Abstract
PurposeThe Activator F (ActF) test on the TEG6s Platelet Mapping assay system is a means of quantifying blood viscoelasticity caused by fibrin network formation, triggered by reptilase and factor XIII, while platelets are inhibited. This unique methodology enables the measurement of blood viscoelasticity, even in highly heparinized blood. Here, we investigated whether fibrinogen concentration could be estimated using the ActF test in blood samples obtained during cardiopulmonary bypass (CPB) and after CPB in patients undergoing cardiovascular surgery.MethodsWe performed a single-center prospective observational study at a university hospital. Forty patients aged ≥ 18 years who underwent elective cardiovascular surgery with CPB were enrolled. Blood samples were drawn after the induction of anesthesia, after declamping of the aorta during CPB, and after the reversal of heparinization using protamine (after CPB). Coagulation profiles were evaluated using the Platelet Mapping assay and standard laboratory tests.ResultsThere were strong correlations between the maximal amplitude of clot strength (MA) in the ActF test and fibrinogen concentration in samples drawn during CPB (R = 0.84, 95% confidence interval [CI] 0.72–0.91; P < 0.001) and after CPB (R = 0.83, 95% CI 0.70–0.91; P < 0.001). The areas under the receiver-operating characteristic curve for the ActF MA for fibrinogen concentrations < 150 mg/dL were 0.86 (95% CI 0.73–1.0) during CPB and 0.98 (95% CI 0.94–1.0) after CPB.ConclusionTEG6s Platelet Mapping ActF MA values strongly correlated with plasma fibrinogen concentration in highly heparinized blood during CPB and yielded highly accurate measurements of low fibrinogen concentrations.
Highlights
Cardiovascular surgery with cardiopulmonary bypass (CPB) often results in a coagulopathy that is caused by hemodilution, the consumption of clotting factors, altered platelet function, and hypothermia [1,2,3]
Global Hemostasis was measured using the TEG6s in all 40 participants after CPB; we excluded one case in which the timing of sampling for the Global Hemostasis assessment was inappropriate for comparison with the results of the Platelet Mapping assessment. MAActF results were obtained for 110/120 measurements within 10 min from the start of measurement
We have shown that Platelet Mapping assays are useful for the estimation of plasma fibrinogen concentration during CPB and after protamine administration. MAActF was strongly correlated with plasma fibrinogen, even in highly heparinized samples
Summary
Cardiovascular surgery with cardiopulmonary bypass (CPB) often results in a coagulopathy that is caused by hemodilution, the consumption of clotting factors, altered platelet function, and hypothermia [1,2,3]. Coagulation management using viscoelastic hemostatic assays has been shown to reduce the volume of blood requiring transfusion during cardiovascular surgery and is recommended in published. Some reports have shown that blood transfusion algorithms involving viscoelastic hemostatic assays during CPB reduce the amount of transfused blood, suggesting that viscoelastic hemostatic assays are clinically useful during CPB [20, 21]. Coagulation parameters of highly heparinized samples cannot be measured using the Global Hemostasis assay, a coagulation test performed on the TEG6s using kaolin and tissue factor as reagents [23], and it is difficult to assess the blood coagulation profile of patients before heparin neutralization during cardiovascular surgery with CPB using this assay system
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