Does bicarbonate correct coagulation function impaired by acidosis in swine?

Area of Science:

• Trauma and Emergency Medicine
• Physiology
• Biochemistry

Background:

• Coagulopathy is a significant factor in trauma-related morbidity and mortality.
• Acidosis is a known contributor to coagulopathy in trauma patients.
• The efficacy of intravascular bicarbonate in rapidly reversing acidosis-induced coagulopathy remains unclear.

Purpose of the Study:

• To investigate the effects of acidosis on coagulation function in vivo.
• To determine if intravascular bicarbonate neutralization of acidosis can rapidly reverse coagulation defects.

Main Methods:

• Acidosis was induced in 12 pigs using hydrochloric acid (HCl) infusion to a target pH of 7.1.
• Pigs were then randomized to receive either Lactated Ringer's (LR) solution to maintain pH 7.1 or bicarbonate to achieve pH 7.4.
• Coagulation parameters including prothrombin time (PT), partial thromboplastin time (PTT), thrombin generation, and clot strength (R, alpha, MA) were assessed at baseline, after acidosis induction, and after pH neutralization.

Main Results:

• Acidosis significantly reduced fibrinogen concentration and platelet counts in both groups.
• Thrombin generation, prothrombin time (PT), partial thromboplastin time (PTT), and clot strength (alpha, MA) were adversely affected by acidosis.
• Following pH neutralization with bicarbonate, fibrinogen and platelet levels remained depleted, and no reversal of acidosis-induced coagulation impairments was observed.

Conclusions:

• Acidosis impairs coagulation by reducing fibrinogen and platelets and inhibiting clotting kinetics.
• Bicarbonate administration to neutralize acidosis did not reverse the observed coagulation deficits.
• These findings suggest that acidosis-induced coagulopathy in trauma may not be rapidly corrected by pH neutralization alone.