| 1. |
- Richards, Stephen, et al.
(författare)
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Genome Sequence of the Pea Aphid Acyrthosiphon pisum
- 2010
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Ingår i: PLoS biology. - : Public Library of Science (PLoS). - 1544-9173 .- 1545-7885. ; 8:2, s. e1000313-
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Tidskriftsartikel (refereegranskat)abstract
- Aphids are important agricultural pests and also biological models for studies of insect-plant interactions, symbiosis, virus vectoring, and the developmental causes of extreme phenotypic plasticity. Here we present the 464 Mb draft genome assembly of the pea aphid Acyrthosiphon pisum. This first published whole genome sequence of a basal hemimetabolous insect provides an outgroup to the multiple published genomes of holometabolous insects. Pea aphids are host-plant specialists, they can reproduce both sexually and asexually, and they have coevolved with an obligate bacterial symbiont. Here we highlight findings from whole genome analysis that may be related to these unusual biological features. These findings include discovery of extensive gene duplication in more than 2000 gene families as well as loss of evolutionarily conserved genes. Gene family expansions relative to other published genomes include genes involved in chromatin modification, miRNA synthesis, and sugar transport. Gene losses include genes central to the IMD immune pathway, selenoprotein utilization, purine salvage, and the entire urea cycle. The pea aphid genome reveals that only a limited number of genes have been acquired from bacteria; thus the reduced gene count of Buchnera does not reflect gene transfer to the host genome. The inventory of metabolic genes in the pea aphid genome suggests that there is extensive metabolite exchange between the aphid and Buchnera, including sharing of amino acid biosynthesis between the aphid and Buchnera. The pea aphid genome provides a foundation for post-genomic studies of fundamental biological questions and applied agricultural problems.
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| 2. |
- Schott, Ulf, et al.
(författare)
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Time to peak effect of aspirin-induced platelet inhibition and ex vivo effects of desmopressin: An observational study
- 2021
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Ingår i: Journal of Integrative Cardiology. - 2058-3702. ; 7, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate time to maximal platelet inhibition after an oral loading dose of ASA. The effect of ex vivo reversal platelet inhibition by desmopressin (DDAVP) was also studied. Methods: Ten healthy volunteers were given a 300 mg ASA-tablet. Blood was sampled at 0, 15, 30, 60, 120 and 180 minutes. DDAVP was added to the samples taken at 120 minutes. Samples were analysed with a Multiplate® platelet aggregometer (MEA) using arachidonic acid (AA), collagen and thrombin aggregation agonists. Results: Platelet inhibition was observed in the sample activated by AA at 15 minutes but not until 120 minutes in the samples activated by collagen. No platelet inhibition was seen in the samples activated by thrombin. The median time to maximal AA-induced platelet inhibition of <30 U was 30 (interquartile range 15-90) minutes. Ex vivo DDAVP did not reverse platelet inhibition. Subgroup analysis did not show any gender differences. Conclusions: ASA induces a strong platelet inhibition within 30 minutes of oral ingestion, with no gender differences. Ex vivo DDAVP did not reverse ASA’s platelet inhibition.
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| 3. |
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| 4. |
- Benardou, Agiatis, et al.
(författare)
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State of the art report on digital research practices, tools and scholarly content use : Deliverable D1.2
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This document constitutes desk research to analyse the current situation related to digital research practices, tools and content for the humanities and social sciences research communities and it comprises of three Milestones submitted separately in the course of the first nine months of the Project, each corresponding to digital research practices, tools and content respectively. Moreover, this report will serve as an exploratory stage which will provide the basis for the confirmation stage, that is the web survey undertaken within Task 1.3, relying heavily on work previously presented in Deliverable 1.1 (Research Communities Identification and Definition Report), in which the humanities and social sciences research communities were largely identified. The Research Communities Web Survey (T.1.3.4), which has been completed and is currently being processed, encompasses - amongst others -questions pertaining to the activities undertaken by Humanities and Social Sciences researchers, as well as questions regarding the use of content and metadata. This current document provides the background work which guided the design of the Web Survey and is meant to complement the related Web Survey findings which will comprise the User Requirements and Case Studies Analysis report, D1.3. Moreover, this work draws from and complements Deliverable 1.5 (Case Studies Expert Forum Report. The present desk research seeks to analyse the current situation related to digital research practices, tools and content for the humanities and social sciences research community, and will serve as an exploratory stage which will provide the basis for the confirmatory stage, that is the Content Strategy and User Requirements reports, due later on in the Project.
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| 5. |
- Bentzer, Peter, et al.
(författare)
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The volume-expanding effects of autologous liquid stored plasma following hemorrhage.
- 2012
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 72:6, s. 490-494
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Tidskriftsartikel (refereegranskat)abstract
- Background: Plasma use has increased since studies have suggested that early treatment with blood components in trauma with severe hemorrhage may improve outcome. Plasma is also commonly used to correct coagulation disturbances in non-bleeding patients. Little is known about the effects of plasma transfusion on plasma volume. We report a prospective interventional study in which the plasma volume-expanding effect of autologous plasma was investigated after a controlled hemorrhage. Methods: Plasma obtained by plasmapheresis from nine healthy regular blood donors was stored at 2-6°C. Five weeks after donation the subjects were bled of 600 ml and then transfused with 600 ml of autologous plasma. Plasma volume was estimated using (125)I-albumin before and after bleeding, and immediately after plasma transfusion. Plasma volume changes were then estimated by measuring changes in hematocrit during the following 3-h period. Results: Estimated plasma volume after bleeding was 3170 ± 320 ml and 3690 ± 380 ml (mean ± standard deviation) immediately following the transfusion of plasma (p 0.05). This increase in plasma volume corresponds to 86 ± 13% of the infused volume. Three hours after transfusion, plasma volume was still 3680 ± 410 ml. Conclusions: Stored liquid plasma has a plasma volume expanding effect up to 86% of its infused volume with a duration of at least 3 h.
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| 6. |
- Breivik, Harald, et al.
(författare)
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Reducing risk of spinal haematoma from spinal and epidural pain procedures
- 2018
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 18:2, s. 129-150
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Forskningsöversikt (refereegranskat)abstract
- Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients' comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. When neuraxial analgesia is considered for a patient on anti-haemostatic medication, with patient-related, or procedure-related risk factors, the balance of benefits against risks of bleeding is decisive; when CNB are offered exclusively to patients who will have a reduction of postoperative morbidity and mortality, then a higher risk of bleeding may be accepted. Robust routines should ensure appropriate discontinuation of anti-haemostatic drugs and early detection and treatment of SH. There is an on-going development of drugs for prevention of thromboembolic events following surgery and childbirth. The present practise advisory provides up-to-date knowledge and experts' experiences so that patients who will greatly benefit from neuraxial pain procedures and have increased risk of bleeding can safely benefit from these procedures. There are always individual factors for the clinician to evaluate and consider. Increasingly it is necessary for the anaesthesia and analgesia provider to collaborate with specialists in haemostasis. Surgeons and obstetricians must be equally well prepared to collaborate for the best outcome for their patients suffering from acute or chronic pain. Optimal pain management is a prerequisite for enhanced recovery after surgery, but there is a multitude of additional concerns, such as early mobilisation, early oral feeding and ileus prevention that surgeons and anaesthesia providers need to optimise for the best outcome and least risk of complications.
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| 7. |
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| 8. |
- Lund, Philip E., et al.
(författare)
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Comparison of two infusion rates of antithrombin concentrate in cardiopulmonary bypass surgery
- 2010
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Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 25:5, s. 305-312
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Tidskriftsartikel (refereegranskat)abstract
- Background: Antithrombin concentrate (AT) is used to treat heparin resistance (HR) in cardiac surgery. It is usually given slowly due to the fear of anaphylaxis. This may delay cardiac catheterisation and the start of cardiopulmonary bypass (CPB). HR is often defined as the failure to reach or maintain a target activated clotting time (ACT) despite a standard dose of heparin. It is not generally possible to predict which patients will display HR, although there are known risk factors. Routine early administration of AT before heparinisation is probably not cost-effective. Infusing AT relatively quickly after demonstrating HR may be more cost-effective, while not delaying surgery. The aim of this study is to investigate the safety and side effects of a faster infusion of AT. Methods: Forty patients undergoing elective heart surgery were included and randomised to two groups in a double-blind fashion. Each group received 1000 IU of AT intravenously (IV). One group received a slow infusion (100 IU/min) before full-dose heparinisation. The other group received a fast infusion (250 IU/min). Haemodynamic and respiratory data were recorded. Any adverse effects were noted. Thrombin-antithrombin, anti-Xa and antithrombin levels in plasma were measured. Results: No anaphylaxis occurred in either group. No differences were found regarding haemodynamics, respiration or laboratory results. Two patients experienced major haemorrhage and recovered; there were two deaths, thought to be unrelated to the study drugs. Conclusion: AT can be infused at a rate of 250 IU/min. This is faster than the current recommendation of 100 IU/min. This rate of infusion allows restricting AT infusion to those patients who display HR, without delaying surgery. Optimal anticoagulant therapy for CPB probably includes point-of-care measurement of ACT and plasma AT and small, but rapid, infusions of AT in heparin-resistant patients.
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| 9. |
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| 10. |
- Overgaard, Morten F, et al.
(författare)
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Physician staffed emergency medical service for children: a retrospective population-based registry cohort study in Odense region, Southern Denmark
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study is to determine diagnostic patterns in the prehospital paediatric population, age distribution, the level of monitoring and the treatment initiated in the prehospital paediatric case. Hypothesis was that advanced prehospital interventions are rare in the paediatric patient population. Setting We performed a retrospective population-based registry cohort study of children attended by a physician-staffed emergency medical service (EMS) unit (P-EMS), in the Odense area of Denmark during a 10-year study period. Participants We screened 44 882 EMS contacts and included 5043 children. Patient characteristics, monitoring and interventions performed by the P-EMS crews were determined. Results We found that paediatric patients were a minority among patients attended by P-EMS units: 11.2% (10.9 to 11.5) (95% CI) of patients were children. The majority of the children were <5 years old; one-third being <2 years old. Respiratory problems, traffic accidents and febrile seizures were the three most common dispatch codes. Oxygen supplementation, intravenous access and application of a cervical collar were the three most common interventions. Oxygen saturation and heart rate were documented in more than half of the cases, but more than one-third of the children had no vital parameters documented. Only 22% of the children had respiratory rate, saturation, heart rate and blood pressure documented. Prehospital invasive procedures such as tracheal intubation (n=74), intraosseous access (n=22) and chest drainage (n=2) were infrequently performed. Conclusion Prehospital paediatric contacts are uncommon, more frequently involving smaller children. Monitoring or at least documentation of basic vital parameters is infrequent and may be an area for improvement. Advanced and potentially life-saving prehospital interventions provide a dilemma since these likely occur too infrequently to allow service providers to maintain their technical skills working solely in the prehospital environment.
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| 11. |
- Schaub, Christian, et al.
(författare)
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Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery
- 2013
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Ingår i: Cardivascular System. - : Herbert Publications PVT LTD. - 2052-4358. ; :1
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Tidskriftsartikel (refereegranskat)abstract
- Background: An optimal dosage and infusion regime for protamine reversal of heparin after cardiopulmonary bypass is important. Methods: Protamine dosages of either 2mg/kg or 4mg/kg bodyweight were compared in 40 patients after first time coronary arterial bypass grafting. Protamine was infused with a syringe driver over 20 minutes. Arterial blood sampling was performed prior to and during surgery, before and at 0.3, 0.6, 1, 3, 6 and 25h after the protamine infusion. C3a-desArg and C4a-desArg were analysed by radioimmunoassay. Coagulation was assayed with Sonoclot and activated clotting time. Results: Significantly higher inter-group plasma levels of C3a-desArg were seen with the greater protamine dose from 0.3- 0.6h, but none for C4a-desArg. Sonoclot parameters and leucocyte count differed significantly between the groups up to 6h, indicating hypercoagulabilty with the higher protamine dose. Significantly longer ACT in the low protamine dosage group indicited unblocked heparin with nonsignificant increased drainage bleeding and transfusions. There were no signs of allergic or anaphylactic reactions in any of the groups. Conclusion: Keeping the protamine dose low, minimizes complement activation with less viscoelastic signs of hypercoagulability. However there is an increased risk for drainage bleeding and unnecessary transfusion if heparin is not fully reversed with protamine post cardiopulmonary bypass. The present study was underpowered to detect significant differences in bleeding.
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| 12. |
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| 13. |
- Svensson Mjöbo, Helena, et al.
(författare)
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Massiv blödning
- 2021. - Fjärde Utgåva
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Ingår i: Förebygg och hantera kriser inom anestesiologi. - 9789151995960 ; , s. 93-100
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Bokkapitel (refereegranskat)
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| 14. |
- Svensson Mjöbo, Helena, et al.
(författare)
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Massive haemorrhage
- 2021. - 4
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Ingår i: TAASK Prevent and Manage crisis in Anaesthesiology. - 9789151995953 ; , s. 93-100
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Bokkapitel (refereegranskat)
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| 15. |
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| 16. |
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TAASK : Prevent and manage crises in anesthesiology
- 2021
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Samlingsverk (redaktörskap) (populärvet., debatt m.m.)abstract
- Prevent and manage crises in anesthesiology gives anesthesiologists and allied professionals an overview of the non-technical and technical skills and knowledge that may be required at very short notice, at almost any time of the day.
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| 17. |
- Thomas, Owain, et al.
(författare)
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A Narrative Review on Central Neuraxial Blocks and Direct Oral Anticoagulants
- 2024
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Ingår i: Journal of Anesthesia & Pain Medicine. ; 9:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective In numerous studies aspiring to clarify when to discontinue direct oral anticoagulants (DOAC) before central nerve blocks (CNB), information about the technique: spinal, epidural, indwelling catheter, multiple attempts, ‘bloody tap’: is incomplete. This creates difficulty making evidence-based recommendations regarding the safest time frame between the last dose of DOAC and CNB to avoid spinal haematoma. Current guidelines and recommendations are based mainly on pharmacokinetic predictions of the time taken to reach low residual plasma levels of DOAC. Empirical research is almost impossible since the risk of haemorrhagic complication is very low.Design A structured search of publications on DOAC and CNB was performed on Pubmed.Results Accurate plasma level measurements by mass spectrometry are usually not available. Indirect calibrated anti-Xa and IIa methods are unreliable at DOAC levels <30 ng/ml. DOAC plasma levels that are safe for CNB are presently unknown.Conclusion We recommend at least 5 half-lives (T1/2) after the last dose of DOAC before performing CNB, as there is wide interindividual variation in T1/2 and thereby residual plasma concentrations. The maximal residual DOAC plasma level should then be below 3% of therapeutic levels. Such long interruption times prior to surgery are problematic in patients at high risk of arterial and venous thromboembolism, it may be safer to withhold DOAC for 4 half-lives and conduct surgery without CNB. Bridging with low molecular weight heparin (LMWH) may increase the risk of spinal haematoma with CNB.
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| 18. |
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| 19. |
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| 20. |
- Thomas, Owain, et al.
(författare)
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Bedside Point of Care Coagulation Testing for Individualized Antivitamin K Reversal: A Prospective Study
- 2013
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Ingår i: Journal of Cardiovascular disease. - 2326-3121. ; 1:1, s. 8-12
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Tidskriftsartikel (refereegranskat)abstract
- A delay in surgery due to laboratory abnormalities may increase mortality in patients with hip fracture. In order to optimize the logistics for urgent surgery in patients with hip fractures and anti-vitamin K treatment, individualized doses of a Prothrombin Concentrate were guided by a bedside whole blood prothrombin time test. Thirty patients with emergency hip fracture and preoperative anti-vitamin K treatment (warfarin) due to atrial fibrillation were studied during a 3 years period (2010-2012). Intravenous vitamin K was recommended as early as possible after admission at the hospital and after diagnosis of the hip fracture by X-ray, but was not controlled by the authors. Preoperatively the patients were treated with repeated doses of 500 units (U) prothrombin complex factor concentrate (PCC) if laboratory Prothrombin Time International ratio (PT-INR) >1.5 and orthopedic surgents urged for immediate surgery. Simultaneosly whole blood PT-INR and activated prothrombin partial thromboplastin time (aPTT) was checked with a bedside point-of-care HEMOCHRON Jr with blood from the citrated vacutainer test tubes, before these were sent to the laboratory. Both types of PT were checked 10 minutes after the intravenous PCC injection. The correlation coefficient between routine citrated plasma PT and the whole blood citrated HEMOCHRON® PT was 0,88 (p>0,001). All patients underwent surgery within 24 hours. No plasma was used. Vitamin K was used in 20 of the patients and reduced the need/doses of PCC as compared to patients with no vitamin K treatment. Five mg of iv vitamin K was more effective than 2 mg iv in reducing the need for PCC.
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| 21. |
- Thomas, Owain, et al.
(författare)
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Coagulative safety of epidural catheters after major upper gastrointestinal surgery : advanced and routine coagulation analysis in 38 patients
- 2016
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Ingår i: Perioperative Medicine. - : Springer Science and Business Media LLC. - 2047-0525. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate slight hypocoagulation. Postoperative patients are prone to thrombosis, and thromboelastometry has previously shown hypercoagulation in this setting. We aimed to better understand perioperative haemostasis by comparing results from routine and advanced tests, hypothesizing that patients undergoing major upper gastrointestinal surgery would be deficient in vitamin K-dependent coagulation factors because of malnutrition, or hypocoagulative because of accumulation of low molecular weight heparin (LMWH).METHODS: Thirty-eight patients receiving epidural analgesia for major upper gastrointestinal surgery were included. We took blood at the time of preoperative epidural catheterization and at catheter withdrawal. Prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT) and platelet count (Plc) were analysed, and also albumin, proteins induced by vitamin K absence (PIVKA-II), rotational thromboelastometry (ROTEM®), multiple electrode aggregometry (Multiplate®) and activities of factors II, VII, IX, X, XI, XII and XIII.RESULTS: Postoperative coagulation was characterized by thrombocytosis and hyperfibrinogenaemia. Mean PT-INR increased significantly from 1.0 ± 0.1 to 1.2 ± 0.2 and mean aPTT increased significantly from 27 ± 3 to 30 ± 4 s. Activity of vitamin K-dependent factors did not decrease significantly: FIX and FX activity increased. FXII and FXIII decreased significantly. Mean Plc increased from 213 ± 153 × 10(6)/L while all mean ROTEM-MCFs (maximal clot firmnesses) especially FIBTEM-MCF increased significantly to above the reference interval. All mean ROTEM® clotting times were within their reference intervals both before and after surgery. ROTEM® (HEPTEM minus INTEM) results were spread around 0. There were significant correlations between routine tests and the expected coagulation factors, but not any of the viscoelastic parameters or PIVKA-II. Multiplate® area under curve and EXTEM-MCF correlated significantly to Plc as did EXTEM-MCF to fibrinogen, FIX, FX and FXIII; and FIBTEM-MCF to Plc, FII, FXI and FXIII.CONCLUSIONS: The increase in PT-INR may be caused by decreased postoperative FVII while the elevated aPTT may be caused by low FXII. The mild postoperative hypocoagulation indicated by routine tests is not consistent with thromboelastometry. The relevance of ROTEM® and Multiplate® in the context of moderately increased routine tests remains unclear. Trial registration number is not applicable since this is not a clinical trial.
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| 22. |
- Thomas, Owain, et al.
(författare)
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Direct oral anticoagulants should often be suspended for longer before neuraxial blockade.
- 2023
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 67:5, s. 682-683
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Tidskriftsartikel (refereegranskat)abstract
- Direct oral anticoagulants (DOACs) require perioperative vigilance to reduce the risk of spinal haematoma. There is a little of information concerning which plasma concentrations of DOACs are safe when administering central neuraxial blocks (CNBs) and there is a wide variability in the rate of elimination, both between individuals and DOACs.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Thomas, Owain, et al.
(författare)
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Thromboelastometry versus free-oscillation rheometry and enoxaparin versus tinzaparin: an in-vitro study comparing two viscoelastic haemostatic tests dose-responses to two low molecular weight heparins at the time of withdrawing epidural catheters from ten patients after major surgery
- 2015
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Ingår i: BMC Anesthesiology. - : BIOMED CENTRAL LTD. - 1471-2253 .- 1471-2253. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Monitoring low molecular weight heparins (LMWHs) in the perioperative period is prudent in patients at high risk of coagulative complications, especially when the patient has an epidural catheter requiring withdrawal, which is associated with the risk of spinal haematoma. The aim of this study was to evaluate the in vitro dose-responses of two different LMWHs on two different viscoelastic haemostatic tests, using blood sampled from patients with normal routine coagulation parameters, on the day after major surgery when their epidural catheters were due to be withdrawn. Methods: Enoxaparin or tinzaparin were added in vitro to blood from ten patients who had undergone oesophageal resection, to obtain plasma concentrations of approximately 0, 0.5, 1.0 and 1.5 IU/mL. Coagulation was monitored using thromboelastometry (ROTEM (R)) using the InTEM (R) activating reagent; and free oscillation rheometry (FOR: ReoRox (R)), activated using thromboplastin. Clot initiation was measured using ROTEM-CT, ReoRox-COT1 and ReoRox-COT2. Clot propagation was measured using ROTEM-CFT, ROTEM-Alpha Angle and ReoRox-Slope. Clot stability was measured using ROTEM-MCF and ReoRox-Gmax, and clot lysis was measured using ROTEM-ML and ReoRox-ClotSR. Results: Clot initiation time assessed by thromboelastometry and FOR was prolonged by increasing concentrations of both LMWHs (P < 0.01). Equivalent doses of tinzaparin in international units (anti FXa units) per millilitre prolonged clot initiation more than enoxaparin (P < 0.05). There was significant inter-individual variation - the ranges of CT and COT1 at LMWH-concentrations of 0 and 1.5 IU/mL overlapped. None of the tests reflecting clot formation rate or stability showed a dose-response to either LMWH but clot lysis showed a tentative negative dose-response to the LMWHs. Conclusions: Clot initiation times dose-dependent prolongation by LMWHs in this study agrees with previous research, as does tinzaparins stronger anti-coagulative effect than enoxaparin at equivalent levels of anti-FXa activity. This casts doubt on the validity of using anti-FXa assays alone to guide dosage of LMWHs. The significant inter-individual variation in dose-response suggests that the relationship between dose and effect in the postoperative period is complicated. While both ROTEM and FOR may have some role in postoperative monitoring, more research is needed before any conclusion can be made about their clinical usefulness.
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| 31. |
- Werner, Mads U., et al.
(författare)
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Postoperativ smärta: större kirurgi
- 2019. - 1
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Ingår i: Akut och cancerrelaterad smärta : Smärtmedicin Vol. 1 - Smärtmedicin Vol. 1. - 9789147112876 ; , s. 361-381
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Bokkapitel (populärvet., debatt m.m.)
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| 32. |
- Winstedt, Dag, et al.
(författare)
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Correction of hypothermic and dilutional coagulopathy with concentrates of fibrinogen and factor XIII: an in vitro study with ROTEM
- 2014
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia. Methods: Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33 degrees C or 37 degrees C with ROTEM EXTEM and FIBTEM reagents. Clotting time (CT), clot formation time (CFT), alpha angle (AA) and maximal clot formation (MCF) were recorded. Results: Fibrinogen with or without factor XIII improved all ROTEM parameters in either solution irrespective of temperature, with the exception of EXTEM-AA and EXTEM-CFT in HES haemodilution. Fibrinogen increased FIBTEM-MCF more in the samples diluted with RAc than HES, particularly in presence of factor XIII. Conclusions: Fibrinogen improved in vitro haemodilution-induced coagulopathy at both 33 degrees C and 37 degrees C, though more efficiently after crystalloid than HES haemodilution. Factor XIII had an additional effect on FIBTEM-MCF, but only after crystalloid dilution.
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| 33. |
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