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TECHNOLOGY, COMPUTING, AND SIMULATION

The Impact of Factor XIII on Coagulation Kinetics and Clot Strength Determined by Thrombelastography

Department of Anesthesiology, The University of Alabama at Birmingham

Address correspondence and reprint requests to Vance G. Nielsen, MD, Department of Anesthesiology, The University of Alabama at Birmingham, 619 S. 19th St., Birmingham, AL 35249-6810. Address e-mail to vance.nielsen{at}ccc.uab.edu

Fibrinogen has been shown to be responsible for most protein-mediated clot strength via thrombelastography. However, factor XIII (FXIII) activity also plays a prominent role in the development of clot strength. Thus, we hypothesized that changes in FXIII activity would significantly increase clot strength. FXIII (0%, 1%, 6.25%, 12.5%, 25%, 50%, and 100% normal activity) was placed in a fixed volume of citrated FXIII-deficient plasma with 1% tissue factor and calcium chloride and underwent thrombelastography for 10 min. We measured the variables reaction time (R; a measurement of clot initiation), (a measure of the rate of clot formation), amplitude (A; a measure of clot strength), and shear elastic modulus (G; a measure of clot strength). FXIII activity significantly decreased R in a pattern of exponential decay (R² = 0.77; P < 0.001). FXIII activity significantly increased , following a sigmoidal pattern (R² = 0.88; P < 0.001). Finally, increases in FXIII activity significantly increased A and G in a sigmoidal pattern (R² = 0.89; P < 0.001). We concluded that FXIII significantly affects R, alpha, A, and G. Thus, transfusion decision making with protein-mediated thrombelastographic patterns must account for the contribution of both fibrinogen and FXIII.

IMPLICATIONS: Changes in fibrinogen concentration have been implicated as the primary determinant of protein-mediated clot strength via thrombelastography. We determined that factor XIII (FXIII) activity significantly enhanced clot strength and speed of clot initiation and formation. Transfusion decision making with thrombelastography must account for the contribution of both fibrinogen and FXIII.

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