Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

Kushimoto, Shigeki; Kudo, Daisuke; Kawazoe, Yu

doi:10.1186/s40560-016-0196-6

Cited by 72 publications

(76 citation statements)

References 66 publications

(112 reference statements)

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“…Although trauma‐related coagulopathy is a serious and often lethal condition, it is amenable to prevention and treatment, providing bleeding control is obtained . As coagulopathy is present in 25–35% of trauma patients, in an effort to prevent these deaths, familiarity with the pathophysiology of ATC and TIC is essential in treatment for trauma patients presenting with coagulopathy or any coagulopathy precursors . Knowledge of the clotting cascade and related factors is important in understanding the physiology behind TIC to ensure proper treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Trauma‐induced coagulopathy is driven both by acute traumatic coagulopathy (ATC) and resuscitation‐associated coagulopathy . Acute traumatic coagulopathy is due to dysregulation of the thrombomodulin–protein C system and is directly related to injury, trauma, and shock.…”

Section: Methodsmentioning

confidence: 99%

“…It presents as increased coagulation activation, coagulation impairment, and increased fibrinolysis. Increased fibrinolysis is the most prominent feature of ATC . In fibrinolysis, tPA and the precursor plasminogen bind to fibrin, leading tPA to activate and turn plasminogen into plasmin.…”

Section: Methodsmentioning

confidence: 99%

“…Coagulopathy is seen in 25–35% of trauma patients and is a common contributor to hemorrhagic death; in fact, it is thought to be responsible for half of the hemorrhagic deaths in trauma patients who receive mass transfusions . Upwards of 30% of trauma‐related deaths are directly associated with massive blood loss, of which 10% are preventable.…”

Section: Introductionmentioning

confidence: 99%

“…Upwards of 30% of trauma‐related deaths are directly associated with massive blood loss, of which 10% are preventable. Coagulopathy also results in higher transfusion requirements which, in turn, significantly increases morbidity as well as mortality compared to non‐coagulopathic trauma patients . Mortality rates are elevated in the first hours following arrival at the trauma center in patients with uncontrolled hemorrhage due to the so‐called “lethal triad”, coagulopathy, acidosis, and hypothermia, which reinforce each other in a vicious cycle.…”

Section: Introductionmentioning

confidence: 99%

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Bad blood: A coagulopathy associated with trauma and massive transfusion review

Vernon

Morgan

Morrison

2019

Acute Medicine & Surgery

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Coagulopathy in trauma patients is a known contributor to death due to hemorrhage. In fact, it seen as frequently as 35% of the time. The complexity of the coagulopathy pathway requires a deliberate and planned approach. The methods used to assess and detect if a patient is coagulopathic remain challenging, but tools have been developed to assist the practitioner to effectively manage and even quickly reverse the coagulopathy. The purpose of this review is to educate trauma and emergency medicine staff on the currently available diagnostic tools to assess coagulopathy, to provide an overview of the coagulopathy pathway, as well as provide examples of how to intervene and treat coagulopathy, including the use of crew resource management during mass transfusion protocol activations.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bad blood: A coagulopathy associated with trauma and massive transfusion review

Vernon

Morgan

Morrison

2019

Acute Medicine & Surgery

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Antithrombin III Levels and Outcomes Among Patients With Trauma

Farrell,

McConnell,

Zilberman-Rudenko

et al. 2024

JAMA Netw Open

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ImportancePatients with trauma exhibit a complex balance of coagulopathy manifested by both bleeding and thrombosis. Antithrombin III is a plasma protein that functions as an important regulator of coagulation. Previous studies have found a high incidence of antithrombin III deficiency among patients with trauma.ObjectiveTo assess whether changes in antithrombin III activity are associated with thrombohemorrhagic complications among patients with trauma.Design, Setting, and ParticipantsThis cohort study was conducted from December 2, 2015, to March 24, 2017, at a level I trauma center. A total of 292 patients with trauma were followed up from their arrival through 6 days from admission. Data, including quantification of antithrombin III activity, were collected for these patients. Thromboprophylaxis strategy; hemorrhage, deep vein thrombosis (DVT), and pulmonary embolism screenings; and follow-up evaluations were conducted per institutional protocols. Data analyses were performed from September 28, 2023, to June 4, 2024.Main Outcomes and MeasuresThe primary study outcome measurements were associations between antithrombin III levels and outcomes among patients with trauma, including ventilator-free days, hospital-free days, intensive care unit (ICU)–free days, hemorrhage, venous thromboembolic events, and mortality.ResultsThe 292 patients had a mean (SD) age of 54.4 (19.0) years and included 211 men (72.2%). Patients with an antithrombin III deficiency had fewer mean (SD) ventilator-free days (27.8 [5.1] vs 29.6 [1.4]; P = .0003), hospital-free days (20.3 [8.2] vs 24.0 [5.7]; P = 1.37 × 10−6), and ICU-free days (25.7 [4.9] vs 27.7 [2.3]; P = 9.38 × 10−6) compared with patients without a deficiency. Antithrombin III deficiency was also associated with greater rates of progressive intracranial hemorrhage (21.1% [28 of 133] vs 6.3% [10 of 159]; P = .0003) and thrombocytopenia (24.8% [33 of 133] vs 5.0% [8 of 159]; P = 1.94 × 10−6). Although antithrombin III deficiency was not significantly associated with DVT, patients who developed a DVT had a more precipitous decrease in antithrombin III levels that were significantly lower than patients who did not develop a DVT.Conclusions and RelevanceIn this cohort study of patients with trauma, antithrombin III deficiency was associated with greater injury severity, increased hemorrhage, and increased mortality, as well as fewer ventilator-free, hospital-free, and ICU-free days. Although this was an associative study, these data suggest that antithrombin III levels may be useful in the risk assessment of patients with trauma.

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Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers

et al. 2023

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ImportanceWhole-blood (WB) resuscitation has gained renewed interest among civilian trauma centers. However, there remains insufficient evidence that WB as an adjunct to component therapy–based massive transfusion protocol (WB-MTP) is associated with a survival advantage over MTP alone in adult civilian trauma patients presenting with severe hemorrhage.ObjectiveTo assess whether WB-MTP compared with MTP alone is associated with improved survival at 24 hours and 30 days among adult trauma patients presenting with severe hemorrhage.Design, Setting, and ParticipantsThis retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program databank from January 1, 2017, and December 31, 2018, included adult trauma patients with a systolic blood pressure less than 90 mm Hg and a shock index greater than 1 who received at least 4 units of red blood cells within the first hour of emergency department (ED) arrival at level I and level II US and Canadian adult civilian trauma centers. Patients with burns, death within 1 hour of ED arrival, and interfacility transfers were excluded. Data were analyzed from February 2022 to September 2022.ExposuresResuscitation with WB-MTP compared with MTP alone within 24 hours of ED presentation.Main Outcomes and MeasuresPrimary outcomes were survival at 24 hours and 30 days. Secondary outcomes selected a priori included major complications, hospital length of stay, and intensive care unit length of stay.ResultsA total of 2785 patients met inclusion criteria: 432 (15.5%) in the WB-MTP group (335 male [78%]; median age, 38 years [IQR, 27-57 years]) and 2353 (84.5%) in the MTP-only group (1822 male [77%]; median age, 38 years [IQR, 27-56 years]). Both groups included severely injured patients (median injury severity score, 28 [IQR, 17-34]; median difference, 1.29 [95% CI, −0.05 to 2.64]). A survival curve demonstrated separation within 5 hours of ED presentation. WB-MTP was associated with improved survival at 24 hours, demonstrating a 37% lower risk of mortality (hazard ratio, 0.63; 95% CI, 0.41-0.96; P = .03). Similarly, the survival benefit associated with WB-MTP remained consistent at 30 days (HR, 0.53; 95% CI, 0.31-0.93; P = .02).Conclusions and RelevanceIn this cohort study, receipt of WB-MTP was associated with improved survival in trauma patients presenting with severe hemorrhage, with a survival benefit found early after transfusion. The findings from this study are clinically important as this is an essential first step in prioritizing the selection of WB-MTP for trauma patients presenting with severe hemorrhage.

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Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

Cited by 72 publications

References 66 publications

Bad blood: A coagulopathy associated with trauma and massive transfusion review

Bad blood: A coagulopathy associated with trauma and massive transfusion review

Antithrombin III Levels and Outcomes Among Patients With Trauma

Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers

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