title: Potential of whole blood coagulation reconstitution by desmopressin and fibrinogen under conditions of hypothermia and acidosis--an in vitro study using rotation thrombelastometry.
abstract: BACKGROUND
  Desmopressin (DDAVP) and fibrinogen improve platelet function and clot stability. We investigated the influence of DDAVP and fibrinogen on whole blood coagulation in an in vitro model of hypothermia and acidosis.
  
  
  METHODS
  After IRB approval and written consent blood samples were taken from 10 healthy volunteers. Samples were prepared with hydrochloric acid to maintain--beside normal pH--reduced pH (∼7.2) and severely reduced pH (∼7.0), and were assigned to four treatment groups: addition of either isotonic saline for compensation of dilutional effects (ISO), desmopressin (DDAVP+), fibrinogen (FIB+), or both substances (DDAVP+FIB+). Baseline was ISO at 37°C and normal pH. Remaining samples were incubated for 30 min and measured at 32°. Rotation thrombelastometry (ROTEM) after extrinsically activation and fibrin polymerization was tested. Repeated measures ANOVA were performed (p < 0.05).
  
  
  RESULTS
  Hypothermia and acidosis synergistically impaired whole blood coagulation. DDAVP+ normalized maximum clot firmness (MCF) at normal pH. Coagulation time (CT) was not affected. FIB+ normalized MCF at pH 7.35 and pH 7.2. CT was normalized independently of pH. DDAVP+FIB+ did not show additional effects to FIB+. Fibrin polymerization was increased by FIB+ and DDAVP+FIB+ independently of pH. DDAVP+ did not alter fibrin polymerization.
  
  
  CONCLUSIONS
  DDAVP and fibrinogen increased whole blood coagulation under hypothermia. Acidosis diminished this effect. Thus, acidosis should be corrected first and then both substances could be used for bridging until normothermia can be achieved. In combination, the effects of fibrinogen were overwhelming DDAVP effects. Thus, combined administration did not show any benefit compared to fibrinogen administration alone.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. hanke.alexander@mh-hannover.de
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Hanke
authors.forename: Christina
authors.initials: C
authors.lastname: Dellweg
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
authors.forename: Christian F
authors.initials: CF
authors.lastname: Weber
authors.forename: Björn
authors.initials: B
authors.lastname: Jüttner
authors.forename: Kai
authors.initials: K
authors.lastname: Johanning
authors.forename: Klaus
authors.initials: K
authors.lastname: Görlinger
authors.forename: Niels
authors.initials: N
authors.lastname: Rahe-Meyer
authors.forename: Peter
authors.initials: P
authors.lastname: Kienbaum
mesh_terms: D000138:Acidosis / Q000097:blood*; D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology*; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005340:Fibrinogen / Q000494:pharmacology*; D006801:Humans; D007035:Hypothermia / Q000097:blood*; D008297:Male; D055503:Protein Multimerization; D013916:Thrombelastography; D014914:Whole Blood Coagulation Time
chemical_list: D005337:Fibrin; D005340:Fibrinogen; D003894:Deamino Arginine Vasopressin