Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients

Connelly, Christopher R.; Van, Philbert Y.; Hart, Kyle D.; Louis, Scott G.; Fair, Kelly A.; Erickson, Anfin; Rick, Elizabeth A.; Simeon, Erika; Bulger, Eileen M.; Arbabi, Saman; Holcomb, John B.; Moore, Laura J.; Schreiber, Martin A.

doi:10.1001/jamasurg.2016.2069

Cited by 53 publications

(58 citation statements)

References 32 publications

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“…23 Previous work has demonstrated that native and kaolin TEGs detect higher rates of hypercoagulability in trauma patients. 18,24 Our data supports that the PL chip appears to have higher utility in defining hypercoagulability as it has eliminated fibrin and thrombin generation to when the clot is being formed and has data consistent with TEG measurements in which an elevated MA is associated with a shorter platelet OT. The role of platelets in increasing clot strength, and an associated increased risk of thrombotic complications has been previously described.…”

Section: Discussionsupporting

confidence: 71%

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Lawson

Moore

et al. 2018

Journal of Surgical Research

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Background: Elevated clot strength (maximum amplitude [MA]) measured by thrombelastography (TEG) is associated with thrombotic complications. However, it remains unclear how MA translates to thrombotic risks, as this measurement is independent of time, blood flow, and clot degradation. We hypothesize that under flow conditions, increased clot strength correlates to time-dependent measurements of coagulation and resistance to fibrinolysis. Materials and methods: Surgical patients at high risk of thrombotic complications were analyzed with TEG and total thrombus-formation analysis system (T-TAS). TEG hypercoagulability was defined as an r <10.2 min, angle >59, MA >66 or LY30 <0.2% (based off of healthy control data, n = 141). The T-TAS AR and PL chips were used to measure clotting at arterial shear rates. T-TAS measurements include occlusion start time, occlusion time (OT), occlusion speed (OSp), and total clot generation (area under the curve). These measurements were correlated to TEG indices (R time, angle, MA, and LY30). Both T-TAS and TEG assays were challenged with tissue plasminogen activator (t-PA) to assess clot resistance to fibrinolysis. Results: Thirty subjects were analyzed, including five controls. TEG-defined hypercoagulability by MA was detectedin52% of the inflammatory bowel disease/cancer patients; 0%was detected in the controls. There were no TEG measurements that significantly correlated with T-TAS AR and PL chip. However, in the presence of t-PA, T-TAS AR determined OSp to have an inverse relationship with TEG angle (−0.477, P = 0.012) and LY30 (−0.449, P = 0.019), and a positive correlation with R time (0.441 P = 0.021). In hypercoagulability determined by TEG MA, T-TAS PL had a significantly reduced OT (4:07 versus 6:27 min, P = 0.043). In hypercoagulability defined by TEG LY30, T-TAS PL had discordant findings, with a significantly prolonged OT (6:36 versus 4:30 min, P = 0.044) and a slower OSp (10.5 versus 19.0 kPa/min, P = 0.030). Conclusions: Microfluidic coagulation assessment with T-TAS has an overall poor correlation with most TEG measurements in a predominantly hypercoagulable patient population, except in the presence of t-PA. The one anticipated finding was an elevated MA having a shorter time to platelet-mediated microfluidic occlusion, supporting the role of platelets and hypercoagulability. However, hypercoagulability defined by LY30 had opposing results in which a low LY30 was associated with a longer PL time to occlusion and slower OSp. These discordant findings warrant ongoing investigation into the relationship between clot strength and fibrinolysis under different flow conditions.

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Section: Discussionsupporting

confidence: 71%

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Lawson

Moore

et al. 2018

Journal of Surgical Research

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“…A clot with high elasticity was more resistant to both mechanical and enzymatic degradation. [15,16] The hypercoagulable state was the following: shortened R time, increased K, MA, and G.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Impact of acute kidney injury on coagulation in adult minimal change nephropathy

Huang

Wei²,

Su³

et al. 2016

Medicine

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A hypercoagulable state exists in patients with nephrotic syndrome (NS), which more easily leads to venous thromboembolism (VTE). However, whether acute kidney injury (AKI), a common complication of NS, affects the hypercoagulable state and VTE has rarely been elucidated. In this study, we aimed to explore coagulation changes and analyze relevant influencing factors in NS-AKI patients.A total of 269 consecutive NS patients with minimal change disease (MCD) between 2011 and 2016 were included in this observational study. Ninety-one cases were in the AKI group and 178 cases in the non-AKI group. The 1:1 propensity score matching (PSM) method was applied to match the baseline information. The coagulation biomarkers were compared, and the thrombosis events were recorded. Linear correlation was performed to detect any relation between D-dimer and clinical data.The PSM method gave matched pairs of 88 MCD patients with AKI and non-AKI patients, resulting in no differences in baseline information. The D-dimer, fibrinogen, and thromboelastography parameters maximum amplitude (MA), G values of the MCD-AKI patients were significantly higher than the levels of the MCD patients without AKI (D-dimer: 1.8 [1.0, 3.3] vs 1.1 [0.6, 1.7] mg/L, P < 0.001; fibrinogen: 7.0±2.0 vs 6.5 ± 1.4 g/L, P = 0.036; MA: 74.6 ± 5.0 vs 70.5 ± 5.3 mm, P = 0.020; G: 15.7 ± 5.3 vs 12.5 ± 3.3, P = 0.034). For the MCD patients, the serum creatinine, white blood cell count, and interleukin-6 levels in the patients with D-dimers >1 mg/L were significantly higher than those of patients with D-dimers ≤1 mg/L. The correlation analysis showed that the D-dimer level was correlated with serum creatinine, white blood cell count, and interleukin-6 (r = 0.410, P = < 0.001; r = 0.248, P = < 0.001; r = 0.306, P = < 0.001, respectively). Five deep vein thrombosis events occurred in the AKI group and 1 pulmonary embolism event occurred in the non-AKI group after adjusting the propensity score value. AKI appeared to have an association with higher incidence of VTE, but the difference was not statistically significant (RR: 4.9, 95% CI: 0.6–42.7, P = 0.154).The MCD-NS patients complicated with AKI had a more severe hypercoagulable state, which might be associated with the active inflammation of AKI that mediated activation of the coagulation system.

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“…The platelet count (253. 27 ter treatment in the control group and treatment group. Furthermore, differences between R value were not statistically significant (P > 0.05), while differences between K value, Angle, MA value and CI value were statistically significant (P < 0.01) before and after treatment between the two groups, especially in the treatment group.…”

Section: The Indexes and Comparison Of Hemorheology In Asuc Patientsmentioning

confidence: 99%

Characteristics of Hemorheology in Patients with Acute Severe Ulcerative Colitis and the Clinical Study of Rivaroxaban Anticoagulant Therapy

et al. 2020

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Objectives:The present study aimed to determine the hemorheological characteristics of patients with acute severe ulcerative colitis (ASUC) and the effect of rivaroxaban anticoagulation therapy. The study also aimed to further explore the mechanisms and novel pathways underlying ASUC therapy. Methods: Various hemorheology tests were performed on 88 hospitalized ASUC patients, including mean platelet volume (MVP), platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) D-dimer and indicators of thrombelastogram (TEG). All results were compared with those of 40 colonic polyp controls. The ASUC patients were randomly divided into control and treatment groups (n = 44 each). The control group received routine mesalazine and methylprednisolone therapy, while the treatment group received rivaroxaban in addition to routine medicines. Montreal classification was used to evaluate the lesion range and the Mayo scoring system was used to evaluate the activity and treatment efficacy of the disease. The Endoscopic Severity Index of Ulcerative Colitis (UCEIS) was used to evaluate mucosal inflammation and Geboes index was used to evaluate mucosa histology. The percentage of microthrombus in pathological sections was calculated via immunohistochemical staining. The two groups were compared for efficacy, side effects, microthrombosis and hemorrheology after 30 days. Results and Conclusions:The results revealed that hypercoagulation is an important pathological stage of ASUC. Rivaroxaban anticoagulant therapy added to routine treatment was more effective than conventional treatment alone, which significantly improved the blood coagulation status of patients, alleviated clinical symptoms, relieved the endoscopic and histological outcomes, reduced the required hormone dosage and were worthy of clinical promotion.

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Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients

Abstract: clinicaltrials.gov Identifier: NCT00990236.

Cited by 53 publications

References 32 publications

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Impact of acute kidney injury on coagulation in adult minimal change nephropathy

Characteristics of Hemorheology in Patients with Acute Severe Ulcerative Colitis and the Clinical Study of Rivaroxaban Anticoagulant Therapy

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