Thrombelastography is Better Than PT, aPTT, and Activated Clotting Time in Detecting Clinically Relevant Clotting Abnormalities After Hypothermia, Hemorrhagic Shock and Resuscitation in Pigs
Abstract
Hypothermia and hemorrhagic shock contribute to coagulopathy after trauma. In this study, we investigated the independent and combined effects of hypothermia and hemorrhage with resuscitation on coagulation in swine and evaluated clinically relevant tests of coagulation. Methods: Pigs (n = 24) were randomized into four groups of six animals each: sham control, hypothermia, hemorrhage with resuscitation, and hypothermia, hemorrhage with resuscitation combined. Hypothermia to 32 Degrees C was induced with a cold blanket. Hemorrhage was induced by bleeding 35% of total blood volume followed by resuscitation with lactated Ringer's solution. Coagulation was assessed by thrombin generation, prothrombin time (PT), activated partial thromboplastin time (aPTT), activated clotting time (ACT), and thrombelastography (TEG) from blood samples taken at baseline and 4 hour after hypothermia and/or hemorrhage with resuscitation. Data were compared with analysis of variance. Results: Baseline values were similar among groups. There were no changes in any measurements in the control group. Compared with baseline values, hemorrhage with resuscitation increased lactate to 140% + or - 15% ( p less than 0.05). Hypothermia decreased platelets to 73% + or - 3% (p less than 0.05) with no effect on fibrinogen. Hemorrhage with resuscitation reduced platelets to 72% + or - 4% and fibrinogen to 71% + or - 3% (both p less than 0.05), with similar decreases in platelets and fibrinogen observed in the combined group. Thrombin generation was decreased to 75%+ or - 4% in hypothermia, 67% + or - 6% in hemorrhage with resuscitation, and 75% + or - 10% in the combined group (all p less than 0.05). There were no significant changes in PT or aPTT by hemorrhage or hypothermia. ACT was prolonged to 122% + or - 1% in hypothermia, 111% + or - 4% in hemorrhage with resuscitation, and 127% + or - 3% in the combined group (all p less than 0.05).
Document Details
- Document Type
- Technical Report
- Publication Date
- Sep 01, 2008
- Accession Number
- ADA627703
Entities
People
- Douglas S. Cortez
- John B Holcomb
- Michael A. Dubick
- Myung S. Park
- Wenjun Zhou Martini
Organizations
- United States Army Institute of Surgical Research