Thromboelastometry (TEM) findings in disseminated intravascular coagulation in a pig model of endotoxinemia

Autor: Heinz Redl, Arthur Schulz, Cristina Solomon, Herbert Schöchl, Martijn van Griensven, Alexander A. Hanke, Wolfgang G. Voelckel, Soheyl Bahrami
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Lipopolysaccharides
Male
medicine.medical_specialty
Swine
Thrombelastography/methods
Article
Fibrin
Andrology
chemistry.chemical_compound
Plasminogen Activator Inhibitor 1
Genetics
medicine
Coagulation testing
Coagulation (water treatment)
Animals
Disseminated Intravascular Coagulation/blood
Blood Coagulation
Molecular Biology
Tissue Plasminogen Activator/blood
Genetics (clinical)
Disseminated intravascular coagulation
biology
medicine.diagnostic_test
Chemistry
Animal
Fibrinolysis
Plasminogen Activator Inhibitor 1/blood
Disseminated Intravascular Coagulation
medicine.disease
Endotoxemia
Fibrinolysis/drug effects
Lipopolysaccharides/administration & dosage
Thrombelastography
Surgery
Blood Cell Count
Endotoxemia/chemically induced
Disease Models
Animal
Thromboelastometry
Clotting time
Blood Coagulation/drug effects
Tissue Plasminogen Activator
Plasminogen activator inhibitor-1
Disease Models
biology.protein
Molecular Medicine
Partial thromboplastin time
Zdroj: Molecular Medicine. 17(3-4):266-72
ISSN: 1076-1551
Popis: Standard coagulation tests have a low specificity and sensitivity for diagnosing disseminated intravascular coagulation. The aim of this study was to determine whether whole blood thromboelastometry (TEM) detects lipopolysaccharide (LPS)-induced changes in coagulation. Blood samples from 10 pigs were drawn at baseline, before and at the end of LPS infusion and 2, 3, 4 and 5 h after the start of endotoxinemia. Simultaneous to TEM, standard coagulation tests and extended coagulation analysis including tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) were performed. Endotoxinemia resulted in a significant acceleration of the nonactivated TEM (NATEM) clotting time 2 h after the end of LPS infusion; in contrast, the changes in international normalized ratio and activated partial thromboplastin time suggested delayed initiation of coagulation. NATEM maximum clot firmness (MCF) and fibrin-based thromboelastometry test (FIBTEM)-MCF decreased significantly from baseline until the last time point (from 64.6 ± 7.8 and 35.1 ± 12.8 mm to 52.8 ± 4.6 and 21.4 ± 11.8 mm, respectively; P = 0.01 for both parameters). A sharp, transient increase of t-PA had no effect on maximum lysis in the NATEM test. PAI-1 increased significantly 3 h after the start of LPS infusion, paralleled by a decrease in maximum lysis. In conclusion, TEM was superior to standard coagulation tests in reflecting initial activation of coagulation during endotoxinemia. TEM further suggested consumption of coagulation substrate; at the same time, inhibition of plasminogen activation was accompanied by improved clot stability. Further investigations are necessary to establish the clinical relevance of these findings.
Databáze: OpenAIRE
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