Early predictors for massive transfusion in older adult severe trauma patients

Ohmori, Takao; Kitamura, Taisuke; Ishihara, Junko; Onishi, Hirokazu; Nojima, Tsuyoshi; Yamamoto, Kotaro T.; Tamura, Ryu; Muranishi, Kentaro; Matsumoto, Toshiyuki; Tokioka, Takamitsu

doi:10.1016/j.injury.2016.12.028

Cited by 34 publications

(30 citation statements)

References 39 publications

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“…Patients with ongoing antithrombotic treatment admitted for any bleeding event to the emergency department [760], as well as general trauma patients without brain injury [761], did not show a significant increase in mortality risk. In elderly patients (≥ 65 years of age) with severe trauma and pre-injury anticoagulants and APA, only the warfarin group had a significantly higher risk of bleeding [762], but in other studies pre-injury APA usage was significantly associated with massive transfusion [763] and haemostatic treatments within 24 h [764], but without an impact on survival. Prior use of APA was also a risk factor for the development of complications in blunt chest trauma [765].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Ferraris et al also reported that preinjury antiplatelet medication does not affect bleeding following an injury [13]. However, other studies have reported that elderly trauma patients on warfarin are at an increased risk of needing a massive transfusion [19,20]. Ohmori et al reported that patients taking anticoagulants had a 4.91-fold or antiplatelets 3.67-fold increased risk of needing a massive transfusion following a trauma, however, this study was conducted with a small sample [20].…”

Section: Discussionmentioning

confidence: 81%

“…However, other studies have reported that elderly trauma patients on warfarin are at an increased risk of needing a massive transfusion [19,20]. Ohmori et al reported that patients taking anticoagulants had a 4.91-fold or antiplatelets 3.67-fold increased risk of needing a massive transfusion following a trauma, however, this study was conducted with a small sample [20]. These conflicting results regarding the effect anticoagulant and antiplatelet medications have on bleeding and transfusions warrant further discussions and studies with greater sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

Kim¹,

Sul²,

Lee³

et al. 2020

Preprint

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Purpose: The elderly are more likely to be on anticoagulant or antiplatelet medications, which increase bleeding. We aimed to determine the effect of preinjury anticoagulant or antiplatelet medications on required blood transfusions and the trauma outcomes of elderly patients.Methods: We retrospectively reviewed the medical records of all elderly trauma patients admitted to Chungbuk National University Hospital from January 2016 to June 2019. We compared the required number of blood transfusion units, complications, and mortality rate between those on anticoagulant or antiplatelet medications and those that were not, using the chi-squared test, independent t-test, liner regression analysis, and logistic regression analysis.Results: Out of 466 patients, 142 were on anticoagulant or antiplatelet medications while 324 were not. There was a significant statistical difference in the unit amount of red blood cells transfused within 4 hours of arriving at the hospital between the medicated and non-medicated groups (0.89 vs 1.43 units, respectively, p = 0.02); however, multivariate analysis showed no statistical difference (p = 0.28). The medication group showed a higher rate of complications compared to the non-medicated group (47.9% vs. 29.6%, respectively, p = 0.001), bleeding (17.6% vs 2.8%, respectively, p = 0.001), and pneumonia (24.4% vs 14.2%, respectively, p =0.01). There was no statistical difference in the mortality rate (16.9% vs. 22.2%, respectively, p = 0.21). Conclusion: Preinjury anticoagulant or antiplatelet medications in elderly trauma patients increased bleeding and complications such as pneumonia but did not affect transfusion requirement, or mortality rate.

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“…In another cohort of trauma patients, ongoing antiplatelet therapy did not significantly increase the risk of mortality [ 24 ]. Nevertheless, in a recent large cohort of severe trauma patients, preinjury antiplatelet therapy was one of the most important risk factors to predict the need for massive transfusion [ 25 ]. Therefore, despite the lack of evidence, APA neutralisation is usually proposed.…”

Section: Management Of Bleeding Associated With Apasmentioning

confidence: 99%

Management of Bleeding Events Associated with Antiplatelet Therapy: Evidence, Uncertainties and Pitfalls

Godier

Albaladéjo

2020

JCM

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Bleeding complications are common in patients treated with antiplatelet agents (APA), but their management relies on poor evidence. Therefore, practical guidelines and guidance documents are mainly based on expert opinion. The French Working Group on Perioperative Haemostasis provided proposals in 2018 to enhance clinical decisions regarding the management of APA-treated patients with a bleeding event. In light of these proposals, this review discusses the evidence and uncertainties of the management of patients with a bleeding event while on antiplatelet therapy. Platelet transfusion is the main option as an attempt to neutralise the effect of APA on primary haemostasis. Nevertheless, efficacy of platelet transfusion to mitigate clinical consequences of bleeding in patients treated with APA depends on the type of antiplatelet therapy, the time from the last intake, the mechanism (spontaneous versus traumatic) and site of bleeding and the criteria of efficacy (in vitro, in vivo). Specific antidotes for APA neutralisation are needed, especially for ticagrelor, but are not available yet. Despite the amount of information that platelet function tests are expected to give, little data support the clinical benefit of using such tests for the management of bleeding events in patients treated or potentially treated with APA.

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Early predictors for massive transfusion in older adult severe trauma patients

Cited by 34 publications

References 39 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

Management of Bleeding Events Associated with Antiplatelet Therapy: Evidence, Uncertainties and Pitfalls

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