Humans ; COVID-19 ; Fibrin Fibrinogen Degradation Products ; Blood Coagulation Factors ; Survival Analysis

Progressive hemorrhagic injury (PHI) can be divided into coagulopathy-related PHI and normal coagu- lation PHI. Coagulation disorders after traumatic brain injuries can be included in trauma-induced coagulopathy (TIC). Some studies showed that TIC is associated with PHI and increases the rates of disability and mortality. In this review, we discussed some mechanisms in TIC, which is of great importance in the development of PHI, including tissue factor (TF) hypothesis, protein C pathway and thrombocytopenia. The main mechanism in the relation of TIC to PHI is hypocoagulability. We also reviewed some coagulopathy parameters and proposed some possible risk factors, predictors and therapies.
Blood Coagulation Disorders ; epidemiology ; etiology ; Brain Injuries, Traumatic ; complications ; Cerebral Hemorrhage ; epidemiology ; etiology ; therapy ; Fibrin Fibrinogen Degradation Products ; analysis ; Humans ; Incidence ; Protein C ; physiology ; Risk Factors ; Thromboplastin ; physiology

OBJECTIVETo analyze the coagulation function and relevant factors of adults patients with acute lymphoblastic leukemia treated with pegasparase (PEG-ASP) or L-asaraginase (L-ASP).

METHODSThe clinical features of 153 patients with acute lymphoblastic leukemia (ALL) received L-ASP or PEG-ASP in our hospital from January 2010 to January 2015 year were analyzed retrospectively. Among 153 patients, 108 patients received L-ASP treatment and 45 patients received PEG-ASP treatment. The change of coagulation function and the incidence of complications of 2 treated groups were compared, and the influence of differenent using time of L-ASP on above mentioned factors were analyzed.

RESULTSThe age, sex, white blood cell count (WBC) at diagnosis, subtype and risk factors of disease, total effective rate and complication rates showed no significant difference in the 2 groups (P > 0.05). The total infusion of fresh frozen plasma (FFP), cryoprecipitate and fibrinogen (FIB) also showed no significant difference (P = 0.12, 0.65, 0.09). FIB levels decreased slower after treatment of PEG-ASP (9.49 vs 6.90) (P = 0.000) than that after treatment of L-ASP. When L-ASP used at interval, FIB level decreased slower than that of continuous use. However, the risk of bleeding is higher when used at interval early (P = 0.01, 0.013).

CONCLUSIONUsing PEG-ASP can better monitor the coagulation function than L-ASP. L-ASP used at interval can monitor the coagulation function easily, but its early use may cause an increased incidence of complications.

Adult ; Antineoplastic Agents ; therapeutic use ; Asparaginase ; therapeutic use ; Blood Coagulation ; drug effects ; Fibrinogen ; analysis ; Hemorrhage ; Humans ; Leukocyte Count ; Polyethylene Glycols ; therapeutic use ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: This study investigated whether patients with acute promyelocytic leukemia (APL) truly fulfill the diagnostic criteria of overt disseminated intravascular coagulation (DIC), as proposed by the International Society on Thrombosis and Haemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH), and analyzed which component of the criteria most contributes to bleeding diathesis. METHODS: A single-center retrospective analysis was conducted on newly diagnosed APL patients between January 1995 and May 2012. RESULTS: A total of 46 newly diagnosed APL patients were analyzed. Of these, 27 patients (58.7%) showed initial bleeding. The median number of points per patient fulfilling the diagnostic criteria of overt DIC by the ISTH and the KSTH was 5 (range, 1 to 7) and 3 (range, 1 to 4), respectively. At diagnosis of APL, 22 patients (47.8%) fulfilled the overt DIC diagnostic criteria by either the ISTH or KSTH. In multivariate analysis of the ISTH or KSTH diagnostic criteria for overt DIC, the initial fibrinogen level was the only statistically significant factor associated with initial bleeding (p = 0.035), but it was not associated with overall survival (OS). CONCLUSIONS: Initial fibrinogen level is associated with initial presentation of bleeding of APL patients, but does not affect OS.
Adult ; Aged ; Biomarkers/blood ; Chi-Square Distribution ; Disseminated Intravascular Coagulation/blood/diagnosis/*etiology/mortality ; Female ; Fibrinogen/analysis ; Hemorrhagic Disorders/blood/diagnosis/*etiology/mortality ; Humans ; Kaplan-Meier Estimate ; Leukemia, Promyelocytic, Acute/blood/*complications/diagnosis/mortality ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Young Adult

OBJECTIVE: Through the analysis of coagulation convention and blood routine parameters of sudden hearing loss (SHL) patients, further prove the correlation of sudden deafness and the the inner ear microcirculation, to guide clinical diagnosis and treatment. METHOD: Select 424 patients (448 ears) with sudden deafness in our department to SHL group. According to hearing curve is classified into low intermediate frequency descent group, high frequency drop and full frequency group, and drawing 244 cases in the same period of hospitalization deviated septum, vocal cord polyp patients as control group. All patients' coagulation detection, D-dimer, blood leukocytes, neutrophils and platelet count percentages were analyzed. Then a meaningful factor multivariate Logistic regression analysis was made. RESULT: There was a statistically significant difference between the two groups' prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombin time measurement, fibrinogen, D-dimer, platelet count, white blood cell, neutrophil ratio(P<0.05); Logistic regression analysis showed that the prothrombin, thrombin time measurement, fibrinogen, D-dimer, neutrophil incidence of sudden hearing loss associated risk factors. CONCLUSION SHL in patients with coagulation dysfunction may be involved in the occurrence of SHL development mechanism, and there is a correlation of the SHL and the dysfunction of inner ear microcirculation.
Blood Coagulation Disorders ; complications ; Ear, Inner ; blood supply ; Fibrin Fibrinogen Degradation Products ; analysis ; Fibrinogen ; Hearing Loss, Sudden ; blood ; complications ; Humans ; Incidence ; Risk Factors

OBJECTIVETo study the current situation of coagulation factor VIII (FVIII) inhibitor development in children with hemophilia A (HA) through a cross-sectional survey, and to explore the risk factors of inhibitor development in order to provide evidence for further prevention and management strategies.

METHODThe clinical data of outpatients with hemophilia A in Beijing Children's Hospital seen from November 2012 to May 2013 were collected, FVIII inhibitor was screened and analyzed its risk factors.

RESULTA total of 102 HA children were enrolled, 5 were mild cases, 32 were moderate, and 65 were severe cases; the median age on enrollment was 55.5 (3.0-200.0) months:19(18.6%) of patients had inhibitors and 9 (8.8%) had low-titer inhibitors, 10 (9.8%) had high-titer inhibitors. Receiving FVIII treatment for life-threatening bleeding (P = 0.03) ,OR 4.10 (95%CI:1.17-14.32) was a risk factor for inhibitor generation and patients within 20 exposure days have more chances of inhibitor development (P = 0.04) ,OR 3.32 (95%CI:1.02-10.86) . High and intense FVIII exposure within short term was the risk factor for high titer inhibitor development (P = 0.01) ,OR 5.25 (95%CI:1.45-21.92) .

CONCLUSIONIntense FVIII exposure for severe hemorrhage was the risk factor of inhibitors development especially of high titer inhibitors.

Adolescent ; Blood Coagulation Factor Inhibitors ; blood ; Child ; Child, Preschool ; Cross-Sectional Studies ; Dose-Response Relationship, Drug ; Factor VIII ; administration & dosage ; antagonists & inhibitors ; Female ; Hemophilia A ; blood ; therapy ; Humans ; Infant ; Male ; Multivariate Analysis ; Risk Factors ; Time Factors

PURPOSE: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. MATERIALS AND METHODS: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30% of estimated blood volume), transfusion of packed red blood cell (pRBC) > or =2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). RESULTS: The amount of perioperative blood loss was 937+/-313 mL, 1014+/-340 mL, and 1076+/-383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4%, 4%, and 12%, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC > or =2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52% risk reduction of combined hemorrhagic and ischemic outcomes (95% confidence interval: 0.25-0.92, p=0.027). CONCLUSION: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.
Age Factors ; Aged ; Anastomosis, Surgical ; Blood Loss, Surgical/prevention & control ; Blood Transfusion ; *Coronary Artery Bypass, Off-Pump ; Female ; Heparin/administration & dosage/therapeutic use ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/etiology/prevention & control ; Perioperative Period ; Platelet Aggregation Inhibitors/administration & dosage/*therapeutic use ; Premedication ; Reference Values ; Retrospective Studies ; Sex Factors ; Ticlopidine/administration & dosage/*analogs & derivatives/therapeutic use ; Whole Blood Coagulation Time

This study was designed to investigate the incidence, causes, and outcomes of new-onset thrombocytopenia (NOT) in Korean intensive care units (ICUs). A prospective cohort study was conducted in medical ICUs of Samsung Medical Center between August 2010 and February 2011. All newly admitted patients were included if they stayed in the ICU for more than 48 hr and did not have thrombocytopenia upon admission. A total of 186 patients were included. NOT developed in 37.1%. Most common cause of NOT was sepsis with disseminated intravascular coagulation (66.7%), followed by drug-induced thrombocytopenia (18.8%), and heparin-induced thrombocytopenia (2.9%). IgG-specific antibody to platelet factor 4/heparin was positive in 2.4% among patients treated with heparin, and thrombosis occurred in two patients. Twenty eight-day mortality was higher in patients that developed NOT compared to those that did not develop NOT (39.1% vs 12%, P < 0.001). NOT increased the odds ratio of 28-day mortality and was an independent risk factor for mortality (OR 3.52; 95% CI 1.32-9.38; P = 0.012). In conclusion, NOT is common and is an independent risk factor for mortality in Korean ICU patients. Therefore, clinicians should make every effort to correct the causes of NOT.
Aged ; Cohort Studies ; Disseminated Intravascular Coagulation/complications ; Female ; Heparin/immunology ; Hospitals ; Humans ; Immunoglobulin G/blood ; Incidence ; Intensive Care Units ; Male ; Middle Aged ; Odds Ratio ; Platelet Factor 4/immunology ; Prognosis ; Prospective Studies ; Republic of Korea ; Risk Factors ; Sepsis/complications ; Survival Analysis ; Thrombocytopenia/*epidemiology/etiology/mortality ; Thrombosis/etiology

This study was designed to investigate the incidence, causes, and outcomes of new-onset thrombocytopenia (NOT) in Korean intensive care units (ICUs). A prospective cohort study was conducted in medical ICUs of Samsung Medical Center between August 2010 and February 2011. All newly admitted patients were included if they stayed in the ICU for more than 48 hr and did not have thrombocytopenia upon admission. A total of 186 patients were included. NOT developed in 37.1%. Most common cause of NOT was sepsis with disseminated intravascular coagulation (66.7%), followed by drug-induced thrombocytopenia (18.8%), and heparin-induced thrombocytopenia (2.9%). IgG-specific antibody to platelet factor 4/heparin was positive in 2.4% among patients treated with heparin, and thrombosis occurred in two patients. Twenty eight-day mortality was higher in patients that developed NOT compared to those that did not develop NOT (39.1% vs 12%, P < 0.001). NOT increased the odds ratio of 28-day mortality and was an independent risk factor for mortality (OR 3.52; 95% CI 1.32-9.38; P = 0.012). In conclusion, NOT is common and is an independent risk factor for mortality in Korean ICU patients. Therefore, clinicians should make every effort to correct the causes of NOT.
Aged ; Cohort Studies ; Disseminated Intravascular Coagulation/complications ; Female ; Heparin/immunology ; Hospitals ; Humans ; Immunoglobulin G/blood ; Incidence ; Intensive Care Units ; Male ; Middle Aged ; Odds Ratio ; Platelet Factor 4/immunology ; Prognosis ; Prospective Studies ; Republic of Korea ; Risk Factors ; Sepsis/complications ; Survival Analysis ; Thrombocytopenia/*epidemiology/etiology/mortality ; Thrombosis/etiology

OBJECTIVETo study the hemostatic effect of chemical constituents from Callicarpa nudiflora.

METHODThe chemical constituents were isolated and purified via silica gel and Sephadex LH-20 column chromatography. Their structures were determined on the basis of spectral analysis. prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) of the constituents rabbit blood samples were tested with rabbit blood in vitro.

RESULTEleven compounds were isolated and identified as two diterpenens: 7alpha-hydroxy sandaracopimaric acid (1), 16, 17-dihydroxy-3-oxophyllocladane (2). Two phenoic glycosides: acteoside (3), samioside(4). Three triterpenes: 2alpha, 3alpha, 24-trihydroxy-ursa-12-en-28-oic acid (5), 2alpha, 3alpha, 19alpha-trihydroxyursa-12-en-28-oic acid-28-0-beta-D-glucopyranosyl ester (6), and 2alpha, 3alpha, 19alpha, 23-tetrahydroxy-ursa-12-en-28-oic acid-28-0-beta-D-glucopyranosyl ester (7). Four flavones: rhamnazin (8), 5-Hydroxy-3, 7, 4'-trimethoxy-flavone (9) , 5-Hydroxy-3, 7, 3', 4'-tetramethoxyflavone (10), and luteoloside (11). All Compounds cannot significantly shorten the PT (P < 0.01), compounds 3, 4, 7, 10 can remarkedly increase APTT (P < 0.01), compound 5 can prolong the T( P < 0.01) obviously, and compound 8 can significantly increase the contents of FIB (P < 0.01).

CONCLUSIONCompounds 2, 4 and 10 were isolated from this genus for the first time, and compounds 1, 3, 5, 6, 7 and 9 had been isolated from this plant for the first time. The hemostatic effect of C. nudiflora may be related to the activation of the intrinsic blood coagulation system.

Animals ; Blood Coagulation Factors ; metabolism ; Callicarpa ; chemistry ; Hemostasis ; drug effects ; Male ; Organic Chemicals ; analysis ; pharmacology ; Rabbits