Rosenthal C, Rau J, Volk T, Sander M, Ziemer S, Von Heymann C
Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany -
Minerva Anestesiol. 2014 Aug;80(8):894-903. Epub 2014 Jan 8.
Volume substitution using colloids and crystalloids dose-dependently induces dilutional coagulopathy. For treatment, fibrinogen concentrate and fresh frozen plasma are options, though the effective dosage of either agent is unclear. The objective of this study was to evaluate, whether high-dose fibrinogen or recommended doses of fresh frozen plasma are equally effective in reversing profound dilutional coagulopathy in vitro.
Blood samples of ten healthy volunteers were diluted by 60% with normal saline, balanced 4% gelatin, or balanced 6% hydroxyethyl starch 130/0.42, and supplemented with either 85mg/kg fibrinogen concentrate or 20mL/kg fresh frozen plasma. Conventional coagulation assays (prothrombin time, activated partial thromboplastin time, plasma fibrinogen, factors V and VIII), and activated rotational thromboelastometry (EXTEM: clotting time, clot formation time,
maximum clot firmness) were performed in all samples.
For saline and gelatin dilutions, plasma fibrinogen and thromboelastometry parameters normalized by fibrinogen concentrate, while conventional coagulation assays and factors V and VIII remained unaffectedly impaired. Fresh frozen plasma improved both conventional coagulation assays, coagulation factors, and thromboelastometry parameters in saline and gelatin dilutions. For hydroxyethyl starch dilutions, plasma fibrinogen increased by fresh frozen plasma, and even normalized by fibrinogen concentrate. Conventional coagulation assays and factors V and VIII improved by fresh frozen plasma only. Thromboelastometry parameters remained mainly unaffected impaired by both fibrinogen concentrate and fresh frozen plasma.
High-dose fibrinogen concentrate and clinically recommended doses of fresh frozen plasma are equally effective and can partially restore viscoelastic coagulation assays in profound saline and gelatin dilutions, but only fresh frozen plasma improves conventional coagulation assays. Hydroxyethyl starch-induced disturbance of fibrin polymerization is neither restored by fibrinogen concentrate nor fresh frozen plasma.
使用胶体和晶体进行容量替代会剂量依赖性地诱发稀释性凝血病。对于治疗而言，纤维蛋白原浓缩物和新鲜冰冻血浆是选择，但两种药物的有效剂量均不明确。本研究的目的是评估高剂量纤维蛋白原或推荐剂量的新鲜冰冻血浆在体外逆转严重稀释性凝血病方面是否同样有效。
采集10名健康志愿者的血样，用生理盐水、4%平衡型明胶或6%平衡型羟乙基淀粉130/0.42将其稀释60%，并补充85mg/kg纤维蛋白原浓缩物或20mL/kg新鲜冰冻血浆。对所有样本进行传统凝血试验（凝血酶原时间、活化部分凝血活酶时间、血浆纤维蛋白原、因子V和VIII）以及活化旋转血栓弹力图检测（EXTEM：凝血时间、凝块形成时间，FIBTEM：最大凝块硬度）。
对于生理盐水和明胶稀释液，纤维蛋白原浓缩物可使血浆纤维蛋白原和血栓弹力图参数恢复正常，而传统凝血试验以及因子V和VIII仍未受影响地受损。新鲜冰冻血浆改善了生理盐水和明胶稀释液中的传统凝血试验、凝血因子以及血栓弹力图参数。对于羟乙基淀粉稀释液，新鲜冰冻血浆可使血浆纤维蛋白原增加，纤维蛋白原浓缩物甚至可使其恢复正常。传统凝血试验以及因子V和VIII仅通过新鲜冰冻血浆得到改善。血栓弹力图参数主要仍未受纤维蛋白原浓缩物和新鲜冰冻血浆的影响而受损。
高剂量纤维蛋白原浓缩物和临床推荐剂量的新鲜冰冻血浆同样有效，并且在严重的生理盐水和明胶稀释中可部分恢复粘弹性凝血试验，但只有新鲜冰冻血浆能改善传统凝血试验。纤维蛋白原浓缩物和新鲜冰冻血浆均不能恢复羟乙基淀粉诱导的纤维蛋白聚合紊乱。
