Article Figures & Data
Figures
- Figure 1
Mechanistic description of VWF release after trauma. This schematic describes VWF synthesis and release under physiological circumstances and after trauma, as well as the potential role of VWF in clot formation after trauma. ULVWF, ultra-large von Willebrand factor; VTE, venous thromboembolism; VWF, von Willebrand factor.
- Figure 2
Individual values for trauma patients and healthy volunteers. Individual values plotted for (A) 22 samples from trauma patients at 0–2 hours from TOI vs. 21 healthy volunteers and (B) 28 samples from trauma patients at 6 hours from TOI vs. 21 healthy volunteers. Values for the REAADS assay (%), VWF:Ag level (µg/mL), and ADAMTS-13:Ag level (µg/mL) are shown. Solid lines represent median. Kruskal-Wallis test for significance: *p<0.05, **p<0.01, ***p<0.001. ADAMTS-3:Ag, ADAMTS-3 antigen; REAADS, Rapid Enzyme Assays for Autoimmune Diseases; TOI, time of injury; VWF:Ag, von Willebrand factor antigen.
Tables
- Table 1
Detailed clinical characteristics of all 30 trauma patients
Patient identification Time points of samples Additional injuries Transfusion (Y/N) ISS ABO blood type 1 0–2 hours, 6 hours TBI N 26 B+ 2 6 hours Facial fractures, TBI N 24 A+ 3 0–2 hours, 6 hours Rib fractures, scapula fracture, clavicle fracture, pelvic fracture, spine fractures, TBI Y 50 O+ 4 0–2 hours, 6 hours Skull fracture, TBI N 26 O+ 5 6 hours Skull base fracture, spine fractures, TBI N 17 O+ 6 6 hours TBI Y 29 B− 7 6 hours TBI N 29 O+ 8 0–2 hours, 6 hours LB Fx (femur) with vascular injury, facial degloving injury, TBI N 38 A+ 9 6 hours Skull fractures, LB Fx (humerus, ulna, radius), TBI N 24 O+ 10 0–2 hours, 6 hours Open ankle fracture, TBI Y 27 B+ 11 0–2 hours, 6 hours TBI Y 26 AB+ 12 6 hours Skull fracture, spine, fractures, LB Fx (tibia/fibula), TBI Y 33 A+ 13 0–2 hours, 6 hours Skull base fractures, spine fractures, TBI Y 33 A+ 14 0–2 hours, 6 hours LB Fx, TBI N 9 AB+ 15 0–2 hours, 6 hours LB Fx N 14 A+ 16 0–2 hours, 6 hours Splenic laceration, LB Fx N 22 O+ 17 0–2 hours, 6 hours LB Fx Y 9 A− 18 6 hours LB Fx N 4 O+ 19 6 hours LB Fx N 17 O+ 20 0–2 hours, 6 hours Cardiac injury from stab wound Y 26 O+ 21 0–2 hours, 6 hours TBI, spine fractures with cord injury, splenic/hepatic/renal lacerations Y 50 O+ 22 0–2 hours, 6 hours TBI, spine fractures, LB Fx (femoral neck), ankle fracture, rib fractures Y 22 A+ 23 0–2 hours, 6 hours Superficial lacerations from stab wounds Y 5 O+ 24 0–2 hours, 6 hours TBI, subgaleal hematoma, splenic laceration, mesenteric injury, spine fractures, rib fractures Y 22 B+ 25 0–2 hours, 6 hours LB Fx (tibia and fibula), thigh hematoma, wrist fracture, scapular fracture, rib fractures Y 14 A+ 26 0–2 hours, 6 hours Spine fractures with cord injury, rib fractures Y 25 A+ 27 0–2 hours, 6 hours TBI, LB Fx (bilateral femur) Y 34 A− 28 0–2 hours TBI, aortic injury, LB Fx (femur and humerus), ankle fracture, pelvic fracture, spinal fractures, rib fractures Y 34 AB+ 29 0–2 hours Liver laceration Y 21 O+ 30 0–2 hours, 6 hours TBI, spine fractures with cord injury, rib fractures Y 75 A+ The table shows individual descriptions (de-identified) of the clinical characteristics of the 30 trauma patients in this study including time points of sample acquisition and all clinically relevant injuries.
ISS, Injury Severity Score; LB Fx, long bone fracture; N, no; TBI, traumatic brain injury; Y, yes.
- Table 2
VWF activity and thrombin generation kinetics in trauma patients versus healthy volunteers*
Including only samples obtained from trauma patients at 0–2 hours from TOI Healthy volunteers
(n=21 samples)Trauma
(n=22 samples)P value REAADS activity (%) 92.0 (71.0–114.0) 190.0 (132.0–264.0) <0.001 ADAMTS-13:Ag (µg/mL) 1.00 (0.89–1.09) 0.84 (0.51–0.94) 0.010 VWF:Ag (µg/mL) 13.4 (7.30–35.94) 22.7 (15.8–28.4) 0.224 REAADS activity (%) × 21/VWF:Ag (µg/mL) 0.193 (0.033–0.243) 0.170 (0.120–0.241) 0.627 ADAMTS-13:Ag/VWF:Ag 0.061 (0.027–0.150) 0.038 (0.024–0.055) 0.068 LT (min) 4.00 (3.33–4.70) 3.67 (3.29–4.67) 0.336 PH (nM) 184.0 (142.6–224.0) 277.8 (206.7–299.8) 0.006 ttPeak (min) 8.33 (7.00–9.30) 6.56 5.67–7.83) 0.003 Including only samples obtained from trauma patients at 6 hours from TOI Trauma
(n=28 samples)REAADS activity (%) 92.0 (71.0–114.0) 167.5 (108.0–312.5.0) <0.001 ADAMTS-13:Ag (µg/mL) 1.00 (0.89–1.09) 0.653 (0.531–0.821) <0.001 VWF:Ag (µg/mL) 13.4 (7.30–35.9) 18.5 (14.1–37.5) 0.063 REAADS activity (%) × 21/VWF:Ag (µg/mL) 0.193 (0.033–0.243) 0.147 (0.089–0.302) 0.531 ADAMTS-13:Ag/VWF:Ag 0.061 (0.027–0.150) 0.034 (0.013–0.044) 0.006 LT (min) 4.00 (3.33–4.67) 4.34 (3.61–4.97) 0.715 PH (nM) 184.0 (142.6–224.0) 226.1 (201.3–254.9) 0.008 ttPeak (min) 8.33 (7.00–9.33) 7.33 (6.34–8.49) 0.035 Analyses were performed on all samples that were 0–2 hours from the TOI (top half of the table) and all samples that were 6 hours from the TOI (bottom half of the table), separately.
Plasma thrombin generation parameters (calibrated automated thrombogram) including LT, PH, and ttPeak are viewed against REAADS activity, ADAMSTS13:Ag level and VWF:Ag level for the same patient samples.
The ratio of REAADS activity (%) to VWF:Ag level is also presented and was calculated using the REAADS 21% value. Additionally, the ratio of ADAMTS-13:Ag level to VWF:Ag level was calculated for both trauma patients and volunteers and is presented.
*Kruskal-Wallis test for statistical significance. Results are presented as median values with IQR, with p<0.05 (bolded) are considered statistically significant.
ADAMTS-13:Ag, ADAMTS-13 antigen; LT, lagtime; PH, peak height; REAADS, Rapid Enzyme Assays for Autoimmune Diseases; TOI, time of injury; ttPeak, time to peak; VWF, von Willebrand factor; VWF:Ag, VWF antigen.
