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Hyperfibrinolysis

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https://www.readbyqxmd.com/read/28219085/fibrinolysis-in-trauma-myth-reality-or-something-in-between
#1
Mark Walsh, Jacob Shreve, Scott Thomas, Ernest Moore, Hunter Moore, Daniel Hake, Tim Pohlman, Patrick Davis, Victoria Ploplis, Andres Piscoya, Julie Wegner, John Bryant, Anton Crepinsek, James Lantry, Forest Sheppard, Francis Castellino
The emphasis on fibrinolysis as an important contributor to trauma-induced coagulopathy (TIC) has led to a debate regarding the relative clinical significance of fibrinolysis in the setting of trauma. The debate has centered on two camps. The one camp defines fibrinolysis in trauma by standard coagulation tests as well as fibrin split products, D-dimers, and plasmin/antiplasmin levels. This camp favors a more liberal use of tranexamic acid and attributes more significance to hyperfibrinolysis in TIC. The other camp favors a definition of fibrinolysis based on the viscoelastic tests (VET), rotational thromboelastometry (ROTEM), and thromboelastography (TEG)...
March 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28219084/diagnosis-and-treatment-of-hyperfibrinolysis-in-trauma-a-european-perspective
#2
Lewis S Gall, Karim Brohi, Ross A Davenport
Fibrinolysis activation occurs almost universally after severe trauma. Systemic hyperfibrinolysis is a key component of acute traumatic coagulopathy and associated with poor clinical outcomes, although controversy exists over optimal treatment strategies. The mechanistic drivers and dynamics of fibrinolytic activation in response to injury and trauma resuscitation are currently unclear. Furthermore, therapeutic triggers are compounded by the lack of a sensitive and rapid diagnostic tool, with discrepancy between hyperfibrinolysis diagnosed by viscoelastic hemostatic assays versus biomarkers for fibrinolysis...
March 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28210886/the-use-of-frozen-plasma-samples-in-thromboelastometry
#3
Christian Schoergenhofer, Nina Buchtele, Michael Schwameis, Johann Bartko, Bernd Jilma, Petra Jilma-Stohlawetz
Thromboelastometry is increasingly used in the clinical and scientific setting. The use of frozen plasma samples may be useful in overcoming certain limitations such as local and timely availability. Whole blood (WB) samples of 20 healthy volunteers were obtained, and plasma was generated. NATEM (n = 20), EXTEM (n = 20) and INTEM (n = 8) analyses were performed in WB, fresh plasma and frozen and thawed plasma. Dabigatran (500, 1000 ng/ml), rivaroxaban (100, 200 ng/ml) or alteplase (333 ng/ml) were added ex vivo to WB, and thromboelastometry was performed in WB and in frozen and thawed plasma samples...
February 16, 2017: Clinical and Experimental Medicine
https://www.readbyqxmd.com/read/28184955/-tranexamic-acid-in-the-german-emergency-medical-service-a%C3%A2-national-survey
#4
V Zickenrott, I Greb, A Henkelmann, F Balzer, S Casu, L Kaufner, C von Heymann, K Zacharowski, C F Weber
BACKGROUND: Trauma-induced coagulopathy, one of the leading causes of trauma-related death, is detected in about one of four trauma patients upon hospital admission. The current European Management of Major Bleeding and Coagulopathy Following Trauma guidelines, published in 2013, recommend that tranexamic acid (TXA) be administered as early as possible to inhibit hyperfibrinolysis (grade of recommendation (GoR 1A)). Furthermore, it is suggested that protocols for the management of patients with bleeding or showing signs of bleeding include the administration of the first dose of TXA at the site of injury or during transportation to hospital (GoR 2C)...
February 9, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28166379/reference-values-for-rotational-thromboelastometry-rotem-in-clinically-healthy-cats
#5
Charlotte Marly-Voquer, Barbara Riond, Rahel Jud Schefer, Annette P N Kutter
OBJECTIVE: To establish reference intervals for rotational thromboelastometry (ROTEM) using feline blood. DESIGN: Prospective study. SETTING: University teaching hospital. ANIMALS: Twenty-three clinically healthy cats between 1 and 15 years. INTERVENTION: For each cat, whole blood was collected via jugular or medial saphenous venipuncture, and blood was placed into a serum tube, a tube containing potassium-EDTA, and tubes containing 3...
March 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28129263/tissue-injury-suppresses-fibrinolysis-after-hemorrhagic-shock-in-nonhuman-primates-rhesus-macaque
#6
Antoni R Macko, Hunter B Moore, Andrew P Cap, M Adam Meledeo, Ernest E Moore, Forest R Sheppard
BACKGROUND: Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, whereas tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a nonhuman primate (NHP) model. METHODS: NHPs were randomized to three injury groups (n = 8/group): 60 minutes severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++)...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28097681/thromboelastography-in-dogs-with-chronic-hepatopathies
#7
W Fry, C Lester, N M Etedali, S Shaw, A DeLaforcade, C R L Webster
BACKGROUND: The coagulation status of dogs with liver disease is difficult to predict using conventional coagulation testing. HYPOTHESIS/OBJECTIVES: To evaluate thromboelastography (TEG) results and associations with conventional coagulation results and indicators of disease severity and prognosis in dogs with chronic hepatopathies (CH). ANIMALS: Twenty-one client-owned dogs. METHODS: Dogs with CH were prospectively (10 dogs) and retrospectively (11 dogs) enrolled from 2008 to 2014...
March 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/27975099/paradoxical-bleeding-and-thrombotic-episodes-of-dysprothrombinaemia-due-to-a-homozygous-arg382his-mutation
#8
Qiulan Ding, Likui Yang, Xiaoqing Zhao, Wenman Wu, Xuefeng Wang, Alireza R Rezaie
We have characterised the pathogenic basis of dysprothrombinaemia in a patient exhibiting paradoxical bleeding and thrombotic defects during pregnancy and postpartum. Genetic analysis revealed that the proband is homozygous for the prothrombin Arg382His mutation, possessing only ~1 % clotting activity. The proband experienced severe bleeding episodes during her pregnancy, which required treatment with prothrombin complex concentrates, and then pulmonary embolism and deep-vein thrombosis at 28 days postpartum, which required treatment with LMWH and fresh frozen plasma...
February 28, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27940454/acute-traumatic-coagulopathy-pathophysiology-and-resuscitation
#9
J W Simmons, M F Powell
Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27913736/additional-effects-of-topical-tranexamic-acid-in-on-pump-cardiac-surgery
#10
RANDOMIZED CONTROLLED TRIAL
Noppon Taksaudom, Sophon Siwachat, Apichat Tantraworasin
Objective Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. Methods From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only...
January 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27890816/pathophysiology-of-hemophilic-arthropathy-and-potential-targets-for-therapy
#11
REVIEW
Astrid E Pulles, Simon C Mastbergen, Roger E G Schutgens, Floris P J G Lafeber, Lize F D van Vulpen
Hemophilia is a congenital clotting factor deficiency characterized by spontaneous and trauma-related bleeding. Spontaneous bleeding shows a predilection for joints, and repeated hemarthroses lead to a disabling condition called hemophilic arthropathy. Treatment of this condition consists of preventing joint bleeding on the one hand and orthopedic surgery as a last resort on the other. Up till now, there is no disease modifying therapy available to fill the gap between these extremes. This review provides an overview of the pathogenesis of hemophilic arthropathy in order to identify potential targets for therapy...
January 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#12
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27824218/coagulopathy-in-sepsis-a-new-look-at-an-old-problem
#13
REVIEW
Małgorzata Lipinska-Gediga
Sepsis is a life-threatening condition characterized by a systemic response to microbial infection. Despite considerable progress in intensive care medicine, the incidence of sepsis and the number of sepsis-related deaths are increasing world-wide. There is a complex relationship between the coagulation, immune and inflammatory systems in sepsis. Activation of the coagulation cascade in sepsis is a result of a pathogen invasion and is a part of a immuno-inflammatory host response. In sepsis, the close cooperation of the immune and coagulation systems through cross signalling results in immunothrombosis...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27805439/effect-of-aminocaproic-acid-on-clot-strength-and-clot-lysis-of-canine-blood-determined-by-use-of-an-in-vitro-model-of-hyperfibrinolysis
#14
Jamie C Brown, Benjamin M Brainard, Daniel J Fletcher, Ben Nie, Robert D Arnold, Chad W Schmiedt
OBJECTIVE To determine pharmacodynamic and pharmacokinetic profiles of aminocaproic acid (ACA) by use of a thromboelastography (TEG)-based in vitro model of hyperfibrinolysis and high-performance liquid chromatography-mass spectrometry. ANIMALS 5 healthy adult dogs. PROCEDURES A single dose of injectable ACA (20, 50, or 100 mg/kg) or an ACA tablet (approximately 100 mg/kg) was administered orally. Blood samples were collected at 0, 15, 30, 45, 60, 90, 120, and 240 minutes after ACA administration for pharmacokinetic analysis...
November 2016: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/27779597/abnormalities-in-fibrinolysis-at-the-time-of-admission-are-associated-with-deep-vein-thrombosis-mortality-and-disability-in-a-pediatric-trauma-population
#15
Christine M Leeper, Matthew D Neal, Christine McKenna, Jason L Sperry, Barbara A Gaines
BACKGROUND: Abnormalities in fibrinolysis are common and associated with increased mortality in injured adults. While hyperfibrinolysis (HF) and fibrinolysis shutdown (SD) are potential prognostic indicators and treatment targets in adults, these derangements are not well described in a pediatric trauma cohort. METHODS: This was a prospective analysis of highest level trauma activations in subjects aged 0 to 18 years presenting to our academic center between June 1, 2015, and July 31, 2016, with admission rapid thrombelastograph...
January 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27779595/sympathoadrenal-activation-and-endotheliopathy-are-drivers-of-hypocoagulability-and-hyperfibrinolysis-in-trauma-a-prospective-observational-study-of-404-severely-injured-patients
#16
Sisse R Ostrowski, Hanne H Henriksen, Jakob Stensballe, Mikkel Gybel-Brask, Jessica C Cardenas, Lisa A Baer, Bryan A Cotton, John B Holcomb, Charles E Wade, Pär I Johansson
BACKGROUND: One third of severely injured patients present with a laboratory-based diagnosis of coagulopathy. This study investigated clinical and biomarker profile of patients with rapid thrombelastography (rTEG) coagulopathy, hypothesizing that sympathoadrenal activation and endothelial damage were drivers of this condition. METHODS: Prospective observational study of 404 trauma patients admitted to a Level 1 US Trauma Center. Patients with admission rTEG and plasma measurements of catecholamines (adrenaline, noradrenaline) and biomarkers reflecting endothelial activation/damage (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin, nucleosomes) were included...
February 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27765582/major-liver-resection-systemic-fibrinolytic-activity-and-the-impact-of-tranexamic-acid
#17
Paul J Karanicolas, Yulia Lin, Jordan Tarshis, Calvin H L Law, Natalie G Coburn, Julie Hallet, Barto Nascimento, Janusz Pawliszyn, Stuart A McCluskey
BACKGROUND: Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs during liver resection. Tranexamic acid (TXA) is an antifibrinolytic agent that decreases bleeding in various settings, but has not been well studied in patients undergoing liver resection. METHODS: In this prospective, phase II trial, 18 patients undergoing major liver resection were sequentially assigned to one of three cohorts: (i) Control (no TXA); (ii) TXA Dose I - 1 g bolus followed by 1 g infusion over 8 h; (iii) TXA Dose II - 1 g bolus followed by 10 mg/kg/hr until the end of surgery...
December 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/27724970/the-pre-hospital-administration-of-tranexamic-acid-to-patients-with-multiple-injuries-and-its-effects-on-rotational-thrombelastometry-a-prospective-observational-study-in-pre-hospital-emergency-medicine
#18
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27716278/a-systematic-review-on-the-rotational-thrombelastometry-rotem%C3%A2-values-for-the-diagnosis-of-coagulopathy-prediction-and-guidance-of-blood-transfusion-and-prediction-of-mortality-in-trauma-patients
#19
REVIEW
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27680483/utility-of-measurement-of-serum-lactate-in-diagnosis-of-coagulopathy-associated-with-peripheral-circulatory-insufficiency-retrospective-evaluation-using-thromboelastometry-from-a-single-center-in-japan
#20
Hiroyuki Koami, Yuichiro Sakamoto, Ryota Sakurai, Miho Ohta, Akiko Goto, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura, Kosuke Chris Yamada, Satoshi Inoue
Recently, serum lactate level rather than systolic blood pressure (sBP) has been widely used to diagnose peripheral circulatory insufficiency, which often leads to coagulopathy with systemic inflammation. However, most of the reported disorders were examined by plasma samples. The aim of this study was to evaluate the utility of serum lactate for detecting coagulopathy with circulatory failure by using thromboelastometry as well as standard coagulation test. 192 adult patients transported to our hospital between January 2013 and September 2014 were enrolled in this retrospective study...
2016: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
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