Issue Information

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F27283933%3A_____%2F17%3A00005387" target="_blank" >RIV/27283933:_____/17:00005387 - isvavai.cz</a>

Výsledek na webu

<a href="https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111/tme.12415" target="_blank" >https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111/tme.12415</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1111/tme.12415" target="_blank" >10.1111/tme.12415</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Issue Information

Popis výsledku v původním jazyce

Fibrinogen plays a key role in the management of major bleeding. The measurement of fibrinogen concentration in bleeding patients should be done as soon as possible (either in laboratory orusing viscoelastic tests, i.e. thromboelastometry/thromboelastography).The result is crucial in guiding the management of acute bleeding. The number of patients on new oral anticoagulants is increasing and they arein a risk of major bleeding. We would like to present a case report of a patienton dabigatran with massive gastrointestinal bleeding. A patient witha history of dabigatran anticoagula tion was admitted to our hospital with haemorrhagic shock. On admission she had extremely pr o-longed coagulation tests and fibrinogen concen tration was so low thatit could not be measured. ROTEM was also done, CT was extremelyprolonged in all tests including FIBTEM, w hich was also initially inter-preted as an extremely low A5 and A10 in both EXTEM and FIBTEMand treated as a major coagulopathy with fibrinogen deficiency. The patient received high doses of PCC (case occurred in March 2015)and fibrinogen supplementation. Due to an atypical ROTEM curve(extremely prolonged CT in FIBTEM which mimicked a severe fibrinogen deficit, but finally with a normal MCF - A10) we cooperated with the haematology laboratory and fibrinogen concentration wasmeasured again using an older labora tory method of derived fibrinogen. Fibrinogen concentration measured by this method was normal(2.5 g/L). Using the stan dard test for fibrinogen, which is done byClauss method, can lead to falsely low r esults in patients on dabigatran.The reason is that the Clauss method is based on conversion of fibrinogen to fibrin by exogenous thrombin. Inhibition of thrombin by dabigatran thus leads to an underestimation of fibrinogen. After this case wecompared fibrinogen by Clauss method and deriv ed fibrinogen in otherpatients on dabigatran and found that the diference between thes e twomethods is clinically significant in patients with higher concentrations ofdabigatran. The extent of underestimation depends on the method usedfor testing (concentration and type of thrombin can play a role) and it can vary between different laboratories. A potential underestimation of fibrinogen concentrationshould always be taken into consideration in patients treated with dabigatran. Cooperation with the haematology laboratory is crucial. The laboratory should be informed that the patient is/could be on dabigatran and use derived fibrinogen for the estimation of fibrinogencon-centration. False underestimation of fibrinogen can lead to unnecessary fibrinogen supplementation. Prolonged CT in FIBTEM can in thebeginning imitate low concentration of fibrinogen and interpretation ofROTEM curves should be done after the completion of the ROTEMcurve if possible.

Název v anglickém jazyce

Issue Information

Popis výsledku anglicky

Fibrinogen plays a key role in the management of major bleeding. The measurement of fibrinogen concentration in bleeding patients should be done as soon as possible (either in laboratory orusing viscoelastic tests, i.e. thromboelastometry/thromboelastography).The result is crucial in guiding the management of acute bleeding. The number of patients on new oral anticoagulants is increasing and they arein a risk of major bleeding. We would like to present a case report of a patienton dabigatran with massive gastrointestinal bleeding. A patient witha history of dabigatran anticoagula tion was admitted to our hospital with haemorrhagic shock. On admission she had extremely pr o-longed coagulation tests and fibrinogen concen tration was so low thatit could not be measured. ROTEM was also done, CT was extremelyprolonged in all tests including FIBTEM, w hich was also initially inter-preted as an extremely low A5 and A10 in both EXTEM and FIBTEMand treated as a major coagulopathy with fibrinogen deficiency. The patient received high doses of PCC (case occurred in March 2015)and fibrinogen supplementation. Due to an atypical ROTEM curve(extremely prolonged CT in FIBTEM which mimicked a severe fibrinogen deficit, but finally with a normal MCF - A10) we cooperated with the haematology laboratory and fibrinogen concentration wasmeasured again using an older labora tory method of derived fibrinogen. Fibrinogen concentration measured by this method was normal(2.5 g/L). Using the stan dard test for fibrinogen, which is done byClauss method, can lead to falsely low r esults in patients on dabigatran.The reason is that the Clauss method is based on conversion of fibrinogen to fibrin by exogenous thrombin. Inhibition of thrombin by dabigatran thus leads to an underestimation of fibrinogen. After this case wecompared fibrinogen by Clauss method and deriv ed fibrinogen in otherpatients on dabigatran and found that the diference between thes e twomethods is clinically significant in patients with higher concentrations ofdabigatran. The extent of underestimation depends on the method usedfor testing (concentration and type of thrombin can play a role) and it can vary between different laboratories. A potential underestimation of fibrinogen concentrationshould always be taken into consideration in patients treated with dabigatran. Cooperation with the haematology laboratory is crucial. The laboratory should be informed that the patient is/could be on dabigatran and use derived fibrinogen for the estimation of fibrinogencon-centration. False underestimation of fibrinogen can lead to unnecessary fibrinogen supplementation. Prolonged CT in FIBTEM can in thebeginning imitate low concentration of fibrinogen and interpretation ofROTEM curves should be done after the completion of the ROTEMcurve if possible.

Druh

D - Stať ve sborníku

CEP obor

—

OECD FORD obor

30230 - Other clinical medicine subjects

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2017

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název statě ve sborníku

Transfusion Medicine

ISBN

—

ISSN

0958-7578

e-ISSN

—

Počet stran výsledku

2

Strana od-do

1-2

Název nakladatele

Wiley

Místo vydání

Oxford

Místo konání akce

Florencie

Datum konání akce

1. 1. 2017

Typ akce podle státní příslušnosti

EUR - Evropská akce

Kód UT WoS článku

—