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Thromb Res. 2014 Sep;134(3):652-8. doi: 10.1016/j.thromres.2014.07.023. Epub 2014 Jul 22.

Cellular microparticle and thrombogram phenotypes in the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study: correlation with coagulopathy.

Author information

1
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Nena.Matijevic@uth.tmc.edu.
2
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Yao-Wei.W.Wang@uth.tmc.edu.
3
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Charles.E.Wade@uth.tmc.edu.
4
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: John.Holcomb@uth.tmc.edu.
5
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Bryan.A.Cotton@uth.tmc.edu.
6
Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Rd SW, Mail Code L-611, Portland, OR 97035, USA. Electronic address: schreibm@ohsu.edu.
7
Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 222 Piedmont Ave., Suite 7000, Cincinnati, OH 45219, USA. Electronic address: muskatp@ucmail.uc.edu.
8
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Erin.E.Fox@uth.tmc.edu.
9
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Deborah.J.deljunco@uth.tmc.edu.
10
Center for Translational Injury Research and Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 5.240, Houston, TX 77030, USA. Electronic address: Jessica.C.Cardenas@uth.tmc.edu.
11
Division of Clinical and Translational Sciences, Department of Internal Medicine, Medical School, Biostatistics/Epidemiology/Research Design Core,Center for Clinical and Translational Sciences and Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1100 Fannin St. UPB 1100.21, Houston, TX 77030, USA. Electronic address: Mohammad.H.Rahbar@uth.tmc.edu.
12
Division of General Surgery, Department of Surgery, School of Medicine, University of California San Francisco, 1001 Potrero Ave. Room 3C-38, San Francisco, CA 94110, USA. Electronic address: mcohen@sfghsurg.ucsf.edu.

Abstract

BACKGROUND:

Trauma-induced coagulopathy following severe injury is associated with increased bleeding and mortality. Injury may result in alteration of cellular phenotypes and release of cell-derived microparticles (MP). Circulating MPs are procoagulant and support thrombin generation (TG) and clotting. We evaluated MP and TG phenotypes in severely injured patients at admission, in relation to coagulopathy and bleeding.

METHODS:

As part of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, research blood samples were obtained from 180 trauma patients requiring transfusions at 5 participating centers. Twenty five healthy controls and 40 minimally injured patients were analyzed for comparisons. Laboratory criteria for coagulopathy was activated partial thromboplastin time (APTT) ≥ 35 sec. Samples were analyzed by Calibrated Automated Thrombogram to assess TG, and by flow cytometry for MP phenotypes [platelet (PMP), erythrocyte (RMP), leukocyte (LMP), endothelial (EMP), tissue factor (TFMP), and Annexin V positive (AVMP)].

RESULTS:

21.7% of patients were coagulopathic with the median (IQR) APTT of 44 sec (37, 53), and an Injury Severity Score of 26 (17, 35). Compared to controls, patients had elevated EMP, RMP, LMP, and TFMP (all p<0.001), and enhanced TG (p<0.0001). However, coagulopathic PROMMTT patients had significantly lower PMP, TFMP, and TG, higher substantial bleeding, and higher mortality compared to non-coagulopathic patients (all p<0.001).

CONCLUSIONS:

Cellular activation and enhanced TG are predominant after trauma and independent of injury severity. Coagulopathy was associated with lower thrombin peak and rate compared to non-coagulopathic patients, while lower levels of TF-bearing PMPs were associated with substantial bleeding.

KEYWORDS:

Blood coagulation; Cell–derived microparticles; Hemorrhage; Thrombin; Trauma

PMID:
25086657
PMCID:
PMC4160305
DOI:
10.1016/j.thromres.2014.07.023
[Indexed for MEDLINE]
Free PMC Article
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