Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism
We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk asse...
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| Veröffentlicht in: | The American surgeon 2015-07, Vol.81 (7), p.663-668 |
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| creator | Allen, Casey J Murray, Clark R Meizoso, Jonathan P Ray, Juliet J Teisch, Laura F Ruiz, Xiomara D Hanna, Mena M Guarch, Gerardo A Manning, Ronald J Livingstone, Alan S Ginzburg, Enrique Schulman, Carl I Namias, Nicholas Proctor, Kenneth G |
| description | We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients. |
| doi_str_mv | 10.1177/000313481508100713 |
| format | Article |
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A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481508100713</identifier><identifier>PMID: 26140884</identifier><language>eng</language><publisher>United States: SAGE PUBLICATIONS, INC</publisher><subject>Aged ; Blood Coagulation - physiology ; Blood platelets ; Blood Platelets - physiology ; Bone surgery ; Catheters ; Coagulation ; Female ; Humans ; Male ; Middle Aged ; Mortality ; Platelet Aggregation Inhibitors - therapeutic use ; Population ; Prospective Studies ; Risk Assessment ; Surveillance ; Thrombelastography ; Thromboembolism ; Trauma centers ; Traumatic brain injury ; Ultrasonic imaging ; Venous Thromboembolism - blood ; Venous Thromboembolism - prevention & control ; Wounds and Injuries - blood</subject><ispartof>The American surgeon, 2015-07, Vol.81 (7), p.663-668</ispartof><rights>Copyright Southeastern Surgical Congress Jul 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-87ab599f4f73d15fdcc544d727a71f9dc54e165220f9d9365784a7b414d5b2d83</citedby><cites>FETCH-LOGICAL-c375t-87ab599f4f73d15fdcc544d727a71f9dc54e165220f9d9365784a7b414d5b2d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26140884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Allen, Casey J</creatorcontrib><creatorcontrib>Murray, Clark R</creatorcontrib><creatorcontrib>Meizoso, Jonathan P</creatorcontrib><creatorcontrib>Ray, Juliet J</creatorcontrib><creatorcontrib>Teisch, Laura F</creatorcontrib><creatorcontrib>Ruiz, Xiomara D</creatorcontrib><creatorcontrib>Hanna, Mena M</creatorcontrib><creatorcontrib>Guarch, Gerardo A</creatorcontrib><creatorcontrib>Manning, Ronald J</creatorcontrib><creatorcontrib>Livingstone, Alan S</creatorcontrib><creatorcontrib>Ginzburg, Enrique</creatorcontrib><creatorcontrib>Schulman, Carl I</creatorcontrib><creatorcontrib>Namias, Nicholas</creatorcontrib><creatorcontrib>Proctor, Kenneth G</creatorcontrib><title>Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.</description><subject>Aged</subject><subject>Blood Coagulation - physiology</subject><subject>Blood platelets</subject><subject>Blood Platelets - physiology</subject><subject>Bone surgery</subject><subject>Catheters</subject><subject>Coagulation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Population</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Surveillance</subject><subject>Thrombelastography</subject><subject>Thromboembolism</subject><subject>Trauma centers</subject><subject>Traumatic brain injury</subject><subject>Ultrasonic imaging</subject><subject>Venous Thromboembolism - blood</subject><subject>Venous Thromboembolism - 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Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Allen, Casey J</au><au>Murray, Clark R</au><au>Meizoso, Jonathan P</au><au>Ray, Juliet J</au><au>Teisch, Laura F</au><au>Ruiz, Xiomara D</au><au>Hanna, Mena M</au><au>Guarch, Gerardo A</au><au>Manning, Ronald J</au><au>Livingstone, Alan S</au><au>Ginzburg, Enrique</au><au>Schulman, Carl I</au><au>Namias, Nicholas</au><au>Proctor, Kenneth G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2015-07</date><risdate>2015</risdate><volume>81</volume><issue>7</issue><spage>663</spage><epage>668</epage><pages>663-668</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.</abstract><cop>United States</cop><pub>SAGE PUBLICATIONS, INC</pub><pmid>26140884</pmid><doi>10.1177/000313481508100713</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The American surgeon, 2015-07, Vol.81 (7), p.663-668 |
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| subjects | Aged Blood Coagulation - physiology Blood platelets Blood Platelets - physiology Bone surgery Catheters Coagulation Female Humans Male Middle Aged Mortality Platelet Aggregation Inhibitors - therapeutic use Population Prospective Studies Risk Assessment Surveillance Thrombelastography Thromboembolism Trauma centers Traumatic brain injury Ultrasonic imaging Venous Thromboembolism - blood Venous Thromboembolism - prevention & control Wounds and Injuries - blood |
| title | Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism |
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