Fibrinogen estimates are influenced by methods of measurement and hemodilution with colloid plasma expanders

Fenger-Eriksen, Christian; Moore, Gary; Rangarajan, Savita; Ingerslev, Jørgen; Sørensen, Benny

doi:10.1111/j.1537-2995.2010.02752.x

Cited by 117 publications

(72 citation statements)

References 22 publications

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“…In addition, standard nephelometric and Clauss-method measurement platforms are less sensitive to HES-induced coagulation defects, whereas TEM is able to detect this specific disturbance [30]. For example, in a study by Urwyler and colleagues [31], specimens drawn from patients during major surgery were tested in parallel using standard Clauss methodology and TEM.…”

Section: Discussionmentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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The use of prothrombin complex concentrates (PCCs) and fibrinogen concentrates (FIBCs) to achieve hemostasis in the perioperative setting as alternatives to allogeneic blood products remains controversial. To examine the efficacy and safety of PCCs and FIBCs, we conducted a systematic review-in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement-to compare the use of these transfusion alternatives in bleeding surgical patients. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Five randomized trials and 15 nonrandomized studies with a comparator group were included in the final review. Studies were sorted into 1 of the following 3 clinical settings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation. Risk of bias was assessed using the Cochrane risk of bias tool. With the exception of 2 randomized controlled trials, the existing body of literature on the use of PCCs and FIBCs in the perioperative setting was assessed to have a high degree of methodological bias. Overall, prospective studies in the cardiac surgery grouping suggested that patients receiving FIBC and/or PCCs required less allogeneic blood transfusion and had less chest tube drainage. In studies of warfarin reversal, PCCs more rapidly corrected the International Normalized Ratio compared to plasma; however, in the setting of intracranial hemorrhage, functional outcomes were poor regardless of the reversal strategy. With regards to safety outcomes, reporting was not uniform and raises concerns of underreporting. Adequately powered, methodologically sound trials would be required for more definitive conclusions to be drawn about the efficacy of PCCs and FIBC over conventional blood components for the treatment of perioperative coagulopathy in bleeding patients.

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Section: Discussionmentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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“…28 32 Recently published data suggest that the mechanical detection principle of fibrinogen testing is more reliable than photometric techniques. 33 Overall, there was a clear advantage for ROTEM w compared with standard coagulation tests in their shorter turnaround times, which will have an impact on timely and more targeted coagulation therapy. 19 24 28 34 35 Although point-of-care testing devices for the measurement of PT and aPTT might improve the time delay of standard laboratory testing, the other limitations of standard testing in the perioperative setting were still valid.…”

Section: R=0882mentioning

confidence: 99%

Comparison of Thromboelastometry (ROTEM®) With Standard Plasmatic Coagulation Testing in Paediatric Surgery

Haas¹,

Spielmann²,

Mauch³

et al. 2012

Survey of Anesthesiology

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Background. Thromboelastometry (ROTEM(R)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests. Methods. Intraoperative blood sampling was obtained in children undergoing elective major surgery. At each time point, standard coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen level] and ROTEM(R) analyses (InTEM, ExTEM, and FibTEM) were performed simultaneously by trained hospital laboratory staff. Results. A total of 288 blood samples from 50 subjects were analysed. While there was a poor correlation between PT and aPTT to ExTEM clotting time (CT) and InTEM CT, respectively, a good correlation was detected between PT and aPTT to clot formation time, and a very good correlation between fibrinogen level and FibTEM assay (r=0.882, P<0.001). Notably, 64% of PT and 94% of aPTT measurements were outside the reference range, while impaired CT was observed in 13% and 6.3%, respectively. Standard coagulation test results were available after a median of 53 min [inter-quartile range (IQR): 45-63 min], whereas 10 min values of ROTEM(R) results were available online after 23 min (IQR: 21-24 min). Conclusions. PT and aPTT cannot be interchangeably used with ROTEM(R) CT. Based on the results of ROTEM(R), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(R) offered faster turnaround times.

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“…Another meaningful limitation is that measurement of fibrinogen levels using the photometric Clauss assay can be considerably altered after massive fluid resuscitation and that colloids may induce erroneously increased levels of fibrinogen [16,17].…”

Section: Diagnosis Of Dilutional Coagulopathymentioning

confidence: 99%

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Haas¹,

Mauch²,

Weiß³

et al. 2012

Transfus Med Hemother

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Perioperative dilutional coagulopathy is a major coagulation disorder during adult and pediatric surgery. Although the main underlying mechanisms are comparable, data of the development and management of dilutional coagulopathy in children are scarce. Observational data showed that intraoperative coagulation disorders mainly based on complex disturbances of clot firmness including acquired fibrinogen as well as factor XIII deficiencies, while clotting time and platelet counts remained fairly stable. A fast and reliable monitoring of the entire coagulation process (e.g. thrombelastometry) might be of extreme value for detection and guidance of effective coagulation management. Although the transfusion of fresh frozen plasma was recommended in several guidelines, the use of coagulation factors might offer an alternative and potentially superior approach in managing perioperative coagulation disorders. Further studies are urgently needed to determine the efficacy of modern coagulation management.

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Fibrinogen estimates are influenced by methods of measurement and hemodilution with colloid plasma expanders

Abstract: This study demonstrated that different automated coagulation analyzers revealed significantly different levels of fibrinogen. The presence of colloid plasma expander gave rise to erroneous high levels of fibrinogen returned from some coagulation analyzers employing the method of Clauss.

Cited by 117 publications

References 22 publications

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Comparison of Thromboelastometry (ROTEM®) With Standard Plasmatic Coagulation Testing in Paediatric Surgery

Management of Dilutional Coagulopathy during Pediatric Major Surgery

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