Comparing the prothrombin time INR versus the APTT to evaluate the coagulopathy of acute trauma

Yuan, Shuai; Ferrell, Chris; Chandler, Wayne L.

doi:10.1016/j.thromres.2006.07.002

Cited by 108 publications

(80 citation statements)

References 30 publications

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“…These processes are reflected in the findings of observational clinical studies that show reduced clotting factor and physiological anticoagulant levels [21][22][23], high thrombin generating capacity [3,4,21,[24][25][26] and reduced platelet counts [27,28] Overall, these data indicate a consumptive coagulopathy. The most depleted coagulation factors are fibrinogen and factor V [22,28], which are likely consumed in part by activated Protein C or free plasmin [29,30], although the relative importance of these proteases in reducing factor levels remains unknown. Thrombin is the key effector molecule in haemostasis; its generation not only converts fibrinogen to fibrin but, like a cytokine, it also activates platelets, leucocytes and endothelium.…”

Section: Pathophysiologymentioning

confidence: 98%

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The pathogenesis of traumatic coagulopathy

2014

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SummaryOver the last 10 years, the management of major haemorrhage in trauma patients has changed radically. This is mainly due to the recognition that many patients who are bleeding when they come in to the emergency department have an established coagulopathy before the haemodilution effects of fluid resuscitation. This has led to the use of new terminology: acute traumatic coagulopathy, acute coagulopathy of trauma shock or trauma‐induced coagulopathy. The recognition of acute traumatic coagulopathy is important, because we now understand that its presence is a prognostic indicator, as it is associated with poor clinical outcome. This has driven a change in clinical management, so that the previous approach of maintaining an adequate circulating volume and oxygen carrying capacity before, as a secondary event, dealing with coagulopathy, has changed to haemostatic resuscitation as early as possible. While there is as yet no universally accepted assay or definition, many experts use prolongation of the prothrombin time to indicate that there is, indeed, a coagulopathy. Hypoxia, acidosis and hypothermia and hormonal, immunological and cytokine production, alongside consumption and blood loss, and the dilutional effects of resuscitation may occur to varying extents depending on the type of tissue damaged, the type and extent of injury, predisposing to, or amplifying, activation of coagulation, platelets, fibrinolysis. These are discussed in detail within the article.

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Section: Pathophysiologymentioning

confidence: 98%

“…The PT/INR is considered an adequate screen for multiple coagulation factor deficiencies, and was thus adopted as a marker of ATC [28]. Every laboratory can provide PT, aPTT and fibrinogen results, and they are useful in guiding transfusion and predicting mortality [51].…”

Section: Standard Coagulation Testsmentioning

confidence: 99%

The pathogenesis of traumatic coagulopathy

2014

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“…83 The prolongation in PT is presumably proportional to the extent of coagulation factor loss and hemodilution. 84 Using the cutoff value of international normalized ratio of more than 1.5 times normal, PT demonstrates a sensitivity of 88% and a specificity of 88% in detecting at least one nonhemostatic coagulation factor level after trauma.…”

Section: Hemostasis Monitoring For Massive Hemorrhagementioning

confidence: 99%

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

et al. 2010

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Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.

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“…To prevent variations among different platforms, normalized aPTT values are used. 35 Normalized aPTT is calculated by dividing the test result by the average aPTT time for the specific setup and protocol. First derivatives of the normalized amplitudes are used for time calculations as explained earlier [ Fig.…”

Section: Aptt Measurements With Control Plasmamentioning

confidence: 99%

Coagulation measurement from whole blood using vibrating optical fiber in a disposable cartridge

et al. 2017

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, "Coagulation measurement from whole blood using vibrating optical fiber in a disposable cartridge," J. Biomed. Opt. 22(11), 117001 (2017), doi: 10.1117/1.JBO.22.11.117001. Abstract. In clinics, blood coagulation time measurements are performed using mechanical measurements with blood plasma. Such measurements are challenging to do in a lab-on-a-chip (LoC) system using a small volume of whole blood. Existing LoC systems use indirect measurement principles employing optical or electrochemical methods. We developed an LoC system using mechanical measurements with a small volume of whole blood without requiring sample preparation. The measurement is performed in a microfluidic channel where two fibers are placed inline with a small gap in between. The first fiber operates near its mechanical resonance using remote magnetic actuation and immersed in the sample. The second fiber is a pick-up fiber acting as an optical sensor. The microfluidic channel is engineered innovatively such that the blood does not block the gap between the vibrating fiber and the pick-up fiber, resulting in high signal-to-noise ratio optical output. The control plasma test results matched well with the plasma manufacturer's datasheet. Activated-partial-thromboplastin-time tests were successfully performed also with human whole blood samples, and the method is proven to be effective. Simplicity of the cartridge design and cost of readily available materials enable a low-cost point-of-care device for blood coagulation measurements.

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Comparing the prothrombin time INR versus the APTT to evaluate the coagulopathy of acute trauma

Cited by 108 publications

References 30 publications

The pathogenesis of traumatic coagulopathy

The pathogenesis of traumatic coagulopathy

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

Coagulation measurement from whole blood using vibrating optical fiber in a disposable cartridge

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