Disparate effects of catecholamines under stress conditions on endothelial glycocalyx injury: An in vitro model.

Geriatric trauma patients have high circulating norepinephrine (NE) levels but attenuated release of epinephrine (Epi) in response to increasing severity of injury. We hypothesized that NE and Epi have different effects on the endothelial and glycocalyx components of the vascular barrier following shock. Human umbilical vein endothelial cells (HUVEC) were treated with varying concentrations of NE or Epi and exposed to simulated shock conditions (HR). Relevant biomarkers were sampled to index glycocalyx injury and endothelial cell activation. NE was associated with significantly greater glycocalyx damage and endothelial activation/injury vs. Epi treatment groups. There were minimal changes in PAI-1 with either NE or Epi ± H/R. However NE ± H/R was associated with significantly higher tPA levels. NE favors a profibrinolytic state. Our study supports investigating liberal use of the anti-fibrinolytic agent tranexamic acid in the severely injured geriatric trauma patient.