Systemic coagulation changes caused by pulmonary artery catheters: Laboratory findings and clinical correlation

David R. King, Stephen M. Cohn, Ara J. Feinstein, Kenneth G. Proctor, Michael Shapiro, Martin Schreiber, Jeffrey H. Levine, Faran Bokhari, Kimberly Nagy

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95% confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.

Original languageEnglish (US)
Pages (from-to)853-859
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number4
DOIs
StatePublished - Oct 2005
Externally publishedYes

Fingerprint

Swan-Ganz Catheterization
Pulmonary Artery
Catheters
Kaolin
Thrombelastography
Swine
Fibrin
Critical Illness
Radial Artery
Temperature
Research Ethics Committees
Thigh
Embolism
Pulmonary Embolism
Thrombin
Catheterization
Polymerization
Analysis of Variance
Confidence Intervals
Lung

Keywords

  • Coagulation
  • Pulmonary Artery Catheter
  • Pulmonary Embolism
  • Swine
  • Thromboelastography

ASJC Scopus subject areas

  • Surgery

Cite this

Systemic coagulation changes caused by pulmonary artery catheters : Laboratory findings and clinical correlation. / King, David R.; Cohn, Stephen M.; Feinstein, Ara J.; Proctor, Kenneth G.; Shapiro, Michael; Schreiber, Martin; Levine, Jeffrey H.; Bokhari, Faran; Nagy, Kimberly.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 4, 10.2005, p. 853-859.

Research output: Contribution to journalArticle

King, David R. ; Cohn, Stephen M. ; Feinstein, Ara J. ; Proctor, Kenneth G. ; Shapiro, Michael ; Schreiber, Martin ; Levine, Jeffrey H. ; Bokhari, Faran ; Nagy, Kimberly. / Systemic coagulation changes caused by pulmonary artery catheters : Laboratory findings and clinical correlation. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 4. pp. 853-859.
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abstract = "Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95{\%} confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.",
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T1 - Systemic coagulation changes caused by pulmonary artery catheters

T2 - Laboratory findings and clinical correlation

AU - King, David R.

AU - Cohn, Stephen M.

AU - Feinstein, Ara J.

AU - Proctor, Kenneth G.

AU - Shapiro, Michael

AU - Schreiber, Martin

AU - Levine, Jeffrey H.

AU - Bokhari, Faran

AU - Nagy, Kimberly

PY - 2005/10

Y1 - 2005/10

N2 - Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95% confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.

AB - Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95% confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.

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KW - Pulmonary Artery Catheter

KW - Pulmonary Embolism

KW - Swine

KW - Thromboelastography

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