Acquired Low Factor XIII Activity Is Associated with an Increased Need for Blood Transfusions in Patients with Gastrointestinal Bleedings

Abstract

Background: Factor XIII plays a key role within the coagulation cascade.

Objective: We aimed to investigate the relevance of factor XIII activity on the outcome of patients with gastrointestinal bleedings.

Methods: In this retrospective, single-center study patients with gastrointestinal bleeding and measurement of factor XIII activity were included. The primary endpoint was the number of red blood cell transfusions in patients with reduced factor XIII activity (< 70%) compared to patients with normal activity. Additionally, the influence of factor XIII substitution was assessed.

Results: Ninety-seven patients (median age: 64 [IQR 55, 77] years, 31 (32%) females) were included in the analysis. Fifty-six (58%) patients suffered from an upper gastrointestinal bleeding. 66 (68%) patients had a factor XIII activity < 70% and 24 (36%) of those received factor XIII substitution. Patients with reduced FXIII activity needed significantly more red blood cell transfusions than patients with normal activity (9 [5, 12] vs. 4 [1, 8], p < 0.001). Patients receiving factor XIII substitution showed a trend toward a decreased need for transfusions after substitution (0 [0, 5] vs. 3 [1, 6], p = 0.066). Factor XIII activity correlated negatively with the INR (r_s = -0.24, p = 0.018) and positively with hemoglobin levels (r_s = 0.28, p = 0.006) and with thrombocyte counts (r_s = 0.30, p = 0.003).

Conclusion: The present study shows an association of factor XIII activity with the requirement of blood transfusions in patients with gastrointestinal bleedings and indicates a potential benefit of factor XIII substitution. Factor XIII activity seems to be dependent from the amount of blood loss and the global coagulation parameters.

Keywords: FXIII; Factor XIII; GI bleeding; Gastrointestinal bleeding.