China 
Africa 
Explore chapters and articles related to this topic
The Epidemiology Of Germinal Matrix/ Intraventricular Hemorrhage *
Published in Michele Kiely, Reproductive and Perinatal Epidemiology, 2019
Nigel Paneth, Jennifer Pinto-Martin
By contrast, McDonald et al. found a strong relationship between several indices of hypocoagulability and GM/IVH.139 A carefully done study by Andrew et al. showed a clear relationship between low platelet counts and risk of GM/IVH in infants <1500 g.140 Serious neurologic sequelae were much commoner in thrombocytopenic infants.
Thromboembolic Disease in the Obstetric Patient: Evaluation, Diagnosis, and Treatment
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
A continuous infusion of heparin is begun at 1000 U/h after a loading dose of 110 U/kg. The PTT is monitored every few hours, and fine adjustments in the infusion rate are made until a stable prolongation is achieved. Further testing is not required over the next 36 to 48 h. Heparin resistance reflects the extent of thrombosis.15 Presumably associated with either the cessation of thrombin production or the return of AT III to normal activity levels, there is a drop in the heparin requirement. The reduction in need must be identified to minimize the risk of a hemorrhagic complication. After 3 to 5 d of intravenous heparin therapy, the patient may be safely switched to subcutaneous heparin by initially splitting the 24-h requirement by either two or three, depending upon the selected dosing interval. The plasma heparin level achieved following subcutaneous injection is stable. Though there is no apparent difference in efficacy between 8- and 12-h dose intervals, the 8-h interval may be preferred if the volume of heparin injected exceeds 1 cc, or if the patient’s history suggests that hypocoagulability should be maintained at the lower limits. Hematoma formation at the injection site (thigh or abdomen) can be minimized by slowly injecting into a pinched roll of adipose and holding the site for a few minutes. Because of the risk of thrombocytopenia, it is advisable to check the platelet count prior to beginning heparin and periodically thereafter.
Prehospital care
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Maria J. Colomina, Maylin Koo, José María Soto-Ejarque
Additionally, we have to consider the effect of hypertonic fluids on coagulation, particularly solutions mixed with dextrans (a water-soluble polysaccharide of glucose). Prehospital administration of these fluids in situations of severe shock (systolic BP ≤70 mmHg) has been associated with laboratory parameters that are consistent with hypocoagulability (decreased or deficient ability of blood to clot) and hyperfibrinolysis (marked increase of subdural hematomas).52
Prospective assessment of platelet function in patients undergoing elective resection of glioblastoma multiforme
Published in Platelets, 2023
Santiago R. Leal-Noval, Manuel Casado, Cancela Palomares, José L. Narros, José L. García-Garmendia, Ginés Escolar, Diego X. Cuenca, Klaus Görlinger
Second, how and when coagulation is assessed by ROTEM is of paramount importance. In our study, we found a state of hypocoagulability (based on decreased ROTEM amplitude), rather than hypercoagulability (based on decreased PT/aPTT). The procoagulant activity of GBM has been documented by ROTEM in 21 patients with cerebral tumors (8 gliomas).28 All intra-operative data had median value within the ROTEM reference ranges, however a significant decreased CT-EXTEM and clot amplitude (MCF in EXTEM, INTEM and APTEM, except FIBTEM) and increased fibrinolisis (median ML > 50% in all the tests) were observed after spiking with tumor tissue extract own citrated whole blood. Authors concluded that there was a procoagulant state counterbalanced by strong hyperfibrinolysis and speculated that tumor extract induced and strong and early drop in platelets count and worsened platelet aggregation leading to reduced clot amplitude (MCF-EXTEM). We found reduced MCF in EXTEM, although we did not observe hyperfibrinolysis, nor did these authors find it in the basal ROTEM, without adding extracts of brain tissue.28
Acute coronary syndrome in patients with cancer
Published in Expert Review of Cardiovascular Therapy, 2022
Fisayomi Shobayo, Muhammad Bajwa, Efstratios Koutroumpakis, Saamir A. Hassan, Nicolas L. Palaskas, Cezar Iliescu, Jun-Ichi Abe, Elie Mouhayar, Kaveh Karimzad, Kara A. Thompson, Anita Deswal, Syed Wamique Yusuf
Thromboelastography (TEG) is a hemostatic tool used to determine the clotting efficacy of blood [117]; it has been proposed as a tool in the management of ACS in the thrombocytopenic patient. Agha and colleagues [118] report hypocoagulability in all patients with platelet counts below 20,000/mm3 and in 75% of patients with a platelet count below 50,000/mm3 [118]. Patients with a platelet count of <50,000/mm3 were more likely to have a hypocoagulable profile on TEG and had overall worse survival at 24 months [118]. Based on their data, the authors recommend TEG measurements in all patients with platelet count <50,000/ mm3 or in all patients with hematological malignancies before invasive coronary procedures [118]. Patients with platelet counts below 20,000/ mm3 have abnormal TEGs; TEG analysis in these patients may guide transfusion requirements if excessive bleeding does occur. A normal TEG in patients with platelet counts between 20,000–50,000/mm3 suggests a reduced risk of bleeding and portends a higher chance of survival [118]. Kasivisvanathan and colleagues [119] also show comparable results in their consecutive prospective analysis of bleeding risks in hematological malignancies and concurrent thrombocytopenia patients. All patients with bleeding episodes demonstrated hypocoagulability on TEG measurements compared to their non-bleeding counterparts [119].
Performance Evaluation of a New Point of Care Viscoelastic Coagulation Monitoring System in Major Abdominal, Orthopaedic and Vascular Surgery
Published in Platelets, 2020
Chris Brearton, Andrew Rushton, Jane Parker, Hannah Martin, Jake Hodgson
One limitation of the study was that none of the intra-operative samples for the Major Abdominal and Orthopedic Surgery groups had abnormal hemostasis. The study was intended to compare VCM and ROTEM® NATEM results for samples with coagulation statuses ranging from hypo- to hypercoagulable. This would have allowed a review of the agreement between the two systems across the likely measurement range and provided a good data set for regression analysis. The patient groups and sample times were selected with the aim of achieving this range of samples. However due to the limitation of selecting only elective patients it was difficult to predict when/if abnormalities of coagulation would occur. Pre-operative samples were expected to show normal coagulability, intra-operative samples from the Major Abdominal and Orthopedic Surgery were anticipated to show varying degrees of hypo- and hypercoagulability, whilst the Vascular Surgery patients were expected to show more extreme hypocoagulability. In reality, the vast majority of samples tested as part of this study fell within the ‘normal’ range on both systems, with the majority of the ‘abnormal’ samples coming from the Vascular Surgery group. This had two disadvantages. Firstly, that it limited our ability to review how the two systems correlate across the range of moderately hypocoagulable to hypercoagulable. Secondly, the available data was not ideal for regression analysis, as rather than a spread of data across a range the study gave two clusters of data points in the ‘normal’ and ‘extreme hypocoagulable’ ranges.