Plasmatic hemostasis at very high altitude — a thrombelastometric approach

Micaela Tobler; Christos Nakas; Matthias Hilty; Andreas Huber; Tobias Merz; Jacqueline Hefti

doi:10.5604/01.3001.0015.5749

Authors

Micaela Tobler Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland https://orcid.org/0000-0002-7136-6873
Christos T. Nakas Laboratory of Biometry, University of Thessaly, Volos, Greece; University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, Unversity of Bern, Switzerland
Matthias P. Hilty Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland https://orcid.org/0000-0002-2765-881X
Andreas Huber Med-Sci Doctorate Course, Private University of the Principality of Liechtenstein, Liechtenstein; Center of Laboratory Medicine, Cantonal Hospital Aarau, Switzerland
Tobias M. Merz Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand https://orcid.org/0000-0002-3149-5873
Jacqueline Pichler Hefti Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Swiss Sportclinic, Bern, Switzerland https://orcid.org/0000-0003-0879-811X

DOI:

https://doi.org/10.5604/01.3001.0015.5749

Keywords:

hypobaric hypoxia, thrombelastometry, coagulation

Abstract

Introduction: Changes in blood coagulation during exposure to high altitude are not well understood and studies of activation and consumption of specific coagulation factors in hypoxic humans have yielded conflicting results. In this study we used thrombelastometry (TEM) which allows a global evaluation of clot formation and lysis process to study blood coagulation profiles in volunteers exposed to prolonged hypobaric hypoxia at extreme altitudes.
Material and methods: We conducted a prospective observational study in 39 healthy volunteers during a research expedition up to an altitude of 7050 m. Plasma based thrombelastometric measurements and standard coagulation parameters were performed at different altitudes.
Results: TEM measurements showed an increase in clotting time (CT) and maximum clot firmness (MCF) at high altitudes, paralleled by an increase in international normalized ratio (INR) and activated partial thromboplastin time (aPTT). Fibrinogen concentration increased until 6022 m. D-Dimer and Thrombin-Antithrombin complex (TAT) increased with time exposed to severe hypoxia. For both measurements high-est levels were found at 4844 m after acclimatization; in contrast, lower values were observed again at 7050m in the group of summiteers. Activated protein C resistance (APC-R) was slightly lowered at all altitudes.
Conclusion: Our results suggest that activation of the coagulation and fibrinolytic system occurs with increasing hypobaric hypoxia with concurrent use of coagulation factors indicating the occurrence of a consumption-coagulopathy phenotype.

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