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Titolo:
HYPOTHERMIC COAGULOPATHY IN TRAUMA - EFFECT OF VARYING LEVELS OF HYPOTHERMIA ON ENZYME SPEED, PLATELET-FUNCTION, AND FIBRINOLYTIC-ACTIVITY
Autore:
WATTS DD; TRASK A; SOEKEN K; PERDUE P; DOLS S; KAUFMANN C;
Indirizzi:
INOVA REG TRAUMA CTR,DEPT TRAUMA SERV,3300 GALLOWS RD FALLS CHURCH VA22042 UNIV MARYLAND BALTIMORE MD 21201 NATL NAVAL MED RES INST BETHESDA MD 00000 UNIFORMED SERV UNIV HLTH SCI,DIV SURG TRAUMA BETHESDA MD 20814
Titolo Testata:
The journal of trauma, injury, infection, and critical care
fascicolo: 5, volume: 44, anno: 1998,
pagine: 846 - 854
Fonte:
ISI
Lingua:
ENG
Soggetto:
MASSIVE TRANSFUSION; COAGULATION; RESUSCITATION; INJURY; THROMBELASTOGRAPHY; TEMPERATURE; IMMEDIATE; SURVIVAL; VICTIMS;
Keywords:
COAGULATION; ENZYME; FIBRINOLYSIS; HYPOTHERMIA; PLATELET; THROMBELASTOGRAPH; TRAUMA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
59
Recensione:
Indirizzi per estratti:
Citazione:
D.D. Watts et al., "HYPOTHERMIC COAGULOPATHY IN TRAUMA - EFFECT OF VARYING LEVELS OF HYPOTHERMIA ON ENZYME SPEED, PLATELET-FUNCTION, AND FIBRINOLYTIC-ACTIVITY", The journal of trauma, injury, infection, and critical care, 44(5), 1998, pp. 846-854

Abstract

Background: The coagulopathy noted in hypothermic trauma patients hasbeen variously theorized to be caused by either enzyme inhibition, platelet alteration, or fibrinolytic processes, but mo study has examined the possibility that all three processes may simultaneously contribute to coagulopathy, but are perhaps triggered at different levels of hypothermia. The purpose of this study was to determine whether, at clinically common levels of hypothermia (33.0-36.9 degrees C), there are specific temperature levels at which coagulopathic alterations are seen in each of these processes. Methods: Of 232 consecutive adult traumapatients presenting to a Level I trauma center, 112 patients met the inclusion criteria of an Injury Severity Score of 9 or greater and time since injury of less than 2 hours. Of the included patients, 40 werenormothermic and 72 were hypothermic (greater than or equal to 37 degrees C, n = 40; 36.9-36 degrees C, n = 29; 35.9-35 degrees C, n = 20; 34.9-34 degrees C, n = 16; 33.9-33 degrees C, n = 7), Included patients were prospectively studied with thromboelastography adjusted to corebod temperature. Additionally, PT, aPTT, platelets, CO2, hemoglobin, hematocrit, and Injury Severity Score were measured. Results: Analysisby multivariate analysis of variance of the relationship between coagulation and temperature demonstrated that in hypothermic trauma patients, 34 degrees C was the critical point at which enzyme activity slowed significantly (p < 0.0001), and at which significant alteration in platelet activity was seen (p < 0.001). Fibrinolysis was not significantly affected at any of the measured temperatures (p > 0.25). Conclusions: Patients whose temperature was greater than or equal to 34.0 degrees C actually demonstrated a significant hypercoagulability. Enzyme activity slowing and decreased platelet function individually contributed to hypothermic coagulopathy in patients with core temperatures below34.0 degrees C. All the coagulation measures affected are part of thepolymerization process of platelets and fibrin, and this process may be the mechanism by which the alteration in coagulation occurs.

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Documento generato il 10/07/20 alle ore 18:01:24