Sustained Release of Tissue Factor Following Thrombosis of Lower Limb Trauma Journal Article

Authors: Walenga, J. M.; Kaiser, P. C.; Prechel, M. M.; Hoppensteadt, D; Jeske, W. P.; Misselwitz, F.; Bacher, P.; Lassen, M. R.; Fareed, J
Article Title: Sustained Release of Tissue Factor Following Thrombosis of Lower Limb Trauma
Abstract: This study was undertaken to provide evidence for the mechanism of venous thromboembolism (VTE) in healthy patients with minor lower limb injury (fracture; Achilles tendon rupture) that was medically managed with plaster cast/brace immobilization. The Plaster Cast clinical trial provided a unique opportunity to identify the natural history of VTE using placebo-controlled patients (n = 183) with validation of the mechanism using the low-molecular-weight heparin (LMWH; reviparin)-treated patients (n = 182). Confirmed VTE in this population was associated with a burst of tissue factor release (and a minor fibrinolytic deficit) leading to thrombin generation that was sustained at least 5 weeks, greater with fractures than with soft-tissue injuries and greater with surgery than with conservative treatment. The root cause likely involves platelet/leukocyte activation (inflammation) rather than endothelial cell injury. Thromboprophylaxis with a low dose of LMWH reduced thrombin generation, with patients undergoing surgery benefitting the most.
Keywords: Female; Humans; Middle Aged; Prospective Studies; Male; Time Factors; Double-Blind Method; trauma; Low-molecular-weight heparin; immobilization; lower limb; reviparin; tissue factor; venous thrombosis; Achilles Tendon/injuries/surgery; Fractures, Bone/blood/surgery; Lower Extremity/injuries/surgery; Tendon Injuries/blood/surgery; Thromboplastin/metabolism; Anticoagulants/administration dosage; Heparin, Low-Molecular-Weight/administration dosage; Venous Thromboembolism/blood/etiology/prevention control
Journal Title: Clinical Applied Thrombosis/Hemostasis
Volume: 20
Issue: 7
ISSN: 1938-2723
Publisher: Unknown  
Date Published: 2014
Start Page: 678
End Page: 686
Language: ENG
Notes: CI: (c) The Author(s) 2014; JID: 9508125; 0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight); 0 (reviparin); 9035-58-9 (Thromboplastin); OTO: NOTNLM; 2014/08/12 [aheadofprint]; ppublish