Utility of clot waveform analysis in Russell's viper bite victims with hematotoxicity

Abraham, Siju V; Rafi, Aboobacker Mohamed; Krishnan, S Vimal; Palatty, Babu Urumese; Innah, Susheela Jacob; Johny, Jerry; Varghese, Salish

doi:10.4103/jets.jets_43_17

Cited by 9 publications

(3 citation statements)

References 26 publications

(37 reference statements)

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“…Global coagulation assays such as viscoelastometric tests (eg, ROTEM, thromboelastogram) or clot waveform analysis look beyond the initiation of coagulation and provide global information on the dynamics of clot development, stabilization, and dissolution that closely reflects hemostasis in vivo. 28,36…”

Section: Discussionmentioning

confidence: 99%

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Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid

Abraham

Hakkeem

Mathew

et al. 2020

Wilderness & Environmental Medicine

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Hematotoxic snake bite is a leading cause of mortality in South India. However, it is rare for the emergency physician to encounter a patient with trauma associated with snakebite. Management of such a patient differs substantially from the routine management of either a trauma patient or a snakebite victim. A 59-y-old man was bitten by a snake, after which he lost consciousness, fell, and sustained facial trauma. He was rushed to the emergency department within 30 min and was discovered to have ongoing oromaxillofacial bleeding. His respiratory distress and gasping respirations warranted orotracheal intubation and ventilation. He was treated with anti-snake venom and underwent viscoelastometry-guided transfusion to correct coagulopathy. Hemostasis was achieved after administration of tranexamic acid and bilateral posterior nasal packing. Imaging studies revealed craniomaxillofacial trauma with intracranial hemorrhage. He underwent a delayed mandibular repair. Judicious, guided fluid management, adequate nutrition, and prompt weaning off the ventilator allowed early discharge of the patient from the hospital. The minimal weakness present in his left lower limb at the time of discharge had improved by the time of follow-up. This report shows the utility of early and rapid anti-snake venom in envenomated victims with coagulopathy. The role of cryoprecipitate, tranexamic acid, and viscoelastometric testing needs further exploration in specific hematotoxic snakebites.

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Section: Discussionmentioning

confidence: 99%

“…50,51 The coagulopathic changes in a snakebite victim happen in a matter of minutes to hours. 36 TXA might have a role in the hyperfibrinolytic phase. Once renal failure sets in, administering TXA could be more harmful because it is dependent on the renal excretion pathway.…”

Section: Role Of Tranexamic Acid In Snakebitementioning

confidence: 99%

Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid

Abraham

Hakkeem

Mathew

et al. 2020

Wilderness & Environmental Medicine

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“…These automated photo-optical coagulation analyzers allow the display of the clot reaction curves and the associated derivative curves [5]. Previous reports have highlighted the usefulness of the APTT clot waveform analysis (CWA) and abnormal biphasic clot reaction curves have been reported to be associated with the early detection of DIC [6,7]. In this study, we measured and analyzed the APTT and PT-based CWA in patients suspected of having DIC.…”

Section: Introductionmentioning

confidence: 99%

Clot waveform analysis in acute promyelocytic leukemia

Terras,

El Borgi,

Betbout

et al. 2023

Blood Coagulation &Amp; Fibrinolysis

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The aim of this study was to evaluate the activated partial thromboplastin time (APTT) and prothrombin time (PT)-based clot waveform analysis (CWA) in patients diagnosed with acute promyelocytic leukemia (APL). APTT-based and PT-based CWA parameters of patients diagnosed with APL were analyzed and compared with healthy volunteers. Four APTT-CWA parameters were noted, maximum velocity corresponding to the first peak of the first derivative (max1), maximum acceleration corresponding to the first peak of the second derivative (max2) and the corresponding peak times of max1 and max2 (Tmax1, Tmax2). For the PT-CWA, two PT-CWA parameters were noted, maximum velocity (max1’) and the corresponding timing (Tmax1’). The results were expressed in medians. Mann–Whitney U test was used to compare the CWA parameters. Correlations were examined using the Spearman correlation test. Tmax1 and Tmax2 were significantly prolonged in patients with APL in comparison with healthy volunteers. Although max1 and max2 were lower in APL patients compared with healthy volunteers, no significant difference was noted. There was a strong and significant correlation between the DIC score and the parameters max1, max2 and max1’ and a very strong and significant correlation between fibrinogen levels and max1, max2 and max1’. When comparing DIC patients with hypofibrinogenemia and DIC without hypofibrinogenemia, a significant difference was noted in max1, max2, Tmax1 and Tmax2. The APTT and PT-based CWA analysis is a good tool to evaluate the bleeding tendency in APL, as it offers a novel approach for evaluating global hemostasis, predicting the bleeding risk and delivering improvements to APL patients management.

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Diagnostic analysis of lupus anticoagulant using clot waveform analysis in activated partial thromboplastin time prolonged cases: A retrospective analysis

Kanouchi

Narimatsu

Shirata

et al. 2021

Health Science Reports

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Background and Aims Hemophilia was diagnosed in precedence research of clot waveform analysis (CWA) using the activated partial thromboplastin time (APTT). In patients with antiphospholipid syndrome (APS), lupus anticoagulant (LA) causes an increase in APTT, suggesting that the waveform would probably be distorted. Therefore, we evaluated using clinical samples. CWA may be useful low cost for clinical detection of LA. We assessed the clinical value of CWA for detection of LA and coagulation using clinical blood samples collected from patients with a prolonged APTT. Methods We used patient samples inspected between April 2011 and March 2013 in Yamagata University Hospital. CWA was performed using the ACL TOP coagulation analyzer, and the associated software program was used to calculate APTT clotting endpoints. An atypical peak was defined as a derivative plot that did not conform to the normal S‐shaped clot reaction curve. Results In total, 162 patients, including 66 men and 96 women, with an average age of 46 years (range: 24‐89 years) were included. We also collected control samples from unmatched healthy donors. All 162 patients were divided according to medication history or condition into the following five groups: heparin (n = 20), warfarin (n = 23), hepatic dysfunction (n = 13), normal (n = 20), and LA‐positive antiphospholipid syndrome (APS; n = 86). Twenty healthy individuals were included as controls. Eighty patients had an atypical peak. Among all, 78 patients (90.6%) were LA‐positive, and 2 patients (2.5%) were treated with warfarin. The remaining two patients had prothrombin time international normalized ratios (PT‐INR) >4.0 while taking warfarin. Those who were APS LA positive with thrombosis and without thrombosis had split the reaction of clotting time, deceleration/acceleration time (D/A) ratio of 2.36 (1.99,3.24) vs 2.34 (2.04,2.86), respectively. Conclusion The significant atypical peak and D/A ratio extension may be explained by the clotting waveforms observed specifically in patients with LA‐positive APS.

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Utility of clot waveform analysis in Russell's viper bite victims with hematotoxicity

Cited by 9 publications

References 26 publications

Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid

Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid

Clot waveform analysis in acute promyelocytic leukemia

Diagnostic analysis of lupus anticoagulant using clot waveform analysis in activated partial thromboplastin time prolonged cases: A retrospective analysis

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