Background: Venous thromboembolism (VTE) prophylaxis remains debated following trauma, and recommendations have not been established. Although hyperfibrinogenemia is a marker of proinflammatory states, it also contributes to thrombus formation. Postinjury hyperfibrinogenemia is common, but the effect of hyperfibrinogenemia on VTE prophylaxis has not been fully elucidated. Therefore, we hypothesized that heparin is less effective for VTE prophylaxis following severe injury due to hyperfibrinogenemia.
Methods: In vitro studies evaluated thromboelastography (TEG) parameters in 10 healthy volunteers after the addition of fibrinogen concentrate and heparin. Data from a recent randomized controlled trial, conducted at an academic level I trauma center surgical intensive care unit, were reviewed. Critically injured patients were randomized to standard VTE prophylaxis (5,000 U low-molecular-weight heparin daily) or TEG-guided prophylaxis (up to 10,000 U low-molecular-weight heparin daily) and were followed up for 5 days. Analysis was performed to evaluate the relationship between fibrinogen levels, measures of anticoagulation, and TEG parameters.
Results: In vitro studies revealed increased fibrinogen reversed the effects of heparin as measured by TEG. Fifty patients were enrolled in the clinical study with 25 in each arm. Thromboelastography parameters, fibrinogen, platelet count, and anti-Xa levels did not differ between groups despite treatment provided. Fibrinogen levels increased over the 5-day study period (597 ± 24.0 to 689.3 ± 25.0), as well as clot strength (9.8 ± 0.4 to 14.5 ± 0.6), which had a significant correlation coefficient (P < 0.01). Moreover, there was a moderate inverse correlation between fibrinogen level and the effect of heparin (RF), which was significant on study days 1 and 3, implicating hyperfibrinogenemia in heparin resistance.
Conclusions: Hypercoagulability and heparin resistance are common following trauma. The preclinical and clinical relationships between fibrinogen levels and hypercoagulability implicate hyperfibrinogenemia as a potential factor in heparin resistance.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902785 | PMC |
| http://dx.doi.org/10.1097/SHK.0000000000000067 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Optimal dosing of VTE prophylaxis for specific patient populations remains an area of concern as insufficient evidence exists regarding dosing for underweight patients. The purpose of this study is to compare the incidence of major bleeding events in underweight patients given different prophylactic doses of enoxaparin. This is a retrospective analysis performed at multiple hospitals within a single health care system.
View Article and Find Full Text PDFRetrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury.
Surg Pract Sci
June 2023
Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642 United States.
Background: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE) but few studies address optimal timing or choice of agent.
Materials And Methods: Retrospective review of moderate to severe TBI patients receiving chemical VTE prophylaxis (early initiation [≤ 72 h from admission], late [> 72 h to 7 days], or delayed [> 7 days]) between 2012 through 2017. Primary outcome was VTE occurrence.
Comorbid conditions increase the incidence of venous thromboembolism after colorectal surgery.
Surg Pract Sci
June 2022
University of Kentucky, Lexington, KY, USA.
Introduction: Colorectal surgery (CRS) patients are at high risk for venous thromboembolism (VTE). The Caprini model elucidates that comorbidities compound to increase VTE risk, but this association in CRS patients remains undefined. We hypothesize that the compounding presence of comorbidities in patients undergoing colorectal resection (CRR) or small bowel resection (SBR) is associated with greater postoperative VTE risk.
View Article and Find Full Text PDFProlonged versus standard thromboprophylaxis in oesophageal cancer patients undergoing surgery: A randomised, controlled study.
J Thromb Haemost
January 2025
Faculty of Health, Aarhus University, Aarhus, Denmark.
Background: Recent guidelines recommend prolonged thromboprophylaxis after oesophagectomy due to cancer. However, no previous studies have examined if prolonged prophylaxis is superior to standard, in-hospital prophylaxis. We aimed to perform the first clinical, randomised study testing the efficacy of a prolonged, one-month thromboprophylaxis with low molecular weight heparin versus the standard treatment.
View Article and Find Full Text PDFLiver Injury as a Risk Factor for Post-Traumatic Venous Thromboembolism.
J Am Coll Surg
January 2025
Division of Trauma & Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Background: Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients.
Study Design: The American College of Surgeons Trauma Quality Improvement Project database (TQIP) 2017-2021 was retrospectively reviewed for patients with a maximum abdominal Abbreviated Injury Score (AIS) ≥ 4 with or without LI.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!