Moderate plasma dilution using artificial plasma expanders shifts the haemostatic balance to hypercoagulation

Abstract

Artificial plasma expanders (PEs) are widely used in modern transfusion medicine. PEs do not contain components of the coagulation system, so their infusion in large volumes causes haemodilution and affects haemostasis. However, the existing information on this effect is contradictory. We studied the effect of the very process of plasma dilution on coagulation and tested the hypothesis that moderate dilution with a PE should accelerate clotting owing to a decrease in concentration of coagulation inhibitors. The standard clotting times, a thrombin generation test, and the spatial rate of clot growth (test of thrombodynamics) were used to assess donor plasma diluted in vitro with various PEs. The pH value and Ca+2 concentration were maintained strictly constant in all samples. The effect of thrombin inhibitors on dilution-induced hypercoagulation was also examined. It was shown that coagulation was enhanced in plasma diluted up to 2.0–2.5-fold with any PE. This enhancement was due to the dilution of coagulation inhibitors in plasma. Their addition to plasma or PE could partially prevent the hypercoagulation shift.

The specifics of clotting and endogenic fibrinolysis in acute coronary syndrome patients

“…Так как измерение отдельных факторов эндогенного фибринолиза имеет много неоднозначных [8,9]. Нами были получены данные, что процесс тромбообразования, так же, как и процесс лизиса тромба активнее протекает у пациентов с ОКС по сравнению со здоровыми добровольцами.…”

In Silico Hemostasis Modeling and Prediction

“…70 They found that dilution progressively reduced the peak of thrombin generation; interestingly, in an experimental report, moderate hemodilution increased thrombin generation. 91 In these simulations hypothermia delayed the onset of thrombin generation and increased thrombin generation (both endogenous thrombin potential and thrombin peak). Another group used the legacy model to describe how changes in blood coagulation factor balance in human immunodeficiency virus patients shift the hemostasis to hypercoagulation, 92 or in patients with hemophilia C, 93 hemophilia A, 94 or deep vein thrombosis, 95 and what is the variation of thrombin generation in healthy individuals.…”

Patho- physiological role of BDNF in fibrin clotting

“…For thrombin clotting time 100 µl of citrated plasma sample were incubated (for 15 min at 37 °C) with the same volume of diluent containing scalar concentrations of BDNF (0, 60 and 120 pg/ml) or BSA (1 mg/ml: control), then, 100 µl of human thrombin (1 U/ml; SIGMA-ALDRICH, St Louis, MO, USA) were added 39 .…”