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Severe trauma increases tissue factor (TF) and Factor XIa (FXIa) levels, particularly in patients experiencing shock. Most trauma patients also show active Factor IXa (FIXa) and FXIa, indicating elevated procoagulant activity.

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Area of Science:

  • Biochemistry
  • Trauma Pathophysiology
  • Hemostasis

Background:

  • Trauma patients exhibit heightened procoagulant activity, potentially linked to tissue factor (TF).
  • Previous studies identified active Factor IXa (FIXa) and Factor XIa (FXIa) in trauma patient plasma.
  • This study investigates TF, FIXa, and FXIa in relation to injury severity and shock in trauma patients.

Purpose of the Study:

  • To evaluate the impact of injury severity and shock on TF, FIXa, and FXIa levels in trauma patients.
  • To quantify the frequency and concentration of these factors in relation to trauma severity.
  • To report the prevalence of active FIXa and FXIa in trauma patient plasma.

Main Methods:

  • Eighty trauma patients were stratified into four groups based on Injury Severity Score and base deficit.
  • Plasma samples were collected at initial hospital arrival and stored.
  • Assays for FXIa, FIXa, and TF activity were performed using thrombin generation response to inhibitory antibodies.

Main Results:

  • Tissue factor (TF) frequency and concentration were significantly higher in severe injury groups compared to non-severe groups.
  • Factor XIa (FXIa) concentrations were approximately fourfold higher in trauma patients experiencing shock.
  • Active FIXa and FXIa were detected in the majority of trauma patient plasma samples, with no endogenous activity in healthy controls.

Conclusions:

  • Higher trauma severity correlates with increased TF frequency and concentration.
  • Shock is associated with elevated FXIa concentrations in trauma patients.
  • The widespread presence of active FIXa and FXIa in trauma patients is reported for the first time.