Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients.

Autor: Ali JT; Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: jtali@seton.org., Daley MJ; Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: mjdaley@seton.org., Vadiei N; Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: nvadiei@seton.org., Enright Z; Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: zme07a@acu.edu., Nguyen J; Department of Pharmaceutical Services, University Medical Center Brackenridge, United States; College of Pharmacy, University of Texas at Austin, United States. Electronic address: josephn5833@gmail.com., Ali S; Department of Trauma Services, University Medical Center Brackenridge, United States. Electronic address: Sali@seton.org., Aydelotte JD; Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: jdaydelotte@seton.org., Teixeira PG; Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: pgteixeira@seton.org., Coopwood TB; Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: tbcoopwoodjr@seton.org., Brown CV; Department of Trauma Services, University Medical Center Brackenridge, United States; Department of Surgery, Dell Medical School at the University of Texas at Austin, United States. Electronic address: cvrbrown@seton.org.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2017 Apr; Vol. 35 (4), pp. 632-636. Date of Electronic Publication: 2016 Dec 26.
DOI: 10.1016/j.ajem.2016.12.061
Abstrakt: Purpose: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC.
Methods: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards.
Results: A total of 54 patients were included (AC, n=27 [warfarin n=13, dabigatran n=6, aXa inhibitor n=8] vs. no AC, n=27). Baseline characteristics were similar between groups, including age (72±13years vs. 72±15; p=0.85), male gender (70% vs. 74%; p=0.76) and blunt mechanism of injury (100% vs. 100%; p=1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p=0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p<0.01).
Conclusion: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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