Viscoelastic Testing in Trauma

Wirtz, Mathijs R.; Baumann, Holger; Klinkspoor, J. H.; Goslings, J. C.; Juffermans, Nicole P.

doi:10.1055/s-0037-1598057

Cited by 19 publications

(2 citation statements)

References 94 publications

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“…To further evaluate the relationship between alcohol and coagulopathy, recent studies have used viscoelastic hemostatic assays (VHAs) such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG) [2,3,11,13]. Unlike standard coagulation tests such as prothrombin time (PT) and partial thromboplastin time, which reflect only a small part of the coagulation cascade, VHAs have the advantage of demonstrating the entire process of coagulation, from clot generation to fibrinolysis, in real time [14]. Recent studies using VHAs have shown that alcohol impairs clot formation and inhibits fibrinolysis [2].…”

Section: Introductionmentioning

confidence: 99%

Effect of acute alcohol intoxication on mortality, coagulation, and fibrinolysis in trauma patients

et al. 2021

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Background The effect of alcohol on the outcome and fibrinolysis phenotype in trauma patients remains unclear. Hence, we performed this study to determine whether alcohol is a risk factor for mortality and fibrinolysis shutdown in trauma patients. Materials and methods A total of 686 patients who presented to our trauma center and underwent rotational thromboelastometry were included in the study. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to determine whether alcohol was an independent risk factor for in-hospital mortality and fibrinolysis shutdown. Results The rate of in-hospital mortality was 13.8% and blood alcohol was detected in 27.7% of the patients among our study population. The patients in the alcohol-positive group had higher mortality rate, higher clotting time, and lower maximum lysis, more fibrinolysis shutdown, and hyperfibrinolysis than those in the alcohol-negative group. In logistic regression analysis, blood alcohol was independently associated with in-hospital mortality (odds ratio [OR] 2.578; 95% confidence interval [CI], 1.550–4.288) and fibrinolysis shutdown (OR 1.883 [95% CI, 1.286–2.758]). Within the fibrinolysis shutdown group, blood alcohol was an independent predictor of mortality (OR 2.168 [95% CI, 1.030–4.562]). Conclusions Alcohol is an independent risk factor for mortality and fibrinolysis shutdown in trauma patients. Further, alcohol is an independent risk factor for mortality among patients who experienced fibrinolysis shutdown.

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Section: Introductionmentioning

confidence: 99%

Effect of acute alcohol intoxication on mortality, coagulation, and fibrinolysis in trauma patients

et al. 2021

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“…These parameters are A5, A10, etc., in rTEG and CA5, CA10, etc., in EXTEM [ 44 ]. These values, in addition to the five key parameters described above, allow the real-time assessment of clotting abnormalities, allowing for an early analysis of hemostatic competence and anticipation of necessary blood product therapy ( Table 1 ) [ 40 , 45 , 47 , 48 ]. Similarly, the functional fibrinogen MA of TEG and the FIBTEM assay of ROTEM both activate clot formation in the presence of platelet inhibitors, producing a tracing reflective of fibrin-specific contributions to clot formation and allowing the prompt recognition of a deficiency in fibrinogen [ 49 ].…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

Mamczak

Speybroeck

Stillson

et al. 2022

JCM

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The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy—a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis—remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.

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Hypovolämisch-hämorrhagischer Schock

2018

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The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e.g. kidneys, endocrine system and endothelium). For further identification of a state of shock caused by bleeding, vital functions, coagulation tests and hematopoietic procedures are implemented. Every hospital should be in possession of a specific protocol for massive transfusions. The differentiated systemic treatment of bleeding consists of maintenance of an adequate homeostasis and the administration of blood products and coagulation factors.

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Viscoelastic Testing in Trauma

Cited by 19 publications

References 94 publications

Effect of acute alcohol intoxication on mortality, coagulation, and fibrinolysis in trauma patients

Effect of acute alcohol intoxication on mortality, coagulation, and fibrinolysis in trauma patients

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

Hypovolämisch-hämorrhagischer Schock

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