Early coagulopathy at hospital admission predicts initial or delayed fibrinogen deficit in severe trauma patients

Deras, Pauline; Villiet, Maxime; Manzanera, Jonathan; Latry, P.; Schved, Jean‐François; Capdevila, Xavier; Charbit, Jonathan

doi:10.1097/ta.0000000000000314

Cited by 33 publications

(28 citation statements)

References 39 publications

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“…Although fibrinogen levels have been reported to reach critically low levels earlier than any other coagulation protein in the course of severe bleeding after injury [6,34], fibrinogen depletion is more likely to be the result than the cause of increased systemic fibrinolysis. This is supported by our results showing that FF-MA was reduced in trauma patients with systemic hyperfibrinolysis, but did not correlate with a patient’s sensitivity to t-PA.…”

Section: Discussionmentioning

confidence: 99%

Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue‐type plasminogen activator in trauma patients

Moore

Chapman

et al. 2015

Journal of Thrombosis and Haemostasis

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Summary Background Systemic hyperfibrinolysis is a lethal phenotype of trauma-induced coagulopathy. Its pathogenesis is poorly understood. Recent studies have support a central role of platelets in hemostasis and in fibrinolysis regulation, implying that platelet impairment is integral to the development of postinjury systemic hyperfibrinolysis. Objective The objective of this study was to identify if platelet function is associated with blood clot sensitivity to fibrinolysis. We hypothesize that platelet impairment of the ADP pathway correlates with fibrinolysis sensitivity in trauma patients. Methods A prospective observational study of patients meeting the criteria for the highest level of activation at an urban trauma center was performed. Viscoelastic parameters associated with platelet function (maximum amplitude [MA]) were measured with native thrombelastography (TEG), and TEG platelet mapping of the ADP pathway (ADP-MA). The contribution of fibrinogen to clotting was measured with TEG (angle) and the TEG functional fibrinogen (FF) assay (FF-MA). Another TEG assay containing tissue-type plasminogen activator (t-PA) (75 ng mL−1) was used to assess clot sensitivity to an exogenous fibrinolytic stimulus by use of the TEG lysis at 30 min (LY30) variable. Multivariate linear regression was used to identify which TEG variable correlated with t-PA-LY30 (quantification of fibrinolysis sensitivity). Results Fifty-eight trauma patients were included in the analysis, with a median injury severity score of 17 and a base deficit of 6 mEq L−1. TEG parameters that significantly predicted t-PA-LY30 were related to platelet function (ADP-MA, P = 0.001; MA, P < 0.001) but not to fibrinogen (FF-MA, P = 0.773; angle, P = 0.083). Clinical predictors of platelet ADP impairment included calcium level (P = 0.001), base deficit (P = 0.001), and injury severity (P = 0.001). Results and Conclusions Platelet impairment of the ADP pathway is associated with increased sensitivity to t-PA. ADP pathway inhibition in platelets may be an early step in the pathogenesis of systemic hyperfibrinolysis.

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Section: Discussionmentioning

confidence: 99%

Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue‐type plasminogen activator in trauma patients

Moore

Chapman

et al. 2015

Journal of Thrombosis and Haemostasis

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“…This has been demonstrated in both the pre-hospital environment and early after arrival in the trauma unit prior to large volume fluid resuscitation (24) (25). In a number of studies the degree of hypofibrinogenaemia is strongly associated with injury severity (22) (26). This suggests fibrinogen deficiency is innately related to the primary and secondary physiological insults induced by severe trauma.…”

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confidence: 98%

Fibrinogen in traumatic haemorrhage: A narrative review

Winearls

Campbell

Hurn

et al. 2017

Injury

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Abstract:Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.

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“…This device indeed assesses only part of the global function of coagulation cascade. We have, however, shown in a previous series that fibrinogen deficit was reliably predicted using the admission PTr value . Moreover, point‐of‐care devices focused on fibrinogen or PLT adhesion are being developed and might be a complementary solution in the future .…”

Section: Discussionmentioning

confidence: 91%

Diagnostic performance of prothrombin time point‐of‐care to detect acute traumatic coagulopathy on admission: experience of 522 cases in trauma center

et al. 2018

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Early coagulopathy at hospital admission predicts initial or delayed fibrinogen deficit in severe trauma patients

Abstract: Prognostic and epidemiologic study, level III.

Cited by 33 publications

References 39 publications

Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue‐type plasminogen activator in trauma patients

Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue‐type plasminogen activator in trauma patients

Fibrinogen in traumatic haemorrhage: A narrative review

Diagnostic performance of prothrombin time point‐of‐care to detect acute traumatic coagulopathy on admission: experience of 522 cases in trauma center

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