title: Acute coagulopathy in a porcine venous hemorrhage and ischemia reperfusion model.
abstract: BACKGROUND
  Injury-related coagulopathy is a complex process. We analyzed coagulation in a swine model of shock using rotational thromboelastometry (ROTEM).
  
  
  METHODS
  Forty-eight swine underwent laparotomy, 35% hemorrhage, supraceliac aortic cross-clamp, then reperfusion and resuscitation. ROTEM measurements and standard labs were taken at baseline and 6 hours into resuscitation.
  
  
  RESULTS
  Clot formation time (98 vs 53 seconds, P = .001) and international normalized ratio (1.67 vs 1.01, P < .001) were prolonged after resuscitation. Maximum clot firmness (61 vs 72 mm, P < .001) and fibrinogen levels (94 vs 165, P < .001) declined significantly during resuscitation. Despite decreased fibrinogen levels, there was no significant increase in fibrinolysis as measured by maximum lysis (3.9% vs 3.8%, P = .99).
  
  
  CONCLUSIONS
  ROTEM demonstrated the development of an acute coagulopathy. The most significant impacts on coagulopathy were seen with clot initiation and fibrin polymerization. Clot strength decreased over time, although there was little impact on clot breakdown because of fibrinolysis.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Quinton
authors.initials: Q
authors.lastname: Hatch
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Mia
authors.initials: M
authors.lastname: Debarros
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Eckert
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Satterly
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nelson
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Rees
authors.initials: R
authors.lastname: Porta
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lesperance
authors.affiliation: Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantenbein Avenue, Portland, OR 97227, USA.
authors.forename: William
authors.initials: W
authors.lastname: Long
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA; Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantenbein Avenue, Portland, OR 97227, USA. Electronic address: matthew.j.martin16.mil@mail.mil.
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
mesh_terms: D000208:Acute Disease; D000818:Animals; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001780:Blood Coagulation Tests; D007813:Laparotomy; D015427:Reperfusion Injury / Q000503:physiopathology*; D012151:Resuscitation; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000503:physiopathology* / Q000628:therapy; D013552:Swine; D013916:Thrombelastography
keywords: Coagulopathy; Porcine; Trauma