Expressiveness of global coagulation parameters in dilutional coagulopathy

Weiß, G.; Lison, Susanne; Spannagl, Michael; Heindl, B.

doi:10.1093/bja/aeq199

Cited by 52 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, the relationship between coagulation factor levels and CT/PT values is not linear: in hemodilution, the concentration of coagulation factors needs to drop to Ͻ 40% before prolongation of CT or PT is observed. 40,41 On the other hand, there is a linear relationship between thrombin generation and levels of coagulation factors, making this assay more sensitive to changes in these proteins. Third, neither EXTEM CT nor PT is influenced by antithrombin, whereas thrombin generation is strongly influenced by antithrombin.…”

Section: Discussionmentioning

confidence: 99%

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

Grottke¹,

Braunschweig

Spronk

et al. 2011

Blood

121

View full text Add to dashboard Cite

Despite increasing use of prothrombin complex concentrate (PCC) to treat hemorrhage-associated coagulopathy, few studies have investigated PCC in trauma, and there is a particular lack of safety data. This study was performed to evaluate PCC therapy in a porcine model of coagulopathy with blunt liver injury. Coagulopathy was induced in 27 anesthetized pigs by replacing approximately 70% blood volume with hydroxyethyl starch 130/0.4 and Ringer's lactate solution; erythrocytes were collected and retransfused. Ten minutes after trauma, animals randomly received PCC (35 or 50 IU/kg) or saline. Coagulation parameters including thromboelastometry, thrombin generation, and blood loss were monitored for 2 hours. Internal organs were examined macroscopically and histologically to determine the presence of emboli and assess liver injury. Total blood loss was significantly lower and survival was higher in both PCC groups versus the control group (P < .05). These outcomes appeared to be dose-independent. Thromboembolism was found in all animals treated with 50 IU/kg PCC; 44% also showed signs of disseminated intravascular coagulation. Liver injury was similar in all animals. In conclusion, 35 IU/kg PCC safely improved coagulation and attenuated blood loss. However, the higher dose of PCC (50 IU/kg) appeared to increase the risk of thromboembolism and disseminated intravascular coagulation. (Blood. 2011;118(7): [1943][1944][1945][1946][1947][1948][1949][1950][1951]

show abstract

Section: Discussionmentioning

confidence: 99%

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

Grottke¹,

Braunschweig

Spronk

et al. 2011

Blood

121

View full text Add to dashboard Cite

show abstract

“…Prolongation of the CT (> 82 seconds) on the EXTEM is related to functionally low levels of factors II, VII, and X, which were treated with FFP. 24 Low A10, A20, and MCF on the EXTEM are indicative of poor clot strength. This is related to either a platelet abnormality or a low fibrinogen level.…”

Section: Transfusion Algorithmsmentioning

confidence: 99%

“…Hemoglobin level, PT, PTT, and platelet counts on admission to the inpatient floor after surgery did not differ significantly between the patients in the ROTEM and Conventional groups. Among TXA-treated patients, there was a trend toward slightly more pRBC and FFP use within the first 24 The most common causes of death associated with an allogeneic transfusion are transfusion-related acute lung injury, followed by hemolytic transfusion reactions. The risk of transfusion-related acute lung injury is estimated to be between 0.08% and 15% following a transfusion.…”

mentioning

confidence: 99%

Rotational thromboelastometry–guided blood product management in major spine surgery

Naik¹,

Pajewski²,

Bogdonoff³

et al. 2015

SPI

View full text Add to dashboard Cite

OBJECT Major spinal surgery in adult patients is often associated with significant intraoperative blood loss. Rotational thromboelastometry (ROTEM) is a functional viscoelastometric method for real-time hemostasis testing. In this study, the authors sought to characterize the coagulation abnormalities encountered in spine surgery and determine whether a ROTEM-guided, protocol-based approach to transfusion reduced blood loss and blood product use and cost. METHODS A hospital database was used to identify patients who had undergone adult deformity correction spine surgery with ROTEM-guided therapy. All patients who received ROTEM-guided therapy (ROTEM group) were matched with historical cohorts whose coagulation status had not been evaluated with ROTEM but who were treated using a conventional clinical and point-of-care laboratory approach to transfusion (Conventional group). Both groups were subdivided into 2 groups based on whether they had received intraoperative tranexamic acid (TXA), the only coagulation-modifying medication administered intraoperatively during the study period. In the ROTEM group, 26 patients received TXA (ROTEM-TXA group) and 24 did not (ROTEM-nonTXA group). Demographic, surgical, laboratory, and perioperative transfusion data were recorded. Data were analyzed by rank permutation test, adapted for the 1:2 ROTEM-to-Conventional matching structure, with p < 0.05 considered significant. RESULTS Comparison of the 2 groups in which TXA was used showed significantly less fresh-frozen plasma (FFP) use in the ROTEM-TXA group than in the Conventional-TXA group (median 0 units [range 0–4 units] vs 2.5 units [range 0–13 units], p < 0.0002) but significantly more cryoprecipitate use (median 1 unit [range 0–4 units] in the ROTEM-TXA group vs 0 units [range 0–2 units] in the Conventional-TXA group, p < 0.05), with a nonsignificant reduction in blood loss (median 2.6 L [range 0.9–5.4 L] in the ROTEM-TXA group vs 2.9 L [0.7–7.0 L] in the Conventional-TXA group, p = 0.21). In the 2 groups in which TXA was not used, the ROTEM-nonTXA group showed significantly less blood loss than the Conventional-nonTXA group (median 1 L [range 0.2–6.0 L] vs 1.5 L [range 1.0–4.5 L], p = 0.0005), with a trend toward less transfusion of packed red blood cells (pRBC) (median 0 units [range 0–4 units] vs 1 unit [range 0–9 units], p = 0.09]. Cryoprecipitate use was increased and FFP use decreased in response to ROTEM analysis identifying hypofibrinogenemia as a major contributor to ongoing coagulopathy. CONCLUSIONS In major spine surgery, ROTEM-guided transfusion allows for standardization of transfusion practices and early identification and treatment of hypofibrinogenemia. Hypofibrinogenemia is an important cause of the coagulopathy encountered during these procedures and aggressive management of this complication is associated with less intraoperative blood loss, reduced transfusion requirements, and decreased transfusion-related cost.

show abstract

“…We decided to induce dilutiondependent impairment of the clotting process with 60% dilution to observe the clinically relevant reduction of clot firmness and prolonged initiation of coagulation that are to be expected during profound dilution only. 16 In addition, especially when hemostatic competence is severely compromised, such as in trauma patients, effective substitution is mandatory to reduce additional blood loss. Our model was adapted from Bolliger et al 11,12 Our dilutions correspond to approximately 25 ml/kg plasma (FLyP or FFP) in a patient of 70 kg body weight.…”

Section: Thromboelastographymentioning

confidence: 99%

In Vitro Hemostatic Properties of French Lyophilized Plasma

Martinaud¹,

Civadier

Ausset³

et al. 2012

Anesthesiology

View full text Add to dashboard Cite

Background: French lyophilized plasma (FLyP) is used routinely by the French Armed Forces in war settings. The authors compared concentrations of coagulation proteins and global in vitro hemostatic properties in FLyP and in the same plasma before lyophilization to assess the impact of lyophilization on coagulation properties. Methods: Twenty-four batches of plasma before and after lyophilization were tested for coagulation proteins. Thrombin generation time, thrombin antithrombin concentration, prothrombin fragment 1 ϩ 2, and thromboelastography were assessed. Finally, the efficiencies of FLyP and plasma before lyophilization were compared on a hemorrhagic shock hemodilution model and tested on TEG

show abstract

Expressiveness of global coagulation parameters in dilutional coagulopathy

Abstract: PTI and MCF are useful for monitoring dilution and intervention points. aPTT and CT reflect intervention points when showing pathological values. The type of diluents does not seem to interfere with PTI and aPTT, but HAES impairs haemostasis in ROTEM(®) more profoundly than saline.

Cited by 52 publications

References 32 publications

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

Rotational thromboelastometry–guided blood product management in major spine surgery

In Vitro Hemostatic Properties of French Lyophilized Plasma

Contact Info

Product

Resources

About