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 Cardioljournal_title
Journal of the American College of Cardiologyauthors
Adrie C,Monchi M,Laurent I,Um S,Yan SB,Thuong M,Cariou A,Charpentier J,Dhainaut JFdoi
10.1016/j.jacc.2005.03.046subject
Has Abstractpub_date
2005-07-05 00:00:00pages
21-8issue
1eissn
0735-1097issn
1558-3597pii
S0735-1097(05)00764-3journal_volume
46pub_type
杂志文章abstract::Relief of left ventricular (LV) outflow obstruction in patients with hypertrophic cardiomyopathy (HCM) and disabling symptoms refractory to maximum medical management has historically been a surgical problem. Surgical septal myectomy permanently abolishes systolic anterior motion of the mitral valve and mitral regurgi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2004-11-16 00:00:00
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更新日期:2004-11-02 00:00:00
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