Predicting prothrombotic tendencies in sepsis using spatial clot growth dynamics

Abstract

Inflammation in sepsis is associated with hypercoagulation that may lead to thrombosis and disseminated intravascular coagulation. Conventional diagnostic assays are poorly sensitive to procoagulant changes in sepsis. Objectives of the article is to study changes in hemostatic state of septic patients using spatial clot growth assay (currently being developed under the trademark of thrombodynamics) and to compare the sensitivity of this method with the sensitivity of conventional methods. Sixteen patients with hematological malignancies and sepsis were enrolled in the study. All patients had been surveyed for a month following the infection onset. Spatial clot growth assay monitors fibrin clot development in a nonstirred thin layer of platelet-free plasma activated by immobilized tissue factor. Clotting time tests, thromboelastography, D-dimer assays were also performed. Spatial clot growth revealed hypercoagulation in six patients. D-dimer levels increase (with vein thrombosis in one case) was subsequently observed in five of them. D-dimer levels did not increase when spatial clot growth was normal. At the next time point, after spatial clot growth assay showed hypercoagulation, the mean D-dimer concentration was significantly higher than after a normal analysis (457 versus 234 μg/l; P < 0.05); there was no such correlation for other assays. The remaining 10 patients had elevated D-dimer levels on the first day; this either decreased gradually or remained elevated. Spatial clot growth showed normalization in survivors and growing hypocoagulation in nonsurvivors. Measuring spatial clot growth dynamics has potential diagnostic utility for the evaluation of thrombotic risk.

More efficient reversal of dabigatran inhibition of coagulation by activated prothrombin complex concentrate or recombinant factor VIIa than by four-factor prothrombin complex concentrate

“…This method has been described in several articles [12][13][14]. Coagulation was detected in a cuvette by time-lapse image capture of light scattering from the fibrin network.…”

An effective tool to evaluate the homeostasis during pregnancy: dynamic thrombophotometry (thrombodynamics)

“…В работе Н. Соши-товой и соавт. [23] было показано, что тромбодинамика является чувствительным тестом активации системы свертывания крови при сепсисе, причем метод продемон-стрировал более раннюю предсказательную способность по сравнению с D-димером. У пациентов с тромбозом глубоких вен с помощью теста тромбодинамики может быть выделена группа с повышенным риском рецидива тромбоза [24].…”

Influence of temperature on spatial fibrin clot formation process in thrombodynamics

“…Фибриновый сгусток начинает формироваться вблизи активатора и постепенно распространяется вглубь объема плазмы. Схема экспериментальной установки и принцип метода приведены в работе [17].…”

“…Затем для серии снимков выбирали прямоугольную область, содержащую поверхность активатора, фибриновый сгусток и свободную от сгустка плазму. Внутри этой области производили послойный расчёт интенсивности светорассеяния в зависимости от расстояния до поверхности активатора, после чего строили профили сгустков [17]. Размер сгустка в каждый момент времени определялся как координата, в которой интенсивность светорассеяния была равна половине максимальной, что соответствует превращению половины фибриногена в фибрин [13].…”