Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jun 2012
Randomized Controlled Trial Comparative StudyComparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty.
In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). ⋯ The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.
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Blood Coagul. Fibrinolysis · Jun 2012
Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation.
We investigated the association of mean platelet volume (MPV) with culprit lesion severity and major cardiac outcomes (MCOs) in patients with acute coronary syndrome (ACS) with non-ST elevation (NSTE). This study included 344 patients with NSTE-ACS who had significant coronary stenosis at least 50%. They were divided into high MPV group (n = 109, upper tertile >9.9 fl) and low MPV group (n = 235, lower and mid tertile ≤ 9.9 fl) according to MPV values on admission. ⋯ In Cox regression analysis, high MPV remained an independent predictor of MCO (hazard ratio 1.52, 95% CI 1.01-2.29, P = 0.04) after adjusting for baseline characteristics. Elevated MPV was independently associated with NSTE-MI presentation and severity of culprit stenosis in NSTE-ACS patients. Moreover, MPV greater than 9.9 fl was predictive of a 12-month MCO.
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Blood Coagul. Fibrinolysis · Jun 2012
Hypothermic anticoagulation: testing individual responses to graded severe hypothermia with thromboelastography.
Selective incircuit blood cooling could be an effective anticoagulation strategy during hemodialysis. However, it is currently unknown what blood temperature would ensure sufficient anticoagulation. Similarly, no information exists about potential interindividual variability in response to graded hypothermia. ⋯ The relationship between blood temperature and coagulation is not linear but exponential (parameters R and K) and sigmoid (parameter α-angle). The lower the blood temperature, the more significant effect on blood coagulation decline. To predict an individual response of the coagulation system over a wide range of temperatures, a mathematical modeling can be used.
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Blood Coagul. Fibrinolysis · Jun 2012
Epidemiology of primary and secondary thrombocytopenia: first analysis of an administrative database in a major Italian institution.
Administrative databases can be a reliable source for estimating the epidemiology of blood disorders. No data are available estimating the epidemiology of thrombocytopenia from administrative data in Italian institutions. We analyzed the administrative database of the Padua University Hospital with the aim to study the epidemiology of thrombocytopenia in patients discharged with an International Classification of Disease, 9th Revision, Clinical Modification (ICD9-CM) code of thrombocytopenia. ⋯ A concordant diagnosis between clinical records and discharge code was found in 82.5% of cases. Following validation of ICD9-CM code, the incidence of ITP (Code 287.31) was 2.6 cases per 100,000 per year. When evaluated for sensitivity and specificity, we found the ICD-9-CM to be useful in studying thrombocytopenia using administrative data.
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Blood Coagul. Fibrinolysis · Jun 2012
The condensed MCMDM-1 VWD bleeding questionnaire as a predictor of bleeding disorders in women with unexplained menorrhagia.
Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Many studies have suggested that underlying bleeding disorders are prevalent in menorrhagic women. However, the assessment and quantifying of hemorrhagic symptoms are still limited and not widely used. ⋯ Bleeding score was strongly correlated to bleeding time in women with possible Glanzmann's thrombasthenia. In VWD, a significant inverse correlation between the bleeding score and the VW factor levels was detected with a significant increase of bleeding score in type III VWD compared with type I. Bleeding disorders are common in women with unexplained menorrhagia and the condensed MCMDM-1VWD bleeding questionnaire can distinguish between menorrhagic women with and without bleeding disorders and help assess their severity.