Clinical influence of preoperative factor XIII activity in patients undergoing pancreatoduodenectomy

Watanabe, Nozomi; Yokoyama, Yukihiro; Sugawara, Gen; Igami, Tsuyoshi; Mizuno, Takashi; Yamaguchi, Junpei; Nagino, Masato

doi:10.1016/j.hpb.2017.07.002

Cited by 8 publications

(11 citation statements)

References 31 publications

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“…FXIII activity at our hospital is routinely measured in patients who experience bleeding despite a normal conventional coagulation test. Patients with an FXIII level <70% (considered to indicate FXIII deficiency 8,10 ) were eligible for inclusion in the study. Patients with a known congenital bleeding disorder were excluded.…”

Section: Methods Patientsmentioning

confidence: 99%

“…3 Bleeding also occurs in the setting of acquired FXIII deficiency, which is caused by autoimmune conditions or FXIII hyperconsumption or hyposynthesis. 4,5 FXIII deficiency has been described after neurosurgery, heart surgery, abdominal oncology surgery, and orthopedic surgery [6][7][8][9][10] , but it has not consistently been linked to an increased risk of postoperative bleeding. 11,12 An FXIII level <70% is considered to indicate deficiency.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 An FXIII level <70% is considered to indicate deficiency. 8,10 However, the level of FXIII required to achieve effective hemostasis in the setting of acquired FXIII deficiency remains to be determined and the literature on this topic is surprisingly scarce. We hypothesize that it will be higher than in the inherited forms.…”

Section: Introductionmentioning

confidence: 99%

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Acquired FXIII Deficiency is Associated with High Morbidity

et al. 2021

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Background: A factor XIII (FXIII) level >30% is considered necessary to prevent spontaneous bleeding. Bleeding is also a risk in patients with acquired FXIII deficiency, but the hemostatic level of FXIII in this context remains to be determined. Material & Methods: We retrospectively analyzed all patients diagnosed with acquired FXIII deficiency at a large hospital over 3 years (study ID NCT04416594, http://www.clinicaltrials.gov) and assessed clinical data to identify the best cut-off point for FXIII activity to distinguish between low and high risk of major bleeding in a mixed medical and surgical population. Results: Of the 97 patients who experienced bleeding despite a normal coagulation test, 43.2% had FXIII activity <70%. FXIII activity was significantly lower in surgical patients and patients admitted to the intensive care unit (ICU). Low FXIII activity was significantly associated with long ICU stays and a high incidence of major bleeding. Conclusions: Acquired FXIII deficiency is associated with high morbidity. The hemostatic level of FXIII in the setting of acquired FXIII deficiency might be above 30%.

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Section: Methods Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acquired FXIII Deficiency is Associated with High Morbidity

et al. 2021

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“…Therefore, clinical manifestations are unreliable indicators of pneumothorax size (44). Additionally, plasma factor XIII has been reported to be a fistula-healing factor and intraoperative bleeding (29,30,45,46). In lung disease, there are some reports related to therapeutic effect of pneumothorax and prolonged air leak after pulmonary lobectomy (47,48).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and failure factors of manual aspiration using a small needle for large pneumothorax in stable patients

Homma¹,

Ojima²,

Shimada³

et al. 2022

J Thorac Dis

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Background: Manual aspiration as the initial management of a large pneumothorax in a clinically stable patient has been reported to be safe and effective. However, the effect with smaller needles, the number of aspiration, the indication other than spontaneous pneumothorax and failure factors are unknown. We assessed the effectiveness and failure risk factors of manual aspiration up to three using a 20-or 22-gauge (G) needle in patients with a large, clinically stable pneumothorax.Methods: We included 107 clinically stable patients with large pneumothorax. Patients who were unstable, required a ventilator, underwent chest tube drainage or had an observed small pneumothorax, bilateral pneumothorax, hemopneumothorax, or postoperative pneumothorax were excluded. Up to three aspirations were performed using 20-or 22-G intravenous needles. When the aspiration volume was ≥2,500 mL or lung expansion did not occur, a chest tube was placed. Results:The first aspiration was successful in 57 patients (53.3%), the second in 16 patients (59.3%), and the third in eight patients (80.0%). No patient experienced any obvious complications or required emergent hospitalization or surgery after aspiration. Aspiration failure was correlated with an inter-pleural distance >20 mm at the level of the hilum (odds ratio: 4.93; 95% confidence interval: 1.49-22.71; P=0.0075), spontaneous secondary pneumothorax (odds ratio: 3.11; 95% confidence interval: 1.14-8.76; P=0.027), and ≤24 h from onset to presentation (odds ratio: 2.95; 95% confidence interval: 1.12-8.26; P=0.028). There were no significant differences in intrathoracic pressure after aspiration or plasma factor XIII levels between patients with resolved and persistent pneumothorax.Conclusions: Manual aspiration up to three times using a small needle might be one of a treatment option in clinically stable patients with any large pneumothorax. Aspiration failure was correlated with an inter-pleural distance >20 mm at the level of the hilum, spontaneous secondary pneumothorax, and ≤24 h from onset to presentation.

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“…An association between lower FXIII levels and peri-operative blood loss has been reported [16,48,49]. FXIII deficiency is associated with post-operative haemorrhagic events and requirement for post-operative transfusion [21,35,50].…”

Section: Surgerymentioning

confidence: 98%

The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing

et al. 2022

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Factor XIII (FXIII) is a protein involved in blood clot stabilisation which also plays an important role in processes including trauma, wound healing, tissue repair, pregnancy, and even bone metabolism. Following surgery, low FXIII levels have been observed in patients with peri-operative blood loss and FXIII administration in those patients was associated with reduced blood transfusions. Furthermore, in patients with low FXIII levels, FXIII supplementation reduced the incidence of post-operative complications including disturbed wound healing. Increasing awareness of potentially low FXIII levels in specific patient populations could help identify patients with acquired FXIII deficiency; although opinions and protocols vary, a cut-off for FXIII activity of ~ 60–70% may be appropriate to diagnose acquired FXIII deficiency and guide supplementation. This narrative review discusses altered FXIII levels in trauma, surgery and wound healing, diagnostic approaches to detect FXIII deficiency and clinical guidance for the treatment of acquired FXIII deficiency.

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Clinical influence of preoperative factor XIII activity in patients undergoing pancreatoduodenectomy

Abstract: Unexpectedly high proportions of patients undergoing pancreatoduodenectomy had low preoperative FXIII activities. Preoperative FXIII deficiency may increase intraoperative bleeding but had no influence on the postoperative outcomes.

Cited by 8 publications

References 31 publications

Acquired FXIII Deficiency is Associated with High Morbidity

Acquired FXIII Deficiency is Associated with High Morbidity

Effectiveness and failure factors of manual aspiration using a small needle for large pneumothorax in stable patients

The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing

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