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CC BY 4.0 · TH Open 2019; 03(01): e10-e19
DOI: 10.1055/s-0038-1677030
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endogenous Procoagulant Activity in Trauma Patients and Its Relationship to Trauma Severity

Shannon M. Prior
1   Department of Biochemistry, University of Vermont, Colchester, Vermont, United States
,
Myung S. Park
2   Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Kenneth G. Mann
1   Department of Biochemistry, University of Vermont, Colchester, Vermont, United States
,
Saulius Butenas
1   Department of Biochemistry, University of Vermont, Colchester, Vermont, United States
› Author Affiliations
Funding This work was supported by the National Institutes of Health (UM1 HL120877 TACTIC grant; S.B., M.S.P) and by the US Army Medical Research and Medical Command (AR 360–5; M.S.P.).
Further Information

Publication History

03 May 2018

27 November 2018

Publication Date:
07 January 2019 (online)

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Abstract

Background It has been observed that trauma patients have elevated plasma procoagulant activity that could be assigned to an elevated concentration of tissue factor (TF). However, in many instances there is a discrepancy between the levels of TF and the procoagulant activity observed. We hypothesized that factor XIa (FXIa) could be responsible for this additional activity and that the presence and levels of both proteins could correlate with trauma severity.

Methods Citrate plasma from 98 trauma patients (47 blunt, 17 penetrating, and 34 thermal) were evaluated in clotting assays for the presence of FXIa and TF activity using respective inhibitory antibodies.

Results When the three trauma patient groups were divided into two cohorts (Injury Severity Score [ISS] > 25 and ISS ≤ 25), higher frequencies and concentrations of both TF and FXIa were observed for all the more severe injury subgroups.

Conclusions The majority of trauma patients have active FXIa in their plasma, with a significant fraction having active TF as well. Additionally, both TF and FXIa frequency and concentration directly relate to trauma severity. These data suggest the use of these two proteins as potential markers for the stratification of trauma patients.

Keywords

factor XIa activity - tissue factor activity - severity of trauma - markers of trauma

Authors' Contributions

S.M.P. participated in data analysis and wrote the manuscript; M.S.P. designed the study and provided plasma samples and clinical data of the patients; K.G.M. participated in the design of the study and methodology of protein quantification and with the data analysis; S.B. participated in the design of the study and development of FXIa and TF assays, and also participated in data analysis and manuscript writing.