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8. Hypothermia-Associated Coagulopathy: A Comparison of Viscoelastic Monitoring, Platelet Function, and Real Time Live Confocal Microscopy at Low Blood Temperatures, an in vitro Experimental Study

Author

Wallner, Bernd, primary, Schenk, Bettina, additional, Hermann, Martin, additional, Paal, Peter, additional, Falk, Markus, additional, Strapazzon, Giacomo, additional, Martini, Wenjun Z., additional, Brugger, Hermann, additional, and Fries, Dietmar, additional

Published
2020
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10. Hypercoagulation and Hypermetabolism of Fibrinogen in Severely Burned Adults.

Author

Martini, Wenjun Z, Holcomb, John B, Yu, Yong-Ming, Wolf, Steven E, Cancio, Leopoldo C, Pusateri, Anthony E, and Dubick, Michael A

Subjects
FIBRINOGEN, STABLE isotopes, HEART beat, ADULTS, ALBUMINS, BURNS & scalds complications, LENGTH of stay in hospitals, RESEARCH, BLOOD coagulation tests, BURNS & scalds, RESEARCH methodology, RESPIRATORY measurements, BLOOD sugar, CASE-control method, MEDICAL cooperation, EVALUATION research, SERUM albumin, COMPARATIVE studies, BLOOD diseases, LACTIC acid
Abstract

This study investigated changes in plasma fibrinogen metabolism and changes in coagulation in severely burned adults. Ten patients (27 ± 3 years; 91 ± 6 kg) with 51 ± 3% TBSA were consented and enrolled into an institutional review board-approved prospective study. On the study day, stable isotope infusion of 1-13C-phenylalanine and d5-phenylalanine was performed to quantify fibrinogen production and consumption. During the infusion, vital signs were recorded and blood samples were drawn every hour. Coagulation was measured by thromboelastograph (TEG). Ten normal healthy volunteers (37 ± 7 years; 74 ± 4 kg) were included as the control group. Burned adults had elevated heart rates (120 ± 2 vs 73 ± 5 [control] beats/minute), respiration rates (23 ± 2 vs 15 ± 1 breaths/minute), plasma glucose (127 ± 10 vs 89 ± 2 mg/dl), and fibrinogen levels (613 ± 35 vs 239 ± 17 mg/dl); and decreased albumin (1.3 ± 0.2 vs 3.7 ± 0.1 g/dl) and total protein (4.4 ± 0.2 vs 6.8 ± 0.1 g/dl, all P < .05). Fibrinogen breakdown was elevated in the burn group (2.3 ± 0.4 vs. 1.0 ± 0.3 µmol/kg/minute); and fibrinogen synthesis was further enhanced in the burn group (4.4 ± 0.7 vs 0.7 ± 0.2 µmol/kg/minute, both P < .05). Clotting speed (TEG-alpha) and clot strength (TEG-MA) were increased in the burn group (62 ± 4 vs 50 ± 4°, and 76 ± 2 vs 56 ± 2 mm, respectively, both P < .05). Fibrinolysis of TEG-LY60 was accelerated in the burn group (16 ± 6 vs 3 ± 1) and so was the increase in D-dimer level in the burn group (4.5 ± 0.4 vs 1.9 ± 0.3 mg/l, both P < .05). The hypercoagulable state postburn is in part a result of increased fibrinogen synthesis, over and above increased fibrinogen breakdown. [ABSTRACT FROM AUTHOR]

Published
2020
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