Document Detail

Impaired thrombin generation and fibrin clot formation in patients with dilutional coagulopathy during major surgery.
MedLine Citation:
PMID:  20024495     Owner:  NLM     Status:  MEDLINE    
Patients subjected to haemodilution during surgery are at increased risk of bleeding. We hypothesised that, in the acquired dilutional coagulopathy, insufficient haemostasis is due to either insufficient thrombin generation or insufficient fibrin clot formation. In tissue factor-activated plasmas from patients with coagulation deficiency, we measured time curves of thrombin generation and fibrin clot formation (thromboelastography). Investigated were in study A: 10 patients treated with vitamin K antagonist and five healthy subjects; in study B: 30 patients undergoing cardiopulmonary bypass (CPB) surgery and infused with on average 2,000 ml crystalloids and colloids (no major bleeding); in study C: 58 patients undergoing major general surgery, and transfused with >5,000 ml crystalloids, colloids and red cell concentrates, who experienced major bleeding and were post-transfused with fresh frozen plasma. The treatment with vitamin K antagonist led to a progressive reduction in thrombin generation but not fibrin clot formation. In CPB patients, plasma factor levels post-surgery were 53-60% of normal. This was accompanied by moderate reduction in both haemostatic processes. In plasmas from patients undergoing major surgery, factor levels were 38-41% of normal, and these levels increased after plasma transfusion. Taking preset thresholds for normal thrombin generation and fibrin clot formation, at least one of these processes was low in 88-93% of the patients with (persistent) bleeding, but only in 40-53% of the patients without bleeding. In conclusion, the ability of thrombin generation and fibrin clot formation is independently reduced in acquired dilutional coagulopathy, while minimal levels of both are required for adequate haemostasis.
S E M Schols; M D Lancé; M A H Feijge; J Damoiseaux; M A Marcus; K Hamulyák; H Ten Cate; J W M Heemskerk; E C M van Pampus
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Publication Detail:
Type:  Journal Article     Date:  2009-12-18
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  103     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-05-19     Revised Date:  2013-03-19    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  318-28     Citation Subset:  IM    
Department of Biochemistry (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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MeSH Terms
Blood Coagulation
Blood Coagulation Disorders / etiology
Blood Loss, Surgical / prevention & control
Blood Transfusion
Fibrin / metabolism*
Hemorrhage / etiology*,  prevention & control
Isotonic Solutions / therapeutic use
Middle Aged
Perioperative Care
Postoperative Hemorrhage / etiology,  therapy
Thrombin / biosynthesis*
Vitamin K / antagonists & inhibitors
Reg. No./Substance:
0/Isotonic Solutions; 0/crystalloid solutions; 12001-79-5/Vitamin K; 9001-31-4/Fibrin; EC
Comment In:
Thromb Haemost. 2013 Feb;109(2):356-7   [PMID:  23238045 ]

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