Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism

and the

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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.

Original languageEnglish (US)
Pages (from-to)42-51
Number of pages10
JournalJournal of the American College of Surgeons
Volume225
Issue number1
DOIs
StatePublished - Jul 1 2017

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Venous Thromboembolism
Recovery of Function
Wounds and Injuries
Blood Platelets
Thrombelastography
Thromboembolism
Arachidonic Acid
Adenosine Diphosphate
Anticoagulants
Collagen
Demography
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism. / and the.

In: Journal of the American College of Surgeons, Vol. 225, No. 1, 01.07.2017, p. 42-51.

Research output: Contribution to journalArticle

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title = "Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism",
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 = "{and the} and McCully, {Belinda H.} and Connelly, {Christopher R.} and Fair, {Kelly A.} and Holcomb, {John B.} and Fox, {Erin E.} and Wade, {Charles E.} and Bulger, {Eileen M.} and Schreiber, {Martin A.} and Holcomb, {John B.} and Wade, {Charles E.} and {del Junco}, {Deborah J.} and Fox, {Erin E.} and Nena Matijevic and Jeanette Podbielski and Beeler, {Angela M.} and Tilley, {Barbara C.} and Sarah Baraniuk and Joshua Nixon and Roann Seay and Appana, {Savitri N.} and Hui Yang and Gonzalez, {Michael O.} and Lisa Baer and {Willa Wang}, {Yao Wei} and Hula, {Brittany S.} and Elena Espino and An Nguyen and Nicholas Pawelczyk and Arora-Nutall, {Kisha D.} and Rishika Sharma and Cardenas, {Jessica C.} and Elaheh Rahbar and Tyrone Burnett and David Clark and {van Belle}, Gerald and Susanne May and Brian Leroux and David Hoyt and Judy Powell and Kellie Sheehan and Alan Hubbard and Arkin, {Adam P.} and Hess, {John R.} and Jeanne Callum and Cotton, {Bryan A.} and Laura Vincent and Timothy Welch and Tiffany Poole and Pivalizza, {Evan G.} and Terence OKeeffe",
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T1 - Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism

AU - and the

AU - McCully, Belinda H.

AU - Connelly, Christopher R.

AU - Fair, Kelly A.

AU - Holcomb, John B.

AU - Fox, Erin E.

AU - Wade, Charles E.

AU - Bulger, Eileen M.

AU - Schreiber, Martin A.

AU - Holcomb, John B.

AU - Wade, Charles E.

AU - del Junco, Deborah J.

AU - Fox, Erin E.

AU - Matijevic, Nena

AU - Podbielski, Jeanette

AU - Beeler, Angela M.

AU - Tilley, Barbara C.

AU - Baraniuk, Sarah

AU - Nixon, Joshua

AU - Seay, Roann

AU - Appana, Savitri N.

AU - Yang, Hui

AU - Gonzalez, Michael O.

AU - Baer, Lisa

AU - Willa Wang, Yao Wei

AU - Hula, Brittany S.

AU - Espino, Elena

AU - Nguyen, An

AU - Pawelczyk, Nicholas

AU - Arora-Nutall, Kisha D.

AU - Sharma, Rishika

AU - Cardenas, Jessica C.

AU - Rahbar, Elaheh

AU - Burnett, Tyrone

AU - Clark, David

AU - van Belle, Gerald

AU - May, Susanne

AU - Leroux, Brian

AU - Hoyt, David

AU - Powell, Judy

AU - Sheehan, Kellie

AU - Hubbard, Alan

AU - Arkin, Adam P.

AU - Hess, John R.

AU - Callum, Jeanne

AU - Cotton, Bryan A.

AU - Vincent, Laura

AU - Welch, Timothy

AU - Poole, Tiffany

AU - Pivalizza, Evan G.

AU - OKeeffe, Terence

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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.

AB - 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.

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