BackgroundCatecholamine infusion elicits an increase in clotting factors and this increase has been attributed to stimulation of β2-adrenorecptors (β2AR). Accordingly, we tested the hypothesis that inhalation of a short-acting selective β2AR agonist can induce a procoagulant state in healthy individuals.MethodsWe recruited 23 healthy volunteers (nine females; mean age: 26±0.8 years; body mass index: 24.7±0.5 kg/m2) and randomly allocated them into two groups, the β2AR arm (seventeen subjects) and the saline arm (six subjects). Hemodynamics, plasma norepinephrine concentration, and procoagulant, anticoagulant, and fibrinolytic profiles of each participant were determined using specific assays before and after inhalation of either 2 mL nebulized normal saline or a mixture of 1 mL saline and 1 mL of salbutamol (5 mg salbutamol sulfate), a selective β2AR agonist, which were delivered by a nebulizer over ten minutes.ResultsSaline inhalation had no effect on the procoagulant, anticoagulant and fibrinolytic profiles of the six healthy volunteer in the study's saline arm. Salbutamol inhalation caused (a) a significant increase in the activity or levels of the procoagulant factors; FVIII increased by 11±3% (p = 0.04), von Willebrand factor increased by 7±1% (p = 0.03), and (b) a significant decrease in the activated partial prothrombin time from 27.4±0.4 seconds to 25.5 ±0.5 seconds (p<0.001) in the 17 volunteers in the study's β2AR arm. D-dimer and prothrombin fragments F1+2 were elevated by 200 ±90% and 505.0 ±300.0%, respectively. In addition, the activity of the anticoagulant protein C pathway (demonstrated by the protein C Global assay) decreased from 1.0±0.08 to 0.82±0.06 (p<0.001). Although plasma levels of tissue plasminogen activator decreased, all other indices of the fibrinolytic system did not change following salbutamol inhalation.ConclusionWe found that a single inhalation of salbutamol, a short-acting β2AR agonist, activates the clotting system without affecting the fibrinolytic system. This induction of a procoagulant state in healthy subjects warrants further investigation in patients treated with these agents.

Objective Studies have demonstrated an association between ABO blood type and bleeding status. The aim of this analysis was to determine whether O blood type is associated with higher early postpartum hemorrhage (PPH) risk as compared to other blood types. Study design In this retrospective case-control study, data was gathered form 4,516 deliveries occurring at our institution between 2014 and 2016. Cases were categorized into one of two groups according to women’s major blood type (O or non-O), and thereafter according to minor blood type (RH positive or negative). The primary outcome was early PPH which was further stratified by clinical severity according to the decrement in hemoglobin concentration after delivery. Categorical variables were compared using the χ2 test while continuous variables were compared using the student's t-test. All data were further analyzed using a stepwise logistic regression model. Results 1,594 (35.3%) of 4,516 women included in this analysis had O blood type. Early PPH occurred in 44 women (2.7%) with O blood type and 65 women (2.22%) with other blood types. O blood type was not associated with an increased risk for early PPH (OR 1.24, 95% CI 0.84–1.82, P = 0.275). This lack of association remained unchanged after stratification by PPH severity. There was also no significant association between Rh blood type and the risk for early PPH (OR 0.97, 95% CI 0.44–1.4, P = 0.422). Conclusions In this cohort, O blood type was not associated with an increased risk for early PPH.

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