Normal prothrombinase activity, increased systemic thrombin activity, and lower antithrombin levels in patients with disseminated intravascular coagulation at an early phase of trauma: Comparison with acute coagulopathy of trauma-shock

作者：Yanagida Yuichiro; Gando Satoshi^*; Sawamura Atsushi; Hayakawa Mineji; Uegaki Shinji; Kubota Nobuhiko; Homma Taeko; Ono Yuichi; Honma Yoshinori; Wada Takeshi; Jesmin Subrina

来源：Surgery, 2013, 154(1): 48-57.

DOI：10.1016/j.surg.2013.02.004

Background. We tested the hypotheses that an increase in systemic thrombin activity occurs in both disseminated intravascular coagulation (DIG) with the fibrinolytic phenotype and in acute coagulopathy of trauma shock (ACoTS), and that the patients diagnosed as having ACoTS overlap or are identical with those diagnosed as having DIG.
Methods. We made a prospective study of 57 trauma patients, including 30 patients with DIG and 27 patients without DIG. Patients with ACoTS, defined as a prothrombin time ratio >1.2, were also investigated. We included 12 healthy volunteers as controls. The levels of soluble fibrin, antithrombin, prothrombinase activity, soluble thrombomodulin, and markers of fibrin(ogen)olysis were measured on days 1 and 3 after the trauma. The systemic inflammatory response syndrome and the Sequential Organ Failure Assessment were scored to evaluate the extent of inflammation and organ dysfunction.
Results. Patients with DIG showed more systemic inflammation and greater Sequential Organ Failure Assessment scores and were transfused with more blood products than the patients without DIG. On day 1, normal prothrombinase activity, increased soluble fibrin, lesser levels of antithrombin, and increased soluble thrombomodulin were observed in patients with DIG in comparison with controls and non-DIG patients. These changes were more prominent in patients with DIC who met the overt criteria for DIC established by the International Society on Thrombosis and Haemostasis. Multiple regression analysis showed that antithrombin is an independent predictor of high soluble fibrin in DIG patients. Greater levels of fibrin and fibrinogen degradation products, D-dimer, and the fibrin and fibrinogen degradation products/D-dimer ratio indicated increased fibrin(ogen)olysis in DIG patients. Almost all ACoTS patients overlapped with the DIG patients. The changes in the measured variables in ACoTS patients coincided with those in DIG patients.
Conclusion. Normal prothrombinase activity and insufficient control of coagulation give rise to systemic increase in thrombin generation and its activity in patients with DIG with the fibrinolytic phenotype at an early phase of trauma. The same is true in patients with ACoTS, and shutoff of thrombin generation was not observed.

• 出版日期2013-7