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Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)
BACKGROUND: Therapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and peri...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488284/ https://www.ncbi.nlm.nih.gov/pubmed/26121484 http://dx.doi.org/10.1371/journal.pone.0130402 |
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author | Thölking, Gerold Mesters, Rolf Dittrich, Ralf Pavenstädt, Hermann Kümpers, Philipp Reuter, Stefan |
author_facet | Thölking, Gerold Mesters, Rolf Dittrich, Ralf Pavenstädt, Hermann Kümpers, Philipp Reuter, Stefan |
author_sort | Thölking, Gerold |
collection | PubMed |
description | BACKGROUND: Therapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM). METHODOLOGY: Ten patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE. PRINCIPAL FINDINGS: TPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness. CONCLUSIONS/SIGNIFICANCE: TPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies. |
format | Online Article Text |
id | pubmed-4488284 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44882842015-07-02 Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) Thölking, Gerold Mesters, Rolf Dittrich, Ralf Pavenstädt, Hermann Kümpers, Philipp Reuter, Stefan PLoS One Research Article BACKGROUND: Therapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM). METHODOLOGY: Ten patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE. PRINCIPAL FINDINGS: TPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness. CONCLUSIONS/SIGNIFICANCE: TPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies. Public Library of Science 2015-06-29 /pmc/articles/PMC4488284/ /pubmed/26121484 http://dx.doi.org/10.1371/journal.pone.0130402 Text en © 2015 Thölking et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Thölking, Gerold Mesters, Rolf Dittrich, Ralf Pavenstädt, Hermann Kümpers, Philipp Reuter, Stefan Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title | Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title_full | Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title_fullStr | Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title_full_unstemmed | Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title_short | Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM) |
title_sort | assessment of hemostasis after plasma exchange using rotational thrombelastometry (rotem) |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488284/ https://www.ncbi.nlm.nih.gov/pubmed/26121484 http://dx.doi.org/10.1371/journal.pone.0130402 |
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