Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation

Chapman, Brandon C.; Moore, Ernest E.; Barnett, Carlton C.; Stovall, Robert T.; Biffl, Walter L.; Burlew, Clay Cothren; Bensard, Denis D.; Jurkovich, Gregory J.; Pieracci, Fredric M.

doi:10.1016/j.amjsurg.2013.07.024

Cited by 49 publications

(43 citation statements)

References 23 publications

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“…Solid organ injured patient can become hypercoagulable within 48 hours of injury (10, 22). Furthermore, the duration that a patients remains in a hypercoagulable state, the higher risk of mortality (23).…”

Section: Discussionmentioning

confidence: 99%

Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality

Moore

Liras

et al. 2017

The American Journal of Surgery

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Introduction The prevalence and impact of hypercoagulability(hypo) in severely injured patients early after injury remains unclear. We hypothesize that the predominant phenotype of postinjury coagulopathy is hypercoagulability(hyper) and it is associated with increased mortality. Material and Methods Blood samples from 141 healthy volunteers assayed with thrombelastography(TEG) were used to identify thresholds of hypo and hypercoagulability(above 95th/below the 5thpercentile) in four TEG indices. These cutoffs were subsequently evaluated in severely injured trauma patients(ISS>15) from two level 1 trauma centers. Results 2,540 patients with a median ISS of 25 were analyzed. Normal TEG was present in 36% of patients. Hyper was found in 38% of patients, with mixed(11%) and hypo(15%) being less common. Compared to normal coagulation patients and after controlling for age, sex, blood pressure, and injury hyper(0.013), mixed(p<0.001) and hypo(p<0.001) were all independent predictors of mortality. Conclusion These data support the ongoing need for goal directed resuscitation in trauma patients, it appears the optimal resuscitation strategy should be targeted towards normalization of coagulation status as both early hyper and hypocoagulability are associated with increased mortality.

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Section: Discussionmentioning

confidence: 99%

Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality

Moore

Liras

et al. 2017

The American Journal of Surgery

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“…These settings include cardiac surgery [67–70], liver transplantations [71], sepsis [72], trauma [73–79], obstetrics [80], psychophysiological stress [81]. These systems have also been utilized to evaluate anticoagulant activity [82, 83] and determine what the critical threshold value is for the initiation of antifibrinolytic therapy in trauma [84].…”

Section: Thrombin Generation Assaysmentioning

confidence: 99%

Global assays of hemostasis

Brummel‐Ziedins

Wolberg

2014

Current Opinion in Hematology

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Purpose of review There exists an imbalance between our understanding of the physiology of the blood coagulation process and the translation of this understanding into useful assays for clinical application. As technology advances, the capabilities for merging the two areas have become more attainable. Global assays have advanced our understanding of the dynamics of the blood coagulation process beyond end point assays and are at the forefront of implementation in the clinic. Recent findings We will review recent advances in the main global assays with a focus on thrombin generation that have potential for clinical utility. These assays include direct (thrombogram, whole blood, purified systems) and indirect empirical measures of thrombin generation (thromboelastography) and mechanism-based computational models that use plasma composition data from individuals to generate thrombin generation profiles. Summary Empirical thrombin generation assays (direct and indirect) and computational modeling of thrombin generation have greatly advanced our understanding of the hemostatic balance. Implementation of these types of assays and visualization approaches in the clinic potentially will provide a basis for the development of individualized patient care. Advances in both empirical and computational global assays have made the goal of predicting pre-crisis changes in an individual’s hemostatic state one step closer.

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“…Albeit those studies have been conducted in populations with a high incidence of in-house thromboembolism, such as trauma patients, current evidence supporting an association between TEG and clinical VTE is scarce [14][15][16][17]. When used as a predictor of DVT or pulmonary embolism, TEG has shown considerable variability in sensitivity and specificity among studies.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastographic predictors of venous thromboembolic events in critically ill patients

Tartamella

Vassallo

Berlot

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Deep venous thromboembolism and pulmonary embolism are still underdiagnosed in the ICU. Thromboelastography (TEG) has shown considerable variability in sensitivity and specificity as a predictor of venous thromboembolism (VTE). We designed a prospective double-blind observational study to predict the risk of VTE using TEG in a cohort of critically ill patients. Seventy-two hours after admission in the ICU and consequent prophylaxis with low-molecular-weight heparin, we performed compressive color-Doppler ultrasound and diagnosed deep venous thrombosis. Computed tomography scan was performed for the diagnosis of pulmonary embolism if pulmonary embolism was suspected based on physical examination and transthoracic echocardiography. Whole blood samples were obtained from central venous lines 6-8 h after subcutaneous administration of low-molecular-weight heparin. Native TEG and modified heparinase TEG were performed using a Thromboelastograph Coagulation Analyzer. Fifty-seven patients were consecutively enrolled of which six (10.5%) developed deep venous thrombosis; two (3.5%) also developed pulmonary embolism. The native thrombodynamic ratio (TDR) was an independent predictor of the odds of thrombosis (odds ratio 1.016, P < 0.05, 95% confidence interval 1.008-1.047), with a 0.93 area under the ROC curve. Using 10.6 as the lower cut-off point, TDR showed 100% sensitivity and 0 negative likelihood ratio (95% confidence interval 0-0.4) in excluding the clinical diagnosis of VTE. Our results show that TDR predicts VTE in the ICU. Our findings are in agreement with those reported by other investigators, who demonstrated that a TDR less that 10 is associated with prophylactic levels of anti-Xa.

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Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation

Cited by 49 publications

References 23 publications

Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality

Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality

Global assays of hemostasis

Thromboelastographic predictors of venous thromboembolic events in critically ill patients

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