Thromboelastometry and Platelet Function during Acclimatization to High Altitude

Alistair S. Rocke; Gordon G. Paterson; Matthew T. Barber; Alexander I. R. Jackson; Shona Main; Calum Stannett; Martin F. Schnopp; J. Kenneth Baillie; Elizabeth H. Horne; Carl Moores; Paul Harrison; Alastair F. Nimmo; A. A. Roger Thompson

doi:10.1160/TH17-02-0138

Thrombosis and Haemostasis, Inhaltsverzeichnis

CC BY 4.0 · Thromb Haemost 2018; 118(01): 063-071
DOI: 10.1160/TH17-02-0138

Coagulation and Fibrinolysis

Schattauer GmbH Stuttgart

Thromboelastometry and Platelet Function during Acclimatization to High Altitude

Alistair S. Rocke

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

,

Gordon G. Paterson

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

²Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom

,

Matthew T. Barber

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

,

Alexander I. R. Jackson

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

³Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom

,

Shona Main

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

,

Calum Stannett

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

,

Martin F. Schnopp

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

,

J. Kenneth Baillie

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

⁴Division of Genetics and Genomics, The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom

,

Elizabeth H. Horne

⁵Department of Clinical Haematology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

,

Carl Moores

⁶Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom

,

Paul Harrison

⁷Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom

,

Alastair F. Nimmo

⁶Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom

,

A. A. Roger Thompson

¹Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom

⁸Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom

› Institutsangaben

Abstract

Interaction between hypoxia and coagulation is important given the increased risk of thrombotic diseases in chronically hypoxic patients who reside at sea level and in residents at high altitude. Hypoxia alters the proteome of platelets favouring a prothrombotic phenotype, but studies of activation and consumption of specific coagulation factors in hypoxic humans have yielded conflicting results. We tested blood from 63 healthy lowland volunteers acclimatizing to high altitude (5,200 m) using thromboelastometry and assays of platelet function to examine the effects of hypoxia on haemostasis. Using data from two separate cohorts of patients following identical ascent profiles, we detected a significant delay in clot formation, but increased clot strength by day 7 at 5,200 m. The latter finding may be accounted for by the significant rise in platelet count and fibrinogen concentration that occurred during acclimatization. Platelet function assays revealed evidence of platelet hyper-reactivity, with shortened PFA-100 closure times and increased platelet aggregation in response to adenosine diphosphate. Post-expedition results were consistent with the normalization of coagulation following descent to sea level. These robust findings indicate that hypoxia increases platelet reactivity and, with the exception of the paradoxical delay in thromboelastometry clotting time, suggest a prothrombotic phenotype at altitude. Further work to elucidate the mechanism of platelet activation in hypoxia will be important and could impact upon the management of patients with acute or chronic hypoxic respiratory diseases who are at risk of thrombotic events.

Keywords

hypoxia - high altitude - haemostasis - platelet function - thromboelastometry

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Referenzen

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