Defining trauma‐induced coagulopathy with respect to future implications for patient management: Communication from the SSC of the ISTH

Moore, Hunter B.; Gando, Satoshi; Iba, Toshiaki; Kim, Paul Y.; Yeh, Calvin H.; Brohi, Karim; Hunt, Beverley J.; Levy, Jerrold H.; Draxler, Dominik F.; Stanworth, Simon; Görlinger, Klaus; Neal, Matthew D.; Schreiber, Martin A.; Barrett, Christopher D.; Medcalf, Robert L.; Moore, Ernest E.; Mutch, Nicola J.; Thachil, Jecko; Urano, Tetsumei; Thomas, Scott; Scărlătescu, Ecaterina; Walsh, Mark

doi:10.1111/jth.14690

Cited by 68 publications

(76 citation statements)

References 71 publications

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“…As they can be performed bedside as point-of-care testing and can give useable results about clot formation and a potential hyperfibrinolysis within one hour, they are chiefly considered as convenient tools for real-time assessment of coagulation and fibrinolysis in whole blood and have been gaining in popularity in various hemorrhagic situations, such as cardiac surgery, obstetrics, and traumatology over decades, for the management of acutely bleeding patients [3]. By contrast, COVID-19 disturbance of hemostasis is likely a combination of hypercoagulability and impaired fibrinolysis (a prothrombotic laboratory phenotype), at least in part, contributing to the thrombotic risk and the prothrombotic laboratory phenotype, but VETs have been nevertheless suggested to be potentially useful, in line with previous works on sepsis [10] and trauma [11,12], for example.…”

Section: Introductionmentioning

confidence: 60%

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Section: Introductionmentioning

confidence: 60%

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Bareille

Hardy

Douxfils

et al. 2021

JCM

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“…Trauma-induced coagulopathy is de ned as a pre-stage of DIC and progresses to DIC as a result of dysregulated in ammatory and coagulo brinolytic responses to trauma 26 . When the trauma is su ciently severe, therefore, DIC develops immediately after trauma without passing through the traumainduced coagulopathy stage 15 .…”

Section: Discussionmentioning

confidence: 99%

Disseminated Intravascular Coagulation Immediately After Trauma Predicts a Poor Prognosis in Severely Injured Patients

Wada

Shiraishi

Gando

et al. 2021

Preprint

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Trauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P <0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.

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“…2 The essential and key coagulopathy in TIC is a primary coagulopathy, and the secondary coagulopathies modify DIC. 1,2 Based on this concept, the Subcommittees stated that primary coagulopathy caused by dysregulated inflammatory and coagulofibrinolytic responses to trauma and traumatic shock leads to organ dysfunction and a poor outcome. 1,2 These ideas suggest that, in severely injured trauma patients, DIC and TIC may elicit the same coagulofibrinolytic changes.…”

Section: Introductionmentioning

confidence: 99%

A multicenter prospective validation study on disseminated intravascular coagulation in trauma‐induced coagulopathy

Gando

Shiraishi

Wada

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Trauma‐induced coagulopathy (TIC) may progress to disseminated intravascular coagulation (DIC) due to dysregulated inflammatory and coagulofibrinolytic responses to trauma. Objectives We explored how DIC and TIC elicit the same coagulofibrinolytic changes which lead to massive transfusion. Methods Severely injured trauma patients with an injury severity score ≥ 16 were prospectively included. Platelet counts, global markers of coagulation and fibrinolysis and specific markers of thrombin and plasmin generation, anticoagulation, endothelial injury, and inhibition of fibrinolysis were measured at presentation to the emergency department (0 hour) and 3 hour after arrival. The patients were subdivided into those with and without DIC and those with and without TIC using the 0‐hour data. Time courses of specific markers and the frequency of massive transfusion were evaluated. The association of various variables with DIC development was also confirmed. Results Two hundred and seventy‐six patients were eligible for the analyses. The severity of injury (odds ratio; 1.038, P = .022) and thrombin generation (odds ratio; 1.014, P = .024) were associated with the development of DIC. Both DIC and TIC patients showed increased thrombin generation, insufficient anticoagulation controls, endothelial injury and increased fibrinolysis followed by elevated plasminogen activator inhibitor‐1 levels at 0 and 3 hours. The frequency of massive transfusion was higher in both DIC (33.6% vs 7.9%, P < .001) and TIC (50.0% vs 13.3%, P < .001) patients than in those without DIC or TIC, respectively. Conclusions Disseminated intravascular coagulation and TIC evoked the same coagulofibrinolytic responses in severely injured trauma patients immediately after trauma and needed massive transfusion.

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Defining trauma‐induced coagulopathy with respect to future implications for patient management: Communication from the SSC of the ISTH

Cited by 68 publications

References 71 publications

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Disseminated Intravascular Coagulation Immediately After Trauma Predicts a Poor Prognosis in Severely Injured Patients

A multicenter prospective validation study on disseminated intravascular coagulation in trauma‐induced coagulopathy

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