The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography

Brill, Jason B.; Badiee, Jayraan; Zander, Ashley L.; Wallace, James D.; Lewis, Paul; Sise, Michael J.; Bansal, Vishal; Shackford, Steven R.

doi:10.1097/ta.0000000000001618

Cited by 105 publications

(99 citation statements)

References 33 publications

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“…Acceleration of TEG R time in trauma subjects correlates with deep vein thrombosis (DVT). Brill et al demonstrated that trauma patients with hypercoaguable TEG on admission have higher rates of DVT than those that do not (15.6% vs 8%, P = .039) . Selby et al studied the coagulation markers thrombin, prothrombin, and soluble fibrin at different time points in trauma subjects.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, blood samples from patients with hypercoaguable TEG on admission have higher rates of DVT than those that do not (15.6% vs 8%, P = .039). 16 Selby et al studied the coagulation markers thrombin, prothrombin, and soluble fibrin at different time points in trauma subjects. They found that soluble fibrin was increased in those who developed DVT compared with those who did not.…”

Section: Heparin Reverses the Procoagulant Effect Of Cctsmentioning

confidence: 99%

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Procoagulant in vitro effects of clinical cellular therapeutics in a severely injured trauma population

George

Prabhakara

Toledano-Furman

et al. 2020

Stem Cells Translational Medicine

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Clinical trials in trauma populations are exploring the use of clinical cellular therapeutics (CCTs) like human mesenchymal stromal cells (MSC) and mononuclear cells (MNC). Recent studies demonstrate a procoagulant effect of these CCTs related to their expression of tissue factor (TF). We sought to examine this relationship in blood from severely injured trauma patients and identify methods to reverse this procoagulant effect. Human MSCs from bone marrow, adipose, and amniotic tissues and freshly isolated bone marrow MNC samples were tested. TF expression and phenotype were quantified using flow cytometry. CCTs were mixed individually with trauma patients' whole blood, assayed with thromboelastography (TEG), and compared with healthy subjects mixed with the same cell sources. Heparin was added to samples at increasing concentrations until TEG parameters normalized. Clotting time or R time in TEG decreased relative to the TF expression of the CCT treatment in a logarithmic fashion for trauma patients and healthy subjects. Nonlinear regression curves were significantly different with healthy subjects demonstrating greater relative decreases in TEG clotting time. In vitro coadministration of heparin normalized the procoagulant effect and required dose escalation based on TF expression. TF expression in human MSC and MNC has a procoagulant effect in blood from trauma patients and healthy subjects. The procoagulant effect is lower in trauma patients possibly because their clotting time is already accelerated. The procoagulant effect due to MSC/MNC TF expression could be useful in the bleeding trauma patient; however, it may emerge as a safety release criterion due to thrombotic risk. The TF procoagulant effect is reversible with heparin.

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Section: Discussionmentioning

confidence: 99%

Section: Heparin Reverses the Procoagulant Effect Of Cctsmentioning

confidence: 99%

Procoagulant in vitro effects of clinical cellular therapeutics in a severely injured trauma population

George

Prabhakara

Toledano-Furman

et al. 2020

Stem Cells Translational Medicine

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“…The MA value of rapid TEG is also an independent predictor of pulmonary embolism (44,45). Other studies have reported that CI had a predictive value for deep venous thrombosis and thrombosis in prostate cancer (46,47). Furthermore, the TEG method simulates the entire process of venous thrombosis ex vivo , and, therefore, the CI value can reflect a composite index of venous thrombosis formation.…”

Section: Discussionmentioning

confidence: 82%

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

et al. 2018

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Efficacy of thromboelastography (TEG)-derived parameters for the prediction of acute thromboembolism (AT) in patients with non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB) remains to be determined. A retrospective propensity score matching (PSM) study was performed to evaluate this efficacy. Patients with NSAID-induced GIB (98 with AT; 830 without AT) were matched for age, sex and history of cardiovascular and cerebrovascular diseases using PSM. Multivariate logistic regression was used to determine the efficacy of TEG-derived predictors of AT. Mean Decrease Gini (MDG) coefficients were used to rank the importance of the variables from random forest algorithm results. Univariate analysis indicated that the following indexes were significantly different between the two groups: Reaction time (R value), coagulation forming time, solidification angle, maximum amplitude (MA), coagulation index (CI), hemoglobin levels, D-dimer levels, platelet aggregation test (pAgt) results, fibrinogen levels and Acute Physiology and Chronic Health Evaluation II score (all P<0.001). Multifactor logistic regression analysis indicated that the R value (P=0.010), solidification angle (P=0.004), MA (P=0.038), D-dimer levels (P=0.012) and pAgt results (P=0.015) were independent predictors of AT in patients with NSAID-induced GIB, achieving an area under the curve of 0.999 in receiver operating characteristic curve analyses. The five most important parameters according to the MDG scores (MDGS) were: Solidification angle (MDGS=58.14), R value (MDGS=20.42), pAgt results (MDGS=15.61), D-dimer levels (MDGS=12.78) and CI (MDGS=12.61). The results of the present study indicated that TEG-derived parameters including the R value, solidification angle, MA and CI, as well as D-dimer levels and pAgt score were significant predictors of AT in patients with NSAID-induced GIB.

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“…This is partially attributable to conventional labs that assess coagulation lacking an ability to detect hypercoagulability. However, whole blood viscoelastic hemostatic assays (VHA) has been shown to predict thrombotic complications in trauma patients, 3,4 liver disease patients, 5 cardiac surgery patients, 6 inflammatory bowel disease patients, 7 and malignancy. 5,8 This is further supported by patients presenting with new onset deep vein thrombosis having hypercoagulable VHA values compared with healthy controls.…”

Section: Introductionmentioning

confidence: 99%

“…4–6,8 Clot strength is a function of both fibrinogen and platelets. 10 However, the majority of clot strength is attributable to platelets, 11 which continue to evolve as an important process driving thrombotic complications in patients in the intensive care unit.…”

Section: Introductionmentioning

confidence: 99%

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Lawson

Moore

et al. 2018

Journal of Surgical Research

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Background: Elevated clot strength (maximum amplitude [MA]) measured by thrombelastography (TEG) is associated with thrombotic complications. However, it remains unclear how MA translates to thrombotic risks, as this measurement is independent of time, blood flow, and clot degradation. We hypothesize that under flow conditions, increased clot strength correlates to time-dependent measurements of coagulation and resistance to fibrinolysis. Materials and methods: Surgical patients at high risk of thrombotic complications were analyzed with TEG and total thrombus-formation analysis system (T-TAS). TEG hypercoagulability was defined as an r <10.2 min, angle >59, MA >66 or LY30 <0.2% (based off of healthy control data, n = 141). The T-TAS AR and PL chips were used to measure clotting at arterial shear rates. T-TAS measurements include occlusion start time, occlusion time (OT), occlusion speed (OSp), and total clot generation (area under the curve). These measurements were correlated to TEG indices (R time, angle, MA, and LY30). Both T-TAS and TEG assays were challenged with tissue plasminogen activator (t-PA) to assess clot resistance to fibrinolysis. Results: Thirty subjects were analyzed, including five controls. TEG-defined hypercoagulability by MA was detectedin52% of the inflammatory bowel disease/cancer patients; 0%was detected in the controls. There were no TEG measurements that significantly correlated with T-TAS AR and PL chip. However, in the presence of t-PA, T-TAS AR determined OSp to have an inverse relationship with TEG angle (−0.477, P = 0.012) and LY30 (−0.449, P = 0.019), and a positive correlation with R time (0.441 P = 0.021). In hypercoagulability determined by TEG MA, T-TAS PL had a significantly reduced OT (4:07 versus 6:27 min, P = 0.043). In hypercoagulability defined by TEG LY30, T-TAS PL had discordant findings, with a significantly prolonged OT (6:36 versus 4:30 min, P = 0.044) and a slower OSp (10.5 versus 19.0 kPa/min, P = 0.030). Conclusions: Microfluidic coagulation assessment with T-TAS has an overall poor correlation with most TEG measurements in a predominantly hypercoagulable patient population, except in the presence of t-PA. The one anticipated finding was an elevated MA having a shorter time to platelet-mediated microfluidic occlusion, supporting the role of platelets and hypercoagulability. However, hypercoagulability defined by LY30 had opposing results in which a low LY30 was associated with a longer PL time to occlusion and slower OSp. These discordant findings warrant ongoing investigation into the relationship between clot strength and fibrinolysis under different flow conditions.

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The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography

Abstract: Prognostic study, level II.

Cited by 105 publications

References 33 publications

Procoagulant in vitro effects of clinical cellular therapeutics in a severely injured trauma population

Procoagulant in vitro effects of clinical cellular therapeutics in a severely injured trauma population

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

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