Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients

Cotton, Bryan A.; Minei, Kristin M.; Radwan, Zayde A.; Matijevic, Nena; Pivalizza, Evan G.; Podbielski, Jeanette; Wade, Charles E.; Kozar, Rosemary A.; Holcomb, John B.

doi:10.1097/ta.0b013e31824d56ad

Cited by 134 publications

(127 citation statements)

References 20 publications

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“…12 Cryoprecipitate is used when the maximal amplitude is Ͻ 55, and venous thromboembolism prophylaxis is escalated when the maximal amplitude is Ͼ 65. 13 Tranexamic acid is used when the LY-30 is Ն 3% on the admission TEG. 14 In October of 2011, we placed RBCs and thawed plasma on our helicopters.…”

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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“…The TEG parameters employed in this study have been used to identify hypercoagulable state in other trauma showed that an elevated MA was an independent risk factor for in hospital PE, even after controlling for age, gender, and injury severity [21]. Branco et al [22] identified a hypercoagulable state in 26.3 % of trauma patients on admission using TEG parameters R, K, aA, MA, G, and EPL.…”

Section: Discussionmentioning

confidence: 97%

“…The association of TBI and a hypercoagulable state is well established [5,7,10]; however, the onset and duration of the hypercoagulable state is not. Elevations in TEG parameters have been associated with a hypercoagulable state [21][22][23]. The purpose of this study was to identify a hypercoagulable state after TBI, as defined by elevations in TEG parameters: maximal amplitude (MA), thrombus generation (TG), G value (G), and alpha angle (aA).…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study

et al. 2014

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“…The effect of heparin and low molecular weight heparin was not affected. For patients who need the long-term use of antiplatelet drugs, the effectiveness and safety of their medication can be guaranteed (7,8). Coronary heart disease is caused by atherosclerosis, which is a serious threat to the life safety of elderly patients.…”

Section: Discussionmentioning

confidence: 99%

The application of thromboelastogram in detection of indexes of antiplatelet therapy for coronary heart disease

Shuwu¹,

Wang²,

Xu³

et al. 2016

J. Thorac. Dis.

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Background: This study aims to explore the application value of thromboelastogram (TEG) in antiplatelet therapy in coronary artery intervention.Methods: A retrospective analysis of 90 cases of coronary interventional treatment was conducted in our hospital from January 2010 to January 2012. Cases were divided into three groups, according to the kind of coronary heart disease: angina pectoris (AP) group (30 cases), unstable angina pectoris (UAP) group (30 cases) and acute myocardial infarction (AMI) group (30 cases). TEG changes in patients between the three groups were analyzed.Results: The differences in international normalized ratio (INR) and activated partial thromboplastin time (APTT) indexes among the three groups of patients were statistically significant (P<0.05), but these indexes significantly decreased in the AMI group. Furthermore, D-D, Fgb, Angle and MA indexes significantly increased in the UAP and AMI groups, compared with the AP group; while TEG regular parameter K and R values were markedly reduced. Coagulation graphics were higher in the UAP and AMI groups than in the AP group (χ 2 =4.261, 3.908; P<0.05), suggesting that the difference was statistically significant. In 11 cases of ischemic events, arachidonic acid (AA)-induced platelet inhibition rate was 63.63%, while adenosine diphosphate (ADP)-induced platelet inhibition rate was 36.37% (χ 2 =5.026; P<0.05); suggesting that ADP-induced platelet inhibition rate was markedly reduced. This is the main risk of ischemic events within three months after percutaneous coronary intervention. Conclusions:The detection of indexes of antiplatelet therapy in coronary artery intervention is helpful for antiplatelet medication, thus can effectively reduce the incidence of ischemic events.

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Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients

Cited by 134 publications

References 20 publications

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study

The application of thromboelastogram in detection of indexes of antiplatelet therapy for coronary heart disease

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