期刊
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
卷 83, 期 3, 页码 381-387出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TA.0000000000001466
关键词
Trauma; venous thromboembolism; thrombin; calibrated automated thrombogram
资金
- National Institute of General Medical Sciences (NIGMS) [K08 GM093133-05]
- Telemedicine and Advanced Technology Research Center (TATRC) of the Department of Defense [W81XWH-10-2-2010]
- Trans-Agency Consortium for Trauma-Induced Coagulopathy
- National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) [1 UL1 RR024150]
- NIH
- National Center for Advancing Translational Sciences (NCATS) [UL1 TR000135]
- [UM1 HL120877-04]
BACKGROUND: Reliable biomarkers predictive of venous thromboembolism (VTE) after acute trauma are uncertain. The objective of the study was to identify risk factors for symptomatic VTE after trauma, including individual plasma coagulome characteristics as reflected by thrombin generation. METHODS: In a prospective, case-cohort study, trauma patients were enrolled over the 4.5-year period, 2011 to 2015. Blood was collected by venipuncture into 3.2% trisodium citrate at 0, 6, 12, 24, and 72 hours after injury and at hospital discharge. Platelet poor plasma was stored at -80 degrees C until analysis. Thrombin generation, as determined by the calibrated automated thrombogram (CAT) using 5 pMtissue factor (TF)/4 mu M phospholipid (PS), was reported as peak height (nM thrombin) and time to peak height (ttPeak [minutes]). Data are presented as median [IQR] or hazard ratio with 95% CI. RESULTS: Among 453 trauma patients (injury severity score = 13.0 [6.0, 22.0], hospital length of stay = 4.0 [2.0, 10.0] days, age = 49 [28, 64] years, 71% male, 96% with blunt mechanism, mortality 3.2%), 83 developed symptomatic VTE within 92 days after injury (35 [42%] after hospital discharge). In a weighted, multivariate Cox model that included clinical and CAT characteristics available within 24 hours of admission, increased patient age (1.35 [1.19,1.52] per 10 years, p < 0.0001), body mass index = 30 kg/m(2) (4.45 [2.13,9.31], p < 0.0001), any surgery requiring general anesthesia (2.53 [1.53,4.19], p = 0.0003) and first available ttPeak (1.67 [1.29, 2.15], p < 0.00001) were independent predictors of incident symptomatic VTE within 92 days after trauma (C-statistic = 0.799). CONCLUSION: The individual's plasma coagulome (as reflected by thrombin generation) is an independent predictor of VTE after trauma. Clinical characteristics and ttPeak can be used to stratify acute trauma patients into high and low risk for VTE. (Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.)
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