Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria.
Transfusion. 2011 Aug;51(8):1695-706. doi: 10.1111/j.1537-2995.2011.03066.x. Epub 2011 Feb 25.
Fibrinogen concentrate administration can be guided by measuring fibrinogen concentration or quality of the fibrin-based clot. This study compared different fibrinogen concentration measurement methods with maximum clot firmness (MCF) of the fibrin clot, assessed by thromboelastometry (FIBTEM), in 33 cardiovascular surgery patients receiving fibrinogen concentrate for hemostatic therapy.
Blood samples were collected after cardiopulmonary bypass (CPB) and after fibrinogen concentrate administration. FIBTEM MCF was measured using a rotational thromboelastometry device (ROTEM, Tem International). Fibrinogen concentration was measured using photo-optical (CA-7000, Siemens Healthcare Diagnostics), mechanical (KC-10 steel ball, Schnitger and Gross hook, Amelung GmbH), and electromechanical (STA-R, Diagnostica Stago) coagulometers. Assessments included agreement between fibrinogen concentration measurements and correlations between fibrinogen concentration and FIBTEM MCF.
After CPB, correlations were significant (p < 0.001) between FIBTEM MCF and fibrinogen concentration determined by steel ball (r = 0.71), hook (r = 0.73), STA-R (r = 0.81), and CA-7000 (r = 0.82) coagulometers. After fibrinogen concentrate administration, agreement between fibrinogen measurement methods was severely impaired, and correlations with FIBTEM MCF were 0.39 (steel ball), 0.33 (hook), 0.59 (STA-R), and 0.33 (CA-7000).
Agreement between fibrinogen concentration measurement methods decreased considerably after fibrinogen concentrate administration. All methods correlated acceptably with FIBTEM MCF at the end of CPB, but not after hemostatic therapy. Further investigation is needed to explain these findings.
纤维蛋白原浓缩物的给药可以通过测量纤维蛋白原浓度或纤维蛋白凝块的质量来指导。本研究比较了 33 例接受纤维蛋白原浓缩物止血治疗的心血管手术患者在体外循环（CPB）后和纤维蛋白原浓缩物给药后的不同纤维蛋白原浓度测量方法与血栓弹力描记法（FIBTEM）测量的最大凝块硬度（MCF）的相关性。
CPB 后和纤维蛋白原浓缩物给药后采集血样。使用旋转血栓弹性描记仪（ROTEM，Tem International）测量 FIBTEM MCF。使用光电（CA-7000，西门子医疗诊断）、机械（KC-10 钢球、Schnitger 和 Gross 钩、Amelung GmbH）和机电（STA-R，Diagnostica Stago）凝血仪测量纤维蛋白原浓度。评估包括纤维蛋白原浓度测量之间的一致性以及纤维蛋白原浓度与 FIBTEM MCF 之间的相关性。
CPB 后，钢球（r=0.71）、钩（r=0.73）、STA-R（r=0.81）和 CA-7000（r=0.82）凝血仪测定的 FIBTEM MCF 与纤维蛋白原浓度之间存在显著相关性（p<0.001）。纤维蛋白原浓缩物给药后，纤维蛋白原测定方法之间的一致性严重受损，与 FIBTEM MCF 的相关性分别为 0.39（钢球）、0.33（钩）、0.59（STA-R）和 0.33（CA-7000）。
纤维蛋白原浓缩物给药后，纤维蛋白原浓度测量方法之间的一致性显著下降。所有方法在 CPB 结束时与 FIBTEM MCF 均有良好的相关性，但在止血治疗后则不然。需要进一步研究以解释这些发现。
