Search Results (44)

Background/Objectives: Platelet activity contributes to myocardial infarction; inadequate inhibition is a risk factor for stent thrombosis and mortality. Inadequate platelet inhibition during treatment is an important risk factor for stent thrombosis and may be associated with increased mortality. This study assessed platelet and coagulation activity in post-MI patients, identifying parameters associated with adverse ST-elevation myocardial infarction (STEMI) outcomes over 3 years, to identify patients needing intensive secondary prevention. Methods: From 57 admitted patients, 19 STEMI patients were analyzed. Thromboelastography (TEG) and Total Thrombus Formation Analysis System (T-TAS) were used to assess hemostasis and coagulation. Selected laboratory parameters were measured for correlations. Major adverse cardiovascular events (MACEs) were defined as ischemic stroke, myocardial infarction, ischemic heart disease, thrombosis, and death from cardiovascular causes. Results: The group with MACEs was characterized by a faster time to initial clot formation and greater reflection of clot strength. T-TAS parameters, such as area under the curve at 10 min (T-TAS AUC10), showed lower values in the same group of patients. A moderate positive correlation suggested that as white blood cell count increases, T-TAS AUC10 values also tend to increase. A strong negative correlation (rho = −1.000, p < 0.01) was observed between low-density lipoprotein and kinetics in the TEG using the kaolin test at baseline in patients with MACEs. Conclusions: Some of the parameters suggest they are associated with adverse outcomes of STEMI, indicate the existence of an inflammatory state, and may contribute to risk stratification of STEMI patients and identify who will require ongoing monitoring. Full article

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

A series of new isatin hydrazones bearing phosphorus-containing moiety was synthesized through a simple, high-yield and easy work-up reaction of phosphine oxide (Phosenazide) or phosphinate (2-chloroethyl (4-(dimethylamino)phenyl)(2-hydrazinyl-2-oxoethyl)phosphinate, CAPAH) hydrazides with aryl-substituted isatins. The ³¹P NMR technique showed that, in most cases, out of 12 examples in solution, the ratio of the two spatial isomers varied from 1:1 to 1:3. Quantum chemical calculations confirmed the predominance of Z,syn form both in the gas phase and in solution. According to X-ray analysis data in crystals, they exist only in Z,syn form too. Most of the phosphine oxide derivatives and 5-methoxy- and 5-bromoaryl phosphinate analogs exhibit anti-aggregant activity at the level of acetylsalicylic acid but inhibit platelet activation processes more effectively. The 5-chloro type phosphinate derivative exhibits anti-aggregant properties more effectively than acetylsalicylic acid under the conditions of the tissue factor (TF)-activated thromboelastography (TEG) model, the ex vivo thrombosis model. Thus, all the obtained results can become the basis for future pharmaceutical developments to create effective anti-aggregation drugs with broad antithrombotic potential. Full article

During pregnancy and the peripartum period in women, hypofibrinolysis and hypercoagulation minimize excessive hemorrhage risk during parturition. While hypercoagulation is documented in peripartum mares, hypofibrinolysis is not. This study aimed to characterize and compare the fibrinolytic potential of healthy, non-pregnant mares and peripartum mares using tissue-factor (TF)-activated, tissue-plasminogen-activator (tPA)-modified thromboelastography (TEG). TF-activated TEG modified with tPA (500 and 650 U/mL) was performed on plasma samples from 9 pregnant mares at 3, 2, and 1 month pre-partum and 1, 7, and 30 days post-partum, as well as on time-matched samples from 6 non-pregnant mares. At both tPA concentrations, there were relative increases in clot strength [MA] and changes in lysis parameters consistent with hypofibrinolysis (increased CL30 and decreased Ly30) in the pregnant mares compared to the non-pregnant mares. The differences were most frequently detected 1 month pre-partum and at 1 and 7 days post-partum, providing preliminary evidence suggesting pregnant mares are hypofibrinolytic during late gestation and the early post-partum period. However, our small sample size, the unexpected changes in fibrinolysis in the non-pregnant mares over time, and the inconsistent performance of the assay indicate a need for a larger study after further assay optimization to confirm the results. Further investigations of the tPA-modified TEG assay and fibrinolysis in clinical cases are warranted. Full article

Background: Thromboelastography-6s (TEG^®6s), a novel device developed to assess coagulation status, presents advantages such as less frequent calibration, ease of use, and greater stability against movements compared to the previous system (TEG5000). This is the first study in the literature to compare coagulation profiles in the early postoperative period of liver resection (LR) using conventional coagulation tests (CCTs) and TEG^®6s. Methods: Forty-six adult patients admitted to the ICU post-surgery after elective LR for malignancy were included. CCTs were used to classify patients into hypocoagulable (HCG) (platelet count < 80 × 10⁹/L, international normalized ratio ≥ 1.4, or activated partial thromboplastin time > 38 s) and normocoagulable (all other cases) groups. Mann–Whitney tests, Spearman’s correlation, and linear regression were used. Results: On ICU admission, nineteen (41.3%) patients had a hypocoagulable profile based on CCTs, but only two (10.5%) of them were rated as hypocoagulable by TEG (p = 0.165). Intraoperatively, HCG patients experienced higher estimated blood loss (EBL) (p = 0.002); they required more fluids (p = 0.019), and more of them received red blood cell transfusions (p = 0.025). They also had higher postoperative arterial lactate levels (p = 0.036). Postoperative 12 h EBL was similar in the two groups (around 150 mL). The ICU stay was longer for HCG group (p = 0.010). Weak associations were observed between TEG/CCTs measures of coagulation initiation [e.g., between R time citrated rapid TEG, and international normalized ratio (r² = 0.448; p < 0.001)], clot formation [i.e., between conventional fibrinogen value using Clauss method and α-angle citrated rapid TEG (r² = 0.542; p < 0.001)], and clot strength [e.g., between conventional fibrinogen and citrated kaolin maximum amplitude (r² = 0.484; p < 0.001)]. Conclusions: CCTs revealed hypocoagulability that was not confirmed by TEG^®6s. However, the thromboelastography coagulation profile was more consistent with the detected non-relevant postoperative bleeding. Full article

Background and Objectives: Serotonin modulates platelet aggregation and secretion, but its role in hemostasis remains controversial. This study hypothesized that the 5-HT₃ receptor antagonist palonosetron may inhibit platelet function and aimed to evaluate its effects on blood coagulation using thromboelastography (TEG). Materials and Methods: Blood samples from 11 healthy volunteers were treated with palonosetron at concentrations of 25, 250, and 2500 ng/mL. Untreated samples served as controls. Coagulation parameters were assessed using global hemostasis (citrated kaolin, citrated rapid TEG, citrated kaolin with heparinase, and citrated functional fibrinogen) and PlateletMapping (adenosine diphosphate [ADP], arachidonic acid, and others) assays. Results: In the global hemostasis assay, maximum amplitude values, reflecting clot strength, decreased with increasing palonosetron concentrations in all tests, including citrated kaolin (p = 0.031), citrated rapid TEG (p = 0.001), citrated kaolin with heparinase (p = 0.033), and citrated functional fibrinogen (p = 0.011). The PlateletMapping assay showed significant reductions in ADP-induced platelet aggregation (p = 0.001), with the largest inhibition observed at 2500 ng/mL (p = 0.007). Despite these changes, all values remained within normal reference ranges. Conclusions: Palonosetron induces hypocoagulable trends in vitro by inhibiting platelet function and fibrinogen-mediated clot strength. However, these changes are unlikely to result in clinically significant hemostatic impairment when used within therapeutic doses. Further research is warranted to confirm these findings and explore their clinical relevance. Full article

Blood coagulation tests are crucial in the clinical management of cardiovascular diseases and preoperative diagnostics. However, the widespread adoption of existing detection devices, such as thromboelastography (TEG) instruments, is hindered by their bulky size, prohibitive cost, and lengthy detection times. In contrast, magnetoelastic sensors, known for their low cost and rapid response, have garnered attention for their potential application in various coagulation tests. These sensors function by detecting resonant frequency shifts in response to changes in blood viscosity during coagulation. Nevertheless, the frequency-based detection approach necessitates continuous and precise frequency scanning, imposing stringent demands on equipment design, processing, and analytical techniques. In contrast, amplitude-based detection methods offer superior applicability in many sensing scenarios. This paper presents a comprehensive study on signal acquisition from magnetoelastic sensors. We elucidate the mathematical relationship between the resonant amplitude of the response signal and liquid viscosity, propose a quantitative viscosity measurement method based on the maximum amplitude of the signal, and construct a corresponding sensing device. The proposed method was validated using glycerol solutions, demonstrating a sensitivity of 13.83 V⁻¹/Pa^0.5s^0.5Kg^0.5m^−1.5 and a detection limit of 0.0817 Pa^0.5s^0.5Kg^0.5m^−1.5. When applied to real-time monitoring of the coagulation process, the resulting coagulation curves and maximum amplitude (MA) parameters exhibited excellent consistency with standard TEG results (R² values of 0.9552 and 0.9615, respectively). Additionally, other TEG parameters, such as R-time, K-time, and α-angle, were successfully obtained, effectively reflecting viscosity changes during blood coagulation. 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

Ortho-R (ChitogenX Inc., Kirkland, QC, Canada) is an injectable combination drug–biologic product that is used as an adjunct to augment the standard of care for the surgical repair of soft tissues. The drug product comprises lyophilized chitosan, trehalose and calcium chloride, and it is dissolved in platelet-rich plasma (PRP), a blood-derived biologic, prior to injection at the surgical site where it will coagulate. The first step of the Ortho-R manufacturing process involves dissolving the chitosan in hydrochloric acid. The purpose of this study was to investigate the effect of increasing the amount of acid used to dissolve the chitosan on final drug product performance, more specifically, on the chitosan–PRP coagulation kinetics. Chitosans were solubilized in hydrochloric acid, with concentrations adjusted to obtain between 60% and 95% protonation of the chitosan amino groups. Freeze-dried Ortho-R was solubilized with PRP, and coagulation was assessed using thromboelastography (TEG). The clotted mixtures were observed with histology. Clot reaction time (TEG R) increased and clot maximal amplitude (TEG MA) decreased with protonation levels as pH decreased. Chitosan distribution was homogeneous in chitosan–PRP clots at the lowest protonation levels, but it accumulated toward the surface of the clots at the highest protonation levels as pH decreased. These changes in coagulation kinetics, clot strength and chitosan distribution induced by high protonation of the chitosan amino groups were partially reversed by adding sodium hydroxide to the dissolved chitosan component in order to decrease pH. Careful control of manufacturing processes is critical, and it is important to consider the impact of each manufacturing step on product performance. Full article

Background: The early prediction of the need for massive transfusions (MTs) and the preparation of blood products are essential for managing patients with primary postpartum hemorrhage (PPH). Thromboelastography (TEG) enables a thorough evaluation of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. We investigated the role of TEG in predicting the need for MT in patients with primary PPH. Methods: A retrospective observational study was conducted in the emergency department (ED) of a university-affiliated, tertiary referral center between November 2015 and August 2023. TEG was performed upon admission. We defined MT as the requirement for transfusion of more than 10 units of packed red blood cells within the first 24 h. The primary outcome was the need for MT. Results: Among the 184 patients with initial TEG, 34 (18.5%) required MT. Except for lysis after 30 min, the MT and non-MT groups had significantly different TEG values. Based on multivariate analysis, an angle < 60 was an independent predictor of MT (odds ratio (OR) 7.769; 95% confidence interval (CI), 2.736–22.062), along with lactate (OR, 1.674; 95% CI, 1.218–2.300) and shock index > 0.9 (OR, 4.638; 95% CI, 1.784–12.056). Alpha angle < 60 degrees indicated the need for MT with 73.5% sensitivity, 72.0% specificity, and 92.3% negative predictive value. Conclusions: Point-of-care testing of TEG has the potential to be a useful tool in accurately predicting the necessity for MT in ED patients with primary PPH at an early stage. Full article

Centhaquine is a novel vasopressor acting on α2A- and α2B-adrenoreceptors, increasing venous return and improving tissue perfusion. We investigated the effects of centhaquine on blood coagulation in normal state and uncontrolled hemorrhage using ex vivo and in vivo experiments in different species. Thromboelastography (TEG) parameters included clotting time (R), clot kinetics [K and angle (α)], clot strength (MA), and percent lysis 30 min post-MA (LY30). In normal rat blood, centhaquine did not alter R, K, α, MA, or LY30 values of the normal vehicle group or the antithrombotic effects of aspirin and heparin. Subsequently, New Zealand white rabbits with uncontrolled hemorrhage were assigned to three resuscitation groups: Sal-MAP 45 group (normal saline to maintain a mean arterial pressure, MAP, of 45 mmHg), Centh-MAP 45 group (0.05 mg kg⁻¹ centhaquine plus normal saline to maintain a MAP of 45 mmHg), and Sal-MAP 60 group (normal saline to maintain a MAP of 60 mmHg). The Sal-MAP 45 group was characterized by no change in R, reduced K and MA, and increased α. In the Centh-MAP 45 group, TEG showed no change in R, K, and α compared to saline; however, MA increased significantly (p = 0.018). In the Sal-MAP 60 group, TEG showed no change in R, an increase in α (p < 0.001), a decrease in K (p < 0.01), and a decrease in MA (p = 0.029) compared to the Centh-MAP 45 group. In conclusion, centhaquine does not impair coagulation and facilitates hemostatic resuscitation. Full article

Pre-eclampsia (PE) is a placenta-mediated disease and remains a major cause of maternal and neonatal mortality and morbidity. As PE develops, normal pregnancy’s hypercoagulable balance is disrupted, leading to platelet hyperactivation, excessive pathological hypercoagulability, and perturbed fibrinolysis. This narrative review aims to summarize the current knowledge regarding hemostasis in PE compared with healthy gestation and the potential effects of maternal PE on neonatal hemostasis. Finally, it aims to discuss hemostasis assessments for normal pregnancies and PE, emphasizing the role of viscoelastic tests, namely, thromboelastography (TEG) and thromboelastometry (ROTEM), for monitoring PE-associated hemostatic alterations. The use of TEG/ROTEM for assessing the hemostatic profile of PE women has been little considered, even though conventional coagulation tests (CCTs) have not helped to monitor hemostasis in this population. Compared with normal pregnancy, TEG/ROTEM in PE reveals an excessive hypercoagulability analogous with the severity of the disease, characterized by higher-stability fibrin clots. The TEG/ROTEM parameters can reflect PE severity and may be used for monitoring and as predictive markers for the disease. Full article

Hypercoagulability in COVID-19 patients was associated with increased mortality risk during the pandemic. This retrospective, observational study investigated whether the use of a thromboelastography (TEG)-guided anticoagulation protocol could decrease death and bleeding in critically ill COVID-19 patients. A TEG-guided protocol was instituted in one of two intensive care units. Primary outcomes of composite scores were the following: (0) major bleed and death; (1) death without major bleed; (2) major bleed without death; and (3) no bleed or death. Out of 134 patients, 67 in the TEG group were propensity matched to 67 in the comparator group based on age, gender, body mass index, presence of chronic kidney disease, cardiovascular disease, diabetes, and duration of non-invasive ventilation. There were no significant differences in rates of composite outcomes of bleeding or death in patients managed with or without a TEG-guided protocol (p = 0.22, Bowker symmetry testing). Out of the 67 patients in the TEG group, the TEG protocol led to anticoagulation change in 26 patients. Death was lower in this TEG-changed group (54%) compared to the comparator group (81%), although not significant (p = 0.07). TEG-guided protocol use did not reduce composite outcomes of death and bleeding, Future studies may further elucidate potential benefits. Full article

Left ventricular assist device (LVAD) implantation is one of the mechanical circulatory support (MCS) treatments for advanced heart failure (HF) patients. MCS has emerged as a lifesaving therapy that improves patients’ quality of life. However, MCS remains limited by a paradoxical coagulopathy accompanied by thrombosis and bleeding. The mechanisms of MCS thrombosis are increasingly being defined, but MCS-related bleeding, which is related to shear-mediated alteration of platelet function, remains poorly understood. Complications might develop due to the high non-physiological shear stress in the device and as a consequence of individual variability in response to the antithrombotic therapy. Thromboelastography (TEG) and genotyping of gene polymorphisms that are involved in the coagulation cascade and in the metabolism of the antithrombotic therapy might be valuable sources of information for the reduction of complication development. The aim of the study was to identify genetic factors related to the development of device complications according to the implanted LVAD type. We compared the clinical and genetic data of HF patients (n = 98) with/without complications with three types of implanted devices: HeartWare HVAD (HW), HeartMate II (HMII), and HeartMate 3 (HM3). rs9923231 in VKORC1 (95%CI −6.28–0.22, p = 0.04) and rs5918 in ITGB3 genes (95%CI 0.003–4.36, p = 0.05) showed significant association with the TEG coagulation index parameter, which identified hyper- and hypo-coagulation states. The wild genotype of rs5918 in the ITGB3 gene prevailed in patients implanted with HM3 devices, which developed fewer complications than with HMII (p = 0.04). Individual genetic information could be useful in the management of patients with HF and the implantation of MCS to reduce the development of complications. Full article

Platelets play a critical role in blood clotting and the development of arterial blockages. Antiplatelet therapy is vital for preventing recurring events in conditions like coronary artery disease and strokes. However, there is a lack of comprehensive guidelines for using antiplatelet agents in elective neurosurgery. Continuing therapy during surgery poses a bleeding risk, while discontinuing it before surgery increases the risk of thrombosis. Discontinuation is recommended in neurosurgical settings but carries an elevated risk of ischemic events. Conversely, maintaining antithrombotic therapy may increase bleeding and the need for transfusions, leading to a poor prognosis. Artificial intelligence (AI) holds promise in making difficult decisions regarding antiplatelet therapy. This paper discusses current clinical guidelines and supported regimens for antiplatelet therapy in neurosurgery. It also explores methodologies like P2Y12 reaction units (PRU) monitoring and thromboelastography (TEG) mapping for monitoring the use of antiplatelet regimens as well as their limitations. The paper explores the potential of AI to overcome such limitations associated with PRU monitoring and TEG mapping. It highlights various studies in the field of cardiovascular and neuroendovascular surgery which use AI prediction models to forecast adverse outcomes such as ischemia and bleeding, offering assistance in decision-making for antiplatelet therapy. In addition, the use of AI to improve patient adherence to antiplatelet regimens is also considered. Overall, this research aims to provide insights into the use of antiplatelet therapy and the role of AI in optimizing treatment plans in neurosurgical settings. Full article