Effects of fibrinogen concentrate after shock/resuscitation: a comparison between in vivo microvascular clot formation and thromboelastometry.

Martini J, Cabrales P, Fries D, Intaglietta M, Tsai AG
Crit Care Med 2013;41:e301-308.
NATA Rating :
Review by : J. Stensballe
NATA Review

Martini et al. confirm in an animal hamster model our knowledge that hydroxyethyl starch can induce coagulopathy, but validate nicely that fibrinogen administration can normalize the colloid-induced coagulopathy, as measured by microthrombus formation.

Microvessels of Syrian Golden hamsters were studied using videomicroscopy. After 50% haemorrhage of blood volume, the animals were resuscitated with hydroxyethyl starch (Hextend, Hospira) substituting 35% of blood volume. Animals were then treated with 250 mg/kg fibrinogen or placebo before venular vessel wall injuries were made by directed laser irradiation.

The study nicely validates that microthrombus formation can be seen after fibrinogen reversal of colloid-induced coagulopathy. Interestingly, this finding also correlates well with viscoelastic hemostatic measurements. Severe limitations exist regarding translation of animal findings to humans, related particularly to the very high dosing of fibrinogen, the small sample size and animal size. Hopefully, this interesting in vivo model will be brought into human research.

– Jabob Stensballe