TEG6s Platelet Mapping assay for the estimation of plasma fibrinogen concentration during cardiovascular surgery: a single-center prospective observational study

Yudai Yamamoto, Yunosuke Sato, Miri Takahashi, Hiroto Yamamoto, Mayumi Echizen, Tokujiro Uchida, Yudai Yamamoto, Yunosuke Sato, Miri Takahashi, Hiroto Yamamoto, Mayumi Echizen, Tokujiro Uchida

Abstract

Purpose: The Activator F (ActF) test on the TEG6s Platelet Mapping assay system is a means of quantifying blood viscoelasticity caused by fibrin network formation, triggered by reptilase and factor XIII, while platelets are inhibited. This unique methodology enables the measurement of blood viscoelasticity, even in highly heparinized blood. Here, we investigated whether fibrinogen concentration could be estimated using the ActF test in blood samples obtained during cardiopulmonary bypass (CPB) and after CPB in patients undergoing cardiovascular surgery.

Methods: We performed a single-center prospective observational study at a university hospital. Forty patients aged ≥ 18 years who underwent elective cardiovascular surgery with CPB were enrolled. Blood samples were drawn after the induction of anesthesia, after declamping of the aorta during CPB, and after the reversal of heparinization using protamine (after CPB). Coagulation profiles were evaluated using the Platelet Mapping assay and standard laboratory tests.

Results: There were strong correlations between the maximal amplitude of clot strength (MA) in the ActF test and fibrinogen concentration in samples drawn during CPB (R = 0.84, 95% confidence interval [CI] 0.72-0.91; P < 0.001) and after CPB (R = 0.83, 95% CI 0.70-0.91; P < 0.001). The areas under the receiver-operating characteristic curve for the ActF MA for fibrinogen concentrations < 150 mg/dL were 0.86 (95% CI 0.73-1.0) during CPB and 0.98 (95% CI 0.94-1.0) after CPB.

Conclusion: TEG6s Platelet Mapping ActF MA values strongly correlated with plasma fibrinogen concentration in highly heparinized blood during CPB and yielded highly accurate measurements of low fibrinogen concentrations.

Keywords: Activator F; Cardiopulmonary bypass; Fibrinogen; Platelet Mapping; Thromboelastography.

Conflict of interest statement

Tokujiro Uchida received an Investigator Initiated Research Grant (IIRG) from Haemonetics Japan GK.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Relationship between Platelet Mapping MAActF and plasma fibrinogen concentration. A During CPB (R = 0.84, 95% CI 0.72–0.91; P < 0.001). B After CPB (R = 0.83, 95% CI 0.70–0.91; P < 0.001). During CPB: samples were drawn after the declamping of the aorta during CPB; after CPB: after heparin reversal using protamine. ActF, activator F; CI, confidence interval; CPB, cardiopulmonary bypass; MA, maximum amplitude; R, Pearson’s correlation coefficient
Fig. 2
Fig. 2
Receiver-operating characteristic curve analysis of MAActF for the measurement of fibrinogen concentrations < 150 or 200 mg/dL during and after CPB. A During CPB (N = 40, number of samples with a fibrinogen concentration < 150 mg/dL = 9). The AUC was 0.86 (95% CI 0.73–1.0). The optimal cut-off value for MAActF was 4.5 mm, with a sensitivity of 89% and specificity of 100%. B After CPB (N = 40, number of samples with a fibrinogen concentration < 150 mg/dL = 5). The AUC was 0.98 (95% CI 0.94–1.0). The optimal cutoff value for MAActF was 5.1 mm, with a sensitivity of 89% and specificity of 100%. C During CPB (N = 40, number of samples with a fibrinogen concentration < 200 mg/dL = 34). The AUC was 0.99 (95% CI 0.95–1.0). The optimal cutoff value for MAActF was 10.5 mm, with a sensitivity of 100% and specificity of 97%. D After CPB (N = 40, number of samples with a fibrinogen concentration < 200 mg/dL = 29). The AUC was 0.85 (95% CI 0.70–0.99). The optimal cutoff value for MAActF was 8.5 mm, with a sensitivity of 73% and specificity of 79%. AUC, area under the curve; ActF, activator F; CI, confidence interval; CPB, cardiopulmonary bypass; MA, maximum amplitude
Fig. 3
Fig. 3
Relationships among MAActF, MACFF, and plasma fibrinogen concentration in samples drawn after CPB. A Comparison of MAActF with MACFF in the context of the relationship with plasma fibrinogen concentration. B Scatterplot showing the relationship between plasma fibrinogen concentration and the difference between MACFF and MAActF after CPB. The mean difference between MACFF and MAActF was 7.3 mm (95% CI 2.3–12.3 mm). After CPB, after heparin reversal using protamine; ActF, activator F; CI, confidence interval; CFF, functional fibrinogen assay as part of the Global Hemostasis assessment; CPB, cardiopulmonary bypass; MA, maximum amplitude; R, Pearson’s correlation coefficient
Fig. 4
Fig. 4
Relationships among MAActF during CPB, MAActF after CPB, and plasma fibrinogen concentration. A Scatter plot of MAActF during CPB and MAActF after CPB (R = 0.86, 95% CI 0.75–0.92; P < 0.001, N = 40). B Scatter plot of MAActF during CPB and plasma fibrinogen concentration after CPB (R = 0.78, 95% CI 0.62–0.88; P < 0.001, N = 40). During CPB: samples were drawn after the declamping of the aorta during CPB; after CPB: after heparin reversal using protamine. ActF, activator F; CI, confidence interval; CPB, cardiopulmonary bypass; MA, maximum amplitude; R, Pearson’s correlation coefficient

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