Features of the hemostasis system in patients with non-alcoholic fatty liver disease

Background. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. In recent years, disorders in the hemostasis system, their role in the progression of liver diseases and the development of cardiovascular complications in NAFLD have been actively studied. The purpose was to investigate the features of the hemostasis system in patients with non-alcoholic fatty liver disease. Materials and methods. We examined 36 individuals with NAFLD (20 women and 16 men) aged 29–73 years. All patients underwent an anthropometric, general clinical, biochemical study of blood serum with the determination of platelets, prothrombin time ratio, international normalized ratio, fibrinogen, ultrasound examination of the abdominal cavity organs with elastometry, followed by statistical data processing. Results. Among patients with NAFLD, class 2 obesity and overweight (30.6 % each), class 1 obesity (27.8 %) prevailed. At the same time, according to the controlled attenuation parameter, 38.9 % of people had a severe degree of steatosis, 33.3 % — moderate and 27.8 % — mild. Regarding the indicators of hemostasis, a significant increase in the level of fibrinogen up to (4.9 ± 0.5) g/l was detected in 44.4 % of patients, its severity tended to grow with an increase in the degree of hepatic steatosis. Conclusions. In 44.4 % of NAFLD patients, with an increase in the degree of hepatic steatosis, the tendency to hypercoagulability has grown with an increase in fibrinogen content by 1.6 times (p < 0.001). Changes in the international normalized ratio, prothrombin time ratio and platelets were determined in isolated cases: more than 83.3 % of patients with NAFLD didn’t have violations of these parameters.

Coagulopathy Induced by Veno-Arterial Extracorporeal Membrane Oxygenation Is Associated With a Poor Outcome in Patients With Out-of-Hospital Cardiac Arrest

Background: In recent years, the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiopulmonary arrest who do not respond to conventional resuscitation, has increased. However, despite the development of VA-ECMO, the outcomes of resuscitated patients remain poor. The poor prognosis may be attributed to deterioration owing to the post-cardiac arrest syndrome (PCAS); this includes the systemic inflammatory response and coagulation activation caused by the extracorporeal circulation (VA-ECMO circuit) itself. This study aimed to evaluate the coagulofibrinolytic changes caused by VA-ECMO and to identify predictive factors of poor prognosis.Methods: We analyzed 151 cases of PCAS with witnessed cardiac arrest. As biomarkers, platelet counts, prothrombin time ratio, fibrin/fibrinogen degradation products, fibrinogen, antithrombin, and lactate were recorded from blood samples from the time of delivery to the third day of hospitalization. The maximum (max) and minimum (min) values of each factor during the study period were calculated. To evaluate the impact of VA-ECMO on patients with PCAS, we performed propensity score matching between the patients who received and did not receive VA-ECMO. Sub-analysis was performed for the group with VA-ECMO.Results: There were significant differences in all baseline characteristics and demographics except the time from detection to hospital arrival, percentage of cardiopulmonary resuscitations (CPR) by witnesses, and the initial rhythm between the groups. Propensity score matching adjusted for prehospital factors demonstrated that the patients who received VA-ECMO developed significantly severe coagulation disorders. In a sub-analysis, significant differences were noted in the prothrombin time ratio min, fibrinogen max, antithrombin max, and lactate min between survivors and non-survivors. In particular, the prothrombin time ratio min and antithrombin max were strongly correlated with poor outcome.Conclusion: In the present study, significant coagulopathy was observed in patients who received VA-ECMO for CPR. In particular, in patients receiving VA-ECMO, the minimum prothrombin time ratio and maximum antithrombin by day 3 of hospitalization were strongly correlated with poor outcomes. These results suggest that VA-ECMO-induced coagulopathy can be a promising therapeutic target for patients resuscitated by VA-ECMO.

Haemostatic effects of levothyroxine and selenomethionine in euthyroid patients with Hashimoto’s thyroiditis

SummaryThe aim of this prospective study was to investigate for the first time whether levothyroxine and selenomethionine, administered alone or in combination, affect coagulation and fibrinolysis in Hashimoto’s thyroiditis patients with normal thyroid function tests. A group of 155 ambulatory women with recently diagnosed and previously untreated Hashimoto’s thyroiditis, of whom 149 completed the study, were randomly assigned in a double-blind fashion to six months of treatment with levothyroxine, selenomethionine, levothyroxine plus selenomethionine, or placebo. The control group included 39 matched healthy women. The prothrombin time ratio, the activated partial thromboplastin time, and plasma levels/activities of fibrinogen, factor VII, von Willebrand factor, factor X and plasminogen activator inhibitor-1 (PAI-1) were assessed at baseline and after three and six months of treatment. Compared with the healthy subjects, Hashimoto’s thyroiditis patients exhibited higher plasma levels/activities of all of the parameters studied, as well as were characterised by the abnormal prothrombin time ratio and activated partial thromboplastin time. All these haemostatic disturbances were reduced or normalised by levothyroxine + selenomethionine treatment, while the effect of levothyroxine or selenomethionine was limited to fibrinogen and PAI-1, respectively. Our results demonstrate that euthyroid women with Hashimoto’s thyroiditis are characterised by abnormal coagulation and fibrinolysis. Levothyroxine and selenomethionine, especially if administered together, produce a beneficial effect on haemostasis in euthyroid patients with this disorder.Note: This study was in part a sub-study of another trial (ACTRN 12611000238976), which assessed the effect of levothyroxine and selenomethionine, administered alone or in combination, on monocyte and lymphocyte cytokine release in Hashimoto“s thyroiditis patients. Trial no.: ACTRN12612000271808.

Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria

SummaryThe Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH).Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n=98) or trauma (n=95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p<0.0001).Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p<0.001).These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death. These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.

Prothrombin Time Ratio Is Reduced by Magnesium Contamination in Evacuated Blood Collection Tubes

SummaryMagnesium ions were detected in sodium citrate solutions in several lots of evacuated blood collection tubes. The mean concentrations ranged between 1.3 and 1.6 mmol/L. Magnesium was also present in the rubber stoppers of the blood collection tubes and could be leached into the citrate solution. It was shown that magnesium added to citrated plasma shortened the prothrombin time of both coumarin and normal plasma. The effect of magnesium was relatively greater on coumarin than on normal plasma resulting in reduced prothrombin time ratio. Shortening of the prothrombin time was also observed when magnesium chloride was added to dialysed plasma, i.e., in the absence of citrate. These results indicate that magnesium contamination can interfere with accurate INR determination in the control of oral anticoagulant therapy.