Whole blood thrombin generation is distinct from plasma thrombin generation in healthy volunteers and after severe injury.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
21
01
2019
revised:
16
05
2019
accepted:
03
07
2019
pubmed:
17
9
2019
medline:
25
2
2020
entrez:
17
9
2019
Statut:
ppublish
Résumé
Plasma thrombin generation has been used to characterize trauma-induced coagulopathy, but description of whole blood thrombin generation is lacking. This study aimed to evaluate plasma and whole blood thrombin generation in healthy volunteers and trauma patients. We hypothesized that (1) plasma and whole blood thrombin generation are distinct, (2) whole blood thrombin generation is more pronounced in trauma patients than in healthy volunteers, and (3) thrombin generation correlates with clinical coagulation assays. Blood was collected from healthy volunteers and trauma patients at a single, level-1 trauma center. Whole blood thrombin generation was assessed with a prototype point-of-care whole blood thrombin generation device, and plasma thrombin generation was measured with a calibrated automated thrombogram analogue. Plasma and whole blood thrombin generation were compared and correlated with international normalized ratio and thrombelastography. Overall, 10 healthy volunteers (average age 30, 50% men) were included and 58 trauma patients (average age 34, 76% men, 55% blunt mechanism, and with a median new injury severity score of 17) were included. Plasma and whole blood thrombin generation differed with more robust thrombin generation in plasma. Trauma patients had a significantly increased whole blood thrombin generation compared with healthy volunteers]. Plasma thrombin generation correlated with international normalized ratio, whereas whole blood thrombin generation did not correlate with thrombelastography. Plasma and whole blood thrombin generation are distinct, highlighting the need to perform standardized assays to better understand their correlation and to assess how whole blood thrombin generation confers differential outcomes in trauma.
Sections du résumé
BACKGROUND
Plasma thrombin generation has been used to characterize trauma-induced coagulopathy, but description of whole blood thrombin generation is lacking. This study aimed to evaluate plasma and whole blood thrombin generation in healthy volunteers and trauma patients. We hypothesized that (1) plasma and whole blood thrombin generation are distinct, (2) whole blood thrombin generation is more pronounced in trauma patients than in healthy volunteers, and (3) thrombin generation correlates with clinical coagulation assays.
METHODS
Blood was collected from healthy volunteers and trauma patients at a single, level-1 trauma center. Whole blood thrombin generation was assessed with a prototype point-of-care whole blood thrombin generation device, and plasma thrombin generation was measured with a calibrated automated thrombogram analogue. Plasma and whole blood thrombin generation were compared and correlated with international normalized ratio and thrombelastography.
RESULTS
Overall, 10 healthy volunteers (average age 30, 50% men) were included and 58 trauma patients (average age 34, 76% men, 55% blunt mechanism, and with a median new injury severity score of 17) were included. Plasma and whole blood thrombin generation differed with more robust thrombin generation in plasma. Trauma patients had a significantly increased whole blood thrombin generation compared with healthy volunteers]. Plasma thrombin generation correlated with international normalized ratio, whereas whole blood thrombin generation did not correlate with thrombelastography.
CONCLUSION
Plasma and whole blood thrombin generation are distinct, highlighting the need to perform standardized assays to better understand their correlation and to assess how whole blood thrombin generation confers differential outcomes in trauma.
Identifiants
pubmed: 31522748
pii: S0039-6060(19)30477-5
doi: 10.1016/j.surg.2019.07.014
pmc: PMC6861673
mid: NIHMS1536100
pii:
doi:
Substances chimiques
Thrombin
EC 3.4.21.5
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1122-1127Subventions
Organisme : NIGMS NIH HHS
ID : P50 GM049222
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM008315
Pays : United States
Organisme : NHLBI NIH HHS
ID : UM1 HL120877
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
Am J Surg. 2017 Dec;214(6):1041-1045
pubmed: 28969894
Anal Biochem. 2018 Jun 15;551:19-25
pubmed: 29746819
J Cell Biochem. 2015 Oct;116(10):2121-6
pubmed: 25800007
J Trauma Acute Care Surg. 2017 Sep;83(3):381-387
pubmed: 28362683
Thromb Haemost. 1999 Mar;81(3):400-6
pubmed: 10102469
J Trauma Acute Care Surg. 2014 Dec;77(6):839-45
pubmed: 25099452
Shock. 2016 Feb;45(2):166-73
pubmed: 26529664
Semin Thromb Hemost. 2016 Mar;42(2):155-65
pubmed: 26716498
Blood. 1996 Nov 1;88(9):3432-45
pubmed: 8896408
Ann Clin Lab Sci. 1999 Oct-Dec;29(4):275-80
pubmed: 10528826
Crit Care Clin. 2017 Jan;33(1):101-118
pubmed: 27894491
J Trauma. 1995 Feb;38(2):185-93
pubmed: 7869433
Thromb Haemost. 2001 Aug;86(2):660-7
pubmed: 11522019
J Trauma Acute Care Surg. 2015 Nov;79(5):726-31
pubmed: 26496097
Thromb Res. 2014 Oct;134(4):803-6
pubmed: 25087886
Thromb Res. 2016 Nov;147:13-15
pubmed: 27664391
Thromb Haemost. 2001 Jun;85(6):958-65
pubmed: 11434702
Clin Chem. 2012 Aug;58(8):1252-9
pubmed: 22665918
J Trauma Acute Care Surg. 2017 Jun;82(6):1073-1079
pubmed: 28328676
Thromb Res. 2013 May;131(5):377-82
pubmed: 23402970
Surgery. 2012 Jun;151(6):831-6
pubmed: 22316436
Thromb Res. 2009 Jul;124(3):281-7
pubmed: 19041119
Blood. 2012 Nov 1;120(18):3837-45
pubmed: 22968460