Coagulation is more affected by quick than slow bleeding in patients with massive blood loss

Abstract

Profuse blood loss affects blood coagulation to various degrees. However, whether bleeding speed affects coagulation remains uncertain. This study aimed to evaluate the effect of bleeding speed on coagulation function. A total of 141 patients in the Department of Thoracic Surgery of our hospital were evaluated between January 2007 and February 2014. There are two groups of patients, those who received decortication for chronic encapsulated empyema were called the slow-bleeding group, and those who received thoracoscopic upper lobectomy were called the fast bleeding group; each group was further subdivided into three: group A, 1000 ml ≤ bleeding amount < 1500 ml; group B, 1500 ml ≤ bleeding amount < 1700 ml; group C, 1700 ml ≤ bleeding amount < 2000 ml. Then, coagulation function was assessed in all patients before and during surgery and at 1, 2, and 24 h after surgery, measuring prothrombin time, activated partial thromboplastin time (APTT), fibrinogen, blood pressure, hematocrit, hemoglobin, and platelets. Bleeding duration was overtly longer in the slow-bleeding group than that in quick bleeding individuals (2.3 ± 0.25 h vs. 0.41 ± 0.13 h, P < 0.001). Fibrinogen, hematocrit, hemoglobin, and platelets strikingly decreased, whereas prothrombin time and APTT values significantly increased with bleeding amounts in both quick and slow-bleeding groups. Interestingly, compared with slow-bleeding patients, coagulation indices at each time point and bleeding amounts had significant differences in the quick bleeding group.Increased consumption of coagulation factors in quick bleeding may have greater impact on coagulation function.

Impact of Anemia on the Outcomes of Endoscopic Intervention in&nbsp;High-Risk NUGIB Patients

“…Studies have shown that massive bleeding can cause the loss of a large amount of blood-clotting factor and platelets, causing the coagulation function to decrease, especially in those with an acute condition [19]. Consistently, our studies reported that the INR and PT of severe patients were statistically higher than in mild patients.…”

Altered Fibrinolysis during and after Surgery

“…But plasma levels of tPA can also increase in situations of acute stress due to its release from the Weibel-Palade bodies of the endothelium. 26 Thrombin, epinephrine, vasopressin, desmopressin, bradykinin, and other substances trigger the release of tPA. Therefore, initially, with high basal levels of plasminogen, the fibrinolysis pathway is relatively well preserved during the early stages of hemodilution.…”

“…25 For example, it has been reported that the activity of antithrombin can decrease to levels of 30% after a 1:6 dilution of whole blood with normal saline in vitro. 17,26 Decreased antithrombin activity prolongs the half-lives of thrombin and FXa, thereby potentially contributing to improved hemostasis in this state of hypocoagulability secondary to hemodilution. However, excess activity of thrombin and activated FX in the circulation could contribute to the pathogenesis of trauma surgery-induced coagulopathy, disseminated intravascular coagulation, and also to postoperative deep vein thrombosis.…”

“…However, excess activity of thrombin and activated FX in the circulation could contribute to the pathogenesis of trauma surgery-induced coagulopathy, disseminated intravascular coagulation, and also to postoperative deep vein thrombosis. 9,26,27 Fibrinolytic and antifibrinolytic activities are also affected in situations of massive blood loss (►Table 1). 28 A progressive hemodilution of α2-antiplasmin and FXIII reduces fibrin crosslinking and prolongs the half-life of plasmin.…”

Exploring the anticoagulant and antiplatelet effect of the extracts of the red marine alga Acanthophora spicifera

“…Disturbs that alter such equilibrium may result in hemorrhage or thrombosis, while the latter is one of the most important cardiovascular diseases, as ischemic attack, stroke and myocardial infarction. They lead to mortality or morbidity worldwide, mainly in western populations (Zhao et al, 2017). Thrombosis generally has medical complications to patients or recurrent hospitalization, and this fact increases healthcare costs (Furie and Furie, 2008).…”