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A 43‑year‑old male diagnosed with end‑stage renal disease on hemodialysis with extensive thrombosis in the inferior vena cava and bilateral iliofemoral vein underwent renal transplantation at our institute. Thrombosis in the major vein can have serious consequences for the success of the transplantation. The common anastomosing vein during renal transplantation is the right external iliac vein, but due to extensive thrombosis, left native nephrectomy with the orthotopic placement of the donor kidney was done. During surgery, the donor renal vein was anastomosed with the left renal vein, and the donor renal artery was anastomosed with the aorta. Postsurgery, the creatinine level showed a progressive decline over time and the patient was discharged home. [ABSTRACT FROM AUTHOR]

To establish a reference range for the canine C-ACT activated clotting time (ACT) test using a water bath and visual clot assessment technique. Healthy, privately owned dogs (n = 48) were prospectively recruited to the study. Blood samples were collected via direct jugular venipuncture for complete blood count, serum biochemistry analysis and measurement of prothrombin time (PT) and activated partial thromboplastin time (aPTT). Five animals with major abnormalities or who became agitated during phlebotomy were excluded. For the 43 remaining animals, 2 mL of blood was collected via the cephalic vein and added directly to a C-ACT tube that was shaken vigorously before being placed in a water bath at 37°C. Tubes were visually assessed for clot formation and C-ACT was recorded in seconds when the magnet within the tube lodged in the clot. The nonparametric reference interval (capturing the central 95% of the data) was 50–80 seconds, with a 90% CI for the lower limit of 50–55 seconds and a 90% CI for the upper limit of 75–80 seconds. The C-ACT ACT test had a positive correlation with aPTT (0.42; 95% CI = 0.13–0.64). There was no evidence of a correlation between C-ACT ACT and age, weight, PT, haematocrit, white blood cell count, platelet count or total protein. The results of this study suggest that the normal reference interval for ACT in dogs using C-ACT tubes in a 37°C water bath is 50–80 seconds. Care should be taken extrapolating the results of this study to the general population, as the smaller study design had less control for confounders than a larger study. However, when using the described analytical methods, C-ACT tube ACT test results >80 seconds should be considered prolonged in dogs and should prompt further investigation. [ABSTRACT FROM AUTHOR]

Objectives: Severe fever with thrombocytopenia syndrome (SFTS) has no vaccine or treatment and an extremely high fatality rate. We aimed to analyze and evaluate the risk factors for death associated with SFTS. Methods: Among reports from 2018 to 2022, we compared and analyzed 1,034 inpatients aged 18 years or older with laboratory-confirmed SFTS who underwent complete epidemiological investigations. Results: Most of the inpatients with SFTS were aged 50 years or older (average age, 67.6 years). The median time from symptom onset to death was 9 days, and the average case fatality rate was 18.5%. Risk factors for death included age of 70 years or older (odds ratio [OR], 4.82); agriculture-related occupation (OR, 2.01); underlying disease (OR, 7.20); delayed diagnosis (OR, 1.28 per day); decreased level of consciousness (OR, 5.53); fever/chills (OR, 20.52); prolonged activated partial thromboplastin time (OR, 4.19); and elevated levels of aspartate aminotransferase (OR, 2.91), blood urea nitrogen (OR, 2.62), and creatine (OR, 3.21). Conclusion: The risk factors for death in patients with SFTS were old age; agriculture-related occupation; underlying disease; delayed clinical suspicion; fever/chills; decreased level of consciousness; and elevated activated partial thromboplastin time, aspartate aminotransferase, blood urea nitrogen, and creatine levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: We analyzed bleeding and thrombotic complications in COVID-19--associated ARDS requiring extracorporeal membrane oxygenation (ECMO). METHODS: This was a single-center observational study of adult subjects undergoing ECMO for COVID-19 (n = 67) or all other cause of ARDS (n = 60), excluding trauma patients. RESULTS: In the COVID-19 group, duration of invasive mechanical ventilation prior to ECMO was lower (2 [0-4] d vs 3 [1--6] d) and ECMO retrieval less frequent (71% vs 87%). No significant differences were found in Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II (APACHE II), or in the in-hospital survival predicted by the Respiratory ECMO Survival Prediction score. During the first 7 d of ECMO support, the COVID-19 group presented higher platelets and fibrinogen, lower activated partial thromboplastin time, but no differences in D-dimer. Thrombotic complications were similar between groups. Higher rates of severe bleeding, namely airway bleeding (37.3% vs 15.0%) and hemothorax (13.4% vs 3.3%), were found in COVID-19, with lower hemoglobin and higher red blood cell transfusions. COVID-19 ARDS was associated with longer ECMO duration (47 [17-80] d vs 19 [12-30] d) and absence of a statistically significant difference concerning in-hospital mortality. CONCLUSIONS: COVID-19--associated ARDS requiring ECMO presented high rates of severe bleeding complications and a protracted course. Further studies are needed to clarify the risks and benefits of ECMO in severe COVID-19--associated ARDS. [ABSTRACT FROM AUTHOR]

Early identification of cerebrovascular atherosclerotic ischemic stroke is necessary for accurate treatment and clinical research. To identify novel predictors and build a predictive model of ischemic strokes due to cerebrovascular atherosclerosis. MIMIC-IV database was used to search for clinical data of patients with ischemic stroke. Included patients were divided into two groups according to their etiologies. Univariate and multivariate logistic regressions were used to build the predictive model, and the model reliability parameters were calculated. The cut-off value for the model was selected according to the Youden index. Clinical data from the Neurovascular Center of Changhai Hospital were used to verify the predictive model. Logistical regressions showed a positive correlation between advanced age, peripheral atherosclerosis, history of transient ischemia, and the diagnosis of ischemic strokes due to cerebrovascular atherosclerosis. The history of atrial fibrillation, levels of the National Institutes of Health Stroke Scale, serum potassium, and activated partial thromboplastin time were negatively correlated to the diagnosis of cerebrovascular atherosclerotic ischemic stroke. The predictive model was constructed from logistic regression results, and the area under the curve was 0.764. The cut-off value for the model was set at 0.089 to achieve the highest Youden index, with sensitivity and specificity of 75.9% and 64.1%. Clinical verification of the model revealed that the sensitivity and specificity of the model were 52.5% and 93.0% respectively. The efficacy of the predictive model was acceptable as an aid in predicting cerebrovascular atherosclerotic ischemic stroke. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the predictive value of Sonoclot analysis and thromboelastography (TEG) for postoperative bleeding in children younger than 12 years coming for cardiac surgery for congenital cyanotic heart disease. This is a prospective, observational study carried out in a single tertiary care military hospital. Ninety patients of the paediatric age group undergoing bypass cardiac surgery for correction of congenital cyanotic heart defect were included in the study. Laboratory-derived values to assess coagulation status (prothrombin time, international normalisation ratio, activated partial thromboplastin time) and point-of-care Sonoclot- and TEG-derived parameters were noted at the start of surgery and postoperatively in all patients. Bleeders were predefined on the basis of chest tube drainage. The incidence of bleeders was 42.2% (38/90 patients), whereas 57.8% (52/90 patients) were non-bleeders. The postoperative R value and preoperative gbPF test were predictive for postoperative bleeders on multivariate analysis. Postoperative gbPF had the highest area under the curve (0.72), with a cut-off value of 1.75, and gbPF had 82% sensitivity and 71% specificity in predicting significant postoperative bleeding in paediatric cyanotic congenital heart surgeries. Transfusion requirements and mechanical ventilation duration were higher in bleeders; however; length of intensive care unit stay, incidence of sepsis and mortality were similar in both the groups. Bleeding in patients undergoing corrective surgery for cyanotic congenital heart disease could be predicted by the preoperative gbPF and postoperative R value. Among these, preoperative gbPF has the maximum predictive value. [ABSTRACT FROM AUTHOR]

Acquired hemophilia is a rare disease resulting from autoantibodies against endogenous factor VIII (FVIII), which associates with bleeding and a high mortality rate. The pathophysiology is still unclear. Recent studies suggest genetic and environmental factors trigger the breakdown of immune tolerance. We report a 77-year-old Taiwanese man presented with multiple ecchymoses and some hemorrhagic blisters three weeks after SARS-CoV-2 mRNA (Moderna) vaccination. Isolated activated partial thromboplastin time (aPTT) prolongation was found. Acquired hemophilia A (AHA) was confirmed by low factor VIII (FVIII) activity and high titer of FVIII inhibitor. The pathohistology of skin biopsy further supported the concomitant diagnosis of bullous pemphigoid. To date, 6 cases of acquired hemophilia A following SARS-CoV-2 mRNA vaccination were reported worldwide. We reviewed and summarized the characteristics of these cases. We also discussed the rare finding of concomitant acquired hemophilia A and bullous pemphigoid. Bullous pemphigoid results from autoantibody against epithelial basement membrane zone of skin. In this article, we proposed possibility of SARS-CoV-2 mRNA vaccine associated autoimmunity against FVIII and epithelial basement membrane zone. [ABSTRACT FROM AUTHOR]

Warfarin is the most widely used anticoagulant in the world, but it has several limitations including its narrow therapeutic range, need for dose adjustment and high potential for interactions. The simultaneous use of other drugs or even medicinal plants and certain foods could interfere with its therapeutic activity. In this context, this study aims to investigate the in vitro anticoagulant potential and phytochemical constitution of 17 plants selected from a previous clinical cross-sectional study (2014), that investigated the habits of plant utilization among patients taking warfarin. Ethanol extracts and essential oils were evaluated, in vitro, as to their effect in the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Four species that presented aPTT >50 s were selected for phytochemical evaluation. Thirteen of the 17 plants selected demonstrated a significant anticoagulant effect in at least one of the evaluated parameters. Citrus sinensis (PT=14.75 and aPTT=53.15), Mentha crispa (aPTT=51.25), Mikania laevigata (PT=14.90 and aPTT=52.10), and Nasturtium officinale (aPTT=50.55) showed greater anticoagulant potential compared to normal plasma pool (PT=12.25 and aPTT=37.73). Chemical profiles of these four species were obtained, and certain compounds were identified: rosmarinic acid from M. crispa and isoorientin from N. officinale. Thus, the results of this study could be a useful indicator for clinical practice towards the possibility of interaction between these plants and anticoagulants, although further clinical research is needed taking into consideration the limitations of in vitro studies. These findings also suggest that further research into the action of these plants could be of real clinical value in identifying potential alternative anticoagulant therapies. [ABSTRACT FROM AUTHOR]

Plant proteinase/protease inhibitors (PIs) have therapeutic potential besides their role in regulating endogenous protease activity in several physiological processes. They exert their function by inhibiting the catalytic activity of specific proteases. The use of PIs for inhibiting coagulation factors and slowing down the blood coagulation process has emerged as a critical intervention point for developing antithrombotic agents. The present study has demonstrated the characterization of bacterially expressed recombinant peanut Bowman-Birk inhibitor (rPnBBI) and evaluation of its anticoagulant potential compared to native PnBBI (isoinhibitors pool) purified from peanuts. The full-length BBI gene was cloned, and rPnBBI (7.53 kDa) expressed in the soluble fraction of Escherichia coli BL21 (DE3) strain was isolated by passing through the trypsin affinity column. The purified rPnBBI with β-sheets as major secondary structural elements exhibited inhibitory activity towards bovine trypsin and chymotrypsin at diverse pH and temperatures. Both, rPnBBI and PnBBI showed anticoagulant effects by prolonging the activated partial thromboplastin time (aPTT) and inhibiting the activity of proteases/factors (plasma kallikrein, FXIIa, FXIa, FIXa, and FXa) involved in the blood coagulation pathway. Besides, rPnBBI and PnBBI showed a similar inhibitory tendency towards FXIIa, FXIa, and FIXa, while rPnBBI exhibited a higher inhibition potential than PnBBI towards FXa. Contrarily, PnBBI showed higher inhibitory potential than rPnBBI on plasma kallikrein. Altogether, the bioactive BBI molecules from the natural food source peanuts showed significant anticoagulant potential, which could be exploited in the prophylaxis of thromboembolic disorders associated with various human diseases. [Display omitted] [ABSTRACT FROM AUTHOR]

Poisoning of nontarget species is a major concern with the use of anticoagulant rodenticides (ARs). At postmortem examination, differentiating toxicosis from incidental exposure is sometimes difficult. Clotting profiles cannot be performed on postmortem samples, and clinically significant serum, blood, and liver AR concentrations are not well-established in most species. We chose diphacinone for our study because, at the time, it was the publicly available AR most commonly detected in samples analyzed at the University of Kentucky Veterinary Diagnostic Laboratory. We determined an approximate minimum toxic dosage (MTD) of oral diphacinone in 3 horses and measured corresponding serum, blood, and liver diphacinone concentrations. Diphacinone was administered orally to healthy horses. Prothrombin time (PT), activated partial thromboplastin time (aPTT), and serum and blood diphacinone concentrations were measured daily. At the study endpoint, the horses were euthanized, and diphacinone concentration was measured in each liver lobe. The horse that received 0.2 mg/kg diphacinone developed prolonged (>1.5× baseline) PT and aPTT; the horse that received 0.1 mg/kg did not. This suggests an approximate oral MTD in horses of 0.2 mg/kg diphacinone. Median liver diphacinone concentration at this dosage was 1,780 (range: 1,590–2,000) ppb wet weight. Marginal (model-adjusted) mean diphacinone concentrations of liver lobes were not significantly different from one another (p = NS). Diphacinone was present in similar concentrations in both serum and blood at each time after administration, indicating that both matrices are suitable for detection of diphacinone exposure in horses. [ABSTRACT FROM AUTHOR]

Zinc (Zn) and its alloys are currently regarded as one of the promising families of biodegradable metals for implant applications owing to their suitable biodegradability and biofunctionality. However, the inadequate mechanical properties of as-cast (AC) pure Zn restricted the practical clinical bone-implant applications due to its coarse grain size and hexagon close-packed crystal structure. Here, the impact of gadolinium (Gd) on the mechanical properties, corrosion resistance, hemolysis percentage, anticoagulant activity, and cytotoxicity of AC and hot-rolled (HR) Zn-1Mg-xGd (x = 0.1, 0.2, and 0.3) (wt.%) alloys were investigated for biodegradable bone-implant applications. Tensile testing showed that the HR Zn-1Mg-0.3Gd alloy exhibited the highest tensile strength of 288.1 MPa, tensile yield strength of 250.9 MPa, and elongation of 13.2%. Electrochemical corrosion and immersion tests revealed that the corrosion rates of both AC and HR specimens increased with increasing Gd content in Hanks' solution, and the HR Zn-1Mg-xGd specimens exhibited higher corrosion rates compared to their AC counterparts. The HR Zn-1Mg-xGd specimens showed an increasing hemolysis percentages and decreasing activated partial thromboplastin time (APTT) values with increasing Gd addition. The alloy extracts of HR samples at ≤ 25% concentration exhibited no cytotoxicity toward MG-63 cells, and the HR Zn-1Mg-0.3Gd alloy displayed the highest cell viability among all three alloy extracts at 12.5% concentration. Overall, the HR Zn-1Mg-0.3Gd can be considered a promising biodegradable implant material for bone-implant materials owing to its high mechanical strength and ductility, suitable degradation rate, and satisfying biocompatibility. In this work, Zn-1Mg-xGd (x = 0.1, 0.2, and 0.3 wt.%) alloys were developed by alloying with gadolinium (Gd) and hot-rolling, and their mechanical properties, corrosion behavior, hemolysis percentage, anticoagulant activity, and cytotoxicity were investigated for biodegradable implant application. Our findings demonstrated that the hot-rolled Zn-1Mg-0.3Gd alloy exhibit the highest ultimate tensile strength of 288.1 MPa, yield strength of 250.9 MPa, and elongation of 13.2%. Hot-rolled Zn-1Mg-xGd alloys show slowly increasing hemolysis percentages and decreasing activated partial thromboplastin time (APTT) values with increasing Gd addition. Extracts of hot-rolled Zn-1Mg-xGd alloys at a concentration of ≤ 25% show no cytotoxicity towards MG-63 cells, and Zn-1Mg-0.3Gd exhibit good cytocompatibility among all three alloys at a concentration of 12.5%. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients with critical illness often display variable hypo- and hypercoagulable sequalae requiring intense monitoring and anticoagulation pharmacotherapy to prevent or treat inappropriate clot formation. It is imperative to understand the various stages of the clotting cascade and where each pharmacotherapy agent exerts its therapeutic effect. Common coagulation tests are utilized to monitor the areas of the clotting cascade and the effects that anticoagulant pharmacotherapy exhibits. Many novel coagulation tests are also in development. The purpose of this narrative review is to evaluate commonly utilized coagulation tests that monitor anticoagulation while in the intensive care unit. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the anticoagulant, antiplatelet and antioxidant activities of protein extract of kenaf seed (PEKS). Methods: Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography techniques were employed for protein characterization. Antioxidant activity of PEKS was assessed using 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. The protective effect of PEKS on sodium nitrite (NaNO2) induced oxidative stress was evaluated using the in vitro red blood cell model, while the effect of PEKS on diclofenac-induced oxidative stress was examined in vivo in rats. Platelet-rich plasma and platelet-poor plasma were used for anticoagulant and antiplatelet activities of PEKS. Results: PEKS revealed similar protein bands on SDS-PAGE under reduced and non-reduced conditions. Several acidic proteins were present in native PAGE. PEKS showed antioxidant properties by scavenging DPPH with an IC50 of 24.58 μg. PEKS exhibited a protective effect on NaNO2 induced oxidative stress in red blood cells by restoring the activity of stress markers. In addition, PEKS alleviated diclofenac-induced tissue damage of the liver, kidney, and small intestine. PEKS showed an anticoagulant effect in both in vivo and in vitro experiments by enhancing normal clotting time. PEKS did not affect prothrombin time but increase activated partial thromboplastin time. Furthermore, PEKS inhibited adenosine diphosphate and epinephrine-induced platelet aggregation. Conclusions: PEKS protects tissues from oxidative stress and exhibits antithrombotic activity. [ABSTRACT FROM AUTHOR]

Background: The recommendation for coagulation blood samples is to centrifuge at 4000 revolutions per minute (rpm) for 15 min to produce platelet-poor plasma before analysis. Rapid centrifugation, defined as centrifuging samples at higher speeds for shorter durations, could potentially reduce turn-around times (TAT), provided sample integrity is maintained. Objective: This study assessed the impact of rapid centrifugation on routine coagulation assay results. Methods: Blood samples were collected from volunteers at Inkosi Albert Luthuli Central Hospital and King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa, from September to November 2021. Samples were centrifuged using Method A, the current standard (4000 rpm/15 min), Method B (4000 rpm/10 min), Method C (5000 rpm/10 min) and Method D (5000 rpm/5 min). Platelet count, prothrombin time, activated partial thromboplastin time, thrombin time (TT), fibrinogen and D-dimer levels were analysed and results from Methods B, C and D compared to reference Method A. Results: Platelet-poor plasma was obtained from all samples (n = 60) using Methods A and B, and from 33/60 (55%) samples using Methods C and D. Differences between Method A and Methods C and D for normal prothrombin time, normal D-dimer and abnormal TT results were statistically significant. Prothrombin time results correlated strongly across all methods, while TT and D-dimer results correlated poorly. Activated partial thromboplastin time and fibrinogen results showed no significant differences across all methods. Conclusion: Rapid centrifugation at 4000 rpm/10 min (Method B) showed results consistent with the reference method. This method could potentially reduce the overall TAT for routine coagulation assays. [ABSTRACT FROM AUTHOR]

Introduction: Factor XI deficiency or hemophilia C is a very rare coagulation factor deficiency, with a global incidence of 1 in 1 million. Although it is an under-recognized entity, it can cause significant bleeding, resulting in life-threatening complications. Materials and Methods: Coagulation parameters were analyzed using a Sysmex CS-2400 coagulation analyzer. Factor XI levels were detected using Factor XI deficient plasma from Siemens. Activated Partial Thromboplastin Time (APTT) testing was performed using Actin FSL from Siemens. Results: Here, we report the two cases of Factor XI deficiency, one genetic and the other a very rare acquired deficiency due to sepsis, detected during the workup of an isolated APTT prolongation. Conclusion: Factor XI deficiency is a rare bleeding disorder that presents as prolonged isolated APTT. Careful clinical evaluation and complete coagulation workup are necessary for the efficient management of patients, which can prevent life-threatening events. [ABSTRACT FROM AUTHOR]

Protein-losing enteropathy (PLE) is known to induce hypercoagulability and resultant thromboembolism in dogs. We hypothesized that hypercoagulability would improve if remission was obtained in dogs with PLE after treatment. This study aimed to evaluate the changes in the coagulation parameters after treatment in dogs diagnosed with PLE. As coagulation parameters, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, thrombinantithrombin complex (TAT), D-dimer, and antithrombin (AT) were measured. In addition to these parameters, rotational thromboelastometry (ROTEM), which evaluates the comprehensive coagulation and fibrinolysis reactions of whole blood, was conducted and the data of clotting time (CT), clot formation time (CFT), a angle (a), maximum clot firmness (MCF) and lysis index at 60 min (LI60) were obtained. Eleven of the 14 dogs diagnosed with PLE were classified as responders to the treatment based on the changes in their plasma albumin (ALB) concentration after treatment. Significant increase in CFT and decrease of a and MCF indicating the resolution of hypercoagulability were found after treatment in responder dogs; however, there was no significant change in the coagulation and fibrinolysis parameters other than those measured by ROTEM. This study demonstrated that the hypercoagulability detected by ROTEM was significantly improved after treatment in dogs with PLE. [ABSTRACT FROM AUTHOR]

Fucoidan, a marine-derived sulfated polysaccharide, exhibits a broad spectrum of biological activities. However, its high molecular weight and viscosity often restrict these benefits. In this study, a new fucoidanase-producing microbial strain Kosakonia oryzendophytica LH-58 was isolated from freshwater for the first time. Three low-molecular-weight fucoidans were synthesized through enzymatic hydrolysis, and their antioxidant, hypoglycemic, hypolipidemic, and anticoagulant properties were evaluated in vitro. With the hydrolysis of fucoidan by fucoidanase, there was no significant change in the composition of monosaccharides, and the sulfate content decreased slightly. Interestingly, reduced molecular weight enhanced antioxidant activity, though anticoagulant efficacy diminished. In vitro experiments demonstrated that a higher molecular weight of fucoidan significantly prolonged activated partial thromboplastin and thrombin times. The fraction F1, with a weight-average molecular weight exceeding 10 kDa, displayed superior hypoglycemic and lipid-lowering effects compared to its counterparts. The IC 50 values for F1's inhibition of α-amylase and α-glucosidase were 0.81 mg/mL and 0.94 mg/mL, respectively, while its binding rates to sodium taurocholate and sodium glycocholate were 50.11% ± 2.32% and 54.58% ± 2.71%, respectively. This study also offers a methodological reference for the swift identification of functional polysaccharides to prevent atherosclerosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objective Acute cerebral infarction is a form of Trousseau syndrome (TS), but is relatively rare and often overlooked by clinicians. The aim of this study was to investigate the clinical, laboratory and imaging features of acute cerebral infarction in non-small cell lung cancer (NSCLC) patients with TS. Methods Clinical data, laboratory examination and imaging data of 25 NSCLC patients with TS presented with acute cerebral infarction were collected retrospectively for analysis. Results Of the 25 patients, 18 males and 7 females, aged 39-78 years old, including 22 cases of adenocarcinoma, 2 cases of squamous cell carcinoma, and 1 case of large cell carcinoma; all patients had clinical symptoms and signs of acute cerebral infarction; plasma D-dimer was significantly increased, and prothrombin time and activated partial thromboplastin time were shortened to varying degrees; all patients showed acute multiple cerebral infarction foci involving multiple intracranial arterial blood supply areas on plain head magnetic resonance imaging (MRI) [diffusion-weighted imaging (DWI) sequence], the blood supply vessel lumen corresponding to the infarction foci did not show moderate to severe stenosis on the head MR angiography (MR). Conclusion NSCLC with multiple acute cerebral infarctions is a rare manifestation of TS, which is characterized by multiple acute cerebral infarctions involving multiple arterial blood supply areas with significant hypercoagulability. Improving the early under- standing of this disease can provide some help for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine the compliance with a predefined dose increment (PDI) nomogram compared with a percentage adjustment (PA) nomogram for the dose titration of argatroban therapy.Design: This was a single-center, retrospective chart review.Setting and Participants: This study was conducted in a tertiary care teaching hospital. Patients were included if they received argatroban from 2013 to 2016.Outcome Measures: The primary safety outcome was the percentage of appropriate dose titrations. The secondary safety and efficacy outcomes included the median time to therapeutic activated partial thromboplastin time (aPTT), the median argatroban dose once therapeutic, and the median time in the therapeutic, subtherapeutic, and supratherapeutic aPTT ranges, as well as the bleeding and thrombotic events during hospitalization.Results: Seventy-seven patients were included in the study. There was no statistically significant difference in the percentage of titrations performed appropriately (P = 0.17). The median time to goal aPTT, the dose when first therapeutic, and the time aPTT was subtherapeutic were similar in both the arms. The patients in the PDI arm were on argatroban for a median time of 55 hours compared with 110.5 hours for the patients in the PA arm (P = 0.001). The patients in the PA arm spent more time in the therapeutic range (P < 0.05) and less time in the supratherapeutic range (P < 0.005).Conclusion: Although there was no difference in the percentage of appropriate dose titrations, the patients in the PA arm spent more time on argatroban, had greater time in the therapeutic aPTT range, and had less time in the supratherapeutic aPTT range. Future studies that include a larger sample size, matching therapeutic aPTT ranges, and similar initial infusion rates would help evaluate further the outcomes between the PDI and PA nomograms. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The VA Northeast Ohio Healthcare System introduced a new nurse-driven anti--factor Xa (anti-Xa) protocol for monitoring unfractionated heparin to replace the previous activated partial thromboplastin time protocol. Objective: To design, implement, and evaluate the efficacy of the anti-Xa monitoring protocol. Methods: An interdisciplinary team of providers collaborated to develop and implement a nurse-driven, facility-wide anti--factor Xa protocol for monitoring unfractionated heparin therapy. The effectiveness of this protocol was evaluated by retrospective analysis. Results: We reviewed 100 medical records for compliance with the new anti-Xa monitoring protocol. We then evaluated 178 patients whose anticoagulation was monitored with the anti-Xa assay to determine the time to therapeutic range. We found that 80% of patients receiving the anti-Xa protocol achieved therapeutic anticoagulation within 24 hours, as compared with 54% of patients receiving the activated partial thromboplastin time protocol (P < .001). Protocol conversion also yielded a decrease in blood draws, dose adjustments, and potential calculation errors. Conclusions: Monitoring intravenous heparin therapy with the anti-Xa assay rather than activated partial thromboplastin time resulted in a shorter time to therapeutic anticoagulation, longer maintenance of therapeutic levels, and fewer laboratory tests and heparin dosage changes. We believe the current practice of monitoring heparin treatment with activated partial thromboplastin time assays should be reexamined. [ABSTRACT FROM AUTHOR]

Background: Hereditary prekallikrein (Fletcher factor) deficiency is a rare condition characterized by a prolonged activated partial thromboplastin time. Inhibitors of plasma kallikrein have recently been approved for prophylaxis of hereditary angioedema and are under investigation for use in other indications. Objective: We attempted to conservatively assess the impact of long-term inhibition of this pathway by reviewing reported comorbidities in patients with hereditary prekallikrein deficiency. Methods: We searched several medical literature databases for publications that reported data from patients with hereditary prekallikrein deficiency (<10% of normal and/or shortening of activated partial thromboplastin time on increased incubation time). Data reporting of cardiovascular, bleeding, and autoimmune-related diseases were extracted. Results: Of 1966 publications screened, 45 publications (which represented 53 patients with prekallikrein deficiency) were included. Among 53 identified patients with prekallikrein deficiency, 25 were explicitly defined as asymptomatic, with no comorbidities mentioned in another three cases. Another 16 of the 53 patients were described as having undergone surgery or dental extractions with no complications. Cardiovascular comorbidities were reported in 19 patients, mainly hypertension (9 patients) and cerebrovascular ischemia or stroke (5 patients). Excessive bleeding episodes after surgery were reported in four patients. Autoimmune-related diseases were reported for three patients (two with Graves disease and one with systemic lupus erythematosus). Conclusion: This review identified patients with hereditary prekallikrein deficiency who reported a spectrum of health outcomes from asymptomatic to infrequent reports of cardiovascular, bleeding, and autoimmune comorbidities. The majority of the reports did not indicate any association between prekallikrein deficiency and comorbidities; however, additional observation is required to confirm the long-term safety of plasma kallikrein inhibition. [ABSTRACT FROM AUTHOR]

Experimental studies have shown that disinfection byproducts (DBPs) induce coagulotoxicity, but human evidence is scarce. This study aimed to explore the relationships of DBP exposures with blood coagulation parameters. Among 858 women from the Tongji Reproductive and Environmental (TREE) study, urinary dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) were detected as internal biomarkers of DBP exposures. We measured activated partial thromboplastin time (APTT), fibrinogen (Fbg), international normalized ratio (INR), prothrombin time (PT), and thrombin time (TT) as blood coagulation parameters. Multivariable linear regression models were utilized to estimate the relationships between urinary DCAA and TCAA and blood coagulation parameters. The effect modifications by demographic and lifestyle characteristics were further explored. Elevated tertiles of urinary DCAA concentrations were associated with increased PT and INR (11.29%, 95% CI: 1.66%, 20.92% and 0.99%, 95% CI: 0.08%, 1.90% for the third vs. first tertile, respectively; both P for trends < 0.05). Stratification analysis showed that the positive associations were only observed among younger (< 30 years), leaner (body mass index < 24.0 kg/m2), and non-passive smoking women. Moreover, elevated tertiles of urinary TCAA concentrations in positive associations with PT and INR were observed among younger women (17.89%, 95% CI: 2.50%, 33.29% and 1.82%, 95% CI: 0.34%, 3.30% for the third vs. first tertile, respectively; both P for trends < 0.05) but not among older women (both P for interactions < 0.05). Higher levels of urinary DCAA and TCAA are associated with prolonged clotting time among women. [Display omitted] • Associations of DBP exposures with blood coagulation parameters were explored firstly. • Urinary DCAA was associated with increased PT and INR. • Age modified the associations of urinary TCAA with PT and INR. • Urinary TCAA in positive associations with PT and INR occurred in younger women. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7 h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819–6.815, p = 0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6 h after the last dose. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to determine the effect of antithrombotic agents in preventing thrombosis after head and neck reconstructive surgery. A randomized clinical trial of referred patients undergoing free flap surgery between February 2015 and July 2017 was conducted. Four hundred and fifty-four patients were randomly assigned to group A (n = 153), administered aspirin and low molecular weight dextran; group B (n = 150), administered low molecular weight heparin; and group C (n = 151), not administered any antithrombotic agent. Patient demographic characteristics, donor site, thrombosis, haematoma, and flap failure were recorded. Coagulation values including platelet count, prothrombin time, and activated partial thromboplastin time were measured during the perioperative period. Repeated-measures ANOVA and the χ2 test were used for data comparisons. No significant inter-group differences were observed for postoperative microvascular thrombosis (P = 0.536) or flap failure (P = 0.615) among the three groups. There were more postoperative haematoma revisions in group B than in groups A and C (P = 0.032). It is concluded that postoperative antithrombotic agents neither provide a significant improvement in the free flap success rate nor decrease the risk of thrombosis and may increase the risk of haematoma. [ABSTRACT FROM AUTHOR]

Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis extracorporeal circuit and optimize hemodialysis adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated partial thromboplastin time, activated clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis. [ABSTRACT FROM AUTHOR]

A previously healthy 11-year-old girl presented with bilateral orbital compartment syndrome secondary to retrobulbar hemorrhages requiring emergency cantholysis. Four days earlier she had sustained head trauma without symptoms until her acute presentation. A basic hematologic profile was remarkable for a prolonged partial thromboplastin time, which did not completely correct with a 1:1 mixing study. This result raised suspicion for the most common acquired deficiency of clot stability, acquired factor VIII deficiency (acquired hemophilia A). Low factor VIII levels and the presence of autoantibodies against autologous factor VIII were confirmed. The child was treated daily with fresh frozen plasma and showed marked improvement over the ensuing days and weeks. [ABSTRACT FROM AUTHOR]

Background and objective The aim of this study was to analyze the incidence of lower limb deep venous thrombosis (DVT) and the corresponding coagulation status in severe patients after thoracic surgery. Methods Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016 and June 2018 were analysed retrospectively. Their general information, disease species, surgical treatment, and coagulation index were reviewed. Results Fifty patients were finally included. There were 34 male and 16 female, aging from 22 to 80 years. The incidence of DVT was 22.0%, all of them were isolated calf DVT. The incidence was 29.4% in male patients, while 6.3% in female; 23.5% in malignant diseases and 18.6% in benign. All coagulation index presented no statistical difference between patients with and without DVT, except activated partial thromboplastin time (APTT). Conclusion Even on the basis of adequate mechanical prophylaxis, lower limb DVT is common in severe patients after thoracic surgery. Meanwhile, male patients and malignant diseases are more suscepted. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Lung Cancer is the property of Chinese Journal of Lung Cancer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Lung Cancer is the property of Chinese Journal of Lung Cancer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Lung Cancer is the property of Chinese Journal of Lung Cancer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with a systemic procoagulant hypofibrinolysis state that is considered as a risk factor for microangiopathy and peripheral vascular diseases. Swimming exercise ameliorates the metabolic dysfunction in type 2 diabetes. Vitamin E is a natural antioxidant that reduces the risk of endothelial dysfunction in metabolic syndrome. The aim of the present study is to investigate the effect of combined swimming exercise with vitamin E on coagulation as well as blood fibrinolysis markers in rats with NAFLD. Methods: Eighty male rats were divided into control, control + vitamin E, control + exercise, high-fat diet (HFD), HFD + vitamin E, HFD + exercise, and HFD + vitamin E + exercise groups. Glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, cholesterol, low-density lipoprotein (LDL) and highdensity lipoprotein (HDL), alanine transaminase (ALT) and aspartate transaminase (AST), intercellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), endothelin-1, von Willebrand factor (vWF), fibrinogen, plasminogen activator inhibitor (PAI-1), fibrin degradation products (FDP), platelet count and aggregation, bleeding and clotting times, activated partial thromboplastin time (aPTT), and prothrombin time (PT) were determined. Results: HFD increased lipid profile, insulin, glucose, HOMA-IR, liver enzymes, adhesion molecules, endothelin- 1, vWF, platelet aggregation, fibrinogen, FDP, and PAI-1, and decreased clotting and bleeding times and HDL. Although exercise reduced lipid profile, glucose, insulin, HOMA-IR, vWF, platelet aggregation, fibrinogen, FDP, and PAI-1 and increased PT, aPTT, bleeding and clotting times, and HDL, vitamin E had no effect. Conclusions: Exercise, but not vitamin E, ameliorated the HFD-induced prothrombotic state and enhanced fibrinolytic activity. [ABSTRACT FROM AUTHOR]

The present study aimed to characterize and evaluate the in vitro and in vivo anticoagulant activity of sulfated glycosaminoglycans from the skins of smooth hound (SHSG) and grey triggerfish (GTSG). The analysis of SHSG and GTSG with acetate cellulose electrophoresis in Zn-acetate revealed the presence of hyaluronic acid (HA), chondroitin sulfate (CS) and dermatan sulfate (DS). Both glycosaminoglycans were evaluated for their in vitro anticoagulant activities using activated partial thromboplastin time (aPTT), thrombin time (TT) and prothrombine time (PT) tests. SHSG and GTSG and calciparin were tested as in vivo anticoagulants by subcutaneous (s.c) injection to adult female Wistar rats in a concentration of 75 mg/kg of body weight. The administration of SHSG, GTSG and calciparin to rats induced a significant decrease of platelet rates compared to the control. The aPTT assay of SHSG and GTSG was prolonged 1.3 and 1.23-fold respectively compared with the control. Toxicity studies were performed to investigate whether or not SHSG and GTSG can cause pathological changes in the liver, proteins and DNA. The concentration and catalytic activity of liver oxidative stress markers and enzymes, respectively, as well as the observed hepatic morphological changes indicated that calciparin induced hepatic toxicity and oxidative damage in the liver. The higher activity and lower toxicity of SHSG and GTSG recommended these compounds as a better drug candidate than calciparin. [ABSTRACT FROM AUTHOR]

• Glass material is grafted with poly(sulfobetaine methacrylate) brushes. • The grafted glass material possesses anti-fog, anti-frost and anti-biofouling properties. • The grafted glass material is hemocompatible. • The antifouling properties are stable. Hydration is at the core of the mechanisms rationalizing the ability of hydrophilic interfaces to resist fogging, frosting and biofouling, and to be hemocompatible. Although essential, very few biomedical interfaces and devices possess this set of properties. This study sheds light on this combination of properties imparted to glass by a dopamine-enabled grafting of poly(sulfobetaine methacrylate) moieties. Water contact angle (WCA), fogging, frost resistance antifouling and blood compatibility tests were then conducted. The very low WCA measured on the glass surface (8.4°) permitted to inhibit condensation and maintain optical transparency, whereas other hydrophilic graftings prepared using hydroxyethylmethacyrlate (HEMA) or poly(ethylene glycol) methyl ether acrylate (PEGMA) lost 15% of their optical transparency. The strong hydration layer provided by the zwitterionic grafting almost entirely inhibited frost formation. While the virgin glass suffered from severe biofouling by various types of cells found in the medical field including Pseudomonas aeruginosa and whole blood, the grafted glass materials resisted biofouling efficiently (90% and 99% decrease using bacteria and whole blood, respectively). Hemocompatibility was supported by negligible haemolyis activity, and activated partial thromboplastin time (APTT, 32.1 s) and prothrombin time (PT, 10.4 s) comparable to those measured with whole blood. Stability was also proven by carrying out antifouling tests after 1 month-immersion in an ultrasonic bath. Thus, these zwitterionic glass materials have potential for application in the biomedical field. [Display omitted] [ABSTRACT FROM AUTHOR]

The use of aspirin in the primary prevention of diseases is debatable. Herbal products might be considered potential substitutes for synthetic chemicals in many situations. Tanacetum parthenium or feverfew is widely used to treat various inflammatory diseases, fever, and headaches. But could it be considered a herbal alternative to aspirin? This double-blind randomized clinical trial was designed to evaluate the effects of feverfew on various immunological and coagulation factors in healthy individuals and to assess its potential adverse effects. Among healthy and non-smoking adult men of Fasa (IRAN), 60 individuals were randomly recruited into control and intervention groups. Participants consumed one capsule (250 mg) of Tanacetum parthenium or placebo every day for 2 weeks. Blood samples were taken from everyone and inflammatory cytokines, prothrombin time (PT), partial thromboplastin time (PTT), and liver function tests were assessed. T-test, Chi-square (X2) distribution, and linear regression analyses were done. The increased serum level of PT was shown in the intervention group (12.2 ± 0.7 s) compared to the control group (11.6 ± 0.6 s) in the t-test (p = 0.003) and the regression model (p = 0.04). PTT (41.8 ± 5.7 s compared to 33.0 ± 5.1 s), IL-17A (28.0 ± 28.6 compared to 18.9 ± 15.9 pg/ml) and Chemokine MCP-1 (1061.3 ± 705.3 compared to 714.2 ± 273.0 pg/ml) also showed a significant increase in the intervention group after consumption of feverfew (P values= 0.001, 0.048 and 0.017 respectively). The data suggested that Tanacetum parthenium (L.) may have anticoagulant properties. It is recommended that more studies with greater sample sizes and longer follow-ups be done in this regard. • Tanacetum parthenium (L.) has no significant side effects in healthy individuals. • Tanacetum parthenium (L.) has no significant severe inflammatory responses in healthy individuals. • Tanacetum parthenium (L.) has anticoagulant properties and a regulatory role in the immune system. [ABSTRACT FROM AUTHOR]

Hirschsprung disease is associated with significant bacterial proliferation and colonic dysbiosis leading to life threating hyperammonemia. In this report, we highlight the use of carglumic acid; a synthetic ammonia scavenger in hyperammonemia secondary to bacterial overgrowth in Hirschsprung disease. A 33-month-old female patient with a history of delayed passage of meconium presented with constipation, vomiting, abdominal distention, and an altered level of consciousness. Physical examination revealed a puffy face, non-pitting edema and distended, rigid, non-tender abdomen with faint bowel sounds. Further investigations showed anemia, hypoalbuminemia, hyperammonemia, prolonged prothrombin time and partial thromboplastin time alongside a normal liver enzymes panel. Abdominal X-ray imaging revealed severely dilated bowel loops reassembling obstruction and impending perforation. A lower gastrointestinal contrast study revealed a classical picture of Hirschsprung disease with a transition zone at the rectosigmoid. Urgent surgical intervention was performed resecting the distended part of the sigmoid colon applying an end colostomy with a distal end closure was done. The diagnosis of Hirschsprung disease was confirmed histopathologically. The patient was started on oral antibiotics and carglumic acid 600 mg q12h for the state of hyperammonemia and the unavailability of sodium benzoate. After its administration the ammonia levels dropped from 302 μmol/L to a nadir of 46 μmol/L. Taking into consideration our case carglumic acid proved to be an effective ammonia scavenger in such cases. [ABSTRACT FROM AUTHOR]

The article discusses a study which aims to explore the frequency of stroke in neonates diagnosed with neonatal seizures.

Copyright of Canadian Journal of Veterinary Research / Revue Canadienne de Recherche Vétérinaire is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Acute ischemic stroke thrombolysis in patients taking dabigatran is controversial because of a presumed increased risk of symptomatic hemorrhagic transformation. Using data from our local hematopathology laboratory, we developed a thrombolysis protocol for acute ischemic stroke patients taking dabigatran. Methods: A local thrombin time (TT)–dabigatran concentration relationship was calculated using dabigatran calibrators. The effect of dabigatran on activated partial thromboplastin time (aPTT) and prothrombin time (PT) (international normalized ratio [INR]) was also measured. A protocol was developed, in which a dabigatran concentration less than 10 ng/mL (corresponding to a TT < 38 seconds or a normal aPTT) was selected as the upper limit for thrombolysis. Consecutive patients presenting with acute stroke were then enrolled in this prospective study. Results: In the 8 months after development of the protocol, 13 potential thrombolysis candidates taking dabigatran were assessed at a median (interquartile range) time of 192 (143) minutes. The median National Institutes of Health Stroke Scale score was 18 (20). The mean time from arrival to TT, aPTT, and PT (INR) results were 39 ± 4.1 minutes, 21 ± 6.5 minutes, and 21 ± 6.5 minutes, respectively. Based on TT/aPTT, 4 patients were ineligible for thrombolysis. Six patients were not treated because of minor or resolving symptoms and another presented with intracerebral hemorrhage. Two patients were treated with intravenous tissue plasminogen activator (tPA), without symptomatic hemorrhagic transformation in either case. In 3 patients (42.8%), aPTT was normal, despite a prolonged TT. Conclusions: Administration of intravenous tPA in dabigatran-treated patients is feasible. Although, the relationship between dabigatran concentrations and coagulation measures varies between laboratories, individual protocols, preferably based on TT, can be developed at acute stroke treatment centers. [Copyright &y& Elsevier]

Purpose: The hemostatic biomarkers for early diagnosis of sepsis-associated coagulopathy have not been identified. The purpose of this study was to evaluate hemostatic biomarker abnormalities preceding a decrease in platelet count, which is a surrogate indicator of overt coagulopathy in sepsis. Materials and Methods: Seventy-five septic patients with a platelet count more than 80 × 103/μL were retrospectively analyzed. Hemostatic biomarkers at intensive care unit admission were compared between patients with and patients without a subsequent decrease in platelet count (⩾30% within 5 days), and the ability of biomarkers to predict a decrease in platelet count was evaluated. Results: Forty-two patients (56.0%) developed a subsequent decrease in platelet count. Severity of illness, incidence of organ dysfunction, and 28-day mortality rate were higher in patients with a subsequent decrease in platelet count. There were significant differences between patients with and patients without a subsequent decrease in platelet count in prothrombin time-international normalized ratio, fibrinogen, thrombin-antithrombin complex, antithrombin, protein C (PC), plasminogen, and α2- plasmin inhibitor (α2-PI). Receiver operating characteristic curve analysis showed that PC (area under the curve, 0.869; 95% confidence interval, 0.699-0.951) and α2-PI (area under the curve, 0.885; 95% confidence interval, 0.714-0.959) were strong predictors of a subsequent decrease in platelet count. Conclusions: Decreased PC and α2-PI activity preceded a decrease in platelet count in intensive care unit patients with sepsis. [ABSTRACT FROM AUTHOR]

Abstract: The coating of hesperidin, a traditional Chinese medicine ingredient, was immobilized to the surface of stainless steel (SS) which was often used in the cardiovascular implant materials and evaluated for its blood compatibility in vitro. The immobilized coating showed prolonged activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT) values compared with stainless steel control. The platelet adhesion and activation test on the hesperidin coating also showed significantly less data compared with the control. The test on conformational change of fibrinogen (fgn) demonstrated the hesperidin coating could reduce this parameter compared with the bare SS. It can be summarized that the hesperidin coating can effectively improve the blood compatibility of the SS surface. We envisage that this coating will provide a potential and effective selection for blood contact devices. [Copyright &y& Elsevier]

Background: Several authors have documented the role of low-molecular-weight heparin injection techniques in bruising. However, few researchers have measured the influence of injection duration on the occurrence and extent of bruising. Purpose: The aim of this study was to evaluate the influence of different durations of subcutaneous heparin injection on the occurrence and extent of bruising. Methods: A quasi-experimental case-crossover study design was adopted in 2010. A consecutive series of patients admitted to 2 orthopedic units in a large (600 beds) teaching hospital located in northern Italy were eligible for enrolment. Injections were administered following a standard procedure. The manipulated variable was the duration of the injection, 10 seconds (treatment A) and 30 seconds (treatment B). The evaluation of bruise occurrence and extension performed after 48 hours and data analysis were conducted in a blinded fashion. Results: A total of 150 patients receiving their first and second subcutaneous heparin injections (300 injections) were enrolled. Eighty-seven bruises were observed out of 300 injections (29%): 57 of 150 (38%) after injections lasting 10 seconds and 30 of 150 (20%) after injections lasting 30 seconds (relative risk, 1.50; 95% confidence interval, 1.21 1.86; P = .00). Of the 87 bruises that occurred, 69 (79.3%) were small (2-5 mm) and 18 (20.6%) were large (>5 mm), with no difference in size between 10- and 30-second injections (relative risk, 0.91; 95% confidence interval, 0.39 2.12; P = .83). Conclusions: Low-molecular-weight heparin injection should be administered over 30 seconds to decrease bruising. Clinical Implications: There is a need to reflect on the feasibility of such a practice because injecting low-molecular-weight heparin at 30 seconds requires accuracy, a steady hand, the absence of tremor, a calm environment, and the ability to administer an infinitesimally small amount of liquid (eg, 0.4 mL) per second. [ABSTRACT FROM AUTHOR]