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Computational simulation and comparison of prothrombin complex concentrate dosing schemes for warfarin reversal in cardiac surgery

Overview of attention for article published in Journal of Anesthesia, January 2016
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About this Attention Score

  • Above-average Attention Score compared to outputs of the same age (62nd percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)

Mentioned by

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4 tweeters

Citations

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6 Dimensions

Readers on

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11 Mendeley
Title
Computational simulation and comparison of prothrombin complex concentrate dosing schemes for warfarin reversal in cardiac surgery
Published in
Journal of Anesthesia, January 2016
DOI 10.1007/s00540-015-2128-3
Pubmed ID
Authors

Kenichi A. Tanaka, Michael A. Mazzeffi, Erik R. Strauss, Fania Szlam, Nina A. Guzzetta

Abstract

Prothrombin complex concentrate (PCC) is increasingly used for acute warfarin reversal. We hypothesized that computational modeling of thrombin generation (TG) could be used to optimize the timing and dose of PCC during hemodilution induced by cardiopulmonary bypass (CPB). Thrombin generation patterns were modeled in anticoagulated patients (n = 59) using a published computational model. Four dosing schemes were evaluated including single full dose (median, 41.2 IU/kg) of PCC before or after CPB, ½-dose before and after CPB, or 1/3-dose before CPB plus 2/3-dose after CPB. Hemodilution was modeled as 40 or 60 % dilution of factors from baseline. The lag time (s) of TG, and peak thrombin level (nM) were evaluated. Prolonged lag time, and reduced peak TG were due to low vitamin K-dependent (VKD) factors, and pre-CPB PCC dose-dependently restored TG to near-normal or normal range. After 40 % dilution, TG parameters were similar among 4 regimens at the end of therapy. The recovery of VKD factors was less when PCC was given before CPB after 60 % dilution, but TG parameters were considered hemostatically effective (>200 nM) with any regimen. Withholding the full dose of PCC until post-CPB resulted in severely depressed TG peak (median, 47 nM) after 60 % dilution, and some supra-normal TG peaks after treatment. Pre-CPB administration of full or divided doses of PCC prevents extremely low TG peak during surgery, and maintains hemostatic TG peaks in both 40 and 60 % hemodilution models. Although PCC's hemostatic activity appears to be highest using the full dose after CPB, hypercoagulability may develop in some cases.

Twitter Demographics

The data shown below were collected from the profiles of 4 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 11 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 11 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 2 18%
Other 2 18%
Student > Master 1 9%
Lecturer 1 9%
Student > Bachelor 1 9%
Other 4 36%
Readers by discipline Count As %
Medicine and Dentistry 6 55%
Unspecified 3 27%
Sports and Recreations 1 9%
Nursing and Health Professions 1 9%

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 January 2016.
All research outputs
#6,409,262
of 12,221,136 outputs
Outputs from Journal of Anesthesia
#127
of 538 outputs
Outputs of similar age
#125,143
of 341,330 outputs
Outputs of similar age from Journal of Anesthesia
#4
of 27 outputs
Altmetric has tracked 12,221,136 research outputs across all sources so far. This one is in the 47th percentile – i.e., 47% of other outputs scored the same or lower than it.
So far Altmetric has tracked 538 research outputs from this source. They receive a mean Attention Score of 2.1. This one has done well, scoring higher than 75% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 341,330 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 62% of its contemporaries.
We're also able to compare this research output to 27 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 85% of its contemporaries.