Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

Acta Cirurgica Brasileira

Paulo Roberto Lima Carreiro¹  Joao Baptista De Rezende-neto¹  Thiago De Assis Lisboa¹  Daniel Dias Ribeiro¹  Elizabeth Ribeiro Da Silva Camargos¹  Marcus Vinicius De Melo Andrade¹  Sandro Baletotti Rizoli¹  Jose Renan Da Cunha Melo¹ 

关键词: Hemorrhage;    Shock;    Resuscitation;    Factor XIII;    Deamino Arginine Vasopressin;    Rabbits;   

DOI  :  10.1590/S0102-865020150030000002

来源: SciELO

【 摘 要 】

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding.METHODS:Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed.RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM.CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.

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