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Trauma induced hypercoagulablity in pediatric patients
Mark L Ryan1, Robert M Van Haren1, Chad M Thorson1
1Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Journal of Pediatric Surgery
|August 6, 2014
Summary
Pediatric trauma induces a hypercoagulable state, characterized by accelerated clotting and elevated markers like d-dimer. Further research is needed to understand the clinical significance and establish pediatric reference ranges for coagulation factors.
Area of Science:
- Pediatric hematology
- Trauma critical care
- Hemostasis and thrombosis
Background:
- Coagulation changes in pediatric trauma are not well understood.
- Existing adult reference ranges may not apply to children.
Purpose of the Study:
- To investigate coagulation alterations in pediatric trauma patients.
- To test the hypothesis that trauma induces a hypercoagulable state in children.
Main Methods:
- Prospective observational study of hospitalized children (8 months to 14 years).
- Coagulation assessed using thromboelastography (TEG) and clotting factor assays.
- Comparison between trauma patients and uninjured controls.
Main Results:
- Trauma patients showed significantly higher prothrombin time (PT) and accelerated TEG clotting time and fibrin cross-linking.
- Elevated d-dimer, Prothrombin Fragment 1+2, and Plasminogen Activator Inhibitor-1 were observed in trauma patients.
- Reduced Protein S activity and a high proportion of abnormal TEG/clotting factor values in pediatric controls compared to adult ranges.
Conclusions:
- Minor trauma in children is associated with a hypercoagulable state.
- Further investigation is required to determine the functional significance of these findings.
- Establishing normal pediatric reference ranges for coagulation parameters is essential.
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