding, coagulopathy, and transfusion of blood and blood products, all contributing to higher rates of morbidity and mortality. The aim of this review is to focus on point-of-care devices to monitor coagulation in trauma. Close monitoring of bleeding and coagulation as well as platelet function in trauma patients allows goal-directed transfusion and an optimization of the patient's coagulation, reduces the exposure to blood products, reduces costs, and probably improves clinical outcome. Noninvasive hemoglobin measurements are not to be used in trauma patients due to a lack in specificity and sensitivity. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Theusinger, Oliver M AU - Theusinger OM AD - Institute of Anesthesiology, University Zurich, University Hospital Zurich, Zurich, Switzerland. oliver.theusinger@usz.ch FAU - Levy, Jerrold H AU - Levy JH LA - eng PT - Journal Article PT - Review DEP - 20121126 PL - United States TA - Anesthesiol Clin JT - Anesthesiology clinics JID - 101273663 RN - 0 (Hemoglobins) SB - IM MH - *Blood Coagulation MH - Blood Platelets/physiology MH - Hemoglobins/analysis MH - Hemorrhage/*diagnosis MH - Humans MH - *Point-of-Care Systems MH - Thrombelastography MH - Wounds and Injuries/*blood EDAT- 2013/01/29 06:00 MHDA- 2013/08/06 06:00 CRDT- 2013/01/29 06:00 PHST- 2013/01/29 06:00 [entrez] PHST- 2013/01/29 06:00 [pubmed] PHST- 2013/08/06 06:00 [medline] AID - S1932-2275(12)00142-5 [pii] AID - 10.1016/j.anclin.2012.10.006 [doi] PST - ppublish SO - Anesthesiol Clin. 2013 Mar;31(1):55-65. doi: 10.1016/j.anclin.2012.10.006. Epub 2012 Nov 26. PMID- 23301972 OWN - NLM STAT- MEDLINE DCOM- 20130312 LR - 20130110 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 53 Suppl 1 DP - 2013 Jan TI - Prehospital detection of traumatic coagulopathy. PG - 48S-51S LID - 10.1111/trf.12035 [doi] AB - Increased focus on traumatic coagulopathy over the last decade has led to more aggressive use of hemostatic agents in resuscitation of the massively bleeding patient. Novel formulations of plasma factors and other therapeutics have opened for early intervention to prevent coagulopathy and may even be utilized in the prehospital setting. Careful selection of patients to receive hemostatic agents early during the resuscitation is of great importance due to the potential detrimental effects of this treatment. Several studies have identified coagulation parameters as reliable predictors of massive transfusion, even very early after trauma. Prothrombin time international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), fibrinogen concentration, and viscoelastic tests such as thrombelastography (TEG) and rotational thrombelastometry (RoTEM) have proved to be of value in predicting massive transfusion when performed in-hospital. PT/INR appears to be slightly more accurate than the other parameters, with a reported sensitivity of 84.8% and an area under the receiver operating curve of 0.87. Comparison studies on PT/INR, aPTT, and viscoelastic assays do suggest that caution should be taken when point-of-care (POC) methods, as opposed to conventional laboratory analyses, are used. Novel techniques for POC measurement of fibrinogen levels are currently being developed, and preclinical data suggest acceptable agreement with conventional methods. A number of factors should be considered regarding the feasibility of POC tests in the prehospital environment. In addition to environmental factors such as temperature, altitude, and humidity, electromagnetic interference issues and operators' skills must be taken into account. Coagulation parameters appear to be a useful tool in identifying patients with increased risk of massive bleeding at an early stage. Further studies are needed to determine if prehospital intervention based on POC analyses improves outcome. CI - (c) 2013 American Association of Blood Banks. FAU - Hagemo, Jostein S AU - Hagemo JS AD - Department of Research, Norwegian Air Ambulance Foundation, Drobak, Norway. jostein.hagemo@norskluftambulanse.no LA - eng PT - Journal Article PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Blood Coagulation Disorders/*diagnosis/*etiology MH - Emergency Medical Services/*methods MH - Humans MH - Partial Thromboplastin Time/methods MH - Point-of-Care Systems MH - Prothrombin Time/methods MH - Thrombelastography/methods MH - Wounds and Injuries/*complications EDAT- 2013/01/18 06:00 MHDA- 2013/03/13 06:00 CRDT- 2013/01/11 06:00 PHST- 2013/01/11 06:00 [entrez] PHST- 2013/01/18 06:00 [pubmed] PHST- 2013/03/13 06:00 [medline] AID - 10.1111/trf.12035 [doi] PST - ppublish SO - Transfusion. 2013 Jan;53 Suppl 1:48S-51S. doi: 10.1111/trf.12035. PMID- 23301970 OWN - NLM STAT- MEDLINE DCOM- 20130312 LR - 20231120 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 53 Suppl 1 DP - 2013 Jan TI - Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options. PG - 28S-37S LID - 10.1111/trf.12033 [doi] AB - Coagulopathy after traumatic brain injury (TBI) is frequent and represents a powerful predictor related to outcome and prognosis. The complex pathophysiological mechanisms of the coagulopathy of TBI are multifactorial and remain still undefined. The nature of the coagulation abnormalities differs between severe TBI and non-TBI with somatic injuries. The current hypothesis for the development of coagulopathy after TBI includes combinations of both hypo- and hypercoagulable states promoted by the magnitude and the extent of the injury resulting in a variable degree of secondary injury via subsequent ischemic and hemorrhagic lesioning. The proposed underlying mechanisms may comprise the release of tissue factor (TF), hyperfibrinolysis, shock, and hypoperfusion thus triggering the protein C pathway, disseminated intravascular coagulation, and platelet dysfunction. Hemocoagulative disorders after TBI may be amenable to treatment, and adequate and timely management may protect from secondary injury and poor outcomes. Functional assays such as viscoelastic tests may be supportive in early detection, diagnosis, and guidance of treatment. This review summarizes the current understanding with regard to frequency, pathogenesis, diagnosis, and treatment of the coagulopathy after TBI. CI - (c) 2013 American Association of Blood Banks. FAU - Maegele, Marc AU - Maegele M AD - Department of Trauma and Orthopedic Surgery, Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany. Marc.Maegele@t-online.de LA - eng PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - *Blood Coagulation Disorders/epidemiology/etiology/therapy MH - *Blood Component Transfusion MH - *Brain Injuries/complications/epidemiology/therapy MH - Humans MH - Incidence MH - Prognosis EDAT- 2013/01/18 06:00 MHDA- 2013/03/13 06:00 CRDT- 2013/01/11 06:00 PHST- 2013/01/11 06:00 [entrez] PHST- 2013/01/18 06:00 [pubmed] PHST- 2013/03/13 06:00 [medline] AID - 10.1111/trf.12033 [doi] PST - ppublish SO - Transfusion. 2013 Jan;53 Suppl 1:28S-37S. doi: 10.1111/trf.12033. PMID- 23301969 OWN - NLM STAT- MEDLINE DCOM- 20130312 LR - 20230815 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 53 Suppl 1 DP - 2013 Jan TI - Pathogenesis of acute traumatic coagulopathy. PG - 23S-27S LID - 10.1111/trf.12032 [doi] AB - Acute traumatic coagulopathy (ATC) is an early endogenous process, driven by the combination of tissue injury and shock that is associated with increased mortality and worse outcomes in the polytrauma patient. This review summarizes our current understanding of the pathophysiology of ATC and the role of rapid diagnostics in the management of severe trauma hemorrhage. In particular we consider diagnostic and therapeutic strategies for bleeding trauma patients with short versus long prehospital times and the concept of remote damage control resuscitation. Endothelial activation of Protein C is a central mechanism of ATC, which produces rapid anticoagulation and fibrinolysis following severe trauma. Continued blood loss, hypothermia, acidosis, and hemodilution potentiate ATC and lead to a global derangement in all components of hemostasis. The contribution and interplay between platelet activity, fibrinogen utilization, endothelial dysfunction, and neurohormonal pathways remain to be defined in ATC pathogenesis but may offer novel therapeutic targets. Conventional laboratory-based tests of coagulation have a limited role in the early management of major trauma hemorrhage. TEG and ROTEM provide a rapid evaluation of clot dynamics in whole blood and are of greater value than coagulation screens in diagnosing and managing trauma hemorrhage. CI - (c) 2013 American Association of Blood Banks. FAU - Davenport, Ross AU - Davenport R AD - Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK. ross.davenport@qmul.ac.uk LA - eng PT - Journal Article PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Protein C) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Acute Disease MH - Blood Coagulation Disorders/*blood/*etiology MH - Blood Platelets/physiology MH - Endothelium, Vascular/metabolism MH - Fibrinogen/metabolism MH - Fibrinolysis/physiology MH - Hemostasis/physiology MH - Humans MH - Protein C/metabolism MH - Wounds and Injuries/*blood/*complications EDAT- 2013/01/18 06:00 MHDA- 2013/03/13 06:00 CRDT- 2013/01/11 06:00 PHST- 2013/01/11 06:00 [entrez] PHST- 2013/01/18 06:00 [pubmed] PHST- 2013/03/13 06:00 [medline] AID - 10.1111/trf.12032 [doi] PST - ppublish SO - Transfusion. 2013 Jan;53 Suppl 1:23S-27S. doi: 10.1111/trf.12032. PMID- 23301966 OWN - NLM STAT- MEDLINE DCOM- 20130312 LR - 20231213 IS - 1537-2995 (Electronic) IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 53 Suppl 1 IP - 0 1 DP - 2013 Jan TI - Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time. PG - 137S-149S LID - 10.1111/trf.12048 [doi] AB - BACKGROUND: Whole blood (WB) has been used in combat since World War I as it is readily available and replaces every element of shed blood. Component therapy has become standard; however, recent military successes with WB resuscitation have revived the debate regarding wider WB use. Characterization of optimal WB storage is needed. We hypothesized that refrigeration preserves WB function and that a pathogen reduction technology (PRT) based on riboflavin and ultraviolet light has no deleterious effect over 21 days of storage. STUDY DESIGN AND METHODS: WB units were stored for 21 days either at 4 degrees C or 22 degrees C. Half of each temperature group underwent PRT, yielding four final treatment groups (n = 8 each): CON 4 (WB at 4 degrees C); CON 22 (WB at 22 degrees C); PRT 4 (PRT WB at 4 degrees C); and PRT 22 (PRT WB at 22 degrees C). Testing was at baseline, Days 1-7, 10, 14, and 21. Assays included coagulation factors; platelet activation, aggregation, and adhesion; and thromboelastography (TEG). RESULTS: Prothrombin time (PT) and partial thromboplastin time increased over time; refrigeration attenuated the effects on PT (p /= 0.032), as well as GPIb-expressing platelets (p 80% in the thrombocytopenic ear bleed model. CONCLUSION: Our in vitro characterization studies in conjunction with preclinical animal safety and efficacy studies demonstrated lot consistency in manufacturing, maintenance of hemostatic functions of Thrombosomes, safety at high dose concentrations, and the potential to provide an effective hemostatic agent at the site of injury. CI - (c) 2013 American Association of Blood Banks. FAU - Fitzpatrick, G Michael AU - Fitzpatrick GM AD - Cellphire Inc., Rockville, Maryland 20882, USA. mfitzpatrick@cellphire.com FAU - Cliff, Richard AU - Cliff R FAU - Tandon, Narendra AU - Tandon N LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Platelet Glycoprotein GPIIb-IIIa Complex) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Animals MH - Bandages MH - Blood Platelets/physiology MH - Disease Models, Animal MH - Dogs MH - Freeze Drying MH - Hemorrhage/*etiology/*therapy MH - *Hemostatic Techniques MH - Humans MH - Macaca mulatta MH - Platelet Glycoprotein GPIIb-IIIa Complex/metabolism MH - Platelet Transfusion/*methods MH - Rabbits MH - Thrombin/metabolism MH - Trauma Severity Indices MH - Wounds and Injuries/*complications EDAT- 2013/01/18 06:00 MHDA- 2013/03/13 06:00 CRDT- 2013/01/11 06:00 PHST- 2013/01/11 06:00 [entrez] PHST- 2013/01/18 06:00 [pubmed] PHST- 2013/03/13 06:00 [medline] AID - 10.1111/trf.12043 [doi] PST - ppublish SO - Transfusion. 2013 Jan;53 Suppl 1:100S-106S. doi: 10.1111/trf.12043. PMID- 23321555 OWN - NLM STAT- MEDLINE DCOM- 20130814 LR - 20131121 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 26 IP - 2 DP - 2013 Apr TI - Potential value of pharmacological protocols in trauma. PG - 221-9 LID - 10.1097/ACO.0b013e32835cca92 [doi] AB - PURPOSE OF REVIEW: Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates. RECENT FINDINGS: Early and aggressive treatment is mandatory to improve the survival of severely bleeding trauma patients. High ratios of fresh frozen plasma to red blood cells are linked to improved outcome in coagulopathic patients; however, treatment is often delayed because most blood products must first be thawed. Lyophilized plasma potentially overcomes these problems. However, until now only limited data on the use of lyophilized plasma in major trauma are available. VETs provide a rapid and comprehensive overview of the coagulation process. Low maximum clot firmness is associated with increased transfusion requirements, and premature lysis of the clot is indicative of poor outcome. Improvement in clot firmness can be achieved by the administration of fibrinogen concentrate or platelet concentrate, depending on the cause of coagulopathy. Early administration of tranexamic acid improves clot stability and outcome in major trauma. Prothrombin complex concentrate increases thrombin generation, but is potentially associated with increased risk of thromboembolic complications. SUMMARY: VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, Austria. herbert.schoechl@auva.at FAU - Schlimp, Christoph J AU - Schlimp CJ FAU - Voelckel, Wolfgang AU - Voelckel W LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Hemostatics) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Coagulation Disorders/diagnosis/*drug therapy MH - Blood Transfusion MH - Cardiac Surgical Procedures/adverse effects MH - Fibrinogen/therapeutic use MH - Hemostatics/*therapeutic use MH - Humans MH - Point-of-Care Systems MH - Thrombelastography MH - Tranexamic Acid/therapeutic use MH - Wounds and Injuries/*complications EDAT- 2013/01/17 06:00 MHDA- 2013/08/15 06:00 CRDT- 2013/01/17 06:00 PHST- 2013/01/17 06:00 [entrez] PHST- 2013/01/17 06:00 [pubmed] PHST- 2013/08/15 06:00 [medline] AID - 10.1097/ACO.0b013e32835cca92 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2013 Apr;26(2):221-9. doi: 10.1097/ACO.0b013e32835cca92. PMID- 23272296 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20121231 LR - 20211021 IS - 2160-2026 (Print) IS - 2160-2026 (Electronic) IS - 2160-2026 (Linking) VI - 2 IP - 3 DP - 2012 TI - Acidosis and correction of acidosis does not affect rFVIIa function in swine. PG - 145-57 AB - BACKGROUND: Hemorrhagic shock and trauma are associated with acidosis and altered coagulation. A fall in pH has been reported to attenuate the activity of recombinant activated Factor VII (rFVIIa) in vitro. However, it is not known if acidosis induced by hemorrhagic shock or infusion of HCl attenuates FVIIa activity in vivo. The purpose of this study was to determine if acidosis, induced by two methods, affects recombinant FVIIa (rFVIIa) activity in swine, and if correction of the pH restores rFVIIa activity to normal. METHODS: Acidosis was induce in anesthetized swine in two separate models: 1) HCl infusion (n=10) and 2) hemorrhage/hypoventilation (n=8). Three groups per model were used: Control (pH7.4), Acidosis (arterial pH7.1) and Acidosis-Corrected (bicarbonate infusion to return pH from 7.1 to 7.4). Pigs were then injected with rFVIIa (90 mug/kg) or vehicle (saline) at target pH and arterial blood samples were taken for measurement of coagulation function, including Thromboelastography -TEG, Thrombin Generation, Activated Clotting Time, Prothrombin Time, activated Partial Thromboplastin Time, Fibrinogen Concentration and Platelet count before and 5min after injection of rFVIIa. RESULTS: Acidosis led to a hypocoagulation as measured by almost all coagulation parameters in both models. Furthermore, the change in coagulation function produced after infusion of rFVIIa was not different between control, acidosis and acidosis-corrected groups for all coagulation parameters measured. CONCLUSION: Acidosis associated with hemorrhagic shock or HCl infusion led to a hypocoagulation that was not corrected with bicarbonate infusion. Furthermore, acidosis did not affect rFVIIa function, and correction of the acidosis with bicarbonate had no effect on rFVIIa function in these models. This suggests that in vivo acidosis did not diminish rFVIIa function. FAU - Darlington, Daniel N AU - Darlington DN AD - US Army Institute of Surgical Research Fort Sam Houston, TX 78234, USA. FAU - Kheirabadi, Bijan S AU - Kheirabadi BS FAU - Scherer, Michael R AU - Scherer MR FAU - Martini, Wenjun Z AU - Martini WZ FAU - Dubick, Michael A AU - Dubick MA LA - eng PT - Journal Article DEP - 20121205 PL - United States TA - Int J Burns Trauma JT - International journal of burns and trauma JID - 101581623 PMC - PMC3523398 OTO - NOTNLM OT - Hemorrhage OT - acidosis OT - coagulation parameters OT - fibrinogen OT - hypocoagulation OT - hypoventilation OT - platelets OT - recombinant factor VIIa OT - rotational thromboelastogram OT - thrombin generation OT - thromboelastography EDAT- 2012/12/29 06:00 MHDA- 2012/12/29 06:01 PMCR- 2012/12/05 CRDT- 2012/12/29 06:00 PHST- 2012/11/02 00:00 [received] PHST- 2012/11/16 00:00 [accepted] PHST- 2012/12/29 06:00 [entrez] PHST- 2012/12/29 06:00 [pubmed] PHST- 2012/12/29 06:01 [medline] PHST- 2012/12/05 00:00 [pmc-release] PST - ppublish SO - Int J Burns Trauma. 2012;2(3):145-57. Epub 2012 Dec 5. PMID- 23271081 OWN - NLM STAT- MEDLINE DCOM- 20130321 LR - 20130925 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 1 DP - 2013 Jan TI - Better hemostatic profiles of never-frozen liquid plasma compared with thawed fresh frozen plasma. PG - 84-90; discussion 90-1 LID - 10.1097/TA.0b013e3182788e32 [doi] AB - BACKGROUND: Immediate use of thawed fresh frozen plasma (FFP) when resuscitating hemorrhagic shock patients has become more common. According to the AABB (formerly known as American Association of Blood Banks), FFP is the preferred product that can be used up to 5 days after thawing. However, limited data exist on the clinical use and hemostatic profiles of Food and Drug Administration-approved liquid plasma (LQP), which can be stored at 1 degrees C to 6 degrees C for up to 26 days. We characterized changes in LQP hemostatic potential during 26 days of cold storage. METHODS: Ten FFP and 10 LQP single-donor units, matched by sex and blood group, were analyzed. FFP was thawed and kept refrigerated for 5 days and LQP for 26 days. Plasma samples were evaluated at Days 0 and 5 for thawed plasma (TP) and 0, 5, 10, 20, and 26 for LQP, by thrombelastography, thrombogram, platelet counts, platelet microparticles, clotting factors, and natural coagulation inhibitors. RESULTS: LQP had a better capacity to form a clot and generate thrombin compared with TP. LQP's hemostatic potential, expressed as endogenous thrombin potential (total amount of thrombin [nM] formed over time [minute]), initially exceeded that of TP (1,425 vs. 1,184, p < 0.05) but decreased to levels similar to TP by Day 26 (1,201 vs. 1,103, p = 0.15). Significantly higher platelet microparticles were found in LQP on Day 26 compared with those in LQP on Day 0 (23.6 x 10(9)/L vs. 3 x 10(9)/L, p < 0.001) or those in TP on Day 5 (2.8 x 10(9)/L). By Day 26, the majority of clotting factors and inhibitors retained more than 88% of their initial activities in LQP, with the few exceptions of factors well known to be unstable. CONCLUSION: The hemostatic profiles of LQP were better and sustained five times longer than the more commonly used TP, indicating that never-frozen plasma can be considered for use in the United States in trauma patients requiring immediate plasma resuscitation. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, Texas 77030, USA. Nena.matijevic@uth.tmc.edu FAU - Wang, Yao-Wei AU - Wang YW FAU - Cotton, Bryan A AU - Cotton BA FAU - Hartwell, Elizabeth AU - Hartwell E FAU - Barbeau, James M AU - Barbeau JM FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Blood Coagulation Factors) RN - EC 3.4.21.5 (Thrombin) SB - IM EIN - J Trauma Acute Care Surg. 2013 Apr;74(4):1182 MH - Blood Coagulation MH - Blood Coagulation Factors/analysis/antagonists & inhibitors MH - *Blood Preservation MH - *Hemostasis MH - Humans MH - Male MH - *Plasma MH - Platelet Count MH - Thrombelastography MH - Thrombin/analysis MH - Wounds and Injuries/*therapy EDAT- 2012/12/29 06:00 MHDA- 2013/03/22 06:00 CRDT- 2012/12/29 06:00 PHST- 2012/12/29 06:00 [entrez] PHST- 2012/12/29 06:00 [pubmed] PHST- 2013/03/22 06:00 [medline] AID - 01586154-201301000-00012 [pii] AID - 10.1097/TA.0b013e3182788e32 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Jan;74(1):84-90; discussion 90-1. doi: 10.1097/TA.0b013e3182788e32. PMID- 23271077 OWN - NLM STAT- MEDLINE DCOM- 20130321 LR - 20191210 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 74 IP - 1 DP - 2013 Jan TI - Coagulation system changes associated with susceptibility to infection in trauma patients. PG - 51-7; discussion 57-8 LID - 10.1097/TA.0b013e3182788b0f [doi] AB - BACKGROUND: Infection following trauma is associated with increased morbidity and mortality and is common following severe hemorrhage. There is a strong interaction between the coagulation and immunity. The objective of this study was to establish if there was an association between changes in coagulation status after hemorrhage and the subsequent incidence of infection. METHODS: Prospective cohort study of adult injured patients presenting to a major trauma center during a 2-year period. Blood was drawn at 24 hours following admission and analyzed using functional thromboelastography testing and laboratory defined tests of coagulation and blood count. Patients were followed up for infectious episodes while in the hospital using Center for Disease Control definitions. RESULTS: A total of 158 patients were recruited; 71 (45%) developed infection and were older (44 years vs. 32 years, p = 0.01) and more severely injured (Injury Severity Score [ISS], 25 vs.10; p < 0.01). White blood cell counts at 24 hours were normal, and there was no difference between groups (both 9.6 x 10/(9)L). Protein C was lower in those with infection (70.2 IU/dL vs. 83.3 IU/dL, p = 0.02), with a dose-dependent increase in infection as levels of protein C decreased. Plasmin activation at 24 hours was also strongly associated with infection plasmin-antiplasmin (infection vs. no infection, 6,156 mug/L vs. 3,324 mug/L, p = 0.03). The infection cohort had overall 12% lower procoagulant levels (varied between factor VIII 6.4% and factor II 16.2%). CONCLUSION: There is a strong association between the status of the coagulation system after 24 hours and the development of infection following trauma. Improved early coagulation management may decrease infection rates in this patient group. LEVEL OF EVIDENCE: Prognostic prospective study, level III. FAU - Cole, Elaine AU - Cole E AD - Department of Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. Elaine.cole@bartsandthelondon.nhs.uk FAU - Davenport, Ross AU - Davenport R FAU - De'Ath, Henry AU - De'Ath H FAU - Manson, Joanna AU - Manson J FAU - Brockamp, Thomas AU - Brockamp T FAU - Brohi, Karim AU - Brohi K LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - 0 (Antifibrinolytic Agents) RN - 0 (Blood Coagulation Factors) RN - 0 (Protein C) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM EIN - J Trauma Acute Care Surg. 2013 Feb;74(2):706. De-Ath, Henry [corrected to De'Ath, Henry] MH - Adult MH - Antifibrinolytic Agents/blood MH - Blood Cell Count MH - *Blood Coagulation MH - Blood Coagulation Factors/analysis MH - Disease Susceptibility MH - Fibrinolysin/analysis MH - Fibrinolysis MH - Humans MH - Infections/*blood/etiology/immunology MH - Length of Stay MH - Protein C/analysis MH - Severity of Illness Index MH - Thrombelastography MH - Wounds and Injuries/blood/*complications EDAT- 2012/12/29 06:00 MHDA- 2013/03/22 06:00 CRDT- 2012/12/29 06:00 PHST- 2012/12/29 06:00 [entrez] PHST- 2012/12/29 06:00 [pubmed] PHST- 2013/03/22 06:00 [medline] AID - 01586154-201301000-00008 [pii] AID - 10.1097/TA.0b013e3182788b0f [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2013 Jan;74(1):51-7; discussion 57-8. doi: 10.1097/TA.0b013e3182788b0f. PMID- 23260867 OWN - NLM STAT- MEDLINE DCOM- 20131105 LR - 20250529 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 44 IP - 5 DP - 2013 May TI - Evaluation of TEG((R)) and RoTEM((R)) inter-changeability in trauma patients. PG - 600-5 LID - S0020-1383(12)00514-1 [pii] LID - 10.1016/j.injury.2012.11.016 [doi] AB - BACKGROUND: Massive haemorrhage is a leading cause of preventable deaths in trauma. Traumatic coagulopathy is frequently present early after trauma, and is associated with increased mortality. A number of recent trials suggest that viscoelastic haemostatic assays (VHA), such as thromboelastography and thromboelastometry, are useful tools in guiding transfusion. Treatment algorithms exist for the use of VHAs but are not validated in traumatic haemorrhage. In this study we examined the inter-changeability of two commonly used VHAs, TEG((R)) and RoTEM((R)). METHODS: A total of 184 trauma patients over the age of 18, requiring full trauma team activation, were included at three different hospitals in three different countries (Copenhagen, Denmark, San Francisco, CA, USA and Oslo, Norway). Blood samples were drawn immediately upon arrival, and TEG((R)) and RoTEM((R)) analyzed simultaneously. Correlations were calculated using. Spearman's rank correlation coefficient. Agreement was evaluated by Bland-Altman plots and calculation of limits of agreement. RESULTS: The mean ISS in the total population was 17, and the mortality was 16.5%. Mean base excess was -2.8 (SD: 4.2). The correlation coefficient for corresponding values for the two devices was 0.24 for the R-time vs CT in all centres combined. For the K-time vs CFT the correlation was 0.48, for the alpha-angleTEG vs alpha-angleRoTEM 0.44, and for MA vs MCF 0.76. Limits of agreement exceeded the preset clinically acceptable deviation of 10% for all variables in all centres except for MA/MCF in one centre (Copenhagen). Generally, correlation coefficients were lower and agreement poorer in the one centre (Oslo) where measurements were performed bedside by clinicians. CONCLUSION: Inter-changeability between TEG((R)) and RoTEM((R)) is limited in the trauma setting. Agreement seems poorer when clinicians operate the devices. Development and validation of separate treatment algorithms for the two devices is required. CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved. FAU - Hagemo, Jostein S AU - Hagemo JS AD - Department of Research, Norwegian Air Ambulance, Drobak, Norway. jostein.hagemo@snla.no FAU - Naess, Paal A AU - Naess PA FAU - Johansson, Par AU - Johansson P FAU - Windelov, Nis A AU - Windelov NA FAU - Cohen, Mitchell Jay AU - Cohen MJ FAU - Roislien, Jo AU - Roislien J FAU - Brohi, Karim AU - Brohi K FAU - Heier, Hans Erik AU - Heier HE FAU - Hestnes, Morten AU - Hestnes M FAU - Gaarder, Christine AU - Gaarder C LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20121220 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Adult MH - Blood Coagulation MH - Blood Coagulation Disorders/*blood/etiology/genetics/therapy MH - Denmark/epidemiology MH - Female MH - Hemorrhage/*blood/diagnosis/therapy MH - Hemostasis MH - Humans MH - Male MH - Middle Aged MH - Norway/epidemiology MH - Reproducibility of Results MH - San Francisco/epidemiology MH - *Thrombelastography/instrumentation/methods MH - Trauma Centers MH - Whole Blood Coagulation Time MH - Wounds and Injuries/*blood/complications/therapy EDAT- 2012/12/25 06:00 MHDA- 2013/11/06 06:00 CRDT- 2012/12/25 06:00 PHST- 2012/07/14 00:00 [received] PHST- 2012/10/29 00:00 [revised] PHST- 2012/11/17 00:00 [accepted] PHST- 2012/12/25 06:00 [entrez] PHST- 2012/12/25 06:00 [pubmed] PHST- 2013/11/06 06:00 [medline] AID - S0020-1383(12)00514-1 [pii] AID - 10.1016/j.injury.2012.11.016 [doi] PST - ppublish SO - Injury. 2013 May;44(5):600-5. doi: 10.1016/j.injury.2012.11.016. Epub 2012 Dec 20. PMID- 23258612 OWN - NLM STAT- MEDLINE DCOM- 20131122 LR - 20171116 IS - 2567-5761 (Electronic) IS - 0720-9355 (Linking) VI - 33 IP - 1 DP - 2013 TI - Thromboelastometry guided therapy of severe bleeding. Essener Runde algorithm. PG - 51-61 LID - 10.5482/HAMO-12-05-0011 [doi] AB - Both, severe haemorrhage and blood transfusion are associated with increased morbidity and mortality. Therefore, it is of particular importance to stop perioperative bleeding as fast and as possible to avoid unnecessary transfusion. Viscoelastic test (ROTEM(R) or TEG(R)) allow for early prediction of massive transfusion and goal-directed therapy with specific haemostatic drugs, coagulation factor concentrates, and blood products. Growing consensus points out, that plasma-based coagulation screening tests like aPTT and PT are inappropriate for monitoring coagulopathy or guide transfusion therapy. Increasing evidence of more than 5000 surgical or trauma patients points towards the beneficial effects of a thrombelastography or -metry based approach in diagnosis and goal-directed therapy of perioperative massive haemorrhage. The Essener Runde task force is a group of clinicians of various specialties (anaesthesiology, intensive care, haemostaseology, haematology, internal medicine, transfusion medicine, surgery) interested in perioperative coagulation management. The ROTEM diagnostic algorithm of the Essener Runde task force was created to standardise and simplify the interpretation of ROTEM(R) results in perioperative settings and to present their possible implications for therapeutic interventions in severe bleeding. To exemplify, this text mainly focuses on coagulation management in trauma. FAU - Lier, H AU - Lier H AD - Department of Anaesthesiology and Intensive Care, Medicine University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. Heiko.Lier@uk-koeln.de FAU - Vorweg, M AU - Vorweg M FAU - Hanke, A AU - Hanke A FAU - Gorlinger, K AU - Gorlinger K LA - eng PT - Journal Article PT - Review DEP - 20130110 PL - Germany TA - Hamostaseologie JT - Hamostaseologie JID - 8204531 RN - 0 (Hemostatics) SB - IM MH - *Algorithms MH - *Decision Support Systems, Clinical MH - Hemostatics/*therapeutic use MH - Humans MH - Postoperative Hemorrhage/*prevention & control MH - Thrombelastography/*methods MH - *Transfusion Reaction EDAT- 2012/12/22 06:00 MHDA- 2013/12/16 06:00 CRDT- 2012/12/22 06:00 PHST- 2012/05/29 00:00 [received] PHST- 2012/11/27 00:00 [accepted] PHST- 2012/12/22 06:00 [entrez] PHST- 2012/12/22 06:00 [pubmed] PHST- 2013/12/16 06:00 [medline] AID - 12-05-0011 [pii] AID - 10.5482/HAMO-12-05-0011 [doi] PST - ppublish SO - Hamostaseologie. 2013;33(1):51-61. doi: 10.5482/HAMO-12-05-0011. Epub 2013 Jan 10. PMID- 23247121 OWN - NLM STAT- MEDLINE DCOM- 20130603 LR - 20220318 IS - 1540-0514 (Electronic) IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 39 IP - 1 DP - 2013 Jan TI - Functional fibrinogen assay indicates that fibrinogen is critical in correcting abnormal clot strength following trauma. PG - 45-9 LID - 10.1097/SHK.0b013e3182787122 [doi] AB - Thromboelastography (TEG) is emerging as the standard in the management of acute coagulopathies in injured patients. Although TEG is sensitive in detecting abnormalities in clot strength, one shortcoming is differentiating between fibrinogen and platelet contributions to clot integrity. Current American algorithms suggest platelet transfusion, whereas European guidelines suggest fibrinogen concentrates for correcting low clot strength. Therefore, we hypothesized that a TEG-based functional fibrinogen (FF) assay would assess the contribution of fibrinogen and platelets to clot strength and provide insight to transfusion priorities. Blood samples were obtained from trauma patients on arrival to the emergency department or who were admitted to the surgical intensive care unit (n = 68). Citrated kaolin TEG, FF, and von Clauss fibrinogen levels (plasma-based clinical standard) were measured. Correlations were assessed using linear regression models. In vitro studies were also performed with adding fibrinogen concentrates to blood collected from healthy volunteers (n = 10). Functional fibrinogen and citrated kaolin TEG parameters were measured. Functional fibrinogen strongly correlated with von Clauss fibrinogen levels (R = 0.87) and clot strength (R = 0.80). The mean fibrinogen contribution to clot strength was 30%; however, there was a direct linear relationship with fibrinogen level and percent fibrinogen contribution to clot strength (R = 0.83). Traditional TEG parameters associated with fibrinogen activity (alpha angle and kinetic time) had significantly lower correlations with FF (R = 0.70 and 0.35). Furthermore, platelet count had only a moderate correlation to clot strength (R = 0.51). The addition of fibrinogen concentrate in in vitro studies increased clot strength (MA) (60.44 +/- 1.48 to 68.12 +/- 1.39) and percent fibrinogen contribution to clot strength (23.8% +/- 1.8% to 37.7% +/- 2.5%). Functional fibrinogen can be performed rapidly with TEG and correlates well with the standard von Clauss fibrinogen assay. Both fibrinogen and platelet contribution of clot strength can be derived from FF. Moreover, FF had a stronger correlation to clot strength, and increased levels were directly associated with increased percent contribution to clot strength. In vitro studies also demonstrated an increase in FF, clot strength, and percent fibrinogen contribution to clot strength with the addition of fibrinogen concentrate. These data suggest that fibrinogen should be addressed early in trauma patients manifesting acute coagulopathy of trauma. FAU - Harr, Jeffrey N AU - Harr JN AD - Department of Surgery, University of Colorado Denver, Aurora, CO, USA. FAU - Moore, Ernest E AU - Moore EE FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Chin, Theresa L AU - Chin TL FAU - Sauaia, Angela AU - Sauaia A FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/blood/diagnosis/*etiology MH - Female MH - Fibrinogen/*analysis/physiology MH - Humans MH - Male MH - Middle Aged MH - Platelet Count MH - Prospective Studies MH - Thrombelastography/methods MH - Wounds and Injuries/blood/*complications PMC - PMC3529156 MID - NIHMS420792 EDAT- 2012/12/19 06:00 MHDA- 2013/06/05 06:00 PMCR- 2014/01/01 CRDT- 2012/12/19 06:00 PHST- 2012/12/19 06:00 [entrez] PHST- 2012/12/19 06:00 [pubmed] PHST- 2013/06/05 06:00 [medline] PHST- 2014/01/01 00:00 [pmc-release] AID - 00024382-201301000-00007 [pii] AID - 10.1097/SHK.0b013e3182787122 [doi] PST - ppublish SO - Shock. 2013 Jan;39(1):45-9. doi: 10.1097/SHK.0b013e3182787122. PMID- 23210556 OWN - NLM STAT- MEDLINE DCOM- 20130129 LR - 20260128 IS - 1365-2044 (Electronic) IS - 0003-2409 (Linking) VI - 68 Suppl 1 DP - 2013 Jan TI - Haemorrhage and coagulopathy in the Defence Medical Services. PG - 49-60 LID - 10.1111/anae.12056 [doi] AB - Over the past 12 years, the United Kingdom Defence Medical Services have evolved an integrated 'damage control resuscitation - damage control surgery' sequence for the management of patients sustaining complex injuries. During 2009, over 3200 units of blood products were administered as massive transfusions to severely injured UK personnel. An important part of the approach to traumatic bleeding is the early, empirical use of predefined ratios of blood and clotting products. As soon as control of bleeding is achieved, current practice is to switch towards a tailored transfusion, based on clinical and laboratory assessments, including point-of-care coagulation testing. A key goal is to provide resuscitation seamlessly throughout surgery, so that patients leave the operating room with their normal physiology restored. This article outlines the current management of haemorrhage and coagulation employed in Afghanistan from the point of wounding to transfer back to the National Health Service. CI - Anaesthesia (c) 2012 The Association of Anaesthetists of Great Britain and Ireland. FAU - Mercer, S J AU - Mercer SJ AD - Aintree University Hospitals NHS Foundation Trust, Liverpool, UK. simonjmercer@hotmail.com FAU - Tarmey, N T AU - Tarmey NT FAU - Woolley, T AU - Woolley T FAU - Wood, P AU - Wood P FAU - Mahoney, P F AU - Mahoney PF LA - eng PT - Journal Article PT - Review PL - England TA - Anaesthesia JT - Anaesthesia JID - 0370524 SB - IM MH - Analgesia MH - Blood Coagulation Disorders/*therapy MH - Hemorrhage/*therapy MH - Hemostasis MH - Hospitals, Military MH - Humans MH - Military Medicine/*methods MH - Military Personnel MH - Monitoring, Intraoperative MH - Patient Care Team MH - Resuscitation MH - United Kingdom MH - Wounds and Injuries/therapy EDAT- 2012/12/12 06:00 MHDA- 2013/01/30 06:00 CRDT- 2012/12/06 06:00 PHST- 2012/12/06 06:00 [entrez] PHST- 2012/12/12 06:00 [pubmed] PHST- 2013/01/30 06:00 [medline] AID - 10.1111/anae.12056 [doi] PST - ppublish SO - Anaesthesia. 2013 Jan;68 Suppl 1:49-60. doi: 10.1111/anae.12056. PMID- 23192064 OWN - NLM STAT- MEDLINE DCOM- 20130124 LR - 20260128 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 73 IP - 6 Suppl 5 DP - 2012 Dec TI - Evolution of coagulopathy monitoring in military damage-control resuscitation. PG - S417-22 LID - 10.1097/TA.0b013e31827546c0 [doi] FAU - Tarmey, Nicholas T AU - Tarmey NT AD - Joint Medical Command, United Kingdom Defence Medical Services & University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom. nicktarmey@doctors.org.uk FAU - Woolley, Tom AU - Woolley T FAU - Jansen, Jan O AU - Jansen JO FAU - Doran, Catherine M AU - Doran CM FAU - Easby, D AU - Easby D FAU - Wood, Paul R AU - Wood PR FAU - Midwinter, Mark J AU - Midwinter MJ LA - eng PT - Journal Article PT - Review PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Blood Coagulation Disorders/*diagnosis/drug therapy/etiology MH - Cardiopulmonary Resuscitation/*methods/mortality MH - Critical Care/methods MH - Female MH - Humans MH - Male MH - Mass Casualty Incidents/mortality/statistics & numerical data MH - Military Medicine/*methods MH - Monitoring, Physiologic/*methods MH - Point-of-Care Systems MH - Quality Improvement MH - Risk Assessment MH - Severity of Illness Index MH - Shock, Hemorrhagic/etiology/mortality/therapy MH - Survival Analysis MH - Thrombelastography/*methods MH - Trauma Severity Indices MH - United Kingdom MH - Warfare MH - Wounds and Injuries/complications/mortality/*therapy EDAT- 2012/12/05 06:00 MHDA- 2013/01/25 06:00 CRDT- 2012/11/30 06:00 PHST- 2012/11/30 06:00 [entrez] PHST- 2012/12/05 06:00 [pubmed] PHST- 2013/01/25 06:00 [medline] AID - 01586154-201212005-00008 [pii] AID - 10.1097/TA.0b013e31827546c0 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S417-22. doi: 10.1097/TA.0b013e31827546c0. PMID- 23178924 OWN - NLM STAT- MEDLINE DCOM- 20130624 LR - 20211021 IS - 2567-689X (Electronic) IS - 0340-6245 (Print) IS - 0340-6245 (Linking) VI - 109 IP - 1 DP - 2013 Jan TI - In vitro and in vivo evaluation of the effect of elevated factor VIII on the thrombogenic process. PG - 53-60 LID - 10.1160/TH12-05-0316 [doi] AB - Factor VIII (FVIII), a procoagulant cofactor, plays a crucial role in the intrinsic coagulation cascade. A causal association between elevated FVIII levels and venous thrombosis incidence has been established; no such association has been confirmed with arterial thrombosis. The independent role of elevated FVIII levels in arteriolar thrombosis was evaluated in a mouse model to determine the thrombogenic potential of elevated levels of FVIII. The in vitro thrombogenic effect of elevated FVIII levels was examined using thrombin-antithrombin (TAT) complex generation and thromboelastography (TEG) assays. The thrombogenic potential of acute and extended elevation of circulating FVIII levels was assessed using ferric chloride induced injury of the cremaster arterioles. The rate of TAT complex formation, and the final concentration of TAT complexes, significantly increased as FVIII levels were elevated from 100% to 400% FVIII activity. TEG analysis of fibrin and clot formation showed that as FVIII levels were elevated, the time to initial fibrin formation decreased and the rate of fibrin formation increased. The acute elevation of circulating FVIII to 400% FVIII activity resulted in significantly decreased times to vessel occlusion. Prolonged elevation of FVIII activity did not significantly affect time to vessel occlusion. In conclusion, acute elevations in FVIII levels result in a non-linear thrombogenic effect, with non-significant increases in thrombogenic risk within the physiological range (FVIII levels up to 200%). Prolonged elevation of plasma FVIII did not further increase the thrombogenic potential of elevated FVIII levels. FAU - Golder, M AU - Golder M AD - Department of Pathology and Molecular Medicine, 201 Richardson Laboratory, Queen's University, Kingston, Ontario, K7L 3N6 Canada. FAU - Mewburn, J AU - Mewburn J FAU - Lillicrap, D AU - Lillicrap D LA - eng GR - P01 HL081588/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20121122 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Chlorides) RN - 0 (Ferric Compounds) RN - 0 (antithrombin III-protease complex) RN - 839MOZ74GK (F8 protein, human) RN - 9000-94-6 (Antithrombin III) RN - 9001-27-8 (Factor VIII) RN - EC 3.4.- (Peptide Hydrolases) RN - U38V3ZVV3V (ferric chloride) SB - IM MH - Animals MH - Antithrombin III MH - *Blood Coagulation/genetics MH - Chlorides MH - Disease Models, Animal MH - Factor VIII/administration & dosage/genetics/*metabolism MH - Ferric Compounds MH - Hemophilia A/blood/*complications/genetics MH - Humans MH - Mice MH - Mice, Inbred C57BL MH - Mice, Knockout MH - Peptide Hydrolases/blood MH - Thrombelastography MH - Thrombosis/*blood/chemically induced/genetics MH - Time Factors MH - Up-Regulation MH - Vascular System Injuries/*blood/chemically induced/genetics PMC - PMC4283763 MID - NIHMS628262 COIS- Conflicts of Interest: the authors have no conflicts of interest. EDAT- 2012/11/28 06:00 MHDA- 2013/06/26 06:00 PMCR- 2015/01/05 CRDT- 2012/11/27 06:00 PHST- 2012/05/14 00:00 [received] PHST- 2012/10/09 00:00 [accepted] PHST- 2012/11/27 06:00 [entrez] PHST- 2012/11/28 06:00 [pubmed] PHST- 2013/06/26 06:00 [medline] PHST- 2015/01/05 00:00 [pmc-release] AID - 12-05-0316 [pii] AID - 10.1160/TH12-05-0316 [doi] PST - ppublish SO - Thromb Haemost. 2013 Jan;109(1):53-60. doi: 10.1160/TH12-05-0316. Epub 2012 Nov 22. PMID- 23176206 OWN - NLM STAT- MEDLINE DCOM- 20130822 LR - 20250529 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 11 IP - 2 DP - 2013 Feb TI - The incidence and magnitude of fibrinolytic activation in trauma patients. PG - 307-14 LID - 10.1111/jth.12078 [doi] AB - BACKGROUND: Trauma is a global disease, with over 2.5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics. OBJECTIVE: To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry. METHODS: A prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009 was performed. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis of > 15%. Fibrinolytic activation (FA) was determined according to plasmin-antiplasmin (PAP) complex and D-dimer levels. Data were collected on demographics, mechanism, severity of injury, and baseline vital signs. The primary outcome measure was 28-day mortality. The secondary outcome measures were 28-day ventilator-free days and 24-h transfusion requirement. RESULTS: Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of 'moderate' fibrinolysis, with PAP complex levels elevated to over twice normal (> 1500 mug L(-1)) without lysis on TEM. TEM detected clot lysis only when PAP complex levels were increased to 30 times normal (P < 0.001) and antiplasmin levels were < 75% of normal. Patients with FA had increased 28-day mortality as compared with those with no FA (12% vs. 1%, P < 0.001), fewer ventilator-free days, and longer hospital stay. CONCLUSIONS: FA occurs in the majority of trauma patients, and the magnitude of FA correlates with poor clinical outcome. This was not detected by conventional TEM, which is an insensitive measure of endogenous fibrinolytic activity. CI - (c) 2012 International Society on Thrombosis and Haemostasis. FAU - Raza, I AU - Raza I AD - Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of, London, UK. FAU - Davenport, R AU - Davenport R FAU - Rourke, C AU - Rourke C FAU - Platton, S AU - Platton S FAU - Manson, J AU - Manson J FAU - Spoors, C AU - Spoors C FAU - Khan, S AU - Khan S FAU - De'Ath, H D AU - De'Ath HD FAU - Allard, S AU - Allard S FAU - Hart, D P AU - Hart DP FAU - Pasi, K J AU - Pasi KJ FAU - Hunt, B J AU - Hunt BJ FAU - Stanworth, S AU - Stanworth S FAU - MacCallum, P K AU - MacCallum PK FAU - Brohi, K AU - Brohi K LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Biomarkers) RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 0 (alpha-2-Antiplasmin) RN - 0 (fibrin fragment D) RN - 0 (plasmin-plasmin inhibitor complex) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - EC 3.4.21.7 (Fibrinolysin) SB - IM CIN - J Thromb Haemost. 2013 Jul;11(7):1435-7. doi: 10.1111/jth.12240. PMID: 23593973 CIN - J Thromb Haemost. 2013 Jul;11(7):1437-8. doi: 10.1111/jth.12296. PMID: 23663357 CIN - J Cardiothorac Vasc Anesth. 2020 Dec;34(12):3495-3496. doi: 10.1053/j.jvca.2020.05.020. PMID: 32593588 MH - Adult MH - Analysis of Variance MH - Biomarkers/blood MH - Blood Coagulation Disorders/*blood/diagnosis/mortality/therapy MH - Blood Transfusion MH - Chi-Square Distribution MH - Female MH - Fibrin Fibrinogen Degradation Products/metabolism MH - Fibrinolysin/metabolism MH - *Fibrinolysis MH - Humans MH - Incidence MH - Injury Severity Score MH - Male MH - Middle Aged MH - Patient Discharge MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies MH - Respiration, Artificial MH - Risk Factors MH - Thrombelastography MH - Time Factors MH - Tissue Plasminogen Activator/blood MH - Wounds and Injuries/*blood/diagnosis/mortality/therapy MH - alpha-2-Antiplasmin/metabolism EDAT- 2012/11/28 06:00 MHDA- 2013/08/24 06:00 CRDT- 2012/11/27 06:00 PHST- 2012/11/27 06:00 [entrez] PHST- 2012/11/28 06:00 [pubmed] PHST- 2013/08/24 06:00 [medline] AID - S1538-7836(22)11116-5 [pii] AID - 10.1111/jth.12078 [doi] PST - ppublish SO - J Thromb Haemost. 2013 Feb;11(2):307-14. doi: 10.1111/jth.12078. PMID- 23153876 OWN - NLM STAT- MEDLINE DCOM- 20130114 LR - 20220408 IS - 1558-3171 (Electronic) IS - 0039-6109 (Linking) VI - 92 IP - 6 DP - 2012 Dec TI - Hypovolemic shock resuscitation. PG - 1403-23 LID - S0039-6109(12)00156-9 [pii] LID - 10.1016/j.suc.2012.08.006 [doi] AB - Several changes in the way patients with hemorrhagic shock are resuscitated have occurred over the past decades, including permissive hypotension, minimal crystalloid resuscitation, earlier blood transfusion, and higher plasma and platelet-to-red cell ratios. Hemostatic adjuncts, such as tranexamic acid and prothrombin complex, and the use of new methods of assessing coagulopathy are also being incorporated into resuscitation of the bleeding patient. These ideas have been incorporated by many trauma centers into institutional massive transfusion protocols, and adoption of these protocols has resulted in improvements in mortality and morbidity. This article discusses each of these new resuscitation strategies and the evidence supporting their use. CI - Copyright (c) 2012 Elsevier Inc. All rights reserved. FAU - Kobayashi, Leslie AU - Kobayashi L AD - Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California San Diego School of Medicine, San Diego, CA 92103, USA. FAU - Costantini, Todd W AU - Costantini TW FAU - Coimbra, Raul AU - Coimbra R LA - eng PT - Journal Article PT - Review DEP - 20121005 PL - United States TA - Surg Clin North Am JT - The Surgical clinics of North America JID - 0074243 SB - IM MH - Blood Coagulation Disorders/diagnosis MH - Blood Transfusion/methods MH - Fluid Therapy MH - Humans MH - Shock/classification/physiopathology/*therapy MH - Shock, Hemorrhagic/therapy MH - Thrombelastography EDAT- 2012/11/17 06:00 MHDA- 2013/01/15 06:00 CRDT- 2012/11/17 06:00 PHST- 2012/11/17 06:00 [entrez] PHST- 2012/11/17 06:00 [pubmed] PHST- 2013/01/15 06:00 [medline] AID - S0039-6109(12)00156-9 [pii] AID - 10.1016/j.suc.2012.08.006 [doi] PST - ppublish SO - Surg Clin North Am. 2012 Dec;92(6):1403-23. doi: 10.1016/j.suc.2012.08.006. Epub 2012 Oct 5. PMID- 23128358 OWN - NLM STAT- MEDLINE DCOM- 20130416 LR - 20121108 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 23 IP - 8 DP - 2012 Dec TI - In-vitro comparison of free oscillation rheometry (ReoRox) and rotational thromboelastometry (ROTEM) in trauma patients upon hospital admission. PG - 688-92 LID - 10.1097/MBC.0b013e328351ebd6 [doi] AB - Plasma-based assays do not provide accurate information on haemostatic resuscitation hence viscoelastic point-of-care haemostatic assays such as rotational thromboelastometry (ROTEM Delta, Pentapharm) are used to monitor coagulopathy in trauma patients. Free oscillation rheometry (FOR) is a new whole blood haemostatic assay that measures not only the clot-forming process but also the initial viscous phase; this could potentially be of value when assessing traumatic coagulopathy. A comparative analysis between FOR and ROTEM was therefore performed. This is a prospective observational study of 40 adult trauma patients admitted to a level 1 trauma centre. Citrated whole blood was analysed with ROTEM EXTEM and FIBTEM assays and FOR Fibscreen1 and Fibscreen2 assays. Predefined variables of ROTEM and FOR were compared using Spearman's rho. ROTEM maximum clot function (MCF) in both EXTEM and FIBTEM correlated (P < 0.0001 for both) with FOR maximum elasticity Fibscreen1 and Fibscreen2, respectively. Interestingly, ROTEM EXTEM clotting time did not correlate with any of the FOR clot initiation parameters COT1, COT2 or COT2-1 of Fibscreen1. A correlation between ROTEM EXTEM and FIBTEM and FOR Fibscreen1 and Fibscreen2 clot formation and clot strength was found as was a significant correlation between lysis index after 60 min and ClotSR30. ROTEM EXTEM did not correlate with COT1, COT2 or COT2-1 of Fibscreen1 and this warrants further investigation. FAU - Solbeck, Sacha AU - Solbeck S AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. sacha@solbeck.dk FAU - Windelov, Nis A AU - Windelov NA FAU - Baek, Nicolai H AU - Baek NH FAU - Nielsen, Jorn D AU - Nielsen JD FAU - Ostrowski, Sisse R AU - Ostrowski SR FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Comparative Study PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Blood Coagulation MH - Female MH - Humans MH - Male MH - Middle Aged MH - Patient Admission MH - Point-of-Care Systems/standards MH - Prospective Studies MH - Thrombelastography/*instrumentation/methods MH - Trauma Centers MH - Whole Blood Coagulation Time/methods MH - Wounds and Injuries/*blood EDAT- 2012/11/07 06:00 MHDA- 2013/04/17 06:00 CRDT- 2012/11/07 06:00 PHST- 2012/11/07 06:00 [entrez] PHST- 2012/11/07 06:00 [pubmed] PHST- 2013/04/17 06:00 [medline] AID - 10.1097/MBC.0b013e328351ebd6 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2012 Dec;23(8):688-92. doi: 10.1097/MBC.0b013e328351ebd6. PMID- 23112213 OWN - NLM STAT- MEDLINE DCOM- 20130304 LR - 20220331 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 110 IP - 2 DP - 2013 Feb TI - Fast interpretation of thromboelastometry in non-cardiac surgery: reliability in patients with hypo-, normo-, and hypercoagulability. PG - 222-30 LID - 10.1093/bja/aes374 [doi] AB - BACKGROUND: Conventional coagulation test are not useful to guide haemostatic therapy in severe bleeding due to their long turn-around time. In contrast, early variables assessed by point-of-care thromboelastometry (ROTEM((R))) are available within 10-20 min and increasingly used to guide haemostatic therapy in liver transplantation and severe trauma. However, the reliability of early ROTEM((R)) variables to predict maximum clot firmness (MCF) in non-cardiac surgery patients with subnormal, normal, and supranormal MCF has not yet been evaluated. METHODS: Retrospective data of 14,162 ROTEM((R)) assays (3939 EXTEM((R)), 3654 INTEM((R)), 3287 FIBTEM((R)), and 3282 APTEM((R)) assays) of patients undergoing non-cardiac surgery were analysed. ROTEM((R)) variables [clotting time (CT), clot formation time (CFT), alpha-angle, A5, A10, and A15] were related to MCF by linear or non-linear regression, as appropriate. The Bland-Altman analyses to assess the bias between early ROTEM((R)) variables and MCF and receiver operating characteristics (ROC) were also performed. RESULTS: Taking the best and worst correlation coefficients for each assay type, CT (r=0.18-0.49) showed the worst correlation to MCF. In contrast, alpha-angle (r=0.85-0.88) and CFT (r=0.89-0.92) demonstrated good but non-linear correlation with MCF. The best and linear correlations were found for A5 (r=0.93-0.95), A10 (r=0.96), and A15 (r=0.97-0.98). ROC analyses provided excellent area under the curve (AUC) values for A5, A10, and A15 (AUC=0.962-0.985). CONCLUSIONS: Early values of clot firmness allow for fast and reliable prediction of ROTEM((R)) MCF in non-cardiac patients with subnormal, normal, and supranormal MCF values and therefore can be used to guide haemostatic therapy in severe bleeding. FAU - Gorlinger, K AU - Gorlinger K AD - Klinik fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen, Universitat Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany. klaus@goerlinger.net FAU - Dirkmann, D AU - Dirkmann D FAU - Solomon, C AU - Solomon C FAU - Hanke, A A AU - Hanke AA LA - eng PT - Journal Article DEP - 20121030 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Area Under Curve MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/blood/*diagnosis MH - Databases, Factual MH - Humans MH - Intraoperative Period MH - Nonlinear Dynamics MH - ROC Curve MH - Reference Values MH - Reproducibility of Results MH - Retrospective Studies MH - Surgical Procedures, Operative/*methods MH - Thrombelastography/*methods MH - Thrombophilia/blood/diagnosis EDAT- 2012/11/01 06:00 MHDA- 2013/03/05 06:00 CRDT- 2012/11/01 06:00 PHST- 2012/11/01 06:00 [entrez] PHST- 2012/11/01 06:00 [pubmed] PHST- 2013/03/05 06:00 [medline] AID - S0007-0912(17)32806-4 [pii] AID - 10.1093/bja/aes374 [doi] PST - ppublish SO - Br J Anaesth. 2013 Feb;110(2):222-30. doi: 10.1093/bja/aes374. Epub 2012 Oct 30. PMID- 23076727 OWN - NLM STAT- MEDLINE DCOM- 20140203 LR - 20171116 IS - 1496-8975 (Electronic) IS - 0832-610X (Linking) VI - 59 IP - 12 DP - 2012 Dec TI - Massive transfusion in the trauma patient: Continuing Professional Development. PG - 1130-45 LID - 10.1007/s12630-012-9795-4 [doi] AB - PURPOSE: Massive transfusion has recently been given a dynamic definition, namely, the replacement of more than four red cell concentrates within an hour. The purpose of this continuing professional development module is to review the pathophysiology of hemorrhagic shock in the trauma patient and the current management strategies of the massively bleeding trauma patient. PRINCIPAL FINDINGS: The massively bleeding trauma patient requires concurrent hemorrhage control and blood replacement therapy. Although there are many complications of massive transfusions, such as acid-base disturbances, electrolyte abnormalities, and hypothermia, perhaps the most difficult aspect to manage is acute trauma coagulopathy. Historically, coagulopathy was attributed to dilution of coagulation factors; however, recent accumulated evidence indicates that it is a multifactorial process associated with hypoperfusion, factor consumption, and hyperfibrinolysis. In an attempt to minimize acute trauma coagulopathy, massive transfusion protocols with equal ratios of red cell concentrates, frozen plasma, and platelets have been proposed. This type of hemostatic resuscitation, with near equal ratios of blood and blood products, has improved survival, but it is not without risk. In addition to the rapid and effective restoration of blood volume, the specific goal of transfusion management should be to maintain the patient's oxygen carrying capacity, hemostasis, and biochemistry. CONCLUSION: The current literature does not permit firm conclusions to be drawn regarding optimal transfusion ratios. It remains appropriate, however, to devise a massive transfusion protocol at the institutional level that provides treating physicians with rapid delivery of a reasonable initial ratio of products. This would permit patient-centred management with an emphasis on surgical control of bleeding, maintenance of normothermia, avoidance of electrolyte abnormalities, acid-base balance, and the timely delivery of blood products. OBJECTIVES: After reading this module, the reader should be able to: 1. Enumerate the complications associated with massive transfusion in the trauma context; 2. Understand how the coagulopathy present in the trauma patient differs from that seen in the elective setting; 3. Identify the modifications suggested by the recent literature for the management of massive transfusion in the trauma setting; 4. Appreciate the evidence for the institution of massive transfusion protocols. FAU - Hayter, Megan A AU - Hayter MA AD - Department of Anesthesiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. FAU - Pavenski, Katerina AU - Pavenski K FAU - Baker, James AU - Baker J LA - eng LA - fre PT - Journal Article PT - Review DEP - 20121018 PL - United States TA - Can J Anaesth JT - Canadian journal of anaesthesia = Journal canadien d'anesthesie JID - 8701709 SB - IM MH - Acute Lung Injury/etiology MH - Blood Coagulation Disorders/etiology MH - *Blood Transfusion MH - Humans MH - Point-of-Care Systems MH - Shock, Hemorrhagic/physiopathology MH - Thrombelastography MH - Transfusion Reaction MH - Wounds and Injuries/blood/*therapy EDAT- 2012/10/19 06:00 MHDA- 2014/02/04 06:00 CRDT- 2012/10/19 06:00 PHST- 2012/06/22 00:00 [received] PHST- 2012/09/18 00:00 [accepted] PHST- 2012/10/19 06:00 [entrez] PHST- 2012/10/19 06:00 [pubmed] PHST- 2014/02/04 06:00 [medline] AID - 10.1007/s12630-012-9795-4 [doi] PST - ppublish SO - Can J Anaesth. 2012 Dec;59(12):1130-45. doi: 10.1007/s12630-012-9795-4. Epub 2012 Oct 18. PMID- 23042192 OWN - NLM STAT- MEDLINE DCOM- 20130311 LR - 20121018 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 38 IP - 5 DP - 2012 Nov TI - The acute coagulopathy of trauma: mechanisms and tools for risk stratification. PG - 450-8 LID - 10.1097/SHK.0b013e31826dbd23 [doi] AB - Trauma remains the leading cause of death, with bleeding as the primary cause of preventable mortality. When death occurs, it happens quickly, typically within the first 6 h after injury. The principal drivers of the acute coagulopathy of trauma have been characterized, but another group of patients with early evidence of coagulopathy both physiologically and mechanistically distinct from this systemic acquired coagulopathy has been identified. This distinct phenotype is present in 25% to 30% of patients with major trauma without being exposed to the traditional triggers and is associated with higher morbidity and a 4-fold increase in mortality. Despite improvements in the resuscitation of exsanguinating patients, one of the remaining keys is to expeditiously and reproducibly identify the patients most likely to require transfusion including massive transfusion with damage control resuscitation principles. Several predictive scoring systems/algorithms for transfusion including massive transfusion in both civilian and military trauma populations have been introduced. The models developed usually suggest combinations of physiologic, hemodynamic, laboratory, injury severity, and demographic triggers identified on the initial evaluation. Many use a combination of dichotomous variables that are readily accessible after the patient's arrival to the trauma bay, but others rely on time-consuming mathematical calculations and may thus have limited real-time application. Weighted and more sophisticated systems including higher numbers of variables perform superiorly. A common limitation to all models is their retrospective nature, and prospective validations are needed. Point-of-care viscoelastic testing may be an alternative to early recognize trauma-induced coagulopathy with the risk of ongoing hemorrhage and transfusion. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany. Marc.Maegele@t-online.de FAU - Spinella, Philip C AU - Spinella PC FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article PT - Review PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 SB - IM MH - Acute Disease MH - Animals MH - *Blood Transfusion MH - *Disseminated Intravascular Coagulation/mortality/physiopathology/therapy MH - *Hemodynamics MH - Humans MH - *Models, Biological MH - Time Factors MH - *Wounds and Injuries/mortality/physiopathology/therapy EDAT- 2012/10/09 06:00 MHDA- 2013/03/12 06:00 CRDT- 2012/10/09 06:00 PHST- 2012/10/09 06:00 [entrez] PHST- 2012/10/09 06:00 [pubmed] PHST- 2013/03/12 06:00 [medline] AID - 10.1097/SHK.0b013e31826dbd23 [doi] PST - ppublish SO - Shock. 2012 Nov;38(5):450-8. doi: 10.1097/SHK.0b013e31826dbd23. PMID- 25755440 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20150310 LR - 20220317 IS - 0973-6883 (Print) IS - 2213-3453 (Electronic) IS - 0973-6883 (Linking) VI - 2 IP - 3 DP - 2012 Sep TI - Surgery in a patient with liver disease. PG - 238-46 LID - 10.1016/j.jceh.2012.05.003 [doi] AB - Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones and hernia are more common in patients with cirrhosis. Assessment of severity of liver dysfunction before surgery is important and the risk benefit of the procedure needs to be carefully assessed. The disease severity may vary from mild transaminase rise to decompensated cirrhosis. Surgery should be avoided if possible in the emergency setting, in the setting of acute and alcoholic hepatitis, in a patient of cirrhosis who is child class C or has a MELD score more than 15 or any patient with significant extrahepatic organ dysfunction. In this subset of patients, all possible means to manage these patients conservatively should be attempted. Modified Child-Pugh scores and model for end-stage liver disease (MELD) scores can predict mortality after surgery fairly reliably including nonhepatic abdominal surgery. Pre-operative optimization would include control of ascites, correction of electrolyte imbalance, improving renal dysfunction, cardiorespiratory assessment, and correction of coagulation. Tests of global hemostasis like thromboelastography and thrombin generation time may be more predictive of the risk of bleeding compared with the conventional tests of coagulation in patients with cirrhosis. Correction of international normalized ratio with fresh frozen plasma does not necessarily mean reduction of bleeding risk and may increase the risk of volume overload and lung injury. International normalized ratio liver may better reflect the coagulation status. Recombinant factor VIIa in patients with cirrhosis needing surgery needs further study. Intra-operatively, safe anesthetic agents like isoflurane and propofol with avoidance of hypotension are advised. In general, nonsteroidal anti-inflammatory drug (NSAIDs) and benzodiazepines should not be used. Intra-abdominal surgery in a patient with cirrhosis becomes more challenging in the presence of ascites, portal hypertension, and hepatomegaly. Uncontrolled hemorrhage due to coagulopathy and portal hypertension, sepsis, renal dysfunction, and worsening of liver failure contribute to the morbidity and mortality in these patients. Steps to reduce ascitic leaks and infections need to be taken. Any patient with cirrhosis undergoing major surgery should be referred to a specialist center with experience in managing liver disease. FAU - Rai, Rakesh AU - Rai R AD - Department of HPB Surgery and Liver Transplantation, Fortis Hospital, Mulund, Mumbai, India. FAU - Nagral, Sanjay AU - Nagral S AD - Department of Surgical Gastroenterology, Jaslok Hospital, Mumbai, India. FAU - Nagral, Aabha AU - Nagral A AD - Department of Gastroenterology, Jaslok Hospital, Mumbai, India. LA - eng PT - Journal Article PT - Review DEP - 20120921 PL - India TA - J Clin Exp Hepatol JT - Journal of clinical and experimental hepatology JID - 101574137 PMC - PMC3940091 OTO - NOTNLM OT - ABG, arterial blood gas OT - ASA, American Society of Anesthesiologists OT - Anesthesia OT - BNP, brain natriuretic peptide OT - COPD, chronic obstructive pulmonary disease OT - CTP, Child-Turcotte-Pugh OT - CVP, central venous pressure OT - Child-Pugh score OT - FDP, fibrin degradation products OT - FFP, fresh frozen plasma OT - HPS, hepatopulmonary syndrome OT - ICG, indocyanine green OT - ICU, intensive care unit OT - INR, international normalized ratio OT - MELD, model for end-stage liver disease OT - NSAID, nonsteroidal anti-inflammatory drug OT - PICD, paracentesis-induced circulatory dysfunction OT - PT, prothrombin time OT - PTT, partial thromboplastin time OT - SBP, spontaneous bacterial peritonitis OT - TEG, thromboelastogram OT - TIPS, transjugular intrahepatic portosystemic shunt OT - cirrhosis OT - coagulopathy OT - hepatic EDAT- 2012/09/01 00:00 MHDA- 2012/09/01 00:01 PMCR- 2012/09/21 CRDT- 2015/03/11 06:00 PHST- 2012/02/17 00:00 [received] PHST- 2012/05/15 00:00 [accepted] PHST- 2015/03/11 06:00 [entrez] PHST- 2012/09/01 00:00 [pubmed] PHST- 2012/09/01 00:01 [medline] PHST- 2012/09/21 00:00 [pmc-release] AID - S0973-6883(12)00027-8 [pii] AID - 10.1016/j.jceh.2012.05.003 [doi] PST - ppublish SO - J Clin Exp Hepatol. 2012 Sep;2(3):238-46. doi: 10.1016/j.jceh.2012.05.003. Epub 2012 Sep 21. PMID- 22931353 OWN - NLM STAT- MEDLINE DCOM- 20140224 LR - 20130725 IS - 1369-1635 (Electronic) IS - 0953-7104 (Linking) VI - 24 IP - 6 DP - 2013 TI - Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry. PG - 454-61 LID - 10.3109/09537104.2012.718383 [doi] AB - Pneumatic tube systems (PTS) present a convenient way for blood sample transport in medical facilities. Associated preanalytical interference in various tests is largely unknown. Implementing point-of-care coagulation management at our institution, we investigated multiple electrode aggregometry (MEA) and rotational thromboelastometry (ROTEM) after PTS transportation. Whole blood samples from patients undergoing general or trauma surgery were analysed by MEA after collection (baseline, '0 x PTS') and sent on a predefined PTS track (n = 12). MEA was repeated after samples travelled the track 4 ('4 x PTS'), 8 ('8 x PTS') and 12 times ('12 x PTS') and compared with stationary controls analysed at the same time. Samples for ROTEM (n = 6) were analysed after collection and travelling the track 12 times. An acceleration detector recorded g-forces on the PTS track. At '0 x PTS' no significant differences in MEA results were detected. Values were significantly lower for transported samples compared with controls ('4 x PTS' to '12 x PTS', p < 0.001). Furthermore, MEA results of PTS samples were significantly decreased for '4 x PTS' to '12 x PTS' compared to baseline (p < 0.001). Except for the clotting time in EXTEM PTS transport did not significantly alter results for investigated ROTEM parameters, compared with baseline and stationary controls. Acceleration detector readout revealed alternating g-forces between -6.3 and +5.9 during transport. PTS transport caused invalid results in MEA while only one ROTEM parameter was found to be affected in this study. Variable acceleration during transport provides a potential reason for platelet activation. The authors recommend sample transport by hand or the device to be placed patient-side when MEA is performed. FAU - Glas, Michael AU - Glas M AD - Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital , Kirrberger Strasse, D-66421 Homburg (Saar) , Germany. michael.glas@uks.eu FAU - Mauer, Dietmar AU - Mauer D FAU - Kassas, Hazim AU - Kassas H FAU - Volk, Thomas AU - Volk T FAU - Kreuer, Sascha AU - Kreuer S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120829 PL - England TA - Platelets JT - Platelets JID - 9208117 SB - IM MH - Blood Coagulation Tests MH - Female MH - Humans MH - Male MH - Platelet Function Tests MH - Point-of-Care Systems MH - Specimen Handling/*instrumentation/*methods MH - Thrombelastography EDAT- 2012/08/31 06:00 MHDA- 2014/02/25 06:00 CRDT- 2012/08/31 06:00 PHST- 2012/08/31 06:00 [entrez] PHST- 2012/08/31 06:00 [pubmed] PHST- 2014/02/25 06:00 [medline] AID - 10.3109/09537104.2012.718383 [doi] PST - ppublish SO - Platelets. 2013;24(6):454-61. doi: 10.3109/09537104.2012.718383. Epub 2012 Aug 29. PMID- 22928166 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20120830 LR - 20211021 IS - 2160-2026 (Electronic) IS - 2160-2026 (Linking) VI - 2 IP - 1 DP - 2012 TI - Effects of In vitro hemodilution, hypothermia and rFVIIa addition on coagulation in human blood. PG - 42-50 AB - INTRODUCTION: Coagulopathy can occur after hemorrhage, trauma and resuscitation, and has been associated with dilution of coagulation factors and hypothermia. Recombinant activated Factor VII (rFVIIa) has been used, often as a last resort, to improve hemostasis in trauma/hemorrhage patients with coagulopathy. The aim of this study was to further characterize the effects of rFVIIa on various coagulation parameters and the influence of temperature and hemodilution. METHODS: WHOLE BLOOD FROM HEALTHY HUMAN VOLUNTEERS WAS INCUBATED IN A COMBINATION OF THREE CONDITIONS: undiluted or diluted 40% with either lactated Ringer's solution or Hextend, at 37 degrees C or 34 degrees C, and with and without rFVIIa (1.26 mug/ml, final concentration). Blood or plasma, as appropriate, was measured for coagulation by thrombin generation, thromboelastography (TEG), prothrombin Time (PT) and activated partial thromboplastin (aPTT). RESULTS: Incubation of plasma at 34 degrees C significantly elevated thrombin generation, and prolonged PT and aPTT. Dilution of blood or plasma with 40% Hextend, but not lactated Ringer's, had a significant effect on TEG parameters, and prolonged PT and aPTT. In control conditions (37 degrees C, 0 dilution), the addition of rFVIIa to human plasma or whole blood led to a significant change in all TEG parameters, and Lagtime for thrombin generation, but not to PT or aPTT. CONCLUSION: Theses data show that thrombin generation is affected by hypothermia, but not 40% dilution. TEG is affected by 40% dilution with Hextend, but not by hypothermia. PT and aPTT are significantly affected by both hypothermia and dilution. Recombinant FVIIa caused a greater change in thrombin generation at 34 degrees C as compared to 37 degrees C, and a greater change in PT at 40% dilution, suggesting that the effect of rFVIIa on coagulation is both temperature and dilution dependant. FAU - Darlington, Daniel N AU - Darlington DN AD - US Army Institute of Surgical Research Fort Sam Houston, Texas 78234, USA. FAU - Kremenevskiy, Igor AU - Kremenevskiy I FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Scherer, Michael R AU - Scherer MR FAU - Fedyk, Chriselda G AU - Fedyk CG FAU - Kheirabaldi, Bijan S AU - Kheirabaldi BS FAU - Delgado, Angel V AU - Delgado AV FAU - Dubick, Michael A AU - Dubick MA LA - eng PT - Journal Article DEP - 20120315 PL - United States TA - Int J Burns Trauma JT - International journal of burns and trauma JID - 101581623 PMC - PMC3415967 OTO - NOTNLM OT - PT OT - TEG OT - aPTT OT - thrombin generation EDAT- 2012/08/29 06:00 MHDA- 2012/08/29 06:01 PMCR- 2012/03/15 CRDT- 2012/08/29 06:00 PHST- 2012/01/25 00:00 [received] PHST- 2012/02/15 00:00 [accepted] PHST- 2012/08/29 06:00 [entrez] PHST- 2012/08/29 06:00 [pubmed] PHST- 2012/08/29 06:01 [medline] PHST- 2012/03/15 00:00 [pmc-release] PST - ppublish SO - Int J Burns Trauma. 2012;2(1):42-50. Epub 2012 Mar 15. PMID- 22868371 OWN - NLM STAT- MEDLINE DCOM- 20121022 LR - 20220330 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 256 IP - 3 DP - 2012 Sep TI - Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. PG - 476-86 LID - 10.1097/SLA.0b013e3182658180 [doi] AB - OBJECTIVE: Injury and shock lead to alterations in conventional coagulation tests (CCTs). Recently, rapid thrombelastography (r-TEG) has become recognized as a comprehensive assessment of coagulation abnormalities. We have previously shown that admission r-TEG results are available faster than CCTs and predict pulmonary embolism. We hypothesized that r-TEGs more reliably predict blood component transfusion than CCTs. METHODS: Consecutive patients admitted between September 2009 and February 2011 who met the highest-level trauma activations were included. All had admission r-TEG and CCTs. We correlated r-TEG values [activated clotting time (ACT), r, k, alpha, maximal amplitude (MA), LY30] with their corresponding CCTs [prothrombin time (PT)/activated partial thromboplastin time (aPTT), international normalized ratio (INR), platelet count and fibrinogen] for transfusion requirements. Charges were calculated for each test. Demographics, vital signs, and injury severity were recorded. RESULTS: We studied 1974 major trauma activations. The median injury severity score was 17 [interquartile range 9-26]; 25% were in shock; 28% were transfused; and 6% died within 24 hours. Overall, r-TEG correlated with CCTs. When controlling for age, injury mechanism, weighted-Revised Trauma Score, base excess and hemoglobin, ACT-predicted red blood cell (RBC) transfusion, and the alpha-angle predicted massive RBC transfusion better than PT/aPTT or INR (P < 0.001). The alpha-angle was superior to fibrinogen for predicting plasma transfusion (P < 0.001); MA was superior to platelet count for predicting platelet transfusion (P < 0.001); and LY-30 (rate of amplitude reduction 30 minutes after the MA is reached) documented fibrinolysis. These correlations improved for transfused, shocked or head injured patients. The charge for r-TEG ($317) was similar to the 5 CCTs ($286). CONCLUSIONS: The r-TEG data was clinically superior to results from 5 CCTs. In addition, r-TEG identified patients with an increased risk of early RBC, plasma and platelet transfusions, and fibrinolysis. Admission CCTs can be replaced with r-TEG. FAU - Holcomb, John B AU - Holcomb JB AD - Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. John.Holcomb@uth.tmc.edu FAU - Minei, Kristin M AU - Minei KM FAU - Scerbo, Michelle L AU - Scerbo ML FAU - Radwan, Zayde A AU - Radwan ZA FAU - Wade, Charles E AU - Wade CE FAU - Kozar, Rosemary A AU - Kozar RA FAU - Gill, Brijesh S AU - Gill BS FAU - Albarado, Rondel AU - Albarado R FAU - McNutt, Michelle K AU - McNutt MK FAU - Khan, Saleem AU - Khan S FAU - Adams, Phillip R AU - Adams PR FAU - McCarthy, James J AU - McCarthy JJ FAU - Cotton, Bryan A AU - Cotton BA LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Blood Coagulation Tests/economics MH - Blood Component Transfusion/*statistics & numerical data MH - Emergency Service, Hospital MH - Female MH - Hemorrhage/etiology/*therapy MH - Hospital Costs MH - Humans MH - Injury Severity Score MH - Linear Models MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Retrospective Studies MH - Texas MH - *Thrombelastography/economics/methods MH - Wounds and Injuries/*complications/mortality EDAT- 2012/08/08 06:00 MHDA- 2012/10/23 06:00 CRDT- 2012/08/08 06:00 PHST- 2012/08/08 06:00 [entrez] PHST- 2012/08/08 06:00 [pubmed] PHST- 2012/10/23 06:00 [medline] AID - 10.1097/SLA.0b013e3182658180 [doi] PST - ppublish SO - Ann Surg. 2012 Sep;256(3):476-86. doi: 10.1097/SLA.0b013e3182658180. PMID- 22867727 OWN - NLM STAT- MEDLINE DCOM- 20130208 LR - 20161229 IS - 1879-3479 (Electronic) IS - 0020-7292 (Linking) VI - 119 IP - 1 DP - 2012 Oct TI - Postpartum hemorrhage management in 2012: predicting the future. PG - 3-5 LID - 10.1016/j.ijgo.2012.07.001 [doi] AB - Transfusion therapy in postpartum hemorrhage (PPH) traditionally has been modeled after precedents set in the Vietnam and Korean wars. However, data from recent military combat casualties suggest a different transfusion strategy. Transfusion of packed red blood cells, fresh frozen plasma, and platelets in a ratio of 1:1:1 improves dilutional coagulopathy and survival. Women who present with low fibrinogen at the time of diagnosis of PPH have poorer outcomes and might benefit from early fibrinogen replacement. The antifibrinolytic agent, tranexamic acid, decreases bleeding and progression to severe PPH, but its role in PPH management is evolving. Observational data suggest that the use of recombinant factor VIIa should be limited to bleeding that has not responded to an optimal transfusion strategy. Point-of-care testing using thromboelastography is helpful in guiding the selection of blood products to be transfused. Additionally, massive transfusion protocols can decrease the overall number of products transfused and improve outcomes. CI - Copyright (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. FAU - Onwuemene, Oluwatoyosi AU - Onwuemene O AD - Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, USA. FAU - Green, David AU - Green D FAU - Keith, Louis AU - Keith L LA - eng PT - Journal Article DEP - 20120804 PL - United States TA - Int J Gynaecol Obstet JT - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics JID - 0210174 RN - 0 (Antifibrinolytic Agents) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Antifibrinolytic Agents/therapeutic use MH - Blood Transfusion/*methods/trends MH - Female MH - Fibrinogen/therapeutic use MH - Humans MH - Point-of-Care Systems MH - Postpartum Hemorrhage/*therapy MH - Pregnancy MH - Thrombelastography MH - Tranexamic Acid/therapeutic use MH - Treatment Outcome EDAT- 2012/08/08 06:00 MHDA- 2013/02/09 06:00 CRDT- 2012/08/08 06:00 PHST- 2012/08/08 06:00 [entrez] PHST- 2012/08/08 06:00 [pubmed] PHST- 2013/02/09 06:00 [medline] AID - S0020-7292(12)00342-6 [pii] AID - 10.1016/j.ijgo.2012.07.001 [doi] PST - ppublish SO - Int J Gynaecol Obstet. 2012 Oct;119(1):3-5. doi: 10.1016/j.ijgo.2012.07.001. Epub 2012 Aug 4. PMID- 22863406 OWN - NLM STAT- MEDLINE DCOM- 20130826 LR - 20220316 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 26 IP - 6 DP - 2012 Dec TI - Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. PG - 1083-93 LID - S1053-0770(12)00319-9 [pii] LID - 10.1053/j.jvca.2012.06.015 [doi] FAU - Tanaka, Kenichi A AU - Tanaka KA AD - Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. atlclot7@me.com FAU - Bolliger, Daniel AU - Bolliger D FAU - Vadlamudi, Ratna AU - Vadlamudi R FAU - Nimmo, Alastair AU - Nimmo A LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20120803 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 SB - IM MH - Blood Coagulation/*physiology MH - Cardiac Surgical Procedures/*adverse effects MH - Disease Management MH - Hemostasis/physiology MH - Humans MH - Postoperative Hemorrhage/*diagnosis/*therapy MH - Thrombelastography/*methods MH - Wounds and Injuries/diagnosis/therapy EDAT- 2012/08/07 06:00 MHDA- 2013/08/27 06:00 CRDT- 2012/08/07 06:00 PHST- 2011/09/09 00:00 [received] PHST- 2012/08/07 06:00 [entrez] PHST- 2012/08/07 06:00 [pubmed] PHST- 2013/08/27 06:00 [medline] AID - S1053-0770(12)00319-9 [pii] AID - 10.1053/j.jvca.2012.06.015 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2012 Dec;26(6):1083-93. doi: 10.1053/j.jvca.2012.06.015. Epub 2012 Aug 3. PMID- 22847397 OWN - NLM STAT- MEDLINE DCOM- 20130920 LR - 20220311 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 18 IP - 2 DP - 2013 Apr TI - Platelet dysfunction is an early marker for traumatic brain injury-induced coagulopathy. PG - 201-8 LID - 10.1007/s12028-012-9745-6 [doi] AB - BACKGROUND: The goal of this study is to determine the presence of platelet dysfunction in patients with traumatic brain injury (TBI). The mechanisms underlying the coagulopathy associated with TBI remain elusive. The question of platelet dysfunction in TBI is unclear. METHODS: This was a prospective observational study conducted at Memorial Hospital of South Bend, IN, and Denver Health Medical Center, CO. A total of 50 patients sustaining TBI, and not under treatment with anticoagulants or platelet inhibitors, were analyzed utilizing modified thromboelastography (TEG) with platelet mapping (TEG/PM), along with standard coagulation tests. RESULTS: Compared to normal controls, patients with severe TBI had a significantly increased percentage of platelet ADP and arachidonic acid (AA) receptor inhibition. Furthermore, the percentage of ADP inhibition distinguished between survivors and non-survivors in patients with TBI (Mann-Whitney test, P = 0.035). ADP inhibition correlates strongly with severity of TBI (Mann-Whitney test, P = 0.014), while AA inhibition did not. CONCLUSION: These data indicate that early platelet dysfunction is prevalent after severe TBI, can be measured in a point-of-care setting using TEG/PM, and correlates with mortality. The mechanism responsible for this platelet dysfunction and associated implications for TBI management remains to be defined. FAU - Davis, Patrick K AU - Davis PK AD - W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN 46556, USA. FAU - Musunuru, Harsha AU - Musunuru H FAU - Walsh, Mark AU - Walsh M FAU - Cassady, Robert AU - Cassady R FAU - Yount, Robert AU - Yount R FAU - Losiniecki, Andrew AU - Losiniecki A FAU - Moore, Ernest E AU - Moore EE FAU - Wohlauer, Max V AU - Wohlauer MV FAU - Howard, Janet AU - Howard J FAU - Ploplis, Victoria A AU - Ploplis VA FAU - Castellino, Francis J AU - Castellino FJ FAU - Thomas, Scott G AU - Thomas SG LA - eng PT - Journal Article PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 RN - 0 (Biomarkers) RN - 0 (Receptors, Purinergic P2) SB - IM MH - Adult MH - Biomarkers/blood MH - Blood Coagulation Disorders/blood MH - Blood Platelet Disorders/*blood MH - Brain Injuries/*blood/diagnosis MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Platelet Function Tests/methods MH - Prospective Studies MH - Receptors, Purinergic P2/metabolism MH - Thrombelastography/*methods MH - Time Factors EDAT- 2012/08/01 06:00 MHDA- 2013/09/21 06:00 CRDT- 2012/08/01 06:00 PHST- 2012/08/01 06:00 [entrez] PHST- 2012/08/01 06:00 [pubmed] PHST- 2013/09/21 06:00 [medline] AID - 10.1007/s12028-012-9745-6 [doi] PST - ppublish SO - Neurocrit Care. 2013 Apr;18(2):201-8. doi: 10.1007/s12028-012-9745-6. PMID- 22846944 OWN - NLM STAT- MEDLINE DCOM- 20121018 LR - 20140731 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 73 IP - 2 DP - 2012 Aug TI - Insertion of central venous catheters induces a hypercoagulable state. PG - 385-90 LID - 10.1097/TA.0b013e31825a0519 [doi] AB - BACKGROUND: Central venous catheters (CVCs) increase the risk of venous thromboembolism. We have previously demonstrated that pulmonary artery catheters are associated with a hypercoagulable state in an animal model and in patients. The purpose of this study is to determine whether the insertion of a CVC is associated with a similar response. ANIMAL: 7F femoral artery catheters were placed in healthy anesthetized swine (N = 16). Serial arterial blood samples were drawn immediately before and after an 8.5F jugular vein CVC and then for 3 hours after CVC removal. Samples were analyzed using kaolin-activated thromboelastography (TEG) at precisely 2 minutes. Human: An institutional review board-approved prospective observational trial was conducted, with informed consent, in patients with critical illness (N = 8) at a Level I trauma center. Blood was drawn from indwelling arterial catheters immediately before and 60 minutes after CVC insertion. Samples were stored in sodium citrate for 15 minutes before TEG. Routine and special coagulation tests were performed on stored samples in the hospital pathology laboratory. RESULTS: Insertion of a CVC decreased TEG clotting time (R) by 55% in swine and by 29% in humans (p < 0.001 and 0.019, respectively). Initial clot formation time (K) was reduced by 41% in swine and by 36% in humans (p = 0.003 and 0.019). Fibrin cross-linking (alpha) was accelerated by 28% in swine and by 17% in humans (p = 0.007 and 0.896), but overall clot strength (maximum amplitude) was not affected. There was no change in routine or special coagulation factors, including von Willebrand factor, antithrombin III, prothrombin time, international normalized ratio, or activated partial thromboplastin time. In animals, the hypercoagulable TEG response was persistent for 3 hours after CVC removal and was prevented by pretreatment with enoxaparin (n = 4) but not heparin (n = 2). CONCLUSION: In healthy swine and patients with critical illness, a systemic hypercoagulable state occurred after CVC insertion, and this may partially account for an increased risk of venous thromboembolism. However, because the sample size was small and not powered to detect changes in coagulation proteins, no inferences can be made about the mechanism for the hypercoagulable response. FAU - Ryan, Mark L AU - Ryan ML AD - Division of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami School of Medicine, Ryder Trauma Center, Miami, Florida 33136, USA. FAU - Thorson, Chad M AU - Thorson CM FAU - King, David R AU - King DR FAU - Van Haren, Robert M AU - Van Haren RM FAU - Manning, Ronald J AU - Manning RJ FAU - Andrews, David M AU - Andrews DM FAU - Livingstone, Alan S AU - Livingstone AS FAU - Proctor, Kenneth G AU - Proctor KG LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Animals MH - Blood Coagulation Tests MH - Catheterization, Central Venous/*adverse effects/methods MH - Cohort Studies MH - Critical Illness MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Models, Animal MH - Prothrombin Time MH - Pulmonary Embolism/epidemiology/*etiology/physiopathology MH - Risk Assessment MH - Swine MH - Thrombelastography MH - Thrombophilia/epidemiology/*etiology/physiopathology MH - Trauma Centers MH - Young Adult EDAT- 2012/08/01 06:00 MHDA- 2012/10/19 06:00 CRDT- 2012/08/01 06:00 PHST- 2012/08/01 06:00 [entrez] PHST- 2012/08/01 06:00 [pubmed] PHST- 2012/10/19 06:00 [medline] AID - 01586154-201208000-00014 [pii] AID - 10.1097/TA.0b013e31825a0519 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2012 Aug;73(2):385-90. doi: 10.1097/TA.0b013e31825a0519. PMID- 22846941 OWN - NLM STAT- MEDLINE DCOM- 20121018 LR - 20220317 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 73 IP - 2 DP - 2012 Aug TI - Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. PG - 365-70; discussion 370 LID - 10.1097/TA.0b013e31825c1234 [doi] AB - BACKGROUND: Hyperfibrinolysis (HF) has been reported to occur in a range of 2% to 34% of trauma patients. Using rapid thromboelastography (r-TEG), we hypothesized that HF is (1) rarely present at admission on patients with severe injury and (2) associated with crystalloid hemodilution. To further strengthen this hypothesis, we created an in vitro hemodilution model to improve our mechanistic understanding of the early HF. METHODS: The trauma registry was queried for patients who were our highest-level trauma activations and admitted directly from the scene (October 2009-October 2010). HF was defined as more than 7.5% amplitude reduction 30 minutes after maximal amplitude (LY30). Using r-TEG, we then created an in vitro hemodilution model (0.9% NS) with and without tissue injury (addition of tissue factor and tissue plasminogen activator) to identify crystalloid volumes and injury needed to achieve specific LY30 values. RESULTS: Admission r-TEG values were captured on 1996 consecutive admissions. Only 41 patients (2%) had HF at admission r-TEG. The groups were similar in demographics. Compared with patients without HF, the HF group had more prehospital crystalloid (1.5 vs. 0.5 L), higher median Injury Severity Score (25 vs. 16), greater admission base deficit (20 vs. 2), and higher mortality (76% vs. 10%); all p < 0.001. Controlling for Injury Severity Score and base deficit on arrival, prehospital fluid was associated with a significant increase in likelihood of HF. In fact, each additional liter of crystalloid was associated with a 15% increased odds of HF. The in vitro model found that hemodilution to 15% of baseline and tissue factor + tissue plasminogen activator was required to achieve an LY30 of 50%. CONCLUSION: Although uncommon immediately after injury, HF is associated with prehospital crystalloid administration and shock at admission and is highly lethal. Our in vitro model confirms that tissue injury and significant crystalloid hemodilution result in severe and immediate HF. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center, Houston, Texas 77030, USA. bryan.a.cotton@uth.tmc.edu FAU - Harvin, John A AU - Harvin JA FAU - Kostousouv, Vadim AU - Kostousouv V FAU - Minei, Kristin M AU - Minei KM FAU - Radwan, Zayde A AU - Radwan ZA FAU - Schochl, Herbert AU - Schochl H FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB FAU - Matijevic, Nena AU - Matijevic N LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Blood Coagulation Disorders/diagnosis/etiology/*mortality MH - Causality MH - Cohort Studies MH - Comorbidity MH - Emergency Medical Services/*methods MH - Female MH - Fibrinolysis MH - Fluid Therapy/*adverse effects MH - Hemodilution/adverse effects MH - Hospital Mortality MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - *Models, Biological MH - Patient Admission MH - Rare Diseases MH - Resuscitation/methods MH - Retrospective Studies MH - Shock, Traumatic/etiology/*mortality MH - Statistics, Nonparametric MH - Survival Analysis MH - Thrombelastography MH - Treatment Outcome MH - Wounds and Injuries/diagnosis/*mortality/*therapy EDAT- 2012/08/01 06:00 MHDA- 2012/10/19 06:00 CRDT- 2012/08/01 06:00 PHST- 2012/08/01 06:00 [entrez] PHST- 2012/08/01 06:00 [pubmed] PHST- 2012/10/19 06:00 [medline] AID - 01586154-201208000-00011 [pii] AID - 10.1097/TA.0b013e31825c1234 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2012 Aug;73(2):365-70; discussion 370. doi: 10.1097/TA.0b013e31825c1234. PMID- 22776724 OWN - NLM STAT- MEDLINE DCOM- 20130211 LR - 20240418 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 20 DP - 2012 Jul 9 TI - Current management of massive hemorrhage in trauma. PG - 47 LID - 10.1186/1757-7241-20-47 [doi] AB - Hemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution, and consumption of clotting factors and platelets. Concepts of damage control surgery have evolved prioritizing early control of the cause of bleeding by non-definitive means, while hemostatic control resuscitation seeks early control of coagulopathy.Hemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells in an immediate and sustained manner as part of the transfusion protocol for massively bleeding patients. Although early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy of massive transfusion remains debated and randomized controlled studies are lacking. Viscoelastical whole blood assays, like TEG and ROTEM however appear advantageous for identifying coagulopathy in patients with severe hemorrhage as opposed the conventional coagulation assays.In our view, patients with uncontrolled bleeding, regardless of it's cause, should be treated with hemostatic control resuscitation involving early administration of plasma and platelets and earliest possible goal-directed, based on the results of TEG/ROTEM analysis. The aim of the goal-directed therapy should be to maintain a normal hemostatic competence until surgical hemostasis is achieved, as this appears to be associated with reduced mortality. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. per.johansson@rh.regionh.dk FAU - Stensballe, Jakob AU - Stensballe J FAU - Ostrowski, Sisse R AU - Ostrowski SR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20120709 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Anticoagulants) RN - 0 (Hemostatics) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Anticoagulants/adverse effects MH - Blood Coagulation Disorders/etiology/therapy MH - Blood Transfusion MH - Hemorrhage/*etiology/*therapy MH - Hemostasis MH - Hemostatics/therapeutic use MH - Humans MH - Multiple Trauma/*complications/therapy MH - Platelet Aggregation Inhibitors/adverse effects PMC - PMC3439269 EDAT- 2012/07/11 06:00 MHDA- 2013/02/12 06:00 PMCR- 2012/07/09 CRDT- 2012/07/11 06:00 PHST- 2012/04/03 00:00 [received] PHST- 2012/07/09 00:00 [accepted] PHST- 2012/07/11 06:00 [entrez] PHST- 2012/07/11 06:00 [pubmed] PHST- 2013/02/12 06:00 [medline] PHST- 2012/07/09 00:00 [pmc-release] AID - 1757-7241-20-47 [pii] AID - 10.1186/1757-7241-20-47 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2012 Jul 9;20:47. doi: 10.1186/1757-7241-20-47. PMID- 22766227 OWN - NLM STAT- MEDLINE DCOM- 20121203 LR - 20220317 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 215 IP - 4 DP - 2012 Oct TI - Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma. PG - 496-502 LID - S1072-7515(12)00445-0 [pii] LID - 10.1016/j.jamcollsurg.2012.06.005 [doi] AB - BACKGROUND: The acute coagulopathy of trauma has been identified as a critical determinant of outcomes. Antifibrinolytic agents have recently been demonstrated to improve outcomes. This prospective study was designed to assess coagulopathy in trauma patients using thromboelastography. STUDY DESIGN: Trauma patients meeting our institution's highest tier of trauma team activation criteria were prospectively enrolled during a 5-month period ending April 1, 2011. Thromboelastography was performed at admission, +1 hour, +2 hours, and +6 hours using citrated blood. Hyperfibrinolysis was defined as estimated percent lysis >/=15%. Patients were followed throughout their hospital course to collect clinical data and outcomes. RESULTS: One hundred and eighteen patients were enrolled (77.1% were male, 51.7% had penetrating trauma, 7.6% had systolic blood pressure <90 mmHg, 47.5% had Injury Severity Score >16, and 23.7% had Glasgow Coma Scale score /=1.3 or activated partial thromboplastin time >/=30), or relative thrombocytopenia (platelet count 65 and 5.8 for mA > 72. CONCLUSION: Admission r-TEG mA values can identify patients with an increased risk of in-hospital PE. Further studies are needed to determine whether alternative anticoagulation strategies should be used for these high-risk patients. LEVEL OF EVIDENCE: Prognostic study, level III. CI - Copyright (c) 2012 by Lippincott Williams & Wilkins. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center, Houston, Texas 77030, USA. bryan.a.cotton@uth.tmc.edu FAU - Minei, Kristin M AU - Minei KM FAU - Radwan, Zayde A AU - Radwan ZA FAU - Matijevic, Nena AU - Matijevic N FAU - Pivalizza, Evan AU - Pivalizza E FAU - Podbielski, Jeanette AU - Podbielski J FAU - Wade, Charles E AU - Wade CE FAU - Kozar, Rosemary A AU - Kozar RA FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - IM MH - Adult MH - Age Distribution MH - Cohort Studies MH - Early Diagnosis MH - Female MH - Humans MH - Incidence MH - Injury Severity Score MH - Linear Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Patient Admission MH - Predictive Value of Tests MH - Pulmonary Embolism/*diagnosis/*epidemiology/etiology MH - Retrospective Studies MH - Risk Assessment MH - Sex Distribution MH - Survival Rate MH - Thrombelastography/*methods MH - Time Factors MH - Trauma Centers MH - Wounds and Injuries/*complications/diagnosis MH - Young Adult EDAT- 2012/06/15 06:00 MHDA- 2012/09/05 06:00 CRDT- 2012/06/15 06:00 PHST- 2012/06/15 06:00 [entrez] PHST- 2012/06/15 06:00 [pubmed] PHST- 2012/09/05 06:00 [medline] AID - 01586154-201206000-00007 [pii] AID - 10.1097/TA.0b013e31824d56ad [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2012 Jun;72(6):1470-5; discussion 1475-7. doi: 10.1097/TA.0b013e31824d56ad. PMID- 22677700 OWN - NLM STAT- MEDLINE DCOM- 20130201 LR - 20120914 IS - 1940-5596 (Electronic) IS - 1089-2532 (Linking) VI - 16 IP - 3 DP - 2012 Sep TI - Trauma and thrombelastography: how changes in the understanding of coagulopathy, testing, and hospital systems have changed one group's practice. PG - 142-52 LID - 10.1177/1089253212446994 [doi] AB - Bleeding disorders associated with trauma are of paramount importance when dealing with the acutely injured individual. Statistically, up to 40% of trauma related deaths are assumed to be related to hemorrhage. Historically, there have been many varying positions on the way to handle this entity. Ironically, it is not always the injury but the physiologic sequelae of that injury that lead to trauma associated deaths. Over time, newer theories have been developed to help the clinician begin to understand the etiology and treatment of this process. The purpose of this paper is to review current literature and explain how these new concepts helped change practice in an urban, academic, Level One Trauma Center. FAU - Sawyer, Michael M AU - Sawyer MM AD - Denver Health and Hospital, Denver, CO 80204, USA. michael.sawyer@dhha.org FAU - Myers, Greg AU - Myers G FAU - Humphrey, Jack AU - Humphrey J FAU - Chandler, Mark AU - Chandler M LA - eng PT - Journal Article PT - Review DEP - 20120607 PL - United States TA - Semin Cardiothorac Vasc Anesth JT - Seminars in cardiothoracic and vascular anesthesia JID - 9807630 SB - IM MH - Academic Medical Centers MH - Blood Coagulation Disorders/diagnosis/etiology/therapy MH - Blood Transfusion/methods MH - Hemorrhage/diagnosis/etiology/*therapy MH - Humans MH - Thrombelastography/*methods MH - Wounds and Injuries/diagnosis/physiopathology/*therapy EDAT- 2012/06/09 06:00 MHDA- 2013/02/05 06:00 CRDT- 2012/06/09 06:00 PHST- 2012/06/09 06:00 [entrez] PHST- 2012/06/09 06:00 [pubmed] PHST- 2013/02/05 06:00 [medline] AID - 1089253212446994 [pii] AID - 10.1177/1089253212446994 [doi] PST - ppublish SO - Semin Cardiothorac Vasc Anesth. 2012 Sep;16(3):142-52. doi: 10.1177/1089253212446994. Epub 2012 Jun 7. PMID- 22670128 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220330 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 39 IP - 2 DP - 2012 Apr TI - Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy. PG - 104-113 AB - BACKGROUND: Massive bleeding and transfusion of packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets are associated with increased morbidity, mortality and costs. PATIENTS AND METHODS: We analysed the transfusion requirements after implementation of point-of-care (POC) coagulation management algorithms based on early, calculated, goal-directed therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in different perioperative settings (trauma surgery, visceral and transplant surgery (VTS), cardiovascular surgery (CVS) and general and surgical intensive care medicine) at 3 different hospitals (AUVA Trauma Centre Salzburg, University Hospital Innsbruck and University Hospital Essen) in 2 different countries (Austria and Germany). RESULTS: In all institutions, the implementation of POC coagulation management algorithms was associated with a reduction in the transfusion requirements for FFP by about 90% (Salzburg 94%, Innsbruck 88% and Essen 93%). Furthermore, PRBC transfusion was reduced by 8.4-62%. The incidence of intraoperative massive transfusion (>/=10 U PRBC) could be more than halved in VTS and CVS (2.56 vs. 0.88%; p < 0.0001 and 2.50 vs. 1.06%; p = 0.0007, respectively). Platelet transfusion could be reduced by 21-72%, except in CVS where it increased by 115% due to a 5-fold increase in patients with dual antiplatelet therapy (2.7 vs. 13.7%; p < 0.0001). CONCLUSIONS: The implementation of perioperative POC coagulation management algorithms based on early, calculated, goal-directed therapy with fibrinogen concentrate and PCC is associated with a reduction in the transfusion requirements for FFP, PRBC and platelets as well as with a reduced incidence of massive transfusion. Thus, the limited blood resources can be used more efficiently. FAU - Gorlinger, Klaus AU - Gorlinger K AD - Klinik fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany. FAU - Fries, Dietmar AU - Fries D FAU - Dirkmann, Daniel AU - Dirkmann D FAU - Weber, Christian F AU - Weber CF FAU - Hanke, Alexander A AU - Hanke AA FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article DEP - 20120308 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC3364099 EDAT- 2012/06/07 06:00 MHDA- 2012/06/07 06:01 PMCR- 2012/03/08 CRDT- 2012/06/07 06:00 PHST- 2011/04/27 00:00 [received] PHST- 2011/08/02 00:00 [accepted] PHST- 2012/06/07 06:00 [entrez] PHST- 2012/06/07 06:00 [pubmed] PHST- 2012/06/07 06:01 [medline] PHST- 2012/03/08 00:00 [pmc-release] AID - tmh-0039-0104 [pii] AID - 10.1159/000337186 [doi] PST - ppublish SO - Transfus Med Hemother. 2012 Apr;39(2):104-113. doi: 10.1159/000337186. Epub 2012 Mar 8. PMID- 22670126 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211021 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 39 IP - 2 DP - 2012 Apr TI - Predictive Models and Algorithms for the Need of Transfusion Including Massive Transfusion in Severely Injured Patients. PG - 85-97 AB - BACKGROUND: Despite improvements on how to resuscitate exsanguinating patients, one remaining key to improve outcome is to expeditiously and reproducibly identify patients most likely to require transfusion including massive transfusion (MT). This work summarizes yet developed algorithms/scoring systems for transfusion including MT in civilian and military trauma populations. METHODS: A systematic search of evidence was conducted utilizing OVID/MEDLINE (1966 to present) and the 'Medical Algorithms Project'. RESULTS AND CONCLUSIONS: The models developed suggest combinations of physiologic, hemodynamic, laboratory, injury severity and demographic triggers identified on the initial evaluation of the bleeding trauma patient. Many approaches use a combination of dichotomous variables readily accessible after arrival but others rely on time-consuming calculations or complex algorithms and may have limited real-time application. Weighted and more sophisticated systems including higher numbers of variables perform superior. A common limitation to all models is their retrospective nature, and prospective validations are urgently needed. Point-of-care viscoelastic testing may be an alternative to these systems. FAU - Maegele, Marc AU - Maegele M AD - Department of Traumatology and Orthopedic Surgery, Germany. FAU - Brockamp, Thomas AU - Brockamp T FAU - Nienaber, Ulrike AU - Nienaber U FAU - Probst, Christian AU - Probst C FAU - Schoechl, Herbert AU - Schoechl H FAU - Gorlinger, Klaus AU - Gorlinger K FAU - Spinella, Philip AU - Spinella P LA - eng PT - Journal Article DEP - 20120308 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC3364090 EDAT- 2012/06/07 06:00 MHDA- 2012/06/07 06:01 PMCR- 2012/03/08 CRDT- 2012/06/07 06:00 PHST- 2012/01/31 00:00 [received] PHST- 2012/02/06 00:00 [accepted] PHST- 2012/06/07 06:00 [entrez] PHST- 2012/06/07 06:00 [pubmed] PHST- 2012/06/07 06:01 [medline] PHST- 2012/03/08 00:00 [pmc-release] AID - tmh-0039-0085 [pii] AID - 10.1159/000337243 [doi] PST - ppublish SO - Transfus Med Hemother. 2012 Apr;39(2):85-97. doi: 10.1159/000337243. Epub 2012 Mar 8. PMID- 22578369 OWN - NLM STAT- MEDLINE DCOM- 20120803 LR - 20191210 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 52 Suppl 1 DP - 2012 May TI - Plasma transfusion for patients with severe hemorrhage: what is the evidence? PG - 30S-7S LID - 10.1111/j.1537-2995.2012.03621.x [doi] AB - The following review will detail the current knowledge in massive hemorrhage with regard to the pathophysiology of the coagulation disturbance, the role of plasma, the role of alternatives to plasma, and the clinical value of having a massive transfusion protocol. The coagulation disturbance in trauma patients is more than just the result of consumption of clotting factors at sites of injury and dilution from the infusion of intravenous fluids and red blood cells (RBCs). Even before substantial amounts of fluid resuscitation and RBC transfusion, one-quarter of trauma patients already have abnormal coagulation variables. There is an apparent role for the activation of protein C, hypofibrinogenemia, and fibrin(gen)olysis in the coagulation disturbance after trauma and massive hemorrhage. None of these three disturbances would be completely mitigated by the use of plasma alone, suggesting that there may be an opportunity to improve care of these patients with alternative strategies, such as fibrinogen concentrates and antifibrinolytics. Despite numerous retrospective cohort studies evaluating 1:1 plasma to RBC formula-driven resuscitation, the overall clinical value of this approach is unclear. Studies have even raised concerns regarding a potential increase in morbidity associated with this approach, particularly for patients overtriaged to 1:1 where a massive transfusion is unlikely. We also do not have sufficient evidence to recommend either goal-directed therapy with thromboelastography or early use of fibrinogen replacement, with either cryoprecipitate or fibrinogen concentrates. We have high-quality data that argue against the role for recombinant Factor VIIa that should prompt removal of this strategy from existing protocols. In contrast, we have high-level evidence that all bleeding trauma patients should receive tranexamic acid as soon as possible after injury. This therapy must be included in hemorrhage protocols. If we are to improve the care of massively bleeding patients on a firm scientific ground, we will need large-scale randomized trials to delineate the role of coagulation replacement and the utility of laboratory monitoring. But even until these trials are completed, it is clear that a massive transfusion protocol is needed in all hospitals that manage bleeding patients, to ensure a prompt and coordinated response to hemorrhage. CI - (c) 2012 American Association of Blood Banks. FAU - Callum, Jeannie L AU - Callum JL AD - Department of Clinical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. jeannie.callum@sunnybrook.ca FAU - Rizoli, Sandro AU - Rizoli S LA - eng PT - Evaluation Study PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Algorithms MH - Blood Coagulation Disorders/complications/therapy MH - Blood Component Transfusion/methods/*statistics & numerical data MH - Evidence-Based Practice/*standards MH - Hemorrhage/etiology/*therapy MH - Humans MH - Models, Biological MH - *Plasma MH - Resuscitation/methods MH - Severity of Illness Index EDAT- 2012/05/18 06:00 MHDA- 2012/08/04 06:00 CRDT- 2012/05/15 06:00 PHST- 2012/05/15 06:00 [entrez] PHST- 2012/05/18 06:00 [pubmed] PHST- 2012/08/04 06:00 [medline] AID - 10.1111/j.1537-2995.2012.03621.x [doi] PST - ppublish SO - Transfusion. 2012 May;52 Suppl 1:30S-7S. doi: 10.1111/j.1537-2995.2012.03621.x. PMID- 22547997 OWN - NLM STAT- MEDLINE DCOM- 20120713 LR - 20211021 IS - 1537-744X (Electronic) IS - 2356-6140 (Print) IS - 1537-744X (Linking) VI - 2012 DP - 2012 TI - The Rapid TEG alpha-Angle may be a sensitive predictor of transfusion in moderately injured blunt trauma patients. PG - 821794 LID - 10.1100/2012/821794 [doi] LID - 821794 AB - BACKGROUND: To guide the administration of blood products, coagulation screening of trauma patients should be fast and accurate. The purpose of this study was to identify the correlation between CCT and TEG in trauma, to determine which CCT or TEG parameter is most sensitive in predicting transfusion in trauma, and to define TEG cut-off points for trauma care. METHODS: A six-month, prospective observational study of 76 adult patients with suspected multiple injuries was conducted at a Level 1 trauma centre of a university hospital. Physicians blinded to TEG results made the decision to transfuse based on clinical evaluation. RESULTS: The study results showed that conventional coagulation tests correlate moderately with Rapid TEG parameters (R: 0.44-0.61). Kaolin and Rapid TEG were more sensitive than CCTs, and the Rapid TEG alpha-Angle was identified as the single parameter with the greatest sensitivity (84%) and validity (77%) at a cut-off of 74.7 degrees. When the Rapid TEG alpha-Angle was combined with heart rate >75 bpm, or haematocrit < 41%, sensitivity (84%, 88%) and specificity (75%, 73%) were improved. CONCLUSION: Cutoff points for transfusion can be determined with the Rapid TEG alpha-Angle and can provide better sensitivity than CCTs, but a larger study population is needed to reproduce this finding. FAU - Jeger, Victor AU - Jeger V AD - Department of Emergency Medicine, University Hospital Inselspital Bern, 3010 Bern, Switzerland. victor.jeger@students.unibe.ch FAU - Willi, Sandra AU - Willi S FAU - Liu, Tun AU - Liu T FAU - Yeh, Daniel D AU - Yeh DD FAU - De Moya, Marc AU - De Moya M FAU - Zimmermann, Heinz AU - Zimmermann H FAU - Exadaktylos, Aristomenis K AU - Exadaktylos AK LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120401 PL - United States TA - ScientificWorldJournal JT - TheScientificWorldJournal JID - 101131163 SB - IM MH - Adult MH - Aged MH - *Blood Transfusion MH - Female MH - Humans MH - Male MH - Middle Aged MH - Point-of-Care Systems MH - Prospective Studies MH - Wounds, Nonpenetrating/*therapy PMC - PMC3322428 EDAT- 2012/05/02 06:00 MHDA- 2012/07/14 06:00 PMCR- 2012/04/01 CRDT- 2012/05/02 06:00 PHST- 2011/10/23 00:00 [received] PHST- 2011/11/17 00:00 [accepted] PHST- 2012/05/02 06:00 [entrez] PHST- 2012/05/02 06:00 [pubmed] PHST- 2012/07/14 06:00 [medline] PHST- 2012/04/01 00:00 [pmc-release] AID - 10.1100/2012/821794 [doi] PST - ppublish SO - ScientificWorldJournal. 2012;2012:821794. doi: 10.1100/2012/821794. Epub 2012 Apr 1. PMID- 22524128 OWN - NLM STAT- MEDLINE DCOM- 20120524 LR - 20220330 IS - 1606-0997 (Print) IS - 2072-1315 (Electronic) IS - 1606-0997 (Linking) VI - 30 IP - 1 DP - 2012 Mar TI - Clinical and epidemiological profiles of severe malaria in children from Delhi, India. PG - 113-6 AB - Plasmodium vivax is traditionally known to cause benign tertian malaria, although recent reports suggest that P. vivax can also cause severe life-threatening disease analogous to severe infection due to P. falciparum. There are limited published data on the clinical and epidemiological profiles of children suffering from 'severe malaria' in an urban setting of India. To assess the clinical and epidemiological profiles of children with severe malaria, a prospective study was carried out during June 2008-December 2008 in the Department of Pediatrics, Guru Teg Bahadur Hospital, a tertiary hospital located in East Delhi, India. Data on children aged < or = 12 years, diagnosed with severe malaria, were analyzed for their demographic, clinical and laboratory parameters. All patients were categorized and treated as per the guidelines of the World Health Organization. In total, 1,680 children were screened for malaria at the paediatric outpatient and casualty facilities of the hospital. Thirty-eight children tested positive for malaria on peripheral smear examination (2.26% slide positivity rate). Of these, 27 (71%) were admitted and categorized as severe malaria as per the definition of the WHO while another 11 (29%) received treatment on outpatient basis. Most (24/27; 88.8%) cases of severe malaria (n=27) were infected with P. vivax. Among the cases of severe malaria caused by Plasmodium vivax (n=24), 12 (50%) presented with altered sensorium (cerebral malaria), seven (29.1%) had severe anaemia (haemoglobin <5 g/dL), and 17 (70.8%) had thrombocytopaenia, of which two had spontaneous bleeding (epistaxis). Cases of severe vivax malaria are clinically indistinguishable from severe falciparum malaria. Our study demonstrated that majority (88.8%) of severe malaria cases in children from Delhi and adjoining districts of Uttar Pradesh were due to P. vivax-associated infection. P. vivax should, thus, be regarded as an important causative agent for severe malaria in children. FAU - Kaushik, Jaya Shankar AU - Kaushik JS AD - Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, India. jayashankarkaushik@gmail.com FAU - Gomber, Sunil AU - Gomber S FAU - Dewan, Pooja AU - Dewan P LA - eng PT - Journal Article PL - Bangladesh TA - J Health Popul Nutr JT - Journal of health, population, and nutrition JID - 100959228 RN - 0 (Antimalarials) SB - IM MH - Antimalarials/therapeutic use MH - Child MH - Child, Preschool MH - Comorbidity MH - Female MH - Humans MH - India/epidemiology MH - Infant MH - Malaria, Falciparum/diagnosis/drug therapy/*epidemiology MH - Malaria, Vivax/diagnosis/drug therapy/*epidemiology MH - Male MH - Plasmodium falciparum/isolation & purification MH - Plasmodium vivax/isolation & purification MH - Prospective Studies MH - Severity of Illness Index PMC - PMC3312368 EDAT- 2012/04/25 06:00 MHDA- 2012/05/25 06:00 PMCR- 2012/03/01 CRDT- 2012/04/25 06:00 PHST- 2012/04/25 06:00 [entrez] PHST- 2012/04/25 06:00 [pubmed] PHST- 2012/05/25 06:00 [medline] PHST- 2012/03/01 00:00 [pmc-release] AID - 10.3329/jhpn.v30i1.11291 [doi] PST - ppublish SO - J Health Popul Nutr. 2012 Mar;30(1):113-6. doi: 10.3329/jhpn.v30i1.11291. PMID- 22523283 OWN - NLM STAT- MEDLINE DCOM- 20121018 LR - 20220408 IS - 1522-1504 (Electronic) IS - 1040-0605 (Linking) VI - 303 IP - 1 DP - 2012 Jul 1 TI - Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. PG - L20-32 LID - 10.1152/ajplung.00300.2011 [doi] AB - Bacterial infections of the lungs and abdomen are among the most common causes of sepsis. Abdominal peritonitis often results in acute lung injury (ALI). Recent reports demonstrate a potential benefit of parenteral vitamin C [ascorbic acid (AscA)] in the pathogenesis of sepsis. Therefore we examined the mechanisms of vitamin C supplementation in the setting of abdominal peritonitis-mediated ALI. We hypothesized that vitamin C supplementation would protect lungs by restoring alveolar epithelial barrier integrity and preventing sepsis-associated coagulopathy. Male C57BL/6 mice were intraperitoneally injected with a fecal stem solution to induce abdominal peritonitis (FIP) 30 min prior to receiving either AscA (200 mg/kg) or dehydroascorbic acid (200 mg/kg). Variables examined included survival, extent of ALI, pulmonary inflammatory markers (myeloperoxidase, chemokines), bronchoalveolar epithelial permeability, alveolar fluid clearance, epithelial ion channel, and pump expression (aquaporin 5, cystic fibrosis transmembrane conductance regulator, epithelial sodium channel, and Na(+)-K(+)-ATPase), tight junction protein expression (claudins, occludins, zona occludens), cytoskeletal rearrangements (F-actin polymerization), and coagulation parameters (thromboelastography, pro- and anticoagulants, fibrinolysis mediators) of septic blood. FIP-mediated ALI was characterized by compromised lung epithelial permeability, reduced alveolar fluid clearance, pulmonary inflammation and neutrophil sequestration, coagulation abnormalities, and increased mortality. Parenteral vitamin C infusion protected mice from the deleterious consequences of sepsis by multiple mechanisms, including attenuation of the proinflammatory response, enhancement of epithelial barrier function, increasing alveolar fluid clearance, and prevention of sepsis-associated coagulation abnormalities. Parenteral vitamin C may potentially have a role in the management of sepsis and ALI associated with sepsis. FAU - Fisher, Bernard J AU - Fisher BJ AD - Division of Pulmonary and Critical Care Medicine, Dept. of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298-0050, USA. FAU - Kraskauskas, Donatas AU - Kraskauskas D FAU - Martin, Erika J AU - Martin EJ FAU - Farkas, Daniela AU - Farkas D FAU - Wegelin, Jacob A AU - Wegelin JA FAU - Brophy, Donald AU - Brophy D FAU - Ward, Kevin R AU - Ward KR FAU - Voelkel, Norbert F AU - Voelkel NF FAU - Fowler, Alpha A 3rd AU - Fowler AA 3rd FAU - Natarajan, Ramesh AU - Natarajan R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120420 PL - United States TA - Am J Physiol Lung Cell Mol Physiol JT - American journal of physiology. Lung cellular and molecular physiology JID - 100901229 RN - 0 (Biomarkers) RN - 0 (Cytoskeletal Proteins) RN - 0 (Ion Channels) RN - EC 7.2.2.13 (Sodium-Potassium-Exchanging ATPase) RN - PQ6CK8PD0R (Ascorbic Acid) SB - IM MH - Abdomen/microbiology/pathology MH - Acute Lung Injury/*drug therapy/metabolism/microbiology/physiopathology MH - Animals MH - Ascorbic Acid/*pharmacology MH - Biomarkers/blood MH - Blood Coagulation/drug effects MH - Bronchoalveolar Lavage/methods MH - Cell Line MH - Cytoskeletal Proteins/metabolism MH - Humans MH - Inflammation/blood/metabolism/physiopathology MH - Ion Channels/metabolism MH - Ion Transport/drug effects MH - Lung/drug effects/metabolism/physiopathology MH - Male MH - Mice MH - Mice, Inbred C57BL MH - Neutrophils/drug effects/metabolism/physiology MH - Peritonitis/drug therapy/metabolism/microbiology/physiopathology MH - Permeability/drug effects MH - Pulmonary Alveoli/drug effects/metabolism/physiopathology MH - Respiratory Mucosa/drug effects/metabolism/physiopathology MH - Sepsis/blood/*drug therapy/metabolism/physiopathology MH - Sodium-Potassium-Exchanging ATPase/metabolism EDAT- 2012/04/24 06:00 MHDA- 2012/10/19 06:00 CRDT- 2012/04/24 06:00 PHST- 2012/04/24 06:00 [entrez] PHST- 2012/04/24 06:00 [pubmed] PHST- 2012/10/19 06:00 [medline] AID - ajplung.00300.2011 [pii] AID - 10.1152/ajplung.00300.2011 [doi] PST - ppublish SO - Am J Physiol Lung Cell Mol Physiol. 2012 Jul 1;303(1):L20-32. doi: 10.1152/ajplung.00300.2011. Epub 2012 Apr 20. PMID- 22520693 OWN - NLM STAT- MEDLINE DCOM- 20120611 LR - 20240610 IS - 1879-1190 (Electronic) IS - 1072-7515 (Print) IS - 1072-7515 (Linking) VI - 214 IP - 5 DP - 2012 May TI - Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. PG - 739-46 LID - 10.1016/j.jamcollsurg.2012.01.050 [doi] AB - BACKGROUND: Our aim was to determine the prevalence of platelet dysfunction using an end point of assembly into a stable thrombus after severe injury. Although the current debate on acute traumatic coagulopathy has focused on the consumption or inhibition of coagulation factors, the question of early platelet dysfunction in this setting remains unclear. STUDY DESIGN: Prospective platelet function in assembly and stability of the thrombus was determined within 30 minutes of injury using whole blood samples from trauma patients at the point of care using thrombelastography-based platelet functional analysis. RESULTS: There were 51 patients in the study. There were significant differences in the platelet response between trauma patients and healthy volunteers, such that there was impaired aggregation to these agonists. In trauma patients, the median ADP inhibition of platelet function was 86.1% (interquartile range [IQR] 38.6% to 97.7%) compared with 4.2 % (IQR 0 to 18.2%) in healthy volunteers. After trauma, the impairment of platelet function in response to arachidonic acid was 44.9% (IQR 26.6% to 59.3%) compared with 0.5% (IQR 0 to 3.02%) in volunteers (Wilcoxon nonparametric test, p < 0.0001 for both tests). CONCLUSIONS: In this study, we show that platelet dysfunction is manifest after major trauma and before substantial fluid or blood administration. These data suggest a potential role for early platelet transfusion in severely injured patients at risk for postinjury coagulopathy. CI - Copyright (c) 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Wohlauer, Max V AU - Wohlauer MV AD - Department of Surgery, University of Colorado Denver, Denver, CO, USA. FAU - Moore, Ernest E AU - Moore EE FAU - Thomas, Scott AU - Thomas S FAU - Sauaia, Angela AU - Sauaia A FAU - Evans, Ed AU - Evans E FAU - Harr, Jeffrey AU - Harr J FAU - Silliman, Christopher C AU - Silliman CC FAU - Ploplis, Victoria AU - Ploplis V FAU - Castellino, Francis J AU - Castellino FJ FAU - Walsh, Mark AU - Walsh M LA - eng GR - P50-GM49222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - R56 HL013423/HL/NHLBI NIH HHS/United States GR - R37 HL013423/HL/NHLBI NIH HHS/United States GR - R01 HL013423/HL/NHLBI NIH HHS/United States GR - T32-GM008315/GM/NIGMS NIH HHS/United States GR - HL013423/HL/NHLBI NIH HHS/United States GR - P50 GM049222/GM/NIGMS NIH HHS/United States PT - Controlled Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*diagnosis/*epidemiology MH - Blood Platelet Disorders/*diagnosis/*epidemiology MH - Comorbidity MH - Female MH - Humans MH - Male MH - Middle Aged MH - Multiple Trauma/diagnosis/*epidemiology MH - Multivariate Analysis MH - Point-of-Care Systems MH - Prevalence MH - Prospective Studies MH - Shock, Hemorrhagic/epidemiology MH - Thrombelastography MH - Trauma Severity Indices MH - Wounds, Nonpenetrating/diagnosis/*epidemiology MH - Wounds, Penetrating/diagnosis/*epidemiology PMC - PMC3348700 MID - NIHMS367120 EDAT- 2012/04/24 06:00 MHDA- 2012/06/12 06:00 PMCR- 2013/05/01 CRDT- 2012/04/24 06:00 PHST- 2011/11/06 00:00 [received] PHST- 2012/01/09 00:00 [revised] PHST- 2012/01/09 00:00 [accepted] PHST- 2012/04/24 06:00 [entrez] PHST- 2012/04/24 06:00 [pubmed] PHST- 2012/06/12 06:00 [medline] PHST- 2013/05/01 00:00 [pmc-release] AID - S1072-7515(12)00123-8 [pii] AID - 10.1016/j.jamcollsurg.2012.01.050 [doi] PST - ppublish SO - J Am Coll Surg. 2012 May;214(5):739-46. doi: 10.1016/j.jamcollsurg.2012.01.050. PMID- 22519961 OWN - NLM STAT- MEDLINE DCOM- 20121226 LR - 20250529 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 10 IP - 7 DP - 2012 Jul TI - Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. PG - 1342-51 LID - 10.1111/j.1538-7836.2012.04752.x [doi] AB - BACKGROUND: Low fibrinogen levels are known to occur in trauma. However, the extent of fibrinogen depletion during trauma hemorrhage, the response to replacement therapy and association with patient outcomes remain unclear. OBJECTIVES: The study aims were to: characterize admission fibrinogen level and correlate it with factors associated with injury; describe the time course of fibrinogen depletion and response to replacement therapy; determine the correlation of fibrinogen level with rotational thromboelastography (ROTEM) parameters; evaluate the effect of fibrinogen supplementation ex vivo; and establish the association between fibrinogen level and clinical outcomes. METHODS: This was a prospective cohort study of 517 patients. Blood samples were drawn on admission and after admistration of every 4 units of packed red blood cells. Fibrinogen levels were determined with the Clauss method, and global hemostatic competence was assessed with thromboelastometry. The effect of fibrinogen supplementation was assessed in a subgroup of coagulopathic patients. RESULTS: Low admission fibrinogen level was independently associated with injury severity score (P < 0.01), shock (P < 0.001), and prehospital fluid volume (P < 0.001). Fibrinogen supplementation during transfusion maintained but did not augment fibrinogen levels. Administration of cryoprecipitate was associated with improved survival. ROTEM parameters correlated with fibrinogen level, and ex vivo fibrinogen administration reversed coagulopathic ROTEM parameters. Fibrinogen level was an independent predictor of mortality at 24 h and 28 days (P < 0.001). CONCLUSIONS: Fibrinogen level is decreased in injured patients on admission and is associated with poor outcomes. ROTEM is a rapid means of assessing hypofibrinogenemia. Earlier administration of specific fibrinogen replacement may improve outcomes, and prospective controlled trials are urgently needed. CI - (c) 2012 International Society on Thrombosis and Haemostasis. FAU - Rourke, C AU - Rourke C AD - Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Curry, N AU - Curry N FAU - Khan, S AU - Khan S FAU - Taylor, R AU - Taylor R FAU - Raza, I AU - Raza I FAU - Davenport, R AU - Davenport R FAU - Stanworth, S AU - Stanworth S FAU - Brohi, K AU - Brohi K LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Erythrocyte Transfusion MH - Female MH - Fibrinogen/*metabolism/therapeutic use MH - Hemorrhage/*blood/drug therapy/therapy MH - Humans MH - Male MH - Middle Aged MH - Treatment Outcome MH - Wounds and Injuries/*blood/drug therapy/therapy EDAT- 2012/04/24 06:00 MHDA- 2012/12/27 06:00 CRDT- 2012/04/24 06:00 PHST- 2012/04/24 06:00 [entrez] PHST- 2012/04/24 06:00 [pubmed] PHST- 2012/12/27 06:00 [medline] AID - S1538-7836(22)06341-3 [pii] AID - 10.1111/j.1538-7836.2012.04752.x [doi] PST - ppublish SO - J Thromb Haemost. 2012 Jul;10(7):1342-51. doi: 10.1111/j.1538-7836.2012.04752.x. PMID- 22510861 OWN - NLM STAT- MEDLINE DCOM- 20121003 LR - 20120418 IS - 1098-9064 (Electronic) IS - 0094-6176 (Linking) VI - 38 IP - 3 DP - 2012 Apr TI - Monitoring prohemostatic treatment in bleeding patients. PG - 282-91 LID - 10.1055/s-0032-1302443 [doi] AB - Acutely bleeding patients are commonly found in the trauma and major surgery scenarios. They require prompt and effective treatment to restore an adequate hemostatic pattern, to avoid serious and sometimes life-threatening complications.Different prohemostatic treatments are available, including allogeneic blood derivatives (fresh frozen plasma, platelet concentrates, and cryoprecipitates), prothrombin complex concentrates, specific coagulation factors (fibrinogen, recombinant factor XIII, recombinant activated factor VII), and drugs (protamine for patients under heparin treatment, desmopressin, antifibrinolytics).For decades, prohemostatic treatment of the acutely bleeding patient was based on empirical strategies and clinical judgment, both in terms of a correct diagnosis of the mechanism(s) leading to bleeding, and of an assessment of the effects of the treatment. This empirical strategy may lead to excessive or unnecessary use of allogeneic blood products, as well as to an incorrect, inefficacious, or even dangerous treatment. Different monitoring devices are nowadays available for guiding the diagnostic and therapeutic decision-making process in an acutely bleeding patient. This review addresses the available tools for monitoring prohemostatic treatment of the bleeding patient, with a specific respect for point-of-care tests (thromboelastography, thromboelastometry, platelet function tests, and heparin monitoring systems) at the light of the existing evidence. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Ranucci, Marco AU - Ranucci M AD - Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico S Donato, Milan, Italy. cardioanestesia@virgilio.it FAU - Baryshnikova, Ekaterina AU - Baryshnikova E FAU - Colella, Dionisio AU - Colella D LA - eng PT - Journal Article PT - Review DEP - 20120218 PL - United States TA - Semin Thromb Hemost JT - Seminars in thrombosis and hemostasis JID - 0431155 RN - 0 (Antifibrinolytic Agents) RN - 0 (Hemostatics) SB - IM MH - Antifibrinolytic Agents/*therapeutic use MH - Hemorrhage/*drug therapy/etiology MH - Hemostatics/*therapeutic use MH - Humans MH - Thrombelastography/*methods EDAT- 2012/04/19 06:00 MHDA- 2012/10/04 06:00 CRDT- 2012/04/19 06:00 PHST- 2012/04/19 06:00 [entrez] PHST- 2012/04/19 06:00 [pubmed] PHST- 2012/10/04 06:00 [medline] AID - 10.1055/s-0032-1302443 [doi] PST - ppublish SO - Semin Thromb Hemost. 2012 Apr;38(3):282-91. doi: 10.1055/s-0032-1302443. Epub 2012 Feb 18. PMID- 22498982 OWN - NLM STAT- MEDLINE DCOM- 20130215 LR - 20181201 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 23 IP - 5 DP - 2012 Jul TI - The in-vitro effect of fibrinogen, factor XIII and thrombin-activatable fibrinolysis inhibitor on clot formation and susceptibility to tissue plasminogen activator-induced fibrinolysis in hemodilution model. PG - 370-8 LID - 10.1097/MBC.0b013e328352cb3f [doi] AB - Patients suffering major traumatic or surgical bleeding are often exposed to hemodilution resulting in dilutional coagulopathy. The aim of this study was to evaluate in vitro the effects of fibrinogen, factor XIII and thrombin-activatable fibrinolysis inhibitor (TAFI) on clot formation and resistance to fibrinolysis in hemodilution conditions. Citrated whole blood from 36 healthy volunteers was diluted to 30 and 60% with lactated Ringer's solution. Blood samples were subsequently supplemented with fibrinogen, FXIII, TAFI or their combinations. Rotation thromboelastometry (ROTEM) in whole blood and thrombin generation in plasma were performed in the presence of CaCl(2) and tissue factor/EXTEM reagent, and fibrinolysis was induced by tissue plasminogen activator (tPA). Hemodilution was expressed by decrease of peak height in thrombin generation and alpha-angle and maximum clot firmness (MCF) in ROTEM. Fibrinogen, FXIII or TAFI did not correct the decrease in thrombin generation peak height. In ROTEM, spiking of diluted blood with fibrinogen stimulated clot propagation. In tPA-treated blood fibrinogen, FXIII and TAFI increased clot firmness and inhibited fibrinolysis. Stronger protection against fibrinolysis was achieved combining FXIII with TAFI. Hemodilution was associated with inhibition of thrombin generation; however, this effect was not sensitive to blood spiking with fibrinogen, FXIII and TAFI. In ROTEM, these hemostasis agents improved clot strength and decreased clot susceptibility to tPA in nondiluted and to more extent in diluted blood. The maximal protection against fibrinolysis was caused by TAFI. Combining FXIII with TAFI exerted synergistic inhibitory effect on fibrinolysis. FAU - Shenkman, Boris AU - Shenkman B AD - Institute of Thrombosis & Hemostasis, and National Hemophilia Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel. borshenk@sheba.health.gov.il FAU - Livnat, Tami AU - Livnat T FAU - Lubetsky, Aharon AU - Lubetsky A FAU - Tamarin, Ilia AU - Tamarin I FAU - Budnik, Ivan AU - Budnik I FAU - Einav, Yulia AU - Einav Y FAU - Martinowitz, Uriel AU - Martinowitz U LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Isotonic Solutions) RN - 0 (Ringer's Lactate) RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) RN - EC 3.4.17.20 (Carboxypeptidase B2) RN - EC 3.4.21.5 (Thrombin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Carboxypeptidase B2/*pharmacology MH - Factor XIII/*pharmacology MH - Fibrinogen/*pharmacology MH - Fibrinolysis/drug effects MH - Hemodilution MH - Humans MH - Isotonic Solutions/chemistry MH - Ringer's Lactate MH - Thrombelastography MH - Thrombin/metabolism MH - Tissue Plasminogen Activator/*pharmacology MH - Whole Blood Coagulation Time EDAT- 2012/04/14 06:00 MHDA- 2013/02/16 06:00 CRDT- 2012/04/14 06:00 PHST- 2012/04/14 06:00 [entrez] PHST- 2012/04/14 06:00 [pubmed] PHST- 2013/02/16 06:00 [medline] AID - 10.1097/MBC.0b013e328352cb3f [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2012 Jul;23(5):370-8. doi: 10.1097/MBC.0b013e328352cb3f. PMID- 22487164 OWN - NLM STAT- MEDLINE DCOM- 20131105 LR - 20191210 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 44 IP - 5 DP - 2013 May TI - Utility of interim ROTEM((R)) values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients. PG - 593-9 LID - S0020-1383(12)00107-6 [pii] LID - 10.1016/j.injury.2012.03.018 [doi] AB - BACKGROUND: Proactive management of trauma-related coagulopathy requires early identification and rapid assessment in order to allow targeted resuscitation. This study determined whether early (interim) ROTEM((R)) (TEM International GmbH, Munich, Germany) values could predict hypocoagulopathy in seriously injured military patients. METHODS: Normal ranges for ROTEM((R)) values were obtained from 50 volunteers. 108 samples were collected during the early phase of clinical management from 48 severe trauma patients. The blood was subject to EXTEM analysis and compared to the 95% tolerance limits from the volunteers. Coagulopathy (was deemed to be present if EXTEM MCF was below 40 mm, which is in the range indicating clinical concern defined by the ROTEM((R)) Expert Working Group. RESULTS: The normal range data was broadly similar to ROTEM((R)) published data. Admission samples were available from 31 battlefield casualties, and 39% of these were coagulopathic 51% of the samples from all 48 patients were coagulopathic (EXTEM MCF<40 mm) and interim EXTEM values of these at 5 and 10 min (A5 and A10) predicted coagulopathy with sensitivities/specificities of 0.96/0.58 (A5) and 1.00/0.70 (A10). In addition, statistical comparison of clotting domains between normal volunteers and trauma patients suggests a difference in clot strengths due to a difference in platelet function rather than platelet number (mean 142 x 10(9)l(-1)). CONCLUSIONS: The A10 value of ROTEM((R)) provides an early sensitive and specific assessment of coagulopathy after military trauma and may be of utility in guiding bespoke resuscitation. We found some speculative evidence that in major trauma platelet function is particularly affected. CI - Crown Copyright (c) 2012. Published by Elsevier Ltd. All rights reserved. FAU - Woolley, T AU - Woolley T AD - Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, ICT Building, Birmingham, Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom. tomwoolley@me.com FAU - Midwinter, M AU - Midwinter M FAU - Spencer, P AU - Spencer P FAU - Watts, S AU - Watts S FAU - Doran, C AU - Doran C FAU - Kirkman, E AU - Kirkman E LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120407 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Adult MH - Afghan Campaign 2001- MH - Blast Injuries/*blood/complications/diagnosis MH - *Blood Coagulation MH - Blood Coagulation Disorders/*blood/diagnosis/etiology MH - Blood Coagulation Tests/instrumentation MH - Early Diagnosis MH - Female MH - Hemostasis MH - Humans MH - Injury Severity Score MH - Male MH - Platelet Count MH - *Point-of-Care Systems MH - Predictive Value of Tests MH - Reproducibility of Results MH - Resuscitation/*methods MH - Sensitivity and Specificity MH - Specimen Handling MH - *Thrombelastography/methods MH - Time Factors MH - Whole Blood Coagulation Time/*methods EDAT- 2012/04/11 06:00 MHDA- 2013/11/06 06:00 CRDT- 2012/04/11 06:00 PHST- 2011/11/15 00:00 [received] PHST- 2012/03/13 00:00 [revised] PHST- 2012/03/15 00:00 [accepted] PHST- 2012/04/11 06:00 [entrez] PHST- 2012/04/11 06:00 [pubmed] PHST- 2013/11/06 06:00 [medline] AID - S0020-1383(12)00107-6 [pii] AID - 10.1016/j.injury.2012.03.018 [doi] PST - ppublish SO - Injury. 2013 May;44(5):593-9. doi: 10.1016/j.injury.2012.03.018. Epub 2012 Apr 7. PMID- 22463102 OWN - NLM STAT- MEDLINE DCOM- 20130109 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 10 IP - 6 DP - 2012 Jun TI - Diannexin, an annexin A5 homodimer, binds phosphatidylserine with high affinity and is a potent inhibitor of platelet-mediated events during thrombus formation. PG - 1109-19 LID - 10.1111/j.1538-7836.2012.04716.x [doi] AB - BACKGROUND: Shielding of procoagulant phosphatidylserine (PS) with annexin A5 attenuates thrombosis, but annexin A5 (35.7 kDa) is rapidly cleared from the circulation. In contrast, Diannexin, a 73.1 kDa homodimer of annexin A5, has an extended half-life. OBJECTIVES: To quantify the affinity of Diannexin for PS, examine its interaction with activated platelets and determine its effects on platelet-mediated events during thrombus formation. METHODS: The affinities of Diannexin and annexin A5 for PS-containing lipid bilayers were compared using surface plasmon resonance, and binding to activated platelets was assessed by flow cytometry. Calibrated automated thrombography and thromboelastography were employed to study the effects of Diannexin on thrombin generation and platelet-fibrin clot formation, respectively, whereas intravital videomicroscopy was used to examine its effect on platelet accumulation and activation after laser-induced injury to murine cremaster arterioles, and a tail tip bleeding model was used to explore its effects on hemostasis. RESULTS: Diannexin and annexin A5 bind PS with K(D) values of 0.6 and 5 nm, respectively, and both bind to the same subpopulation of PS-exposing platelets. Diannexin inhibited thrombin generation and platelet-fibrin clot formation in vitro at 10 nm (P<0.05-0.001 compared with control), and reduced platelet accumulation at 1 mug g(-1) (P<0.05) and activation at 0.25 mug g(-1) (P<0.001) in experimentally induced arterial thrombi in mice while increasing blood loss at 1 mug g(-1) (P<0.01). CONCLUSIONS: Diannexin binds to PS with high affinity and is a potent inhibitor of platelet-mediated events during thrombus formation. CI - (c) 2012 International Society on Thrombosis and Haemostasis. FAU - Rand, M L AU - Rand ML AD - Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada. margaret.rand@sickkids.ca FAU - Wang, H AU - Wang H FAU - Pluthero, F G AU - Pluthero FG FAU - Stafford, A R AU - Stafford AR FAU - Ni, R AU - Ni R FAU - Vaezzadeh, N AU - Vaezzadeh N FAU - Allison, A C AU - Allison AC FAU - Kahr, W H A AU - Kahr WH FAU - Weitz, J I AU - Weitz JI FAU - Gross, P L AU - Gross PL LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Annexin A5) RN - 0 (Fibrinolytic Agents) RN - 0 (Lipid Bilayers) RN - 0 (Phosphatidylserines) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (diannexin, human) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Animals MH - Annexin A5/metabolism/*pharmacology MH - Blood Coagulation/drug effects MH - Blood Platelets/*drug effects/metabolism MH - Dimerization MH - Disease Models, Animal MH - Dose-Response Relationship, Drug MH - Fibrinolytic Agents/metabolism/*pharmacology MH - Flow Cytometry MH - Hemostasis/*drug effects MH - Humans MH - Lipid Bilayers/metabolism MH - Male MH - Mice MH - Mice, Inbred C57BL MH - Microscopy, Video MH - Phosphatidylserines/*metabolism MH - Platelet Activation/*drug effects MH - Platelet Aggregation Inhibitors/metabolism/*pharmacology MH - Surface Plasmon Resonance MH - Thrombelastography MH - Thrombin/metabolism MH - Thrombosis/blood/*drug therapy MH - Time Factors EDAT- 2012/04/03 06:00 MHDA- 2013/01/10 06:00 CRDT- 2012/04/03 06:00 PHST- 2012/04/03 06:00 [entrez] PHST- 2012/04/03 06:00 [pubmed] PHST- 2013/01/10 06:00 [medline] AID - S1538-7836(22)06301-2 [pii] AID - 10.1111/j.1538-7836.2012.04716.x [doi] PST - ppublish SO - J Thromb Haemost. 2012 Jun;10(6):1109-19. doi: 10.1111/j.1538-7836.2012.04716.x. PMID- 25365659 OWN - NLM STAT- MEDLINE DCOM- 20150624 LR - 20160511 IS - 2040-7947 (Electronic) IS - 2040-7939 (Linking) VI - 28 IP - 4 DP - 2012 Apr TI - Effects of neck damping properties on brain response underimpact loading. PG - 472-94 LID - 10.1002/cnm.1480 [doi] AB - In this paper, head-neck boundary conditions and modeling of the head are studied circumspectly. The neck is modeled using discrete elements and the head model is three-dimensional. In the study presented here, a viscoelastic foundation (i.e., foundation defined by both springs and dampers) concept is introduced to simulate the head-neck boundary conditions during the impact load to the head. Time histories of the brain response in finite element head models with a viscoelastic neck are compared with the corresponding solutions of finite element head models with an elastic neck, and without a neck. It is observed that the magnitude of peaks in the brain's response time histories, at a later stage (i.e., 6 to 15 ms) of the simulation, decreases when dampers are induced to the elastic neck. A parametric study is also conducted to examine the brain response while varying different damping coefficient values for the neck. The magnitude of peaks in the brain's response time histories for models with different neck damping coefficients is observed to maintain some form of proportionality. In other words, the magnitude of peaks in the brain's response time histories decreases with an increased damping coefficient of the neck at the later stage of the simulation (i.e., 6 to 15 ms). From the outcomes of this study, it can be determined that the head-neck boundary conditions during head impact loading are important for studying the brain's response at the later stages of the head impact. CI - Copyright (c) 2011 John Wiley & Sons, Ltd. FAU - Dirisala, V AU - Dirisala V AD - Department of Mechanical Engineering, North Dakota State University, Fargo, ND, 58108-6050, USA. FAU - Karami, G AU - Karami G FAU - Ziejewski, M AU - Ziejewski M LA - eng PT - Journal Article DEP - 20111122 PL - England TA - Int J Numer Method Biomed Eng JT - International journal for numerical methods in biomedical engineering JID - 101530293 SB - IM MH - Adult MH - Biomechanical Phenomena/*physiology MH - *Brain/anatomy & histology/physiology MH - Brain Injuries/*physiopathology MH - Elastic Modulus/physiology MH - Finite Element Analysis MH - *Head/anatomy & histology/physiology MH - Humans MH - Intracranial Pressure MH - Male MH - *Models, Biological MH - *Neck/anatomy & histology/physiology MH - Stress, Mechanical MH - Viscosity OTO - NOTNLM OT - finite elements OT - head modeling OT - impact loading OT - intracranial pressure OT - shear strain OT - shear stress OT - viscoelastic foundation EDAT- 2012/04/01 00:00 MHDA- 2015/06/25 06:00 CRDT- 2014/11/04 06:00 PHST- 2010/08/31 00:00 [received] PHST- 2011/07/15 00:00 [revised] PHST- 2011/10/03 00:00 [accepted] PHST- 2014/11/04 06:00 [entrez] PHST- 2012/04/01 00:00 [pubmed] PHST- 2015/06/25 06:00 [medline] AID - 10.1002/cnm.1480 [doi] PST - ppublish SO - Int J Numer Method Biomed Eng. 2012 Apr;28(4):472-94. doi: 10.1002/cnm.1480. Epub 2011 Nov 22. PMID- 22425448 OWN - NLM STAT- MEDLINE DCOM- 20120618 LR - 20180719 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 203 IP - 5 DP - 2012 May TI - Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury. PG - 584-588 LID - S0002-9610(12)00075-X [pii] LID - 10.1016/j.amjsurg.2011.12.011 [doi] AB - BACKGROUND: The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury. METHODS: Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis. RESULTS: Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit-free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%). CONCLUSIONS: Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention. CI - Copyright (c) 2012 Elsevier Inc. All rights reserved. FAU - Kunio, Nicholas R AU - Kunio NR AD - Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. Electronic address: kunion@ohsu.edu. FAU - Differding, Jerome A AU - Differding JA AD - Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. FAU - Watson, Katherine M AU - Watson KM AD - Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. FAU - Stucke, Ryland S AU - Stucke RS AD - Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. FAU - Schreiber, Martin A AU - Schreiber MA AD - Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. LA - eng PT - Journal Article DEP - 20120315 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/*etiology MH - Brain Injuries/*complications/*mortality MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - *Thrombelastography EDAT- 2012/03/20 06:00 MHDA- 2012/06/19 06:00 CRDT- 2012/03/20 06:00 PHST- 2011/11/04 00:00 [received] PHST- 2011/12/15 00:00 [revised] PHST- 2011/12/15 00:00 [accepted] PHST- 2012/03/20 06:00 [entrez] PHST- 2012/03/20 06:00 [pubmed] PHST- 2012/06/19 06:00 [medline] AID - S0002-9610(12)00075-X [pii] AID - 10.1016/j.amjsurg.2011.12.011 [doi] PST - ppublish SO - Am J Surg. 2012 May;203(5):584-588. doi: 10.1016/j.amjsurg.2011.12.011. Epub 2012 Mar 15. PMID- 22386721 OWN - NLM STAT- MEDLINE DCOM- 20130131 LR - 20120821 IS - 1879-2472 (Electronic) IS - 0049-3848 (Linking) VI - 130 IP - 3 DP - 2012 Sep TI - Hemostatically distinct FFPs equally improve abnormal TEG variables in an in vitro dilutional coagulopathy model. PG - 429-34 LID - 10.1016/j.thromres.2012.02.007 [doi] AB - INTRODUCTION: To improve fresh frozen plasma (FFP) availability, thawed plasma is stored at 4 degrees C for up to 5 days and considered equivalent to freshly thawed FFP. However, we have shown that hemostatic potential of thawed plasma is highly variable between donors and significantly diminished during storage. We hypothesized that smaller volumes of plasma with higher hemostatic potential (FFP-H) would be needed to restore normal thrombelastogram (TEG) values compared to plasma with lower hemostatic potential (FFP-L). MATERIALS AND METHODS: A dilutional coagulopathy model was established from whole blood by diluting plasma with saline to 23%, while cellular components were kept unchanged. Saline was gradually replaced with equal volumes of FFPs with distinctive hemostatic potentials, which was evaluated by the calibrated automated thrombogram. Clot formation in the presence of tissue factor was evaluated by TEG at baseline and after addition of increasing concentrations of FFP-H and FFP-L. RESULTS: Blood dilution with saline in the presence of tissue factor resulted in abnormal TEGs that resemble a pattern observed in severely bleeding trauma patients. All FFPs produced similar improvements in TEG variables despite different hemostatic potentials. TEG changes were solely dependent on FFP volume and reached the normal reference range when plasma concentration increased to 40%. CONCLUSION: Plasma dilution and tissue factor in whole blood results in an abnormal TEG with a hyperfibrinolytic pattern. A plasma concentration of at least 40% was necessary for TEG normalization after dilution with saline. An effect of FFPs' hemostatic potential on clot formation could not be detected by TEG in this in vitro model. CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved. FAU - Kostousov, Vadim AU - Kostousov V AD - Department of Surgery, and Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, usa. FAU - Wang, Yao-Wei W AU - Wang YW FAU - Wade, Charles E AU - Wade CE FAU - Holcomb, John B AU - Holcomb JB FAU - Cotton, Bryan A AU - Cotton BA FAU - Matijevic, Nena AU - Matijevic N LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20120303 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM MH - Blood Coagulation Disorders/*blood MH - *Hemostasis MH - Humans MH - Plasma/*physiology MH - Reproducibility of Results MH - Sensitivity and Specificity MH - *Thrombelastography EDAT- 2012/03/06 06:00 MHDA- 2013/02/01 06:00 CRDT- 2012/03/06 06:00 PHST- 2011/08/15 00:00 [received] PHST- 2012/02/01 00:00 [revised] PHST- 2012/02/06 00:00 [accepted] PHST- 2012/03/06 06:00 [entrez] PHST- 2012/03/06 06:00 [pubmed] PHST- 2013/02/01 06:00 [medline] AID - S0049-3848(12)00052-7 [pii] AID - 10.1016/j.thromres.2012.02.007 [doi] PST - ppublish SO - Thromb Res. 2012 Sep;130(3):429-34. doi: 10.1016/j.thromres.2012.02.007. Epub 2012 Mar 3. PMID- 22364525 OWN - NLM STAT- MEDLINE DCOM- 20120529 LR - 20211021 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 20 DP - 2012 Feb 24 TI - Early and individualized goal-directed therapy for trauma-induced coagulopathy. PG - 15 LID - 10.1186/1757-7241-20-15 [doi] AB - Severe trauma-related bleeding is associated with high mortality. Standard coagulation tests provide limited information on the underlying coagulation disorder. Whole-blood viscoelastic tests such as rotational thromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process in trauma. The results are available within minutes and they provide information about the initiation of coagulation, the speed of clot formation, and the quality and stability of the clot. Viscoelastic tests have the potential to guide coagulation therapy according to the actual needs of each patient, reducing the risks of over- or under-transfusion. The concept of early, individualized and goal-directed therapy is explored in this review and the AUVA Trauma Hospital algorithm for managing trauma-induced coagulopathy is presented. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria. Herbert.schoechl@auva.at FAU - Maegele, Marc AU - Maegele M FAU - Solomon, Cristina AU - Solomon C FAU - Gorlinger, Klaus AU - Gorlinger K FAU - Voelckel, Wolfgang AU - Voelckel W LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20120224 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Anticoagulants) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Algorithms MH - Anticoagulants/therapeutic use MH - Blood Coagulation Disorders/etiology/physiopathology/*therapy MH - Blood Viscosity MH - Fibrinogen/administration & dosage MH - Hemorrhage/therapy MH - Humans MH - Needs Assessment MH - Platelet Function Tests MH - Thrombelastography MH - Wounds and Injuries/complications PMC - PMC3306198 EDAT- 2012/03/01 06:00 MHDA- 2012/05/30 06:00 PMCR- 2012/02/24 CRDT- 2012/02/28 06:00 PHST- 2011/12/25 00:00 [received] PHST- 2012/02/24 00:00 [accepted] PHST- 2012/02/28 06:00 [entrez] PHST- 2012/03/01 06:00 [pubmed] PHST- 2012/05/30 06:00 [medline] PHST- 2012/02/24 00:00 [pmc-release] AID - 1757-7241-20-15 [pii] AID - 10.1186/1757-7241-20-15 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2012 Feb 24;20:15. doi: 10.1186/1757-7241-20-15. PMID- 22297558 OWN - NLM STAT- MEDLINE DCOM- 20130419 LR - 20121106 IS - 1938-2723 (Electronic) IS - 1076-0296 (Linking) VI - 18 IP - 6 DP - 2012 Nov TI - Detection of tPA-induced hyperfibrinolysis in whole blood by RapidTEG, KaolinTEG, and functional fibrinogenTEG in healthy individuals. PG - 638-44 LID - 10.1177/1076029611434527 [doi] AB - BACKGROUND: Rapid identification of clinically relevant coagulopathies in, acute coagulopathy of trauma shock (ACOTS) has led to the development of faster point-of-care viscoelastic whole-blood-based tests like rapid thrombelastography (RapidTEG). The sensitivity of RapidTEG to detect hyperfibrinolysis, as compared to standard KaolinTEG, is unknown. To investigate this, the ability of RapidTEG, KaolinTEG, and functional fibrinogenTEG (FFTEG) to detect tPA-induced (tissue plasminogen activator) lysis in whole blood from healthy individuals was investigated. Our hypothesis was that the initial powerful clot formation in the RapidTEG assay would reduce the sensitivity as compared to the normally used KaolinTEG assay. We also evaluated the FFTEG assay. METHODS: In vitro comparison of the sensitivity of RapidTEG, KaolinTEG, and FFTEG to 1.8 nmol/L tPA in citrated whole blood (299 +/- 23 ng/mL plasma) induced hyperfibrinolysis in 10 healthy individuals and duplicate titration of the tPA whole blood (WB) concentration from 0.09 to 7.2 nmol/L (14-1144 ng/mL plasma) in 1 healthy donor. RESULTS: At 1.8 nmol/L tPA, KaolinTEG, RapidTEG, and FFTEG all detected fibrinolysis but with different sensitivities. In the titration study, KaolinTEG and FFTEG displayed a continuous dose-response association and RapidTEG also displayed a dose-dependent response but only for higher levels of tPA, thus yielding a smaller "dose-sensitive range" compared to KaolinTEG and FFTEG. CONCLUSION: This pilot study demonstrated that KaolinTEG, RapidTEG, and FFTEG all were able to detect lysis at 1.8 nmol/L tPA but with a difference in sensitivity. Furthermore, KaolinTEG and FFTEG showed a continuous dose dependence related to the tPA concentration, whereas RapidTEG only detected lysis at higher tPA concentrations. FAU - Genet, Gustav Folmer AU - Genet GF AD - University of Copenhagen, Copenhagen, Denmark. gustavgenet@hotmail.com FAU - Ostrowski, Sisse Rye AU - Ostrowski SR FAU - Sorensen, Anne Marie AU - Sorensen AM FAU - Johansson, Par Ingemar AU - Johansson PI LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120131 PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 RN - 0 (Plasminogen Activator Inhibitor 1) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - Plasminogen Activator Inhibitor-1 Deficiency SB - IM MH - Adult MH - Female MH - *Hemolysis MH - Hemorrhagic Disorders/*blood MH - Humans MH - Male MH - Pilot Projects MH - Plasminogen Activator Inhibitor 1/blood/deficiency MH - Thrombelastography/*methods MH - Tissue Plasminogen Activator/*metabolism EDAT- 2012/02/03 06:00 MHDA- 2013/04/23 06:00 CRDT- 2012/02/03 06:00 PHST- 2012/02/03 06:00 [entrez] PHST- 2012/02/03 06:00 [pubmed] PHST- 2013/04/23 06:00 [medline] AID - 1076029611434527 [pii] AID - 10.1177/1076029611434527 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2012 Nov;18(6):638-44. doi: 10.1177/1076029611434527. Epub 2012 Jan 31. PMID- 22270921 OWN - NLM STAT- MEDLINE DCOM- 20120723 LR - 20250529 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 25 IP - 2 DP - 2012 Apr TI - Acute traumatic coagulopathy. PG - 229-34 LID - 10.1097/ACO.0b013e3283509675 [doi] AB - PURPOSE OF REVIEW: Recent therapeutic and observational studies have demonstrated improved survival with better management of haemostasis early after injury. This review delineates our current understanding of the clinical importance, aetiology and pathophysiology of acute traumatic coagulopathy (ATC). RECENT FINDINGS: Trauma causes an acute disruption of the equilibrium between all components of haemostasis (coagulation, anticoagulation, fibrinolysis, platelets and endothelium). In patients with a combination of severe tissue damage and systemic hypoperfusion, this will progress rapidly to an endogenous coagulopathy that is independently associated with worse outcomes. New discoveries of the interactions between neurohormonal, vascular, and coagulation systems are beginning to explain how this haemostatic impairment develops and offer novel targets for therapeutic manipulation. Routine coagulation screening tests are ineffective for diagnosing ATC and guiding resuscitation in real-time. Viscoelastic coagulation tests (such as ROTEM or TEG) have emerged as practical, rapid and sensitive diagnostic modalities. Their role in therapeutic targeting requires further validation. SUMMARY: Conventional concepts of traumatic coagulopathy as a late occurring condition in response to iatrogenic haemodilution are redundant. ATC is an endogenous impairment of haemostasis that begins at the moment of injury. Further outcome improvements are possible with better understanding of the process by which this coagulopathy develops and how it may be inhibited. FAU - Frith, Daniel AU - Frith D AD - Trauma Sciences, Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK. FAU - Davenport, Ross AU - Davenport R FAU - Brohi, Karim AU - Brohi K LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Acute Disease MH - Animals MH - Blood Coagulation Disorders/*etiology MH - Blood Platelets/physiology MH - Endothelium, Vascular/physiology MH - Hemostasis MH - Humans MH - Wounds and Injuries/*blood/complications EDAT- 2012/01/25 06:00 MHDA- 2012/07/24 06:00 CRDT- 2012/01/25 06:00 PHST- 2012/01/25 06:00 [entrez] PHST- 2012/01/25 06:00 [pubmed] PHST- 2012/07/24 06:00 [medline] AID - 10.1097/ACO.0b013e3283509675 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2012 Apr;25(2):229-34. doi: 10.1097/ACO.0b013e3283509675. PMID- 22204772 OWN - NLM STAT- MEDLINE DCOM- 20130515 LR - 20121211 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 44 IP - 1 DP - 2013 Jan TI - Temporal changes in ROTEM(R)-measured coagulability of citrated blood samples from coagulopathic trauma patients. PG - 36-9 LID - S0020-1383(11)00574-2 [pii] LID - 10.1016/j.injury.2011.12.003 [doi] AB - BACKGROUND: Rotational thromboelastometry (ROTEM((R))) relies on citrated blood samples, which are regarded as biologically stable for up to 4 h after venepuncture. However, this recommendation is based on data from normal volunteers. The aim of this study was to evaluate possible temporal changes in the coagulability of blood samples from coagulopathic trauma patients. PATIENTS AND METHODS: This is a prospective series of 10 coagulopathic (maximum clot firmness, MCF<40 mm) trauma patients. ROTEM((R)) EXTEM (tissue factor activated) and FIBTEM (tissue factor activated, cytochalasin D inhibited) analyses were performed on samples obtained on admission, and after approximately 60 min of storage in an incubator, at 37 degrees C. RESULTS: There were statistically significant differences between the median EXTEM MCF (22 mm vs 54 mm, p<0.001) and alpha angle (30.5 vs 59.5 degrees , p=0.004) of the analyses performed immediately after sampling, and 51 min (median) subsequently, but not coagulation time (CT, p=0.133), clot formation time (p=0.0625) or maximum lysis (ML, p=0.154). There were also no differences in median FIBTEM MCF (p=1.00) or CT (p=0.877) between the immediate and delayed analyses. CONCLUSIONS: Repeated ROTEM((R)) EXTEM analysis of citrated samples from coagulopathic trauma patients shows a spontaneous improvement in coagulability with time. The absence of parallel changes on FIBTEM analysis suggests that this effect may be due to a change in platelet function. CI - Crown Copyright (c) 2011. Published by Elsevier Ltd. All rights reserved. FAU - Jansen, J O AU - Jansen JO AD - Royal Army Medical Corps, United Kingdom. j.o.jansen@gmx.com FAU - Luke, D AU - Luke D FAU - Davies, E AU - Davies E FAU - Spencer, P AU - Spencer P FAU - Kirkman, E AU - Kirkman E FAU - Midwinter, M J AU - Midwinter MJ LA - eng PT - Journal Article DEP - 20111227 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Adult MH - Afghan Campaign 2001- MH - Blast Injuries/*blood MH - Blood Coagulation MH - Blood Coagulation Disorders/*blood/therapy MH - Blood Coagulation Tests/*methods MH - Female MH - Hemostasis MH - Humans MH - Male MH - Pilot Projects MH - Platelet Count MH - Point-of-Care Systems MH - Predictive Value of Tests MH - Prospective Studies MH - *Thrombelastography MH - Time Factors MH - Wounds, Penetrating/*blood EDAT- 2011/12/30 06:00 MHDA- 2013/05/17 06:00 CRDT- 2011/12/30 06:00 PHST- 2011/07/18 00:00 [received] PHST- 2011/11/26 00:00 [revised] PHST- 2011/12/06 00:00 [accepted] PHST- 2011/12/30 06:00 [entrez] PHST- 2011/12/30 06:00 [pubmed] PHST- 2013/05/17 06:00 [medline] AID - S0020-1383(11)00574-2 [pii] AID - 10.1016/j.injury.2011.12.003 [doi] PST - ppublish SO - Injury. 2013 Jan;44(1):36-9. doi: 10.1016/j.injury.2011.12.003. Epub 2011 Dec 27. PMID- 22193152 OWN - NLM STAT- MEDLINE DCOM- 20120723 LR - 20120307 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 25 IP - 2 DP - 2012 Apr TI - Coagulation monitoring of the bleeding traumatized patient. PG - 235-41 LID - 10.1097/ACO.0b013e32834fab76 [doi] AB - PURPOSE OF REVIEW: Death due to trauma is the leading cause of lost life years worldwide, with haemorrhage being responsible for 30-40% of trauma mortality and accounting for almost 50% of the deaths in the initial 24 h. On admission, 25-35% of trauma patients present with coagulopathy, which is associated with a several-fold increase in morbidity and mortality. RECENT FINDINGS: Plasma-based routine coagulation tests, like prothrombin time and activated partial thromboplastin time, are inappropriate for monitoring coagulopathy and guide therapy in trauma patients. Instead viscoelastic haemostatic assays (VHAs) such as thrombelastography and rotation thromboelastometry should be used. Clinical studies including about 1500 trauma patients have reported on the benefit of using the VHAs to identify coagulopathy, predict need for massive transfusion and enable goal-directed therapy. SUMMARY: This article reviews the basic principles of VHA, the correlation between the VHA whole blood clot formation in accordance with the cell-based model of haemostasis, the current use of VHA-guided therapy in trauma and limitations of VHA. FAU - Johansson, Par I AU - Johansson PI AD - Section for Transfusion Medicine, Regional Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. per.johansson@rh.regionh.dk LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - *Blood Coagulation MH - Blood Viscosity MH - Hemorrhage/*blood MH - Hemostasis MH - Humans MH - Thrombelastography MH - Wounds and Injuries/*blood EDAT- 2011/12/24 06:00 MHDA- 2012/07/24 06:00 CRDT- 2011/12/24 06:00 PHST- 2011/12/24 06:00 [entrez] PHST- 2011/12/24 06:00 [pubmed] PHST- 2012/07/24 06:00 [medline] AID - 10.1097/ACO.0b013e32834fab76 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2012 Apr;25(2):235-41. doi: 10.1097/ACO.0b013e32834fab76. PMID- 22182886 OWN - NLM STAT- MEDLINE DCOM- 20120214 LR - 20151119 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 71 IP - 6 DP - 2011 Dec TI - Use of freeze-dried plasma in French intensive care unit in Afghanistan. PG - 1761-4; discussion 1764-5 LID - 10.1097/TA.0b013e31822f1285 [doi] AB - BACKGROUND: Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Massive hemorrhage management includes transfusion of red blood cells and plasma in a 1:1 ratio. Fresh frozen plasma requires thawing and badly fits the emergency criteria. Since 1994, the French Military Blood Bank has been producing freeze-dried plasma (FDP) and providing it for overseas operation. The aim of our study was to evaluate the use of FDP in war settings and to assess its clinical efficiency and safety. PATIENTS: We performed a prospective study of the FDP delivered at the International Security Assistance Force Role 3 Military Medical Treatment Facility in the Kabul Afghanistan International Airport between February 2010 and February 2011. We included every patient who received at least one unit of FDP. Basic clinical data were recorded at admission. Transfusion requirements were monitored. Biological testing were performed before and after administration of FDP including hemoglobin concentration, platelets count, fibrinogen level, prothrombin time (PT), and thromboelastography. RESULTS: Eighty-seven casualties received FDP during 93 episodes of transfusion. On average, 3.5 FDP units were transfused per episodes of transfusion. Of the 87 patients studied, 7 died because of nonsurvivable injuries and outcomes were unavailable for 11. The other 59 patients survived. PT significantly declined by an average of 3.3 seconds after FDP transfusion. This moderate decrease in PT reflects continued bleeding and resuscitation. It nevertheless suggests improvement in hemostasis before surgical control of bleeding. All FDP users reported ease of use, clinically observed efficacy equivalent to fresh frozen plasma and the absence of adverse effects associated with FDP. CONCLUSION: Our results provide evidence of the effectiveness of FDP for the prevention or correction of coagulopathy and hemorrhage in combat casualties. FAU - Martinaud, Christophe AU - Martinaud C AD - Federation de Biologie Clinique, Hopital d'Instruction des Armees Percy, Clamart, France. christophe.martinaud@inserm.fr FAU - Ausset, Sylvain AU - Ausset S FAU - Deshayes, Anne Virginie AU - Deshayes AV FAU - Cauet, Amandine AU - Cauet A FAU - Demazeau, Nicolas AU - Demazeau N FAU - Sailliol, Anne AU - Sailliol A LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adult MH - Afghanistan MH - Blood Component Transfusion/*methods MH - Cohort Studies MH - Critical Care/methods MH - Female MH - France MH - Freeze Drying MH - *Hemostatic Techniques MH - Hospitals, Military MH - Humans MH - *Intensive Care Units MH - Male MH - Middle Aged MH - Prospective Studies MH - Risk Assessment MH - Shock, Hemorrhagic/diagnosis/mortality/*therapy MH - Survival Rate MH - Treatment Outcome MH - Warfare MH - Young Adult EDAT- 2011/12/21 06:00 MHDA- 2012/02/15 06:00 CRDT- 2011/12/21 06:00 PHST- 2011/12/21 06:00 [entrez] PHST- 2011/12/21 06:00 [pubmed] PHST- 2012/02/15 06:00 [medline] AID - 00005373-201112000-00048 [pii] AID - 10.1097/TA.0b013e31822f1285 [doi] PST - ppublish SO - J Trauma. 2011 Dec;71(6):1761-4; discussion 1764-5. doi: 10.1097/TA.0b013e31822f1285. PMID- 22071999 OWN - NLM STAT- MEDLINE DCOM- 20120103 LR - 20250529 IS - 1529-8809 (Electronic) IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 71 IP - 5 Suppl 1 DP - 2011 Nov TI - Clotting factor deficiency in early trauma-associated coagulopathy. PG - S427-34 LID - 10.1097/TA.0b013e318232e5ab [doi] AB - BACKGROUND: Coagulopathic bleeding is a leading cause of in-hospital death after injury. A recently proposed transfusion strategy calls for early and aggressive frozen plasma transfusion to bleeding trauma patients, thus addressing trauma-associated coagulopathy (TAC) by transfusing clotting factors (CFs). This strategy may dramatically improve survival of bleeding trauma patients. However, other studies suggest that early TAC occurs by protein C activation and is independent of CF deficiency. This study investigated whether CF deficiency is associated with early TAC. METHODS: This is a prospective observational cohort study of severely traumatized patients (Injury Severity Score >/= 16) admitted shortly after injury, receiving minimal fluids and no prehospital blood. Blood was assayed for CF levels, thromboelastography, and routine coagulation tests. Critical CF deficiency was defined as /=16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM(R) analyses (extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) tests) were performed. We divided patients into two groups: massive transfusion (MT, those who received >/=10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0 to 9 units). RESULTS: Of 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, P < 0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (P < 0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0 to 3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83). CONCLUSIONS: FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Donaueschingenstrasse 13, A-1200 Vienna, Austria. herbert.schoechl@trauma.lbg.ac.at FAU - Cotton, Bryan AU - Cotton B FAU - Inaba, Kenji AU - Inaba K FAU - Nienaber, Ulrike AU - Nienaber U FAU - Fischer, Henrik AU - Fischer H FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Solomon, Cristina AU - Solomon C LA - eng PT - Journal Article DEP - 20111111 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Crit Care. 2011;15(6):1021. doi: 10.1186/cc10569. PMID: 22226090 MH - Adult MH - Analysis of Variance MH - *Blood Coagulation Tests MH - *Blood Transfusion MH - Erythrocyte Transfusion MH - Female MH - Fibrinogen/analysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - ROC Curve MH - Retrospective Studies MH - Statistics, Nonparametric MH - Thrombelastography MH - Wounds and Injuries/*blood/therapy PMC - PMC3388656 EDAT- 2011/11/15 06:00 MHDA- 2013/06/13 06:00 PMCR- 2011/11/11 CRDT- 2011/11/15 06:00 PHST- 2011/06/30 00:00 [received] PHST- 2011/07/22 00:00 [revised] PHST- 2011/11/11 00:00 [accepted] PHST- 2011/11/15 06:00 [entrez] PHST- 2011/11/15 06:00 [pubmed] PHST- 2013/06/13 06:00 [medline] PHST- 2011/11/11 00:00 [pmc-release] AID - cc10539 [pii] AID - 10.1186/cc10539 [doi] PST - ppublish SO - Crit Care. 2011;15(6):R265. doi: 10.1186/cc10539. Epub 2011 Nov 11. PMID- 22049808 OWN - NLM STAT- MEDLINE DCOM- 20111206 LR - 20190923 IS - 0035-8665 (Print) IS - 0035-8665 (Linking) VI - 157 IP - 3 Suppl 1 DP - 2011 Sep TI - Massive transfusion. PG - S277-83 AB - Massive Transfusion is a part of Damage Control Resuscitation. The aim of transfusion therapy is to restore oxygen delivery to poorly perfused tissues and to treat the acute coagulopathy of trauma. The severity and complexity of modern injuries have led to the use of swift, protocol-driven care with the use of'Shock Packs' and management of metabolic complications. The proactive treatment of the coagulopathy has been termed Haemostatic Resuscitation. The delivery of this transfusion capability has required an increasingly sophisticated logistic and laboratory response. New operational capabilities have included cold chain solutions; laboratory management information systems; platelet apheresis and ROTEM. This investment in the massive transfusion capability has delivered rapid resuscitation. It has also enabled clinicians to direct individualised transfusion support following initial resuscitation i.e. goal directed therapy. Future technical solutions should further support the prehospital delivery of transfusion while addressing the logistic tail. However, the key to success is the knowledge and skills of frontline staff to deliver safe and appropriate blood transfusion. FAU - Doughty, H A AU - Doughty HA AD - Queen Elizabeth Hospital Birmingham. heidi.doughty@nhsbt.nhs.uk FAU - Woolley, T AU - Woolley T FAU - Thomas, G O R AU - Thomas GO LA - eng PT - Journal Article PL - England TA - J R Army Med Corps JT - Journal of the Royal Army Medical Corps JID - 7505627 SB - IM MH - Afghan Campaign 2001- MH - Blood Coagulation Disorders/etiology/therapy MH - Blood Transfusion/*methods MH - Hemostasis MH - Humans MH - Monitoring, Physiologic MH - Platelet Transfusion MH - Shock, Hemorrhagic/therapy MH - Wounds and Injuries/complications EDAT- 2011/11/05 06:00 MHDA- 2011/12/13 00:00 CRDT- 2011/11/05 06:00 PHST- 2011/11/05 06:00 [entrez] PHST- 2011/11/05 06:00 [pubmed] PHST- 2011/12/13 00:00 [medline] AID - 10.1136/jramc-157-03s-04 [doi] PST - ppublish SO - J R Army Med Corps. 2011 Sep;157(3 Suppl 1):S277-83. doi: 10.1136/jramc-157-03s-04. PMID- 22046550 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20111110 LR - 20211021 IS - 2090-2859 (Electronic) IS - 2090-2840 (Print) IS - 2090-2840 (Linking) VI - 2011 DP - 2011 TI - The role of thrombelastography in multiple trauma. PG - 895674 LID - 10.1155/2011/895674 [doi] LID - 895674 AB - Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. FAU - Jeger, Victor AU - Jeger V AD - Department of Emergency Medicine, University Hospital Inselspital, 3010 Bern, Switzerland. FAU - Zimmermann, Heinz AU - Zimmermann H FAU - Exadaktylos, Aristomenis K AU - Exadaktylos AK LA - eng PT - Journal Article DEP - 20110907 PL - United States TA - Emerg Med Int JT - Emergency medicine international JID - 101567070 PMC - PMC3200213 EDAT- 2011/11/03 06:00 MHDA- 2011/11/03 06:01 PMCR- 2011/09/07 CRDT- 2011/11/03 06:00 PHST- 2011/05/22 00:00 [received] PHST- 2011/07/07 00:00 [accepted] PHST- 2011/11/03 06:00 [entrez] PHST- 2011/11/03 06:00 [pubmed] PHST- 2011/11/03 06:01 [medline] PHST- 2011/09/07 00:00 [pmc-release] AID - 10.1155/2011/895674 [doi] PST - ppublish SO - Emerg Med Int. 2011;2011:895674. doi: 10.1155/2011/895674. Epub 2011 Sep 7. PMID- 22029598 OWN - NLM STAT- MEDLINE DCOM- 20120126 LR - 20211020 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 19 DP - 2011 Oct 26 TI - Thrombelastography and biomarker profiles in acute coagulopathy of trauma: a prospective study. PG - 64 LID - 10.1186/1757-7241-19-64 [doi] AB - BACKGROUND: Severe injury induces an acute coagulopathy associated with increased mortality. This study compared the Thrombelastography (TEG) and biomarker profiles upon admission in trauma patients. METHODS: Prospective observational study of 80 trauma patients admitted to a Level I Trauma Centre. Data on demography, biochemistry including standard coagulation tests, hematology, transfusions, Injury Severity Score (ISS) and TEG were recorded. Retrospective analysis of thawed plasma/serum for biomarkers reflecting tissue injury (histone-complexed DNA fragments), sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (sCD40L, protein C, activated Protein C, tissue-type plasminogen activator, plasminogen activator inhibitor-1, D-dimer, prothrombinfragment 1+2, plasmin/alpha2-antiplasmin complex, thrombin/antithrombin complex, tissue factor pathway inhibitor, antithrombin, von willebrand factor, factor XIII). Comparison of patients stratified according to ISS/TEG maximum clot strength. Linear regression analysis of variables associated with clot strength. RESULTS: Trauma patients had normal (86%), hypercoagulable (11%) or hypocoagulable (1%) TEG clot strength; one had primary hyperfibrinolysis. Hypercoagulable patients had higher age, fibrinogen and platelet count (all p < 0.05), none had increased activated partial thromboplastin time (APTT) or international normalized ratio (INR) and none required massive transfusion (> 10 red blood cells the initial 24 h). Patients with normal or hypercoagulable TEG clot strength had comparable biomarker profiles, but the few patients with hypocoagulable TEG clot strength and/or hyperfibrinolysis had very different biomarker profiles.Increasing ISS was associated with higher levels of catecholamines, histone-complexed DNA fragments, sCD40L, activated protein C and D-dimer and reduced levels of non-activated protein C, antithrombin, fibrinogen and factor XIII (all p < 0.05). Fibrinogen and platelet count were associated independently with clot strength in patients with ISS 26. In patients with ISS > 26, adrenaline and sCD40L were independently negatively associated with clot strength. CONCLUSIONS: Trauma patients displayed different coagulopathies by TEG and variables independently associated with clot strength changed with ISS. In the highest ISS group, adrenaline and sCD40L were independently negatively associated with clot strength indicating that these may contribute to acute coagulopathy. FAU - Ostrowski, Sisse R AU - Ostrowski SR AD - Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. sisse.ostrowski@gmail.com FAU - Sorensen, Anne Marie AU - Sorensen AM FAU - Larsen, Claus F AU - Larsen CF FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article DEP - 20111026 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Biomarkers/*blood MH - Blood Coagulation Disorders/*etiology MH - Chi-Square Distribution MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Humans MH - Injury Severity Score MH - Linear Models MH - Male MH - Predictive Value of Tests MH - Prospective Studies MH - Statistics, Nonparametric MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications PMC - PMC3212903 EDAT- 2011/10/28 06:00 MHDA- 2012/01/27 06:00 PMCR- 2011/10/26 CRDT- 2011/10/28 06:00 PHST- 2011/09/09 00:00 [received] PHST- 2011/10/26 00:00 [accepted] PHST- 2011/10/28 06:00 [entrez] PHST- 2011/10/28 06:00 [pubmed] PHST- 2012/01/27 06:00 [medline] PHST- 2011/10/26 00:00 [pmc-release] AID - 1757-7241-19-64 [pii] AID - 10.1186/1757-7241-19-64 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2011 Oct 26;19:64. doi: 10.1186/1757-7241-19-64. PMID- 22020385 OWN - NLM STAT- MEDLINE DCOM- 20120305 LR - 20250529 IS - 1546-1696 (Electronic) IS - 1087-0156 (Print) IS - 1087-0156 (Linking) VI - 29 IP - 11 DP - 2011 Oct 23 TI - A zymogen-like factor Xa variant corrects the coagulation defect in hemophilia. PG - 1028-33 LID - 10.1038/nbt.1995 [doi] AB - Effective therapies are needed to control excessive bleeding in a range of clinical conditions. We improve hemostasis in vivo using a conformationally pliant variant of coagulation factor Xa (FXa(I16L)) rendered partially inactive by a defect in the transition from zymogen to active protease. Using mouse models of hemophilia, we show that FXa(I16L) has a longer half-life than wild-type FXa and does not cause excessive activation of coagulation. Once clotting mechanisms are activated to produce its cofactor FVa, FXa(I16L) is driven to the protease state and restores hemostasis in hemophilic animals upon vascular injury. Moreover, using human or murine analogs, we show that FXa(I16L) is more efficacious than FVIIa, which is used to treat bleeding in hemophilia inhibitor patients. FXa(I16L) may provide an effective strategy to enhance blood clot formation and act as a rapid pan-hemostatic agent for the treatment of bleeding conditions. FAU - Ivanciu, Lacramioara AU - Ivanciu L AD - Department of Pediatrics, Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. FAU - Toso, Raffaella AU - Toso R FAU - Margaritis, Paris AU - Margaritis P FAU - Pavani, Giulia AU - Pavani G FAU - Kim, Haein AU - Kim H FAU - Schlachterman, Alexander AU - Schlachterman A FAU - Liu, Jian-Hua AU - Liu JH FAU - Clerin, Valerie AU - Clerin V FAU - Pittman, Debra D AU - Pittman DD FAU - Rose-Miranda, Rosalind AU - Rose-Miranda R FAU - Shields, Kathleen M AU - Shields KM FAU - Erbe, David V AU - Erbe DV FAU - Tobin, James F AU - Tobin JF FAU - Arruda, Valder R AU - Arruda VR FAU - Camire, Rodney M AU - Camire RM LA - eng GR - P01 HL074124/HL/NHLBI NIH HHS/United States GR - P01 HL-74124/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20111023 PL - United States TA - Nat Biotechnol JT - Nature biotechnology JID - 9604648 RN - 0 (Enzyme Precursors) RN - 0 (Hemostatics) RN - 0 (Recombinant Proteins) RN - EC 3.4.21.21 (Factor VIIa) RN - EC 3.4.21.5 (Thrombin) RN - EC 3.4.21.6 (Factor Xa) SB - IM MH - Animals MH - Blood Coagulation/genetics MH - Disease Models, Animal MH - Enzyme Precursors/pharmacokinetics/*therapeutic use MH - Factor VIIa/genetics/metabolism MH - Factor Xa/pharmacokinetics/*therapeutic use MH - Gene Expression MH - HEK293 Cells MH - Hemophilia A/*drug therapy MH - Hemorrhage/drug therapy MH - Hemostasis/genetics MH - Hemostatics/pharmacokinetics/*therapeutic use MH - Humans MH - Mice MH - Mice, Inbred BALB C MH - Mice, Inbred C57BL MH - Recombinant Proteins/genetics/therapeutic use MH - Thrombelastography MH - Thrombin/metabolism PMC - PMC4157830 MID - NIHMS323371 COIS- Conflict of Interest Statement R.M.C. receives licensing fees and research funding from Pfizer. V.C., D.D.P., R.R.M., K.M.S., D.V.E., and J.F.T. are employees of Pfizer, Inc. EDAT- 2011/10/25 06:00 MHDA- 2012/03/06 06:00 PMCR- 2014/09/08 CRDT- 2011/10/25 06:00 PHST- 2011/07/18 00:00 [received] PHST- 2011/09/07 00:00 [accepted] PHST- 2011/10/25 06:00 [entrez] PHST- 2011/10/25 06:00 [pubmed] PHST- 2012/03/06 06:00 [medline] PHST- 2014/09/08 00:00 [pmc-release] AID - nbt.1995 [pii] AID - 10.1038/nbt.1995 [doi] PST - epublish SO - Nat Biotechnol. 2011 Oct 23;29(11):1028-33. doi: 10.1038/nbt.1995. PMID- 22017416 OWN - NLM STAT- MEDLINE DCOM- 20120302 LR - 20220408 IS - 1365-2141 (Electronic) IS - 0007-1048 (Linking) VI - 155 IP - 5 DP - 2011 Dec TI - Management of major trauma haemorrhage: treatment priorities and controversies. PG - 537-48 LID - 10.1111/j.1365-2141.2011.08885.x [doi] AB - The severely injured trauma patient often arrives in the emergency department bleeding, coagulopathic and in need of a blood transfusion. The diagnosis and management of these patients has vastly improved with a better understanding of acute traumatic coagulopathy (ATC). In the emergency setting, traditional laboratory coagulation screens are of limited use in the diagnosis and management of life-threatening bleeding. Whole blood assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM) provide a rapid evaluation of clot formation, strength and lysis. Rapid diagnosis of ATC and aggressive haemostatic transfusion strategies utilizing early high doses of plasma are associated with improved outcomes in trauma. At present there is no accurate guide for transfusion in trauma, therefore blood and clotting products are administered on an empiric basis. Targeted transfusion therapy for major trauma haemorrhage based on comprehensive and rapid measures of coagulation e.g. TEG/ROTEM may lead to improved outcomes while optimizing blood utilization. Evidence for the clinical application of TEG and ROTEM in trauma is emerging with a number of studies evaluating their ability to diagnose coagulopathy early and facilitate goal-directed transfusion. This review explores current controversies and best practice in the diagnosis and management of major haemorrhage in trauma. CI - (c) 2011 Blackwell Publishing Ltd. FAU - Davenport, Ross AU - Davenport R AD - Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK. ross.davenport@bartsandthelondon.nhs.uk FAU - Khan, Sirat AU - Khan S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20111021 PL - England TA - Br J Haematol JT - British journal of haematology JID - 0372544 SB - IM MH - Blood Coagulation MH - Blood Coagulation Disorders/blood/diagnosis/therapy MH - Blood Transfusion MH - Hemorrhage/*therapy MH - Humans MH - Point-of-Care Systems MH - Thrombelastography MH - Wounds and Injuries/blood/*therapy EDAT- 2011/10/25 06:00 MHDA- 2012/03/03 06:00 CRDT- 2011/10/25 06:00 PHST- 2011/10/25 06:00 [entrez] PHST- 2011/10/25 06:00 [pubmed] PHST- 2012/03/03 06:00 [medline] AID - 10.1111/j.1365-2141.2011.08885.x [doi] PST - ppublish SO - Br J Haematol. 2011 Dec;155(5):537-48. doi: 10.1111/j.1365-2141.2011.08885.x. Epub 2011 Oct 21. PMID- 21959490 OWN - NLM STAT- MEDLINE DCOM- 20111229 LR - 20110930 IS - 1536-3732 (Electronic) IS - 1049-2275 (Linking) VI - 22 IP - 5 DP - 2011 Sep TI - Review of "primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma". PG - 1980 LID - 10.1097/SCS.0b013e31822eaabc [doi] FAU - Koshy, John C AU - Koshy JC AD - Baylor College of Medicine, Houston, TX, USA. jckoshy@bcm.edu FAU - Hollier, Larry H Jr AU - Hollier LH Jr LA - eng PT - Journal Article PL - United States TA - J Craniofac Surg JT - The Journal of craniofacial surgery JID - 9010410 MH - Acute Disease MH - Adult MH - Blood Coagulation Disorders/diagnosis/*etiology/*physiopathology MH - Blood Transfusion/*statistics & numerical data MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Male MH - Point-of-Care Systems MH - Prospective Studies MH - Thrombelastography MH - Time Factors MH - Wounds and Injuries/*complications/therapy EDAT- 2011/10/01 06:00 MHDA- 2011/12/30 06:00 CRDT- 2011/10/01 06:00 PHST- 2011/10/01 06:00 [entrez] PHST- 2011/10/01 06:00 [pubmed] PHST- 2011/12/30 06:00 [medline] AID - 00001665-201109000-00108 [pii] AID - 10.1097/SCS.0b013e31822eaabc [doi] PST - ppublish SO - J Craniofac Surg. 2011 Sep;22(5):1980. doi: 10.1097/SCS.0b013e31822eaabc. PMID- 21955460 OWN - NLM STAT- MEDLINE DCOM- 20120126 LR - 20211020 IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 19 DP - 2011 Sep 28 TI - Reduced clot strength upon admission, evaluated by thrombelastography (TEG), in trauma patients is independently associated with increased 30-day mortality. PG - 52 LID - 10.1186/1757-7241-19-52 [doi] AB - INTRODUCTION: Exsanguination due to uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. About one third of trauma patients present with coagulopathy on admission, which is associated with increased mortality and will aggravate bleeding in a traumatized patient. Thrombelastographic (TEG) clot strength has previously been shown to predict outcome in critically ill patients. The aim of the present study was to investigate this relation in the trauma setting. METHODS: A retrospective study of trauma patients with an injury severity qualifying them for inclusion in the European Trauma Audit and Research Network (TARN) and a TEG analysis performed upon arrival at the trauma centre. RESULTS: Eighty-nine patients were included. The mean Injury Severity Score (ISS) was 21 with a 30-day mortality of 17%. Patients with a reduced clot strength (maximal amplitude < 50 mm) evaluated by TEG, presented with a higher ISS 27 (95% CI, 20-34) vs. 19 (95% CI, 17-22), p = 0.006 than the rest of the cohort. Clot strength correlated with the amount of packed red blood cells (p = 0.01), fresh frozen plasma (p = 0.04) and platelet concentrates (p = 0.03) transfused during the first 24 hours of admission. Patients with low clot strength demonstrated increased 30-day mortality (47% vs. 10%, p < 0.001). By logistic regression analysis reduced clot strength was an independent predictor of increased mortality after adjusting for age and ISS. CONCLUSION: Low clot strength upon admission is independently associated with increased 30-day mortality in trauma patients and it could be speculated that targeted interventions based on the result of the TEG analysis may improve patient outcome. Prospective randomized trials investigating this potential are highly warranted. FAU - Nystrup, Kristin B AU - Nystrup KB AD - Department of Clinical Immunology, Section for Transfusion Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Windelov, Nis A AU - Windelov NA FAU - Thomsen, Annemarie B AU - Thomsen AB FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article DEP - 20110928 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Adult MH - Area Under Curve MH - Blood Coagulation Disorders/diagnosis/*etiology/*mortality/physiopathology MH - Chi-Square Distribution MH - Denmark/epidemiology MH - Female MH - Humans MH - Injury Severity Score MH - Logistic Models MH - Male MH - Retrospective Studies MH - Risk Factors MH - *Thrombelastography MH - Wounds and Injuries/*complications/*mortality PMC - PMC3203039 EDAT- 2011/10/01 06:00 MHDA- 2012/01/27 06:00 PMCR- 2011/09/28 CRDT- 2011/09/30 06:00 PHST- 2011/07/19 00:00 [received] PHST- 2011/09/28 00:00 [accepted] PHST- 2011/09/30 06:00 [entrez] PHST- 2011/10/01 06:00 [pubmed] PHST- 2012/01/27 06:00 [medline] PHST- 2011/09/28 00:00 [pmc-release] AID - 1757-7241-19-52 [pii] AID - 10.1186/1757-7241-19-52 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2011 Sep 28;19:52. doi: 10.1186/1757-7241-19-52. PMID- 21942848 OWN - NLM STAT- MEDLINE DCOM- 20120206 LR - 20151119 IS - 1557-9042 (Electronic) IS - 0897-7151 (Linking) VI - 28 IP - 10 DP - 2011 Oct TI - Thromboelastometric (ROTEM) findings in patients suffering from isolated severe traumatic brain injury. PG - 2033-41 LID - 10.1089/neu.2010.1744 [doi] AB - Severe traumatic brain injury (sTBI) is often accompanied by coagulopathy and an increased risk of bleeding. To identify and successfully treat bleeding disorders associated with sTBI, rapid assessment of coagulation status is crucial. This retrospective study was designed to assess the potential role of whole-blood thromboelastometry (ROTEM((R)), Tem International, Munich, Germany) in patients with isolated sTBI (abbreviated injury scale [AIS](head) >/=3 and AIS(extracranial) <3). Blood samples were obtained immediately following admission to the emergency room of the Trauma Centre Salzburg in Austria. ROTEM analysis (EXTEM, INTEM, and FIBTEM tests) and standard laboratory coagulation tests (prothrombin time index [PTI, percentage of normal prothrombin time], activated partial thromboplastin time [aPTT], fibrinogen concentration, and platelet count) were compared between survivors and non-survivors. Out of 88 patients with sTBI enrolled in the study, 66 survived and 22 died. PTI, fibrinogen, and platelet count were significantly higher in survivors (p<0.005). Accordingly, aPTT was shorter in this group (p<0.0001). ROTEM analysis revealed shorter clotting times in extrinsically activated thromboelastometric test (EXTEM) and intrinsically activated thromboelastometric test (INTEM) (p<0.001), shorter clot formation times in EXTEM and INTEM (p<0.0001), and higher maximum clot firmness in EXTEM, INTEM, and FIBTEM (p<0.01) in survivors compared with non-survivors. Logistic regression analysis revealed extrinsically activated thromboelastometric test with cytochalasin D (FIBTEM) MCF and aPTT to have the best predictive value for mortality. According to the degree of coagulopathy, non-survivors received more RBC (p=0.016), fibrinogen concentrate (p=0.01), and prothrombin complex concentrate (p<0.001) within 24 h of arrival in the emergency room. ROTEM testing appeared to offer an early signal of severe life-threatening sTBI. Further studies are warranted to confirm these results and to investigate the role of ROTEM in guiding coagulation therapy. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria. herbert.schoechl@trauma.lbg.ac.at FAU - Solomon, Cristina AU - Solomon C FAU - Traintinger, Stefan AU - Traintinger S FAU - Nienaber, Ulrike AU - Nienaber U FAU - Tacacs-Tolnai, Astrid AU - Tacacs-Tolnai A FAU - Windhofer, Christian AU - Windhofer C FAU - Bahrami, Soheyl AU - Bahrami S FAU - Voelckel, Wolfgang AU - Voelckel W LA - eng PT - Journal Article DEP - 20110923 PL - United States TA - J Neurotrauma JT - Journal of neurotrauma JID - 8811626 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Cell Count MH - Blood Coagulation Disorders/blood/etiology MH - Blood Coagulation Tests MH - Blood Gas Analysis MH - Blood Pressure/physiology MH - Brain Injuries/*blood/complications MH - Critical Care MH - Emergency Medical Services MH - Female MH - Fibrinogen/metabolism MH - Glasgow Coma Scale MH - Hemostasis MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Platelet Count MH - Point-of-Care Systems MH - Prognosis MH - Prothrombin Time MH - Survivors MH - Thrombelastography/*methods MH - Young Adult EDAT- 2011/09/29 06:00 MHDA- 2012/02/07 06:00 CRDT- 2011/09/28 06:00 PHST- 2011/09/28 06:00 [entrez] PHST- 2011/09/29 06:00 [pubmed] PHST- 2012/02/07 06:00 [medline] AID - 10.1089/neu.2010.1744 [doi] PST - ppublish SO - J Neurotrauma. 2011 Oct;28(10):2033-41. doi: 10.1089/neu.2010.1744. Epub 2011 Sep 23. PMID- 21918164 OWN - NLM STAT- MEDLINE DCOM- 20111207 LR - 20220317 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 113 IP - 5 DP - 2011 Nov TI - Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma. PG - 1003-12 LID - 10.1213/ANE.0b013e31822e183f [doi] AB - BACKGROUND: We investigated whether hyperfibrinolysis and its severity was associated with outcome of traumatized and nontraumatized patients. METHODS: From April 2008 to April 2010, all emergency patients with hyperfibrinolysis were enrolled in this study. Hyperfibrinolysis patients were divided into traumatized (trauma hyperfibrinolysis group) and nontraumatized (nontrauma hyperfibrinolysis group). The trauma hyperfibrinolysis group was matched with 24 polytrauma patients without hyperfibrinolysis (matched trauma group). Data from rotational thromboelastometry measurements, blood gas analysis (metabolic state), laboratory analysis, injury severity score, and 30-day mortality were collected. RESULTS: Thirty-five patients with hyperfibrinolysis were identified (13 traumatized, 22 nontraumatized). Overall mortality for hyperfibrinolysis was 54%. Mortality in the trauma hyperfibrinolysis group (77%+/-12%) was significantly higher than in the nontrauma hyperfibrinolysis group (41%+/-10%; P=0.001, 95% CI 5%-67%) and the matched trauma group (33%+/-10%; P=0.009, 95% CI 13%-74%). Hyperfibrinolysis is significantly (P=0.017) associated with mortality in trauma patients. In the blood gas analysis representing the metabolic state, only pH (P=0.02) and potassium (P=0.01) were significantly lower in the trauma hyperfibrinolysis group compared to the nontrauma hyperfibrinolysis group. CONCLUSIONS: Mortality from hyperfibrinolysis is significantly higher in trauma compared with nontrauma patients, and hyperfibrinolysis is an independent factor predicting mortality in trauma patients. Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment. FAU - Theusinger, Oliver M AU - Theusinger OM AD - Institute of Anesthesiology, Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, and Institute of Sockal and Preventive Medicine, University of Zurich, CH-8091 Zurich, Switzerland. oliver.theusinger@usz.ch FAU - Wanner, Guido A AU - Wanner GA FAU - Emmert, Maximilian Y AU - Emmert MY FAU - Billeter, Adrian AU - Billeter A FAU - Eismon, Jennifer AU - Eismon J FAU - Seifert, Burkhardt AU - Seifert B FAU - Simmen, Hans-Peter AU - Simmen HP FAU - Spahn, Donat R AU - Spahn DR FAU - Baulig, Werner AU - Baulig W LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110914 PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Blood Coagulation MH - Blood Gas Analysis MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Kaplan-Meier Estimate MH - Kinetics MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Retrospective Studies MH - Survival Analysis MH - Thrombelastography/instrumentation/*methods MH - Treatment Outcome MH - Wounds and Injuries/metabolism/*mortality/*pathology MH - Young Adult EDAT- 2011/09/16 06:00 MHDA- 2011/12/13 00:00 CRDT- 2011/09/16 06:00 PHST- 2011/09/16 06:00 [entrez] PHST- 2011/09/16 06:00 [pubmed] PHST- 2011/12/13 00:00 [medline] AID - ANE.0b013e31822e183f [pii] AID - 10.1213/ANE.0b013e31822e183f [doi] PST - ppublish SO - Anesth Analg. 2011 Nov;113(5):1003-12. doi: 10.1213/ANE.0b013e31822e183f. Epub 2011 Sep 14. PMID- 21901227 OWN - NLM STAT- MEDLINE DCOM- 20120208 LR - 20240103 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 106 IP - 4 DP - 2011 Oct TI - Prothrombin complex concentrate reduces blood loss and enhances thrombin generation in a pig model with blunt liver injury under severe hypothermia. PG - 724-33 LID - 10.1160/TH11-02-0101 [doi] AB - Although prothrombin complex concentrate (PCC) is increasingly used for the treatment of trauma-induced coagulopathy, few studies have investigated the impact and safety of PCC for this indication. The present study was performed to assess PCC for treatment of coagulopathy after blunt liver injury under severe hypothermia. Coagulopathy in 14 anaesthetised pigs was induced by haemodilution. Subsequently, standardised blunt liver injury was induced under severe hypothermia (32.8-33.2 degrees C). Animals were randomised to receive either PCC (35 IU kg(-)(1)) or saline (control). Coagulation was assessed over the following 2 hours by thromboelastometry and thrombin generation. Internal organs were examined to determine presence of emboli. The administration of PCC showed a significant reduction in blood loss (p=0.002 vs. controls) and a significant increase in the rate of survival (p=0.022 vs. controls). Plasma thrombin generation in the PCC group increased considerably above baseline levels, with significant increases in peak thrombin levels and endogenous thrombin potential versus controls throughout the follow-up period. In addition, PT decreased significantly in the PCC group versus the control group. However, only slight improvements in thromboelastometry variables were observed. Histology showed an equal degree of liver injury in both groups, and no thromboembolism. In severely hypothermic pigs, the application of PCC corrected trauma-induced coagulopathy and reduced blood loss. Thus, the infusion of PCC might be a reasonable approach to reduce the need for blood cell transfusion in trauma. Furthermore, the impact and safety of PCC application can be monitored through thrombin generation and thromboelastometry under hypothermia. FAU - Honickel, Markus AU - Honickel M AD - Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany. FAU - Rieg, Annette AU - Rieg A FAU - Rossaint, Rolf AU - Rossaint R FAU - Braunschweig, Till AU - Braunschweig T FAU - Spronk, Henri M H AU - Spronk HM FAU - ten Cate, Hugo AU - ten Cate H FAU - van Oerle, Rene AU - van Oerle R FAU - Tolba, Rene AU - Tolba R FAU - Grottke, Oliver AU - Grottke O LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110908 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Blood Coagulation Factors) RN - 37224-63-8 (prothrombin complex concentrates) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Animals MH - Blood Coagulation Disorders/*drug therapy/etiology/pathology/physiopathology MH - Blood Coagulation Factors/*administration & dosage/adverse effects MH - Disease Models, Animal MH - Hemorrhage MH - Humans MH - Hypothermia MH - Liver/*drug effects/injuries/metabolism/pathology MH - Liver Diseases/complications/*drug therapy/pathology/physiopathology MH - Swine MH - Thrombelastography MH - Thrombin/metabolism MH - Wounds, Nonpenetrating/complications/*drug therapy/pathology/physiopathology EDAT- 2011/09/09 06:00 MHDA- 2012/02/09 06:00 CRDT- 2011/09/09 06:00 PHST- 2011/02/15 00:00 [received] PHST- 2011/07/18 00:00 [accepted] PHST- 2011/09/09 06:00 [entrez] PHST- 2011/09/09 06:00 [pubmed] PHST- 2012/02/09 06:00 [medline] AID - 11-02-0101 [pii] AID - 10.1160/TH11-02-0101 [doi] PST - ppublish SO - Thromb Haemost. 2011 Oct;106(4):724-33. doi: 10.1160/TH11-02-0101. Epub 2011 Sep 8. PMID- 21899867 OWN - NLM STAT- MEDLINE DCOM- 20120208 LR - 20211020 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 151 IP - 1 DP - 2012 Jan TI - Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes. PG - 48-54 LID - 10.1016/j.surg.2011.06.023 [doi] AB - BACKGROUND: Predicting refractory coagulopathy early in resuscitation of injured patients may decrease a leading cause of preventable death. We hypothesized that clot strength (G) measured by point-of-care rapid thrombelastography (r-TEG) on arrival in the emergency department can predict massive transfusion (MT) and coagulation-related mortality (MT-death). METHODS: Trauma alerts/activations from May 2008 to September 2010 were reviewed. The variables included the following: age, sex, injury severity score (ISS), systolic blood pressure (SBP), base deficit (BD), traditional coagulation tests (international normalized ratio ([INR], partial thromboplastin time [PTT]), TEG-derived G, and blood products transfused within the first 6 hours. Independent predictors of 2 outcomes (MT [>/=10 packed red blood cells units/6 h] and MT-related death) were identified using logistic regression. The individual predictive values of BD, INR, PTT, and G were assessed comparing the areas under the receiver operating characteristic curves (AUC ROC), while adjusting for age, ISS, and SBP. RESULTS: Among the 80 study patients, 48% required MT, and 21% died of MT-related complications. INR, ISS, and G were independent predictors of MT, whereas age, ISS, SBP, and G were independently associated with MT-death. The predictive power for outcome MT did not differ among INR (adjusted AUC ROC = 0.92), PTT (AUC ROC = 0.90, P = .41), or G (AUC ROC = 0.89, P = .39). For outcome MT-death, G had the greatest adjusted AUC ROC (0.93) compared with the AUC ROC for BD (0.87, P = .05), INR (0.88, P = .11), and PTT (0.89; P = .19). CONCLUSION: These data suggest that the point-of-care TEG parameter clot strength (G) provides consistent, independent prediction of MT and MT-death early in the resuscitation of injured patients. CI - Copyright (c) 2012 Mosby, Inc. All rights reserved. FAU - Pezold, Michael AU - Pezold M AD - Department of Surgery, University of Colorado at Denver, Denver, CO, USA. FAU - Moore, Ernest E AU - Moore EE FAU - Wohlauer, Max AU - Wohlauer M FAU - Sauaia, Angela AU - Sauaia A FAU - Gonzalez, Eduardo AU - Gonzalez E FAU - Banerjee, Anirban AU - Banerjee A FAU - Silliman, Christopher C AU - Silliman CC LA - eng GR - P50 GM049222/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States GR - P50GM49222/GM/NIGMS NIH HHS/United States GR - T32GM08315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20110906 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adolescent MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology/mortality MH - Blood Transfusion/statistics & numerical data MH - Colorado/epidemiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Point-of-Care Systems MH - *Thrombelastography MH - Trauma Centers/statistics & numerical data MH - Wounds and Injuries/*complications/mortality MH - Young Adult PMC - PMC4364997 MID - NIHMS670276 EDAT- 2011/09/09 06:00 MHDA- 2012/02/09 06:00 PMCR- 2015/03/18 CRDT- 2011/09/09 06:00 PHST- 2011/03/21 00:00 [received] PHST- 2011/06/15 00:00 [accepted] PHST- 2011/09/09 06:00 [entrez] PHST- 2011/09/09 06:00 [pubmed] PHST- 2012/02/09 06:00 [medline] PHST- 2015/03/18 00:00 [pmc-release] AID - S0039-6060(11)00306-0 [pii] AID - 10.1016/j.surg.2011.06.023 [doi] PST - ppublish SO - Surgery. 2012 Jan;151(1):48-54. doi: 10.1016/j.surg.2011.06.023. Epub 2011 Sep 6. PMID- 21893014 OWN - NLM STAT- MEDLINE DCOM- 20130325 LR - 20241204 IS - 1603-9629 (Electronic) IS - 0907-8916 (Linking) VI - 58 IP - 9 DP - 2011 Sep TI - Evidence based evaluation of immuno-coagulatory interventions in critical care. PG - B4316 AB - Cochrane systematic reviews with meta-analyses of randomised trials provide guidance for clinical practice and health-care decision-making. In case of disagreements between research evidence and clinical practice, high quality systematic reviews can facilitate implementation or deimplementation of medical interventions into clinical practice. This applies especially to treatment of critically ill patients where interventions are most often costly and the clinical conditions are associated with high mortality. OBJECTIVES: To assess the potential benefits or harms of 1) antithrombin III (AT III) for critically ill patients; 2) inhaled nitric oxide (INO) for acute respiratory distress syndrome (ARDS) and acute lung injury (ALI); 3) aerosolized prostacyclin for ARDS and ALI; 4) thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. METHODS: We performed four systematic reviews of relevant randomised clinical trials. To quantify the estimated effect of various interventions, we conducted meta-analyses, where appropriate, to determine intervention effects using the Cochrane Collaboration methodology, trial sequential analyses (TSA), the GRADE, and the PRISMA-guidelines when conducting our systematic reviews. All reviews were performed according to published protocols following the recommendations of the Cochrane Handbook for systematic reviews of interventions. We performed multiple subgroup and sensitivity analyses with regard to methodological quality and various clinical outcomes. Trials were identified through Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE Science Citation Index-Expanded, The Chinese Biomedical Database and LILACS. We included all randomized clinical trials. We hand-searched reference lists, reviews, and contacted authors and experts for additional trials. We searched ClinicalTrials.gov, Centre Watch Clinical Trials Listing Service and ControlledTrials.com for missed, unreported, or ongoing trials. We screened bibliographies of relevant articles and conference proceedings and wrote to trialists and pharmaceutical companies producing the drugs in question. RESULTS: Four systematic reviews included a total of 44 trials with 5,551 patients. Only 15 of the trials were classified as trials with low risk of bias (high methodological quality) regarding generation of the allocation sequence, allocation concealment, blinding, follow-up and other types of bias. 1) Compared with placebo or no intervention, AT III did not significantly affect overall mortality (relative risk (RR) 0.96, 95% confidence interval (CI) 0.89 to 1.03). No subgroup analyses on risk of bias, populations of patients, or with and without adjuvant heparin yielded significant results. AT III significantly increased the risk of bleeding events (RR 1.52, 95% CI 1.30 to 1.78). 2) INO showed no statistically significant effect on overall mortality (RR 1.06, 95% CI 0.93 to 1.22) and in several subgroup and sensitivity analyses, indicating robust results. Limited data demonstrated no effect of INO on duration of ventilation, ventilator-free days, and length of stay in the intensive care unit and hospital. We found a statistically significant, but transient improvement in oxygenation in the first 24 hours, expressed as the ratio of PO2 to fraction of inspired oxygen (mean difference (MD) 15.91, 95% CI 8.25 to 23.56). However, INO appears to significantly increase the risk of renal impairment among adults (RR 1.59, 95% CI 1.17 to 2.16) but did not significantly affect the risk of bleeding or methaemoglobin or nitrogen dioxide formation. 3) We found only one small low risk of bias paediatric trial examining the role of aerosolized prostacyclin in ALI or ARDS. Based on this limited amount of data, we were unable to support or refute the routine use of this intervention in ALI or ARDS. 4) Compared with standard treatment, TEG or ROTEM showed no statistically significant effect on overall mortality (RR 0.77, 95% CI 0.35 to 1.72) but only five trials provided data on mortality. Our analyses demonstrated a statistically significant effect of TEG or ROTEM on the amount of bleeding (MD -85.05 ml, 95% CI -140.68 to -29.42) but failed to show any statistically significant effect on other predefined outcomes. However, whether this reduction has implication for the patient's clinical condition is still uncertain. CONCLUSION: We did not find reliable evidence to support the clinical use of the assessed immuno-coagulatory interventions for general use in critical care based on the available evidence. A large proportion of the trials had serious methodological shortcomings, small number of patients, and short trial duration. The sparse data provided in the included trials may be or may not be promising but is not necessarily evidence of absence of a beneficial or harmful effect, because many of the outcome measures have not been adequately addressed so far. There is an urgent need for several randomised clinical trials with low risk of bias and low risk of random error to evaluate the use of the assessed interventions. FAU - Afshari, Arash AU - Afshari A AD - Department of Anaesthesiology, Juliane Marie Center, Rigshospitalet, University of Copenhagen, Blegdamsvej, Denmark. arriba.a@gmail.com LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - Denmark TA - Dan Med Bull JT - Danish medical bulletin JID - 0066040 RN - 9000-94-6 (Antithrombin III) RN - DCR9Z582X0 (Epoprostenol) RN - 31C4KY9ESH (Nitric Oxide) SB - IM MH - Adult MH - Humans MH - *Antithrombin III/therapeutic use MH - *Blood Coagulation/physiology MH - *Blood Coagulation Disorders/drug therapy/physiopathology MH - Critical Care MH - *Epoprostenol/therapeutic use MH - *Evidence-Based Medicine/methods MH - *Hemostasis/physiology MH - *Inflammation/blood/drug therapy MH - *Nitric Oxide/therapeutic use EDAT- 2011/09/07 06:00 MHDA- 2013/03/26 06:00 CRDT- 2011/09/07 06:00 PHST- 2011/09/07 06:00 [entrez] PHST- 2011/09/07 06:00 [pubmed] PHST- 2013/03/26 06:00 [medline] AID - B4316 [pii] PST - ppublish SO - Dan Med Bull. 2011 Sep;58(9):B4316. PMID- 21872428 OWN - NLM STAT- MEDLINE DCOM- 20120417 LR - 20220321 IS - 1532-9496 (Electronic) IS - 0887-7963 (Linking) VI - 26 IP - 1 DP - 2012 Jan TI - Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. PG - 1-13 LID - 10.1016/j.tmrv.2011.07.005 [doi] AB - In the recent years, thromboelastography has become a popular monitoring device for hemostasis and transfusion management in major surgery, trauma, and hemophilia. Thromboelastography is performed in whole blood and assesses the viscoelastic property of clot formation under low shear condition. Thromboelastography can be performed with a variety of activator and inhibitors at different concentrations representing the most important factors for different intervals and clot formation variables reported in multiple studies and algorithms. Furthermore, fibrinogen levels and platelet counts have a major influence on thromboelastographic variables. In addition, differences in patient populations, devices, and preanalytical conditions contribute to some conflicting findings in different studies. CI - Copyright (c) 2012 Elsevier Inc. All rights reserved. FAU - Bolliger, Daniel AU - Bolliger D AD - Department of Anesthesia and Intensive Care Medicine, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. dabolliger@uhbs.ch FAU - Seeberger, Manfred D AU - Seeberger MD FAU - Tanaka, Kenichi A AU - Tanaka KA LA - eng PT - Journal Article PT - Review DEP - 20110826 PL - United States TA - Transfus Med Rev JT - Transfusion medicine reviews JID - 8709027 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Algorithms MH - *Blood Coagulation MH - Blood Coagulation Tests MH - Blood Platelets/metabolism MH - Fibrinogen/metabolism MH - Hematocrit MH - Hematology/*methods MH - Hemostasis MH - Humans MH - Partial Thromboplastin Time MH - Thrombelastography/*methods MH - Time Factors EDAT- 2011/08/30 06:00 MHDA- 2012/04/18 06:00 CRDT- 2011/08/30 06:00 PHST- 2011/08/30 06:00 [entrez] PHST- 2011/08/30 06:00 [pubmed] PHST- 2012/04/18 06:00 [medline] AID - S0887-7963(11)00064-2 [pii] AID - 10.1016/j.tmrv.2011.07.005 [doi] PST - ppublish SO - Transfus Med Rev. 2012 Jan;26(1):1-13. doi: 10.1016/j.tmrv.2011.07.005. Epub 2011 Aug 26. PMID- 21825945 OWN - NLM STAT- MEDLINE DCOM- 20111006 LR - 20110809 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 71 IP - 2 DP - 2011 Aug TI - Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission. PG - 407-14; discussion 414-7 LID - 10.1097/TA.0b013e31821e1bf0 [doi] AB - BACKGROUND: Recognition of trauma-induced coagulopathy by conventional coagulation testing (CCT) is limited by their slow results, incomplete characterization, and their poor predictive nature. Rapid thrombelastography (r-TEG) delivers a more comprehensive assessment of the coagulation system but has not been prospectively validated in trauma patients. The purpose of this pilot study was to evaluate the timeliness of r-TEG results, their correlation with CCTs, and the ability of r-TEG to predict early blood transfusion. METHODS: Over a 5-month period, 583 consecutive major trauma activations were prospectively entered into a database, of which 272 met entry criteria. r-TEG and CCTs (prothrombin time, international normalized ratio, partial thromboplastin time, and platelet count) were obtained on all patients. Graphical results for r-TEG were displayed "real time" in the trauma bay. Spearman's correlation and regression models were used to compare r-TEG and CCTs. RESULTS: Early r-TEG values (activated clotting time [ACT], k-time, and r-value) were available within 5 minutes, late r-TEG values (maximal amplitude and alpha-angle) within 15 minutes, and CCTs within 48 minutes (p < 0.001). ACT, r-value, and k-time showed strong correlation with prothrombin time, international normalized ratio, and partial thromboplastin time (all r >0.70; p < 0.001), whereas maximal amplitude (r = -0.49) and alpha-angle (r = 0.40) correlated with platelet count (both p < 0.001). Linear regression demonstrated ACT predicted red blood cells (coef. 0.05; 95% confidence interval [CI], 0.04-0.06; p < 0.001), plasma (coef. 0.03; 95% CI, 0.02-0.04; p < 0.001), and platelet (coef. 0.06; 95% CI, 0.04-0.07; p < 0.001) transfusions within the first 2 hours of arrival. Controlling for all demographics and Emergency Department vitals, ACT >128 predicted massive transfusion (>/=10 U) in the first 6 hours (odds ratio, 5.15; 95% CI, 1.36-19.49; p = 0.01). In addition, ACT <105 predicted patients who did not receive any transfusions in the first 24 hours (odds ratio, 2.80; CI, 1.02-7.07; p = 0.04). CONCLUSIONS: Graphical r-TEG results are available within minutes, correlate with conventional coagulation test that are not as rapidly available, and are predictive of early transfusions of packed red blood cells, plasma, and platelets. FAU - Cotton, Bryan A AU - Cotton BA AD - Department of Surgery, The University of Texas Health Science Center, Houston, Texas 77030, USA. bryan.a.cotton@uth.tmc.edu FAU - Faz, Gabriel AU - Faz G FAU - Hatch, Quinton M AU - Hatch QM FAU - Radwan, Zayde A AU - Radwan ZA FAU - Podbielski, Jeanette AU - Podbielski J FAU - Wade, Charles AU - Wade C FAU - Kozar, Rosemary A AU - Kozar RA FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis MH - Blood Component Transfusion MH - Blood Transfusion/*statistics & numerical data MH - Electronic Health Records MH - Female MH - Hospitalization MH - Humans MH - Injury Severity Score MH - Linear Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Pilot Projects MH - Specimen Handling MH - Thrombelastography/*methods MH - Time Factors MH - Wounds and Injuries/complications MH - Young Adult EDAT- 2011/08/10 06:00 MHDA- 2011/10/07 06:00 CRDT- 2011/08/10 06:00 PHST- 2011/08/10 06:00 [entrez] PHST- 2011/08/10 06:00 [pubmed] PHST- 2011/10/07 06:00 [medline] AID - 00005373-201108000-00021 [pii] AID - 10.1097/TA.0b013e31821e1bf0 [doi] PST - ppublish SO - J Trauma. 2011 Aug;71(2):407-14; discussion 414-7. doi: 10.1097/TA.0b013e31821e1bf0. PMID- 21790635 OWN - NLM STAT- MEDLINE DCOM- 20120313 LR - 20220318 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 52 IP - 1 DP - 2012 Jan TI - Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy. PG - 23-33 LID - 10.1111/j.1537-2995.2011.03264.x [doi] AB - BACKGROUND: Massive transfusion (MTP) protocol design is hindered by lack of accurate assessment of coagulation. Rapid thrombelastography (r-TEG) provides point-of-care (POC) analysis of clot formation. We designed a prospective study to test the hypothesis that integrating TEG into our MTP would facilitate goal-directed therapy and provide equivalent outcomes compared to conventional coagulation testing. STUDY DESIGN AND METHODS: Thiry-four patients who received more than 6 units of red blood cells (RBCs)/6 hours who were admitted to our Level 1 trauma center after r-TEG implementation (TEG) were compared to 34 patients admitted prior to TEG implementation (Pre-TEG). Data are presented as mean+/-SEM. RESULTS: Emergency department pre-TEG versus TEG shock, and coagulation indices, were not different: systolic blood pressure (94 mmHg vs. 101 mmHg), temperature (35.3 degrees C vs. 35.9 degrees C), pH (7.16 vs. 7.11), base deficit (-13.0 vs. -14.7), lactate (6.5 vs. 8.1), international normalized ratio (INR; 1.59 vs. 1.83), and partial thromboplastin time (48.3 vs. 57.9). Although not significant, patients with Injury Severity Score range 26 to 35 were more frequent in the pre-TEG group. Fresh-frozen plasma (FFP):RBCs, platelets:RBCs, and cryoprecipitate (cryo):RBC ratios were not significantly different at 6 or 12 hours. INR at 6 hours did not discriminate between survivors and nonsurvivors (p=0.10), whereas r-TEG "G" value was significantly associated with survival (p=0.03), as was the maximum rate of thrombin generation (MRTG; mm/min) and total thrombin generation (TG; area under the curve) (p=0.03 for both). Patients with MRTG of more than 9.2 received significantly less components of RBCs, FFP, and cryo (p=0.048, p=0.03, and p=0.04, respectively). CONCLUSION: Goal-directed resuscitation via r-TEG appears useful for management of trauma-induced coagulopathy. Further experience with POC monitoring could result in more efficient management leading to a reduction of transfusion requirements. CI - (c) 2011 American Association of Blood Banks. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Department of Surgery and Anesthesia, Denver Health Medical Center, Denver, Colorado, USA. jeffrykashuk@gmail.com FAU - Moore, Ernest E AU - Moore EE FAU - Wohlauer, Max AU - Wohlauer M FAU - Johnson, Jeffrey L AU - Johnson JL FAU - Pezold, Michael AU - Pezold M FAU - Lawrence, Jerry AU - Lawrence J FAU - Biffl, Walter L AU - Biffl WL FAU - Burlew, C Clay Cothren AU - Burlew CC FAU - Barnett, Carlton AU - Barnett C FAU - Sawyer, Michael AU - Sawyer M FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States GR - T32GM08315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20110725 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Adult MH - Blood Coagulation Disorders/*therapy MH - Blood Component Transfusion MH - Female MH - Humans MH - Male MH - Prospective Studies MH - *Thrombelastography MH - Trauma Centers/statistics & numerical data MH - Young Adult EDAT- 2011/07/28 06:00 MHDA- 2012/03/14 06:00 CRDT- 2011/07/28 06:00 PHST- 2011/07/28 06:00 [entrez] PHST- 2011/07/28 06:00 [pubmed] PHST- 2012/03/14 06:00 [medline] AID - 10.1111/j.1537-2995.2011.03264.x [doi] PST - ppublish SO - Transfusion. 2012 Jan;52(1):23-33. doi: 10.1111/j.1537-2995.2011.03264.x. Epub 2011 Jul 25. PMID- 21765358 OWN - NLM STAT- MEDLINE DCOM- 20120113 LR - 20250529 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 39 IP - 12 DP - 2011 Dec TI - Functional definition and characterization of acute traumatic coagulopathy. PG - 2652-8 LID - 10.1097/CCM.0b013e3182281af5 [doi] AB - OBJECTIVE: To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage. DESIGN: Prospective observational cohort study. SETTING: Level 1 trauma center. PATIENTS: Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital. INTERVENTIONS: None. MEASUREMENTS: Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission. MAIN RESULTS: Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% false-negative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of 1.2, p < .001). CONCLUSIONS: In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of /=1.3 and >/=1.5) and TEG-R (>8 min) to diagnose VitK-CF deficits (/=15 or Glasgow Coma Score 0.5), and significant differences in mortality were detected for defined ROTEM((R)) thresholds [FIBTEM 7 mm (21% vs 9%, P=0.006), EXTEM MCF (maximum clot firmness) 45 mm (25.4% vs 9.4%, P=0.001)]. EXTEM MCF was independently associated with early mortality [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.9-0.99] and MCF FIBTEM with need for red blood cell transfusion (OR 0.92, 95% CI 0.87-0.98). In polytrauma patients with or without head injury (n=274), the prevalence of low fibrinogen concentrations, impaired fibrin polymerization, and reduced clot firmness was 26%, 30%, and 22%, respectively, and thus higher than the prolonged international normalized ratio (14%). Hyperfibrinolysis increased fatality rates and occurred as frequently in isolated brain injury (n=60) as in polytrauma (n=274) (5%, 95% CI 1.04-13.92 vs 7.3%, 95% CI 4.52-11.05). All patients showed elevated F1+2 and TAT and low AT levels, indicating increased thrombin formation. CONCLUSIONS: Our data enlarge the body of evidence showing that ROTEM((R)) assays are useful in trauma patients. Treatment concepts should focus on maintaining fibrin polymerization and treating hyperfibrinolysis. FAU - Tauber, H AU - Tauber H AD - Clinic of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. FAU - Innerhofer, P AU - Innerhofer P FAU - Breitkopf, R AU - Breitkopf R FAU - Westermann, I AU - Westermann I FAU - Beer, R AU - Beer R FAU - El Attal, R AU - El Attal R FAU - Strasak, A AU - Strasak A FAU - Mittermayr, M AU - Mittermayr M LA - eng PT - Journal Article DEP - 20110623 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/*diagnosis/epidemiology/therapy MH - Cohort Studies MH - Erythrocyte Transfusion MH - Female MH - Fibrinolysis MH - Humans MH - Male MH - Middle Aged MH - Platelet Count MH - Prevalence MH - Prospective Studies MH - Thrombelastography/*methods MH - Wounds, Nonpenetrating/blood/*complications EDAT- 2011/06/28 06:00 MHDA- 2011/10/14 06:00 CRDT- 2011/06/28 06:00 PHST- 2011/06/28 06:00 [entrez] PHST- 2011/06/28 06:00 [pubmed] PHST- 2011/10/14 06:00 [medline] AID - S0007-0912(17)33077-5 [pii] AID - 10.1093/bja/aer158 [doi] PST - ppublish SO - Br J Anaesth. 2011 Sep;107(3):378-87. doi: 10.1093/bja/aer158. Epub 2011 Jun 23. PMID- 21703173 OWN - NLM STAT- MEDLINE DCOM- 20120521 LR - 20250108 IS - 1600-0641 (Electronic) IS - 0168-8278 (Print) IS - 0168-8278 (Linking) VI - 56 IP - 1 DP - 2012 Jan TI - Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography. PG - 129-36 LID - 10.1016/j.jhep.2011.04.020 [doi] AB - BACKGROUND & AIMS: Patients with acute liver injury/failure (ALI/ALF) are assumed to have a bleeding diathesis on the basis of elevated INR; however, clinically significant bleeding is rare. We hypothesized that patients with ALI/ALF have normal hemostasis despite elevated INR. METHODS: Fifty-one patients with ALI/ALF were studied prospectively using thromboelastography (TEG), which measures the dynamics and physical properties of clot formation in whole blood. ALI was defined as an INR >/=1.5 in a patient with no previous liver disease, and ALF as ALI with hepatic encephalopathy. RESULTS: Thirty-seven of 51 patients (73%) had ALF and 22 patients (43%) underwent liver transplantation or died. Despite a mean INR of 3.4+/-1.7 (range 1.5-9.6), mean TEG parameters were normal, and 5 individual TEG parameters were normal in 32 (63%). Low maximum amplitude, the measure of ultimate clot strength, was confined to patients with platelet counts <126x10(9)/L. Maximum amplitude was higher in patients with ALF than ALI and correlated directly with venous ammonia concentrations and with increasing severity of liver injury assessed by elements of the systemic inflammatory response syndrome. All patients had markedly decreased procoagulant factor V and VII levels, which were proportional to decreases in anticoagulant proteins and inversely proportional to elevated factor VIII levels. CONCLUSIONS: Despite elevated INR, most patients with ALI/ALF maintain normal hemostasis by TEG, the mechanisms of which include an increase in clot strength with increasing severity of liver injury, increased factor VIII levels, and a commensurate decline in pro- and anticoagulant proteins. CI - Copyright (c) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. FAU - Stravitz, R Todd AU - Stravitz RT AD - Section of Hepatology and Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA 23298-0341, USA. rstravit@vcu.edu FAU - Lisman, Ton AU - Lisman T FAU - Luketic, Velimir A AU - Luketic VA FAU - Sterling, Richard K AU - Sterling RK FAU - Puri, Puneet AU - Puri P FAU - Fuchs, Michael AU - Fuchs M FAU - Ibrahim, Ashraf AU - Ibrahim A FAU - Lee, William M AU - Lee WM FAU - Sanyal, Arun J AU - Sanyal AJ LA - eng GR - R01 AA020758/AA/NIAAA NIH HHS/United States GR - R01 DK058369/DK/NIDDK NIH HHS/United States GR - U01 DK058369/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20110519 PL - Netherlands TA - J Hepatol JT - Journal of hepatology JID - 8503886 RN - 0 (Blood Coagulation Factors) SB - IM CIN - Med Klin Intensivmed Notfmed. 2013 Apr;108(3):181. PMID: 23729036 MH - Adult MH - Blood Coagulation Factors/metabolism MH - Chemical and Drug Induced Liver Injury/blood/complications/etiology MH - Female MH - *Hemostasis MH - Humans MH - Liver/*injuries MH - Liver Failure, Acute/*blood/complications/etiology MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - *Thrombelastography PMC - PMC4944117 MID - NIHMS557941 EDAT- 2011/06/28 06:00 MHDA- 2012/05/23 06:00 PMCR- 2016/07/14 CRDT- 2011/06/28 06:00 PHST- 2011/01/26 00:00 [received] PHST- 2011/03/29 00:00 [revised] PHST- 2011/04/06 00:00 [accepted] PHST- 2011/06/28 06:00 [entrez] PHST- 2011/06/28 06:00 [pubmed] PHST- 2012/05/23 06:00 [medline] PHST- 2016/07/14 00:00 [pmc-release] AID - S0168-8278(11)00384-9 [pii] AID - 10.1016/j.jhep.2011.04.020 [doi] PST - ppublish SO - J Hepatol. 2012 Jan;56(1):129-36. doi: 10.1016/j.jhep.2011.04.020. Epub 2011 May 19. PMID- 21655681 OWN - NLM STAT- MEDLINE DCOM- 20120109 LR - 20231120 IS - 2567-689X (Electronic) IS - 0340-6245 (Linking) VI - 106 IP - 2 DP - 2011 Aug TI - Platelet function following trauma. A multiple electrode aggregometry study. PG - 322-30 LID - 10.1160/TH11-03-0175 [doi] AB - Platelets play a central role in coagulation. Currently, information on platelet function following trauma is limited. We performed a retrospective analysis of patients admitted to the emergency room (ER) at the AUVA Trauma Centre, Salzburg, after sustaining traumatic injury. Immediately after admission to the ER, blood was drawn for blood cell counts, standard coagulation tests, and platelet function testing. Platelet function was assessed by multiplate electrode aggregometry (MEA) using adenosine diphosphate (ADPtest), collagen (COLtest) and thrombin receptor activating peptide-6 (TRAPtest) as activators. The thromboelastometric platelet component, measuring the contribution of platelets to the elasticity of the whole-blood clot, was assessed using the ROTEM device. The study included 163 patients, 79.7% were male, and the median age was 43 years. The median injury severity score was 18. Twenty patients (12.3%) died. Median platelet count was significantly lower among non-survivors than survivors (181,000/mul vs. 212,000/mul; p=0.01). Although platelet function defects were relatively minor, significant differences between survivors and non-survivors were observed in the ADPtest (94 vs. 79 U; p=0.0019), TRAPtest (136 vs. 115 U; p<0.0001), and platelet component (134 vs.103 MCEEXTEM - MCEFIBTEM; p=0.0012). Aggregometry values below the normal range for ADPtest and TRAPtest were significantly more frequent in non-survivors than in survivors (p=0.0017 and p=0.0002, respectively). Minor decreases in platelet function upon admission to the ER were a sign of coagulopathy accompanying increased mortality in patients with trauma. Further studies are warranted to confirm these results and investigate the role of platelet function in trauma haemostatic management. FAU - Solomon, Cristina AU - Solomon C AD - Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria. FAU - Traintinger, Stefan AU - Traintinger S FAU - Ziegler, Bernhard AU - Ziegler B FAU - Hanke, Alexander AU - Hanke A FAU - Rahe-Meyer, Niels AU - Rahe-Meyer N FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Schochl, Herbert AU - Schochl H LA - eng PT - Journal Article DEP - 20110609 PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Peptide Fragments) RN - 0 (thrombin receptor peptide (42-47)) RN - 61D2G4IYVH (Adenosine Diphosphate) RN - 9007-34-5 (Collagen) SB - IM MH - Adenosine Diphosphate/pharmacology MH - Adult MH - Austria/epidemiology MH - Collagen/pharmacology MH - Electrodes MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Peptide Fragments/pharmacology MH - Platelet Aggregation/drug effects MH - Platelet Count MH - Platelet Function Tests/instrumentation/*methods MH - Retrospective Studies MH - Thrombelastography MH - Trauma Centers MH - Wounds and Injuries/*blood/mortality EDAT- 2011/06/10 06:00 MHDA- 2012/01/10 06:00 CRDT- 2011/06/10 06:00 PHST- 2011/03/14 00:00 [received] PHST- 2011/05/03 00:00 [accepted] PHST- 2011/06/10 06:00 [entrez] PHST- 2011/06/10 06:00 [pubmed] PHST- 2012/01/10 06:00 [medline] AID - 11-03-0175 [pii] AID - 10.1160/TH11-03-0175 [doi] PST - ppublish SO - Thromb Haemost. 2011 Aug;106(2):322-30. doi: 10.1160/TH11-03-0175. Epub 2011 Jun 9. PMID- 21598443 OWN - NLM STAT- MEDLINE DCOM- 20110523 LR - 20110518 IS - 1613-7671 (Electronic) IS - 0043-5325 (Linking) VI - 122 Suppl 5 DP - 2010 Dec TI - Point of care diagnostic: thromboelastometry (ROTEM(R)). PG - S19-20 FAU - Haas, Thorsten AU - Haas T AD - Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. LA - eng PT - Journal Article PL - Austria TA - Wien Klin Wochenschr JT - Wiener klinische Wochenschrift JID - 21620870R SB - IM MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Elasticity MH - Equipment Design MH - Hemorrhage/etiology MH - Humans MH - *Point-of-Care Systems MH - Thrombelastography/*instrumentation/*methods MH - Thrombosis/blood/etiology MH - Wounds and Injuries/complications EDAT- 2011/05/21 06:00 MHDA- 2011/05/24 06:00 CRDT- 2011/05/21 06:00 PHST- 2011/05/21 06:00 [entrez] PHST- 2011/05/21 06:00 [pubmed] PHST- 2011/05/24 06:00 [medline] PST - ppublish SO - Wien Klin Wochenschr. 2010 Dec;122 Suppl 5:S19-20. PMID- 21549397 OWN - NLM STAT- MEDLINE DCOM- 20111013 LR - 20131121 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 142 IP - 3 DP - 2011 Sep TI - Bleeding and management of coagulopathy. PG - 662-7 LID - 10.1016/j.jtcvs.2011.03.015 [doi] AB - Bleeding after cardiac surgery remains a significant problem, increasing both length of stay and mortality, and is caused by multiple factors including dilutional changes, ongoing fibrinolysis, and platelet dysfunction. The evaluation of coagulopathy is problematic because of the long turnaround time of standard coagulation tests. Algorithms involving point of care testing, including thromboelastography and thromboelastometry, have been published; all have the potential to reduce transfusion requirements. Massive transfusion coagulopathy that occurs in trauma can also be seen in complex aortic surgery and other massive bleeding patients and should prompt consideration of a transfusion protocol involving fixed ratios of fresh frozen plasma, platelets, and red blood cells. Pharmacologic agents such as antifibrinolytics are commonly administered, but a multimodal approach to management is important. Recombinant and purified coagulation products are being studied and provide clinicians specific agents to treat targeted deficiencies. A general multi-modal approach is required and recommendations are made for the management of bleeding and coagulopathy in cardiac surgical patients. CI - Copyright (c) 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. FAU - Sniecinski, Roman M AU - Sniecinski RM AD - Department of Anesthesiology, Emory University School of Medicine, Cardiothoracic Anesthesiology and Critical Care, Emory Healthcare, Atlanta, GA 30322, USA. FAU - Levy, Jerrold H AU - Levy JH LA - eng PT - Journal Article PT - Review DEP - 20110505 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 RN - 0 (Antifibrinolytic Agents) RN - 0 (Hemostatics) RN - 0 (Recombinant Proteins) RN - 6T84R30KC1 (Tranexamic Acid) RN - 9001-32-5 (Fibrinogen) RN - 9087-70-1 (Aprotinin) RN - ENR1LLB0FP (Deamino Arginine Vasopressin) RN - U6F3787206 (Aminocaproic Acid) SB - IM MH - Algorithms MH - Aminocaproic Acid/administration & dosage MH - Antifibrinolytic Agents/administration & dosage MH - Aprotinin/therapeutic use MH - Blood Coagulation Disorders/*therapy MH - Blood Component Transfusion MH - Blood Transfusion MH - Blood Volume MH - Cardiac Surgical Procedures/*adverse effects MH - Deamino Arginine Vasopressin/pharmacology MH - Fibrinogen/analysis MH - Hemostatics/pharmacology/therapeutic use MH - Recombinant Proteins/therapeutic use MH - Thrombelastography MH - Tranexamic Acid/administration & dosage EDAT- 2011/05/10 06:00 MHDA- 2011/10/14 06:00 CRDT- 2011/05/10 06:00 PHST- 2010/05/13 00:00 [received] PHST- 2011/03/06 00:00 [revised] PHST- 2011/03/21 00:00 [accepted] PHST- 2011/05/10 06:00 [entrez] PHST- 2011/05/10 06:00 [pubmed] PHST- 2011/10/14 06:00 [medline] AID - S0022-5223(11)00336-9 [pii] AID - 10.1016/j.jtcvs.2011.03.015 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2011 Sep;142(3):662-7. doi: 10.1016/j.jtcvs.2011.03.015. Epub 2011 May 5. PMID- 21545904 OWN - NLM STAT- MEDLINE DCOM- 20110719 LR - 20110825 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 201 IP - 5 DP - 2011 May TI - Trauma induces a hypercoagulable state that is resistant to hypothermia as measured by thrombelastogram. PG - 587-91 LID - 10.1016/j.amjsurg.2011.01.012 [doi] AB - BACKGROUND: The aim of this study was to test the hypothesis that severely injured trauma patients would be hypercoagulable compared with controls measured by thromboelastography and that this hypercoagulability would persist over a broad range of temperatures. METHODS: A prospective study evaluating the effects of temperature on coagulation in trauma patients with Injury Severity Scores >/= 15 and controls was completed. Thromboelastography was performed 24 hours after admission at 4 temperatures ranging from 32 degrees C to 38 degrees C. RESULTS: Ninety-two subjects (46 patients) were analyzed. Patients had a median Injury Severity Score of 20 (interquartile range, 16-26). Time to clot formation increased (P < .001) and fibrin cross-linking decreased (P < .01) in both groups as temperature decreased. Between groups, time to clot formation, fibrin cross-linking, and clot strength were significantly different at each temperature (P < .01), with patients being more hypercoagulable. Time to clot formation and fibrin cross-linking were more affected by temperature in controls compared with patients (P < .02). CONCLUSIONS: Severely injured patients are more hypercoagulable than controls throughout a broad range of temperature. Decreasing temperature has a greater effect on coagulation in controls compared with patients. CI - Copyright (c) 2011 Elsevier Inc. All rights reserved. FAU - Differding, Jerome A AU - Differding JA AD - Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA. FAU - Underwood, Samantha J AU - Underwood SJ FAU - Van, Philbert Y AU - Van PY FAU - Khaki, Rakan A AU - Khaki RA FAU - Spoerke, Nicholas J AU - Spoerke NJ FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - *Body Temperature MH - Female MH - Follow-Up Studies MH - Humans MH - *Hypothermia, Induced MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prospective Studies MH - Thrombelastography/*methods MH - Thrombophilia/*etiology/physiopathology/prevention & control MH - Wounds and Injuries/*complications/physiopathology/therapy EDAT- 2011/05/07 06:00 MHDA- 2011/07/20 06:00 CRDT- 2011/05/07 06:00 PHST- 2010/11/09 00:00 [received] PHST- 2011/01/21 00:00 [revised] PHST- 2011/01/21 00:00 [accepted] PHST- 2011/05/07 06:00 [entrez] PHST- 2011/05/07 06:00 [pubmed] PHST- 2011/07/20 06:00 [medline] AID - S0002-9610(11)00110-3 [pii] AID - 10.1016/j.amjsurg.2011.01.012 [doi] PST - ppublish SO - Am J Surg. 2011 May;201(5):587-91. doi: 10.1016/j.amjsurg.2011.01.012. PMID- 21509749 OWN - NLM STAT- MEDLINE DCOM- 20110803 LR - 20220317 IS - 1365-2168 (Electronic) IS - 0007-1323 (Linking) VI - 98 IP - 7 DP - 2011 Jul TI - Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury. PG - 894-907 LID - 10.1002/bjs.7497 [doi] AB - BACKGROUND: Hypothermia, acidosis and coagulopathy have long been considered critical combinations after severe injury. The aim of this review was to give a clinical update on this triad in severely injured patients. METHODS: A non-systematic literature search on hypothermia, acidosis and coagulopathy after major injury was undertaken, with a focus on clinical data from the past 5 years. RESULTS: Hypothermia (less than 35 degrees C) is reported in 1.6-13.3 per cent of injured patients. The occurrence of acidosis is difficult to estimate, but usually follows other physiological disturbances. Trauma-induced coagulopathy (TIC) has both endogenous and exogenous components. Endogenous acute traumatic coagulopathy is associated with shock and hypoperfusion. Exogenous effects of dilution from fluid resuscitation and consumption through bleeding and loss of coagulation factors further add to TIC. TIC is present in 10-34 per cent of injured patients, depending on injury severity, acidosis, hypothermia and hypoperfusion. More expedient detection of coagulopathy is needed. Thromboelastography may be a useful point-of-care measurement. Management of TIC is controversial, with conflicting reports on blood component therapy in terms of both outcome and ratios of blood products to other fluids, particularly in the context of civilian trauma. CONCLUSION: The triad of hypothermia, acidosis and coagulopathy after severe trauma appears to be fairly rare but does carry a poor prognosis. Future research should define modes of early detection and targeted therapy. CI - Copyright (c) 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. FAU - Thorsen, K AU - Thorsen K AD - Department of Surgery, Stavanger University Hospital, Stavanger, Norway. FAU - Ringdal, K G AU - Ringdal KG FAU - Strand, K AU - Strand K FAU - Soreide, E AU - Soreide E FAU - Hagemo, J AU - Hagemo J FAU - Soreide, K AU - Soreide K LA - eng PT - Journal Article PT - Review DEP - 20110420 PL - England TA - Br J Surg JT - The British journal of surgery JID - 0372553 SB - IM MH - Acidosis/*etiology MH - Blood Coagulation Disorders/*etiology MH - Early Diagnosis MH - Fluid Therapy MH - Humans MH - Hypothermia/*etiology MH - Point-of-Care Systems MH - Prognosis MH - Wounds and Injuries/*complications EDAT- 2011/04/22 06:00 MHDA- 2011/08/04 06:00 CRDT- 2011/04/22 06:00 PHST- 2011/02/10 00:00 [accepted] PHST- 2011/04/22 06:00 [entrez] PHST- 2011/04/22 06:00 [pubmed] PHST- 2011/08/04 06:00 [medline] AID - 10.1002/bjs.7497 [doi] PST - ppublish SO - Br J Surg. 2011 Jul;98(7):894-907. doi: 10.1002/bjs.7497. Epub 2011 Apr 20. PMID- 21467918 OWN - NLM STAT- MEDLINE DCOM- 20111223 LR - 20110707 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 22 IP - 5 DP - 2011 Jul TI - The prognostic value of thrombelastography in identifying neurosurgical patients with worse prognosis. PG - 416-9 LID - 10.1097/MBC.0b013e3283464f53 [doi] AB - Coagulopathy in patients with intracranial haemorrhage or traumatic brain injury (TBI) is associated with clinical deterioration and worse outcome. Whole blood viscoelastic haemostatic assays, like thrombelastography (TEG), might aid conventional coagulation assays in identification of patients with worse prognosis. We performed a review of patients (totalling 78 patients) with primary acute intracranial haemorrhage or isolated TBI admitted to a neurointensive care unit (NICU) for more than 24 h during a period of 9 months, who had TEG analysis performed at admission. Primary outcome was all-cause 30-day mortality, whereas decline in Glasgow Coma Scale (GCS) score at 24 h after admission or death due to cerebral incarceration were secondary outcomes. Patients were defined as hypocoaguable if TEG reaction time was more than 8 min, angle less than 55 degrees and/or maximal amplitude less than 51 mm. Patients were defined hypocoaguable according to conventional coagulation assays if international normalized ratio was more than 1.3, platelet counts less than 100x10/l and/or activated partial thromboplastine time more than 35 s. Eight patients were hypocoaguable by TEG on admission to NICU and had higher 30-day mortality (63% vs. 16%, P=0.008), more often declined in GCS (57% vs. 16%, P=0.02) and expired due to cerebral incarceration (50% vs. 6%, P=0.02). Hypocoagulability by TEG, lower admission GCS and subarachnoid haemorrhage were independently associated with higher 30-day mortality [TEG: odds ratio (OR) 14.8 (2.2-100.1), P=0.006; GCS: OR 1.3 (1.1-1.5), P=0.006; subarachnoid haemorrhage: OR: 5.3 (1.3-22.3), P=0.02]. Only two patients were hypocoaguable by both conventional coagulation assays and TEG. The current data indicate that hypocoagulability by TEG at admission to NICU predicts worse prognosis. Low concordance with conventional coagulation assays indicates that TEG might be valuable in identifying patients with clinically relevant coagulopathy. FAU - Windelov, Nis A AU - Windelov NA AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, nis.windelov@gmail.com FAU - Welling, Karen-Lise AU - Welling KL FAU - Ostrowski, Sisse R AU - Ostrowski SR FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 SB - IM MH - Blood Coagulation Disorders MH - Brain Injuries/*mortality MH - Humans MH - Intracranial Hemorrhages/*mortality MH - *Predictive Value of Tests MH - Prognosis MH - Survival Rate MH - *Thrombelastography MH - Thrombophilia/diagnosis/mortality MH - Treatment Outcome EDAT- 2011/04/07 06:00 MHDA- 2011/12/24 06:00 CRDT- 2011/04/07 06:00 PHST- 2011/04/07 06:00 [entrez] PHST- 2011/04/07 06:00 [pubmed] PHST- 2011/12/24 06:00 [medline] AID - 10.1097/MBC.0b013e3283464f53 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2011 Jul;22(5):416-9. doi: 10.1097/MBC.0b013e3283464f53. PMID- 21441889 OWN - NLM STAT- MEDLINE DCOM- 20110714 LR - 20171116 IS - 1827-1596 (Electronic) IS - 0375-9393 (Linking) VI - 77 IP - 3 DP - 2011 Mar TI - Blood transfusion in trauma patients: unresolved questions. PG - 349-59 AB - Massive transfusion is an essential part of resuscitation efforts in acute trauma patients. The goal is to quickly correct trauma-induced coagulopathy and replace red blood cell (RBC) mass with the minimal number as well as the appropriate choice of blood components to minimize the possible adverse effects of transfusions. Early trauma induced coagulopathy (ETIC) is present in about 20% of patients upon hospital admission and predicts for decreased survival. The mechanism of ETIC is still being elucidated; however, most theories of ETIC's pathophysiology justify the early use of plasma. Most massive transfusion protocol (MTP) ratios deliver blood products in a ratio of 1:1:1 for RBCs:plasma:platelets, which is supported by the majority of the literature demonstrating improved patient survival with higher ratios (>1 plasma and platelet for every 2 RBCs transfused). Indeed, formula-driven MTPs allow trauma services to react quickly to ETIC and provide coagulation factors and platelets in these ratios without having to wait for the results of coagulation assays while the patient's coagulopathy worsens. New MTPs are being created which are adjusted according to an individual's coagulation laboratory values based on point-of-care laboratory tests, such as thromboelastography. When creating an MTP, product wastage due to inappropriate activation and improper product storage should be considered and closely monitored. Another area of discussion regarding transfusion in trauma includes the potential association of prolonged storage of RBCs and adverse outcomes, which has yet to be confirmed. Significant progress has been made in the transfusion management of trauma patients, but further studies are required to optimize patient care and outcomes. FAU - Cushing, M AU - Cushing M AD - Transfusion Medicine and Cellular Therapy, Department of Pathology and Laboratory, Medicine, Weill Cornell Medical College, New York, New York, USA. mec2013@med.cornell.edu FAU - Shaz, B H AU - Shaz BH LA - eng PT - Journal Article PT - Review PL - Italy TA - Minerva Anestesiol JT - Minerva anestesiologica JID - 0375272 SB - IM MH - Blood Coagulation Disorders/etiology/therapy MH - Blood Component Transfusion/methods MH - Blood Preservation MH - *Blood Transfusion MH - Erythrocyte Count MH - Humans MH - Platelet Count MH - Resuscitation MH - Transfusion Reaction MH - Wounds and Injuries/blood/*therapy EDAT- 2011/03/29 06:00 MHDA- 2011/07/16 06:00 CRDT- 2011/03/29 06:00 PHST- 2011/03/29 06:00 [entrez] PHST- 2011/03/29 06:00 [pubmed] PHST- 2011/07/16 06:00 [medline] AID - R02116419 [pii] PST - ppublish SO - Minerva Anestesiol. 2011 Mar;77(3):349-59. PMID- 21421259 OWN - NLM STAT- MEDLINE DCOM- 20111102 LR - 20211020 IS - 1879-2472 (Electronic) IS - 0049-3848 (Print) IS - 0049-3848 (Linking) VI - 128 IP - 1 DP - 2011 Jul TI - Decline in platelet microparticles contributes to reduced hemostatic potential of stored plasma. PG - 35-41 LID - 10.1016/j.thromres.2011.02.011 [doi] AB - INTRODUCTION: In an effort to administer life-saving transfusions quickly, some trauma centers maintain thawed plasma (TP). According to AABB, TP is approved for transfusion for up to five days when stored at 1-6 degrees C. However, the alterations in microparticles (MP) contained in the plasma, which are an integral component of plasma's hemostatic capacity, are not well characterized. We report on MP changes in TP between its initial thaw (FFP-0) and five days (FFP-5) of storage. MATERIALS AND METHODS: FFP units (n=30) were thawed at 37 degrees C and kept refrigerated for five days. Phenotypes of residual cells, which include platelets, erythrocytes, leukocytes, monocytes, endothelial cells, and MP counterparts of each cell type, were analyzed by flow cytometry. Functional assays were used for MP procoagulant activity, plasma thrombin generation, and clotting properties (thromboelastography). RESULTS: In FFP-0 the majority (94%) of residual cells were platelets, along with significant levels of platelet MPs (4408 x 10(3)/L). FFP-5 showed a decline in MP count by 50% (p<0.0001), and procoagulant activity by 29% (p<0.0001). FFP-5 exhibited only 54% (p<0.0001) of the potential for thrombin generation as FFP-0, while thromboelastography indicated a slower clotting response (p<0.0001) and a longer delay in reaching maximum clot (p<0.01). Removal of MP by filtration resulted in reduced thrombin generation, while the MP replacement restored it. CONCLUSIONS: Decline in MP with storage contributes to FFP-5's reduced ability to provide the hemostatic potential exhibited by FFP-0, suggesting the presence of platelet MPs in freshly TP may be beneficial and protective in the initial treatment of hemorrhage. CI - Copyright (c) 2011 Elsevier Ltd. All rights reserved. FAU - Matijevic, Nena AU - Matijevic N AD - Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. nevenka.matijevic-aleksic@uth.tmc.edu FAU - Wang, Yao-Wei W AU - Wang YW FAU - Kostousov, Vadim AU - Kostousov V FAU - Wade, Charles E AU - Wade CE FAU - Vijayan, K Vinod AU - Vijayan KV FAU - Holcomb, John B AU - Holcomb JB LA - eng GR - P50 GM038529/GM/NIGMS NIH HHS/United States GR - P50 GM038529-19/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20110321 PL - United States TA - Thromb Res JT - Thrombosis research JID - 0326377 SB - IM MH - Adolescent MH - Adult MH - Aged MH - *Blood Platelets MH - *Blood Preservation MH - *Cell-Derived Microparticles MH - *Cryopreservation MH - Hemostasis MH - Humans MH - Middle Aged MH - Partial Thromboplastin Time MH - *Plasma MH - Thrombelastography MH - Young Adult PMC - PMC3109134 MID - NIHMS290102 COIS- Conflict of interest statement None. EDAT- 2011/03/23 06:00 MHDA- 2011/11/04 06:00 PMCR- 2011/07/01 CRDT- 2011/03/23 06:00 PHST- 2010/12/09 00:00 [received] PHST- 2011/02/14 00:00 [revised] PHST- 2011/02/16 00:00 [accepted] PHST- 2011/03/23 06:00 [entrez] PHST- 2011/03/23 06:00 [pubmed] PHST- 2011/11/04 06:00 [medline] PHST- 2011/07/01 00:00 [pmc-release] AID - S0049-3848(11)00078-8 [pii] AID - 10.1016/j.thromres.2011.02.011 [doi] PST - ppublish SO - Thromb Res. 2011 Jul;128(1):35-41. doi: 10.1016/j.thromres.2011.02.011. Epub 2011 Mar 21. PMID- 21375741 OWN - NLM STAT- MEDLINE DCOM- 20111207 LR - 20220330 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 15 IP - 2 DP - 2011 TI - Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. PG - R83 LID - 10.1186/cc10078 [doi] AB - INTRODUCTION: Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy. METHODS: This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving >/= 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission >/= 2 mmol/L, injury severity score (ISS) >/= 16, abbreviated injury scale for thorax and/or abdomen and/or extremity >/= 3, and for head/neck < 5. RESULTS: For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 +/- 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 +/- 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69). CONCLUSIONS: TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products. FAU - Schochl, Herbert AU - Schochl H AD - Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Donaueschingenstrasse 13, A-1200 Vienna, Austria. FAU - Nienaber, Ulrike AU - Nienaber U FAU - Maegele, Marc AU - Maegele M FAU - Hochleitner, Gerald AU - Hochleitner G FAU - Primavesi, Florian AU - Primavesi F FAU - Steitz, Beatrice AU - Steitz B FAU - Arndt, Christian AU - Arndt C FAU - Hanke, Alexander AU - Hanke A FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Solomon, Cristina AU - Solomon C LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110304 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Crit Care. 2011;15(3):433; author reply 433. doi: 10.1186/cc10224. PMID: 21672283 MH - Adult MH - Blood Transfusion/*methods MH - Female MH - Fibrinogen/*metabolism MH - Humans MH - Male MH - Middle Aged MH - *Plasma MH - Retrospective Studies MH - Thrombelastography/*methods MH - Treatment Outcome MH - Wounds and Injuries/*therapy MH - Young Adult PMC - PMC3219338 EDAT- 2011/03/08 06:00 MHDA- 2011/12/13 00:00 PMCR- 2011/03/04 CRDT- 2011/03/08 06:00 PHST- 2010/07/27 00:00 [received] PHST- 2010/12/11 00:00 [revised] PHST- 2011/03/04 00:00 [accepted] PHST- 2011/03/08 06:00 [entrez] PHST- 2011/03/08 06:00 [pubmed] PHST- 2011/12/13 00:00 [medline] PHST- 2011/03/04 00:00 [pmc-release] AID - cc10078 [pii] AID - 10.1186/cc10078 [doi] PST - ppublish SO - Crit Care. 2011;15(2):R83. doi: 10.1186/cc10078. Epub 2011 Mar 4. PMID- 21369792 OWN - NLM STAT- MEDLINE DCOM- 20110727 LR - 20220408 IS - 1556-0961 (Electronic) IS - 1541-6933 (Linking) VI - 14 IP - 2 DP - 2011 Apr TI - Comparison of hypertonic saline and mannitol on whole blood coagulation in vitro assessed by thromboelastometry. PG - 238-43 LID - 10.1007/s12028-010-9475-6 [doi] AB - BACKGROUND: Hypertonic saline (HS) is an alternative to mannitol for decreasing intracranial pressure in traumatic brain injury and before craniotomy. Both HS and mannitol may interfere with blood coagulation but their influence on coagulation has not been compared in controlled situations. Therefore, we evaluated different strengths of HS and 15% mannitol on blood coagulation in vitro. METHODS: Citrated fresh whole blood, withdrawn from 10 volunteers, was diluted with 0.9%, 2.5%, or 3.5% HS or 15% mannitol to make 10 vol.% and 20 vol.% hemodilution in vitro. The diluted blood and undiluted control samples were analyzed with thromboelastometry (ROTEM((R))) using two activators, tissue thromboplastin without (ExTEM((R))) or with cytochalasin (FibTEM((R))). RESULTS: In the FibTEM((R)) analysis, maximum clot firmness (MCF) was stronger in the 2.5% HS group than in the mannitol group after both dilutions (P < 0.05). In the ExTEM((R)) analysis, clot formation time (CFT) was more delayed in the mannitol group than in the 0.9%, 2.5%, or 3.5% HS groups in 20 vol.% hemodilution (P < 0.05). MCF was weaker in the mannitol group than in the other groups after 20 vol.% dilution (P < 0.05). MCF was also weaker in the 3.5% than in the 0.9% saline group after 20 vol.% dilution (P < 0.05). CONCLUSIONS: Blood coagulation is disturbed more by 15% mannitol than by equiosmolar 2.5% saline. This disturbance seems to be attributed to overall clot formation and strength but also to pure fibrin clot firmness. This saline solution might be more favorable than mannitol before craniotomy in patients with a high risk of bleeding. FAU - Luostarinen, Teemu AU - Luostarinen T AD - Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Toolo Hospital, PO Box 266, 00029, Helsinki, Finland. teemu.luostarinen@hus.fi FAU - Niiya, Tomohisa AU - Niiya T FAU - Schramko, Alexey AU - Schramko A FAU - Rosenberg, Per AU - Rosenberg P FAU - Niemi, Tomi AU - Niemi T LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 RN - 0 (Diuretics, Osmotic) RN - 0 (Saline Solution, Hypertonic) RN - 3OWL53L36A (Mannitol) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Brain Injuries/drug therapy/surgery MH - Craniotomy MH - Critical Care MH - Diuretics, Osmotic/*pharmacology MH - Female MH - Humans MH - In Vitro Techniques MH - Male MH - Mannitol/*pharmacology MH - Saline Solution, Hypertonic/*pharmacology MH - Thrombelastography/*drug effects MH - Young Adult EDAT- 2011/03/04 06:00 MHDA- 2011/07/28 06:00 CRDT- 2011/03/04 06:00 PHST- 2011/03/04 06:00 [entrez] PHST- 2011/03/04 06:00 [pubmed] PHST- 2011/07/28 06:00 [medline] AID - 10.1007/s12028-010-9475-6 [doi] PST - ppublish SO - Neurocrit Care. 2011 Apr;14(2):238-43. doi: 10.1007/s12028-010-9475-6. PMID- 21318436 OWN - NLM STAT- MEDLINE DCOM- 20110801 LR - 20250626 IS - 1432-1238 (Electronic) IS - 0342-4642 (Linking) VI - 37 IP - 4 DP - 2011 Apr TI - Coagulation management in multiple trauma: a systematic review. PG - 572-82 LID - 10.1007/s00134-011-2139-y [doi] AB - PURPOSE: The management of trauma patients suffering from active bleeding has improved with a better understanding of trauma-induced coagulopathy. The aim of this manuscript is to give recommendations for coagulation management. METHODS: A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review. CONCLUSIONS: The "coagulopathy of trauma" is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of deranged coagulation should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2-1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For patients suffering from active bleeding, permissive hypotension (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of bleeding. This option is contraindicated in injuries of the central nervous system and in patients with coronary heart disease, or with known hypertension. Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively bleeding patients, pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%. FAU - Lier, Heiko AU - Lier H AD - Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany. heiko.lier@uk-koeln.de FAU - Bottiger, Bernd W AU - Bottiger BW FAU - Hinkelbein, Jochen AU - Hinkelbein J FAU - Krep, Henning AU - Krep H FAU - Bernhard, Michael AU - Bernhard M LA - eng PT - Journal Article PT - Systematic Review DEP - 20110212 PL - United States TA - Intensive Care Med JT - Intensive care medicine JID - 7704851 SB - IM MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/*drug therapy/surgery MH - Blood Component Transfusion MH - Humans MH - Multiple Trauma/*blood/therapy MH - Plasma MH - Thrombelastography EDAT- 2011/02/15 06:00 MHDA- 2011/08/02 06:00 CRDT- 2011/02/15 06:00 PHST- 2010/08/24 00:00 [received] PHST- 2011/01/21 00:00 [accepted] PHST- 2011/02/15 06:00 [entrez] PHST- 2011/02/15 06:00 [pubmed] PHST- 2011/08/02 06:00 [medline] AID - 10.1007/s00134-011-2139-y [doi] PST - ppublish SO - Intensive Care Med. 2011 Apr;37(4):572-82. doi: 10.1007/s00134-011-2139-y. Epub 2011 Feb 12. PMID- 21308350 OWN - NLM STAT- MEDLINE DCOM- 20111014 LR - 20131121 IS - 1791-244X (Electronic) IS - 1107-3756 (Linking) VI - 27 IP - 4 DP - 2011 Apr TI - Diverse inhibition of plasminogen activator inhibitor type 1 by theaflavins of black tea. PG - 525-9 LID - 10.3892/ijmm.2011.615 [doi] AB - Fruits, vegetables, spices and a variety of teas are suggested for the prevention of many diseases. They encompass active, non-nutritional ingredients called nutraceuticals which are defined as food products that provide health benefits. Many nutraceuticals have been tested to identify inhibitors of plasminogen activator inhibitor (PAI-1). PAI-1 is the major and fast acting physiological inhibitor of fibrinolysis. However, preclinical studies of PAI-1 inhibitors have revealed an additional role of PAI-1 in the pathogenesis of vascular remodeling, renal injury, diabetes, obesity, Alzheimer's disease and cancer. Thus PAI-1 is a potential therapeutic target in some of these diseases. Our previous study revealed that a black tea extract (containing mostly theaflavins) inhibits PAI-1. In this study we report results for four pure (>98%) theaflavins. Inactivation of PAI-1 was tested by clot formation and by its lysis using thromboelastometry and measurements of human plasma turbidity. Among four tested theaflavins, theaflavin-3'-gallate was the most potent in PAI-1 inhibition trailed by theaflavin-3,3'-digallate, while the other two i.e., theaflavin and theaflavin-3-gallate did not show inhibitory activity. FAU - Jankun, Jerzy AU - Jankun J AD - Urology Research Center, Department of Urology, The University of Toledo-Health Science Campus, 3000 Arlington Ave., Toledo, OH 43614, USA. jerzy.jankun@utoledo.edu FAU - Skotnicka, Magdalena AU - Skotnicka M FAU - Lysiak-Szydlowska, Wieslawa AU - Lysiak-Szydlowska W FAU - Al-Senaidy, Abdulrahman AU - Al-Senaidy A FAU - Skrzypczak-Jankun, Ewa AU - Skrzypczak-Jankun E LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110209 PL - Greece TA - Int J Mol Med JT - International journal of molecular medicine JID - 9810955 RN - 0 (Antioxidants) RN - 0 (Biflavonoids) RN - 0 (Plasminogen Activator Inhibitor 1) RN - 0 (Recombinant Proteins) RN - 0 (Tea) RN - 1IA46M0D13 (theaflavin) RN - 8R1V1STN48 (Catechin) SB - IM MH - Antioxidants/chemistry/metabolism/*pharmacology MH - Biflavonoids/chemistry/metabolism/*pharmacology MH - Catechin/chemistry/metabolism/*pharmacology MH - Fibrinolysis/drug effects MH - Humans MH - Plasminogen Activator Inhibitor 1/*metabolism MH - Protein Binding/drug effects MH - Recombinant Proteins/metabolism MH - *Tea/chemistry MH - Thrombosis/drug therapy EDAT- 2011/02/11 06:00 MHDA- 2011/10/15 06:00 CRDT- 2011/02/11 06:00 PHST- 2010/10/25 00:00 [received] PHST- 2010/12/29 00:00 [accepted] PHST- 2011/02/11 06:00 [entrez] PHST- 2011/02/11 06:00 [pubmed] PHST- 2011/10/15 06:00 [medline] AID - 10.3892/ijmm.2011.615 [doi] PST - ppublish SO - Int J Mol Med. 2011 Apr;27(4):525-9. doi: 10.3892/ijmm.2011.615. Epub 2011 Feb 9. PMID- 21217486 OWN - NLM STAT- MEDLINE DCOM- 20110204 LR - 20250529 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 70 IP - 1 DP - 2011 Jan TI - Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2. PG - 90-5; discussion 95-6 LID - 10.1097/TA.0b013e318202e486 [doi] AB - BACKGROUND: Damage control resuscitation targets acute traumatic coagulopathy with the early administration of high-dose fresh frozen plasma (FFP). FFP is administered empirically and as a ratio with the number of packed red blood cells (PRBC). There is controversy over the optimal FFP:PRBC ratio with respect to outcomes, and their hemostatic effects have not been studied. We report preliminary findings on the effects of different FFP:PRBC ratios on coagulation. METHODS: This is a prospective observational cohort study of trauma patients requiring >4 U of PRBCs. Blood was drawn before and after each 4-U PRBC interval for prothrombin time and analysis by rotational thromboelastometry. Interval change in coagulation parameters were compared with the FFP:PRBC ratio received during each interval. RESULTS: Sixty 4-U PRBC intervals from 50 patients were available for analysis. All measures of coagulation deteriorated with low FFP:PRBC ratios (<1:2). Maximal hemostatic effect was observed in the 1:2 to 3:4 group: 12% decrease in prothrombin time (p=0.006), 56% decrease in clotting time (p=0.047), and 38% increase in maximum clot firmness (p=0.024). Transfusion with >/=1:1 ratio did not confer any additional improvement. There was a marked variability in response to FFP, and hemostatic function deteriorated in some patients exposed to 1:1 ratios. The beneficial effects of plasma were confined to patients with coagulopathy. CONCLUSIONS: Interim results from this prospective study suggest that FFP:PRBC ratios of >/=1:1 do not confer any additional advantage over ratios of 1:2 to 3:4. Hemostatic benefits of plasma therapy are limited to patients with coagulopathy. FAU - Davenport, Ross AU - Davenport R AD - Trauma Clinical Academic Unit, Blizard Institute of Cell and Molecular Science, the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. FAU - Curry, Nicola AU - Curry N FAU - Manson, Joanna AU - Manson J FAU - De'Ath, Henry AU - De'Ath H FAU - Coates, Amy AU - Coates A FAU - Rourke, Claire AU - Rourke C FAU - Pearse, Rupert AU - Pearse R FAU - Stanworth, Simon AU - Stanworth S FAU - Brohi, Karim AU - Brohi K LA - eng GR - CS/08/08/17/DH_/Department of Health/United Kingdom GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adult MH - Blood Coagulation/physiology MH - Blood Transfusion/methods/standards MH - *Erythrocyte Count MH - Female MH - Hemorrhage/therapy MH - Hemostasis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Plasma/*physiology MH - Prothrombin Time MH - Thrombelastography MH - Treatment Outcome MH - Wounds and Injuries/*therapy EDAT- 2011/01/11 06:00 MHDA- 2011/02/05 06:00 CRDT- 2011/01/11 06:00 PHST- 2011/01/11 06:00 [entrez] PHST- 2011/01/11 06:00 [pubmed] PHST- 2011/02/05 06:00 [medline] AID - 00005373-201101000-00013 [pii] AID - 10.1097/TA.0b013e318202e486 [doi] PST - ppublish SO - J Trauma. 2011 Jan;70(1):90-5; discussion 95-6. doi: 10.1097/TA.0b013e318202e486. PMID- 21217484 OWN - NLM STAT- MEDLINE DCOM- 20110204 LR - 20250529 IS - 1529-8809 (Electronic) IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 70 IP - 1 DP - 2011 Jan TI - Multiple levels of degradation diminish hemostatic potential of thawed plasma. PG - 71-9; discussion 79-80 LID - 10.1097/TA.0b013e318207abec [doi] AB - BACKGROUND: Severe bleeding after injury requires transfusion of blood products, including fresh frozen plasma (FFP). Many centers are keeping thawed plasma (TP) ready for massively transfused patients. According to the American Association of Blood Banks Standards, TP is approved for transfusion up to 5 days after thawing, when stored at 1 degrees C to 6 degrees C. However, there are no clinical data analyzing the effects of the approved 5-day storage on plasma. We hypothesize that the hemostatic potential (HP) of freshly thawed (FFP-0) was superior to plasma stored for 5 days (FFP-5). METHODS: FFP from 30 single donors were thawed at 37 degrees C and kept at 1 degrees C to 6 degrees C for 5 days. HP was evaluated at day 0 and 5 by measuring kinetics of thrombin generation (TG), kinetics of clot formation by thromboelastography, clotting factors and inhibitors, and cell-derived microparticles (MPs) by flow cytometry. RESULTS: When comparing FFP-5 to FFP-0, FFP-5 exhibited only 40% of the potential of FFP-0 for TG (6.2 nM/min vs. 14.3 nM/min, p<0.0001), a slower clotting response via thromboelastography (reaction time: 4.3 minutes vs. 3.2 minutes, p<0.0001) and a longer delay in reaching maximum thrombus generation (5.7 minutes vs. 4.6 minutes, p<0.01). Diminished HP was accompanied by a significant decline in multiple coagulation proteins, including FV, VII, VIII, von Willebrand factor, and free Protein S, by up to 30%, and a decrease of 50% in MP counts. CONCLUSION: The HP and clot forming ability of TP significantly declined with storage. Hence, freshly TP may have a greater ability to restore hemostasis and correct coagulopathy compared with FFP-5. The clinical consequences for transfused patients deserve further exploration. FAU - Matijevic, Nena AU - Matijevic N AD - Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center-Houston, Houston, Texas 77030, USA. nevenka.matijevic-aleksic@uth.tmc.edu FAU - Kostousov, Vadim AU - Kostousov V FAU - Wang, Yao-Wei W AU - Wang YW FAU - Wade, Charles E AU - Wade CE FAU - Wang, Weiwei AU - Wang W FAU - Letourneau, Phillip AU - Letourneau P FAU - Hartwell, Elizabeth AU - Hartwell E FAU - Kozar, Rosemary AU - Kozar R FAU - Ko, Tien AU - Ko T FAU - Holcomb, John B AU - Holcomb JB LA - eng GR - P50 GM038529/GM/NIGMS NIH HHS/United States GR - T32 GM008792/GM/NIGMS NIH HHS/United States GR - P50 GM38529/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Blood Coagulation Factors) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Blood Coagulation/physiology MH - Blood Coagulation Factors/analysis MH - Female MH - Flow Cytometry MH - Hemorrhage/blood/therapy MH - Hemostasis/*physiology MH - Humans MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Plasma/*physiology MH - Prothrombin Time MH - Thrombelastography MH - Time Factors MH - Young Adult PMC - PMC3126652 MID - NIHMS299991 EDAT- 2011/01/11 06:00 MHDA- 2011/02/05 06:00 PMCR- 2012/01/01 CRDT- 2011/01/11 06:00 PHST- 2011/01/11 06:00 [entrez] PHST- 2011/01/11 06:00 [pubmed] PHST- 2011/02/05 06:00 [medline] PHST- 2012/01/01 00:00 [pmc-release] AID - 00005373-201101000-00011 [pii] AID - 10.1097/TA.0b013e318207abec [doi] PST - ppublish SO - J Trauma. 2011 Jan;70(1):71-9; discussion 79-80. doi: 10.1097/TA.0b013e318207abec. PMID- 21157299 OWN - NLM STAT- MEDLINE DCOM- 20110601 LR - 20101223 IS - 1473-5733 (Electronic) IS - 0957-5235 (Linking) VI - 22 IP - 1 DP - 2011 Jan TI - Carbon monoxide releasing molecule-2 attenuates the anticoagulant and amplifies the hypofibrinolytic effects of hypothermia in human plasma in vitro. PG - 67-72 LID - 10.1097/MBC.0b013e3283423534 [doi] AB - Hypothermia is known to contribute to coagulopathy in trauma and other major surgical procedures. Although the effects of hypothermia on coagulation have been characterized, the effects on fibrinolysis remained to be elucidated. Thus, our goals were to discern the effects of hypothermia on fibrinolysis in human plasma, and secondarily determine if a new procoagulant/antifibrinolytic molecule, carbon monoxide releasing molecule (tricarbonyldichlororuthenium (II) dimer; CORM-2) would modify thrombus growth/disintegration under hypothermic conditions. Normal plasma was exposed to 0 or 100 mumol/l CORM-2, with coagulation activated by tissue factor and fibrinolysis initiated with 100 U/ml tissue-type plasminogen activator. Plasma samples were exposed to 37 degrees , 35 degrees , 33 degrees , 31 degrees , 29 degrees , or 27 degrees C (n = 6 per temperature/CORM-2 concentration). Thrombus growth/disintegration kinetics were monitored with thrombelastography until clot lysis time occurred. Hypothermia significantly prolonged the onset and decreased the velocity of clot growth in plasma without decreasing clot strength. Although hypothermia did not affect the time to onset of fibrinolysis, it did significantly decrease the velocity of lysis. The addition of CORM-2 significantly increased the velocity of clot growth and clot strength at all temperatures tested compared with unexposed plasma. Further, CORM-2 addition significantly prolonged the onset of fibrinolysis and diminished the velocity of lysis. Hypothermia resulted in slower growing, slower lysing thrombi in normal plasma. CORM-2 enhanced coagulation and markedly attenuated fibrinolysis at all temperatures tested. Further investigation is warranted to determine if CORM-2 administration can improve hemostasis in preclinical models of hypothermia and trauma. FAU - Nielsen, Vance G AU - Nielsen VG AD - Department of Anesthesiology, Drexel University College of Medicine, Broad & Vine Streets, Philadelphia, PA 19102, USA. vance.nielsen@drexelmed.edu FAU - George, Shelley J AU - George SJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Coagulants) RN - 0 (Organometallic Compounds) RN - 0 (tricarbonyldichlororuthenium (II) dimer) SB - IM MH - Blood Coagulation/*drug effects MH - Coagulants/*pharmacology MH - Fibrinolysis/drug effects MH - Humans MH - Hypothermia/*blood MH - Organometallic Compounds/*pharmacology MH - Thrombelastography/drug effects EDAT- 2010/12/16 06:00 MHDA- 2011/06/02 06:00 CRDT- 2010/12/16 06:00 PHST- 2010/12/16 06:00 [entrez] PHST- 2010/12/16 06:00 [pubmed] PHST- 2011/06/02 06:00 [medline] AID - 10.1097/MBC.0b013e3283423534 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2011 Jan;22(1):67-72. doi: 10.1097/MBC.0b013e3283423534. PMID- 21150521 OWN - NLM STAT- MEDLINE DCOM- 20110201 LR - 20101214 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 69 IP - 6 DP - 2010 Dec TI - The role of rotation thromboelastometry in early prediction of massive transfusion. PG - 1403-8; discussion 1408-9 LID - 10.1097/TA.0b013e3181faaa25 [doi] AB - INTRODUCTION: Early prediction of massive transfusion (MT) is critical in the management of severely injured trauma patients. Variables available early after injury including physiologic, laboratory, and rotation thromboelastometric (ROTEM) parameters were evaluated as predictors for the need of MT. METHODS: After Institutional Review Board approval, we retrospectively reviewed a cohort of severely injured trauma patients (Injury Severity Score >/= 16) admitted to a Level I trauma center with available ROTEM measurements on hospital admission during a 1-year study period. Patients with isolated head injury (Abbreviated Injury Scale head >/= 3 and Abbreviated Injury Scale chest, abdomen, and extremity < 3) and patients with a penetrating mechanism of injury were excluded. Patients who received a MT (>/= 10 units packed red blood cell within 24 hours of admission) were compared with patients who did not. Variables independently associated with MT were identified using stepwise logistic regression. RESULTS: A total of 53 patients met inclusion criteria. Of these, 18 patients (34.0%) received a MT and 35 patients (66.0%) did not. Massively transfused patients had significantly lower baseline hemoglobin values (7.9 g/dL +/- 0.4 g/dL vs. 11.4 g/dL +/- 0.4 g/dL; p < 0.001) and a trend toward higher lactate (4.8 mmol/L +/- 0.8 mmol/L vs. 3.0 mmol/L +/- 0.3 mmol/L; p = 0.056) and base deficit values (5.9 mmol/L +/- 1.1 mmol/L vs. 3.6 mmol/L +/- 0.6 mmol/L; p = 0.052). Mean international normalized ratio (1.46 +/- 0.07 vs. 1.22 +/- 0.05; p = 0.001) and partial thromboplastin times (42.4 seconds +/- 5.0 seconds vs. 29.7 seconds +/- 1.8 seconds; p < 0.001) were significantly higher in MT patients. Patients receiving a MT had significantly altered ROTEM values on admission compared with non-MT patients. An increase in the clot formation time (471.3 seconds +/- 169.9 seconds vs. 178.1 seconds +/- 19.9 seconds; p = 0.001), a shortening of the maximum clot firmness (37.5 mm +/- 2.9 mm vs. 50.7 mm +/- 1.4 mm; p < 0.001), and a shortening of the clot amplitude at all time points (10/20/30 minutes) were observed in massively transfused trauma patients. Variables independently associated with MT included a hemoglobin level 10 units/6 hours (n = 32), moderate (Mod) 5 to 9 units/6 hours (n = 15), and minimal (Min) <5 units/6 hours (n = 14). r-TEG was performed by adding tissue factor to uncitrated whole blood. r-TEG estimated percent lysis was categorized as PF when >15% estimated percent lysis was detected. Coagulopathy was defined as r-TEG clot strength = G < 5.3 dynes/cm. Logistic regression was used to define independent predictors of PF. RESULTS: A total of 34% of injured patients requiring MT had PF, which was associated with lower emergency department systolic blood pressure, core temperature, and greater metabolic acidosis (analysis of variance, P < 0.0001). The risk of death correlated significantly with PF (P = 0.026). PF occurred early (median, 58 minutes; interquartile range, 1.2-95.9 minutes); every 1 unit drop in G increased the risk of PF by 30%, and death by over 10%. CONCLUSIONS: Our results confirm the existence of PF in severely injured patients. It occurs early (<1 hour), and is associated with MT requirements, coagulopathy, and hemorrhage-related death. These data warrant renewed emphasis on the early diagnosis and treatment of fibrinolysis in this cohort. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery, Penn State Hershey Medical Center, College of Medicine, Hershey, PA 17033, USA. jkashuk@hmc.psu.edu. FAU - Moore, Ernest E AU - Moore EE FAU - Sawyer, Michael AU - Sawyer M FAU - Wohlauer, Max AU - Wohlauer M FAU - Pezold, Michael AU - Pezold M FAU - Barnett, Carlton AU - Barnett C FAU - Biffl, Walter L AU - Biffl WL FAU - Burlew, Clay C AU - Burlew CC FAU - Johnson, Jeffrey L AU - Johnson JL FAU - Sauaia, Angela AU - Sauaia A LA - eng PT - Journal Article PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Acute Disease MH - Adult MH - Blood Coagulation Disorders/diagnosis/*etiology/*physiopathology MH - Blood Transfusion/*statistics & numerical data MH - Chi-Square Distribution MH - Female MH - Fibrinolysis/*physiology MH - Humans MH - Injury Severity Score MH - Logistic Models MH - Male MH - Point-of-Care Systems MH - Prospective Studies MH - Statistics, Nonparametric MH - Thrombelastography MH - Time Factors MH - Wounds and Injuries/*complications/therapy EDAT- 2010/08/27 06:00 MHDA- 2010/09/30 06:00 CRDT- 2010/08/27 06:00 PHST- 2010/08/27 06:00 [entrez] PHST- 2010/08/27 06:00 [pubmed] PHST- 2010/09/30 06:00 [medline] AID - 00000658-201009000-00003 [pii] AID - 10.1097/SLA.0b013e3181f09191 [doi] PST - ppublish SO - Ann Surg. 2010 Sep;252(3):434-42; discussion 443-4. doi: 10.1097/SLA.0b013e3181f09191. PMID- 20719351 OWN - NLM STAT- MEDLINE DCOM- 20101007 LR - 20100917 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 148 IP - 4 DP - 2010 Oct TI - Progressive postinjury thrombocytosis is associated with thromboembolic complications. PG - 667-74; discussion 674-5 LID - 10.1016/j.surg.2010.07.013 [doi] AB - BACKGROUND: Our previous investigation demonstrated that despite routine chemoprophylaxis, thrombelastography, which is a comprehensive test measuring the viscoelastic properties of blood, identified a hypercoagulable state in a cohort of critically ill surgical patients that was associated with thromboemobolic events. Furthermore, because thrombelastography allows for the comprehensive assessment of coagulation status, this work suggested that platelet hyperactivity is a component of the hypercoagulable state. We hypothesized that progressive postinjury thrombocytosis contributes to a hypercoagulable state that is associated with thrombelastography. METHODS: One thousand four hundred and forty severely injured patients surviving >48 h were entered into a database prospectively over 12 years. The variables that were evaluated in associated with thrombocytosis (platelet count >450,000) included age, Injury Severity Score, packed red blood cell transfusions in 12 h, and thromboemobolic complications (TE) (deep venous thrombosis, pulmonary embolus, mesenteric thrombosis, stroke, and arterial thrombosis). The time frame for the development of thrombocytosis was assessed at greater or less than 7 days postinjury. Logistic regression was used to identify the independent variables predictive of thrombocytosis and to adjust the association of thrombocytosis with TE for other risk factors. C-statistic was used to assess the discriminative power of thrombocytosis for prediction of TE. RESULTS: The mean age was 37.4 +/- 0.4 years. The Injury Severity Score was 29.3 +/- 0.3, and mean red blood cell transfusions in 12 h was 4.4 +/- 0.2 units. Injury via blunt force occurred in 76% of patients, and 72% of patients were male. Thrombocytosis was identified in 447 (31%) patients and was noted almost exclusively >7 days postinjury (98%). TE developed in 35 (8%) of the 447 patients with thrombocytosis, compared with 45 (4.5%) of the remaining 993 patients who did not develop thrombocytosis. Persistent thrombocytosis >7 days was associated with TE (P > .0001). Logistic regression analysis indicated that when adjusted for intensive care unit duration of stay, transfusions, age, and Injury Severity Score, patients with sustained thrombocytosis more than 3 days were noted to have a 1.4 x increased risk of TE (odds ratio, 1.12; 95% confidence interval, 1.04-1.2; P = .002; C-statistic = 0.82). CONCLUSION: Persistent thrombocytosis in critically injured patients receiving routine chemoprophylaxis is associated with thrombotic complications. Subsequent investigation is warranted to differentiate enzymatic from platelet hypercoagulability to ascertain the role of antiplatelet therapy for prevention of TE. CI - Copyright (c) 2010 Mosby, Inc. All rights reserved. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Department of Surgery, Division of Trauma, Acute Care, and Acute Care Surgery, Penn State Hershey Medical Center and College of Medicine, Hershey, PA 17033-0850, USA. jkashuk@hmc.psu.edu FAU - Moore, Ernest E AU - Moore EE FAU - Johnson, Jeffrey L AU - Johnson JL FAU - Biffl, Walter L AU - Biffl WL FAU - Burlew, Clay C AU - Burlew CC FAU - Barnett, Carlton AU - Barnett C FAU - Sauaia, Angela AU - Sauaia A LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States GR - T32GM08315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20100817 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Blood Platelets MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Thrombelastography MH - Thrombocytosis/*etiology MH - Thromboembolism/*etiology/prevention & control MH - Thrombophilia/*diagnosis/etiology MH - Wounds and Injuries/*complications MH - Young Adult EDAT- 2010/08/20 06:00 MHDA- 2010/10/12 06:00 CRDT- 2010/08/20 06:00 PHST- 2010/02/23 00:00 [received] PHST- 2010/07/08 00:00 [accepted] PHST- 2010/08/20 06:00 [entrez] PHST- 2010/08/20 06:00 [pubmed] PHST- 2010/10/12 06:00 [medline] AID - S0039-6060(10)00381-8 [pii] AID - 10.1016/j.surg.2010.07.013 [doi] PST - ppublish SO - Surgery. 2010 Oct;148(4):667-74; discussion 674-5. doi: 10.1016/j.surg.2010.07.013. Epub 2010 Aug 17. PMID- 20708846 OWN - NLM STAT- MEDLINE DCOM- 20110218 LR - 20101026 IS - 1532-2777 (Electronic) IS - 0306-9877 (Linking) VI - 75 IP - 6 DP - 2010 Dec TI - Acute coagulopathy of trauma: balancing progressive catecholamine induced endothelial activation and damage by fluid phase anticoagulation. PG - 564-7 LID - 10.1016/j.mehy.2010.07.031 [doi] AB - Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally hyperfibrinolytic in severely injured patients. Since high catecholamine levels may directly damage the endothelium and thereby promote systemic coagulation activation, we hypothesize that the progressive hypocoagulability and ultimate hyperfibrinolysis observed in whole blood with increasing injury severity, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant microvasculature open. The hypothesis delineated in the present paper thus infers that the state of the fluid phase, including its cellular elements, is a consequence of the degree of the tissue injury and importantly, critically related to the degree of endothelial damage, with a progressively more procoagulant endothelium inducing a gradient of increasing anticoagulation towards the fluid phase. The implications of this hypothesis may include targeted treatment strategies according to the degree of sympathoadrenal response as evaluated by whole blood viscoelastical hemostatic assays in trauma patients. CI - Copyright (c) 2010 Elsevier Ltd. All rights reserved. FAU - Johansson, P I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. FAU - Ostrowski, S R AU - Ostrowski SR LA - eng PT - Journal Article DEP - 20100813 PL - United States TA - Med Hypotheses JT - Medical hypotheses JID - 7505668 RN - 0 (Catecholamines) SB - IM MH - Blood Coagulation Disorders/*etiology/*physiopathology MH - Catecholamines/*blood MH - Endothelium/*metabolism MH - Hemostasis/*physiology MH - Humans MH - Thrombelastography MH - Wounds and Injuries/*complications/pathology EDAT- 2010/08/17 06:00 MHDA- 2011/02/22 06:00 CRDT- 2010/08/17 06:00 PHST- 2010/04/05 00:00 [received] PHST- 2010/07/19 00:00 [accepted] PHST- 2010/08/17 06:00 [entrez] PHST- 2010/08/17 06:00 [pubmed] PHST- 2011/02/22 06:00 [medline] AID - S0306-9877(10)00269-0 [pii] AID - 10.1016/j.mehy.2010.07.031 [doi] PST - ppublish SO - Med Hypotheses. 2010 Dec;75(6):564-7. doi: 10.1016/j.mehy.2010.07.031. Epub 2010 Aug 13. PMID- 20693919 OWN - NLM STAT- MEDLINE DCOM- 20110726 LR - 20110525 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 70 IP - 4 DP - 2011 Apr TI - Carbon monoxide-releasing molecule-2 enhances coagulation and diminishes fibrinolytic vulnerability in diluted plasma in vitro. PG - 939-47 LID - 10.1097/TA.0b013e3181e50a3b [doi] AB - BACKGROUND: A carbon monoxide-releasing molecule (tricarbonyldichlororuthenium (II) dimer; CORM-2) enhances coagulation and attenuates vulnerability to fibrinolysis in normal and hemophiliac human plasma. We tested the hypothesis that plasma diluted with resuscitative fluids would demonstrate improved coagulation and decreased fibrinolytic vulnerability after exposure to CORM-2. METHODS: Normal, platelet-poor plasma was diluted 0%, 20%, 30%, 40%, or 50% with 0.9% NaCl (NS) or low-molecular-weight hydroxyethyl starch (VOL) and, subsequently, exposed to 0 mumol/L or 100 mumol/L CORM-2 before activation with tissue factor (n = 4 per condition). Additional plasma samples diluted with NS or VOL (0% or 30%) were exposed to 0 mumol/L or 100 mumol/L CORM-2 and 0 U/mL or 100 U/mL tissue-type plasminogen activator to assess fibrinolytic vulnerability (n = 8 per condition). Thrombelastographic data were collected until either clot strength stabilized or clot lysis occurred, as appropriate. RESULTS: CORM-2 exposure maintained normal to supranormal velocity of clot formation and strength in plasma diluted up to 40% with NS. In contrast, although CORM-2 exposure improved coagulation kinetics, dilution with VOL markedly degraded thrombus formation kinetics. Similarly, fibrinolytic vulnerability to tissue-type plasminogen activator was markedly improved by CORM-2 exposure in samples diluted with NS, whereas VOL-diluted thrombi were still abnormally weak and easily lysed compared with undiluted samples despite CORM-2 exposure. CONCLUSIONS: CORM-2 exposure attenuated the decrease in coagulation kinetics and enhancement of fibrinolytic vulnerability associated with hemodilution. Extensive preclinical investigation remains to be performed to determine the route of administration, safety, and efficacy of CORM-2 and other CORMs to treat trauma-associated bleeding. FAU - Nielsen, Vance G AU - Nielsen VG AD - Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. vance.nielsen@drexelmed.edu FAU - Green, Parmis AU - Green P FAU - Green, Michael AU - Green M FAU - Martin-Ross, Amber AU - Martin-Ross A FAU - Khan, Ejaz S AU - Khan ES FAU - Kirklin, James K AU - Kirklin JK FAU - George, James F AU - George JF LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Coagulants) RN - 0 (Organometallic Compounds) RN - 0 (tricarbonyldichlororuthenium (II) dimer) RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Blood Coagulation/*drug effects MH - Coagulants/*pharmacology MH - Fibrinolysis/*drug effects MH - Humans MH - Organometallic Compounds/*pharmacology MH - Thrombelastography MH - Thromboplastin/*metabolism MH - Tissue Plasminogen Activator/*metabolism EDAT- 2010/08/10 06:00 MHDA- 2011/07/27 06:00 CRDT- 2010/08/10 06:00 PHST- 2010/08/10 06:00 [entrez] PHST- 2010/08/10 06:00 [pubmed] PHST- 2011/07/27 06:00 [medline] AID - 10.1097/TA.0b013e3181e50a3b [doi] PST - ppublish SO - J Trauma. 2011 Apr;70(4):939-47. doi: 10.1097/TA.0b013e3181e50a3b. PMID- 20622618 OWN - NLM STAT- MEDLINE DCOM- 20100928 LR - 20260127 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 69 Suppl 1 DP - 2010 Jul TI - Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. PG - S40-8 LID - 10.1097/TA.0b013e3181e4257b [doi] AB - BACKGROUND: Coagulopathy in trauma patients is currently defined by the results of standard laboratory tests (prothrombin time and activated partial thromboplastin time). These results offer little in the hemostatic resuscitation that occurs in the treatment of battlefield patients who receive massive transfusions. Thromboelastometry (TEM) is a technique that can offer rapid, near-patient testing of coagulation status. METHODS: A prospective observational field study was performed in a deployed military setting to determine the feasibility of using TEM to assess the coagulation status of patients admitted to the emergency department and who subsequently received a massive transfusion. RESULTS: TEM was performed on 31 patients, 25 were direct admissions to the emergency department, 19 of whom were enrolled into the massive transfusion protocol, and 60% were involved in a blast incident. Standard laboratory testing showed that 10% of all patients were coagulopathic on admission compared with 64% with an abnormal TEM trace (p = 0.0005). All patients had abnormal maximum clot firmness. The TEM amplitude at 10 minutes is associated with the subsequent development of abnormal maximum clot firmness. Two exemplar cases are discussed, which illustrate the potential benefit of using TEM to monitor and guide and individualize therapy during a massive transfusion. CONCLUSIONS: It is feasible to use TEM in a deployed military setting. We have shown that rotational thromboelastometry significantly detects more abnormalities in the coagulation status than the standard laboratory tests (prothrombin time, and activated partial thromboplastin time). FAU - Doran, Catherine M AU - Doran CM AD - Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Institute of Research and Development, Birmingham Research Park, Birmingham, United Kingdom. cmcdoran@yahoo.co.uk FAU - Woolley, Tom AU - Woolley T FAU - Midwinter, Mark J AU - Midwinter MJ LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adolescent MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Blood Transfusion MH - Follow-Up Studies MH - Humans MH - Male MH - *Military Personnel MH - Partial Thromboplastin Time/methods MH - Predictive Value of Tests MH - Prospective Studies MH - Prothrombin Time/methods MH - Reproducibility of Results MH - Thrombelastography/*methods/statistics & numerical data MH - Trauma Centers MH - United States MH - *Warfare MH - Wounds and Injuries/blood/*complications/diagnosis MH - Young Adult EDAT- 2010/08/05 06:00 MHDA- 2010/09/30 06:00 CRDT- 2010/07/13 06:00 PHST- 2010/07/13 06:00 [entrez] PHST- 2010/08/05 06:00 [pubmed] PHST- 2010/09/30 06:00 [medline] AID - 00005373-201007001-00007 [pii] AID - 10.1097/TA.0b013e3181e4257b [doi] PST - ppublish SO - J Trauma. 2010 Jul;69 Suppl 1:S40-8. doi: 10.1097/TA.0b013e3181e4257b. PMID- 20626354 OWN - NLM STAT- MEDLINE DCOM- 20110131 LR - 20101004 IS - 1399-6576 (Electronic) IS - 0001-5172 (Linking) VI - 54 IP - 9 DP - 2010 Oct TI - Management of major blood loss: an update. PG - 1039-49 LID - 10.1111/j.1399-6576.2010.02265.x [doi] AB - Haemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution and consumption of clotting factors and platelets. Concepts of damage control surgery have evolved, prioritizing the early control of the cause of bleeding by non-definitive means, while haemostatic control resuscitation seeks early control of coagulopathy. Haemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells (RBCs) in an immediate and sustained manner as part of the transfusion protocol for massively bleeding patients. Transfusion of RBCs, plasma and platelets in a similar proportion as in whole blood prevents both hypovolaemia and coagulopathy. Although an early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy of massive transfusion remains debated and randomized controlled studies are lacking. Results from recent before-and-after studies in massively bleeding patients indicate that trauma exsanguination protocols involving the early administration of plasma and platelets are associated with improved survival. Furthermore, viscoelastic whole blood assays, such as thrombelastography (TEG)/rotation thromboelastometry (ROTEM), appear advantageous for identifying coagulopathy in patients with severe haemorrhage, as opposed to conventional coagulation assays. In our view, patients with uncontrolled bleeding, regardless of its cause, should be treated with goal-directed haemostatic control resuscitation involving the early administration of plasma and platelets and based on the results of the TEG/ROTEM analysis. The aim of the goal-directed therapy should be to maintain a normal haemostatic competence until surgical haemostasis is achieved, as this appears to be associated with reduced mortality. FAU - Johansson, P I AU - Johansson PI AD - Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. per.johansson@rh.regionh.dk FAU - Ostrowski, S R AU - Ostrowski SR FAU - Secher, N H AU - Secher NH LA - eng PT - Journal Article PT - Review DEP - 20100706 PL - England TA - Acta Anaesthesiol Scand JT - Acta anaesthesiologica Scandinavica JID - 0370270 RN - 0 (Hemostatics) SB - IM MH - Blood Transfusion MH - Hemorrhage/*therapy MH - Hemostasis MH - Hemostatics/therapeutic use MH - Humans EDAT- 2010/07/16 06:00 MHDA- 2011/02/01 06:00 CRDT- 2010/07/15 06:00 PHST- 2010/07/15 06:00 [entrez] PHST- 2010/07/16 06:00 [pubmed] PHST- 2011/02/01 06:00 [medline] AID - AAS2265 [pii] AID - 10.1111/j.1399-6576.2010.02265.x [doi] PST - ppublish SO - Acta Anaesthesiol Scand. 2010 Oct;54(9):1039-49. doi: 10.1111/j.1399-6576.2010.02265.x. Epub 2010 Jul 6. PMID- 20617413 OWN - NLM STAT- MEDLINE DCOM- 20101008 LR - 20100709 IS - 1940-6029 (Electronic) IS - 1064-3745 (Linking) VI - 663 DP - 2010 TI - In vitro methods of evaluating antithrombotics and thrombolytics. PG - 1-28 LID - 10.1007/978-1-60761-803-4_1 [doi] AB - Platelets play a crucial role in primary hemostasis by forming hemostatic plugs at sites of vascular injury. There is abundant evidence that platelets also play a pivotal role in the pathogenesis of arterial thrombotic disorders, including unstable angina (UA), myocardial infarction (MI), and stroke. The underlying pathophysiological mechanism of these processes has been recognized as the disruption or erosion of a vulnerable atherosclerotic plaque, leading to local platelet adhesion and subsequent formation of partially or completely occlusive platelet thrombi. A variety of methods have been used to assess platelet aggregation, blood coagulation, and the ex vivo and/or in vitro efficacy of platelet antagonists, anticoagulants, and thrombolytics. FAU - Mousa, Shaker A AU - Mousa SA AD - Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA. LA - eng PT - Journal Article PL - United States TA - Methods Mol Biol JT - Methods in molecular biology (Clifton, N.J.) JID - 9214969 RN - 0 (Fibrinolytic Agents) RN - 0 (Receptors, Fibrinogen) RN - 9007-34-5 (Collagen) SB - IM MH - Animals MH - Blood Coagulation/drug effects MH - Blood Platelets/cytology/drug effects MH - Cell Adhesion/drug effects MH - Chromatography, Gel MH - Collagen/metabolism MH - Drug Evaluation, Preclinical/*methods MH - Erythrocytes/cytology/metabolism MH - Fibrinolytic Agents/*pharmacology/therapeutic use MH - Flow Cytometry MH - Humans MH - Lasers MH - Male MH - Platelet Aggregation/drug effects MH - Rats MH - Rats, Sprague-Dawley MH - Receptors, Fibrinogen/metabolism MH - Rheology MH - Thrombelastography/drug effects MH - Thrombosis/drug therapy/physiopathology MH - Viscosity EDAT- 2010/07/10 06:00 MHDA- 2010/10/12 06:00 CRDT- 2010/07/10 06:00 PHST- 2010/07/10 06:00 [entrez] PHST- 2010/07/10 06:00 [pubmed] PHST- 2010/10/12 06:00 [medline] AID - 10.1007/978-1-60761-803-4_1 [doi] PST - ppublish SO - Methods Mol Biol. 2010;663:1-28. doi: 10.1007/978-1-60761-803-4_1. PMID- 20466110 OWN - NLM STAT- MEDLINE DCOM- 20100607 LR - 20100514 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 199 IP - 5 DP - 2010 May TI - Splenectomy leads to a persistent hypercoagulable state after trauma. PG - 646-51 LID - 10.1016/j.amjsurg.2010.01.015 [doi] AB - BACKGROUND: It was hypothesized that splenectomy following trauma results in hypercoagulability. METHODS: A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury. RESULTS: Patients with splenectomy (n = 30) and nonoperative management (n = 50) were enrolled. Splenectomy patients were older, had higher Injury Severity Scores, and had longer intensive care unit and hospital stays (P < .05). Splenectomy patients had significantly increased white blood cell counts and platelet counts at baseline and follow-up (P < .01). Fibrinogen was initially elevated in both groups and remained elevated in the splenectomy group (P < .05). Tissue plasminogen activator, plasminogen activator inhibitor-1, and activated partial thromboplastin time were higher in splenectomy patients only at baseline (P < .05). Baseline thromboelastography showed faster fibrin cross-linking and enhanced fibrinolysis following splenectomy (P < .05). Only clot strength was greater at follow-up in the splenectomy group (P < .01). Deep venous thrombosis developed in 7% of splenectomy patients and no control patients (P = .03). CONCLUSIONS: A significant difference in deep venous thrombosis formation was noted, and coagulation assays indicated persistent hypercoagulability following splenectomy for trauma. CI - Copyright 2010 Elsevier Inc. All rights reserved. FAU - Watters, Jennifer M AU - Watters JM AD - Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, OR, USA. wattersj@ohsu.edu FAU - Sambasivan, Chitra N AU - Sambasivan CN FAU - Zink, Karen AU - Zink K FAU - Kremenevskiy, Igor AU - Kremenevskiy I FAU - Englehart, Michael S AU - Englehart MS FAU - Underwood, Samantha J AU - Underwood SJ FAU - Schreiber, Martin A AU - Schreiber MA LA - eng GR - 5 M01 RR00334/RR/NCRR NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - IM MH - Adult MH - Blood Chemical Analysis MH - Blood Coagulation Disorders/epidemiology/etiology MH - Cohort Studies MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Injury Severity Score MH - Male MH - Multiple Trauma/diagnosis/mortality/*surgery MH - Platelet Count MH - Probability MH - Prospective Studies MH - Prothrombin Time MH - Reference Values MH - Risk Assessment MH - Splenectomy/*adverse effects/methods MH - Thrombophilia/*epidemiology/etiology MH - Thrombosis/epidemiology/*etiology MH - Wounds and Injuries/diagnosis/*surgery EDAT- 2010/05/15 06:00 MHDA- 2010/06/09 06:00 CRDT- 2010/05/15 06:00 PHST- 2009/11/07 00:00 [received] PHST- 2010/01/07 00:00 [revised] PHST- 2010/01/07 00:00 [accepted] PHST- 2010/05/15 06:00 [entrez] PHST- 2010/05/15 06:00 [pubmed] PHST- 2010/06/09 06:00 [medline] AID - S0002-9610(10)00049-8 [pii] AID - 10.1016/j.amjsurg.2010.01.015 [doi] PST - ppublish SO - Am J Surg. 2010 May;199(5):646-51. doi: 10.1016/j.amjsurg.2010.01.015. PMID- 20453765 OWN - NLM STAT- MEDLINE DCOM- 20100527 LR - 20131121 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 68 IP - 5 DP - 2010 May TI - Effects of ethanol intoxication and gender on blood coagulation. PG - 1106-11 LID - 10.1097/TA.0b013e3181d86860 [doi] AB - BACKGROUND: Ethanol intoxication is a common contributor to traumatic injury. It is unknown whether ethanol consumption contributes to the coagulation differences seen between men and women after trauma. Our aim was to examine the combined effect of ethanol intoxication and gender on coagulation. METHODS: Fifty-eight healthy subjects participated and chose to enter into a control group (CG; n = 20; 10 men and 10 women) or drinking group (DG; n = 38; 20 men and 18 women). Venous blood samples for thrombelastography, plasminogen activator inhibitor, thrombin-antithrombin complex, and tissue plasminogen activator were drawn at the beginning of the study. Subjects then interacted in a social atmosphere for at least 2 hours, eating and consuming alcoholic (DG) or nonalcoholic (CG) beverages. After 2 hours, blood alcohol level was determined and blood was drawn for a second set of coagulation studies. RESULTS: Demographics were similar between groups except for age (36.7 years CG vs. 29.9 years DG; p = 0.009). All baseline thrombelastography measurements were similar between the CG and DG. Blood alcohol levels in the DG were similar between genders at the end of study. At the end of study, a decreased rate of fibrin formation, decreased clot strength, and a decreased rate of fibrin cross-linking was seen in men but not in women. Fibrinolysis was inhibited in drinkers compared with controls. CONCLUSIONS: Consumption of commonly ingested quantities of alcohol correlated with the development of a hypocoagulable state in men but had no effect on coagulation status in women. This phenomenon may contribute to differences in post-trauma coagulation status previously noted between genders. FAU - Spoerke, Nicholas AU - Spoerke N AD - Division of Trauma and Critical Care, Oregon Health and Science University, Portland, Oregon, USA. spoerken@ohsu.edu FAU - Underwood, Samantha AU - Underwood S FAU - Differding, Jerome AU - Differding J FAU - Van, Phil AU - Van P FAU - Sambasivan, Chitra AU - Sambasivan C FAU - Shapiro, David AU - Shapiro D FAU - Schreiber, Martin AU - Schreiber M LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Plasminogen Inactivators) RN - 0 (antithrombin III-protease complex) RN - 3K9958V90M (Ethanol) RN - 9000-94-6 (Antithrombin III) RN - 9001-31-4 (Fibrin) RN - EC 3.4.- (Peptide Hydrolases) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - *Alcoholic Intoxication/blood/complications MH - Antithrombin III MH - Blood Coagulation Disorders/*blood/etiology MH - Case-Control Studies MH - Ethanol/*blood MH - Female MH - Fibrin/metabolism MH - Fibrinolysis/physiology MH - Humans MH - Male MH - Oregon MH - Peptide Hydrolases/blood MH - Plasminogen Inactivators/blood MH - Prospective Studies MH - *Sex Characteristics MH - Statistics, Nonparametric MH - Thrombelastography MH - Tissue Plasminogen Activator/blood MH - Wounds and Injuries/etiology EDAT- 2010/05/11 06:00 MHDA- 2010/05/28 06:00 CRDT- 2010/05/11 06:00 PHST- 2010/05/11 06:00 [entrez] PHST- 2010/05/11 06:00 [pubmed] PHST- 2010/05/28 06:00 [medline] AID - 00005373-201005000-00013 [pii] AID - 10.1097/TA.0b013e3181d86860 [doi] PST - ppublish SO - J Trauma. 2010 May;68(5):1106-11. doi: 10.1097/TA.0b013e3181d86860. PMID- 20400026 OWN - NLM STAT- MEDLINE DCOM- 20100722 LR - 20250529 IS - 1479-666X (Print) IS - 1479-666X (Linking) VI - 8 IP - 3 DP - 2010 Jun TI - The acute coagulopathy of trauma shock: clinical relevance. PG - 159-63 LID - 10.1016/j.surge.2009.10.022 [doi] AB - Recent observational studies have identified an acute coagulopathy in trauma victims that is present on arrival in the emergency room. It has been associated with a four-fold increase in mortality and increased incidence of organ failure. Conventional trauma resuscitation and transfusion protocols are designed for dilutional coagulopathy and appear inadequate in the management of acute traumatic coagulopathy and massive transfusion. Acute Coagulopathy of Trauma Shock (ACoTS) is caused by a combination of tissue injury and shock, and may occur without significant fluid administration, clotting factor depletion or hypothermia. The mechanism through which acute coagulopathy develops is unclear but activation of the protein C pathway has been implicated. Standard coagulation tests do not identify cases in a timely fashion and ACoTS should be suspected in any trauma patient with a significant magnitude of injury and shock, as evidenced by an abnormal admission base deficit on blood gas. Development of point of care coagulometers and whole blood coagulation analysers, such as rotational thromboelastometry, may enable earlier laboratory identification of this group. Retrospective studies performed by the American military indicate that resuscitation of severely injured patients with higher ratios of plasma given early may improve outcome and reduce overall blood product use. The place of adjunctive pharmaceutical agents within this strategy remains unclear. There is an acute coagulopathy associated with trauma and shock that is an independent predictor of outcomes. Delineation of this entity, with directed management protocols should lead to a reduction in avoidable deaths from haemorrhage after trauma. CI - Copyright (c) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. FAU - Frith, Daniel AU - Frith D AD - Trauma Clinical Academic Unit, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, UK. FAU - Brohi, Karim AU - Brohi K LA - eng GR - RP-PG-0407-10036/DH_/Department of Health/United Kingdom PT - Journal Article PT - Review DEP - 20100206 PL - Scotland TA - Surgeon JT - The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland JID - 101168329 RN - 0 (Protein C) SB - IM MH - Acute Disease MH - Blood Coagulation MH - Blood Coagulation Disorders/blood/*etiology MH - Humans MH - Prognosis MH - Protein C/metabolism MH - Shock, Traumatic/*complications RF - 37 EDAT- 2010/04/20 06:00 MHDA- 2010/07/23 06:00 CRDT- 2010/04/20 06:00 PHST- 2009/10/15 00:00 [received] PHST- 2009/10/22 00:00 [accepted] PHST- 2010/04/20 06:00 [entrez] PHST- 2010/04/20 06:00 [pubmed] PHST- 2010/07/23 06:00 [medline] AID - S1479-666X(09)00023-7 [pii] AID - 10.1016/j.surge.2009.10.022 [doi] PST - ppublish SO - Surgeon. 2010 Jun;8(3):159-63. doi: 10.1016/j.surge.2009.10.022. Epub 2010 Feb 6. PMID- 20374650 OWN - NLM STAT- MEDLINE DCOM- 20101110 LR - 20240103 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 14 IP - 2 DP - 2010 TI - Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. PG - R55 LID - 10.1186/cc8948 [doi] AB - INTRODUCTION: The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. METHODS: This retrospective analysis included trauma patients who received >or= 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score. RESULTS: Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014). CONCLUSIONS: ROTEM-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Dr Franz-Rehrl-Platz 5, Salzburg, Austria. Herbert.Schoechl@auva.at FAU - Nienaber, Ulrike AU - Nienaber U FAU - Hofer, Georg AU - Hofer G FAU - Voelckel, Wolfgang AU - Voelckel W FAU - Jambor, Csilla AU - Jambor C FAU - Scharbert, Gisela AU - Scharbert G FAU - Kozek-Langenecker, Sibylle AU - Kozek-Langenecker S FAU - Solomon, Cristina AU - Solomon C LA - eng PT - Journal Article DEP - 20100407 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Blood Coagulation Factors) RN - 9001-26-7 (Prothrombin) RN - 9001-32-5 (Fibrinogen) SB - IM CIN - Crit Care. 2010;14(3):162. doi: 10.1186/cc9009. PMID: 20550726 MH - Adult MH - Blood Coagulation Factors/therapeutic use MH - Female MH - Fibrinogen/administration & dosage/*therapeutic use MH - Hemorrhage/drug therapy MH - Hemostatic Techniques MH - Humans MH - Male MH - Middle Aged MH - Prothrombin/administration & dosage/*therapeutic use MH - Retrospective Studies MH - Thrombelastography/*methods MH - Wounds and Injuries/*blood PMC - PMC2887173 EDAT- 2010/04/09 06:00 MHDA- 2010/11/11 06:00 PMCR- 2010/04/07 CRDT- 2010/04/09 06:00 PHST- 2009/10/17 00:00 [received] PHST- 2010/01/29 00:00 [revised] PHST- 2010/04/07 00:00 [accepted] PHST- 2010/04/09 06:00 [entrez] PHST- 2010/04/09 06:00 [pubmed] PHST- 2010/11/11 06:00 [medline] PHST- 2010/04/07 00:00 [pmc-release] AID - cc8948 [pii] AID - 10.1186/cc8948 [doi] PST - ppublish SO - Crit Care. 2010;14(2):R55. doi: 10.1186/cc8948. Epub 2010 Apr 7. PMID- 20224372 OWN - NLM STAT- MEDLINE DCOM- 20100503 LR - 20220330 IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 251 IP - 4 DP - 2010 Apr TI - Postinjury coagulopathy management: goal directed resuscitation via POC thrombelastography. PG - 604-14 LID - 10.1097/SLA.0b013e3181d3599c [doi] AB - Progressive postinjury coagulopathy remains the fundamental rationale for damage control surgery, but the decision to abort operative intervention must occur before laboratory confirmation of coagulopathy. Current massive transfusion protocols have embraced pre-emptive resuscitation strategies emphasizing administration of packed red blood cells, fresh frozen plasma, and platelets in ratios approximating 1:1:1 during the first 24 hours postinjury, based on US military retrospective experience and recent noncontrolled civilian data. This policy, termed "damage control resuscitation" assumes that patients presenting with life threatening hemorrhage at risk for postinjury coagulopathy should receive component therapy in rations approximating those found in whole blood during the first 24 hours. While we concur with the concept of pre-emptive coagulation factor replacement, and initially suggested this in 1982, we remain concerned for the continued unbridled administration of fresh frozen plasma and platelets without objective evidence of their specific requirement. A major limitation of current massive transfusion protocols is the lack of real time assessment of coagulation function to guide evolving blood component requirements. Existing laboratory coagulation testing was originally designed for evaluation of hemophilia and subsequently used for monitoring anticoagulation therapy. Consequently, the applicability of these tests in the trauma setting has never been proven and the time required to conduct these assays is incompatible with prompt correction of the coagulopathy in the trauma setting. This review examines the current approach to postinjury coagulopathy, including identification of patients at risk, resuscitation strategies, design and implementation of institutional massive transfusion protocols, and the potential benefits of goal-directed therapy by real time assessment of coagulation function via point of care rapid thromboelastography. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Department of Surgery, Denver Health Medical Center, University of Colorado Denver, CO, USA. jkashuk@hmc.psu.edu FAU - Moore, Ernest E AU - Moore EE FAU - Sawyer, Michael AU - Sawyer M FAU - Le, Tuan AU - Le T FAU - Johnson, Jeffrey AU - Johnson J FAU - Biffl, Walter L AU - Biffl WL FAU - Cothren, C Clay AU - Cothren CC FAU - Barnett, Carlton AU - Barnett C FAU - Stahel, Philip AU - Stahel P FAU - Sillman, Christopher C AU - Sillman CC FAU - Sauaia, Angela AU - Sauaia A FAU - Banerjee, Anirban AU - Banerjee A LA - eng GR - P50GM049222/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Animals MH - Blood Coagulation Disorders/blood/diagnosis/etiology/*therapy MH - Blood Component Transfusion MH - Humans MH - Plasma MH - Platelet Transfusion MH - *Point-of-Care Systems MH - *Resuscitation MH - Shock, Hemorrhagic/blood MH - *Thrombelastography MH - Wounds and Injuries/blood/*complications RF - 91 EDAT- 2010/03/13 06:00 MHDA- 2010/05/04 06:00 CRDT- 2010/03/13 06:00 PHST- 2010/03/13 06:00 [entrez] PHST- 2010/03/13 06:00 [pubmed] PHST- 2010/05/04 06:00 [medline] AID - 10.1097/SLA.0b013e3181d3599c [doi] PST - ppublish SO - Ann Surg. 2010 Apr;251(4):604-14. doi: 10.1097/SLA.0b013e3181d3599c. PMID- 20133450 OWN - NLM STAT- MEDLINE DCOM- 20100318 LR - 20180126 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 104 IP - 3 DP - 2010 Mar TI - Haemodilution-induced profibrinolytic state is mitigated by fresh-frozen plasma: implications for early haemostatic intervention in massive haemorrhage. PG - 318-25 LID - 10.1093/bja/aeq001 [doi] AB - BACKGROUND: Fibrinolysis contributes to coagulopathy after major trauma and surgery. We hypothesized that progressive haemodilution is responsible, at least in part, for increased fibrinolytic tendency of blood clot. METHODS: The study was performed in two parts. First, whole blood (WB) samples collected from six healthy, consented volunteers were diluted in vitro with either saline or fresh-frozen plasma (FFP) to 40% and 15% of baseline. We quantified factor levels related to coagulation and fibrinolysis, and measured endogenous thrombin generation in undiluted control plasma samples and in samples diluted with saline or FFP. Additionally, thromboelastometry was used to assess susceptibility to fibrinolysis after adding tissue plasminogen activator in undiluted WB samples and in samples diluted with saline before and after substitution of fibrinogen or FFP. Secondly, as a model of in vivo haemodilution, we evaluated the same parameters before and after operation in nine consented patients undergoing off-pump coronary artery bypass surgery. RESULTS: The dilution with saline caused dose-dependent decreases in plasma levels of coagulation and antifibrinolytic factors, and in thrombin generation. In FFP-supplemented samples, factor levels and thrombin generation were maintained within normal ranges. Fibrinolytic tendency was significantly higher after haemodilution with saline independent of fibrinogen substitution compared with FFP. Similarly, increased tendency for fibrinolysis was also observed in the in vivo haemodilution. CONCLUSIONS: We demonstrated in vitro and in vivo that progressive haemodilution decreases endogenous antifibrinolytic proteins including alpha(2)-antiplasmin and thrombin-activatable fibrinolysis inhibitor, resulting in increased fibrinolytic tendency. Therefore, early fluid replacement therapy with FFP might be advantageous after massive haemorrhage. FAU - Bolliger, D AU - Bolliger D AD - Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, USA. FAU - Szlam, F AU - Szlam F FAU - Levy, J H AU - Levy JH FAU - Molinaro, R J AU - Molinaro RJ FAU - Tanaka, K A AU - Tanaka KA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20100203 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - 0 (Antifibrinolytic Agents) RN - 0 (alpha-2-Antiplasmin) RN - 451W47IQ8X (Sodium Chloride) RN - EC 3.4.17.20 (Carboxypeptidase B2) RN - EC 3.4.21.5 (Thrombin) RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Adult MH - Aged MH - Antifibrinolytic Agents/blood MH - Carboxypeptidase B2/blood MH - Coronary Artery Bypass, Off-Pump MH - Female MH - Fibrinolysis/drug effects/*physiology MH - Hemodilution/*adverse effects MH - Hemostasis, Surgical/methods MH - Humans MH - In Vitro Techniques MH - Male MH - Middle Aged MH - *Plasma MH - Sodium Chloride/pharmacology MH - Thrombelastography/methods MH - Thrombin/biosynthesis MH - Tissue Plasminogen Activator/pharmacology MH - Young Adult MH - alpha-2-Antiplasmin/analysis EDAT- 2010/02/06 06:00 MHDA- 2010/03/20 06:00 CRDT- 2010/02/06 06:00 PHST- 2010/02/06 06:00 [entrez] PHST- 2010/02/06 06:00 [pubmed] PHST- 2010/03/20 06:00 [medline] AID - S0007-0912(17)33679-6 [pii] AID - 10.1093/bja/aeq001 [doi] PST - ppublish SO - Br J Anaesth. 2010 Mar;104(3):318-25. doi: 10.1093/bja/aeq001. Epub 2010 Feb 3. PMID- 20104173 OWN - NLM STAT- MEDLINE DCOM- 20100712 LR - 20100420 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 23 IP - 2 DP - 2010 Apr TI - New developments in massive transfusion in trauma. PG - 246-50 LID - 10.1097/ACO.0b013e328336ea59 [doi] AB - PURPOSE OF REVIEW: Trauma patients requiring massive transfusion represent a population at high risk for potentially preventable death. This review describes recent advances in the early recognition and treatment of the coagulopathy of trauma, as well as ongoing work to define optimal resuscitation strategies. RECENT FINDINGS: Damage control resuscitation involves the rapid correction of hypothermia and acidosis, direct treatment of coagulopathy, and early transfusion in trauma patients. Recent evidence demonstrates improved mortality and lower overall blood product usage with higher ratios of plasma and platelets to red blood cells transfused. Adjuncts to damage control resuscitation such as factor VIIa may also be beneficial. Thrombelastography and advances in point-of-care testing may provide timely measurements to help guide massive transfusion in patients based on their individual needs. SUMMARY: As optimal resuscitation strategies continue to evolve, recent efforts have focused on early and aggressive treatment of coagulopathy, with higher ratios of plasma and platelets to red blood cells transfused. Early evidence suggests that such strategies have a beneficial outcome in regards to trauma-related mortality. FAU - Greer, Sarah E AU - Greer SE AD - Dartmouth Hitchcock Medical Center, Departments of Surgery, USA. FAU - Rhynhart, Kurt K AU - Rhynhart KK FAU - Gupta, Rajan AU - Gupta R FAU - Corwin, Howard L AU - Corwin HL LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Recombinant Proteins) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Blood Coagulation Disorders/complications MH - Blood Transfusion/*methods MH - Factor VIIa/therapeutic use MH - Humans MH - Recombinant Proteins/therapeutic use MH - Resuscitation MH - Thrombelastography MH - Wounds and Injuries/blood/*therapy RF - 68 EDAT- 2010/01/28 06:00 MHDA- 2010/07/14 06:00 CRDT- 2010/01/28 06:00 PHST- 2010/01/28 06:00 [entrez] PHST- 2010/01/28 06:00 [pubmed] PHST- 2010/07/14 06:00 [medline] AID - 10.1097/ACO.0b013e328336ea59 [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2010 Apr;23(2):246-50. doi: 10.1097/ACO.0b013e328336ea59. PMID- 21416027 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211020 IS - 1660-3796 (Print) IS - 1660-3818 (Electronic) IS - 1660-3796 (Linking) VI - 37 IP - 6 DP - 2010 TI - Storage of Blood Components Does Not Decrease Haemostatic Potential: In vitro Assessment of Fresh versus Stored Blood Components Using Thromboelastography. PG - 329-335 AB - SUMMARY: BACKGROUND: Major surgery and severe trauma typically lead to massive blood loss requiring rapid transfusion of large amounts of blood products. It has been suggested that fresh, unrefrigerated whole blood provides a haemostatic advantage in this setting. The aim of the current study was to compare the clot formation parameters of fresh, unrefrigerated whole blood and whole blood reconstituted from components stored for varying periods of time, using rotational thromboelastography (ROTEM(R)). METHODS: Fresh whole blood and reconstituted whole blood using combinations of non-leucoreduced red cell units (stored for 7, 14, 21, 28, or 35 days), platelet concentrates (stored for 1, 3 or 5 days), and fresh frozen plasma (stored for 6 months) were analysed using ROTEM. Measurements of the clotting time (CT), clot formation time (CFT), and maximal clot firmness (MCF) were compared between units of fresh whole blood and reconstituted whole blood samples. RESULTS: There was no difference in the haemostatic parameters measured of fresh whole blood and reconstituted whole blood using red cell units stored for less than 21 days. ROTEM demonstrated that the CT and CFT were significantly shorter for reconstituted whole blood samples using red cells stored for longer than 21 days when compared to fresh whole blood and to reconstituted whole blood samples using red cell units stored for less than 21 days. The CT was inversely correlated to the duration of platelet storage. The MCF was unchanged regardless of duration of blood product storage. CONCLUSION: Fresh unrefrigerated whole blood and blood products stored for short duration (less than 21 days) were not superior to those stored for longer durations. FAU - Bartfeld, Galia AU - Bartfeld G AD - Department of Internal Medicine B, Meir Medical Centre, Kfar Saba, Israel. FAU - Ellis, Martin AU - Ellis M FAU - Lubetzky, Aharon AU - Lubetzky A FAU - Yahalom, Vered AU - Yahalom V FAU - Kenet, Gili AU - Kenet G LA - eng PT - Journal Article DEP - 20101117 PL - Switzerland TA - Transfus Med Hemother JT - Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie JID - 101176417 PMC - PMC3048943 EDAT- 2010/01/01 00:00 MHDA- 2010/01/01 00:01 PMCR- 2010/11/17 CRDT- 2011/03/19 06:00 PHST- 2010/04/29 00:00 [received] PHST- 2010/08/04 00:00 [accepted] PHST- 2011/03/19 06:00 [entrez] PHST- 2010/01/01 00:00 [pubmed] PHST- 2010/01/01 00:01 [medline] PHST- 2010/11/17 00:00 [pmc-release] AID - 322256 [pii] AID - tmh0037-0329 [pii] AID - 10.1159/000322256 [doi] PST - ppublish SO - Transfus Med Hemother. 2010;37(6):329-335. doi: 10.1159/000322256. Epub 2010 Nov 17. PMID- 20007735 OWN - NLM STAT- MEDLINE DCOM- 20100208 LR - 20260518 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 110 IP - 2 DP - 2010 Feb 1 TI - Multidisciplinary approach to the challenge of hemostasis. PG - 354-64 LID - 10.1213/ANE.0b013e3181c84ba5 [doi] AB - A multidisciplinary panel consisting of experts chosen by the 2 chairs of the group representing experts in anesthesiology, blood banking, hematology, critical care medicine, and various surgical disciplines (trauma, cardiac, pediatric, neurologic, obstetrics, and vascular) convened in January 2008 to discuss hemostasis and management of the bleeding patient across different clinical settings, with a focus on perioperative considerations. Although there are many ways to define hemostasis, one clinical definition would be control of bleeding without the occurrence of pathologic thrombotic events (i.e., when balance among procoagulant, anticoagulant, fibrinolytic, and antifibrinolytic activities is achieved). There are common hemostatic challenges that include lack of scientific evidence and standardized guidelines for the use of therapeutic drugs, need for reliable and rapid laboratory tools for measuring hemostasis, and individual variability. Clinically meaningful and accurate real-time laboratory data reflecting a patient's hemostatic status are needed to guide treatment decisions. Current available routine laboratory tests of hemostasis (e.g., platelet count, prothrombin time/international normalized ratio, and activated partial thromboplastin time) do not reflect the complexity of in vivo hemostasis and can mislead the clinician. Although point-of-care coagulation monitoring tests including measures of thromboelastography/elastometry provide insight into overall hemostatic status, they are time-consuming to perform, complex to interpret, and require trained personnel. There is a particular need to develop laboratory tests that can measure the effects of anticoagulant and antiplatelet agents for individual patients, predict bleeding complications, and guide therapy when and if treatment with blood products or pharmacologic drugs is required. Formation of an organization comprised of specialists who treat bleeding patients will foster multidisciplinary collaborations and promote discussions of the current state of hemostasis treatment and future priorities for hemostasis research. Controlled trials with clinically meaningful end points and suitable study populations, as well as observational studies, investigator-initiated studies, and large registry and database studies are essential to answer questions in hemostasis. Because of the complexities of maintaining hemostatic balance, advances in hemostasis research and continuing communication across specialties are required to improve patient care and outcomes. FAU - Levy, Jerrold H AU - Levy JH AD - Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care, Emory University School of Medicine, Atlanta, Georgia 30322, USA. jlevy01@emory.ed FAU - Dutton, Richard P AU - Dutton RP FAU - Hemphill, J Claude 3rd AU - Hemphill JC 3rd FAU - Shander, Aryeh AU - Shander A FAU - Cooper, David AU - Cooper D FAU - Paidas, Michael J AU - Paidas MJ FAU - Kessler, Craig M AU - Kessler CM FAU - Holcomb, John B AU - Holcomb JB FAU - Lawson, Jeffrey H AU - Lawson JH CN - Hemostasis Summit Participants LA - eng PT - Journal Article PT - Review DEP - 20091210 PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Hemostatics) SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/*therapy MH - Blood Loss, Surgical/prevention & control MH - Cardiac Surgical Procedures MH - Clinical Trials as Topic MH - Endothelium, Vascular/physiology MH - Hemorrhage/etiology/*therapy MH - Hemostasis/*physiology MH - Hemostatic Techniques MH - Hemostatics/therapeutic use MH - Humans MH - Wounds and Injuries/complications RF - 50 FIR - Levy, Jerrold H IR - Levy JH FIR - Kessler, Craig IR - Kessler C FIR - Dutton, Richard IR - Dutton R FIR - Hemphill, J Claude IR - Hemphill JC FIR - Holcomb, John IR - Holcomb J FIR - Lawson, Jeffrey IR - Lawson J FIR - Shander, Aryeh IR - Shander A FIR - Aird, Bill IR - Aird B FIR - Cotton, Bryan A IR - Cotton BA FIR - Dworkin, Gary IR - Dworkin G FIR - Hess, John R IR - Hess JR FIR - Hoffman, Maureane IR - Hoffman M FIR - Key, Nigel IR - Key N FIR - Mazer, David IR - Mazer D FIR - Paidas, Michael J IR - Paidas MJ FIR - Wolfe, Roger Shere IR - Wolfe RS FIR - Smith, Peter IR - Smith P FIR - Steiner, Marie IR - Steiner M FIR - Urban, Michael K IR - Urban MK FIR - Wade, Charlie IR - Wade C FIR - Zabramski, Joseph IR - Zabramski J EDAT- 2009/12/17 06:00 MHDA- 2010/02/09 06:00 CRDT- 2009/12/17 06:00 PHST- 2009/12/17 06:00 [entrez] PHST- 2009/12/17 06:00 [pubmed] PHST- 2010/02/09 06:00 [medline] AID - ANE.0b013e3181c84ba5 [pii] AID - 10.1213/ANE.0b013e3181c84ba5 [doi] PST - ppublish SO - Anesth Analg. 2010 Feb 1;110(2):354-64. doi: 10.1213/ANE.0b013e3181c84ba5. Epub 2009 Dec 10. PMID- 19912209 OWN - NLM STAT- MEDLINE DCOM- 20100701 LR - 20100603 IS - 1464-410X (Electronic) IS - 1464-4096 (Linking) VI - 105 IP - 10 DP - 2010 May TI - Very long half-life plasminogen activator inhibitor type 1 reduces bleeding in a mouse model. PG - 1469-76 LID - 10.1111/j.1464-410X.2009.08962.x [doi] AB - OBJECTIVE: To investigate the potential for the future clinical use of a very long half-life plasminogen activator inhibitor type 1 (VLHL PAI-1) as a haemostatic agent. MATERIALS AND METHODS: We developed a VLHL PAI-1 (half-life >700 h) recombinant mutant of PAI-1 and assessed VLHL PAI-1 for its ability to inhibit fibrinolysis in vitro using human, rabbit, mouse and rat blood. Fibrin clot lysis time, monitored by thromboelastometry, was determined at various concentrations of VLHL PAI-1. Also, we determined total bleeding time and total blood loss of control, VLHL PAI-1-, tissue-type plasminogen activator (tPA)- and tPA + VLHL PAI-1-treated mice. RESULTS: Using a thromboelastometer, mouse blood was most similar to human blood in its coagulation and fibrinolytic characteristics. We evaluated the affect of VLHL PAI-1 on haemostasis using the mouse model and showed that VLHL PAI-1 is an effective inhibitor of fibrin clot degradation. It reduced time of bleeding and total blood loss. CONCLUSION: VLHL PAI-1 may provide an important physiological mechanism to protect clots from premature dissolution in surgical and trauma settings. FAU - Jankun, Jerzy AU - Jankun J AD - Urology Research Center, Department of Urology, Health Science Campus, The University of Toledo, Toledo, OH 43614, USA. Jerzy.Jankun@utoledo.edu FAU - Selman, Steven H AU - Selman SH FAU - Keck, Rick W AU - Keck RW FAU - Lysiak-Szydlowska, Wieslawa AU - Lysiak-Szydlowska W FAU - Skrzypczak-Jankun, Ewa AU - Skrzypczak-Jankun E LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091113 PL - England TA - BJU Int JT - BJU international JID - 100886721 RN - 0 (Hemostatics) RN - 0 (Plasminogen Activator Inhibitor 1) SB - IM MH - Animals MH - Blood Coagulation/drug effects MH - Hemorrhage/*prevention & control MH - Hemostatics/*therapeutic use MH - Humans MH - Mice MH - Mice, Inbred C57BL MH - Plasminogen Activator Inhibitor 1/*therapeutic use EDAT- 2009/11/17 06:00 MHDA- 2010/07/02 06:00 CRDT- 2009/11/17 06:00 PHST- 2009/11/17 06:00 [entrez] PHST- 2009/11/17 06:00 [pubmed] PHST- 2010/07/02 06:00 [medline] AID - BJU8962 [pii] AID - 10.1111/j.1464-410X.2009.08962.x [doi] PST - ppublish SO - BJU Int. 2010 May;105(10):1469-76. doi: 10.1111/j.1464-410X.2009.08962.x. Epub 2009 Nov 13. PMID- 19882085 OWN - NLM STAT- MEDLINE DCOM- 20100901 LR - 20220410 IS - 1414-431X (Electronic) IS - 0100-879X (Linking) VI - 42 IP - 12 DP - 2009 Dec TI - Normal range values for thromboelastography in healthy adult volunteers. PG - 1210-7 LID - S0100-879X2009007500002 [pii] AB - Thromboelastography (TEG) provides a functional evaluation of coagulation. It has characteristics of an ideal coagulation test for trauma, but is not frequently used, partially due to lack of both standardized techniques and normal values. We determined normal values for our population, compared them to those of the manufacturer and evaluated the effect of gender, age, blood type, and ethnicity. The technique was standardized using citrated blood, kaolin and was performed on a Haemoscope 5000 device. Volunteers were interviewed and excluded if pregnant, on anticoagulants or having a bleeding disorder. The TEG parameters analyzed were R, K, alpha, MA, LY30, and coagulation index. All volunteers outside the manufacturer's normal range underwent extensive coagulation investigations. Reference ranges for 95% for 118 healthy volunteers were R: 3.8-9.8 min, K: 0.7-3.4 min, alpha: 47.8-77.7 degrees, MA: 49.7-72.7 mm, LY30: -2.3-5.77%, coagulation index: -5.1-3.6. Most values were significantly different from those of the manufacturer, which would have diagnosed coagulopathy in 10 volunteers, for whom additional investigation revealed no disease (81% specificity). Healthy women were significantly more hypercoagulable than men. Aging was not associated with hypercoagulability and East Asian ethnicity was not with hypocoagulability. In our population, the manufacturer's normal values for citrated blood-kaolin had a specificity of 81% and would incorrectly identify 8.5% of the healthy volunteers as coagulopathic. This study supports the manufacturer's recommendation that each institution should determine its own normal values before adopting TEG, a procedure which may be impractical. Consideration should be given to a multi-institutional study to establish wide standard values for TEG. FAU - Scarpelini, S AU - Scarpelini S AD - Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. FAU - Rhind, S G AU - Rhind SG FAU - Nascimento, B AU - Nascimento B FAU - Tien, H AU - Tien H FAU - Shek, P N AU - Shek PN FAU - Peng, H T AU - Peng HT FAU - Huang, H AU - Huang H FAU - Pinto, R AU - Pinto R FAU - Speers, V AU - Speers V FAU - Reis, M AU - Reis M FAU - Rizoli, S B AU - Rizoli SB LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091030 PL - Brazil TA - Braz J Med Biol Res JT - Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas JID - 8112917 RN - 0 (Blood Group Antigens) SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Blood Group Antigens MH - Female MH - Humans MH - Male MH - Racial Groups MH - Reference Values MH - Thrombelastography EDAT- 2009/11/03 06:00 MHDA- 2010/09/02 06:00 CRDT- 2009/11/03 06:00 PHST- 2009/05/15 00:00 [received] PHST- 2009/10/08 00:00 [accepted] PHST- 2009/11/03 06:00 [entrez] PHST- 2009/11/03 06:00 [pubmed] PHST- 2010/09/02 06:00 [medline] AID - S0100-879X2009007500002 [pii] AID - 10.1590/s0100-879x2009001200015 [doi] PST - ppublish SO - Braz J Med Biol Res. 2009 Dec;42(12):1210-7. doi: 10.1590/s0100-879x2009001200015. Epub 2009 Oct 30. PMID- 19789037 OWN - NLM STAT- MEDLINE DCOM- 20091014 LR - 20090930 IS - 1532-7361 (Electronic) IS - 0039-6060 (Linking) VI - 146 IP - 4 DP - 2009 Oct TI - Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients. PG - 764-72; discussion 772-4 LID - 10.1016/j.surg.2009.06.054 [doi] AB - BACKGROUND: Despite routine prophylaxis, thromboembolic events (TEs) in surgical patients remain a substantial problem. Furthermore, the timing and incidence of hypercoagulability, which predisposes to these events is unknown, with institutional screening programs serving primarily to establish a diagnosis after an event has occurred. Emerging evidence suggests that point of care (POC) rapid thrombelastography (r-TEG) provides a real-time analysis of comprehensive thrombostatic function, which represents an analysis of both enzymatic and platelet components of thrombus formation. We hypothesized that r-TEG can be used as a screening tool to identify hypercoagulable states in surgical patients and would predict subsequent thromboembolic events. METHODS: Rapid thrombelastography r-TEG analyses were performed on 152 critically ill patients in the surgical intensive care unit (ICU) during 7 months. Hypercoagulability was defined as clot strength (G)>12.4 dynes/cm(2). Variables of interest for identifying hypercoagulability and thromboembolic events included sex, age, operating hospital service, specific injury patterns, injury severity score (ISS), transfusion within first 24 h, ICU duration of stay, ventilator days, hospital admission days, and thromboprophylaxis. Comparisons between the hypercoagulable and normal groups or between the groups with and without thromboembolic events were performed using Chi-square tests or the Fisher exact test for categorical variables and independent sample t tests or Wilcoxon rank sum tests for continuous variables. Multivariate logistic regression analysis (LR) was performed to identify independent predictors of thromboembolic events. A receiver operating characteristic curve was used to measure the performance of G for predicting the occurrence of a TE event. All tests were 2-sided with significance of P < .05. RESULTS: In all, 86 patients (67%) were hypercoagulable by r-TEG. More than 85% of patients in the hypercoagulable group and 79% in the normal group received thromboprophylaxis during the study period. The differences between hypercoagulable and normal groups by bivariate analysis included high-risk injuries (52% vs 35%; P = .03), spinal cord injury (27% vs 12%; P = .03), median ICU duration of stay (13 vs 7 days; P < .001), median ventilator days (6 vs 2; P < .001), and median hospital duration of stay (20 vs 13 days; P < .001). A total of 16 patients (19%) of the hypercoagulable group suffered a thromboembolic event, and 10 hypercoagulable patients (12%) had thromboembolic events predicted by prior r-TEG hypercoagulability. No patients with normal coagulability by r-TEG had an event (P < .001). LR analysis showed that the strongest predictor of TE after controlling for the presence of thromboprophylaxis was elevated G value (odds ratio: 1.25, 95% confidence interval [CI]: 1.12-1.39). For every 1 dyne/cm(2) increase in G, the odds of a TE increased by 25%. CONCLUSION: These results indicate that the presence of hypercoagulability identified by r-TEG is predictive of thromboembolic events in surgical patients. Subsequent study is necessary to define optimal prophylactic treatment strategies for patients with r-TEG proven hypercoagulability. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Department of Surgery, Denver Health Medical Center, Denver, CO 80204, USA. jeffry.kashuk@dhha.org FAU - Moore, Ernest E AU - Moore EE FAU - Sabel, Allison AU - Sabel A FAU - Barnett, Carlton AU - Barnett C FAU - Haenel, James AU - Haenel J FAU - Le, Tuan AU - Le T FAU - Pezold, Michael AU - Pezold M FAU - Lawrence, Jerry AU - Lawrence J FAU - Biffl, Walter L AU - Biffl WL FAU - Cothren, C Clay AU - Cothren CC FAU - Johnson, Jeffrey L AU - Johnson JL LA - eng PT - Journal Article PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adult MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Postoperative Complications/*etiology MH - Retrospective Studies MH - Thrombelastography/*methods MH - Thromboembolism/*etiology MH - Thrombophilia/complications/*diagnosis EDAT- 2009/10/01 06:00 MHDA- 2009/10/15 06:00 CRDT- 2009/10/01 06:00 PHST- 2009/02/19 00:00 [received] PHST- 2009/06/09 00:00 [accepted] PHST- 2009/10/01 06:00 [entrez] PHST- 2009/10/01 06:00 [pubmed] PHST- 2009/10/15 06:00 [medline] AID - S0039-6060(09)00482-6 [pii] AID - 10.1016/j.surg.2009.06.054 [doi] PST - ppublish SO - Surgery. 2009 Oct;146(4):764-72; discussion 772-4. doi: 10.1016/j.surg.2009.06.054. PMID- 19775458 OWN - NLM STAT- MEDLINE DCOM- 20110302 LR - 20250104 IS - 1757-7241 (Print) IS - 1757-7241 (Electronic) IS - 1757-7241 (Linking) VI - 17 DP - 2009 Sep 23 TI - Thrombelastography and tromboelastometry in assessing coagulopathy in trauma. PG - 45 LID - 10.1186/1757-7241-17-45 [doi] AB - Death due to trauma is the leading cause of lost life years worldwide, with haemorrhage being responsible for 30-40% of trauma mortality and accounting for almost 50% of the deaths the initial 24 h. On admission, 25-35% of trauma patients present with coagulopathy, which is associated with a several-fold increase in morbidity and mortality. The recent introduction of haemostatic control resuscitation along with emerging understanding of acute post-traumatic coagulability, are important means to improve therapy and outcome in exsanguinating trauma patients. This change in therapy has emphasized the urgent need for adequate haemostatic assays to monitor traumatic coagulopathy and guide therapy. Based on the cell-based model of haemostasis, there is emerging consensus that plasma-based routine coagulation tests (RCoT), like prothrombin time (PT) and activated partial thromboplastin time (APTT), are inappropriate for monitoring coagulopathy and guide therapy in trauma. The necessity to analyze whole blood to accurately identify relevant coagulopathies, has led to a revival of the interest in viscoelastic haemostatic assays (VHA) such as Thromboelastography (TEG) and Rotation Thromboelastometry (ROTEM). Clinical studies including about 5000 surgical and/or trauma patients have reported on the benefit of using the VHA as compared to plasma-based assays, to identify coagulopathy and guide therapy. This article reviews the basic principles of VHA, the correlation between the VHA whole blood clot formation in accordance with the cell-based model of haemostasis, the current use of VHA-guided therapy in trauma and massive transfusion (haemostatic control resuscitation), limitations of VHA and future perspectives of this assay in trauma. FAU - Johansson, Par I AU - Johansson PI AD - Regional Blood Bank, Rigshospitalet, University of Copenhagen, Denmark. per.johansson@rh.regionh.dk FAU - Stissing, Trine AU - Stissing T FAU - Bochsen, Louise AU - Bochsen L FAU - Ostrowski, Sisse R AU - Ostrowski SR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20090923 PL - England TA - Scand J Trauma Resusc Emerg Med JT - Scandinavian journal of trauma, resuscitation and emergency medicine JID - 101477511 SB - IM MH - Blood Coagulation Disorders/*diagnosis/physiopathology MH - Hemostasis MH - Humans MH - *Thrombelastography MH - Wounds and Injuries/*blood PMC - PMC2758824 EDAT- 2009/09/25 06:00 MHDA- 2009/09/25 06:01 PMCR- 2009/09/23 CRDT- 2009/09/25 06:00 PHST- 2009/07/01 00:00 [received] PHST- 2009/09/23 00:00 [accepted] PHST- 2009/09/25 06:00 [entrez] PHST- 2009/09/25 06:00 [pubmed] PHST- 2009/09/25 06:01 [medline] PHST- 2009/09/23 00:00 [pmc-release] AID - 1757-7241-17-45 [pii] AID - 10.1186/1757-7241-17-45 [doi] PST - epublish SO - Scand J Trauma Resusc Emerg Med. 2009 Sep 23;17:45. doi: 10.1186/1757-7241-17-45. PMID- 19695750 OWN - NLM STAT- MEDLINE DCOM- 20091221 LR - 20250529 IS - 1532-1681 (Electronic) IS - 0268-960X (Print) IS - 0268-960X (Linking) VI - 23 IP - 6 DP - 2009 Nov TI - Resuscitation and transfusion principles for traumatic hemorrhagic shock. PG - 231-40 LID - 10.1016/j.blre.2009.07.003 [doi] AB - The transfusion approach to massive hemorrhage has continually evolved since it began in the early 1900s. It started with fresh whole blood and currently consists of virtually exclusive use of component and crystalloid therapy. Recent US military experience has reinvigorated the debate on what the most optimal transfusion strategy is for patients with traumatic hemorrhagic shock. In this review we discuss recently described mechanisms that contribute to traumatic coagulopathy, which include increased anti-coagulation factors and hyperfibrinolysis. We also describe the concept of damage control resuscitation (DCR), an early and aggressive prevention and treatment of hemorrhagic shock for patients with severe life-threatening traumatic injuries. The central tenants of DCR include hypotensive resuscitation, rapid surgical control, prevention and treatment of acidosis, hypothermia, and hypocalcemia, avoidance of hemodilution, and hemostatic resuscitation with transfusion of red blood cells, plasma, and platelets in a 1:1:1 unit ratio and the appropriate use of coagulation factors such as rFVIIa and fibrinogen-containing products (fibrinogen concentrates, cryoprecipitate). Fresh whole blood is also part of DCR in locations where it is available. Additional concepts to DCR since its original description that can be considered are the preferential use of "fresh" RBCs, and when available thromboelastography to direct blood product and hemostatic adjunct (anti-fibrinolytics and coagulation factor) administration. Lastly we discuss the importance of an established massive transfusion protocol to rapidly employ DCR and hemostatic resuscitation principles. While the majority of recent trauma transfusion papers are supportive of these general concepts, there is no Level 1 or 2 data available. Taken together, the preponderance of data suggests that these concepts may significantly decrease mortality in massively transfused trauma patients. FAU - Spinella, Philip C AU - Spinella PC AD - University of Connecticut, Pediatric Intensivist, Department of Pediatrics, Department of Surgery, Connecticut Children's Medical Center, Hartford, CT 06106, USA. pspinella@ccmckids.org FAU - Holcomb, John B AU - Holcomb JB LA - eng GR - P50 GM038529/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Review DEP - 20090819 PL - England TA - Blood Rev JT - Blood reviews JID - 8708558 SB - IM MH - *Blood Transfusion MH - Humans MH - *Resuscitation MH - Shock, Hemorrhagic/*therapy MH - Shock, Traumatic/*therapy PMC - PMC3159517 MID - NIHMS299669 COIS- Conflict of interest statement No conflict of interest. EDAT- 2009/08/22 09:00 MHDA- 2009/12/22 06:00 PMCR- 2011/08/22 CRDT- 2009/08/22 09:00 PHST- 2009/08/22 09:00 [entrez] PHST- 2009/08/22 09:00 [pubmed] PHST- 2009/12/22 06:00 [medline] PHST- 2011/08/22 00:00 [pmc-release] AID - S0268-960X(09)00041-1 [pii] AID - 10.1016/j.blre.2009.07.003 [doi] PST - ppublish SO - Blood Rev. 2009 Nov;23(6):231-40. doi: 10.1016/j.blre.2009.07.003. Epub 2009 Aug 19. PMID- 19691584 OWN - NLM STAT- MEDLINE DCOM- 20091124 LR - 20110825 IS - 1476-4431 (Electronic) IS - 1476-4431 (Linking) VI - 19 IP - 1 DP - 2009 Feb TI - Pulmonary thromboembolism. PG - 30-52 LID - 10.1111/j.1476-4431.2009.00388.x [doi] AB - OBJECTIVE: To review the pathophysiology, clinical signs, diagnosis, and treatment of pulmonary thromboembolism (PTE) in small animals. DATA SOURCES: Human and veterinary clinical studies, reviews, texts, and recent research in canine and feline PTE diagnosis and thromboembolic therapeutics. HUMAN DATA SYNTHESIS: In humans, clinical probability assessment and point-of-care D-dimer-based algorithms are widely used. Computed tomography pulmonary angiography is the gold standard for PTE diagnosis in humans. Echocardiography is increasingly used for bedside assessment of affected patients. In low-risk human patients anticoagulants alone are recommended while patients with cardiogenic shock are treated with thrombolytics followed by anticoagulation. VETERINARY DATA SYNTHESIS: PTE is associated with numerous predisposing conditions causing hypercoagulability, blood flow stasis, or endothelial injury. Identifying at-risk patients is key to diagnosis in small animals. Thromboelastography provides a method for identifying hypercoagulable patients. Computed tomography pulmonary angiography may replace selective pulmonary angiography as the imaging technique of choice for PTE diagnosis. PTE therapy consists of supportive treatment combined with appropriate, individualized thromboembolic pharmacotherapy for acute treatment and chronic management. Thrombolytic therapy for PTE remains controversial but may be indicated in hemodynamically unstable acute PTE. Thromboprophylaxis in specific conditions is rational although evidence of efficacy is limited. Prognosis depends upon degree of cardiopulmonary compromise and patient response to therapy. Mortality rates in small animals are unknown. CONCLUSIONS: New diagnostic techniques and advances in therapy offer significant potential for improvements in the identification and treatment of PTE in small animals. Further study must be directed to validating new diagnostic modalities and evaluating therapeutic regimes. FAU - Goggs, Robert AU - Goggs R AD - Department of Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, Herts, UK. FAU - Benigni, Livia AU - Benigni L FAU - Fuentes, Virginia Luis AU - Fuentes VL FAU - Chan, Daniel L AU - Chan DL LA - eng PT - Journal Article PT - Review PL - United States TA - J Vet Emerg Crit Care (San Antonio) JT - Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) JID - 101152804 RN - 0 (Anticoagulants) SB - IM MH - Animals MH - Anticoagulants/therapeutic use MH - Cat Diseases/diagnosis/*therapy MH - Cats MH - Dog Diseases/diagnosis/*therapy MH - Dogs MH - Humans MH - Pulmonary Embolism/diagnosis/therapy/*veterinary RF - 244 EDAT- 2009/08/21 09:00 MHDA- 2009/12/16 06:00 CRDT- 2009/08/21 09:00 PHST- 2009/08/21 09:00 [entrez] PHST- 2009/08/21 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - VEC388 [pii] AID - 10.1111/j.1476-4431.2009.00388.x [doi] PST - ppublish SO - J Vet Emerg Crit Care (San Antonio). 2009 Feb;19(1):30-52. doi: 10.1111/j.1476-4431.2009.00388.x. PMID- 19667878 OWN - NLM STAT- MEDLINE DCOM- 20090917 LR - 20250529 IS - 1529-8809 (Electronic) IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 67 IP - 2 DP - 2009 Aug TI - Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. PG - 266-75; discussion 275-6 LID - 10.1097/TA.0b013e3181ae6f1c [doi] AB - OBJECTIVES: To investigate the hemostatic status of critically ill, nonbleeding trauma patients. We hypothesized that a hypercoagulable state exists in patients early after severe injury and that the pattern of clotting and fibrinolysis are similar between burned and nonburn trauma patients. MATERIALS: Patients admitted to the surgical or burn intensive care unit within 24 hours after injury were enrolled. Blood samples were drawn on days 0 through 7. Laboratory tests included prothrombin time (PT), activated partial thromboplastin time (aPTT), levels of activated factor XI, D-dimer, protein C percent activity, antithrombin III percent activity, and thromboelastography (TEG). RESULTS: Study subjects were enrolled from April 1, 2004, to May 31, 2005, and included nonburn trauma patients (n = 33), burned patients (n = 25), and healthy (control) subjects (n = 20). Despite aggressive thromboprophylaxis, three subjects (2 burned and 1 nonburn trauma patients [6%]) had pulmonary embolism during hospitalization. Compared with controls, all patients had prolonged PT and aPTT (p < 0.05). The rate of clot formation (alpha angle) and maximal clot strength were higher for patients compared with those of controls (p < 0.05), indicating a hypercoagulable state. Injured patients also had lower protein C and antithrombin III percent activities and higher fibrinogen levels (p < 0.05 for all). Activated factor XI was elevated in 38% of patients (control subjects had undetectable levels). DISCUSSION: Thromboelastography analysis of whole blood showed that patients were in a hypercoagulable state; this was not detected by plasma PT or aPTT. The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved. FAU - Park, Myung S AU - Park MS AD - U S Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. park.myung@mayo.edu FAU - Martini, Wenjun Z AU - Martini WZ FAU - Dubick, Michael A AU - Dubick MA FAU - Salinas, Jose AU - Salinas J FAU - Butenas, Saulius AU - Butenas S FAU - Kheirabadi, Bijan S AU - Kheirabadi BS FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Vos, Jeffrey A AU - Vos JA FAU - Guymon, Charles H AU - Guymon CH FAU - Wolf, Steven E AU - Wolf SE FAU - Mann, Kenneth G AU - Mann KG FAU - Holcomb, John B AU - Holcomb JB LA - eng GR - P01 HL046703/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Protein C) RN - 9000-94-6 (Antithrombin III) RN - EC 3.4.21.27 (Factor XIa) SB - IM MH - Adult MH - Antithrombin III/analysis MH - Case-Control Studies MH - Factor XIa/analysis MH - Female MH - Humans MH - Intensive Care Units MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Protein C/analysis MH - Prothrombin Time MH - Pulmonary Embolism/diagnosis/etiology MH - *Thrombelastography MH - Thrombophilia/*diagnosis/*etiology MH - Venous Thromboembolism/diagnosis/etiology MH - Wounds and Injuries/*complications PMC - PMC3415284 MID - NIHMS326445 COIS- Conflict of interest: None EDAT- 2009/08/12 09:00 MHDA- 2009/09/18 06:00 PMCR- 2012/08/09 CRDT- 2009/08/12 09:00 PHST- 2009/08/12 09:00 [entrez] PHST- 2009/08/12 09:00 [pubmed] PHST- 2009/09/18 06:00 [medline] PHST- 2012/08/09 00:00 [pmc-release] AID - 00005373-200908000-00007 [pii] AID - 10.1097/TA.0b013e3181ae6f1c [doi] PST - ppublish SO - J Trauma. 2009 Aug;67(2):266-75; discussion 275-6. doi: 10.1097/TA.0b013e3181ae6f1c. PMID- 19656278 OWN - NLM STAT- MEDLINE DCOM- 20100302 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 7 IP - 10 DP - 2009 Oct TI - Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non-compressible hemorrhage in swine. PG - 1663-71 LID - 10.1111/j.1538-7836.2009.03562.x [doi] AB - INTRODUCTION: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non-compressible hemorrhage, using a porcine liver injury model. METHODS: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. RESULTS: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg(-1)) was lower in Stasix-treated animals (22.2 +/- 3.5) than in control animals (34.7 +/- 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. CONCLUSIONS: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non-compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage. FAU - Hawksworth, J S AU - Hawksworth JS AD - Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD 20910, USA. FAU - Elster, E A AU - Elster EA FAU - Fryer, D AU - Fryer D FAU - Sheppard, F AU - Sheppard F FAU - Morthole, V AU - Morthole V FAU - Krishnamurthy, G AU - Krishnamurthy G FAU - Tomori, T AU - Tomori T FAU - Brown, T S AU - Brown TS FAU - Tadaki, D K AU - Tadaki DK LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20090728 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 SB - IM MH - Animals MH - Female MH - Freeze Drying MH - Hemorrhage/*therapy MH - *Hemostatic Techniques/adverse effects MH - Humans MH - Lacerations/complications MH - Liver/injuries MH - Liver Diseases/etiology/*therapy MH - Male MH - *Platelet Transfusion/adverse effects MH - Sus scrofa MH - Thrombosis/etiology EDAT- 2009/08/07 09:00 MHDA- 2010/03/03 06:00 CRDT- 2009/08/07 09:00 PHST- 2009/08/07 09:00 [entrez] PHST- 2009/08/07 09:00 [pubmed] PHST- 2010/03/03 06:00 [medline] AID - S1538-7836(22)10580-5 [pii] AID - 10.1111/j.1538-7836.2009.03562.x [doi] PST - ppublish SO - J Thromb Haemost. 2009 Oct;7(10):1663-71. doi: 10.1111/j.1538-7836.2009.03562.x. Epub 2009 Jul 28. PMID- 19620551 OWN - NLM STAT- MEDLINE DCOM- 20090807 LR - 20220330 IS - 1538-3644 (Electronic) IS - 0004-0010 (Linking) VI - 144 IP - 7 DP - 2009 Jul TI - Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. PG - 685-90 LID - 10.1001/archsurg.2009.111 [doi] AB - HYPOTHESIS: We hypothesize that the 2 antithrombotic treatment regimens, systemic heparin sodium vs antiplatelet agents, are equivalent for the treatment of blunt cerebrovascular injuries (BCVIs) to prevent devastating injury-related strokes. DESIGN: Retrospective review of a prospective database. SETTING: Level I trauma center. PATIENTS: Patients with BCVIs from January 1, 1997, to January 1, 2007. MAIN OUTCOME MEASURES: Incidence of cerebrovascular accident (CVA), stratified by treatment. RESULTS: During the study period, 422 BCVIs were identified in 301 patients (64.8% men; mean [SEM] age, 37.0 [0.8] years; mean [SEM] injury severity score, 27.0 [0.9]). A total of 22 patients presented with neurologic ischemia, and 5 patients sustained CVAs after embolization and/or stenting of an injury. Treatment was initiated for 282 asymptomatic BCVIs (heparin, 192; aspirin, 67; aspirin and/or clopidogrel, 23); 1 patient had a CVA (0.5%). Of 107 patients with untreated, asymptomatic BCVIs, 23 (21.5%) had a CVA. For untreated patients sustaining BCVI-related CVAs, the mean (SEM) time to diagnosis was 58 (10) hours. For those who did not exhibit symptoms within 2 hours of injury, mean time to diagnosis of CVA was 75 (11) hours. Injury healing rates (heparin, 39%; aspirin, 43%; aspirin/clopidogrel, 46%) and injury progression rates (12%; 10%; 15%) were equivalent between therapeutic regimens. CONCLUSIONS: With an overall CVA risk of 21% and a documented latent period, comprehensive screening, early diagnosis, and institution of antithrombotic therapy for BCVI are clearly warranted. The type of treatment, heparin vs antiplatelet agents, does not appear to affect either stroke risk or injury healing rates. FAU - Cothren, C Clay AU - Cothren CC AD - Department of Surgery, Denver Health Medical Center, Denver, CO 80204, USA. clay.cothren@dhha.org FAU - Biffl, Walter L AU - Biffl WL FAU - Moore, Ernest E AU - Moore EE FAU - Kashuk, Jeffry L AU - Kashuk JL FAU - Johnson, Jeffrey L AU - Johnson JL LA - eng PT - Journal Article PL - United States TA - Arch Surg JT - Archives of surgery (Chicago, Ill. : 1960) JID - 9716528 RN - 0 (Fibrinolytic Agents) RN - 0 (Platelet Aggregation Inhibitors) RN - 9005-49-6 (Heparin) SB - IM MH - Adult MH - Brain Injuries/complications/*drug therapy MH - Cerebrovascular Disorders/*drug therapy MH - Contraindications MH - Female MH - Fibrinolytic Agents/*administration & dosage MH - Head Injuries, Closed/*drug therapy MH - Heparin/*administration & dosage MH - Humans MH - Injury Severity Score MH - Male MH - Platelet Aggregation Inhibitors/*administration & dosage MH - Retrospective Studies MH - Stroke/epidemiology/*prevention & control MH - Thrombelastography MH - Treatment Outcome EDAT- 2009/07/22 09:00 MHDA- 2009/08/08 09:00 CRDT- 2009/07/22 09:00 PHST- 2009/07/22 09:00 [entrez] PHST- 2009/07/22 09:00 [pubmed] PHST- 2009/08/08 09:00 [medline] AID - 144/7/685 [pii] AID - 10.1001/archsurg.2009.111 [doi] PST - ppublish SO - Arch Surg. 2009 Jul;144(7):685-90. doi: 10.1001/archsurg.2009.111. PMID- 19590321 OWN - NLM STAT- MEDLINE DCOM- 20090728 LR - 20240103 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 67 IP - 1 DP - 2009 Jul TI - Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. PG - 125-31 LID - 10.1097/TA.0b013e31818b2483 [doi] AB - BACKGROUND: The aim of this study was to diagnose hyperfibrinolysis (HF) and its pattern using thrombelastometry and to correlate the diagnosis with mortality. Furthermore, routine laboratory based and the rotational thrombelastometry analyzer (ROTEM)-derived variables were also correlated with survival. METHODS: Severe trauma patients showing HF in ROTEM were consecutively enrolled in the study. Three different HF patterns were compared: fulminant breakdown within 30 minutes, intermediate HF of 30 to 60 minutes, and late HF after 60 minutes. Injury severity score (ISS), hemodynamics, hemoglobin, hematocrit, platelet count (PC), fibrinogen, and ROTEM variables at admission were analyzed. The observed mortality was compared with the predicted trauma and injury severity score mortality. RESULTS: Thirty-three patients were diagnosed with HF. The mean ISS was 47 +/- 14. Fulminant, intermediate, or late HF (n = 11 each group) resulted in 100%, 91%, or 73% mortality, respectively, with the best prognosis for late HF (p = 0.0031). The actual overall mortality of HF (88%) exceeded the predicted trauma and injury severity score mortality (70%) (p = 0.039). Lower PC (123 +/- 53 vs. 193 +/- 91; p = 0.034), ROTEM prolonged clot formation time [CFT, 359 (140/632) vs. 82 (14/190); p = 0.042], and lower platelet contribution to maximum clot firmness [MCF(EXTEM) - MCF(FIBTEM), 34 (20/40) vs. 46 (40/53); p = 0.026] were associated with increased mortality. CONCLUSION: ROTEM-based diagnosis of HF predicted outcome. Further independent predictors of death were combination of HF with hemorrhagic shock, low PC, and prolonged CFT in ROTEM. ROTEM-based point of care testing in the emergency room is thus able to identify prognostic factors such as prolonged CFT and low platelet contribution to clot firmness (MCF(EX) - MCF(FIB)) earlier than standard laboratory-based monitoring. FAU - Schochl, Herbert AU - Schochl H AD - Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, Austria. FAU - Frietsch, Thomas AU - Frietsch T FAU - Pavelka, Michaela AU - Pavelka M FAU - Jambor, Csilla AU - Jambor C LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Blood Coagulation Factors) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/blood/*diagnosis/etiology MH - Blood Coagulation Factors/analysis MH - Diagnosis, Differential MH - Female MH - Fibrinolysis/*physiology MH - Follow-Up Studies MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prognosis MH - Retrospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds, Nonpenetrating/blood/*complications MH - Young Adult EDAT- 2009/07/11 09:00 MHDA- 2009/07/29 09:00 CRDT- 2009/07/11 09:00 PHST- 2009/07/11 09:00 [entrez] PHST- 2009/07/11 09:00 [pubmed] PHST- 2009/07/29 09:00 [medline] AID - 00005373-200907000-00022 [pii] AID - 10.1097/TA.0b013e31818b2483 [doi] PST - ppublish SO - J Trauma. 2009 Jul;67(1):125-31. doi: 10.1097/TA.0b013e31818b2483. PMID- 19577246 OWN - NLM STAT- MEDLINE DCOM- 20090911 LR - 20220330 IS - 1095-8673 (Electronic) IS - 0022-4804 (Linking) VI - 156 IP - 1 DP - 2009 Sep TI - Noncitrated whole blood is optimal for evaluation of postinjury coagulopathy with point-of-care rapid thrombelastography. PG - 133-8 LID - 10.1016/j.jss.2009.03.046 [doi] AB - INTRODUCTION: Progressive postinjury coagulopathy has become the fundamental rationale for damage control surgery, and the decision to abort operative intervention must occur prior to overt laboratory confirmation of coagulopathy. Current coagulation testing is most commonly performed for monitoring anticoagulation therapy, the results are delayed, and the applicability of these tests in the trauma setting is questionable. Point-of-care (POC) rapid thrombelastography (r-TEG) provides real time analysis of thrombostatic function, which may allow for accurate, goal directed therapy. The test differs from standard thrombelastography (TEG) because the clotting process and subsequent analysis is accelerated by the addition of tissue factor to the whole blood sample, but is limited by the requirement that the analysis be performed within 4 min of blood draw to prevent clot formation. Consequently, citrated specimens have been proposed to obviate this time limitation. We hypothesized that the speed of r-TEG analysis following tissue factor addition to citrated blood might compromise accurate determinations compared with noncitrated whole blood. Additionally, we sought to compare the use of r-TEG with conventional coagulation tests in analysis of postinjury coagulopathy. METHODS: We conducted a retrospective study of severely injured patients entered into our trauma database between January and June 2008 who were at risk for postinjury coagulopathy. Patients needed simultaneous conventional coagulation (INR, fibrinogen, platelet count) and r-TEG specimens with either fresh or citrated whole blood for inclusion in the study. kappa-Statistics were used to determine the agreement between the tests in predicting hypocoagulability. McNemar's chi(2) tests were used to compare theoretical blood product administration between r-TEG and conventional coagulation tests for noncitrated specimens. Therapeutic transfusion triggers were: INR (>1.5) and r-TEG ACT (>125 s) for FFP administration; fibrinogen (<133 mg/dL) and alpha-angle (<63 degrees ) for cryoprecipitate; and platelet count (<100K) and maximum amplitude (MA) (<52 mm) for aphaeresis platelets. Statistical significance was established as P<0.05 using two-sided tests. RESULTS: Forty-four patients met the inclusion criteria. kappa-Values (correlation) were higher in noncitrated versus citrated specimens for all comparisons between conventional and r-TEG tests, indicating better performance of r-TEG with the noncitrated specimens. FFP would have been administered to significantly more patients based on conventional transfusion triggers (61.5% by INR transfusion triggers versus 26.9% by r-TEG-ACT triggers, P=0.003). There was no statistically significant difference in potential cryoprecipitate or aphaeresis platelet administration. CONCLUSION: POC r-TEG is superior when performed with uncitrated versus citrated whole blood for evaluation of postinjury coagulation status. As a real time measure of total thrombostatic function, our preliminary data suggest that r-TEG may effectively guide transfusion therapy and result in reduced FFP administration compared with conventional coagulation tests. FAU - Kashuk, Jeffry L AU - Kashuk JL AD - Department of Surgery, Denver Health Medical Center, University of Colorado at Denver, Denver, CO 80204, USA. jeffry.kashuk@dhha.org FAU - Moore, Ernest E AU - Moore EE FAU - Le, Tuan AU - Le T FAU - Lawrence, Jerry AU - Lawrence J FAU - Pezold, Michael AU - Pezold M FAU - Johnson, Jeffrey L AU - Johnson JL FAU - Cothren, Clay C AU - Cothren CC FAU - Biffl, Walter L AU - Biffl WL FAU - Barnett, Carlton AU - Barnett C FAU - Sabel, Allison AU - Sabel A LA - eng PT - Comparative Study PT - Journal Article DEP - 20090503 PL - United States TA - J Surg Res JT - The Journal of surgical research JID - 0376340 RN - 2968PHW8QP (Citric Acid) RN - 9035-58-9 (Thromboplastin) SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - *Citric Acid MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - Point-of-Care Systems MH - Retrospective Studies MH - Thrombelastography/*methods MH - *Thromboplastin MH - Wounds and Injuries/*complications MH - Young Adult EDAT- 2009/07/07 09:00 MHDA- 2009/09/12 06:00 CRDT- 2009/07/07 09:00 PHST- 2009/01/08 00:00 [received] PHST- 2009/03/21 00:00 [revised] PHST- 2009/03/25 00:00 [accepted] PHST- 2009/07/07 09:00 [entrez] PHST- 2009/07/07 09:00 [pubmed] PHST- 2009/09/12 06:00 [medline] AID - S0022-4804(09)00157-7 [pii] AID - 10.1016/j.jss.2009.03.046 [doi] PST - ppublish SO - J Surg Res. 2009 Sep;156(1):133-8. doi: 10.1016/j.jss.2009.03.046. Epub 2009 May 3. PMID- 19527478 OWN - NLM STAT- MEDLINE DCOM- 20091201 LR - 20161125 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 49 IP - 10 DP - 2009 Oct TI - The in vitro effect of recombinant factor VIIa on coated platelet formation and clot dynamics of stored platelet concentrates. PG - 2186-94 LID - 10.1111/j.1537-2995.2009.02242.x [doi] AB - BACKGROUND: Storage can negatively impact the hemostatic potential of platelet concentrates (PCs) used for transfusion. At the site of vascular injury, normal platelets (PLTs) are hypothesized to change into highly procoagulant-coated PLTs upon costimulation with collagen and thrombin. We investigated whether activated recombinant factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S) could improve the ability of stored PLTs to support coagulation under conditions that promote the formation of coated PLTs. STUDY DESIGN AND METHODS: PCs stored for 1, 4, 6, and 8 days were costimulated with thrombin and with convulxin, a collagen glycoprotein VI receptor agonist, to create coated PLTs. The effect of rFVIIa on the ability of stored PCs to form coated PLTs, generate thrombin, and impact clot dynamics was evaluated by flow cytometry, a plasma-based assay, and thrombelastography, respectively. RESULTS: Coated PLT formation decreased significantly with increasing storage time (80% vs. 50%-55%, p < 0.05), and this was not affected by the addition of rFVIIa. rFVIIa accelerated thrombin generation (p < 0.001) and clot formation (p < 0.001) and significantly increased thrombin generation throughout the storage period (p < 0.001). Resistance to fibrinolysis was impaired at the end of storage, and this was not affected by the addition of rFVIIa. CONCLUSION: rFVIIa accelerated thrombin and clot formation throughout storage, with the most pronounced effect observed in the PCs that had been stored for the shortest length of time (Day 1). Resistance to fibrinolysis was gradually impaired throughout the storage period and was not affected by the addition of rFVIIa. FAU - Svendsen, Mette S AU - Svendsen MS AD - Blood Bank, Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. FAU - Kristensen, Annemarie T AU - Kristensen AT FAU - Bochsen, Louise AU - Bochsen L FAU - Salado-Jimena, Jose A AU - Salado-Jimena JA FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20090610 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Coagulants) RN - 0 (Crotalid Venoms) RN - 0 (Lectins, C-Type) RN - 0 (Platelet Glycoprotein GPIIb-IIIa Complex) RN - 0 (Recombinant Proteins) RN - 37206-04-5 (convulxin) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Platelets/chemistry/*drug effects MH - Coagulants/*pharmacology MH - Crotalid Venoms/chemistry MH - Factor VIIa/*pharmacology MH - Fibrinolysis/drug effects MH - Flow Cytometry MH - Humans MH - Lectins, C-Type/chemistry MH - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors/metabolism MH - Recombinant Proteins/pharmacology MH - Thrombelastography MH - Thrombin/chemistry EDAT- 2009/06/17 09:00 MHDA- 2009/12/16 06:00 CRDT- 2009/06/17 09:00 PHST- 2009/06/17 09:00 [entrez] PHST- 2009/06/17 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - TRF02242 [pii] AID - 10.1111/j.1537-2995.2009.02242.x [doi] PST - ppublish SO - Transfusion. 2009 Oct;49(10):2186-94. doi: 10.1111/j.1537-2995.2009.02242.x. Epub 2009 Jun 10. PMID- 19524872 OWN - NLM STAT- MEDLINE DCOM- 20091001 LR - 20090615 IS - 1931-5244 (Print) IS - 1878-1810 (Linking) VI - 154 IP - 1 DP - 2009 Jul TI - Early evaluation of acute traumatic coagulopathy by thrombelastography. PG - 34-9 LID - 10.1016/j.trsl.2009.04.001 [doi] AB - Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, Ill) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t-testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude (MA)), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 +/- 17.1 vs MA = 35.7 +/- 19.3, P = 0.004) and a correlation of fibrinogen <100 mg/dL with fatalities (P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 +/- 11,618 versus 270 +/- 393 s (P = < 0.001), and MA was 46.4 +/- 22.4 versus 64.7 +/- 9.8 mm (P < 0.001). Hyperfibrinolysis (percent fibrinolysis after 60 min (LY60) >15%) was observed in 3 patients in the ED with a 67% fatality rate (P = < 0.001 by chi-square testing). PlateletMapping assays correlated with the need for blood transfusion. The abnormal TEG System parameters correlated with fatality. These coagulopathies were already evident OS. The TEG assays can assess coagulopathy, platelet dysfunction, and hyperfibrinolysis at an early stage posttrauma and suggest more effective interventions. FAU - Carroll, Roger C AU - Carroll RC AD - Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn 37920, USA. RCCarrol@mc.utmck.edu FAU - Craft, Robert M AU - Craft RM FAU - Langdon, Russell J AU - Langdon RJ FAU - Clanton, Colin R AU - Clanton CR FAU - Snider, Carolyn C AU - Snider CC FAU - Wellons, Douglas D AU - Wellons DD FAU - Dakin, Patrick A AU - Dakin PA FAU - Lawson, Christy M AU - Lawson CM FAU - Enderson, Blaine L AU - Enderson BL FAU - Kurek, Stanley J AU - Kurek SJ LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20090503 PL - United States TA - Transl Res JT - Translational research : the journal of laboratory and clinical medicine JID - 101280339 SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/*etiology MH - Blood Transfusion MH - Decision Making MH - Evidence-Based Medicine MH - Female MH - Humans MH - Male MH - Middle Aged MH - Plasma MH - Platelet Transfusion MH - Prospective Studies MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications/therapy EDAT- 2009/06/16 09:00 MHDA- 2009/10/02 06:00 CRDT- 2009/06/16 09:00 PHST- 2008/11/17 00:00 [received] PHST- 2009/04/02 00:00 [revised] PHST- 2009/04/03 00:00 [accepted] PHST- 2009/06/16 09:00 [entrez] PHST- 2009/06/16 09:00 [pubmed] PHST- 2009/10/02 06:00 [medline] AID - S1931-5244(09)00113-3 [pii] AID - 10.1016/j.trsl.2009.04.001 [doi] PST - ppublish SO - Transl Res. 2009 Jul;154(1):34-9. doi: 10.1016/j.trsl.2009.04.001. Epub 2009 May 3. PMID- 19509608 OWN - NLM STAT- MEDLINE DCOM- 20090630 LR - 20090610 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 66 IP - 6 DP - 2009 Jun TI - Thrombelastography versus AntiFactor Xa levels in the assessment of prophylactic-dose enoxaparin in critically ill patients. PG - 1509-15; discussion 1515-7 LID - 10.1097/TA.0b013e3181a51e33 [doi] AB - BACKGROUND: A standard dose of enoxaparin is frequently used for deep venous thrombosis (DVT) prophylaxis. Evidence suggests inconsistent bioavailability in intensive care unit (ICU) patients. Antifactor Xa activity (anti-Xa) has been used to monitor enoxaparin dosing but its accuracy and availability are problematic. Thrombelastography (TEG) is used to evaluate coagulation in diverse settings. The purpose of this study was to analyze whether TEG could be used to predict which enoxaparin-treated patients would develop DVT. METHODS: Two hundred sixty-one simultaneous enoxaparin-active (active) and enoxaparin-neutralized (neutral) TEGs were performed in 61 surgical ICU patients over four consecutive days. Patient characteristics and anti-Xa were collected. DVT screening was per ICU protocol. RESULTS: Mean (+/-SEM) age was 54 (+/-2.3) years and Acute Physiology and Chronic Health Evaluation II score was 17 (+/-0.7). There were 30 trauma and 31 general surgery patients (69% men). The DVT rate was 28%. Time to clot formation (R) and percent lysis at 30 minutes were different between active versus neutralized blood (p < 0.001). R time was 1.5 minutes shorter in patients with DVT versus those without (p < 0.001) indicating hypercoagulability in DVT patients. Anti-Xa levels were similar in patients with (0.135 +/- 0.012) and without (0.135 +/- 0.007) DVT (p = 0.97). There were no differences in age, body mass index, injury severity score, Acute Physiology and Chronic Health Evaluation II score, or trauma status between DVT and non-DVT groups. CONCLUSIONS: TEG demonstrates differences between enoxaparin-neutralized and enoxaparin-active blood in ICU patients that may be used to guide dosing. TEG differentiates enoxaparin-treated patients who subsequently develop DVT while anti-Xa levels do not. TEG demonstrates an enoxaparin-related increase in fibrinolysis. FAU - Van, Philbert Y AU - Van PY AD - Division of Trauma and Critical Care, Oregon Health & Science University, Portland, Oregon 97239-3098, USA. FAU - Cho, S David AU - Cho SD FAU - Underwood, Samantha J AU - Underwood SJ FAU - Morris, Melanie S AU - Morris MS FAU - Watters, Jennifer M AU - Watters JM FAU - Schreiber, Martin A AU - Schreiber MA LA - eng GR - M01 RR000334/RR/NCRR NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Antibodies) RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) RN - EC 3.4.21.6 (Factor Xa) SB - IM MH - Antibodies/*immunology MH - Anticoagulants/*administration & dosage MH - Chemoprevention MH - Critical Illness MH - Enoxaparin/*administration & dosage MH - Factor Xa/*immunology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - *Thrombelastography MH - Venous Thrombosis/*prevention & control EDAT- 2009/06/11 09:00 MHDA- 2009/07/01 09:00 CRDT- 2009/06/11 09:00 PHST- 2009/06/11 09:00 [entrez] PHST- 2009/06/11 09:00 [pubmed] PHST- 2009/07/01 09:00 [medline] AID - 00005373-200906000-00001 [pii] AID - 10.1097/TA.0b013e3181a51e33 [doi] PST - ppublish SO - J Trauma. 2009 Jun;66(6):1509-15; discussion 1515-7. doi: 10.1097/TA.0b013e3181a51e33. PMID- 19489008 OWN - NLM STAT- MEDLINE DCOM- 20091202 LR - 20250529 IS - 1552-4981 (Electronic) IS - 1552-4973 (Print) IS - 1552-4973 (Linking) VI - 91 IP - 1 DP - 2009 Oct TI - The design and testing of a dual fiber textile matrix for accelerating surface hemostasis. PG - 381-9 LID - 10.1002/jbm.b.31413 [doi] AB - The standard treatment for severe traumatic injury is frequently compression and application of gauze dressing to the site of hemorrhage. However, while able to rapidly absorb pools of shed blood, gauze fails to provide strong surface (topical) hemostasis. The result can be excess hemorrhage-related morbidity and mortality. We hypothesized that cost-effective materials (based on widespread availability of bulk fibers for other commercial uses) could be designed based on fundamental hemostatic principles to partially emulate the wicking properties of gauze while concurrently stimulating superior hemostasis. A panel of readily available textile fibers was screened for the ability to activate platelets and the intrinsic coagulation cascade in vitro. Type E continuous filament glass and a specialty rayon fiber were identified from the material panel as accelerators of hemostatic reactions and were custom woven to produce a dual fiber textile bandage. The glass component strongly activated platelets while the specialty rayon agglutinated red blood cells. In comparison with gauze in vitro, the dual fiber textile significantly enhanced the rate of thrombin generation, clot generation as measured by thromboelastography, adhesive protein adsorption and cellular attachment and activation. These results indicate that hemostatic textiles can be designed that mimic gauze in form but surpass gauze in ability to accelerate hemostatic reactions. CI - (c) 2009 Wiley Periodicals, Inc. FAU - Fischer, Thomas H AU - Fischer TH AD - Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. tfischer@med.unc.edu FAU - Vournakis, John N AU - Vournakis JN FAU - Manning, James E AU - Manning JE FAU - McCurdy, Shane L AU - McCurdy SL FAU - Rich, Preston B AU - Rich PB FAU - Nichols, Timothy C AU - Nichols TC FAU - Scull, Christopher M AU - Scull CM FAU - McCord, Marian G AU - McCord MG FAU - Decorta, Joseph A AU - Decorta JA FAU - Johnson, Peter C AU - Johnson PC FAU - Smith, Carr J AU - Smith CJ LA - eng GR - R24 HL063098/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Biomed Mater Res B Appl Biomater JT - Journal of biomedical materials research. Part B, Applied biomaterials JID - 101234238 RN - 0 (Blood Proteins) RN - 0 (Hemostatics) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Adult MH - Animals MH - Blood Coagulation MH - Blood Proteins/chemistry MH - Hemorrhage/*therapy MH - *Hemostasis MH - *Hemostatics MH - Humans MH - *Textiles MH - Thrombelastography MH - Thrombin/metabolism PMC - PMC3086053 MID - NIHMS122900 EDAT- 2009/06/03 09:00 MHDA- 2009/12/16 06:00 PMCR- 2011/05/03 CRDT- 2009/06/03 09:00 PHST- 2009/06/03 09:00 [entrez] PHST- 2009/06/03 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] PHST- 2011/05/03 00:00 [pmc-release] AID - 10.1002/jbm.b.31413 [doi] PST - ppublish SO - J Biomed Mater Res B Appl Biomater. 2009 Oct;91(1):381-9. doi: 10.1002/jbm.b.31413. PMID- 19486172 OWN - NLM STAT- MEDLINE DCOM- 20100511 LR - 20161125 IS - 1365-2516 (Electronic) IS - 1351-8216 (Linking) VI - 15 IP - 5 DP - 2009 Sep TI - Lower doses of rFVIIa therapy are safe and effective for surgical interventions in patients with severe FXI deficiency and inhibitors. PG - 1065-73 LID - 10.1111/j.1365-2516.2009.02043.x [doi] AB - Severe FXI deficiency is a rare injury-related bleeding disorder. In patients with FXI inhibitors, surgeries may be treated using recombinant activated factor VII; however, treatment safety is a major concern and the best dosing regimen as well as mode of administration is still to be defined. We describe four patients with severe factor XI deficiency and inhibitors to FXI, undergoing eight (four major) surgical procedures treated with continuous infusion of rFVIIa. Following acute MI that evolved after surgery of our first patient, all other patients were treated with low-dose bolus rFVIIa followed by low-dose continuous infusion of rFVIIa. Haemostasis was successfully achieved and no further thrombotic complications occurred. To support our clinical results ex-vivo thromboelastography studies were performed, demonstrating the differences of clot formation and lysis between patients with FXI deficiency and healthy controls and suggesting that low-dose rFVIIa corrects coagulation similarly to high-dose rFVIIa in FXI deficiency. Recombinant FVIIa at low doses may effectively induce haemostasis and seems to be a safe treatment mode in patients with FXI deficiency and inhibitors undergoing surgeries. FAU - Kenet, G AU - Kenet G AD - Thrombosis Unit, The Israeli National Hemophilia Center, The Institute of Thrombosis and Hemophilia, Sheba Medical Center, Tel Hashomer, Israel. Gili.Kenet@sheba.health.gov.il FAU - Lubetsky, A AU - Lubetsky A FAU - Luboshitz, J AU - Luboshitz J FAU - Ravid, B AU - Ravid B FAU - Tamarin, I AU - Tamarin I FAU - Varon, D AU - Varon D FAU - Martinowitz, U AU - Martinowitz U LA - eng PT - Journal Article DEP - 20090526 PL - England TA - Haemophilia JT - Haemophilia : the official journal of the World Federation of Hemophilia JID - 9442916 RN - 0 (Blood Coagulation Factor Inhibitors) RN - 0 (Hemostatics) RN - 0 (Recombinant Proteins) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Blood Coagulation Factor Inhibitors/*administration & dosage MH - Clinical Protocols MH - Dose-Response Relationship, Drug MH - Drug Administration Schedule MH - Factor VIIa/*administration & dosage MH - Factor XI Deficiency/complications/*drug therapy MH - Hemostasis, Surgical/methods MH - Hemostatics/*administration & dosage MH - Humans MH - Male MH - Middle Aged MH - Postoperative Complications/drug therapy/*prevention & control MH - Postoperative Hemorrhage/drug therapy/*prevention & control MH - Recombinant Proteins/administration & dosage EDAT- 2009/06/03 09:00 MHDA- 2010/05/12 06:00 CRDT- 2009/06/03 09:00 PHST- 2009/06/03 09:00 [entrez] PHST- 2009/06/03 09:00 [pubmed] PHST- 2010/05/12 06:00 [medline] AID - HAE2043 [pii] AID - 10.1111/j.1365-2516.2009.02043.x [doi] PST - ppublish SO - Haemophilia. 2009 Sep;15(5):1065-73. doi: 10.1111/j.1365-2516.2009.02043.x. Epub 2009 May 26. PMID- 19390256 OWN - NLM STAT- MEDLINE DCOM- 20091127 LR - 20090424 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 22 IP - 2 DP - 2009 Apr TI - Transfusion strategies in postinjury coagulopathy. PG - 289-98 LID - 10.1097/ACO.0b013e32832678ed [doi] AB - PURPOSE OF REVIEW: Coagulopathy represents one of the major challenges in the management of the severely injured patient. The present review will attempt to define the current 'optimal' transfusion strategies for the coagulopathic trauma patient and to assess potential weaknesses in the pertinent literature. RECENT FINDINGS: Existing limitations in the management of postinjury coagulopathy include the lack of a uniform definition of the entity, the lack of understanding the mechanisms, and the lack of accurate and rapid diagnostic tests. Rapid thromboelastography represents an improved diagnostic modality that allows 'point-of-care' testing of postinjury coagulopathy and monitoring of transfusion strategies. Ongoing controversies in the field include the optimal target blood pressure and the ideal threshold for blood component transfusions in the hospital. Furthermore, the concentration of plasma transfusions remains an ongoing debate. SUMMARY: Coagulopathy has a significant impact on survival after major trauma. Most recent publications in the field are of retrospective design, and thus do not allow definitive recommendations for clinical practice. Well designed prospective trials and improved basic research studies are required to improve this important aspect of trauma care. FAU - Stahel, Philip F AU - Stahel PF AD - Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204, USA. philip.stahel@dhha.org FAU - Moore, Ernest E AU - Moore EE FAU - Schreier, Star L AU - Schreier SL FAU - Flierl, Michael A AU - Flierl MA FAU - Kashuk, Jeffry L AU - Kashuk JL LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Coagulation Disorders/*etiology/physiopathology/*therapy MH - *Blood Transfusion MH - Clinical Protocols MH - Erythrocytes MH - Fibrinogen/therapeutic use MH - Humans MH - Plasma MH - Platelet Transfusion MH - Thrombelastography MH - Wounds and Injuries/*complications RF - 61 EDAT- 2009/04/25 09:00 MHDA- 2009/12/16 06:00 CRDT- 2009/04/25 09:00 PHST- 2009/04/25 09:00 [entrez] PHST- 2009/04/25 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - 00001503-200904000-00024 [pii] AID - 10.1097/ACO.0b013e32832678ed [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2009 Apr;22(2):289-98. doi: 10.1097/ACO.0b013e32832678ed. PMID- 19390255 OWN - NLM STAT- MEDLINE DCOM- 20091127 LR - 20171116 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 22 IP - 2 DP - 2009 Apr TI - The role of thromboelastometry and recombinant factor VIIa in trauma. PG - 281-8 LID - 10.1097/ACO.0b013e328325a6be [doi] AB - PURPOSE OF REVIEW: Recombinant factor VIIa (rFVIIa) and thromboelastography have acquired increasing importance in patients with severe bleeding and coagulopathy. This article reviews the current opinions regarding their use, with the purpose of clarifying the ambiguities that exist in dealing with trauma patients. RECENT FINDINGS: Recent evidence encourages the early use of rFVIIa and thromboelastography in the severe trauma patient with hemorrhagic shock, as a component of the damage control strategy. rFVIIa may decrease short-term mortality and the rate of required blood components during resuscitation, with no apparent increase in thromboembolic complications. Thromboelastometry enables better and earlier recognition of the coagulopathy accompanying such trauma patients. In patients with traumatic brain injury and coagulopathy, rFVIIa may delay or even halt the need for surgery, with no proven decrease in mortality. In those who needed urgent neurosurgical intervention, rFVIIa may rapidly correct the coagulopathy, enabling earlier and safer surgical intervention. SUMMARY: Thromboelastometry may guide the medical staff when and to whom rFVIIa could be administered. Evidence also encourages the use of rFVIIa in traumatic brain injury. More research is required to prove decreases in mortality using both thromboelastography and rFVIIa in trauma, with a focus on clear end points and goal-directed therapy. FAU - Bartal, Carmi AU - Bartal C AD - The Medical-Surgical Intensive Care Unit, Critical Care Department, Soroka University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. carmibt@zahav.net.il FAU - Yitzhak, Avraham AU - Yitzhak A LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 RN - 0 (Recombinant Proteins) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Brain Injuries/blood/drug therapy MH - Clinical Protocols MH - Contraindications MH - Factor VIIa/*therapeutic use MH - Guidelines as Topic MH - Hemorrhage/*blood/*drug therapy/etiology MH - Humans MH - Intracranial Hemorrhage, Traumatic/blood/drug therapy MH - Patient Selection MH - Recombinant Proteins/therapeutic use MH - *Thrombelastography MH - Wounds and Injuries/*blood/complications/drug therapy RF - 66 EDAT- 2009/04/25 09:00 MHDA- 2009/12/16 06:00 CRDT- 2009/04/25 09:00 PHST- 2009/04/25 09:00 [entrez] PHST- 2009/04/25 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - 00001503-200904000-00023 [pii] AID - 10.1097/ACO.0b013e328325a6be [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2009 Apr;22(2):281-8. doi: 10.1097/ACO.0b013e328325a6be. PMID- 19359945 OWN - NLM STAT- MEDLINE DCOM- 20090507 LR - 20140730 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 66 IP - 4 DP - 2009 Apr TI - Can RapidTEG accelerate the search for coagulopathies in the patient with multiple injuries? PG - 1253-7 LID - 10.1097/TA.0b013e31819d3caf [doi] AB - Early recognition of coagulopathy may improve the care of patients with multiple injuries. Rapid thrombelastography (RapidTEG) is a new variant of thrombelastography (TEG), in which coagulation is initiated by the addition of protein tissue factor. The kinetics of coagulation and the times of measurement were compared for two variants of TEG--RapidTEG and conventional TEG, in which coagulation was initiated with kaolin. The measurements were performed on blood samples from 20 patients with multiple injuries. The RapidTEG results were also compared with conventional measurements of blood coagulation. The mean time for the RapidTEG test was 19.2 +/- 3.1 minutes (mean +/- SD), in comparison with 29.9 +/- 4.3 minutes for kaolin TEG and 34.1 +/- 14.5 minutes for conventional coagulation tests. The mean time for the RapidTEG test was 30.8 +/- 5.72 minutes, in comparison with 41.5 +/- 5.66 minutes for kaolin TEG and 64.9 +/- 18.8 for conventional coagulation tests---measured from admission of the patients to the resuscitation bay until the results were available. There were significant correlations between the RapidTEG results and those from kaolin TEG and conventional coagulation tests. RapidTEG is the most rapid available test for providing reliable information on coagulopathy in patients with multiple injuries. This has implications for improving patient care. FAU - Jeger, Victor AU - Jeger V AD - Emergency Department, University Hospital Berne, Inselspital, Switzerland. FAU - Zimmermann, Heinz AU - Zimmermann H FAU - Exadaktylos, Aristomenis K AU - Exadaktylos AK LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 24H4NWX5CO (Kaolin) RN - 9035-58-9 (Thromboplastin) SB - IM CIN - J Trauma. 2009 Apr;66(4):1258. doi: 10.1097/TA.0b013e31819adb04. PMID: 19359946 CIN - J Trauma. 2009 Aug;67(2):417-8. doi: 10.1097/TA.0b013e3181ac9cdc. PMID: 19667905 CIN - J Trauma. 2010 Feb;68(2):508. doi: 10.1097/TA.0b013e3181caa82e. PMID: 20154572 MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation/drug effects MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Emergency Service, Hospital MH - Female MH - Humans MH - Kaolin/pharmacology MH - Male MH - Middle Aged MH - Multiple Trauma/*complications/*physiopathology MH - Point-of-Care Systems MH - Thrombelastography/*methods MH - Thromboplastin MH - Young Adult EDAT- 2009/04/11 09:00 MHDA- 2009/05/08 09:00 CRDT- 2009/04/11 09:00 PHST- 2009/04/11 09:00 [entrez] PHST- 2009/04/11 09:00 [pubmed] PHST- 2009/05/08 09:00 [medline] AID - 00005373-200904000-00055 [pii] AID - 10.1097/TA.0b013e31819d3caf [doi] PST - ppublish SO - J Trauma. 2009 Apr;66(4):1253-7. doi: 10.1097/TA.0b013e31819d3caf. PMID- 19300245 OWN - NLM STAT- MEDLINE DCOM- 20091127 LR - 20171116 IS - 1473-6500 (Electronic) IS - 0952-7907 (Linking) VI - 22 IP - 2 DP - 2009 Apr TI - Coagulopathy in trauma patients: what are the main influence factors? PG - 255-60 LID - 10.1097/ACO.0b013e32832922be [doi] AB - PURPOSE OF REVIEW: Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue. Uncompensated hemorrhage often culminates in death, highlighting the significance of recognizing the main influences in coagulopathy of trauma. RECENT FINDINGS: With recent improvements in prehospital care, trauma specialists face more challenging cases than ever before. Hemostatic transfusion strategies, with early and more aggressive use of plasma, platelets, cryoprecipitate and coagulation factor isolates, decrease blood loss in trauma patients. Combined with point-of-care testing for thromboelastography, coagulation panels, lactate and local pO2, there is an opportunity for frontline trauma clinicians to directly improve patient outcomes. SUMMARY: Although mortality previously was thought to be summarily independent of medical interventions and resuscitations, we now know the opposite to be true; it is our expectation and indeed our obligation to recognize and manage the coagulopathy of trauma better than in past years. In as much as we continue to prevent acidosis, hypothermia and the progressive coagulopathy following injury, trauma victims the world over are benefiting and surviving longer, living proof that demonstrates the utility of managing the coagulopathy of trauma. FAU - Maani, Christopher V AU - Maani CV AD - Department of Anesthesiology, USA Institute of Surgical Research and Army Burn Center, Brooke Army Medical Center, Fort Sam Houston 78234, USA. Christopher.Maani@us.army.mil FAU - DeSocio, Peter A AU - DeSocio PA FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Opin Anaesthesiol JT - Current opinion in anaesthesiology JID - 8813436 SB - IM MH - Acidosis/*complications MH - Blood Coagulation Disorders/etiology/*physiopathology/therapy MH - Blood Coagulation Tests MH - Hemodilution/adverse effects MH - Hemorrhage/etiology/*physiopathology/therapy MH - Humans MH - Hypothermia/*complications MH - Transfusion Reaction MH - Wounds and Injuries/complications/*physiopathology/therapy RF - 43 EDAT- 2009/03/21 09:00 MHDA- 2009/12/16 06:00 CRDT- 2009/03/21 09:00 PHST- 2009/03/21 09:00 [entrez] PHST- 2009/03/21 09:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - 10.1097/ACO.0b013e32832922be [doi] PST - ppublish SO - Curr Opin Anaesthesiol. 2009 Apr;22(2):255-60. doi: 10.1097/ACO.0b013e32832922be. PMID- 19249246 OWN - NLM STAT- MEDLINE DCOM- 20090827 LR - 20090401 IS - 1473-0502 (Print) IS - 1473-0502 (Linking) VI - 40 IP - 2 DP - 2009 Apr TI - Thrombelastography. PG - 119-23 LID - 10.1016/j.transci.2009.01.019 [doi] AB - BACKGROUND: Thromboelastography (TEG) records the continuous profiles of whole blood coagulation by measurement of the viscoelastic changes associated with fibrin polymerization, and thereby provides a global assessment of haemostatic function. In the past decades there has been an increasing interest for TEG in clinical practice. In this paper we present the rationale for the method and a discussion of the possible application of TEG. MATERIAL AND METHODS: This review is based on personal experience and literature retrieved from searches in PubMed. RESULTS AND INTERPRETATION: Currently TEG is used with standard coagulation tests to decrease the risk for bleeding and reduce the homologous blood transfusion in cardiac surgery with cardiopulmonary bypass and in liver surgery. Other applications are severe trauma, obstetric medicine, haemophilia and hypercoagulable conditions. Development of a modified TEG, using heparin in combination with reptilase and factor XIIIa, has the potential to monitor the effects of platelet inhibiting drugs. It should be kept in mind that the TEG is a global test of coagulation and therefore the need for additional haemostatic tests should be evaluated when applicable. The main advantage for TEG is an inexpensive patient near method for quick evaluation of the patient's global haemostatic system. Used by experienced hands, TEG is a valuable haemostatic test, the future of which is already present. FAU - Reikvam, Hakon AU - Reikvam H AD - Institute of Internal Medicine, Haukeland University Hospital, 5021 Bergen, Norway. Hakon.Reikvam@med.uib.no FAU - Steien, Egil AU - Steien E FAU - Hauge, Bjorn AU - Hauge B FAU - Liseth, Knut AU - Liseth K FAU - Hagen, Kristin Gjerde AU - Hagen KG FAU - Storkson, Rolf AU - Storkson R FAU - Hervig, Tor AU - Hervig T LA - eng PT - Journal Article PT - Review DEP - 20090226 PL - England TA - Transfus Apher Sci JT - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JID - 101095653 MH - Blood Coagulation Disorders/*diagnosis MH - Humans MH - Thrombelastography/*methods MH - Thrombophilia/*diagnosis RF - 25 EDAT- 2009/03/03 09:00 MHDA- 2009/08/28 09:00 CRDT- 2009/03/03 09:00 PHST- 2009/03/03 09:00 [entrez] PHST- 2009/03/03 09:00 [pubmed] PHST- 2009/08/28 09:00 [medline] AID - S1473-0502(09)00036-6 [pii] AID - 10.1016/j.transci.2009.01.019 [doi] PST - ppublish SO - Transfus Apher Sci. 2009 Apr;40(2):119-23. doi: 10.1016/j.transci.2009.01.019. Epub 2009 Feb 26. PMID- 19135193 OWN - NLM STAT- MEDLINE DCOM- 20090917 LR - 20220409 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 40 IP - 1 DP - 2009 Jan TI - Exsanguination in trauma: A review of diagnostics and treatment options. PG - 11-20 LID - 10.1016/j.injury.2008.10.007 [doi] AB - Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The aim of prehospital care of bleeding trauma patients is to deliver the patient to a facility for definitive care within the shortest amount of time by rapid transport and minimise therapy to what is necessary to maintain adequate vital signs. Rapid decisions have to be made using regional trauma triage protocols that have incorporated patient condition, transport times and the level of care than can be performed by the prehospital care providers and the receiving hospitals. The treatment of bleeding patients is aimed at two major goals: stopping the bleeding and restoration of the blood volume. Fluid resuscitation should allow for preservation of vital functions without increasing the risk for further (re)bleeding. To prevent further deterioration and subsequent exsanguinations 'permissive hypotension' may be the goal to achieve. Within the hospital, a sound trauma team activation system, including the logistic procedure as well as activation criteria, is essential for a fast and adequate response. After determination of haemorrhagic shock, all efforts have to be directed to stop the bleeding in order to prevent exsanguinations. A simultaneous effort is made to restore blood volume and correct coagulation. Reversal of coagulopathy with pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of sliding-gantry based computer tomography diagnostic systems, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery, the staged approach in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. When performing 'blind' transfusion or 'damage control resuscitation', a predetermined fixed ratio of blood components may result in the administration of higher plasma and platelets doses and may improve outcome. The role of thromboelastography and thromboelastometry as point-of-care tests for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly (10min) after the blood sample is taken. Thus, therapy guided by the test results will allow for administration of specific coagulation factors that will be depleted despite administration with fresh frozen plasma during massive transfusion of blood components. FAU - Geeraedts, L M G Jr AU - Geeraedts LM Jr AD - Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands. FAU - Kaasjager, H A H AU - Kaasjager HA FAU - van Vugt, A B AU - van Vugt AB FAU - Frolke, J P M AU - Frolke JP LA - eng PT - Journal Article PT - Review DEP - 20090108 PL - Netherlands TA - Injury JT - Injury JID - 0226040 RN - 0 (Hemostatics) SB - IM MH - Blood Transfusion MH - Emergencies MH - Emergency Medical Services/*methods MH - Hemorrhage/etiology/*therapy MH - Hemostatics/therapeutic use MH - Humans MH - Multiple Trauma/complications/*therapy MH - Resuscitation/methods MH - Shock, Hemorrhagic/therapy RF - 125 EDAT- 2009/01/13 09:00 MHDA- 2009/09/18 06:00 CRDT- 2009/01/13 09:00 PHST- 2007/11/21 00:00 [received] PHST- 2008/10/01 00:00 [revised] PHST- 2008/10/07 00:00 [accepted] PHST- 2009/01/13 09:00 [entrez] PHST- 2009/01/13 09:00 [pubmed] PHST- 2009/09/18 06:00 [medline] AID - S0020-1383(08)00469-5 [pii] AID - 10.1016/j.injury.2008.10.007 [doi] PST - ppublish SO - Injury. 2009 Jan;40(1):11-20. doi: 10.1016/j.injury.2008.10.007. Epub 2009 Jan 8. PMID- 18673348 OWN - NLM STAT- MEDLINE DCOM- 20090115 LR - 20220317 IS - 1537-2995 (Electronic) IS - 0041-1132 (Linking) VI - 48 IP - 11 DP - 2008 Nov TI - Effects of plasma dilution on tissue-factor-induced thrombin generation and thromboelastography: partly compensating role of platelets. PG - 2384-94 LID - 10.1111/j.1537-2995.2008.01872.x [doi] AB - BACKGROUND: Bleeding upon major surgery or severe trauma is treated by transfusion with crystalloids, colloids, or plasma. This treatment, however, can lead to dilutional coagulopathy and impaired hemostasis. We investigated the suitability of two integrative coagulation tests to measure the hemostatic activity of diluted plasma. STUDY DESIGN AND METHODS: Plasma from healthy donors was diluted in vitro with saline or colloid (venofundin or gelofusin). Coagulant activity in response to tissue factor was monitored by calibrated automated thrombin (CAT) generation and rotational thromboelastography (TEG), detecting formation of elastic fibrin clots. Plasma from patients receiving fluid infusion during coronary artery bypass grafting (CABG) was analyzed with the same assays. RESULTS: Optimal activity of CAT and TEG assays required the presence of 10 pmol per L tissue factor and 4 micromol per L phospholipid vesicles or 100 x 10(9) platelets (PLTs) per L. Strikingly, thrombin generation and clot formation became impaired at a higher extent of dilution with PLTs present (< or =40% plasma) than with phospholipid vesicles present (< or =60% plasma). Colloids aggravated the dilution effect on clot formation, but FFP antagonized the dilution effect on thrombin and clot formation. In contrast, fibrinogen and Factor (F)XIII only restored the impaired clot formation. In plasma samples from patients undergoing CABG, CAT and TEG assay variables were altered to an extent corresponding with the volume of fluid infusion. CONCLUSION: Thrombin generation and clot formation are reduced at a plasma dilution of more than 40 percent. In either process, PLTs can partly compensate for the dilution effect. In vitro dilution with colloids impaired fibrin clot elasticity compared to saline. FAU - Schols, Saskia E M AU - Schols SE AD - Department of Biochemistry, Maastricht University and University Hospital, Maastricht, The Netherlands. FAU - Feijge, Marion A H AU - Feijge MA FAU - Lance, Marcus D AU - Lance MD FAU - Hamulyak, Karly AU - Hamulyak K FAU - ten Cate, Hugo AU - ten Cate H FAU - Heemskerk, Johan W M AU - Heemskerk JW FAU - van Pampus, Elisabeth C M AU - van Pampus EC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080723 PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - 0 (Anticoagulants) RN - 0 (Colloids) RN - 0 (Crystalloid Solutions) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Innovin) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Protamines) RN - 0 (Recombinant Proteins) RN - 0 (Succinates) RN - 39340-57-3 (succinylated gelatin) RN - 9000-70-8 (Gelatin) RN - 9005-49-6 (Heparin) RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Anticoagulants/adverse effects/pharmacology/therapeutic use MH - Blood Coagulation/*drug effects MH - Blood Platelets/*physiology MH - Colloids/adverse effects/pharmacology/therapeutic use MH - Coronary Artery Bypass MH - Crystalloid Solutions MH - Gelatin/pharmacology/therapeutic use MH - Hemorrhagic Disorders/blood/etiology/prevention & control MH - Heparin/adverse effects/pharmacology/therapeutic use MH - Humans MH - Hydroxyethyl Starch Derivatives/adverse effects/pharmacology/therapeutic use MH - Isotonic Solutions/adverse effects/pharmacology/therapeutic use MH - Osmolar Concentration MH - *Plasma MH - Plasma Substitutes/adverse effects/pharmacology MH - Protamines/pharmacology/therapeutic use MH - Recombinant Proteins/pharmacology MH - Succinates/pharmacology/therapeutic use MH - *Thrombelastography MH - Thrombin/*biosynthesis MH - Thromboplastin/*pharmacology EDAT- 2008/08/05 09:00 MHDA- 2009/01/16 09:00 CRDT- 2008/08/05 09:00 PHST- 2008/08/05 09:00 [pubmed] PHST- 2009/01/16 09:00 [medline] PHST- 2008/08/05 09:00 [entrez] AID - TRF01872 [pii] AID - 10.1111/j.1537-2995.2008.01872.x [doi] PST - ppublish SO - Transfusion. 2008 Nov;48(11):2384-94. doi: 10.1111/j.1537-2995.2008.01872.x. Epub 2008 Jul 23. PMID- 18600085 OWN - NLM STAT- MEDLINE DCOM- 20090818 LR - 20220408 IS - 0957-5235 (Print) IS - 0957-5235 (Linking) VI - 19 IP - 5 DP - 2008 Jul TI - High incidence of vaproate-induced coagulation disorders in children receiving valproic acid: a prospective study. PG - 375-82 LID - 10.1097/MBC.0b013e3282f3f9ec [doi] AB - Reports have been published on blood coagulation disturbances by valproate therapy. In the present prospective trial, blood samples were drawn before valproate therapy, after 6 weeks of therapy, after more than 6 weeks and after longer than 6 months of valproate therapy from 23 children newly treated with valproate. Two children developed thrombocytopenia, and six children with initial normal von Willebrand factor showed acquired von Willebrand's disease. Fibrinogen levels dropped below the lower limit in 12 patients and subnormal factor XIII plasma levels were observed in 17% of patients. No patient developed signs of hemorrhage. Eight percent of patients developed valproate-induced thrombocytopenia. Reduction in platelets did not reach statistic significance. Thrombelastography showed a 47% incidence of altered platelet function. We found a statistically significant, positive correlation between clotting time of collagen extrinsic pathway inhibitor and, accordingly, adenosindiphosphate and valproate level. Plasmatic coagulation investigations showed a significant decrease of prothrombin time. Activated partial thromboplastin time measurements also showed significant prolongation with valproate. Activity of von Willebrand factor antigen and von Willebrand factor ristocetin cofactor significantly decreased. Factor XIII activity significantly decreased after valproate therapy for longer than 6 months (17% of children). Fibrinogen was significantly reduced. In the coagulatory system a decrease in the main antiprotease antithrombin III activity was observed. Blood coagulation disturbances are common in patients with valproate, but rarely become clinically symptomatic. Acquired von Willebrand's disease and hypofibrinogenemia may become relevant in patients with surgery or trauma. Particular attention should be paid to factor-XIII deficiency, which is especially seen with valproate therapy. FAU - Koenig, Stephan AU - Koenig S AD - Department of Pediatrics, Germany, Mannheim University Hospital, University of Heidelberg, Germany. drstkoenig@aol.com FAU - Gerstner, Thorsten AU - Gerstner T FAU - Keller, Anja AU - Keller A FAU - Teich, Martin AU - Teich M FAU - Longin, Elke AU - Longin E FAU - Dempfle, Carl-Erik AU - Dempfle CE LA - eng PT - Clinical Trial PT - Journal Article PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Anticonvulsants) RN - 0 (Von Willebrand antigen) RN - 0 (von Willebrand Factor) RN - 614OI1Z5WI (Valproic Acid) RN - 9001-32-5 (Fibrinogen) RN - 9013-56-3 (Factor XIII) SB - IM MH - Anticonvulsants/administration & dosage/*adverse effects MH - Blood Platelets/metabolism MH - Child MH - Child, Preschool MH - Factor XIII/analysis MH - Female MH - Fibrinogen/analysis MH - Humans MH - Male MH - Prospective Studies MH - Thrombelastography/methods MH - Thrombocytopenia/*blood/*chemically induced MH - Valproic Acid/administration & dosage/*adverse effects MH - von Willebrand Diseases/*blood/*chemically induced MH - von Willebrand Factor/analysis/immunology EDAT- 2008/07/05 09:00 MHDA- 2009/08/19 09:00 CRDT- 2008/07/05 09:00 PHST- 2008/07/05 09:00 [pubmed] PHST- 2009/08/19 09:00 [medline] PHST- 2008/07/05 09:00 [entrez] AID - 00001721-200807000-00007 [pii] AID - 10.1097/MBC.0b013e3282f3f9ec [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2008 Jul;19(5):375-82. doi: 10.1097/MBC.0b013e3282f3f9ec. PMID- 18555151 OWN - NLM STAT- MEDLINE DCOM- 20080807 LR - 20080616 IS - 0041-1345 (Print) IS - 0041-1345 (Linking) VI - 40 IP - 4 DP - 2008 May TI - Epidural anesthesia? No of course. PG - 1216-7 LID - 10.1016/j.transproceed.2008.03.109 [doi] AB - Although the contraindications for thoracic epidural anesthesia (TEA) are well defined, the debate continues about whether TEA improves outcomes. Pro and con trials and a metaanalysis in the past have yielded equivocal results; they did not deal with new vascular intervention or drugs. The benefit of TEA in surgery is to provide analgesia. In subgroups, TEA can decrease the mortality and morbidity. In contrast, the cost can increase in the situation of a complication that is opposite to the side effects is rare, but the impairment caused by them is out of proportion to the benefits. Primary or secondary prophylaxis with antithrombotic drugs is increasing in developed countries because of the increasing cardiovascular interventions and aging of the population. The neuroaxial guidelines are useful, but the changing of the coagulation profile after hepatectomy is not included in them. The decision to use TEA in liver surgery must be individualized with steps planned from the beginning. TEA suitability is based on an evaluation of the contraindications, comorbidities, coagulation profiles, hepatic reserve, and balance of benefits and risks. The insertion or withdrawal of the epidural catheter should be made with care according to the neuroaxial guidelines and in the presence of a normal TEG. The decreasing level of prothrombin content and platelet counts after hepatectomy should be closely monitored every 2 to 5 days. FAU - Fazakas, J AU - Fazakas J AD - Semmelweis Medical University, Transplantation and Surgical Department, Budapest, Hungary. fj1@freemail.hu FAU - Toth, Sz AU - Toth S FAU - Fule, B AU - Fule B FAU - Smudla, A AU - Smudla A FAU - Mandli, T AU - Mandli T FAU - Radnai, M AU - Radnai M FAU - Doros, A AU - Doros A FAU - Nemes, B AU - Nemes B FAU - Kobori, L AU - Kobori L LA - eng PT - Journal Article PL - United States TA - Transplant Proc JT - Transplantation proceedings JID - 0243532 RN - 0 (Fibrinolytic Agents) SB - IM MH - Analgesia, Epidural MH - *Anesthesia, Epidural/adverse effects MH - Fibrinolytic Agents/therapeutic use MH - Hematoma/etiology MH - Humans MH - Hypotension/etiology MH - Nausea/etiology MH - Postoperative Period MH - Spinal Cord Injuries/etiology MH - Treatment Refusal MH - Unconsciousness EDAT- 2008/06/17 09:00 MHDA- 2008/08/08 09:00 CRDT- 2008/06/17 09:00 PHST- 2008/06/17 09:00 [pubmed] PHST- 2008/08/08 09:00 [medline] PHST- 2008/06/17 09:00 [entrez] AID - S0041-1345(08)00347-3 [pii] AID - 10.1016/j.transproceed.2008.03.109 [doi] PST - ppublish SO - Transplant Proc. 2008 May;40(4):1216-7. doi: 10.1016/j.transproceed.2008.03.109. PMID- 18524134 OWN - NLM STAT- MEDLINE DCOM- 20081223 LR - 20181201 IS - 0035-9033 (Print) IS - 0035-9033 (Linking) VI - 94 IP - 1 DP - 2008 TI - Molecular weight of hydroxyethyl starch molecules influences coagulation profile measured by thrombelastography. PG - 7-13 AB - BACKGROUND: The consensus about the ideal intravenous fluid in trauma patients remains open. However, hypertonic saline and hydroxyethyl starch (HES) seems to have advantages in terms of immuno-modulatory and haemodynamic effects. Nevertheless clotting abnormalities are frequently reported in association with the use of HES. We investigated the influence of light, medium and heavy molecular weight (MW) hydroxyethyl starch (HES) on coagulation in 29 healthy subjects. METHODS: Ringer's lactate (RL) served as a control solution. Thrombelastography using Haemoscope's Thrombelastograph (TEG) hemostasis system was used to assess the effect of HES polymers and RL. TEG analysis was performed using recalcified native whole blood both with and without the addition of platelet activating factor IV (PAF IV) before and immediately after infusion of one of the solutions. RESULTS: Infusion of RL or one of the three HES solutions exerts an anticoagulant effect as demonstrated by a increase in clot formation time (R) and a decrease in maximum amplitude (MA), and the angle. The addition of PAF IV reversed these changes. CONCLUSIONS: This data indicate clear evidence of platelet activity per se or platelet interaction with the plasmatic coagulation system. FAU - Felfernig, M AU - Felfernig M FAU - Virmani, S AU - Virmani S FAU - Weintraud, M AU - Weintraud M FAU - Oberndorfer, U AU - Oberndorfer U FAU - Zimpfer, M AU - Zimpfer M FAU - Veen, H AU - Veen H FAU - Blaicher, A M AU - Blaicher AM LA - eng PT - Journal Article PT - Randomized Controlled Trial PL - England TA - J R Nav Med Serv JT - Journal of the Royal Naval Medical Service JID - 7503111 RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Isotonic Solutions) RN - 0 (Platelet Activating Factor) RN - 8026-10-6 (Ringer's Solution) SB - IM MH - Adult MH - Blood Coagulation MH - Female MH - Humans MH - Hydroxyethyl Starch Derivatives/*chemistry MH - Isotonic Solutions MH - Male MH - Middle Aged MH - Molecular Weight MH - Platelet Activating Factor/pharmacology MH - Ringer's Solution MH - Sensitivity and Specificity MH - Thrombelastography/methods/*standards EDAT- 2008/06/06 09:00 MHDA- 2008/12/24 09:00 CRDT- 2008/06/06 09:00 PHST- 2008/06/06 09:00 [pubmed] PHST- 2008/12/24 09:00 [medline] PHST- 2008/06/06 09:00 [entrez] PST - ppublish SO - J R Nav Med Serv. 2008;94(1):7-13. PMID- 18497710 OWN - NLM STAT- MEDLINE DCOM- 20090330 LR - 20151119 IS - 1540-0514 (Electronic) IS - 1073-2322 (Linking) VI - 31 IP - 1 DP - 2009 Jan TI - Reproducibility of an animal model simulating complex combat-related injury in a multiple-institution format. PG - 87-96 LID - 10.1097/SHK.0b013e3181777ffb [doi] AB - We developed a complex combat-relevant model of abdominal and extremity trauma, hemorrhagic shock, hypothermia, and acidosis. We then simulated injury, preoperative, and operative phases. We hypothesized that this model is reproducible and useful for randomized multicenter preclinical trials. Yorkshire swine were anesthetized, intubated, and instrumented. They then underwent femur fracture, 60% total blood volume hemorrhage, a 30-min shock period, induced hypothermia to 33 degrees C, and hemorrhage volume replacement with 3:1 isotonic sodium chloride solution (NS) at each of three centers. Hemodynamic parameters were measured continuously. Thromboelastography, arterial blood gas, and laboratory values were collected at baseline, after the shock period, and after NS replacement. Thirty-seven animals were used for model development. Eight (21%) died before completion of the study period. Twenty-nine survivors were included in the analysis. MAP (+/-SEM) after the shock period was 32 +/- 2 mmHg and was similar between centers (P = 0.4). Mean pH, base deficit, and lactate levels were 7.29 +/- 0.02, 8.20 +/- 0.65 mmol/L, and 5.29 +/- 0.44 mmol/L, respectively, after NS replacement. These were similar between centers (P > 0.05). Prothrombin time values increased significantly over time at all centers, reflecting a progressive coagulopathy (P < 0.02). Thromboelastography maximum amplitude values were similar among centers (P > 0.05) and demonstrated progressively weakened platelet interaction over time (P < 0.03). Hematocrit was similar after controlled hemorrhage (P = 0.15) and dilution (P = 0.9). The pH, lactate, base deficit, and coagulation tests reflect a severely injured state. A complex porcine model of polytrauma and shock can be used for multi-institutional study with excellent reproducibility. A consistent severe injury profile was achieved, after which experimental interventions can be applied. This is the first report of a reproducible multicenter trauma and resuscitation-related animal model. FAU - Cho, S David AU - Cho SD AD - Division of Trauma and Critical Care, Oregon Health and Science University, Portland, Oregon 97239, USA. chos@ohsu.edu FAU - Holcomb, John B AU - Holcomb JB FAU - Tieu, Brandon H AU - Tieu BH FAU - Englehart, Michael S AU - Englehart MS FAU - Morris, Melanie S AU - Morris MS FAU - Karahan, Z Ayhan AU - Karahan ZA FAU - Underwood, Samantha A AU - Underwood SA FAU - Muller, Patrick J AU - Muller PJ FAU - Prince, M Dale AU - Prince MD FAU - Medina, Leticia AU - Medina L FAU - Sondeen, Jill AU - Sondeen J FAU - Shults, Christian AU - Shults C FAU - Duggan, Michael AU - Duggan M FAU - Tabbara, Malek AU - Tabbara M FAU - Alam, Hasan B AU - Alam HB FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Journal Article PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Isotonic Solutions) RN - 33X04XA5AT (Lactic Acid) RN - 451W47IQ8X (Sodium Chloride) SB - IM MH - Acidosis/blood/*physiopathology MH - Animals MH - Blood Gas Analysis MH - *Disease Models, Animal MH - Femoral Fractures/blood/*physiopathology MH - Hematocrit MH - Hemodynamics MH - Humans MH - Hydrogen-Ion Concentration MH - Hypothermia, Induced MH - Isotonic Solutions/pharmacology MH - Lactic Acid/blood MH - Multicenter Studies as Topic MH - Reproducibility of Results MH - Shock, Hemorrhagic/blood/*physiopathology MH - Sodium Chloride/pharmacology MH - Swine MH - Thrombelastography MH - Time Factors MH - *Warfare EDAT- 2008/05/24 09:00 MHDA- 2009/03/31 09:00 CRDT- 2008/05/24 09:00 PHST- 2008/05/24 09:00 [entrez] PHST- 2008/05/24 09:00 [pubmed] PHST- 2009/03/31 09:00 [medline] AID - 10.1097/SHK.0b013e3181777ffb [doi] PST - ppublish SO - Shock. 2009 Jan;31(1):87-96. doi: 10.1097/SHK.0b013e3181777ffb. PMID- 18440953 OWN - NLM STAT- MEDLINE DCOM- 20080617 LR - 20220316 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 100 IP - 6 DP - 2008 Jun TI - Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. PG - 792-7 LID - 10.1093/bja/aen083 [doi] AB - BACKGROUND: Blood loss and uncontrollable bleeding are major factors affecting survival in trauma patients. Because treatment with antifibrinolytic drugs may be effective, early detection of hyperfibrinolysis with rotation thrombelastography (ROTEM may be beneficial. METHODS: Eighty-seven trauma patients were included in this prospective observational study. Blood samples were collected at admission. After in vitro activation with tissue factor (EXTEM) and inhibition with aprotinin (APTEM), ROTEM parameters including maximal clot firmness (MCF) and clot lysis index at 30 min (CLI(30)) were determined. Hyperfibrinolysis was defined as a euglobulin lysis time (ELT) <90 min. Threshold for ROTEM parameters were determined with receiver-operating characteristic curves (ROC) analysis according to the ELT results. RESULTS: ELT was determined in a subgroup of 23 patients. In this group of patients, ROC analysis showed that for a threshold of 18 mm (MCF-EXTEM), 71% (CLI(30)) and 7% (increase of MCF-APTEM), sensitivity was, respectively, 100%, 75%, and 80% with a specificity of 100%. With the application of these thresholds to the whole trauma cohort, ROTEM analysis detected hyperfibrinolysis in five patients [6%, 95% confidence interval (CI): 2-13%]. As expected, patients with hyperfibrinolysis were more severely injured (median Injury Severity Score: 75 vs 20, P<0.05), had greater coagulation abnormalities [international normalized ratio (INR): 8.2 vs 1.3, P<0.05; fibrinogen: 0.0 vs 2.2 g litre(-1), P<0.05], and a higher mortality rate (100%, CI: 48-100% vs 11% CI: 5-20%, P<0.05). CONCLUSIONS: ROTEM provided rapid and accurate detection of hyperfibrinolysis in severely injured trauma patients. FAU - Levrat, A AU - Levrat A AD - Department of Anesthesiology and Critical Care, Lyon-Sud Hospital, Hospices Civils de Lyon and University Lyon 1, Pierre-Benite F-69495, France. FAU - Gros, A AU - Gros A FAU - Rugeri, L AU - Rugeri L FAU - Inaba, K AU - Inaba K FAU - Floccard, B AU - Floccard B FAU - Negrier, C AU - Negrier C FAU - David, J-S AU - David JS LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080424 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - 0 (Blood Coagulation Factors) SB - IM MH - Adult MH - Blood Coagulation Disorders/*diagnosis/etiology MH - Blood Coagulation Factors/analysis MH - Female MH - *Fibrinolysis MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - Sensitivity and Specificity MH - Thrombelastography/*methods MH - Wounds and Injuries/*complications EDAT- 2008/04/29 09:00 MHDA- 2008/06/18 09:00 CRDT- 2008/04/29 09:00 PHST- 2008/04/29 09:00 [pubmed] PHST- 2008/06/18 09:00 [medline] PHST- 2008/04/29 09:00 [entrez] AID - S0007-0912(17)34297-6 [pii] AID - 10.1093/bja/aen083 [doi] PST - ppublish SO - Br J Anaesth. 2008 Jun;100(6):792-7. doi: 10.1093/bja/aen083. Epub 2008 Apr 24. PMID- 18437714 OWN - NLM STAT- MEDLINE DCOM- 20080523 LR - 20190917 IS - 1073-2322 (Print) IS - 1073-2322 (Linking) VI - 29 IP - 3 DP - 2008 Mar TI - The influence of sex hormones on coagulation and inflammation in the trauma patient. PG - 334-41 AB - Recent clinical studies have shown a sex dimorphism of morbidity and mortality due to shock, trauma, and sepsis, with females tolerating these insults better than males. Experimental animal studies have suggested that sex hormones have a pivotal role in this dimorphism. In the present investigation, a prospective cohort study at a university level-1 trauma center was conducted to evaluate the association between sex hormones and alterations in coagulation and inflammation. Patients with an admission to the intensive care unit, injury severity score (ISS) greater than 4, and obtainable consent were included in the study. In addition to routine clinical laboratories and patient outcomes, plasma TNF-[alpha], IL-6, IL-8, estradiol, progesterone, and testosterone were measured. Sixty-two patients (71% men, 29% women) met criteria for entry. Mean age was 42 +/- 17 years, and mean ISS was 23 +/- 13, with no statistical difference in age or ISS between sexes. Estradiol levels were positively correlated with ISS (P < 0.05) and negatively correlated with TNF-[alpha] (P < 0.01). Initial estradiol levels were higher in patients who developed an infection (P < 0.05). Testosterone was negatively correlated with age (P < 0.01) and was higher in patients who developed acute respiratory distress syndrome (P < 0.05) and in patients who did not survive (P < 0.05). The estradiol-to-progesterone ratio (E2-Pr) was higher in the survivors (P < 0.05). The E2-Pr had positive correlations with fibrinogen levels, rate of fibrin deposition and cross-linking, and overall clot strength (P < 0.05). Estradiol-to-progesterone ratio was negatively correlated with partial thromboplastin times (P < 0.01). In men, the E2-Pr was also negatively correlated with the time to onset of clot formation (P = 0.03). Sex hormone levels (or their ratios) were not correlated to platelet count or international normalized ratios. These findings provide evidence that sex hormone levels in the early posttraumatic period are significantly associated with alterations in the hemostatic and inflammatory response to trauma. FAU - Gee, Arvin C AU - Gee AC AD - Trauma/Critical Care Section, Division of General Surgery, Department of Surgery, Oregan Health & Science University, Portland, Oregan 97239, USA. geea@ohsu.edu FAU - Sawai, Rebecca S AU - Sawai RS FAU - Differding, Jerome AU - Differding J FAU - Muller, Patrick AU - Muller P FAU - Underwood, Samantha AU - Underwood S FAU - Schreiber, Martin A AU - Schreiber MA LA - eng GR - 1UL1 RR024120-01/RR/NCRR NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Shock JT - Shock (Augusta, Ga.) JID - 9421564 RN - 0 (Cytokines) RN - 0 (Gonadal Steroid Hormones) RN - 0 (Inflammation Mediators) RN - 3XMK78S47O (Testosterone) RN - 4G7DS2Q64Y (Progesterone) RN - 4TI98Z838E (Estradiol) SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Cohort Studies MH - Cytokines/blood MH - Estradiol/blood MH - Female MH - Gonadal Steroid Hormones/*blood MH - Humans MH - Inflammation/*blood MH - Inflammation Mediators/blood MH - Male MH - Middle Aged MH - Partial Thromboplastin Time MH - Progesterone/blood MH - Prospective Studies MH - Severity of Illness Index MH - Sex Characteristics MH - Testosterone/blood MH - Thrombelastography MH - Wounds and Injuries/*blood EDAT- 2008/04/26 09:00 MHDA- 2008/05/24 09:00 CRDT- 2008/04/26 09:00 PHST- 2008/04/26 09:00 [pubmed] PHST- 2008/05/24 09:00 [medline] PHST- 2008/04/26 09:00 [entrez] AID - 10.1097/shk.0b013e3181506ee5 [doi] PST - ppublish SO - Shock. 2008 Mar;29(3):334-41. doi: 10.1097/shk.0b013e3181506ee5. PMID- 18376174 OWN - NLM STAT- MEDLINE DCOM- 20080514 LR - 20131121 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 64 IP - 2 Suppl DP - 2008 Feb TI - A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. PG - S64-8 LID - 10.1097/TA.0b013e318160772d [doi] AB - BACKGROUND: Bleeding is a major cause of death in patients with traumatic injuries. Recently, thrombelastography (TEG) has been suggested as an additional means of evaluating coagulation in trauma patients. We hypothesized that TEG data would aid in defining the coagulopathy of trauma in patients with penetrating traumatic injuries. METHODS: A retrospective study was performed of patients (n = 44) with penetrating injuries admitted to a combat support hospital during a 2-month period in 2004. Recorded data included standard laboratory data, TEG parameters, and blood product use in the first 24 hours after admission. Values were compared with clinically accepted ranges and those obtained from the Haemoscope Corporation. RESULTS: At admission, International Normalization Ratio, prothrombin time, and partial thromboplastin time were increased in 39% (>or=1.5), 31% (>16 seconds), and 37% (>40 seconds) of patients, respectively, suggesting hypocoagulation, but these variables did not correlate with the use of blood products (p > 0.05). TEG values obtained within 24 hours of admission (6 hours +/- 5.7 hours; median of 4.5 hours) demonstrated hypocoagulation based on delayed propagation of the clot (increased K time and reduced alpha-angle) and decreased clot strength (reduced maximal amplitude [MA]). MA correlated (r = 0.57, p < 0.01) with blood product use as well as platelet count (r = 0.61, p < 0.01). Patients with reduced MA (n = 23) used more blood products and had reduced platelet counts and hematocrit. CONCLUSION: Thrombelastography was a more accurate indicator of blood product requirements in our patient population than prothrombin time, partial thromboplastin time, and International Normalization Ratio. Thrombelastography enhanced by platelet count and hematocrit can guide blood transfusion requirements. FAU - Plotkin, Amy J AU - Plotkin AJ AD - Pittsburgh Tissue Engineering Initiative, Pittsburgh, Pennsylvania, USA. FAU - Wade, Charles E AU - Wade CE FAU - Jenkins, Donald H AU - Jenkins DH FAU - Smith, Kimberly A AU - Smith KA FAU - Noe, Jody C AU - Noe JC FAU - Park, Myung S AU - Park MS FAU - Perkins, Jeremy G AU - Perkins JG FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Blood Coagulation/*physiology MH - *Blood Transfusion MH - Humans MH - *Iraq War, 2003-2011 MH - Needs Assessment MH - Predictive Value of Tests MH - Retrospective Studies MH - *Thrombelastography MH - United States MH - Wounds, Penetrating/*blood/etiology/*therapy EDAT- 2008/04/11 09:00 MHDA- 2008/05/15 09:00 CRDT- 2008/04/11 09:00 PHST- 2008/04/11 09:00 [pubmed] PHST- 2008/05/15 09:00 [medline] PHST- 2008/04/11 09:00 [entrez] AID - 00005373-200802001-00011 [pii] AID - 10.1097/TA.0b013e318160772d [doi] PST - ppublish SO - J Trauma. 2008 Feb;64(2 Suppl):S64-8. doi: 10.1097/TA.0b013e318160772d. PMID- 18376164 OWN - NLM STAT- MEDLINE DCOM- 20080514 LR - 20220317 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 64 IP - 2 Suppl DP - 2008 Feb TI - Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients. PG - S188-94 LID - 10.1097/TA.0b013e318160a5a3 [doi] AB - BACKGROUND: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of in- hospital mortality in burned and nonburned trauma patients. METHODS: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >or=3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Multiple logistic regression with stepwise selection and likelihood ratio test was performed to identify predictors for mortality. A receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of identified predictors. Validation of the model with an additional cohort was performed. RESULTS: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961 (95% confidence interval: 0.891, 1.000, p < 0.05). The area under the ROC curve for the validation cohort (n = 66) was 0.936 (95% confidence interval: 0.875, 0.997, p < 0.001). CONCLUSION: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care. FAU - Park, Myung S AU - Park MS AD - US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. myung.park@amedd.army.mil FAU - Salinas, Jose AU - Salinas J FAU - Wade, Charles E AU - Wade CE FAU - Wang, Jingjing AU - Wang J FAU - Martini, Wenjun AU - Martini W FAU - Pusateri, Anthony E AU - Pusateri AE FAU - Merrill, Gerald A AU - Merrill GA FAU - Chung, Kevin AU - Chung K FAU - Wolf, Steven E AU - Wolf SE FAU - Holcomb, John B AU - Holcomb JB LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Blood Coagulation Factors) RN - 0 (Cytokines) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Blood Coagulation Factors/*metabolism MH - Burns/*blood/complications/*mortality MH - Case-Control Studies MH - Cohort Studies MH - Cytokines/*blood MH - Female MH - Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - ROC Curve MH - Thrombelastography MH - Wounds and Injuries/*complications/*mortality EDAT- 2008/04/11 09:00 MHDA- 2008/05/15 09:00 CRDT- 2008/04/11 09:00 PHST- 2008/04/11 09:00 [pubmed] PHST- 2008/05/15 09:00 [medline] PHST- 2008/04/11 09:00 [entrez] AID - 00005373-200802001-00028 [pii] AID - 10.1097/TA.0b013e318160a5a3 [doi] PST - ppublish SO - J Trauma. 2008 Feb;64(2 Suppl):S188-94. doi: 10.1097/TA.0b013e318160a5a3. PMID- 18339213 OWN - NLM STAT- MEDLINE DCOM- 20081020 LR - 20191210 IS - 1365-2346 (Electronic) IS - 0265-0215 (Linking) VI - 25 IP - 7 DP - 2008 Jul TI - Fibrinolysis or hypercoagulation during radical prostatectomy? An evaluation of thrombelastographic parameters and standard laboratory tests. PG - 538-43 LID - 10.1017/S0265021508003852 [doi] AB - BACKGROUND AND OBJECTIVES: Radical prostatectomy is at high risk for intraoperative and postoperative bleeding due to surgical trauma, release of urokinase and tissue type plasminogen activator. We conducted this prospective, observational multi-centre study to assess the degree of systemic fibrinolysis or hypercoagulation in the perioperative period. We studied serial changes in standard laboratory values and in thrombelastographic (TEG; Haemoscope Corporation, Skokie, IL, USA) parameters including lysis at 30 and 60 min (LY-30, LY-60), alpha-angle (alpha) and maximum amplitude. METHODS: In all, 49 patients undergoing radical retropubic prostatectomy in five Italian University Hospitals were included. Blood samples were taken before surgery (T1), at the removal of the prostate (T2), 4 h after surgery (T3) and then 1 day after surgery (T4). Native blood samples were analysed using a thrombelastograph Haemoscope 5000 (Haemoscope Corporation). RESULTS: We did not see any relevant activation of fibrinolysis during any stage. Intraoperatively, we showed even more activated blood coagulation with consumption of fibrinogen and a reduced TEG percentage clot lysis. Only at the first postoperative sample point we saw a trend towards a more fibrinolytic state indicated by increasing partial thromboplastin time, LY-30 and LY-60 values, and a peak of the fibrin degradation product D-dimers. This is consistent with a normal reaction to the hypercoagulable state before and is unlikely to be due to an intraoperative tissue type plasminogen activator release. We found no evidence of an uncontrolled activation of fibrinolysis on the day after surgery. On the contrary, alpha-values which indicate the rate of clot formation and which increase during hypercoagulation showed the tendency to rise slightly compared with the preoperative value. CONCLUSION: Neither standard coagulation parameters nor TEG values showed any significant activation of fibrinolysis or of hypercoagulation in the preoperative period. Nevertheless, hypercoagulation seems to have a substantial clinical impact as it has been shown that cardiovascular complications and pulmonary embolism were the most common causes of death after retropubic prostatectomy. FAU - Ziegler, S AU - Ziegler S AD - Department of Anesthesiology and Critical Care, Universita degli Studi di Parma, Azienda Ospedaliera di Parma, Parma, Italy. zieglerstefanie@gmail.com FAU - Ortu, A AU - Ortu A FAU - Reale, C AU - Reale C FAU - Proietti, R AU - Proietti R FAU - Mondello, E AU - Mondello E FAU - Tufano, R AU - Tufano R FAU - di Benedetto, P AU - di Benedetto P FAU - Fanelli, G AU - Fanelli G LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Multicenter Study DEP - 20080313 PL - England TA - Eur J Anaesthesiol JT - European journal of anaesthesiology JID - 8411711 RN - 0 (Biomarkers) RN - EC 3.4.21.77 (Prostate-Specific Antigen) SB - IM MH - Aged MH - Biomarkers/blood MH - Fibrinolysis/physiology MH - Humans MH - Intraoperative Care/*methods/standards MH - Male MH - Middle Aged MH - Postoperative Complications/blood/diagnosis/physiopathology MH - Prospective Studies MH - Prostate/pathology/surgery MH - Prostate-Specific Antigen/blood MH - Prostatectomy/*adverse effects/methods MH - Retrospective Studies MH - Thrombelastography/*methods/standards MH - Thrombophilia/blood/*diagnosis/physiopathology EDAT- 2008/03/15 09:00 MHDA- 2008/10/22 09:00 CRDT- 2008/03/15 09:00 PHST- 2008/03/15 09:00 [pubmed] PHST- 2008/10/22 09:00 [medline] PHST- 2008/03/15 09:00 [entrez] AID - S0265021508003852 [pii] AID - 10.1017/S0265021508003852 [doi] PST - ppublish SO - Eur J Anaesthesiol. 2008 Jul;25(7):538-43. doi: 10.1017/S0265021508003852. Epub 2008 Mar 13. PMID- 18292410 OWN - NLM STAT- MEDLINE DCOM- 20080311 LR - 20161124 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 106 IP - 3 DP - 2008 Mar TI - Improved clot formation by combined administration of activated factor VII (NovoSeven) and fibrinogen (Haemocomplettan P). PG - 732-8, table of contents LID - 10.1213/ane.0b013e318163fc76 [doi] AB - BACKGROUND: Recombinant activated factor VII (rFVIIa) is increasingly used for treating refractory bleeding after cardiac surgery. However, hemostasis also depends on coagulation factors, including fibrinogen, which stabilizes platelet plugs at sites of vascular injury. We compared the hemostatic effects of rFVIIa, fibrinogen, or their combination. METHODS: Blood samples were obtained from 12 volunteers and from 7 patients after cardiopulmonary bypass (CPB). The in vitro effects of rFVIIa (1.5 microg/mL), fibrinogen (100 mg/dL), and the combination were evaluated under simulated coagulopathy in volunteer plasma using heparin (0.1 U/mL) or tissue plasminogen activator (0.1 microg/mL). Hemostatic interventions were compared using thromboelastometry, which measures clotting time (CT, s), angle of thrombus formation, and maximal clot firmness (MCF, mm). The Thrombinoscope was used to quantitate thrombin generation after addition of fibrinogen and/or rFVIIa. RESULTS: In heparinized volunteer plasma, rFVIIa shortened CT (1st and 3rd quartiles) from 663 (522-736) to 435 (397-531) s, but it did not affect MCF. Fibrinogen increased MCF from 26.0 (24.4-26.7) to 30.5 (26.3-31.5) mm without affecting CT. The combination of rFVIIa and fibrinogen in heparinized samples was most effective in improving CT to 359 (324-522) s and MCF to 29 (27.8-31.0) mm. In tissue plasminogen activator-treated volunteer plasma, fibrinolysis increased by more than 45% by the addition of rFVIIa. After CPB, both CT and MCF were most improved with coadministration of rFVIIa and fibrinogen. Thrombinoscope evaluation demonstrated that rFVIIa decreased the lag time and increased peak thrombin generation, whereas fibrinogen had no effect. CONCLUSION: The onset of fibrin formation and thrombin generation were shortened after rFVIIa addition, but fibrin clot strength was only increased after fibrinogen supplementation. In vitro clot formation was most improved by using both rFVIIa and fibrinogen in whole blood after CPB. FAU - Tanaka, Kenichi A AU - Tanaka KA AD - Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Emory University School of Medicine, 1364 Clifton Rd., NE, Atlanta, GA 30322, USA. FAU - Taketomi, Taro AU - Taketomi T FAU - Szlam, Fania AU - Szlam F FAU - Calatzis, Andreas AU - Calatzis A FAU - Levy, Jerrold H AU - Levy JH LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Coagulants) RN - 0 (Recombinant Proteins) RN - 9001-32-5 (Fibrinogen) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Blood Coagulation Tests MH - *Cardiac Surgical Procedures MH - Cardiopulmonary Bypass MH - Coagulants/*pharmacology/therapeutic use MH - Drug Therapy, Combination MH - Factor VIIa/*pharmacology/therapeutic use MH - Fibrinogen/administration & dosage/*pharmacology/*therapeutic use MH - Hemostasis/*drug effects MH - Humans MH - Postoperative Hemorrhage/blood/*drug therapy MH - Recombinant Proteins/administration & dosage/pharmacology/*therapeutic use MH - Time Factors EDAT- 2008/02/23 09:00 MHDA- 2008/03/12 09:00 CRDT- 2008/02/23 09:00 PHST- 2008/02/23 09:00 [pubmed] PHST- 2008/03/12 09:00 [medline] PHST- 2008/02/23 09:00 [entrez] AID - 106/3/732 [pii] AID - 10.1213/ane.0b013e318163fc76 [doi] PST - ppublish SO - Anesth Analg. 2008 Mar;106(3):732-8, table of contents. doi: 10.1213/ane.0b013e318163fc76. PMID- 18292408 OWN - NLM STAT- MEDLINE DCOM- 20080311 LR - 20141120 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 106 IP - 3 DP - 2008 Mar TI - Antithrombin affects hemostatic response to recombinant activated factor VII in factor VIII deficient plasma. PG - 719-24, table of contents LID - 10.1213/ane.0b013e3181618702 [doi] AB - BACKGROUND: Thromboembolic complications can occur with recombinant activated factor VII (rFVIIa) treatment in trauma and surgical patients but they are infrequent in hemophiliacs. Bleeding diathesis in these conditions is often attributed to reduced thrombin generation, which may be improved with rFVIIa. Normally, thrombin that diffuses from local vascular injury sites is quickly inactivated by antithrombin (AT). Evaluating the influence of AT levels on thrombin generation in hypocoagulable FVIII-deficient plasma would be a simple approach to better understand how procoagulant stimuli, such as rFVIIa, might result in postoperative thrombotic complications. We hypothesize that reduced AT concentrations would increase the procoagulant effects of rFVIIa in FVIII-deficient plasma. METHODS: Thrombin generation was evaluated in vitro in FVIII-deficient and AT/FVIII-deficient plasma using thrombelastography and a thrombin generation assay (Thrombinoscope). The effect of added rFVIIa on these variables was evaluated. RESULTS: Delayed thrombus formation based on thrombelastography in FVIII-deficient plasma was predictably reversed by rFVIIa. Improved thrombus formation and responses to rFVIIa were observed when AT levels were 20%-50% of normal. Thrombin generation in FVIII-deficient plasma increased in an inverse relationship to AT levels. Supplemental rFVIIa decreased the lag time of thrombin generation but not the amount of thrombin generated. CONCLUSIONS: Using FVIII-deficient plasma as a model of reduced thrombin generation, we demonstrate that low AT levels enhance in vitro hemostatic responses to rFVIIa. Reduced AT levels in trauma and surgical patients with normal or increased FVIII levels may be considered potentially prothrombotic. Monitoring of AT levels during rFVIIa therapy may thus reduce thrombotic complications in nonhemophiliacs. FAU - Szlam, Fania AU - Szlam F AD - Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Rd., NE, Atlanta, GA 30322, USA. FAU - Taketomi, Taro AU - Taketomi T FAU - Sheppard, Chelsea A AU - Sheppard CA FAU - Kempton, Christine L AU - Kempton CL FAU - Levy, Jerrold H AU - Levy JH FAU - Tanaka, Kenichi A AU - Tanaka KA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Antithrombins) RN - 0 (Coagulants) RN - 0 (Recombinant Proteins) RN - EC 3.4.21.21 (Factor VIIa) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Antithrombins/*deficiency MH - Blood Coagulation Tests MH - Coagulants/*pharmacology MH - Factor VIIa/*pharmacology MH - Hemophilia A/*blood MH - Hemostasis/*drug effects MH - Humans MH - In Vitro Techniques MH - Recombinant Proteins/*pharmacology MH - Thrombin/*metabolism MH - Time Factors EDAT- 2008/02/23 09:00 MHDA- 2008/03/12 09:00 CRDT- 2008/02/23 09:00 PHST- 2008/02/23 09:00 [pubmed] PHST- 2008/03/12 09:00 [medline] PHST- 2008/02/23 09:00 [entrez] AID - 106/3/719 [pii] AID - 10.1213/ane.0b013e3181618702 [doi] PST - ppublish SO - Anesth Analg. 2008 Mar;106(3):719-24, table of contents. doi: 10.1213/ane.0b013e3181618702. PMID- 18249328 OWN - NLM STAT- MEDLINE DCOM- 20080523 LR - 20151119 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 22 IP - 1 DP - 2008 Feb TI - Does OxyVita, a new-generation hemoglobin-based oxygen carrier, or oxyglobin acutely interfere with coagulation compared with normal saline or 6% hetastarch? An ex vivo thromboelastography study. PG - 34-9 LID - 10.1053/j.jvca.2007.02.016 [doi] AB - OBJECTIVES: Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt hemoglobin-based oxygen carrier (HBOC) was studied. DESIGN: Preliminary laboratory study of donor blood using thromboelastography (TEG). SETTING: University laboratory. PARTICIPANTS: Volunteer donor blood. INTERVENTIONS: Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), hemoglobin glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed. MEASUREMENTS AND MAIN RESULTS: At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and alpha) than either HBOC. CONCLUSIONS: OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer's anticipated effective dose of 10 g or 2 to 3 mL/kg. FAU - Jahr, Jonathan S AU - Jahr JS AD - Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. jsjahr@mednet.ucla.edu FAU - Weeks, David L AU - Weeks DL FAU - Desai, Poonam AU - Desai P FAU - Lim, Jennifer C AU - Lim JC FAU - Butch, Anthony W AU - Butch AW FAU - Gunther, Robert AU - Gunther R FAU - Driessen, Bernd AU - Driessen B LA - eng PT - Journal Article DEP - 20070524 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 RN - 0 (Blood Substitutes) RN - 0 (Hemoglobins) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (OxyVita) RN - 0 (hemoglobin glutamer-200) RN - 451W47IQ8X (Sodium Chloride) SB - IM MH - Blood Coagulation/*drug effects MH - Blood Substitutes/administration & dosage/*pharmacology MH - Dose-Response Relationship, Drug MH - Hemoglobins/administration & dosage/*pharmacology MH - Humans MH - Hydroxyethyl Starch Derivatives/administration & dosage/pharmacology MH - Shock, Hemorrhagic/blood/therapy MH - Sodium Chloride/pharmacology MH - Thrombelastography/*drug effects EDAT- 2008/02/06 09:00 MHDA- 2008/05/24 09:00 CRDT- 2008/02/06 09:00 PHST- 2006/12/06 00:00 [received] PHST- 2008/02/06 09:00 [pubmed] PHST- 2008/05/24 09:00 [medline] PHST- 2008/02/06 09:00 [entrez] AID - S1053-0770(07)00053-5 [pii] AID - 10.1053/j.jvca.2007.02.016 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2008 Feb;22(1):34-9. doi: 10.1053/j.jvca.2007.02.016. Epub 2007 May 24. PMID- 18001200 OWN - NLM STAT- MEDLINE DCOM- 20080227 LR - 20231120 IS - 0897-7151 (Print) IS - 0897-7151 (Linking) VI - 24 IP - 11 DP - 2007 Nov TI - Platelet dysfunction in patients with severe traumatic brain injury. PG - 1699-706 AB - Coagulopathy is a common phenomenon in traumatic brain injury (TBI) and a major contributor to a poor outcome. Thrombocytopenia is a strong negative prognostic factor in TBI, but bleeding tendency can be present even with a normal platelet count. We investigated platelet function in patients with TBI by means of modified thromboelastography (i.e., platelet mapping [TEG-PM]). Four groups were studied: (1) patients with severe isolated TBI (n = 20), (2) patients with general trauma without TBI (the ICU group, n = 10), (3) patients with chronic alcohol abuse (n = 7; as alcohol abuse is common in patients with TBI), and (4) healthy volunteers (n = 10). We measured platelet counts in venous blood (Plt), Ivy bleeding time, standard TEG parameters, and platelet responses to arachidonic acid (AA) and adenosindiphosphate (ADP), using TEG-PM. TBI patients had a lower Plt (180 +/- 68 x 10(9) ; mean +/- SD) and a longer bleeding time (674 +/- 230 sec) than healthy controls, (256 +/- 43 x 10(9), p < 0.01) and (320 +/- 95 sec, p < 0.005), respectively. TBI patients had dramatically lower platelet responses to AA (0-86%, mean 22%) compared to healthy controls (57-89%, mean 73%), the ICU group (4-75%, mean 49%), and the alcohol abusers (17-88%, mean 64%; p < 0.001). Responses to ADP did not differ significantly between the groups. Patients with low responsiveness to AA at admittance to the hospital were likely to develop bleeding complications later. Patients with TBI develop platelet dysfunction, which most likely contributes to bleeding complications. The observed platelet dysfunction appears to involve the cyclooxygenase pathway. TEG-PM analysis can be used to identify patients with a high risk of bleeding complications. FAU - Nekludov, Michael AU - Nekludov M AD - Department of Anesthesiology and Intensive Care, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. michael.nekludov@karolinska.se FAU - Bellander, Bo-Michael AU - Bellander BM FAU - Blomback, Margareta AU - Blomback M FAU - Wallen, Hakan N AU - Wallen HN LA - eng PT - Journal Article PL - United States TA - J Neurotrauma JT - Journal of neurotrauma JID - 8811626 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Blood Coagulation/*physiology MH - Brain Injuries/*blood MH - Case-Control Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Activation/*physiology MH - Platelet Function Tests MH - Prospective Studies MH - Thrombelastography MH - Time Factors MH - Trauma Severity Indices EDAT- 2007/11/16 09:00 MHDA- 2008/02/28 09:00 CRDT- 2007/11/16 09:00 PHST- 2007/11/16 09:00 [pubmed] PHST- 2008/02/28 09:00 [medline] PHST- 2007/11/16 09:00 [entrez] AID - 10.1089/neu.2007.0322 [doi] PST - ppublish SO - J Neurotrauma. 2007 Nov;24(11):1699-706. doi: 10.1089/neu.2007.0322. PMID- 17993954 OWN - NLM STAT- MEDLINE DCOM- 20080107 LR - 20220317 IS - 1529-8809 (Electronic) IS - 0022-5282 (Linking) VI - 63 IP - 5 DP - 2007 Nov TI - In vitro effect of activated recombinant factor VII (rFVIIa) on coagulation properties of human blood at hypothermic temperatures. PG - 1079-86 AB - BACKGROUND: Recombinant activated factor VII (rFVIIa) is currently administered off-label to control diffuse coagulopathic bleeding of patients with traumatic injuries. These patients are often cold, acidotic, and coagulopathic upon arrival and each responds differently to rFVIIa therapy. This study investigated the effects of hypothermia on clotting and the potential benefit of rFVIIa administration on blood coagulation at different hypothermic temperatures. METHOD: Citrated blood samples were collected from eight healthy volunteers (20-45 years old) and incubated at 37 degrees C, 34 degrees C, 31 degrees C, and 28 degrees C for 30 minutes. rFVIIa (1.26 microg/mL equivalent to 90 microg/kg in vivo dose) or vehicle solution (saline) was added to each blood sample, incubated (10 minutes), and analyzed at the respective temperatures by standard coagulation tests and thrombelastography. RESULTS: The clot reaction time of blood samples, measured as prothrombin time, activated partial thromboplastin time, and R time (thrombelastography analysis), was significantly prolonged at 31 degrees C or below compared with at 37 degrees C. The clot formation rate ([alpha] angle, maximum clotting velocity [Vmax]) was decreased at all cold temperatures. Maximum clot strength (maximum amplitude) was only affected (reduced) at 28 degrees C. Addition of rFVIIa shortened the prothrombin time, activated partial thromboplastin time, and R times at every temperature, surpassing the normal (37 degrees C) temperature values in 31 degrees C and 34 degrees C cold samples. Similarly, clot formation rate parameters (clotting time, [alpha] angle, Vmax) were also improved by rFVIIa addition and normothermic values were restored in 31 degrees C and 34 degrees C cold blood samples. rFVIIa did not affect maximum amplitude at any temperature. CONCLUSIONS: Mild to moderate hypothermia delayed the initial clot reaction and reduced clot formation rate without affecting ultimate clot strength. FVIIa effectively compensated for the adverse effects of hypothermia except in severe cases. These results suggest that administration of FVIIa should be beneficial in enhancing hemostasis in hypothermic trauma patients without the need for prior correction of the patient's body temperature. FAU - Kheirabadi, Bijan S AU - Kheirabadi BS AD - Division of Damage Control Resuscitation, US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. bijan.kheirabadi@cen.amedd.army.mil FAU - Delgado, Angel V AU - Delgado AV FAU - Dubick, Michael A AU - Dubick MA FAU - Scherer, Michael R AU - Scherer MR FAU - Fedyk, Chriselda G AU - Fedyk CG FAU - Holcomb, John B AU - Holcomb JB FAU - Pusateri, Anthony E AU - Pusateri AE LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Recombinant Proteins) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Adult MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests MH - Factor VIIa/*pharmacology MH - Female MH - Humans MH - Hypothermia/*blood MH - In Vitro Techniques MH - Male MH - Middle Aged MH - Recombinant Proteins/pharmacology MH - Reference Values MH - Temperature MH - Thrombelastography EDAT- 2007/11/13 09:00 MHDA- 2008/01/08 09:00 CRDT- 2007/11/13 09:00 PHST- 2007/11/13 09:00 [pubmed] PHST- 2008/01/08 09:00 [medline] PHST- 2007/11/13 09:00 [entrez] AID - 00005373-200711000-00018 [pii] AID - 10.1097/TA.0b013e31815885f1 [doi] PST - ppublish SO - J Trauma. 2007 Nov;63(5):1079-86. doi: 10.1097/TA.0b013e31815885f1. PMID- 17958535 OWN - NLM STAT- MEDLINE DCOM- 20080107 LR - 20071025 IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 47 IP - 11 DP - 2007 Nov TI - Impairment of the hemostatic potential of platelets during storage as evaluated by flow cytometry, thrombin generation, and thrombelastography under conditions promoting formation of coated platelets. PG - 2057-65 AB - BACKGROUND: The increasing demand for platelet (PLT) transfusions has focused attention on appropriate use. Coated PLTs are a subpopulation of highly procoagulant PLTs formed by simultaneous stimulation by the agonist's collagen and thrombin hypothesized to drive clot formation at the site of vascular injury. Prolonged storage of PLTs may reduce their ability to support optimal hemostasis upon transfusion. STUDY DESIGN AND METHODS: PLT concentrates (PCs) stored for 1, 4, 6, and 8 days were costimulated with thrombin and the collagen glycoprotein VI (GPVI) receptor agonist convulxin, and their ability to form coated PLTs was determined by flow cytometry. Further, a plasma-based thrombin generation assay and thrombelastography were used to evaluate the aged PCs' capacity to support thrombin generation and clot formation, respectively. The stored PCs were additionally tested by standard quality control methods. RESULTS: PLT quality as measured by standard analyses was acceptable according to current practice. The hemostatic potential, however, was impaired with increasing storage time. The formation of coated PLTs decreased significantly from approximately 85 to 55 percent with increasing storage time (p<0.05). The velocity of clot formation was significantly increased from Day 4 (p<0.05). The velocity of thrombin generation and resistance against fibrinolysis were significantly reduced on Day 8 compared to Day 1 of storage (p<0.05). CONCLUSION: Data in the present study suggest that storage significantly reduced the stored PLTs' ability to respond to conditions expected to exist at the site of vascular injury and that storage-induced reduction in PLT activation sensitivity correlated with a loss of hemostatic potential. FAU - Svendsen, Mette S AU - Svendsen MS AD - Hemostasis Biology, Novo Nordisk A/S, Maaloev, Denmark. FAU - Rojkjaer, Rasmus AU - Rojkjaer R FAU - Kristensen, Annemarie T AU - Kristensen AT FAU - Salado-Jimena, Jose A AU - Salado-Jimena JA FAU - Kjalke, Marianne AU - Kjalke M FAU - Johansson, Par I AU - Johansson PI LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transfusion JT - Transfusion JID - 0417360 RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Platelets/cytology/*physiology MH - *Blood Preservation MH - Flow Cytometry MH - *Hemostasis MH - Humans MH - Platelet Activation MH - Thrombelastography MH - Thrombin/biosynthesis MH - Time Factors EDAT- 2007/10/26 09:00 MHDA- 2008/01/08 09:00 CRDT- 2007/10/26 09:00 PHST- 2007/10/26 09:00 [pubmed] PHST- 2008/01/08 09:00 [medline] PHST- 2007/10/26 09:00 [entrez] AID - TRF01430 [pii] AID - 10.1111/j.1537-2995.2007.01430.x [doi] PST - ppublish SO - Transfusion. 2007 Nov;47(11):2057-65. doi: 10.1111/j.1537-2995.2007.01430.x. PMID- 17651347 OWN - NLM STAT- MEDLINE DCOM- 20070911 LR - 20191210 IS - 0041-1132 (Print) IS - 0041-1132 (Linking) VI - 47 IP - 2 Suppl DP - 2007 Aug TI - The blood bank: from provider to partner in treatment of massively bleeding patients. PG - 176S-181S; discussion 182S-183S AB - BACKGROUND: Continued hemorrhage remains a major cause of mortality in massively transfused patients of whom many develop coagulopathy. Reviewing transfusion practice for these patients, we found that at our hospital more than 10 percent received a suboptimal transfusion therapy and that survivors had a higher platelet count than nonsurvivors. We therefore investigated whether the blood bank could improve its service and hence improve the outcome. METHODS: The blood bank introduced monitoring of the delivery of blood products and contacted the clinician provided there was an imbalance in the transfusion practice. For massively transfused patients, transfusion packages, including five red blood cells, five fresh-frozen plasma, and two platelet concentrates, were introduced to improve hemostatic competence. The Thrombelastograph (TEG) Haemostatic System (Haemoscope Corp., Niles, IL) was implemented, aiding in the diagnosis and treatment of coagulopathy. RESULTS: The fraction of suboptimally transfused patients declined from more than 10 percent to less than 3 percent. The transfusion package administered intraoperatively to patients operated on for a ruptured abdominal aortic aneurysm resulted in decreased postoperative transfusion requirements and improved 30-day survival (66% vs. 44%) compared with controls. Performing TEG alone in patients with significant bleeding as judged by the anesthetist reduced the number of analyses by approximately 85 percent, while those patients with coagulopathy remained identified. The TEG showed a 97 percent predictability in identifying a surgical cause of bleeding in postoperative patients. Ten percent of the massively bleeding trauma patients had hyperfibrinolysis as the major cause of bleeding, whereas 45 percent were hypercoagulable. CONCLUSION: The initiative from the blood bank has improved the transfusion practice and, hence, survival in massively transfused patients at our hospital. FAU - Johansson, Par I AU - Johansson PI AD - Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. LA - eng PT - Evaluation Study PT - Journal Article PT - Review PL - United States TA - Transfusion JT - Transfusion JID - 0417360 SB - IM MH - Algorithms MH - Blood Banks/*organization & administration MH - Blood Coagulation Disorders/diagnosis/*therapy MH - Blood Loss, Surgical/mortality/prevention & control MH - Blood Transfusion/*statistics & numerical data MH - Hemorrhage/diagnosis/*therapy MH - Hemostasis MH - Hemostatic Techniques/instrumentation MH - Humans MH - Models, Biological MH - *Partnership Practice RF - 13 EDAT- 2007/08/19 09:00 MHDA- 2007/09/12 09:00 CRDT- 2007/08/19 09:00 PHST- 2007/08/19 09:00 [pubmed] PHST- 2007/09/12 09:00 [medline] PHST- 2007/08/19 09:00 [entrez] AID - TRF01381 [pii] AID - 10.1111/j.1537-2995.2007.01381.x [doi] PST - ppublish SO - Transfusion. 2007 Aug;47(2 Suppl):176S-181S; discussion 182S-183S. doi: 10.1111/j.1537-2995.2007.01381.x. PMID- 17568492 OWN - NLM STAT- MEDLINE DCOM- 20070719 LR - 20241128 IS - 0008-428X (Print) IS - 1488-2310 (Electronic) IS - 0008-428X (Linking) VI - 50 IP - 3 DP - 2007 Jun TI - An approach to transfusion and hemorrhage in trauma: current perspectives on restrictive transfusion strategies. PG - 202-9 AB - Hemorrhagic shock is a leading cause of death in trauma patients. Surgical control of bleeding and fluid resuscitation with both crystalloid and blood products remain the mainstay of therapy for injured patients with bleeding. However, there has been a recent re-evaluation of transfusion practice. Both the fear of transmissible disease and the costs of transfusing blood products have led to increasingly restrictive transfusion practices. A small percentage of trauma patients require massive transfusion. These patients are complex and difficult to manage, and clinicians must act quickly to save them. There is little evidence to help guide clinical transfusion decisions in these patients. A rational approach to using blood products requires an understanding of the end points of resuscitation. Resuscitation with fluids and red cells is necessary to improve perfusion and oxygen delivery to tissues. Avoiding overtransfusion is key, however, because transfusion is also associated with significant risks. This trend toward reducing allogenic blood exposure will likely continue. New technologies that have the potential of reducing blood loss and transfusion requirements in trauma patients with massive bleeding are being developed, and similar old technologies are being reapplied. FAU - Tien, Homer AU - Tien H AD - Canadian Forces Health Service, Department of National Defense, Toronto, Ont, Canada. FAU - Nascimento, Bartolomeu Jr AU - Nascimento B Jr FAU - Callum, Jeannie AU - Callum J FAU - Rizoli, Sandro AU - Rizoli S LA - eng PT - Journal Article PT - Review PL - Canada TA - Can J Surg JT - Canadian journal of surgery. Journal canadien de chirurgie JID - 0372715 RN - 0 (Fibrin Tissue Adhesive) RN - 0 (Hemostatics) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Recombinant Proteins) RN - 9001-25-6 (Factor VII) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Factor VII/therapeutic use MH - Factor VIIa MH - Fibrin Tissue Adhesive MH - Hemorrhage/etiology/*therapy MH - Hemostatics/therapeutic use MH - Humans MH - Isotonic Solutions/therapeutic use MH - Plasma Substitutes/therapeutic use MH - Recombinant Proteins/therapeutic use MH - Resuscitation MH - Thrombelastography MH - Transfusion Reaction MH - Wounds and Injuries/complications/*therapy PMC - PMC2384284 EDAT- 2007/06/15 09:00 MHDA- 2007/07/20 09:00 CRDT- 2007/06/15 09:00 PHST- 2007/06/15 09:00 [pubmed] PHST- 2007/07/20 09:00 [medline] PHST- 2007/06/15 09:00 [entrez] AID - 0002789-200706000-00009 [pii] PST - ppublish SO - Can J Surg. 2007 Jun;50(3):202-9. PMID- 17426904 OWN - NLM STAT- MEDLINE DCOM- 20070913 LR - 20181113 IS - 0364-2313 (Print) IS - 0364-2313 (Linking) VI - 31 IP - 5 DP - 2007 May TI - Coagulopathy: its pathophysiology and treatment in the injured patient. PG - 1055-64 AB - Hemorrhage continues to be one of the leading causes of death following trauma. Trauma patients are susceptible to the early development of coagulopathy and the most severely injured patients are coagulopathic on hospital admission. Hypothermia, acidosis, and dilution from standard resuscitation can worsen the presenting coagulopathy and perpetuate bleeding. Early identification of coagulopathy is dependent on clinical awareness and point of care laboratory values. Routinely used laboratory coagulation parameters fail to adequately describe this state. Thrombelastography is a test that can be done at the bedside and uses whole blood to provide a functional evaluation of coagulation. Rapid diagnosis of coagulopathy, followed by prevention or correction of hypothermia and acidosis should be a priority during the initial evaluation and resuscitation. Judicious use of resuscitation fluids and early replacement of coagulation factors will help prevent iatrogenic hemodilution. This review covers the pathophysiology as well as the clinical and laboratory diagnosis of coagulopathy. Prevention and treatment strategies are discussed, including early transfusion of coagulation factors during massive transfusion and the use of recombinant factor VIIa. Damage control resuscitation is briefly discussed, and it involves the combination of hypotensive resuscitation and hemostatic resuscitation. Finally, a description of the use of fresh whole blood in the military setting is included. Its use has been proven to be safe and beneficial in this setting and warrants further investigation as an adjunct to the management of civilian trauma patients. FAU - Tieu, Brandon H AU - Tieu BH AD - Department of Surgery, Division of Trauma and Critical Care, Oregon Health & Science University, Portland, Oregon 97239, USA. FAU - Holcomb, John B AU - Holcomb JB FAU - Schreiber, Martin A AU - Schreiber MA LA - eng PT - Journal Article PT - Review PL - United States TA - World J Surg JT - World journal of surgery JID - 7704052 RN - 9001-25-6 (Factor VII) SB - IM MH - Blood Coagulation Disorders/diagnosis/etiology/*physiopathology/*therapy MH - Blood Transfusion MH - Factor VII MH - Hemostasis MH - Humans MH - Resuscitation/methods MH - Wounds and Injuries/*complications RF - 63 EDAT- 2007/04/12 09:00 MHDA- 2007/09/14 09:00 CRDT- 2007/04/12 09:00 PHST- 2007/04/12 09:00 [pubmed] PHST- 2007/09/14 09:00 [medline] PHST- 2007/04/12 09:00 [entrez] AID - 10.1007/s00268-006-0653-9 [doi] PST - ppublish SO - World J Surg. 2007 May;31(5):1055-64. doi: 10.1007/s00268-006-0653-9. PMID- 17299811 OWN - NLM STAT- MEDLINE DCOM- 20071009 LR - 20220330 IS - 0260-437X (Print) IS - 0260-437X (Linking) VI - 27 IP - 3 DP - 2007 May-Jun TI - Triethylene glycol HO(CH2CH2O)3H. PG - 291-9 AB - TEG is a liquid higher glycol of very low vapor pressure with uses that are primarily industrial. It has a very low order of acute toxicity by i.v., i.p., peroral, percutaneous and inhalation (vapor and aerosol) routes of exposure. It does not produce primary skin irritation. Acute eye contact with the liquid causes mild local transient irritation (conjunctival hyperemia and slight chemosis) but does not induce corneal injury. Animal maximization and human volunteer repeated insult patch tests studies have shown that TEG does not cause skin sensitization. A study with Swiss-Webster mice demonstrated that TEG aerosol has properties of a peripheral chemosensory irritant material and caused a depression of breathing rate with an RD(50) of 5140 mg m(-3). Continuous subchronic peroral dosing of TEG in the diet of rats did not produce any systemic cumulative or long-term toxicity. The effects seen were dose-related increased relative kidney weight, increased urine volume and decreased urine pH, probably a result of the renal excretion of TEG and metabolites following the absorption of large doses of TEG. There was also decreased hemoglobin concentration, decreased hematocrit and increased mean corpuscular volume, probably due to hemodilution following absorption of TEG. The NOAEL was 20 000 ppm TEG in diet. Short-term repeated aerosol exposure studies in the rat demonstrated that, by nose-only exposure, the threshold for effects by respiratory tract exposure was 1036 mg m(-3). Neither high dosage acute nor repeated exposures to TEG produce hepatorenal injury characteristic of that caused by the lower glycol homologues. Elimination studies with acute peroral doses of TEG given to rats and rabbits showed high recoveries (91-98% over 5 days), with the major fraction appearing in urine (84-94%) and only 1% as CO(2). TEG in urine is present in unchanged and oxidized forms, but only negligible amounts as oxalic acid. Developmental toxicity studies with undiluted TEG given by gavage produced maternal toxicity in rats (body weight, food consumption, water consumption, and relative kidney weight) with a NOEL of 1126 mg kg(-1) day(-1), and mice (relative kidney weight) with a NOEL of 5630 mg kg(-1) day(-1). Developmental toxicity, expressed as fetotoxicity, had a NOEL of 5630 mg kg(-1) day(-1) with the rat and 563 mg kg(-1) day(-1) with mice. Neither species showed any evidence of embryotoxicity or teratogenicity. There was no evidence for reproductive toxicity with mice given up to 3% TEG in drinking water in a continuous breeding study. TEG did not produce mutagenic or clastogenic effects in the following in vitro genetic toxicology studies: Salmonella typhimurium reverse mutation test, SOS-chromotest in E. coli, CHO forward gene mutation test (HGPRT locus), CHO sister chromatid exchange test, and a chromosome aberration test with CHO cells. The use patterns suggest that exposure to TEG is mainly occupational, with limited exposures by consumers. Exposure is normally by skin and eye contact. Local and systemic adverse health effects by cutaneous exposure are likely not to occur, and eye contact will produce transient irritation without corneal injury. The very low vapor pressure of TEG makes it unlikely that significant vapor exposure will occur. Aerosol exposure is not a usual exposure mode, and acute aerosol exposures are unlikely to be harmful, although a peripheral sensory irritant effect may develop. However, repeated exposures to a TEG aerosol may result in respiratory tract irritation, with cough, shortness of breath and tightness of the chest. Recommended protective and precautionary measures include protective gloves, goggles or safety glasses and mechanical room ventilation. LC(50) data to various fish, aquatic invertebrates and algae, indicate that TEG is essentially nontoxic to aquatic organisms. Also, sustained exposure studies have demonstrated that TEG is of a low order of chronic aquatic toxicity. The bioconcentration potential, environmental hydrolysis, and photolysis rates are low, and soil mobility high. In the atmosphere TEG is degraded by reacting with photochemically produced hydroxyl radicals. These considerations indicate that the potential for ecotoxicological effects with TEG is low. CI - (c) 2007 John Wiley & Sons, Ltd. FAU - Ballantyne, Bryan AU - Ballantyne B AD - Consultant in Clinical and Occupational Toxicology, 871 Chappell Road, Charleston, WV 25304, USA. FAU - Snellings, William M AU - Snellings WM LA - eng PT - Journal Article PT - Review PL - England TA - J Appl Toxicol JT - Journal of applied toxicology : JAT JID - 8109495 RN - 3P5SU53360 (triethylene glycol) RN - 3WJQ0SDW1A (Polyethylene Glycols) SB - IM MH - Animals MH - Humans MH - Polyethylene Glycols/*administration & dosage/*chemistry/pharmacokinetics MH - Skin Tests/methods MH - Toxicity Tests/methods RF - 62 EDAT- 2007/02/15 09:00 MHDA- 2007/10/10 09:00 CRDT- 2007/02/15 09:00 PHST- 2007/02/15 09:00 [pubmed] PHST- 2007/10/10 09:00 [medline] PHST- 2007/02/15 09:00 [entrez] AID - 10.1002/jat.1220 [doi] PST - ppublish SO - J Appl Toxicol. 2007 May-Jun;27(3):291-9. doi: 10.1002/jat.1220. PMID- 17299655 OWN - NLM STAT- MEDLINE DCOM- 20070315 LR - 20221212 IS - 1424-7860 (Print) IS - 0036-7672 (Linking) VI - 136 IP - 49-50 DP - 2006 Dec 23 TI - Transfusion dependency of cardiac surgery--update 2006. PG - 781-8 AB - In developed countries perioperative blood transfusion requirements for red blood cell concentrates (RBC), platelet concentrates (PC), fresh frozen plasma (FFP) and stable plasma derivatives have now levelled off with more patients requiring less or no products whilst fewer patients need the larger proportion of donations. This text explores the reasons for such a development in patients undergoing cardiovascular surgery where the transfusion requirement has drastically declined in recent years. A reduced requirement of a mean of 2 RBCs is now the need per patient in most centers. Such a reduction is possible through various recent perioperative improvements: (i) thorough preoperative haematological checks in order to equip the patient for blood loss, surgical trauma and extracorporeal circulation (ECC) in which heparinized blood is pumped at high speed through an oxygenator, heat exchanger, reservoirs, tubings and connectors. (ii) Peroperative administration of inhibitors of fibrinolysis (aprotinin, epsilon-aminocaproic acid) reduce profuse haemorrhagic tendency. Successful attempts to minimise ECCs, including foamless aspiration of wound blood, refined surgical technology, tissue glue, and point-of-care laboratory testing (POCT) in the operating theatre all contribute to a reduced transfusion requirement. A substantial proportion of patients can now be operated on without ECC. New thrombelastography analysis allows for real-time monitoring of haemorrhagic/thrombogenic risk. Modern blood product quality contributes to limiting blood product usage. (iii) During the postoperative recovery phase, anaemia can be corrected by i.v.iron and recombinant human erythropoietin. Such measures allow the transfusion trigger, based on haemoglobin concentration, to be set as low as 70 g/l in suitable patients. FAU - Nydegger, U AU - Nydegger U AD - Octapharma Switzerland, Lachen/SZ. urs.nydegger@octapharma.ch LA - eng PT - Journal Article PT - Review PL - Switzerland TA - Swiss Med Wkly JT - Swiss medical weekly JID - 100970884 RN - 0 (Anticoagulants) SB - IM MH - Anticoagulants/therapeutic use MH - Blood Loss, Surgical/prevention & control MH - Blood Transfusion/methods/*statistics & numerical data MH - *Cardiovascular Surgical Procedures/methods MH - Extracorporeal Circulation/*statistics & numerical data MH - *Hemostatic Techniques MH - Humans MH - Preoperative Care RF - 60 EDAT- 2007/02/15 09:00 MHDA- 2007/03/16 09:00 CRDT- 2007/02/15 09:00 PHST- 2007/02/15 09:00 [pubmed] PHST- 2007/03/16 09:00 [medline] PHST- 2007/02/15 09:00 [entrez] AID - smw-11651 [pii] AID - 10.4414/smw.2006.11651 [doi] PST - ppublish SO - Swiss Med Wkly. 2006 Dec 23;136(49-50):781-8. doi: 10.4414/smw.2006.11651. PMID- 17264960 OWN - NLM STAT- MEDLINE DCOM- 20070323 LR - 20070131 IS - 0340-6245 (Print) IS - 0340-6245 (Linking) VI - 97 IP - 2 DP - 2007 Feb TI - Recombinant human activated factor VII is thrombogenic in a rabbit model of cyclic flow reduction and does not reduce intra-abdominal bleeding. PG - 296-303 AB - Recombinant human activated factor VII (rHuFVIIa) can reduce bleeding but may be associated with arterial thrombosis. We hypothesized that rHuFVIIa would increase the occurrence of cyclic flow reductions (CFR) and reduce intra-abdominal bleeding in an experimental model. An adapted Folts' model of carotid artery lesion and stenosis was used. Twenty four rabbits were randomized to receive rHuFVIIa (group F) or placebo (group P) in a double-blind fashion. A standardized injury to the common carotid artery resulted in CFR and/or thrombosis. Hematological values, coagulation and thromboelastographic (TEG) variables were compared. Intra-abdominal bleeding was evaluated by measuring blood loss from standardized hepatosplenic lesions. The median number (range) of spontaneous CFR [group P: 6 (0-15); group F: 8 (0-16)] was comparable between groups. The number of induced CFR (by "shaking" of the artery) needed to avert thrombosis (group F: 2; group P: 0; p < 0.05) and the incidence of complete carotid artery thrombosis (group F: 3; group P: 0; p < 0.05) were higher in group F. Intra-abdominal bleeding was similar in both groups. TEG analysis demonstrated a hypercoagulable state in both groups but the magnitude of the change was statistically more important in group F. rHuFVIIa increases thrombosis in a rabbit model of carotid artery injury. The bleeding from hepatic and splenic lesions is not reduced by administration of rHuFVIIa despite a hypercoagulable state confirmed by standard TEG analysis. FAU - Charbonneau, Sonia AU - Charbonneau S AD - Department of Anesthesiology, CHUM, Hopital Notre-Dame, Montreal, Canada. FAU - Girard, Francois AU - Girard F FAU - Boudreault, Daniel AU - Boudreault D FAU - Ruel, Monique AU - Ruel M FAU - Blais, Normand AU - Blais N FAU - Hardy, Jean-Francois AU - Hardy JF LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Germany TA - Thromb Haemost JT - Thrombosis and haemostasis JID - 7608063 RN - 0 (Coagulants) RN - 0 (Recombinant Proteins) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Animals MH - Blood Coagulation/*drug effects MH - Blood Flow Velocity/*drug effects MH - Carotid Artery Thrombosis/blood/*chemically induced/etiology/physiopathology MH - Carotid Stenosis/complications MH - Coagulants/*adverse effects MH - Disease Models, Animal MH - Factor VIIa/*adverse effects MH - Hematocrit MH - Hemorrhage/*blood/prevention & control MH - Humans MH - Liver/surgery MH - Male MH - Platelet Count MH - Rabbits MH - Random Allocation MH - Recombinant Proteins/adverse effects MH - Spleen/surgery MH - Thrombelastography MH - Time Factors EDAT- 2007/02/01 09:00 MHDA- 2007/03/24 09:00 CRDT- 2007/02/01 09:00 PHST- 2007/02/01 09:00 [pubmed] PHST- 2007/03/24 09:00 [medline] PHST- 2007/02/01 09:00 [entrez] AID - 07020296 [pii] PST - ppublish SO - Thromb Haemost. 2007 Feb;97(2):296-303. PMID- 17127479 OWN - NLM STAT- MEDLINE DCOM- 20070202 LR - 20061127 IS - 0953-7104 (Print) IS - 0953-7104 (Linking) VI - 17 IP - 8 DP - 2006 Dec TI - Thrombelastography: current clinical applications and its potential role in interventional cardiology. PG - 509-18 AB - Thrombelastography is a bedside blood test used to assess patients' haemostatic status. It has a well-established role in hepatobiliary and cardiac surgery and is also used in obstetrics and trauma medicine to assess coagulation and identify the causes of post-operative bleeding. It is not routinely used in the diagnosis or treatment of thrombosis although recently it has been shown to predict thrombotic events post-operatively and after percutaneous intervention (PCI). In cardiovascular medicine the importance of the platelet in the pathophysiology of vascular events is increasingly apparent. As a result antiplatelet therapy is a cornerstone of the treatment for coronary disease, particularly in the setting of acute coronary syndromes. The increasing utilization of stents, particularly drug-eluting devices, in PCI has also necessitated widespread use of antiplatelet agents to minimize the risk of stent thrombosis. A quick, accurate and reliable test to measure the effect of platelet inhibition by antiplatelet agents on clotting in an individual patient would be of profound clinical value. The results from such a test could provide prognostic information, allow treatment with antiplatelet agents to be tailored to the individual and identify resistance to one or more of these agents. Optimization and tailoring of anti-platelet therapy in patients with cardiovascular disease, particularly those undergoing PCI, using such a test may reduce morbidity and mortality from thrombotic and haemorrhagic complications. Current methods of assessing platelet activity measure platelet count and function in isolation. Optical aggregation is the most widely used method for assessing platelet function but it is relatively time consuming, measures platelet function in isolation rather than in the context of clot formation and is not a bedside test. By contrast the modified thrombelastograph platelet mapping kit marketed by Haemoscope can be used to assess the effects of antiplatelet agents on ex vivo blood clotting, thus giving a measurement more relevant to in vivo responses. This represents a potentially powerful tool to assess response of individual patients to antiplatelet therapy, particularly in the context of PCI. FAU - Hobson, A R AU - Hobson AR AD - Southampton University Hospital, Wessex Cardiac Unit, Southampton, UK. FAU - Agarwala, R A AU - Agarwala RA FAU - Swallow, R A AU - Swallow RA FAU - Dawkins, K D AU - Dawkins KD FAU - Curzen, N P AU - Curzen NP LA - eng PT - Journal Article PT - Review PL - England TA - Platelets JT - Platelets JID - 9208117 RN - 0 (Anticoagulants) SB - IM MH - Anticoagulants/*blood/therapeutic use MH - *Drug Monitoring/methods MH - Humans MH - Postoperative Hemorrhage/blood/*diagnosis/drug therapy/etiology MH - *Thrombelastography/methods MH - Thrombosis/blood/*diagnosis/drug therapy/etiology RF - 63 EDAT- 2006/11/28 09:00 MHDA- 2007/02/03 09:00 CRDT- 2006/11/28 09:00 PHST- 2006/11/28 09:00 [pubmed] PHST- 2007/02/03 09:00 [medline] PHST- 2006/11/28 09:00 [entrez] AID - RTUU65285X4659RW [pii] AID - 10.1080/09537100600935259 [doi] PST - ppublish SO - Platelets. 2006 Dec;17(8):509-18. doi: 10.1080/09537100600935259. PMID- 17123394 OWN - NLM STAT- MEDLINE DCOM- 20070813 LR - 20091021 IS - 1351-8216 (Print) IS - 1351-8216 (Linking) VI - 12 Suppl 6 DP - 2006 Dec TI - Basic aspects of bypassing agents. PG - 48-52; discussion 52-3 AB - Bypassing agents consist of activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa (rFVIIa). Their main utilization is for prevention and treatment of bleeding complications, which may occur in inhibitor-developing haemophiliacs, although new indications for rFVIIa (e.g. trauma-related and cerebral bleeds) are now under evaluation in clinical trials. The mechanisms of action for these agents are still not fully understood. The relative complexity of the composition of aPCC suggests the possibility of multiple modes of action for achieving haemostasis. Among those possibilities, the contributions of activated factor X and prothrombin have been demonstrated in recent years both in vitro and in animal models for the only aPCC which remains on the market. rFVIIa also exhibits a complex mode of action, improving coagulation through both tissue factor-dependent and -independent pathways. The various mechanisms that occur at the cellular surfaces, particularly on the outer leaflet of the platelet membrane, primarily contribute to Xase complex formation and thrombin generation. The ways in which these agents affect the complex kinetics of fibrin formation at the site of vascular damage need further clarification, although significant progress has been achieved in the last 10 years. In addition, the ex vivo monitoring that would reflect achievement of haemostasis in vivo is still not standardized, although several attempts using thromboelastography, thrombin generation and the kinetics of fibrin formation have been initiated. FAU - Negrier, C AU - Negrier C AD - Unite d'Hemostase Clinique, Centre Regional de Traitement de l'Hemophilie, Lyon, France. claude.negrier@chu-lyon.fr FAU - Dargaud, Y AU - Dargaud Y FAU - Bordet, J C AU - Bordet JC LA - eng PT - Journal Article PT - Review PL - England TA - Haemophilia JT - Haemophilia : the official journal of the World Federation of Hemophilia JID - 9442916 RN - 0 (Blood Coagulation Factors) RN - 0 (Hemostatics) RN - 9001-31-4 (Fibrin) RN - EC 3.4.21.21 (Factor VIIa) RN - EC 3.4.21.5 (Thrombin) SB - IM MH - Blood Coagulation/*drug effects/physiology MH - Blood Coagulation Factors/*therapeutic use MH - Factor VIIa/*therapeutic use MH - Fibrin/drug effects MH - Hemophilia A/*drug therapy/physiopathology MH - Hemostatics/*therapeutic use MH - Humans MH - Thrombin/*therapeutic use RF - 22 EDAT- 2006/11/25 09:00 MHDA- 2007/08/19 09:00 CRDT- 2006/11/25 09:00 PHST- 2006/11/25 09:00 [pubmed] PHST- 2007/08/19 09:00 [medline] PHST- 2006/11/25 09:00 [entrez] AID - HAE1366 [pii] AID - 10.1111/j.1365-2516.2006.01366.x [doi] PST - ppublish SO - Haemophilia. 2006 Dec;12 Suppl 6:48-52; discussion 52-3. doi: 10.1111/j.1365-2516.2006.01366.x. PMID- 17109736 OWN - NLM STAT- MEDLINE DCOM- 20070319 LR - 20230829 IS - 1538-7933 (Print) IS - 1538-7836 (Linking) VI - 5 IP - 2 DP - 2007 Feb TI - Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. PG - 289-95 AB - BACKGROUND: Reagent-supported thromboelastometry with the rotation thrombelastography (e.g. ROTEM) is a whole blood assay that evaluates the visco-elastic properties during blood clot formation and clot lysis. A hemostatic monitor capable of rapid and accurate detection of clinical coagulopathy within the resuscitation room could improve management of bleeding after trauma. OBJECTIVES: The goals of this study were to establish whether ROTEM correlated with standard coagulation parameters to rapidly detect bleeding disorders and whether it can help to guide transfusion. METHODS: Ninety trauma patients were included in the study. At admission, standard coagulation assays were performed and ROTEM parameters such as clot formation time (CFT) and clot amplitude (CA) were obtained at 15 min (CA(15)) with two activated tests (INTEM, EXTEM) and at 10 min (CA(10)) with a test analyzing specifically the fibrin component of coagulation (FIBTEM). RESULTS: Trauma induced significant modifications of coagulation as assessed by standard assays and ROTEM. A significant correlation was found between prothrombin time (PT) and CA(15)-EXTEM (r = 0.66, P < 0.0001), between activated partial thromboplastin time and CFT-INTEM (r = 0.91, P < 0.0001), between fibrinogen level and CA(10)-FIBTEM (r = 0.85, P < 0.0001), and between platelet count and CA(15)-INTEM (r = 0.57, P < 0.0001). A cutoff value of CA(15)-EXTEM at 32 mm and CA(10)-FIBTEM at 5 mm presented a good sensitivity (87% and 91%) and specificity (100% and 85%) to detect a PT > 1.5 of control value and a fibrinogen less than 1 g L(-1), respectively. CONCLUSIONS: ROTEM is a point-of-care device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion. FAU - Rugeri, L AU - Rugeri L AD - Laboratory of Haemostasis, Edouard Herriot Hospital, Hospices Civils de Lyon and Claude Bernard University, Lyon, France. lucia.rugeri@chu-lyon.fr FAU - Levrat, A AU - Levrat A FAU - David, J S AU - David JS FAU - Delecroix, E AU - Delecroix E FAU - Floccard, B AU - Floccard B FAU - Gros, A AU - Gros A FAU - Allaouchiche, B AU - Allaouchiche B FAU - Negrier, C AU - Negrier C LA - eng PT - Evaluation Study PT - Journal Article DEP - 20061116 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 SB - IM MH - Blood Coagulation Disorders/*diagnosis MH - Blood Coagulation Tests/standards MH - Humans MH - Point-of-Care Systems/standards MH - Sensitivity and Specificity MH - Thrombelastography/instrumentation/methods/*standards MH - *Wounds and Injuries EDAT- 2006/11/18 09:00 MHDA- 2007/03/21 09:00 CRDT- 2006/11/18 09:00 PHST- 2006/11/18 09:00 [pubmed] PHST- 2007/03/21 09:00 [medline] PHST- 2006/11/18 09:00 [entrez] AID - S1538-7836(22)10082-6 [pii] AID - 10.1111/j.1538-7836.2007.02319.x [doi] PST - ppublish SO - J Thromb Haemost. 2007 Feb;5(2):289-95. doi: 10.1111/j.1538-7836.2007.02319.x. Epub 2006 Nov 16. PMID- 17102653 OWN - NLM STAT- MEDLINE DCOM- 20070215 LR - 20141120 IS - 0957-5235 (Print) IS - 0957-5235 (Linking) VI - 17 IP - 8 DP - 2006 Nov TI - Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry. PG - 661-5 AB - The objective was to study the effects of ethanol on coagulation and fibrinolysis in whole blood. Blood samples from healthy volunteers were analyzed before and after in-vitro addition of ethanol in order to achieve ethanol concentrations of 0, 1, 2 and 4 per thousand, respectively (0, 22, 44 and 88 mmol/l). Coagulation and fibrinolysis were then assessed using rotational thromboelastometry. We found that increasing ethanol levels increasingly impaired coagulation as evaluated with rotational thromboelastometry, with a maximum prolongation of the clot formation time of 118% at an ethanol level of 4 per thousand (P < 0.000001). We also found a very strong impairment of fibrinolysis already at an ethanol level of 1 per thousand. This is the first study assessing the effects of ethanol on coagulation and fibrinolysis in a whole blood model. The impairment of coagulation is similar in nature to the impairment found in patients suffering from hypothermia. The impairment is at a level that may be of clinical importance (e.g. in patients suffering from trauma). The inhibition of fibrinolysis is obvious already at an ethanol level of 1 per thousand and it may be a contributing factor to the increased amount of coronary and cerebrovascular ischemic events after binge drinking. FAU - Engstrom, Martin AU - Engstrom M AD - Department of Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden. martin.engstrom@med.lu.se FAU - Schott, Ulf AU - Schott U FAU - Reinstrup, Peter AU - Reinstrup P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Central Nervous System Depressants) RN - 3K9958V90M (Ethanol) SB - IM MH - Alcohol Drinking/adverse effects MH - Blood Coagulation/*drug effects MH - Blood Coagulation Disorders/chemically induced MH - Central Nervous System Depressants/*adverse effects/blood MH - Ethanol/*adverse effects/blood MH - Fibrinolysis/*drug effects MH - Hemorrhage/chemically induced MH - Humans MH - In Vitro Techniques MH - Thrombelastography EDAT- 2006/11/15 09:00 MHDA- 2007/02/16 09:00 CRDT- 2006/11/15 09:00 PHST- 2006/11/15 09:00 [pubmed] PHST- 2007/02/16 09:00 [medline] PHST- 2006/11/15 09:00 [entrez] AID - 00001721-200611000-00009 [pii] AID - 10.1097/MBC.0b013e32801010b7 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 2006 Nov;17(8):661-5. doi: 10.1097/MBC.0b013e32801010b7. PMID- 16966998 OWN - NLM STAT- MEDLINE DCOM- 20061018 LR - 20240103 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 61 IP - 3 DP - 2006 Sep TI - Acidosis impairs the coagulation: A thromboelastographic study. PG - 624-8 AB - BACKGROUND: Coagulopathy is a contributor to and predictor of death in bleeding patients. Acidosis is known to be a predictor of worse outcome in trauma patients and to be a coexisting factor in coagulopathic patients, but it has not been studied if it is a causal factor in the development of coagulopathy. METHODS: We have adjusted the pH level in blood samples from healthy volunteers to different levels between 7.4 and 6.8 by the use of hydrochloric acid. Thereafter we have studied the coagulation at the different pH levels by the use of thromboelastography. RESULTS: We found a strong correlation between pH levels and impairment of the coagulation, where the clot strength is increased much slower at pH levels below 7.4 even though the initiation of the clotting seems to be normal. The clot formation time was increased by 168% at pH 6.8 as compared with pH 7.4 (p < 0.00001, r = 0.89) whereas the clotting time was left unaffected. CONCLUSIONS: Acidosis causes a strong impairment of the coagulation as measured with thromboelastography. The impairment found when lowering pH from 7.4 to 7.15 was almost identical to the impairment seen in another study by Kettner et al. when the temperature was lowered from 36 degrees C to 32 degrees C. FAU - Engstrom, Martin AU - Engstrom M AD - Department of Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden. martin.engstrom@med.lu.se FAU - Schott, Ulf AU - Schott U FAU - Romner, Bertil AU - Romner B FAU - Reinstrup, Peter AU - Reinstrup P LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Acidosis/*complications/physiopathology MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/*etiology MH - Humans MH - Hydrogen-Ion Concentration MH - *Thrombelastography EDAT- 2006/09/13 09:00 MHDA- 2006/10/19 09:00 CRDT- 2006/09/13 09:00 PHST- 2006/09/13 09:00 [pubmed] PHST- 2006/10/19 09:00 [medline] PHST- 2006/09/13 09:00 [entrez] AID - 00005373-200609000-00017 [pii] AID - 10.1097/01.ta.0000226739.30655.75 [doi] PST - ppublish SO - J Trauma. 2006 Sep;61(3):624-8. doi: 10.1097/01.ta.0000226739.30655.75. PMID- 16799348 OWN - NLM STAT- MEDLINE DCOM- 20060823 LR - 20131121 IS - 0898-4921 (Print) IS - 0898-4921 (Linking) VI - 18 IP - 3 DP - 2006 Jul TI - Increased lactate levels impair the coagulation system--a potential contributing factor to progressive hemorrhage after traumatic brain injury. PG - 200-4 AB - Progressive intracerebral contusions are a major problem in the management of patients with severe traumatic brain injury that is also linked to worse outcome. Microdialysis studies have revealed that lactate levels are very high inside contusions, corresponding to significant acidosis. The current study was performed in an effort to investigate whether the lactate accumulation inside cerebral contusions may be a contributing factor to the prolonged bleeding inside contusions. We have investigated the effects of lactic acidosis on the coagulation system with rotational thromboelastometry. It was a laboratory study involving 6 healthy volunteers. Blood was drawn and the pH was adjusted by addition of lactic acid in vitro. The pH levels studied were 7.4, 7.2, 7.0, and 6.8. The pH was also readjusted to 7.4 by addition the buffer THAM to blood initially adjusted to a pH of 6.8 to study the reversibility of potential adverse effects induced by the lactic acidosis. We found the coagulation to be significantly impaired by lactic acidosis (P = 0.000l). The impairment found was reversible after correction of the acidosis by a buffer. In conclusion, we found that lactic acidosis impaired the coagulation system. The impairment caused by lactic acidosis may be one factor causing the progressive hemorrhage in posttraumatic cerebral contusions, known to have high levels of lactate and correspondingly low pH. It may also be important to consider in bleeding trauma patients. FAU - Engstrom, Martin AU - Engstrom M AD - Department of Anaesthesia and Intensive Care, Lund University Hospital, Sweden. martin.engstrom@med.lu.se FAU - Schott, Ulf AU - Schott U FAU - Nordstrom, Carl-Henrik AU - Nordstrom CH FAU - Romner, Bertil AU - Romner B FAU - Reinstrup, Peter AU - Reinstrup P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Neurosurg Anesthesiol JT - Journal of neurosurgical anesthesiology JID - 8910749 RN - 0 (Buffers) RN - 023C2WHX2V (Tromethamine) RN - 33X04XA5AT (Lactic Acid) SB - IM MH - Acidosis/blood/physiopathology MH - Blood Coagulation/*physiology MH - Brain Injuries/complications/*physiopathology MH - Buffers MH - Cerebral Hemorrhage, Traumatic/etiology/*physiopathology MH - Disease Progression MH - Humans MH - Hydrogen-Ion Concentration MH - Lactic Acid/*blood MH - Thrombelastography MH - Tromethamine/pharmacology EDAT- 2006/06/27 09:00 MHDA- 2006/08/24 09:00 CRDT- 2006/06/27 09:00 PHST- 2006/06/27 09:00 [pubmed] PHST- 2006/08/24 09:00 [medline] PHST- 2006/06/27 09:00 [entrez] AID - 00008506-200607000-00007 [pii] AID - 10.1097/01.ana.0000211002.63774.8a [doi] PST - ppublish SO - J Neurosurg Anesthesiol. 2006 Jul;18(3):200-4. doi: 10.1097/01.ana.0000211002.63774.8a. PMID- 16790652 OWN - NLM STAT- MEDLINE DCOM- 20060816 LR - 20181201 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 103 IP - 1 DP - 2006 Jul TI - The value of an albumin-based intravascular volume replacement strategy in elderly patients undergoing major abdominal surgery. PG - 191-9, table of contents AB - The value of human albumin (HA) for treating hypovolemia is controversial. Less expensive alternatives such as hydroxyethyl starch (HES) are sometimes refused because of unwanted side effects. We prospectively randomized 50 patients older than 70 years old undergoing major abdominal surgery to receive either 5% HA (n = 25) or a third generation HES preparation (6% HES 130/0.4; n = 25) when mean arterial blood pressure was <60 mm Hg and central venous pressure was <10 mm Hg. Hemodynamics, inflammation (interleukin-6), endothelial activation-integrity (adhesion molecules), coagulation (thrombelastography), and renal function (including kidney-specific proteins) were monitored after the induction of anesthesia, after surgery, 5 h in the intensive care unit, and on the first postoperative day. HA patients received 3960 +/- 590 mL of HA and 5070 +/- 1030 mL of Ringer's lactate solution, and HES patients received 3500 +/- 530 mL of HES and 4550 +/- 880 mL of Ringer's lactate solution. Total protein remained normal only in the HA-treated patients. No significant differences (P > 0.1) between the groups were seen with regard to hemodynamics, coagulation, and kidney function. Plasma levels of interleukin-6 and soluble adhesion molecules were significantly (P < 0.05) higher in the HA- than in the HES-treated patients. We conclude that HA in elderly patients undergoing major abdominal surgery can easily be replaced by a modern HES preparation. Because of the decreased inflammatory response and endothelial activation-injury, HES 130/0.4 seems to be the more appropriate fluid strategy for these patients. FAU - Boldt, Joachim AU - Boldt J AD - Clinic of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr 79, D-67063 Ludwigshafen, Germany. BoldtJ@gmx.net FAU - Scholhorn, Thilo AU - Scholhorn T FAU - Mayer, Jochen AU - Mayer J FAU - Piper, Sven AU - Piper S FAU - Suttner, Stefan AU - Suttner S LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Retracted Publication PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Albumins) RN - 0 (Cell Adhesion Molecules) RN - 0 (Colloids) RN - 0 (HES 130-0.4) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Interleukin-6) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Ringer's Lactate) SB - IM EIN - Anesth Analg. 2007 Feb;104(2):317 RIN - Anesth Analg. 2011 May;112(5):1085. doi: 10.1213/ANE.0b013e31821a9273. PMID: 21451071 MH - Abdomen/*surgery MH - Aged MH - Aged, 80 and over MH - Albumins/*administration & dosage MH - Blood Coagulation MH - Blood Loss, Surgical MH - Cell Adhesion Molecules/blood MH - Colloids/administration & dosage MH - Female MH - Hemodynamics MH - Humans MH - Hydroxyethyl Starch Derivatives/administration & dosage MH - Interleukin-6/blood MH - Isotonic Solutions/administration & dosage MH - Male MH - Plasma Substitutes/*administration & dosage MH - Postoperative Complications MH - Ringer's Lactate MH - Urine EDAT- 2006/06/23 09:00 MHDA- 2006/08/17 09:00 CRDT- 2006/06/23 09:00 PHST- 2006/06/23 09:00 [pubmed] PHST- 2006/08/17 09:00 [medline] PHST- 2006/06/23 09:00 [entrez] AID - 103/1/191 [pii] AID - 10.1213/01.ane.0000221179.07006.06 [doi] PST - ppublish SO - Anesth Analg. 2006 Jul;103(1):191-9, table of contents. doi: 10.1213/01.ane.0000221179.07006.06. PMID- 16647482 OWN - NLM STAT- MEDLINE DCOM- 20060811 LR - 20071115 IS - 0041-1345 (Print) IS - 0041-1345 (Linking) VI - 38 IP - 3 DP - 2006 Apr TI - Intraoperative coagulation evaluation of ischemia-reperfusion injury in small bowel transplantation: a way to explore. PG - 820-2 AB - BACKGROUND AND AIM OF STUDY: The success of intestinal transplantation is affected by the extreme susceptibility of the small bowel to ischemia-reperfusion (I/R) injury. Platelet aggregation decreases after reperfusion in small intestinal ischemia and liver transplantation. Thromboelastography (TEG) is a coagulation test performed whole on blood. The aims of this study were to assess coagulation derangements during bowel transplantation to define appropriate modalities of intraoperative coagulation monitoring. A secondary endpoint was to determine whether measurements of coagulation derangements were useful to estimate small intestinal I/R injury. MATERIALS AND METHODS: We recruited 19 patients who had undergone elective small bowel transplantation for primary short-gut syndrome. We divided our patients into two groups depending on their reperfusion injury as evaluated with a biopsy after reperfusion: group A composed of eight patients who had a reperfusion injury: group B composed of 11 patients who did not experience this problem. We measured five thromboelastogram indicators (r, k, angle, MA, CL30) at defined intervals: dissection phase (T1), vascular anastomoses phase (T2) as well as 30 minutes (T3) and 120 minutes (T4) after reperfusion during the intestinal reconstruction phase. RESULTS: We did not observe any significant difference between intraoperative blood loss, core temperature, or volume of fluid fresh frozen plasma, or platelet administration. Angle and MA were decreased significantly among patients with reperfusion injury. DISCUSSION: Patients showed a hypocoagulation pattern during all the manipulations. This derangement did not depend on the ischemia time. In patients with I/R injury the angle and MA did not change during ischemia, but did change significantly upon reperfusion. Several mechanisms may cause coagulation derangements. During the ischemic period, there may be damage to the vascular bed of the ischemic organ. When arterial blood passes through the damaged vascular bed after reperfusion, platelet activation occurs to varying degrees, resulting in reduced platelet function. CONCLUSION: Further studies are needed to confirm this preliminary work, which was limited by the low number of patients, in order to elucidate relevant mechanisms and develop predictive algorithms. FAU - Siniscalchi, A AU - Siniscalchi A AD - Department of Anesthesiology, Liver and Multiorgan Transplant Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. sinianest@libero.it FAU - Spedicato, S AU - Spedicato S FAU - Lauro, A AU - Lauro A FAU - Pinna, A D AU - Pinna AD FAU - Cucchetti, A AU - Cucchetti A FAU - Dazzi, A AU - Dazzi A FAU - Piraccini, E AU - Piraccini E FAU - Begliomini, B AU - Begliomini B FAU - Braglia, V AU - Braglia V FAU - Serri, T AU - Serri T FAU - Faenza, S AU - Faenza S LA - eng PT - Journal Article PL - United States TA - Transplant Proc JT - Transplantation proceedings JID - 0243532 SB - IM MH - Anastomosis, Surgical MH - *Blood Coagulation Tests MH - Blood Loss, Surgical MH - Body Temperature MH - Hemodynamics MH - Humans MH - Intestinal Mucosa/pathology MH - Intestine, Small/pathology/*transplantation MH - *Monitoring, Intraoperative MH - Platelet Transfusion MH - Reperfusion Injury/*blood/diagnosis MH - Short Bowel Syndrome/*surgery MH - Time Factors MH - *Transplantation, Homologous EDAT- 2006/05/02 09:00 MHDA- 2006/08/12 09:00 CRDT- 2006/05/02 09:00 PHST- 2006/05/02 09:00 [pubmed] PHST- 2006/08/12 09:00 [medline] PHST- 2006/05/02 09:00 [entrez] AID - S0041-1345(06)00036-4 [pii] AID - 10.1016/j.transproceed.2006.01.035 [doi] PST - ppublish SO - Transplant Proc. 2006 Apr;38(3):820-2. doi: 10.1016/j.transproceed.2006.01.035. PMID- 16572074 OWN - NLM STAT- MEDLINE DCOM- 20060727 LR - 20221207 IS - 1341-1098 (Print) IS - 1341-1098 (Linking) VI - 12 IP - 1 DP - 2006 Feb TI - Midterm results of transluminal endovascular grafting in patients with DeBakey type III dissecting aortic aneurysms. PG - 42-9 AB - OBJECTIVE: Transluminal endovascular grafting (TEG) is less invasive than conventional operative procedures for the treatment of DeBakey type III dissecting aortic aneurysms (DAA). We have used two different kinds of stent grafts covered with woven Dacron grafts, a Gianturco Z-stent graft (G-SG) and a Spiral Z-stent graft (S-SG). Because the G-SG lacks adequate flexibility, the end of the graft may injure the intima after long-term deployment in the proximal descending aorta. We have used S-SGs, which are more flexible than G-SG, to improve outcome. We report our late midterm results and discuss treatment policy. SUBJECTS AND METHODS: We studied 45 patients with DeBakey type III DAA. Thirty-two G-SGs and 13 S-SGs were used. Follow-up ranged from 1 year 6 months to 8 years 5 months (mean, 5 years 2 months). RESULTS: 1) Surgical outcome: (a) TEG was technically successful in all patients. There was no operative mortality. (b) One week after surgery, 36 patients had no endoleaks, 5 had minor endoleaks, and 4 had major endoleaks. 2) Late midterm results: (a) Four patients with residual major endoleaks, underwent replacement of the descending thoracic aorta. (b) Intimal injury occurred at the distal end of the stent graft 4 to 18 months (mean, 10.5 months) after surgery in 12 patients with G-SG and 1 with S-SG. One of these patients had recurrent dissection, and 12 had ulcer like projections (ULP). Two patients underwent additional stent implantation to block blood flow. (c) Four patients with S-SG had major endoleaks 3 to 6 months after surgery. In 3 of these patients, the Spiral Z-stents were compressed and occluded, and thrombus had formed in the lumen. Three patients underwent replacement of the descending thoracic aorta. (d) Additional replacement of the descending thoracic aorta was done in 9 of the 45 patients (20%) 4 to 24 months after TEG. All patients responded to treatment and were discharged from the hospital. CONCLUSION: Intimal injury was caused by Gianturco Z-stents because of inadequate flexibility, and endoleaks and stent-graft occlusion were caused by Spiral Z-stents because of insufficient radial force against the aortic wall. The development of stents with these improved properties is expected to further improve outcome. FAU - Suzuki, Shinichi AU - Suzuki S AD - Department of Cardiovascular Surgery, Yokohama City University School of Medicine, Yokohama, Japan. FAU - Imoto, Kiyotaka AU - Imoto K FAU - Uchida, Keiji AU - Uchida K FAU - Takanashi, Yoshinori AU - Takanashi Y FAU - Kichikawa, Kimihiko AU - Kichikawa K LA - eng PT - Journal Article PL - Japan TA - Ann Thorac Cardiovasc Surg JT - Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia JID - 9703158 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Aortic Dissection/*surgery MH - Aortic Aneurysm/*surgery MH - *Blood Vessel Prosthesis Implantation MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Postoperative Complications MH - Prosthesis Design MH - *Stents MH - Tomography, X-Ray Computed MH - Treatment Outcome EDAT- 2006/03/31 09:00 MHDA- 2006/07/28 09:00 CRDT- 2006/03/31 09:00 PHST- 2006/03/31 09:00 [pubmed] PHST- 2006/07/28 09:00 [medline] PHST- 2006/03/31 09:00 [entrez] PST - ppublish SO - Ann Thorac Cardiovasc Surg. 2006 Feb;12(1):42-9. PMID- 16428520 OWN - NLM STAT- MEDLINE DCOM- 20060221 LR - 20181203 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 102 IP - 2 DP - 2006 Feb TI - The effect of fibrinogen substitution on reversal of dilutional coagulopathy: an in vitro model. PG - 347-51 AB - Colloids and crystalloids are usually administered as treatment for hypovolemia in severely injured patients. However, dilution of clotting factors and platelets together with impaired fibrinogen polymerization are associated with fluid therapy and may aggravate hemorrhage, thus worsening final outcome of these patients. We investigated, in an in vitro model, whether the addition of fibrinogen to diluted blood samples can reverse dilutional coagulopathy. Blood from 5 healthy male volunteers was diluted by 60% using lactated Ringer's solution, 4% modified gelatin solution, or 6% hydroxyethyl starch 130/0.4, as well as the combination of lactated Ringer's solution with either of the 2 colloid solutions. Thereafter, aliquots of diluted blood samples were incubated with 3 different concentrations of fibrinogen (0.75, 1.5, and 3.0 mg/mL). Measurements were performed by modified thrombelastography (ROTEM; Pentapharm, Munich, Germany). After 60% dilution, clotting times increased, whereas clot firmness and fibrin polymerization decreased significantly. After administration of fibrinogen, clotting times decreased and clot firmness, as well as fibrin polymerization, increased in all diluted blood samples. The effect of in vitro fibrinogen substitution on ROTEM variables was dependent on the fibrinogen dosage and the type of solution used to dilute the blood samples. FAU - Fries, Dietmar AU - Fries D AD - Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. dietmar.fries@uibk.ac.at FAU - Innerhofer, Petra AU - Innerhofer P FAU - Reif, Christian AU - Reif C FAU - Streif, Werner AU - Streif W FAU - Klingler, Anton AU - Klingler A FAU - Schobersberger, Wolfgang AU - Schobersberger W FAU - Velik-Salchner, Corinna AU - Velik-Salchner C FAU - Friesenecker, Barbara AU - Friesenecker B LA - eng PT - Journal Article PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Colloids) RN - 0 (Crystalloid Solutions) RN - 0 (Isotonic Solutions) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Coagulation/*physiology MH - Blood Coagulation Disorders/*blood/etiology/therapy MH - Colloids MH - Crystalloid Solutions MH - Fibrinogen/*administration & dosage/physiology MH - Hemodilution/*adverse effects MH - Hemorrhage/blood/etiology/therapy MH - Hemostasis MH - Humans MH - In Vitro Techniques MH - Isotonic Solutions MH - Male MH - Thrombelastography EDAT- 2006/01/24 09:00 MHDA- 2006/02/24 09:00 CRDT- 2006/01/24 09:00 PHST- 2006/01/24 09:00 [pubmed] PHST- 2006/02/24 09:00 [medline] PHST- 2006/01/24 09:00 [entrez] AID - 102/2/347 [pii] AID - 10.1213/01.ane.0000194359.06286.d4 [doi] PST - ppublish SO - Anesth Analg. 2006 Feb;102(2):347-51. doi: 10.1213/01.ane.0000194359.06286.d4. PMID- 16270349 OWN - NLM STAT- MEDLINE DCOM- 20060627 LR - 20051226 IS - 1549-3296 (Print) IS - 1549-3296 (Linking) VI - 76 IP - 2 DP - 2006 Feb TI - New physically and chemically crosslinked hyaluronate (HA)-based hydrogels for cartilage repair. PG - 416-24 AB - When dissolved in aqueous solutions, sodium hyaluronate substituted with low amounts of alkyl chains [amphiphilic hyaluronate (HA)] can give rise to hydrogels thanks to intermolecular reversible hydrophobic interactions, leading to a three-dimensional (3D) network. Such hydrogels possess shear-thinning properties and can thus be injected in cartilage defect to promote chondrocyte proliferation and cartilage repair. However, these hydrogels are only physically crosslinked and can progressively loose their 3D structure when they are in contact with aqueous fluids. To overcome this drawback, HA derivatives substituted with dodecyl chains were chemically crosslinked by a difunctional reagent, tetraethylene glycol ditosylate (TEG-diOTs). To preserve the shear-thinning properties of amphiphilic HA, small amounts of TEG-diOTs were used so as to obtain a low chemical crosslinking ratio. After optimization of the synthesis parameters, aqueous solutions of the HA derivatives, crosslinked both physically and chemically, were obtained, with rheological properties improved compared to the amphiphilic polymers. As the hydrogels are aimed to cartilage repair, they were sterilized by wet heating; the effect of this treatment on the polymer characteristics was analyzed by different techniques. A similar study was carried out on HA derivatives stored under conditions mimicking physiological ones. CI - (c) 2005 Wiley Periodicals, Inc. FAU - Huin-Amargier, Cecile AU - Huin-Amargier C AD - Laboratoire de Chimie Physique Macromoleculaire, UMR CNRS-INPL 7568, Groupe ENSIC, BP 451, 54001 Nancy Cedex, France. FAU - Marchal, Philippe AU - Marchal P FAU - Payan, Elisabeth AU - Payan E FAU - Netter, Patrick AU - Netter P FAU - Dellacherie, Edith AU - Dellacherie E LA - eng PT - Journal Article PL - United States TA - J Biomed Mater Res A JT - Journal of biomedical materials research. Part A JID - 101234237 RN - 0 (Cross-Linking Reagents) RN - 0 (Hydrogels) RN - 9004-61-9 (Hyaluronic Acid) SB - IM MH - Animals MH - Chondrocytes/cytology MH - Cross-Linking Reagents/*chemistry MH - Fractures, Cartilage/*therapy MH - Humans MH - Hyaluronic Acid/*chemistry MH - Hydrogels/*chemistry/therapeutic use MH - Regeneration MH - Sterilization MH - Viscosity EDAT- 2005/11/05 09:00 MHDA- 2006/06/28 09:00 CRDT- 2005/11/05 09:00 PHST- 2005/11/05 09:00 [pubmed] PHST- 2006/06/28 09:00 [medline] PHST- 2005/11/05 09:00 [entrez] AID - 10.1002/jbm.a.30536 [doi] PST - ppublish SO - J Biomed Mater Res A. 2006 Feb;76(2):416-24. doi: 10.1002/jbm.a.30536. PMID- 16221315 OWN - NLM STAT- MEDLINE DCOM- 20060201 LR - 20181113 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 9 Suppl 5 IP - Suppl 5 DP - 2005 TI - Mechanistic implications for the use and monitoring of recombinant activated factor VII in trauma. PG - S15-24 AB - As interest in the use of activated recombinant factor VII (rFVIIa) in trauma grows, questions arise regarding how best to monitor rFVIIa therapy and when rFVIIa may be expected to improve hemostasis. Knowledge of the mechanisms of action may be combined with available data on laboratory monitoring and efficacy in various coagulopathic states in coming to clinically relevant conclusions. This review addresses the physiology of hemostasis, placing emphasis on how rFVIIa influences the process by both tissue factor dependent and tissue factor independent mechanisms. This is extended to a mechanistic consideration of how rFVIIa may function under acidotic, hypothermic, and hemodilutional and/or consumptive conditions of trauma related coagulopathy. When these considerations are viewed alongside the available clinical data, it becomes apparent that rFVIIa has potential to improve hemostasis during trauma coagulopathy, within limitations. Common laboratory procedures are discussed with reference to mechanisms of action of rFVIIa and the available clinical data. Although there is no single assay that can predict rFVIIa efficacy in trauma, the prothrombin time (PT) is recommended as a minimum. Although a shortened PT does not predict success, correction of PT into the normal range may be a better indicator. A nonresponding PT appears to indicate that rFVIIa alone will not lead to hemostasis, and that additional blood products and other measures must be applied. Once the patient is more stable, PT and thromboelastography are recommended. FAU - Pusateri, Anthony E AU - Pusateri AE AD - US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. Anthony.pusateri@amedd.army.mil FAU - Park, Myung S AU - Park MS LA - eng PT - Journal Article PT - Review DEP - 20051007 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Recombinant Proteins) RN - 9001-25-6 (Factor VII) RN - AC71R787OV (recombinant FVIIa) RN - EC 3.4.21.21 (Factor VIIa) SB - IM MH - Blood Coagulation/drug effects/*physiology MH - Clinical Laboratory Techniques MH - *Factor VII/pharmacology/physiology/therapeutic use MH - Factor VIIa MH - Homeostasis/*drug effects MH - Humans MH - Prothrombin Time MH - Recombinant Proteins/pharmacology/therapeutic use MH - Thrombelastography/*methods MH - Wounds and Injuries/blood/physiopathology/*therapy PMC - PMC3226119 EDAT- 2005/10/14 09:00 MHDA- 2006/02/02 09:00 PMCR- 2005/10/07 CRDT- 2005/10/14 09:00 PHST- 2005/10/14 09:00 [pubmed] PHST- 2006/02/02 09:00 [medline] PHST- 2005/10/14 09:00 [entrez] PHST- 2005/10/07 00:00 [pmc-release] AID - cc3781 [pii] AID - 10.1186/cc3781 [doi] PST - ppublish SO - Crit Care. 2005;9 Suppl 5(Suppl 5):S15-24. doi: 10.1186/cc3781. Epub 2005 Oct 7. PMID- 15981443 OWN - NLM STAT- MEDLINE DCOM- 20050802 LR - 20091119 IS - 0970-258X (Print) IS - 0970-258X (Linking) VI - 18 IP - 2 DP - 2005 Mar-Apr TI - von Willebrand disease: a laboratory approach. PG - 78-84 AB - von Willebrand disease (VWD) is a common inherited bleeding disorder. Accurate diagnosis and classification of VWD is crucial for clinical management. A detailed clinical history, including that of bleeding, is required. A family and drug history are also important. Genetic factors such as blood group, and environmental factors such as stress, trauma, pregnancy and inflammation should also be considered. The age, ethnic group and hormonal status could also affect the von Willebrand factor (VWF) levels. No single test is robust enough to detect all variants of VWD. In view of the heterogeneity of the disease and limitations in assays, a battery of tests should be performed before a final diagnosis can be reached. These include the screening coagulation tests, factor VIII:C assay, VWF antigen assay, assessment of functional VWF which includes VWF ristocetin cofactor assays, VWF collagen binding assay, ristocetin-induced platelet aggregation and VWF multimer analysis. The newer ELISA techniques based on VWF binding with factor VIII glycoprotein (Gp) 1b and cerebrosides have also helped in determining certain unusual forms of VWD. The advent of new systems such as platelet function analysers (PFA), thromboelastography (TEG) and clot signature analysers (CSA), which are designed to assess either the primary platelet function or as a global haemostasis screen, have facilitated and simplified the diagnosis. However, few centres all over the world can perform all these expensive tests to provide a final diagnosis of VWD. We reviewed the laboratory investigations required for a diagnosis of VWD. Apart from congenital VWD, the possibility of acquired VWD should be considered in those with a negative past history of bleeding or in the presence of an underlying disease. FAU - Trasi, Sucheta AU - Trasi S AD - Institute of Haematology (ICMR), 7th floor, Multistoreyed Building, K.E.M. Hospital, Parel, Mumbai 400008, Maharashtra, India. FAU - Ghosh, Kanjaksha AU - Ghosh K FAU - Shetty, Shrimati AU - Shetty S FAU - Mohanty, Dipika AU - Mohanty D LA - eng PT - Journal Article PT - Review PL - India TA - Natl Med J India JT - The National medical journal of India JID - 8809315 RN - 0 (von Willebrand Factor) SB - IM MH - Algorithms MH - Humans MH - Immunoassay MH - Platelet Aggregation MH - von Willebrand Diseases/*diagnosis/physiopathology MH - von Willebrand Factor/analysis RF - 46 EDAT- 2005/06/29 09:00 MHDA- 2005/08/03 09:00 CRDT- 2005/06/29 09:00 PHST- 2005/06/29 09:00 [pubmed] PHST- 2005/08/03 09:00 [medline] PHST- 2005/06/29 09:00 [entrez] PST - ppublish SO - Natl Med J India. 2005 Mar-Apr;18(2):78-84. PMID- 15761339 OWN - NLM STAT- MEDLINE DCOM- 20050408 LR - 20220330 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 58 IP - 3 DP - 2005 Mar TI - Hypercoagulability is most prevalent early after injury and in female patients. PG - 475-80; discussion 480-1 AB - BACKGROUND: Hypercoagulability after injury is a major source of morbidity and mortality. Recent studies indicate that there is a gender-specific risk in trauma patients. This study was performed to determine the course of coagulation after injury and to determine whether there is a gender difference. We hypothesized that hypercoagulability would occur early after injury and that there would be no difference between men and women. METHODS: This was a prospective cohort study. Inclusion criteria were admission to the intensive care unit, Injury Severity Score > 4, and the ability to obtain consent from the patient or a relative. A Thrombelastograph (TEG) analysis was performed and routine coagulation parameters and thrombin-antithrombin complexes were measured within 24 hours of injury and then daily for 4 days. RESULTS: Sixty-five patients met criteria for entry into the study. Their mean age was 42 +/- 17 years and their mean Injury Severity Score was 23 +/- 12. Forty patients (62%) were men. The prevalence of a hypercoagulable state by TEG was 62% on day 1 and 26% on day 4 (p < 0.01). Women were significantly more hypercoagulable on day 1 than men as measured by the time to onset of clotting (women, 2.9 +/- 0.7 minutes; men, 3.9 +/- 1.5 minutes; p < 0.01; normal, 3.7-8.3 minutes). Mean platelet counts, international normalized ratios, and partial thromboplastin times were within normal limits throughout the study. Thrombin activation as measured by thrombin-antithrombin complexes decreased from 34 +/- 15 microg/L on day 1 to 18 +/- 8 microg/L (p < 0.01) on day 4, consistent with the prevalence of hypercoagulability by TEG. CONCLUSION: Hypercoagulability after injury is most prevalent during the first 24 hours. Women are more hypercoagulable than men early after injury. The TEG is more sensitive than routine coagulation assays for the detection of a hypercoagulable state. FAU - Schreiber, Martin A AU - Schreiber MA AD - Oregon Health & Science University, Portland, Oregon 97239, USA. schreibm@ohsu.edu FAU - Differding, Jerome AU - Differding J FAU - Thorborg, Per AU - Thorborg P FAU - Mayberry, John C AU - Mayberry JC FAU - Mullins, Richard J AU - Mullins RJ LA - eng GR - 5 M01 RR000334/RR/NCRR NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adult MH - Analysis of Variance MH - Erythrocyte Transfusion/statistics & numerical data MH - Female MH - Humans MH - Injury Severity Score MH - International Normalized Ratio MH - Male MH - Middle Aged MH - Multiple Trauma/*complications MH - Oregon/epidemiology MH - Partial Thromboplastin Time MH - Platelet Count MH - Prevalence MH - Prospective Studies MH - Risk Factors MH - Sensitivity and Specificity MH - Severity of Illness Index MH - Sex Characteristics MH - Sex Distribution MH - Thrombelastography MH - Thromboembolism/etiology MH - Thrombophilia/blood/diagnosis/*epidemiology/*etiology MH - Time Factors MH - Trauma Centers EDAT- 2005/03/12 09:00 MHDA- 2005/04/09 09:00 CRDT- 2005/03/12 09:00 PHST- 2005/03/12 09:00 [pubmed] PHST- 2005/04/09 09:00 [medline] PHST- 2005/03/12 09:00 [entrez] AID - 00005373-200503000-00007 [pii] AID - 10.1097/01.ta.0000153938.77777.26 [doi] PST - ppublish SO - J Trauma. 2005 Mar;58(3):475-80; discussion 480-1. doi: 10.1097/01.ta.0000153938.77777.26. PMID- 15013052 OWN - NLM STAT- MEDLINE DCOM- 20040413 LR - 20131121 IS - 0920-1211 (Print) IS - 0920-1211 (Linking) VI - 57 IP - 2-3 DP - 2003 Dec TI - Effect of valproate on hemostatic function in patients with traumatic brain injury. PG - 111-9 AB - OBJECTIVES: To evaluate whether valproate (VPA) resulted in laboratory or clinical evidence of a change in bleeding-related measures associated with VPA therapy in patients sustaining a traumatic brain injury. METHODS: Fibrinogen, platelet count and clot elastic shear modulus using the Thrombelastograph (TEG) coagulation analyzer were measured at baseline, 4, 14, 30, and 180 days post-injury. Clinically significant events, defined as the trigger for requiring a transfusion, were identified and evaluated as to possible treatment effects. RESULTS: Compared to baseline, the platelet count in the VPA groups was decreased on day 4, increased by 100% on day 14, and returned to baseline levels by day 30. Fibrinogen was significantly increased by day 4 and returned to baseline by day 30. The platelet count was correlated with an increase in the maximum amplitude or width of the TEG tracing; a measure of strength of the clot, suggesting that valproate did not alter the clot strength contributed by platelets. None of the clinical events requiring transfusions appeared to be treatment related. CONCLUSIONS: No serious hemostatic adverse events occurred in the trauma patients receiving VPA or phenytoin that could be attributed to treatment. FAU - Anderson, Gail D AU - Anderson GD AD - Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195, USA. gaila@u.washington.edu FAU - Temkin, Nancy R AU - Temkin NR FAU - Chandler, Wayne L AU - Chandler WL FAU - Winn, H Richard AU - Winn HR LA - eng GR - R01 NS19643/NS/NINDS NIH HHS/United States PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, P.H.S. PL - Netherlands TA - Epilepsy Res JT - Epilepsy research JID - 8703089 RN - 614OI1Z5WI (Valproic Acid) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Aged MH - Brain Injuries/*blood/*drug therapy MH - Double-Blind Method MH - Female MH - Fibrinogen/metabolism MH - Hemostasis/*drug effects/physiology MH - Humans MH - Male MH - Middle Aged MH - Platelet Count/methods MH - Statistics, Nonparametric MH - Valproic Acid/adverse effects/*therapeutic use EDAT- 2004/03/12 05:00 MHDA- 2004/04/14 05:00 CRDT- 2004/03/12 05:00 PHST- 2003/07/08 00:00 [received] PHST- 2003/10/06 00:00 [revised] PHST- 2003/10/10 00:00 [accepted] PHST- 2004/03/12 05:00 [pubmed] PHST- 2004/04/14 05:00 [medline] PHST- 2004/03/12 05:00 [entrez] AID - S0920121103002274 [pii] AID - 10.1016/j.eplepsyres.2003.11.001 [doi] PST - ppublish SO - Epilepsy Res. 2003 Dec;57(2-3):111-9. doi: 10.1016/j.eplepsyres.2003.11.001. PMID- 14987789 OWN - NLM STAT- MEDLINE DCOM- 20040618 LR - 20161124 IS - 0300-9572 (Print) IS - 0300-9572 (Linking) VI - 60 IP - 1 DP - 2004 Jan TI - The effect of hypertonic saline dextran on whole blood coagulation. PG - 101-4 AB - Hypertonic saline dextran (RescueFlow) is being promoted for resuscitation from hypovolaemia following injury. We studied the in vitro effect on coagulation of serial dilutions of blood with this fluid. There was a mild procoagulant effect up to a dilution of 11% and an anticoagulant effect above this level, which rapidly increased so that coagulation was grossly deranged at a 15% dilution. Although the clinical significance of these findings is not yet known, it may suggest that for hypertonic saline dextran there is little to separate the top of the therapeutic window from the threshold of potentially serious adverse effects. FAU - Coats, Timothy John AU - Coats TJ AD - Department of Accident and Emergency, Barts and the London, Queen Mary's School of Medicine, University of London, Royal London Hospital, Whitechapel, London E1 1BB, UK. t.j.coats@qmul.ac.uk FAU - Heron, Mischa AU - Heron M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Ireland TA - Resuscitation JT - Resuscitation JID - 0332173 RN - 0 (Anticoagulants) RN - 0 (Coagulants) RN - 0 (Dextrans) RN - 0 (Saline Solution, Hypertonic) RN - 0 (hypertonic saline-dextran solution) RN - 451W47IQ8X (Sodium Chloride) SB - IM MH - Anticoagulants/pharmacology MH - Blood Coagulation/*drug effects MH - Coagulants/pharmacology MH - Dextrans/administration & dosage/*pharmacology MH - Dose-Response Relationship, Drug MH - Fluid Therapy MH - Humans MH - Saline Solution, Hypertonic/administration & dosage/*pharmacology MH - Sodium Chloride/administration & dosage/*pharmacology MH - Thrombelastography MH - Time Factors EDAT- 2004/02/28 05:00 MHDA- 2004/06/23 05:00 CRDT- 2004/02/28 05:00 PHST- 2003/05/08 00:00 [received] PHST- 2003/07/29 00:00 [revised] PHST- 2003/08/07 00:00 [accepted] PHST- 2004/02/28 05:00 [pubmed] PHST- 2004/06/23 05:00 [medline] PHST- 2004/02/28 05:00 [entrez] AID - S0300957203002843 [pii] AID - 10.1016/j.resuscitation.2003.08.001 [doi] PST - ppublish SO - Resuscitation. 2004 Jan;60(1):101-4. doi: 10.1016/j.resuscitation.2003.08.001. PMID- 14980916 OWN - NLM STAT- MEDLINE DCOM- 20040401 LR - 20190704 IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 98 IP - 3 DP - 2004 Mar TI - Peroxynitrite decreases rabbit tissue factor activity in vitro. PG - 668-71, table of contents AB - Tissue factor (TF) is a primary initiator of physiological coagulation in vivo. Peroxynitrite (OONO(-)), a molecule formed from nitric oxide (NO) and superoxide (O(2). (-)), decreases human TF activity in vitro. Coagulopathy has been associated with hepatoenteric ischemia-reperfusion known to involve formation of OONO(-). Further, circulating TF activity decreases in rabbits after hepatoenteric ischemia-reperfusion. We hypothesized that exposure of rabbit TF to OONO(-) would result in a decrease in activity. OONO(-) generation was performed with 3-morpholinosydnonimine (SIN-1), a molecule that produces both nitric oxide and superoxide. Rabbit brain TF was incubated at 37 degrees C for 90 min with 1) 0 mM SIN-1, 2) 5 mM SIN-1, 3) 5 mM SIN-1 and 2000 U/mL recombinant human superoxide dismutase (hSOD1), or 4) 2000 U/mL hSOD1 (n = 8 per condition). TF activity was assessed by addition of TF samples to human plasma and measuring clot formation kinetics with a thrombelastograph(R). TF exposure to SIN-1 resulted in a 48% decrease in activity that was significantly different from the other three conditions (P < 0.001). There were no significant differences between the other conditions. We conclude that rabbit TF is inhibited by OONO(-), and further investigation to determine the role of OONO(-) in coagulopathies associated with hepatoenteric ischemia-reperfusion is warranted. IMPLICATIONS: Tissue factor (TF) initiates physiological coagulation in vivo. Hepatoenteric ischemia-reperfusion injury is associated with peroxynitrite (OONO(-)) formation, coagulopathy and decreased TF activity in rabbits. We determined that OONO(-) decreased rabbit TF activity in vitro via thrombelastography(R). FAU - Nielsen, Vance G AU - Nielsen VG AD - Department of Anesthesiology, The Center for Free Radical Biology, The University of Alabama at Birmingham, Birmingham, AL 35249-6810, USA. vance.nielsen@cc.uab.edu FAU - Crow, John P AU - Crow JP LA - eng GR - R01 NS40819/NS/NINDS NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Nitric Oxide Donors) RN - 11062-77-4 (Superoxides) RN - 14691-52-2 (Peroxynitrous Acid) RN - 5O5U71P6VQ (linsidomine) RN - 9035-58-9 (Thromboplastin) RN - D46583G77X (Molsidomine) RN - EC 1.15.1.1 (Superoxide Dismutase) SB - IM MH - Animals MH - Blood Coagulation/drug effects MH - Brain Chemistry/drug effects MH - Humans MH - In Vitro Techniques MH - Molsidomine/*analogs & derivatives/pharmacology MH - Nitric Oxide Donors/pharmacology MH - Peroxynitrous Acid/*pharmacology MH - Rabbits MH - Reperfusion Injury/blood MH - Superoxide Dismutase/pharmacology MH - Superoxides/metabolism MH - Thrombelastography MH - Thromboplastin/*antagonists & inhibitors/*physiology EDAT- 2004/02/26 05:00 MHDA- 2004/04/02 05:00 CRDT- 2004/02/26 05:00 PHST- 2004/02/26 05:00 [pubmed] PHST- 2004/04/02 05:00 [medline] PHST- 2004/02/26 05:00 [entrez] AID - 10.1213/01.ane.0000101988.62847.0c [doi] PST - ppublish SO - Anesth Analg. 2004 Mar;98(3):668-71, table of contents. doi: 10.1213/01.ane.0000101988.62847.0c. PMID- 14564249 OWN - NLM STAT- MEDLINE DCOM- 20040109 LR - 20130520 IS - 0375-9393 (Print) IS - 0375-9393 (Linking) VI - 69 IP - 6 DP - 2003 Jun TI - Thrombelastography. Present and future perspectives in clinical practice. PG - 501-9, 509-15 AB - Thrombelastography (TEG) is a method for evaluating the viscoelastic properties of the blood clot, from its formation to its lysis. All major surgeries may be associated with massive blood loss, with blood component transfusion therapy often becoming mandatory. The clinician's goal is thus to optimize and possibly minimize blood components usage. To this end, TEG allows for a qualitative and dynamic analysis of the specific blood clotting process, from clot formation through its lysis, highlighting alterations at every single step in the cascade. With TEG is thus possible to know if bleeding is due to a failure to provide adequate surgical hemostasis, if there is platelet dysfunction, or to detect anomalies in coagulation proteases or their inhibitors, or if the blood loss is associated to early, excessive fibrinolysis. The theoretical advantages of TEG are the ease of performing the test, the fast sample reading times (now 30 minutes) and the informative FAU - Di Benedetto, P AU - Di Benedetto P AD - Department of Anesthesiology and Critical Care S. Andrea University Hospital, Rome, Italy. piadibe@hotmail.com FAU - Baciarello, M AU - Baciarello M FAU - Cabetti, L AU - Cabetti L FAU - Martucci, M AU - Martucci M FAU - Chiaschi, A AU - Chiaschi A FAU - Bertini, L AU - Bertini L LA - eng LA - ita PT - Comparative Study PT - Journal Article PL - Italy TA - Minerva Anestesiol JT - Minerva anestesiologica JID - 0375272 SB - IM MH - Blood Coagulation/physiology MH - Blood Coagulation Tests MH - Blood Loss, Surgical/prevention & control MH - Female MH - Forecasting MH - Humans MH - Liver Transplantation MH - Male MH - Monitoring, Intraoperative MH - Obstetric Labor Complications/blood/prevention & control MH - Postpartum Hemorrhage/blood/prevention & control MH - Pregnancy MH - *Thrombelastography MH - Thrombosis/*blood MH - Uterine Hemorrhage/blood/prevention & control MH - Wounds and Injuries/blood/surgery EDAT- 2003/10/18 05:00 MHDA- 2004/01/10 05:00 CRDT- 2003/10/18 05:00 PHST- 2003/10/18 05:00 [pubmed] PHST- 2004/01/10 05:00 [medline] PHST- 2003/10/18 05:00 [entrez] PST - ppublish SO - Minerva Anestesiol. 2003 Jun;69(6):501-9, 509-15. PMID- 12761010 OWN - NLM STAT- MEDLINE DCOM- 20030617 LR - 20210902 IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 96 IP - 6 DP - 2003 Jun TI - The effect of graded hypothermia (36 degrees C-32 degrees C) on hemostasis in anesthetized patients without surgical trauma. PG - 1772-1776 LID - 10.1213/01.ANE.0000062520.65192.C9 [doi] AB - The isolated effects of hypothermia on hemostasis have not been investigated in healthy humans. We cooled 16 anesthetized patients scheduled for elective intracranial surgery to 32 degrees C body core temperature and assessed prothrombin time (PT), activated partial thromboplastin time, thrombelastogram (TEG), closure time, and platelet count at 36 degrees C, 34 degrees C, and 32 degrees C body core temperature after the induction of anesthesia but before surgical intervention. Activated partial thromboplastin time, hematocrit, and closure time did not change, whereas PT and platelet count decreased during cooling. Platelet count decreased without a decrease in hematocrit; hence, a dilution by administered fluids seemed unlikely. The small decrease of platelet count is probably clinically irrelevant in patients with normal platelet count and function. The small decrease in PT indicates an alteration of the extrinsic pathway of coagulation. TEG measurements showed a delay of clot formation in temperature-adjusted measurements but showed no change if the test temperature was 37 degrees C. This indicates that hypothermia reduces plasmatic coagulation and platelet reactivity. However, the clot strength is not altered by hypothermia. All coagulation variables remained within the normal ranges. Our results may indicate that moderate short-term (4-h) hypothermia has only minor adverse effects in healthy humans. We can make no statement about the effects of hypothermia of longer duration. IMPLICATIONS: This study investigated the isolated effects of hypothermia in healthy anesthetized humans. We found only minor effects of body temperature reduction to 32 degrees C on assessed coagulation variables, indicating only minor effects in otherwise healthy humans. FAU - Kettner, S C AU - Kettner SC AD - *Department of Anesthesiology and General Intensive Care, University of Vienna, General Hospital Vienna, Vienna, Austria; and daggerLudwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna, Austria. FAU - Sitzwohl, C AU - Sitzwohl C FAU - Zimpfer, M AU - Zimpfer M FAU - Kozek, S A AU - Kozek SA FAU - Holzer, A AU - Holzer A FAU - Spiss, C K AU - Spiss CK FAU - Illievich, U M AU - Illievich UM LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - IM MH - Adult MH - *Anesthesia, General MH - Body Temperature/physiology MH - Female MH - Hematocrit MH - Hemostasis/*physiology MH - Humans MH - *Hypothermia, Induced MH - Male MH - Middle Aged MH - Neurosurgical Procedures MH - Partial Thromboplastin Time MH - Platelet Count MH - Prothrombin Time MH - Thrombelastography EDAT- 2003/05/23 05:00 MHDA- 2003/06/18 05:00 CRDT- 2003/05/23 05:00 PHST- 2003/05/23 05:00 [pubmed] PHST- 2003/06/18 05:00 [medline] PHST- 2003/05/23 05:00 [entrez] AID - 00000539-200306000-00041 [pii] AID - 10.1213/01.ANE.0000062520.65192.C9 [doi] PST - ppublish SO - Anesth Analg. 2003 Jun;96(6):1772-1776. doi: 10.1213/01.ANE.0000062520.65192.C9. PMID- 12698142 OWN - NLM STAT- MEDLINE DCOM- 20030630 LR - 20220408 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 125 IP - 4 DP - 2003 Apr TI - Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. PG - 797-808 AB - OBJECTIVE: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass grafting. METHODS: Two hundred unselected patients referred for elective primary coronary artery bypass grafting were randomly assigned to undergo off-pump coronary artery bypass grafting with an Octopus tissue stabilizer (Medtronic, Inc, Minneapolis, Minn) or conventional coronary artery bypass grafting with cardiopulmonary bypass by a single surgeon. Revascularization intent determined before random assignment was compared with the revascularization performed. All management followed strict, unbiased, criteria-driven protocols. Patients and nonoperative care providers were blinded to surgical group. RESULTS: Baseline characteristics were similar. The number of grafts performed per patient (mean +/- SD 3.39 +/- 1.04 for off-pump coronary artery bypass grafting, 3.40 +/- 1.08 for conventional coronary artery bypass grafting) and the index of completeness of revascularization (number of grafts performed/number of grafts intended, 1.00 +/- 0.18 for off-pump coronary artery bypass grafting, 1.01 +/- 0.09 for conventional coronary artery bypass grafting) were similar. Likewise, the index of completeness of revascularization was similar between groups for the lateral wall. Combined hospital and 30-day mortalities and stroke rates were similar. Postoperative myocardial serum enzyme measures were significantly lower after off-pump coronary artery bypass grafting, suggesting less myocardial injury. Adjusted postoperative thromboelastogram indices, fibrinogen, international normalized ratio, and platelet levels all showed significantly less coagulopathy after off-pump coronary artery bypass grafting. Patients undergoing off-pump coronary artery bypass grafting received fewer units of blood, were more likely to avoid transfusion altogether, and had a higher hematocrit at discharge. Cardiopulmonary bypass was an independent predictor of transfusion (odds ratio 2.42, P =.0073) by multivariate analysis. More patients undergoing off-pump coronary artery bypass grafting were extubated in the operating room and within 4 hours. Postoperative length of stay (in days) was shorter for off-pump coronary artery bypass grafting (5.1 +/- 6.5 for off-pump coronary artery bypass grafting, 6.1 +/- 8.2 for conventional coronary artery bypass grafting, P =.005 by Wilcoxon test). One patient (in the conventional coronary artery bypass grafting group) required angioplasty for graft closure within 30 days. CONCLUSIONS: When compared with conventional coronary artery bypass grafting with cardiopulmonary bypass, off-pump coronary artery bypass grafting achieved similar completeness of revascularization, similar in-hospital and 30-day outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury. FAU - Puskas, J D AU - Puskas JD AD - Division of Cardiothoracic Surgery, Emory University School of Medicine, and the Emory Center for Outcomes Research, Crawford Long Hospital, Atlanta, Ga 30308, USA. john_puskas@emoryhealthcare.org FAU - Williams, W H AU - Williams WH FAU - Duke, P G AU - Duke PG FAU - Staples, J R AU - Staples JR FAU - Glas, K E AU - Glas KE FAU - Marshall, J J AU - Marshall JJ FAU - Leimbach, M AU - Leimbach M FAU - Huber, P AU - Huber P FAU - Garas, S AU - Garas S FAU - Sammons, B H AU - Sammons BH FAU - McCall, S A AU - McCall SA FAU - Petersen, R J AU - Petersen RJ FAU - Bailey, D E AU - Bailey DE FAU - Chu, H AU - Chu H FAU - Mahoney, E M AU - Mahoney EM FAU - Weintraub, W S AU - Weintraub WS FAU - Guyton, R A AU - Guyton RA LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CIN - J Thorac Cardiovasc Surg. 2004 Jan;127(1):300-1; author reply 301. doi: 10.1016/s0022-5223(03)00802-x. PMID: 14752458 MH - Blood Transfusion MH - Coronary Artery Bypass/*methods MH - Female MH - Follow-Up Studies MH - Humans MH - Length of Stay MH - Male MH - Middle Aged MH - Prospective Studies MH - Retrospective Studies EDAT- 2003/04/17 05:00 MHDA- 2003/07/02 05:00 CRDT- 2003/04/17 05:00 PHST- 2003/04/17 05:00 [pubmed] PHST- 2003/07/02 05:00 [medline] PHST- 2003/04/17 05:00 [entrez] AID - S0022522303000047 [pii] AID - 10.1067/mtc.2003.324 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2003 Apr;125(4):797-808. doi: 10.1067/mtc.2003.324. PMID- 12454546 OWN - NLM STAT- MEDLINE DCOM- 20030313 LR - 20191106 IS - 1070-5295 (Print) IS - 1070-5295 (Linking) VI - 8 IP - 6 DP - 2002 Dec TI - Early intensive care unit intervention for trauma care: what alters the outcome? PG - 587-92 AB - This review focuses on early management of multiple trauma patients with traumatic brain injury. Early usage of multislice computed tomography can substantially shorten the time spent on diagnostic workup in the emergency room and, therefore, speeds the initiation of lifesaving interventions for the control of hemorrhage. The important role of hemostatic angiographic embolization and its timing, in addition to surgical control of bleeding in patients suffering from pelvic fracture or organ lesions, is emphasized. The ongoing controversy regarding the strategy of fluid resuscitation is discussed. The concept of permissive hypotension seems to be promising but is absolutely contraindicated in patients with traumatic brain injury. Coagulation management should be guided by coagulation monitoring, including thromboelastography. A novel approach to reduce major bleeding is the application of recombinant factor VIIa. Strong effort should be directed toward the management of traumatic brain injury and the maintenance of cerebral perfusion pressure. The optimization of treatment of patients with multiple trauma, including brain injury, is a multidisciplinary task. FAU - Sumann, Gunther AU - Sumann G AD - Department of Anesthesiology and Critical Care Medicine, Leopold Franzens University, Innsbruck, Austria. guenther.sumann@uibk.ac.at FAU - Kampfl, Andreas AU - Kampfl A FAU - Wenzel, Volker AU - Wenzel V FAU - Schobersberger, Wolfgang AU - Schobersberger W LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Curr Opin Crit Care JT - Current opinion in critical care JID - 9504454 SB - IM MH - Algorithms MH - Brain Injuries/diagnosis/physiopathology/*therapy MH - Cerebrovascular Circulation MH - Emergency Medical Services/*methods MH - Humans MH - Monitoring, Physiologic/methods MH - Multiple Trauma/diagnosis/*therapy RF - 54 EDAT- 2002/11/28 04:00 MHDA- 2003/03/14 04:00 CRDT- 2002/11/28 04:00 PHST- 2002/11/28 04:00 [pubmed] PHST- 2003/03/14 04:00 [medline] PHST- 2002/11/28 04:00 [entrez] AID - 10.1097/00075198-200212000-00017 [doi] PST - ppublish SO - Curr Opin Crit Care. 2002 Dec;8(6):587-92. doi: 10.1097/00075198-200212000-00017. PMID- 12022205 OWN - NLM STAT- MEDLINE DCOM- 20020607 LR - 20041117 IS - 0019-5847 (Print) IS - 0019-5847 (Linking) VI - 99 IP - 11 DP - 2001 Nov TI - Rupture uterus--changing Indian scenario. PG - 634-7 AB - A total of 60 cases of rupture uterus managed in last five years in the department of obstetrics and gynaecology at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi were reviewed. Of these 77% cases reported to the hospital with rupture uterus while in 23% cases rupture occurred after admission. The factor responsible for rupture in admitted patients was either oxytocin induction/augmentation in scarred uterus or obstetrical manipulation in unscarred uterus; 80% cases were totally unsupervised during antenatal period. Previous uterine scar was responsible for rupture in as high as 63.3% cases. The commonest previous surgery was caesarean section mostly for non-recurrent causes. Obstructed labour was responsible for rupture in 26.6% cases while traumatic rupture was seen in 10% cases. Repair of uterine rent was performed in 54% cases while rest required hysterectomy. Bladder injury was associated in 9 cases and was repaired at the time of laparotomy. Maternal mortality was 3.33% and foetal mortality was 78.66%. The changing trends observed in the present study are those of low maternal mortality and decreasing incidence of obstructed labour in the aetiology of rupture uterus. FAU - Rashmi AU - Rashmi AD - Department of Obstetrics & Gynaecology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi. FAU - Radhakrisknan, G AU - Radhakrisknan G FAU - Vaid, N B AU - Vaid NB FAU - Agarwal, N AU - Agarwal N LA - eng PT - Journal Article PL - India TA - J Indian Med Assoc JT - Journal of the Indian Medical Association JID - 7505608 SB - IM MH - Adolescent MH - Adult MH - Female MH - Humans MH - Incidence MH - India/epidemiology MH - *Uterine Rupture/diagnosis/epidemiology/therapy EDAT- 2002/05/23 10:00 MHDA- 2002/06/12 10:01 CRDT- 2002/05/23 10:00 PHST- 2002/05/23 10:00 [pubmed] PHST- 2002/06/12 10:01 [medline] PHST- 2002/05/23 10:00 [entrez] PST - ppublish SO - J Indian Med Assoc. 2001 Nov;99(11):634-7. PMID- 11754883 OWN - NLM STAT- MEDLINE DCOM- 20020212 LR - 20220408 IS - 0020-1383 (Print) IS - 0020-1383 (Linking) VI - 32 IP - 10 DP - 2001 Dec TI - Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture. PG - 765-70 AB - The effect of surgery for femoral neck fracture on whole blood coagulation and the relationship of altered coagulation to deep venous thrombosis were investigated in 250 patients. Whole blood coagulation was measured using thrombelastography preoperatively, in the early postoperative period and at 6-week review. Significant hypercoagulability was demonstrated after surgery and persisted to 6-week review. A significant correlation between hypercoagulability and the development of deep venous thrombosis is demonstrated. Hypercoagulability is shown to be a major factor in thrombosis formation following proximal femoral neck fracture surgery. FAU - Wilson, D AU - Wilson D AD - Department of Orthopaedic Surgery, Musgrave Park Hospital, Stockman's Lane, BT97JB, Belfast, UK. wilsondarrin@hotmail.com FAU - Cooke, E A AU - Cooke EA FAU - McNally, M A AU - McNally MA FAU - Wilson, H K AU - Wilson HK FAU - Yeates, A AU - Yeates A FAU - Mollan, R A AU - Mollan RA LA - eng PT - Journal Article PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Aged MH - Aged, 80 and over MH - Arthroplasty, Replacement, Hip MH - Female MH - Femoral Neck Fractures/*surgery MH - Follow-Up Studies MH - Fracture Fixation MH - Humans MH - Male MH - *Postoperative Complications MH - Postoperative Period MH - Thrombelastography/methods MH - Thrombophilia/*etiology MH - Venous Thrombosis/etiology EDAT- 2002/01/05 10:00 MHDA- 2002/02/13 10:01 CRDT- 2002/01/05 10:00 PHST- 2002/01/05 10:00 [pubmed] PHST- 2002/02/13 10:01 [medline] PHST- 2002/01/05 10:00 [entrez] AID - S0020-1383(01)00139-5 [pii] AID - 10.1016/s0020-1383(01)00139-5 [doi] PST - ppublish SO - Injury. 2001 Dec;32(10):765-70. doi: 10.1016/s0020-1383(01)00139-5. PMID- 11413430 OWN - NLM STAT- MEDLINE DCOM- 20010726 LR - 20190727 IS - 0362-2436 (Print) IS - 0362-2436 (Linking) VI - 26 IP - 10 DP - 2001 May 15 TI - The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. PG - 1152-6 AB - STUDY DESIGN: Controlled study to assess the efficacy of aprotinin and Amicar in reducing blood loss during complex spinal fusions. OBJECTIVES: To compare blood loss and the clotting profile with a thromboelastogram in patients with spinal deformities undergoing sequential anterior and posterior spinal fusions treated intraoperatively with either aprotinin or Amicar. SUMMARY OF BACKGROUND DATA: Spinal fusion for correction of adult spinal deformities is associated with large blood losses despite the implementation of multiple factors to reduce this blood loss. The antifibrinolytics aprotinin and Amicar have both been shown to reduce blood loss in other surgical procedures with the potential for large blood loss. Hence, we compared their efficacy for reducing blood loss in complex spinal fusions. METHODS: Sixty patients for elective sequential anteroposterior thoracolumbosacral fusions were randomly assigned to three groups: control, aprotinin, and Amicar. Patients were assessed for blood loss, transfusion requirements, postoperative complications, and coagulation profile using a thromboelastogram. RESULTS: The study demonstrated a significant reduction in total blood loss (aprotinin 3628 mL, Amicar 4056 mL, control 5181 mL) and transfusion requirements using the half-dose aprotinin regimen compared with Amicar or control. Aprotinin also preserved the thromboelastogram mean clot formation time, clot strength, and clotting index compared with Amicar or control. CONCLUSIONS: For complex spinal operations with large blood losses, the half-dose aprotinin regimen will reduce blood loss and the need for blood components and may have a role in reducing postoperative lung injury. FAU - Urban, M K AU - Urban MK AD - Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA. FAU - Beckman, J AU - Beckman J FAU - Gordon, M AU - Gordon M FAU - Urquhart, B AU - Urquhart B FAU - Boachie-Adjei, O AU - Boachie-Adjei O LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 RN - 0 (Antifibrinolytic Agents) RN - 9087-70-1 (Aprotinin) RN - U6F3787206 (Aminocaproic Acid) SB - IM MH - Aminocaproic Acid/*therapeutic use MH - Antifibrinolytic Agents/administration & dosage/*therapeutic use MH - Aprotinin/administration & dosage/*therapeutic use MH - Blood Coagulation MH - Blood Loss, Surgical/*prevention & control MH - Blood Transfusion MH - Dose-Response Relationship, Drug MH - Humans MH - Middle Aged MH - *Spinal Fusion MH - Spine/*surgery MH - Thrombelastography EDAT- 2001/06/20 10:00 MHDA- 2001/07/28 10:01 CRDT- 2001/06/20 10:00 PHST- 2001/06/20 10:00 [pubmed] PHST- 2001/07/28 10:01 [medline] PHST- 2001/06/20 10:00 [entrez] AID - 10.1097/00007632-200105150-00012 [doi] PST - ppublish SO - Spine (Phila Pa 1976). 2001 May 15;26(10):1152-6. doi: 10.1097/00007632-200105150-00012. PMID- 10674526 OWN - NLM STAT- MEDLINE DCOM- 20000224 LR - 20190831 IS - 0735-6757 (Print) IS - 0735-6757 (Linking) VI - 18 IP - 1 DP - 2000 Jan TI - Phospholipase A2-induced coagulation abnormalities after bee sting. PG - 22-7 AB - We will examine the correlation between various bee venom phospholipase A2 (PLA2) concentrations and several parameters of coagulation in human plasma in order to offer a rationale for requesting a particular laboratory coagulation test after bee sting(s). We will also evaluate in vitro the influence of clinically available drugs with a noncompetitive inhibitory effect on PLA2 on the anticoagulant effect of bee venom PLA2. Prothrombin index (PTi), partial thromboplastin time (PTT), antithrombin III (AT III), soluble fibrin monomers (SFM), the activity of coagulation factors I, II, V, and VIII, and thrombelastography (TEG) parameters (split point [Sp], reaction time [R], kinetic time [K], coagulation time [R + K], maximal amplitude [MA], and the growth angle [alpha]) were determined before and after addition of 1.4, 2.7, and 4.1 units (1, 2, and 3 microg protein respectively) of bee venom PLA2. Linear regression was used to determine the significance of the relationship between these coagulation parameters and bee venom PLA2 concentrations used. To study the influence of ketamine, lidocaine, magnesium, furosemide, and cromolyn on the anticoagulant effect of bee venom PLA2, PTi and factor II- and V-activities were measured before and after addition of 2.7 units of PLA2 and PLA2 plus one of the tested substances. Determinations of F II, PTi, F V, and F VIII showed a negative correlation to bee venom PLA2 concentration (r = -0.88, -0.86, -0.81, and -0.79 respectively). A positive correlation was found for PTT (r = 0.69). FII- activity and PTi correlated better with bee venom PLA2 concentration than other parameters. F I, AT III, and SFM showed no changes. Whereas Sp, R, and K were prolonged by bee venom PLA2 and a was reduced, there was no correlation to the PLA2 concentration. Addition of none of the 5 substances could correct the effects of bee venom PLA2 on the coagulation. In a patient with toxic reaction or a severe anaphylactic reaction after bee sting(s) we suggest determinations of FII and/or PTi. This will allow a quick and economical assessment of coagulation abnormalities after bee sting(s). Noncompetitive PLA2-inhibitors (ketamine, lidocaine, magnesium, furosemide, and cromolyn) are unable to correct in vitro the anticoagulant effect of bee venom PLA2. They cannot be recommended at this stage for this purpose. Further investigations with competitive PLA2-inhibitors are warranted. FAU - Petroianu, G AU - Petroianu G AD - University of Heidelberg at Mannheim, Department of Pharmacology and Toxicology, Germany. petroia@rumms.uni-mannheim.de FAU - Liu, J AU - Liu J FAU - Helfrich, U AU - Helfrich U FAU - Maleck, W AU - Maleck W FAU - Rufer, R AU - Rufer R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Am J Emerg Med JT - The American journal of emergency medicine JID - 8309942 RN - 0 (Bee Venoms) RN - 690G0D6V8H (Ketamine) RN - 7LXU5N7ZO5 (Furosemide) RN - 9000-94-6 (Antithrombin III) RN - 9001-24-5 (Factor V) RN - 9001-26-7 (Prothrombin) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) RN - 98PI200987 (Lidocaine) RN - EC 3.1.1.32 (Phospholipases A) RN - EC 3.1.1.4 (Phospholipases A2) RN - I38ZP9992A (Magnesium) RN - Q2WXR1I0PK (Cromolyn Sodium) SB - IM MH - Animals MH - Antithrombin III/metabolism MH - Bee Venoms/chemistry/*enzymology MH - *Bees MH - Blood Coagulation Disorders/*blood/*etiology MH - Blood Coagulation Tests/*methods MH - Cromolyn Sodium/pharmacology MH - Drug Evaluation, Preclinical MH - Factor V/metabolism MH - Factor VIII/metabolism MH - Female MH - Fibrinogen/metabolism MH - Furosemide/pharmacology MH - Humans MH - Insect Bites and Stings/*complications MH - Ketamine/pharmacology MH - Lidocaine/pharmacology MH - Linear Models MH - Magnesium/pharmacology MH - Male MH - Phospholipases A/*adverse effects/analysis/antagonists & inhibitors/drug effects MH - Phospholipases A2 MH - Prothrombin/metabolism EDAT- 2000/02/16 09:00 MHDA- 2000/02/26 09:00 CRDT- 2000/02/16 09:00 PHST- 2000/02/16 09:00 [pubmed] PHST- 2000/02/26 09:00 [medline] PHST- 2000/02/16 09:00 [entrez] AID - S0735-6757(00)90042-1 [pii] AID - 10.1016/s0735-6757(00)90042-1 [doi] PST - ppublish SO - Am J Emerg Med. 2000 Jan;18(1):22-7. doi: 10.1016/s0735-6757(00)90042-1. PMID- 10450445 OWN - NLM STAT- MEDLINE DCOM- 19990902 LR - 20190513 IS - 0035-9203 (Print) IS - 0035-9203 (Linking) VI - 93 IP - 2 DP - 1999 Mar-Apr TI - The role of thromboelastography in the management of children with snake-bite in southern Africa. PG - 177-9 AB - In the absence of a direct laboratory test of envenomation, there is a need for an alternative mechanism for the early recognition of envenomation following snake-bite in children. A severe clinical diathesis may result either from envenomation or from the release of an inappropriate tourniquet applied as 'first-aid' often several hours before presentation to hospital. Abnormalities of clotting are associated with both events. A normal thromboelastogram (TEG) provides early recognition of patients in whom the clinical course is likely to be benign (sensitivity = 94%). An abnormal TEG identifies patients of whom 50% will develop a severe clinical diathesis. A TEG is a more accurate predictor of disease severity than International Normalized Ratio alone. The TEG does not supplant clinical observation in the management of snake-bite in children but allows stratification into high- and low-risk categories. FAU - Hadley, G P AU - Hadley GP AD - Department of Paediatric Surgery, University of Natal, Durban, South Africa. hadley@med.und.ac.za FAU - McGarr, P AU - McGarr P FAU - Mars, M AU - Mars M LA - eng PT - Journal Article PL - England TA - Trans R Soc Trop Med Hyg JT - Transactions of the Royal Society of Tropical Medicine and Hygiene JID - 7506129 RN - 0 (Snake Venoms) SB - IM MH - Child MH - Humans MH - International Normalized Ratio MH - Predictive Value of Tests MH - Sensitivity and Specificity MH - Snake Bites/*blood/therapy MH - Snake Venoms/*blood MH - South Africa MH - *Thrombelastography EDAT- 1999/08/18 00:00 MHDA- 1999/08/18 00:01 CRDT- 1999/08/18 00:00 PHST- 1999/08/18 00:00 [pubmed] PHST- 1999/08/18 00:01 [medline] PHST- 1999/08/18 00:00 [entrez] AID - 10.1016/s0035-9203(99)90300-0 [doi] PST - ppublish SO - Trans R Soc Trop Med Hyg. 1999 Mar-Apr;93(2):177-9. doi: 10.1016/s0035-9203(99)90300-0. PMID- 10071991 OWN - NLM STAT- MEDLINE DCOM- 19990325 LR - 20190704 IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 88 IP - 3 DP - 1999 Mar TI - The effects of in vitro hemodilution with gelatin, hydroxyethyl starch, and lactated Ringer's solution on markers of coagulation: an analysis using SONOCLOT. PG - 483-8 AB - Blood-saving strategies have recently been established to avoid allogeneic transfusion during surgery or after trauma. This includes an expanding use of crystalloids and colloids. These solutions interfere with coagulation systems, but quantitative measurements are still lacking. The SONOCLOT (Sienco Company, Morrison, CO) analysis (SCT), a viscoelastic test, measures clot formation and includes information on the cellular, as well as the plasmatic coagulation, system. To quantify hemodilutional effects on in vitro coagulation, we studied gelatin (G), hydroxyethyl starch 6% (HES; molecular weight 450,000), and lactated Ringer's solution (RL) in 33% and 66% dilutions measuring routines laboratory and SCT variables. Hemodilution with RL tended to increase in vitro coagulability. Among the tested colloids, G had the least impact on markers of coagulation. G33% did not differ significantly from the undiluted control group. HES had the largest impact on markers of coagulation compared with G and RL. In conclusion, SCT provides a fast and easy to perform bedside test to quantify in vitro hemodilution. IMPLICATIONS: The effects of progressive hemodilution on coagulation are difficult to measure. SONOCLOT analyses provide an easy to perform test with fast information on cellular and plasmatic coagulation properties. Among colloids, hydroxyethyl starch has the largest impact on markers of coagulation compared with gelatin or lactated Ringer's solution. FAU - Konrad, C AU - Konrad C AD - Department of Anesthesiology and Intensive Care, Kantonsspital, Lucerne, Switzerland. Fieber_Konrad@Compuserve.com FAU - Markl, T AU - Markl T FAU - Schuepfer, G AU - Schuepfer G FAU - Gerber, H AU - Gerber H FAU - Tschopp, M AU - Tschopp M LA - eng PT - Clinical Trial PT - Journal Article PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Biomarkers) RN - 0 (Excipients) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Ringer's Lactate) RN - 9000-70-8 (Gelatin) SB - IM MH - Adult MH - Biomarkers/analysis MH - Blood Coagulation/*drug effects MH - Blood Coagulation Tests/methods MH - Elasticity MH - Excipients/*pharmacology MH - Gelatin/*pharmacology MH - Hemodilution/*methods MH - Humans MH - Hydroxyethyl Starch Derivatives/*pharmacology MH - Isotonic Solutions/*pharmacology MH - Plasma Substitutes/*pharmacology MH - Ringer's Lactate MH - Viscosity EDAT- 1999/03/11 00:00 MHDA- 1999/03/11 00:01 CRDT- 1999/03/11 00:00 PHST- 1999/03/11 00:00 [pubmed] PHST- 1999/03/11 00:01 [medline] PHST- 1999/03/11 00:00 [entrez] AID - 10.1097/00000539-199903000-00003 [doi] PST - ppublish SO - Anesth Analg. 1999 Mar;88(3):483-8. doi: 10.1097/00000539-199903000-00003. PMID- 9688200 OWN - NLM STAT- MEDLINE DCOM- 19981005 LR - 20190909 IS - 0305-4179 (Print) IS - 0305-4179 (Linking) VI - 24 IP - 4 DP - 1998 Jun TI - Bacteriology of burns. PG - 347-9 AB - A retrospective study was undertaken at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, to examine the bacterial isolates from the Burns unit and to determine the antibiograms of the isolates to commonly used antimicrobial agents. A total of 600 pus samples from as many patients received, over a period of 5 years (June 1993-June 1997) yielded 920) isolates. Pseudomonas spp. was the most common (36%) followed by Staphylococcus aureus (19%), Klebsiella spp. (15.54%), Proteus spp. (11.19%), Enterococcus faecalis (8.5%), Escherichia coli (5.10%), Acinetobacter spp. (1.1%), Salmonella senftenberg (0.8%) and other (3%). Pseudomonas spp. was the most susceptible to ceftazidime (83% susceptible) and cefoperazone (82% susceptible), whereas the drugs most effective in other Gram-negative organisms were amikacin, netilmicin and ciproflox. Vancomycin was effective in 100% of Gram-positive organisms. The infection of burn wounds with multiple organisms, with the superadded problem of drug resistance, necessitate the institution of a drug policy by the hospitals for burn patients. FAU - Revathi, G AU - Revathi G AD - Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. FAU - Puri, J AU - Puri J FAU - Jain, B K AU - Jain BK LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Anti-Bacterial Agents MH - Burn Units MH - Burns/*microbiology MH - Child, Preschool MH - Cross Infection/drug therapy/epidemiology/microbiology MH - Disease Outbreaks MH - Drug Resistance, Microbial MH - Drug Therapy, Combination/therapeutic use MH - Gram-Negative Bacteria/drug effects/*isolation & purification MH - Gram-Negative Bacterial Infections/drug therapy/epidemiology/*microbiology MH - Gram-Positive Bacteria/drug effects/*isolation & purification MH - Gram-Positive Bacterial Infections/drug therapy/epidemiology/*microbiology MH - Humans MH - India/epidemiology MH - Microbial Sensitivity Tests MH - Retrospective Studies MH - Wound Infection/drug therapy/epidemiology/*microbiology EDAT- 1998/08/04 00:00 MHDA- 1998/08/04 00:01 CRDT- 1998/08/04 00:00 PHST- 1998/08/04 00:00 [pubmed] PHST- 1998/08/04 00:01 [medline] PHST- 1998/08/04 00:00 [entrez] AID - S0305417998000096 [pii] AID - 10.1016/s0305-4179(98)00009-6 [doi] PST - ppublish SO - Burns. 1998 Jun;24(4):347-9. doi: 10.1016/s0305-4179(98)00009-6. PMID- 9607115 OWN - NLM STAT- MEDLINE DCOM- 19980811 LR - 20190914 IS - 0957-5235 (Print) IS - 0957-5235 (Linking) VI - 9 IP - 1 DP - 1998 Jan TI - Haemostatic disturbances in burned patients during early excision and skin grafting. PG - 19-28 AB - Bleeding is a major problem during early excision of burned skin. Therefore, 13 severely burned adult patients operated on during the first week after the trauma were studied. Blood loss was replaced with crystalloids, colloids and packed red cell concentrates (PRC). After ten infused PRCs, four fresh frozen plasma (FFP) units were given and thereafter one FFP unit with one PRC unit. Arterial blood samples were drawn before anaesthesia (SO), during operation after every four units of PRC transfusion (S1-4), 4 h postoperatively (S5) and on the first postoperative morning (S6). Prothrombin time (%) and activated partial thromboplastin time (s) were abnormal before operation (median values 67%, range 22-99% and 44 s, range 30-86 s, respectively). Prothrombin time decreased during operation and reached the critical level for normal haemostasis at S2. Thrombelastography showed decreased clot formation rate and impaired fibrin platelet interaction peri- and postoperatively. Fibrinogen and factor VIII activity were high preoperatively (median 6.1 g/l and 253%) and the critical values for normal haemostasis were not reached. Burned patients have a consumption coagulopathy which, in combination with haemodilution during operation, results in a clinically significant deficiency of coagulation factors II, VII and X, in spite of reactive elevation of coagulation factor VIII and fibrinogen. FAU - Niemi, T AU - Niemi T AD - Department of Anaesthesiology, Helsinki University Central Hospital, Finland. FAU - Svartling, N AU - Svartling N FAU - Syrjala, M AU - Syrjala M FAU - Asko-Seljavaara, S AU - Asko-Seljavaara S FAU - Rosenberg, P AU - Rosenberg P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - 0 (Hemoglobins) SB - IM MH - Adult MH - Aged MH - Blood Coagulation Disorders/blood/*etiology/surgery MH - Blood Coagulation Tests MH - Blood Transfusion MH - Burns/blood/*complications/surgery MH - Female MH - Hematocrit MH - Hemoglobins/analysis MH - Humans MH - Male MH - Middle Aged MH - Perioperative Care MH - Platelet Count MH - Postoperative Complications/therapy MH - Prospective Studies MH - *Skin Transplantation/adverse effects EDAT- 1998/06/02 00:00 MHDA- 1998/06/02 00:01 CRDT- 1998/06/02 00:00 PHST- 1998/06/02 00:00 [pubmed] PHST- 1998/06/02 00:01 [medline] PHST- 1998/06/02 00:00 [entrez] AID - 10.1097/00001721-199801000-00003 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 1998 Jan;9(1):19-28. doi: 10.1097/00001721-199801000-00003. PMID- 9603087 OWN - NLM STAT- MEDLINE DCOM- 19980610 LR - 20220311 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 44 IP - 5 DP - 1998 May TI - Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. PG - 846-54 AB - BACKGROUND: The coagulopathy noted in hypothermic trauma patients has been variously theorized to be caused by either enzyme inhibition, platelet alteration, or fibrinolytic processes, but no study has examined the possibility that all three processes may simultaneously contribute to coagulopathy, but are perhaps triggered at different levels of hypothermia. The purpose of this study was to determine whether, at clinically common levels of hypothermia (33.0-36.9 degrees C), there are specific temperature levels at which coagulopathic alterations are seen in each of these processes. METHODS: Of 232 consecutive adult trauma patients presenting to a Level I trauma center, 112 patients met the inclusion criteria of an Injury Severity Score of 9 or greater and time since injury of less than 2 hours. Of the included patients, 40 were normothermic and 72 were hypothermic (> or =37 degrees C, n = 40; 36.9-36 degrees C, n = 29; 35.9-35 degrees C, n = 20; 34.9-34 degrees C, n = 16; 33.9-33 degrees C, n = 7). Included patients were prospectively studied with thrombelastography adjusted to core body temperature. Additionally, PT, aPTT, platelets, CO2, hemoglobin, hematocrit, and Injury Severity Score were measured. RESULTS: Analysis by multivariate analysis of variance of the relationship between coagulation and temperature demonstrated that in hypothermic trauma patients, 34 degrees C was the critical point at which enzyme activity slowed significantly (p < 0.0001), and at which significant alteration in platelet activity was seen (p < 0.001). Fibrinolysis was not significantly affected at any of the measured temperatures (p > 0.25). CONCLUSIONS: Patients whose temperature was > or =34.0 degrees C actually demonstrated a significant hypercoagulability. Enzyme activity slowing and decreased platelet function individually contributed to hypothermic coagulopathy in patients with core temperatures below 34.0 degrees C. All the coagulation measures affected are part of the polymerization process of platelets and fibrin, and this process may be the mechanism by which the alteration in coagulation occurs. FAU - Watts, D D AU - Watts DD AD - Department of Trauma Services, Inova Regional Trauma Center, Falls Church, Virgina 22042-3300, USA. FAU - Trask, A AU - Trask A FAU - Soeken, K AU - Soeken K FAU - Perdue, P AU - Perdue P FAU - Dols, S AU - Dols S FAU - Kaufmann, C AU - Kaufmann C LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adolescent MH - Adult MH - Blood Coagulation/physiology MH - Blood Coagulation Disorders/blood/*etiology MH - Blood Platelets/physiology MH - Body Temperature MH - Female MH - Fibrinolysis MH - Fluid Therapy MH - Hematocrit MH - Humans MH - Hypothermia/blood/*complications MH - Injury Severity Score MH - Male MH - Multivariate Analysis MH - Partial Thromboplastin Time MH - Prospective Studies MH - Thrombelastography MH - Wounds and Injuries/blood/classification/*complications EDAT- 1998/05/29 00:00 MHDA- 1998/05/29 00:01 CRDT- 1998/05/29 00:00 PHST- 1998/05/29 00:00 [pubmed] PHST- 1998/05/29 00:01 [medline] PHST- 1998/05/29 00:00 [entrez] AID - 10.1097/00005373-199805000-00017 [doi] PST - ppublish SO - J Trauma. 1998 May;44(5):846-54. doi: 10.1097/00005373-199805000-00017. PMID- 10168534 OWN - NLM STAT- MEDLINE DCOM- 19970815 LR - 20151030 IS - 0022-1058 (Print) IS - 0022-1058 (Linking) VI - 29 IP - 2 DP - 1997 Jun TI - Hemostatic assessment of patients undergoing intraaortic balloon pump therapy. PG - 78-82 AB - Patients undergoing intraaortic balloon pump (IABP) therapy are at risk for developing coagulopathies due to the adverse effects of prolonged exposure of the synthetic surface of the polyurethane balloon to blood components. Hemorrhagic risk has been attributed to a number of factors including thrombocytopenia, vascular injury, and/or platelet degranulation which increase the potential of receiving autogeneic blood transfusions. The present study is a prospective evaluation of coagulation using a viscoelastic monitor (Thrombelastograph--TEG) that measures functional aspects of clot development and stabilization in patients being treated with IABP therapy. Following Institutional Review Board approval, six patients undergoing IABP therapy for hemodynamic instability were enrolled in this study. Blood samples were taken prior to balloon insertion, at 8, 16, 24, 48, 72, and 96 hours on IABP therapy, and 24 hours following the removal of the balloon when applicable. Samples were incubated with heparinase to degrade heparin and TEG profiles were subsequently determined in duplicate. Measured parameters on the TEG included R-time, K-time, maximum amplitude, alpha angle, and lysis at 30 and 60 minutes with calculation of the TEG index. Mortality was 33% following IABP discontinuation. Transfusion of packed red blood cells occurred in 50% of the patients during their balloon pump therapy. Patients demonstrated a significant deviance in fibrinolytic potential from pre-IABP lysis (1.6% +/- 1.8) at both 24 hours (18.8% +/- 22.9) and 48 hours (21.9% +/- 28.5) of therapy (p < 0.05) which returned to baseline shortly after balloon removal. Activation of coagulation factors appeared evident by a steadily increasing alpha angle from pre-IABP data (3.1 +/- 9.2) throughout the duration of therapy and 24 hour recovery (53 +/- 14; p < .005), and by a steadily trending increase in the TEG index pre-IABP (.251 +/- 1.4) to post-IABP (2.6 +/- 1.7; p < 0.05). The results indicate that IABP therapy induces an increase in fibrinolytic potential at 24 to 48 hours of balloon pump therapy with a paradoxical trend toward increased coagulability, potentially predisposing the patient to hemorrhagic risk. FAU - Ficek, S J AU - Ficek SJ AD - Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, USA. FAU - Stammers, A AU - Stammers A FAU - Deligonul, U AU - Deligonul U FAU - Shurmur, S W AU - Shurmur SW FAU - Alonso, A AU - Alonso A FAU - Galbraith, T AU - Galbraith T LA - eng PT - Journal Article PL - France TA - J Extra Corpor Technol JT - The journal of extra-corporeal technology JID - 0267637 MH - Aged MH - Female MH - Fibrinolysis MH - Hemorrhage/etiology MH - *Hemostasis MH - Humans MH - Intra-Aortic Balloon Pumping/*adverse effects MH - Male MH - Middle Aged MH - Thrombelastography EDAT- 1997/05/07 00:00 MHDA- 1997/05/07 00:01 CRDT- 1997/05/07 00:00 PHST- 1997/05/07 00:00 [pubmed] PHST- 1997/05/07 00:01 [medline] PHST- 1997/05/07 00:00 [entrez] PST - ppublish SO - J Extra Corpor Technol. 1997 Jun;29(2):78-82. PMID- 9137263 OWN - NLM STAT- MEDLINE DCOM- 19970522 LR - 20220410 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 42 IP - 4 DP - 1997 Apr TI - Usefulness of thrombelastography in assessment of trauma patient coagulation. PG - 716-20; discussion 720-2 AB - OBJECTIVE: Thrombelastography (TEG) is used to rapidly assess coagulation abnormalities in cardiac and transplant surgery. The purpose of this study was to investigate TEG in the initial assessment of trauma patient coagulation. METHODS: TEG was performed on 69 adult blunt trauma patients during their initial evaluation. Demographics, history of inherited coagulopathies, medications, TEG parameters, platelet count, prothrombin time/partial thromboplastin time, Revised Trauma Score (RTS), Injury Severity Score (ISS), use of blood products, and outcome were recorded. RESULTS: Mortality was 4.3%. Fifty-two patients demonstrated coagulation abnormalities by TEG; of these, 45 were hypercoagulable (mean ISS 13.1), and seven were hypocoagulable (mean ISS 28.6). Six of the seven hypocoagulable patients received blood transfusions within the first 24 hours. Mean ISS of the 17 patients with normal TEG parameters was 3.7. Logistic regression of ISS, Revised Trauma Score, prothrombin time/partial thromboplastin time, and TEG on use/nonuse of blood products within the first 24 hours demonstrates that only ISS (p < 0.001) and TEG (p < 0.05) are predictive of early transfusion. CONCLUSIONS: The majority of blunt trauma patients in this series were hypercoagulable. TEG is a rapid, simple test that can broadly determine coagulation abnormalities. TEG is an early predictor of transfusion in blunt injury patients. FAU - Kaufmann, C R AU - Kaufmann CR AD - Department of Surgery, Fairfax Regional Trauma Center, Falls Church, Virginia, USA. FAU - Dwyer, K M AU - Dwyer KM FAU - Crews, J D AU - Crews JD FAU - Dols, S J AU - Dols SJ FAU - Trask, A L AU - Trask AL LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Coagulation Disorders/*blood/*etiology/therapy MH - Blood Transfusion MH - Female MH - Humans MH - Injury Severity Score MH - Logistic Models MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Reproducibility of Results MH - Thrombelastography/instrumentation/methods/*standards MH - Time Factors MH - Wounds, Nonpenetrating/*complications EDAT- 1997/04/01 00:00 MHDA- 1997/04/01 00:01 CRDT- 1997/04/01 00:00 PHST- 1997/04/01 00:00 [pubmed] PHST- 1997/04/01 00:01 [medline] PHST- 1997/04/01 00:00 [entrez] AID - 10.1097/00005373-199704000-00023 [doi] PST - ppublish SO - J Trauma. 1997 Apr;42(4):716-20; discussion 720-2. doi: 10.1097/00005373-199704000-00023. PMID- 7674412 OWN - NLM STAT- MEDLINE DCOM- 19951019 LR - 20190711 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 39 IP - 2 DP - 1995 Aug TI - Hemostatic competency and elastase-alpha 1-proteinase inhibitor levels in surgery, trauma, and sepsis. PG - 381-5 AB - Previous studies investigated the effects of neutrophil elastase on isolated factors in the hemostatic process. Some of these reported effects are, however, procoagulative and others anticoagulative. The aim of this study was to ascertain the effect of elastase on the in vivo hemostatic competency. The effect of elastase activity on the hemostatic competency was determined in a group of 50 surgical intensive care unit patients and 23 control subjects. Surgical intensive care unit patients were subgrouped into a surgery, a trauma, and a sepsis-multiple organ failure group. Elastase activity was assessed by elastase-alpha 1-proteinase inhibitor levels and hemostatic competency by thromboelastography. Thromboelastography results showed a relatively normal coagulative ability in the surgery group, a varying degree of thromboelastographic hypocoagulability in the trauma group, and pronounced thromboelastographic instability in the sepsis-multiple organ failure group. Increases in elastase-alpha 1-proteinase inhibitor levels up to 200 micrograms/L were accompanied by a compromised coagulative ability as seen in a prolongation of both the first and second phases of the clotting time, as well as a decrease in the maximal clot elasticity. FAU - Viljoen, M AU - Viljoen M AD - Department of Physiology, Faculty of Medicine, University of Pretoria, Republic of South Africa. FAU - Roux, L J AU - Roux LJ FAU - Pretorius, J P AU - Pretorius JP FAU - Coetzee, I H AU - Coetzee IH FAU - Viljoen, E AU - Viljoen E LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (alpha 1-Antitrypsin) RN - 0 (alpha 1-antitrypsin-leukocyte elastase complex) RN - EC 3.4.21.36 (Pancreatic Elastase) RN - EC 3.4.21.37 (Leukocyte Elastase) SB - IM MH - Case-Control Studies MH - Critical Care MH - Hemostasis/*physiology MH - Humans MH - Leukocyte Elastase/*metabolism MH - Pancreatic Elastase/*metabolism MH - Prognosis MH - Sepsis/*blood/enzymology MH - Thrombelastography MH - Wounds and Injuries/*blood/enzymology MH - alpha 1-Antitrypsin/*metabolism EDAT- 1995/08/01 00:00 MHDA- 1995/08/01 00:01 CRDT- 1995/08/01 00:00 PHST- 1995/08/01 00:00 [pubmed] PHST- 1995/08/01 00:01 [medline] PHST- 1995/08/01 00:00 [entrez] AID - 10.1097/00005373-199508000-00033 [doi] PST - ppublish SO - J Trauma. 1995 Aug;39(2):381-5. doi: 10.1097/00005373-199508000-00033. PMID- 8180336 OWN - NLM STAT- MEDLINE DCOM- 19940610 LR - 20190914 IS - 0957-5235 (Print) IS - 0957-5235 (Linking) VI - 5 IP - 1 DP - 1994 Feb TI - Neutrophil activation and morbidity in young adults with cyanotic congenital heart disease. PG - 17-22 AB - Young adults with cyanotic congenital heart disease have a high incidence of respiratory and haemostatic problems. Activated neutrophils release vasoactive and chemotactic factors which result in endothelial injury, lung parenchymal damage and the activation of platelets and coagulation pathways. To investigate the contribution of neutrophil activation to morbidity in young adults with cyanotic congenital heart disease, plasma neutrophil elastase levels were measured in 25 cyanotic patients and the results compared to patients with acyanotic heart disease and normal controls. Neutrophil elastase levels were significantly elevated in the group with cyanotic congenital heart disease (P < 0.001). Platelet activation was significantly increased in the patients with cyanotic heart disease (P < 0.001). Platelet aggregation was impaired only in those with haematocrits greater than 0.50 (P < 0.02). Whole blood coagulation, as determined by thrombelastography, was within normal limits. The reason for neutrophil activation in patients with cyanotic congenital heart disease is unclear, but activated neutrophils may contribute to the respiratory and haemostatic problems common to these patients. FAU - McLeod, K A AU - McLeod KA AD - Department of Cardiology, Killinbeck Hospital, Leeds, UK. FAU - Martin, P AU - Martin P FAU - Williams, G AU - Williams G FAU - Walker, D R AU - Walker DR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Blood Coagul Fibrinolysis JT - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JID - 9102551 RN - EC 3.4.21.36 (Pancreatic Elastase) RN - EC 3.4.21.37 (Leukocyte Elastase) SB - IM MH - Adult MH - Female MH - Heart Defects, Congenital/*blood MH - Humans MH - Leukocyte Elastase MH - Male MH - Middle Aged MH - Neutrophils/*physiology MH - Pancreatic Elastase/blood MH - Platelet Activation MH - Platelet Aggregation MH - Thrombelastography EDAT- 1994/02/01 00:00 MHDA- 1994/02/01 00:01 CRDT- 1994/02/01 00:00 PHST- 1994/02/01 00:00 [pubmed] PHST- 1994/02/01 00:01 [medline] PHST- 1994/02/01 00:00 [entrez] AID - 10.1097/00001721-199402000-00003 [doi] PST - ppublish SO - Blood Coagul Fibrinolysis. 1994 Feb;5(1):17-22. doi: 10.1097/00001721-199402000-00003. PMID- 8259328 OWN - NLM STAT- MEDLINE DCOM- 19940119 LR - 20131121 IS - 0031-1758 (Print) IS - 0031-1758 (Linking) VI - 31 IP - 10 DP - 1993 Oct TI - Persistent hypercoagulation associated with heterotopic ossification in patients with spinal cord injury long after injury has occurred. PG - 653-9 AB - Three patients are presented with traumatic spinal cord injury (SCI) complicated by acute heterotopic ossification (HO), and concurrent deep vein thrombosis 15 months, 18 months and 22 years after SCI, accompanied by persistent hypercoagulation. The diagnosis of HO preceded deep vein thrombosis in all three patients. All were treated with etidronate disodium and therapeutic heparin followed by oral anticoagulation. As these patients were not acutely injured, the questions arose as to what predisposed them to deep vein thrombosis and when was the appropriate time to discontinue anticoagulation. Over a course of 3 years following deep vein thrombosis, these patients were monitored for evidence of hypercoagulation by D-dimer assay, plasma fibrinogen estimation, and rate of whole blood clotting by Sonoclot coagulation analyzer. The activity of acute HO was assessed by three-phase bone scan. A steady state of hypercoagulation, reflected by an increase in all three parameters, ran parallel to the extent of acute HO for the entire observation period. Moreover, hypercoagulation was persistently greater during increased acute HO activity even when the warfarin-induced prothrombin time ratio was 1.2-1.5. In addition, as acute heterotopic ossification activity decreased, the test values returned to near normal during warfarin therapy.(ABSTRACT TRUNCATED AT 250 WORDS) FAU - Perkash, A AU - Perkash A AD - Spinal Cord Injury Service, Department of Veterans Affairs Medical Center, Palo Alto, California 94304. FAU - Sullivan, G AU - Sullivan G FAU - Toth, L AU - Toth L FAU - Bradleigh, L H AU - Bradleigh LH FAU - Linder, S H AU - Linder SH FAU - Perkash, I AU - Perkash I LA - eng PT - Journal Article PL - England TA - Paraplegia JT - Paraplegia JID - 2985038R RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 5Q7ZVV76EI (Warfarin) RN - 9001-32-5 (Fibrinogen) RN - 9005-49-6 (Heparin) SB - IM MH - Adult MH - Blood Coagulation Disorders/blood/drug therapy/*etiology MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinogen/analysis MH - Heparin/therapeutic use MH - Humans MH - Male MH - Middle Aged MH - Ossification, Heterotopic/*etiology MH - Spinal Cord Injuries/*complications MH - Thrombophlebitis/blood/drug therapy/etiology MH - Warfarin/therapeutic use EDAT- 1993/10/01 00:00 MHDA- 1993/10/01 00:01 CRDT- 1993/10/01 00:00 PHST- 1993/10/01 00:00 [pubmed] PHST- 1993/10/01 00:01 [medline] PHST- 1993/10/01 00:00 [entrez] AID - 10.1038/sc.1993.105 [doi] PST - ppublish SO - Paraplegia. 1993 Oct;31(10):653-9. doi: 10.1038/sc.1993.105. PMID- 2504556 OWN - NLM STAT- MEDLINE DCOM- 19891003 LR - 20041117 IS - 0366-6999 (Print) IS - 0366-6999 (Linking) VI - 102 IP - 1 DP - 1989 Jan TI - Studies on hypercoagulation state in thromboangiitis obliterans. PG - 67-71 AB - Thirteen hypercoagulation parameters related to coagulation, anticoagulation, platelet functions, dynamics of clot formation and hemorrheology were determined in 15-109 patients with thromboangiitis obliterans (TAO). The results showed that VIIIR = Ag, PAdT, PagT, HPF, and whole blood and plasma viscosity were elevated, fibrinogen elevated in the active stage, AT-III declined, RBC electrophoresis time prolonged, and changes suggesting hypercoagulation in thromboelastogram. All these indicated the existence of a hypercoagulation state in TAO patients, which could contribute to the process of thrombosis. The relationship between immune reactions and blood hypercoagulability could be crucial in the pathogenesis of TAO. Immune reactions causing injury of vascular endothelium play a primary and fundamental role, and blood hypercoagulability could play a secondary but important role in the course of the disease. FAU - Zheng, P AU - Zheng P FAU - Chen, S J AU - Chen SJ FAU - Shao, H Z AU - Shao HZ LA - eng PT - Journal Article PL - China TA - Chin Med J (Engl) JT - Chinese medical journal JID - 7513795 RN - 0 (Antigens) RN - 0 (von Willebrand Factor) RN - 9000-94-6 (Antithrombin III) RN - 9001-27-8 (Factor VIII) SB - IM MH - Adult MH - Antigens/*analysis MH - Antithrombin III/*analysis MH - *Blood Viscosity MH - Factor VIII/analysis/*immunology MH - Humans MH - Male MH - Middle Aged MH - Thromboangiitis Obliterans/*blood/etiology MH - von Willebrand Factor EDAT- 1989/01/01 00:00 MHDA- 1989/01/01 00:01 CRDT- 1989/01/01 00:00 PHST- 1989/01/01 00:00 [pubmed] PHST- 1989/01/01 00:01 [medline] PHST- 1989/01/01 00:00 [entrez] PST - ppublish SO - Chin Med J (Engl). 1989 Jan;102(1):67-71. PMID- 290194 OWN - NLM STAT- MEDLINE DCOM- 19791128 LR - 20191021 VI - 28 IP - 1 DP - 1979 TI - The significance of cerebral and systemic disseminated intravascular coagulation in early prognosis of brain injury. PG - 96-7 FAU - Tikk, A AU - Tikk A FAU - Noormaa, U AU - Noormaa U LA - eng PT - Journal Article PL - Austria TA - Acta Neurochir Suppl (Wien) JT - Acta neurochirurgica. Supplementum JID - 0140560 RN - 9001-32-5 (Fibrinogen) SB - IM MH - Blood Coagulation Tests MH - Brain Concussion/blood MH - Brain Injuries/*blood/diagnosis MH - *Cerebrovascular Circulation MH - Coma/blood MH - Contusions/blood MH - Disseminated Intravascular Coagulation/*blood/diagnosis MH - Fibrinogen/analysis MH - Fibrinolysis MH - Humans MH - Platelet Aggregation MH - Prognosis MH - Thrombelastography MH - Thrombocytopenia/blood EDAT- 1979/01/01 00:00 MHDA- 1979/01/01 00:01 CRDT- 1979/01/01 00:00 PHST- 1979/01/01 00:00 [pubmed] PHST- 1979/01/01 00:01 [medline] PHST- 1979/01/01 00:00 [entrez] AID - 10.1007/978-3-7091-4088-8_21 [doi] PST - ppublish SO - Acta Neurochir Suppl (Wien). 1979;28(1):96-7. doi: 10.1007/978-3-7091-4088-8_21. PMID- 660699 OWN - NLM STAT- MEDLINE DCOM- 19780828 LR - 20190711 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 18 IP - 6 DP - 1978 Jun TI - Disseminated intravascular multiple systems activation (DIMSA) following thermal injury. PG - 432-9 AB - Seventy-seven major thermal injury victims were studied with a number of hematologic and immunologic tests initially and sequentially during the first postburn month. The patients were grouped by initial prognostic index as well as by ultimate survival. Pairs were grouped by initial prognostic index as well as by ultimate survival. Pairs of test data from subjects studied at successive time intervals were compared with prognostic index and ultimate survival. Statistically significant changes in coagulation, fibrinolytic, complement, and kinin tests all occurred within these groups. These findings strongly suggest that intravascular contamination occurs following thermal injury in proportion to the extent of the burn, because of the occurrence and persistence of statistically significant multiple system changes. Regrouping all of the blood data according to ultimate death or survival reinforced the concept of intravascular contamination and provided the basis by which one can compute laboratory prognostic indices. The combination of plasminogen, C'3 complement, C'H50, one-minute kinin, and TEG index discriminated between death and survival with 91% accuracy by the end of the first postburn week. These data offer the potential for select blood measurements in refining current prognostic indicators. This may provide an objective data base for the analysis of new treatment programs in thermal injury victims. FAU - Zuckerman, L AU - Zuckerman L FAU - Caprini, J A AU - Caprini JA FAU - Lipp, V AU - Lipp V FAU - Vagher, J P AU - Vagher JP LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Fibrin Fibrinogen Degradation Products) RN - 9001-32-5 (Fibrinogen) RN - 9001-91-6 (Plasminogen) RN - 9007-36-7 (Complement System Proteins) RN - 9035-58-9 (Thromboplastin) RN - EC 3.4.21.- (Kallikreins) SB - IM MH - Blood Cell Count MH - Blood Platelets MH - Burns/*blood/diagnosis MH - Complement System Proteins/analysis MH - Fibrin Fibrinogen Degradation Products/analysis MH - Fibrinogen/analysis MH - Hematocrit MH - Humans MH - Kallikreins/blood MH - Plasminogen/analysis MH - Prognosis MH - Prothrombin Time MH - Thrombelastography MH - Thromboplastin/analysis EDAT- 1978/06/01 00:00 MHDA- 1978/06/01 00:01 CRDT- 1978/06/01 00:00 PHST- 1978/06/01 00:00 [pubmed] PHST- 1978/06/01 00:01 [medline] PHST- 1978/06/01 00:00 [entrez] AID - 10.1097/00005373-197806000-00008 [doi] PST - ppublish SO - J Trauma. 1978 Jun;18(6):432-9. doi: 10.1097/00005373-197806000-00008. PMID- 603216 OWN - NLM STAT- MEDLINE DCOM- 19780310 LR - 20041117 IS - 0355-9521 (Print) IS - 0355-9521 (Linking) VI - 66 IP - 6 DP - 1977 TI - Coagulation disorders in severely and critically injured patients. PG - 269-77 AB - Forty-five patients with multiple injuries treated at an intensive care unit were studied prospectively. The patients were divided into two groups: the severely injured (no mortality) and critically injured (56% mortality). Treatment was started within two hours from the accident in all cases. The following coagulation parameters were measured for eight days: euglobulin lysis time (ELT), thromboelastography (TEG), vecalcification time (RECA), partial thromboplastin time (PTT), factor V, factor VIII, Normotest, Thrombotest, thrombin time, fibrinogen and platelets. Severe coagulation disorders were observed in one-third of the patients 12-48 hours after trauma. The abnormalities were more pronounced in patients who had sustained very severe injuries and arrived in a state of shock. The ELT was shortened 0-6 hours after the accident and accelerated coagulation was indicated simultaneously by decreased PTT, RECA, and r-values as well as by elevated Thrombotest and factor VIII values. The factor V and fibrinogen levels were initially lowered. Low platelet values at 2-4 days, prolonged thrombin and r-times, secondary decrease of fibrinogen FV, FVIII, and low Thrombotest values suggested disseminated intravascular coagulation associated with complications, such as fat embolism and "shock lung" syndromes. General bleeding tendency with high mortality was observed in 16% of the patients. FAU - Avikainen, V AU - Avikainen V LA - eng PT - Journal Article PL - Finland TA - Ann Chir Gynaecol JT - Annales chirurgiae et gynaecologiae JID - 7609767 RN - 9001-24-5 (Factor V) RN - 9001-27-8 (Factor VIII) RN - 9001-32-5 (Fibrinogen) SB - IM MH - Adult MH - Blood Cell Count MH - Blood Coagulation Disorders/*etiology MH - Blood Coagulation Tests MH - Blood Platelets MH - Blood Transfusion MH - Brain Injuries/complications MH - Factor V/analysis MH - Factor VIII/analysis MH - Fibrinogen/analysis MH - Fibrinolysis MH - Humans MH - Prospective Studies MH - Shock, Traumatic/therapy MH - Thoracic Injuries/complications MH - Thrombelastography MH - Wounds and Injuries/blood/*complications EDAT- 1977/01/01 00:00 MHDA- 1977/01/01 00:01 CRDT- 1977/01/01 00:00 PHST- 1977/01/01 00:00 [pubmed] PHST- 1977/01/01 00:01 [medline] PHST- 1977/01/01 00:00 [entrez] PST - ppublish SO - Ann Chir Gynaecol. 1977;66(6):269-77. PMID- 1171400 OWN - NLM STAT- MEDLINE DCOM- 19751021 LR - 20190514 IS - 0028-3878 (Print) IS - 0028-3878 (Linking) VI - 25 IP - 7 DP - 1975 Jul TI - Local alterations of hemostatic-fibrinolytic mechanisms in reforming subdural hematomas. PG - 669-75 AB - Multiple chemical and coagulation determinations were undertaken on the subdural hematoma fluid from the reformed effusions of two patients. It was found that plasma or blood repeatedly reentered the subdural cavity. Coagulation studies compared the in vitro effects of subdural fluid with those of cerebrospinal fluid, serum, and a buffer control. Despite some chemical differences, the subdural fluids from both patients behaved similarly by (1) accelerating the intrinsic clotting system, (2) producing defective clot formation, and (3) accelerating the fibrinolytic system. It is presumed that these continuous hemostatic-fibrinolytic alterations, acting in the subdural sac, may have important implications in the growth and reformation of subdural hematomas, and a hypothesis of the mechanisms involved is presented. FAU - Labadie, E L AU - Labadie EL FAU - Glover, D AU - Glover D LA - eng PT - Journal Article PL - United States TA - Neurology JT - Neurology JID - 0401060 RN - 0 (Blood Proteins) RN - 5Q7ZVV76EI (Warfarin) RN - 9001-91-6 (Plasminogen) SB - IM MH - Aged MH - *Blood Coagulation MH - Blood Coagulation Tests MH - Blood Proteins/analysis MH - Erythrocyte Count MH - Female MH - *Fibrinolysis MH - Hematoma, Subdural/*blood/cerebrospinal fluid MH - Humans MH - Male MH - Middle Aged MH - Plasminogen/analysis MH - Recurrence MH - Thrombelastography MH - Time Factors MH - Warfarin/adverse effects EDAT- 1975/07/01 00:00 MHDA- 1975/07/01 00:01 CRDT- 1975/07/01 00:00 PHST- 1975/07/01 00:00 [pubmed] PHST- 1975/07/01 00:01 [medline] PHST- 1975/07/01 00:00 [entrez] AID - 10.1212/wnl.25.7.669 [doi] PST - ppublish SO - Neurology. 1975 Jul;25(7):669-75. doi: 10.1212/wnl.25.7.669. PMID- 5077085 OWN - NLM STAT- MEDLINE DCOM- 19721204 LR - 20231120 IS - 0003-4932 (Print) IS - 1528-1140 (Electronic) IS - 0003-4932 (Linking) VI - 176 IP - 2 DP - 1972 Aug TI - Coagulopathy after major combat injury: occurrence, management, and pathophysiology. PG - 243-6 FAU - McNamara, J J AU - McNamara JJ FAU - Burran, E L AU - Burran EL FAU - Stremple, J F AU - Stremple JF FAU - Molot, M D AU - Molot MD LA - eng PT - Journal Article PL - United States TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - IM MH - Blood Cell Count MH - Blood Coagulation Disorders/*epidemiology/etiology/physiopathology/therapy MH - Blood Coagulation Tests MH - Blood Platelets MH - Blood Transfusion MH - Hematocrit MH - Humans MH - *Military Medicine MH - Postoperative Complications MH - Prothrombin Time MH - Thrombelastography MH - United States MH - Vietnam MH - Wounds and Injuries/*surgery PMC - PMC1355312 EDAT- 1972/08/01 00:00 MHDA- 1972/08/01 00:01 PMCR- 1973/02/01 CRDT- 1972/08/01 00:00 PHST- 1972/08/01 00:00 [pubmed] PHST- 1972/08/01 00:01 [medline] PHST- 1972/08/01 00:00 [entrez] PHST- 1973/02/01 00:00 [pmc-release] AID - 10.1097/00000658-197208000-00021 [doi] PST - ppublish SO - Ann Surg. 1972 Aug;176(2):243-6. doi: 10.1097/00000658-197208000-00021. PMID- 5351798 OWN - NLM STAT- MEDLINE DCOM- 19700102 LR - 20231120 IS - 0022-5282 (Print) IS - 0022-5282 (Linking) VI - 9 IP - 11 DP - 1969 Nov TI - Alterations in coagulation and fibrinolytic mechanisms in acute trauma. PG - 939-65 FAU - Attar, S AU - Attar S FAU - Boyd, D AU - Boyd D FAU - Layne, E AU - Layne E FAU - McLaughlin, J AU - McLaughlin J FAU - Mansberger, A R AU - Mansberger AR FAU - Cowley, R A AU - Cowley RA LA - eng PT - Journal Article PL - United States TA - J Trauma JT - The Journal of trauma JID - 0376373 RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) RN - 9001-91-6 (Plasminogen) RN - S8TIM42R2W (Bradykinin) SB - IM MH - Adolescent MH - Adult MH - Aged MH - *Blood Coagulation MH - Blood Coagulation Factors/analysis MH - Blood Coagulation Tests MH - Blood Platelets MH - Bradykinin/analysis MH - Brain Injuries/blood MH - Child MH - Female MH - Fibrinogen/analysis MH - *Fibrinolysis MH - Hemostasis MH - Humans MH - Male MH - Middle Aged MH - Plasminogen/analysis MH - Platelet Adhesiveness MH - Prothrombin Time MH - Shock/blood MH - Thrombelastography MH - Wounds and Injuries/*blood EDAT- 1969/11/01 00:00 MHDA- 1969/11/01 00:01 CRDT- 1969/11/01 00:00 PHST- 1969/11/01 00:00 [pubmed] PHST- 1969/11/01 00:01 [medline] PHST- 1969/11/01 00:00 [entrez] AID - 10.1097/00005373-196911000-00004 [doi] PST - ppublish SO - J Trauma. 1969 Nov;9(11):939-65. doi: 10.1097/00005373-196911000-00004. PMID- 5385122 OWN - NLM STAT- MEDLINE DCOM- 19701005 LR - 20131216 IS - 0375-9997 (Print) IS - 0375-9997 (Linking) VI - 36 DP - 1969 TI - Disseminated intravascular coagulation in shock. PG - 159-70 FAU - Hardaway RM, E D AU - Hardaway RM ED LA - eng PT - Journal Article PL - Germany TA - Thromb Diath Haemorrh Suppl JT - Thrombosis et diathesis haemorrhagica. Supplementum JID - 8106633 RN - 0 (Anticoagulants) RN - 0 (Blood Coagulation Factors) RN - 9001-32-5 (Fibrinogen) RN - 9035-58-9 (Thromboplastin) SB - IM MH - Acidosis MH - Anticoagulants/blood MH - Blood Coagulation Disorders/*etiology/therapy MH - Blood Coagulation Factors MH - Blood Coagulation Tests MH - Blood Flow Velocity MH - Blood Transfusion MH - Blood Volume MH - Capillaries/physiopathology MH - Fibrinogen/analysis MH - Fibrinolysis MH - Humans MH - Prothrombin Time MH - Shock, Hemorrhagic/*complications MH - Thrombelastography MH - Thrombocytopenia MH - Thromboplastin EDAT- 1969/01/01 00:00 MHDA- 1969/01/01 00:01 CRDT- 1969/01/01 00:00 PHST- 1969/01/01 00:00 [pubmed] PHST- 1969/01/01 00:01 [medline] PHST- 1969/01/01 00:00 [entrez] PST - ppublish SO - Thromb Diath Haemorrh Suppl. 1969;36:159-70. PMID- 14121767 OWN - NLM STAT- MEDLINE DCOM- 19961201 LR - 20221207 IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 55 DP - 1964 Feb TI - MAJOR SURGICAL PROCEDURES, INCLUDING AMPUTATION, ON A HEMOPHILIAC. PG - 220-32 FAU - MILES, J S AU - MILES JS FAU - VONKAULLA, E AU - VONKAULLA E FAU - VONKAULLA, K N AU - VONKAULLA KN LA - eng PT - Journal Article PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Hemostatics) RN - 9001-26-7 (Prothrombin) RN - 9001-32-5 (Fibrinogen) SB - OM MH - *Amputation, Surgical MH - *Blood Coagulation Tests MH - *Blood Transfusion MH - *Femoral Fractures MH - *Fibrinogen MH - *Fibula MH - *Fractures, Bone MH - *Hemophilia A MH - *Hemostasis MH - *Hemostatics MH - Humans MH - *Infusions, Parenteral MH - *Leg Injuries MH - *Prothrombin MH - *Surgical Procedures, Operative MH - *Thrombelastography MH - *Tibial Fractures MH - *Urine OTO - NLM OT - *AMPUTATION OT - *BLOOD COAGULATION TESTS OT - *BLOOD TRANSFUSION OT - *FEMORAL FRACTURES OT - *FIBRINOGEN OT - *FIBULA OT - *FRACTURES OT - *HEMOPHILIA OT - *HEMOSTASIS OT - *HEMOSTATICS OT - *INFUSIONS, PARENTERAL OT - *LEG INJURIES OT - *PROTHROMBIN OT - *SURGERY, OPERATIVE OT - *THROMBOELASTOGRAPHY OT - *TIBIAL FRACTURES OT - *URINE EDAT- 1964/02/01 00:00 MHDA- 1964/02/01 00:01 CRDT- 1964/02/01 00:00 PHST- 1964/02/01 00:00 [pubmed] PHST- 1964/02/01 00:01 [medline] PHST- 1964/02/01 00:00 [entrez] AID - 0039-6060(64)90281-8 [pii] PST - ppublish SO - Surgery. 1964 Feb;55:220-32. PMID- 14102522 OWN - NLM STAT- MEDLINE DCOM- 19961201 LR - 20181201 IS - 0035-3469 (Print) IS - 0035-3469 (Linking) VI - 36 DP - 1963 Dec TI - CHYMORAL AND COAGULATION. PG - 745-57 FAU - PESSEREAU, G AU - PESSEREAU G FAU - MONTEIL, R AU - MONTEIL R LA - eng PT - Journal Article PL - France TA - Rev Int Serv Sante Armees JT - Revue international des services de sante des armees de terre, de mer et de l'air JID - 7503658 RN - 0 (Coagulants) RN - 0 (Drug Combinations) RN - 0 (Hemostatics) RN - 8076-22-0 (chymotrypsin, trypsin drug combination) RN - 9001-32-5 (Fibrinogen) RN - EC 3.4.21.1 (Chymotrypsin) RN - EC 3.4.21.4 (Trypsin) SB - OM MH - *Blood Coagulation MH - *Blood Platelets MH - *Burns MH - *Chymotrypsin MH - *Coagulants MH - *Drug Combinations MH - *Fibrinogen MH - *Hemostatics MH - Humans MH - *Pharmacology MH - *Thrombelastography MH - *Trypsin OTO - NLM OT - *BLOOD COAGULATION OT - *BLOOD PLATELETS OT - *BURNS OT - *CHYMOTRYPSIN OT - *FIBRINOGEN OT - *PHARMACOLOGY OT - *THROMBOELASTOGRAPHY OT - *TRYPSIN EDAT- 1963/12/01 00:00 MHDA- 1963/12/01 00:01 CRDT- 1963/12/01 00:00 PHST- 1963/12/01 00:00 [pubmed] PHST- 1963/12/01 00:01 [medline] PHST- 1963/12/01 00:00 [entrez] PST - ppublish SO - Rev Int Serv Sante Armees. 1963 Dec;36:745-57.