Model of trauma-induced coagulopathy including hemodilution, fibrinolysis, acidosis, and hypothermia

Шенкман, Борис; Budnik, Ivan; Einav, Yulia; Hauschner, Hagit; Andrejchin, Mykhaylo; Martinowitz, Uriel

doi:10.1097/ta.0000000000001282

Cited by 46 publications

(35 citation statements)

References 29 publications

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“…Additionally, we found that acidemia at the time of admission is associated with mortality. Acidemia (pH < 7.20) may contribute to worsened trauma-induced coagulopathy and mortality, as previously described [ 17 - 18 ].…”

Section: Discussionmentioning

confidence: 65%

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

Isbell

Cohn

Inaba³

et al. 2018

Cureus

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Background: In trauma patients with cirrhosis who require laparotomy, little data exists to establish clinical predictors of the outcome. We sought to determine the prognosticators of mortality in this population.Methods: We performed a 10-year review at four, busy Level I trauma centers of patients with cirrhosis identified during trauma laparotomy. We compared vital signs, laboratory values, and transfusion requirements for those who survived versus those who died. A linear regression was then conducted to determine the variables associated with death in this population.Results: A total of 66 patients were included and 47% (31/66) died. The model for end-stage liver disease (MELD) score was low (7.8 in Lived, 10.2 in Died). Packed red blood cell (PRBC) transfusion at six hours was greater in those who died; those receiving > 6 units of PRBCs at 6 hours had an increased likelihood of death (odds ratio OR 5.8 (95% CI 1.9, 17.4)). All patients receiving ≥ 17 units of PRBCs died. We found an association between lower preoperative platelets (PLTs), higher preoperative international normalized ratio (INR) and partial thromboplastin time (PTT), lower preoperative pH (presence of profound acidemia), increased intraoperative crystalloid use, and increased intraoperative blood product administration to be associated with death (p < 0.05).Conclusions: Cirrhotic trauma patients requiring laparotomy should be considered to have a high chance of mortality if they receive six or more PRBCs, are acidotic (pH ≤ 7.25) at the time of hospital arrival, or have coagulopathy at the time of admission (INR > 1.2, PTT > 40).

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Section: Discussionmentioning

confidence: 65%

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

Isbell

Cohn

Inaba³

et al. 2018

Cureus

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“…12 In our study, we found that lower pH and lower prothrombin time in percentage (Quick) were associated with a higher number of RBC units transfused. In the study by Shenkman et al, 13 metabolic acidosis was a risk factor for clot formation and impaired platelet function; moreover, it was associated with systemic disseminated intravascular coagulation. 14 In clinical practice, acidosis has been shown to be an independent risk factor for RBC transfusion.…”

Section: Discussionmentioning

confidence: 96%

Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation

et al. 2018

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“…, Shenkman et al . ). The accumulation of catecholamines and metabolites after injury, the extent of endothelial activation and the host immune response also affect the phenotype of TIC (Cohen et al .…”

Section: Acquired Hyperfibrinolysismentioning

confidence: 97%

“…Trauma-induced coagulopathy (TIC) is a term used to describe the spectrum of coagulation changes that occur following severe injury (Hess et al 2008). There are multiple phenotypes of TIC, and the clinical manifestation is influenced primarily by thrombin production, platelet function and fibrinolysis (Moore et al 2015, Shenkman et al 2017. The accumulation of catecholamines and metabolites after injury, the extent of endothelial activation and the host immune response also affect the phenotype of TIC (Cohen et al 2009, Johansson et al 2012, Johansson et al 2017.…”

Section: Acute Traumatic Coagulopathymentioning

confidence: 99%

A review of hyperfibrinolysis in cats and dogs

Birkbeck

Humm

Cortellini

2019

J of Small Animal Practice

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The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point‐of‐care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point‐of‐care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed.

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Model of trauma-induced coagulopathy including hemodilution, fibrinolysis, acidosis, and hypothermia

Abstract: A new model of TIC is created. Contribution of various constituents to pathogenesis of TIC and their interactions are evaluated.

Cited by 46 publications

References 29 publications

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation

A review of hyperfibrinolysis in cats and dogs

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