NDLI: Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Collins, P. W. Solomon, C. Sutor, K. Crispin, D. Hochleitner, G. Rizoli, S. Schöchl, H. Schreiber, M. Ranucci, M.
Description	Country affiliation: United kingdom Author Affiliation: Collins PW ( School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK peter.collins@wales.nhs.uk.); Solomon C ( CSL Behring, Marburg, Germany Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria.); Sutor K ( Meridian HealthComms, Cheshire, UK.); Crispin D ( Meridian HealthComms, Cheshire, UK.); Hochleitner G ( CSL Behring, Vienna, Austria.); Rizoli S ( Department of Surgery and Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada.); Schöchl H ( Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, Austria Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.); Schreiber M ( Trauma, Critical Care and Acute Care Surgery Division, Oregon Health and Science University, Portland, OR, USA.); Ranucci M ( Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.)
Abstract	BACKGROUND: We aimed to create a theoretical tool to model the effect of three haemostatic agents containing fibrinogen (therapeutic plasma, cryoprecipitate, and fibrinogen concentrate) on the patient's plasma fibrinogen level. METHODS: A mathematical model was developed step-wise. The relationship between the amount of haemostatic agent and plasma fibrinogen level was plotted for each agent. A fibrinogen concentration simulator (FCS(amount)) was developed, where the amount of haemostatic agent was calculated from patient characteristics, agent characteristics, and target plasma fibrinogen level. Refinements were introduced so that (i) FCS(amount) would account for in vivo fibrinogen recovery, (ii) circulatory volume would not increase ad infinitum with increasing amounts, and (iii) red blood cells would be included in the simulation if haematocrit decreased below a certain level. A second FCS (FCS(level)) was created to calculate fibrinogen levels resulting from specified amounts of haemostatic agents. RESULTS: Fibrinogen concentration in haemostatic agents has a critical impact on their ability to increase patients' fibrinogen levels. If the target plasma fibrinogen level approaches the concentration of the fibrinogen source, the required amounts increase exponentially; it is impossible to achieve a target above the concentration of the fibrinogen source. CONCLUSIONS: We successfully developed two theoretical tools answering the questions: 'How much therapeutic plasma, cryoprecipitate, or fibrinogen concentrate would be needed to achieve a specified target fibrinogen level?' and 'What would be the resultant fibrinogen level for a specified amount of haemostatic agent?' The current tools are not intended for clinical application, but they are potentially useful for educational purposes.
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
DOI	10.1093/bja/aeu086
Journal	British Journal of Anaesthesia
Issue Number	4
Volume Number	113
Language	English
Publisher	Oxford University Press
Publisher Date	2014-10-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology Fibrinogen Therapeutic Use Hemostatics Plasma Blood Volume Body Height Physiology Computer Simulation Dose-response Relationship, Drug Erythrocytes Administration & Dosage Hematocrit Chemistry Models, Theoretical Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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