title: Clotting factor XIII and desmopressin improve hemostasis in uncontrolled bleeding.
abstract: OBJECTIVE
  To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding.
  
  
  METHODS
  Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed.
  
  
  RESULTS
  Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM.
  
  
  CONCLUSIONS
  Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.
authors: Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors: Paulo Roberto Lima
authors: PR
authors: Carreiro
authors: St. Michael's Hospital, University of Toronto, ON, Canada.
authors: Joao Baptista de
authors: JB
authors: Rezende-Neto
authors: Department of Surgery, UFMG, Belo Horizonte, MG, Brazil.
authors: Thiago de Assis
authors: Tde A
authors: Lisboa
authors: Department of Internal Medicine, UFMG, Belo Horizonte, MG, Brazil.
authors: Daniel Dias
authors: DD
authors: Ribeiro
authors: Department of Morphology, UFMG, Belo Horizonte, MG, Brazil.
authors: Elizabeth Ribeiro da Silva
authors: ER
authors: Camargos
authors: St. Michael's Hospital, University of Toronto, ON, Canada.
authors: Marcus Vinicius de Melo
authors: MV
authors: Andrade
authors: St. Michael's Hospital, University of Toronto, ON, Canada.
authors: Sandro Baletotti
authors: SB
authors: Rizoli
authors: Department of Surgery, UFMG, Belo Horizonte, MG, Brazil.
authors: Jose Renan da Cunha
authors: JR
authors: Melo
mesh_terms: D000818:Animals; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005176:Factor XIII / Q000627:therapeutic use*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects*; D006490:Hemostatics / Q000627:therapeutic use*; D008297:Male; D008855:Microscopy, Electron, Scanning; D011817:Rabbits; D011897:Random Allocation; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D005176:Factor XIII; D003894:Deamino Arginine Vasopressin