PMID- 29851903
OWN - NLM
STAT- MEDLINE
DCOM- 20190502
LR  - 20201209
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 85
IP  - 3
DP  - 2018 Sep
TI  - In vitro effects of a kaolin-coated hemostatic dressing on anticoagulated blood.
PG  - 485-490
LID - 10.1097/TA.0000000000001999 [doi]
AB  - BACKGROUND: The use of kaolin-coated dressings has become common and have 
      efficacy in normal patients, but their increased use will inevitably include use 
      on bleeding patients taking anticoagulants. We hypothesize that kaolin coating 
      material (KCM) will improve clotting regardless of anticoagulation medication. 
      METHODS: A prospective study was performed on blood from patients who were on a 
      vitamin K antagonist (VKA), unfractionated heparin (UH), an antiplatelet (AP) 
      agent, a Xa inhibitor (Xa), or a direct thrombin inhibitor (DTI). None were on 
      more than one type of anticoagulation medication. Viscoelastic testing was 
      performed with and without KCM. All p values were adjusted for multiple 
      comparisons. RESULTS: The addition of KCM significantly decreased the time for 
      initial clot formation (CT) in all groups. The mean CT for controls was decreased 
      from 692 to 190.8 s (p < 0.0001). KCM decreased the initial clot formation time 
      by about 1.5 times in those on DTI (p = 0.043) and 2.5 times in those taking AP 
      medication (p < 0.001). The most profound effect was seen in those on UH (no KCM 
      1,602 s vs. KCM 440 s; p < 0.001), VKA (no KCM 1,152 s vs. 232 s; p < 0.01), and 
      Xa (no KCM 1,342 s vs. 287 s; p < 0.001). Analysis of other clot formation 
      parameters revealed that KCM significantly improved the clot formation kinetics 
      (CFT) only in patients taking Xa (p = 0.03). KCM improved maximum clot strength 
      in patients on Xa inhibitors (p = 0.05). Patients on UH had a larger effect size 
      with an increase in clot strength from 24.35 mm to 43.35 mm whereas those on Xa 
      had an increase of 38.7 mm to 49.85 mm. CONCLUSION: In this in vitro analysis, 
      the addition of KCM to the blood of patients taking any of these anticoagulation 
      medications significantly improved the time to initial clot formation, indicating 
      that kaolin-based hemostatic dressings will be effective in initiating clot 
      formation in patients on anticoagulants. LEVEL OF EVIDENCE: Therapeutic, level 
      IV.
FAU - Cripps, Michael W
AU  - Cripps MW
AD  - Department of Surgery (M.W.C., N.V., J.C.W., P.E.G.), UT Southwestern, Dallas, 
      Texas; UT Houston Health Science Center (C.C.C.), Houston, Texas; and Department 
      of Clinical Sciences, Division of Biostatistics (P.A.N.), UT Southwestern, 
      Dallas, Texas.
FAU - Cornelius, Canon C
AU  - Cornelius CC
FAU - Nakonezny, Paul A
AU  - Nakonezny PA
FAU - Vazquez, Natalia
AU  - Vazquez N
FAU - Wey, Jocelyn C
AU  - Wey JC
FAU - Gales, Peter E
AU  - Gales PE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Hemostatics)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Sulfonamides)
RN  - 0 (Viscoelastic Substances)
RN  - 12001-79-5 (Vitamin K)
RN  - 24H4NWX5CO (Kaolin)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - I0VM4M70GC (Dabigatran)
RN  - IY90U61Z3S (argatroban)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/therapeutic use
MH  - Antithrombins/blood
MH  - Arginine/analogs & derivatives
MH  - Bandages/trends
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Tests/methods
MH  - Dabigatran/administration & dosage/therapeutic use
MH  - Factor Xa Inhibitors/blood
MH  - Hemostatics/*therapeutic use
MH  - Heparin/blood
MH  - Humans
MH  - Kaolin/adverse effects/*pharmacology
MH  - Pipecolic Acids/administration & dosage/therapeutic use
MH  - Platelet Aggregation Inhibitors/blood
MH  - Prospective Studies
MH  - Rivaroxaban/administration & dosage/therapeutic use
MH  - Sulfonamides
MH  - Viscoelastic Substances/chemistry
MH  - Vitamin K/*antagonists & inhibitors/blood
EDAT- 2018/06/01 06:00
MHDA- 2019/05/03 06:00
CRDT- 2018/06/01 06:00
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2019/05/03 06:00 [medline]
PHST- 2018/06/01 06:00 [entrez]
AID - 10.1097/TA.0000000000001999 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2018 Sep;85(3):485-490. doi: 
      10.1097/TA.0000000000001999.