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Acquired Fibrinogen Deficiency in Severe Trauma Patients and its Early Detection
Škola, Josef ; Černý, Vladimír (advisor) ; Durila, Miroslav (referee) ; Blatný, Jan (referee)
UNIVERZITA KARLOVA Lékařská fakulta v Hradci Králové Acquired fibrinogen deficiency in severe trauma patients and its early detection Josef Škola Summary Doktorský studijní program Chirurgie Hradec Králové 2023 This thesis deals with developing and early diagnostics of acquired fibrinogen deficiency in patients with severe trauma. Fibrinogen is an essential glycoprotein of the coagulation system, which is converted by thrombin into insoluble fibrin, the fundamental component of a blood clot, in the final stage of blood coagulum formation. Trauma-induced coagulopathy is a complex disorder of blood coagulation resulting from extensive tissue damage, traumatic shock, activation of the sympathoadrenal system, dysregulation of fibrinolysis, as well as loss of coagulation factors through bleeding, consumption or dilution of remaining dilutions. Hypothermia, acidosis, hypocalcemia, or preexisting factors on the patient's side (e.g., anticoagulant or antiplatelet therapy) also contribute to impaired haemocoagulation. Acquired fibrinogen deficiency (hypofibrinogenemia) is vital in the early phase of trauma-induced coagulopathy. Fibrinogen is the first of the coagulation factors to achieve a clinically significant decrease in plasma concentration. Hypofibrinogenemia is associated with the magnitude of blood loss, the...
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Use of rotational thromboelastometry (ROTEM) in perioperative medicine and its comparison with standard coagulation testing (PT, aPTT)
Jonáš, Jakub ; Durila, Miroslav (advisor) ; Vaněk, Tomáš (referee) ; Bláha, Jan (referee)
Assessment of the hemostasis is one of the basic components of patient care during the perioperative period. Coagulation tests, including prothrombin and activated partial thromboplastin time, fibrinogen concentration, and platelet count, are standard in hemostasis testing. However, the method of their evaluation and the time availability of their results are not satisfactory, especially in the case of the life-threatening bleeding. For this reason, rotational thromboelastometry (ROTEM) as a viscoelastic method appears to be more promising. The aim of the first part of this work was to verify whether the relevant ROTEM results are more available in time than the results of standard laboratory tests in conditions of our facility. The correlation of comparable ROTEM parameters and standard coagulation tests was evaluated in the second part of the work. Then, the impact of the hemostasis assessment using ROTEM on the reduction of transfusion products used before invasive and surgical procedures was evaluated. Finally, it was also determined whether the implementation of ROTEM in the management of the perioperative bleeding influences the blood loss, consumption of transfusion products and length of hospital stay. The results of this work confirm that the evaluation of hemostasis using ROTEM is significantly...
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Influence of crystalloid and colloid solutions on blood coagulation using the rotational thromboelastometry (ROTEM) method
Binterová, Silvie ; Durila, Miroslav (advisor) ; Vaněk, Tomáš (referee) ; Bláha, Jan (referee)
Fluid resuscitation with crystalloid and colloid solutions is a common treatment in perioperative medicine. However, a variety of unbalanced or balanced solutions is used in clinical practice and there is still a vivid debate going on regarding the selection of optimal fluid with minimal negative effect on coagulation. The goal of the dissertation was to investigate the adverse effect of balanced crystalloids and colloids on whole blood coagulation measured by method of rotational thromboelastometry. In the first phase of the work we had assessed the adverse effect of balanced crystalloid, hydroxyethyl starch and gelatin after dilution of blood with the solution in vitro. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry. In the second phase of the work we evaluated the negative effect of infusion solution after dilution in vivo. We had obtained blood samples from 30 patients during knee arthroscopy before and after administration of 500 ml of crystalloid or hydroxyethyl starch or gelatin. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry.In compliance with the results of the dissertation, hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Based on...
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The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...
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Influence of crystalloid and colloid solutions on blood coagulation using the rotational thromboelastometry (ROTEM) method
Binterová, Silvie ; Durila, Miroslav (advisor) ; Vaněk, Tomáš (referee) ; Bláha, Jan (referee)
Fluid resuscitation with crystalloid and colloid solutions is a common treatment in perioperative medicine. However, a variety of unbalanced or balanced solutions is used in clinical practice and there is still a vivid debate going on regarding the selection of optimal fluid with minimal negative effect on coagulation. The goal of the dissertation was to investigate the adverse effect of balanced crystalloids and colloids on whole blood coagulation measured by method of rotational thromboelastometry. In the first phase of the work we had assessed the adverse effect of balanced crystalloid, hydroxyethyl starch and gelatin after dilution of blood with the solution in vitro. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry. In the second phase of the work we evaluated the negative effect of infusion solution after dilution in vivo. We had obtained blood samples from 30 patients during knee arthroscopy before and after administration of 500 ml of crystalloid or hydroxyethyl starch or gelatin. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry.In compliance with the results of the dissertation, hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Based on...
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The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...
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