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Evaluation of Potential Clinical Surrogate Markers of a Trauma Induced Alteration of Clotting Factor Activities.

Burggraf M, Payas A, Schoeneberg C, Wegner A, Kauther MD, Lendemans S - Biomed Res Int (2016)

Bottom Line: Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission.Conclusions.Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Emergency Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. The aim of this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations following multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors were analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed reduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base deficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII activity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with certain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies. Nevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and also its potential prognostic value needs further evaluation.

No MeSH data available.


Related in: MedlinePlus

International Normalized Ratio (INR) of patients and control group. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). The Mann-Whitney U-test was performed with ∗∗P = 0.001.
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fig1: International Normalized Ratio (INR) of patients and control group. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). The Mann-Whitney U-test was performed with ∗∗P = 0.001.

Mentions: Routinely performed coagulation tests showed significant changes following multiple trauma (Figures 1–4). The patients' International Normalized Ratio (INR) was elevated (1.06 versus 0.96, P = 0.001) whereas the Partial Thromboplastin Time (PTT) was shortened (25.3 versus 28.8 seconds, P < 0.05) compared to controls. Serum levels of calcium were reduced as well (2.13 versus 2.30 mmol/L, P < 0.0001). Fibrinogen showed a trend towards decreased levels. However, this reduction did not reach statistical significance (237 versus 296 mg/dL, P = 0.08).


Evaluation of Potential Clinical Surrogate Markers of a Trauma Induced Alteration of Clotting Factor Activities.

Burggraf M, Payas A, Schoeneberg C, Wegner A, Kauther MD, Lendemans S - Biomed Res Int (2016)

International Normalized Ratio (INR) of patients and control group. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). The Mann-Whitney U-test was performed with ∗∗P = 0.001.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940535&req=5

fig1: International Normalized Ratio (INR) of patients and control group. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). The Mann-Whitney U-test was performed with ∗∗P = 0.001.
Mentions: Routinely performed coagulation tests showed significant changes following multiple trauma (Figures 1–4). The patients' International Normalized Ratio (INR) was elevated (1.06 versus 0.96, P = 0.001) whereas the Partial Thromboplastin Time (PTT) was shortened (25.3 versus 28.8 seconds, P < 0.05) compared to controls. Serum levels of calcium were reduced as well (2.13 versus 2.30 mmol/L, P < 0.0001). Fibrinogen showed a trend towards decreased levels. However, this reduction did not reach statistical significance (237 versus 296 mg/dL, P = 0.08).

Bottom Line: Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission.Conclusions.Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Emergency Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. The aim of this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations following multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors were analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed reduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base deficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII activity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with certain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies. Nevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and also its potential prognostic value needs further evaluation.

No MeSH data available.


Related in: MedlinePlus