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Effects of coagulation factor deficiency on plasma coagulation kinetics determined via thrombelastography®: critical roles of fibrinogen and factors II, VII, X and XII

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Abstract:

Background: 

Thrombelastography (TEG®) is used to assess coagulopathy. However, a comprehensive characterization of the effects of specific coagulation factor deficiencies and mode of activation on TEG® data does not exist. Methods: 

Thrombelastography® was performed for 15 min with control plasma and plasmas deficient (<1% activity) in Factors II, V, VII, VIII, IX, X, XI, XII, or XIII activated with celite (0.28 mg ml−1) or tissue factor (TF, 0.1%) (n = 6 per condition). Additional fibrinogen concentration activity (75–345 mg dl−1) and Factor II, VII, X and XII activity-response relationships (1%, 6.25%, 12.5%, 25%, 50% and 100% activity) were obtained (n = 8 per condition). Thrombelastography® parameters included reaction time (R), angle (α), and clot strength (A, amplitude; G, elastic modulus). Results: 

Celite activation of FXII-deficient plasma, TF activation of FVII-deficient and FX-deficient plasma, and celite or TF activation of FII-deficient plasma resulted in an almost undetectable clot. Compared to control values, celite activation of plasmas deficient in FXI, FIX and FVIII resulted in prolonged R and decreased α values, whereas TF activation resulted in decreased α values. Celite and TF activation of FV-deficient plasma resulted in prolonged R and decreased α values, whereas FXIII-deficient plasma had decreased α, A and G-values compared to control values. Conclusions: 

The fundamental finding of this study is that coagulation factor deficiencies affect TEG® parameters in both a factor-dependent and activation-dependent fashion. Utilizing both celite and TF activation improves the diagnostic power of TEG®. Based on such TEG® data, more targeted administration of blood products could potentially help improve perioperative hemostatic outcomes.

Keywords: Celite; coagulation factor deficiency; thrombelastography; tissue factor

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2005.00602.x

Affiliations: 1: Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL, and 2: Haemoscope Corporation, Niles, IL

Publication date: February 1, 2005

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