Different recovery profiles of coagulation factors, thrombin generation, and coagulation function after hemorrhagic shock in pigs.
BACKGROUND
Hemorrhagic shock contributes to coagulopathy after trauma. We investigated daily changes of coagulation components and coagulation function for 5 days in hemorrhaged and resuscitated pigs.


METHODS
Fourteen pigs were randomized into the sham control (C) and the hemorrhage and lactated Ringer's resuscitation (H-LR) groups. On day 1, hemorrhage was induced in the H-LR group by bleeding 35% of the total blood volume, followed by LR resuscitation at three times the bled volume. Pigs in the C group were not hemorrhaged or resuscitated. Hemodynamics and coagulation were measured daily after H-LR on day 1 to day 5.


RESULTS
No changes in hemodynamics and coagulation function occurred in C. Hemorrhage decreased mean arterial pressure and increased heart rate. LR resuscitation corrected these changes within 2 hours. Compared with the baseline values (BL) on day 1, fibrinogen levels were decreased to 76% ± 6% by H-LR on day 1, increased to 217% ± 16% on day 2, and remained increased thereafter; platelet counts were decreased to 63% ± 5% by H-LR on day 1 and remained lower on days 2 and 3 but returned to BL by days 4 and 5 (all p < 0.05). Thrombin generation was decreased by H-LR on days 1 and 2 but then increased to above BL on days 4 and 5. Coagulation factor levels were decreased by H-LR on day 1 but returned to BL on day 3 except for factor XIII. Clot strength was decreased by H-LR on day 1 and returned to BL by day 2. Clot rapidity did not change on day 1 but was decreased on days 2 and 3 and returned to BL on days 4 and 5.


CONCLUSIONS
Hemorrhage and resuscitation reduced coagulation components and compromised coagulation function, which showed different recovery profiles over the 5-day study period.
US Army Institute of Surgical Research, Ft Sam Houston, San Antonio, Texas 78234, USA. wenjun.martini@amedd.army.mil
Wenjun Z
WZ
Martini
Douglas S
DS
Cortez
Michael A
MA
Dubick
Lorne H
LH
Blackbourne
D000818:Animals; D001777:Blood Coagulation / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D004195:Disease Models, Animal; D018450:Disease Progression; D005340:Fibrinogen / Q000378:metabolism; D006439:Hemodynamics / Q000502:physiology*; D008297:Male; D010976:Platelet Count; D011897:Random Allocation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012771:Shock, Hemorrhagic / Q000097:blood* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D034421:Sus scrofa; D013552:Swine; D013916:Thrombelastography; D013918:Thrombin Time; D013997:Time Factors
D001779:Blood Coagulation Factors; D005340:Fibrinogen