Abstract
Background
Coagulation abnormalities contribute to poor outcomes in critically ill patients.
In trauma patients exposed to a hot environment, a systemic inflammatory response
syndrome, elevated body temperature, and reduced central blood volume occur in parallel
with changes in hemostasis and endothelial damage. The objective of this study was
to evaluate whether experimentally elevated body temperature and reduced central blood
volume (CBV) per se affects hemostasis and endothelial activation.
Methods
Eleven healthy volunteers were subjected to heat stress, sufficient to elevate core
temperature, and progressive reductions in CBV by lower body negative pressure (LBNP).
Changes in hemostasis were evaluated by whole blood haemostatic assays, standard hematologic
tests and by plasma biomarkers of coagulation and endothelial activation/disruption.
Results
Elevated body temperature and decreased CBV resulted in coagulation activation evidenced
by shortened activated partial tromboplastin time (−9% [IQR −7; −4]), thrombelastography:
reduced reaction time (−15% [−24; −4]) and increased maximum amplitude (+4% (2; 6)),
all P < 0.05. Increased fibrinolysis was documented by elevation of D-dimer (+53% (12;
59), P = 0.016). Plasma adrenaline and noradrenaline increased 198% (83; 346) and 234% (174;
363) respectively (P = 0.006 and P = 0.003).
Conclusions
This experiment revealed emerging hypercoagulability in response to elevated body
temperature and decreased CBV, whereas no effect on the endothelium was observed.
We hypothesize that elevated body temperature and reduced CBV contributes to hypercoagulability,
possibly due to moderate sympathetic activation, in critically ill patients and speculate
that normalization of body temperature and CBV may attenuate this hypercoagulable
response.
Keywords
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Article info
Publication history
Published online: July 01, 2013
Accepted:
June 6,
2013
Received in revised form:
May 20,
2013
Received:
December 20,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
