title: Effects of Fibrinogen Concentrate on Thrombin Generation, Thromboelastometry Parameters, and Laboratory Coagulation Testing in a 24-Hour Porcine Trauma Model.
abstract: BACKGROUND
  In a 24-hour porcine model of liver injury, we showed that fibrinogen supplementation does not downregulate endogenous fibrinogen synthesis. Here we report data from the same study showing the impact of fibrinogen on coagulation variables.
  
  
  METHODS
  Coagulopathy was induced in 20 German land race pigs by hemodilution and blunt liver injury. Animals randomly received fibrinogen concentrate (100 mg/kg) or saline. Coagulation parameters were assessed and thromboelastometry (ROTEM) was performed.
  
  
  RESULTS
  Fibrinogen concentrate significantly reduced the prolongations of EXTEM clotting time, EXTEM clot formation time, and prothrombin time induced by hemodilution and liver injury. A decrease in clot strength was also ameliorated. Endogenous thrombin potential was significantly higher in the fibrinogen group than in the control group, 20 minutes (353 ± 24 vs 289 ± 22 nmol/L·min; P < .05) and 100 minutes (315 ± 40 vs 263 ± 38 nmol/L·min; P < .05) after the start of infusion. However, no significant between-group differences were seen in other thrombin generation parameters or in d-dimer or thrombin-antithrombin levels. Fibrinogen-platelet binding was reduced following liver injury, with no significant differences between groups. No significant between-group differences were observed in any parameter at ∼12 and ∼24 hours.
  
  
  CONCLUSIONS
  This study suggests that, in trauma, fibrinogen supplementation may shorten some measurements of the speed of coagulation initiation and produce a short-lived increase in endogenous thrombin potential, potentially through increased clotting substrate availability. Approximately 12 and 24 hours after starting fibrinogen concentrate/saline infusion, all parameters measured in this study were comparable in the 2 study groups.
authors.affiliation: Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany.|Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Zentai
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria.|CSL Behring GmbH, Marburg, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.affiliation: Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Paola E J
authors.initials: PE
authors.lastname: van der Meijden
authors.affiliation: Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Henri M H
authors.initials: HM
authors.lastname: Spronk
authors.affiliation: Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schnabel
authors.affiliation: Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany ogrottke@ukaachen.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Grottke
mesh_terms: D000818:Animals; D001780:Blood Coagulation Tests / Q000379:methods*; D004195:Disease Models, Animal; D015536:Down-Regulation; D005340:Fibrinogen / Q000096:biosynthesis / Q000378:metabolism / Q000494:pharmacology*; D006438:Hemodilution; D006487:Hemostasis; D006801:Humans; D008099:Liver / Q000293:injuries; D008297:Male; D011897:Random Allocation; D013552:Swine; D013916:Thrombelastography / Q000379:methods*; D013917:Thrombin / Q000378:metabolism*; D014949:Wounds, Nonpenetrating / Q000097:blood*
chemical_list: D005340:Fibrinogen; D013917:Thrombin
keywords: bleeding; blood coagulation factors; hemostasis