The effect of Factor XIII on bleeding in coronary surgery

Background: One cause of diffuse bleeding after cardiac operations may be a low plasma concentration of Factor XIII, which is essential for coagulation, but is not covered by standard coagulation monitoring. Methods: In a prospective pilot study, Factor XIII levels before and after extracorporeal circulation were investigated, and drain volumes and blood transfusions of a control group of 11 patients were compared with a group of 11 patients who received 2500 units Factor XIII postoperatively. Results: Factor XIII fell significantly from preoperative values of 96.1% and 88.7% (control) to 55.7% and 51.8% (control) postoperatively. By administration of Factor XIII, plasma level rose significantly from 55.7% to 103.1%; in the control group the value remained low. Drain volumes on the first and second postoperative day were significantly lower in the Factor XIII group. In the control group 1.9 units of red blood cells and 1.6 units fresh frozen plasma were administered, in the Factor XIII group 0.9 and 0.6 units were necessary. Conclusions: Faktor XIII influences bleeding after coronary surgery and can reduce the need for blood transfusions. In patients with prolonged diffuse bleeding, we therefore recommend substitution of Factor XIII.