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Background: Viscoelastic tests are now routinely used for coagulopathy correction in patients with cirrhosis. Thromboelastography (TEG) and rotational thromboelastometry (RoTEM®) are the most widely studied tests in this population. However, they have not been compared with each other in critically ill patients with liver disease presenting with nonvariceal bleed. Hence, we aimed to compare these tests for coagulopathy correction in patients with liver disease presenting with nonvariceal bleeding.
Methods: Sixty adult patients with liver cirrhosis presented to the liver intensive care unit, presenting with a nonvariceal upper gastrointestinal (GI) bleed (diagnosed by doing upper GI endoscopy which revealed bleeding from a nonvariceal source) oral or nasal bleed were enrolled. The patients were allocated to the TEG group (Group T) or RoTEM group (Group R) depending on the immediate availability of the viscoelastic test. Coagulopathy correction was done in each group as per established protocols and the results were compared.
Results: There was a significant difference in the fresh frozen plasma (FFP) transfusion between the groups. The TEG group received more FFP when compared to the RoTEM group ( = 0.001).
Conclusion: RoTEM-based coagulopathy correction leads to lesser use of blood products with similar control of bleeding when compared to TEG, in critically ill patients with cirrhosis.
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http://dx.doi.org/10.4103/ijciis.ijciis_65_23 | DOI Listing |
Medicine (Baltimore)
September 2025
Division of General Internal Medicine, Department of Medicine, University Hospitals, Genève, Switzerland.
Rationale: This case highlights the importance of considering a wide range of possible diagnoses when faced with unexplained hemorrhagic symptoms. When standard investigations fail to identify a clear cause, it is essential to conduct a detailed dietary history. This can lead to the diagnosis of scurvy, a reversible vitamin C deficiency that is often overlooked in populations at risk.
View Article and Find Full Text PDFJ Thromb Haemost
August 2025
Department of Biology, the University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address:
Background: Autosomal recessive mutations in genes encoding vitamin K cycle enzymes cause hereditary vitamin K-dependent clotting factor deficiency (VKCFD), a disorder characterized by excessive bleeding and a spectrum of non-bleeding phenotypes. While high-dose vitamin K therapy can partially or fully correct coagulopathy, impact on non-bleeding symptoms is limited.
Objectives: To investigate the molecular basis underlying the differential response to vitamin K therapy, we characterized novel gamma-glutamyl carboxylase (GGCX) mutations identified in a VKCFD patient.
Medicine (Baltimore)
August 2025
Department of Critical Care Medicine, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China.
Rationale: Symmetrical peripheral gangrene (SPG) is a rare and life-threatening condition characterized by symmetrical distal ischemic damage that can progress to gangrene at 2 or more anatomical sites, without involvement of a large vessel obstruction or vasculitis. We report the case of an older adult female who developed septic shock and disseminated intravascular coagulation (DIC) postoperatively, complicated by the onset of SPG.
Patient Concerns: A 66-year-old female was transferred to the intensive care unit for postoperative management.
Cureus
July 2025
Department of Trauma and Orthopaedics, North Manchester General Hospital, Manchester, GBR.
Intrathecal haematoma is a rare and potentially devastating cause of acute spinal cord compression. In the absence of trauma, anticoagulation, or a known bleeding disorder, diagnosis can be significantly delayed. This report presents an unusual case of an intrathecal haematoma precipitated by exertion in a previously undiagnosed case of von Willebrand disease.
View Article and Find Full Text PDFJ Perinat Med
August 2025
Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia.
Introduction: Amniotic Fluid Embolism (AFE) is a rare but catastrophic obstetric emergency characterized by the sudden entry of amniotic fluid or fetal debris into the maternal circulation. This triggers acute cardiopulmonary collapse, disseminated intravascular coagulation (DIC), and multi-organ failure. Despite its low incidence, AFE remains a significant contributor to maternal mortality worldwide.
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