The swine as a vehicle for research in trauma-induced coagulopathy: Introducing principal component analysis for viscoelastic coagulation tests.

Abstract

BACKGROUND:

Uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. Tissue injury and shock result in trauma-induced coagulopathy (TIC). There are still uncertainties regarding detection methods and best practice management for TIC, and a deeper understanding of the pathophysiology requires robust animal models. The applicability of swine in coagulation studies, particularly after trauma has not been sufficiently elucidated. We, therefore, evaluated the swine as a vehicle for TIC research in a selection of trauma modalities.

METHODS:

Twenty-six landrace swine (3 females/23 males) (mean weight, 60.0 kg) were anesthetized and randomized to negative controls, receiving no manipulation (n = 5), positive controls by hemodilution (n = 5), pulmonary contusion without hemorrhage (n = 5), pulmonary contusion with hemorrhage (n = 5), and blast polytrauma with hypothermia, hypoperfusion, hypoventilation, and systemic inflammation (n = 6). A comprehensive coagulation panel was analyzed at baseline, 20 minutes and 120 minutes after trauma.

RESULTS:

PT(INR), aPTT, thrombocytes, and fibrinogen did not change after trauma. D-dimer increased (p < 0.0001), prothrombin decreased (p < 0.05) and aPC decreased (p < 0.01) after polytrauma. PAI-1 decreased after pulmonary contusion with hemorrhage (p < 0.05). Positive controls displayed changes in PT(INR), thrombocytes, fibrinogen, prothrombin, aPC (p < 0.05). Principal Component Analysis of rotational thromboelastometry presented pathologic coagulation profiles in both polytrauma and positive control groups with vectors extending outside the 95% confidence interval, which were not detected in negative controls.

CONCLUSION:

Coagulopathy was induced after severe porcine blast polytrauma, specifically detected in rotational thromboelastometry. A novel method for principal component analysis of viscoelastic tests was introduced which may increase the detection sensitivity and differentiation of TIC phenotypes and should be further investigated in trauma populations.

• Authors: Andreas Brännström, Erik von Oelreich, Louise Elander Degerstedt, Albin Dahlquist, Anders Hånell, Jenny Gustavsson, Mattias Günther
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 90 Issue 2 Pg. 360-368 (02 01 2021) ISSN: 2163-0763 [Electronic] United States
• PMID: 33093294 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Animals
• Blood Coagulation (physiology)
• Blood Coagulation Tests (methods)
• Disease Models, Animal
• Hemorrhage (blood, diagnosis, etiology, therapy)
• Humans
• Principal Component Analysis
• Sensitivity and Specificity
• Swine
• Thrombelastography (methods)
• Trauma Severity Indices
• Wounds and Injuries (blood, classification, complications)