Hypercoagulability in response to elevated body temperature and central hypovolemia

Martin A S Meyer, Sisse R. Ostrowski, Anders Overgaard, Matthew S. Ganio, Niels H. Secher, Craig G. Crandall, Pär I. Johansson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Coagulation abnormalities contribute to poor outcomes in critically ill patients. In trauma patients exposed to a hot environment, a systemic inflammatory response syndrome, elevated body temperature, and reduced central blood volume occur in parallel with changes in hemostasis and endothelial damage. The objective of this study was to evaluate whether experimentally elevated body temperature and reduced central blood volume (CBV) per se affects hemostasis and endothelial activation. Methods: Eleven healthy volunteers were subjected to heat stress, sufficient to elevate core temperature, and progressive reductions in CBV by lower body negative pressure (LBNP). Changes in hemostasis were evaluated by whole blood haemostatic assays, standard hematologic tests and by plasma biomarkers of coagulation and endothelial activation/disruption. Results: Elevated body temperature and decreased CBV resulted in coagulation activation evidenced by shortened activated partial tromboplastin time (-9% [IQR-7;-4]), thrombelastography: reduced reaction time (-15% [-24;-4]) and increased maximum amplitude (4% (2; 6)), all P < 0.05. Increased fibrinolysis was documented by elevation of D-dimer (+53% (12; 59), P = 0.016). Plasma adrenaline and noradrenaline increased 198% (83; 346) and 234% (174; 363) respectively (P = 0.006 and P = 0.003). Conclusions: This experiment revealed emerging hypercoagulability in response to elevated body temperature and decreased CBV, whereas no effect on the endothelium was observed. We hypothesize that elevated body temperature and reduced CBV contributes to hypercoagulability, possibly due to moderate sympathetic activation, in critically ill patients and speculate that normalization of body temperature and CBV may attenuate this hypercoagulable response.

Original languageEnglish (US)
JournalJournal of Surgical Research
Volume185
Issue number2
DOIs
StatePublished - Dec 2013

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Hypovolemia
Thrombophilia
Blood Volume
Body Temperature
Hemostasis
Critical Illness
Lower Body Negative Pressure
Thrombelastography
Systemic Inflammatory Response Syndrome
Hematologic Tests
Fibrinolysis
Hemostatics
Epinephrine
Endothelium
Norepinephrine
Healthy Volunteers
Hot Temperature
Biomarkers
Temperature
Wounds and Injuries

Keywords

  • Catecholamines
  • Central blood volume
  • Hyperthermia
  • Hypovolemia
  • LBNP
  • Sepsis
  • SIRS
  • TEG
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Meyer, M. A. S., Ostrowski, S. R., Overgaard, A., Ganio, M. S., Secher, N. H., Crandall, C. G., & Johansson, P. I. (2013). Hypercoagulability in response to elevated body temperature and central hypovolemia. Journal of Surgical Research, 185(2). https://doi.org/10.1016/j.jss.2013.06.012

Hypercoagulability in response to elevated body temperature and central hypovolemia. / Meyer, Martin A S; Ostrowski, Sisse R.; Overgaard, Anders; Ganio, Matthew S.; Secher, Niels H.; Crandall, Craig G.; Johansson, Pär I.

In: Journal of Surgical Research, Vol. 185, No. 2, 12.2013.

Research output: Contribution to journalArticle

Meyer, Martin A S ; Ostrowski, Sisse R. ; Overgaard, Anders ; Ganio, Matthew S. ; Secher, Niels H. ; Crandall, Craig G. ; Johansson, Pär I. / Hypercoagulability in response to elevated body temperature and central hypovolemia. In: Journal of Surgical Research. 2013 ; Vol. 185, No. 2.
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AU - Ostrowski, Sisse R.

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AU - Secher, Niels H.

AU - Crandall, Craig G.

AU - Johansson, Pär I.

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