Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism

Allen Casey J, Clark R. Murray, Jonathan P. Meizoso, Ray Juliet J, Teisch Laura F, Ruiz Xiomara, Hanna Mena M, Guarch Gerardo A, Ronald J. Manning, Alan Livingstone, Enrique Ginzburg, Carl I Schulman, Nicholas Namias, Kenneth G Proctor

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Abstract

We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R<sup>2</sup> = 0.095, P = 0.008) and at Day 7 (r = 0.516, R<sup>2</sup> = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R<sup>2</sup> = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.

Original languageEnglish (US)
Pages (from-to)663-664
Number of pages2
JournalAmerican Surgeon
Volume81
Issue number7
StatePublished - Jul 1 2015

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Venous Thromboembolism
Blood Platelets
Wounds and Injuries
Thrombelastography
Thrombophilia
Low Molecular Weight Heparin
Intensive Care Units
Heparin
Length of Stay
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Casey J, A., Murray, C. R., Meizoso, J. P., Juliet J, R., Laura F, T., Xiomara, R., ... Proctor, K. G. (2015). Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism. American Surgeon, 81(7), 663-664.

Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism. / Casey J, Allen; Murray, Clark R.; Meizoso, Jonathan P.; Juliet J, Ray; Laura F, Teisch; Xiomara, Ruiz; Mena M, Hanna; Gerardo A, Guarch; Manning, Ronald J.; Livingstone, Alan; Ginzburg, Enrique; Schulman, Carl I; Namias, Nicholas; Proctor, Kenneth G.

In: American Surgeon, Vol. 81, No. 7, 01.07.2015, p. 663-664.

Research output: Contribution to journalArticle

Casey J, A, Murray, CR, Meizoso, JP, Juliet J, R, Laura F, T, Xiomara, R, Mena M, H, Gerardo A, G, Manning, RJ, Livingstone, A, Ginzburg, E, Schulman, CI, Namias, N & Proctor, KG 2015, 'Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism', American Surgeon, vol. 81, no. 7, pp. 663-664.
Casey J A, Murray CR, Meizoso JP, Juliet J R, Laura F T, Xiomara R et al. Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism. American Surgeon. 2015 Jul 1;81(7):663-664.
Casey J, Allen ; Murray, Clark R. ; Meizoso, Jonathan P. ; Juliet J, Ray ; Laura F, Teisch ; Xiomara, Ruiz ; Mena M, Hanna ; Gerardo A, Guarch ; Manning, Ronald J. ; Livingstone, Alan ; Ginzburg, Enrique ; Schulman, Carl I ; Namias, Nicholas ; Proctor, Kenneth G. / Coagulation profile changes due to thromboprophylaxis and platelets in trauma patients at high-risk for venous thromboembolism. In: American Surgeon. 2015 ; Vol. 81, No. 7. pp. 663-664.
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abstract = "We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed. Upon admission, 87 per cent were hypercoagulable, and 81 per cent remained hypercoagulable by Day 7 (P = 0.504). TPX was initiated 3.4 ± 1.4 days after admission; 68 per cent received unfractionated heparin and 32 per cent received low-molecular-weight heparin. The VTE rate was 18 per cent, length of stay 38 (25-37) days, and mortality of 17.6 per cent. In all, 76 per cent had a rapid clotting time at admission versus 39 per cent at Day 7 (P < 0.001); correcting from 7.75 (6.45-8.90) minutes to 10.45 (7.90-15.25) minutes (P < 0.001). At admission, 41 per cent had an elevated maximum clot formation (MCF) and 85 per cent had at Day 7 (P < 0.001); increasing from 61(55-65) mm to 75(69-80) mm (P < 0.001). Platelets positively correlated with MCF at admission (r = 0.308, R2 = 0.095, P = 0.008) and at Day 7 (r = 0.516, R2 = 0.266, P < 0.001). Change in platelet levels correlated with change in MCF (r = 0.332, R2 = 0.110, P = 0.005). In conclusion, hypercoagulability persists despite the use of TPX. Although clotting time normalizes, MCF increases in correlation with platelet levels. As platelet function is a dominant contributor to sustained trauma-evoked hypercoagulability, antiplatelet therapy may be indicated in the management of severely injured trauma patients.",
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AU - Laura F, Teisch

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