Early evaluation of acute traumatic coagulopathy by thrombelastography
| Autor: | Douglas D. Wellons, Carolyn C. Snider, Blaine L. Enderson, Stanley Kurek, Patrick A. Dakin, Colin R. Clanton, Christy M. Lawson, Roger C. Carroll, Robert M. Craft, Russell J. Langdon |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Decision Making Platelet Transfusion Plasma Physiology (medical) Case fatality rate medicine Coagulopathy Humans Blood Transfusion Prospective Studies Prospective cohort study Prothrombin time Evidence-Based Medicine medicine.diagnostic_test business.industry Biochemistry (medical) Public Health Environmental and Occupational Health General Medicine Emergency department Blood Coagulation Disorders Middle Aged medicine.disease Thromboelastography Thrombelastography Anesthesia Wounds and Injuries Female business Partial thromboplastin time |
| Zdroj: | Translational Research. 154:34-39 |
| ISSN: | 1931-5244 |
| DOI: | 10.1016/j.trsl.2009.04.001 |
| Popis: | Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, Ill) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t-testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude (MA)), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 +/- 17.1 vs MA = 35.7 +/- 19.3, P = 0.004) and a correlation of fibrinogen100 mg/dL with fatalities (P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 +/- 11,618 versus 270 +/- 393 s (P =0.001), and MA was 46.4 +/- 22.4 versus 64.7 +/- 9.8 mm (P0.001). Hyperfibrinolysis (percent fibrinolysis after 60 min (LY60)15%) was observed in 3 patients in the ED with a 67% fatality rate (P =0.001 by chi-square testing). PlateletMapping assays correlated with the need for blood transfusion. The abnormal TEG System parameters correlated with fatality. These coagulopathies were already evident OS. The TEG assays can assess coagulopathy, platelet dysfunction, and hyperfibrinolysis at an early stage posttrauma and suggest more effective interventions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect