纤溶亢进：创伤后纤溶功能障碍的关键表型异常

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2024-10-01 DOI:10.1016/j.rpth.2024.102568

Kyosuke Takahashi , Kazuma Yamakawa , Anaar E. Siletz , Morihiro Katsura , John B. Holcomb , Charles E. Wade , Jessica C. Cardenas , Erin E. Fox , Morgan Schellenberg , Matthew Martin , Kenji Inaba , Kazuhide Matsushima

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引用次数: 0

摘要

背景创伤性纤溶功能障碍通常根据血栓弹性成像（TEG）30 分钟裂解（LY30）的结果分为 3 种表型：纤溶关闭、生理性纤溶和纤溶亢进。目标评估 TEG 确定的创伤后纤维蛋白溶解表型是否与关键纤维蛋白溶解相关血清标志物水平以及死亡率和住院并发症风险相关。方法这是一项实用随机优化血小板和血浆比例试验的二次分析。根据患者到达时的纤溶程度，使用 TEG LY30 值对患者进行分层：低 LY30，0.8%；正常 LY30，0.81% 至 0.9%；高 LY30，≥3%。结果共纳入 547 例患者（低 LY30，320 例；正常 LY30，108 例；高 LY30，119 例）。与低 LY30 组或正常 LY30 组相比，高 LY30 组患者入院时的组织纤溶酶原激活剂和纤溶酶-抗凝血酶值更高（分别为 P < .001）。低 LY30 组和正常 LY30 组的组织纤溶酶原激活因子、纤溶酶-抗纤溶酶原和纤溶酶原激活因子抑制剂 1 的水平没有明显差异。结论我们的研究结果表明，纤溶亢进是创伤性纤溶功能障碍最常见的形式，与较差的预后有关。

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Hyperfibrinolysis: a crucial phenotypic abnormality of posttraumatic fibrinolytic dysfunction

Background

Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated.

Objectives

To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications.

Methods

This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Patients were stratified according to the degree of fibrinolysis upon arrival using TEG LY30 values: low LY30, <0.8%; normal LY30, 0.81% to 0.9%; and high LY30, ≥3%. Serial values of molecular markers (0-72 hours after admission) and clinical outcomes were compared between fibrinolysis groups.

Results

A total of 547 patients were included (low LY30, 320; normal LY30, 108; high LY30, 119). The high LY30 group had higher tissue plasminogen activator and plasmin-antiplasmin values upon hospital arrival than the low LY30 or normal LY30 groups (P < .001, respectively). There was no significant difference in levels of tissue plasminogen activator, plasmin-antiplasmin, and plasminogen activator inhibitor 1 between the low LY30 and normal LY30 groups. The high LY30 group was associated with an increased risk of 24-hour and 30-day mortality, while there was no significant difference in mortality between the low LY30 and normal LY30 groups.