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Cleveland Clinic Journal of Medicine Sep 2022Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic... (Review)
Review
Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. We now recognize that in cirrhosis there is a simultaneous decrease in both clotting and anticlotting factors, leading to a new equilibrium. Conventional coagulation tests such as the platelet count and prothrombin time do not assess the reduced anticoagulation factors in cirrhosis and overestimate the bleeding risk, and any intervention based on these test results can lead to thrombotic complications. This article reviews the changes in hemostasis associated with cirrhosis, newer tests for assessing coagulation, and preprocedural minimization of coagulopathy.
Topics: Humans; Blood Coagulation Disorders; Hemostasis; Blood Coagulation; Liver Cirrhosis; Blood Coagulation Tests; Thrombosis
PubMed: 37907441
DOI: 10.3949/ccjm.89a.21018 -
Acta Clinica Croatica Jun 2022Coagulation abnormalities are common in bleeding or critically ill patient and hemostatic management remains a major challenge for the emergency physician. Management of... (Review)
Review
Coagulation abnormalities are common in bleeding or critically ill patient and hemostatic management remains a major challenge for the emergency physician. Management of bleeding patients consists of bleeding control, restoration of blood volume, and correction of any associated coagulopathy. Traditionally, the fresh frozen plasma (FFP) is used for correction of coagulopathy to manage and prevent bleeding, but today Prothrombin complex concentrates (PCCs) offer an attractive alternative because they offers a number of advantages over FFP, including lower infusion volume, rapid INR normalization, faster availability, lack of blood group specificity, and better safety profile. The aim of the present review is to provide an short overview about using PCC, their indication, efficacy and safety in different bleeding setting's.
Topics: Humans; International Normalized Ratio; Blood Coagulation Factors; Blood Coagulation Disorders; Hemorrhage; Emergency Service, Hospital; Anticoagulants
PubMed: 36304807
DOI: 10.20471/acc.2022.61.s1.09 -
Mayo Clinic Proceedings Jan 2021Patients with the severe form of coronavirus disease 2019 (COVID-19) have been frequently found to suffer from both arterial and venous thrombotic events due to the... (Review)
Review
Patients with the severe form of coronavirus disease 2019 (COVID-19) have been frequently found to suffer from both arterial and venous thrombotic events due to the perpetuation of a hypercoagulable state. This phenomenon, termed COVID-19-associated coagulopathy, is now considered a major component of the pathophysiology of this novel infectious disease, leading to widespread thrombosis. While at first, the vascular insults may be limited to the pulmonary microvasculature, as the disease progresses, systemic involvement occurs, culminating in distant organ thrombosis and multiorgan dysfunction syndrome. In this review article, we discuss recent insights into the pathophysiologic mechanisms of COVID-19-associated coagulopathy and review the clinical, histopathologic, and laboratory evidence, which leads us to conclude that COVID-19 is both a pulmonary and vascular disorder.
Topics: Blood Coagulation Disorders; COVID-19; Disease Progression; Humans; SARS-CoV-2
PubMed: 33413819
DOI: 10.1016/j.mayocp.2020.10.031 -
Bulletin of Mathematical Biology Mar 2021Blood coagulation represents one of the most studied processes in biomedical modelling. However, clinical applications of this modelling remain limited because of the...
Blood coagulation represents one of the most studied processes in biomedical modelling. However, clinical applications of this modelling remain limited because of the complexity of this process and because of large inter-patient variation of the concentrations of blood factors, kinetic constants and physiological conditions. Determination of some of these patients-specific parameters is experimentally possible, but it would be related to excessive time and material costs impossible in clinical practice. We propose in this work a methodological approach to patient-specific modelling of blood coagulation. It begins with conventional thrombin generation tests allowing the determination of parameters of a reduced kinetic model. Next, this model is used to study spatial distributions of blood factors and blood coagulation in flow, and to evaluate the results of medical treatment of blood coagulation disorders.
Topics: Blood Coagulation; Blood Coagulation Disorders; Humans; Models, Biological; Patient-Specific Modeling
PubMed: 33772645
DOI: 10.1007/s11538-021-00890-8 -
Annals of the Academy of Medicine,... Jan 2022Trauma-induced coagulopathy (TIC) is a form of coagulopathy unique to trauma patients and is associated with increased mortality. The complexity and incomplete... (Review)
Review
INTRODUCTION
Trauma-induced coagulopathy (TIC) is a form of coagulopathy unique to trauma patients and is associated with increased mortality. The complexity and incomplete understanding of TIC have resulted in controversies regarding optimum management. This review aims to summarise the pathophysiology of TIC and appraise established and emerging advances in the management of TIC.
METHODS
This narrative review is based on a literature search (MEDLINE database) completed in October 2020. Search terms used were "trauma induced coagulopathy", "coagulopathy of trauma", "trauma induced coagulopathy pathophysiology", "massive transfusion trauma induced coagulopathy", "viscoelastic assay trauma induced coagulopathy", "goal directed trauma induced coagulopathy and "fibrinogen trauma induced coagulopathy'.
RESULTS
TIC is not a uniform phenotype but a spectrum ranging from thrombotic to bleeding phenotypes. Evidence for the management of TIC with tranexamic acid, massive transfusion protocols, viscoelastic haemostatic assays (VHAs), and coagulation factor and fibrinogen concentrates were evaluated. Although most trauma centres utilise fixed-ratio massive transfusion protocols, the "ideal" transfusion ratio of blood to blood products is still debated. While more centres are using VHAs to guide blood product replacement, there is no agreed VHA-based transfusion strategy. The use of VHA to quantify the functional contributions of individual components of coagulation may permit targeted treatment of TIC but remains controversial.
CONCLUSION
A greater understanding of TIC, advances in point-of-care coagulation testing, and availability of coagulation factors and fibrinogen concentrates allows clinicians to employ a more goal-directed approach. Still, hospitals need to tailor their approaches according to available resources, provide training and establish local guidelines.
Topics: Blood Coagulation Disorders; Blood Transfusion; Hemorrhage; Hemostasis; Hemostatics; Humans
PubMed: 35091729
DOI: 10.47102/annals-acadmedsg.2020381 -
Equine Veterinary Journal Jan 2021Genetic bleeding disorders can have a profound impact on a horse's health and athletic career. As such, it is important to understand the mechanisms of these diseases... (Review)
Review
Genetic bleeding disorders can have a profound impact on a horse's health and athletic career. As such, it is important to understand the mechanisms of these diseases and how they are diagnosed. These diseases include haemophilia A, von Willebrand disease, prekallikrein deficiency, Glanzmann's Thrombasthenia and Atypical Equine Thrombasthenia. Exercise-induced pulmonary haemorrhage also has a proposed genetic component. Genetic mutations have been identified for haemophilia A and Glanzmann's Thrombasthenia in the horse. Mutations are known for von Willebrand disease and prekallikrein deficiency in other species. In the absence of genetic tests, bleeding disorders are typically diagnosed by measuring platelet function, von Willebrand factor, and other coagulation protein levels and activities. For autosomal recessive diseases, genetic testing can prevent the breeding of two carriers.
Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Factors; Hemorrhage; Hemostasis; Horse Diseases; Horses; Thrombasthenia
PubMed: 32463964
DOI: 10.1111/evj.13290 -
British Journal of Anaesthesia Dec 2015The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the... (Review)
Review
The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the impact that they have on the safety profile of the anaesthetic options for labour and delivery is crucial to any anaesthetist caring for the parturient. This article analyses current theories on coagulation and reviews the physiological changes to coagulation that occur during pregnancy and the best methods with which to evaluate coagulation. Finally, we examine some of the more common disorders of coagulation that occur during pregnancy, including von Willebrand disease, common factor deficiencies, platelet disorders, the parturient on anticoagulants, and the more rare acute fatty liver of pregnancy, with a focus on their implications for neuraxial anaesthesia.
Topics: Anesthesia, Obstetrical; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Disorders, Inherited; Blood Coagulation Tests; Female; Hemostasis; Humans; Pregnancy; Pregnancy Complications, Hematologic
PubMed: 26658204
DOI: 10.1093/bja/aev374 -
Shock (Augusta, Ga.) Aug 2020Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and... (Review)
Review
Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.
Topics: Blood Coagulation Disorders; Burns; Female; Fibrinolysis; Humans; Inflammation; Male
PubMed: 31804296
DOI: 10.1097/SHK.0000000000001484 -
The Indian Journal of Medical ResearchThe ongoing pandemic of novel coronavirus 2019 is rapidly evolving, and newer organ- and system-specific manifestations are being observed. Thrombotic complications and... (Review)
Review
The ongoing pandemic of novel coronavirus 2019 is rapidly evolving, and newer organ- and system-specific manifestations are being observed. Thrombotic complications and coagulopathy are frequent manifestations of the disease, especially in sick patients, which appear to be unique and distinct from sepsis-induced coagulopathy, disseminated intravascular coagulation and other viral infection-induced coagulation abnormalities. Elevated D-dimers and fibrinogen in the early stage of the disease with minimally deranged prothrombin time and platelet counts are prominent and distinguishing features. Venous and arterial thromboses, as opposed to bleeding events, are the major clinical correlates. There is much to be known about the pathogenesis of COVID-associated coagulopathy; however, the mechanisms overlap with thrombotic microangiopathy, haemophagocytic syndrome and antiphospholipid syndrome compounded by the diffuse endothelial damage. The recommendations regarding the treatment are still evolving, but antithrombotic therapy has a definite role in positive outcomes of sick patients.
Topics: Anticoagulants; Blood Coagulation Disorders; COVID-19; Humans; SARS-CoV-2; Venous Thromboembolism
PubMed: 34643567
DOI: 10.4103/ijmr.IJMR_3841_20 -
Anesthesiology Apr 2014
Review
Topics: Anticoagulants; Blood Coagulation Disorders; Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation; Heart Arrest; Hemorrhage; Humans; Hypothermia, Induced; Mechanical Thrombolysis
PubMed: 24296763
DOI: 10.1097/ALN.0000000000000086