Prothrombin complex concentrate reduces blood loss and enhances thrombin generation in a pig model with blunt liver injury under severe hypothermia

Markus Honickel; Annette Rieg; Rolf Rossaint; Till Braunschweig; Henri M. H. Spronk; Hugo ten Cate; Rene van Oerle; Rene Tolba; Oliver Grottke

doi:10.1160/TH11-02-0101

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(04): 724-733
DOI: 10.1160/TH11-02-0101

Animal Models

Schattauer GmbH

Prothrombin complex concentrate reduces blood loss and enhances thrombin generation in a pig model with blunt liver injury under severe hypothermia

Authors

Markus Honickel^*

¹Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
Annette Rieg^*

¹Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
Rolf Rossaint

¹Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
Till Braunschweig

²Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany
Henri M. H. Spronk

³Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
Hugo ten Cate

³Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
Rene van Oerle

³Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
Rene Tolba

⁴Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany
Oliver Grottke

¹Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany

⁴Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany

Abstract

Summary

Although prothrombin complex concentrate (PCC) is increasingly used for the treatment of trauma-induced coagulopathy, few studies have investigated the impact and safety of PCC for this indication. The present study was performed to assess PCC for treatment of coagulopathy after blunt liver injury under severe hypothermia. Coagulopathy in 14 anaesthetised pigs was induced by haemodilution. Subsequently, standardised blunt liver injury was induced under severe hypothermia (32.8–33.2°C). Animals were randomised to receive either PCC (35 IU kg^-1) or saline (control). Coagulation was assessed over the following 2 hours by thromboelastometry and thrombin generation. Internal organs were examined to determine presence of emboli. The administration of PCC showed a significant reduction in blood loss (p=0.002 vs. controls) and a significant increase in the rate of survival (p=0.022 vs. controls). Plasma thrombin generation in the PCC group increased considerably above baseline levels, with significant increases in peak thrombin levels and endogenous thrombin potential versus controls throughout the follow-up period. In addition, PT decreased significantly in the PCC group versus the control group. However, only slight improvements in thromboelastometry variables were observed. Histology showed an equal degree of liver injury in both groups, and no thromboembolism. In severely hypothermic pigs, the application of PCC corrected trauma-induced coagulopathy and reduced blood loss. Thus, the infusion of PCC might be a reasonable approach to reduce the need for blood cell transfusion in trauma. Furthermore, the impact and safety of PCC application can be monitored through thrombin generation and thromboelastometry under hypothermia.

Note: This study was performed at the RWTH Aachen University Hospital, Pauwelsstrasse 30, D-52074 Aachen, Germany.

Keywords

Haemostasis - shock - thromboelastometry - trauma - prothrombin complex concentrate (PCC) - thrombin generation

Full Text

References

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