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  1. Article ; Online: Thrombocytopenia: the most frequent haemostatic disorder in the ICU.

    Pluta, Jan / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2019  Volume 51, Issue 1, Page(s) 56–63

    Abstract: Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are ...

    Abstract Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are the most frequent. A differential diagnosis of profound thrombocytopenia is crucial for effective treatment. A low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This article aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of the clinical management of this haemostatic disorder.
    MeSH term(s) Algorithms ; Hemostatic Disorders/etiology ; Hemostatic Disorders/therapy ; Humans ; Intensive Care Units ; Thrombocytopenia/etiology ; Thrombocytopenia/therapy
    Language English
    Publishing date 2019-07-06
    Publishing country Poland
    Document type Journal Article ; Review
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5603/AIT.2019.0011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: DIC, SIC or CAC - the haemostatic profile in COVID-19 patients hospitalised in the intensive care unit: a single-centre retrospective analysis.

    Pluta, Jan / Pihowicz, Andrzej / Horban, Andrzej / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2021  Volume 53, Issue 2, Page(s) 108–114

    Abstract: Introduction: Infection with SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome requiring mechanical ventilation under the conditions of the Intensive Care Unit (ICU). The state of hypercoagulation described in COVID-19 may ... ...

    Abstract Introduction: Infection with SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome requiring mechanical ventilation under the conditions of the Intensive Care Unit (ICU). The state of hypercoagulation described in COVID-19 may deepen respiratory failure, leading to increased mortality. The aim of the presented study is to characterise the haemostatic profile based on the results of clotting system parameters and risk assessment of thromboembolic complications of patients hospitalised in the ICU.
    Material and methods: This retrospective study covered the first 10 adult patients hospitalised in the ICU of the Hospital for Infectious Diseases in Warsaw in the second quarter of 2020. Demographic, clinical and laboratory parameters of the coagulation system and the risk of thromboembolic complications were assessed. Well known criteria of haemostatic disorders were used to classify the observed derangements.
    Results: The most frequently observed deviations in the coagulation system were high concentrations of D-dimer and fibrinogen. In select cases the clotting time was prolonged. No severe thrombocytopenia was observed. All patients presented a high risk of thromboembolic complications as assesed by the Padua score. The observed clotting abnormalities did not meet the criteria for DIC (disseminated intravascular coagulation) and SIC (sepsis-induced coagulopathy) diagnosis.
    Conclusions: The main elements of coagulopathy that were observed in our cases differ from those usually seen in patients with recognised sepsis. The unique haemostatic profile of COVID-19 patients treated in the ICU has been described as CAC (COVID-19-associated coagulopathy).
    MeSH term(s) Adult ; Blood Coagulation Tests/methods ; COVID-19/complications ; COVID-19/therapy ; Disseminated Intravascular Coagulation/blood ; Disseminated Intravascular Coagulation/diagnosis ; Disseminated Intravascular Coagulation/etiology ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Inflammation Mediators/blood ; Intensive Care Units ; Male ; Middle Aged ; Poland ; Retrospective Studies ; Sepsis/blood ; Sepsis/diagnosis ; Sepsis/etiology
    Chemical Substances Fibrin Fibrinogen Degradation Products ; Inflammation Mediators ; fibrin fragment D
    Language English
    Publishing date 2021-07-20
    Publishing country Poland
    Document type Journal Article
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5114/ait.2021.106691
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: COVID-19: coagulation disorders and anticoagulant treatment in patients hospitalised in ICU.

    Pluta, Jan / Cieniewicz, Agnieszka / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2021  Volume 53, Issue 2, Page(s) 153–161

    Abstract: Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen ... ...

    Abstract Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen levels, the abnormalities in standard coagulation tests and platelet count are minimal. Recent studies suggest contribution of fibrinolysis shutdown to this phenomenon. Endothelial injury and alteration of its antithrombotic activity can lead to micro- and macrovascular thrombosis in the lungs, occurrence of which is associated with poor clinical outcome in critically ill patients with COVID-19. Additionally, the hypercoagulability induced by activation of coagulation pathways during the immune response to SARS-CoV-2 infection contributes to impaired organ perfusion. This, alongside with hypoxemia, leads to multiorgan failure. Various diagnostic regimens, some of which include global assays of haemostasis, are currently being published and discussed. Numerous guidelines and recommendations of scientific societies and groups of specialists have been published. However, there is no single optimal algorithm for anticoagulation treatment and monitoring specific to the ICU patients with COVID-19. The authors have attempted to summarize the data related to CAC and thrombotic disease and develop an algorithm consistent with the latest clinical practice guideline recommendations.
    MeSH term(s) Algorithms ; Anticoagulants/therapeutic use ; Blood Coagulation/drug effects ; Blood Coagulation Disorders/drug therapy ; Blood Coagulation Disorders/etiology ; COVID-19/complications ; Female ; Humans ; Intensive Care Units ; Male ; Thrombosis/etiology ; Thrombosis/prevention & control ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; COVID-19 Drug Treatment
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2021-05-17
    Publishing country Poland
    Document type Journal Article ; Review
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5114/ait.2021.105783
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Assessment of haemostasis and impact of fibrinogen supplementation on clot properties using global haemostasis assays in patients on chronic dialysis.

    Pluta, Jan / Nicińska, Barbara / Durlik, Magdalena / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2020  Volume 52, Issue 4, Page(s) 274–280

    Abstract: Backgorund: Multifactorial haemostasis disorders are typical of patients with end-stage renal disease (ESRD) on chronic haemodialysis (HD). Thromboelastometry and impedance aggregometry allow for a comprehensive assessment of clot formation, lysis, and ... ...

    Abstract Backgorund: Multifactorial haemostasis disorders are typical of patients with end-stage renal disease (ESRD) on chronic haemodialysis (HD). Thromboelastometry and impedance aggregometry allow for a comprehensive assessment of clot formation, lysis, and platelet (PLT) function. This study aims to determine the haemostatic profile in a group of patients with ESRD on chronic, interrupted dialysis, especially in terms of PLT function and the impact of
    Methods: A total of 22 patients on chronic HD and 22 healthy controls (HC) were enrolled in the prospective study with a control group. Global haemostasis assays (GHA) were used to describe the haemostasis profile and to assess the effect of fibrinogen concentrate supplementation on improving clot quality.
    Results: Despite the lack of considerable differences in the number of PLTs, there was a significantly lower potential of PLT aggregation in the HD group (922 ±163 AU*min). A higher concentration of fibrinogen was also observed in this group which presented considerably higher maximum clot firmness (MCF) FIBTEM (22 ±5.3 mm). Clotting time (CT) EXTEM was also prolonged (72 ±23 s). No hyperfibrinolysis was reported. In vitro fibrinogen concentrate supplementation resulted in significant improvement in MCF FIBTEM (30 mm vs. 22 mm; P < 0.001). However, it also led to a deterioration in PLT aggregation as assessed by TRAPtest.
    Conclusions: The haemostasis profile of ESRD patients demonstrates a limited potential of PLT aggregation, with no improvement after fibrinogen addition.
    MeSH term(s) Adult ; Dietary Supplements ; Female ; Fibrinogen/administration & dosage ; Hemostasis ; Humans ; Kidney Failure, Chronic/blood ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis
    Chemical Substances Fibrinogen (9001-32-5)
    Language English
    Publishing date 2020-11-02
    Publishing country Poland
    Document type Journal Article
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5114/ait.2020.100568
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Response to the article "Perioperative standards for the treatment of coagulation disorders and usage of blood products in patients undergoing liver transplantation used in the Clinic for Transplant Surgery in Wrocław".

    Pluta, Jan / Cieniewicz, Agnieszka / Trzebicki, Janusz

    Advances in clinical and experimental medicine : official organ Wroclaw Medical University

    2019  Volume 28, Issue 3, Page(s) 415–416

    Abstract: We read with interest the article by Łukaszewski et al. published in Advances in Clinical and Experimental Medicine:1211-1215, published online on July 18th, 2018, as ahead of print). As enthusiasts of promoting global assays of hemostasis, we would like ...

    Abstract We read with interest the article by Łukaszewski et al. published in Advances in Clinical and Experimental Medicine:1211-1215, published online on July 18th, 2018, as ahead of print). As enthusiasts of promoting global assays of hemostasis, we would like to commend the authors for their commitment and effort in their implementation and clinical application. As the authors rightly pointed out in the article, perioperative care of liver transplantation (OLTx) patients is challenging for transplant team members due to the risk of severe changes in global hemostasis. Łukaszewski et al. presented a single center experience in using rotational thromboelastometry (ROTEM) to monitor hemostasis during liver transplantation. In our center, this method has been used routinely since 2008. So far it has been used in over 400 patients undergoing OLTx. Considering the potential contribution to thrombotic complications (including portal vein thrombosis after liver transplantation), we believe that antifibrinolytic treatment should be reserved for patients with active bleeding and hyperfibrinolysis confirmed by ROTEM. The available literature indicates an increased risk of thrombotic complications in patients receiving antifibrinolytic therapy. This raises an important question for the authors about the reason for using Exacyl® in all 12 of the cases presented, even in patients who did not require any blood product transfusion. We hope that our letter will open up further discussion on this subject, which is undoubtedly crucial for OLTx patients' safety.
    MeSH term(s) Blood Coagulation Disorders/diagnosis ; Blood Transfusion ; Hemostasis ; Humans ; Liver Transplantation ; Thrombelastography/methods ; Tranexamic Acid
    Chemical Substances Tranexamic Acid (6T84R30KC1)
    Language English
    Publishing date 2019-03-14
    Publishing country Poland
    Document type Letter
    ZDB-ID 2270257-X
    ISSN 1899-5276 ; 1230-025X
    ISSN 1899-5276 ; 1230-025X
    DOI 10.17219/acem/104539
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The assessment of platelet function using multiple electrode aggregometry in practical procedures in anaesthesia.

    Pluta, Jan / Nicińska, Barbara / Ciurzyński, Michał / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2018  Volume 50, Issue 3, Page(s) 210–214

    Abstract: Background: Platelets are responsible for primary haemostasis. Patients with suspected platelet dysfunction require prompt clinical assessment when qualifying for emergency surgical procedures. The purpose of this article is to present our experience in ...

    Abstract Background: Platelets are responsible for primary haemostasis. Patients with suspected platelet dysfunction require prompt clinical assessment when qualifying for emergency surgical procedures. The purpose of this article is to present our experience in platelet function assessment using whole-blood multiple electrode aggregometry (MEA) in various clinical conditions.
    Case reports: Retrospective analysis of three patients with thrombocytopathy associated with normal platelet counts was performed using standard laboratory tests complemented by MEA. In two cases, platelet dysfunction was due to antiplatelet drugs, while in one other case it was caused by chronic kidney disease.
    Conclusions: Anaesthesiologists strive to make the perioperative period as safe as possible. Platelet function assessment should be considered in every patient in whom haemostatic disturbances are suspected. MEA provides support for clinical decision-making, especially in patients who undergo haemodialysis or require antiplatelet therapy, and are in need of emergency surgery.
    MeSH term(s) Adult ; Aged, 80 and over ; Anesthesia ; Electrodes ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; Platelet Aggregation Inhibitors/therapeutic use ; Platelet Function Tests/instrumentation ; Platelet Function Tests/methods ; Retrospective Studies
    Chemical Substances Platelet Aggregation Inhibitors
    Language English
    Publishing date 2018-07-16
    Publishing country Poland
    Document type Case Reports ; Journal Article
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5603/AIT.a2018.0025
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  7. Article ; Online: Multiple electrode aggregometry as a method for platelet function assessment according to the European guidelines.

    Pluta, Jan / Nicińska, Barbara / Trzebicki, Janusz

    Anaesthesiology intensive therapy

    2018  Volume 50, Issue 3, Page(s) 230–233

    Abstract: Platelets play an essential role in haemostasis. Assessment of their function is vital for anaesthesiologists evaluating haemostatic potential, especially during emergency operations. The monitoring of platelets function had been implemented into the ... ...

    Abstract Platelets play an essential role in haemostasis. Assessment of their function is vital for anaesthesiologists evaluating haemostatic potential, especially during emergency operations. The monitoring of platelets function had been implemented into the European recommendations for management of perioperative and posttraumatic bleeding. One of the diagnostic methods described in the recommendations is multiple electrode aggregometry. As antiplatelet therapy becomes more widely used in modern medicine, this method, in contrast to standard laboratory tests, can significantly help to identify patients with drug-induced thrombocytopaty. The aggregometry enables prompt evaluation of the platelets aggregation which is very useful for everyday decision-making in goal-directed hemostatic therapy.
    MeSH term(s) Electrodes ; Europe ; Humans ; Platelet Aggregation ; Platelet Function Tests/instrumentation ; Platelet Function Tests/methods ; Point-of-Care Systems ; Practice Guidelines as Topic
    Language English
    Publishing date 2018-07-12
    Publishing country Poland
    Document type Journal Article
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5603/AIT.a2018.0024
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Fascia Iliaca Block in Hip and Femur Fractures to Reduce Opioid Use.

    Jain, Nirpeksh / Kotulski, Charles / Al-Hilli, Ali / Yeung-Lai-Wah, Paul / Pluta, Joanna / Heegeman, David

    The Journal of emergency medicine

    2022  Volume 63, Issue 1, Page(s) 1–9

    Abstract: Background: Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures.: Objectives: To demonstrate that administering FICB preoperatively to patients with hip or ...

    Abstract Background: Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures.
    Objectives: To demonstrate that administering FICB preoperatively to patients with hip or proximal femur fractures in the emergency department (ED) is likely to reduce opioid use and related complications, and to decrease hospital length of stay (LOS).
    Methods: An unblinded study of adult patients with hip and proximal femur fractures who consented to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the ED. We compared this group with a contemporaneous group of controls who only received systemic opioids. Over the course of approximately 6 months, main outcome measured between the two groups was amount of morphine equivalents given from block administration until 8 h after. We also compared complications such as delirium, constipation, and bleeding rates (oozing from injection site or hematoma formation).
    Results: A total of 166 patients with hip and proximal femur fractures from August 12, 2018 to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with no significant difference in LOS. A statistically significant difference in opioid-related adverse outcomes was found between the anticoagulated group vs. the no anticoagulation group.
    Conclusions: FICB is a safe and effective preoperative technique for initial pain management in patients with hip and proximal femur fractures, as it can also be used with additional systemic opioids. FICB administration may reduce systemic opioid use preoperatively, thus reducing opioid-related adverse effects with no significant impact on hospital LOS.
    MeSH term(s) Adult ; Analgesics, Opioid/adverse effects ; Bupivacaine/pharmacology ; Bupivacaine/therapeutic use ; Epinephrine/pharmacology ; Epinephrine/therapeutic use ; Fascia ; Femoral Fractures/complications ; Femoral Fractures/drug therapy ; Femoral Fractures/surgery ; Femur ; Humans ; Morphine/adverse effects ; Nerve Block/methods ; Opioid-Related Disorders/drug therapy
    Chemical Substances Analgesics, Opioid ; Morphine (76I7G6D29C) ; Bupivacaine (Y8335394RO) ; Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2022-08-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2022.04.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Tuning the cocrystal yield in matrix-assisted cocrystallisation via hot melt extrusion: A case of theophylline-nicotinamide cocrystal.

    Gajda, Maciej / Nartowski, Karol P / Pluta, Janusz / Karolewicz, Bożena

    International journal of pharmaceutics

    2019  Volume 569, Page(s) 118579

    Abstract: Polymer-assisted cocrystallisation via hot melt extrusion (HME) facilitates the cocrystallisation process and increases cocrystal yield compared with the HME of neat cocrystal components. This makes it an attractive method for the single-step continuous ... ...

    Abstract Polymer-assisted cocrystallisation via hot melt extrusion (HME) facilitates the cocrystallisation process and increases cocrystal yield compared with the HME of neat cocrystal components. This makes it an attractive method for the single-step continuous synthesis of pharmaceutical cocrystals. The aim of this study is to understand the effect of semicrystalline (Poloxamer P407, PXM) or amorphous (Soluplus®, SOL) polymers on the cocrystallisation of model theophylline-nicotinamide (TP:NA, 1:1) cocrystal with significantly different melting temperatures of API (TP, m.p. = 271.4 °C) and coformer (NA, m.p. = 128.7 °C) in neat and matrix-assisted cocrystallisation via HME. Compared with the processing of neat cocrystal components, the addition of PXM led to formulation of TP:NA cocrystal embedded in the polymer matrix and increased the cocrystal formation efficiency. On the other hand, the co-processing of cocrystal components with SOL resulted in the formation of cocrystal embedded in the amorphous polymer matrix or in the partially amorphous TP:NA/SOL composites. The one-step formulation of API:coformer mixtures with polymers using HME may result in phase changes or the formation of amorphous solid dispersions, which highlights the importance of matrix selection and phase control of the final product.
    MeSH term(s) Crystallization ; Hot Melt Extrusion Technology ; Hot Temperature ; Niacinamide/chemistry ; Poloxamer/chemistry ; Polyethylene Glycols/chemistry ; Polyvinyls/chemistry ; Theophylline/chemistry
    Chemical Substances Polyvinyls ; polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol graft copolymer ; Poloxamer (106392-12-5) ; Niacinamide (25X51I8RD4) ; Polyethylene Glycols (3WJQ0SDW1A) ; Theophylline (C137DTR5RG)
    Language English
    Publishing date 2019-07-27
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 428962-6
    ISSN 1873-3476 ; 0378-5173
    ISSN (online) 1873-3476
    ISSN 0378-5173
    DOI 10.1016/j.ijpharm.2019.118579
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  10. Article ; Online: Continuous, one-step synthesis of pharmaceutical cocrystals via hot melt extrusion from neat to matrix-assisted processing - State of the art.

    Gajda, Maciej / Nartowski, Karol P / Pluta, Janusz / Karolewicz, Bożena

    International journal of pharmaceutics

    2019  Volume 558, Page(s) 426–440

    Abstract: Use of hot melt extrusion (HME) as continuous manufacturing process in the cocrystal synthesis is of increasing interest from both industrial and academic perspective and it is seen as a newly developing branch of mechanochemistry with possible broad ... ...

    Abstract Use of hot melt extrusion (HME) as continuous manufacturing process in the cocrystal synthesis is of increasing interest from both industrial and academic perspective and it is seen as a newly developing branch of mechanochemistry with possible broad application in single step synthesis and formulation of pharmaceutical cocrystals. Furthermore, one-step formulation of pharmaceutical products results in combined processing of pharmaceutical cocrystal mixtures with polymers using HME, which may result in phase change or formation of amorphous solid dispersions during the material processing. The manuscript aims at providing selection guidelines and understanding of processing parameters and instrumental setup of importance to design the HME process for cocrystal synthesis. Furthermore, importance of stoichiometry control of the final product and the matrix selection criteria in simultaneous synthesis and formulation of pharmaceutical cocrystals via HME are provided. The first part of this review, introduce mechanochemical methods of cocrystals synthesis along brief explanation of the possible molecular mechanisms of cocrystal synthesis via mechanochemical approach. Subsequently, the critical process parameters i.e. temperature, screw speed, screw configuration or material feed rate of importance in successful synthesis of high quality product are described followed by literature examples of the processing of neat cocrystal compounds or matrix assisted cocrystallisation.
    MeSH term(s) Crystallization ; Drug Compounding/methods ; Hot Temperature ; Pharmaceutical Preparations/chemistry
    Chemical Substances Pharmaceutical Preparations
    Language English
    Publishing date 2019-01-18
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 428962-6
    ISSN 1873-3476 ; 0378-5173
    ISSN (online) 1873-3476
    ISSN 0378-5173
    DOI 10.1016/j.ijpharm.2019.01.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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