Assessing Platelet and Fibrinogen Contribution to Clot Strength Using Modified Thromboelastography in Pregnant Women

Gottumukkala, Vijaya; Sharma, Shiv K.; Philip, John

doi:10.1213/00000539-199912000-00024

Cited by 78 publications

(31 citation statements)

References 10 publications

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“…When platelet function was blocked in blood samples taken from pregnant women, clot strength was found to increase linearly with the increase of fibrinogen (13). However, at certain levels of fibrinogen, no correlation was found between platelet counts and platelet contribution to clot strength (13).…”

Section: Discussionmentioning

confidence: 91%

“…In obstetric patients, fibrinogen concentration usually increases by 50% to 250% (13). This elevation is believed to be beneficial in limiting blood loss during delivery, because failure to increase fibrinogen concentration is associated with severe bleeding (20).…”

Section: Discussionmentioning

confidence: 99%

“…These data suggest the potential compensatory role of fibrinogen in restoring coagulation function in vivo after hemorrhagic shock. ments of coagulation function owing to their being able to track clot initiation, clot growth, platelet activation and fibrinolysis in whole blood (11)(12)(13). The importance of thrombelastography measurements in treating trauma patients has been described by Plotkin et al (14).…”

Section: Introductionmentioning

confidence: 99%

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Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Martini

2011

Mol Med

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Martini

2011

Mol Med

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“…A typical ROTEM tracing and its interpretation is shown in figure 2. Normal values of measurements (obtained from healthy volunteers) are listed in Further specifications can be made by adding platelet antagonists such as abciximax (ReoPRO  , Pentapharm) or cytochalasin (FIBTEM  , Pentapharm) to the blood sample, which neutralize platelet effects, thus clot strength depends on fibrinogen concentrations only [32]. The addition of heparinase (HEPTEM  , Pentapharm) permits detection of the effects of heparin and heparinoids as the cause of hypocoagulability [33].…”

Section: Rotem Measurement Techniquementioning

confidence: 99%

Monitoring of Perioperative Dilutional Coagulopathy Using the ROTEM® Analyzer: Basic Principles and Clinical Examples

Innerhofer¹,

Streif²,

Kühbacher³

et al. 2004

Transfus Med Hemother

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Recent changes in quality of transfusion supply, transfusion triggers as well as fluid therapy promote the development of dilutional coagulopathy. Nevertheless, up to now guidelines generally assume presence of hypocoagulability when more than one individual circulating blood volume is lost. This might be true for some patients under some conditions but is not necessarily true for every patient. Routine coagulation tests are insufficient in predicting increased bleeding and, moreover, only available after an unacceptable time delay. Therefore, the occurrence of diffuse microvascular bleeding is often used as clinical sign to start hemostatic therapy. However, such severe derangement of hemostasis might lead to the development of secondary tissue damage and frequently is unresponsive to conventional treatment. Coagulopathy occurring during extensive surgery or after polytrauma can be detected and treated early when using the ROTEM monitoring. Recent data showing a direct beneficial effect of hemostatic therapy on blood loss and final outcome are scarce. However, evidence exists that the amount of blood loss, the presence of coagulopathy, and the number of transfusions needed are associated with poor outcome in bleeding patients. Although manifold articles have been published already using thrombelastography for various indications (MEDLINE research ‘thrombelastography’, 2,022 articles), further data are needed to confirm the clinical experience that this technique is an excellent tool for safe patient management.

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“…Colloids cause plasma to turn cloudy, which in turn results in an erroneous shortening of the measured coagulation times as well as falsely high values when determining the fibrinogen concentration after Klaus [25]. In this respect functional fibrinogen measurement by thrombelastography, as already mentioned, might be advantageous [26].…”

Section: Dilutional Coagulopathy: Thrombelastography Vs Standard Coamentioning

confidence: 99%

Dilutional Coagulopathy, an Underestimated Problem?

Fries¹,

Streif²,

Haas³

et al. 2004

Transfus Med Hemother

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When no fresh frozen plasma is available, acute major blood loss is compensated above all with crystalloids, colloids, and erythrocyte concentrates, meaning that all plasma clotting factors are diluted. Consumption coagulopathy is almost always accompanied by dilutional coagulopathy. Formulas for calculating critical blood loss and standard coagulation tests are often not helpful in the case of massive transfusion. On the other hand, systems suitable for point of care, such as thrombelastography, have important advantages. In the case of consumption and dilutional coagulopathy plasma coagulation is disturbed, and critical values are first seen for fibrinogen. Fibrin polymerization is not only impaired by the bleeding-induced loss and dilution of fibrinogen but also by interaction with artificial colloids, particularly hydroxyethyl starch preparations. Therapy of consumption and dilutional coagulopathy calls for fresh frozen plasma. If this is not available in sufficient quantity or within a reasonable time, coagulation factor concentrates must be used. Neither fresh frozen plasma therapy nor treatment with coagulation factor concentrates has been the subject of detailed clinical study. Further studies are needed to work out guidelines for coagulation management in the case of massive blood loss.

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Assessing Platelet and Fibrinogen Contribution to Clot Strength Using Modified Thromboelastography in Pregnant Women

Cited by 78 publications

References 10 publications

Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

Monitoring of Perioperative Dilutional Coagulopathy Using the ROTEM® Analyzer: Basic Principles and Clinical Examples

Dilutional Coagulopathy, an Underestimated Problem?

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