No Abstract available.
Thrombelastography*

Introduction: Type 2 DM (T2DM) is associated with inflammation and vascular dysfunction which impact hemostasis. Thromboelastography (TEG) as a hemostasis assessment method, is not routinely applied in T2DM. Methodology: A cross-sectional study was conducted among T2DM patients attending the Endocrinology Clinic of Saiful Anwar Hospital, Indonesia. Glycemic profiles were determined using fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG), and glycosylated hemoglobin (HbA1c). Therapy for T2DM was classified into insulin and non-insulin regimens. The primary and secondary hemostasis profile were examined using TEG and was classified as hypo- hyper- and normo-coagulable states. Result: A total of 57 T2DM patients were included. Kruskal-Wallis test did not reveal a significant association between glycemic profiles and groups of hemostasis. However, the median HbA1c was higher in the hypercoagulable group of primary hemostasis and fibrinolysis. The median FPG and 2hPPG were higher in the normo-coagulable group of secondary hemostasis. Logistic regression did not indicate a significant association between type of therapy for diabetes and hemostasis profile. Conclusion This study did not find significant associations between glycemic levels and type of DM therapy with hemostasis profiles using the TEG method in patients with T2DM.
Diabetes Mellitus ; Thrombelastography ; Hemostasis

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. METHODS: Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography (TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. CONCLUSIONS: Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.
Blood Coagulation ; Hemodilution* ; Humans ; Thrombelastography

BACKGROUND: Thromboelastography (TEG) measures the viscoelastic properties of clotting blood, displaying a visual trace of all phases of coagulation and fibrinolysis. When performing a TEG, it is commonly recommended to store whole blood at 37oC with only a 3-6 min delay after sampling. However, it is difficult to actually keep this recommend time and temperature. The purpose of this study is to investigate the effects on TEG by inadvertent technical errors due to inappropriate measurement time and temperature. METHODS: Twenty healthy male volunteers were studied. TEG measurements were performed at: stat, 4 min, and 8 min at room temperature, and 4 min and 8 min at 37 degrees C. Parameters used were: reaction time (R), clot formation time (K), maximal amplitude (MA), clot formation velocity (alpha-angle), clot lysis 60 min (LY60) and TEG index. RESULTS: When compared with the routine recommendation, 4 min lag time at 37 degrees C, R and K were shortened and alpha angle and LY60 were increased at 8 min after the sample. However, temperature differences did not significantly affect TEG parameters. CONCLUSIONS: Inappropriate measurement temperature does not result in significant changes of TEG parameters, but, delayed storage resulted in a false hypercoagulation state and increased fibrinolysis.
Fibrinolysis ; Humans ; Male ; Reaction Time ; Thrombelastography ; Volunteers

A fifty five-year-old man who had been decrease in levels of coagulation factors V, VIII, X and XI was monitored by thromboelastography(TEG) to evaluate the effectiveness of blood component replacement therapy during operation of chest wall reconstruction. Cryoprecipitate(9 units) was infused in the preoperative day because the clot formation rate was slow( : 27.5 ). During the operation cryoprecipitate(9 units), fresh frozen plasma(9 units), whole blood(2 units) and packed red blood cells(6 units) were transfused for blood loss of 4000 ml and abnormal findings on TEG. The operation site was not abnormal bleeding tendency. So TEG patterns were normal toward the end of operation. As a result, TEG is effective to monitor hemostasis and guide for transfusion therapy of coagulation abnormalities associated with intraoperative blood loss.
Blood Coagulation Factors ; Hemorrhage ; Hemostasis ; Humans ; Thoracic Wall ; Thrombelastography*

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and it may induce some degree of coagulation impairment. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution with several solutions. METHODS: Sixty healthy patients were randomly allocated to six groups according to experimental solution, and each group contained 10 patients. Whole blood was diluted by 0%, 10%, 25%, 50% with 0.9% normal saline, 4% modified fluid gelatin, 10% pentastarch, 10% dextran 40 and two brands of 6% hydroxyethyl starchs (Salinehes(R) , HAES-steril(R) ). At each dilution, thromboelastographic parameters {(r, k, alpha angle, maximum amplitude (MA)} were measured using thromboelastography (TEG) and were compared with those of an undiluted specimen obtained concurrently from the same patients. RESULTS: Hemodilutions of 25% and 50% with 0.9% normal saline decreased r and k times, and increased alpha angle but there was no difference in MA. Hemodilutions of 10% and 25% with modified gelatin solution did not change the parameters. However, 50% hemodilution of the gelatin solution decreased the k time and increased alpha angle. Hemodilutions of more than 10% with 10% pentastarch increased the k time, decreased alpha angle and MA. Hemodilutions of more than 10% with 10% dextran 40 increased r and k times, and decreased alpha angles and MA according to the quantities of this dilutional solution. Hemodilutions of more than 25% with 10% dextran 40 increased k times above 400%. Hemodilutions of more than 10% of 6% HES (Salinehes(R) , M.W: 70,000 dalton) decreased MA. Hemodilutions of more than 10% of 6% HES (HAES-steril(R) , M.W: 200,000 dalton) decreased the alpha angle. CONCLUSIONS: 25% and 50% hemodilutions of 0.9% normal saline induce a hypercoagulable state, but hemodilutions of more than 10% with each colloid solution decreased coagulability of whole blood according to the degree of dilution, except in the case of modified fluid gelatin solution. Hemodilutions of more than 25% with 10% dextran 40 induce a severe coagulation impairment.
Colloids ; Dextrans ; Gelatin ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Starch ; Thrombelastography*

BACKGROUND: To avoid the risks associated with transfusion of homologous blood products, artificial colloid solutions represent an alternative for intra-operative blood loss replacement. However, synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. We investigated the effect of Hydroxyethyl starch (HES) on blood coagulation in vitro under thromboelastography (TEG). METHODS: Whole blood was withdrawn from fifteen volunteers undergoing peripheral surgery who had no history of coagulation defect. Whole blood was diluted with HES to 25, 50 and 75 vol% concentrations, and the changes in coagulation status were analysed using TEG and were compared with those of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilution with HES solution at 50 vol% concentration decreased the MA and alpha angle values (P < 0.05), but the R and K values remained unchanged. In case of profound hemodilution at a 75 vol% concentration, the values of MA and alpha angle were severely decreased (P < 0.05) and the values of R and K were severely increased (P < 0.05). CONCLUSIONS:There were many reports that moderate hemodilution with crystalloids increased coagulability, but hemodilutions up to 50 vol% concentration with HES solution did not significantly change blood coagulability. Significant hypocoagulability occurred at a 75 vol% hemodilution with HES.
Blood Coagulation ; Colloids ; Hemodilution ; Humans ; Starch* ; Thrombelastography* ; Volunteers

OBJECTIVE: To assess the changes in the coagulation profiles of patients with chronic kidney disease (CKD) using thromboelastography (TEG) and identify the risk factors of hypercoagulation in CKD patients. METHODS: A total of 128 patients with CKD admitted in Hunan Provincial People's Hospital between August, 2018 and May, 2019 were recruited. The results of conventional coagulation test and TEG were compared between patients with CKD and 21 healthy control adults. The patients with CKD were divided into hypercoagulation group with a maximum amplitude (MA) > 68 mm (=66) and non-hypercoagulation group (MA≤68 mm, =62). The laboratory indicators were compared between the groups, and the factors affecting the hypercoagulable state in patients with CKD were analyzed. RESULTS: The levels of fibrinogen and D-Dimer increased significantly in patients with CKD at different stages as compared with the control subjects ( < 0.05). In the patients with CKD, the reaction time and K time decreased while MA, α-angle and coagulation index increased significantly in patients in stage 3-4 and those in stage 5 either with or without hemodialysis compared with the control group ( < 0.05). The estimated glomerular filtration rate (eGFR), percentage of patients with diabetes mellitus, history of stroke, percentage of neutrophils, neutrophil-lymphocyte ratio, red blood cell count, hemoglobin levels, platelet count, serum creatinine, serum cystatin-C, serum albumin, and lipoprotein (a) all differed significantly between hypercoagulation group and non-hypercoagulation group ( < 0.05). The eGFR, platelet count and hemoglobin levels were identified as independent factors affecting hypercoagulability in patients with CKD ( < 0.05). CONCLUSIONS s The hypercoagulable state of patients with CKD worsens gradually with the disease progression, and eGFR, platelet count and hemoglobin levels are all risk factors for the hypercoagulable state in patients with CKD.
Blood Coagulation ; Humans ; Renal Insufficiency, Chronic ; Risk Factors ; Thrombelastography ; Thrombophilia

OBJECTIVE: To explore the effects of hematocrit (HCT) on the parameters of thromboelastography (TEG) in healthy adults, so as to judge coagulation and fibrinolysis more accurately. METHODS: Three hundred and ninety-three healthy adults examined in Chengdu 363 Hospital Affiliated to Southwest Medical University from May 2018 to May 2019 were selected. HCT and TEG were detected at the same time. The differences of TEG parameters between the high HCT group and the low HCT group were compared. The correlation between HCT and TEG parameters was analyzed. The differences of TEG parameters between the healthy adults in Plateau and plain areas were compared. RESULTS: Among the parameters of TEG, R and K in high HCT group were significantly higher, and Angle, MA and CI were significantly lower than those in low HCT group, which showed statistically significance (P<0.05). There was no significant difference in LY30 and EPL between the two groups (P>0.05). R and K positively correlated with HCT (r=0.112, 0.517, P=0.027, 0.000), and Angle, MA and CI negatively correlated with HCT (r=-0.490, -0.408, -0.414, P=0.000). LY30 and EPL not correlated with HCT (P>0.05). HCT in plateau area was significantly higher than that in plain area (P<0.05). Among the parameters of TEG, K value was significantly higher, and Angle, MA and CI were significantly lower than those in plain area (P<0.05). R, LY30 and EPL were not significantly different from those in plain area (P>0.05). CONCLUSION The difference of HCT may affect the values of R, K, Angle, MA and CI in TEG parameters. R and K positively correlate with HCT, while Angle, MA and CI negatively correlate with HCT. It is suggested that a suitable TEG reference range for the local population should be established, in plateau area especially K, Angle, MA and CI, which will be more conducive to the accurate evaluation of patients' coagulation and fibrinolysis status.
Adult ; Blood Coagulation ; Hematocrit ; Humans ; Reference Values ; Thrombelastography

BACKGROUND: Prophylactic administration of tranexamic acid (TA) reduces bleeding and transfusion requirement after open heart operations. This study was performed to determine the relationship between inhibition of fibrinolysis and TA blood concentration. METHOD: In phase I, recombinant tissue plasminogen activator[r-tPA (0, 50, 100, 150 ng/ml)] was added to the blood of volunteer and induced fibrinolysis. In phase II, 4 thromboelastography (TEG) models of severe fibrinolysis in which TA was added to achieve blood levels (0, 0.72, 1.44, 2.88 mg/ml) were compared to determine the lowest effective dose. In phase III, the lowest dose (0.72 mg/ml) was mixed with the blood and evaluated on TEG in open heart operation. In phase IV, a placebo group and study group receiving TA in an loading dose of 5 mg/kg before bypass following infusion of 2 mg/kg/hour. Used analysis is Mann Whitney U test and Wilcoxon rank signed test. RESULT: In phase I, fibrinolytic inhibition at A30/MA (r=0.752) and A60/MA (r=0.735) were linearly correlated with the blood r-tPA concentration. In phase II, severe fibrinolysis (r-tPA 100 ng/ml) was reversed completely at all doses of TA. In phase III, the fibrinolysis index at 10 min. after starting bypass, aorta declamping, and 1 hour after operation were improved when the patient's blood was treated with TA (0.72 mg/ml). In phase IV, blood treated with TA showed less fibrinolysis and better TEG results than the placebo group. CONCLUSION: A small dose of TA (5 mg/kg), which was determined by an in vitro model of fibrinolysis on TEG, was effective in preventing changes in fibrinolytic index during cardiopulmonary bypass in open heart surgery.
Aorta ; Cardiopulmonary Bypass ; Fibrinolysis* ; Heart* ; Hemorrhage ; Plasminogen ; Thoracic Surgery* ; Thrombelastography* ; Tranexamic Acid* ; Volunteers