Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Thrombosis Research Group, Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre and Leeds Institute for Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
J Thromb Haemost. 2015 Dec;13(12):2192-201. doi: 10.1111/jth.13167. Epub 2015 Nov 20.
Optimal hemostatic management during orthotopic liver transplantation (OLT) remains a challenge. The cause of bleeding during OLT is multifactorial, and may include hemostatic imbalance. Fibrinogen concentrates are increasingly being used to control perioperative bleeding during OLT. However, administration is based on arbitrary thresholds of fibrinogen levels. Importantly, studies on fibrin clot structure during OLT are lacking.
We determined the hemostatic efficacy of fibrinogen concentrate in correcting the fibrin structure.
Plasma samples taken at various times during OLT from 15 patients and 15 healthy controls were spiked with 1 g L(-1) fibrinogen concentrate or saline. Turbidity, fibrin fiber density and permeability of the fibrin clots were assessed.
Clotting rate and turbidity were significantly decreased at the start of surgery, and decreased even further during surgery. Addition of fibrinogen significantly increased the clotting rate and turbidity at all time points, but did not normalize it. Fibrin density was significantly reduced after reperfusion as compared with the density at the start of surgery and in healthy controls. Fibrin density improved significantly after addition of fibrinogen in samples taken at the start of surgery and after reperfusion. The severely impaired polymerization and decreased density after reperfusion were accompanied by significantly increased permeability of the clot as compared with the start of surgery and in controls, which was completely restored after addition of fibrinogen.
Ex vivo addition of fibrinogen concentrate during OLT substantially improves the structural properties of the fibrin clot, which, particularly after reperfusion, shows hypocoagulable features. These data support the use of fibrinogen concentrate to control bleeding complications during OLT.
原位肝移植（OLT）期间的最佳止血管理仍然是一个挑战。OLT 期间出血的原因是多因素的，可能包括止血失衡。纤维蛋白原浓缩物越来越多地被用于控制 OLT 围手术期出血。然而，给药是基于纤维蛋白原水平的任意阈值。重要的是，缺乏关于 OLT 期间纤维蛋白凝块结构的研究。
我们确定纤维蛋白原浓缩物在纠正纤维蛋白结构方面的止血效果。
从 15 名患者和 15 名健康对照者在 OLT 过程中的不同时间点采集血浆样本，并用 1 g/L 纤维蛋白原浓缩物或生理盐水进行处理。评估浊度、纤维蛋白纤维密度和纤维蛋白凝块的通透性。
手术开始时凝血率和浊度显著降低，手术过程中进一步降低。添加纤维蛋白原显著增加了所有时间点的凝血率和浊度，但并未使其正常化。与手术开始时和健康对照组相比，再灌注后纤维蛋白密度显著降低。与手术开始时和对照组相比，再灌注后严重受损的聚合和纤维蛋白密度降低伴随着纤维蛋白凝块的通透性显著增加，添加纤维蛋白原后完全恢复。
OLT 过程中体外添加纤维蛋白原浓缩物可显著改善纤维蛋白凝块的结构特性，尤其是再灌注后，表现出低凝特性。这些数据支持使用纤维蛋白原浓缩物来控制 OLT 期间的出血并发症。
