Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%

被引:57
作者
De Lorenzo, C [1 ]
Calatzis, A [1 ]
Welsch, U [1 ]
Heindl, B [1 ]
机构
[1] Univ Munich, Dept Anesthesiol, Dept Hemostaseol & Transfus Med, Dept Anat, D-80336 Munich, Germany
关键词
D O I
10.1213/01.ane.0000200297.98089.ce
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Severe bleeding often induces coagulopathy via loss, consumption, and dilution of clotting factors and platelets. The aims of our in vitro study were to characterize the influence of progressive hemodilution with either NaCl 0.9% or hydroxyethyl starch (HES) 6% on blood clot formation and to analyze the effect of substitution of fibrinogen and platelets on dilutional coagulopathy. Whole blood samples drawn from 8 volunteers were diluted from 20% to 80% of the sample volume with both diluents separately. Clot formation was measured by thrombelastography. At a 60% dilution, either fibrinogen and/or platelets were added to the samples. Clot firmness became critical after 40% dilution with HES 6% but not until 60% dilution with NaCl 0.9%. When platelet function was blocked, fibrin polymerization was severely impaired after 20% dilution with HES 6%, whereas such an effect was only seen after 80% dilution with NaCl 0.9%. The addition of fibrinogen reconstituted the clot firmness in the presence of NaCl 0.9%, but this had only a minor effect after dilution with HES 6%. Platelets alone or in addition were not able to improve clot firmness to a clinically relevant extent. Dilutional coagulopathy induced by crystalloids can, in vitro, be effectively reversed by supplementation of fibrinogen. In contrast, HES molecules interfere with fibrin polymerization and, thus, administration of fibrinogen after dilution with HES 6% failed to significantly improve clot firmness.
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页码:1194 / 1200
页数:7
相关论文
共 24 条
[11]   BLUTGERINNUNGSSTUDIEN MIT DER THROMBELASTOGRAPHIE, EINEM NEUEN UNTERSUCHUNGSVERFAHREN [J].
HARTERT, H .
KLINISCHE WOCHENSCHRIFT, 1948, 26 (37-3) :577-583
[12]   High dose fibrinogen administration for acute therapy of coagulopathy during massive perioperative transfusion [J].
Heindl, B ;
DeLorenzo, C ;
Spannagl, M .
ANAESTHESIST, 2005, 54 (08) :787-790
[13]   HEMOSTATIC FACTORS AND REPLACEMENT OF MAJOR BLOOD-LOSS WITH PLASMA-POOR RED-CELL CONCENTRATES [J].
HIIPPALA, ST ;
MYLLYLA, GJ ;
VAHTERA, EM .
ANESTHESIA AND ANALGESIA, 1995, 81 (02) :360-365
[14]  
Hiippala ST, 1995, BLOOD COAGUL FIBRIN, V6, P743
[15]   The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation [J].
Innerhofer, P ;
Fries, D ;
Margreiter, J ;
Klingler, A ;
Kühbacher, G ;
Wachter, B ;
Oswald, E ;
Salner, E ;
Frischhut, B ;
Schobersberger, W .
ANESTHESIA AND ANALGESIA, 2002, 95 (04) :858-865
[16]   Voluven®, a lower substituted novel hydroxyethyl starch (HES 130/0.4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5 [J].
Langeron, O ;
Doelberg, M ;
Ang, ET ;
Bonnet, F ;
Capdevila, X ;
Coriat, P .
ANESTHESIA AND ANALGESIA, 2001, 92 (04) :855-862
[17]   Early coagulopathy predicts mortality in trauma [J].
MacLeod, JBA ;
Lynn, M ;
McKenney, MG ;
Cohn, SM ;
Murtha, M .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 55 (01) :39-44
[18]   THROMBELASTOGRAPHY [J].
MALLETT, SV ;
COX, DJA .
BRITISH JOURNAL OF ANAESTHESIA, 1992, 69 (03) :307-313
[19]   Reduced quality of clot formation with gelatin-based plasma substitutes [J].
Mardel, SN ;
Saunders, FM ;
Allen, H ;
Menezes, G ;
Edwards, CM ;
Ollerenshaw, L ;
Baddeley, D ;
Kennedy, A ;
Ibbotson, RM .
BRITISH JOURNAL OF ANAESTHESIA, 1998, 80 (02) :204-207
[20]   In vivo effect of haemodilution with saline on coagulation:: a randomized controlled trial [J].
Ng, KFJ ;
Lam, CCK ;
Chan, LC .
BRITISH JOURNAL OF ANAESTHESIA, 2002, 88 (04) :475-480