Thrombin generation profiles as predictors of symptomatic venous thromboembolism after trauma: A prospective cohort study

Myung S. Park, Grant M. Spears, Kent R. Bailey, Ailing Xue, Michael J. Ferrara, Amy Headlee, Sabtir K. Dhillon, Donald H. Jenkins, Scott P. Zietlow, William S. Harmsen, Aneel A. Ashrani, John A. Heit

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

BACKGROUND Reliable biomarkers predictive of venous thromboembolism (VTE) after acute trauma are uncertain. The objective of the study was to identify risk factors for symptomatic VTE after trauma, including individual plasma coagulome characteristics as reflected by thrombin generation. METHODS In a prospective, case-cohort study, trauma patients were enrolled over the 4.5-year period, 2011 to 2015. Blood was collected by venipuncture into 3.2% trisodium citrate at 0, 6, 12, 24, and 72 hours after injury and at hospital discharge. Platelet poor plasma was stored at -80 °C until analysis. Thrombin generation, as determined by the calibrated automated thrombogram (CAT) using 5 pM tissue factor (TF)/4 μM phospholipid (PS), was reported as peak height (nM thrombin) and time to peak height (ttPeak [minutes]). Data are presented as median [IQR] or hazard ratio with 95% CI. RESULTS Among 453 trauma patients (injury severity score = 13.0 [6.0, 22.0], hospital length of stay = 4.0 [2.0, 10.0] days, age = 49 [28, 64] years, 71% male, 96% with blunt mechanism, mortality 3.2%), 83 developed symptomatic VTE within 92 days after injury (35 [42%] after hospital discharge). In a weighted, multivariate Cox model that included clinical and CAT characteristics available within 24 hours of admission, increased patient age (1.35 [1.19,1.52] per 10 years, p < 0.0001), body mass index ≥30 kg/m 2 (4.45 [2.13,9.31], p < 0.0001), any surgery requiring general anesthesia (2.53 [1.53,4.19], p = 0.0003) and first available ttPeak (1.67 [1.29, 2.15], p < 0.00001) were independent predictors of incident symptomatic VTE within 92 days after trauma (C-statistic = 0.799). CONCLUSION The individual's plasma coagulome (as reflected by thrombin generation) is an independent predictor of VTE after trauma. Clinical characteristics and ttPeak can be used to stratify acute trauma patients into high and low risk for VTE. LEVEL OF EVIDENCE Prognostic, level III.

Original languageEnglish (US)
Pages (from-to)381-387
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number3
DOIs
StatePublished - Sep 1 2017

Keywords

  • Trauma
  • calibrated automated thrombogram
  • thrombin
  • venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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