title: Is dilutional coagulopathy induced by different colloids reversible by replacement of fibrinogen and factor XIII concentrates?
abstract: BACKGROUND
  In this in vitro trial, we assessed the effect on blood coagulation of 60% dilution with different colloids and investigated reversibility by replacement of factor XIII (F XIII), fibrinogen, and the combination of fibrinogen and F XIII.
  
  
  METHODS
  Using the blood of 12 volunteers, the following measurements were performed at baseline and after 60% dilution with (hydroxyethyl starch solutions) HES 130/0.42, gelatin, or balanced gelatin solution: blood gas analyses, coagulation factor concentrations (F I, F II, F VII, F VIII, F XIII), impedance aggregometry (Multiplate®), and rotational thromboelastometry (ROTEM). Then F XIII and fibrinogen as well as a combination of both were added, in concentrations corresponding to 6 g fibrinogen and 1250 IU F XIII in adults. ROTEM measurements and determination of factor concentrations were again performed.
  
  
  RESULTS
  Colloid dilution led to a significant reduction of fibrinogen polymerization, especially with HES. Platelet function was impaired by all colloids, with gelatin having a significantly greater effect (area under the curve, collagen Test, P ≤ 0.008) than HES and balanced gelatin solution. The substitution of F XIII only did not improve clot formation. Substitution of fibrinogen improved the polymerization of fibrinogen in dilutions with gelatin and balanced gelatin solution (P = 0.002), whereas HES-induced coagulopathy could not be corrected. The combination of fibrinogen and F XIII showed a better effect than the addition of fibrinogen only for certain variables.
  
  
  CONCLUSIONS
  Coagulation and platelet function are impaired by all 3 colloids. However, in vitro gelatin-induced coagulopathy was significantly more reversible than HES-induced coagulopathy.
authors.affiliation: From the *Institute of Anesthesiology and †Clinic of Cardiac and Vascular Surgery, University and University Hospital Zurich, Switzerland; ‡Department of Anesthesiology, Metro Health Medical Center, Cleveland, Ohio; and §Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Switzerland.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Kind
authors.forename: Gabriela H
authors.initials: GH
authors.lastname: Spahn-Nett
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eismon
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D001784:Blood Gas Analysis; D003102:Colloids / Q000737:chemistry*; D005176:Factor XIII / Q000494:pharmacology*; D005260:Female; D005340:Fibrinogen / Q000494:pharmacology*; D005780:Gelatin / Q000737:chemistry; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D013916:Thrombelastography / Q000379:methods
chemical_list: D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin; D005340:Fibrinogen; D005176:Factor XIII