Activated factor XI-antithrombin complex presenting as an independent predictor of 30-days mortality in out-of-hospital cardiac arrest patients. Issue 204 (August 2021)

• Record Type: Journal Article
• Authors: Aarsetøy, Reidun; ten Cate, Hugo; Spronk, Henri; Van Oerle, Rene; Aarsetøy, Hildegunn; Staines, Harold; Nilsen, Dennis W.T.
• Is Part Of: Thrombosis research. Issue 204(2021)
• Page Start: 1
• Page End: 8
• Publication Date: 2021-08
• Subjects: Coagulation activation -- Factor XIa-antithrombin complex -- Factor IXa-antithrombin complex -- Out-of-hospital cardiac arrest -- Prognosis -- Thrombin-antithrombin complex; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.05.014
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Cardiac arrest and cardiopulmonary resuscitation (CPR) are associated with activated coagulation and microvascular fibrin deposition with subsequent multiorgan failure and adverse outcome. Objectives: Activated Factor XI-antithrombin (FXIa-AT) complex, activated Factor IX–antithrombin (FIXa-AT) complex and thrombin-antithrombin (TAT) complex were measured as markers of coagulation activation, and evaluated as independent prognostic indicators in out-of-hospital cardiac arrest (OHCA) patients. Methods: From February 2007 until December 2010 blood samples were collected in close approximation to CPR from patients with OHCA of assumed cardiac origin. Follow-up samples in survivors were drawn 8–12 h and 24–48 h after hospital admission. All measurements were determined by ELISA. Results: Thirty-seven patients presented with asystole and 77 with ventricular fibrillation as first recorded heart rhythm. At 30-days follow-up, 70 patients (61.4%) had died. All patients had elevated levels of FXIa-AT complex, FIXa-AT complex and TAT. Initial levels were significantly higher in non-survivors compared to 30-days survivors. A significant increase in risk of 30-days all-cause mortality was observed through increasing quartiles of all three biomarkers in univariate Cox regression analysis. Compared to the lowest quartile (Q1), only FXIa-AT complex levels in Q3 (HR 3.17, p = 0.011) and Q2 (HR 3.02, p = 0.016) were independently associated with all-cause mortality in the multivariable analysis. FIXa-AT complex and TAT-complex did not behave as independent predictors. Conclusions: Complexes of FXIa-AT were independently associated with 30-days survival in OHCA-patients. Clinical trial registration: ClinicalTrials. gov, NCT02886273 . Highlights: Assessment of coagulation activation in out-of-hospital cardiac arrest patients Blood samples were obtained on-scene and during hospitalization. Antithrombin inactivated complexes of XIa, IXa and thrombin were measured. Antithrombin inactivated XIa was independently associated with 30-days mortality. Prediction was related to activation of the intrinsic coagulation pathway.