Diverse coagulopathies in a rabbit model with different abdominal injuries

doi:10.5847/wjem.j.1920-8642.2017.02.011

Abstract

Abstract:

BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries was developed and evaluated by examining indicators of clotting and fibrinolysis.

METHODS: Forty New Zealand white rabbits were randomly divided into four groups: group 1 (sham), group 2 (hemorrhage), group 3 (hemorrhage-liver injury), and group 4 (hemorrhage-liver injury/intestinal injury-peritonitis). Coagulation was detected by thromboelastography before trauma (T₀), at 1 hour (T₁) and 4 hours (T₂) after trauma.

RESULTS: Rabbits that suffered from hemorrhage alone did not differ in coagulation capacity compared with the sham group. The clot initiations (R times) of group 3 at T₁ and T₂ were both shorter than those of groups 1, 2, and 4 (P<0.05). In group 4, clot strength was decreased at T₁ and T₂ compared with those in groups 1, 2, and 3 (P<0.05), whereas the R time and clot polymerization were increased at T₂ (P<0.05). The clotting angle significantly decreased in group 4 compared with groups 2 and 3 at T₂ (P<0.05).

CONCLUSION: This study suggests that different abdominal traumatic shock show diverse coagulopathy in the early phase. Isolated hemorrhagic shock shows no obvious effect on coagulation. In contrast, blunt hepatic injury with hemorrhage shows hypercoagulability, whereas blunt hepatic injury with hemorrhage coupled with peritonitis caused by a ruptured intestine shows a tendency toward hypocoagulability.

Key words: Hemorrhagic shock, Multiple trauma model, Inflammation, Coagulopathy, Thromboelastography

Ruo Wu, Luo-gen Peng, Hui-min Zhao. Diverse coagulopathies in a rabbit model with different abdominal injuries[J]. World Journal of Emergency Medicine, 2017, 8(2): 141-147.

Figures/Tables 4

Table 1

Figure 1.

Table 2

Figure 2.

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Variables T₀ T₁ T₂
Temperature (°C)
Group 1	39.2 (0.6) 38.1 (0.6) 37.6 (0.7)
Group 2	39.0 (0.5) 37.3 (0.8)^* 36.8 (0.8)^*
Group 3	38.9 (0.3) 36.8 (0.5)^* 36.1 (0.4)^*#
Group 4	39.1 (0.5) 36.4 (0.6)^# 35.3 (0.6)^#Δ
Mean arterial pressure (mmHg)
Group 1	97.4 (5.0) 97.8 (6.3) 91.1( 4.1)
Group 2	97.0 (3.8) 55.2 (1.9)^* 51.1 (3.2)^*
Group 3	96.9 (3.9) 55.2 (2.7)^* 51.0 (2.2)^*
Group 4	96.8 (4.5) 55.7 (2.5)^* 49.5 (1.7)^*
Hemoglobin (g/L)
Group 1	117.2 (5.9) 106.3(6.9) 110.7 (9.1)
Group 2	117.2 (9.1) 84.9 (7.0)^* 78.5 (7.6)^*
Group 3	114.8 (6.5) 76.6 (7.2)^# 72.7 (8.4)^
Group 4	110.0 (6.3) 78.5 (6.0)^# 69.7 (5.0)^#
Alanine aminotransferase (U/L)
Group 1	34.8 (5.4) 33.1 (6.7) 34.5 (6.2)
Group 2	31.1 (8.5) 32.2 (6.8) 35.1 (5.4)
Group 3	37.6 (8.6) 37.2 (13.8) 65.7 (25.2)^*#
Group 4	33.4 (10.1) 37.1 (15.9) 71.1 (12.0)^*#
Lactate (mmol/L)
Group 1	4.4 (0.8) 4.2 (0.5) 4.3 (0.7)
Group 2	4.5 (0.7) 7.4 (1.1)^* 7.4 (0.8)^*
Group 3	3.5 (1.1) 6.8 (1.3)^* 8.8 (1.6)^*
Group 4	4.4 (0.8) 10.9 (4.3)^* 18.9 (8.2)^*#Δ
Neutrophil (%)
Group 1	17.1 (3.2) 15.4 (5.0) 16.9 (3.3)
Group 2	16.1 (4.6) 15.7 (5.0) 17.9 (4.6)
Group 3	16.0 (3.4) 17.9 (6.4) 18.2 (3.9)
Group 4	17.0 (4.3) 16.3 (5.3) 57.9 (11.3)^*#Δ

Variables T₀ T₁ T₂
R time (minutes)
Group 1	3.0 (1.0) 3.9 (1.2) 2.8 (0.8)
Group 2	3.5 (1.7) 3.2 (1.3) 2.6 (0.6)
Group 3	3.3 (0.9) 1.9 (1.3)^* 1.2 (0.8)^*
Group 4	3.4 (1.1) 4.9 (3.4) 6.8 (3.2)^*
K time (minutes)
Group 1	1.2 (0.4) 1.2 (0.2) 1.3 (0.8)
Group 2	1.5 (1.1) 1.7 (0.7) 1.1 (0.3)
Group 3	2.1 (0.7) 1.1 (0.5)^1.0 (0.5)^
Group 4	1.4 (0.7) 1.8 (1.1) 2.5 (0.8)^*
Ang (°)
Group 1	69.9 (9.2) 70.6 (6.2) 71.1 (9.2)
Group 2	70.7 (10.8) 70.6 (6.9) 75.9 (2.5)
Group 3	66.4 (6.9) 74.9 (4.0) 76.2 (2.3)^*
Group 4	70.9 (7.7) 70.1 (10.9) 59.8 (16.1)
MA (mm)
Group 1	70.4 (3.6) 71.1 (2.6) 71.2 (2.3)
Group 2	69.0 (2.8) 68.5 (4.8) 66.3 (7.0)
Group 3	69.8 (5.0) 69.7 (4.6) 68.5 (6.3)
Group 4	73.1 (4.3) 64.5 (3.5)^* 48.7 (12.6)^*#

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