Clinical paperProlonged targeted temperature management compromises thrombin generation: A randomised clinical trial

AimTo investigate whether prolonged compared with standard duration of targeted temperature management (TTM) compromises coagulation.MethodsComatose survivors after out-of-hospital cardiac arrest (n = 82) were randomised to standard (24 h) or prolonged (48 h) duration of TTM at 33 ± 1 °C. Blood samples were drawn 22, 46 and 70 h after attaining the target temperature. Samples were analysed for rotational thromboelastometry (ROTEM® (EXTEM®, INTEM®, FIBTEM® and HEPTEM®)) and thrombin generation using the Calibrated Automated Thrombogram® assay.ResultsWith the 22-h sample, we revealed no difference between groups in the ROTEM® and thrombin generation results beside a slightly higher EXTEM® and INTEM® maximum velocity in the prolonged group (p-values ≤0.04). With the 46-h sample, ROTEM® showed no differences when using EXTEM®; however, 11% (p < 0.01) longer clotting time and 12% (p < 0.01) longer time to maximum velocity were evident in the prolonged group than in the standard group when using INTEM®. The prolonged group had reduced thrombin generation compared with the standard group as indicated by 30% longer lag time (p = 0.04), 106 nM decreased peak concentration (p < 0.001), 36% longer time to peak (p = 0.01) and 411 nM*minute decreased endogenous thrombin potential (p < 0.001). With the 70-h sample, no differences in ROTEM® results were found between groups. However, the prolonged group had reduced thrombin generation indicated by longer lag time, decreased peak concentration and longer time to peak (all p-values ≤ 0.02) compared with the standard group.ConclusionProlonged TTM in post-cardiac arrest patients impairs thrombin generation.ClinicalTrials.gov identifier: NCT02258360.