Admission Rapid Thrombelastography Can Replace Conventional Coagulation Tests in the Emergency Department

Holcomb, John B.; Minei, Kristin M.; Scerbo, Michelle H.; Radwan, Zayde A.; Wade, Charles E.; Kozar, Rosemary A.; Gill, Brijesh S.; Albarado, Rondel; McNutt, Michelle K.; Khan, Saleem Ahmed; Adams, Phillip R.; McCarthy, James J.; Cotton, Bryan A.

doi:10.1097/sla.0b013e3182658180

Cited by 366 publications

(319 citation statements)

References 73 publications

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“…Prothrombin time, partial thromboplastin time, and international normalized ratio are not used on admission because they have been shown to be of little value and TEG provides more rapid and useful data. 12 Cryoprecipitate is used when the maximal amplitude is Ͻ 55, and venous thromboembolism prophylaxis is escalated when the maximal amplitude is Ͼ 65. 13 Tranexamic acid is used when the LY-30 is Ն 3% on the admission TEG.…”

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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“…Cotton et al and Holcomb et al demonstrated that the r-TEG values for activated clotting time (ACT), k-time, and the R-time were available within 5 minutes, and the maximal amplitude (mA) and alpha angle were available within 15 minutes. These values correlated with CCTs in relation to coagulopathy [16,21]. To date, few reports have described the utility of r-TEG in diagnosing coagulopathy in TBI patients.…”

Section: Introductionmentioning

confidence: 66%

“…Coagulopathy was defined by the presence of one or more of the following: aPTT >35 seconds, INR >1.5, platelet count <150 x 10 9 /L, fibrinogen <180 mg/dL, ACT >128 seconds, k >2.5 minutes, alpha <56 degrees, mA <55 millimeters, and LY30 >3% (21). These critical TEG values were based on our previous work where inflection points on scatter-plot analyses identified when transfusion requirements and mortality increased substantially.…”

Section: Definitions and Outcomesmentioning

confidence: 99%

Hypocoagulability in Traumatic Brain Injury as Measured by Traditional Means and Thrombelastography

Sixta¹,

Cardenas²,

Kitagawa³

et al. 2015

J Neurol Neurophysiol

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“…In a prospective cohort study of 517 trauma patients, thromboelastography enabled rapid detection of hypofi brinogenemia, and early administration of fi brinogen was related with improved survival [23]. Using rapid thromboelastography, Holcomb et al re cently succeeded in identifying patients with an increased risk of fi brinolysis and erythrocyte, plasma and platelet transfusions out of 1,974 major trauma patients [24]. Schochl et al [25] retrospectively analyzed the eff ects of thromboelastometry-guided hemostatic therapy in 131 trauma patients who received ≥ 5 erythrocyte concentrate units within 24 hours after admission.…”

Section: Massive Bleeding and Trauma Patientsmentioning

confidence: 99%

Point-of-Care Coagulation Management in Intensive Care Medicine

Meybohm¹,

Zacharowski²,

Weber³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Admission Rapid Thrombelastography Can Replace Conventional Coagulation Tests in the Emergency Department

Abstract: The r-TEG data was clinically superior to results from 5 CCTs. In addition, r-TEG identified patients with an increased risk of early RBC, plasma and platelet transfusions, and fibrinolysis. Admission CCTs can be replaced with r-TEG.

Cited by 366 publications

References 73 publications

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Hypocoagulability in Traumatic Brain Injury as Measured by Traditional Means and Thrombelastography

Point-of-Care Coagulation Management in Intensive Care Medicine

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