Improved Clot Formation by Combined Administration of Activated Factor VII (NovoSeven®) and Fibrinogen (Haemocomplettan® P)

Tanaka, Kenichi A.; Taketomi, Taro; Szlam, Fania; Calatzis, Andreas; Levy, Jerrold H.

doi:10.1213/ane.0b013e318163fc76

Cited by 63 publications

(36 citation statements)

References 33 publications

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“…Significant correlation among MA, fibrinogen concentration, and platelet count has been reported in both normal and hypercoagulable people and dogs 27, 28, 29. Fibrinogen has been reported to increase MA in both humans and dogs because of the fact that MA is primarily dependent on the cross binding of platelets and fibrinogen 30, 31. Fibrinogen may be considered one of the “driving forces” behind inflammation because it directly influences the production of proinflammatory cytokines and chemokines,10, 32, 33 and this is further supported in this study by the positive correlations among MA, total leukocyte count and mature neutrophil count—cells responsible for the production of cytokines and chemokines.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Hemostatic Abnormalities in Canine Spirocercosis and Its Association with Systemic Inflammation

Pazzi

Goddard

Kristensen

et al. 2013

Veterinary Internal Medicne

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BackgroundCanine spirocercosis is caused by the nematode Spirocerca lupi and is characterized by esophageal fibro‐inflammatory nodules that may undergo neoplastic transformation. No sensitive and specific laboratory assays other than histopathology have been reported to differentiate non‐neoplastic from neoplastic disease.Hypothesis/ObjectivesDogs with spirocercosis will have evidence of hypercoagulability based on thromboelastography (TEG)‐derived maximal amplitude (MA); increased MA will be correlated with increased acute phase protein (APP) concentrations (C‐reactive protein [CRP] and fibrinogen); increased MA and APPs will be exacerbated with neoplastic spirocercosis.AnimalsThirty‐nine client‐owned dogs with naturally occurring spirocercosis and 15 sex‐matched healthy controls.MethodsA prospective comparative study evaluating TEG, activated partial thromboplastin time, prothrombin time, antithrombin (AT) activity, platelet count and D‐dimer concentration, and APPs of dogs with non‐neoplastic (n = 24) and neoplastic (n = 15) spirocercosis compared to control dogs.ResultsMedian MA was significantly increased in the non‐neoplastic group (P < .01) and neoplastic group (P < .01) compared to the controls. Both APPs were significantly increased in the neoplastic group compared to the non‐neoplastic and control groups. MA was strongly correlated with fibrinogen (r = 0.85, P < .001) and CRP (r = 0.73, P < .001). An MA >76 mm provided 96% specificity and 73% sensitivity for differentiation of disease state.Conclusions and Clinical ImportanceCanine spirocercosis is associated with increased TEG variables, MA and α, and decreased AT activity, which may indicate a hypercoagulable state seemingly more severe with neoplastic transformation. MA was correlated with APP in dogs with spirocercosis and can be used as an adjunctive test to support the suspicion of neoplastic transformation.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Hemostatic Abnormalities in Canine Spirocercosis and Its Association with Systemic Inflammation

Pazzi

Goddard

Kristensen

et al. 2013

Veterinary Internal Medicne

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“…Therapy in the bleeding patient should be multimodal to include repletion of other coagulation proteins, antifibrinolytic agents, and blood products including platelets and RBCs as needed. [93][94][95][96][97][98][99][100] Fibrinogen concentrate represents an important option for treating coagulopathic bleeding, allowing reduction of allogeneic blood product transfusion. Further multicenter studies in a variety of clinical settings are needed to determine optimal dosing strategies and target thresholds for fibrinogen therapy.…”

Section: Discussionmentioning

confidence: 99%

How I use fibrinogen replacement therapy in acquired bleeding

Levy

Goodnough

2015

Blood

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142

102

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Fibrinogen is a critical protein for hemostasis and clot formation. However, transfusion guidelines have variable recommendations for maintaining fibrinogen levels in bleeding patients. An increasing number of studies support the practice of fibrinogen replacement therapy for acquired coagulopathies, and additional studies are underway. Fibrinogen therapy can be administered with cryoprecipitate or fibrinogen concentrates, and clinical practice varies according to their availability and licensing status. Fibrinogen concentrate therapy has been studied in animal models and clinical trials and supports the critical role of fibrinogen repletion in bleeding patients. Point-of-care testing will have an important role in guiding fibrinogen replacement for hemostatic therapy in clinical settings such as cardiovascular surgery, postpartum hemorrhage, and trauma. Fibrinogen therapy is an important component of a multimodal strategy for the treatment of coagulopathic bleeding.

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“…This suggests that intraoperative use of thromboelastometry might alter transfusion patterns [5] and might predict postoperative bleeding in children undergoing cardiac surgery [6]. Ex-vivo experiments employing thromboelastometry to test the effect of blood products and/or haemostatic agents have previously been conducted in adults [7][8][9], but equivalent studies in children are needed.…”

Section: Introductionmentioning

confidence: 99%

Ex-vivo response to blood products and haemostatic agents after paediatric cardiac surgery

Hvas

Andreasen

Christiansen

et al. 2013

Blood Coagulation &Amp; Fibrinolysis

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Bleeding complications after cardiac surgery are of particular importance in children because they are more prone to volume overload. To optimize haemostatic intervention, the coagulopathy has to be characterized, and knowledge about the effect of blood products and haemostatic agents is needed. The aims of the present study were to investigate changes in coagulation profiles after paediatric cardiac surgery and the effect after ex-vivo addition of blood products and haemostatic agents. Coagulation profiles were evaluated by thromboelastometry (ROTEM) in 54 children before and immediately after cardiac surgery. The haemostatic potential of various factor concentrates (fibrinogen concentrate, recombinant factor VIIa and factor XIII), fresh frozen plasma (FFP), pooled platelets and tranexamic acid was investigated. After surgery, the coagulation profiles revealed significantly prolonged clotting time (P=0.008), and reduced clot propagation (P<0.001) as well as reduced whole blood clot stability (P<0.001). Ex-vivo addition of pooled platelets fully reversed the postoperative coagulopathy; this was also seen after addition of recombinant factor VIIa although less pronounced. Finally, addition of fibrinogen concentrate, FFP or tranexamic acid improved clot stability significantly. Whole blood coagulation was significantly impaired after cardiac surgery in children. Ex-vivo studies showed a total reversal of the coagulopathy after addition of pooled platelets and significantly improved clot stability after addition of fibrinogen concentrate, FFP and tranexamic acid, respectively.

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Improved Clot Formation by Combined Administration of Activated Factor VII (NovoSeven®) and Fibrinogen (Haemocomplettan® P)

Abstract: The onset of fibrin formation and thrombin generation were shortened after rFVIIa addition, but fibrin clot strength was only increased after fibrinogen supplementation. In vitro clot formation was most improved by using both rFVIIa and fibrinogen in whole blood after CPB.

Cited by 63 publications

References 33 publications

Evaluation of Hemostatic Abnormalities in Canine Spirocercosis and Its Association with Systemic Inflammation

Evaluation of Hemostatic Abnormalities in Canine Spirocercosis and Its Association with Systemic Inflammation

How I use fibrinogen replacement therapy in acquired bleeding

Ex-vivo response to blood products and haemostatic agents after paediatric cardiac surgery

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