Evaluation of fibrinogen concentrates and prothrombin complex concentrates on coagulation changes in a hypothermic in vitro model using thromboelastometry and thromboelastography. (September 2015)

• Record Type: Journal Article
• Authors: Durila, Miroslav; Lukáš, Pavel; Astraverkhava, Marta; Vymazal, Tomáš
• Is Part Of: Scandinavian journal of clinical & laboratory investigation. Volume 75:Number 5(2015)
• Page Start: 407
• Page End: 414
• Publication Date: 2015-09
• Subjects: Clinical biochemistry -- Periodicals; Physiology, Pathological -- Periodicals; Physiology, Experimental -- Periodicals; Medicine -- Research -- Periodicals; Clinical medicine -- Periodicals; 616.0072
• DOI: 10.3109/00365513.2015.1031694
• Languages: English
• ISSNs: 0036-5513

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background</italic>.</bold> Hypothermic coagulopathy is very challenging in bleeding trauma patients. Therefore, we decided to evaluate the efficacy of fibrinogen and prothrombin complex in 30°C hypothermia <italic>in vitro</italic> to investigate if higher levels of fibrinogen and prothrombin complex concentrate can compensate for the hypothermic effect on coagulation as measured by thromboelastometry/thromboelastography. <bold><italic>Methods</italic>.</bold> Blood samples were obtained from 12 healthy volunteers (six men and six women) in our study. Measurements were performed at 37°C and 30°C simultaneously, then at 30°C with adding fibrinogen and prothrombin complex and in the last step samples with added coagulation factors were warmed back to 37°C. <bold><italic>Results</italic>.</bold> We found that 30°C hypothermic coagulopathy can be detected both by thromboelastometry and thromboelastography. Hypothermic coagulopathy can be restored by fibrinogen to the point where the results do not significantly differ from 37°C values (<italic>p</italic> > 0.05). After warming the sample with fibrinogen to 37°C, the thrombodynamic potential index was not significantly different from baseline (<italic>p</italic> > 0.05), although there was a trend to prothrombotic status. The addition of prothrombin complex concentrate to 30°C hypothermic sample was not able to correct hypothermic coagulopathy <italic>in vitro</italic>. <bold><italic>Conclusions</italic>.</bold> Coagulopathy caused by the 30°C hypothermia <italic>in vitro</italic> model can be corrected by fibrinogen concentrate compared to prothrombin complex concentrate. In spite of a tendency to prothrombotic status, this was not significant with the use of the recommended dose of fibrinogen even after warming the blood to 37°C. However, measurement performed at 37°C seems to be safer than at 30°C.</p> </abstract>