Coagulopathy after successful cardiopulmonary resuscitation following cardiac arrest: implication of the protein C anticoagulant pathway.

Abstract:

OBJECTIVES:We investigated coagulation abnormalities in out-of-hospital cardiac arrest (OHCA) patients, with special attention to the protein C anticoagulant pathway. BACKGROUND:Successfully resuscitated cardiac arrest is followed by a systemic inflammatory response and by activation of coagulation, both of which may contribute to organ failure and neurological dysfunction. METHODS:Coagulation parameters were measured in all patients admitted after successfully resuscitated OHCA. RESULTS:At admission, 67 patients had a systemic inflammatory response with increased interleukin-6 and coagulation activity (thrombin-antithrombin complex), reduced anticoagulation (antithrombin, protein C, and protein S), activated fibrinolysis (plasmin-antiplasmin complex), and, in some cases, inhibited fibrinolysis (increased plasminogen activator inhibitor-1 with a peak on day 1). These abnormalities were more severe in patients who died within two days (50 of 67, 75%) and were most severe in patients dying from early refractory shock. Protein C and S levels were low compared to healthy volunteers and discriminated OHCA survivors from nonsurvivors. Furthermore, a subgroup of patients had a transient increase in plasma-activated protein C at admission followed by undetectable levels. This, along with an increase in soluble thrombomodulin over time, suggests secondary endothelial injury and dysfunction of the protein C anticoagulant pathway similar to that observed in severe sepsis. CONCLUSIONS:Major coagulation abnormalities were found after successful resuscitation of cardiac arrest. These abnormalities are consistent with secondary down-regulation of the thrombomodulin-endothelial protein C receptor pathway.

journal_name

J Am Coll Cardiol

authors

Adrie C,Monchi M,Laurent I,Um S,Yan SB,Thuong M,Cariou A,Charpentier J,Dhainaut JF

doi

10.1016/j.jacc.2005.03.046

subject

Has Abstract

pub_date

2005-07-05 00:00:00

pages

21-8

issue

1

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)00764-3

journal_volume

46

pub_type

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