FUNCTIONAL FIBRINOGEN ASSAY INDICATES THAT FIBRINOGEN IS CRITICAL IN CORRECTING ABNORMAL CLOT STRENGTH FOLLOWING TRAUMA
FUNCTIONAL FIBRINOGEN ASSAY INDICATES THAT FIBRINOGEN IS CRITICAL IN CORRECTING ABNORMAL CLOT STRENGTH FOLLOWING TRAUMA
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DOI：
10.1097/shk.0b013e3182787122
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发表时间：
2013-01-01
期刊：
影响因子：
3.1
通讯作者：
Silliman, Christopher C.
中科院分区：
文献类型：
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作者：
Harr, Jeffrey N.;Moore, Ernest E.;Silliman, Christopher C.
血栓弹力图 (TEG) 正在成为治疗受伤患者急性凝血病的标准。尽管 TEG 在检测凝块强度异常方面很敏感，但其缺点之一是区分纤维蛋白原和血小板对凝块完整性的贡献。目前的美国算法建议输注血小板，而欧洲指南则建议浓缩纤维蛋白原来纠正低凝块强度。因此，我们假设基于 TEG 的功能性纤维蛋白原 (FF) 测定将评估纤维蛋白原和血小板对凝血强度的贡献，并为输血优先事项提供见解。血液样本是从到达急诊科或入住外科重症监护病房的创伤患者身上采集的（n = 68）。测量了柠檬酸高岭土 TEG、FF 和冯·克劳斯纤维蛋白原水平（基于血浆的临床标准）。使用线性回归模型评估相关性。还进行了体外研究，将纤维蛋白原浓缩物添加到从健康志愿者（n = 10）收集的血液中。测量了功能性纤维蛋白原和柠檬酸高岭土的 TEG 参数。功能性纤维蛋白原与冯·克劳斯纤维蛋白原水平 (R-2 = 0.87) 和凝块强度 (R-2 = 0.80) 密切相关。纤维蛋白原对血块强度的平均贡献为 30%；然而，与纤维蛋白原水平和纤维蛋白原对凝块强度的贡献百分比存在直接的线性关系（R-2 = 0.83）。与纤维蛋白原活性相关的传统 TEG 参数（角度和动力学时间）与 FF 的相关性显着较低（R-2 = 0.70 和 0.35）。此外，血小板计数与凝块强度仅有中等相关性（R-2 = 0.51）。在体外研究中添加纤维蛋白原浓缩物可增加血栓强度 (MA)（60.44 +/- 1.48 至 68.12 +/- 1.39）以及纤维蛋白原对血栓强度的贡献百分比（23.8% +/- 1.8% 至 37.7% +/- 2.5%）。功能性纤维蛋白原可以使用 TEG 快速进行，并且与标准冯·克劳斯纤维蛋白原测定具有良好的相关性。纤维蛋白原和血小板对血块强度的贡献都可以从 FF 中得出。此外，FF 与凝块强度具有更强的相关性，并且水平的增加与对凝块强度的贡献百分比的增加直接相关。体外研究还表明，添加纤维蛋白原浓缩物后，FF、凝块强度以及纤维蛋白原对凝块强度的贡献百分比有所增加。这些数据表明，对于表现出急性创伤凝血病的创伤患者，应尽早解决纤维蛋白原问题。
Thromboelastography (TEG) is emerging as the standard in the management of acute coagulopathies in injured patients. Although TEG is sensitive in detecting abnormalities in clot strength, one shortcoming is differentiating between fibrinogen and platelet contributions to clot integrity. Current American algorithms suggest platelet transfusion, whereas European guidelines suggest fibrinogen concentrates for correcting low clot strength. Therefore, we hypothesized that a TEG-based functional fibrinogen (FF) assay would assess the contribution of fibrinogen and platelets to clot strength and provide insight to transfusion priorities. Blood samples were obtained from trauma patients on arrival to the emergency department or who were admitted to the surgical intensive care unit (n = 68). Citrated kaolin TEG, FF, and von Clauss fibrinogen levels (plasma-based clinical standard) were measured. Correlations were assessed using linear regression models. In vitro studies were also performed with adding fibrinogen concentrates to blood collected from healthy volunteers (n = 10). Functional fibrinogen and citrated kaolin TEG parameters were measured. Functional fibrinogen strongly correlated with von Clauss fibrinogen levels (R-2 = 0.87) and clot strength (R-2 = 0.80). The mean fibrinogen contribution to clot strength was 30%; however, there was a direct linear relationship with fibrinogen level and percent fibrinogen contribution to clot strength (R-2 = 0.83). Traditional TEG parameters associated with fibrinogen activity (a angle and kinetic time) had significantly lower correlations with FF (R-2 = 0.70 and 0.35). Furthermore, platelet count had only a moderate correlation to clot strength (R-2 = 0.51). The addition of fibrinogen concentrate in in vitro studies increased clot strength (MA) (60.44 +/- 1.48 to 68.12 +/- 1.39) and percent fibrinogen contribution to clot strength (23.8% +/- 1.8% to 37.7% +/- 2.5%). Functional fibrinogen can be performed rapidly with TEG and correlates well with the standard von Clauss fibrinogen assay. Both fibrinogen and platelet contribution of clot strength can be derived from FF. Moreover, FF had a stronger correlation to clot strength, and increased levels were directly associated with increased percent contribution to clot strength. In vitro studies also demonstrated an increase in FF, clot strength, and percent fibrinogen contribution to clot strength with the addition of fibrinogen concentrate. These data suggest that fibrinogen should be addressed early in trauma patients manifesting acute coagulopathy of trauma.