Coagulation Factor XIII Reduces Postoperative Bleeding After Coronary Surgery with Extracorporeal Circulation

Gödje, O.; Gallmeier, U.; Schelian, M.; Grünewald, Martin; Mair, Helmut

doi:10.1055/s-2005-872853

Cited by 121 publications

(112 citation statements)

References 8 publications

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“…Patients treated with placebo had the most bleeding and those treated with 2500 units had the least with the 1250 unit group being intermediate, but these differences were not statistically significant. Patients who had post-administration levels of factor XIII <70% had increased chest tube drainage and blood product transfusion during the first 48 hours (153). The authors concluded that FXIII administration would be justified if levels after extracorporeal circulation are <70% (153).…”

Section: Role Of Transglutaminases In Vascular Permeabilitymentioning

confidence: 99%

“…Patients who had post-administration levels of factor XIII <70% had increased chest tube drainage and blood product transfusion during the first 48 hours (153). The authors concluded that FXIII administration would be justified if levels after extracorporeal circulation are <70% (153).…”

Section: Role Of Transglutaminases In Vascular Permeabilitymentioning

confidence: 99%

“…In adult patients undergoing CABG, factor XIII levels fell to a nadir value of approximately 55% at 30 minutes after the onset of extracorporeal circulation (153). Patients were randomized in a double blinded study to placebo, 1250 units or 2500 units of human coagulation factor XIII.…”

Section: Role Of Transglutaminases In Vascular Permeabilitymentioning

confidence: 99%

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Roles of transglutaminases in cardiac and vascular diseases

Sane

Kontos²,

Greenberg³

2007

Front Biosci

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All transglutaminases share the common enzymatic activity of transamidation, or the cross-linking of glutamine and lysine residues to form N epsilon (gamma-glutamyl) lysyl isopeptide bonds. The plasma proenzyme factor XIII is responsible for stabilizing the fibrin clot against physical and fibrinolytic disruption. Another member of the transglutaminase family, tissue transglutaminase or TG2 is abundantly expressed in cardiomyocytes, vascular cells and macrophages. The transglutaminases have a variety of functions independent of their transamidating activity. For example, TG2 binds and hydrolyzes GTP, thereby fostering signal transduction by several G protein coupled receptors. Accumulating evidence points to novel roles for factor XIII and TG2 in cardiovascular biology including: (a) modulating platelet activity, (b) regulating glucose control, (c) contributing to the development of hypertension, (d) influencing the progression of atherosclerosis, (e) regulating vascular permeability and angiogenesis (f) and contributing to myocardial signaling, contractile activity and ischemia/reperfusion injury. In this review, we summarize the cardiovascular biology of two members of the family of transglutaminases, Factor XIII and TG2.

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Section: Role Of Transglutaminases In Vascular Permeabilitymentioning

confidence: 99%

Section: Role Of Transglutaminases In Vascular Permeabilitymentioning

confidence: 99%

See 1 more Smart Citation

Roles of transglutaminases in cardiac and vascular diseases

Sane

Kontos²,

Greenberg³

2007

Front Biosci

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“…Therefore, large volume transfusions of FFP would be necessary to effectively increase the fibrinogen concentration, and achieving the target fibrinogen concentration of 1.5-2.0 g/l is virtually impossible given the average fibrinogen concentration of 2 g/l. When replacing most FFP transfusions with fibrinogen concentrate, monitoring factor XIII levels is advisable after the replacement of approximately 50% of the blood volume; in addition, a 60% factor XIII activity level is to be maintained with the administration of factor XIII concentrate [35,[50][51][52].…”

Section: Acute Anemiamentioning

confidence: 99%

Applying ‘Patient Blood Management’ in the trauma center

Theusinger

Stein

Spahn

2014

Current Opinion in Anaesthesiology

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PURPOSE OF REVIEW: The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. RECENT FINDINGS: Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SUMMARY: Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients. Purpose of review The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. Recent findingsEarly administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SummaryApplying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.

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“…In a randomised controlled trial of recombinant factor XIII vs placebo, there was no therapeutic benefit on transfusion avoidance, transfusion requirements or operative revision, despite an observed correction of factor XIII levels. Factor XIII administration outside clinical trials should therefore be discouraged [67][68][69][70][71].…”

Section: Factor XIIImentioning

confidence: 99%

Haemostatic management of cardiac surgical haemorrhage

2014

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SummaryAlmost 30 000 cardiopulmonary bypass operations are performed in the UK every year, consuming a considerable portion of the UK blood supply. Each year, in cardiac surgery, 90% of blood products are used by only 10% of patients, and over the past 25 years, much innovation and research has gone into improving peri-operative diagnosis and therapy for these patients. Visco-elastic tests performed at the bedside, with modifications to allow direct quantification of fibrinogen levels, are probably the biggest advancement. There is no clear advantage of thromboelastometry over thromboelastography, and the published literature remains scarce. Visco-elastic testing has recently been coupled with the systematic replacement of clotting factors by means of factor concentrates, with objective improvement in terms of blood loss, red blood cell usage and surgical re-exploration. The National Institute for Health and Care Excellence has reviewed the available evidence and recommended visco-elastic tests as cost effective in cardiac surgery. Factor concentrates, however, carry significant risks, particularly unnecessary donor exposures, potential selective over-correction of partial deficiencies and the possibility that the postoperative risk of venous thromboembolism is increased; as yet there are no data on risk-benefit analysis. There are a number of promising drugs used in topical haemostasis, but the requirement to apply these before major bleeding is manifest limits their use considerably. Hyperfibrinolysis is less important than in the past due to the wide spread adoption of antifibrinolytic agents and close intra-operative monitoring of heparin effect.

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Coagulation Factor XIII Reduces Postoperative Bleeding After Coronary Surgery with Extracorporeal Circulation

Abstract: Factor XIII administration reduces postoperative blood loss and the extent of blood transfusion after coronary surgery, however administration is only helpful if plasma levels are below the normal value. Measurement of plasma levels is recommended before Factor XIII substitution.

Cited by 121 publications

References 8 publications

Roles of transglutaminases in cardiac and vascular diseases

Roles of transglutaminases in cardiac and vascular diseases

Applying ‘Patient Blood Management’ in the trauma center

Haemostatic management of cardiac surgical haemorrhage

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