Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Jan 2010
Case ReportsAlgorithm-based coagulation management of catastrophic amniotic fluid embolism.
Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. ⋯ Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.
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Blood Coagul. Fibrinolysis · Jan 2010
Comparative StudyEvaluation of coagulation stages of hemorrhaged swine: comparison of thromboelastography and rotational elastometry.
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) assesses blood viscoelastic properties and clotting kinetics that can be measured by Haemoscope TEG and Pentapharm ROTEM devices using slightly different methodologies. These devices were compared by measuring blood samples associated with various degrees of coagulopathy. Blood samples, collected from swine undergoing three types of severe injury and resuscitation protocol resulting in normal, hypercoagulopathy, and hypocoagulopathy, were assessed with TEG or ROTEM before the surgical procedures, and after injury, fluid resuscitation, and simulated hospital phase. ⋯ Overall, TEG readings were higher than ROTEM readings; this disparity between the two instruments was attenuated with hypercoaguable samples. Both devices yielded similar information regarding the status of coagulation related to trauma. Because of operating characteristics, the same instrument should be used for monitoring the same patient or study.
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Blood Coagul. Fibrinolysis · Jan 2010
Comparative StudyAssessment of platelet response to clopidogrel with multiple electrode aggregometry, the VerifyNow P2Y12 analyzer and platelet Vasodilator-Stimulated Phosphoprotein flow cytometry.
Multiple electrode platelet aggregometry (MEA) adenosine diphosphate (ADP) test is able to detect the platelet response to clopidogrel. The values obtained with MEA ADPtest correlate with those obtained with light transmission aggregometry and peri-interventional MEA ADPtest measurements are highly associated with the risk of early stent thrombosis after percutaneous coronary intervention. The main purpose of the present study was to correlate MEA ADPtest with the VerifyNow P2Y12 analyzer, Platelet VASP flow cytometry and the MEA ADPtest HS in order to test if these assays can substitute for each other. ⋯ Of the 12 patients in the upper quintile of postclopidogrel values according to MEA ADPtest, seven were in the upper quintile according to VerifyNow P2Y12 (P < 0.001), six were in the upper quintile according to MEA ADPtest HS (P = 0.004) and three were in the upper quintile according to VASP (P = 0.63). Therefore, the studied whole blood assays cannot substitute for each other. Each assay with prognostic significance will have to undergo the ultimate test for individualized antiplatelet therapy in form of an adequately powered randomized clinical trial that shows that adjustment of antiplatelet therapy is beneficial for the patient.
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Blood Coagul. Fibrinolysis · Jan 2010
Inherited dysfibrinogenemia: clinical phenotypes associated with five different fibrinogen structure defects.
Hereditary dysfibrinogenemia is a rare clotting disorder, which results from mutations in at least one of the three fibrinogen genes. We examined the frequency of hemostatic clinical and laboratory anomalies at presentation of 37 probands from 12 unrelated families with five different defects (Aalpha R16C, gamma A357T, gamma318-319 del, gamma M310T, and Aalpha R16S), among. The median age was 51 years (11-86 years). ⋯ In 19% of probands (9/37, all above age of 50 years), had experienced at least one episode of arterial or venous thrombosis. Among these, were two (7%) with deep venous thrombosis, seven with arterial thrombosis, and five (14%) had experienced both. We propose that the higher frequency of prolonged PT than aPTT, in ours and in other reported studies, reflects the polymerization delay, which in aPTT is attenuated owing to contact activation prior to calcium addition.
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Blood Coagul. Fibrinolysis · Jan 2010
Case ReportsUnusual onset of venous thromboembolism and heparin-induced thrombocytopenia in a patient with essential thrombocythemia.
Essential thrombocythemia is a hematological disorder characterized by clonal hemopoiesis in the bone marrow and increased number of circulating platelets. It is usually discovered accidentally at the time of routine blood examinations or can become clinically evident with either thrombotic or hemorrhagic complications. In the present article, we describe the case of a 66-year-old woman with pneumonia due to Pneumocystis carinii, who experienced deep vein thrombosis and pulmonary embolism during hospitalization with a subsequent heparin-induced thrombocytopenia. Bone marrow examination performed after clinical improvement revealed the patient to be affected by essential thrombocythemia.