An Algorithmic Approach to Coagulation Testing

Klein, Kimberly; Hartman, Sarah K.; Teruya, Jun; Hui, Shiu‐Ki Rocky

doi:10.1016/j.disamonth.2012.04.006

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…Moreover, several studies have shown no change in the management plans of their patients despite the abnormal or normal coagulation profles that were seen among their patients [9,10]. Te cost-efectiveness of coagulation profle testing in the ED has been investigated in many studies and several international committees do not encourage pre-procedure or pre-operative coagulation profle tests [20][21][22][23][24]. We suggest that a coagulation testing policy based on clinical presentation (active bleeding or bruising, stroke, or a condition necessitating anticoagulation), risk factors (known bleeding disorder, anticoagulants intake, and liver disease) is needed.…”

Section: Discussionmentioning

confidence: 99%

Are We Overusing Coagulation Studies in the Emergency Department?

Alyahya,

Alalshaikh,

Alkhulaif

et al. 2024

Emergency Medicine International

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Background and Objectives. Blood tests are often indiscriminately requested in the Emergency department (ED) and many EDs have preset orders that are usually performed at triage before clinical assessment to improve the flow of patients through the department. We conducted this study to evaluate the frequency of requests for coagulation profile, the incidence of abnormal coagulation profiles and the unnecessary use of coagulation profile testing in our institution. Methods. This retrospective observational study, conducted in the ED of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, during July and August of 2021(2 months) examined coagulation profile requests. Patients’ demographic data (age and gender), medical and clinical history (presenting complaint, comorbidities, and diagnosis), the use of antiplatelets or anticoagulant agents and laboratory values for PT, APTT, and INR were collected. We calculated the total cost of unnecessary coagulation profile testing based on the independent assessment of two ED consultants. Results. Of 1,754 patients included in the study, 811 (46.2%) were males and 943 (53.8%) were females, with a mean age of 42.1 ± 18.5 years. There were 29 (1.7%) patients with liver disease and 21 (1.2%) patients had thromboembolic disease. The majority of the patients’ results were within normal levels of PT (n = 1,409, 80.3%), APTT (n = 1,262, 71.9%), and INR (n = 1,711, 97.4%). Evidence of active bleeding was detected in 29 patients (1.7%). Among patients with bleeding only one had an abnormal INR (3.01) and was on warfarin. Forty-six (2.6%) patients had elevated INR level. Cohen’s kappa between the two consultants was recorded at 0.681 (substantial agreement) in their assessment of the appropriateness of coagulation tests requests and both consultants believed that 1,051 tests (59.9%) were not indicated and were unnecessary. The expected annual cost saving if the unnecessary tests were removed would be around SAR 1,897,200 (approximately US$ 503,232) which is about SAR 180000 (US$ 48000)/1000 patients. Conclusion. This study showed that coagulation tests are overused in the ED. More than half of coagulation profile tests in our study population were deemed unnecessary and associated with significant cost. Targeted testing based on specific patient presentation and medical history can guide physicians in wisely choosing who needs coagulation studies.

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Section: Discussionmentioning

confidence: 99%

Are We Overusing Coagulation Studies in the Emergency Department?

Alyahya,

Alalshaikh,

Alkhulaif

et al. 2024

Emergency Medicine International

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show abstract

“…Upon damage to vascular endothelial cells, collagen exposure, release of von Willebrand factor (vwf), and tissue factors jointly initiate the coagulation system. Coagulation is a complicated process that includes three enzyme-catalyzed reaction cascades: intrinsic, extrinsic, and common (Figure 2) (Chapin & Hajjar, 2015;Klein et al, 2012) (Undas & Ariëns, 2011;Ząbczyk & Undas, 2017). Subsequently, in the presence of thrombin and factor XIII, the fibrils spontaneously cluster into reticular soluble proteins and adhere to activated platelets in the injured blood vessels to form a firm thrombus.…”

Section: Fib Rinog En and Mechanis M Of Thrombus Formationmentioning

confidence: 99%

“…Upon damage to vascular endothelial cells, collagen exposure, release of von Willebrand factor (vwf), and tissue factors jointly initiate the coagulation system. Coagulation is a complicated process that includes three enzyme‐catalyzed reaction cascades: intrinsic, extrinsic, and common (Figure 2 ) (Chapin & Hajjar, 2015 ; Klein et al, 2012 ). Activation of the intrinsic pathway of coagulation is triggered by collagen exposed to the endothelium, converting inactivated coagulation factor XII to activated XIIa and consequently activating factor XI to XIa.…”

Section: Fibrinogen and Mechanism Of Thrombus Formationmentioning

confidence: 99%

Research progress on the fibrinolytic enzymes produced from traditional fermented foods

Wang

Peng

Xie

et al. 2023

Food Science & Nutrition

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Cardiovascular diseases (CVDs) are a global health problem and leading cause of death worldwide. Thrombus formation, one of the CVDs, is essentially the formation of fibrin clots. The existing thrombolytic agents have the disadvantages of high price, short half‐life, and high bleeding risk; hence, there is an urgent need to find the alternative thrombolytic agents. In recent years, traditional fermented foods have been widely investigated for their outstanding effects in the prevention and treatment of thrombus formation. In this review, we have focused on fibrinolytic enzymes produced by microorganisms during the fermentation of traditional fermented foods and their potential use for treating CVDs. First, we discussed about the sources of fibrinolytic enzymes and microbial strains that produce those enzymes followed by the optimization of fermentation process, purification, and physicochemical properties of fibrinolytic enzymes. Finally, we have summarized the thrombolytic effects of fibrinolytic enzymes in humans and mice. Fibrinolytic enzymes produced by microorganisms during the fermentation of traditional fermented foods not only lyse thrombi but also acts as anti‐atherosclerotic, anti‐hyperlipidemia, and neuroprotection agents. Therefore, fibrinolytic enzymes from traditional fermented foods have great potential for the prevention and treatment of CVDs.

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An Algorithmic Approach to Coagulation Testing

Cited by 2 publications

References 8 publications

Are We Overusing Coagulation Studies in the Emergency Department?

Are We Overusing Coagulation Studies in the Emergency Department?

Research progress on the fibrinolytic enzymes produced from traditional fermented foods

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