Influence of low frequency electric fields on anti- and pro-coagulability of the vascular endothelium: new insights into high-voltage electrical injury.
After high-voltage electric injury, patients often show tissue necrosis and thrombosis of blood vessels even remote from entry and exit site of electrical current. In this study, plasma levels of TAT, F(1+2), PAI-1, and t-PA were determined in vivo in three patients with high-voltage injury for 96 hours after trauma. In order to analyse a possible effect on haemostasis related to endothelial cell damage, protein S, TF, ET-1, PGI(2), NO, t-PA, and PAI-1 were determined for 72 hours in vitro in cell culture supernatant of HUVECs that had been exposed to 1, 10, 30, and 50 electric field periods of 50 Hz with field strength of 60 V/cm and duration of 20 ms. Furthermore, expression of thrombomodulin was immunohistochemically analysed. Clotting activation could be observed in our patients by increased levels of F(1+2) and TAT between 12 and 72 hours after injury, whereas fibrinolysis was disturbed due to high PAI-1. One patient presented thrombosis of vessels by day 3. In vitro, PAI-1 increased significantly (p<0.05) in medium of cells with an application of 30 and 50 periods between 2 and 48 hours. Between 4 and 72 hours, the concentration of t-PA was significantly lower (p<0.05) in the medium of HUVECs exposed to 10, 30, and 50 periods, whereas there was a significant increase (p<0.05) in the concentration of TF in the cell groups with an application of 30 and 50 periods. 24, 48, and 72 hours after injury, there was just weak or no staining for thrombomodulin in HUVECs with an application of 30 and 50 periods. The disturbed balance between clotting system and fibrinolysis seen in vitro after electric injury might explain the clinical observation of a progressive thrombosis of blood vessels after electric injury leading to tissue loss.
Ulrich
Dietmar
D
Department of Plastic Surgery and Hand Surgery--Burn Center, University Hospital, Aachen University of Technology, Germany. dietmar.ulrich@post.rwth-aachen.de
Pallua
Norbert
N
Lichtenegger
Franziska
F
Hafemann
Bernd
B
Silny
Jiri
J
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D002478:Cells, Cultured; D004556:Electric Injuries / Q000097:blood*; D004560:Electricity / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000166:cytology / Q000502:physiology*; D006801:Humans; D008297:Male; D018180:Thrombomodulin / Q000097:blood; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014471:Umbilical Veins / Q000166:cytology
D015415:Biomarkers; D018180:Thrombomodulin