title: Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry.
abstract: OBJECTIVE
  Dilutional coagulopathy as a consequence of cardiopulmonary bypass (CPB) system priming may also be affected by the composition of the priming solution. The direct effects of distinct priming solutions on fibrinogen, one of the foremost limiting factors during dilutional coagulopathy, have been minimally evaluated. Therefore, the authors investigated whether hemodilution with different priming solutions distinctly affects the fibrinogen-mediated step in whole blood clot formation.
  
  
  METHODS
  Prospective observational laboratory study.
  
  
  METHODS
  University hospital laboratory.
  
  
  METHODS
  Eight male healthy volunteers.
  
  
  METHODS
  Blood samples diluted with gelatin-, albumin-, or hydroxyethyl starch (HES)-based priming solutions were ex-vivo evaluated for clot formation by rotational thromboelastometry.
  
  
  RESULTS
  The intrinsic pathway (INTEM) coagulation time increased from 186 +/- 19 seconds to 205 +/- 16, 220 +/- 17, and 223 +/- 18 seconds after dilution with gelatin-, albumin-, or HES-containing prime solutions (all p < 0.05 v baseline). The extrinsic pathway (EXTEM) coagulation time was only minimally affected by hemodilution. Moreover, all 3 priming solutions significantly reduced the INTEM and EXTEM maximum clot firmness. The HES-containing priming solution induced the largest decrease in the maximum clot firmness attributed to fibrinogen, from 13 +/- 1 mm (baseline) to 6 +/- 1 mm (p < 0.01 v baseline).
  
  
  CONCLUSIONS
  All studied priming solutions prolonged coagulation time and decreased clot formation, but the fibrinogen-limiting effect was the most profound for the HES-containing priming solution. These results suggest that the composition of priming solutions may distinctly affect blood clot formation, in particular with respect to the fibrinogen component in hemostasis.
authors.affiliation: Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Arinda C M
authors.initials: AC
authors.lastname: Brinkman
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Romijn
authors.forename: Lerau J M
authors.initials: LJ
authors.lastname: van Barneveld
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Greuters
authors.forename: Dennis
authors.initials: D
authors.lastname: Veerhoek
authors.forename: Alexander B A
authors.initials: AB
authors.lastname: Vonk
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004548:Elasticity; D005112:Extracorporeal Circulation; D005337:Fibrin / Q000502:physiology*; D005340:Fibrinogen / Q000378:metabolism; D005780:Gelatin / Q000627:therapeutic use; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D066298:In Vitro Techniques; D008297:Male; D019999:Pharmaceutical Solutions / Q000627:therapeutic use*; D010952:Plasma Substitutes / Q000627:therapeutic use; D011446:Prospective Studies; D012709:Serum Albumin / Q000627:therapeutic use; D013916:Thrombelastography; D014914:Whole Blood Coagulation Time
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D019999:Pharmaceutical Solutions; D010952:Plasma Substitutes; D012709:Serum Albumin; D005780:Gelatin; D005337:Fibrin; D005340:Fibrinogen