Point-of-Care Coagulation Monitoring in Trauma Patients

Stein, Philipp; Kaserer, Alexander; Spahn, G.; Spahn, Donat R.

doi:10.1055/s-0037-1598062

Cited by 37 publications

(32 citation statements)

References 82 publications

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“…Most recent version of the transfusion and coagulation algorithm . ACT, activated clotting time; CFT, clot formation time; CT, clotting time; FFP, fresh frozen plasma; HIT, heparin‐induced thrombocytopenia; INR, international normalised ratio; IU/U, international units; i.v., intravenous; MCF, maximum clot firmness; PT, prothrombin time; RBC, red blood cells; rFVIIa, recombinant‐activated factor VII; TT, thrombin time.…”

Section: Methodsmentioning

confidence: 99%

Change of transfusion and treatment paradigm in major trauma patients

et al. 2017

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Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid. The incidence of massive transfusion (≥ 10 units of red blood cells from emergency department arrival until intensive care unit admission) was compared with the predicted incidence according to the trauma associated severe haemorrhage score. All adult (≥ 16 years) trauma patients primarily admitted to the University Hospital Zürich with an injury severity score ≥ 16 were included. In 2005-2007, the observed and trauma associated severe haemorrhage score that predicted the incidence of massive transfusion were identical, whereas in 2012-2014 the observed incidence was less than half that predicted (3.7% vs. 7.5%). Compared to 2005-2007, the proportion of patients transfused with red blood cells and fresh frozen plasma was significantly lower in 2012-2014 in both the emergency department (43% vs. 17%; 31% vs. 6%, respectively), and after 24 h (53% vs. 27%; 37% vs. 16%, respectively). The use of tranexamic acid and coagulation factor XIII also increased significantly in the 2012-2014 time period. Implementation of a revised trauma management strategy, which included goal-directed coagulation management, was associated with a reduced incidence of massive transfusion and a reduction in the transfusion of red blood cells and fresh frozen plasma.

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Section: Methodsmentioning

confidence: 99%

Change of transfusion and treatment paradigm in major trauma patients

et al. 2017

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“…infections, volume overload, immunosuppression and kidney injury) [11][12][13][14] and it has been shown that a reduced transfusion requirement improved clinical outcomes including mortality [15,16]. Therefore, a factor-based, goal-directed coagulation management guided by viscoelastic point of care tests [2] has been proposed as a new approach of haemostatic resuscitation [1,7,[17][18][19]. This coagulation management was proven to decrease transfusion requirement with beneficial outcomes in trauma patients [1,7,17,18].…”

Section: Discussionmentioning

confidence: 99%

“…A goal-directed, factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines to treat and prevent trauma induced coagulopathy [1]. Such individualized coagulation management needs to be guided by viscoelastic testing and laboratory values [2,3] to meet patients' demands and is therefore more complex than traditional transfusion strategies of red blood cells (RBC), fresh frozen plasma (FFP) and platelet concentrates (PC) at fixed ratios [4]. Predefined coagulation algorithms were introduced to tackle this issue and to guide the haemostatic management of clinicians at the emergency department [5,6].…”

Section: Introductionmentioning

confidence: 99%

Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma

Stein

Rössler

Braun

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background: A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemostatic management is associated with an increased risk for thromboembolic events. Methods: In this retrospective observational study carried out at the University Hospital Zurich we compared two three-year periods before (period 1: 2005-2007) and after (period 2: 2012-2014) implementation of a factor-based coagulation algorithm. We included all adult patients following major trauma primarily admitted to the University Hospital Zurich. Thromboembolic events were defined as a new in-hospital appearance of any peripheral thrombosis, arterial embolism, pulmonary embolism, stroke or myocardial infarction. A logistic regression was performed to investigate the association of thromboembolic events with possible confounders such as age, sex, specific Abbreviated Injury Scale (AIS) subgroups, allogeneic blood products, and the coagulation management. Results: Out of 1138 patients, 772 met the inclusion criteria: 344 patients in period 1 and 428 patients in period 2. Thromboembolic events were present in 25 patients (7.3%) of period 1 and in 42 patients (9.8%) of period 2 (raw OR 1.39, 95% CI 0.83 to 2.33, p = 0.21). Only AIS extremities (adjusted OR 1.26, 95% CI 1.05 to 1.52, p = 0.015) and exposure to allogeneic blood products (adjusted OR 2.39, 95% CI 1.33 to 4.30, p = 0.004) were independently associated with thromboembolic events in the logistic regression, but the factor-based coagulation management was not (adjusted OR 1.60, 95% CI 0.90-2.86, p = 0.11). Conclusion: There is no evidence that a goal-directed, factor-based coagulation management is associated with an increased risk for thromboembolic events following major trauma.

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“…In this issue of Seminars in Thrombosis & Hemostasis, Stein et al explain the concept of goal-directed point-of-care coagulation management in trauma patients and present algorithms which allow a reduction of allogeneic blood product transfusion and an improvement of trauma patient outcome. 4 Wirtz et al then provide an overview on viscoelastic testing in trauma patients. 5 Perioperative blood loss in cardiac surgery is associated with transfusion requirements, the need for rethoracotomy and mortality.…”

Section: Point-of-care Tests In Patients Presenting With Bleedingmentioning

confidence: 99%

Point-of-Care Testing in Acute Hemorrhagic and Thrombotic States

Levi

2017

Semin Thromb Hemost

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Point-of-Care Coagulation Monitoring in Trauma Patients

Cited by 37 publications

References 82 publications

Change of transfusion and treatment paradigm in major trauma patients

Change of transfusion and treatment paradigm in major trauma patients

Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma

Point-of-Care Testing in Acute Hemorrhagic and Thrombotic States

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