See the published version of this preprint at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
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Original research
Tobias Koller
Hospital de la Santa Creu i Sant Pau
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6247-0193
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with the capability to restore coagulation could be a desirable future treatment component in massive transfusion.
Methods: Starting from a coagulation factor and blood cell-free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under the presence of platelets was performed for comparability to whole blood conditions.
Results: Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 minutes and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 minutes and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.
Conclusions: Combinations of coagulation factor concentrates suspended in albumin solutions can restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.
Trial registration: Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.
Keywords
Massive Bleeding, Blood Transfusion, Fibrinogen, Factor XIII, Prothrombin Complex Concentrate, Fluid Therapy, Hemostatic Resuscitation, Plasma Substitutes
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CURRENT STATUS: Published
View the published article at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
Version 2
Posted 04 Feb, 2021
No community comments so far
Editorial decision: Accept
On 14 Mar, 2021
Review #2 received
Received 10 Feb, 2021
Reviewer #2 agreed
On 06 Feb, 2021
Reviewers invited
Invitations sent on 03 Feb, 2021
Reviewer #1 agreed
On 03 Feb, 2021
Review #1 received
Received 03 Feb, 2021
Editor assigned
On 31 Jan, 2021
Submission checks complete
On 31 Jan, 2021
Editor invited
On 31 Jan, 2021
No comments provided
Editorial decision: Minor Revision
On 11 Jan, 2021
Review #1 received
Received 14 Dec, 2020
Review #2 received
Received 09 Dec, 2020
Reviewer #3 agreed
On 02 Dec, 2020
Reviewer #2 agreed
On 02 Dec, 2020
Reviewers invited
Invitations sent on 01 Dec, 2020
Reviewer #1 agreed
On 01 Dec, 2020
Editor assigned
On 27 Oct, 2020
Submission checks complete
On 26 Oct, 2020
Editor invited
On 26 Oct, 2020
First submitted
On 24 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original research
Tobias Koller
Hospital de la Santa Creu i Sant Pau
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6247-0193
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
Version 2
Posted 04 Feb, 2021
No community comments so far
Editorial decision: Accept
On 14 Mar, 2021
Review #2 received
Received 10 Feb, 2021
Reviewer #2 agreed
On 06 Feb, 2021
Reviewers invited
Invitations sent on 03 Feb, 2021
Reviewer #1 agreed
On 03 Feb, 2021
Review #1 received
Received 03 Feb, 2021
Editor assigned
On 31 Jan, 2021
Submission checks complete
On 31 Jan, 2021
Editor invited
On 31 Jan, 2021
No comments provided
Editorial decision: Minor Revision
On 11 Jan, 2021
Review #1 received
Received 14 Dec, 2020
Review #2 received
Received 09 Dec, 2020
Reviewer #3 agreed
On 02 Dec, 2020
Reviewer #2 agreed
On 02 Dec, 2020
Reviewers invited
Invitations sent on 01 Dec, 2020
Reviewer #1 agreed
On 01 Dec, 2020
Editor assigned
On 27 Oct, 2020
Submission checks complete
On 26 Oct, 2020
Editor invited
On 26 Oct, 2020
First submitted
On 24 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
Background: Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with the capability to restore coagulation could be a desirable future treatment component in massive transfusion.
Methods: Starting from a coagulation factor and blood cell-free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under the presence of platelets was performed for comparability to whole blood conditions.
Results: Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 minutes and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 minutes and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.
Conclusions: Combinations of coagulation factor concentrates suspended in albumin solutions can restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.
Trial registration: Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.
Figure 1
Figure 2
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