Skip to main content

Dose-response of fibrinogen and factor XIII concentrate for correcting albumin-induced coagulopathy

Introduction

Natural colloid albumin induces a lesser degree of dilutional coagulopathy than synthetic colloids. Fibrinogen concentrate has emerged as a promising strategy to treat coagulopathy, and factor XIII (FXIII) works synergistically with fibrinogen to correct coagulopathy following haemodilution with crystalloids. Objectives were to examine the ability of fibrinogen and FXIII concentrates to reverse albumin-induced dilutional coagulopathy.

Methods

High and low concentrations of both fibrinogen and FXIII were used to reverse coagulopathy induced by 1:1 dilution in vitro with 5% albumin of blood samples from healthy volunteers, monitored by rotational thromboelastometry (ROTEM).

Results

Haemodilution with albumin significantly attenuated EXTEM maximum clot firmness (MCF), α angle (AA), clotting time (CT) and clot formation time (CFT), and FIBTEM MCF (P < 0.001). Following haemodilution, both doses of fibrinogen significantly corrected all ROTEM parameters (P ≤0.02), except the lower dose did not correct AA. Compared with the lower dose, the higher dose of fibrinogen significantly improved FIBTEM MCF and EXTEM MCF, AA and CFT (P < 0.001). The lower dose of FXIII did not significantly correct any of the ROTEM parameters, and the high dose only improved EXTEM CT (P = 0.004). All combinations of high/low concentrations of fibrinogen/ FXIII significantly improved all ROTEM parameters examined (P ≤0.001). Fibrinogen concentration generally had a greater effect on each parameter than did FXIII concentration; the best correction of ROTEM parameters was achieved with high-dose fibrinogen concentrate and either low-dose or high-dose FXIII.

Conclusion

Fibrinogen concentrate successfully corrected initiation, propagation and clot firmness deficits induced by haemodilution with albumin, and FXIII synergistically improved fibrin-based clot strength.

References

  1. 1.

    Anesth Analg. 2008, 106: 1360-1365. 10.1213/01.ane.0b013e3181684339

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to US Schött.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Schött, U., Winstedt, D. & Hanna, J. Dose-response of fibrinogen and factor XIII concentrate for correcting albumin-induced coagulopathy. Crit Care 17, P361 (2013). https://doi.org/10.1186/cc12299

Download citation

Keywords

  • Albumin
  • Fibrinogen
  • Clot Time
  • Factor Xiii
  • Fibrinogen Concentration