Trauma induced hypercoagulablity in pediatric patients

Mark L. Ryan, Robert M. Van Haren, Chad M. Thorson, David Andrews, Eduardo Perez, Holly Neville, Juan E Sola, Kenneth G Proctor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response. Methods A prospective observational study was conducted in hospitalized patients (age 8 months to 14 years) admitted for trauma or elective surgery. Informed consent was obtained from the parents and informed assent was obtained in patients 7 years of age or older. Coagulation changes were evaluated on fresh whole blood using thromboelastography (TEG) and on stored plasma using assays for special clotting factors. Results Forty three patients (22 trauma, median injury severity score = 9; and 21 uninjured controls) were evaluated. For trauma vs control, prothrombin time (PT) was higher by about 10% (p < 0.001), but activated partial thromboplastin time was not altered. TEG clotting time (R;p = 0.005) and fibrin cross-linking were markedly accelerated (K time, alpha angle; p < 0.001) relative to the control patients. d-Dimer, Prothrombin Fragment 1 + 2, and Plasminogen Activator Inhibitor-1 were all elevated, whereas Protein S activity was reduced (all p < 0.01). Importantly, a large fraction of TEG values and clotting factor assays in the pediatric control group were outside the published reference ranges for adults. Conclusion A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges.

Original languageEnglish
Pages (from-to)1295-1299
Number of pages5
JournalJournal of Pediatric Surgery
Volume49
Issue number8
DOIs
StatePublished - Jan 1 2014

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Pediatrics
Thrombelastography
Wounds and Injuries
Blood Coagulation Factors
Reference Values
Injury Severity Score
Partial Thromboplastin Time
Protein S
Plasminogen Activator Inhibitor 1
Prothrombin Time
Fibrin
Informed Consent
Observational Studies
Parents
Prospective Studies
Control Groups

Keywords

  • Coagulation
  • Pediatric
  • Thromboelastography
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Trauma induced hypercoagulablity in pediatric patients. / Ryan, Mark L.; Van Haren, Robert M.; Thorson, Chad M.; Andrews, David; Perez, Eduardo; Neville, Holly; Sola, Juan E; Proctor, Kenneth G.

In: Journal of Pediatric Surgery, Vol. 49, No. 8, 01.01.2014, p. 1295-1299.

Research output: Contribution to journalArticle

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