Comparative Response of Platelet fV and Plasma fV to Activated Protein C and Relevance to a Model of Acute Traumatic Coagulopathy
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Acute traumatic coagulopathy ATC has been linked to an increase in activated protein C aPC from 40 pM in healthy individuals to 175 pM. aPC exerts its activity primarily through cleavage of active coagulation factor Va fVa. Platelets reportedly possess fVa which is more resistant to aPC cleavage than plasma fVa this work examines the hypothesis that normal platelets are sufficient to maintain coagulation in the presence of elevated aPC. Coagulation responses of normal plasma, fV deficient plasma fVdp, and isolated normal platelets in fVdp were conducted prothrombin PT tests, turbidimetry. and thromboelastography TEG, including the dose response of aPC on the samples. PT and turbidimetric assays demonstrate that normal plasma is resistant to aPC at doses much higher than those found in ATC. Additionally, an average physiological number of washed normal platelets 200,000 plateletsmm expn 3 was sufficient to eliminate the anti-coagulant effects of aPC up to 10nM, nearly two orders of magnitude above the ATC concentration and even the steady-state pharmacological concentration of human recombinant aPC, as measured by TEG. aPC also demonstrated no significant effect on clot lysis in normal plasma samples with or without platelets. Although platelet fVA shows slightly superior resistance to aPCs effects compared to plasma fVA in static models, neither fVA is sufficiently cleaved in simulations of ATC or pharmacologically-delivered aPC to diminish coagulation parameters. aPC is likely a correlative indicator of ATC or may play a cooperative role with other activity altering products generated in ATC.
- Anatomy and Physiology
- Medicine and Medical Research