title: Correction of hypothermic and dilutional coagulopathy with concentrates of fibrinogen and factor XIII: an in vitro study with ROTEM.
abstract: BACKGROUND
  Fibrinogen concentrate treatment can improve coagulation during massive traumatic bleeding. The aim of this in vitro study was to determine whether fibrinogen concentrate, or a combination of factor XIII and fibrinogen concentrates, could reverse a haemodilution-induced coagulopathy during hypothermia.
  
  
  METHODS
  Citrated venous blood from 10 healthy volunteers was diluted in vitro by 33% with 130/0.42 hydroxyethyl starch (HES) or Ringer's acetate (RAc). The effects of fibrinogen concentrate corresponding to 4 gram per 70 kg, or a combination of the same dose of fibrinogen with factor XIII (20 IU per kg), were measured using rotational thromboelastometry (ROTEM). The blood was analysed at 33°C or 37°C with ROTEM EXTEM and FIBTEM reagents. Clotting time (CT), clot formation time (CFT), alpha angle (AA) and maximal clot formation (MCF) were recorded.
  
  
  RESULTS
  Fibrinogen with or without factor XIII improved all ROTEM parameters in either solution irrespective of temperature, with the exception of EXTEM-AA and EXTEM-CFT in HES haemodilution. Fibrinogen increased FIBTEM-MCF more in the samples diluted with RAc than HES, particularly in presence of factor XIII.
  
  
  CONCLUSIONS
  Fibrinogen improved in vitro haemodilution-induced coagulopathy at both 33°C and 37°C, though more efficiently after crystalloid than HES haemodilution. Factor XIII had an additional effect on FIBTEM-MCF, but only after crystalloid dilution.
authors.affiliation: Faculty of Medicine, Lund University, Lund, Sweden. dag.winstedt@med.lu.se.|Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, 221 85, Sweden. dag.winstedt@med.lu.se.
authors.forename: Dag
authors.initials: D
authors.lastname: Winstedt
authors.affiliation: Faculty of Medicine, Lund University, Lund, Sweden. odt@cantab.net.|Department of Paediatric Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, 221 85, Sweden. odt@cantab.net.
authors.forename: Owain D
authors.initials: OD
authors.lastname: Thomas
authors.affiliation: Research and Development Centre, Skåne, Skåne University Hospital Lund, Lund, 221 85, Sweden. fredrik.x.nilsson@skane.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Nilsson
authors.affiliation: Faculty of Medicine, Lund University, Lund, Sweden. knut.olanders@skane.se.|Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, 221 85, Sweden. knut.olanders@skane.se.
authors.forename: Knut
authors.initials: K
authors.lastname: Olanders
authors.affiliation: Faculty of Medicine, Lund University, Lund, Sweden. ulf.schott@skane.se.|Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, 221 85, Sweden. ulf.schott@skane.se.
authors.forename: Ulf
authors.initials: U
authors.lastname: Schött
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D001780:Blood Coagulation Tests; D005176:Factor XIII / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D064368:Healthy Volunteers; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D007035:Hypothermia / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013916:Thrombelastography / Q000379:methods*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D005340:Fibrinogen; D005176:Factor XIII