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Purpose – determine the characteristics of changes of procoagulant, anticoagulant and fibrinolytic links of the hemostatic system in patients with hypertension in combination with coronary heart disease. Materials and methods. 127 people were examined - 14 healthy (control), 61 patients with stage II hypertension with concomitant coronary heart disease (group 2), 52 hypertensive patients with stage III with concomitant coronary heart disease (group 3). There were evaluated indicators of hemostasis system: thrombin time, activated partial thromboplastin time, prothrombin index, soluble fibrin monomer complex, fibrinogen, protein C, antithrombin III of, and the time of XII-dependent fibrinolysis. Results. Patients on both study groups SFMC content significantly higher than the control group. SFMC content in patients with stage II hypertension with concomitant coronary heart disease exceed normative value of 3 times, and in the group of hypertensive patients with stage III with with concomitant coronary heart disease of 3.65 times. The content of fibrinogen in the third group of patients exceeded the indicators of the control group by 27.6%, the difference was significant (p

The objective of this study was to quantify intraoperative bleeding in patients with cirrhosis and correlate it with clinical characteristics and laboratory coagulation tests.A case-control study was carried out with 74 patients with cirrhosis who were submitted to preoperative coagulation tests (complete blood count, platelet count, prothrombin time/international normalized ratio, thrombin time, activated partial thrombin time, platelet aggregation, fibrinogen, protein C, protein S, antithrombin, and von Willebrand factor level and activity). The levels of nitrogen compounds that can affect the platelet function were determined in saliva and blood by using automated enzymatic-colorimetric assays.Patients with cirrhosis had changes in almost all coagulation tests. The average volumes of intraoperative bleeding and blood lost per minute in the study group (5.36 mL/min and 0.19 mL/min, respectively) were greater than those in the control group (3.05 mL/min and 0.11 mL/min, respectively; P.05). In the control group, ascites (P = .012) and presence of periapical lesion (0.034) were positively correlated with bleeding (mL/min). With regard to coagulation tests and nitrogen compounds, only a positively moderate correlation with the platelet aggregation test was observed.No patients had hemorrhagic events and it was not possible to correlate a greater amount of bleeding with coagulation tests or nitrogen compounds in the study group.

Purpose The study objective was to explore whether prophylaxis with vitamin K1 improves abnormal coagulation function–associated cefoperazone-sulbactam in patients treated in the long term with low-dose aspirin. Methods This retrospective, observational study assessed patients treated with long-term low-dose aspirin in a naval military hospital in China from 2004 to 2018, including all patients treated concurrently with cefoperazone-sulbactam with or without vitamin K1. Differences in the coagulation index were analyzed statistically before and after receipt of cefoperazone-sulbactam. Findings The cohort included 227 patients. After cefoperazone-sulbactam treatment, the mean (SD) prothrombin time (PT) was 14.07 (3.07) seconds, activated partial thromboplastin time (aPTT) was 35.15 (4.78) seconds, and international normalized ratio (INR) was 1.49 (0.49) in the cefoperazone-sulbactam group, which was significantly higher than the PT of 11.55 (1.29), aPTT of 31.37 (2.20), and INR of 1.12 (0.35) before cefoperazone-sulbactam treatment. No significant difference was in the cefoperazone-sulbactam plus vitamin K1 group. In addition, no significant difference was found in the thrombin time or fibrinogen level between before and after cefoperazone-sulbactam treatment in both groups. The mean (SD) platelet counts of the 2 groups were 197.34 (71.82) × 109/L and 187.75 (72.66) × 1 09/L after cefoperazone-sulbactam treatment, respectively, which was significantly lower than 231.77 (77.05) × 109/L and 232.08 (84.48) × 109/L before cefoperazone-sulbactam treatment. There were greater proportions of coagulation disorders (prolongation of PT, aPTT, INR, and bleeding) after cefoperazone-sulbactam treatment in the cefoperazone-sulbactam group compared with that in the cefoperazone-sulbactam plus vitamin K1 group. Implications Results indicate that, after adding cefoperazone-sulbactam to the regimens of patients receiving long-term low-dose aspirin, therapy contributed to remarkable increase in abnormal coagulation function and coagulation disorders. Prophylaxis with vitamin K1 decreased the risk of these abnormalities in blood coagulation parameters associated with cefoperazone-sulbactam in patients taking long-term aspirin.

Tetramethylpyrazine (TMP) is commonly used as an antiplatelet drug in clinic. However, the short half-life and low bioavailability limited its applications. 3, 5, 6-Trimethylpyrazine-2-carboxAylic acid (TMP-COOH) and 2-hydroxy-3, 5, 6-trimethylpyrazine (TMP-OH) are the two major active metabolites of TMP in vivo. Both displayed antiplatelet aggregation activity but have obvious disadvantage of rapid metabolism. In this study, conjugates of TMP-COOH/TMP-OH with amino acids were designed to address this issue. We demonstrated that 13 out of 20 conjugates displayed higher antiplatelet aggregation activity than TMP. The optimized compound 4a was further proved to reduce clot retraction, prolong the bleeding time, thrombin time, prothrombin time, activated partial thromboplatin time and reduce fibrinogen content. Taken together, we demonstrated the conjugation strategy could be exploited to develop TMP derivatives for antiplatelet agents.

Background Proprotein convertase subtilisin/kexin type 9 (PCSK9) is considered to have multiple roles in the development of atherosclerosis, which is recently reported to participate in the thrombotic process. We aimed to examine the relationship between PCSK9 concentration, coagulation indexes and cardiovascular events. Methods A total of 2293 consecutive patients with angina-like chest pain and without lipid-lowering drugs treatment were enrolled and followed up for major adverse cardiovascular events (MACEs). Circulating PCSK9 concentration was determined by ELISA. The routine coagulation tests including activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time were performed. The associations between PCSK9 concentration, routine coagulation indicators and MACEs were analyzed. Results Patients with high PCSK9 levels had lower PT and APTT levels (all p p Conclusions Our study firstly suggested that PCSK9 concentration was negatively correlated with plasma levels of PT. Furthermore, high PCSK9 and low PT were associated with MACEs and the combination of PCSK9 with PT had an addictive effect on predicting cardiovascular outcomes in patients with chest pain, which was useful for further subdivision of cardiovascular risks.

Objective. The study focused on the separation effects of ultrasound blood flow signal detection, based on empirical mode decomposition (EMD) algorithm, and the clinical efficacy of Compound Danshen injection and magnesium sulfate in the treatment of pregnancy-induced hypertension (PIH) syndrome. Methods. The empirical mode decomposition (EMD) algorithm was optimized first and compared with other algorithms for the accuracy and stability in separation of blood flow signals. 80 patients with PIH syndrome undergoing ultrasound examination were selected as the research subjects and randomly divided into control group and observation group according to the actual treatment methods. 40 cases in the observation group were treated with Compound Danshen injection + magnesium sulfate, and 40 cases in the control group were treated with magnesium sulfate. After the treatment, the clinical indicators of the two groups of patients were analyzed. Results. The accuracy and stability in separating blood flow signal of the optimized EMD algorithm were better than those of other algorithms. After treatment, the total effective rate and blood pressure control of the observation group were significantly better than those of the control group, and the incidence of adverse maternal and infant outcomes was significantly lower than that of the control group. After treatment, the endothelin-1 (ET-1), C-reactive protein (CRP), and homocysteine (Hcy) indexes of the two groups of patients decreased significantly, and the decrease level of the observation group was significantly greater than that of the control group ( P P

Objective. To explore the effects of epidural anesthesia and general anesthesia on perioperative cognitive function and deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA). Methods. Total of 68 patients undergoing TKA in our hospital from September 2019 to March 2021 were selected and divided into the control group under general anesthesia and the observation group under epidural anesthesia according to the different anesthesia methods, 34 patients in each group. TKA was selected in both groups and performed by the same group of physicians, anesthesiologists, and nursing staff. The mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) were observed immediately before anesthesia (T1), 30 min after anesthesia (T2), after surgery (T3), and 1 d after surgery (T4). The changes of platelet (PLC), fibrinogen (Fbg), prothrombin time (PT), activated partial thrombin time (APTT), and other coagulation indicators were recorded. The Montreal Cognitive Assessment (MoCA) scores before surgery and 1 d and 3 d after surgery were observed. The blood samples of the two groups were collected before surgery and 1 d and 3 d after surgery, and the levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the peripheral blood of the two groups were measured by ELISA. The number of postoperative mental disorders and DVT in the two groups was calculated. Results. The MAP and HR of T4 were lower than those of T1, T2, and T3. The MAP of T2, T3, and T4 in the observation group was lower than that in the control group ( P < 0.05 ), and the SpO2 of T1–T4 in the two groups did not change significantly, and there was no significant difference between the two groups ( P > 0.05 ). Compared with T1, there was no significant difference in PLC, Fbg, and PT in the observation group T4 ( P > 0.05 ), and APTT was lower than T1 ( P < 0.05 ). The PLC, PT, and APTT of T4 in the control group were all lower than those of T1 ( P < 0.05 ), and there was no significant difference between Fbg and T1 ( P > 0.05 ). The PLC, Fbg, and PT of T4 in the observation group were higher than those in the control group, while APTT was lower than that in the control group ( P < 0.05 ). The MoCA scores of patients in both groups on the 1st and 3rd day after operation were lower than those before operation, and the observation group was higher than that in the control group ( P < 0.05 ). The BDNF and NGF of patients in both groups were lower than those before operation on the 1st day after operation, and the BDNF and NGF in the observation group were higher than those in the control group on the 1st and 3rd day after operation ( P < 0.05 ). The mental disorder (2.94%) and DVT incidence (2.94%) in the observation group were lower than those in the control group (29.41%, 26.47%) ( P < 0.05 ). Conclusion. Epidural anesthesia for patients with TKA can obtain better clinical effects, maintain stable hemodynamic and coagulation states, reduce stress response of patients at the same time, and reduce perioperative cognitive dysfunction and the incidence of DVT in patients.

Objective. To investigate the efficacy of enteric-coated Bifidobacterium triple viable capsules combined with enteral nutrition in the treatment of patients with chronic critical illness (CCI) and their effects on the immune and coagulation function of patients. Methods. 106 CCI patients admitted to the intensive care unit of our hospital from December 2018 to March 2020 were selected as the research objects, and they were randomly divided into the control group (n = 53) and the observation group (n = 53). The control group was given symptomatic treatment, etiological treatment, clinical nursing, enteral nutrition support, and other conventional treatment methods according to the patient’s condition. On this basis, the observation group was treated with enteric-coated Bifidobacterium triple viable capsules, and both groups were treated for 14 days. All patients were followed up for 3 months after treatment, and their death/cure prognosis was recorded. The acute physiological and chronic health (APACHE II) scoring system was used to evaluate the acute physiological and chronic health status of the two groups before and after treatment, and the organs of the patients were scored with sepsis-related organ failure assessment (SOFA) score. T lymphocyte subsets (CD3+, CD4+, CD8+, and CD4+/CD8+), prothrombin time (PT), activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (DD) were measured before and after treatment. Results. The cure rate of the observation group was slightly higher than that of the control group, and the mortality rate was slightly lower than that of the control group, but the difference was not statistically significant ( P < 0.05 ). After treatment, the APACHE II and SOFA scores of the two groups were lower than before treatment, and the APACHE II and SOFA scores of the observation group were lower than those of the control group, and the differences were both statistically significant ( P < 0.05 ). After treatment, the levels of CD3+, CD4+, and CD4+/CD8+ in the two groups were higher than those before treatment, and the levels of CD8+ were lower than before treatment. The CD3+, CD4+, and CD4+/CD8+ levels of the observation group were higher than those of the control group, and the CD8+ levels were lower than the control group, and the differences were both statistically significant ( P < 0.05 ). After treatment, the PT and APTT levels of the two groups of patients were higher than those before treatment, and the levels of FIB and DD were lower than those before treatment. The PT and APTT levels of the observation group were higher than those of the control group, and the FIB and DD levels were lower than those of the control group, and the differences were both statistically significant ( P < 0.05 ). Conclusion. The combination of enteric-coated Bifidobacterium triple viable capsules and enteral nutrition for CCI has high cure rate, which can not only improve the patients’ physiological health status and organ dysfunction but also effectively improve the patients’ immune and coagulation function, which is worthy of promotion.

Patients with hereditary spherocytosis and b-Thalassemia are characterized by the increased risk of thrombosis. The early manifestation of thrombotic complications can occur even in childhood especially after surgery. Hypercoagulability can be associated with endothelial dysfunction. The aim of this study was to investigate the hemostatic state and endothelial function in children with hereditary spherocytosis and b-thalassemia. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. The hemostatic status of 18 children (10 boys and 8 girls from 1 to 13 years) with hereditary spherocytosis and of 8 children (4 boys and 4 girls from 3 to 8 years) with b-thalassemia was assessed using clotting times (activated partial thromboplastin time – APTT, thrombin time – TT, prothrombin time PT), fibrinogen levels and markers of endothelium dysfunction: endothelin-1 and thrombomodulin levels. Patients with hereditary spherocytosis were divided into 2 groups: during the hemolytic crisis (11 patients) and without the hemolytic crisis (7 patients). Patients with b-Thalassemia were divided into 3 groups: b-thalassemia major, b-thalassemia intermedia and b-thalassemia minor. APTT, TT and PT were not changed significantly between groups. We find the decreased fibrinogen levels in patients with severe condition: in hereditary spherocytosis patients during hemolytic crisis (1.9 ± 0.3 ng/ml with normal range 2–3.9 ng/ml) and in b-thalassemia major patients (1.8 ± 0.3 ng/ml with normal range 2–3.9 ng/ml). This could be caused by consumption of fibrinogen during acute hemolysis. The Thrombomodulin levels were increased in all hereditary spherocytosis patients, but median value was higher in group with hemolytic crisis (6665 pg/ml vs 5976 pg/ml with ormal value 275–909 pg/ml) indicating endothelium dysfunction and activation of blood clotting. In b-thalassemia patients Thrombomodulin levels were more elevated in b-thalassemia major and b-thalassemia intermedia (6389 ± 537 pg/ml и 6804 ± 120 pg/ml) compared to b-thalassemia minor (2727 ± 213 pg/ml) which is still higher than normal range. Endothelin-1 levels were elevated on 55% with hereditary spherocytosis patients during crisis vs 43% without. In general Endothelin-1 levels were more elevated in b-thalassemia patients (were normal in b-thalassemia minor) vs hereditary spherocytosis patients (2.33 ± 2.89 fmol/ml vs 0.95 ± 0.35 fmol/ml). Thrombomodulin and endothelin-1 levels revealed endothelium dysfunction in children with hemolysis. More dramatic changes observed in severe condition: in hereditary spherocytosis patients during hemolytic crisis and in b-thalassemia major and b-thalassemia intermedia patients.

Background Blood samples indicative of jaundice, lipemia, hemolysis, and others are often encountered in the laboratory, and such features impact greatly on the detection of coagulation items. To understand the anti-interference ability of the magnetic bead method automatic coagulation instrument and the optical method automatic coagulation instrument against jaundice, lipemia, and hemolysis, anti-interference experiments of prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) were conducted using ExC810 (magnetic bead method) and CS5100 (optical method). Methods Interference samples were prepared with bilirubin, hemoglobin, and lipids, while control samples were prepared with NaOH and distilled water. The samples contained different values of PT, APTT, TT, and FIB and were detected by magnetic bead method and optical method, respectively. The relative deviation was calculated according to the formula. Results In the anti-interference experiment of PT, APTT, TT, and FIB (jaundice, lipemia, hemolysis), the deviation between the test results and the control results with the addition of interfering substances tested by ExC810 was lower overall than that of CS5100. However, after the addition of interfering substances, most of the items were not detected by CS5100 in the anti-lipidemia experiment. Conclusions When testing coagulation function, the magnetic bead method has better anti-interference recognition of jaundice, lipemia, and hemolysis than the optical method, and its anti-lipemic interference has a particularly obvious advantage.

Aims: Sapparin tablet, a medicine used for the treatment of blood diseases specially curing blood thickening or impure blood, liver disease in Mongolian Traditional Medicine. The objectives of the study were to determine total biological active substances and analyze the anticoagulation activity of the Sapparin. Study Design: Experimental study. Place and Duration of Study: Department of Chemistry and Technology and Department of Pharmacology, Institute of Traditional Medicine and Technology of Mongolia. Methodology: Quantitative determination of the total active constituents (phenolic, flavonoid, and carotinoids) of the methanol extracts of Sapparin was performed by using Folin-Ciocalteu reagent, aluminium chloride reagent by spectrophotometry. A totally of forty weighing between 220-250 gm were used. Effect of Sapparin was assessed on coagulation parameters following 7, 14, 21 and 28 days administration of 37 mg/kg, 56 mg/kg, 113 mg/kg to healthy rats. The blood coagulation parameters such as prothrombin time (PT) and the activated partial thromboplastin time (aPTT) were measured by means of Quick’s one-stage assay and modified aPTT assay respectively in the rats. Additionally, thrombin activity test was estimated in rats with PT assay using a hemagglutination analyzer. The levels of serum X and von Willebrand factor were measured in Sapparin and control groups by ELISA. Results: The total content of the phenols measured as 5.33±0.0005%, flavonoids as 12.95± 2.21% and carotinoids as 4.31±0.96%. There was significant increase in all assays except fibrinogen, prothrombin time, thrombin, aPTT. Sapparin treatment significantly reduced levels of serum X factor and von Willebrand factor was significantly decreased in rats. Conclusion: Results of this study suggest that Sapparin shows considerable anti-anticoagulant activity in animals and has potential to reduce cardiovascular morbidity and mortality.

To investigate the correlation of platelet and coagulation function with blood stasis syndrome (BSS) in coronary heart disease (CHD). The protocol for this meta-analysis was registered on PROSPERO (CRD42019129452). PubMed, Excerpta Medica Database (Embase), the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from inception to 1st June, 2020. Trials were considered eligible if they enrolled BSS and non-BSS (NBSS) patients with CHD and provided information on platelet and coagulation function. The platelet function, coagulation function, and fibrinolytic activity were compared between the BSS and NBSS groups. Forest plots were generated to show the SMDs or ESs with corresponding 95% CIs for each study. Subgroup analysis and sensitivity analysis were performed to explore potential sources of heterogeneity. The systematic search identified 1,583 articles. Thirty trials involving 10,323 patients were included in the meta-analysis. The results showed that mean platelet volume, platelet distribution width, platelet aggregation rate, platelet P selectin, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), thromboxane B2 (TXB2), 6-keto-prostaglandin F1alpha (6-keto-PGF1 α), and TXB2/6-keto-PGF1 α were higher in the BSS group than in the NBSS group (P

To determine the value of coagulation indicators: D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), in predicting the severity and prognosis of COVID-19.Around 150 patients with confirmed COVID-19 disease, who were admitted at Rajarajeswari Medical College and Hospital, Bangalore between April 15 2021 and July 15, 2021, were included in the study. The changes of D-Dimer, PT, APTT were tested, and the correlation with, clinical classifications, demographics, CT imaging, vaccination status against COVID-19 and prognosis were observed.Coagulation disorder occurred at the early stage of COVID-19 infection, in a total of 150 patients observed, 109 (72.66%, St. deviation of 4.26) patients having DD increased at time of admission and 148 patients (98.66%) having increased coagulation profile. The levels of DD and coagulation profile were correlated with clinical classification and also the CT severity and vaccination status. Among 41(27.33%) patients who died, 31(20.66%) patients had DD increased at the first lab test, 40 (26.66%) patients had DD increased on the fifth day of lab tests. The results shows that D-dimer is raised in severe category of COVID-19 infection. Also the CT severity is high (severe, with CT score>15) 71(47.33%) patients with increased D-dimer on admission. It was observed that 41(27.33%) patients who were vaccinated had increased D-dimer 70(46.66%) compared to unvaccinated patients. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value (P Coagulation dysfunction is more likely to occur in severe and critically ill patients. DD and PT could be used as the significant indicators in predicting the mortality of COVID-19 and measuring the level of D-dimer and coagulation parameters from the early stage of the disease can also be useful in controlling and managing of COVID-19 disease, also vaccinated patients had better outcome among the unvaccinated patients.

In recent decades, numerous scientific works are devoted to the study of the clinical and prognostic significance of albuminuria, methods of its detection, as well as treatment measures aimed at controlling this pathological condition. The objective of this work was to determine the features of changes of plasma hemostasis in patients with essential hypertension (EH), depending on the presence of albuminuria. Materials and methods. We have exa-mined 113 people: 14 apparently healthy ones (group 1, controls), 41 patients with EH stage II with concomitant albuminuria (group 2), 58 patients with EH stage II without concomitant albuminuria (group 3). We have conducted laboratory studies: measured activated partial thromboplastin time, prothrombin index, thrombin time, fibrinogen, soluble fibrin monomer complex (SFMC), time of XIIa-dependent fibrinolysis, antithrombin III, protein C. Results. There was found an increased content of SFMC, which in patients from group 3 was 135 % higher, and in patients of group 2 — 247 % higher than reference values. At that, in patients with albuminuria, this index was much higher even than in individuals with EH without albuminuria — exceeded by 48 %. Time of XIIa-dependent fibrinolysis in both group 2 and 3 was much longer than normal one. Expressed changes occurred in the system of natural anticoagulants, which were statistically significant in relation to the control group only in patients with albuminuria, and in the group of patients without albuminuria they were not significantly different from the control group. Conclusions. Patients with essential hypertension, regardless of the severity of albuminuria, showed a significant inhibition of fibrinolytic activity of the blood and activation of the last units of blood clotting — fibrin formation. Albuminuria was associated with a more significant activation of fibrin formation and was combined with inhibition of own anticoagulant activity of the blood, as evidenced by the decrease in the content of antithrombin III and protein C.

The high concentrated thrombin time (hcTT), a thrombin time modified by increasing the thrombin concentration, is a possible alternative assay to activated partial thromboplastin time (aPTT) in unfractionated heparin (UFH) monitoring. This study aimed to determine the optimal thrombin concentration used in the hcTT assay for UFH monitoring.A total of 30 blood samples obtained from healthy volunteers were included in this study. Thrombin concentrations of 10.0, 15.0, 20.0, and 25.0 IU/ml were used in the hcTT assay. The consistency between the hcTT and anti-FXa assays was evaluated. To validate the hcTT assay, linearity, repeatability, reproducibility, and diagnostic performance of the assay were assessed.The hcTT assay using thrombin concentration of 15.0 IU/ml showed a strong correlation to the anti-FXa assay with RThe hcTT assay can be used as an alternative assay for UFH therapy monitoring. A further study using clinical samples is recommended to confirm the appropriateness of the hcTT assay for clinical application.

Covid-19 pandemic reveals that the virus causes Covid-19 associated coagulopathy and it is well known that thrombotic risk is associated with ethnicity. To describe the Covid-19 associated coagulopathy in Indian population and to correlate it with the disease severity and survivor status. A cross sectional descriptive study of 391 confirmed Covid-19 cases was carried out over a period of 1.5 months. Patients were categorised as mild to moderate, severe and very severe and also labelled as survivors and non survivors. Prothrombin time (PT), International normalised ratio (INR), activated partial thromboplastin time, D dimer, Fibrin degradation products (FDP), fibrinogen and thrombin time and platelet counts were investigated among the subgroups. Mean age was higher in patients with severe disease (57.62 ± 13.08) and among the non survivors (56.54 ± 12.78). Statistically significant differences in D dimer, FDP, PT, INR and age were seen among the 3 subgroups and survivors. Strong significant positive correlation was noted between D dimer and FDP (r = 0.838, p

The OBJECTIVE was to study the features of changes in the blood coagulation system that contribute to the development of postoperative complications in patients depending on the stage of non-tumor mechanical jaundice at admission.METHODS AND MATERIALS. A total of 537 patients with mechanical jaundice were examined and changes in the blood coagulation system were analyzed. Vascular-platelet hemostasis was characterized by the following tests: capillary resistance, the number of desquamated endothelial cells, the number of blood platelets. Plasma hemostasis was analyzed using activated partial thromboplastin time, plasma soluble fibrin level, thrombin time, prothrombin ratio, prothrombin index, and fibrinogen blood level. Then, XIIa-dependent fibrinolysis in the blood and the level of the fibrin D-dimer in the blood plasma were determined.RESULTS. It was found that in the first stage of mechanical jaundice, with cholestasis, there were no changes in blood coagulation system that go beyond the normal limits. In the second stage, during cytolysis of hepatocytes, hyperbilirubinemia and hypertransaminasemia contribute to the activation of platelet first, and then plasma hemostasis. In the third stage (cholangitis), the death of endotheliocytes increases and there is a deficiency of blood coagulation factors due to their consumption and increased fibrinolysis.CONCLUSION. In the stage of cholestasis in patients with non-tumors mechanical jaundice, the parameters of the coagulation system remain within the reference values. In the stage of cytolysis, as endotheliotoxicosis increases, platelet and plasma hemostasis begins to activate, which can lead to thrombosis and thromboembolism in vital organs. In the stage of cholangitis, further activation of plasma hemostasis causes hemorrhagic syndrome. The occurrence of the described disorders in blood coagulation system with the progression of MJ dictates the need to monitor the changes in the blood coagulation system and their correction for the prevention of intra-and postoperative complications.

Summary Dabigatran is an orally administrated anticoagulant that directly inhibits thrombin. However, the drug can affect routine coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT), as well as haemostasis assays, (e.g., clot-based coagulation factor assays). There are limited data on the effect of dabigatran on some fibrinogen measurements and on D-dimer assays, both important components in the laboratory assessment of disseminated intravascular coagulation (DIC). The objectives of this study were: (1) to determine the effects of various concentrations of dabigatran on fibrinogen and D-Dimer assays; and (2) to compare the von Clauss method of fibrinogen measurement using two reagents with differing thrombin concentrations (35 UNIH/mL and 100 UNIH/mL) and PT-derived fibrinogen measurement in the presence of the drug. Aliquots of pooled normal plasma were spiked with different concentrations of dabigatran to reflect in vivo on-therapy levels as well as levels observed in cases of massive accumulation of the drug. Of the routine coagulation assays, in ascending order of sensitivity to dabigatran were PT, APTT and TT. The von Clauss method of measuring fibrinogen using a reagent with low thrombin concentration was affected even at drug levels corresponding to in vivo trough concentrations, whereas the reagent with higher thrombin concentration was only affected at drug levels that were above observed peak concentrations in patients taking 150 mg of the drug twice daily. PT-derived fibrinogen was affected at approximately in vivo peak drug concentrations. The D-dimer assay was affected only at drug concentrations well above peak drug levels. Attempts at in vitro neutralisation of the drug with DOAC-Stop resulted in ‘correction’ of some of these measurements depending on drug concentration. Like the routine coagulation assays, there is a dabigatran concentration dependent effect on the accuracy of fibrinogen and D-dimer assays. Falsely low fibrinogen results due to dabigatran may confound the assessment of DIC and diagnostic laboratories need to evaluate the performance of their own reagents.

BACKGROUND A systematic review and meta-analysis were conducted to explore the clinical efficacy and coagulation function of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) in critically ill patients, to provide an effective treatment options for CRRT in severe patients. METHODS The English databases Embase, Medline, PubMed, Ovid, Springer, and Web of Science were searched to screen for randomized controlled trials (RCTs) on RCA in the CRRT treatment of critically ill patients published before June 1, 2020. Meta analysis using the RevMan5.3 provided by the Cochrane collaboration network. The search terms included "citrate anticoagulation", "patient in severe condition", "CRRT", "clinical effect", and "coagulation function". RESULTS ten articles meeting requirements were included, comprising 1,411 subjects. Meta-analysis results showed that after treatment, total calcium/ionized calcium (totCa/ionCa) [mean difference (MD) =0.05; 95% confidence interval (CI): (-0.02 to 0.12); Z=1.31; P=0.19], prothrombin time [MD =4.51; 95% CI: (2.77, 6.24); Z=5.10; P

Ticks are hematophagous ectoparasites and cause a major public health threat worldwide. Development of anti-tick vaccines is regarded to be an optimal alternative for tick control. AV422, a unique protein in ticks, is secreted into hosts during blood-feeding, but its roles are not confirmed in Haemaphysalis flava ticks. We retrieved a gene fragment encoding AV422 from a transcriptome dataset of H. flava, and based on it, we reconstructed the full length of AV422 from H. flava (Hf-AV422) by rapid amplification of cDNA ends. Expression profiles of Hf-AV422 in whole ticks and organs of different engorgement levels were determined by qPCR. Then its opening reading frame (ORF) was expressed in Escherichia coli strain BL21 (DE3). The prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) assays were conducted to test anticoagulant activities of the purified recombinant protein (rHf-AV422). The full length of AV422 was 1152 bp. Hf-AV422 showed to be conserved as indicated by multiple sequence alignment. Expression of Hf-AV422 was significantly higher in salivary glands and cuticles than in ovaries. Its expression in whole ticks decreased during engorgement with the highest levels in 1/4 engorged ticks. rHf-AV422 prolonged PT, APTT and TT when incubated with rabbit plasma. Our data demonstrated that Hf-AV422 is a conserved salivary protein with anticoagulant activity. Further studies are needed to test in detail its functional properties to ensure it an adequate antigen candidate for the development of broad-spectrum vaccines against ticks.

Background: Intestinal obstruction with strangulation can be life-threating, and it is critical to make an accurate and timely diagnosis for emergency surgery. Objective: This was aimed to investigate the value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction. Materials and Methods: Fifty-four patients with intestinal obstruction were retrospectively studied. The correlation between coagulation indicators and inflammatory markers with intestinal obstruction was analyzed. Receiver operating characteristic curves were created to assess their ability in discriminative diagnosis. Results: Levels of fibrinogen (Fib), C-reactive protein (CRP), neutrophil ratio, and D-Dimer were significantly greater, while thrombin time was significantly shorter in strangulated intestinal obstruction compared with simple intestinal obstruction. Furthermore, Fib levels in the necrosis subgroup of strangulated intestinal obstruction were significantly higher than those in the ischemia subgroup and simple intestinal obstruction group. The areas under the receiver operating characteristic curve were 0.58 for white blood cells, 0.78 for CRP, and 0.80 for Fib. Using the optimal cutoff values of Fib (3.71 g/L) and CRP (14.54 mg/L), the sensitivity, specificity, positive predictive value, and negative predictive value in discriminating between strangulated intestinal obstruction and simple intestinal obstruction were 51.43%, 100%, 100%, and 52.78% for Fib, and 56.25%, 94.44%, 94.74%, and 54.84% for CRP, respectively. Conclusions: Fib and CRP demonstrate good performance in predicting strangulation and are indicative of intestinal necrosis and ischemia. The combination of this coagulation indicator and inflammatory marker holds potential for better discrimination between strangulated and simple intestinal obstruction.

BACKGROUND AND PURPOSE Antigen-binding fragment (Fab ) reversal agents were developed to reverse, in bleeding emergency, the long-acting anticoagulant effect of JNJ-64179375 (JNJ-9375), a monoclonal antibody that binds exosite-1 on thrombin. EXPERIMENTAL APPROACH The pharmacokinetic and pharmacodynamic (PK/PD) activities of three reversal agents of varying in vitro binding affinities to JNJ-9375 were characterised in cynomolgus monkeys. The time course of JNJ-9375 anticoagulant activity and reversal effects of each agent were evaluated. A mechanism-based PK/PD model, which integrated free serum concentrations of reversal agent, total and free serum concentrations of JNJ-9375, and thrombin time, was developed to quantitatively relate JNJ-9375 neutralisation to reversal of induced thrombin time prolongation. Model-based allometric scale-up of the lead reversal agent and the PK/PD relationship of JNJ-9375 in healthy volunteers were utilised to predict clinical dosing regimens. KEY RESULTS Lowering of free JNJ-9375 by the reversal agents corresponded with reversal of thrombin time prolongation. Total JNJ-9375 displayed typical mAb clearance at 2.75 ml·day-1 ·kg-1 , whereas reversal agents cleared faster between 1400 and 2400 ml·day-1 ·kg-1 . The model-estimated in vivo KD values for JNJ-9375 reversal agents were 9 nM (ICHB-256), 0.4 nM (ICHB-281) and 13.7 pM (ICHB-164), in rank-ordered agreement of their KD values determined in vitro. The three reversal agents exhibited different neutralisation characteristics in vivo, governed primarily by their binding kinetics to JNJ-9375. The model predicted a priori free JNJ-9375 kinetics after dosing ICHB-164 (JNJ-67842125) and JNJ-9375 under a different regimen. CONCLUSION AND IMPLICATIONS The results enabled selection of JNJ-67842125 as the reversal agent for JNJ-9375.

Experimental studies and analyses of new compounds with different mechanisms of action on systemic haemostasis are relevant for the identification and development of potential pharmacological preparations. The modified sulphated polysaccharides with anticoagulant and antithrombin activity were studied for haemostasis. Platelet-rich plasma was obtained by centrifugation at 200g for 10 minutes. The remaining citrate blood was further centrifuged at 1500g for 10 min to obtain platelet-poor plasma. The antithrombin activity of the compounds was evaluated In vitro by their effect on the recalcification time, thrombin and prothrombin time of rabbit and human blood plasma stabilized with a 3.8% sodium citrate solution in the ratio 9:1. The results showed that the anticoagulant activity of the studied sulphates increased with an increasing degree of sulphation. Sulphated polysaccharides showed strong anticoagulant activity In vitro. The experimental results showed a significant increase in the coagulation time of blood plasma in tests for prothrombin and thrombin time. These properties of these components are of particular interest, and further detailed studies of the physicochemical characteristics and mechanisms of action of these molecules should be performed, which will eventually allow them to be used as heparin-like drugs.

The aim of this study is to investigate the differences in hemostasiological parameters among patients with atherotrombotic and cardiemobolic subtypes of ischemic stroke and the relationship between the parameters and the severity of the disease in the first day. The study included 68 patients who were examined on the first day of the disease with a diagnosis of acute cerebrovascular disorders on ischemic type, among them 47 (69%) men and 21 (31%) women aged from 42 to 75 years (the average age was 61,85 ± 2,33 years old). We quantified the stroke severity by using the National Institutes of Health Stroke Scale, findings of magnetic resonance tomography and / or computer tomography of the brain; ultrasound scan of intra- and extracranial vessels of the brain was performed to verify the diagnosis. Patients were divided into 2 groups: Group 1 included atherotrombotic subtype of ischemic stroke (n = 51 individuals), group 2 included cardiembolic subtype of ischemic stroke (n = 17 individuals. The state of the hemostasis system was studied by the analysis of complete coagulograms. The patients with ischemic stroke were found to have a thrombin time reduction compared to the control group. The dynamics of this indicator in the coagulogram points out an increased risk of thrombosis in the patients of both groups with a significant predominance among the patients with an atherotrombotic stroke. In both groups of the patients with ischemic stroke, there was a decrease in intensity, time and rate of aggregation in 30 seconds compared to the control group, indicating the imbalance of platelet response to adenosine diphosphate-induced aggregation. When the rate and intensity of aggregation (the lowering of platelet aggregation function) for 30 seconds decreased, the aggregation time (the activation of platelet function) also reduced. The analysis of coagulogram indicators points out the possibility of developing the syndrome of disseminated intravascular coagulation among patients with ischemic stroke. In this case, the decrease in the platelet aggregation properties indicates the development of thrombocytopathy under a preserved platelet number among the patients with ischemic stroke. The degree of the severity of atherotrombotic ischemic stroke is associated with indicators of coagulation hemostasis and platelet aggregation characteristics. The severity of cardioembolic ischemic stroke is associated with processes of platelet aggregation processes.

Context.— Assessing direct oral anticoagulant (DOAC) drug levels by reliable laboratory assays is necessary in a number of clinical scenarios. Objective.— To evaluate the performance of DOAC-specific assays for various concentrations of dabigatran and rivaroxaban, assess the interlaboratory variability in measurement of these DOACs, and investigate the responsiveness of the routine clotting assays to various concentrations of these oral anticoagulants. Design.— College of American Pathologists proficiency testing survey data from 2013 to 2016 were summarized and analyzed. Results.— For dabigatran, the interlaboratory coefficient of variation (CV) of ecarin chromogenic assay was broad (ranging from 7.5% to 29.1%, 6.3% to 15.5%, and 6.8% to 9.0% for 100-ng/mL, 200-ng/mL, and 400-ng/mL targeted drug concentrations, respectively). The CV for diluted thrombin time for dabigatran was better overall (ranging from 11.6% to 17.2%, 9.3% to 12.3, and 7.1% to 11.2% for 100 ng/mL, 200 ng/mL, and 400 ng/mL, respectively). The rivaroxaban-calibrated anti-Xa assay CVs also showed variability (ranging from 11.5% to 22.2%, 7.2% to 10.9%, and 6.4% to 8.1% for 50-ng/mL, 200-ng/mL, and 400-ng/mL targeted drug concentrations, respectively). The prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed variable dose- and reagent-dependent responsiveness to DOACs: PT was more responsive to rivaroxaban and aPTT to dabigatran. The undiluted thrombin time showed maximum prolongation across all 3 dabigatran concentrations, making it too sensitive for drug-level monitoring, but supporting its use as a qualitative screening assay. Conclusions.— DOAC-specific assays performed reasonably well. While PT and aPTT cannot be used safely to determine DOAC degree of anticoagulation, a normal thrombin time excludes the presence of dabigatran.

A Woman with Pain, Swelling, and Ecchymosis of the Left Arm An 82-year-old woman was admitted with pain, swelling, and discoloration of the left arm. CT revealed hematoma involving the brachioradia...

The aim of this study was to assess visceral leishmaniasis (VL) among infected Sudanese patients in Al–Gedaref state. Methods and Results: A case-control study was conducted among patients with VL attending Al–Gaderif Teaching Hospital. A total of 80 subjects were included in the study: 40 patients with VL (the main group [MG]) and 40 apparently healthy individuals (the control group [CG]). The complete blood count (CBC) was determined using the Sysmex KX-21 N hematological analyzer. The platelet-poor plasma was used to determine prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (aPTT). The age group of 12-21 years was the most frequent (40%) among VL patients. Male patients were significantly more frequent (72.5%) than females (P-value=0.02). In MG, the Hb level was 8.71±1.73g/dL, compared to 14.25±4.11g/dL in CG, which reflected the severity of the disease. WBCs and neutrophils decreased significantly, compared to CG, but lymphocytes increased significantly. Thrombocytopenia was observed among pediatric patients, indicating bleeding tendency as one of the VL complications. The platelet and coagulation profile of patients was also altered. PT and aPTT were prolonged significantly, compared to CG.

Amygdalus persica L., belongs to Rosaceae family, and its flowers are used as medicine and food. n-Butanol extract of A. persica flowers were isolated and purified with various column chromatographies, and the fourteen compounds, chlorogenic acid butyl ester (1), rutin (2), protocatechuic acid (3), caffeic acid (4), 5-O-coumarroylquinic acid methyl ester (5), kaempferol-3-O-neohesperidoside (6), quercetin-3-O-β-D-glucoside (7), 3,5-dicaffeoylquinic acid (8), quercetin-3-O-α-L-rhamnoside (9), 5-O-coumaroylquinic acid (10), kaempferol-3-O-α-L-rhamnoside (11), kaempferol-3-O-β-D-galactoside (12), D-glucitol (13), and multiflorin A (14), were identified by spectroscopic data and physical data. All the compounds except compound 2 were identified from A. persica flowers for the first time. The compounds were investigated for their coagulation activity by activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and bibrinogen (FIB) in vitro. The results of coagulation activity showed that rutin (2), caffeic acid (4), kaempferol-3-O-neohesperidoside (6), kaempferol-3-O-α-L-rhamnoside (11), and kaempferol-3-O-β-D-galactoside (12) exhibited significant procoagulant activity, while chlorogenic acid butyl ester (1) possessed anticoagulant activity in vitro.

The objective: to reveal the features of the parameters of the blood coagulation system in women in dynamics – from the acute period of ovarian apoplexy to the long-term postoperative period.Materials and methods. The study involved 82 women (main group, n=82), operated on for ovarian apoplexy, and 30 patients in the control group (n=30), who had no history of this pathology. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in age (average age was 26,1±2,3 years) and statistically comparable.Results. During the study, it was found that in the acute period of ovarian apoplexy, pathological changes were found in the plasma, vascular-platelet components and the fibrinolytic system of hemostasis, as evidenced by the lengthening of the thrombin time to 22,3±1,32 seconds, an increase in the concentration of fibrinogen to 6,73±0,64 g/l, SFMC up to 0,7±0,03 g/l and platelet hyperaggregation, stimulated by ADF, ristocetin and collagen, and reaching 80%. The extremely high content of D-dimer in the abdominal cavity in patients with ovarian apoplexy indicated increased thrombus formation in the damaged ovary, followed by activation of the fibrinolytic system and lysis of fibrin clots. Genetic thrombogenicity was found in general in 80,4% of patients, including those with a predominant lesion of the folate cycle enzymes - in every second patient.Positive dynamics with a tendency to normocoagulation was observed in the distant postoperative period. In the reference range were SFMC indices in 86,6% of cases, fibrinogen and thrombin time in 89,1% of cases, ristocetin-stimulated aggregatogram in 95,1% of cases (p

Objective To compare the blood loss after procedures of primary unilateral or one‐stage bilateral total knee arthroplasty (TKA) caused by open‐box prosthesis and closed‐box prosthesis. Methods This was a retrospective study. Patients undergoing procedures of primary TKA between January 2017 and July 2020 in our institution were assessed for eligibility for this study. Those who were diagnosed with knee osteoarthritis and underwent primary unilateral or one‐stage bilateral TKA by using PFC Sigma PS150 (closed‐box prosthesis) or Vanguard (open‐box prosthesis) knee systems and had complete data of laboratory indexes on postoperative day (POD) 1, POD 3, and POD 5 were the interested population. At last 243 patients were enrolled, among which 88 patients were classified into the unilateral closed‐box group, 66 patients into the unilateral open‐box group, 47 patients into the one‐stage bilateral closed‐box group, and 42 patients into the one‐stage bilateral open‐box group. The perioperative management and operative techniques were almost the same for each patient, except the selection of prosthesis, which was decided according to surgeon's preference. The baseline information, postoperative laboratory indexes tested on POD 1, POD 3, and POD 5 including hemoglobin, hematocrit, platelet, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR), the primary outcome measurements including the maximum decreased value of hemoglobin and the volume of total blood loss, and the secondary outcome measurements including the transfusion rate and the average transfused red blood cell (RBC) units were well compared between the open‐box group and the closed‐box group. Results The baseline was comparable between groups, except higher preoperative levels of hemoglobin (134.43 g/L vs 126.51 g/L, P = 0.003) and hematocrit (39.92% vs 37.37%, P = 0.000) observed in the one‐stage bilateral open‐box group. The differences of postoperative coagulation function monitored by TT, PT, APTT, and INR were clinically irrelevant between groups. For patients receiving unilateral TKA, significantly higher value of decreased hemoglobin (26.06 g/L vs 21.05 g/L, P = 0.025) and significantly larger amount of total blood loss (920.34 mL vs 723.19 mL, P = 0.013) were observed in the open‐box group. For patients receiving one‐stage bilateral TKA, the open‐box prosthesis was observed to cause more hemoglobin drop (37.81 g/L vs 32.02 g/L, P = 0.071) and total blood loss (1327.26 mL vs 1177.42 mL, P = 0.247) compared to the closed‐box prosthesis, though the differences were not significant. The transfusion rate and the average transfused RBC units were not significantly different between the open‐box group and the closed‐box group no matte whether the patients were from the unilateral TKA group or from one‐stage bilateral TKA group. Conclusion The use of open‐box prosthesis caused more hemoglobin drop and total blood loss than closed‐box prosthesis after primary unilateral or one‐stage bilateral TKA, resulting in comparable transfusion rate and average transfused RBC units between groups., Different characteristics between the closed‐box knee prosthesis and the open‐box knee prosthesis. The closed‐box prosthesis completely covers the whole area of cancellous bone at the distal femur, while the open‐box prosthesis leaves an uncovered area of cancellous bone at the intercondylar fossa, which may be a source of bleeding and results in more total blood loss postoperatively.

Background: Hyperfibrinolysis and pro/anti-inflammatory imbalance usually occur in the early stage of severe burns. Soluble urokinase-type plasminogen activator receptor (suPAR) is involved in fibrinolysis and inflammation. To date, the levels of circulating suPAR in non-survivors with severe burns remain unknown. This study aimed to investigate the early association between circulating suPAR levels and biomarkers of fibrinolysis, pro/anti-inflammatory, and prognosis. Methods: Sixty-four consecutive Chinese patients with severe burns and 26 healthy volunteers were enrolled in a prospective observational cohort. Clinical characteristics and laboratory data were collected prospectively. Blood samples were collected at 48 h post-burn, and suPAR and biomarkers of pro/anti-inflammatory and fibrinolysis were detected by enzyme-linked immunosorbent assays. Important indicators between non-survivors and survivors were compared. Linear regression analysis was performed to screen variables associated with suPAR. Logistic regression analysis and receiver operating characteristic curve (ROC) analysis were performed to evaluate the prognostic value of suPAR. Result: Compared with the control group, the circulating suPAR levels in the survivors (P

BACKGROUND To investigate the relationships of cancer antigen (CA) 125, CA 19-9, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen (FIB), and D-dimer values with ovarian endometriosis (OEM), and to explore the validation of biomarkers for noninvasive preoperative evaluation of patients with severe OEM. METHODS This retrospective case-control study included 413 women with OEM (of whom 143 cases were stage I to II, 139 cases were stage III, and 131 cases were stage IV, respectively) and 158 women without OEM as controls. Subjects' serum CA-125 and CA19-9 levels, and coagulation test results (serum PT, aPTT, and D-dimer values) were evaluated. RESULTS The serum CA-125, aPTT, FIB and D-dimer levels were statistically different between OEM patients in the stages I to (and) II group and those in the stages III and IV group (P

The comorbid course of liver cirrhosis and atrial fibrillation causes higher levels of hospitalizations, mortality and ischemic stroke. According to current data, hemostasis in patients with liver cirrhosis is in a rebalanced dynamic state, but there are no data on the effect of atrial fibrillation on the hemostasis in patients with liver cirrhosis. Aims of the study. To assess abnormalities in primary, secondary haemostasis and fibrinolytic system in patients with liver cirrhosis and atrial fibrillation by using standard laboratory coagulation parameters and to investigate their changes depending on the stage of liver cirrhosis A, B, C according to Child-Pugh score. Materials and methods. A cross-sectional prospective study was conducted with the inclusion of 106 patients aged 42 to 83 years: group I (n = 70) - with liver cirrhosis and atrial fibrillation, II (n = 36) - with liver cirrhosis, which were distributed depending on the Child-Pugh score stages of cirrhosis and 20 healthy individuals. The levels of platelets, activated partial thromboplastin time, international normalized ratio, prothrombin time, thrombin time, fibrinogen, D-dimer were assessed on a Steellex M200 coagulometer. Statistical analysis (IBM SPSS Statistics) was performed. Results. The level of platelets in patients of group I was reduced by 37.4% (200 ± 8.33 vs. 274.7 ± 3.4; p,000.001), an activated partial thromboplastin time was prolonged by 38.6% (44.35 ± 1.39 vs. 32.01 ± 0.63, p˂0.001), prothrombin time was prolonged by 73.5% (19.4 ± 0.87 vs. 11.18 ± 0.53, p˂0.001), thrombin time was prolonged by 2.07 (25, 7 ± 1.31 vs. 12.4 ± 0.66, p˂0.001), the international normalized ratio was increased by 24.3% (1.38 ± 0.04 vs.1.11 ± 0.01, p˂0.001) compared to control. The fibrinogen level was 20.9% higher (4.17 ± 0.17 vs. 3.45 ± 0.11, p˂0.001) than in control group and was 83.7% higher (4.17 ± 0.17 vs. 2.27 ± 0.13, p˂0.001) than in group II. The D-dimer level was 83% higher than in control (675 ± 22.3 vs. 368.8 ± 21.85, p˂0.001) and 44% higher (675 ± 22.3 vs. 469 ± 37.18, p ˂0.001) compared with group II. Conclusions. In patients with liver cirrhosis and atrial fibrillation abnormalities of primary hemostasis are detected due to decrease of platelets on the background of portal hypertension. At the secondary stage of hemostasis indicators of external and internal coagulation mechanisms are prolonged due to the reduced synthesis of coagulation factors by the liver. Increased level of fibrinogen is determined at the stage of compensated and subcompensated cirrhosis with a gradual decrease at the stage of decompensation. The high activity of the fibrinolytic system is observed due to increase in the D-dimer levels, which may indicate a prothrombotic state in these patients.

Background Intravenous immunoglobulin (IVIG) resistance prediction remains substantial in Kawasaki disease (KD), with limited data on the predictive value of coagulation profile for IVIG resistance, particularly for repeated IVIG resistance. Therefore, the aim of our study was to testify the predictive validity of coagulation profile for both initial IVIG resistance and repeated IVIG resistance in KD. Methods A total of 385 KD patients were prospectively recruited between April 2015 and May 2019. Coagulation and other profiles were evaluated between the IVIG‐responsive and IVIG‐resistant groups. Multivariate logistic regression analysis was applied to determine the association between coagulation profiles and IVIG resistance. ROC curves analysis was further performed to assess the validity of coagulation profiles in predicting both initial IVIG resistance and repeated IVIG resistance. Results Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen degradation products (FDPs), and D‐dimer were significantly increased in the initial IVIG‐resistant group with antithrombin III (ATIII) and thrombin time (TT) significantly reduced. Meanwhile, ATIII was declined markedly in repeated IVIG‐resistant patients. Multivariate logistic regression analysis showed that PT, APTT, D‐dimer, and ATIII were independent risk factors for predicting initial IVIG resistance and ATIII for predicting repeated IVIG‐resistant patients with KD. PT, APTT, D‐dimer, and ATIII cutoff values of 13.95 s, 41.15 s, 1.48 mg/L, and 89.5% yielded sensitivities of 73%, 32%, 71%, and 81%, and specificities of 55%, 88%, 62%, and 51% for predicting initial IVIG resistance, respectively. The cutoff value of ATIII for predicting repeated IVIG resistance was 68.5%, with sensitivity of 71% and specificity of 55%. Conclusions KD patients who have hypercoagulation during the acute phase might be at higher risk of developing IVIG resistance.

Aim: To investigate the hemostatic effect of ethanol extracts of Euonymus fortunei and their different polar fractions, and to analyze the changes in intracellular calcium ion concentration in platelet cells. Methodology: Bleeding time and clotting time was assessed by the slide method and the tail-breaking method, respectively. Four coagulation indexes, including prothrombin time, activated partial thromboplastin time, thrombin time, and the content of fibrinogen, as well as platelet aggregation effect were also determined. The concentration of calcium ions in platelet cells treated by n-butanol fraction with good active hemostatic activity was also examined. Results: Compared with the control group, the n-butanol fraction of E. fortunei can not only significantly shorten the bleeding time and coagulation time, but also obviously shorten activated partial thromboplastin time. However, no significant difference was found on the content of fibrinogen. Platelet aggregation experiments show that the n-butanol fraction can increase the intracellular Ca2+ concentration of platelet cells, which may be related to the activation of downstream signals through the platelet membrane G protein-coupled receptor. Conclusion: Ethanol extract of E. fortunei has excellent hemostatic activity, which may be related to the increase of intracellular Ca2+ concentration caused by G protein-coupled receptor on the platelet membrane surface. E. fortunei could be a potential medicinal plant used for hemostatic treatment.

Dizhou Zhao, Jieyu Fang, Wei Xiong, Jun Lin, Wanmei Chen, Chujun Wu Department of Anesthesia, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of ChinaCorrespondence: Jieyu FangDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-Sen University, No. 56 Zhongshan Road II, Guangzhou, People’s Republic of ChinaTel + 86-13660121136Email fangjy@mail.sysu.edu.cnBackground: Sugammadex has been a revolutionary reversal of neuromuscular blockade. It is known to be highly efficient. However, a change in the coagulation profile is one of the most dangerous potential complications which is a concern for both surgeon and anesthetist. Bleeding may cause hypovolemic shock, hematoma, and so on. To investigate the effects of sugammadex on coagulation profiles in patients with thyroidectomy, we compared patients that were treated with either sugammadex or neostigmine.Patients and Methods: Eighty patients with thyroid neoplasms undergoing thyroidectomy were randomly allocated to sugammadex group (group S) or neostigmine group (group N). Induction of anesthesia was preformed using propofol, sufentanil, and rocuronium. Group S received sugammadex 2.0mg/kg after trachea intubation, similarly Group N received neostigmine 40 μg/kg, for reversal of rocuronium-induced neuromuscular blockade. The intraoperative coagulation profiles were monitored after the rocuronium injection (T0), 10 minutes after reversal (T1) and 30 minutes after reversal (T2) by testing activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), thrombin time (TT), and TEG-Haemonetics. Amount of bleeding was recorded during perioperative period.Results: There was no significant difference in the thromboelastogram, APTT, PT, FIB, or TT measurements at each time point in Group N. The reaction time (R time) and kinetics time (K time) of Group S in T1 were significantly longer than the corresponding times at T0 and T2, and the R times were significantly longer than those in Group N at the same time points (P< 0.05). Additionally, in Group S, the APTT was prolonged in T1 and returned to normal in T2.Conclusion: The result showed that sugammadex provided transient efficacy in prolonging the coagulation parameters, while neostigmine did not change the coagulation profile.Keywords: sugammadex, neostigmine, TEG-Haemonetics, coagulation, thyroidectomy

A long-term blood feeder, like the Hyalomma dromedarii tick, requires extended control over all hemostatic defense mechanisms generated by the host during feeding, including blood coagulation. To overcome this, ticks have evolved numerous molecules that target proteases in the blood coagulation cascade. New insights into the role of clotting factors in the development and progression of cancer have identified anticoagulant treatment as a potential therapeutic approach. In this context, the present work assessed the anticoagulation activities of crude and fractionated salivary gland extract (SGE) prepared from semi-fed H. dromedarii females. Additionally, the antitumor effects of the potent anti-thrombin fractions were determined against colon cancer (Caco-2) and normal skin (HFB4) cells. Crude SGE significantly prolonged clotting time in prothrombin time (PT), activated partial thromboplastin time (aPTT) and thrombin time (TT) assays and inhibited thrombin in FII-activity assay. Using anion-exchange chromatography, the fractions that strongly inhibited thrombin (3.A4 and 3.A5) were eluted. Both fractions prolonged the aPTT and TT clotting times and reduced the activity of FII significantly. The protein profiles of both fractions indicated the presence of a single polypeptide band of about 99 kDa. Regarding anti-cancer potential of the tested fractions, Caco-2 cells showed reduced viability with obvious morphological changes, induced apoptosis and a reduced level of vascular endothelial growth factor (VEGF). G2/M cell cycle arrest was observed only in 3.A5-treated cells. No cytotoxic effects were observed in HFB4 cells. These results demonstrated the potential of tick-derived anticoagulants, specifically thrombin inhibitors, as effective tools in colorectal cancer treatment. Further purification of the effector molecule(s) is required to fully characterize their structures and mechanisms of action.

There is no study on food-derived peptide with both anticoagulant and angiotensin I-converting enzyme inhibitory (ACEI) activities yet. In this work, the anticoagulant and ACEI activities of the casein hydrolysates released by pepsin digestion were evaluated for the first time to the best of our knowledge. Results indicated that the casein hydrolysate exhibited potent anticoagulant activity by prolonging the thrombin time (TT) and the activated partial thromboplastin time (APTT). Compared with control samples, at 10 mg/mL, the TT and APTT of casein hydrolysate were 186.0 % ± 6.6 % and 163.5 % ± 7.4 %, respectively. The casein hydrolysate also showed a strong ACEI activity with an IC50 value of 1.775 mg/mL. The components of the bioactive casein hydrolysate were analyzed by nanoscale liquid chromatography quadrupole time-of-flight tandem mass spectrometry (NanoLC-Q-TOF-MS/MS). Total of 115 peptides were identified, among which 34, 9, 55 and 17 peptides were derived from αs1-, αs2-, β-, and κ-casein, respectively. The results of PeptideRanker and PepSite 2 analysis showed that 6 peptides (FRQFYQL, NENLLRF, NPWDQVKR, PVVVPPFLQ, PVRGPFPIIV, and ARHPHPHLSF) have both ACEI and anticoagulant activities by binding to the active sites of ACE and thrombin. This study indicated that casein is a potential functional food supplement that can be used for medical purposes.

Background . Magnetic nanoparticles (MNPs) are considered as a means of targeted delivery, diagnosis and treatment, the main route of administration for them is intravascular, so it is important to evaluate their interaction with blood. We previously studied the effect of two samples of MNPs (MNP1 and MNP2) on the viability of human umbilical vein endothelial cells and hemocompatibility on human heparinized whole blood. Objective . The aim of the present study is to evaluate the effect of MNP1 and MNP2 on hemostasis. Design and methods . MNP1 and MNP2 suspensions were administered intravenously in outbred Wistar rats once and repeatedly (7 days); prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and fibrinogen concentration were evaluated before administration, on the 15th and 31st days after the last administration. Results . It was shown that MNP1 and MNP2 decreased in TT and an increased in APTT (in the MNCH1 and MNCH2 groups) as well as its increased in the fibrinogen concentration (in the MNCH2 groups) after a single dose (400 mg/kg) on day 31. Repeated administration of 60 mg/kg MNCH1 led to decrease the fibrinogen concentration (day 15) and to increase in APTT (day 31) in females. Repeated administration of 10 mg/kg MNCH2 caused an increase in APTT (males and females) and a decrease in fibrinogen concentration (females) on the 15th and 31st days. Conclusion . Thus, a single administration of 400 mg/kg MNPs caused an imbalance in the blood coagulation system, changes were independed on the sex of animals, but depended on the time after administration. Repeated administration of MNPs caused gender-dependent hypocoagulation changes (more pronounced in females).

DOI: 10.30906/2073-8099-2020-12-6-38-42 The regulatory effect of lysine-containing peptides Arg-Lys-Lys-Arg-Pro-Gly-Pro (RKKRPGP) and Lys-Arg-Lys-Pro-Gly-Pro (KRKPGP) on the blood coagulation of animals has been established. Repeated oral or intranasal administration of peptides in a daily dose of 100 mg/kg of body weight of rats for 7 days every 24 hours resulted in a decrease in antiplatelet activity by 29 – 49 %, factor XIIIa activity by 15 – 49 % compared to control (saline). At the same time, the anticoagulant activity of the blood plasma of rats increased by 16 – 33 % according to the test of activated partial thromboplastin time (APTT), and by 23 – 57 % according to the test of thrombin time (TV). In addition, under the influence of the peptide KRKPGP, the concentration of fibrinogen coagulated by thrombin decreased by 47 – 49 %. Thus, both peptides, when administered orally and intranasally, showed antiplatelet anticoagulant activity in a healthy body to a different egree and reduced the activity of coagulation factor XIIIа. Consequently, lysine-containing peptides are involved in the regulation of blood coagulation and can be considered promising antithrombotic substances.

Background Several routine coagulation tests have been developed to give insight in the coagulation pathway. The laboratory diagnostical process consists of 3 phases, the pre-analytical, analytical and post-analytical phase; however, the pre-analytical phase is most sensitive to errors. The amount of time blood is stored, can affect the measurements of these coagulation tests and result in an incorrect conclusion. Therefore, we performed experiments to determine the maximal storage time, centrifuged blood samples can be reliably measured. Methods Citrated whole blood from hospital patients, who were tested for routine coagulation, was collected in 2.7 mL citrate tubes. These whole blood samples were centrifuged and the plasma was stored on top of the cell pellet at room temperature. After 2 h, 4 h, 6 h, 12 h and 24 h, the prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen concentration, antithrombin activity, D-dimer concentration and thrombin time were measured using Sysmex CS2100 coagulation analysers. Results and conclusion Analytical evaluation of routine coagulation tests resulted in various significant differences and large variations between the various time intervals. Our results indicated that the PT and INR can be measured up till 24 h of storage. Centrifuged blood for measuring the fibrinogen concentration, antithrombin activity, D-dimer concentration and thrombin time can be stored up to 4 h, while 2 h of storage might already be too long for obtaining reliable aPTT measurements.

Objective This article aims to analyze the phenotype and genotype of an inherited dysfibrinogenemia pedigree associated with a heterozygous mutation in the FGA gene, and to investigate the pathogenesis of this disease. Clinical Presentation The proband of interest is a 29-year-old woman. She was in her 37 weeks of gestation. Routine coagulation tests showed low fibrinogen activity (0.91 g/L; normal range: 2.0–4.0 g/L) and normal fibrinogen antigen (FIB:Ag) level (2.09 g/L; normal range: 2.0–4.0 g/L). Techniques The prothrombin time, activated partial thromboplastin time, thrombin time, and activity of plasma fibrinogen (FIB:C) were detected by the one-stage clotting method. The FIB:Ag, D-dimer, and fibrinogen degradation products were tested by the immunoturbidimetry method. To identify the novel missense mutation, fibrinogen gene sequencing and molecular modeling were performed. We used ClustalX-2.1-win and online bioinformatic software to analyze the conservation and possible effect of the amino acid substitution on fibrinogen. Results Phenotypic analysis revealed that the FIB:C of the proband was significantly reduced while the FIB:Ag was normal. Sequencing analysis detected a heterozygous C.2185G > A point mutation in the FGA gene (AαGlu710Lys). Bioinformatic and modeling analyses indicated that the mutation probably caused harmful effects on fibrinogen. Conclusion The heterozygous mutation of Glu710Lys in the FGA gene was identified that could cause the reduction of the FIB structure stability and result in the dysfibrinogenemia.

Bletilla striata is widely used for stanching bleeding. In this study, polysaccharides from B. striata (BSP) were extracted by hot water. Four polysaccharides named BSP-1-BSP-4 were fractionated using DEAE-52 cellulose. BSP fractions contained sulfate, and the degrees of substitution of BSP-3 and BSP-4 were 1.59 and 1.70, respectively. Analysis of monosaccharide composition showed that four polysaccharides were mainly composed of mannan and glucose. The in vitro results showed that BSP-1-BSP-4 elicited pro-coagulant capacities by shortening the activating partial thromboplastin time, prothrombin time, and thrombin time and elevating the fibrinogen content. Immunomodulatory activity was evaluated by MTT assay, the pinocytic capacity and NO production. Although BSP fractions did not affect RAW 264.7 cell viability, they, especially BSP-2, enhanced the immunomodulatory activity by increasing the pinocytic capacity and NO production. Overall, BSP may be developed as a potential coagulant with immunomodulatory effects.

The objective of this study was to examine anticoagulant effects of fucoidan sulfate grafted on a TiO2 nano-film. Using silica sol as a film-forming binding agent and high-molecular-weight polyvinyl alcohol as a film-forming aid, a nano-TiO2 film was produced by applying a bonding film-forming method. Photocatalytic performance and resistance to heat, corrosion, and aging were investigated. Using glutaraldehyde as a cross-linking agent, brown algal polysaccharide sulfate was grafted onto the surface of NH3 plasma-treated nano-film. The effects of pH, reaction temperature, and reaction time on grafting effects of nano-film are discussed. XPS was used to analyze chemical elements on the surface of nano-film, and partial thromboplastin time (APTT), thromboplastin time (PT), and thrombin time (TT) were used to evaluate anticoagulant activity of the graft nano-film In Vitro. The TiO2 nano-film showed excellent resistance to heat, water, corrosion, and aging, and produced good interfacial adhesion performance. The grafting process optimum occurred at pH 2, 40 °C, and a reaction time of 6 h. Under these conditions, the optimal value of grafted silk fibroin membrane APTT was 72 s, and coagulation time of APTT and TT was increased by 37 s and 6 s, respectively, compared with the control, suggesting anticoagulant effects. Regarding stability, grafted fucoidan sulfate did not dissolve easily from the matrix; therefore, this product appears to be a promising novel biomaterial with effective anticoagulant properties.

The present work deals with the extraction and purification of chondroitin sulfate/dermatan sulfate from skin (CSG) and bone (CBG) of corb (Sciaena umbra). Electrophoresis of these polymers in barium acetate buffer on cellulose acetate revealed two fractions similar to dermatan sulfate and chondroitin sulfate. The in vivo anticoagulant activity of both chondroitin sulfate/dermatan sulfate (CS/DS) were evaluated, at 25 and 75 mg kg−1 of body weight (b.w), using activated partial thromboplastin time (aPTT), prothrombine time (TT) and thrombin time (PT) tests. Results showed that aPTT of CSG and CBG at 75 mg kg−1 of b.w were prolonged by 1.59 and 1.48-fold respectively, compared with the control. Further, toxicity studies on liver performed by the catalytic activity of transaminases in plasma, oxidative stress markers and hepatic morphological changes demonstrated that CSG and CBG at both doses are not toxics. In summary, the higher activity and lower toxicity of both CS/DS, especially at 25 mg kg−1 of b.w, recommended these compounds as a better drug candidate.

The inhibition of factor XIa (FXIa) is a trending paradigm for the development of new generations of anticoagulants without a substantial risk of bleeding. In this report, we present the discovery of a benzyl tetra‐phosphonate derivative as a potent and selective inhibitor of human FXIa. Biochemical screening of four phosphonate/phosphate derivatives has led to the identification of the molecule that inhibited human FXIa with an IC50 value of ∼7.4 μM and a submaximal efficacy of ∼68 %. The inhibitor was at least 14‐fold more selective to FXIa over thrombin, factor IXa, factor Xa, and factor XIIIa. It also inhibited FXIa‐mediated activation of factor IX and prolonged the activated partial thromboplastin time of human plasma. In Michaelis‐Menten kinetics experiment, inhibitor 1 reduced the VMAX of FXIa hydrolysis of a chromogenic substrate without significantly affecting its KM suggesting an allosteric mechanism of inhibition. The inhibitor also disrupted the formation of FXIa – antithrombin complex and inhibited thrombin‐mediated and factor XIIa‐mediated formation of FXIa from its zymogen factor XI. Inhibitor 1 has been proposed to bind to or near the heparin/polyphosphate‐binding site in the catalytic domain of FXIa. Overall, inhibitor 1 is the first benzyl tetraphosphonate small molecule that allosterically inhibits human FXIa, blocks its physiological function, and prevents its zymogen activation by other clotting factors under in vitro conditions. Thus, we put forward benzyl tetra‐phosphonate 1 as a novel lead inhibitor of human FXIa to guide future efforts in the development of allosteric anticoagulants., The biochemical screening of four phosphonate/phosphate derivatives has led to the identification of a molecule that inhibited human FXIa with an IC50 value of ∼7.4 μM and a submaximal efficacy of ∼68 %. The inhibitor was at least 14‐fold more selective to FXIa over thrombin, factor IXa, factor Xa, and factor XIIIa.

International audience; The present study was undertaken to establish a distinct relationship between blue crab chitosan (Cs) acetylation degree (AD) and molecular weight (Mw) and its structural features, thermal properties and bioactivity. Therefore, chitosans with different AD were prepared and Cellulase was used to produce Cs derivatives with decreasing Mw. Results clearly display a decrease of the ordered structure of Cs, with the increase of AD and the decrease of Mw. Thermal stability/degradation screening disclose a greater thermal resistance for Cs with lower AD and higher Mw. The anti-adhesive potential of Cs was, additionally, studied, as function of AD and Mw. The effectiveness of Cs in preventing biofilm adhesion was strongly influenced by its AD and Mw, with the lowest inhibition values for higher AD and lower Mw. Interestingly, the effectiveness of Cs in disrupting pre-formed biofilms increased with decreasing Mw. Moreover, Cs derivatives were found to be advantageously efficient in prolonging human blood clotting times, based on data of activated partial thromboplastin time, Quick time and thrombin time assays, typically for the intrinsic coagulation pathway. Accordingly, depending on the predicted application of Cs, either in food, biomedical and pharmaceutical industries, AD and Mw are critical traits to be inevitably reflected on.

Purpose of Review: The introduction of newer anticoagulants requires clinicians to fully appreciate, interpret, and correctly apply the use of coagulation assays, such as the prothrombin time (PT), activated partial thromboplastin time (APTT), and anti-factor Xa assays. For oral vitamin K antagonists, the international normalized ratio (INR) is a predictor of anticoagulation intensity. However, for direct oral anticoagulants (DOACs), the PT or INR and APTT are unable to quantify the level of anticoagulation intensity as there is a poor correlation between plasma concentration of DOAC with these routine coagulation assays and that significant anticoagulant effect may still be present despite normal or near normal results for these routine assays. Recent Findings: In the USA, there are 5 DOACs available including dabigatran, a direct thrombin inhibitor and 4 direct factor Xa inhibitors (FXaI), each with varying indications, doses, pharmacodynamic, and pharmacokinetic characteristics. A thorough understanding of these properties aids in the management of the periprocedural or bleeding patient. Summary: In this first section of this manuscript, we will review the laboratory tests that are commonly performed for assessing a patient’s coagulation status with known DOAC exposure. The second section will describe 3 real-world challenging case studies in DOAC-treated patients, with a focus on presenting clinical queries, interpretation of baseline laboratory tests with interpretations, followed by the case discussion to combine interpretation of appropriate laboratory tests with clinical patient considerations in an effort to guide clinical decision-making.

OBJECTIVES One of the most prevalent complications of orthotopic liver transplant is primary graft dysfunction. Recent studies have shown the preconditioning effect of remifentanil on animal livers but not human livers. Here, we compared the preconditioning effects of remifentanil and fentanyl in orthotopic liver transplant in human patients. MATERIALS AND METHODS In this double-blind clinical trial, 100 patients who underwent liver transplant from deceased donors were randomly allocated into 2 groups. Patients in the remifentanil group received remifentanil infusion, and those in the fentanyl group received fentanyl infusion during maintenance of anesthesia. Serum aminotransferase levels, prothrombin time (international normalized ratio), partial thrombin time, arterial blood gas levels, and renal function tests were evaluated over 7 days posttransplant. Intensive care unit stay and hospitalization were also recorded. RESULTS The median peak alanine aminotransferase level during 7 days after transplant was 2100 U/L (interquartile range, 1230-3220) in the remifentanil group and 3815 U/L (interquartile range, 2385-5675) in the fentanyl group (P = .048). Metabolic acidosis, renal state, prothrombin time (international normalized ratio), and partial thrombin time were similar in both groups (P > .05). Durations of stay in the intensive care unit and hospital were not significantly different between the 2 groups (P = .75 and P = .23, respectively). Overall, the clinical outcomes were similar in the remifentanil and fentanyl groups (P > .05). CONCLUSIONS We found that remifentanil and fentanyl were not different with regard to their preconditioning effects and graft protection in orthotopic liver transplant recipients.

BACKGROUND: The design and fabrication of hemocompatible and low-toxicity formulations remains a challenging task. Hydrogels are of considerable importance for biomedical applications since they are highly compatible with living tissue, both in vivo and in vitro. OBJECTIVE: The present study aimed to develop and evaluate the characterizations and in vitro hemocompatibility of a hydrogel using polyvinyl alcohol and gelatin with different concentrations. METHODS: The gelling process was realized by cross-linking the polyvinyl alcohol and gelatin. The morphological and structural examinations of the synthetic hydrogels were done by scanning electron microscopy (SEM) and X-ray powder diffraction (XRD). The swelling behavior of the prepared hydrogels in water was evaluated. Prothrombin time, activated partial thromboplastin time, and thrombin time were measured, and a hemolysis test was done to evaluate the hemocompatibility of prepared hydrogels. RESULTS: The increase of the gelatin concentration in polyvinyl gelatin hydrogel increases the porosity and enhances the absorptivity of the prepared hydrogel. The measured hematological parameters indicated enhancement of hemocompatibility as the gelatin concentration was increased in the prepared hydrogel. CONCLUSIONS: The results obtained from this study confirm that gelatin was able to improve the properties of the polyvinyl alcohol–gelatin hydrogel and enhance the hemocompatibility. Thus, the prepared hydrogel could be used in a variety of biomedical applications.