Quantification of hypercoagulable state after blunt trauma: Microparticle and thrombin generation are increased relative to injury severity, while standard markers are not
Quantification of hypercoagulable state after blunt trauma: Microparticle and thrombin generation are increased relative to injury severity, while standard markers are not
复制标题
DOI：
10.1016/j.surg.2011.12.022
复制
发表时间：
2012-06-01
期刊：
影响因子：
3.8
通讯作者：
Heit, John A.
中科院分区：
文献类型：
--
作者：
Park, Myung S.;Owen, Barbara A. L.;Heit, John A.
背景。重大创伤是发生静脉血栓栓塞的独立危险因素。虽然凝血酶生成和/或促凝微粒的增加已在其他静脉血栓栓塞风险较高的患者组（如癌症或冠状动脉疾病）中检测到，但这种关联尚未在创伤患者中得到证实。本初步研究的目的是表征和量化个体创伤后早期凝血酶的产生和血浆微粒。在创伤室采集52名钝性损伤患者（病例）和19名未受伤门诊患者（对照组）的血液，并将其处理成血小板缺乏的血浆，以便：(1)通过流式细胞术分离微粒进行鉴定和定量，(2)通过校准的自动血栓造影测量体外凝血酶生成。收集到的数据以平均值+/-标准差或四分位数范围的中位数表示。其中男性39例，女性13例（年龄40 +/- 17岁），损伤严重程度评分13 +/- 11分，国际标准化比值1.0 +/- 0.1分，凝血活素时间25 +/- 3秒，血小板计数238 +/- 62（千）。通过Annexin V染色测定的总促凝剂微粒数量（未指定细胞类型）比非创伤对照组增加（分别为541 +/- 139/ μ L和155 +/- 148/ μ L； P < .001）。与对照组相比，创伤患者凝血酶生成量无显著差异；凝血酶峰值与损伤严重程度相关（Spearman相关系数R为0.35;P = 0.02）。钝性创伤患者有更多的循环促凝微粒和体外凝血酶生成增加。未来对微颗粒细胞特异性特征和创伤损伤后凝血酶生成动力学变化的研究将确定微颗粒是否有助于损伤后观察到的高凝状态。(手术,2012;151:831-6)。
Background. Major trauma is an independent risk factor for developing venous thromboembolism. While increases in thrombin generation and/or procoagulant microparticles have been detected in other patient groups at greater risk for venous thromboembolism, such as cancer or coronary artery disease, this association has yet to be documented in trauma patients. This pilot study was designed to characterize and quantify thrombin generation and plasma microparticles in individuals early after traumatic injury.Methods. Blood was collected in the trauma bay from 52 blunt injured patients (cases) and 19 uninjured outpatients (controls) and processed to platelet poor plasma to allow for (1) isolation of microparticles for identification and quantification by flow cytometry, and (2) in vitro thrombin generation as measured by calibrated automatic thrombography. Data collected are expressed as either mean +/- standard deviation or median with interquartile range.Results. Among the cases, which included 39 men and 13 women (age, 40 +/- 17 years), the injury severity score was 13 +/- 11, the international normalized ratio was 1.0 +/- 0.1, the thromboplastin time was 25 +/- 3 seconds, and platelet count was 238 +/- 62 (thousands). The numbers of total (cell type not specified) procoagulant microparticles, as measured by Annexin V staining, were increased compared to nontrauma controls (541 +/- 139/mu L and 155 +/- 148/mu L, respectively; P < .001). There was no significant difference in the amount of thrombin generated in trauma patients compared to controls; however, peak thrombin was correlated to injury severity (Spearman correlation coefficient R, 0.35; P = .02).Conclusion. Patients with blunt trauma have greater numbers of circulating procoagulant microparticles and increased in vitro thrombin generation. Future studies to characterize the cell-specific profiles of microparticles and changes in thrombin generation kinetics after traumatic injury will determine whether microparticles contribute to the hypercoagulable state observed after injury. (Surgery, 2012;151:831-6.)