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Hypercoagulability after trauma: hemostatic changes and relationship to venous thromboembolism
1Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. rita.selby@sunnybrook.ca
Thrombosis Research
|December 2, 2008
Summary
Major trauma causes increased thrombin generation, but standard coagulation markers do not predict venous thromboembolism (VTE). Increasing age is the primary risk factor for VTE after severe injury.
Area of Science:
- Trauma and Injury
- Hematology
- Thrombosis Research
Background:
- Major trauma induces a hypercoagulable state, increasing pathological thrombosis risk.
- Sequential changes in coagulation markers post-trauma and their link to clinical thrombosis are poorly understood.
Purpose of the Study:
- To characterize sequential changes in coagulation and fibrinolysis markers after multi-system trauma.
- To determine the relationship between these markers and clinical thrombosis development.
Main Methods:
- Prospective cohort study of 135 trauma patients without anticoagulant prophylaxis.
- Serial measurement of in vivo coagulation and fibrinolysis markers for 2 weeks.
- Assessment of asymptomatic deep vein thrombosis (DVT) via venography and investigation of suspected DVT/pulmonary embolism (PE).
Main Results:
- Overall venous thromboembolism (VTE) rate was 59%.
- Thrombin generation markers increased within 24 hours, persisting for ~5 days.
- No compensatory increase in Tissue Factor Pathway Inhibitor (TFPI) or FXa-TFPI; FXa-TFPI remained depressed.
- Coagulation markers did not independently predict VTE; increasing age was the sole significant predictor.
Conclusions:
- Major trauma causes persistent thrombin generation with disrupted regulation.
- Coagulation markers lack independent predictive value for VTE post-trauma.
- Increasing age is the most critical clinical predictor of VTE in trauma patients.
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