M Margaret Knudson, Hunter B Moore, Ernest E Moore, Lucy Z Kornblith, Lazlo N Kiraly, Michelle K McNutt, Charles E Wade, Brandon R Bruns, Angela Sauaia
{"title":"组织纤溶酶原激活剂抵抗是创伤后静脉血栓栓塞的早期预测因子:CLOTT研究组的一项前瞻性研究。","authors":"M Margaret Knudson, Hunter B Moore, Ernest E Moore, Lucy Z Kornblith, Lazlo N Kiraly, Michelle K McNutt, Charles E Wade, Brandon R Bruns, Angela Sauaia","doi":"10.1097/TA.0000000000003625","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) remains a frequent postinjury complication with well established but nonmodifiable risk factors. We hypothesized that fibrinolysis shutdown (SD) as measured by thromboelastography (TEG) would be an independent risk factor for VTE in trauma patients.</p><p><strong>Methods: </strong>A subgroup of patients enrolled in the CLOTT-2 (Consortium of Leaders in the Study of Traumatic Thromboembolism 2), multicenter prospective cohort study had kaolin TEG and tissue plasminogen activator (tPA)-TEG data at 12 and 24 hours postadmission. Patients underwent a screening duplex venous ultrasound examination during the first week unless clot was already detected on computed tomography. Injury factors associated with early fibrinolysis SD (defined as kaolin TEG Ly30 ≤0.3%) and/or tPA resistance (tPA-R) (defined as kaolin TEG with tPA 75 ng Ly30 <2.1%) were investigated as was the association of the TEG measurements with the development of VTE.</p><p><strong>Results: </strong>A total of 141 patients had both TEG measurements at 24 hours, and 135 had both TEG measurements at 12 hours. Shutdown was evident at 12 hours in 71 of 135 (52.6%) patients and in 62 of 141 (44%) at 24 hours. Tissue plasminogen activator resistance was found in 61 of 135 (45.2%) at 12 hours and in 49 of 141 (34.3%) at 24 hours. Factors significantly associated with SD included receiving >4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39-22.39).</p><p><strong>Conclusion: </strong>Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"597-603"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"6","resultStr":"{\"title\":\"Tissue plasminogen activator resistance is an early predictor of posttraumatic venous thromboembolism: A prospective study from the CLOTT research group.\",\"authors\":\"M Margaret Knudson, Hunter B Moore, Ernest E Moore, Lucy Z Kornblith, Lazlo N Kiraly, Michelle K McNutt, Charles E Wade, Brandon R Bruns, Angela Sauaia\",\"doi\":\"10.1097/TA.0000000000003625\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Venous thromboembolism (VTE) remains a frequent postinjury complication with well established but nonmodifiable risk factors. We hypothesized that fibrinolysis shutdown (SD) as measured by thromboelastography (TEG) would be an independent risk factor for VTE in trauma patients.</p><p><strong>Methods: </strong>A subgroup of patients enrolled in the CLOTT-2 (Consortium of Leaders in the Study of Traumatic Thromboembolism 2), multicenter prospective cohort study had kaolin TEG and tissue plasminogen activator (tPA)-TEG data at 12 and 24 hours postadmission. Patients underwent a screening duplex venous ultrasound examination during the first week unless clot was already detected on computed tomography. Injury factors associated with early fibrinolysis SD (defined as kaolin TEG Ly30 ≤0.3%) and/or tPA resistance (tPA-R) (defined as kaolin TEG with tPA 75 ng Ly30 <2.1%) were investigated as was the association of the TEG measurements with the development of VTE.</p><p><strong>Results: </strong>A total of 141 patients had both TEG measurements at 24 hours, and 135 had both TEG measurements at 12 hours. Shutdown was evident at 12 hours in 71 of 135 (52.6%) patients and in 62 of 141 (44%) at 24 hours. Tissue plasminogen activator resistance was found in 61 of 135 (45.2%) at 12 hours and in 49 of 141 (34.3%) at 24 hours. Factors significantly associated with SD included receiving >4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39-22.39).</p><p><strong>Conclusion: </strong>Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>\",\"PeriodicalId\":501845,\"journal\":{\"name\":\"The Journal of Trauma and Acute Care Surgery\",\"volume\":\" \",\"pages\":\"597-603\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"6\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Trauma and Acute Care Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TA.0000000000003625\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/5/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000003625","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/5/20 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 6
摘要
背景:静脉血栓栓塞(VTE)仍然是一种常见的损伤后并发症，具有明确但不可改变的危险因素。我们假设，通过血栓弹性成像(TEG)测量的纤溶关闭(SD)将是创伤患者静脉血栓栓塞的独立危险因素。方法:入选CLOTT-2(创伤性血栓栓塞研究领导者联盟2)的患者亚组，多中心前瞻性队列研究，在入院后12和24小时获得高岭土TEG和组织纤溶酶原激活物(tPA)-TEG数据。除非在计算机断层扫描上已经检测到血栓，否则患者在第一周内接受筛查性双静脉超声检查。与早期纤维蛋白溶解SD(定义为高岭土TEG Ly30≤0.3%)和/或tPA抵抗(tPA- r)(定义为高岭土TEG与tPA 75 ng Ly30)相关的损伤因素结果:共有141例患者在24小时时进行了两项TEG测量，135例患者在12小时进行了两项TEG测量。135例患者中有71例(52.6%)在12小时明显停药，141例患者中有62例(44%)在24小时明显停药。组织纤溶酶原激活剂在12小时有61例(45.2%)耐药，在24小时有49例(34.3%)耐药。与SD显著相关的因素包括在最初24小时内接受> 4u的FFP，存在重大脑损伤或骨盆骨折，以及需要进行大手术。相比之下，与早期tPA-R显著相关的因素包括24小时内输注红细胞量> 4u，以及存在严重的胸部损伤或长骨骨折。深静脉血栓15例，肺血栓5例(总VTE率14.2%)。12小时组织纤溶酶原激活剂耐药是静脉血栓栓塞的独立危险因素(危险比5.57;95%置信区间，1.39-22.39)。结论:入院后12小时tPA-R定义的高凝状态的早期发展是损伤后静脉血栓栓塞的潜在可改变的危险因素。证据水平:治疗/护理管理;II级。
Tissue plasminogen activator resistance is an early predictor of posttraumatic venous thromboembolism: A prospective study from the CLOTT research group.
Background: Venous thromboembolism (VTE) remains a frequent postinjury complication with well established but nonmodifiable risk factors. We hypothesized that fibrinolysis shutdown (SD) as measured by thromboelastography (TEG) would be an independent risk factor for VTE in trauma patients.
Methods: A subgroup of patients enrolled in the CLOTT-2 (Consortium of Leaders in the Study of Traumatic Thromboembolism 2), multicenter prospective cohort study had kaolin TEG and tissue plasminogen activator (tPA)-TEG data at 12 and 24 hours postadmission. Patients underwent a screening duplex venous ultrasound examination during the first week unless clot was already detected on computed tomography. Injury factors associated with early fibrinolysis SD (defined as kaolin TEG Ly30 ≤0.3%) and/or tPA resistance (tPA-R) (defined as kaolin TEG with tPA 75 ng Ly30 <2.1%) were investigated as was the association of the TEG measurements with the development of VTE.
Results: A total of 141 patients had both TEG measurements at 24 hours, and 135 had both TEG measurements at 12 hours. Shutdown was evident at 12 hours in 71 of 135 (52.6%) patients and in 62 of 141 (44%) at 24 hours. Tissue plasminogen activator resistance was found in 61 of 135 (45.2%) at 12 hours and in 49 of 141 (34.3%) at 24 hours. Factors significantly associated with SD included receiving >4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39-22.39).
Conclusion: Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.
Level of evidence: Therapeutic/Care Management; Level II.
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