title: Experimental model of hyperfibrinolysis designed for rotational thromboelastometry in children with congenital heart disease.
abstract: We assessed an in-vitro model of hyperfibrinolysis using rotational thromboelastometry (ROTEM) by the addition of increasing concentrations of tissue-type plasminogen activator (t-PA) on whole blood obtained from children undergoing cardiac surgery. We assessed the relevance of this model by repeating the tests in the same population after tranexamic acid (TXA) infusion. In addition, we determined the sensitivity and specificity of ROTEM parameters to detect the different degrees of fibrinolysis. Blood samples obtained from 20 children were analyzed at two predefined timepoints: after induction of anesthesia, before TXA (baseline), and at the end of surgery during TXA infusion (end surgery). At baseline, an extrinsic activation with tissue factor (EXTEM) test was performed without and with increasing concentration of t-PA (102, 255, 512, 1024, 1535, and 2539 units t-PA/ml). At the end of surgery, a second EXTEM test was performed without and with two different t-PA concentrations (1535 and 2539 units t-PA/ml). At baseline, increasing t-PA concentrations in the EXTEM test induced a gradual increase of hyperfibrinolysis characterized by a reduction in clot firmness and stability parameters. In the presence of TXA, t-PA-induced hyperfibrinolysis was completely abolished. Lysis-onset time (LOT) and degree of fibrinolysis measured at 30 min (LI30) best assessed the degree of fibrinolysis. This in-vitro model of t-PA-induced hyperfibrinolysis using the EXTEM test of ROTEM may represent a promising tool to assess hyperfibrinolysis in the pediatric population. In addition, we observed that LOT and LI30 should be considered as the best parameters to detect different degrees of fibrinolysis.
authors: aDepartment of Anesthesiology, Queen Fabiola Children's University Hospital, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium bDepartment of Anesthesia, Peri-operative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA cDepartment of Hematology and Hemostasis, Queen Fabiola Children's University Hospital, Brugmann University Hospital, Free University of Brussels dDepartment of Pediatric Intensive Care, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium.
authors: David
authors: D
authors: Faraoni
authors: Laurence
authors: L
authors: Rozen
authors: Ariane
authors: A
authors: Willems
authors: Cristel Sanchez
authors: CS
authors: Torres
authors: Luis M
authors: LM
authors: Pereira
authors: Anne
authors: A
authors: Demulder
authors: Philippe
authors: P
authors: Van der Linden
mesh_terms: D000933:Antifibrinolytic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005342:Fibrinolysis / Q000187:drug effects*; D006330:Heart Defects, Congenital / Q000097:blood* / Q000601:surgery; D006474:Hemorrhagic Disorders / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D066298:In Vitro Techniques; D007223:Infant; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013916:Thrombelastography / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D014148:Tranexamic Acid / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D010959:Tissue Plasminogen Activator