Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Sep 2014
Point-of-care testing of clopidogrel-mediated platelet inhibition and risk for cardiovascular events after coronary angiography with or without percutaneous coronary intervention.
High-on-treatment platelet reactivity (HPR) during antiplatelet treatment with clopidogrel is associated with increased risk for adverse cardiovascular events after percutaneous coronary intervention (PCI). Recent studies have indicated that the point-of-care platelet function test Plateletworks can predict such events. The objectives were to investigate the incidence of HPR, to identify correlating variables, and to assess if platelet function testing could predict adverse cardiovascular events. ⋯ This group had a higher BMI (P < 0.001), and had more often received their clopidogrel loading dose within 6-24 h before coronary angiography (P = 0.001). At 3 months follow-up, the event rates of myocardial infarction and rehospitalization, respectively, were higher in HPR patients [5.1 vs. 1.7%, odds ratio (OR) 3.12, 95% confidence interval (CI) 1.05-9.27, P = 0.03; and 23.0 vs. 14.2%, OR 1.80, CI 1.13-2.86, P = 0.01, respectively]. Testing with Plateletworks identified patients at increased risk of myocardial infarction and rehospitalization within 3 months after coronary angiography with or without PCI.
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Blood Coagul. Fibrinolysis · Sep 2014
Does incorporation of thromboelastography improve bleeding prediction following adult cardiac surgery?
Cardiopulmonary bypass (CPB) coagulopathy increases utilization of allogenic blood/blood products, which can negatively affect patient outcomes. Thromboelastography (TEG) is a point-of-care measurement of clot formation and fibrinolysis. We investigated whether the addition of TEG parameters to a clinically based bleeding model would improve the predictability of postoperative bleeding. ⋯ Advanced age, male gender, preoperative clopidogrel use for 5 days or less, greater cell saver blood utilization, and lower postoperative hematocrit levels were associated with increased 8-h CTO (P < 0.05). Adding TEG angle and maximum amplitude to model 1 did not improve CTO predictability. When TEG angle and maximum amplitude were added as predictor factors, the predictability of the bleeding model did not improve.
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Blood Coagul. Fibrinolysis · Sep 2014
Coagulation competence and fluid recruitment after moderate blood loss in young men.
The coagulation system is activated by a reduction of the central blood volume during orthostatic stress and lower body negative pressure suggesting that also a blood loss enhances coagulation. During bleeding, however, the central blood volume is supported by fluid recruitment to the circulation and redistribution of the blood volume. In eight supine male volunteers (24 ± 3 years, blood volume of 6.9 ± 0.7 l; mean ± SD), 2 × 450 ml blood was withdrawn over ∼ 30 min while cardiovascular variables were monitored. ⋯ Clot strength (maximal amplitude: 57 ± 4 mm), clot lysis 30 min after maximal amplitude (LY30: 0.8% [0-3.5%] (median [range])), and platelet count (218 ± 25 × 10(9) l(-1)) were unaffected. For supine males, ∼ 25% of a moderate blood loss is compensated by fluid recruitment to the circulation, which may explain the minor cardiovascular response. Yet, a blood loss of 450 ml accelerates coagulation, and this is further accentuated when blood loss is 900 ml.
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Blood Coagul. Fibrinolysis · Jul 2014
Dabigatran assessment in patients with acute complications using routine coagulation assays.
Complications while on dabigatran therapy, particularly bleeding and thrombosis, are occurring, and require laboratory assessment. The utility of routine coagulation assays has been previously evaluated in stable patients, but not those with acute complications. The purpose of this study was to determine how to employ routine coagulation assays to assess dabigatran in patients with acute complications. ⋯ There was wide variation in the sensitivity of commercial fibrinogen assays to dabigatran, with some even showing interference in the therapeutic range but this could be mitigated. The PTT is unreliable as a method for assessment of dabigatran in patients with acute complications. The TT assay is a simple and reliable alternative, particularly when combined with a fibrinogen level.
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Blood Coagul. Fibrinolysis · Jul 2014
Review Multicenter StudyLong-term outcomes after pulmonary embolism: current knowledge and future research.
In this article, we provide the rationale for the ELOPE (Evaluation of Long-term Outcomes after Pulmonary Embolism) Study, a prospective, observational, multicenter cohort study of patients with a newly diagnosed, first episode of pulmonary embolism (www.clinicaltrials.govNCT01174628) that aims to identify clinical, anatomic, physiologic and biomarker determinants of poor outcome after pulmonary embolism. Pulmonary embolism, the most serious form of venous thromboembolism (VTE), leads to the hospitalization or death of over 30,000 Canadians, 225,000 Americans and 300,000 Europeans each year, numbers that have risen over the past decade. Although numerous studies have evaluated optimal approaches to the diagnosis and treatment of pulmonary embolism, their focus has primarily been on short-term outcomes such as mortality and recurrent VTE in the days, weeks or months after pulmonary embolism diagnosis. ⋯ Residual pulmonary vascular abnormalities on follow-up imaging and echocardiogram are frequent in pulmonary embolism patients, but the clinical significance of these abnormalities is poorly understood. Whether initial and/or residual clot burden, recurrent pulmonary embolism, altered pulmonary artery or right ventricular hemodynamics or other prognostic factors such as biomarker levels contribute to long-term morbidity after pulmonary embolism is as yet unknown. The ELOPE Study will describe and identify the predictors of long-term outcomes after pulmonary embolism in the setting of a rigorous, multicenter cohort study in which long-term clinical, anatomic, physiologic and functional sequelae such as quality of life, return to work and loss of productivity after pulmonary embolism are systematically evaluated.