The tissue-plasminogen activator-challenged thromboelastography provides a comprehensive assessment of fibrinolysis in the severely injured.

IF 3.7 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2025-04-01 Epub Date: 2025-01-17 DOI:10.1097/TA.0000000000004526

Elizabeth R Maginot, Hunter B Moore, Ernest E Moore, Isabella M Bernhardt, Trace B Moody, Collin M White, Halima Siddiqui, Flobater I Gawargi, Reynold Henry, James G Chandler, Angela Sauaia, Christopher D Barrett

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Abstract

Background: Tissue-plasminogen activator-challenged thromboelastography (tPA-TEG) predicts massive transfusion and mortality better than conventional rapid thromboelastography (rTEG), with little concordance between their lysis values (LY30). We hypothesized that the main fibrinolytic inhibitors plasminogen activator inhibitor-1 (PAI-1) and α-2 antiplasmin (A2AP), as well as markers of fibrinolytic activation (plasmin-antiplasmin [PAP], tPA-PAI-1 complex, tPA activity), would correlate more strongly with tPA-TEG versus rTEG LY30 and may explain the recent findings of four distinct fibrinolytic phenotypes in trauma based on these two TEG methodologies.

Methods: Adult trauma patients (n = 56) had tPA-TEG, rTEG, and plasma obtained on arrival to the emergency department with institutional review board approval. Plasminogen activator inhibitor-1 activity, A2AP, PAP, and tPA-PAI-1 complex as well as tPA activity were measured. Data were analyzed using Spearman's correlations and analysis of variance.

Results: The median age was 34 years, 75% were male, and the New Injury Severity Score was 14. Mortality was 25%, and 23% required a massive transfusion. There was a significant negative correlation between PAI-1 activity and A2AP with tPA-TEG LY30 ( r = -0.77, p < 0.0001 and r = -0.62, p < 0.0001). There was a significant positive correlation between PAP complex and tPA-TEG LY30 ( r = 0.74, p < 0.0001). There was no correlation between any fibrinolytic analyte and rTEG LY30. When stratified by phenotype, patients with hypofibrinolysis and nonpathologic fibrinolysis had higher active PAI-1 ( p < 0.05) and A2AP levels ( p < 0.05), lower PAP ( p < 0.05), and tPA-PAI-1 complex ( p < 0.05). Tissue-plasminogen activator activity was higher in hyperfibrinolysis relative to the other three groups ( p < 0.05).

Conclusion: Tissue-plasminogen activator-TEG LY30 more accurately reflects fibrinolysis phenotypes in trauma patients than conventional TEG methods. This provides an explanation for tPA-TEG's superior performance over rTEG in predicting clinical outcomes.

Level of evidence: Diagnostic Tests/Criteria; Level III.

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组织纤溶酶原激活物挑战的血栓弹性成像提供了一个全面的评估纤维蛋白溶解在严重损伤。

背景：组织纤溶酶原激活物激发的血栓弹性成像（tPA-TEG）比传统的快速血栓弹性成像（rTEG）更能预测大量输血和死亡率，两者的溶解值（LY30）几乎没有一致性。我们假设主要的纤溶酶抑制剂纤溶酶原激活物抑制剂-1 （PAI-1）和α-2抗纤溶酶（A2AP），以及纤溶酶激活标志物（纤溶酶抗纤溶酶[PAP]， tPA-PAI-1复合物，tPA活性）与tPA-TEG和rTEG LY30的相关性更强，并且可以解释最近基于这两种TEG方法在创伤中发现的四种不同的纤溶表型。方法：56例成人外伤患者经机构审查委员会批准，在到达急诊科时进行tPA-TEG、rTEG和血浆检测。测定纤溶酶原激活物抑制剂-1活性、A2AP、PAP、tPA- pai -1复合物及tPA活性。数据分析采用Spearman相关和方差分析。结果：中位年龄34岁，男性占75%，新损伤严重程度评分为14分。死亡率为25%，23%的人需要大量输血。PAI-1活性、A2AP与tPA-TEG LY30呈显著负相关（r = -0.77, p < 0.0001; r = -0.62, p < 0.0001）。PAP复合物与tPA-TEG LY30呈显著正相关（r = 0.74, p < 0.0001）。任何纤溶分析物与rTEG LY30均无相关性。当按表型分层时，低纤溶和非病理性纤溶患者活性PAI-1和A2AP水平较高（p < 0.05）， PAP水平较低（p < 0.05）， tPA-PAI-1复合物水平较低（p < 0.05）。高纤溶组组织纤溶酶原激活物活性高于其他3组（p < 0.05）。结论：组织-纤溶酶原激活物-TEG LY30比常规TEG方法更准确地反映创伤患者的纤溶表型。这就解释了tPA-TEG在预测临床结果方面优于rTEG的原因。证据水平：基础科学；N/A。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.