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• W2002139985 abstract "Conclusion: PlateletMapping assays correlate with a need for blood transfusion and abnormal thrombelastogram parameters correlate with death. Summary: There is a significant association between post-traumatic coagulopathy and death. It is postulated that poor perfusion coupled with shock and tissue factor release along with thrombin generation results in an imbalance of the thrombin-thrombomodulin-protein C pathway (Ann Surg 2007;245:812-8). Overactivated protein C leads to loss of factors Va and VIIIa. This results in an impaired coagulation and coagulopathy manifesting as consumption or dilution of clotting factors, hyperthermia, acidosis, and platelet dysfunction or consumption (J Trauma 2008;64:s64-8). In this study the authors sought to determine how early after trauma coagulopathy could be observed and to assess whether coagulopathy as determined by thrombelastogram (TEG) and PlateletMapping correlated with post-traumatic transfusion or death. TEG assays were performed on 161 patients treated at a level 1 trauma center during a 12-month period. Inclusion criteria were an injury severity score >9 and air ambulance transport. The investigators collected a citrated blood sample at the accident scene before fluid resuscitation. A second citrated and heparinized blood sample was collected ≤1 hour of arrival in the emergency department. Citrated blood samples were analyzed by the TEG system for reaction (R) time, clot formation (K) time, clotting rate (angle), strength of clot (maximum amplitude [MA]), and percent fibrinolysis at 60 minutes (LY60). The heparinized blood sample was analyzed by PlateletMapping assays for fibrinogen levels and adenosine diphosphate (ADP)-platelet activation. Comparisons were made between on-site and emergency department assays and subsequent death or need for transfusion. No real differences in the TEG parameters were observed from on-site vs those obtained in the emergency department. TEG parameters did not correlate with the need for transfusion; however, poor platelet function observed by PlateletMapping did significantly correlate with need for transfusion. Abnormal ADP-platelet activation was highly correlated with the need for transfusion (P = .013). There was a significant correlation of all standard TEG parameters with death. Fibrinogen levels <100 mg/dL, as determined by PlateletMapping, also significantly correlated with death. Comment: The study demonstrates coagulopathy can be detected quickly after trauma and presumably after any event producing acute blood loss such as rupture of an abdominal or thoracic aneurysm. There was little difference between TEG parameters measured at the site of the accident vs those measured in the emergency department. Currently, decisions to transfuse packed red cells or fresh frozen plasma are empiric. It may be that the TEG system along with PlateletMapping can provide evidence-based transfusion and more efficient use of blood products in the bleeding patient." @default.
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• W2002139985 date "2010-01-01" @default.
• W2002139985 modified "2023-09-25" @default.
• W2002139985 title "Early Evaluation of Acute Traumatic Coagulopathy by Thrombelastography" @default.
• W2002139985 doi "https://doi.org/10.1016/j.jvs.2009.11.065" @default.
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