title: Comparative response of platelet fV and plasma fV to activated protein C and relevance to a model of acute traumatic coagulopathy.
abstract: BACKGROUND
  Acute traumatic coagulopathy (ATC) has been linked to an increase in activated protein C (aPC) from 40 pM in healthy individuals to 175 pM. aPC exerts its activity primarily through cleavage of active coagulation factor Va (fVa). Platelets reportedly possess fVa which is more resistant to aPC cleavage than plasma fVa; this work examines the hypothesis that normal platelets are sufficient to maintain coagulation in the presence of elevated aPC.
  
  
  METHODS
  Coagulation responses of normal plasma, fV deficient plasma (fVdp), and isolated normal platelets in fVdp were conducted: prothrombin (PT) tests, turbidimetry, and thromboelastography (TEG), including the dose response of aPC on the samples.
  
  
  RESULTS
  PT and turbidimetric assays demonstrate that normal plasma is resistant to aPC at doses much higher than those found in ATC. Additionally, an average physiological number of washed normal platelets (200,000 platelets/mm3) was sufficient to eliminate the anti-coagulant effects of aPC up to 10 nM, nearly two orders of magnitude above the ATC concentration and even the steady-state pharmacological concentration of human recombinant aPC, as measured by TEG. aPC also demonstrated no significant effect on clot lysis in normal plasma samples with or without platelets.
  
  
  CONCLUSIONS
  Although platelet fVa shows slightly superior resistance to aPC's effects compared to plasma fVa in static models, neither fVa is sufficiently cleaved in simulations of ATC or pharmacologically-delivered aPC to diminish coagulation parameters. aPC is likely a correlative indicator of ATC or may play a cooperative role with other activity altering products generated in ATC.
authors.affiliation: United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America.
authors.forename: James E
authors.initials: JE
authors.lastname: Campbell
authors.affiliation: United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America.
authors.forename: Michael Adam
authors.initials: MA
authors.lastname: Meledeo
authors.affiliation: United States Army Institute of Surgical Research, Coagulation and Blood Research Program, JBSA-FT Sam Houston, Houston, Texas, United States of America.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000494:pharmacology; D015703:Antigens, CD / Q000378:metabolism; D001778:Blood Coagulation Disorders / Q000097:blood*; D001792:Blood Platelets / Q000378:metabolism*; D000074283:Endothelial Protein C Receptor; D005165:Factor V / Q000378:metabolism*; D005169:Factor VIII / Q000378:metabolism; D015943:Factor Va / Q000378:metabolism; D005337:Fibrin / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D019934:International Normalized Ratio; D008954:Models, Biological; D009391:Nephelometry and Turbidimetry; D010743:Phospholipids / Q000378:metabolism; D011486:Protein C / Q000378:metabolism*; D059748:Proteolysis / Q000187:drug effects; D011517:Prothrombin Time; D011956:Receptors, Cell Surface / Q000378:metabolism; D012995:Solubility; D013916:Thrombelastography; D010959:Tissue Plasminogen Activator / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D015703:Antigens, CD; D000074283:Endothelial Protein C Receptor; C478370:PROCR protein, human; D010743:Phospholipids; D011486:Protein C; D011956:Receptors, Cell Surface; D015943:Factor Va; D005165:Factor V; D005169:Factor VIII; D005337:Fibrin; D010959:Tissue Plasminogen Activator