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Tytuł pozycji:

Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients.

Tytuł :
Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients.
Autorzy :
Stettler GR; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA. .
Moore EE; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.; Denver Health Medical Center, Aurora, USA.
Nunns GR; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.
Moore HB; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.
Huebner BR; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.
Silliman CC; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.; Department of Pediatrics, University of Colorado Denver, Aurora, USA.; Vitalant Research Institute, Denver, USA.
Banerjee A; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.
Sauaia A; Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.; School of Public Health, University of Colorado, Aurora, USA.
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Źródło :
European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2020 Mar 10. Date of Electronic Publication: 2020 Mar 10.
Publication Model :
Ahead of Print
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: 2011- : Heidelberg : Springer Heidelberg
Original Publication: Munich : Urban & Vogel, 2007-
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Grant Information :
T32-GM008315 and P50-GM49222 United States GM NIGMS NIH HHS; USAMRAA and W81XWH-12-2-0028 U.S. Department of Defense; UM1-HL120877 United States HL NHLBI NIH HHS
Contributed Indexing :
Keywords: Alcohol; Alcohol intoxication; Fibrinolysis shutdown; Trauma-induced coagulopathy
Entry Date(s) :
Date Created: 20200312 Latest Revision: 20200909
Update Code :
20201218
PubMed Central ID :
PMC7222146
DOI :
10.1007/s00068-020-01328-x
PMID :
32157340
Czasopismo naukowe
Introduction: High alcohol consumption has been associated with decreased fibrinolysis and enhanced thrombosis risk in cardiovascular disease. In trauma, alcohol has been associated with poor clot formation; however, its effect on fibrinolysis has not been fully investigated. We assessed the association of blood alcohol levels and fibrinolysis in trauma activation patients.
Methods: We queried our prospective registry of trauma activations from 2014 to 2016. Associations between viscoelastic measurements [rapid thrombelastography (rTEG)] and blood alcohol level (BAL) were determined and adjusted for confounders by a multinomial logistic regression. Lysis phenotypes were defined by the % lysis in 30 min (LY30) as follows: hyperfibrinolysis ≥ 3%, physiologic 0.9-2.9%, and fibrinolysis shutdown < 0.9%.
Results: Overall, 191 (43.8%) had BAL measured. There were 65 (34%) patients that had no detectable BAL, 32 (16.8%) had BAL of 10-150 mg/dL, and 94 (49.2%) patients had BAL > 150 mg/dL. BAL had a moderate, but significant inverse correlation with LY30 (Rho = - 0.315, p < 0.001), while there were no significant correlations between BAL and other TEG values. The distribution of fibrinolysis phenotypes varied significantly by BAL levels (p < 0.009, with high BAL having more shutdown and less hyperfibrinolysis than the other two BAL level groups. Multinomial logistic regression showed that after adjustment for confounders, BAL levels > 150 mg/dL were independently associated with a threefold increase in the odds of shutdown compared to undetectable BAL (OR 3.37, 95% CI 1.04-8.05, p = 0.006). High BAL was also significantly associated with higher odds of shutdown compared to low BAL (OR 2.63, 95% CI 1.15-6.06). Compared to physiologic fibrinolysis, fibrinolysis shutdown was associated with increased mortality (OR 2.87, 95% CI 1.41-5.83) and VFD < 28 (OR 2.54, 95% CI 1.47-4.39).
Conclusion: In the injured patient, high blood alcohol levels are associated with increased incidence of fibrinolysis shutdown. This finding has implications for postinjury hemostatic resuscitation as these patients may be harmed by anti-fibrinolytics. Further research is needed to assess whether the association with fibrinolysis is modified by the chronicity and type of alcohol consumed and whether anti-fibrinolytic therapy in intoxicated patients produces adverse effects.

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