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A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentrate in cardiac surgery patients

Authors

  • Cristina Solomon,

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  • Janne Cadamuro,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Bernhard Ziegler,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Herbert Schöchl,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Michael Varvenne,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Benny Sørensen,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Gerald Hochleitner,

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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  • Niels Rahe-Meyer

    1. From the Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria; the Department of Anaesthesiology and Intensive Care Medicine and the Department of Haematology, Hannover Medical School, Hannover, Germany; the Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria; the Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; the Haemostasis Research Unit, Centre for Haemostasis and Thrombosis, Guy's and St Thomas NHS Foundation Trust and King's College London School of Medicine, London, United Kingdom; the Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Skejby, Denmark; CSL Behring, Vienna, Austria; and the Department of Anaesthesiology and Intensive Care Medicine, Franziskus Hospital, Bielefeld, Germany.
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Cristina Solomon, Department of Anaesthesiology and Intensive Care, Salzburger Landeskliniken SALK, 48 Müllner Hauptstrasse, 5020 Salzburg, Austria; e-mail: solomon.cristina@googlemail.com.

Abstract

BACKGROUND: Fibrinogen concentrate administration can be guided by measuring fibrinogen concentration or quality of the fibrin-based clot. This study compared different fibrinogen concentration measurement methods with maximum clot firmness (MCF) of the fibrin clot, assessed by thromboelastometry (FIBTEM), in 33 cardiovascular surgery patients receiving fibrinogen concentrate for hemostatic therapy.

STUDY DESIGN AND METHODS: Blood samples were collected after cardiopulmonary bypass (CPB) and after fibrinogen concentrate administration. FIBTEM MCF was measured using a rotational thromboelastometry device (ROTEM, Tem International). Fibrinogen concentration was measured using photo-optical (CA-7000, Siemens Healthcare Diagnostics), mechanical (KC-10 steel ball, Schnitger and Gross hook, Amelung GmbH), and electromechanical (STA-R, Diagnostica Stago) coagulometers. Assessments included agreement between fibrinogen concentration measurements and correlations between fibrinogen concentration and FIBTEM MCF.

RESULTS: After CPB, correlations were significant (p < 0.001) between FIBTEM MCF and fibrinogen concentration determined by steel ball (r = 0.71), hook (r = 0.73), STA-R (r = 0.81), and CA-7000 (r = 0.82) coagulometers. After fibrinogen concentrate administration, agreement between fibrinogen measurement methods was severely impaired, and correlations with FIBTEM MCF were 0.39 (steel ball), 0.33 (hook), 0.59 (STA-R), and 0.33 (CA-7000).

CONCLUSION: Agreement between fibrinogen concentration measurement methods decreased considerably after fibrinogen concentrate administration. All methods correlated acceptably with FIBTEM MCF at the end of CPB, but not after hemostatic therapy. Further investigation is needed to explain these findings.

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