Different recovery profiles of coagulation factors, thrombin generation, and coagulation function after hemorrhagic shock in pigs

摘要

Background: Hemorrhagic shock contributes to coagulopathy after trauma. We investigated daily changes of coagulation components and coagulation function for 5 days in hemorrhaged and resuscitated pigs. Methods: Fourteen pigs were randomized into the sham control(C)and the hemorrhage and lactated Ringer's resuscitation (H-LR) groups. On day 1, hemorrhage was induced in the H-LR group by bleeding 35% of the total blood volume, followed by LR resuscitation at three times the bled volume. Pigs in the C group were not hemorrhaged or resuscitated. Hemodynamics and coagulation were measured daily after H-LR on day 1 to day 5. Results: No changes in hemodynamics and coagulation function occurred in C. Hemorrhage decreased mean arterial pressure and increased heart rate. LR resuscitation corrected these changeswithin 2 hours. Compared with the baselinevalues (BL) on day 1, fibrinogen levels were decreased to 76% T 6% by H-LR on day 1, increased to 217% T 16% on day 2, and remained increased thereafter; platelet counts were decreased to 63% T 5% by H-LR on day 1 and remained lower on days 2 and 3 but returned to BL by days 4 and 5 (all p < 0.05). Thrombin generation was decreased by H-L Ron days 1 and 2 but then increased to above BL on days 4 and 5. Coagulationfactor levels were decreased by H-LR on day 1but returned to BL on day 3 except for factor XIII. Clot strengthwas decreased by H-LR onday 1and returned to BL by day 2. Clot rapidity did not change on day 1 but was decreased on days 2 and 3 and returned to BL on days 4 and 5. Conclusion: Hemorrhage and resuscitation reduced coagulation components and compromised coagulation function, which showed different recovery profiles over the 5-day study period. J Trauma Acute Care Surg. 2012; 73: 640-647.