scholarly journals Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

2007 ◽  
Vol 34 (6) ◽  
pp. 396-411 ◽  
Author(s):  
Klaus Görlinger ◽  
Csilla Jambor ◽  
Alexander A. Hanke ◽  
Daniel Dirkmann ◽  
Michael Adamzik ◽  
...  
Keyword(s):  
Platelet Function ◽  
Platelet Transfusion ◽  
Function Analysis ◽  
Point Of Care ◽  
Coagulation Management ◽  
And Control

Abstract 16676: Heightened Platelet Function: An Unrecognized Component of the Covid Hypercoagulability State

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kevin Bliden ◽  
Amit Rout ◽  
Rahul Chaudhary ◽  
Jaime Barnes ◽  
Sahib Singh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Platelet Function ◽  
Function Analysis ◽  
Point Of Care ◽  
Fibrin Clot ◽  
High Rate ◽  
Clot Strength ◽  
Markers Of Inflammation ◽  
Co Morbidity ◽  
D Dimer

Introduction: Thrombo-inflammatory syndrome (TIS) characterized by a pathophysiological state of hypercoagulability, heightened platelet function, and inflammation has been observed in patients with acute myocardial infarction, and HIV. Hypothesis: The incidence of TIS is observed at a high rate in COVID-19 patients and worsens with symptom severity Methods: Blood samples from COVID-19 positive hospitalized patients (n=24) was collected for coagulation and platelet function analysis using point-of-care thromboelastography, TEG6s (Haemonetics, Corp) and routine labs were collected to measure markers of inflammation, coagulation, and organ damage (Table). Disease severity was grouped according to oxygen supplementation requirements and comparisons were made using unpaired t-test and chi-squared tests. Thrombo-inflammation was defined as the presence of both hypercoagulability by TEG [Clot initiation (R) < 4.6, fibrin clot strength (FCS) >32mm, and platelet fibrin clot strength (PFCS) >69] and D-dimer >ULN. Results: Ninety- five percent of COVID positive patients had at least one co-morbidity with the incidence of hypertension (71%), diabetes (50%), and obesity (42%) being the most frequent. A total of 63% (16/24) of patients had TIS, the incidence was significantly increased with escalating disease severity (p=0.03). A significant stepwise (p<0.05) increase in FCS, D-Dimer, WBC count, lactate dehydrogenase, and procalcitonin was observed with worsening respiratory function (table). MA-ADP a measure of platelet function was in the high normal range for 81 % of patients. Conclusions: Thrombo-inflammatory is observed with most COVID patients, importantly heightened platelet function is a component of the syndrome and raises the question if antiplatelet therapy is needed in select COVID patients. Selective assessments with TEG6s may facilitate antithrombotic personalization.

scholarly journals Point-of-Care Platelet Function Analysis

2009 ◽  
Vol 53 (10) ◽  
pp. 857-859 ◽  
Author(s):  
Elisabeth Mahla ◽  
Mark J. Antonino ◽  
Udaya S. Tantry ◽  
Paul A. Gurbel
Keyword(s):  
Platelet Function ◽  
Function Analysis ◽  
Point Of Care

Platelet Transfusion in Perioperative Medicine

2019 ◽  
Vol 46 (01) ◽  
pp. 050-061
Author(s):  
Thomas Thiele ◽  
Andreas Greinacher
Keyword(s):  
Platelet Function ◽  
Platelet Transfusion ◽  
Point Of Care ◽  
Adverse Outcomes ◽  
Perioperative Medicine ◽  
Transfusion Strategy ◽  
Transfusion Threshold ◽  
Primary Hemostasis ◽  
Weak Evidence ◽  
Platelet Transfusions

AbstractPlatelet transfusions aim to improve primary hemostasis and to prevent or treat bleeding in patients with reduced platelet numbers and/or platelet function. In this review, the authors address the role of platelet transfusions with a focus on perioperative medicine. They summarize different causes of thrombocytopenia in perioperative patients, describe general characteristics and potential adverse effects of different platelet concentrates, describe principles of perioperative platelet transfusion strategies, and highlight specific perioperative scenarios, for example, in patients undergoing antiplatelet therapy. The evidence for any transfusion threshold in perioperative patients based on platelet numbers is low. The evidence supporting prophylactic platelet transfusions in the perioperative setting is very low, and all recommended thresholds for preintervention platelet transfusions are based on weak evidence or expert opinion. Besides the platelet count, platelet function, additional risk factors for bleeding, and the pharmacokinetic properties of concomitant antiplatelet drugs are important criteria for the decision to transfuse or not to transfuse platelets. The few available prospective trials give at least a signal that a liberal platelet transfusion strategy might be associated with poorer outcomes compared with a restrictive platelet transfusion strategy in critically ill patients. Given the unknown risks for adverse outcomes, a therapeutic transfusion strategy during surgery (eventually guided by point of care testing in cardiac surgery, major liver surgery, and major trauma) may be most appropriate for interventions, in which intraoperative bleeding can be controlled until platelets are available, and during the postsurgery period.

“Aspirin - resistance”? A few critical considerations on definition, terminology, diagnosis, clinical value, natural course of atherosclerotic disease, and therapeutic consequences

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 429-438 ◽  
Author(s):  
Berent ◽  
Sinzinger
Keyword(s):  
Platelet Function ◽  
Point Of Care ◽  
Aspirin Resistance ◽  
Point Of View ◽  
Evidence Based ◽  
Platelet Function Tests ◽  
Clinical Value ◽  
Vascular Events ◽  
Therapeutic Consequences ◽  
Function Tests

Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term “aspirin resistance” was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Intertest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Therefore, it may be more appropriate to speak about “treatment failure” to aspirin therapy than using the term “aspirin resistance”. There is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term “aspirin resistance” should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended.

Coagulation parameters and platelet function analysis in patients with acromegaly

2015 ◽  
Author(s):  
Hamiyet Yilmaz Yasar ◽  
Mustafa Demirpence ◽  
Ayfer Colak ◽  
Banu Ozturk Ceyhan ◽  
Yusuf Temel ◽  
...  
Keyword(s):  
Platelet Function ◽  
Function Analysis ◽  
Coagulation Parameters

scholarly journals Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Johannes Herrmann ◽  
Quirin Notz ◽  
Tobias Schlesinger ◽  
Jan Stumpner ◽  
Markus Kredel ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Platelet Function ◽  
Distress Syndrome ◽  
Point Of Care ◽  
Retrospective Observational Study ◽  
Bleeding Complications ◽  
Thromboembolic Events

Abstract Background Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT. Methods This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020. Results Median age was 61 years (IQR: 51–69). Median PaO2/FiO2 on admission was 122 mmHg (IQR: 87–189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3–10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications. Conclusions Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..

The Use of the Point of Care Helena ICHOR/Plateletworks® and the Accumetrics Ultegra® RPFA for Assessment of Platelet Function with GPIIb-IIIa Antagonists

2004 ◽  
Vol 18 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Melanie M. White ◽  
Rajini Krishnan ◽  
Teddi J. Kueter ◽  
Mary V. Jacoski ◽  
Lisa K. Jennings
Keyword(s):  
Platelet Function ◽  
Point Of Care
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