Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy
Abstract Background There is room for improvement of prevention of venous thromboembolism (VTE) after lower-leg cast application or knee arthroscopy. Information about the mechanism of clot formation in these patients may be useful to identify new prophylaxis targets. We aimed to study the effect of...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-023-00493-4 |
| _version_ | 1797836317943398400 |
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| author | Carolina E. Touw Banne Nemeth Raymond A. van Adrichem Astrid van Hylckama Vlieg Rob G. H. H. Nelissen Ton Lisman Suzanne C. Cannegieter |
| author_facet | Carolina E. Touw Banne Nemeth Raymond A. van Adrichem Astrid van Hylckama Vlieg Rob G. H. H. Nelissen Ton Lisman Suzanne C. Cannegieter |
| author_sort | Carolina E. Touw |
| collection | DOAJ |
| description | Abstract Background There is room for improvement of prevention of venous thromboembolism (VTE) after lower-leg cast application or knee arthroscopy. Information about the mechanism of clot formation in these patients may be useful to identify new prophylaxis targets. We aimed to study the effect of 1) lower-leg injury and 2) knee arthroscopy on thrombin generation. Methods A cross-sectional study was conducted using plasma samples of POT-(K)CAST trials to measure ex vivo thrombin generation (Calibrated Automated Thrombography [CAT]) and plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin (TAT), fibrinopeptide A (FPA). Plasma was obtained shortly after lower-leg trauma or before and after (< 4 h) knee arthroscopy. Participants were randomly selected from those who did not develop VTE. For aim 1, samples of 88 patients with lower-leg injury were compared with 89 control samples (i.e., preoperative samples of arthroscopy patients). Linear regression was used to obtain mean differences (or ratios if ln-retransformed because of skewedness) adjusted for age, sex, body mass index, comorbidities. For aim 2, pre- and postoperative samples of 85 arthroscopy patients were compared, for which mean changes were obtained. Results In patients with lower-leg injury (aim 1), endogenous thrombin potential, thrombin peak, velocity index, FPA and TAT were increased as compared with controls. In arthroscopy patients (aim 2), pre- and postoperative levels were similar for all parameters. Conclusion Lower-leg trauma increases thrombin generation both ex vivo and in vivo, in contrast to knee arthroscopy. This may imply that the pathogenesis of VTE is different in both situations. |
| first_indexed | 2024-04-09T15:07:58Z |
| format | Article |
| id | doaj.art-e6d8fe8f5650491e909c3670df213edc |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-04-09T15:07:58Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-e6d8fe8f5650491e909c3670df213edc2023-04-30T11:24:36ZengBMCThrombosis Journal1477-95602023-04-0121111110.1186/s12959-023-00493-4Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopyCarolina E. Touw0Banne Nemeth1Raymond A. van Adrichem2Astrid van Hylckama Vlieg3Rob G. H. H. Nelissen4Ton Lisman5Suzanne C. Cannegieter6Department of Clinical Epidemiology, Leiden University Medical CenterDepartment of Clinical Epidemiology, Leiden University Medical CenterDepartment of Clinical Epidemiology, Leiden University Medical CenterDepartment of Clinical Epidemiology, Leiden University Medical CenterDepartment of Orthopaedics, Leiden University Medical CenterDepartment of Surgery, Surgical Research Laboratory, University Medical Center Groningen, University of GroningenDepartment of Clinical Epidemiology, Leiden University Medical CenterAbstract Background There is room for improvement of prevention of venous thromboembolism (VTE) after lower-leg cast application or knee arthroscopy. Information about the mechanism of clot formation in these patients may be useful to identify new prophylaxis targets. We aimed to study the effect of 1) lower-leg injury and 2) knee arthroscopy on thrombin generation. Methods A cross-sectional study was conducted using plasma samples of POT-(K)CAST trials to measure ex vivo thrombin generation (Calibrated Automated Thrombography [CAT]) and plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin (TAT), fibrinopeptide A (FPA). Plasma was obtained shortly after lower-leg trauma or before and after (< 4 h) knee arthroscopy. Participants were randomly selected from those who did not develop VTE. For aim 1, samples of 88 patients with lower-leg injury were compared with 89 control samples (i.e., preoperative samples of arthroscopy patients). Linear regression was used to obtain mean differences (or ratios if ln-retransformed because of skewedness) adjusted for age, sex, body mass index, comorbidities. For aim 2, pre- and postoperative samples of 85 arthroscopy patients were compared, for which mean changes were obtained. Results In patients with lower-leg injury (aim 1), endogenous thrombin potential, thrombin peak, velocity index, FPA and TAT were increased as compared with controls. In arthroscopy patients (aim 2), pre- and postoperative levels were similar for all parameters. Conclusion Lower-leg trauma increases thrombin generation both ex vivo and in vivo, in contrast to knee arthroscopy. This may imply that the pathogenesis of VTE is different in both situations.https://doi.org/10.1186/s12959-023-00493-4Leg injuryKnee injuryArthroscopyCoagulationThrombin generation |
| spellingShingle | Carolina E. Touw Banne Nemeth Raymond A. van Adrichem Astrid van Hylckama Vlieg Rob G. H. H. Nelissen Ton Lisman Suzanne C. Cannegieter Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy Thrombosis Journal Leg injury Knee injury Arthroscopy Coagulation Thrombin generation |
| title | Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy |
| title_full | Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy |
| title_fullStr | Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy |
| title_full_unstemmed | Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy |
| title_short | Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy |
| title_sort | enhanced in vivo and ex vivo thrombin generation after lower leg trauma but not after knee arthroscopy |
| topic | Leg injury Knee injury Arthroscopy Coagulation Thrombin generation |
| url | https://doi.org/10.1186/s12959-023-00493-4 |
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