Thromboelastometric detection of clotting Factor XIII deficiency in cardiac surgery patients

Abstract

In summary, 'teenTEM' test does not seem to detect Factor XIII deficient patients in cardiac surgery. Furthermore, post-operative blood loss could not be predicted neither by ROTEM nor by laboratory analysis of Factor XIII. In vitro administration of Factor XIII appears to improve laboratory measures of haemostasis.

Rotational thromboelastometry can detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis

“…Among patients with cirrhosis of the liver, MCF measurements demonstrated a significant positive correlation between factor XIII activity and clot strength, a finding suggesting that reduced MCF on all tests should arouse suspicion of factor XIII deficiency in such patients. In contrast, EXTEM, INTEM and APTEM results showed that ML was not correlated with factor XIII activity, a finding in line with those of previous studies …”

“…In contrast, EXTEM, INTEM and APTEM results showed that ML was not correlated with factor XIII activity, a finding in line with those of previous studies. 19,20 Rotational thromboelastometry values were inversely correlated with the results of conventional coagulation tests, such as INR and aPTT; this finding supported those of previous studies. 7 However, in contrast to previous studies, 7 our study did not find any correlation between platelet counts and factor XIII activity (r=.09, P=.45).…”

“…Factor XIII acts in the last steps of haemostasis, and its activity is also reduced in patients with chronic liver diseases . Whether rotational thromboelastometry can demonstrate factor XIII deficiency has been studied in patients undergoing cardiac and neurosurgical procedures; however, these studies excluded patients with liver diseases. Furthermore, in vitro studies showed increased clot strength after factor XIII supplementation .…”

“…suggested that an aprotinin‐resistant mild fibrinolysis in ROTEM analysis may indicate a factor XIII deficiency in a patient undergoing a Whipple procedure. However, a prospective study involving neurosurgical and cardiac surgery patients did not detect this phenomenon. No studies have yet evaluated ROTEM analysis of factor XIII activity in patients with liver diseases.…”

Haemostatic management of cardiac surgical haemorrhage

“…In a randomised controlled trial of recombinant factor XIII vs placebo, there was no therapeutic benefit on transfusion avoidance, transfusion requirements or operative revision, despite an observed correction of factor XIII levels. Factor XIII administration outside clinical trials should therefore be discouraged [67][68][69][70][71].…”