Abstract
Hemorrhagic coagulopathy (without neurological injuries) constitutes 40% of injury-related death in civilian hospitals and on the battlefield, and the underlying contributing mechanisms remain unclear. The purpose of this study is to investigate the effects of fibrinogen availability on coagulation function after hemorrhage in pigs. Sixteen crossbred commercial Yorkshire swine were randomized into the control group (group C) (n = 8) and hemorrhage group (group H) (n = 8). Hemorrhage was induced in group H by bleeding 35% of the estimated total blood volume, followed by resuscitation with lactated Ringer solution at three times the bled volume. Pigs in group C were not hemorrhaged or resuscitated. Blood samples were withdrawn at baseline, 15 min, 3 h, 6 h, and 24 h after hemorrhage and lactated Ringer (LR) resuscitation (H-LR). Coagulation was assessed by using thrombelastography. All baseline measurements were similar between groups C and H. Hemorrhage caused a decrease in mean arterial pressure and an increase in heart rate in group H, but LR resuscitation corrected these changes within 1 h. Compared to baseline values, fibrinogen concentrations in group H decreased at 15 min, 3 h and 6 h after H-LR, but increased to double that of the baseline value at 24 h; platelet counts decreased throughout the study; clot strength was decreased at 15 min, 3 h and 6 h, but returned to baseline value at 24 h after H-LR. Hemorrhage caused decreases in fibrinogen and platelets, and compromised clot strength. The rebound of fibrinogen at 24 h restored clot strength despite platelet deficit. These data suggest the potential compensatory role of fibrinogen in restoring coagulation function in vivo after hemorrhagic shock.
Highlights
Normal hemostasis involves complex interactions of fibrinogen, platelets, coagulation factors and enzymes
prothrombin time (PT), activated partial thromboplastin time (aPTT) and coagulation factors were measured with the blood coagulation system (BCS) (Dade Behring, Deerfield, IL, USA)
The statistically significant level was set at P < 0.05. All animals from both groups survived to the end of the study (24 h after H–lactated Ringer (LR))
Summary
Normal hemostasis involves complex interactions of fibrinogen, platelets, coagulation factors and enzymes. Following trauma injury and blood loss, all components involved in the coagulation process are depleted and further diluted by resuscitation of crystalloid or colloid fluids. In the United States, blood products, such as platelet concentrates, cryoprecipitate, or fresh frozen plasma have been used in patients with bleeding complications [3,4]. To observe the effects of fibrinogen on survival, Stinger et al performed a retrospective analysis in massive transfused trauma patients at a United States Army combat support hospital and reported that the amount of fibrinogen administered from transfused blood products correlates with survival [5].
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