Prevalence and impact of admission hyperfibrinolysis in severely injured pediatric trauma patients

Liras, Ioannis N.; Cotton, Bryan A.; Cardenas, Jessica C.; Harting, Matthew T.

doi:10.1016/j.surg.2015.05.004

Cited by 45 publications

(45 citation statements)

References 17 publications

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“…Hyperfibrinolysis has been reported in humans with various diseases, including trauma, [28][29][30] and is a reason for severe uncontrollable clinical bleeding. 29,31 It has been documented previously in a dog with A. vasorum infection, 20 a dog with acute traumatic coagulopathy 32 and in dogs with spontaneous hemoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum

Sigrist

Hofer‐Inteeworn

Schefer

et al. 2017

Veterinary Internal Medicne

109

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BackgroundThe pathomechanism of Angiostrongylus vasorum infection‐associated bleeding diathesis in dogs is not fully understood.ObjectiveTo describe rotational thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum and to compare ROTEM parameters between infected dogs with and without clinical signs of bleeding.AnimalsA total of 21 dogs presented between 2013 and 2016.MethodsDogs with A. vasorum infection and ROTEM evaluation were retrospectively identified. Thrombocyte counts, ROTEM parameters, clinical signs of bleeding, therapy, and survival to discharge were retrospectively retrieved from patient records and compared between dogs with and without clinical signs of bleeding.ResultsEvaluation by ROTEM showed hyperfibrinolysis in 8 of 12 (67%; 95% CI, 40–86%) dogs with and 1 of 9 (11%; 95% CI, 2–44%) dogs without clinical signs of bleeding (P = .016). Hyperfibrinolysis was associated with severe hypofibrinogenemia in 6 of 10 (60%; 95% CI, 31–83%) of the cases. Hyperfibrinolysis decreased or resolved after treatment with 10–80 mg/kg tranexamic acid. Fresh frozen plasma (range, 14–60 mL/kg) normalized follow‐up fibrinogen function ROTEM (FIBTEM) maximal clot firmness in 6 of 8 dogs (75%; 95% CI, 41–93%). Survival to discharge was 67% (14/21 dogs; 95% CI, 46–83%) and was not different between dogs with and without clinical signs of bleeding (P = .379).Conclusion and Clinical ImportanceHyperfibrinolysis and hypofibrinogenemia were identified as an important pathomechanism in angiostrongylosis‐associated bleeding in dogs. Hyperfibrinolysis and hypofibrinogenemia were normalized by treatment with tranexamic acid and plasma transfusions, respectively.

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Section: Discussionmentioning

confidence: 99%

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum

Sigrist

Hofer‐Inteeworn

Schefer

et al. 2017

Veterinary Internal Medicne

109

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“…Patients were categorized according to their brinolytic phenotypes as determined by their LY30, as follows: hyper brinolysis was de ned as LY30 >3%, brinolysis shutdown as LY30 of less than 0.8% and physiologic brinolysis as LY30 between 0.8% and 3%, based on the previous studies. [18][19][20][21] Follow-up and outcomes…”

Section: Thromboelastographymentioning

confidence: 99%

“…[7,8] Notably, either TEG detected hyper brinolysis or brinolysis shutdown was related to poor prognosis in patients with trauma or severe diseases. [9][10][11][12] In patients with CHDs, modi ed TEG was applied to measure platelet reactivity [13,14] and coagulation function [15]. However, little is known about abnormal brinolysis in patients with CHDs.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Impact of Fibrinolytic Dysregulation in Patients with Acute Coronary Syndromes

Wan

Lie

et al. 2020

Preprint

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Background：Dual antiplatelet therapy can reduce coronary thrombosis and improve the prognosis in patients with acute coronary syndrome (ACS). However, there was limited prognostic information about fibrinolytic dysregulation in patients with ACS. This study is aimed to evaluated the prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndrome (ACS).Methods：We retrospectively analyzed coagulation and fibrinolysis related indexes of ACS in hospitalized adults with rapid thrombelastography between May 2016 and December 2018. All of the follow-up visits were ended by December 2019. The primary outcome was the occurrence of major adverse cardiovascular events (MACEs), which included unstable angina pectoris, non-fatal myocardial infarction, non-fatal cerebral infarction, heart failure and all-cause death. Results：338 patients were finally included with an average age of 62.5 ± 12.8 years old, 273 (80.5%) were males, 137(40.5%) patients were with STEMI. Fibrinolysis shutdown and hyperfibrinolysis were observed among 163 (48.2%) and 76(22.5%) patients, respectively. During a total of 603.2 person·years of follow-up period, 77 MACEs occurred (22.8%). Multivariate Cox regression analysis indicated that age [HR: 1.031 95% CI: 1.007-1.056, P = 0.012] and LY30 [HR: 1.097, 95% CI: 1.013-1.188, P = 0.023] were independently correlated with the occurrence of MACEs. The hazard ratios pertaining to MACEs in patients with LY30＜0.8% and ＞3.0% compared with those in the physiologic range(LY30: 0.8-3.0%) were 2.275 [HR: 2.275, 95% CI: 1.241-1.241, P = 0.003] and 1.196 [HR: 1.196, 95% CI: 0.679-2.109,P=0.535], respectively.Conclusions: Fibrinolytic dysregulation is very common in selected patients with ACS, and hyperfibrinolysis (HF) (LY30 >3%) is associated with poor outcomes in patients with ACS

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“…This research provided a biological explanation for the time to treatment interaction. Early fibrinolysis is common after trauma and is associated with increased mortality 17– 19 . Trauma triggers the early release of tissue plasminogen activator (TPA), the enzyme that converts plasminogen into the fibrinolytic enzyme plasmin 20, 21 .…”

Section: Statistical Analysis Planmentioning

confidence: 99%

Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial

Roberts¹,

Belli²,

Brenner³

et al. 2018

Wellcome Open Res

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Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide reliable evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients to an intravenous infusion of tranexamic acid or matching placebo in addition to usual care. This paper presents a protocol update (version 2.1) and statistical analysis plan for the CRASH-3 trial. Results: The primary outcome is head injury death in hospital within 28 days of injury for patients treated within 3 hours of injury (deaths in patients treated after 3 hours will also be reported). Because there are strong scientific reasons to expect that tranexamic acid will be most effective in patients treated immediately after injury and less effective with increasing delay, the effect in patients treated within one hour of injury is of particular interest. Secondary outcomes are all-cause and cause-specific mortality, vascular occlusive events (myocardial infarction, pulmonary embolism, deep vein thrombosis, stroke), disability based on the Disability Rating Scale and measures suggested by patient representatives, seizures, neurosurgical intervention, neurosurgical blood loss, days in intensive care and adverse events. Sub-group analyses will examine the effect of tranexamic acid on head injury death stratified by time to treatment, severity of TBI and baseline risk. Conclusion: The CRASH-3 trial will provide reliable evidence of the effectiveness and safety of tranexamic acid in patients with acute TBI. Registration: International Standard Randomised Controlled Trials registry ( ISRCTN15088122) 19/07/2011, and ClinicalTrials.gov ( NCT01402882) 25/07/2011.

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Prevalence and impact of admission hyperfibrinolysis in severely injured pediatric trauma patients

Cited by 45 publications

References 17 publications

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum

Prevalence and Impact of Fibrinolytic Dysregulation in Patients with Acute Coronary Syndromes

Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial

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