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Thromb Haemost 2010; 104(02): 385-391
DOI: 10.1160/TH09-12-0858
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

In vitro factor XIII supplementation increases clot firmness in Rotation Thromboelastometry (ROTEM®)

Oliver M. Theusinger   *
1   Institute of Anesthesiology, University Hospital Zurich, Switzerland
,
Werner Baulig   *
1   Institute of Anesthesiology, University Hospital Zurich, Switzerland
,
Lars M. Asmis
2   Clinic of Hematology, University Hospital Zurich, Switzerland
,
Burkhardt Seifert
3   Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
,
Donat R. Spahn
1   Institute of Anesthesiology, University Hospital Zurich, Switzerland
› Author Affiliations Financial support: This study was supported by departmental funds. Material was provided by Axon Lab AG, 5405 Baden-Dättwil, Switzerland and CSL Behring AG, 8048 Zürich, Switzerland.
Further Information

Publication History

Received: 23 December 2009

Accepted after major revision: 07 March 2010

Publication Date:
24 November 2017 (online)

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Summary

Factor XIII (F XIII) is an essential parameter for final clot stability. The purpose of this study was to determine the impact of the addition of factor (F)XIII on clot stability as assessed by Rotation Thromboelastometry (ROTEM®). In 90 intensive care patients ROTEM® measurements were performed after in vitro addition of F XIII 0.32 IU, 0.63 IU, 1.25 IU and compared to diluent controls (DC; aqua injectabile) resulting in approximate F XIII concentrations of 150, 300 and 600%. Baseline measurements without any additions were also performed. The following ROTEM® parameters were measured in FIBTEM and EXTEM tests: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis (ML), maximum clot elasticity (MCE) and α-angle (αA). Additionally, laboratory values for FXIII, fibrinogen (FBG), platelets and haematocrit were contemporaneously determined. In the perioperative patient population mean FBG concentration was elevated at 5.2 g/l and mean FXIII concentration was low at 62%. The addition of FXIII led to a FBG concentration-dependent increase in MCF both in FIBTEM and EXTEM. Mean increases in MCF (FXIII vs. DC) of approximately 7 mm and 6 mm were observed in FIBTEM and EXTEM, respectively. F XIII addition also led to decreased CFT, increased αA, and reduced ML in FIBTEM and EXTEM. In vitro supplementation of FXIII to supraphysiologic levels increases maximum clot firmness, accelerates clot formation and increases clot stability in EXTEM and FIBTEM as assayed by ROTEM® in perioperative patients with high fibrinogen and low FXIII levels.

Keywords

Thromboelastometry - blood coagulation - haemostasis - thromboelastography - factor XIII

* These authors contributed equally to this study.


 

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