Efficacy of fibrinogen and prothrombin complex concentrate used to reverse dilutional coagulopathy—a porcine model
- 1 October 2006
- journal article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 97 (4), 460-467
- https://doi.org/10.1093/bja/ael191
Abstract
This study was conducted to assess whether the combined administration of fibrinogen and prothrombin complex concentrate (PCC) enables the reversal of dilutional coagulopathy resulting from intended blood loss and fluid replacement, and whether this treatment reduces further blood loss and mortality. In 20 anaesthetized pigs, approximately 65% of the estimated blood volume was withdrawn and replaced with the same amount of hydroxyethyl starch (6% HES 130/0.4) to mimic blood loss and to develop a dilutional coagulopathy. Pigs (randomized) received either fibrinogen (200 mg kg(-1)) and PCC (35 IU kg(-1)) (n=10), or placebo (n=10). Thereafter, a standard liver laceration was performed to induce uncontrolled haemorrhage. The subsequent blood loss and survival time were determined as primary outcome variables. Throughout the experiment serial blood samples were obtained to assess the competence of the haemostatic system using standard coagulation tests, modified Thrombelastograph measurements (ROTEM) and electron microscopy clot imaging. As compared with baseline, after haemodilution both groups showed statistically significant impairment of haemostasis as measured with standard coagulation tests and thrombelastography. These parameters significantly improved after administration of the study drugs while aPPT measurements remained unchanged. Blood loss after liver injury was significantly less in the treatment group as compared with placebo: 240 ml (50-830) vs 1800 ml (1500-2500) (P<0.0001). All treated animals survived, whereas 80% of the placebo group died (P<0.0001). During haemodilution, substitution of fibrinogen and PCC causes an enhancement of coagulation and final clot strength. This reversal of dilutional coagulopathy may reduce blood loss and mortality when large amounts of colloids are needed to maintain normovolaemia during huge blood losses.Keywords
This publication has 27 references indexed in Scilit:
- The Effect of Fibrinogen Substitution on Reversal of Dilutional Coagulopathy: An In Vitro ModelAnesthesia & Analgesia, 2006
- Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine modelBritish Journal of Anaesthesia, 2005
- The Effects of Perioperatively Administered Colloids and Crystalloids on Primary Platelet-Mediated Hemostasis and Clot FormationAnesthesia & Analgesia, 2002
- The Effect of the Combined Administration of Colloids and Lactated Ringer’s Solution on the Coagulation System: An In Vitro Study Using Thrombelastograph® Coagulation Analysis (ROTEG®)Anesthesia & Analgesia, 2002
- Replacement of Massive Blood LossVox Sanguinis, 1998
- Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trialsBMJ, 1998
- Reduced quality of clot formation with gelatin-based plasma substitutesBritish Journal of Anaesthesia, 1998
- Laboratory Hemostatic Abnormalities in Massively Transfused Patients Given Red Blood Cells and CrystalloidAmerican Journal of Clinical Pathology, 1991
- Coagulation Changes during Packed Red Cell Replacement of Major Blood LossAnesthesiology, 1988
- Hemostasis in Massively Transfused Trauma PatientsAnnals of Surgery, 1979