The swine as a vehicle for research in trauma-induced coagulopathy: Introducing principal component analysis for viscoelastic coagulation tests

• Published in: The journal of trauma and acute care surgery Vol. 90; no. 2; pp. 360 - 368
• Main Authors: Brännström, Andreas, von Oelreich, Erik, Degerstedt, Louise Elander, Dahlquist, Albin, Hånell, Anders, Gustavsson, Jenny, Günther, Mattias
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2021
• Subjects: Animals; Blood Coagulation - physiology; Blood Coagulation Tests - methods; Disease Models, Animal; Hemorrhage - blood; Hemorrhage - diagnosis; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Medicin och hälsovetenskap; Principal Component Analysis; Sensitivity and Specificity; Swine; Thrombelastography - methods; Trauma Severity Indices; Wounds and Injuries - blood; Wounds and Injuries - classification; Wounds and Injuries - complications
• ISSN: 2163-0755; 2163-0763; 2163-0763
• DOI: 10.1097/TA.0000000000002997

Uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. Tissue injury and shock result in trauma-induced coagulopathy (TIC). There are still uncertainties regarding detection methods and best practice management for TIC, and a deeper understanding of the pathophysiology requires robust animal models. The applicability of swine in coagulation studies, particularly after trauma has not been sufficiently elucidated. We, therefore, evaluated the swine as a vehicle for TIC research in a selection of trauma modalities.
Twenty-six landrace swine (3 females/23 males) (mean weight, 60.0 kg) were anesthetized and randomized to negative controls, receiving no manipulation (n = 5), positive controls by hemodilution (n = 5), pulmonary contusion without hemorrhage (n = 5), pulmonary contusion with hemorrhage (n = 5), and blast polytrauma with hypothermia, hypoperfusion, hypoventilation, and systemic inflammation (n = 6). A comprehensive coagulation panel was analyzed at baseline, 20 minutes and 120 minutes after trauma.
PT(INR), aPTT, thrombocytes, and fibrinogen did not change after trauma. D-dimer increased (p < 0.0001), prothrombin decreased (p < 0.05) and aPC decreased (p < 0.01) after polytrauma. PAI-1 decreased after pulmonary contusion with hemorrhage (p < 0.05). Positive controls displayed changes in PT(INR), thrombocytes, fibrinogen, prothrombin, aPC (p < 0.05). Principal Component Analysis of rotational thromboelastometry presented pathologic coagulation profiles in both polytrauma and positive control groups with vectors extending outside the 95% confidence interval, which were not detected in negative controls.
Coagulopathy was induced after severe porcine blast polytrauma, specifically detected in rotational thromboelastometry. A novel method for principal component analysis of viscoelastic tests was introduced which may increase the detection sensitivity and differentiation of TIC phenotypes and should be further investigated in trauma populations.