Faculty Collaboration Database

Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism. J Am Coll Surg 2017 Jul;225(1):42-51

Date

03/21/2017

Pubmed ID

28315812

Pubmed Central ID

PMC5592971

DOI

10.1016/j.jamcollsurg.2017.03.001

Scopus ID

2-s2.0-85017347587 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients.

STUDY DESIGN: Secondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value < 0.05 indicates significance.

RESULTS: Despite similar patient demographics, VTE patients exhibited hypercoagulable thromboelastography parameters and enhanced platelet function at admission (p < 0.05). Both groups exhibited hypocoagulable thromboelastography parameters, platelet dysfunction, and suppressed clot lysis (low clot lysis at 30 minutes) 2 hours after admission (p < 0.05). The VTE patients exhibited delayed coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05).

CONCLUSIONS: Recovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation.

Author List

McCully BH, Connelly CR, Fair KA, Holcomb JB, Fox EE, Wade CE, Bulger EM, Schreiber MA, PROPPR Study Group

Authors

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin
Olga Y. Kaslow MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anticoagulants
Blood Coagulation Disorders
Blood Coagulation Tests
Female
Humans
Injury Severity Score
Male
Middle Aged
Recovery of Function
Thrombelastography
Trauma Centers
Venous Thromboembolism
Wounds and Injuries