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European Journal of Trauma and Emergency Surgery

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01-12-2021 | Tissue Plasminogen Activator | Original Article

Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients

Authors: Gregory R. Stettler, Ernest E. Moore, Geoffrey R. Nunns, Hunter B. Moore, Benjamin R. Huebner, Christopher C. Silliman, Anirban Banerjee, Angela Sauaia

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2021

Abstract

Introduction

High alcohol consumption has been associated with decreased fibrinolysis and enhanced thrombosis risk in cardiovascular disease. In trauma, alcohol has been associated with poor clot formation; however, its effect on fibrinolysis has not been fully investigated. We assessed the association of blood alcohol levels and fibrinolysis in trauma activation patients.

Methods

We queried our prospective registry of trauma activations from 2014 to 2016. Associations between viscoelastic measurements [rapid thrombelastography (rTEG)] and blood alcohol level (BAL) were determined and adjusted for confounders by a multinomial logistic regression. Lysis phenotypes were defined by the % lysis in 30 min (LY30) as follows: hyperfibrinolysis ≥ 3%, physiologic 0.9–2.9%, and fibrinolysis shutdown < 0.9%.

Results

Overall, 191 (43.8%) had BAL measured. There were 65 (34%) patients that had no detectable BAL, 32 (16.8%) had BAL of 10–150 mg/dL, and 94 (49.2%) patients had BAL > 150 mg/dL. BAL had a moderate, but significant inverse correlation with LY30 (Rho = − 0.315, p < 0.001), while there were no significant correlations between BAL and other TEG values. The distribution of fibrinolysis phenotypes varied significantly by BAL levels (p < 0.009, with high BAL having more shutdown and less hyperfibrinolysis than the other two BAL level groups. Multinomial logistic regression showed that after adjustment for confounders, BAL levels > 150 mg/dL were independently associated with a threefold increase in the odds of shutdown compared to undetectable BAL (OR 3.37, 95% CI 1.04–8.05, p = 0.006). High BAL was also significantly associated with higher odds of shutdown compared to low BAL (OR 2.63, 95% CI 1.15–6.06). Compared to physiologic fibrinolysis, fibrinolysis shutdown was associated with increased mortality (OR 2.87, 95% CI 1.41–5.83) and VFD < 28 (OR 2.54, 95% CI 1.47–4.39).

Conclusion

In the injured patient, high blood alcohol levels are associated with increased incidence of fibrinolysis shutdown. This finding has implications for postinjury hemostatic resuscitation as these patients may be harmed by anti-fibrinolytics. Further research is needed to assess whether the association with fibrinolysis is modified by the chronicity and type of alcohol consumed and whether anti-fibrinolytic therapy in intoxicated patients produces adverse effects.

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Title: Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients
Authors: Gregory R. Stettler
Ernest E. Moore
Geoffrey R. Nunns
Hunter B. Moore
Benjamin R. Huebner
Christopher C. Silliman
Anirban Banerjee
Angela Sauaia
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Tissue Plasminogen Activator
Intoxication
Fibrinolytic Therapy
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01328-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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