Clot activators do not expedite the time to predict massive transfusion in trauma patients analyzed with tissue plasminogen activator thrombelastography

Walker, Carson B.; Moore, Ernest E.; Kam, Adi; Dexter-Meldrum, Jacob; Nydam, Trevor L.; Chapman, Michael P.; Chandler, James G.; Sauaia, Angela; Barrett, Christopher D.; Yaffe, Michael B.; Moore, Hunter B.

doi:10.1016/j.surg.2019.05.011

Cited by 6 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A substantial amount of plasmin (> 10% total plasmin generation potential) can be buffered by the peripheral blood before it causes significant coagulation changes in healthy individuals. 37 Therefore, PAP levels while reflective of plasmin generation do not define fibrinolysis status, as plasmin can be activated for Fig. 1 Activation of coagulation and fibrinolysis following hemorrhagic shock.…”

Section: Low Fibrinolytic States Early After Injury: Fibrinolysis Shumentioning

confidence: 99%

Temporal Changes in Fibrinolysis following Injury

Moore

2020

Semin Thromb Hemost

Self Cite

View full text Add to dashboard Cite

Trauma patients present to the emergency department with a spectrum of fibrinolytic activity. This wide variance in fibrinolysis activity is a complex multifactorial process impacted by the degree of hemorrhagic shock and the amount of tissue injury the individual sustains. The fibrinolytic activity of the trauma patient at presentation to the hospital has prognostic and therapeutic implications. Those patients with high fibrinolytic activity (hyperfibrinolysis) are at risk of mortality from hemorrhage, whereas those patients with low fibrinolytic activity (shutdown or hypofibrinolysis) are at an increased risk of delayed mortality from traumatic brain injury or organ failure. These phenotypes of fibrinolysis acutely following injury change with resuscitation, and the majority of trauma patients will transition to a fibrinolytic resistant state several hours after injury. The mechanism for this near-global transition to this acquired fibrinolysis appears to be related to the generation of plasminogen activator inhibitor-1 in the liver. Those patients who do not recover from this fibrinolytic state 24 hours after injury have a poor prognosis. The purpose of this article is to review the different states of fibrinolytic activity following injury and how they change over time following resuscitation and in the intensive care unit.

show abstract

Section: Low Fibrinolytic States Early After Injury: Fibrinolysis Shumentioning

confidence: 99%

Temporal Changes in Fibrinolysis following Injury

Moore

2020

Semin Thromb Hemost

Self Cite

View full text Add to dashboard Cite

show abstract

“…This clinical pharmacist facilitated COVID-19 patients' ultrasound screening, diagnosis, and monitoring of prophylactic and full anticoagulation treatment. [18][19][20][21]47 This multidisciplinary team was adapted from previous programs that utilized a similar dynamic for management of trauma-related anticoagulation…”

Section: Discussionmentioning

confidence: 99%

“…prophylaxis and treatment (46,47). Nine of thirty-one (29%) COVID-19 patients had radiographic evidence of VTE despite no clinical symptoms on initial presentation.…”

mentioning

confidence: 99%

Impact of a clinical pharmacist in ultrasound-guided venous thromboembolism screening in hospitalized COVID-19 patients: a pilot prospective study.

Gillespie

Khan

Stillson

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent SARS-COV-2 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and role of the clinical pharmacist in treating these patients.Methods: We present a prospective pilot program of thirty-one consecutive SARS-CoV-2 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include: demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record.Results: Nine of the thirty-one patients presented with venous thrombosis. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings.Conclusion: VTE screening of hospitalized SARS-CoV-2 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.

show abstract

“…44 Finally, one of the most challenging yet important aspects for advancing VHA and other global hemostasis analytics for real-time decision making is shortening the length of time it takes to get information on fibrinolysis. To that end, the present authors have worked extensively on rapid fibrinolysis diagnostics through a variety of modifications to the assayed blood samples, such as adding exogenous tPA, 135 plasmin, 133 or both 136 to VHA assays as a way to challenge the system and see if patients have already exhausted their native ability to inhibit fibrinolysis, essentially releasing the brakes on the system. These assay results, in essence, can rapidly identify patients (<15 minutes) in whom any further insults, such as hypotension, that cause tPA release would cause a major clinical bleed and warrant prompt treatment with TXA or other antifibrinolytic therapy.…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

Advances in the Management of Coagulopathy in Trauma: The Role of Viscoelastic Hemostatic Assays across All Phases of Trauma Care

Meizoso

Barrett

Moore

et al. 2022

Semin Thromb Hemost

Self Cite

View full text Add to dashboard Cite

Uncontrolled bleeding is the leading cause of preventable death following injury. Trauma-induced coagulopathy can manifest as diverse phenotypes ranging from hypocoagulability to hypercoagulability, which can change quickly during the acute phase of trauma care. The major advances in understanding coagulation over the past 25 years have resulted from the cell-based concept, emphasizing the key role of platelets and their interaction with the damaged endothelium. Consequently, conventional plasma-based coagulation testing is not accurate in predicting bleeding and does not provide an assessment of which blood products are indicated. Viscoelastic hemostatic assays (VHA), conducted in whole blood, have emerged as a superior method to guide goal-directed transfusion. The major change in resuscitation has been the shift from unbridled crystalloid loading to judicious balanced blood product administration. Furthermore, the recognition of the rapid changes from hypocoagulability to hypercoagulability has underscored the importance of ongoing surveillance beyond emergent surgery. While the benefits of VHA testing are maximized when used as early as possible, current technology limits use in the pre-hospital setting and the time to results compromises its utility in the emergency department. Thus, most of the reported experience with VHA in trauma is in the operating room and intensive care unit, where there is compelling data to support its value. This overview will address the current and potential role of VHA in the seriously injured patient, throughout the continuum of trauma management.

show abstract

Clot activators do not expedite the time to predict massive transfusion in trauma patients analyzed with tissue plasminogen activator thrombelastography

Cited by 6 publications

References 23 publications

Temporal Changes in Fibrinolysis following Injury

Temporal Changes in Fibrinolysis following Injury

Impact of a clinical pharmacist in ultrasound-guided venous thromboembolism screening in hospitalized COVID-19 patients: a pilot prospective study.

Advances in the Management of Coagulopathy in Trauma: The Role of Viscoelastic Hemostatic Assays across All Phases of Trauma Care

Contact Info

Product

Resources

About