Influence of Different Hydroxyethyl Starch (HES) Formulations on Fibrinogen Measurement in HES-Diluted Plasma

Adam, Susanne; Karger, Ralf; Kretschmer, V.

doi:10.1177/1076029609336855

Cited by 31 publications

(22 citation statements)

References 18 publications

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“…[30][31][32] Starches have also been shown to affect measurement of plasma fibrinogen concentration with the Clauss method. 33 Therefore, the use of HES 130/0.4 in our population may have contributed to the lower MCF cut-off value. Alternatively, it may also have influenced the cut-off value we observed for plasma fibrinogen concentration.…”

Section: Discussionmentioning

confidence: 90%

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Faraoni

Willems

Savan

et al. 2014

European Journal of Anaesthesiology

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Post-CPB plasma fibrinogen concentration significantly influences blood loss in children undergoing cardiac surgery. A fibrinogen concentration of at least 1.5 g l or a MCF of at least 3 mm should accurately predict excessive blood loss in cardiac surgery children. Further prospective trials are needed to assess the effect of fibrinogen supplementation on postoperative blood loss in this population.

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Section: Discussionmentioning

confidence: 90%

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Faraoni

Willems

Savan

et al. 2014

European Journal of Anaesthesiology

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“…These studies showed that FIB was overestimated by >50% and >100% with 30% and 50% dilution, respectively. Notably, in this context the concentration of HES appears to be more important than molecular size [39,40]. …”

Section: Discussionmentioning

confidence: 99%

Estimation of plasma fibrinogen levels based on hemoglobin, base excess and Injury Severity Score upon emergency room admission

et al. 2013

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IntroductionFibrinogen plays a key role in hemostasis and is the first coagulation factor to reach critical levels in massively bleeding trauma patients. Consequently, rapid estimation of plasma fibrinogen (FIB) is essential upon emergency room (ER) admission, but is not part of routine coagulation monitoring in many centers. We investigated the predictive ability of the laboratory parameters hemoglobin (Hb) and base excess (BE) upon admission, as well as the Injury Severity Score (ISS), to estimate FIB in major trauma patients.MethodsIn this retrospective study, major trauma patients (ISS ≥16) with documented FIB analysis upon ER admission were eligible for inclusion. FIB was correlated with Hb, BE and ISS, alone and in combination, using regression analysis.ResultsA total of 675 patients were enrolled (median ISS 27). FIB upon admission correlated strongly with Hb, BE and ISS. Multiple regression analysis showed that Hb and BE together predicted FIB (adjusted R2 = 0.46; loge(FIB) = 3.567 + 0.223.Hb - 0.007.Hb2 + 0.044.BE), and predictive strength increased when ISS was included (adjusted R2 = 0.51; loge(FIB) = 4.188 + 0.243.Hb - 0.008.Hb2 + 0.036.BE - 0.031.ISS + 0.0003.ISS2). Of all major trauma patients admitted with Hb <12 g/dL, 74% had low (<200 mg/dL) FIB and 54% had critical (<150 mg/dL) FIB. Of patients admitted with Hb <10 g/dL, 89% had low FIB and 73% had critical FIB. These values increased to 93% and 89%, respectively, among patients with an admission Hb <8 g/dL. Sixty-six percent of patients with only a weakly negative BE (<−2 mmol/L) showed low FIB. Of patients with BE <−6 mmol/L upon admission, 81% had low FIB and 63% had critical FIB. The corresponding values for BE <−10 mmol/L were 89% and 78%, respectively.ConclusionsUpon ER admission, FIB of major trauma patients shows strong correlation with rapidly obtainable, routine laboratory parameters such as Hb and BE. These two parameters might provide an insightful and rapid tool to identify major trauma patients at risk of acquired hypofibrinogenemia. Early calculation of ISS could further increase the ability to predict FIB in these patients. We propose that FIB can be estimated during the initial phase of trauma care based on bedside tests.

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“…It is possible that fibrinogen levels were overestimated in the present study, because hydroxyethyl starch had been administered. [48][49][50] The method used to determine the incidence of DIC in this animal study was based on clinical judgment, with consideration of the International Society on Thrombosis and Hemostasis criteria, which were designed for humans. 35 There are no established diagnostic criteria for porcine DIC, but the clinical signs of DIC were clear in this study.…”

Section: Discussionmentioning

confidence: 99%

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

Grottke¹,

Braunschweig

Spronk

et al. 2011

Blood

122

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Despite increasing use of prothrombin complex concentrate (PCC) to treat hemorrhage-associated coagulopathy, few studies have investigated PCC in trauma, and there is a particular lack of safety data. This study was performed to evaluate PCC therapy in a porcine model of coagulopathy with blunt liver injury. Coagulopathy was induced in 27 anesthetized pigs by replacing approximately 70% blood volume with hydroxyethyl starch 130/0.4 and Ringer's lactate solution; erythrocytes were collected and retransfused. Ten minutes after trauma, animals randomly received PCC (35 or 50 IU/kg) or saline. Coagulation parameters including thromboelastometry, thrombin generation, and blood loss were monitored for 2 hours. Internal organs were examined macroscopically and histologically to determine the presence of emboli and assess liver injury. Total blood loss was significantly lower and survival was higher in both PCC groups versus the control group (P < .05). These outcomes appeared to be dose-independent. Thromboembolism was found in all animals treated with 50 IU/kg PCC; 44% also showed signs of disseminated intravascular coagulation. Liver injury was similar in all animals. In conclusion, 35 IU/kg PCC safely improved coagulation and attenuated blood loss. However, the higher dose of PCC (50 IU/kg) appeared to increase the risk of thromboembolism and disseminated intravascular coagulation. (Blood. 2011;118(7): [1943][1944][1945][1946][1947][1948][1949][1950][1951]

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Influence of Different Hydroxyethyl Starch (HES) Formulations on Fibrinogen Measurement in HES-Diluted Plasma

Cited by 31 publications

References 18 publications

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Estimation of plasma fibrinogen levels based on hemoglobin, base excess and Injury Severity Score upon emergency room admission

Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury

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