Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time

Myung S. Park, Wenjun Z. Martini, Michael A. Dubick, Jose Salinas, Saulius Butenas, Bijan S. Kheirabadi, Anthony E. Pusateri, Jeffrey A. Vos, Charles H. Guymon, Steven E. Wolf, Kenneth G. Mann, John B. Holcomb

Research output: Contribution to journalArticle

215 Citations (Scopus)

Abstract

OBJECTIVES: To investigate the hemostatic status of critically ill, nonbleeding trauma patients. We hypothesized that a hypercoagulable state exists in patients early after severe injury and that the pattern of clotting and fibrinolysis are similar between burned and nonburn trauma patients. MATERIALS: Patients admitted to the surgical or burn intensive care unit within 24 hours after injury were enrolled. Blood samples were drawn on days 0 through 7. Laboratory tests included prothrombin time (PT), activated partial thromboplastin time (aPTT), levels of activated factor XI, D-dimer, protein C percent activity, antithrombin III percent activity, and thromboelastography (TEG). RESULTS: Study subjects were enrolled from April 1, 2004, to May 31, 2005, and included nonburn trauma patients (n = 33), burned patients (n = 25), and healthy (control) subjects (n = 20). Despite aggressive thromboprophylaxis, three subjects (2 burned and 1 nonburn trauma patients [6%]) had pulmonary embolism during hospitalization. Compared with controls, all patients had prolonged PT and aPTT (p < 0.05). The rate of clot formation (α angle) and maximal clot strength were higher for patients compared with those of controls (p < 0.05), indicating a hypercoagulable state. Injured patients also had lower protein C and antithrombin III percent activities and higher fibrinogen levels (p < 0.05 for all). Activated factor XI was elevated in 38% of patients (control subjects had undetectable levels). DISCUSSION: Thromboelastography analysis of whole blood showed that patients were in a hypercoagulable state; this was not detected by plasma PT or aPTT. The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved.

Original languageEnglish (US)
Pages (from-to)266-275
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume67
Issue number2
DOIs
StatePublished - Aug 2009

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Thrombelastography
Partial Thromboplastin Time
Prothrombin Time
Wounds and Injuries
Factor XIa
Antithrombin III
Protein C
Pulmonary Embolism
Fibrinolysis
Hemostatics
Critical Illness
Fibrinogen
Intensive Care Units
Healthy Volunteers

Keywords

  • Deep vein thrombosis
  • Pulmonary embolism
  • Thromboelastograph

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. / Park, Myung S.; Martini, Wenjun Z.; Dubick, Michael A.; Salinas, Jose; Butenas, Saulius; Kheirabadi, Bijan S.; Pusateri, Anthony E.; Vos, Jeffrey A.; Guymon, Charles H.; Wolf, Steven E.; Mann, Kenneth G.; Holcomb, John B.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 67, No. 2, 08.2009, p. 266-275.

Research output: Contribution to journalArticle

Park, MS, Martini, WZ, Dubick, MA, Salinas, J, Butenas, S, Kheirabadi, BS, Pusateri, AE, Vos, JA, Guymon, CH, Wolf, SE, Mann, KG & Holcomb, JB 2009, 'Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time', Journal of Trauma - Injury, Infection and Critical Care, vol. 67, no. 2, pp. 266-275. https://doi.org/10.1097/TA.0b013e3181ae6f1c
Park, Myung S. ; Martini, Wenjun Z. ; Dubick, Michael A. ; Salinas, Jose ; Butenas, Saulius ; Kheirabadi, Bijan S. ; Pusateri, Anthony E. ; Vos, Jeffrey A. ; Guymon, Charles H. ; Wolf, Steven E. ; Mann, Kenneth G. ; Holcomb, John B. / Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 67, No. 2. pp. 266-275.
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AU - Martini, Wenjun Z.

AU - Dubick, Michael A.

AU - Salinas, Jose

AU - Butenas, Saulius

AU - Kheirabadi, Bijan S.

AU - Pusateri, Anthony E.

AU - Vos, Jeffrey A.

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AB - OBJECTIVES: To investigate the hemostatic status of critically ill, nonbleeding trauma patients. We hypothesized that a hypercoagulable state exists in patients early after severe injury and that the pattern of clotting and fibrinolysis are similar between burned and nonburn trauma patients. MATERIALS: Patients admitted to the surgical or burn intensive care unit within 24 hours after injury were enrolled. Blood samples were drawn on days 0 through 7. Laboratory tests included prothrombin time (PT), activated partial thromboplastin time (aPTT), levels of activated factor XI, D-dimer, protein C percent activity, antithrombin III percent activity, and thromboelastography (TEG). RESULTS: Study subjects were enrolled from April 1, 2004, to May 31, 2005, and included nonburn trauma patients (n = 33), burned patients (n = 25), and healthy (control) subjects (n = 20). Despite aggressive thromboprophylaxis, three subjects (2 burned and 1 nonburn trauma patients [6%]) had pulmonary embolism during hospitalization. Compared with controls, all patients had prolonged PT and aPTT (p < 0.05). The rate of clot formation (α angle) and maximal clot strength were higher for patients compared with those of controls (p < 0.05), indicating a hypercoagulable state. Injured patients also had lower protein C and antithrombin III percent activities and higher fibrinogen levels (p < 0.05 for all). Activated factor XI was elevated in 38% of patients (control subjects had undetectable levels). DISCUSSION: Thromboelastography analysis of whole blood showed that patients were in a hypercoagulable state; this was not detected by plasma PT or aPTT. The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved.

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