Anni Nørgaard Jeppesen, Christophe Duez, Hans Kirkegaard, Anders Morten Grejs, Anne-Mette Hvas
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引用次数: 1
Abstract
Hypothermia affects coagulation, but the effect of hypothermia on fibrinolysis is not clarified. Imbalance in the fibrinolytic system may lead to increased risk of bleeding or thrombosis. Our aim was to investigate if resuscitated cardiac arrest patients treated with hypothermia had an unbalanced fibrinolysis. A prospective cohort study, including 82 patients were treated with hypothermia at 33°C ± 1°C after out-of-hospital cardiac arrest. Blood samples were collected at 24 hours (hypothermia) and at 72 hours (normothermia). Samples were analyzed for fibrin D-dimer, tissue plasminogen activator (tPA), plasminogen, plasminogen activator Inhibitor-1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and an in-house dynamic fibrin clot formation and lysis assay.Compared with normothermia, hypothermia significantly increased plasminogen activity (mean difference = 10.4%, 95% confidence interval [CI] 7.9-12.9), p < 0.001), PAI-1 levels (mean difference = 275 ng/mL, 95% CI 203-348, p < 0.001), and tPA levels (mean difference = 1.0 ng/mL, 95% CI 0.2-1.7, p = 0.01). No differences between hypothermia and normothermia were found in TAFI activity (p = 0.59) or in the fibrin D-dimer levels (p = 0.08). The fibrin clot lysis curves showed three different patterns: normal-, flat-, or resistant clot lysis curve. At hypothermia 45 (55%) patients had a resistant clot lysis curve and 33 (44%) patients had a resistant clot lysis curve at normothermia (p = 0.047). Comatose, resuscitated, cardiac arrest patients treated with hypothermia express an inhibited fibrinolysis even after rewarming. This could potentially increase the thromboembolic risk. ClinicalTrials.gov ID: NCT02258360.
期刊介绍:
Therapeutic Hypothermia and Temperature Management is the first and only journal to cover all aspects of hypothermia and temperature considerations relevant to this exciting field, including its application in cardiac arrest, spinal cord and traumatic brain injury, stroke, burns, and much more. The Journal provides a strong multidisciplinary forum to ensure that research advances are well disseminated, and that therapeutic hypothermia is well understood and used effectively to enhance patient outcomes. Novel findings from translational preclinical investigations as well as clinical studies and trials are featured in original articles, state-of-the-art review articles, protocols and best practices.
Therapeutic Hypothermia and Temperature Management coverage includes:
Temperature mechanisms and cooling strategies
Protocols, risk factors, and drug interventions
Intraoperative considerations
Post-resuscitation cooling
ICU management.