Evaluation of clotting factor activities early after severe multiple trauma and their correlation with coagulation tests and clinical data

Abstract

IntroductionTraumatic injuries are amongst the leading causes of death worldwide, frequently as a result of uncontrolled hemorrhage. Critical deficiencies in clotting factors have been noted in trauma-induced coagulopathy. However, the exact underlying conditions that result in devastating coagulopathies remain unclear. The purpose of this study was to elucidate these underlying deficiencies.MethodsBlood samples were drawn from 45 severely injured trauma patients on their arrival at the resuscitation room, and the activities of all soluble clotting factors and routine coagulation tests were assessed. The Mann–Whitney-U-test was used to assess differences in coagulation activity between the patients and healthy controls. Furthermore, Spearman’s rank correlation was used to analyze the blood work.ResultsAfter severe trauma the levels of serum fibrinogen and calcium were significantly reduced. Furthermore, traumatized patients had a significantly increased International Normalized Ratio (INR) compared to healthy controls. The median activities of all clotting factors were reduced after severe multiple trauma, with the exception of factor VIII, which was increased. Statistically significant differences were observed for factors II (80 vs. 122 %, P < 0.0001), V (76 vs. 123 %, P < 0.0001), VII (90 vs. 114 %, P = 0.002), VIII (200 vs. 108 %, P < 0.0001), and X (86 vs. 122 %, P < 0.0001). Spearman’s correlation indicated a significant negative correlation between INR on arrival with fibrinogen and levels of factors II, V, and VII, whereas Partial Thromboplastin Time was significantly negatively correlated with factor VIII (all P < 0.0001).ConclusionsThese findings suggest a general but rather moderate impairment of clotting factor activities following severe multiple trauma. In the concept of a calculated coagulation therapy, this could demand for the use of factor concentrates with higher ratios of clotting factors. Finally, the physiological importance of strongly elevated factor VIII activity remains unclear, but a possible interference with ex vivo measurements of Partial Thromboplastin Time has to be considered.

Evaluation of Potential Clinical Surrogate Markers of a Trauma Induced Alteration of Clotting Factor Activities

“…Written informed consent was obtained from the participants. This study expands data from an original prospective study of severely injured patients by minor to moderate multiple trauma victims [ 8 ].…”

“…Cohen et al, based on a subgroup analysis of data from the PROMMTT-study, demonstrated that clotting factor activities are reduced in coagulopathic major trauma patients receiving blood products [ 7 ]. Furthermore, a moderate reduction of clotting factor activities early after severe multiple trauma, irrespective of patient coagulation status, was shown [ 8 ]. However, all studies excluded a considerable number of patients from the final analysis according to certain patient characteristics (e.g., injury severity).…”

Clotting-Factor Concentrations 5 Days After Discontinuation of Warfarin

“…5 Surgeons consider CF activities less than 30% to be critical as surgical hemostasis appears to be compromised when CF levels fall below 30%. 6 The ASRA guidelines on neuraxial and regional procedures in patients taking anticoagulants, on the other hand, chose CF activities of less than 40% as indicating a significant risk of clinical bleeding. 1 Similar to the ASRA guidelines, we considered CF activities of less than 40% as the cutoff for increased risk of bleeding.…”

Tactical damage control resuscitation in austere military environments

“…A decrease of all the coagulation factors is observed, but is especially significant in the case of fibrinogen;29 30 a fibrinogen deficit is observed in 14–26% of all seriously injured patients 31 32. This decrease occurs early after a severe trauma even before any fluid administration 33 34.…”