Hypercoagulability in porcine hemorrhagic shock is present early after trauma and resuscitation

The understanding of coagulopathy associated with trauma continues to evolve. Trauma patients are frequently coagulopathic early after injury and become hypercoagulable within days of injury. Thrombelastography (TEG) allows real-time evaluation of the coagulation status of patients. We hypothesized that TEG will identify post-traumatic hypercoagulable state in our porcine model of hemorrhagic shock and resuscitation.

Fourteen male Yorkshire pigs were sedated, instrumented, and splenectomized via laparotomy. Eight of these animals underwent a shock protocol consisting of a pulmonary contusion via captive bolt gun, 35% hemorrhage and two liver fractures. Vitals, hemodynamics, physiologic parameters and TEG were measured at baseline, after shock and at intervals after injury thru 72 h post-injury.

Animals undergoing surgery and instrumentation demonstrated the same hypercoagulable patterns as animals that received shock, injury, and resuscitation. In this model, hypercoagulability was present in both groups at 4 h after injury and continued for 72 h post-injury (increased angle and maximum amplitude, P < 0.05, compared to baseline). Statistically significant differences between the groups were noted at both 16 and 48 h post-injury.

Hypercoagulability is present early after surgical intervention and trauma. This finding has implications for use of deep venous thrombosis (DVT) prophylaxis in trauma patients.