In Vitro Effects of Detergent Sclerosants on Clot Formation and Fibrinolysis

Abstract Objective To investigate the in vitro effects of detergent sclerosants sodium tetradecyl sulphate (STS) and polidocanol (POL) on clot formation and lysis. Materials and methods clot kinetics were assessed in whole blood by thromboelastography (TEG® ) and rotational thromboelastometry (ROTEM® ). Fibrinogen was measured by the Clauss method in plasma and factor XIII (FXIII) by enzyme-linked immunosorbent assay (ELISA). Turbidity measurements were used to assess clot lysis in plasma, and fibrinolysis in non-cross-linked and cross-linked fibrin. D-dimer was measured by VIDAS® , STA® Liatest® and AxSYM® assays. Results Strong clots were formed at low sclerosant concentrations (0.075–0.1%). At midrange concentrations (0.15% STS, 0.15–0.3% POL), both agents inhibited the contribution of platelets to clot firmness and formed weak clots prone to lysis. At higher concentrations (STS ≥0.3% and POL ≥0.6%), clot formation was inhibited. STS destroyed FXIII at ≥0.15% and fibrinogen at ≥0.6%. Neither sclerosant had a significant effect on cross-linked fibrin, but STS had a lytic effect on non-cross-linked fibrin. STS caused an artefactual elevation of D-dimer in the VIDAS® assay when fibrinogen was present. Conclusion Detergent sclerosants demonstrated a trimodal effect on clot formation, initiating strong clots at low concentrations, weak clots at midrange concentrations and preventing clot formation at higher concentrations. Neither agent had fibrinolytic activity.