Thromboelastometry and organ failure in trauma patients: a prospective cohort study

Abstract

IntroductionData on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality.MethodsThis was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥11.7 dynes/cm2 and hypocoagulability as a G value of <5.0 dynes/cm2. ROTEM was performed on admission and 24 hours later.ResultsA total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.ConclusionsThe incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0687-6) contains supplementary material, which is available to authorized users.

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

“…Comparison with a large sample of non-trauma volunteers without an activator enabled identification of this change in coagulation following injury. A large multicenter study using tissue factor to activate the viscoelastic assays showed that 10% of trauma patients had a hypercoaguable state within 24 h of injury [33]. The use of tissue factor may have masked endogenous circulating factors that promote clot formation following trauma.…”

Washing or filtering of blood products does not improve outcome in a rat model of trauma and multiple transfusion

“…(C) α‐angle measured in degrees (dotted lines are reference values*: 61–83 degrees). (D) G‐value measured in dynes/cm2 (dotted lines are reference values*: 5–11.7 dynes/cm2) . * = Based on human reference values.…”

“…Balanced resuscitation with blood products in ratios similar to whole blood is the mainstay to treat trauma‐induced coagulopathy and prevent exsanguination. However, transfusion is associated with adverse effects, including multiple organ failure (MOF) and nosocomial infection . The mechanisms by which transfusion exerts these effects probably include modulation of the host coagulation and immune response.…”

“…The mechanisms by which transfusion exerts these effects probably include modulation of the host coagulation and immune response. Several studies showed an association between trauma‐induced coagulopathy and the development of MOF . Also, following trauma, both pro‐ and anti‐inflammatory profiles have been reported .…”

Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)

“…Certain components of "the lethal triad" such as acidosis with blood рН below 7.2 [43], hypothermia below 35°С [44,53,54] or hypocoagulation [55][56][57][58] are also independent risk factors for unfavorable outcome. Hypothermia is associated with such polytrauma death predictors as blood loss, acidosis and coagulopathy [59].…”