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Hartmann, J. and Croteau, S. E.
Am J Hematol., 2016
© 2016 Wiley Periodicals, Inc.
Gurbel, P.A., Bliden, K.P., Tantry, U.S., Monroe, A.L., Muresan, A.A., Brunner, N.E., Lopez-Espina, C.G., Delmenico, P.R., Cohen, E., Raviv, G., Haugen, D.L., Ereth, M.H.
Deming regression analysis demonstrated a strong correlation between the two systems for the standard hemostasis tests (R r = 0.932, MA r = 0.972, LY30 r = 0.938). Method comparison analysis showed an acceptable agreement between PlateletMapping (PM) assays for measuring arachidonic acid (indicator of aspirin response)- and adenosine diphosphate (indicator of P2Y12 inhibitor response)-induced platelet aggregation (total agreement = 90%, and 72%, respectively). TEG6s precision testing yielded low variability (CV 0–13%) in all measures. The new point-of-care TEG6s is associated with greater ease of use than the TEG5000 and provides precise results. The results correlated between methods for all variables. TEG6s is a promising device for near-patient hemostasis monitoring and future trials of personalized therapy designed to reduce bleeding and thrombosis.
Delaney, M., Wendel, S., Bercovitz, R.S., Cid, J., Cohn, C., Dunbar, N.M., Apelseth, T.O., Popovsky, M., Stanworth, S.J., Tinmouth, A., Van De Watering, L., Waters, J.H., Yazer, M., Ziman, A.
The Lancet, 2016
© 2016 Elsevier Ltd. All rights reserved.
Dias, J.D., Norem, K., Doorneweerd, D.D., Thurer, R.L., Popovsky, M.A., Omert, L.A.
Archives of Pathology and Laboratory Medicine, 2015
Context: The clinical introduction of new oral anticoagulants (NOACs) has stimulated the development of tests to quantify the effects of these drugs and manage complications associated with their use. Until recently, the only treatment choices for the prevention of venous thromboembolism in orthopedic surgical patients, as well as for stroke and systemic embolism in patients with atrial fibrillation, were vitamin K antagonists, antiplatelet drugs, and unfractionated and low-molecular-weight heparins. With the approval of NOACs, treatment options and consequent diagnostic challenges have expanded.
Objective: To study the utility of thromboelastography (TEG) in monitoring and differentiating between 2 currently approved classes of NOACs, direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban and apixaban).
Design: Blood samples from healthy volunteers were spiked with each NOAC in both the presence and absence of ecarin, and the effects on TEG were evaluated.
Results: Both the kaolin test reaction time (R time) and the time to maximum rate of thrombus generation were prolonged versus control samples and demonstrated a dose response for apixaban (R time within the normal range) and dabigatran. The RapidTEG activated clotting time test allowed the creation of a dose-response curve for all 3 NOACs. In the presence of anti-Xa inhibitors, the ecarin test promoted significant shortening of kaolin R times to the hypercoagulable range, while in the presence of the direct thrombin inhibitor only small and dose-proportional R time shortening was observed.
Conclusions: The RapidTEG activated clotting time test and the kaolin test appear to be capable of detecting and monitoring NOACs. The ecarin test may be used to differentiate between Xa inhibitors and direct thrombin inhibitors. Therefore, TEG may be a valuable tool to investigate hemostasis and the effectiveness of reversal strategies for patients receiving NOACs.
Silliman, C.C., Kelher, M.R., Khan, S.Y., LaSarre, M., West, F.B., Land, K.J., Mish, B., Ceriano, L., Sowemimo-Coker, S.
© 2014 by The American Society of Hematology.
Corteś-Puch, I., Wang, D., Sun, J., Solomon, S.B., Remy, K.E., Fernandez, M., Feng, J., Kanias, T., Bellavia, L., Sinchar, D., Perlegas, A., Solomon, M.A., Kelley, W.E., Popovsky, M.A., Gladwin, M.T., Kim-Shapiro, D.B., Klein, H.G., Natanson, C.
Study Design and Methods: Sixteen sets, each containing 3 units of ABO-identical RBCs in AS-3 were obtained from a blood bank. Three units of RBCs were combined together and then split into three equal aliquots, A, B, and C. Unit A was unfiltered while Units B and C were filtered with a leukoreduction filter and the EF, respectively. All the units were stored at 4°C in a blood bank refrigerator for 42 days. We measured RBC viscoelasticity, hemolysis, RBC adenosine triphosphate, Band 3 proteins, cytokines, PLTs, WBCs, and immunoglobulin before and after filtration and on Days 21 and 42 of storage. Data were analyzed by repeated-measures analysis of variance with Newman-Keuls multiple comparison test.
Results: The EF significantly (p<0.05) reduced the levels of immunoglobulin (control IgG, 2.184 ± 1.918 mg/mL; BPF4, 2.216 ± 1.956 mg/mL; and EF, 0.363 ± 0.391 mg/mL), PLTs, cytokines, and improved viscoelastic properties when compared to either control or leukoreduced RBCs.
Conclusion: The EF achieved lower levels of WBCs, improved viscoelastic properties, and reduced levels of immunoglobulins and cytokines but significance will require clinical evaluation.
© 2013 American Association of Blood Banks.
Andrzejewski Jr., C., Casey, M.A., Popovsky, M.A.
Methods: A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes.
Results: Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40% in group II (P < .001). The overall 30-day mortality was 1.3%. There were no differences in mortality, reoperation for bleeding, or other postoperative outcomes between the groups.
Conclusions: Implementation of a comprehensive blood conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes.
© 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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