Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

Abstract

PURPOSE:To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS:Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3:FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7:FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS:Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS:Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.

Porcine liver injury model to assess tantalum-containing bioactive glass powders for hemostasis

“…Hemorrhage may also be complicated with hypothermia, acidosis, and dilutional coagulopathy due to excessive blood loss, reduction in clotting factors, and clotting factor activity; the combination of those conditions is also known as the lethal triad [ 19 – 22 ]. About 25% of severe trauma cases result in coagulopathy increasing mortality rate four times [ 19 – 21 , 23 ]. The liver is the most commonly injured solid organ in the abdominal cavity in both blunt and penetrating traumas [ 17 , 18 , 20 , 24 ].…”