Maginot Elizabeth R, Moore Hunter B, Moore Ernest E, Bernhardt Isabella M, Moody Trace B, White Collin M, Siddiqui Halima, Gawargi Flobater I, Henry Reynold, Chandler James G, Sauaia Angela, Barrett Christopher D
From the Division of Acute Care Surgery, Department of Surgery (E.R.M., T.B.M., C.M.W., H.S., R.H., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (H.B.M.), AdventHealth Porter; Department of Surgery (E.E.M., J.G.C.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Department of Surgery (E.E.M.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Hunter College (I.M.B.), New York, New York; Sauaia Statistical Solutions, LLC (A.S.), Denver, Colorado; and Department of Cellular and Integrative Physiology (F.I.G., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska.
J Trauma Acute Care Surg. 2025 Apr 1;98(4):578-586. doi: 10.1097/TA.0000000000004526. Epub 2025 Jan 17.
Tissue-plasminogen activator-challenged thromboelastography (tPA-TEG) predicts massive transfusion and mortality better than conventional rapid thromboelastography (rTEG), with little concordance between their lysis values (LY30). We hypothesized that the main fibrinolytic inhibitors plasminogen activator inhibitor-1 (PAI-1) and α-2 antiplasmin (A2AP), as well as markers of fibrinolytic activation (plasmin-antiplasmin [PAP], tPA-PAI-1 complex, tPA activity), would correlate more strongly with tPA-TEG versus rTEG LY30 and may explain the recent findings of four distinct fibrinolytic phenotypes in trauma based on these two TEG methodologies.
Adult trauma patients (n = 56) had tPA-TEG, rTEG, and plasma obtained on arrival to the emergency department with institutional review board approval. Plasminogen activator inhibitor-1 activity, A2AP, PAP, and tPA-PAI-1 complex as well as tPA activity were measured. Data were analyzed using Spearman's correlations and analysis of variance.
The median age was 34 years, 75% were male, and the New Injury Severity Score was 14. Mortality was 25%, and 23% required a massive transfusion. There was a significant negative correlation between PAI-1 activity and A2AP with tPA-TEG LY30 ( r = -0.77, p < 0.0001 and r = -0.62, p < 0.0001). There was a significant positive correlation between PAP complex and tPA-TEG LY30 ( r = 0.74, p < 0.0001). There was no correlation between any fibrinolytic analyte and rTEG LY30. When stratified by phenotype, patients with hypofibrinolysis and nonpathologic fibrinolysis had higher active PAI-1 ( p < 0.05) and A2AP levels ( p < 0.05), lower PAP ( p < 0.05), and tPA-PAI-1 complex ( p < 0.05). Tissue-plasminogen activator activity was higher in hyperfibrinolysis relative to the other three groups ( p < 0.05).
Tissue-plasminogen activator-TEG LY30 more accurately reflects fibrinolysis phenotypes in trauma patients than conventional TEG methods. This provides an explanation for tPA-TEG's superior performance over rTEG in predicting clinical outcomes.
Diagnostic Tests/Criteria; Level III.
组织型纤溶酶原激活剂激发的血栓弹力图（tPA - TEG）在预测大量输血和死亡率方面优于传统的快速血栓弹力图（rTEG），但其溶解值（LY30）之间的一致性较差。我们推测主要的纤溶酶抑制剂纤溶酶原激活物抑制剂 - 1（PAI - 1）和α - 2抗纤溶酶（A2AP）以及纤溶激活标志物（纤溶酶 - 抗纤溶酶[PAP]、tPA - PAI - 1复合物、tPA活性）与tPA - TEG的LY30相关性更强，而与rTEG的LY30相关性较弱，这可能解释了基于这两种TEG方法在创伤中发现的四种不同纤溶表型的最新研究结果。
经机构审查委员会批准，成年创伤患者（n = 56）在抵达急诊科时接受tPA - TEG、rTEG检查并采集血浆。检测纤溶酶原激活物抑制剂 - 1活性、A2AP、PAP、tPA - PAI - 1复合物以及tPA活性。使用Spearman相关性分析和方差分析对数据进行分析。
患者中位年龄为34岁，75%为男性，新损伤严重程度评分为14分。死亡率为25%，23%的患者需要大量输血。PAI - 1活性和A2AP与tPA - TEG的LY30呈显著负相关（r = -0.77，p < 0.0001和r = -0.62，p < 0.0001）。PAP复合物与tPA - TEG的LY30呈显著正相关（r = 0.74，p < 0.0001）。任何纤溶分析物与rTEG的LY30均无相关性。按表型分层时，低纤溶和非病理性纤溶患者的活性PAI - 1（p < 0.05）和A2AP水平较高（p < 0.05），PAP（p < 0.05）和tPA - PAI - 1复合物较低（p < 0.05）。相对于其他三组，高纤溶患者的组织型纤溶酶原激活剂活性更高（p < 0.05）。
与传统TEG方法相比，组织型纤溶酶原激活剂 - TEG的LY30能更准确地反映创伤患者的纤溶表型。这为tPA - TEG在预测临床结局方面优于rTEG提供了解释。
诊断试验/标准；III级。
