S. A. Eidelson1, C. A. Karcutskie1, C. I. Schulman1, N. Namias1, K. G. Proctor1 1University Of Miami,Department Of Surgery,Miami, FL, USA
Introduction:
Thomboelastography (TEG) has had an increasingly useful role in critical care. It has been postulated that platelets may contribute to hypercoagulability after trauma. There is not yet definitive data on when these patients become hypercoagulable, or how long this persists. We hypothesize that patients will gradually develop abnormal platelet function after trauma.
Methods:
Prospective study of patients sustaining blunt or penetrating trauma admitted to the intensive care unit from 8/2011-4/2015. Patients were all deemed high risk for venous thromboembolism with a Greenfield Risk Assessment Profile Score of 10 or greater. All patients received bilateral lower extremity duplex ultrasounds and TEGs on admission and then weekly afterwards. Additionally, all patients received mechanical and chemical thromboprophylaxis.
Results:
One hundred patients received TEGs on both admission and at one week. The cohort was aged 47±20 years, with 76% blunt trauma and 24% penetrating trauma. The deep venous thrombosis rate was 22%. The maximum amplitude (MA) TEG value, which indicates platelet function, was in the hypercoagulable range in 7 patients (7.0%) on admission. At week 1, MA was in the hypercoagulable range in 62 patients (62%), significantly higher compared to admission (p<0.001). Fifty-five of these patients also received TEGs at week 2. In this subgroup, hypercoagulable MA values were seen in 5 (9.1%), 36 (65.5%), and 37 (67.3%) patients at admission, week 1, and week 2, respectively. Again, there were significantly more hypercoagulable patients at week 1 than admission (p<0.001). There was no difference in hypercoagulability at weeks 1 and 2.
Conclusion:
Despite the use of chemical thromboprophylaxis, trauma patients appear to exhibit abnormal platelet function as early as week 1. This hypercoagulability seems to persist to at least week 2. Antiplatelet therapy may play a significant role in thromboprophylaxis after trauma.