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| 1 | Heparin resistance in severe thermal injury:a prospective cohort study显示文摘Background:Low molecular-weight heparin(LMWH)is routinely administered to burn patients for thromboprophylaxis.Some studies have reported heparin resistance,yet the mechanism(s)and prevalence have not been systematically studied.We hypothesized that nucleosomes,composed of histone structures with associated DNA released from injured tissue and activated immune cells in the form of neutrophil extracellular traps(NETs or NETosis),neutralize LMWH resulting in suboptimal anticoagulation,assessed by reduction in anti-factor Xa activity.Methods:Blood was sampled from>15%total body surface area(TBSA)burn patients receiving LMWH on days 5,10 and 14.Peak anti-factor Xa(AFXa)activity,anti-thrombin(ATIII)activity,cellfree DNA(cfDNA)levels and nucleosome levels were measured.Mixed effects regression was adjusted for multiple confounders,including injury severity and ATIII activity,and was used to test the association between nucleosomes and AFXa.Results:A total of 30 patients with severe burns were included.Mean TBSA 43%(SD 17).Twentythree(77%)patients were affected by heparin resistance(defined by AFXa activity<0.2 IU/mL).Mean peak AFXa activity across samples was 0.18 IU/mL(SD 0.11).Mean ATIII was 81.9%activity(SD 20.4).Samples taken at higher LWMH doses were found to have significantly increased AFXa activity,though the effect was not observed at all doses,at 8000 IU no samples were heparin resistant.Nucleosome levels were negatively correlated with AFXa(r=−0.29,p=0.050)consistent with the hypothesis.The final model,with peak AFXa as the response variable,was adjusted for nucleosome levels(p=0.0453),ATIII activity(p=0.0053),LMWH dose pre-sample(p=0.0049),drug given(enoxaparin or tinzaparin)(p=0.03),and other confounders including severity of injury,age,gender,time point of sample.Conclusions:Heparin resistance is a prevalent issue in severe burns.Nucleosome levels were increased post-burn,and showed an inverse association with AFXa consistent with the hypothesis that they may interfere with the anticoagulant effect of heparin in vivo and contribute to heparin resistance.Accurate monitoring of AFXa activity with appropriate therapy escalation plans are recommended with dose adjustment following severe burn injury. | Liam D Cato Benjamin Bailiff Joshua Price Christos Ermogeneous Jon Hazeldine William Lester Gillian Lowe Christopher Wearn Jonathan RB Bishop Janet M Lord Naiem Moiemen Paul Harrison | 2021 | Burns & Trauma2021，9，1： | 3 |
| 2 | Impact of atrial fibrillation on the risk of death:the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D'Agostino RB | 1998 | Circnlation1998，98，10： | 1 |
| 3 | Stress induced p38 Mitogen-Activated protein kinase activation Mediates κ-Opioid-Dependent dysphoria显示文摘 | Michael RB Benjamin BL Megumi Aita | 2007 | J Neurosci2007，27，11： | 1 |
| 4 | Left atrial size and the risk of stroke and death-The Framingham heart study显示文摘 | Agostino RB Belanger AJ | 1995 | Circulation1995，92，： | 1 |
| 5 | Impact of atrial fibrillation on the risk of death : the Framingham heart 显示文摘 | Benjamin E J Wolf PA D'Agostino RB | 1998 | Circulation1998，98，10： | 1 |
| 6 | Impact of artrial fibrilltion on the risk of daeth:The Framingham heart study显示文摘 | Benjamin EJ Wolf PA Dagostino RB | 1998 | Circulation1998，98，： | 1 |
| 7 | Lefft atrial size and the risk of stroke and death-The Framinghm heart study显示文摘 | Benjamin EJ Agostion RB Belanger Aj | 1995 | Circulation1995，92，： | 1 |
| 8 | Impact of atrial fi- brillation on the risk of death : the Framingham Heart Study 显示文摘 | Benjamin E J Wolf PA D' Agostino RB | 1998 | Circulation1998，98，11： | 1 |
| 9 | Impact of atrial fibrilla-tion on the risk of death:the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D’Agostino RB | 1998 | Circula-tion1998，98，10： | 1 |
| 10 | Impact of atriaI fi- brillation Oil the risk of death:The Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D' Agostino RB | 1998 | Circulation1998，98，： | 1 |
| 11 | Impact of atrial fibrillation on the risk of death:the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D' Agostino RB | | 0，，： | 1 |
| 12 | Impact of fibrillation on the risk of death: the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D'Agostino RB | 1998 | Circulation1998，98，10： | 1 |
| 13 | Impact of atrial fibrillation on the risk of death: the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D'Agostino RB | 1998 | Circulation1998，98，： | 1 |
| 14 | Impact of atrial fibrillation on the risk of death: the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D'Agostino RB | 1998 | Circulation1998，98，： | 1 |
| 15 | Impact of fibrillation on the risk of death : The Framingham Heart Study 显示文摘 | Benjamin EJ Wolf PA D'Agostino RB' | 1998 | Circulation1998，98，10： | 1 |
| 16 | Impact of atrial fibrillalion on the risk of death: the Framingham Heart Study 显示文摘 | Benjamin EJ Wolf PA D' Agosfino RB | 1998 | Cireulation1998，98，： | 1 |
| 17 | Impact of atrial fibrillation on the risk of death: the Framingham Heart Study显示文摘 | Benjamin Wolf PA D'Agostino RB | 1998 | Circulation1998，98，10： | 1 |
| 18 | Impact of atrial fibril-lation on the risk of death: the Framingham Heart Study显示文摘 | Benjamin EJ Wolf PA D’ Agostino RB | 1998 | Circula-tion1998，98，10： | 1 |
| 19 | Impact of atrial fib- rillation on the risk of death: the Framingham Heart Study 显示文摘 | Benjamin EJ Wolf PA D'Agostino RB | 1998 | Circulation1998，98，： | 1 |
| 20 | Left atrial size and the risk of stroke and death: the framingham heart study显示文摘 | Benjamin EJ D'Agostino RB Belanger AJ | 1995 | Circulation1995，92，4： | 1 |
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