-
The Israel Medical Association Journal... Jun 2023Factor VII (FVII) deficiency is characterized by normal activated partial thromboplastin time (aPTT) and prolonged prothrombin time (PT) values. It is diagnosed by...
BACKGROUND
Factor VII (FVII) deficiency is characterized by normal activated partial thromboplastin time (aPTT) and prolonged prothrombin time (PT) values. It is diagnosed by determining protein level and coagulation activity (FVII:C). FVII:C measurements are expensive and time consuming.
OBJECTIVES
To analyze correlations between PT, international normalized ratio (INR), and FVII:C in pediatric patients before otolaryngology surgery and to establish alternative methods for identifying FVII deficiency.
METHODS
FVII:C data were collected from 96 patients with normal aPTT and prolonged PT values during preoperative otolaryngology surgery coagulation workup between 2016 and 2020. We compared demographic and clinical parameters using Spearman correlation coefficient and receiver operating characteristic (ROC) curve analysis to determine the accuracy of PT and INR values to predict FVII deficiency.
RESULTS
The median values of PT, INR and FVII:C were 13.5 seconds, 1.14, and 67.5%, respectively. In total, 65 participants (67.7%) displayed normal FVII:C compared to 31 (32.3%) with decreased FVII:C. A statistically significant negative correlation was observed between FVII:C and PT values and between FVII:C and INR. Despite statistically significant ROC of 0.653 for PT (P-value = 0.017, 95% confidence interval [95%CI] 0.529-0.776) and 0.669 for INR (P-value = 0.08, 95%CI 0.551-0.788), we were unable to determine an optimal cutoff point to predict FVII:C deficiency with high sensitivity and high specificity.
CONCLUSIONS
We could not identify a PT or INR threshold to best predict clinically relevant FVII:C levels. When PT is abnormal, determining FVII:C protein levels is needed for diagnosing FVII deficiency and considering surgical prophylactic treatment.
Topics: Humans; Child; Prothrombin Time; International Normalized Ratio; Factor VII; Blood Coagulation Tests; Factor VII Deficiency
PubMed: 37381933
DOI: No ID Found -
Methods in Molecular Biology (Clifton,... 2023Lupus anticoagulants (LA) rarely affect routine prothrombin time assays because the high phospholipid (PL) content in thromboplastin reagents tends to overwhelm the...
Lupus anticoagulants (LA) rarely affect routine prothrombin time assays because the high phospholipid (PL) content in thromboplastin reagents tends to overwhelm the antibodies. Dilution of thromboplastin to create a dilute prothrombin time (dPT) screening test renders the assay sensitive to the presence of LA. Technical and diagnostic performances are enhanced if recombinant thromboplastins are employed in place of tissue-derived reagents. Presence of an LA cannot be deduced from an elevated screening test alone since other coagulation disturbances can prolong clotting times. Confirmatory testing with less dilute or undiluted thromboplastin reveals the PL-dependent nature of LA by reducing the clotting time relative to that of the screening test. Where appropriate, such as a known or suspected coagulation factor deficiency, mixing tests are valuable in correcting factor deficiencies and evidencing inhibitory properties of LA, to increase diagnostic specificity. Although LA testing is commonly restricted to dilute Russell's viper venom time and activated partial thromboplastin time, dPT is sensitive to LA unreactive in those assays, and inclusion in routine testing increases detection rates of clinically significant antibodies.
Topics: Humans; Lupus Coagulation Inhibitor; Prothrombin Time; Thromboplastin; Blood Coagulation Tests; Antiphospholipid Syndrome; Partial Thromboplastin Time; Phospholipids
PubMed: 37204717
DOI: 10.1007/978-1-0716-3175-1_17 -
International Journal of Molecular... Jan 2022Aortic aneurysms are sometimes associated with enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). In enhanced-fibrinolytic-type DIC, both... (Review)
Review
Aortic aneurysms are sometimes associated with enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). In enhanced-fibrinolytic-type DIC, both coagulation and fibrinolysis are markedly activated. Typical cases show decreased platelet counts and fibrinogen levels, increased concentrations of fibrin/fibrinogen degradation products (FDP) and D-dimer, and increased FDP/D-dimer ratios. Thrombin-antithrombin complex or prothrombin fragment 1 + 2, as markers of coagulation activation, and plasmin-α plasmin inhibitor complex, a marker of fibrinolytic activation, are all markedly increased. Prolongation of prothrombin time (PT) is not so obvious, and the activated partial thromboplastin time (APTT) is rather shortened in some cases. As a result, DIC can be neither diagnosed nor excluded based on PT and APTT alone. Many of the factors involved in coagulation and fibrinolysis activation are serine proteases. Treatment of enhanced-fibrinolytic-type DIC requires consideration of how to control the function of these serine proteases. The cornerstone of DIC treatment is treatment of the underlying pathology. However, in some cases surgery is either not possible or exacerbates the DIC associated with aortic aneurysm. In such cases, pharmacotherapy becomes even more important. Unfractionated heparin, other heparins, synthetic protease inhibitors, recombinant thrombomodulin, and direct oral anticoagulants (DOACs) are agents that inhibit serine proteases, and all are effective against DIC. Inhibition of activated coagulation factors by anticoagulants is key to the treatment of DIC. Among them, DOACs can be taken orally and is useful for outpatient treatment. Combination therapy of heparin and nafamostat allows fine-adjustment of anticoagulant and antifibrinolytic effects. While warfarin is an anticoagulant, this agent is ineffective in the treatment of DIC because it inhibits the production of coagulation factors as substrates without inhibiting activated coagulation factors. In addition, monotherapy using tranexamic acid in cases of enhanced-fibrinolytic-type DIC may induce fatal thrombosis. If tranexamic acid is needed for DIC, combination with anticoagulant therapy is of critical importance.
Topics: Anticoagulants; Antifibrinolytic Agents; Aortic Aneurysm; Disseminated Intravascular Coagulation; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Heparin; Humans; Partial Thromboplastin Time; Prothrombin Time; alpha-2-Antiplasmin
PubMed: 35163216
DOI: 10.3390/ijms23031296 -
BioMed Research International 2020To investigate the value of coagulation indicators D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen...
OBJECTIVE
To investigate the value of coagulation indicators D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fg) in predicting the severity and prognosis of COVID-19.
METHODS
A total of 115 patients with confirmed COVID-19, who were admitted to Tianyou Hospital of Wuhan University of Science and Technology between January 18, 2020, and March 5, 2020, were included. The dynamic changes of DD, PT, APTT, and Fg were tested, and the correlation with CT imaging, clinical classifications, and prognosis was studied.
RESULTS
Coagulation disorder occurred at the early stage of COVID-19 infection, with 50 (43.5%) patients having DD increased and 74 (64.3%) patients having Fg increased. The levels of DD and Fg were correlated with clinical classification. Among 23 patients who deceased, 18 had DD increased at the first lab test, 22 had DD increased at the second and third lab tests, and 18 had prolonged PT at the third test. The results from ROC analyses for mortality risk showed that the AUCs of DD were 0.742, 0.818, and 0.851 in three times of test, respectively; PT was 0.643, 0.824, and 0.937. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value ( < 0.01).
CONCLUSIONS
Coagulation dysfunction is more likely to occur in severe and critically ill patients. DD and PT could be used as the significant indicators in predicting the mortality of COVID-19.
Topics: Adult; Aged; Aged, 80 and over; Betacoronavirus; Blood Coagulation Disorders; COVID-19; China; Coronavirus Infections; Disease Progression; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Lung; Male; Middle Aged; Pandemics; Partial Thromboplastin Time; Pneumonia, Viral; Prognosis; Prothrombin Time; SARS-CoV-2; Thrombin Time; Tomography, X-Ray Computed
PubMed: 32596339
DOI: 10.1155/2020/6159720 -
Nutrition (Burbank, Los Angeles County,... Oct 2019The aim of this study was to evaluate the effect of low doses of l-arginine supplementation on hemogram, integrity of DNA and spleen, inflammatory infiltrate in the...
OBJECTIVE
The aim of this study was to evaluate the effect of low doses of l-arginine supplementation on hemogram, integrity of DNA and spleen, inflammatory infiltrate in the jejunum, and in the coagulogram of rats submitted to 5-fluorouracil (5-FU) chemotherapy.
METHODS
Thirty-two Wistar rats were fed commercial feed and water ad libitum and grouped into four (eight rats per group): The control group was given a 0.9% physiologic solution to simulate the application of 5-FU in the other groups; the G group was given a dose of 5-FU; the G and G groups were given a dose of 5-FU and supplemented with 50 and 100 mg l-arginine/d added in the drinking water ad libitum.
RESULTS
The rats in the G group did not lose weight after chemotherapy. G rats presented polycythemia owing to dehydration caused by diarrhea generated by 5-FU. G rats had increased total leukocyte count, eosinophils, lymphocytes, and index in the total index of DNA damage, yet showed a reduction in prothrombin time and in the spleen depletion index. Rats in the G, G, and G groups had similar moderate inflammatory infiltrate in the jejunum.
CONCLUSION
Supplementation with 100 mg/d of l-arginine minimized immunosuppression, spleen depletion, and prothrombin time and contributed to the breakdown of 5-FU-generated DNA in Wistar rats. Supplementation with 50 mg/d of l-arginine decreased the weight loss generated by 5-FU in Wistar rats. Supplements with 50 or 100 mg of l-arginine did not interfere with 5-FU-generated jejunal inflammatory infiltrate.
Topics: Animals; Arginine; DNA Damage; Disease Models, Animal; Female; Fluorouracil; Immunosuppression Therapy; Prothrombin Time; Rats; Rats, Wistar
PubMed: 31252338
DOI: 10.1016/j.nut.2019.04.012 -
PloS One 2022COVID-19 is a viral disease caused by a new strain of corona virus. Currently, prognosis and risk stratification of COVID-19 patients is done by the disease's clinical...
BACKGROUND
COVID-19 is a viral disease caused by a new strain of corona virus. Currently, prognosis and risk stratification of COVID-19 patients is done by the disease's clinical presentation. Therefore, identifying laboratory biomarkers for disease prognosis and risk stratification of COVID-19 patients is critical for prompt treatment. Therefore, the main objective of this study was to assess the risk stratification and prognostic value of basic coagulation parameters and factors associated with disease severity among COVID-19 patients at the Tibebe Ghion Specialized Hospital, COVID-19 treatment center, Northwest Ethiopia.
METHODS
A follow-up study was conducted among conveniently recruited COVID-19 patients attended from March to June 2021. Socio-demographic and clinical data were collected using a structured questionnaire and checklist, respectively. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were analyzed by the HUMACLOT DUE PLUS® machine. Descriptive statistics were used to summarize the socio-demographic and clinical characteristics of study participants. Kruskal Wallis tests were used to compare the difference between parametric and non-parametric continuous variables, respectively. The area under the receiver operating characteristic curve (AUC) was used to evaluate the value of PT and APTT in the risk stratification and disease prognosis of COVID-19 patients. Ordinal logistic regression was used to identify the factors associated with disease severity and prognosis. A P-value < 0.05 was defined as statistically significant for all results.
RESULT
Baseline PT at a cut-off value ≥ 16.25 seconds differentiated severe COVID-19 patients from mild and moderate patients (AUC: 0.89, 95% CI: 0.83-0.95). PT also differentiated mild COVID-19 patients from moderate and severe patients at a cut-off value ≤ 15.35 seconds (AUC: 0.90, 95% CI: 0.84-0.96). Moreover, alcohol drinkers were a 3.52 times more likely chance of having severe disease than non-drinkers (95% CI: 1.41-8.81). A one-year increment in age also increased the odds of disease severity by 6% (95% CI: 3-9%). An increment of ≥ 0.65 seconds from the baseline PT predicted poor prognosis (AUC: 0.93, 0.87-0.99).
CONCLUSIONS AND RECOMMENDATIONS
Prolonged baseline PT was observed in severe COVID-19 patients. Prolonged baseline PT was also predicted to worsen prognosis. An increase from the baseline PT was associated with worsen prognosis. Therefore, PT can be used as a risk stratification and prognostic marker in COVID-19 patients.
Topics: Blood Coagulation Disorders; COVID-19; Follow-Up Studies; Humans; Partial Thromboplastin Time; Prognosis; Prothrombin Time; Retrospective Studies; Risk Assessment; COVID-19 Drug Treatment
PubMed: 35951632
DOI: 10.1371/journal.pone.0272216 -
Medicina (Kaunas, Lithuania) Dec 2020Prolonged tourniquet stasis induced by venepuncture can lead to the release of the plasma of cell lysis products, as well as tissue factor (TF), impairing the quality of...
Prolonged tourniquet stasis induced by venepuncture can lead to the release of the plasma of cell lysis products, as well as tissue factor (TF), impairing the quality of coagulation test results. The accidental presence of TF in vitro can trigger the coagulation mechanism, generating a false decrease in prothrombin time (PT). Identification of short PT tests below the normal reference value that could suggest a situation of hypercoagulability. The study aimed to compare the results of the shortened PT tests at their first determination with the eventual correction following duplication of the analysis from the same sample. Identification of the shortened PT tests has been carried out for a period of 4 months, upon 544 coagulation samples referred to the Hematology department of Sf. Spiridon County Clinical Emergency Hospital from Iasi, Romania. Out of the 544 samples of which the results indicated a state of hypercoagulability, by repeating the determination from the same sample, for 200 (36.76%) PT tests ( = 0.001) the value was corrected, falling within the normal reference range. For 344 (63.24%) tests, the results suggested a situation of hypercoagulability. In order to guarantee the highest quality of the laboratory services, a proper interpretation and report of the patients' results must be congruent and harmoniously associated to the actual clinical condition of the patient. Duplication of the PT determination from the same sample would exclude situations of false hypercoagulability and would provide significant improvement for the patient's safety.
Topics: Blood Coagulation; Blood Coagulation Tests; Humans; Prothrombin Time; Romania; Thrombophilia
PubMed: 33379139
DOI: 10.3390/medicina57010013 -
Anesthesiology Oct 2021From preoperative medications to intraoperative needs to postoperative thromboprophylaxis, anticoagulants are encountered throughout the perioperative period. This... (Review)
Review
From preoperative medications to intraoperative needs to postoperative thromboprophylaxis, anticoagulants are encountered throughout the perioperative period. This review will focus on coagulation testing clinicians utilize to monitor the effects of these medications.
Topics: Anticoagulants; Blood Coagulation; Humans; International Normalized Ratio; Monitoring, Intraoperative; Perioperative Care; Physician's Role; Physicians; Point-of-Care Testing; Prothrombin Time
PubMed: 34499103
DOI: 10.1097/ALN.0000000000003903 -
Updates in Surgery Jun 2022There are no ideal biomarkers including the TNM stage that can accurately predict the recurrence of colorectal cancer (CRC) and the benefit of chemotherapy for stage II...
Prothrombin time (PT) and CEA as prognostic predictive biomarkers for postoperative recurrence after curative resection in patients with stage I-III colorectal cancer: a retrospective cohort study.
There are no ideal biomarkers including the TNM stage that can accurately predict the recurrence of colorectal cancer (CRC) and the benefit of chemotherapy for stage II patients. Here, 451 CRC patients were divided into three groups according to preoperative levels of prothrombin time (PT) and CEA to analyze the value of these indexes in predicting postoperative recurrence in different TNM stages. Preoperatively elevated levels of PT and CEA were significantly associated with a high 5-year cumulative recurrence rate (CRR) and short recurrence-free survival (RFS). According to PT and CEA levels, the 5-year CRR and RFS differed significantly among the High-risk (PT ≥ 12.65 s and CEA ≥ 10.175 ng/ml), Middle-risk (PT ≥ 12.65 s or CEA ≥ 10.175 ng/ml), and Low-risk (PT < 12.65 s and CEA < 10.175 ng/ml) groups (p < 0.001). In the same TNM stage, the 5-year CRR of the High-risk group was significantly higher and the RFS was markedly shorter than those in the Low-risk and even those in stage III (p < 0.001). In the subgroup of early stage (stage I and II), the 5-year CRR of the High-risk group was significantly higher and the RFS was significantly shorter than those in stage IIIA and IIIB (p < 0.001), which is similar to IIIC. In conclusion, preoperatively elevated levels of serum PT and CEA were reliable predictors of postoperative high-risk recurrence in CRC and combined with TNM stage precisely identify postoperative recurrence CRC patients in stage I-III and the benefit of adjuvant chemotherapy for patients with stage II CRC.
Topics: Biomarkers, Tumor; Carcinoembryonic Antigen; Colorectal Neoplasms; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Prothrombin Time; Retrospective Studies
PubMed: 35322387
DOI: 10.1007/s13304-022-01268-8 -
Clinica Chimica Acta; International... Aug 2023Coagulopathy is a common complication of heart failure (HF), but the prognostic significance of coagulation abnormalities for HF is still poorly understood. This...
BACKGROUND
Coagulopathy is a common complication of heart failure (HF), but the prognostic significance of coagulation abnormalities for HF is still poorly understood. This investigation sought to elucidate the association between admission prothrombin time activity (PTA) and short-term readmission in HF.
METHODS
In this retrospective study, we extracted data from a publicly accessible database for hospitalized HF patients in China. The admission laboratory findings were screened by the least absolute shrinkage and selection operator (LASSO) regression. Afterward, the study population was stratified according to the admission PTA level. In univariate and multivariate analysis, we employed logistics regression model to evaluate the association of admission PTA level with short-term readmission. Subgroup analysis was preformed to examine the interaction effect between admission PTA level and covariates, including age, sex, and systolic blood pressure (SBP).
RESULTS
A total of 1505 HF patients were included, of whom 58.7% were female and 35.6% were between 70 and 79 y. In LASSO procedure, admission PTA level was included in optimized models for short-term readmission, and readmitted patients tended to have a lower admission PTA level. Multivariate analysis suggested that the low admission PTA level (admission PTA ≤ 62.3%) was associated with increased risk of 90-day readmission (odds ratio 1.63 [95% CI, 1.09 to 2.46]; P = 0.02) and 180-day readmission (odds ratio 1.65 [95% CI, 1.18 to 2.33]; P = 0.01) compared with patients with the highest admission PTA level (admission PTA ≥ 76.8%) after full adjustment. Moreover, no significant interaction effect was observed in the subgroup analysis, except for admission SBP.
CONCLUSION
Low admission PTA level is associated with an increased risk of 90-day and 180-day hospital readmission in patients with HF.
Topics: Humans; Female; Male; Patient Readmission; Retrospective Studies; Prothrombin Time; Risk Factors; Heart Failure
PubMed: 37392864
DOI: 10.1016/j.cca.2023.117463