The Effect of Major Surgical Procedures on Plasma and Platelet Levels of Factor XIII

Abstract

SummaryFactor XIII (FSF or fibrinoligase), an enzyme required for normal blood coagulation, can be measured by its catalysis of the incorporation of a fluorescent amine, monodansylcadaverine (N-(5-aminopentyl)-5-dimethylamino-l-naphthalene-sulfon-amide) into casein. The amine incorporation test was applied to fourteen patients who had major operations. Levels of factor XIII were measured before surgery and at intervals of two, four, and six days after operation. Plasma factor XIII showed a significant, linear decrease for each day after surgery. Patients having orthopedic surgery showed less pronounced changes than the remaining patients. Factor XIII also decreased after operation in patients with neoplastic disease, but the change was not different from that after general surgical procedures done in the absence of neoplasia. Platelet factor XIII levels were increased on the second day after operation, diminished on day four, and increased above pre-operative levels on the sixth day after surgery. Possible explanations of the observations are presented.

Functional factor XIII-A is exposed on the stimulated platelet surface

“…Under certain circumstances, the antifibrinolytic effect of platelet FXIII-A may be central in stabilizing thrombi, such as during surgery when plasma FXIII-A 2 B 2 levels rapidly decline 67 73 This is thought to be the result of the remaining levels of free FXIII-A in the plasma; however, our results suggest that platelet FXIII-A may also compensate under these circumstances. Our data demonstrate that when plasma FXIII-A 2 B 2 is below 20% of normal, the antifibrinolytic effect of platelet FXIII-A becomes apparent, with levels of 10% of normal being statistically significant.…”

“…37 We show that inhibiting platelet activation or FXIIIa activity dramatically reduces stabilization of thrombi by platelets. The impact of platelet FXIII-A on thrombus stabilization suggests it may translocate from the activated membrane into the adjacent fibrin network, but the extent of diffusion requires further clarification.Under certain circumstances, the antifibrinolytic effect of platelet FXIII-A may be central in stabilizing thrombi, such as during surgery when plasma FXIII-A 2 B 2 levels rapidly decline 67 73 This is thought to be the result of the remaining levels of free FXIII-A in the plasma; however, our results suggest that platelet FXIII-A may also compensate under these circumstances. Our data demonstrate that when plasma FXIII-A 2 B 2 is below 20% of normal, the antifibrinolytic effect of platelet FXIII-A becomes apparent, with levels of 10% of normal being statistically significant.…”

“…It has recently been shown that supplementing blood of thrombocytopenic patients with FXIII, thrombin activatable fibrinolysis inhibitor, or fibrinogen increases clot strength and decreases lysis. 67 These proteins are all contained in platelets, and their presence indicates that local concentrations of these proteins, including surface-bound FXIII-A, mediate thrombus stabilization. Indeed, an increase in FXIII-A activity over time was observed on incorporation of intact platelets into plasma clots.…”

“…Under certain circumstances, the antifibrinolytic effect of platelet FXIII-A may be central in stabilizing thrombi, such as during surgery when plasma FXIII-A 2 B 2 levels rapidly decline 67 or following cardiopulmonary bypass with extracorporeal circuit. Acquired FXIII deficiency can also occur in the absence of surgery, as in the case of aortic dissection in which plasma FXIII-A 2 B 2 levels deplete to 30% to 35% of normal.…”

Novel aspects of platelet factor XIII function

“…The antifibrinolytic function of platelet FXIII-A may be central in stabilizing thrombi in certain situations, such as during surgery when plasma FXIII-A2B2 levels rapidly decline [69] or following cardiopulmonary bypass with extracorporeal circuit.…”