This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (38) Citing Articles via Google Scholar Google Scholar Articles by Kettner, S. C. Articles by Zimpfer, M. Search for Related Content PubMed PubMed Citation Articles by Kettner, S. C. Articles by Zimpfer, M.

---

CARDIOVASCULAR ANESTHESIA

Use of abciximab-Modified Thrombelastography in Patients Undergoing Cardiac Surgery

S. C. Kettner, MD^*,, O. P. Panzer, MD^*, S. A. Kozek, MD^*, F. A. Seibt, MD^*,, B. Stoiser, MD, J. Kofler, MD, G. J. Locker, MD, and M. Zimpfer, MD^*,

*Department of Anesthesiology and General Intensive Care and the Department of Internal Medicine I, University of Vienna, General Hospital Vienna; and Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna, Austria

Address correspondence and reprint requests to Stephan C. Kettner, MD, Department of Anesthesiology and General Intensive Care, General Hospital Vienna, 18-20 Währinger Gürtel, A-1090 Vienna, Austria. Address e-mail to stephan.kettner{at}akh-wien.ac.at

Thrombelastography (TEG) is a reliable coagulation monitoring system that can guide blood product transfusion in cardiac surgery. The maximum amplitude (MA) of TEG measures clot strength, which is dependent on both fibrinogen level and platelet function. Inhibition of platelet function with abciximab-fab is suggested to permit quantitative assessment of the contribution of fibrinogen to clot strength. We hypothesized that abciximab-modified TEG permits prediction of plasma fibrinogen levels and that the difference of standard MA and abciximab-modified MA (MA) is a correlate for platelet function. We correlated abciximab-modified MA with plasma fibrinogen levels and MA with platelet count in patients undergoing coronary revascularization. Correlation between plasma fibrinogen levels and abciximab-modified MA was significant (adjusted r²: 0.8; P < 0.0001). Correlation of MA with platelet count was not significant when calculated in millimeters (adjusted r²: 0.04; P = 0.73). However, when MA was calculated in dynes per square centimeter (GMA), it correlated significantly with platelet count (adjusted r²: 0.51;

P < 0.0001). We conclude that abciximab-modified TEG may therefore help to discriminate between hypofibrinogenemia and platelet dysfunction as a cause of decreased MA.

Implications: We examined the use of abciximab-modified thrombelastography in patients undergoing cardiac surgery. Modification of thrombelastography with abciximab-fab allows prediction of fibrinogen levels, despite coagulation altered by cardiac surgery. The difference of standard maximum amplitude and abciximab-modified maximum amplitude correlates with platelet function when expressed in dynes per square centimeter.

This article has been cited by other articles:

				C. Jambor, V. Reul, T. W. Schnider, P. Degiacomi, H. Metzner, and W. C. Korte In Vitro Inhibition of Factor XIII Retards Clot Formation, Reduces Clot Firmness, and Increases Fibrinolytic Effects in Whole Blood Anesth. Analg., October 1, 2009; 109(4): 1023 - 1028. [Abstract] [Full Text] [PDF]

				T. Lang, K. Johanning, H. Metzler, S. Piepenbrock, C. Solomon, N. Rahe-Meyer, and K. A. Tanaka The Effects of Fibrinogen Levels on Thromboelastometric Variables in the Presence of Thrombocytopenia Anesth. Analg., March 1, 2009; 108(3): 751 - 758. [Abstract] [Full Text] [PDF]

				M. T. Ganter and C. K. Hofer Coagulation Monitoring: Current Techniques and Clinical Use of Viscoelastic Point-of-Care Coagulation Devices Anesth. Analg., May 1, 2008; 106(5): 1366 - 1375. [Abstract] [Full Text] [PDF]

				D. Fries, A. Krismer, A. Klingler, W. Streif, G. Klima, V. Wenzel, T. Haas, and P. Innerhofer Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine model Br. J. Anaesth., August 1, 2005; 95(2): 172 - 177. [Abstract] [Full Text] [PDF]

				B. E. Miller, S. R. Tosone, N. A. Guzzetta, J. L. Miller, and K. K. Brosius Fibrinogen in Children Undergoing Cardiac Surgery: Is It Effective? Anesth. Analg., November 1, 2004; 99(5): 1341 - 1346. [Abstract] [Full Text] [PDF]

				V. G. Nielsen, W. Q. Gurley Jr, and T. M. Burch The Impact of Factor XIII on Coagulation Kinetics and Clot Strength Determined by Thrombelastography Anesth. Analg., July 1, 2004; 99(1): 120 - 123. [Abstract] [Full Text] [PDF]

				V. A. Bowbrick, D. P. Mikhailidis, and G. Stansby Value of Thromboelastography in the Assessment of Platelet Function Clinical and Applied Thrombosis/Hemostasis, April 1, 2003; 9(2): 137 - 142. [Abstract] [PDF]

				U. Cammerer, W. Dietrich, T. Rampf, S. L. Braun, and J. A. Richter The Predictive Value of Modified Computerized Thromboelastography and Platelet Function Analysis for Postoperative Blood Loss in Routine Cardiac Surgery Anesth. Analg., January 1, 2003; 96(1): 51 - 57. [Abstract] [Full Text] [PDF]

				J. D. Chaney, T. M. Adair, W. A. Lell, D. C. McGiffin, and V. G. Nielsen Hemostatic Analysis of a Patient with Hereditary Angioedema Undergoing Coronary Artery Bypass Grafting Anesth. Analg., December 1, 2001; 93(6): 1480 - 1482. [Abstract] [Full Text] [PDF]

				C. M. Samama Thromboelastography: The Next Step Anesth. Analg., March 1, 2001; 92(3): 563 - 564. [Full Text] [PDF]

				E. Mahla, T. Lang, M. N. Vicenzi, G. Werkgartner, R. Maier, C. Probst, and H. Metzler Thromboelastography for Monitoring Prolonged Hypercoagulability After Major Abdominal Surgery Anesth. Analg., March 1, 2001; 92(3): 572 - 577. [Abstract] [Full Text] [PDF]