Acquired FXIII Deficiency is Associated with High Morbidity

Duque, Patricia; Chasco-Ganuza, Maite; Ortuzar, Ariana; Almaraz, Carolina; Terradillos, E.; Pérez‐Rus, Gloria; Pascual‐Izquierdo, Cristina

doi:10.1055/a-1481-2733

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…In other words, although patients in the FXIII group were initially prone to a much higher risk of death, the outcome of both groups was comparable in the end. This observation is supported by Duque et al who reported on the association between low FXIII activity and long ICU stay as well as high incidences of major bleedings [ 21 ].…”

Section: Discussionsupporting

confidence: 66%

The potential impact of coagulation factor XIII in trauma-induced coagulopathy – a retrospective case series analysis

Wilhelmi

Albrecht

Macke

et al. 2023

Eur J Trauma Emerg Surg

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Background The role of factor XIII (FXIII) in trauma-induced coagulopathy (TIC) is not fully understood. Methods We evaluated FXIII supplementation in severely injured patients with persistent bleeding. This was a retrospective case series analysis. Results Twenty-four patients received FXIII concentrate within 24 h of admission for bleeding that continued after transfusion of > 6 U red blood cells (RBCs); control patients (n = 27) did not receive FXIII concentrate. Both study groups were similar regarding injury severity score and global coagulation tests, but FXIII activity levels were significantly higher and lactate levels significantly lower in the control group, respectively. The differences in FXIII activity between the groups could be attributed to a more severe trauma-induced coagulopathy in FXIII-deficient patients, as demonstrated by lower fibrinogen and higher lactate levels. The median dose of FXIII concentrate within 24 h of admission was 2500 IU (IQR: 1250–4375). Median 24-h transfusion of RBCs (primary study endpoint) was significantly higher in the FXIII group versus controls (10.0 U, IQR 5–14 U vs. 2, IQR 0–6 U; p < 0.01). Subsequently, while patients were in the intensive care unit, there was no statistically significant difference regarding RBC transfusion anymore and the overall clinical outcomes were similar in both patient groups. Conclusions The substitution of FXIII in patients who were more seriously compromised due to higher lactate levels and who presented with initially more severe bleedings than patients in the control group, resulted in a comparable transfusion necessity after 24 h. Thus, we guess that the substitution of FXIII in severely injured patients with ongoing bleeding might have an impact on their clinical outcome.

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Section: Discussionsupporting

confidence: 66%

The potential impact of coagulation factor XIII in trauma-induced coagulopathy – a retrospective case series analysis

Wilhelmi

Albrecht

Macke

et al. 2023

Eur J Trauma Emerg Surg

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“…Thus, early bleeding control is essential for improving outcomes [ 24 ]. Duque et al recently demonstrated that an FXIII level <35% is associated with an increase in major bleeding events as well as prolonged ICU stays [ 25 ]. However, as the FXIII group lost more blood, both prior to and after FXIII administration (compared to non-substituted patients), it is unlikely that FXIII administration affected bleeding control.…”

Section: Discussionmentioning

confidence: 99%

Factor XIII Measurement and Substitution in Trauma Patients after Admission to an Intensive Care Unit

Katzensteiner

Ponschab

Schöchl

et al. 2022

JCM

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Trauma patients admitted to an intensive care unit (ICU) may potentially experience a deficiency of coagulation factor thirteen (FXIII). In this retrospective cohort study conducted at a specialized trauma center, ICU patients were studied to determine the dependency of FXIII activity levels on clinical course and substitution with blood and coagulation products. A total of 189 patients with a median injury severity score (ISS) of 25 (16–36, IQR) were included. Abbreviated injury scores for extremities (r = −0.38, p < 0.0001) but not ISS (r = −0.03, p = 0.45) showed a negative correlation with initial FXIII levels. Patients receiving FXIII concentrate presented with a median initial FXIII level of 54 (48–59)% vs. 88 (74–108)%, p < 0.0001 versus controls; they had fewer ICU-free days: 17 (0–22) vs. 22 (16–24), p = 0.0001; and received higher amounts of red blood cell units: 5 (2–9) vs. 4 (1–7), p < 0.03 before, and 4 (2–7) vs. 1 (0–2), p < 0.0001 after FXIII substitution. Matched-pair analyses based on similar initial FXIII levels did not reveal better outcome endpoints in the FXIII-substituted group. The study showed that a low initial FXIII level correlated with the clinical course in this trauma cohort, but a substitution of FXIII did not improve endpoints within the range of the studied FXIII levels. Future prospective studies should investigate the utility of FXIII measurement and lower threshold values of FXIII, which trigger substitution in trauma patients.

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“…However, defining the target population that might be at risk of acquired FXIII deficiency may be challenging. Based on our retrospective analysis [ 30 ], we have previously hypothesized that this high-risk population could be stratified per patient characteristics (being frail, plenty of co-morbidities, or oncological patients which would be at higher risk) and per procedural kinds (being emergent and/or major procedures that need intensive care unit admission and are linked to increased inflammatory response, the ones of higher risk).…”

Section: Importance Of Fxiii In the Acute Care Settingmentioning

confidence: 99%

“…Third, the level of FXIII activity required achieving effective hemostasis is to be determined, though we have recently reported it might has to be well above 30% in a mixed medical and surgical population [ 30 ], being then higher than in the inherited forms as previously suggested [ 13 ].…”

Section: Importance Of Fxiii In the Acute Care Settingmentioning

confidence: 99%

“…Fourth, given that FXIII measurement is not universally available, one might postulate that FXIII deficiency could be indirectly investigated through fibrinogen measurement as FXIII circulates in a complex with it [ 31 ]. Unfortunately, fibrinogen, which assessment is commonly accessible, is no predictor of FXIII deficiency [ 30 , 32 ]. Viscoelastic assays are also used to optimize clinical management at bedside monitoring.…”

Section: Importance Of Fxiii In the Acute Care Settingmentioning

confidence: 99%

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Factor XIII in the Acute Care Setting and Its Relevance in Obstetric Bleeding

Duque

Korte²

2022

Transfus Med Hemother

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Background: Major hemorrhage is one of the main causes of preventable mortality in either severe trauma, high-risk surgical patient, or the obstetric population. As underlined by the cell-based coagulation model, a resistant and stable clot is essential to prevent or to stop an ongoing bleeding. Coagulation factor XIII (FXIII) stabilizes the newly formed clot by cross-linking the fibrin monomers into a three-dimensional network and by impeding fibrinolysis. Thus, FXIII is an essential coagulation factor in the acutely bleeding patient. Summary: Acquired FXIII deficiency is much more common than the inherited form. On the basis of acute tissue injury which leads to major bleeding, acquired FXIII deficiency is traditionally considered to be secondary to consumption. However, recent evidence in the field of obstetrics and high-risk surgery suggests that it might be an associated factor rather than a consequence of the bleeding, which would mean that early replacement of FXIII could potentially improve outcomes. However, FXIII measurement is not universally available. Assessing FXIII through viscoelastic assays seems feasible, though likely it is not yet accurate. Moreover, the target population at risk and the aimed FXIIIlevel required to achieve hemostasis in each condition are yet to be defined. Key Messages: FXIII should be assessed and replaced if necessary in the acutely bleeding patient. We recommend FXIII to be included in an escalating scheme of hemostatic therapies in the acute care setting.

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Acquired FXIII Deficiency is Associated with High Morbidity

Cited by 6 publications

References 26 publications

The potential impact of coagulation factor XIII in trauma-induced coagulopathy – a retrospective case series analysis

The potential impact of coagulation factor XIII in trauma-induced coagulopathy – a retrospective case series analysis

Factor XIII Measurement and Substitution in Trauma Patients after Admission to an Intensive Care Unit

Factor XIII in the Acute Care Setting and Its Relevance in Obstetric Bleeding

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