Coagulation Disorders in Combat Casulties

Simmons, R. L.; Collins, John J.; Heisterkamp, Charles A.; Mills, Douglas; Andren, R; Phillips, Louise Lang

doi:10.1097/00000658-196904000-00001

Cited by 109 publications

(29 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 In wounded, previously healthy, soldiers requiring MT, DIC was mild and was not associated with clinical bleeding. 7,11 Recent studies suggest that there is no significant correlation between total units of blood transfused and the severity of impaired hemostasis, suggesting that consumption of coagulation factors and platelets is more important than simple hemodilution. 41,74,75 In trauma patients, two major mechanisms are responsible for the occurrence of DIC.…”

Section: The Trauma Settingmentioning

confidence: 99%

“…2,3,5,7,8,11,41,65,73,75,77,83,84 Minor prolongations of the PT or aPTT ratio (ratio = measured value/control value) are poor predictors of bleeding in massively transfused patients. 5 Ciavarella et al have shown that, in 36 massively transfused patients, patients with a PT or aPTT ratio greater or equal to 1.8 had an 80 to 85% chance of exhibiting MVB.…”

Section: The Elective Surgical Settingmentioning

confidence: 99%

See 1 more Smart Citation

Transfusion massive et coagulopathie: physiopathologie et implications cliniques

Frcpc²,

et al. 2004

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies.M Me et th ho od ds s: : Medline was searched for articles on "massive transfusion," "transfusion," "trauma," "surgery," "coagulopathy" and "hemostatic defects." A group of experts reviewed the findings.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Coagulopathy will result from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. The clinical significance of the effects of hydroxyethyl starch solutions on hemostasis remains unclear. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Red cells play an important role in coagulation and hematocrits higher than 30% may be required to sustain hemostasis. In elective surgery patients, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. In trauma patients, tissue trauma, shock, tissue anoxia and hypothermia contribute to the development of disseminated intravascular coagulation and microvascular bleeding. The use of platelets and/or fresh frozen plasma should depend on clinical judgment as well as the results of coagulation testing and should be used mainly to treat a clinical coagulopathy.C Co on nc cl lu us si io on ns s: : Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding. Objectif

show abstract

Section: The Trauma Settingmentioning

confidence: 99%

Section: The Elective Surgical Settingmentioning

confidence: 99%

Transfusion massive et coagulopathie: physiopathologie et implications cliniques

Frcpc²,

et al. 2004

View full text Add to dashboard Cite

show abstract

“…In 1969, Simmons et al were the first to report a relationship between shock and prolonged prothrombin time (PT) and partial thromboplastin time (PTT) in combat trauma patients during the Vietnam War. 9 Since that time, research efforts have focused on a distinct posttraumatic coagulopathy independent from classic sequelae of iatrogenic resuscitation injury such as hemodilution and hypothermia. This trauma-induced coagulopathy (TIC) is associated with increased transfusion requirements, risk of complications, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Advances in the understanding of trauma-induced coagulopathy

Chang

Cardenas

Wade

et al. 2016

Blood

236

225

View full text Add to dashboard Cite

Ten percent of deaths worldwide are due to trauma, and it is the third most common cause of death in the United States. Despite a profound upregulation in procoagulant mechanisms, one-quarter of trauma patients present with laboratory-based evidence of trauma-induced coagulopathy (TIC), which is associated with poorer outcomes including increased mortality. The most common causes of death after trauma are hemorrhage and traumatic brain injury (TBI). The management of TIC has significant implications in both because many hemorrhagic deaths could be preventable, and TIC is associated with progression of intracranial injury after TBI. This review covers the most recent evidence and advances in our understanding of TIC, including the role of platelet dysfunction, endothelial activation, and fibrinolysis. Trauma induces a plethora of biochemical and physiologic changes, and despite numerous studies reporting differences in coagulation parameters between trauma patients and uninjured controls, it is unclear whether some of these differences may be “normal” after trauma. Comparisons between trauma patients with differing outcomes and use of animal studies have shed some light on this issue, but much of the data continue to be correlative with causative links lacking. In particular, there are little data linking the laboratory-based abnormalities with true clinically evident coagulopathic bleeding. For these reasons, TIC continues to be a significant diagnostic and therapeutic challenge.

show abstract

“…6 For example, prior to the era of blood fractionation, the transfusion of large volumes of stored blank blood did not result in a hemorrhagic diathesis in young and previously healthy soldiers wounded during the Vietnam war. 7 More recently, it has been shown that abnormalities of the prothrombin time (PT) and of the activated partial thromboplastin time (aPTT) occur after the transfusion of 12 units of PRBC and that thrombocytopenia develops after the transfusion of 20 units. 8 Yet, despite several attempts at defining meaningful laboratory indicators of impending or established coagulopathy, the relationship between laboratory hemostatic abnormalities and abnormal clinical bleeding remains unclear.…”

Section: List Of Abbreviationsmentioning

confidence: 99%

“…CRYSTALLOIDS In elective surgery, rapid hemodilution with crystalloids has been shown to induce changes on thromboelastography suggestive of increased thrombin generation and a hypercoagulable state. 12,13 The clinical significance of this effect, specially in trauma patients who are initially hypercoagulable, 7 remains unclear. Nonetheless, crystalloid-induced hypercoagulability casts a doubt on studies of the effects of colloids on coagulation that used crystalloids as a control.…”

Section: Pathophysiology Of Coagulopathy In Mtmentioning

confidence: 99%

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Hardy

Moerloose

Samama

2006

Can J Anesth/J Can Anesth

191

108

View full text Add to dashboard Cite

Purpose:To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. Methods:Medline was searched for articles on "massive transfusion," "transfusion," "trauma," "surgery," "coagulopathy" and "hemostatic defects." A group of experts reviewed the findings. Principal findings:Coagulopathy will result from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. The clinical significance of the effects of hydroxyethyl starch solutions on hemostasis remains unclear. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Red cells play an important role in coagulation and hematocrits higher than 30% may be required to sustain hemostasis. In elective surgery patients, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. In trauma patients, tissue trauma, shock, tissue anoxia and hypothermia contribute to the development of disseminated intravascular coagulation and microvascular bleeding. The use of platelets and/or fresh frozen plasma should depend on clinical judgment as well as the results of coagulation testing and should be used mainly to treat a clinical coagulopathy. Conclusions:Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.

show abstract

Coagulation Disorders in Combat Casulties

Cited by 109 publications

References 25 publications

Transfusion massive et coagulopathie: physiopathologie et implications cliniques

Transfusion massive et coagulopathie: physiopathologie et implications cliniques

Advances in the understanding of trauma-induced coagulopathy

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Contact Info

Product

Resources

About