Acute Traumatic Coagulopathy
|
|
|
- Nicholas Bennett
- 5 years ago
- Views:
Transcription
1 Jean-Francois Pittet, M.D. Depts of Anesthesia and Surgery Cardiovascular Research Institute University of California San Francisco Acute Traumatic Coagulopathy
2 Plan 1. Description of the coagulation system 2. Post-traumatic coagulopathy: mechanisms 3. Mouse model of trauma-hemorrhage 4. Therapeutic approach of post-traumatic coagulopathy
3 1. Coagulation in the perfect world
4 Initiation phase Trauma, induces the initiation of coagulation Tissue factor (TF) is exposed and binds to FVIIa or FVII which is subsequently converted to FVIIa Hypoxia The complex between TF and FVIIa activates FIX and FX FXa binds to FVa on the cell surface
5 Amplification phase The FXa/FVa complex converts small amounts of prothrombin into thrombin The small amount of thrombin generated activates FVIII, FV, FXI and platelets locally. FXIa converts FIX to FIXa Activated platelets bind FVa, FVIIIa and FIXa
6 Propagation phase Fibrin The FVIIIa/FIXa complex activates FX on the surfaces of activated platelets FXa in association with FVa converts large amounts of prothrombin into thrombin creating a thrombin burst. The thrombin burst leads to the formation of a stable fibrin clot.
7 2. Coagulopathy in the wild Mechanisms of Acute Traumatic Coagulopathy
8 The Lethal Triad Bloody Vicious Cycle Severe Trauma Bleeding Tissue Hypoxia Fluid Replacement RBC Transfusion Acidosis Dilution Hypothermia Coagulopathy
9 The Lethal Triad Bloody Vicious Cycle Severe Trauma Bleeding Tissue Hypoxia Fluid Replacement RBC Transfusion Acidosis Dilution Hypothermia Coagulopathy Occurs Occurs at at ph ph < Not Not reversed with with ph ph neutralization Seen Seen only only at at <33 C?? in in only only 9% 9% pts pts IV IV Fluids Fluids
10 Acute Traumatic Coagulopathy Study at Royal London Hospital Brohi et al J Trauma 54: , trauma patients admitted over 6-year period Median time Incident Hospital Admission: 72 minutes 24.4% arrived to the Hospital coagulopathic No coagulopathy: 10.9% mortality Coagulopathy: 46% mortality
11 Posttraumatic Coagulopathy EAC endogenous acute coag. SAC systemic acquired coag. Death MODS Recover Injury Hemorrhage Ø Coag Recover SAC systemic acquired coag. Recovery Death MODS Time after Injury
12 Possible Mechanisms for EAC Impaired thrombin formation? Coagulation factor deficiency? Activation of the natural anticoagulant pathways (Protein C, Tissue Factor Pathway Inhibitor and antithrombin)?
13 Acute Traumatic Coagulopathy Study at San Francisco General Hospital Ann Surg 245: , severely traumatized patients admitted to SFGH Median time injury hospital admission: 28 minutes 18% of the patients had a systolic BP < 100 mm Hg 27% of the patients had an arterial base deficit > 6
14 Acute Traumatic Coagulopathy: Role of Hypoperfusion A C PTT (s) Base Deficit (meq/l) * PTT (s) + * Prothrombin fragments 1+2 B D PT (s) PT (s) Base Deficit (meq/l) 22 BD BD -6 BD > BD > <2 2-4 >4 <2 2-4 > Prothrombin fragments 1+2 (nm) * + *
15 Acute Traumatic Coagulopathy: Role of Protein C Pathway A PTT (s) PT (s) * Protein C (%) B * Protein C (%) C apc (ng/ml) * BD -6 BD > -6 D Factor V (%) Protein C (%)
16 Acute Traumatic Coagulopathy: Effect on Fibrinolysis A PAI-1 (AU/ml) * Protein C (%) B D-Dimers (ng/ml) * * Protein C (%)
17 Activated protein C pathway Fibrin D-Dimers Thrombin binds Thrombomodulin HYPOPERFUSION PC PC EPCR APC The complex Thrombin- Thrombomodulin activates Protein C APC decreases FVIIIa and FVa and induces D-dimers production
18 Acute Traumatic Coagulopathy (EAC) Early coagulopathy after trauma and shock: - Independent of traditional iatrogenic causes. - Associated with tissue hypoperfusion. - Secondary to the activation of the Protein C pathway. - Associated with a derepression of fibrinolysis. - Hypoperfusion is necessary for TBI patients to be coagulopathic early after trauma.
19 3. Mouse Model of Trauma-Hemorrhage
20 Animal Model of Trauma/Hemorrhage Soft-Tissue Trauma Hemorrhagic shock: Non-ventilated, fixed-pressure. Blood withdrawn via vascular line. MAP 35 +/- 5mmHg x 60 min. Fluid Resuscitation: 2x shed blood volume + shed blood
21 Acute Traumatic Coagulopathy in Mice
22 Acute Traumatic Coagulopathy is Mediated by apc Anticoagulant Function mab 1591 apc anticoagulant cytoprotective
23 Inhibition of the Cytoprotective Domain of Protein C Causes Diffuse Intravascular Coagulation Lung Injury mab 1609 apc anticoagulant cytoprotective A. Control mab B. mab 1609 Perivascular Hemorrhage Pulm. Artery with Thrombus.
24 Acute Traumatic Coagulopathy in Mice: mab 1609 apc anticoagulant cytoprotective
25 Summary * First Animal Model of Acute Traumatic Coagulopathy - Mimics human response to trauma/hypoperfusion * Role of Activated Protein C in Trauma/Hypoperfusion apc function REQUIRED for Acute Traumatic Coagulopathy SURVIVAL/ Prevention of DIC Anticoagulant + - Cytoprotective - +
26 Clinical Implications 1.Inhibition of anticoagulant function of Protein C could become a NEW, mechanistic treatment for Acute Traumatic Coagulopathy in trauma patients. 2. Role of protein C in organ dysfunction in traumatic shock: recombinant mutant non-anticoagulant protein C potential treatment in humans?
27 4. But what should we do?
28 Focus on Coagulopathy Early use of blood products Massive blood loss: Give products in a ratio of PRBC:FFP:platelets 1:1:1?
29 Massive Transfusion Traditionally, FFP & platelet concentrates are given as needed ---> > However: 1. The coagulation lab is slow! 2. Patients already have a coagulopathy, why wait?
30 Prevent the Lethal Triad 1.Keep warm: All fluids through warmers Keep the OR warm 2.Minimalize crystalloid: Continue a 1:1:1 resus. 3.Reduce Shock: Damage control surgery 4.Break the cycle: Consider other components X Hypothermia X Dilution X Acidosis Bleeding X Coagulopathy
31 Thank You
32 Acknowledgments Mitchel J. Cohen Michael West Karim Brohi Natasha Bir Brian Chesebro Michel Carles Pamela Rahn Marybeth Howard Greg Stahl Chuck Esmon John Griffin Ken Mann Adam Arkin John Doyle John Holcomb Funded by Grants from NIH (NIGMS)
Applying ROTEM to the Management of Bleeding in Trauma
Applying ROTEM to the Management of Bleeding in Trauma Sandro Rizoli, MD PhD FRCSC FACS Professor Surgery & Critical Care Medicine Trauma Program Director Chair Trauma Care Disclosure NONE ROTEM Growing
Hemostasis. by Mohie-Aldien Elsayed
Hemostasis by Mohie-Aldien Elsayed Hemostasis Hemostasis is defined as the process that maintains the flowing blood in a fluid state and confined to the circulatory system Coagulation prevents excess blood
REVIEW OF TRANEXAMIC ACID IN TRAUMA
REVIEW OF TRANEXAMIC ACID IN TRAUMA At the bottom of this article are the links to a couple of pretty good recent reviews about the current state of TXA. But first a bit of background. Coagulopathy in
HaematologY. Dr Tom Bate Again!
HaematologY Dr Tom Bate Again! THE FRCA What you need to know Blood Groups ~30 blood group systems recognised (ISBT) ABO, Rhesus, Lewis, Kell, Duffy, Kidd MNS system, Kell system The ABO antigens are the
Strategies for transfusion therapy and monitoring
Strategies for transfusion therapy and monitoring Jakob Stensballe Consultant Anaesthetist & Transfusion Medicine MD PhD Dept. of Anesthesia, Centre of Head and Orthopedics & Section for Transfusion Medicine,
Red Cell Transfusion LESSONS FROM TRAUMA
Red Cell Transfusion LESSONS FROM TRAUMA Sandro Rizoli, MD PhD FRCSC FACS Professor Surgery & Critical Care Medicine Trauma Program Director Chair Trauma Care Disclosure KCI Canada CSL Behring NovoNordisk
Using TEG in the ED, OR, and ICU. Don H. Van Boerum, MD, FACS
Using TEG in the ED, OR, and ICU Don H. Van Boerum, MD, FACS Trauma Surgeon, Director of Surgical Critical Care, Co-Director of Shock Trauma ICU, Intermountain Medical Center, Intermountain Healthcare
Management of Bleeding in the Anticoagulated Patient Short Snappers CSIM 2015 Elizabeth Zed, MD, FRCPC October 17, 2015
+ Management of Bleeding in the Anticoagulated Patient Short Snappers CSIM 2015 Elizabeth Zed, MD, FRCPC October 17, 2015 + Disclosures Off label use of PCC and apcc will be discussed My centre participates
Special Coagulation - APC Resistance. DiaPharma Group, Inc. Customer Service: Technical Support:
Special Coagulation - APC Resistance DiaPharma Group, Inc. Customer Service: 1.800.526.5224 Technical Support:1.800.447.3846 www.diapharma.com 1 Review of Hemostasis Overview Pathways of coagulation, anticoagulation,
Coagulopathy Case-2. Andy Nguyen, M.D. 2009
Coagulopathy Case-2 Andy Nguyen, M.D. 2009 CLINICAL HISTORY A 42 year-old man brought to the emergency room with severe burn. Patient was rescued by firemen in a serious fire. He had been found unconscious
What Can We Learn from Animal Models of Coagulopathy and Bleeding (about plasma transfusion)?
Test What Can We Learn from Animal Models of Coagulopathy and Bleeding (about plasma transfusion)? William Sheffield Associate Director, Research CBS Centre for Innovation, and Professor, Pathology and
Primary hemostasis. Vascular endothelium Vasoconstriction : local tissue factor, nervous system
Primary hemostasis Vascular endothelium Vasoconstriction : local tissue factor, nervous system Platelet Plug Platelet Adhesion Platelet Activation Platelet Aggregation Platelet Plug Formation Secondary
The evolution of TQIP Best Practices for Massive Transfusion
The evolution of TQIP Best Practices for Massive Transfusion Bryan A Cotton, MD, MPH Associate Professor of Surgery Department of Surgery and The Center for Translational Injury Research University of
New Anticoagulants Linda Liu, M.D.
Difficult Task New Anticoagulants Professor UCSF Dept of Anesthesia 15 minutes! Emphasis on 2 new oral anticoagulants Dabigatran Rivaroxaban Relation to anesthesia Rapid reversal Regional anesthesia UC
ANEMIA. Oral iron. IV iron gluconate (order set #233)
PREVENTION ANEMIA Oral iron IV iron gluconate (order set #233) TRANSEXAMIC ACID Efficacy of IV TXA in Reducing Blood Loss After Elective C-section: Prospective, Randomized, Double-blind, Placebo Controlled
WFH 2014 World Congress Medical Free Paper 8 ALN AT3: An Investigational RNAi Therapeutic Targeting Antithrombin for the Treatment of Hemophilia
WFH 214 World Congress Medical Free Paper 8 ALN AT3: An Investigational RNAi Therapeutic Targeting Antithrombin for the Treatment of Hemophilia May 15, 214 Akin Akinc, PhD Antithrombin and ALN-AT3 Program
Managing Coagulation Abnormalities Linda Liu, M.D.
Managing Coagulation Abnormalities Professor UCSF Dept of Anesthesia UC SF 1 Difficult Task Coagulation Abnormalities 30 minutes Emphasis on 2 new oral anticoagulants Dabigatran Rivaroxaban UC SF 2 UC
Princess Alexandra Hospital Emergency Department. Clinical Procedure. 1 Introduction
Princess Alexandra Hospital Emergency Department Clinical Procedure Trauma, Resuscitation Review Officer: Glenn Ryan 1 Introduction Version no: 1 Approval Date: 16/07/2014 Review Date: 16/07/2016 Authority:
Clinical Procedure. ROTEM Trauma, Resuscitation. Princess Alexandra Hospital Emergency Department. 1 Introduction
Princess Alexandra Hospital Emergency Department Clinical Procedure Trauma, Resuscitation Review Officer: Glenn Ryan 1 Introduction Version no: 1 Approval Date: 16/07/2014 Review Date: 16/07/2016 Authority:
Use of Thromboelastography in the Management of the Trauma Patient Rio Grande Trauma Conference
Use of Thromboelastography in the Management of the Trauma Patient Rio Grande Trauma Conference John A. Aucar, MD, MSHI, FACS, CPE EmCare Acute Care Surgery Del Sol Medical Center Associate Professor,
Transfusion & Non-transfusion Approaches to Bleeding
Transfusion & Non-transfusion Approaches to Bleeding Maureane Hoffman, MD, PhD Professor of Pathology, Duke University and Director, Transfusion Service and Hematology Laboratory Durham Veterans Affairs
The Combined Use of Bypassing Agents with Antithrombin Reduction in Plasma of Hemophilia A and B Patients with Inhibitors
Venkat Living Venkat with Hemophilia Living with Hemophilia The Combined Use of Bypassing Agents with Antithrombin Reduction in Plasma of Hemophilia A and B Patients with Inhibitors Tami Livnat 1, Alfica
These handouts are only meant as a guide while you follow the presentation on the screen. Sometimes the speaker will change some of the slides.
These handouts are only meant as a guide while you follow the presentation on the screen. Sometimes the speaker will change some of the slides. If you would like the 1 slide per page handouts, please ask
CHROMOGENIC SUBSTRATE TECHNOLOGY. Giovanni Russi
CHROMOGENIC SUBSTRATE TECHNOLOGY Giovanni Russi What is a chromogenic substrate? A peptide linked to a chromophore The peptide is formed by 3-5 residues The chromophore is p-nitroaniline (p-na) The residues
Blood transfusion in special situations and poly-trauma. Dr Marina Karakantza Consultant Haematologist in Transfusion Medicine, LTHT
Blood transfusion in special situations and poly-trauma Dr Marina Karakantza Consultant Haematologist in Transfusion Medicine, LTHT Uncontrolled bleeding is a major preventable cause of death in trauma
Coagulation in perspective: Blood management. Objectives
Coagulation in perspective: Blood management Julie Wegner, PhD jawrbl@gmail.com Objectives To gain a basic understanding of the following: 1. Coagulation components and processes Why patients bleed. 2.
Factor Concentrates. More is better? Alexander Duncan MD Emory Medical Labs
Factor Concentrates. More is better? Alexander Duncan MD Emory Medical Labs Call from OR! Scenario -1 Patients is bleeding out! Don t ask why, what rate what s been done! We need blood now! What kind of
Current Evidence based management of Massive Haemorrhage
Current Evidence based management of Massive Haemorrhage Kerry Gunn Department of Anaesthesia and Perioperative Medicine Auckland City Hospital Summary A small proportion (4%) need an aggressive approach
Introduction Hemostasis: Tourniquet Test & Bleeding Time. Hematology-Immunology System Faculty of Medicine Universitas Padjadjaran LOGO
Introduction Hemostasis: Tourniquet Test & Bleeding Time Hematology-Immunology System Faculty of Medicine Universitas Padjadjaran LOGO Hemostasis A series of reactions that function to stop bleeding, maintaining
Disclosure (s) Relevant financial relationship(s) None Off-label usage None Change in slide set You betcha! (YES!) 2015 MFMER slide-1
Disclosure (s) Relevant financial relationship(s) None Off-label usage None Change in slide set You betcha! (YES!) 2015 MFMER slide-1 Learning Objectives Explain the concept of thrombophilia Recognize
Coagulation Cascade. TF-VIIa. Tissue Factor + VII. XIIa. Prothrombin. XIa. IXa. VIIIa. Thrombin. XL- Fibrin. XIII Monomer. Fibrinogen.
Coagulation Cascade Intrinsic Pathway Extrinsic Pathway Contact Activation XIIa XI XIa Prekallikrein HMW Kininogen IX IXa Ca 2+ Anticoagulation proteins: Protein C, Protein S, Antithrombin III, TFPI TF
Session 1 Topics. Vascular Phase of Hemostasis. Coagulation Pathway. Action of Unfractionated Heparin. Laboratory Monitoring of Anticoagulant Therapy
~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 1 of 4 Session 1 Topics Review of coagulation and the vascular phase of hemostasis Unfractionated heparin Low molecular
The Next Big Thing. Dr Anne Weaver Consultant in Emergency Medicine & Pre-hospital Care Clinical Director for Trauma Royal London Hospital
The Next Big Thing Dr Anne Weaver Consultant in Emergency Medicine & Pre-hospital Care Clinical Director for Trauma Royal London Hospital Things to share with you Good conference / interesting journal
Activated Protein C Resistance vs Factor V Leiden assay: Which is the most cost effective?
Activated Protein C Resistance vs Factor V Leiden assay: Which is the most cost effective? Rajiv K. Pruthi, M.B.B.S Co-Director, Special Coagulation Laboratory & Director, Mayo Comprehensive Hemophilia
Coagulation Mechanisms Dr. Nervana Bayoumy
Coagulation Mechanisms Dr. Nervana Bayoumy Associate Professor Department of Physiology Objectives At the end of this lecture you should be able to: 1. Recognize the different clotting factors 2. Understand
Plasma Testing in the Clinical Coagulation Laboratory: New drugs, new problems.
Test Plasma Testing in the Clinical Coagulation Laboratory: New drugs, new problems. Karen A. Moffat BEd, MSc, ART, FCSMLS(D) Technical Specialist, Coagulation, HRLMP Assistant Professor, Department of
Hemostasis practice: state-of-the-art
Perspective Page 1 of 6 Hemostasis practice: state-of-the-art Giuseppe Lippi 1, Emmanuel J. Favaloro 2 1 Section of Clinical Biochemistry, Department of Neurological, Biomedical and Movement Sciences,
Resuscitation: Past Beliefs and Current Clinical Trials. David B. Hoyt, MD FACS Executive Director American College of Surgeons Chicago, IL
Resuscitation: Past Beliefs and Current Clinical Trials David B. Hoyt, MD FACS Executive Director American College of Surgeons Chicago, IL Early Gun Shot Wounds Pare` 1507- focus infection Poisoned
Managing Massive Transfusions in diverse Patient Populations in a Non-Metropolitan Area
Managing Massive Transfusions in diverse Patient Populations in a Non-Metropolitan Area SHAUNA M.M. STURGILL, LAURIE GILLARD LEARNING OBJECTIVES 1. Compare and contrast massive transfusion protocols for
General Principles of. Hemostasis. Kristine Krafts, M.D.
General Principles of Hemostasis Kristine Krafts, M.D. Hemostasis is a balancing act! pro-ting plugs up holes in blood vessels anti-ting keeps ting under control Pro-Clotting Pro-Clotting vessels platelets
The Role Of Point of Care Coagulation Testing (POCCT) in Patient Blood Management. Elham Khalaf Adeli
The Role Of Point of Care Coagulation Testing (POCCT) in Patient Blood Management Elham Khalaf Adeli Overview PBM, bleeding management, Coagulation POC Testing Review of laboratory conventional coagulation
Emergency and Perioperative Hemostasis Testing: Which Assays Provide Helpful Information. Wayne Chandler, MD Laboratory Medicine Seattle Children s
Emergency and Perioperative Hemostasis Testing: Which Assays Provide Helpful Information Wayne Chandler, MD Laboratory Medicine Seattle Children s Emergency Hemostasis Testing Patients actively bleeding
Local vasoconstriction. is due to local spasm of the smooth muscle (symp. reflex) can be maintained by platelet vasoconstrictors
Hemostasis Hemostasis ( hemo =blood; sta= remain ) is the stoppage of bleeding, which is vitally important when blood vessels are damaged. Following an injury to blood vessels several actions may help
New Insights into the Diagnosis & Management of Venous Thromboembolism (VTE) Michael Miller, M.D.
New Insights into the Diagnosis & Management of Venous Thromboembolism (VTE) Michael Miller, M.D. Professor of Cardiovascular Medicine University of Maryland School of Medicine Copyright A.P. Wheeler 2009
Recombinant Factor VII vs Cryoprecipitate. Dr. M. Truter Moderator: Prof. Pretorius
Recombinant Factor VII vs Cryoprecipitate Dr. M. Truter Moderator: Prof. Pretorius Discussion with Dr. J. Potgieter (Haematology) No articles on Recombinant factor VII vs Cryoprecipitate Different indications
Improving Outcomes of Cardiac Surgery with a Point-of-Care Based Transfusion Algorithm
Improving Outcomes of Cardiac Surgery with a Point-of-Care Based Transfusion Algorithm Summer Syed (local PI) Keyvan Karkouti Deputy Anesthesiologist-in-Chief, Toronto General Hospital, University Health
Bleeding Emergencies. Gregory W. Hendey, MD, FACEP Professor of Clinical Emergency Medicine UCSF Fresno
Bleeding Emergencies Gregory W. Hendey, MD, FACEP Professor of Clinical Emergency Medicine UCSF Fresno Objectives To discuss indications and agents used for reversal of coagulopathy To apply those principles
EDUCATIONAL COMMENTARY MASSIVE TRANSFUSION PROTOCOL
EDUCATIONAL COMMENTARY MASSIVE TRANSFUSION PROTOCOL Commentary provided by: Kathleen Trudell MLS (ASCP) CM SBBCM University of Nebraska Medical Center Division of Medical Laboratory Science College of
Use of ROTEM from the Laboratory Perspective. A/Prof David Roxby SA Pathology
Use of ROTEM from the Laboratory Perspective A/Prof David Roxby SA Pathology What s the Problem? Constant changes in treatment recommendations Lack of good evidence to guide practice Variations in clinical
Implementation of massive transfusion protocols to guide practice in severe bleeding- is your institution ready?
Implementation of massive transfusion protocols to guide practice in severe bleeding- is your institution ready? Ryan Zarychanski MD MSc University of Manitoba Sections of Hematology and Critical Care
Waterfall/ Cascade Model:1960 s. Coagulation Challenges During the Perioperative Period
Coagulation Challenges During the Perioperative Period Professor Dept Anesthesia and Perioperative Care UC San Francisco Waterfall/ Cascade Model:1960 s Intrinsic Pathway Kallikrein fxii fxi Extrinsic
DEPARTMENT OF CLINICAL LABORATORY SCIENCES SCHOOL OF HEALTH TECHNOLOGY AND MANAGEMENT THE UNIVERSITY AT STONY BROOK STONY BROOK, NEW YORK
DEPARTMENT OF CLINICAL LABORATORY SCIENCES SCHOOL OF HEALTH TECHNOLOGY AND MANAGEMENT THE UNIVERSITY AT STONY BROOK STONY BROOK, NEW YORK 11794-8205 COAGULATION COMPETENCY EVALUATION FORM STUDENT NAME:
Massive Haemorrhage J Davies B Ferguson
Massive Haemorrhage J Davies B Ferguson What is Massive Haemorrhage (MH)? Difficult to apply rules as to how much blood loss defines a major haemorrhage. Easier to define how the patient s condition is
Pulmonary Coagulopathy
9th International Congress and Scientific Seminar 2009 Bangladesh Society of Medicine, Dhaka, Bangladesh Pulmonary Coagulopathy Pulmonary Coagulopathy as a New Therapeutic Target Marcus Schultz Disclosure
Clinical Use of Plasma for Transfusion. Irma Szymanski, MD Professor of Pathology, Emerita University of Massachusetts Medical School
Clinical Use of Plasma for Transfusion Irma Szymanski, MD Professor of Pathology, Emerita University of Massachusetts Medical School PLASMA PRODUCTS FOR TRANSFUSION Fresh Frozen Plasma (FFP) Thawed Plasma
POST-ISTH: Novità dal meeting di Toronto 2015 Piastrine: fisiopatologia. Erica De Candia Università Cattolica -Roma
POST-ISTH: Novità dal meeting di Toronto 2015 Piastrine: fisiopatologia Erica De Candia Università Cattolica -Roma Novità ISTH 2015: Piastrine: Fisiopatologia i) Alternative platelet function throughout
Venous thromboembolism (VTE) Can Biomarkers Help to Guide Duration of Therapy After VTE? New Chest Guidelines 2016
Venous thromboembolism (VTE) Can Biomarkers Help to Guide Duration of Therapy After VTE? Marlene Grenon, MD Associate Professor of Surgery University of California San Francisco UCSF Vascular Surgery Symposium
In Hospital Bleeding Management
In Hospital Bleeding Management Geno J Merli, MD, MACP, FSVM, FHM Professor Medicine & Surgery Co-Director Jefferson Vascular Center Sidney Kimmel Medical College Thomas Jefferson University Hospitals
2013 Health Press Ltd.
Fast Facts Fast Facts: Bleeding Disorders Second edition David Green MD PhD Professor of Medicine Emeritus Feinberg School of Medicine Northwestern University Chicago, Illinois, USA Christopher A Ludlam
TEG: The ABCs of Implementing Thromboelastography in a Trauma Center
TEG: The ABCs of Implementing Thromboelastography in a Trauma Center Mary Kay Bader RN, MSN, CCNS, FNCS, FAHA Neuro/Critical Care CNS Mission Hospital Learning Objectives Implement TEG into a Trauma Center
THE EFFECT OF THAWING FRESH FROZEN PLASMA AT VARIOUS TEMPERATURES ON IN VITRO COAGULATION FACTOR ACTIVITY
THE EFFECT OF THAWING FRESH FROZEN PLASMA AT VARIOUS TEMPERATURES ON IN VITRO COAGULATION FACTOR ACTIVITY Brian Leslie Levy A research report submitted to the Faculty of Health Sciences, University of
Novel Anti-coagulant Agents. David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan
Novel Anti-coagulant Agents David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan Objectives Provide an overview of the normal coagulation, including perioperative testing
New factor concentrates on the way to the market
New factor concentrates on the way to the market ISCB, Copenhagen, 1 September 2015 John R. Hess, MD, MPH, FACP, FAAAS Professor of Laboratory Medicine and Hematology Medical Director, Transfusion Service,
THE PROCOAGULANT ROLE OF NUCLEIC ACIDS IN THE CONTACT SYSTEM
THE PROCOAGULANT ROLE OF NUCLEIC ACIDS IN THE CONTACT SYSTEM THE PROCOAGULANT ROLE OF NUCLEIC ACIDS IN THE CONTACT SYSTEM By JAGMANPREET S. DANG, Honors B.Sc. A Thesis Submitted to the School of Graduate
LABORATORY APPROACH TO BLEEDING DISORDERS DR NISHANTH PG 1 ST YEAR DEPARTMENT OF PATHOLOGY
LABORATORY APPROACH TO BLEEDING DISORDERS DR NISHANTH PG 1 ST YEAR DEPARTMENT OF PATHOLOGY 1 WHEN IS THE LAB REQUIRED TO INVESTIGATE FOR A POSSIBLE BLEEDING DISORDER? Clinically suspected bleeding tendency
Effects of recombinant activated Factor VII and supplementary oxygen on coagulopathy after trauma
Effects of recombinant activated Factor VII and supplementary oxygen on coagulopathy after trauma Thesis submitted for the degree of Doctor of Medicine at Newcastle University Lt Colonel Thomas Woolley
Alternative Haemostatic Agents in the Management of Obstetric Haemorrhage
Alternative Haemostatic Agents in the Management of Obstetric Haemorrhage Clinical Associate Professor Nolan McDonnell School of Medicine and Pharmacology, School of Women s and Infants Health University
Suitability of analytical methods for detection of thrombogenic factor XIa in Privigen
Suitability of analytical methods for detection of thrombogenic factor XIa in Privigen Absence of thrombogenic factors in Privigen M. Moses, K. Ruhwedel, H.-A. Stöhr, L. Duse, A. Feussner, W. Wormsbächer,
Laboratory Investigation of Challenging Cases. Laura A. Worfolk, Ph.D Scientific Director, Coagulation
Laboratory Investigation of Challenging Cases Laura A. Worfolk, Ph.D Scientific Director, Coagulation Coagulation Cascade XII XIIa XI HMWK/Prekallikrein XIa VII Injury IX X IXa VIII Xa X TF TF/VIIa Prothrombin
Bivalirudin (Angiomax ) vs. Heparin during Peripheral Vascular Interventions: Which is Better and How to Decide?
Bivalirudin (Angiomax ) vs. Heparin during Peripheral Vascular Interventions: Which is Better and How to Decide? Vinod Nair MD FACC FSCAI Cardiovascular Ins6tute of the South, Houma Financial Disclosure:
& & & 15, :30-10:15 AM
Massive Transfusion: Controversy Continues Thrombin-Containing Local Hemostatic Products: Risks and Benefits Prothrombin Concentrates for Warfarin Reversal: Where are we now in the US? Presented by: Dr.
Massive Haemorrhage P Donnelly B Ferguson
Massive Haemorrhage P Donnelly B Ferguson What is Massive Haemorrhage (MH)? Difficult to apply rules as to how much blood loss defines a major haemorrhage. Easier to define how the patient s condition
The Coagulation Workup In The Office Setting
CAA Conference alm Springs 2012 The Coagulation Workup In The Office Setting CAA Conference alm Springs, October 2012 Robert Miller, A-C Henoch-Schoenlein urpura 1 CAA Conference alm Springs 2012 2 CAA
Alnylam Pharmaceuticals R&D Day. July 11, 2013
Alnylam Pharmaceuticals R&D Day July 11, 2013 Alnylam Forward Looking Statements This presentation contains forward-looking statements, within the meaning of Section 27A of the Securities Act of 1933 and
HIBOR. 1st Prophilaxis. Acute phase treatment. Pentasaccharide. Long-term 2ª ACOs UFH LMWH LMWH LMWH. Competitors
HIBOR Competitors 1st Prophilaxis LMWH Pentasaccharide Long-term Profilaxis treatment 2ª ACOs LMWH Acute phase treatment UFH LMWH Unfractionated heparin (UFH) Discovered by J. Mc Lean in 1916. Later named
Alberta Health Services - Edmonton Zone Massive Hemorrhage Protocol
This document applies to all Covenant and AHS sites. Client Resource 23: Alberta Health Services - Edmonton Zone Regional Laboratory Services This document is applicable at site(s): GNH MIS RAH SGH UAH
Evaluation of Complex Coagulation Cases: Case-Based Illustrations of Important Issues
Evaluation of Complex Coagulation Cases: Case-Based Illustrations of Important Issues Kristi J. Smock, MD Associate Professor of Pathology University of Utah Health Sciences Center Medical Director, Hemostasis/Thrombosis
Emerging Use Of Rotational Thromboelastometry (ROTEM) in Trauma Resuscitation. Ashley Millham, CD, BSC CCPA
Emerging Use Of Rotational Thromboelastometry (ROTEM) in Trauma Resuscitation Ashley Millham, CD, BSC CCPA Goals of this session: 1. Identify the deadly triad in trauma, the goal of damage control resuscitation
Manejo de la transfusión de plaquetas. Ileana López-Plaza, MD
Manejo de la transfusión de plaquetas Ileana López-Plaza, MD Thrombocytopenia Common in ICU setting 25-38% with< 100,000/µL 2-3 % with < 10,000/µL Common etiologies Drug-induced: heparin, antibiotics,
Satoshi Gando 1*, Toshihiko Mayumi 2 and Tomohiko Ukai 3
Gando et al. Thrombosis Journal (2018) 16:13 https://doi.org/10.1186/s12959-018-0167-3 REVIEW Open Access Activated protein C plays no major roles in the inhibition of coagulation or increased fibrinolysis
LABORATORY DIAGNOSIS OF BLEEDING DISORDERS
LABORATORY DIAGNOSIS OF BLEEDING DISORDERS Primary & Secondary Hemostasis Disorders http://.columbia.edu/itc/hs/medical/selective/advclinicalpathology/2004/lecture/lab%20diagnosis%20of%20bleeding%20disorders.ppt
Viscoelastic haemostatic assays and fibrinogen concentration tests during haemodilution: The effects of fibrinogen and factor XIII
Viscoelastic haemostatic assays and fibrinogen concentration tests during haemodilution: The effects of fibrinogen and factor XIII WINSTEDT, DAG Published: 2014-01-01 Link to publication Citation for published
Disclosures. I have received research funding from: I have received consulting fees/honoraria from: Novo Nordisk CSL-Behring Boehringer Ingelheim
Test Disclosures I have received research funding from: Novo Nordisk CSL-Behring Boehringer Ingelheim I have received consulting fees/honoraria from: Novo Nordisk CSL-Behring Baxter The Medicines Company
Disclosures. Thromboelastography. TEG Methodology. TEG Output. Thromboelastography (TEG): Basics & Clinical Applications
Thromboelastography (TEG): Basics & Clinical Applications Paula J. Santrach MD Associate Professor, Laboratory Medicine Mayo Clinic Rochester, MN Disclosures Relevant financial relationships NONE Off label
Index. Autoimmune thrombocytopenic purpura (AITP), 100, 102, 105, 108, 187 Automated platelet counters, , 108
A Accuracy, 6, 7, 15, 46, 52, 53, 61, 75, 100, 143, 144, 149, 166, 176, 178 Acquired coagulation disorders, 111 115 Acquired platelet disorders, 99 108 ACT. See Activated clotting time (ACT) Activated
Ch 13: Blood. What does blood do? Transport: Regulation: Protection:
Ch 13: Blood What does blood do? Transport: Regulation: Protection: SLOs Describe the composition of plasma and list the major functions of plasma proteins. Map hematopoiesis, starting from a pluripotent
Lina Al-Lawama. Rama Al-Ashqar. Malik Al-Zohlof
2 Lina Al-Lawama Rama Al-Ashqar Malik Al-Zohlof Anticoagulant drugs Recap Last lecture we were talking about antiplatelet drugs, we mentioned 5 drugs : Aspirin which is used alone with patents that have
Pharmacotherapy Resuscitation in Acute Traumatic Coagulopathy: Ready for Prime Time? September 29, 2017
Pharmacotherapy Resuscitation in Acute Traumatic Coagulopathy: Ready for Prime Time? September 29, 2017 Martha Evans, PharmD PGY-1 Pharmacy Resident Dell Seton Medical Center martha.evans@ascension.org
TSOAC Case Study 1. Question. TSOAC Case Study 1 Continued
TSOAC Case Study 1 An otherwise healthy 56-year-old man presents to the emergency department with left leg pain and swelling for the last 3 days. Compression ultrasonography confirms left common femoral
These slides and the data they contain are the sole property of the author(s) of the slide set.
These slides and the data they contain are the sole property of the author(s) of the slide set. Reproduction or distribution of the content of the slides or the data they contain requires the prior, specific
Combined factor VII/protein C deficiency results in intrauterine coagulopathy in mice
Combined factor VII/protein C deficiency results in intrauterine coagulopathy in mice Joyce C.Y. Chan, 1 Ivo Cornelissen, 1 Desire Collen, 2 Victoria A. Ploplis, 1 and Francis J. Castellino 1 1 W.M. Keck
2015 Goring Coagulation Conference
2015 Goring Coagulation Conference A Subcutaneously Administered Investigational RNAi Therapeutic (ALN-AT3) Targeting Antithrombin for Treatment of Hemophilia: Interim Phase 1 Study Results in Healthy
R.Li, C.Swaelens, F.Vandermijnsbrugge, B.Cantinieaux BSTH Laboratory of haematology, Porte de Hal,
Institut J. Bordet Normal with Actin-FS avoids intrinsic pathway factors assays in the presence of an isolated prolongation of (Platelin-LS) without hemorrhagic history R.Li, C.Swaelens, F.Vandermijnsbrugge,
A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa
A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa Lu G, Deguzman FR, Hollenbach SJ, et al. Department of Biology, Portola Pharmaceuticals Inc.,
The Clinical Use and Immunologic Impact of Thrombin in Surgery
The Clinical Use and Immunologic Impact of Thrombin in Surgery Jeffrey H. Lawson, M.D., Ph.D. Departments of Surgery and Pathology Duke University Medical Center Durham, North Carolina Bovine Thrombin
TRANSFUSION MANAGEMENT OF MASSIVE HAEMORRHAGE
POLICY AND PROCEDURE ON TRANSFUSION MANAGEMENT OF MASSIVE HAEMORRHAGE IN THE CORK UNIVERSITY HOSPITAL Reference Number: PPG-CUH-CUH-210 Revision No: 01 Review Cycle: 2 years Author (Lead): Dr Oonagh Gilligan
DOACs Can Be Reversed!
1 DOACs Can Be Reversed! AC Forum 14 th National Conference April 21, 2017 Adam Cuker, MD, MS Perelman School of Medicine University of Pennsylvania 2 Full disclosures (last 12 months) Research support
Sign up to receive ATOTW weekly -
BLOOD PHYSIOLOGY PART 2 ANAESTHESIA TUTORIAL OF THE WEEK 231 11 TH JULY 2011 Dr Karen Hayes Royal Devon & Exeter Correspondence to: kmhayes@hotmail.co.uk QUESTIONS Before continuing, try to answer the
EDUCATIONAL COMMENTARY D-DIMER UPDATE
EDUCATIONAL COMMENTARY D-DIMER UPDATE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits see the Continuing
Laboratory investigation in the Bleeding Patient. Dr Craig Taylor Consultant Haematologist May 2016
Laboratory investigation in the Bleeding Patient Dr Craig Taylor Consultant Haematologist May 2016 Introduction Bleeding is common May consume significant resources Crossmatched blood Lab results may be