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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
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
2   University College London, Division of Surgery and Interventional Science, Royal Free Hospital, London, UK
,
Jim S. Pate
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
3   Centre for Health and Human Performance, London, UK
,
Andre Vercueil
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
4   King's College Hospital, Denmark Hill, London, UK
,
Patrick W. Doyle
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
5   Anaesthetic Department, Charing Cross Hospital, Fulham Palace Road, London, UK
,
Michael G. Mythen
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
,
Mike P. W. Grocott
1   UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, UK
6   Integrative Physiology Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Southampton, UK
7   Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
,
for the Caudwell Xtreme Everest Research Group › Author Affiliations
Further Information

Publication History

Received: 05 January 2012

Accepted after minor revision: 21 February 2012

Publication Date:
29 November 2017 (online)

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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
 

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