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Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%.
Anesth Analg. 2006 Apr; 102(4):1194-200.A&A

Abstract

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.

Authors+Show Affiliations

Department of Anesthesiology, Ludwig Maximilians University, Munich, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16551923

Citation

De Lorenzo, Claudia, et al. "Fibrinogen Concentrate Reverses Dilutional Coagulopathy Induced in Vitro By Saline but Not By Hydroxyethyl Starch 6%." Anesthesia and Analgesia, vol. 102, no. 4, 2006, pp. 1194-200.
De Lorenzo C, Calatzis A, Welsch U, et al. Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%. Anesth Analg. 2006;102(4):1194-200.
De Lorenzo, C., Calatzis, A., Welsch, U., & Heindl, B. (2006). Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%. Anesthesia and Analgesia, 102(4), 1194-200.
De Lorenzo C, et al. Fibrinogen Concentrate Reverses Dilutional Coagulopathy Induced in Vitro By Saline but Not By Hydroxyethyl Starch 6%. Anesth Analg. 2006;102(4):1194-200. PubMed PMID: 16551923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%. AU - De Lorenzo,Claudia, AU - Calatzis,Andreas, AU - Welsch,Ulrich, AU - Heindl,Bernhard, PY - 2006/3/23/pubmed PY - 2006/4/14/medline PY - 2006/3/23/entrez SP - 1194 EP - 200 JF - Anesthesia and analgesia JO - Anesth Analg VL - 102 IS - 4 N2 - 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. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/16551923/Fibrinogen_concentrate_reverses_dilutional_coagulopathy_induced_in_vitro_by_saline_but_not_by_hydroxyethyl_starch_6_ L2 - https://doi.org/10.1213/01.ane.0000200297.98089.ce DB - PRIME DP - Unbound Medicine ER -