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Levels of procoagulant microvesicles are elevated after traumatic injury and platelet microvesicles are negatively correlated with mortality.

Curry N, Raja A, Beavis J, Stanworth S, Harrison P - J Extracell Vesicles (2014)

Bottom Line: Circulating procoagulant MV, rich in phospholipid, were significantly elevated following traumatic injury relative to controls and remained elevated at 72 h post-injury.Patients who died (n=9, 18%) had significantly fewer CD41/AnnV+ MV and lower endogenous thrombin potential relative to patients who survived.Lower levels of procoagulant MV are associated with mortality and further investigation of this association is warranted.

View Article: PubMed Central - PubMed

Affiliation: Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals Trust, Churchill Hospital, Oxford, UK.

ABSTRACT

Background: Microvesicles (MV) have been implicated in the development of thrombotic disease, such as acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF). Trauma patients are at increased risk of late thrombotic events, particularly those who receive a major transfusion. The aims of this study were: (a) to determine whether there were increased numbers of pro-coagulant MV following injury; (b) to determine their cellular origin; and (c) to explore the effects of MV with clinical outcomes; in particular red cell transfusion requirements and death.

Methods: Trauma patients were recruited at a Level 1 trauma centre. The presence of MV procoagulant phospholipid (PPL) was assessed using 2 activity assays (PPL and thrombin generation). Enumeration and MV cellular origin was assessed using 2 colour flow cytometry.

Results: Fifty consecutive patients were recruited; median age 38 (IQR: 24-55), median ISS 18 (IQR: 9-27). Circulating procoagulant MV, rich in phospholipid, were significantly elevated following traumatic injury relative to controls and remained elevated at 72 h post-injury. Red cell/AnnV+ and platelet/AnnV+ MV numbers were 6-fold and 2-fold higher than controls, respectively. Patients who died (n=9, 18%) had significantly fewer CD41/AnnV+ MV and lower endogenous thrombin potential relative to patients who survived.

Conclusions: MV are elevated following traumatic injury and may be implicated in the increased risk of trauma patients to pro-thrombotic states such as MOF and ARDS. Lower levels of procoagulant MV are associated with mortality and further investigation of this association is warranted.

No MeSH data available.


Related in: MedlinePlus

Procoagulant phospholipid measurements using the PPL assay: comparison of 2 time points following injury. Box plots (median and IQR) depicting average PPL results in trauma participants at 2 time points (time 0 and 72 h), when compared to a healthy control group. The PPL assays were significantly shorter (p<0.001) at both time points in the trauma cohort when compared to the control. Time 0 h trauma samples were significantly shorter than the results at time 72 h (p<0.001), suggesting more procoagulant MV early after injury.
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Figure 0001: Procoagulant phospholipid measurements using the PPL assay: comparison of 2 time points following injury. Box plots (median and IQR) depicting average PPL results in trauma participants at 2 time points (time 0 and 72 h), when compared to a healthy control group. The PPL assays were significantly shorter (p<0.001) at both time points in the trauma cohort when compared to the control. Time 0 h trauma samples were significantly shorter than the results at time 72 h (p<0.001), suggesting more procoagulant MV early after injury.

Mentions: PPL clotting times were significantly shorter in the trauma group; median value 51.1 sec at time 0 h (IQR: 36.1–55.5 sec) and 64.2 sec at time 72 h (IQR: 55.7–70.6 sec), when compared with the control group, median 82.9 sec (IQR: 71.1–88.8 sec); p<0.001 for both time points (Mann–Whitney U, 2 tailed) (see Fig 1). 80% and 33% of trauma patients’ results were shorter than the local normal range (data not shown), for admission and time 72 h, respectively. Comparison between the 2 time points for trauma demonstrated significantly shorter PPL times at admission than at 72 h (p<0.001, Wilcoxon signed rank).


Levels of procoagulant microvesicles are elevated after traumatic injury and platelet microvesicles are negatively correlated with mortality.

Curry N, Raja A, Beavis J, Stanworth S, Harrison P - J Extracell Vesicles (2014)

Procoagulant phospholipid measurements using the PPL assay: comparison of 2 time points following injury. Box plots (median and IQR) depicting average PPL results in trauma participants at 2 time points (time 0 and 72 h), when compared to a healthy control group. The PPL assays were significantly shorter (p<0.001) at both time points in the trauma cohort when compared to the control. Time 0 h trauma samples were significantly shorter than the results at time 72 h (p<0.001), suggesting more procoagulant MV early after injury.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216813&req=5

Figure 0001: Procoagulant phospholipid measurements using the PPL assay: comparison of 2 time points following injury. Box plots (median and IQR) depicting average PPL results in trauma participants at 2 time points (time 0 and 72 h), when compared to a healthy control group. The PPL assays were significantly shorter (p<0.001) at both time points in the trauma cohort when compared to the control. Time 0 h trauma samples were significantly shorter than the results at time 72 h (p<0.001), suggesting more procoagulant MV early after injury.
Mentions: PPL clotting times were significantly shorter in the trauma group; median value 51.1 sec at time 0 h (IQR: 36.1–55.5 sec) and 64.2 sec at time 72 h (IQR: 55.7–70.6 sec), when compared with the control group, median 82.9 sec (IQR: 71.1–88.8 sec); p<0.001 for both time points (Mann–Whitney U, 2 tailed) (see Fig 1). 80% and 33% of trauma patients’ results were shorter than the local normal range (data not shown), for admission and time 72 h, respectively. Comparison between the 2 time points for trauma demonstrated significantly shorter PPL times at admission than at 72 h (p<0.001, Wilcoxon signed rank).

Bottom Line: Circulating procoagulant MV, rich in phospholipid, were significantly elevated following traumatic injury relative to controls and remained elevated at 72 h post-injury.Patients who died (n=9, 18%) had significantly fewer CD41/AnnV+ MV and lower endogenous thrombin potential relative to patients who survived.Lower levels of procoagulant MV are associated with mortality and further investigation of this association is warranted.

View Article: PubMed Central - PubMed

Affiliation: Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals Trust, Churchill Hospital, Oxford, UK.

ABSTRACT

Background: Microvesicles (MV) have been implicated in the development of thrombotic disease, such as acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF). Trauma patients are at increased risk of late thrombotic events, particularly those who receive a major transfusion. The aims of this study were: (a) to determine whether there were increased numbers of pro-coagulant MV following injury; (b) to determine their cellular origin; and (c) to explore the effects of MV with clinical outcomes; in particular red cell transfusion requirements and death.

Methods: Trauma patients were recruited at a Level 1 trauma centre. The presence of MV procoagulant phospholipid (PPL) was assessed using 2 activity assays (PPL and thrombin generation). Enumeration and MV cellular origin was assessed using 2 colour flow cytometry.

Results: Fifty consecutive patients were recruited; median age 38 (IQR: 24-55), median ISS 18 (IQR: 9-27). Circulating procoagulant MV, rich in phospholipid, were significantly elevated following traumatic injury relative to controls and remained elevated at 72 h post-injury. Red cell/AnnV+ and platelet/AnnV+ MV numbers were 6-fold and 2-fold higher than controls, respectively. Patients who died (n=9, 18%) had significantly fewer CD41/AnnV+ MV and lower endogenous thrombin potential relative to patients who survived.

Conclusions: MV are elevated following traumatic injury and may be implicated in the increased risk of trauma patients to pro-thrombotic states such as MOF and ARDS. Lower levels of procoagulant MV are associated with mortality and further investigation of this association is warranted.

No MeSH data available.


Related in: MedlinePlus