Comprehensive evaluation of coagulation in swine subjected to isolated primary blast injury

Blast is one of the major causes of injury and death in recent armed conflicts. With increased use of improvised explosive devices in Iraq and Afghanistan, more than 71% of combat casualties are caused by explosions. Blast injuries can range from primary (caused by shock wave) to quaternary injuries (e.g., burns), and such injuries can result in an acute coagulopathy denoted by a hypocoagulable state. It is not clear if this coagulopathy observed in victims of explosion is caused by local or general effect of the primary blast injury itself. In this study, 13 pigs were subjected to severe isolated open-field blast injury and we measured indices of coagulation impairment during the first hour after injury: ROTEM, prothrombin time, activated partial thromboplastin time, coagulation factors, thrombin generation potential, platelet count, platelet activation, platelet function, and procoagulant microparticle formation. After 1 h, the mortality was 33%. No coagulation dysfunction was observed in the survivors in this period. This study presented a highly reproducible and consistent isolated blast injury in large mammals with comprehensive coagulation testing. The data suggest that isolated primary blast injury is not responsible for acute coagulopathy of trauma in victims of explosion but seems to lead to an early hypercoagulable state.