title: Characterization of the hypercoagulable state following severe orthopedic trauma.
abstract: BACKGROUND
  Acute traumatic coagulopathy develops in seriously injured patients, which is followed by a paradoxical hypercoagulable state. The hypercoagulable state contributes to venous thromboembolism, and yet, there are no sensitive tests available to detect it. The aim of this study was to characterize the hypercoagulable state caused by major orthopedic trauma using the overall hemostatic potential (OHP) assay.
  
  
  METHODS
  Major orthopedic trauma patients admitted during a 7-month period in 2012 were included in the study. Blood samples were drawn 1 hour before surgery, then 1, 7, 24 hours and 3, 5, 10, and 42 days postoperatively. The assay parameters were determined and analyzed according to injury severity (polytrauma or nonpolytrauma), type of surgical intervention, and shock status. Values were compared with 20 healthy controls.
  
  
  RESULTS
  Forty-one consecutive patients were enrolled (age, 41.5 ± 2.7 years; 70% male; Injury Severity Score [ISS], 21.5 ± 2.1). Hypercoagulability based on OHP was present in the preoperative sample compared with the controls (OHP, 13.8 ± 1.4 U vs. 8.1 ± 0.5 U; p = 0.020) and then further elevated after surgery (1 hour postoperative, 17.8 ± 2.0 U vs. preoperative, 13.8 ± 1.4 U, p = 0.008). Polytrauma patients were more hypercoagulable than nonpolytrauma at the preoperative sample time (17.7 ± 2.6 U vs. 10.7 ± 1.2 U, p = 0.040) and postoperative period (24.3 ± 3.4 U vs. 11.9 ± 1.4 U, p = 0.006). The OHP for patients undergoing open pelvic surgery (28.3 ± 3.0 U) was higher than both intramedullary nailing (16.2 ± 2.0 U) and percutaneous pelvic surgery (17.0 ± 1.7 U) on Day 5 (p < 0.05). Patients demonstrated a higher OHP than controls did at all time points, except at 6 weeks (patients, 10.8 ± 1.7 U vs. controls, 8.1 ± 0.5 U; p = 0.400).
  
  
  CONCLUSIONS
  The OHP assay detected the hypercoagulable state following major orthopedic trauma and surgical intervention, which was present for 10 days postoperatively. The extent of hypercoagulability could be associated with polytrauma and the type of surgical intervention; however, further studies are needed to confirm this.
  
  
  METHODS
  Epidemiologic study, level III.
authors: From the Division of Surgery (A.E.W., N.L., Z.J.B.), Department of Traumatology, John Hunter Hospital; School of Medicine and Public Health (P.M.), University of Newcastle, Newcastle, New South Wales; The Baird Institute for Heart and Lung Surgical Research (J.J.B.E, P.G.B.); Faculty of Medicine (J.J.B.E., P.G.B.), The University of Sydney; ANZAC Research Institute (J.J.B.E., J.L.C.); Cardiothoracic Surgical Unit (P.G.B.), Royal Prince Alfred Hospital; and Department of Haematology (J.L.C.), Concord Repatriation and General Hospital, Sydney, Australia.
authors: Amanda E
authors: AE
authors: White
authors: J James B
authors: JJ
authors: Edelman
authors: Natalie
authors: N
authors: Lott
authors: Paul G
authors: PG
authors: Bannon
authors: Patrick
authors: P
authors: McElduff
authors: Jennifer L
authors: JL
authors: Curnow
authors: Zsolt J
authors: ZJ
authors: Balogh
mesh_terms: D000328:Adult; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000097:blood / Q000150:complications / Q000601:surgery; D019637:Orthopedic Procedures; D019851:Thrombophilia / Q000097:blood / Q000209:etiology*; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000601:surgery