The Experts below are selected from a list of 2028 Experts worldwide ranked by ideXlab platform
Martin A. Schreiber - One of the best experts on this subject based on the ideXlab platform.
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The international normalized ratio overestimates coagulopathy in patients after major hepatectomy
American journal of surgery, 2014Co-Authors: Scott G. Louis, Jeffrey S. Barton, Gordon M. Riha, Susan L. Orloff, Brett C. Sheppard, Rodney F. Pommier, Samantha J. Underwood, Jerome A. Differding, Martin A. Schreiber, Kevin G. BillingsleyAbstract:Abstract Background The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of Hypocoagulability in this patient population. Methods Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5. Results Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C. Conclusions TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates Hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population.
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Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury
American journal of surgery, 2012Co-Authors: Nicholas R. Kunio, Jerome A. Differding, Katherine M. Watson, Ryland S. Stucke, Martin A. SchreiberAbstract:Abstract Background The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury. Methods Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis. Results Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed Hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit–free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%). Conclusions Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention.
Bryan A. Cotton - One of the best experts on this subject based on the ideXlab platform.
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Hypocoagulability in traumatic brain injury as measured by traditional means and thrombelastography
Journal of Neurology and Neurophysiology, 2015Co-Authors: Sherry L Sixta, Jessica C. Cardenas, Ryan S. Kitagawa, Charles E. Wade, John B. Holcomb, Bryan A. CottonAbstract:Background: Conflicting data exist regarding the association of traumatic brain injury (TBI) with coagulopathy as measured by conventional coagulation testing (CCT). Objective: This study is intended to determine the prevalence of coagulopathy in TBI patients by CCT and rapid thrombelastography (r-TEG) and to determine the relationship between these laboratory tests and mortality. Methods: Over an 18-month period, the admission r-TEG values (ACT, R-value, k-time, alpha, mA, and LY30) and CCTs (aPTT, INR, platelet count, and fibrinogen) were recorded on the highest-level trauma activations admitted directly from the injury scene. Patients were then categorized as non-TBI (Head AIS 0-2) or isolated TBI (Head AIS >2 and all other AIS scores ≤ 2), and all other patients were excluded. A patient has determined to have a coagulopathy if one or more of the following was present: aPTT>35 sec, INR>1.5, platelet count 128, R>1.1, k>2.5, alpha 3%. Results: 1847 non-TBI patients and 77 isolated-TBI were identified. No significant difference was detected between the groups by CCT, but the isolated-TBI group was found to have more patients with mA<55 by r-TEG (p=0.034). Multiple logistic regression revealed mA<55 (OR 3.68; p=0.015) or alpha<56 (OR 22.23; p<0.001) were predictive of 24-hour mortality in all patients. However, in isolated TBI patients, the presence of either of these hypocoagulable variables was uniformly fatal. Conclusion: No difference in coagulopathy prevalence was observed between TBI and non-TBI patients by CCT, but a higher prevalence of coagulopathy by r-TEG values was found in isolated TBI patients and was predictive of mortality.
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Hypocoagulability in Traumatic Brain Injury as Measured by Traditional Means and Thrombelastography
Journal of Neurology & Neurophysiology, 2015Co-Authors: Sherry L Sixta, Jessica C. Cardenas, Ryan S. Kitagawa, Charles E. Wade, John B. Holcomb, Bryan A. CottonAbstract:Background: Conflicting data exist regarding the association of traumatic brain injury (TBI) with coagulopathy as measured by conventional coagulation testing (CCT). Objective: This study is intended to determine the prevalence of coagulopathy in TBI patients by CCT and rapid thrombelastography (r-TEG) and to determine the relationship between these laboratory tests and mortality. Methods: Over an 18-month period, the admission r-TEG values (ACT, R-value, k-time, alpha, mA, and LY30) and CCTs (aPTT, INR, platelet count, and fibrinogen) were recorded on the highest-level trauma activations admitted directly from the injury scene. Patients were then categorized as non-TBI (Head AIS 0-2) or isolated TBI (Head AIS >2 and all other AIS scores ≤ 2), and all other patients were excluded. A patient has determined to have a coagulopathy if one or more of the following was present: aPTT>35 sec, INR>1.5, platelet count 128, R>1.1, k>2.5, alpha 3%. Results: 1847 non-TBI patients and 77 isolated-TBI were identified. No significant difference was detected between the groups by CCT, but the isolated-TBI group was found to have more patients with mA
S. Mariotti - One of the best experts on this subject based on the ideXlab platform.
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Thyroid disorders and Hypocoagulability.
Seminars in thrombosis and hemostasis, 2011Co-Authors: Francesco Marongiu, Doris Barcellona, Antonella Mameli, S. MariottiAbstract:This review focuses attention on some practical aspects of the relationship between thyroid disorders and Hypocoagulability, as related to an impairment of hemostasis and fibrinolysis. An understanding of this topic in daily clinical practice is important given that the interaction between hemostatic abnormalities and thyroid disorders is still poorly recognized by the medical community. Even if the bleeding tendency is in general mild and may be reversed by restoration of an euthyroid state, severe hemorrhagic events may complicate the course of both hyper- and hypothyroidism, as precipitated by such conditions as thrombocytopenia, acquired von Willebrand syndrome, and acquired hemophilia. The pathogenesis of the hemostatic abnormalities resides in either the direct effect of thyroid hormones or some conditions in an autoimmune mechanism. Physicians and endocrinologists should pay close attention to both clinical hemorrhagic events in their patients as well as to any laboratory abnormalities identified by blood coagulation testing.
Gianluca Rompianesi - One of the best experts on this subject based on the ideXlab platform.
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thromboelastographic changes in liver and pancreatic cancer surgery hypercoagulability Hypocoagulability or normocoagulability
European Journal of Anaesthesiology, 2010Co-Authors: Lesley De Pietri, Giorgia Marconi, Alexia Reggiani, Stefano Aiello, Roberto Montalti, B Begliomini, Giulia Scaglioni, Fabrizio Di Benedetto, Alberto Pasetto, Gianluca RompianesiAbstract:Background and objectiveDespite clinical and laboratory evidence of perioperative hypercoagulability, alterations in haemostasis after potentially haemorrhagic oncologic surgery are difficult to predict. This study aims to evaluate the entity, the extent and the duration of perioperative coagulative
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Thromboelastographic changes in liver and pancreatic cancer surgery: hypercoagulability, Hypocoagulability or normocoagulability?
'Ovid Technologies (Wolters Kluwer Health)', 2010Co-Authors: D. L. Pietri, Giorgia Marconi, Stefano Aiello, Roberto Montalti, Begliomini Bruno, Scaglioni Giulia, Reggiani Alexia, Di Benedetto Fabrizio, Pasetto Alberto, Gianluca RompianesiAbstract:BACKGROUND AND OBJECTIVE: Despite clinical and laboratory evidence of perioperative hypercoagulability, alterations in haemostasis after potentially haemorrhagic oncologic surgery are difficult to predict. This study aims to evaluate the entity, the extent and the duration of perioperative coagulative alterations following pancreas and liver oncologic surgery, by the use of both routine tests and thromboelastogram (TEG). METHODS: Fifty-six patients undergoing liver (n = 38) and pancreatic (n = 18) surgery were studied. The coagulation profile was evaluated by platelet count, prothrombin time-international normalized ratio, activated partial thromboplastin time, antithrombin III and TEG at the beginning, at the end of the operation and on postoperative days 1, 3, 5 and 10. RESULTS: All preoperative coagulative screening and TEG traces were normal before incision. In the postoperative period of the liver and pancreas groups, despite an increase in prothrombin time-international normalized ratio, a reduction in antithrombin III and platelet count and normal activated partial thromboplastin time and fibrinogen, TEG evidenced a normocoagulability in the liver group, with a major tendency towards Hypocoagulability in the pancreas group, as evidenced by a transient increase in R-time and K-time between postoperative days 1 and 3. During the study period, four cases of pulmonary embolism, resolved with heparin infusion, were recorded, in the absence of laboratory and thromboelastographic evidence of hypercoagulability. CONCLUSION: Despite laboratory tests evidencing Hypocoagulability in both groups, TEG traces showed a normocoagulability in liver resections, whereas a transient thromboelastographic Hypocoagulability was evident in patients undergoing pancreas surgery. The discrepancy between laboratory values and thromboelastographic variables was even more evident in patients undergoing major liver resections compared with minor ones. Our study supports the role of thromboelastography, despite its limitations, as a valuable tool for the evaluation of the perioperative whole coagulation process and hypercoagulability changes and to increase patient safety through better management of antithrombotic therapy
Jerome A. Differding - One of the best experts on this subject based on the ideXlab platform.
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The international normalized ratio overestimates coagulopathy in patients after major hepatectomy
American journal of surgery, 2014Co-Authors: Scott G. Louis, Jeffrey S. Barton, Gordon M. Riha, Susan L. Orloff, Brett C. Sheppard, Rodney F. Pommier, Samantha J. Underwood, Jerome A. Differding, Martin A. Schreiber, Kevin G. BillingsleyAbstract:Abstract Background The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of Hypocoagulability in this patient population. Methods Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5. Results Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C. Conclusions TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates Hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population.
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Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury
American journal of surgery, 2012Co-Authors: Nicholas R. Kunio, Jerome A. Differding, Katherine M. Watson, Ryland S. Stucke, Martin A. SchreiberAbstract:Abstract Background The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury. Methods Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis. Results Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed Hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit–free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%). Conclusions Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention.