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International Normalized Ratio

Manish Raturi, Shamee Shastry, Mohandoss Murugesan, Poornima B Baliga, Kalyana Chakravarthy
BACKGROUND: Conventional coagulation screening tests such as Prothrombin time, International normalized ratio (INR) and activated partial thromboplastin time are often used to predict bleeding in various clinical situations. We aimed to observe the effect of Fresh-frozen plasma (FFP) on these parameters. Methods: Patients' demographics, pre- and post-transfusion coagulation parameters were noted to assess the level of correction. The magnitude of improvement in INR was determined using the formula given by Holland and Brooks...
January 2018: Asian Journal of Transfusion Science
Lu Zhao, Shanquan Chen, Xiaowei Shi, Hongcui Cao, Lanjuan Li
BACKGROUND: Liver disease is a major cause of death and disability. Mesenchymal stem cells (MSCs) show promise for the treatment of liver disease. However, whether MSC-based therapy is more effective than conventional treatment is unclear, as are the optimal MSC source, the administration frequency, and the most effective MSC delivery route. We therefore undertook a systematic review and meta-analysis of the therapeutic efficacy of MSCs against liver disease and the related factors. METHODS: We systematically searched Medline (PubMed), Cochrane Library, EMBASE, ClinicalTrials...
March 21, 2018: Stem Cell Research & Therapy
Saadia Sherazi, Peter Kouides, Charles Francis, Charles Julian Lowenstein, Majed Refaai, Grace Conley, Brent Alan Johnson, Eugene Muchnik, Susan Lien, Howard Todd Massey, Jeffrey Dean Alexis
BACKGROUND: Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation. METHODS: A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation...
March 1, 2018: International Journal of Artificial Organs
Caitlin S Brown, Wesley R Zemrak, Kaitlin J Dyer, Stephen Rolfe
Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis...
March 20, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Kamal Hassan, Yotam Elimeleh, Mona Shehadeh, Hassan Fadi, Irina Rubinchik
Background: Disturbances in sexual function are common among dialysis patients. Normal erections require a complex balance of physiological, psychological, emotional, hormonal, neurological and vascular factors. This study examined a possible association of overhydration (OH) with male sexual dysfunction and depression in hemodialysis (HD) patients. Patients and methods: This cross-sectional study assessed hydration status by whole-body bioimpedance spectroscopy in patients on maintenance HD for more than 12 months...
2018: Therapeutics and Clinical Risk Management
Kirk R Bingham, Jeffrey B Riley, Gregory J Schears
Anticoagulation during infant-pediatric extracorporeal life support (ECLS) has been a topic of study for many years, but management of anticoagulation is still only partially understood. Adequate anticoagulation during ECLS is imperative for successful outcomes and understanding the individual variables that play part is crucial for properly implementing anticoagulation management strategies. The purpose of our study was to compare the relationships between the variables of activated partial thromboplastin time (aPTT), activated clotting time, international normalized ratio, bleeding, thrombus formation, kaolin + heparinase thromboelastograph alpha angle, kaolin thromboelastograph reaction time (KTEG R-time), heparin dose rates (HDR), antithrombin (AT), anti-Xa, bivalirudin dose rate, argatroban dose rate, interventions, and transfusions...
March 2018: Journal of Extra-corporeal Technology
Danielle Berglund, Varvara Kirchner, Timothy Pruett, Saumya Mangalick, Raja Kandaswamy, Oscar K Serrano, Bradley Benson, Steven Mongin, John Lake, Srinath Chinnakotla
BACKGROUND: Living liver donation is one of the most selfless and humane acts a person can perform. Few single-center reports have been published specifically evaluating complications and quality of life postdonation. STUDY DESIGN: A retrospective analysis of outcomes of 176 living liver donors at our center to determine the incidence, type, and Clavien grade of complications, as well as long-term quality of life RESULTS: Of 176 living donors, 154 underwent right hepatectomy; 4, left-hepatectomy lobectomy; and 18, left lateral segmentectomy...
March 16, 2018: Journal of the American College of Surgeons
Csaba P Kovesdy, Kunihiro Matsushita, Yingying Sang, Nigel J Brunskill, Juan J Carrero, Gabriel Chodick, Takeshi Hasegawa, Hiddo L Heerspink, Atsushi Hirayama, Gijs W D Landman, Adeera Levin, Dorothea Nitsch, David C Wheeler, Josef Coresh, Stein I Hallan, Varda Shalev, Morgan E Grams
Aims: Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results: We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium...
March 14, 2018: European Heart Journal
Katrine Munk Begtrup, Johanne Andersen Hojbjerg, Birgitte Vrou Offersen, Anne-Mette Hvas
Cancer is associated with increased risk of venous thromboembolic disease. Venous thromboembolic disease accounts for a substantial addition to morbidity and mortality rates in cancer patients and is the second leading cause of death in cancer patients, exceeded only by the underlying cancer. Only few previous studies have investigated the influence of radiotherapy on hemostasis and whether radiotherapy in itself causes an increased risk of venous thromboembolic disease. The aim was to investigate if adjuvant radiotherapy affects hemostasis after surgery and chemotherapy in patients with breast cancer...
March 19, 2018: Platelets
Pan Zhao, Li Zang, Xiaoying Zhang, Yafang Chen, Zhijie Yue, Hongliang Yang, Haifeng Zhao, Yong Yu, Yafei Wang, Zhigang Zhao, Yizhuo Zhang, Xiaofang Wang
The objective of the present study was to evaluate the prognostic values of platelet count (PLT) and platelet to lymphocyte ratio (PLR) in diffuse large B-cell lymphoma (DLBCL), creating a novel prognostic scoring system. A total of 309 patients with newly diagnosed DLBCL were retrospectively analyzed. Receiver operating characteristic analysis was used to determine the optimal threshold values for PLT and PLR, which were 250×109 /l and 170, respectively. The patients with PLT ≥250×109 /l and PLR ≥170 experienced significantly decreased overall survival (OS) (P<0...
April 2018: Oncology Letters
Sheylla M Felau, Lucas P Sales, Marina Y Solis, Ana Paula Hayashi, Hamilton Roschel, Ana Lúcia Sá-Pinto, Danieli Castro Oliveira De Andrade, Keyla Y Katayama, Maria Claudia Irigoyen, Fernanda Consolim-Colombo, Eloisa Bonfa, Bruno Gualano, Fabiana B Benatti
Endothelial cells are thought to play a central role in the pathogenesis of antiphospholipid syndrome (APS). Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation has been shown to improve endothelial function in a number of diseases; thus, it could be of high clinical relevance in APS. The aim of this study was to evaluate the efficacy of n-3 PUFA supplementation on endothelial function (primary outcome) of patients with primary APS (PAPS). A 16-week randomized clinical trial was conducted with 22 adult women with PAPS...
2018: Frontiers in Immunology
Hayrullah Yazar, Fatma Özdemir, Elif Köse
BACKGROUND: This study investigated the effects of cooled and standard centrifuges on the results of coagulation tests to examine the effects of centrifugation temperature. METHODS: Equal-volume blood samples from each patient were collected at the same time intervals and subjected to standard (25°C) and cooled centrifugation (2-4°C). Subsequently, the prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer values were determined in runs with the same lot numbers in the same coagulation device using the Dia-PT R (PT and INR), Dia-PTT-liquid (aPTT), Dia-FIB (fibrinogen), and Dia-D-dimer kits, respectively...
March 16, 2018: Acta Haematologica
Jing Li Huang, Theo A Woehrle, Pat Conway, Catherine A McCarty, Madeline M Eyer, Steven D Eyer
PURPOSE: In 2007, Essentia Health St. Mary's Medical Center (SMMC), a Level II trauma center in northeastern Minnesota, implemented a protocol for patients who presented with blunt head trauma and were receiving warfarin for anticoagulation. The purpose of this study was to determine the incidence and risk factors of early delayed, warfarin-associated intracranial hemorrhage (ICH). METHODS: Adult patients with signs and symptoms of head injury on warfarin who were admitted by protocol to SMMC between March 2007 and June 2015 were included...
March 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
D Marshall Brinkley, David DeNofrio, Robin Ruthazer, Amanda R Vest, Navin K Kapur, Gregory S Couper, Michael S Kiernan
BACKGROUND: Since Food and Drug Administration's approval of the HeartMate II left ventricular assist device (LVAD) as destination therapy, the number of hospitals offering LVAD therapy has grown rapidly. A rising number are performed at centers without internal transplant programs. We sought to determine whether outcomes after destination therapy LVAD implantation are similar at transplant and nontransplant centers. METHODS AND RESULTS: Adult recipients of a primary, continuous-flow LVAD as destination therapy between January 2012 and March 2014 from the Interagency Registry for Mechanically Assisted Circulatory Support were included...
March 2018: Circulation. Heart Failure
James B Lilleker, Axel C P Diederichsen, Søren Jacobsen, Mark Guy, Mark E Roberts, Jamie C Sergeant, Robert G Cooper, Louise P Diederichsen, Hector Chinoy
Objectives: Limitations in the methods available for identifying cardiac involvement and accurately quantifying disease activity in the idiopathic inflammatory myopathies (IIMs) may contribute to poor outcomes. We investigated the utility of different serum muscle damage markers [total creatine kinase (CK), cardiac troponin T (cTnT) and cardiac troponin I (cTnI)] to address these issues. Methods: We assessed disease activity and cardiac involvement using the International Myositis Assessment and Clinical Studies Group core set measures in 123 participants with confirmed adult-onset IIM from the UK and Denmark...
March 12, 2018: Rheumatology
Michael Kerin Morgan, Mathew Guilfoyle, Ramez Kirollos, Gillian Z Heller
BACKGROUND: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. OBJECTIVE: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. METHODS: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery...
March 12, 2018: Neurosurgery
Tomohide Yoshie, Toshihiro Ueda, Tatsuro Takada, Shinji Nogoshi, Fumio Miyashita, Satoshi Takaishi, Takayuki Fukano, Daiki Tokuura, Yasuhiro Hasegawa
BACKGROUND: Faster time to recanalization leads to better clinical outcomes in patients treated with endovascular thrombectomy. Whether the association between time to recanalization and clinical outcomes depends on cerebral blood volume (CBV) obtained from pretreatment computed tomography (CT) perfusion (CTP) imaging was investigated. METHODS: In consecutive patients with acute ischemic stroke who achieved recanalization by endovascular thrombectomy for intracranial internal carotid artery or M1 occlusion, the effects on clinical outcome of time to recanalization and the relative CBV value (rCBV) assessed by pretreatment CTP were evaluated...
March 7, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Andreas K Øvlisen, Anders Oest, Mette D Bendtsen, John Bæch, Preben Johansen, Line S Lynggaard, Ingolf Mølle, Thomas B Mortensen, Duruta Weber, Gideon Ertner, Claudia Schöllkopf, Jesper Q Thomassen, Ove Juul Nielsen, Lene Sofie Granfeldt Østgård, Martin Bøgsted, Karen Dybkær, Hans E Johnsen, Marianne T Severinsen
Stringent complete remission (sCR) of acute myeloid leukemia is defined as normal hematopoiesis after therapy. Less sCR, including non-sCR, was introduced as insufficient blood platelet, neutrophil, or erythrocyte recovery. These latter characteristics were defined retrospectively as postremission transfusion dependency and were suggested to be of prognostic value. In the present report, we evaluated the prognostic impact of achieving sCR and non-sCR in the Danish National Acute Leukaemia Registry, including 769 patients registered with classical CR (ie, <5% blasts in the postinduction bone marrow analysis)...
March 13, 2018: Blood Advances
Andrew McPhail, Dominick Jokel
The question of this review is: what is the effectiveness of Kcentra/Beriplex/Confidex compared to plasma for international normalized ratio (INR) reduction in adult patients (18 years and over) on any vitamin K antagonist therapy?
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Joshua D Brown, Amie J Goodin, Gregory Y H Lip, Val R Adams
BACKGROUND: The Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile International Normalized Ratio (INR), Elderly, Drugs or alcohol use (HAS-BLED) score has strong predictive validity for major bleeding complications, but limited validation has been conducted in venous thromboembolism (VTE). This study evaluates the HAS-BLED score in a large cohort of VTE patients. METHODS AND RESULTS: A retrospective cohort of adults ≥18 years with primary diagnosis of VTE between January 1, 2010 and November 31, 2013 were identified in an insurance claims database...
March 7, 2018: Journal of the American Heart Association
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