Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study
1
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
2
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Donaueschingenstraße 13, 1200 Vienna, Austria
3
Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, Garnisonstrasse 7, 4010 Linz, Austria
4
Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
5
Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Doktor-Franz-Rehrl-Platz 5, 5010 Salzburg, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(12), 3805; https://doi.org/10.3390/jcm9123805
Received: 27 October 2020
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Revised: 23 November 2020
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Accepted: 24 November 2020
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Published: 25 November 2020
(This article belongs to the Special Issue Clinical Management of Major Bleeding and Coagulopathy Following Trauma)
Guidelines for the treatment of severe bleeding comprise viscoelastic-test-guided use of coagulation factor concentrates as part of their recommendations. The aim of this study is to investigate the effects of substituting fibrinogen, prothrombin complex concentrate, and a combination of both on conventional coagulation tests, viscoelastic test results, and thrombin generation. Blood was drawn from seven healthy volunteers to obtain platelet-free plasma, which later was diluted by replacing 40%, 60%, 80%, 90%, 95%, and 99% with a crystalloid solution. The diluted samples were spiked with fibrinogen concentrate, prothrombin complex concentrate, a combination of both, or a corresponding amount of crystalloid solution. Up to a dilution level of 95%, viscoelastically determined clotting time was significantly shorter in the group substituted with fibrinogen only in comparison with the additional use of prothrombin complex concentrate. Clot firmness and endogenous thrombin potential remained at relatively stable values up to a dilution level of 95% with the substitution of fibrinogen but not prothrombin complex concentrate. Substitution of prothrombin complex concentrate led to an excessive overshoot of thrombin generation. The results of our study question currently propagated treatment algorithms for bleeding patients that include the use of prothrombin complex concentrate for patients without former intake of oral anticoagulants. Even in severely bleeding patients, thrombin generation might be sufficient to achieve adequate hemostasis.
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Keywords:
coagulation; factor concentrates; hemorrhage; massive transfusion
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MDPI and ACS Style
Gratz, J.; Schlimp, C.J.; Honickel, M.; Hochhausen, N.; Schöchl, H.; Grottke, O. Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study. J. Clin. Med. 2020, 9, 3805. https://doi.org/10.3390/jcm9123805
AMA Style
Gratz J, Schlimp CJ, Honickel M, Hochhausen N, Schöchl H, Grottke O. Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study. Journal of Clinical Medicine. 2020; 9(12):3805. https://doi.org/10.3390/jcm9123805
Chicago/Turabian StyleGratz, Johannes, Christoph J. Schlimp, Markus Honickel, Nadine Hochhausen, Herbert Schöchl, and Oliver Grottke. 2020. "Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study" Journal of Clinical Medicine 9, no. 12: 3805. https://doi.org/10.3390/jcm9123805
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