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Prolonged targeted temperature management compromises thrombin generation: A randomised clinical trial.

Anni Nørgaard Jeppesen1, Anne-Mette Hvas2, Christophe Henri Valdemar Duez1

  • 1Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Research Centre for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark.

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Summary

Prolonged targeted temperature management (TTM) in cardiac arrest survivors impairs thrombin generation, affecting coagulation. This study found significant differences in thrombin generation markers with longer TTM durations.

Keywords:
CoagulationHaemostasisHeart arrestHypothermiaTargeted temperature management

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Hematology

Background:

  • Targeted temperature management (TTM) is crucial for post-cardiac arrest care.
  • The optimal duration of TTM remains a subject of investigation, particularly concerning its impact on hemostasis.

Purpose of the Study:

  • To determine if prolonged TTM (48 hours) compared to standard TTM (24 hours) affects coagulation parameters in comatose survivors of out-of-hospital cardiac arrest.

Main Methods:

  • A randomized trial involving 82 cardiac arrest survivors compared 24-hour TTM with 48-hour TTM at 33°C.
  • Coagulation was assessed using rotational thromboelastometry (ROTEM) and thrombin generation assays at multiple time points (22, 46, and 70 hours).

Main Results:

  • At 46 hours, prolonged TTM showed no differences in EXTEM ROTEM but revealed longer clotting times with INTEM ROTEM.
  • The prolonged TTM group exhibited significantly reduced thrombin generation, evidenced by longer lag times, decreased peak concentrations, and reduced endogenous thrombin potential.
  • No significant differences in ROTEM results were observed at 70 hours, but thrombin generation remained impaired in the prolonged TTM group.

Conclusions:

  • Prolonged TTM (48 hours) in post-cardiac arrest patients is associated with impaired thrombin generation.
  • These findings suggest that extended TTM duration may compromise the coagulation system in this patient population.