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Correction of hypothermic and dilutional coagulopathy with concentrates of fibrinogen and factor XIII: an in vitro study with ROTEM

Winstedt, Dag LU ; Thomas, Owain LU ; Nilsson, Fredrik; Olanders, Knut LU and Schött, Ulf LU (2014) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 22.
Abstract
Background: Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia. Methods: Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33 degrees C or 37 degrees C with ROTEM... (More)
Background: Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia. Methods: Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33 degrees C or 37 degrees C with ROTEM EXTEM and FIBTEM reagents. Clotting time (CT), clot formation time (CFT), alpha angle (AA) and maximal clot formation (MCF) were recorded. Results: Fibrinogen with or without factor XIII improved all ROTEM parameters in either solution irrespective of temperature, with the exception of EXTEM-AA and EXTEM-CFT in HES haemodilution. Fibrinogen increased FIBTEM-MCF more in the samples diluted with RAc than HES, particularly in presence of factor XIII. Conclusions: Fibrinogen improved in vitro haemodilution-induced coagulopathy at both 33 degrees C and 37 degrees C, though more efficiently after crystalloid than HES haemodilution. Factor XIII had an additional effect on FIBTEM-MCF, but only after crystalloid dilution. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Factor XIII, Fibrinogen, Hemodilution, Hypothermia, Hemostasis, Thrombelastography
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
22
publisher
BioMed Central
external identifiers
  • wos:000346873200001
  • scopus:84989295852
ISSN
1757-7241
DOI
10.1186/s13049-014-0073-z
language
English
LU publication?
yes
id
b422692c-7d5a-4a23-815c-a122a7af8ac7 (old id 4941413)
date added to LUP
2015-02-03 07:09:52
date last changed
2017-09-24 04:08:43
@article{b422692c-7d5a-4a23-815c-a122a7af8ac7,
  abstract     = {Background: Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia. Methods: Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33 degrees C or 37 degrees C with ROTEM EXTEM and FIBTEM reagents. Clotting time (CT), clot formation time (CFT), alpha angle (AA) and maximal clot formation (MCF) were recorded. Results: Fibrinogen with or without factor XIII improved all ROTEM parameters in either solution irrespective of temperature, with the exception of EXTEM-AA and EXTEM-CFT in HES haemodilution. Fibrinogen increased FIBTEM-MCF more in the samples diluted with RAc than HES, particularly in presence of factor XIII. Conclusions: Fibrinogen improved in vitro haemodilution-induced coagulopathy at both 33 degrees C and 37 degrees C, though more efficiently after crystalloid than HES haemodilution. Factor XIII had an additional effect on FIBTEM-MCF, but only after crystalloid dilution.},
  articleno    = {73},
  author       = {Winstedt, Dag and Thomas, Owain and Nilsson, Fredrik and Olanders, Knut and Schött, Ulf},
  issn         = {1757-7241},
  keyword      = {Factor XIII,Fibrinogen,Hemodilution,Hypothermia,Hemostasis,Thrombelastography},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine},
  title        = {Correction of hypothermic and dilutional coagulopathy with concentrates of fibrinogen and factor XIII: an in vitro study with ROTEM},
  url          = {http://dx.doi.org/10.1186/s13049-014-0073-z},
  volume       = {22},
  year         = {2014},
}