Fibrinolysis in Multisystem Trauma Patients

Enderson, Blaine L.; Chen, James P.; Robinson, Richard; Maull, Kimball I.

doi:10.1097/00005373-199109000-00007

Cited by 87 publications

(41 citation statements)

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“…FpA and to some extent FM and FbDP were positively corre lated to ISS. Previous studies in patients with head injury have demonstrated that high lev els of FbDP were related to the amount of brain tissue damage as defined by cranial computer tomography scans or GCS [10][11][12], However, in a study on multiple trauma pa tients, D-dimer levels were not correlated to ISS [13], Pulmonary dysfunction or ARDS is a common complication after multiple trauma and associated with a high mortality. Primary resuscitation with volume replace ment and endotracheal intubation followed by lifesaving surgery, early operative stabili zation of extremity fractures and mechanical ventilation with positive end-expiratory pres sure postoperatively are considered to be im- 94 Sorensen/Jensen/Rahr/Borris/Lassen/ Fibrinogen and Fibrin in Trauma Fedders/Haase/Knudsen 100-i □ PD Fig.…”

Section: Discussionmentioning

confidence: 97%

Fibrinogen and Fibrin Derivatives in Traumatized Patients: Relation to Injury Severity and Posttraumatic Pulmonary Dysfunction

Sørensen

Jensen

Rahr

et al. 1993

Pathophysiol Haemos Thromb

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In a prospective study including 30 traumatized patients, levels of fibrinogen, fibrinopeptide A (FpA), fibrin monomers (FM) and fibrin degradation products (FbDP) were measured on admission and on days 1 2, 3 and 7 after the incident. High levels of FpA, FM and FbDP were observed immediately after the trauma. Fibrinogen levels increased during the first 7 posttraumatic days whereas FpA and FM decreased. FbDP was significantly higher on day 7 than on day 3. All variables were to some extent correlated to the injury severity score. FbDP were significantly lower on the day after admission in 4 patients who developed pulmonary dysfunction compared with patients without this complication.

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Section: Discussionmentioning

confidence: 97%

Fibrinogen and Fibrin Derivatives in Traumatized Patients: Relation to Injury Severity and Posttraumatic Pulmonary Dysfunction

Sørensen

Jensen

Rahr

et al. 1993

Pathophysiol Haemos Thromb

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“…In addition there is poor correlation between platelet count and continued bleeding and in these settings there is justification for platelet transfusion even with a 'normal' platelet count [21]. Increased fibrinolytic activity and imbalance in production and degradation of fibrin may also lead to excessive bleeding [22]. Thromboelastography can broadly determine coagulation abnormalities and give information about fibrinolytic activity and platelet function.…”

Section: Phase II -Damage Control Surgerymentioning

confidence: 99%

Damage Control Surgery for Abdominal Trauma

Chaudhry

Tiwari²,

Singh³

2006

Medical Journal Armed Forces India

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Damage control is not a modern concept, but the application of this approach represents a new paradigm in surgery, borne out of a need to save patients with severe exsanguinating injuries. Definitive control and repair may be accomplished in the immediate post injury setting but the physiological derangement due to massive shock state resulting from the severe injury and the resuscitation that follows, often leads to a fully repaired but dead patient. The vicious triad of death in trauma, namely hypothermia, acidosis and coagulopathy should be tackled by initial abbreviated laparotomy, correction of physiological derangements and finally definitive repair of all injuries at second laparotomy. The concept needs a dedicated team effort with careful patient selection for achieving the optimal results. MJAFI 2006; 62 : 259-262

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“…When there is extensive injury, a picture can emerge that resembles, and in some cases is indistinguishable from, disseminated intravascular coagulation (DIC), with decreases in coagulation factors resulting in a hemorrhagic diathesis, and a coagulation profile characterized by increased evidence of fibrinolytic activity. [6][7][8] Coagulation abnormalities are particularly severe in patients with major parenchymal brain injury, a finding that is not surprising given the thromboplastin-rich nature of the brain. 9,10 Hypothermia is common in patients coming to trauma centers 11,12 and has been shown to cause a number of coagulation abnormalities, including a decrease in the function of the enzymes of the clotting cascade and the induction of DIC.…”

Section: Etiologymentioning

confidence: 99%