Hypercoagulability Is Most Prevalent Early after Injury and in Female Patients

Schreiber, Martin A.; Differding, Jerome A.; Thorborg, Per; Mayberry, John C.; Mullins, Richard J.

doi:10.1097/01.ta.0000153938.77777.26

Cited by 204 publications

(176 citation statements)

References 34 publications

(25 reference statements)

Supporting

Mentioning

158

Contrasting

Unclassified

Order By: Relevance

“…For example, CA 15 -EXTEM correlated with both PT and fibrinogen, whereas CA 10 -FIBTEM correlated with fibrinogen and CFT-INTEM with APTT. In trauma, Schreiber et al [29] suggested correlations between TEG Ò parameters and APTT (r-time) or platelets (MA), whereas in cardiac surgery, Kettner et al [32] found a correlation between fibrinogen and MA. Vorweg et al [22] proposed that CFT-INTEM could guide platelet transfusion.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Rugeri¹,

Levrat

David

et al. 2007

Journal of Thrombosis and Haemostasis

438

330

View full text Add to dashboard Cite

Summary. Background: Reagent-supported thromboelastometry with the rotation thrombelastography (e.g. ROTEM Ò ) is a whole blood assay that evaluates the visco-elastic properties during blood clot formation and clot lysis. A hemostatic monitor capable of rapid and accurate detection of clinical coagulopathy within the resuscitation room could improve management of bleeding after trauma. Objectives: The goals of this study were to establish whether ROTEM correlated with standard coagulation parameters to rapidly detect bleeding disorders and whether it can help to guide transfusion. Methods: Ninety trauma patients were included in the study. At admission, standard coagulation assays were performed and ROTEM parameters such as clot formation time (CFT) and clot amplitude (CA) were obtained at 15 min (CA 15 ) with two activated tests (INTEM, EXTEM) and at 10 min (CA 10 ) with a test analyzing specifically the fibrin component of coagulation (FIBTEM). Results: Trauma induced significant modifications of coagulation as assessed by standard assays and ROTEM. A significant correlation was found between prothrombin time (PT) and CA 15 -EXTEM (r ¼ 0.66, P < 0.0001), between activated partial thromboplastin time and CFT-INTEM (r ¼ 0.91, P < 0.0001), between fibrinogen level and CA 10 -FIB-TEM (r ¼ 0.85, P < 0.0001), and between platelet count and CA 15 -INTEM (r ¼ 0.57, P < 0.0001). A cutoff value of CA 15 -EXTEM at 32 mm and CA 10 -FIBTEM at 5 mm presented a good sensitivity (87% and 91%) and specificity (100% and 85%) to detect a PT > 1.5 of control value and a fibrinogen less than 1 g L )1, respectively. Conclusions: ROTEM is a point-ofcare device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Rugeri¹,

Levrat

David

et al. 2007

Journal of Thrombosis and Haemostasis

438

330

View full text Add to dashboard Cite

show abstract

“…32,33 Elevation of inflammatory cytokines has been documented in the burned and nonburned trauma patient populations. IL-6 and IL-8 have been shown to be elevated early after trauma and are significantly elevated in those who develop multiple organ failure.…”

Section: Roc Areasmentioning

confidence: 99%

Combining Early Coagulation and Inflammatory Status Improves Prediction of Mortality in Burned and Nonburned Trauma Patients

Park

Salinas

Wade

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

View full text Add to dashboard Cite

“…18 A large retrospective review of patients in a neurological ICU determined that 86% of deep vein thromboses were detected by routine screening within the first week. 16 Early administration of chemical prophylaxis for these patients seems essential, but its use should be weighed against the potential risks for hemorrhagic complications.…”

mentioning

confidence: 99%

Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms

Tanweer¹,

Boah²,

Huang³

2013

JNS

View full text Add to dashboard Cite

Object Patients undergoing placement of an external ventricular drain (EVD) are at increased risk for development of venous thromboembolisms (VTEs). Early chemical prophylaxis has been shown to decrease rates of embolism formation, but the risks for bleeding and the optimal time to initiate prophylaxis have not been clearly defined for this patient population. The authors evaluated the safety and risks for bleeding when chemical prophylaxis for VTEs was started within 24 hours of EVD placement. Methods To compare rates of hemorrhage among patients who received prophylaxis within 24 hours and those who received it later than 24 hours after admission, the authors conducted an institutional review board–approved retrospective review. Patients were those who had had an EVD placed and postprocedural imaging conducted at Bellevue Hospital, New York, from January 2009 through April 2012. Data collected included demographics, diagnosis, coagulation panel results, time to VTE prophylaxis and imaging, and occurrence of VTEs. The EVD-associated hemorrhages were classified as Grade 0, no hemorrhage; Grade 1, petechial hyperdensity near the drain; Grade 2, hematoma of 1–15 ml; Grade 3, epidural or subdural hematoma greater than 15 ml; or Grade 4, intraventricular hemorrhage or hematoma requiring surgical intervention. Results Among 99 patients, 111 EVDs had been placed. Low-dose unfractionated heparin had been given within 24 hours of admission (early prophylaxis) to 56 patients and later than 24 hours after admission (delayed prophylaxis) to 55 patients. There were no statistical differences across all grades (0–4) among those who received early prophylaxis (n = 45, 5, 5, 1, and 0, respectively) and those who received delayed prophylaxis (n = 46, 4, 1, 1, and 3, respectively) (p = 0.731). In the early prophylaxis group, 3 VTEs were discovered among 32 of 56 patients screened for clinically suspected VTEs. In the delayed prophylaxis group, 5 VTEs were discovered among 33 of 55 patients screened for clinically suspected VTEs (p = 0.71). Conclusions Hemorrhagic complications did not increase when chemical prophylaxis was started within 24 hours of admission. Also, the incidence of VTEs did not differ between patients in the early and delayed prophylaxis groups. Larger randomized controlled trials are probably needed to assess decreases in VTEs with earlier prophylaxis.

show abstract

Hypercoagulability Is Most Prevalent Early after Injury and in Female Patients

Abstract: Hypercoagulability after injury is most prevalent during the first 24 hours. Women are more hypercoagulable than men early after injury. The TEG is more sensitive than routine coagulation assays for the detection of a hypercoagulable state.

Cited by 204 publications

References 34 publications

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Combining Early Coagulation and Inflammatory Status Improves Prediction of Mortality in Burned and Nonburned Trauma Patients

Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms

Contact Info

Product

Resources

About