Heparin-like Effect Associated With Risk of Bleeding, Sepsis, and Death in Patients With Severe Alcohol-Associated Hepatitis

Premkumar, Madhumita; Bihari, Chhagan; Saxena, Priyanka; Devurgowda, Devaraja; Vyas, Tanmay; Mirza, Roshni; Jain, Priyanka; Kumar, Guresh; Bhatia, P.; Baweja, Sukriti; Choudhury, Ashok; Sarin, Shiv Kumar

doi:10.1016/j.cgh.2019.04.057

Cited by 17 publications

(14 citation statements)

References 24 publications

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“… 15 , 16 Sonoclot profiling has been used to create and implement individualized peri-operational anticoagulation and antiplatelet remedies in patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention. 17 Sonoclot signature analysis has greater sensitivity in monitoring coagulation factors and platelet function in patients with coronavirus disease (COVID-19), 18 severe alcohol-associated hepatitis, 19 and ICU point-of-care coagulation testing. 20 Thromboelastography is a dependable scheme for evaluating coagulability during sepsis and trauma; 21 however, Sonoclot characterization is superior to thromboelastography with respect to hypercoagulable state sensitivity, 22 practical cost, and usability.…”

Section: Introductionmentioning

confidence: 99%

Sonoclot Signature Analysis: A New Point-of-Care Testing Method for Defining Heat Stroke-Induced Coagulopathy

Min

Wan²,

Liu

et al. 2021

IJGM

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Section: Introductionmentioning

confidence: 99%

Sonoclot Signature Analysis: A New Point-of-Care Testing Method for Defining Heat Stroke-Induced Coagulopathy

Min

Wan²,

Liu

et al. 2021

IJGM

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“…However, this is in contrast to many studies which show ACLF as a hypocoagulable state. 3,4 The study also notices a profound hyperfibrinogenemia with prolonged clot lysis time in non-liver septics compared to ACLF patients. 1 The hemostatic profile in sepsis is more of consumptive coagulopathy as in disseminated intravascular coagulation (DIC) but in ACLF it is more of dysfibrinogenemia with endothelial activation and fibrinolysis.…”

Section: Is It a Real Balance In Hemostasis?mentioning

confidence: 81%

Is it a real balance in hemostasis?

Rathinasamy

Singh

Premkumar

et al. 2021

Journal of Thrombosis and Haemostasis

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“…Though a greater number of abnormal parameters on a GCT may predict increased likelihood of mortality, these are dynamic tests, and a single cut-off does not carry any relevance as a predictor of mortality. 28 …”

Section: Discussionmentioning

confidence: 99%

Clinical Validation of Global Coagulation Tests to Guide Blood Component Transfusions in Cirrhosis and ACLF

Premkumar

Mehtani

Divyaveer

et al. 2021

Journal of Clinical and Translational Hepatology

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Background and Aims Patients with cirrhosis and acute-on-chronic liver failure (ACLF) may have bleeding complications and need for invasive procedures. Point-of-care (POC) coagulation tests like thromboelastography (TEG) and Sonoclot may be better for guiding patient management than the standard coagulation tests (SCTs), like prothrombin time, platelet count and international normalized ratio. Methods We prospectively compared and validated the POC tests and SCTs in 70 persons with ACLF and 72 persons with decompensated cirrhosis who had clinical bleeding and checked for episodes of re-bleeding and transfusion requirements. We assessed pre-procedure requirement of blood components when correction was done based on an SCT or POC strategy. Results Episodes of bleeding were seen in 45% and 28% of ACLF and cirrhosis patient, respectively ( p =0.036), with the major site of bleeding being gastrointestinal (31% and 16%, respectively). Platelet counts correlated with TEG-maximum amplitude in cirrhosis ( p =0.045) and prothrombin time correlated positively with TEG-reaction (R) time ( p =0.032), TEG-Clot kinetics (K) time ( p =0.042), Son-activated clotting time ( p =0.038) and negatively with clot rate ( p =0.043) in ACLF, making these correctable target variables in POC transfusion algorithms. Of 223 procedures, transfusion of fresh frozen plasma and platelet concentrate was reduced by 25% ( p =0.035) and 20.8% ( p =0.045) by using a POC strategy in 76 patients. Correction of deranged Son-activated clotting time and TEG-reaction time was noted in 68% and 72% after 24 h of fresh frozen plasma transfusion in ACLF and 85% and 80% in cirrhosis, respectively. Conclusions Our study clinically validates that POC tests can better detect coagulation defects and transfusion thresholds in ACLF and cirrhosis, whereas use of conventional tests appear to be less suitable in patients with clinical bleeding. Trial Registration NCT04332484.

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Heparin-like Effect Associated With Risk of Bleeding, Sepsis, and Death in Patients With Severe Alcohol-Associated Hepatitis

Cited by 17 publications

References 24 publications

Sonoclot Signature Analysis: A New Point-of-Care Testing Method for Defining Heat Stroke-Induced Coagulopathy

Sonoclot Signature Analysis: A New Point-of-Care Testing Method for Defining Heat Stroke-Induced Coagulopathy

Is it a real balance in hemostasis?

Clinical Validation of Global Coagulation Tests to Guide Blood Component Transfusions in Cirrhosis and ACLF

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