Original articleEarly evaluation of acute traumatic coagulopathy by thrombelastography
Section snippets
Methods
After institutional review board approval, TEG Hemostasis System (Haemoscope Corporation) assays were performed on 161 severely injured trauma patients brought to a level 1 trauma center by air ambulance over a 12-month period. Because most of these patients would be unconscious, and the next of kin was not readily available, the requirement for informed consent was waived. Inclusion criteria were severe injury (injury severity score > 9) and air ambulance transport. There were no exclusion
Results
Patient characteristics are given in Table I. It should be noted that 15 patients were classified as being in shock, which is defined as a systolic blood pressure ≤ 90. Most patients had multiple trauma (32%) and multiple fractures (32%), which mostly result from motor vehicle collisions. Standard coagulation and blood parameters are given in Table II.
To assess the time line of coagulopathy posttrauma, the standard TEG parameters (shown in Fig 1) from OS and ED samples (an average of 45 min
Discussion
Coagulopathy has long been recognized as a major contributor to posttraumatic fatality. Shock and hypoperfusion coupled with massive tissue factor release from injured tissue can lead to an overactivation of the thrombin-thrombomodulin-protein C pathway.2, 3, 4, 5, 10 This can result in the systemic destruction of factor V and VIII and impairment of coagulation. This study demonstrates that coagulopathy can be detected very quickly after trauma. The most common coagulopathy was a prolonged R,
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Supported by Haemoscope Corporation, and 1 author (R.C.C.) is a paid consultant for Haemoscope Corporation.