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Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
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Hypercoagulability in pregnant trauma patients.
Lisa J Toelle1, Gabrielle E Hatton1, Jerrie S Refuerzo1
1Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA.
Trauma Surgery & Acute Care Open
|July 12, 2021
Summary
Injured pregnant women show a hypercoagulable hemostatic profile, but without increased risk of venous thromboembolism (VTE). This suggests pregnancy-associated hypercoagulability may be a normal adaptation, not a pathological state.
Area of Science:
- Trauma and emergency medicine
- Obstetrics and gynecology
- Hematology
Background:
- Circulating hormones influence coagulopathy in pregnancy and post-trauma.
- The hemostatic profile of pregnant women after injury remains uncharacterized.
Purpose of the Study:
- To hypothesize that injured pregnant females exhibit a hypercoagulable hemostatic profile and higher incidence of venous thromboembolic events (VTE) compared to non-pregnant females and males.
- To characterize the hemostatic profile of pregnant women after injury using thromboelastography (TEG).
Main Methods:
- A cohort study of adult trauma patients from 2009-2018 with TEG measurements on arrival.
- Nearest-neighbor matching to compare 76 pregnant patients with 301 non-pregnant females and 301 males based on age, Injury Severity Score, prehospital transfusion, and Glasgow Coma Scale.
- Defined hypercoagulable profiles by alpha angle (α) ≥76° and maximum amplitude (MA) ≥65 mm; high lysis at 30 minutes after MA (LY-30) ≥3.0%, low LY-30 ≤0.8%.
Main Results:
- Pregnant females demonstrated a higher α angle, high MA, and lower LY-30 compared to both control groups.
- Pregnant females met hypercoagulable criteria more frequently, with a low LY-30, yet had no VTE events compared to 2% in control groups.
- Low MA and high LY-30 correlated with increased mortality risk, irrespective of sex or pregnancy status; hypocoagulable α angle was linked to pregnancy complications.
Conclusions:
- Injured pregnant females commonly present with a hypercoagulable hemostatic profile based on standard reference ranges.
- The absence of VTE events in this group suggests that this hypercoagulable profile may represent a non-pathologic adaptation to pregnancy.
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