Accuracy of training blood volume quantifi cation using a visual estimation tool

BACKGROUND:We investigated whether the use of a specially designed visual estimation tool may improve accuracy in quantifying blood volumes related to surface spreading.METHODS:A prospective,paired-control,single-blinded experimental study was performed at a medical university.Anesthesiologists and emergency medical personnel estimated various blood volumes on surfaces with varying absorptivity(carpet,towel,polyvinyl chloride,wooden fl ooring)in an experimental setting.We assessed the sensitivity of training blood volume quantifi cation using a self-designed visual estimation tool by comparing the accuracy of visual blood volume estimations before and after practical training with the tool.RESULTS:A total of 352 estimations by 44 participants were evaluated.Accurate estimations improved significantly from pre-training to post-training(P<0.05).The sensitivity of blood volume quantifi cation was 33.0%after training with the visual estimation tool.Estimations did not depend on age,profession,gender or years of the estimator’s professional experience.CONCLUSIONS:Training with a visual estimation tool by professional rescuers can improve the estimation accuracy of blood volumes spread on surfaces with varying absorptivity.

Congenital Dysfibrinogenemia Presented with Massive Hematomas Formed after Hysterectomy

Congenital dysfibrinogenemia (CD) is a qualitative congenital fibrinogen (Fbg) disorder characterized by normal antigen levels of dysfunctional Fbg. A 41-year-old Japanese woman visited the emergent room of our hospital due to acute and severe abdominal pain. Catheterization of the full bladder released her abdominal pain. Magnetic resonance imaging showed a huge pelvic mass, suggesting an intra-mural giant myoma. Before the removal operation of myoma, screening tests showed no abnormalities, including prothrombin time and activated partial thromboplastin time. However, Fbg level was not determined. The patient wanted to receive early surgical treatment, and an abdominal hysterectomy was performed as usual and the intra-operative blood loss was 100 g (ml). However, we found subcutaneous and pelvic hematomas, although active bleeding was not recognized on an emergent computed tomography examination. At that time, we noticed a low level of plasma Fbg (47 mg/dl). We performed a re-laparotomy to remove hematomas. All ligated blood vessels were re-ligated, and oozing points were vaporized. Around the re-operation, six units of fresh frozen plasma and twelve units of red blood cell suspension were transfused. The clinical course after the 2nd operation was uneventful except for the low level of Fbg. An additional study showed that the value of the Fbg activity and antigen was dissociated, and the patient was diagnosed CD with γ275 Arg to His (CGC to CAC) mutation.

Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions

Background：There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines （CRUSADE） and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction （ACUITY-HORIZONS） scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions （PCIs） with drug-eluting stents （DES） in patients receiving dual antiplatelet therapy.We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.Methods：We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital,China.All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center.Major bleeding was defined as Types 2,3,and 5 according to Bleeding Academic Research Consortium Definition criteria.Results：During a 2-year follow-up,245 of 9782 patients （2.5%） had major bleeding （MB）.CRUSADE （21.00 [12.00,29.75] vs.18.00 [11.00,26.00],P 〈 0.001） and ACUITY-HORIZONS （9.00 [3.00,14.00] vs.6.00 [3.00,12.00],P 〈 0.001） risk scores were both significantly higher in the MB than non-MB groups.Both scores showed a moderate predictive value for MB in the whole study cohort （area under the receiver-operating characteristics curve [AUROC],0.565;95% confidence interval [CI],0.529-0.601,P =0.001;AUROC,0.566;95% CI,0.529-0.603,P 〈 0.001,respectively） and in the acute coronary syndrome （ACS） subgroup （AUROC：0.579,95% CI：0.531-）.627,P =0.001;AUROC,0.591;95% CI,0.544-0.638,P 〈 0.001,respectively）.However,neither score was a significant predictor in the non-ACS subgroup （P 〉 0.05）.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.Conclusions：CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.

Mild Renal Dysfunction and Risk of Thromboembolism and Bleeding in Patients with Atrial Fibrillation:The Chinese Atrial Fibrillation Registry Study

Objective:Previous studies indicated that patients with atrial fibrillation(AF)and moderate-to-severe chronic kidney disease(CKD)are at a higher risk of thromboembolism and bleeding during anticoagulation.Whether mild CKD is associated with an increased risk of thromboembolism and bleeding in AF patients remains unknown.This study aimed to evaluate the impact of mild CKD on thromboembolism and major bleeding among patients with AF.Methods:Baseline serum creatinine was available in 17,559 of 25,512 patients enrolled in the China-AF study between August 2011 and December 2018.After excluding those who underwent AF ablation or with moderate-to-severe CKD,7191 non-valvular AF patients(2059 with mild CKD and 5132 with normal renal function)with regular follow-up for at least 6 months were included.Primary outcomes were the time to the first occurrence of thromboembolic and major bleeding events.Results:Over a mean follow-up of(44.4±23.4)months,639 thromboembolism and 231 major bleeding events occurred.The crude incidence rates of thromboembolism were higher in the mild CKD group than that of the normal renal function group(3.0/100 person-years vs.2.2/100 person-years,P<0.0001),while the crude incidence rates of major bleeding were comparable between the two groups(1.0/100 person-years vs.0.8/100 person-years,P=0.076).After multivariate analyses,mild CKD was not associated with an increased risk of thromboembolism(HR=1.05,95%CI:0.89-1.25,P=0.547)or major bleeding(HR=1.11,95%CI:0.84–1.47,P=0.476).Conclusions:Mild CKD was not an independent risk factor of thromboembolism or major bleeding in patients with AF.

The optimal anticoagulation strategy for COVID-19,prophylactic or therapeutic?:a meta-analysis,trial sequential analysis,and meta-regression of more than 27,000 participants

Background:Anticoagulants are promising regimens for treating coronavirus disease 2019(COVID-19).However,whether prophylactic or intermediate-to-therapeutic dosage is optimal remains under active discussion.Methods:We comprehensively searched PubMed,Embase,Scopus,Web of Science,Cochrane Library,ClinicalTrials,and MedRxiv databases on April 26,2022.Two independent researchers conducted literature selection and data extraction separately according to predetermined criteria.Notably,this is the first meta-analysis on COVID-19,taking serious consideration regarding the dosage overlap between the 2 comparison groups of prophylactic anticoagulation(PA)and intermediate-to-therapeutic anticoagulation(I-TA).Results:We included 11 randomized controlled trials(RCTs)and 36 cohort studies with 27,051 COVID-19 patients.By analyzing all the RCTs,there was no significant difference in mortality between the PA and I-TA groups,which was further confirmed by trial sequential analysis(TSA)(odds ratio[OR]:0.93;95%confidence interval[CI]:0.71–1.22;P=0.61;TSA adjusted CI:0.71–1.26).The rate of major bleeding was remarkably higher in the I-TA group than in the PA group,despite adjusting for TSA(OR:1.73;95%CI:1.15–2.60;P=0.009;TSA adjusted CI:1.09–2.58).RCTs have supported the beneficial effect of I-TA in reducing thrombotic events.After including all studies,mortality in the I-TA group was significantly higher than in the PA group(OR:1.38;95%CI:1.15–1.66;P=0.0005).The rate of major bleeding was similar to the analysis from RCTs(OR:2.24;95%CI:1.86–2.69;P<0.00001).There was no distinct difference in the rate of thrombotic events between the 2 regimen groups.In addition,in both critical and noncritical subgroups,I-TA failed to reduce mortality but increased major bleeding rate compared with PA,as shown in meta-analysis of all studies,as well as RCTs only.Meta-regression of all studies suggested that there was no relationship between the treatment effect and the overall risk of mortality or major bleeding(P=0.14,P=0.09,respectively).Conclusion:I-TA is not superior to PA for treating COVID-19 because it fails to lower the mortality rate but increases the major bleeding rate in both critical and noncritical patients.