Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients

BACKGROUND Supported by the National Natural Science Foundation of China,No.The prognostic value of coagulation disorder in coronavirus disease 2019(COVID-19)patients should be demonstrated.AIM To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.METHODS Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5,2020 with confirmed COVID-19 were included.The primary outcomes were death and survival as of March 11.Demographics,vital signs,comorbidities and laboratory tests were collected and compared between those who died and survivors.Logistic regression analysis for prognostic factors was performed.Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.RESULTS The total number of patients with confirmed COVID-19 who were enrolled was 213.The median age was 62 years,and 95 patients(44.6%)were men.Fifty-one patients were critical(23.9%),79 patients were severe(37.1%)and 83 patients were moderate(39%).As of March 11,2020,99 patients were discharged(46.5%),79 patients(37.1%)stayed in the hospital and 35 patients(16.2%)died.Median time to death was 6(4-8)d,while median hospital stay was 32(22-36)d in survivors(P<0.001).More men(P=0.002)and elderly patients(P<0.001)were found in the group of those who died.The respiration rate at admission was higher in the group of those who died(P<0.001).The incidences of hypertension(P=0.028),cerebrovascular disease(P<0.001),chronic kidney disease(P=0.02)and chronic obstructive pulmonary disease(P<0.001)were higher in the group of those who died.Platelet count was decreased in the group of those who died(P=0.002)whereas prothrombin time(P<0.001),activated partial thromboplastin time(P=0.033),concentration of D-dimer(P<0.001)and fibrin degradation products(P<0.001)were increased in the group of those who died.Prothrombin time[odds ratio(OR):2.19,P=0.004],respiration rate(OR:1.223,P<0.001),age(OR:1.074,P<0.001)and fibrin degradation products concentration(OR:1.02,P=0.014)were predictors of death.The survival rate was significantly lower in patients with prolonge CONCLUSION Prothrombin time,concentration of fibrin degradation products,respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.

Effects of Chloroquine and Naphthoquinone on Prothrombin Time and Activated Partial Thromboplastin Time of Swiss Mice

Concerns on the coagulation variables, Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) which are part of coagulation parameters used in assessing haemostatsis in haematology, led to the study of the effects of naphthoquinone and chloroquine on the PT and APTT of mice infected with Plasmodium berghei, and treated with graded concentrations of chloroquine and naphthoquinone. Using brain thromboplastin with calcium and rabbit brain cephalosporin ad kaolin respectively the experiment aimed at demonstrating the effect of chloroquine with purity of 99.79% and naphthoquinone with purity of 97.00%, upon a three-day intraperitoneal administration at concentrations of 0.1 mg/kg, 0.5 mg/kg, 1.0 mg/kg and 2.0 mg/kg. Result showed that the APTT and PT of naphthoquinone at 2.0 mg/kg, were 196.67 seconds, and 67.63 seconds respectively, while the APTT and PT of chloroquine were 3.63 seconds and 1.40 seconds respectively for the same concentration. Also, naphthoquinone showed lower APTT but sustained PT at concentrations below 1.50 mg/kg whereas both APTT and PT increased from concentrations above 1.50 mg/kg. On the other hand chloroquine showed a lowered APTT between 0.00 to 0.15 mg/kg while PT was sustained, but both APTT and PT increased from concentration of 0.15 mg/kg gradually. This study conclusively showed that chloroquine has a shorter APTT and PT than naphthoquinones, even though they elicited similar actions. Apart from this, naphthoquinone and chloroquine belonging to the same family, naphthoquinone could be more toxic than chloroquine at the dosages equivalent to 1.50 mg/kg, therefore, any administration of naphthoquinone above this dosage should be closely monitored to avoid any form of danger to the patient.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

Clinical association between coagulation indicators and bone metastasis in patients with gastric cancer

BACKGROUND Bones are one of the most common target organs for cancer metastasis.Early evaluation of bone metastasis(BM)status is clinically significant.Cancer patients often experience a hypercoagulable state.AIM To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer(GC).METHODS We conducted a single-center retrospective study and enrolled 454 patients.Clinical information including routine blood examination and coagulation markers were collected before any treatment.Patients were grouped according to the status of BM.Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators.Cutoff values,sensitivity and specificity were based on the maximum Youden index.Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.RESULTS Of the 454 enrolled patients,191 patients were diagnosed with BM.The receiver operating characteristic curve analysis suggested that prothrombin time(PT)Wang X et al.Coagulation indicators predict bone metastasis WJGO https://www.wjgnet.com 1254 July 15,2023 Volume 15 Issue 7[cutoff:13.25;sensitivity:0.651;specificity:0.709;area under receiver operating characteristic curve(AUC)=0.738],activated partial thromboplastin time(aPTT)(cutoff:35.15;sensitivity:0.640;specificity:0.640;AUC=0.678)and fibrin degradation products(FDP)(cutoff:2.75;sensitivity:0.668;specificity:0.801;AUC=0.768)act as novel predictors for BM.Based on multivariate logistic regression analysis,the results showed the independent correlation between PT[odds ratio(OR):3.16;95%confidence interval(CI):1.612-6.194;P=0.001],aPTT(OR:2.234;95%CI:1.157-4.313;P=0.017)and FDP(OR:3.17;95%CI:1.637-6.139;P=0.001)and BM in patients with GC.Moreover,age,carcinoembryonic antigen,erythrocyte and globulin were found to be significantly associated with BM.CONCLUSION Coagulation markers,namely PT,aPTT and FDP,might be potential predictors for screening BM in patients with GC.

Textile UWB 5G Antenna for Human Blood Clot Measurement

The antenna plays an essential role in the medical industry.The short-range 5th Generation(5G)communication can be used for seamless transmission,reception,patient monitoring,sensing and measuring various processes at high speeds.A passive Ultra Wide Band(UWB)antenna,used as a sensor in the mea-surement of Prothrombin Time(PT)i.e.,blood clot is being proposed.The inves-tigated micro-strip patch UWB antenna operating in the frequency range of 3.1 to 10.6 GHz consists of a circular patch with a diamond-shaped slot made of jeans substrate material with good sensing properties is accomplished by adjusting the copper thickness of the patch.Due to the turbidity in blood plasma,PT measure-ment is the repetitive approach to get accurate value.In order to solve this issue,an antenna is designed,fabricated and analysed to obtain the accurate PT mea-surements from blood plasma.The blood clotting is observed by electromagnetic emitted voltage converted into the frequency range of 5 to 10 GHz and voltage range of 0.66 to 0.87 mV.The circular UWB antenna is constructed employing jean’s substrate with a partial ground plane to improve the S-parameter,gain,bandwidth and performance characteristics.The proposed antenna with Specific Absorption Rate(SAR)value within the acceptable range can be used as a wear-able device in the human body,leveraging 5G technology.This antenna is well suited for various other applications like wireless sensors,wearable devices and short-range communication applications.

Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy

BACKGROUND: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. METHODS: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. RESULTS: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, andrenal failure were significant predictors of overall intra-hospital mortality on multivariate analysis. CONCLUSIONS: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.

Study on Coagulation Activity of Callicarpa nudiflora

[Objective] This study aimed to study the coagulation effect of Callicarpa nudiflora. [Method] The effects of CaUtcarpa nudiflora on blood coagulation system of mice were investigated by measuring prothmmbin time （PT）, thrombin time（TT）, activated partial thromboplastin time （APTT） and plasma fibrinogen （FIB）, [Result] Compared with the control group, the crude extracts and ：eluted parts of Ca#/carpa nudiflora all significantly shortened PT, APTT and TT, and increased the content of FIB in mice, [Coadadon] The crude extracts and eluted parts of Callicarpa nudiflora have a coagulation-promoting effect through affecting several links of the coagulation process in mice,

Influence of different cultivars of Phoenix dactylifera L-date fruits on blood clotting and wound healing

Objective: To investigate different types of dates and medical properties of influencing blood clotting and wound healing in an animal model. Methods: Three different cultivars of dates(Ajwa, Khalas, and Fardh) were examined in-vivo, for blood clotting and wound healing using CD1 mice of both sexes. Study of toxicity to animals was performed accordingly prior to further investigations. The ethanolic extracts were given orally to animals as a constituent in their daily water. Blood samples were obtained from the mice inferior vena cava to carry out the prothrombin time(PT) assay using the manual method and confirmed using a semi-automated machine. The bleeding time(BT) assay was performed using the cutting technique. In the wound healing analysis, a small cut(5-10 mm) in the skin overlying the thigh was conducted in all mice under anesthesia. The diameter of the cut and healing status were measured on a daily basis throughout the time of the experiment using a roller. Results: Ajwa was able to elevate both PT and BT(P<0.05), significantly in a time-dependent manner followed by Khalas date(P<0.05). The results of PT and BT of Fardh date were found to be very close to those of the control group(P<0.05). Despite its activity as an anticoagulant, Khalas date showed a potential property to enhance wound healing in contrast to other dates and the control groups in this study. Conclusions: Omani Khalas date fruit has both antithrombotic as well as wound healing properties. The results open a new gate with these fruits for exploring the potential component(s) that may play an important role in antithrombotic as well as wound healing process.

Iridoid glycosides extracted from Zhizi(Fructus Gardeniae)decrease collagen-induced platelet aggregation and reduce carotid artery thrombosis in an invivo rat model

OBJECTIVE: To investigate the anti-platelet aggregation and antithrombotic effects in rats of iridoid glycosides extracted from Zhizi (FructusGardeniae). METHODS: The present study evaluated the antithrombotic activity of iridoid glycosides (IGs) in a rat model of carotid artery thrombosis. The effects on coagulation, such as thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT), and the effect on collagen-induced platelet aggregation in vivo were investigated. Rats were intragastrically administered IGs (50, 100 or 200 mg/ kg) twice daily for 3 days. RESULTS: IGs were shown for the first time to have an antithrombotic action through the inhibition of platelet aggregation, with little effect on the coagulation time of peripheral blood. Our results also showed that IGs may significantly and dose-dependently reduce arterial thrombus load in a model of carotid artery thrombosis and inhibit collagen-induced platelet aggregation in rats. IGs (100or 200 mg/kg) had no significant effect on APTT and PT, but did lengthenTT at a higher dose. CONCLUSION: These data, together with the previously reported neuroprotective effects of IGs in rats with cerebral ischemia, suggest that the antithrombotic action of IGs may potentially contribute to the treatment of cerebral ischemic diseases, including cerebral apoplexy.

paired Coagulation Status in the Crohn＇s Disease Patients Complicated with Intestinal Fistula

Background： Intestinal fistula is one of the common complications of Crohn＇s disease （CD） that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula. Methods： Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinting Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student＇s t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups. Results： Compared with CD patients without intestinal fistula, prothrombin time （PT） in patients with intestinal fistula was significantly longer （12.13 ± 1.27 s vs. 13.18± 1.51 s,P〈0.001 in overall cohort： 11.56± 1.21 svs. 12.61 ±0.73 s,P 0.001 in females： and 12.51± 1.17 s vs. 13.37± 1.66 s, P - 0.003 in males）. Platelet （PLT） count was much lower in intestinal fistula group than in nonintestinal fistula group （262.53 ± 94.36 × 109/L vs. 310.36 ± 131.91× 109/L, P = 0.009）. Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT （odds ratio [OR] 1.900, P 〈 0.001 ）, a reduced amount of PLT （OR = 0.996, P = 0.（124）, and an increased operation history （OR = 5.408, P 〈 0.001 ）. Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline （ 12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006）. Conclusions： Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.

In vitro assessment of the effect of Undaria pinnatifida extracts on erythrocytes membrane integrity and blood coagulation parameters of Equus caballus

Objective:To study the activity of polysaccharides extracted from Undaria pinnatifida(U.pinnatifida)in vitro on red blood cell of Equus caballus,and compare it with heparin.Methods:Algal extracts was tested at two different concentrations 10 mg/mL and 20 mg/mL.In all studies,using horse red blood cells,control experiments were carried out without extract.We evaluated the toxicity of algal extracts through trypan blue test and haemolysis test and anticoagulant action measured by activated partial thromboplastin time,prothrombin time and fibrinogen test.Results:The polysaccharide extract of U.pinnatifida appeared to have no cytotoxic effect on the horse red blood cells.The values of prothrombin time,activated partial thromboplastin time and fibrinogen were significantly changed in the presence of the extract.Conclusions:This study suggests a possible exploitation of U.pinnatifida,thriving in the lagoon of Venice,as a source of anticoagulant drug,with the aim of transforming waste into a valuable biomass.