title: Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque).
abstract: Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, whereas tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a nonhuman primate (NHP) model.
  
  
  
  NHPs were randomized to three injury groups (n = 8/group): 60 minutes severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++). Animals were resuscitated and monitored for 360 minutes. Blood samples were collected at baseline, end-of-shock, end-of-resuscitation (EOR), and T = 360 minutes for assessments of: severity of shock (lactate) and coagulation via prothrombin time, partial thromboplastin time, D-dimer, fibrinogen, antithrombin-III, von Willebrand factor, and viscoelastic testing (ROTEM). Results are reported as mean ± SEM; statistics: two-way analysis of variance and t-tests (significance: p < 0.05).
  
  
  
  Blood loss, prothrombin time, partial thromboplastin time, antithrombin-III, fibrinogen, and von Willebrand factor were equivalent among groups and viscoelastic testing revealed few differences throughout the study. D-dimer increased approximately threefold, at EOR in the HS group, and at T = 360 minutes in the HS+ and HS++ groups (p < 0.05). At EOR, in the HS group compared with the HS+ and HS++ groups; the D-dimer-lactate ratio was twofold greater (2.2 ± 0.3 vs. 1.1 ± 0.3 and 1.1 ± 0.2, respectively; p < 0.05) and tissue factor-activated fibrin clot 30-minute lysis index was lower (98 ± 1% vs. 100 ± 0% and 100 ± 0%, respectively; p < 0.05).
  
  
  
  NHPs in HS exhibit acute suppression of fibrinolysis in the presence of tissue injury. Additional assessments to more comprehensively evaluate the mechanisms linking tissue injury with the observed fibrinolysis shutdown response are warranted.
authors.affiliation: From the Naval Medical Research Unit San Antonio (A.R.M., F.R.S.), Sam, Houston, Texas; Department of Surgery (H.B.M., E.E.M.), Denver Health Medical Center, Denver, Colorado; Department of Surgery, University of Colorado Denver (E.E.M.), Aurora, Colorado; and US Army Institute of Surgical Research (A.P.C., M.A.M.), Sam Houston, Texas.
authors.forename: Antoni R
authors.initials: AR
authors.lastname: Macko
authors.forename: Hunter B
authors.initials: HB
authors.lastname: Moore
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: M Adam
authors.initials: MA
authors.lastname: Meledeo
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Forest R
authors.initials: FR
authors.lastname: Sheppard
mesh_terms: D000818:Animals; D001780:Blood Coagulation Tests; D004195:Disease Models, Animal; D005264:Femoral Fractures / Q000097:blood*; D005342:Fibrinolysis / Q000502:physiology*; D008253:Macaca mulatta; D010641:Phenotype; D011897:Random Allocation; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000097:blood*; D017695:Soft Tissue Injuries / Q000097:blood*