Trauma induced hypercoagulablity in pediatric patients

Mark L. Ryan, Robert M. Van Haren, Chad M. Thorson, David M. Andrews, Eduardo A. Perez, Holly L. Neville, Juan E. Sola, Kenneth G. Proctor

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Purpose Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response. Methods A prospective observational study was conducted in hospitalized patients (age 8 months to 14 years) admitted for trauma or elective surgery. Informed consent was obtained from the parents and informed assent was obtained in patients 7 years of age or older. Coagulation changes were evaluated on fresh whole blood using thromboelastography (TEG) and on stored plasma using assays for special clotting factors. Results Forty three patients (22 trauma, median injury severity score = 9; and 21 uninjured controls) were evaluated. For trauma vs control, prothrombin time (PT) was higher by about 10% (p < 0.001), but activated partial thromboplastin time was not altered. TEG clotting time (R;p = 0.005) and fibrin cross-linking were markedly accelerated (K time, alpha angle; p < 0.001) relative to the control patients. d-Dimer, Prothrombin Fragment 1 + 2, and Plasminogen Activator Inhibitor-1 were all elevated, whereas Protein S activity was reduced (all p < 0.01). Importantly, a large fraction of TEG values and clotting factor assays in the pediatric control group were outside the published reference ranges for adults. Conclusion A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges.

Original languageEnglish (US)
Pages (from-to)1295-1299
Number of pages5
JournalJournal of Pediatric Surgery
Volume49
Issue number8
DOIs
StatePublished - Aug 2014
Externally publishedYes

Keywords

  • Coagulation
  • Pediatric
  • Thromboelastography
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'Trauma induced hypercoagulablity in pediatric patients'. Together they form a unique fingerprint.

  • Cite this

    Ryan, M. L., Van Haren, R. M., Thorson, C. M., Andrews, D. M., Perez, E. A., Neville, H. L., Sola, J. E., & Proctor, K. G. (2014). Trauma induced hypercoagulablity in pediatric patients. Journal of Pediatric Surgery, 49(8), 1295-1299. https://doi.org/10.1016/j.jpedsurg.2013.11.050