Whole blood thrombin generation is distinct from plasma thrombin generation in healthy volunteers and after severe injury.

Abstract

BACKGROUND:

Plasma thrombin generation has been used to characterize trauma-induced coagulopathy, but description of whole blood thrombin generation is lacking. This study aimed to evaluate plasma and whole blood thrombin generation in healthy volunteers and trauma patients. We hypothesized that (1) plasma and whole blood thrombin generation are distinct, (2) whole blood thrombin generation is more pronounced in trauma patients than in healthy volunteers, and (3) thrombin generation correlates with clinical coagulation assays.

METHODS:

Blood was collected from healthy volunteers and trauma patients at a single, level-1 trauma center. Whole blood thrombin generation was assessed with a prototype point-of-care whole blood thrombin generation device, and plasma thrombin generation was measured with a calibrated automated thrombogram analogue. Plasma and whole blood thrombin generation were compared and correlated with international normalized ratio and thrombelastography.

RESULTS:

Overall, 10 healthy volunteers (average age 30, 50% men) were included and 58 trauma patients (average age 34, 76% men, 55% blunt mechanism, and with a median new injury severity score of 17) were included. Plasma and whole blood thrombin generation differed with more robust thrombin generation in plasma. Trauma patients had a significantly increased whole blood thrombin generation compared with healthy volunteers]. Plasma thrombin generation correlated with international normalized ratio, whereas whole blood thrombin generation did not correlate with thrombelastography.

CONCLUSION:

Plasma and whole blood thrombin generation are distinct, highlighting the need to perform standardized assays to better understand their correlation and to assess how whole blood thrombin generation confers differential outcomes in trauma.

• Authors: Julia R Coleman, Ernest E Moore, Jason M Samuels, Joshua J Ryon, Jesse T Nelson, Alexander Olson, Sandi Caus, Matthew G Bartley, Navin G Vigneshwar, Mitchell J Cohen, Anirban Banerjee, Christopher C Silliman, Saulius Butenas
• Journal: Surgery (Surgery) Vol. 166 Issue 6 Pg. 1122-1127 (12 2019) ISSN: 1532-7361 [Electronic] United States
• PMID: 31522748 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Thrombin

Topics

• Adult
• Blood Coagulation Disorders (blood, diagnosis, etiology)
• Female
• Healthy Volunteers
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Plasma (metabolism)
• Prospective Studies
• Thrombelastography (methods)
• Thrombin (analysis, metabolism)
• Wounds and Injuries (blood, complications, diagnosis)