Fibrinolysis in trauma patients: wide variability demonstrated by the Lysis Timer.

Hyperfibrinolysis contributes to the pathophysiology of trauma-induced coagulopathy. At present, systematic administration of tranexamic acid (TXA) is recommended in all patients in the early phase of trauma. However, there is some debate regarding whether TXA is beneficial in all trauma patients. A rapid and accurate tool to diagnose hyperfibrinolysis may be useful for tailoring TXA treatment. We conducted a proof-of-concept study of consecutive adult trauma patients. A first blood sample was obtained at the time of pre-hospital care (T1). Patients received 1 g of TXA after T1. A second sample was obtained on arrival at the emergency unit (T2). We examined coagulation, fibrin and fibrinogen formation and degradation. Fibrinolysis was assessed by determining tissue plasminogen activator (t-PA) antigen and plasminogen activator inhibitor 1 (PAI-1) activity and global fibrinolysis capacity assay using a device developed by Hyphen BioMed: the Lysis Timer (GFC/LT). The study population consisted of 20 patients (42 ± 21 years, index of severity score 32 ± 21). Both coagulation and fibrinolysis were altered at T1. GFC/LT values exhibited hyperfibrinolysis only in five patients. Principal component analysis carried out at T1 showed two main axes of alteration. The major axis was related to coagulation, altered in all patients, while the second axis was related to fibrinolysis. GFC/LT was mainly influenced by PAI-1 activity while fibrin monomers were related to the severity of trauma. At T2, GFC/LT exhibited the marked effect of TXA on clot lysis time. In conclusion, GFC/LT demonstrated huge variation in the fibrinolytic response to trauma.

[The laboratory biochemical markers of severity of trauma in acute period after multiple fractures of bones of extremities].

The article presents results of studying alterations of biochemical indices of blood serum in 47 patients of both genders with multiple fractures of bones of lower extremities occurred in period up to 5 days after trauma. All examined patients were allocated in 5 groups: group I (n=10, average age 41±9 years) - patients received during 24 hours after trauma; group II (n=10, average age 42±7 years) - patients received during 24-48 hours after trauma; group III (n=10, average age 42±6 years) - patients received after 72-96 hours after trauma; group IV (n=8, average age 43±6years) - patients received 72-96 hours after trauma; group V (n=9 average age 39±8 years) - patients received after 96-120 hours after trauma. It is established that in examined patients the higher level of lactate (rate 0.745) and increased activity of aspartate aminotransferase (rate 0.553) are established most often. The high rate of increasing of activity of creatinine phosphatase was marked. The reliable correlation dependence on treatment period had three indices: total creatinine kinase, r=-0.534 (p=0.03); total protein, r=-0.477 (p=0.02) and lactate, r=0.406 (p=0.04). It was established also that average periods of treatment of received patients with both increased activity of total creatine kinase and level of lactate or decreased level of total protein, were reliably higher than average periods of treatment of patients with normal indices at the moment of reception into hospital. These three indices can be included into listing of tests for evaluation of trauma severity in patients with multiple fractures of bones of lower extremities with possibility of application of these tests as additional criteria of monitoring under management of patients in post-traumatic period.