Prolonged targeted temperature management compromises thrombin generation: A randomised clinical trial. (September 2017)

• Record Type: Journal Article
• Authors: Jeppesen, Anni Nørgaard; Hvas, Anne-Mette; Duez, Christophe Henri Valdemar; Grejs, Anders Morten; Ilkjær, Susanne; Kirkegaard, Hans
• Is Part Of: Resuscitation. Volume 118(2017)
• Page Start: 126
• Page End: 132
• Publication Date: 2017-09
• Subjects: APTT activated partial thromboplastin time -- C Celcius -- CI confidence intervals -- ETP endogenous thrombin potential -- ICU Intensive Care Unit -- INR international normalised ratio -- IQR inter quartile range -- ROSC return of spontaneous circulation -- SAPSII Simplified Acute Physiology Score II; Heart arrest -- Coagulation -- Haemostasis -- Targeted temperature management -- Hypothermia; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.06.004
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: To investigate whether prolonged compared with standard duration of targeted temperature management (TTM) compromises coagulation. Methods: Comatose survivors after out-of-hospital cardiac arrest (n = 82) were randomised to standard (24 h) or prolonged (48 h) duration of TTM at 33 ± 1 °C. Blood samples were drawn 22, 46 and 70 h after attaining the target temperature. Samples were analysed for rotational thromboelastometry (ROTEM ® (EXTEM ®, INTEM ®, FIBTEM ® and HEPTEM ® )) and thrombin generation using the Calibrated Automated Thrombogram ® assay. Results: With the 22-h sample, we revealed no difference between groups in the ROTEM ® and thrombin generation results beside a slightly higher EXTEM ® and INTEM ® maximum velocity in the prolonged group (p-values ≤0.04). With the 46-h sample, ROTEM ® showed no differences when using EXTEM ® ; however, 11% (p < 0.01) longer clotting time and 12% (p < 0.01) longer time to maximum velocity were evident in the prolonged group than in the standard group when using INTEM ® . The prolonged group had reduced thrombin generation compared with the standard group as indicated by 30% longer lag time (p = 0.04), 106 nM decreased peak concentration (p < 0.001), 36% longer time to peak (p = 0.01) and 411 nM*minute decreased endogenous thrombin potential (p < 0.001). With the 70-h sample, no differences in ROTEM ® results were found between groups. However, the prolonged group had reduced thrombin generation indicated by longer lag time, decreased peak concentration and longer time to peak (all p-values ≤ 0.02) compared with the standard group. Conclusion: Prolonged TTM in post-cardiac arrest patients impairs thrombin generation. ClinicalTrials.gov identifier: NCT02258360.