Reversible Hypothermia-Induced Inhibition of Human Platelet Activation in Whole Blood in Vitro and in Vivo

Michelson, Alan D.; Macgregor, H.; Kestin, AS; Barnard, Marc R.; Rohrer, Michael J.

doi:10.21236/ada360296

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…It affects wound infection risk, transfusion rates and increases mortality. 9 - 12 Due to a paucity of hip fracture specific evidence in this domain, we provide an overview of applicable literature in similar populations regarding hypothermia and its impact on outcomes.…”

Section: Introductionmentioning

confidence: 99%

Too Cool? Hip Fracture Care and Maintaining Body Temperature

Arkley

Taher

Dixon

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

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Section: Introductionmentioning

confidence: 99%

Too Cool? Hip Fracture Care and Maintaining Body Temperature

Arkley

Taher

Dixon

et al. 2020

Geriatr Orthop Surg Rehabil

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“…In addition, the relative protection of thrombin from antithrombin III afforded by fibrin binding is overcome by the high concentrations of heparin used during cardiopulmonary bypass (40) [4.5 U/ml with an activated clotting time > 999 seconds in our original study (21)]. Coupled with the direct inhibitory effects of hypothermia on platelet activation (21,36,28), the inhibition of thrombin by heparin provides a rational mechanism for attenuated platelet responses during bypass.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Heparin on Fibrinolytic Activity and Platelet Function

Upchurch¹,

Valeri²,

Khuri³

et al. 1995

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Heparin, a polyanionic glycosaminoglycan, is used routinely prior to the induction of cardiopulmonary bypass. Earlier observations in our laboratory suggested that the postoperative bleeding which occurs, despite neutralization of heparin with prdtamine, is secondary to hypothermia and dilutional anemia during bypass. An additional, potential mechanism for excessive bleeding following cardiopulmonary bypass is that heparin activates the fibrinolytic system, which may, in turn, adversely affect hemostasis. To understand better the effects of heparin administration on the fibrinolytic system in vivo, we simulated the anticoagulant regimen of cardiopulmonary bypass by administering increasing doses of intravenous heparin to five adult baboons over 60 minutes. We measured fibrinolytic parameters serially following heparinization, and demonstrated that heparin induces activation of the fibrinolytic system. We showed that the fibrinolytic system was activated in vivo as evidenced by an increase in plasmin activity and immunoreactive plasmin light chain, as well as an increase in immunoreactive fibrinogen fragment E in yjtro. These results demonstrate that the fibrinolytic system is activated in vivo by the administration of heparin during cardiopulmonary bypass. These data suggest that, despite administration of a neutralizing agent such as protamine, heparin may contribute to postoperative bleeding complications following cardiopulmonary bypass surgery owing principally to its longer-lived effects on the fibrinolytic system.

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Reversible Hypothermia-Induced Inhibition of Human Platelet Activation in Whole Blood in Vitro and in Vivo

Cited by 2 publications

References 14 publications

Too Cool? Hip Fracture Care and Maintaining Body Temperature

Too Cool? Hip Fracture Care and Maintaining Body Temperature

The Effect of Heparin on Fibrinolytic Activity and Platelet Function

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