Evaluation of Hemostatic Function with Thromboelastography in Dogs with Hypercoagulable Diseases

김자원,남아령,이규필,송근호,윤화영,서경원 한국임상수의학회 2017 한국임상수의학회지 Vol.34 No.2

Thromboembolic complications are increasing in veterinary medicine. Thromboelastography (TEG) is a more comprehensive method for assessing the clotting process than standard plasma-based coagulation tests. This study compared the ability of TEG and standard coagulation tests to analyze the overall hemostatic state of dogs. The study involved 40 dogs with underlying diseases that predispose to hypercoagulability, including neoplasia, hyperadrenocorticism, immune-mediated diseases, gastrointestinal diseases, and protein-losing nephropathies and enteropathies, and 20 healthy dogs. Their overall hemostatic functional state was evaluated by TEG and routine coagulation assays, including activated partial thromboplastin time, prothrombin time, platelet count, and D-dimer concentration. TEG analysis showed significant differences in clot formation time, α angle, and maximum amplitude (MA) between diseased and control dogs (P < 0.001 each). Increased MA was the most frequent abnormality on TEG and was indicative of hypercoagulability. TEG was useful in detecting hemostatic dysfunction in dogs with diseases associated with hypercoagulability. Dogs with TEG tracings indicative of hypercoagulability are likely to be in procoagulant states. Future prospective studies are needed to evaluate whether TEG tracings indicative of hypercoagulability are predictive of thrombosis in dogs.

Assessment of coagulation function by thromboelastography in dogs with mitral valve insufficiency

Chorok Jeong,Minwoong Seo,Ocki Chang,Jinho Park,Chul Park 한국동물위생학회 2022 한국동물위생학회지 (KOJVS) Vol.45 No.1

In veterinary medicine, a variety of disease are known to cause coagulation abnormalities. Identifica-tion of these coagulation abnormalities have been relied on traditional coagulation assays(platelet concentration, aPTT, PT, D-dimer, fibrinogen) which take only a small part of the coagulation path-ways rather than global hemostatic capacity. Among of the hypercoagulable diseases, cardiovascular disease, such as mitral valvular disease, was not regarded as the cause of the hypercoagulability. The value of a thromboelastography (TEG) as an early predictor of coagulopathy, especially hypercoagu-lability, has been founded. It was associated with decreased R and K values, and increased MA and α angle. The objective of this study was to compare thromboelastography results and those of tradi-tional coagulation tests between twenty adult dogs with mitral insufficiency (MVI group) and eleven adult healthy dogs (Healthy group). As a results, MA values in the patients with mitral insufficiency (68.8±7.8 mm) were significantly higher than the normal patients (60.4±4.8 mm) (P value<0.05). Al-though a little report has been reported in veterinary medicine, platelet activation seems to be related with hypercoagulability in MVI patients in human medicine. The result of this report can support this pathophysiology in veterinary medicine. In addition to traditional coagulation assay, global as-sessment of coagulopathy using TEG, especially ability to detect hypercoagulability, may be useful for customized treatment in MVI patients. To achieve this, further study is needed to define pathophysi-ology and effect of medication.

다발성 골수종 환자에서 총경동맥 폐색에 의한 대뇌 경색 1예

정혜원 대한뇌졸중학회 2005 Journal of stroke Vol.7 No.2

Cerebral involvement is an unusual complication in patients with multiple myeloma (MM). The causes includeh y p e r v i s c o s i t y, amyloidosis, metabolic derangements such as hypercalcemia and leptomeningeal metastasis ordirect invasion, in addition to the complication and toxicity of chemotherapy. Cerebral infarction associated withMM has been rarely reported. The mechanism of cerebral infarction was mainly small artery involvement byhyperviscosity or hypercoagulability. We present a rare case of cerebral infarction, due to extracranial carotidartery occlusion associated with MM.(Korean Journal of Stroke 2005;7(2): 228~231)

Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis, Coagulopathy, Endothelial Dysfunction, and Downregulation of ACE2

Putu Lohita Rahmawati,Kumara Tini,Ni Made Susilawathi,IA Sri Wijayanti,DPG Purwa Samatra 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.2

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to largevessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARSCoV- 2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Dong Ki Ahn,Won Shik Shin,Jin Woo Kim,Seong Min Yi 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.4

Background: Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. Methods: This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. Results: The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. Conclusions: With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombincontaining local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

Evaluation of Thromboelastography Analysis for Treatment of Heartworm Disease in Dogs over Time: a Pilot Study

한동현,Won-Kyoung Yoon,Hyekyung Lee,유도현,정동인 한국임상수의학회 2019 한국임상수의학회지 Vol.36 No.1

Thromboelastography (TEG) analysis consists of α, G, K, MA, and R types of values and tests the effectiveness of blood clotting, which can be assessed for platelet function, clotting strength, and fibrinolysis. Canine heartworm diseases caused by Dirofilaria immitis, a vascular nematode, can lead to hyperfibrinolysis and hypercoagulation. In this study, G and MA values showed a statistically significant decrease over time after treatment of heartworm disease. Additionally, the α-value showed a high correlation with G, K, MA, and R values. The G value showed a high correlation with K and MA values, while The K value showed a high correlation with MA and R values. This study clearly found a gradual decrease in G and MA values in dogs with heartworm disease over time, both before and after treatment. This suggests that the clot formation time is longer and that the intensity of clot formation is lowered and may improve the risk of thromboembolism in dogs with heartworm disease.

Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study

이미지,정종원,안명주,김선우,석진명,장혜민,김경문,정진상,이광호,방오영 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.1

Background and Purpose Patients with active cancer are at an increased risk for stroke. Hypercoagulability plays an important role in cancer-related stroke. We aimed to test whether 1) hypercoagulability is a predictor of survival, and 2) correction of the hypercoagulable state leads to better survival in patients with stroke and active cancer. Methods We recruited consecutive patients with acute ischemic stroke and active systemic cancer between January 2006 and July 2015. Hypercoagulability was assessed using plasma D-dimer levels before and after 7 days of anticoagulation treatment. The study outcomes included overall and 1-year survival. Plasma D-dimer levels before and after treatment were tested in univariate and multivariate Cox regression models. We controlled for systemic metastasis, stroke mechanism, age, stroke severity, primary cancer type, histology, and atrial fibrillation using the forward stepwise method. Results A total of 268 patients were included in the analysis. Patients with high (3rd–4th quartiles) pre-treatment plasma D-dimer levels showed decreased overall and 1-year survival (adjusted HR, 2.19 [95% CI, 1.46–3.31] and 2.70 [1.68–4.35], respectively). After anticoagulation treatment, post-treatment D-dimer level was significantly reduced and independently associated with poor 1-year survival (adjusted HR, 1.03 [95% CI, 1.01–1.05] per 1 μg/mL increase, P=0.015). The successful correction of hypercoagulability was a protective factor for 1-year survival (adjusted HR 0.26 [CI 0.10–0.68], P=0.006). Conclusions Hypercoagulability is associated with poor survival after stroke in patients with active cancer. Effective correction of hypercoagulability may play a protective role for survival in these patients

Hypercoagulable states: an algorithmic approach to laboratory testing and update on monitoring of direct oral anticoagulants

Megan O. Nakashima,Heesun J. Rogers 대한혈액학회 2014 Blood Research Vol.49 No.2

Hypercoagulability can result from a variety of inherited and, more commonly, acquired conditions. Testing for the underlying cause of thrombosis in a patient is complicated both by the number and variety of clinical conditions that can cause hypercoagulability as well as the many potential assay interferences. Using an algorithmic approach to hyper-coagulability testing provides the ability to tailor assay selection to the clinical scenario. It also reduces the number of unnecessary tests performed, saving cost and time, and preventing potential false results. New oral anticoagulants are powerful tools for manag-ing hypercoagulable patients; however, their use introduces new challenges in terms of test interpretation and therapeutic monitoring. The coagulation laboratory plays an essen-tial role in testing for and treating hypercoagulable states. The input of laboratory pro-fessionals is necessary to guide appropriate testing and synthesize interpretation of results.

Evaluation of Plasma D-dimer Concentration in Cats with Hypertrophic Cardiomyopathy

김태영,한숙희,최란,현창백 한국임상수의학회 2014 한국임상수의학회지 Vol.31 No.2

Arterial thromboembolism (ATE) is a common and fatal complication of hypertrophic cardiomyopathy(HCM) in cats. Therefore in this study, we evaluated the hypercoagulability (using plasma concentration of D-dimer)in HCM cats with different stage of heart failure and left atrial enlargement and also investigated the any correlationwith echocardiographic indices (including left free wall thickness at diastole, interventricular septal thickness at diastole,LA to Ao ratio, heart failure stage, existence of systolic anterior motion of mitral valve). The median plasma D-dimerconcentration in this study population was 0.51 ± 0.70 (range 0 to 2.50) ug/mL in the control group, 1.47 ± 1.29 (range0.3 to 5.79) ug/mL in the HCM group, 1.48 ± 1.65 (range 0.3 to 5.79) ug/mL in the ISACHC I group, 1.62 ± 0.4(range 1.31 to 2.07) ug/mL in the ISACHC II group, 1.36 ± 0.91 (range 0.3 to 2.31) ug/mL in the ISACHC III group,1.90 ± 1.60 (range 0.3 to 5.79) ug/mL in the cat with LA dilation, 1.72 ± 0.72 (range 0.6 to 2.31) ug/mL in cats withSEC-T, 1.19 ± 0.70 (range 0.3 to 2.31) ug/mL in the cats with SAM, and 1.63 ± 0.80 (range 0.6 to 2.31) ug/mL inthe cats with ATE. Our study found the median and mean concentration of plasma D-dimer was higher in cat withHCM, ATE, SECT and SAM and clearly provides evidence of hypercoagulability in cats with HCM, although theseverity was not correlated to the dilation of LA and the presence of heart failure. This is the first study evaluatingthe hypercoagulability in cats with HCM in Korea.

In silico investigation of Panax ginseng lead compounds against COVID-19 associated platelet activation and thromboembolism

Yixian Quah,Yuan Yee Lee,Seung-Jin Lee,Sung Dae Kim,Man Hee Rhee,Seung-Chun Park The Korean Society of Ginseng 2023 Journal of Ginseng Research Vol.47 No.2

Hypercoagulability is frequently observed in patients with severe coronavirus disease-2019 (COVID-19). Platelets are a favorable target for effectively treating hypercoagulability in COVID-19 patients as platelet hyperactivity has also been observed. It is difficult to develop a treatment for COVID-19 that will be effective against all variants and the use of antivirals may not be fully effective against COVID-19 as activated platelets have been detected in patients with COVID-19. Therefore, patients with less severe side effects often turn toward natural remedies. Numerous phytochemicals are being investigated for their potential to treat a variety of illnesses, including cancer and bacterial and viral infections. Natural products have been used to alleviate COVID-19 symptoms. Panax ginseng has potential for managing cardiovascular diseases and could be a treatment for COVID-19 by targeting the coagulation cascade and platelet activation. Using molecular docking, we analyzed the interactions of bioactive chemicals in P. ginseng with important proteins and receptors involved in platelet activation. Furthermore, the SwissADME online tool was used to calculate the pharmacokinetics and drug-likeness properties of the lead compounds of P. ginseng. Dianthramine, deoxyharrtingtonine, and suchilactone were determined to have favorable pharmacokinetic profiles.