What question did this study set out to answer?

To evaluate whether plasma assays of thrombin generation, clot structure, fibrin formation, and plasmin generation differentiate hyperfibrinolysis and fibrinolysis shutdown phenotypes in trauma patients.

June 10, 2022Journal of Trauma and Acute Care SurgeryOpen Access

Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy

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To evaluate whether plasma assays of thrombin generation, clot structure, fibrin formation, and plasmin generation differentiate hyperfibrinolysis and fibrinolysis shutdown phenotypes in trauma patients.
Evaluated platelet-poor plasma from an observational cross-sectional trauma cohort with whole-blood thromboelastography-defined fibrinolysis shutdown (LY30 < 0.9%, n=11) or hyperfibrinolysis (LY30 > 3%, n=9), compared with noninjured controls.
Measured thrombin generation via fluorescence, fibrin network structure via confocal microscopy, fibrin formation via turbidity, and plasmin generation via calibrated assay with or without tissue factor or tissue plasminogen activator.
Spontaneous thrombin generation was absent in controls but present in both patient subgroups, exhibiting a shorter lag time and denser fibrin networks in hyperfibrinolysis than shutdown.
Without tissue plasminogen activator, shutdown plasma showed faster fibrin formation while hyperfibrinolysis plasma lysed spontaneously; exogenous tissue plasminogen activator masked these differences.
Tissue plasminogen activator-triggered plasmin generation was similar between hyperfibrinolysis and shutdown groups, and variations in LY30, fibrin architecture, and clot lysis correlated with systemic pH.

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Implication

Observational cross-sectional study demonstrates distinct thrombin and clot dynamics across fibrinolytic phenotypes in trauma patients, highlighting mechanistic differences in coagulopathy.

Cite This Study

Lawson et al. (2022) studied this question.

synapsesocial.com/papers/6a81f63e75df31edc9f202a3 https://doi.org/10.1097/ta.0000000000003723

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Implication

Observational cross-sectional study demonstrates distinct thrombin and clot dynamics across fibrinolytic phenotypes in trauma patients, highlighting mechanistic differences in coagulopathy.

Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy

Key Points

Discussion

Implication

Cite This Study

Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy

Key Points

Discussion

Implication

Cite This Study

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