Cellular microparticle and thrombogram phenotypes in the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study: Correlation with coagulopathy
Cellular microparticle and thrombogram phenotypes in the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study: Correlation with coagulopathy
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DOI：
10.1016/j.thromres.2014.07.023
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发表时间：
2014-09-01
影响因子：
7.5
通讯作者：
Cohen, Mitchell Jay
中科院分区：
文献类型：
--
作者：
Matijevic, Nena;Wang, Yao-Wei W.;Cohen, Mitchell Jay
背景：严重创伤后创伤诱导的凝血功能障碍与出血和死亡率增加有关。损伤可能导致细胞表型改变和细胞源性微粒（MP）的释放。循环MP是促凝血剂并支持凝血酶生成（TG）和凝血。我们评估了MP和TG表型严重受伤的患者入院时，凝血功能障碍和bleeding.Methods：作为前瞻性观察多中心重大创伤输血（PROMMTT）研究的一部分，研究血液样本从180创伤患者需要输血在5个参与中心。对25名健康对照和40名轻伤患者进行了分析比较。凝血功能障碍的实验室标准为活化部分凝血活酶时间（APTT）≥ 35秒。通过校准的自动血栓图分析样品以评估TG，并通过流式细胞术分析MP表型[血小板（PMP）、红细胞（RMP）、白细胞（LMP）、内皮细胞（EMP）、组织因子（TFMP）和膜联蛋白V阳性（AVMP）]。21.7%的患者为凝血病，中位（IQR）APTT为44秒（37，53），损伤严重程度评分为26（17，35）。与对照组相比，患者EMP、RMP、LMP和TFMP升高（均p < 0.001），TG升高（p < 0.0001）。然而，与非凝血病患者相比，凝血病PROMMTT患者具有显著较低的PMP、TFMP和TG，较高的大量出血和较高的死亡率（均p < 0.001）。与非凝血病患者相比，凝血病与较低的凝血酶峰值和速率相关，而较低水平的TF携带PMP与大量出血相关。(C)2014爱思唯尔有限公司版权所有。
Background: Trauma-induced coagulopathy following severe injury is associated with increased bleeding and mortality. Injury may result in alteration of cellular phenotypes and release of cell-derived microparticles (MP). Circulating MPs are procoagulant and support thrombin generation (TG) and clotting. We evaluated MP and TG phenotypes in severely injured patients at admission, in relation to coagulopathy and bleeding.Methods: As part of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, research blood samples were obtained from 180 trauma patients requiring transfusions at 5 participating centers. Twenty five healthy controls and 40 minimally injured patients were analyzed for comparisons. Laboratory criteria for coagulopathy was activated partial thromboplastin time (APTT) >= 35 sec. Samples were analyzed by Calibrated Automated Thrombogram to assess TG, and by flow cytometry for MP phenotypes [platelet (PMP), erythrocyte (RMP), leukocyte (LMP), endothelial (EMP), tissue factor (TFMP), and Annexin V positive (AVMP)].Results: 21.7% of patients were coagulopathic with the median (IQR) APTT of 44 sec (37, 53), and an Injury Severity Score of 26 (17, 35). Compared to controls, patients had elevated EMP, RMP, LMP, and TFMP (all p < 0.001), and enhanced TG (p < 0.0001). However, coagulopathic PROMMTT patients had significantly lower PMP, TFMP, and TG, higher substantial bleeding, and higher mortality compared to non-coagulopathic patients (all p < 0.001).Conclusions: Cellular activation and enhanced TG are predominant after trauma and independent of injury severity. Coagulopathy was associated with lower thrombin peak and rate compared to non-coagulopathic patients, while lower levels of TF-bearing PMPs were associated with substantial bleeding. (C) 2014 Elsevier Ltd. All rights reserved.