Plasma thrombin generation kinetics in trauma patients across the age spectrum

Abstract

• Trauma induces early changes in thrombin generation kinetics. • Initiation and time to peak thrombin generation positively correlate to age. • TBI and transfusion impact age related trends in both plasma coagulation markers. • Age-specific models of thrombin generation and TIC are needed. Injured patients have early changes to normal coagulation that can impact long term risk for thrombotic complications. There is little known about how age impacts biomarkers of coagulation after traumatic injury. In this pilot study, we aimed to characterize thrombin generation kinetics, a known predictor of venous thromboembolism, in trauma patients across the age spectrum. Citrated plasma samples were collected from 174 trauma patients (3–94 years old). Thrombin generation kinetics were measured using calibrated automated thrombogram (CAT) and expressed as lag time (LT – minutes) and time to peak (ttPeak – minutes). Kruskal-Wallis, Spearman correlation, and multivariable regression analysis were carried out. Data in median and quartiles [Q1, Q3]. P < 0.05 significant. Pediatric patients ( n = 14) had shortest LT and ttPeak compared to adult and geriatric ( n = 43), who had longest (LT: 2.67 [2.48, 3.00] vs. 2.93 [2.56, 3.48] vs. 3.15 [2.74, 3.67], p = 0.029; ttPeak: 4.98 [4.67, 5.67] vs. 5.53 [5.00, 6.56] vs. 5.94 [5.52, 6.91], p = 0.011). LT and ttPeak correlated with age (Spearman 0.285 and 0.305, both p < 0.001). Clinical factors, specifically, age, injury severity score, and transfusion status were associated with LT and ttPeak in multivariable models. Trauma patients exhibit prolonged initiation and time to peak thrombin generation with age. Further studies are needed to determine the age-specific role of thrombin generation kinetics in thrombotic complications after trauma.