Schols Saskia E M, van der Meijden Paola E J, van Oerle René, Curvers Joyce, Heemskerk Johan W M, van Pampus Elisabeth C M
Department of Biochemistry (CARIM), Maastricht University, Maastricht, The Netherlands.
Thromb Haemost. 2008 Jan;99(1):64-70. doi: 10.1160/TH07-07-0438.
In a clinical setting, fresh frozen plasma (FFP) is transfused to diluted patients with complicated surgery or trauma, as guided by prolonged conventional coagulation times or low fibrinogen levels. However, the limited sensitivity of these coagulation tests may restrict their use in measuring the effect of transfusion and hence predicting the risk of perioperative bleeding. We used the more sensitive, calibrated automated thrombogram (CAT) method to evaluate the result of therapeutic FFP transfusion to 51 patients with dilutional coagulopathy. Thrombin generation was measured in pre- and post-transfusion plasma samples in the presence of either platelets or phospholipids. For all patients, the transfusion led to higher plasma coagulation factor levels, a shortened activated partial thromboplastin time, and a significant increase in thrombin generation (peak height and endogenous thrombin potential). Interestingly, thrombin generation parameters and fibrinogen levels were higher in post-transfusion plasmas from patients who stopped bleeding (n = 32) than for patients with ongoing bleeding (n = 19). Plasmas from 15 of the 19 patients with ongoing bleeding were markedly low in either thrombin generation or fibrinogen level. We conclude that the thrombin generation method detects improved haemostatic activity after plasma transfusion. Furthermore, the data suggest that thrombin generation and fibrinogen are independent determinants of the risk of perioperative bleeding in this patient group.
在临床环境中，新鲜冰冻血浆（FFP）会在传统凝血时间延长或纤维蛋白原水平降低的指导下，输注给进行复杂手术或遭受创伤的稀释性凝血障碍患者。然而，这些凝血试验的敏感性有限，可能会限制它们在衡量输血效果以及预测围手术期出血风险方面的应用。我们使用更敏感的校准自动血栓图（CAT）方法，评估了对51例稀释性凝血障碍患者进行治疗性FFP输血的结果。在存在血小板或磷脂的情况下，测量输血前和输血后血浆样本中的凝血酶生成情况。对于所有患者，输血导致血浆凝血因子水平升高、活化部分凝血活酶时间缩短，以及凝血酶生成显著增加（峰值高度和内源性凝血酶潜力）。有趣的是，止血的患者（n = 32）输血后血浆中的凝血酶生成参数和纤维蛋白原水平高于仍在出血的患者（n = 19）。19例仍在出血的患者中，有15例的血浆凝血酶生成或纤维蛋白原水平明显较低。我们得出结论，凝血酶生成方法可检测到输血后止血活性的改善。此外，数据表明凝血酶生成和纤维蛋白原是该患者群体围手术期出血风险的独立决定因素。
