Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA.
Denver Health Medical Center, Aurora, USA.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1827-1835. doi: 10.1007/s00068-020-01328-x. Epub 2020 Mar 10.
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.
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%.
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).
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.
大量饮酒与心血管疾病中纤维蛋白溶解减少和血栓形成风险增加有关。在创伤中，酒精与血凝块形成不良有关；然而，其对纤维蛋白溶解的影响尚未得到充分研究。我们评估了创伤激活患者血液酒精水平与纤维蛋白溶解之间的关联。
我们从 2014 年至 2016 年查询了我们的创伤激活前瞻性登记处。通过多项逻辑回归确定了粘弹性测量[快速血栓弹性描记术（rTEG）]与血液酒精水平（BAL）之间的关联，并对混杂因素进行了调整。通过 30 分钟内的溶解百分比（LY30）定义纤溶表型如下：高纤维蛋白溶解 ≥ 3%，生理 0.9-2.9%，纤维蛋白溶解关闭 < 0.9%。
总体而言，有 191 名（43.8%）测量了 BAL。有 65 名（34%）患者没有可检测到的 BAL，32 名（16.8%）患者的 BAL 为 10-150mg/dL，94 名（49.2%）患者的 BAL > 150mg/dL。BAL 与 LY30 呈中度但显著负相关（Rho = - 0.315，p < 0.001），而 BAL 与其他 TEG 值之间没有显著相关性。纤溶表型的分布因 BAL 水平而显著不同（p < 0.009，高 BAL 比其他两个 BAL 水平组具有更多的关闭和较少的高纤维蛋白溶解。多项逻辑回归显示，在校正混杂因素后，BAL 水平 > 150mg/dL 与不可检测到的 BAL 相比，纤溶关闭的几率增加了三倍（OR 3.37，95%CI 1.04-8.05，p = 0.006）。与低 BAL 相比，高 BAL 也与更高的纤溶关闭几率显著相关（OR 2.63，95%CI 1.15-6.06）。与生理纤溶相比，纤溶关闭与死亡率增加（OR 2.87，95%CI 1.41-5.83）和 VFD < 28（OR 2.54，95%CI 1.47-4.39）有关。
在受伤患者中，高血液酒精水平与纤维蛋白溶解关闭的发生率增加有关。这一发现对受伤后止血复苏有影响，因为这些患者可能会因抗纤溶药物而受到伤害。需要进一步研究以评估纤维蛋白溶解的关联是否因慢性和所消耗的酒精类型而改变，以及在中毒患者中使用抗纤维蛋白溶解药物是否会产生不良影响。
