• Sergio M Navarro, Riley J Thompson, Taleen A MacArthur, Grant M Spears, Kent R Bailey, Joe M Immermann, Nikoli Yudin, Jing-Fei Dong, Rosemary A Kozar, and Myung S Park.
• Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, United States 55905.
• Shock. 2024 Dec 3.

BackgroundNeutrophil extracellular traps (NETs), and its formation and release, known as NETosis, may play a role in the initiation of thrombin generation (TG) in trauma. The objective of this study was to assess whether trauma patients, who develop symptomatic venous thromboembolism (VTE), have increased levels of plasma citrullinated histone H3 (CitH3) and accelerated TG kinetics.MethodsPatients presenting to a Level I Trauma Center as trauma activations had samples collected within 12 hours of time of injury (TOI), alongside healthy volunteers (HV). CitH3 was measured by enzyme-linked immunosorbent assay, and TG data were measured using a thrombin generation analyzer, comparing results between patients developing symptomatic VTE vs those who did not, within 90 days of injury. Data were expressed as median and quartiles [Q1, Q3], and tested using Wilcoxon rank-sum or Fisher's exact test, or 1-sample test of Spearman's correlation, p < 0.05 considered significant.Results39 trauma patient samples were analyzed (10 with and 29 without VTE), and compared to 15 HV samples. CitH3 levels in patients who developed VTE were significantly greater as compared to those who did not (12.8 ng/mL [7.1, 30.8]; 3.0 ng/mL [1.8,6.8], p = 0.024), with levels in both groups greater compared to HV (1.2 [0.3, 4.1], p = 0.003, p = 0.012), respectively. TG profiles were accelerated in patients developing VTE, with differences in peak height (337.6 nM [304.4, 356.0]; 231.8 nM [180.2, 281.8], p = 0.008), endogenous thrombin potential (1718.5 nM*min [1500, 1794]; 1208.5 nM*min (1072, 1417], p = 0.003) and velocity index (213.2 nM/min [162.3, 260.5]; 124.3 nM/min [93.2, 223.1], p = 0.03), respectively.ConclusionsTrauma patients developing VTE exhibit increased NETosis, measured by increased CitH3 levels and accelerated TG early after injury, outlining an area for further understanding VTE after trauma.Copyright © 2024 by the Shock Society.

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