Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Donaueschingenstrasse 13, A-1200 Vienna, Austria.
Anesth Analg. 2013 Jul;117(1):23-9. doi: 10.1213/ANE.0b013e3182937b91. Epub 2013 Jun 3.
Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG(®)) or thromboelastometry (ROTEM(®)) measure the elasticity of extrinsically activated clotting under conditions of platelet inhibition. There are no reports on whether components of the FFPAs have any effects on fibrin polymerization, aside from the effects of platelet inhibition.
Using various platelet-free plasma (PFP) preparations, we compared the extrinsically activated EXTEM thromboelastometric assay with 3 FFPAs: FIBTEM, FIBTEM PLUS, and the Functional Fibrinogen Test(®) (FFTEG). These FFPAs activate coagulation extrinsically but additionally inhibit platelet function. We used calibration plasma (Instrumentation Laboratory and Siemens), pooled fresh-frozen plasma (Octaplas) and freshly prepared PFP from a healthy volunteer. EXTEM and all FFPAs were run in parallel on a ROTEM device.
Median (interquartile range) maximum clot firmness (MCF) values for all plasma preparations were: 20.5 mm (17.25-22.0 mm) in EXTEM, 23.0 mm (18.5-24.0 mm) in FIBTEM, 23.0 mm (18.25-24.75 mm) in FIBTEM PLUS, and 18.0 mm (16.0-19.0 mm) in FFTEG. Compared with EXTEM, FIBTEM and FIBTEM PLUS (P < 0.01) showed increased MCF values whereas FFTEG (P < 0.001) showed decreased MCF values. Further experiments in PFP showed that the platelet inhibitors used in the FFPAs (cytochalasin D or the glycoprotein-IIb/IIIa inhibitor abciximab) were not causing these alterations in MCF. However, reducing the activating tissue factor concentration (by diluting the extrinsic assay) decreased the MCF.
We speculate that FIBTEM and FIBTEM PLUS may contain stabilizing agents that enhance fibrin polymerization whereas FFTEG might contain less tissue factor than the ROTEM assays.
血栓弹力描记法（TEG(®)）或血栓弹力仪（ROTEM(®)）中的黏弹性测试，如功能性纤维蛋白原聚合测定（FFPA），可在血小板抑制的情况下测量外在激活的凝血的弹性。除了血小板抑制作用外，尚无关于这些 FFPA 成分对纤维蛋白聚合是否有任何影响的报道。
我们使用不同的无血小板血浆（PFP）制剂，比较了外在激活 EXTEM 血栓弹力测定与 3 种 FFPA：FIBTEM、FIBTEM PLUS 和功能性纤维蛋白原测试（FFTEG）。这些 FFPA 可在不抑制血小板功能的情况下，从外在途径激活凝血。我们使用校准血浆（Instrumentation Laboratory 和 Siemens）、混合新鲜冷冻血浆（Octaplas）和来自健康志愿者的新鲜制备的 PFP。在 ROTEM 仪器上同时运行 EXTEM 和所有 FFPA。
所有血浆制剂的最大凝块硬度（MCF）中位数（四分位距）值为：EXTEM 中为 20.5mm（17.25-22.0mm），FIBTEM 中为 23.0mm（18.5-24.0mm），FIBTEM PLUS 中为 23.0mm（18.25-24.75mm），FFTEG 中为 18.0mm（16.0-19.0mm）。与 EXTEM 相比，FIBTEM 和 FIBTEM PLUS（P<0.01）的 MCF 值升高，而 FFTEG（P<0.001）的 MCF 值降低。在 PFP 中的进一步实验表明，FFPA 中使用的血小板抑制剂（细胞松弛素 D 或糖蛋白 IIb/IIIa 抑制剂 abciximab）并未导致 MCF 的这些变化。然而，降低外在测定的组织因子浓度（通过稀释外在测定）会降低 MCF。
我们推测，FIBTEM 和 FIBTEM PLUS 可能含有增强纤维蛋白聚合的稳定剂，而 FFTEG 可能比 ROTEM 测定法含有更少的组织因子。
