Search Results (83)

Patient blood management (PBM) is a multidisciplinary approach aimed at improving patient outcomes through targeted anemia treatment that minimizes allogeneic blood transfusions, employs blood conservation techniques, and avoids inappropriate use of blood product transfusions. Viscoelastic testing (VET) techniques, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), have led to significant advancements in PBM. These techniques offer real-time whole-blood assessment of hemostatic function. This provides the clinician with a more complete hemostasis perspective compared to that provided by conventional coagulation tests (CCTs), such as the prothrombin time (PT) and the activated partial thromboplastin time (aPTT), which only assess plasma-based coagulation. VET does this by mapping the complex processes of clot formation, stability, and breakdown (i.e., fibrinolysis). As a result of real-time whole-blood coagulation assessment during hemorrhage, hemostasis can be achieved through targeted transfusion therapy. This approach helps fulfill an objective of PBM by helping to reduce unnecessary transfusions. However, challenges remain that limit broader adoption of VET, particularly in hospital settings. Of these, standardization and the high cost of the devices are those that are faced the most. This discussion highlights the potential of VET application in PBM to guide blood-clotting therapies and improve outcomes in patients with coagulopathies from various causes that result in hemorrhage. Another aim of this discussion is to highlight the limitations of implementing these technologies so that appropriate measures can be taken toward their wider integration into clinical use. Full article

The hemostatic system in the newborn is a complex entity, characterized by dynamism in its development; therefore, the correct measurement of its potential is challenging. In this narrative review, we analyzed the current knowledge of the “developmental hemostasis” of the newborn; we also studied the performance of routine coagulation tests in its evaluation, with considerations about the establishment of neonatal age-specific normal ranges and about the role of preanalytical variables, in particular, hematocrit (which could represent an important cause of error); we also focused on the increasing importance of viscoelastic coagulation tests, which are becoming increasingly widespread (especially in some settings such as intensive care unit) and are able to quickly provide information about the hemostatic function of the newborn, even if they lack adequate standardization in the neonatal period. Full article

Post-acute sequelae of COVID-19 have been associated with an elevated risk of thromboembolism and adverse cardiovascular events (CVEs). We aim to evaluate whether alterations in poorly studied hemostatic and endothelial proteins are associated with CVEs in patients previously admitted to the ICU and evaluated one year post-discharge. We carried out a cross-sectional study involving 63 COVID-19 patients previously admitted to the ICU one year post-discharge. Plasma levels of factor IX (coagulation factor), protein C, protein S (natural anticoagulant), and von Willebrand factor (VWF, an endothelial marker) were measured using a Luminex 200™ analyzer. Generalized linear models (GLMs) were used to assess the association of these coagulation proteins with CVEs and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We found that lower levels of factor IX (p = 0.011), protein C (p = 0.028), and protein S (p = 0.008) were associated with CVEs one year after ICU discharge. Additionally, at the one-year follow-up, we found lower levels of factor IX (p = 0.002) and higher levels of VWF (p = 0.006) associated with higher levels of NT-proBNP, underscoring the involvement of both hemostatic imbalance and persistent endothelial dysfunction. Our findings revealed a gender-specific pattern of associations with NT-proBNP levels. These findings highlight the significant role of persistent hemostatic imbalance and endothelial dysfunction in the development of cardiovascular abnormalities among COVID-19 survivors discharged from the ICU. Full article

Pulmonary hemorrhage (PH) is a life-threatening complication predominantly affecting preterm infants, particularly those with very low birth weight (VLBW) and fetal growth restriction (FGR). Typically occurring within the first 72 h of life, PH is characterized by acute respiratory deterioration and significant morbidity and mortality. This review synthesizes current evidence on the multifactorial pathogenesis of PH, highlighting the roles of immature pulmonary vasculature, surfactant-induced hemodynamic shifts, and left ventricular diastolic dysfunction. Key risk factors include respiratory distress syndrome (RDS), hemodynamically significant patent ductus arteriosus (hsPDA), sepsis, coagulopathies, and genetic predispositions. Diagnostic approaches incorporate clinical signs, chest imaging, lung ultrasound, and echocardiography. Management strategies are multifaceted and include ventilatory support—particularly high-frequency oscillatory ventilation (HFOV)—surfactant re-administration, blood product transfusion, and targeted hemostatic agents. Emerging therapies such as recombinant activated factor VII and antifibrinolytics show promise but require further investigation. Preventive measures like antenatal corticosteroids and early indomethacin prophylaxis may reduce incidence, particularly in high-risk populations. Despite advancements in neonatal care, PH remains a major contributor to neonatal mortality and long-term neurodevelopmental impairment. Future research should focus on individualized risk stratification, early diagnostic tools, and optimized treatment protocols to improve outcomes. Multidisciplinary collaboration and innovation are essential to advancing care for this vulnerable population. Full article

Background/Objectives: Cirsium setosum (commonly known as thistle) is a traditional Chinese medicinal plant with significant therapeutic potential, exhibiting hemostatic, antioxidant, and wound-healing properties. Electrospinning offers a versatile platform for fabricating nanoscale scaffolds with tunable functionality, making them ideal for drug delivery and tissue engineering. Methods: In this study, a bioactive extract from thistle was obtained and incorporated into a thermosensitive triblock copolymer (PNNS) and polycaprolactone (PCL) to develop a multifunctional nanofibrous scaffold for enhanced wound healing. The prepared nanofibers were thoroughly characterized using Fourier-transform infrared spectroscopy (FTIR), contact angle measurements, thermogravimetric analysis (TGA), and tensile fracture testing to assess their physicochemical properties. Results: Notably, the inclusion of PNNS imparted temperature-responsive behavior to the scaffold, enabling controlled deformation in response to thermal stimuli—a feature that may facilitate wound contraction and improve scar remodeling. Specifically, the scaffold demonstrated rapid shrinkage at a physiological temperature (38 °C) within minutes while maintaining structural integrity at ambient conditions (20 °C). In vitro studies confirmed the thistle extract’s potent antioxidant activity, while in vivo experiments revealed their effective hemostatic performance in a liver bleeding model when delivered via the composite nanofibers. Thistle extract and skin temperature-responsive contraction reduced the inflammatory outbreak at the wound site and promoted collagen deposition, resulting in an ideal wound-healing rate of above 95% within 14 days. Conclusions: The integrated strategy that combines mechanical signals, natural extracts, and electrospinning nanotechnology offers a feasible design approach and significant technological advantages with enhanced therapeutic efficacy. Full article

This study employs layer-by-layer self-assembly technology to develop novel antibacterial hemostatic microspheres to tackle significant blood loss and related complications resulting from accidents, surgeries, and natural disasters. By measuring the zeta potential and particle size of protamine, carboxymethyl starch (CMS), and hydroxypropyl trimethyl ammonium chloride chitosan (HACC), the optimal assembly conditions were determined. The optimal pH for the monolayer assembly is 3.0, with a CMS concentration of 3 mg/mL and a mass ratio of 1:4 between protamine and CMS, and the assembly process lasts for 2 h. The optimal assembly conditions for the bilayer assembly are a pH of 4.0, an HACC concentration of 1 mg/mL, and a mass ratio of the one-layer assembly to HACC of 1:2. The performance of the assembled microspheres was analyzed via antibacterial and coagulation experiments, revealing excellent antibacterial and coagulation effects, with inhibition rates against Escherichia coli and Bacillus subtilis both exceeding 99%, and a coagulation index of 0%. Additionally, the bilayer assembled microspheres also exhibited strong adsorption capacity and good biocompatibility. In summary, this study provides important scientific evidence for the development of new hemostatic materials, demonstrating significant clinical application potential. Full article

Background: Hydrogen peroxide (H₂O₂) is a well-known hemostatic and antiseptic agent in neurosurgical practice. While there are concerns regarding the use of H₂O₂ due to its potential for neuronal damage, the pathophysiological effect on neuronal cells is not clearly understood. Methods: An online survey concerning the use of H₂O₂ was conducted in a board-certified platform, and an experimental study was designed to investigate the effect of H₂O₂ on neuronal and tumor cells. Brain tissues of mice and brain/tumor tissues of humans were irrigated with H₂O₂ 3%, H₂O₂ 1.5%, and NaCl 0.9%, and processed by bipolar coagulation. Tissue sections were obtained and stained with H&E and analyzed by the depth and degree of neuronal damage measured from the cortical surface (μm). Results: In total, 242 neurosurgeons participated in the survey, and 81% of neurosurgeons reported use of H₂O₂ in neurosurgical practice. however only 5% of the participants had a literature-based knowledge of the pathophysiological mechanism of H₂O₂. In total, eight mouse brain tissues, 21 human brain tissues, and seven human tumor tissues were processed and analyzed. The experimental study found that H₂O₂ caused vacuolization of neuronal tissue in mouse brain tissues, with a mean depth of damage of 343.7 ± 39.7 μm after 2 min and 460.1 ± 36.4 μm after 10 min exposure to H₂O₂ 3% (p < 0.001). In human brain tissues, vacuolization was detected in sections exposed to H₂O₂ 1.5% and 3%, with a mean depth of damage of 543.8 ± 304.5 μm and 859.0 ± 379 μm (p = 0.003). In the bipolar coagulation group, the mean depth of neuronal damage, of 2504 ± 1490 μm, was nearly three times greater than that in the H₂O₂ group (p < 0.001). Similar results were observed in human tumor tissues as well. Conclusions: H₂O₂ seems to cause less local damage on neuronal and tumor cells than conventional bipolar cauterization, suggesting it as a good alternative to be used for hemostasis and marginal tumor cell treatment. However, due to its potential risk for embolism, H₂O₂ should be used with caution. Full article

Background/Objectives: The regeneration of the facial nerve using low-level laser therapy (LLLT) has been infrequently reported. Polydeoxyribonucleotides (PDRNs), a blend of short deoxyribonucleotide polymers known for their non-toxic and non-allergic properties, are recognized as a stimulator of cell growth that enhances cell proliferation and supports wound healing. This study investigates the synergistic effect of the topical sustained release of PDRN/F-127 and LLLT on facial nerve regeneration following crush injury-induced paralysis in rats. Methods: The main trunk of the facial nerve was compressed for 1 min using a hemostat. Animals were divided into five groups: a control group (n = 4), group I (Pluronic F-127 only, n = 4), group II (Pluronic F-127/PDRN, n = 4), group III (Pluronic F-127 + LLLT, n = 4), and group IV (Pluronic F-127/PDRN + LLLT, n = 4). We measured the recovery of vibrissa fibrillation, action potential, and facial nerve blood flow (FNBF). Results: Group IV exhibited a comparatively faster development of vibrissa fibrillation over time than the other groups. After the intervention, significant differences in vibrissa fibrillation values were observed at all time points (p = 0.0028) according to the repeated one-way ANOVA. Regarding the threshold of action potential, all five groups revealed a significant difference (one-way ANOVA, p < 0.0001; multiple comparisons via Tukey’s test). Among the groups, group IV showed a significantly reduced threshold of action potential compared to the other groups. Group IV showed the most notable recovery in FNBF compared to the other groups. One-way ANOVA showed a significant difference (p < 0.0001; multiple comparisons by Dunnett’s test). Conclusions: These findings suggest that PDRN and LLLT may work together synergistically to enhance peripheral nerve regeneration. Future studies should investigate the underlying molecular mechanisms and evaluate the potential clinical applications of this combined treatment strategy. Full article

Phlomoides rotata, a traditional medicinal plant, always grows on the Tibetan Plateau at a high altitude of 3100–5200 m. The major active ingredients in P. rotata were used in medicines due to their diverse pharmacological effects, including hemostatic, anti-inflammatory, antitumor, immuno-modulatory, and antioxidant activities. This study screened 15 top endophytic genus through the analysis of OTUs and the top 30 metabolites with relatively high content in P. rotata roots from four different habitats (HN, GL, YS, and CD regions) in Qinghai Province. Twelve physicochemical indicators were measured and analyzed in the rhizosphere soils of P. rotata habitats. The results indicated that the top 30 metabolites compounds included 7 amino acids, 5 sugars and alcohols, 4 phenylpropanoids, 3 Organic acids, and 3 Alkaloids. Four endophytic bacteria (Acidibacter, Sphingomonas, Variovorax, and Sphingobium) and three endophytic fungi (Tetracladium, Cadophora, and Minimelanolocus) were dominant genera in P. rotata roots from four habitats. There were 109 positive significant correlations and 57 negative correlations between OTUs of endophytic bacteria and contents of top 30 metabolites, and 59 positive significant correlations and 58 negative correlations between OTUs of endophytic fungus and contents of top 30 metabolites. The OTUs of Acidibacter were significantly positively correlated with the content of 5 soil physicochemical indicators (total phosphorus, amylase, sucrase, total potassium, or soil organic carbon) and significantly negatively correlated with the content of acid protease. OTUs of Tetracladium or Cadophora showed a positive correlation with the content of total phosphorus and a negative correlation with that of alkaline phosphatase. This study provides a theoretical basis for the study of the correlation between endophytes and metabolites in P. rotata roots. Full article

Background: Sepsis is a major cause of patient death in intensive care units (ICUs). Rapid diagnosis of sepsis assists in optimizing treatments and improves outcomes. Several biomarkers are employed to aid in the diagnosis, prognostication, severity grading, and sub-type discrimination of severe septic infections (SSIs), including current diagnostic parameters, hemostatic measures, and specific organ dysfunction markers. Methods: This study involved 129 critically ill adults categorized into three groups: sepsis (Se = 48), pneumonia (Pn = 48), and Se/Pn (33). Concentrations of five plasma markers (IL-6, IL-8, TREM1, uPAR, and presepsin) were compared with 13 well-established measures of SSI in critically ill patients. These measures were heart rate (HR), white blood count (WBC), C-reactive protein (CRP), procalcitonin (PCT), lactate plasma concentrations, and measures of hemostasis status (platelets count (PLT), fibrinogen, prothrombin time (PT), activated partial thromboplastin time (APTT), international normalization ratio (INR) and D-dimer). Plasma bilirubin and creatinine served as indicators of liver and kidney dysfunction, respectively. Results: Promising roles for these biomarkers were found. The best results were for presepsin, which scored 10/13, followed by IL-6 and IL-8 (each scored 7/13), and the worst were for TREM-1 and uPAR (scored 3/13). Presepsin, IL-6, and IL-8 discriminated between the SSI sub-types, whilst only presepsin correlated with bilirubin and creatinine. uPAR was positive for kidney dysfunction, and TREM-1 was the only indicator of artificial ventilation (AV). Conclusions: Presepsin is an important potential biomarker in SSIs. However, further work is needed to define this marker’s diagnostic and prognostic cutoff values. Full article

Background/Objectives: This systematic review evaluates the effectiveness of various hematological treatment protocols and local hemostatic measures in preventing oral bleeding and other complications during and after dental treatments in children with inherited bleeding disorders and inhibitors. Methods: This study was registered in the PROSPERO database. The comprehensive search strategy for this systematic review was conducted across five databases, namely, PubMed, Google Scholar, Web of Science, Scopus, and Cochrane Library. The search was aimed at identifying relevant literature published from January 2000 up to February 2024. Eligible studies included those with various designs, such as randomized controlled trials (RCTs), observational studies, cohort studies, case–control studies, and cross-sectional studies. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, treatment protocols, local measures, complications, and outcomes was collected. Results: The systematic review included a total of five studies, encompassing participants ranging from ages of 2 to 18 years. These studies varied in their scope, with some focusing on hemophilia A with inhibitors while others addressed broader inherited bleeding disorders. The interventions examined included various prophylactic and treatment measures such as Emicizumab, recombinant factor VIIa, and local hemostatic measures. The study outcomes primarily assessed the efficacy of these interventions in preventing postoperative bleeding and improving quality of life. Emicizumab has significantly shifted the treatment paradigm for children with inherited bleeding disorders and inhibitors. This prophylactic treatment has been associated with a marked reduction in the frequency of bleeding episodes, fewer hospital admissions for bleeding management, and enhanced participation in daily activities. Conclusions: This review highlights gaps in the management of dental care in children with inherited bleeding disorders and inhibitors. It underscores the need for standardized protocols that integrate new prophylactic treatments such as Emicizumab. Our findings suggest that adopting updated protocols can significantly reduce bleeding complications during dental procedures. Full article

Objectives: To compare post-operative bleeding measures in patients who underwent prostatic artery embolization (PAE) prior to water-jet ablation (aquablation) vs. water-jet ablation alone. Methods: A retrospective review identified 145 patients treated with water-jet ablation for benign prostatic hyperplasia from December 2018 to June 2021. Patients were divided into two groups: water-jet ablation alone (n = 56) vs. pre-operative PAE and water-jet ablation (n = 89). Patient demographics, pertinent laboratory values, operative reports, and hospital courses were reviewed. Results: PAE was technically successful in all patients (n = 89), and all 89 patients underwent successful water-jet ablation within a median time of 2 days. Compared to water-jet ablation alone, pre-operative PAE resulted in a significant reduction in post-operative bleeding as measured via lower rates of continuous bladder irrigation, hemostatic measures, and hematuria. Pre-operative PAE was also associated with lower rates of post-operative urinary retention (odds ratio 17, p = 0.02) and less likely to require reoperation 30 days after the procedure (p = 0.003). There were no major PAE-related adverse events reported in the combination arm. Conclusions: Compared to water-jet ablation alone, pre-operative PAE resulted in fewer bleeding-related complications and urinary retention. Full article

Liver transplantation is a complex surgical procedure in which various forms of coagulation dysfunction can occur, including perioperative hypercoagulability. The hemostasis balance in liver graft recipients with end-stage liver disease can shift to thrombosis or haemorrhage, depending on the associated risk factors and clinical conditions. Hypercoagulability can result in serious complications such as thromboembolism, which can affect the vessels of the newly transplanted liver graft. Standard coagulation tests (SCTs), such as prothrombin time and activated partial thromboplastin time (aPTT), have a poor ability to diagnose and monitor an early stage of hypercoagulability. Recent studies demonstrated that viscoelastic hemostatic elastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are promising alternative tools for diagnosing hypercoagulability disorders. VETs measure clotting and clot formation time, clot strength (maximum clot firmness), fibrin and platelet contribution to clot firmness, and fibrinolysis, which makes them more sensitive in identifying liver graft recipients at risk for thrombosis as compared with SCTs. However, developing evidence-based guidelines for the prophylaxis and treatment of hypercoagulability based on VET results is still needed. Full article

Background: Anticoagulant drugs are a valuable tool for minimizing thrombotic risks in at-risk patients. The purpose of this study is to conduct a literature review highlighting the management of these drugs during daily clinical dental practice. Materials and Methods: We limited our search to English-language papers published between 1 January 1989, and 7 March 2024, in PubMed, Scopus and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords “anticoagulant AND dentistry” were used. Results: Twenty-five clinical trials were included for final review from 623 articles obtained from the databases Web of Science (83), PubMed (382), and Scopus (158), eliminating duplicates and 79 off-topic items, resulting in 419 articles after removing 315 entries and confirming eligibility. Overall, these studies support the use of local hemostatic measures to manage the risk of bleeding in patients on anticoagulant therapy undergoing dental procedures and highlight the importance of greater education and collaboration among healthcare professionals. Conclusions: Research and clinical investigation have improved understanding and management of dental procedures in patients undergoing anticoagulant or antiplatelet therapy. Hemostatic agents, clinical protocols, risk factors, and continuous education are essential for navigating the complexities of anticoagulant therapy, ensuring optimal outcomes and enhancing patient well-being. Full article

Background/Objectives: FVIII reagent activity varies across different assays, as well as activated partial thromboplastin time (APTT) reagents. The hemostatic ability of various FVIII reagents was examined via clot waveform analysis (CWA). Methods: APTT was measured using 12 APTT reagents, a small amount of tissue factor-induced FIX activation (sTF/FIXa) and a small amount of thrombin time (sTT) in order to examine 10 FVIII reagents and reference plasma (RP) using CWA. FVIII activity was measured using CWA-APTT, a chromogenic assay, or CWA-sTT. Results: Although the peak time (PT) and peak height (PH) of the CWA-APTT were markedly different in different FVIII reagents using several APTT reagents, the PTs of CWA-APTT were generally normal or shortened and the PHs of CWA-APTT were generally lower than those of RP. The FVIII activity varied, as evaluated using APTT, and was higher when using the CWA-sTT method than the APTT or chromogenic methods. CWA-sTT showed an elevated second peak of first DPH in all FVIII reagents, and both CWA-sTF/FIXa and CWA-sTT were enhanced using APTT reagents. Conclusions: Our evaluation of the hemostatic ability of FVIII reagents varied among APTT reagents. CWA-sTT can be used to further evaluate the hemostatic ability of an FVIII concentrate based on thrombin burst. Full article