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In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma.

Publication ,  Journal Article
Rumph, B; Bolliger, D; Narang, N; Molinaro, RJ; Levy, JH; Szlam, F; Tanaka, KA
Published in: J Cardiothorac Vasc Anesth
June 2010

OBJECTIVE: The authors hypothesized that various hemostatic products may differently affect viscoelastic clot formation depending on their respective procoagulant activity and fibrinogen content. DESIGN: In vitro coagulopathy modeling using warfarin-treated plasma (international normalized ratio, 2.8-3.8) and fibrinogen-deficient plasma evaluated by rotational thromboelastometry (ROTEM; Pentapharm, Munich, Germany). SETTING: A university laboratory. INTERVENTION: Different volumes of cryoprecipitate, fresh frozen plasma (FFP), fibrinogen concentrate, and platelet concentrate were mixed with each abnormal plasma to simulate the in vivo transfusions of 250 mL to 1,000 mL. Three thromboelastometric variables that reflect the rate and extent of clot growth were measured: (1) coagulation time (CT), (2) angle, and (3) maximal clot firmness (MCF). MEASUREMENTS AND MAIN RESULTS: In warfarin-treated plasma, the addition of FFP, cryoprecipitate, and platelets led to a dose-dependent improvement of CT and angle, whereas MCF increased with cryoprecipitate or platelets only. The addition of fibrinogen concentrate improved MCF and angle but not CT. In fibrinogen-deficient plasma, the addition of cryoprecipitate, platelets, and fibrinogen concentrate led to a dose-dependent improvement of ROTEM variables, whereas the addition of FFP resulted in significantly longer CT and lower MCF values compared with other hemostatic products. The addition of platelets in the presence of cytochalasin D (a platelet inhibitor) resulted in improvements of ROTEM variables that were similar to when FFP was added to warfarin-treated and fibrinogen-deficient plasma. CONCLUSIONS: Cryoprecipitate supports clot formation on ROTEM more efficiently than FFP because of the high fibrinogen content. Improved ROTEM variables after platelet addition are presumably caused by increased interaction among thrombin-activated platelets and fibrinogen.

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

June 2010

Volume

24

Issue

3

Start / End Page

408 / 412

Location

United States

Related Subject Headings

  • Warfarin
  • Thrombelastography
  • Prothrombin
  • Plasma
  • In Vitro Techniques
  • Humans
  • Hemostasis
  • Dose-Response Relationship, Drug
  • Data Interpretation, Statistical
  • Blood Platelets
 

Citation

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Rumph, B., Bolliger, D., Narang, N., Molinaro, R. J., Levy, J. H., Szlam, F., & Tanaka, K. A. (2010). In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma. J Cardiothorac Vasc Anesth, 24(3), 408–412. https://doi.org/10.1053/j.jvca.2009.07.012
Rumph, Brady, Daniel Bolliger, Nikhil Narang, Ross J. Molinaro, Jerrold H. Levy, Fania Szlam, and Kenichi A. Tanaka. “In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma.J Cardiothorac Vasc Anesth 24, no. 3 (June 2010): 408–12. https://doi.org/10.1053/j.jvca.2009.07.012.
Rumph B, Bolliger D, Narang N, Molinaro RJ, Levy JH, Szlam F, et al. In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma. J Cardiothorac Vasc Anesth. 2010 Jun;24(3):408–12.
Rumph, Brady, et al. “In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma.J Cardiothorac Vasc Anesth, vol. 24, no. 3, June 2010, pp. 408–12. Pubmed, doi:10.1053/j.jvca.2009.07.012.
Rumph B, Bolliger D, Narang N, Molinaro RJ, Levy JH, Szlam F, Tanaka KA. In vitro comparative study of hemostatic components in warfarin-treated and fibrinogen-deficient plasma. J Cardiothorac Vasc Anesth. 2010 Jun;24(3):408–412.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

EISSN

1532-8422

Publication Date

June 2010

Volume

24

Issue

3

Start / End Page

408 / 412

Location

United States

Related Subject Headings

  • Warfarin
  • Thrombelastography
  • Prothrombin
  • Plasma
  • In Vitro Techniques
  • Humans
  • Hemostasis
  • Dose-Response Relationship, Drug
  • Data Interpretation, Statistical
  • Blood Platelets