Caroline Shams Hakimi1, Inger Fagerberg Blixter2, Emma C Hansson3, Camilla Hesse4, Håkan Wallén5, Anders Jeppsson6. 1. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden. Electronic address: caroline.hakimi@gmail.com. 2. Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden. Electronic address: inger.fagerberg.blixter@vgregion.se. 3. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden. Electronic address: emma.hansson@vgregion.se. 4. Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden. Electronic address: camilla.hesse@biomedlab.gu.se. 5. Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden. Electronic address: hakan.wallen@ds.se. 6. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden(3). Electronic address: anders.jeppsson@vgregion.se.
Abstract
INTRODUCTION: Bleeding after cardiac surgery may be caused by surgical factors, impaired haemostasis, or a combination of both. Transfusion of blood products is used to improve haemostasis, but little is known about what combination is optimal. We hypothesized that addition of both fibrinogen and platelets to blood samples from cardiac surgery patients would improve clot formation and platelet aggregation to a greater extent than if the components were added separately. MATERIALS AND METHODS: Increasing doses of fibrinogen concentrate (+0.5, 1.0, and 1.5 g · l(-1)) and/or platelet concentrate (+46, 92, and 138 × 10(9) platelets l(-1)) were added to postoperative blood samples from 15 cardiac surgery patients. Clot formation was assessed with rotational thromboelastometry and platelet aggregation was assessed with multiple-electrode aggregometry before and after addition of the blood products. The effects of the different additives were compared. RESULTS AND CONCLUSIONS: Ex vivo supplementation with fibrinogen or platelet concentrate resulted in significantly shortened clotting time and improved clot strength in a dose-dependent manner. Combination of fibrinogen and platelets further improved the clotting time and strength. Platelet supplementation enhanced platelet aggregation in a dose-dependent manner while fibrinogen had no or reducing effect. Combining fibrinogen and platelets improved platelet aggregation less than the use of platelets alone. In conclusion, combined platelet and fibrinogen supplementation of blood samples from cardiac surgery patients had an additive effect on clot formation compared to the individual components, but it resulted in less platelet aggregation than with platelet supplementation alone. These results may have implications for clinical transfusion protocols.
INTRODUCTION: Bleeding after cardiac surgery may be caused by surgical factors, impaired haemostasis, or a combination of both. Transfusion of blood products is used to improve haemostasis, but little is known about what combination is optimal. We hypothesized that addition of both fibrinogen and platelets to blood samples from cardiac surgery patients would improve clot formation and platelet aggregation to a greater extent than if the components were added separately. MATERIALS AND METHODS: Increasing doses of fibrinogen concentrate (+0.5, 1.0, and 1.5 g · l(-1)) and/or platelet concentrate (+46, 92, and 138 × 10(9) platelets l(-1)) were added to postoperative blood samples from 15 cardiac surgery patients. Clot formation was assessed with rotational thromboelastometry and platelet aggregation was assessed with multiple-electrode aggregometry before and after addition of the blood products. The effects of the different additives were compared. RESULTS AND CONCLUSIONS: Ex vivo supplementation with fibrinogen or platelet concentrate resulted in significantly shortened clotting time and improved clot strength in a dose-dependent manner. Combination of fibrinogen and platelets further improved the clotting time and strength. Platelet supplementation enhanced platelet aggregation in a dose-dependent manner while fibrinogen had no or reducing effect. Combining fibrinogen and platelets improved platelet aggregation less than the use of platelets alone. In conclusion, combined platelet and fibrinogen supplementation of blood samples from cardiac surgery patients had an additive effect on clot formation compared to the individual components, but it resulted in less platelet aggregation than with platelet supplementation alone. These results may have implications for clinical transfusion protocols.
Authors: Conrad Lacom; Alexander Tolios; Markus W Löffler; Beate Eichelberger; Peter Quehenberger; Eva Schaden; Marion Wiegele Journal: Biochem Med (Zagreb) Date: 2022-06-15 Impact factor: 2.515
Authors: Dag Winstedt; Owain D Thomas; Fredrik Nilsson; Knut Olanders; Ulf Schött Journal: Scand J Trauma Resusc Emerg Med Date: 2014-12-16 Impact factor: 2.953