Recombinant human tissue-type plasminogen activator derivative(China Resources Angde Biotech Pharma)

In sepsis, fibrinolysis resistance correlates with worse outcomes. Practically, rotational thromboelastometry (ROTEM) is used to report residual clot amplitude relative to maximum amplitude at specified times after clot formation clot lysis indices (CLIs). However, healthy individuals can exhibit similar CLIs, thus making it challenging to solely diagnose the low fibrinolytic state. Furthermore, CLI does not include the kinetics of clot formation, which can affect overall fibrinolysis. Therefore, a more nuanced analysis, such as time to attain maximal clot amplitude after reaching maximal clot formation velocity (t-AUCi), is needed to better identify fibrinolysis resistance in sepsis.

To evaluate the correlation between the degree of fibrinolytic activation and t-AUCi in healthy or septic individuals.

Whole blood (n = 60) from septic or healthy donors was analyzed using tissue factor-activated (EXTEM) and nonactivated (NATEM) ROTEM assays. Lysis was initiated with tissue-type plasminogen activator, and CLI and t-AUCi were calculated. Standard coagulation tests and plasma fibrinolysis markers (D-dimer, plasmin-α2-antiplasmin complex, plasminogen activator inhibitor type 1, and plasminogen) were also measured.

t-AUCi values decreased with increasing fibrinolytic activity and correlated positively with CLI for different degrees of clot lysis both in EXTEM and NATEM. t-AUCi cutoff value of 1962.0 seconds in EXTEM predicted low fibrinolytic activity with 81.8% sensitivity and 83.7% specificity. In addition, t-AUCi is not influenced by clot retraction.

Whole-blood point-of-care ROTEM analyses with t-AUCi offers a more rapid and parametric evaluation of fibrinolytic potential compared with CLI, which can be used for a more rapid and accurate diagnosis of fibrinolysis resistance in sepsis.

We report the case of a patient who developed a severe pulmonary embolus postoperatively despite perioperative venous thromboembolism (VTE) prophylaxis as prescribed.

A 50-year-old female patient underwent a robotic total hysterectomy for uterine fibroids. Her perioperative VTE risk was assessed as moderate, and compression and intermittent air compression stockings were used postoperatively until the morning following the surgery. The surgery was uneventful, and the patient was discharged on postoperative day 4. On postoperative day 19, the patient experienced rapid dyspnea and was diagnosed with a severe pulmonary embolus.

Heparin, a tissue-type plasminogen activator, and a catecholamine were administered, and the patient recovered well.

VTE measures in minimally invasive gynecologic surgery are not well defined, and future thrombotic risk assessments specific to minimally invasive gynecologic surgery may be necessary.