Significant age, race and gender differences in global coagulation assays parameters in the normal population

Ho, Prahlad; Ng, Cheryl; Rigano, Joseph; Tacey, Mark; Smith, Carole L.; Donnan, Geoffrey A; Nandurkar, Harshal

doi:10.1016/j.thromres.2017.04.009

Cited by 33 publications

(39 citation statements)

References 9 publications

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“…Our results are comparable with their data, as they also found a correlation between female sex, advanced age and a trend towards enhanced coagulation . These effects regarding thromboelastometry parameters have also been found in other studies . Interestingly, just like Lang et al., we found significant differences between men and women regarding CT EXTEM , MCF FIBTEM , MCF INTEM , alpha angle INTEM and CFT INTEM , but not for CT INTEM .…”

Section: Discussionsupporting

confidence: 92%

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta

et al. 2018

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Thromboelastometry point-of-care coagulation testing facilitates optimised management of bleeding. Previous thromboelastometry systems required the blood sample and liquid reagents to be pipetted in several manual steps by trained personnel. The ROTEMsigma coagulation analyser is a fully automated point-of-care device. We aimed to assess the reference ranges of the new device and to compare the results with those of the predecessor device, the ROTEMdelta. We took blood from healthy volunteers and from hyper-or hypocoagulable patients; blood samples from healthy volunteers served to determine reference ranges for the most important parameters for the ROTEMsigma: CT EXTEM 48-61 s; A5 EXTEM 30-51 mm; MCF EXTEM 54-70 mm; CT INTEM 138-174 s; MCF INTEM 51-67 mm and MCF FIBTEM 5-24 mm. We then used blood samples from patients to compare the results obtained between the old and the new device. We found a strong correlation between the same tests performed on two ROTEMsigma devices and between the ROTEMsigma and the ROTEMdelta with respect to the determination of thromboelastometry parameters of hyper-and hypocoagulable patients (all p < 0.001 and R > 0.8). Performance evaluation for the ROTEMsigma device showed very high precision (R > 0.99, p < 0.001). Our reference ranges can serve as an important aid for other hospitals using this new device.

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Section: Discussionsupporting

confidence: 92%

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta

et al. 2018

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“…The maturation of the coagulation cascade and reduced levels of procoagulation factors in the neonatal period 9 may play a role in clot resolution time. There is little evidence available on sex differences in thrombotic profiles in adults 10,11 and such differences are not explored in neonatal populations. These two findings should not affect the clinical care, but should be incorporated into the future studies as potential covariates for further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Enoxaparin in the Neonatal Intensive Care Unit

et al. 2019

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Objective This article evaluates the efficacy of enoxaparin when targeting anti-factor Xa levels of 0.5 to 1 units per milliliter in the neonatal intensive care unit. Study Design This is a retrospective chart review of 45 neonates receiving enoxaparin for the treatment of venous thromboembolism. Enoxaparin dosing and corresponding anti-factor Xa levels were collected. Time to resolution of clot was confirmed by imaging and compared between clots in various locations. Results The median time to clot resolution was 76 days (interquartile range 40–91 days). Clot location, postnatal age, and sex at the clot onset were significantly associated with time to clot resolution in a multivariable Cox model (p-value: 0.03, 0.03, and < 0.01, respectively). Of the 54 patients analyzed for safety, 5 patients (9.3%) experienced bleeding events resulting in the discontinuation of enoxaparin. Conclusion Based on our findings, 50% of all patients evaluated, regardless of thrombus location, achieved resolution within the first 76 days of therapy. Clots located in the extremities tended to resolve sooner, hence earlier reimaging should be considered.

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“…This may explain the lower lysis in our cohort, due to artefactual impact of clot retraction. However, this does not explain reduced lysis seen in older normal controls, not on any antiplatelet agents nor the lack of impact of aspirin on clot lysis in patients with myeloproliferative neoplasm . Hence, given the contradictory findings, further clinical and laboratory studies are warranted, including assessment of other fibrinolytic markers to explore the significance of this observation, as an underlying compensatory mechanism should not be excluded.…”

Section: Discussionmentioning

confidence: 93%

“…The normal control population data used (n = 97, 31 males, 66 females, median age 43.7 years) were from the original study performed by our research group. 20 However, for comparison to this study, six normal control participants were removed from analysis as they had platelet count <150 × 10 9 /L or had platelet clumping. von Willebrand factor activity assay makes use of the binding of von Willebrand factor to its receptor glycoprotein 1b.…”

Section: Normal Control Populationmentioning

confidence: 99%

A comparison of global coagulation assays between normal controls and patients with thrombocytopenia

Lim

Leung

Manitta

et al. 2018

Int J Lab Hematology

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Introduction Some patients with thrombocytopenia may be at risk of bleeding although quantitative platelet count is not always a sufficient predictive factor. Global coagulation assays such as thromboelastography (TEG®), calibrated automated thrombogram (CAT) and overall haemostatic potential (OHP) may provide a better assessment of an individual's haemostatic profile. Methods Blood samples were collected from thrombocytopenic patients. TEG® was performed on citrated whole blood, while CAT and OHP were performed on platelet‐poor plasma. Results were compared to our previously collected normal controls. Results Fifty‐eight participants (24 immune thrombocytopenia, 34 chemotherapy/malignancy‐related) with mean age of 57.5 years were recruited. Compared to normal controls, thrombocytopenic participants had comparable maximum amplitude but reduced clot lysis (0.0% vs 0.6%; P < 0.001) on TEG® with reduced endogenous thrombin potential on CAT (1252.2 vs 1353.0 nmol/L/min; P = 0.040). No differences were seen in the OHP parameters. TEG® showed significant difference between marked and mild thrombocytopenia groups with minimal differences seen on CAT and OHP. Those with marked thrombocytopenia showed reduced maximum amplitude (47.2 vs 57.8 mm; P = 0.002) as expected while participants with mild thrombocytopenia (platelet count 100‐150 × 109/L) paradoxically demonstrated increased maximum amplitude (66.4 vs 57.8 mm; P < 0.001). Conclusion Global coagulation assays, particularly TEG®, can detect subtle differences in coagulation in thrombocytopenic patients. While patients with marked thrombocytopenia showed reduced maximum amplitude, patients with mild thrombocytopenia appear to paradoxically show increased maximum amplitude, suggesting compensatory activity within the coagulation pathway which may in part explain why not all thrombocytopenic patients have bleeding complications.

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Significant age, race and gender differences in global coagulation assays parameters in the normal population

Cited by 33 publications

References 9 publications

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta

Evaluation of the Efficacy of Enoxaparin in the Neonatal Intensive Care Unit

A comparison of global coagulation assays between normal controls and patients with thrombocytopenia

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Significant age, race and gender differences in global coagulation assays parameters in the normal population

Cited by 33 publications

References 9 publications

A comparison of the new ROTEM®sigma with its predecessor, the ROTEMdelta

A comparison of the new ROTEM®sigma with its predecessor, the ROTEMdelta

Evaluation of the Efficacy of Enoxaparin in the Neonatal Intensive Care Unit

A comparison of global coagulation assays between normal controls and patients with thrombocytopenia

Contact Info

Product

Resources

About

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta

A comparison of the new ROTEM^®sigma with its predecessor, the ROTEMdelta