title: Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism.
abstract: We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R(2) = 0.095, P = 0.008) and at Day 7 (r = 0.516, R(2) = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R(2) = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.
authors.affiliation: Divisions of Trauma and Surgical Critical Care, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.forename: Clark R
authors.initials: CR
authors.lastname: Murray
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.forename: Juliet J
authors.initials: JJ
authors.lastname: Ray
authors.forename: Laura F
authors.initials: LF
authors.lastname: Teisch
authors.forename: Xiomara D
authors.initials: XD
authors.lastname: Ruiz
authors.forename: Mena M
authors.initials: MM
authors.lastname: Hanna
authors.forename: Gerardo A
authors.initials: GA
authors.lastname: Guarch
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Manning
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Enrique
authors.initials: E
authors.lastname: Ginzburg
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000502:physiology*; D001792:Blood Platelets / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D018570:Risk Assessment; D013916:Thrombelastography; D054556:Venous Thromboembolism / Q000097:blood* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000097:blood*
chemical_list: D010975:Platelet Aggregation Inhibitors