Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome

Christoph Schriefl; Christian Schoergenhofer; Juergen Grafeneder; Michael Poppe; Christian Clodi; Matthias Mueller; Florian Ettl; Bernd Jilma; Pia Wallmueller; Nina Buchtele; Constantin Weikert; Heidrun Losert; Michael Holzer; Fritz Sterz; Michael Schwameis

doi:10.1055/s-0040-1719029

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2021; 121(04): 477-483
DOI: 10.1055/s-0040-1719029

Coagulation and Fibrinolysis

Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome

Christoph Schriefl

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Christian Schoergenhofer

²Department of Clinical Pharmacology, Medical University of Vienna, Austria

,

Juergen Grafeneder

²Department of Clinical Pharmacology, Medical University of Vienna, Austria

,

Michael Poppe

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Christian Clodi

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Matthias Mueller

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Florian Ettl

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Bernd Jilma

²Department of Clinical Pharmacology, Medical University of Vienna, Austria

,

Pia Wallmueller

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Nina Buchtele

³Department of Medicine I, Medical University of Vienna, Vienna, Austria

,

Constantin Weikert

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Heidrun Losert

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Michael Holzer

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Fritz Sterz

¹Department of Emergency Medicine, Medical University of Vienna, Austria

,

Michael Schwameis

¹Department of Emergency Medicine, Medical University of Vienna, Austria

› Institutsangaben

Abstract

Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults ≥18 years of age who suffered a nontraumatic cardiac arrest and had achieved return of spontaneous circulation between January 2013 and December 2018. Patients receiving anticoagulants or thrombolytic therapy and those subjected to extracorporeal membrane oxygenation support were excluded. Routine blood sampling was performed on admission as soon as a vascular access was available. The primary outcome was 30-day neurologic function, assessed by the Cerebral Performance Category scale (3–5 = unfavorable neurologic function). Multivariable regression was used to assess associations between normal (≤41 seconds) and prolonged (>41 seconds) aPTT on admission (exposure) and the primary outcome. Results are given as odds ratio (OR) with 95% confidence intervals (95% CIs). Out of 1,591 cardiac arrest patients treated between 2013 and 2018, 360 patients (32% female; median age: 60 years [interquartile range: 48–70]) were eligible for analysis. A total of 263 patients (73%) had unfavorable neurologic function at day 30. aPTT prolongation >41 seconds was associated with a 190% increase in crude OR of unfavorable neurologic function (crude OR: 2.89; 95% CI: 1.78–4.68, p < 0.001) and with more than double the odds after adjustment for traditional risk factors (adjusted OR: 2.01; 95% CI: 1.13–3.60, p = 0.018). In conclusion, aPTT prolongation on admission is associated with unfavorable neurologic outcome after successful resuscitation from cardiac arrest.

Keywords

cardiac arrest - survival - activated partial thromboplastin time

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