Reduced coagulation at high altitude identified by thromboelastography

Daniel S. Martin; Jim S. Pate; Andre Vercueil; Patrick W. Doyle; Michael G. Mythen; Mike P. W. Grocott; for the Caudwell Xtreme Everest Research Group

doi:10.1160/TH12-01-0004

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(06): 1066-1071
DOI: 10.1160/TH12-01-0004

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Reduced coagulation at high altitude identified by thromboelastography

Daniel S. Martin

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

²University College London, Division of Surgery and Interventional Science, Royal Free Hospital, London, UK

,

Jim S. Pate

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

³Centre for Health and Human Performance, London, UK

,

Andre Vercueil

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

⁴King's College Hospital, Denmark Hill, London, UK

,

Patrick W. Doyle

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

⁵Anaesthetic Department, Charing Cross Hospital, Fulham Palace Road, London, UK

,

Michael G. Mythen

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

,

Mike P. W. Grocott

¹UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK

⁶Integrative Physiology Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Southampton, UK

⁷Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK

,

for the Caudwell Xtreme Everest Research Group

› Author Affiliations

Abstract

Summary

The impact of hypoxaemia on blood coagulation remains unclear despite use of a variety of measures to address the issue. We report the first use of thromboelastography (TEG) at high altitude to describe the dynamics of clot formation in whole blood samples. Seventeen healthy volunteers ascended to 5,300 m following an identical ascent profile; TEG measurements at 4,250 m and 5,300 m were compared with those from sea level. Peripheral oxygen saturation (SpO₂) and haematocrit were also measured. Ascent resulted in a decline in SpO₂ from 97.8 (± 1.2) % at sea level to 86.9 (± 3.3) % at 4,250 m and 79.5 (± 5.8) % at 5,300 m (p<0.001); haematocrit rose from 43.7 (± 2.8) % at sea level, to 46.7 (± 3.9) % and 52.6 (± 3.2) % at 4,250 m and 5,300 m, respectively (p<0.01). TEG reaction (R)-time and kinetic (K)-time were both increased at 5,300 m compared to sea level, 8.95 (± 1.37) minutes (min) to 11.69 (± 2.91) min (p=0.016) and 2.40 (± 0.66) min to 4.99 (± 1.67) min (p<0.001), respectively. Additionally the alpha (α)- angle was decreased from 57.7 (± 8.2) to 51.6 (± 6.4) (p<0.001). There was no change in maximum amplitude (MA) on ascent to altitude. These changes are consistent with an overall pattern of slowed coagulation at high altitude.

Keywords

Altitude - hypoxia - blood coagulation - thrombelastography - blood coagulation tests

Full Text

References

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