Exploring microgravity-induced changes to the coagulation system using thrombelastograph - a topical review

Abstract

An internal jugular venous thrombus in an astronaut was first identified in 2020 following a two-month microgravity exposure. This raised concerns about thromboembolic events (TE) during spaceflights. Studies have suggested that microgravity can induce changes in blood composition, venous flow and endothelial dysfunction, which might all contribute to a hypercoagulable state. However, whether these proposed mechanisms translate into a clinically significant increase in TE risk remains unclear since, even though humans have spent >200 person-years in space, no studies of blood coagulation in microgravity have been carried out. Additionally, the specific risks and implications of microgravity-induced coagulation changes in diverse populations, including future spacefarers with varying health conditions and ages, remain unclear. The precise risks and effects of microgravity-induced coagulation, especially as they relate to diverse groups such as future space travellers with different health conditions and age ranges, remain ambiguous and require further exploration. Thrombelastography (TEG), often used in trauma, surgery and anesthesiology, offers a comprehensive assessment of whole blood coagulation dynamics, providing a more holistic view compared to traditional coagulation assays. In particular, TEG has the ability to predict the hypercoagulable state associated with TE. A previous study of coagulation disorders in a 60-day bedrest setting has provided valuable insights into blood coagulation dynamics, although TEG did not differ in this specific study. However, the transferability of these findings to true microgravity environments remains to be elucidated. Understanding the effects of microgravity on the coagulation process is crucial for ensuring the health and safety of astronauts during space missions. By leveraging thrombelastography to study the end-result of the coagulation cascade, we can obtain valuable insights into the impact of microgravity on the coagulation system and comprehensively evaluate the risk of TE. Furthermore, this knowledge could inform preventive strategies and enhance the safety of future long-duration missions and diverse populations participating in future low-cost spaceflight ventures.