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Background: The golden hour of trauma denotes the critical first hour after severe injury where timely medical response is crucial, although scientific support for this time frame is inconsistent. This study emphasizes optimizing trauma care by tailoring treatment to the specific injury rather than focusing solely on the speed of treatment. The aim is to document the need for improvement in prehospital trauma care, particularly by the use of blood and coagulation products. Methods: After a pilot study, a purpose-designed online questionnaire targeted at German physicians and rescue service personnel was utilized to collect their views on general trauma care and specifically on the use of blood and coagulation products in prehospital settings. It also assessed the appropriateness of nine specific blood and coagulation products via a 5-point Likert scale. The percentages for each item were calculated for both physicians (n = 110) and rescue service personnel (n = 142) separately as well as an overall score to delineate patterns of agreement or disagreement. Results: The study reached 9837 individuals, whereby 371 initially answered the questionnaire and 252 participants from Germany were finally included in the statistical analysis. The majority of both physicians (89.1%) and rescue service personnel (90.8%) agreed on the need to improve prehospital trauma care, particularly through the use of blood and coagulation products. Specifically, 60.9% of physicians and 83.8% of rescue personnel supported the prehospital administration of these products. Red blood cell concentrates and fibrinogen were notably endorsed, with 76.2% and 67.1% approval, respectively, for their potential to enhance survival in patients with significant blood loss; however, opinions varied on other blood products. Conclusion: The data demonstrated a readiness to change the trauma approach and confirmed that effective options are available. The utilization of certain products is supported by existing research, underlining the need for their practical implementation in preclinical settings. Here, the emphasis shifts from the isolated time components to the quality of care delivered in an optimized time interval. Ideally, timely and high-quality care should complement each other, leveraging all available therapeutic resources. This could lead to the development of a golden approach to trauma to optimize outcomes in trauma care. [ABSTRACT FROM AUTHOR]

Der Nachweis von Antiphospholipid-Antikörpern ist nicht nur für die Diagnose, sondern auch für die Risikostratifizierung des Antiphospholipid-Syndroms (APS) unerlässlich. In den letzten Jahren hat sich gezeigt, dass das aPL-Profil das Risiko für thromboembolische und geburtshilfliche Komplikationen bestimmt. Dennoch bleibt die Labordiagnostik trotz kontinuierlicher Bemühungen zur Standardisierung und Harmonisierung eine Herausforderung. [ABSTRACT FROM AUTHOR]

The article focuses on Factor XI (FXI) as a potential target for anticoagulation, shedding light on its role in blood clotting and thrombosis formation. It details the intricate interplay of FXI in the coagulation cascade, emphasizing its activation, physiological regulation, and its implications in both bleeding disorders and thrombotic events. It explores FXI's distinct characteristics, its role in coagulation, and the prospects of inhibiting FXIa for more effective anticoagulant treatments.

The birth of Romanian-language science does not coincide with the birth of the nation and it becomes problematic when trying to define it as a fixed and static cultural concept confined within the national state borders. Oscillating between two main views on "national science" as being a contact point and a separating line between cultural spaces, we will analyse in this article the way in which the Romanian-language science coagulated in scientific schools in the first interwar decades by using French and German models, decanting them and transforming them in a relevant way. We contend that this coagulation of foreign models into a "national" science was not the merit of a coherent central political project but rather a common endeavour of individuals from all cultural centers who actively contributed, through their collaboration and competition, to the participation of Romanian-language science to the international dialogue. [ABSTRACT FROM AUTHOR]

Percutaneous hepatic chemosaturation is a treatment option for unresectable primary or secondary liver tumors. In this procedure the part of the inferior vena cava (VCI) that collects blood from the hepatic veins is isolated using a double balloon catheter. Like this, systemic distribution of the chemotherapeutic agent melphalan which is administered via the hepatic artery can be prevented. After passage through the liver and drainage from the retrohepatic VCI, the chemosaturated blood passes through two extracorporeal filters. Subsequently, the filtered blood is returned via the jugular vein. The procedure is often accompanied by severe hemodynamic instability, the cause of which is still not completely understood. In addition, coagulation management of extracorporeal circulation is often challenging. The authors report a case in which a thrombus formed in the returning leg of the extracorporeal circulation despite sufficient activated clotting time (ACT). Targeted problem search and resolution were necessary simultaneously to hemodynamic stabilization and interdisciplinary collaboration to successfully perform the intervention and provide the patient with safe treatment. [ABSTRACT FROM AUTHOR]

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Intra- und postoperative Gerinnungsstörungen verlangen rasches Handeln auf der Basis von spezifischen Informationen. Die intra-operative Gerinnungsdiagnostik in den Händen von OP-Teams hat in den vergangenen Jahren einen massiven Aufschwung genommen, insbesondere bei Herz-OPs und bei Transplantationen. Durch schnellere und zum Teil bessere Ergebnisse hat sich dabei in verschiedenen Bereichen auch die Therapie verändert. Die interne und externe Qualitätskontrolle sind jedoch noch nicht in allen Aspekten befriedigend. [ABSTRACT FROM AUTHOR]

Die angeborene thrombotisch-thrombozytopenische Purpura (aTTP) ist eine seltene, erbliche Gerinnungsstörung, die durch einen schweren Mangel an ADAMTS131 (eine Protease, die den von-Willebrand-Faktor spaltet) verursacht wird. Das klinische Bild reicht von lebensbedrohlichen hämolytischen Krisen über Symptome der chronischen Anämie und Thrombozytopenie bis zu neurologischen Defiziten. [ABSTRACT FROM AUTHOR]

This article presents the case of a 6-week-old infant who, despite oral vitamin K prophylaxis and otherwise normal developmental progress, suffered a severe intracerebral and subdural hemorrhage, which required surgical evacuation. The interdisciplinary approach is described with emphasis on the management of hemostasis. Furthermore, the clinical picture of intracranial bleeding due to vitamin K deficiency, which is nowadays rare in the Western World, is described in the anesthesiology literature for the first time. The usual recommendations regarding prophylaxis as well as certain risk factors are presented. [ABSTRACT FROM AUTHOR]

Background: In order to ensure evidence-based haemostatic management of postpartum haemorrhage (PPH, blood loss >500 ml) consistent with guidelines appropriate structural conditions must be fulfilled regardless of different levels (1-3) in perinatal care. The aim of the survey was to identify differences in haemostatic management in PPH under consideration of the different levels of perinatal care in Germany.Materials and Methods: An electronic questionnaire assessing the structural and therapeutic preconditions for haemostatic management was sent to 533 anaesthesiology departments serving obstetric units.Results: A total of 156 (29 %) questionnaires returned from hospitals of all levels were analysed. PPH occur in all and increase with higher level hospitals (level 1 <5 PPH/year vs. 3 >30 PPH/year). The percentage of PPH requiring red blood cell (RBC) transfusion amounts to <25 % (all levels). A bleeding history (35 %, all levels), laboratory coagulation tests (29 %, all levels) as well as viscoelastic point-of-care coagulation tests (42 %, mainly level 3) are limited in their availability. Blood loss is usually estimated (99 %, all levels), not measured. Tranexamic acid (>80 %, all levels), fibrinogen (>60 %, all levels) and fresh frozen plasma (FFP) (30 %, level 2a) are first line therapeutics. In level 2b and 3 FFP is a second line therapeutic. RBC transfusion is indicated at haemoglobin <5-7 g/dl (57-69 %, all levels), while 15-29 % in level 3 did not base their decision to transfuse RBC on haemoglobin only.Conclusions: Guideline-consistent haemostatic management of PPH is provided in almost all hospitals independent of the perinatal care level. Deviances from guidelines (measuring blood loss, bleeding history of the patient) affect all levels of perinatal care in Germany. [ABSTRACT FROM AUTHOR]

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Background: Microvascular tissue transfer has become a safe and reliable tool in the reconstructive armamentarium, yielding high success rates. However, little is known about the changes in coagulation after free tissue transfer and their potential impact on morbidity.Methods: Fibrinogen concentration and platelet count among other values were available and assessed in 139 undergoing free tissue transfer before, immediately after, and 1–3 as well as 8–11 days after surgery. In patients undergoing urgent revision for either bleeding or microvascular thrombosis, blood samples were drawn directly before re-exploration. Results: In the patients without any surgical revision and in those with thrombosis of the microvascular pedicle, both fibrinogen concentration and platelet count increased significantly during the early and late post-operative window. Patients that developed bleeding necessitating re-exploration showed an inadequate increase in fibrinogen levels, resulting in significantly lower concentrations compared to the other two groups. There were no significant differences in platelet count or PTT between these groups.Conclusion: Free flap surgery induces acute and subacute changes in coagulation, comparable to other major surgeries and severe injuries. This leads to an increase in platelet count and fibrinogen over the post-operative course. Patients that developed bleeding requiring surgical re-exploration showed an insufficient increase in fibrinogen, resulting in significantly lower fibrinogen levels. Therefore, monitoring and correction of fibrinogen levels might aid in preventing or treating bleeding complications following free flap surgery.

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Die Untersuchungsergebnisse der genetischen Analytik von erblichen Gerinnungsstörungen, wie der hereditären Thrombophilie, bilden die Grundlage für wichtige klinische Entscheidungen, die auf das gesamte Leben des Patienten große Auswirkungen haben. Die Qualitätssicherung ist hier also besonders wichtig: INSTAND e. V. führt Ringversuche zum Mutationsnachweis der Faktoren V und II sowie der Gerinnungsinhibitoren Protein C, Protein S und Antithrombin durch. [ABSTRACT FROM AUTHOR]

The article focuses on measurement of coagulation parameters that is an integral part of the diagnostic portfolio of laboratories of all sizes including examines Roche's own system family for coagulation consisting of cobas t 411, cobas t 511 and cobas t 711 analyzers covers all laboratory sizes.

The article evaluates the two coagulation analyzers CoagL and CoagXL from Diagon which offer small and medium-sized laboratories a modern and economical solution for coagulation diagnostics.

[english] We report on a case of Klippel-Trenaunay syndrome with a histologically diagnosed dedifferentiated angiosarcoma. During operative tumor debulking, a disseminated bleeding developed which required a massive transfusion of red blood cell concentrates and therapeutic plasma. While plasmatic coagulation was within normal range, thromboelastometry showed a distinct hyperfibrinolysis. The bleeding was controlled by prolonged cauterisation and the substitution of tranexam acid as well as fresh frozen plasma. As a result of this treatment, hyperfibrinolysis showed complete restitution within a few hours. Histologically, a malignant peripheral nerve sheat tumor, a dedifferentiated angiosarcoma, a spindle cell sarcoma and an osteosarcoma were diagnosed within the tissue samples.

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The incidence of congenital heart defects (CHD) has remained constant over many years; however, due to improved therapeutic options an increasing number of children and adolescents even with complex heart defects now reach adulthood. The increasing prevalence of adults with persisting or surgically corrected CHD as well as age-dependent non-cardiac comorbidities will increase the need for medical and non-cardiac surgical treatment in this population. Although elective medical care for these patients should be reserved for highly specialized centers, emergency treatment might become necessary in a non-specialized hospital setting as well. Due to the variety and complexity of CHD it is difficult to provide standardized guidelines for the anesthetic management. The treatment of patients with complex CHD requires a profound understanding of the underlying CHD and the current state of the hemodynamics by the anesthesiologist. Furthermore, typical comorbidities, such as chronic heart failure, altered coagulation and arrhythmia also have to be taken into account to ensure successful perioperative treatment. Especially in patients with shunt lesions or passive pulmonary blood flow the anesthetic management often substantially affects the hemodynamics and may be the starting point of severe decompensation. Awareness of anesthesia-induced changes of pulmonary and/or systemic vascular resistance as well as of preload alterations are the basis for successful anesthetic management. Finally, a multidisciplinary approach including cardiologists and radiologists in the planning is absolutely essential to achieve an optimal postoperative result for the patient. [ABSTRACT FROM AUTHOR]

The present article reviews recent progress in the measurement of aggregation rates in colloidal suspensions by light scattering. Time-resolved light scattering offers the possibility to measure absolute aggregation rate constants for homoaggregation as well as heteroaggregation processes. We further discuss the typical concentration dependencies of the aggregation rate constants on additives. Addition of simple salts containing monovalent counterions leads to screening of the electrostatic repulsion of the charged particles and a transition from slow to rapid aggregation. Addition of salts containing multivalent counterions may lead to a charge reversal, which results in a sequence of two instability regions. Heteroaggregation rates between oppositely charged particles decrease with increasing salt level. This decrease is caused by screening of the electrostatic attraction between these particles.

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Objective: Quantitation of D-dimer level during a sickling crisis and its correlation with other clinical abnormalities. Design: Prospective longitudinal study. Setting: Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia. Patients: Adult patients (12 years and older) admitted acutely with a sickle cell crisis who consent to taking part in the study. Candidates may re-participate if they are readmitted with a further acute painful crisis. Results: 36 patients with homozygous sickle cell disease consented to take part in the study. D-dimer levels were raised in 31 (68.9%) of 45 episodes of painful crisis of whom 13 had an abnormal chest X-ray. Of those with a normal chest X-ray only one patient had a raised D-dimer level: sensitivity of 92.3%, specificity 40.6%, positive predictive value 38.7% and negative predictive value of 92.9% for an abnormal chest X-ray. Conclusion: D-dimer levels are frequently raised during an acute painful crisis. A normal level has a high negative predictive value for an abnormal chest X-ray.

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Despite improved strategies in the treatment of polytraumatized patients the mortality rate of severely injured patients remains high. Thus, worldwide 5 million patients die due to trauma or trauma-related complications each year. As the majority of early trauma-related deaths are attributed to or caused by exsanguination the prevention and treatment of coagulopathy is of paramount significance. With the aim of developing guidelines and improve strategies to treat polytraumatized patients the multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2005. Under consideration of new clinical studies, an updated version of the original publication from 2007 has recently been published. Based on a systematic review of published literature the recommendations were formed according to 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE). This publication summarizes the main recommendations with a special emphasis on revisions and new aspects. [ABSTRACT FROM AUTHOR]

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Some new blood products and plasma derivatives have extended the possibilities in hemotherapy to such an extent that the therapeutic and evidence-based therapy options can only really be managed with the aid of guidelines. Four approved plasma preparations are available in Germany: fresh frozen plasma, lyophilized plasma, solvent-detergent (SD) pool plasma and methylene blue-light-treated plasma. Evidence of the clinical efficacy of plasma is mainly based on uncontrolled observational studies, case reports or expert opinion. Plasma is indicated for complex coagulopathy associated with manifest or imminent bleeding, particularly with massive transfusion, disseminated intravascular coagulation and liver disease. With the exception of emergency situations when clotting assay results are not available in time, a clinically relevant coagulopathy must be verified before plasma is administered. The rapid infusion of at least 10 ml of plasma per kg body weight is required to significantly increase the respective clotting factor or inhibitor levels. Prothrombin complex concentrates (PPSB) should be preferred to plasma for the rapid reversal of oral anticoagulation. Side effects of plasma are rare but have to be considered. [ABSTRACT FROM AUTHOR]

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In this review some basic aspects of the clinical presentation, the laboratory testing and the management of a child with a bleeding tendency are discussed. It should help the physician in making the decision whether a laboratory examination in a child with a history of bleedings is necessary or not. In addition, the most frequent mechanisms for a detective hemostasis are explained. [ABSTRACT FROM AUTHOR]

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Obstructive sleep apnoea syndrome (OSAS) is associated with an increased risk for cardiovascular diseases. Question of the study Previous investigations demonstrated a prothrombin activation in patients with untreated OSAS. These patients also had additional concurrent risk factors for prothrombin activation such as hypertension, obesity, diabetes, or coronary artery disease. Therefore, this study investigated the effect of adequate therapy of OSAS on prothrombin activation. Patients and methods In all patients referred to the sleep laboratory with the diagnosis of OSAS after diagnostic polysomnography, levels of prothrombin fragments 1 and 2 (F 1 + 2), thrombin-antithrombin complex (TAT), fibrin monomer and D-dimer were measured. Patients were treated with nasal continuous positive airway pressure (nCPAP). After a treatment period of 4-6 weeks, polysomnography and the coagulation tests were repeated. Results Twenty-three consecutive patients were included in this study (21 male; age: 50.3 ± 11.5 years; BMI: 31.7 ± 5.5 kg/m²). All patients had severe OSAS (AHI: 44.4 ± 26.5/h; desaturation index: 45.3 ± 17.8/h). Sufficient treatment with nCPAP was achieved in all patients (mean CPAP pressure: 7.9 ± 0.6 mbar; daily usage: 6.3 ± 2.1/h; AHI: 3.1 ± 2.3/h; desaturation index: 2.3 ± 1.8/h). On study-inclusion values for F 1 + 2 and TAT were significantly increased. After treatment with nCPAP, a highly significant decrease could be demonstrated (F 1 + 2: 6.55 ± 3.57 vs. 1.85 ± 2.59; TAT: 53.1 ± 16.4 vs. 13.6 ± 18.5; P < 0.001). Fibrin monomer and D-dimers were not detectable at increased levels at any point during the study. Conclusions Patients with OSAS have an increased level of prothrombin activation. This can be reduced significantly with nCPAP therapy. [ABSTRACT FROM AUTHOR]

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Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract., (© 2022. The Author(s).)

Although patients with peripheral arterial disease (PAD) are at a high risk of major bleeding owing to their comorbidity and risk profile, no validated tools exist to predict bleeding risk. To make matters worse, several randomized and controlled trials have excluded patients who are at a high risk of bleeding. Using routine health insurance claims data and machine learning methods, a pragmatic prediction model was developed and internally validated. The OAC 3 -PAD risk score identified eight variables that can predict major bleeding events within 1 year of inpatient treatment for PAD. This risk score can help to carry out a tailored patient-centered risk-benefit assessment in order to obtain the maximum potential from available antithrombotic treatment strategies., (© The Author(s) 2022.)

A 38-year-old patient with cerebral P. falciparum malaria was admitted 12 days after a short trip to Kenya. The serum level of tumor necrosis factor (TNF- α) was elevated (251 pg/ml). In contrast, Protein C (plasma activity 36.1%; antigen concentration 31.7%) and protein C inhibitor 1 (activity 0.55 U/ml) levels were decreased. This suggested a state of functional activation of the clotting system which was confirmed by elevated levels (4.8 ng/ml) of circulating thrombinantithrombin-III-complexes (TAT). Protein S (total and free) and coagulation factor IX levels were within normal range. Under successful antiparasitic therapy, TNF- α as well as protein C and protein C inhibitor 1 levels returned to baseline within one week. In the context of other studies that demonstrate procoagulant effects of TNF- α, it is remarkable that in the case of complicated P. falciparum malaria, an elevated concentration of TNF- α can be paralleled by a decreased plasma level of protein C and an increase in TAT suggesting a procoagulant state. [ABSTRACT FROM AUTHOR]

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