Monitoring the coagulation status of trauma patients with viscoelastic devices

Abstract

Coagulopathy is a physiological response to massive bleeding that frequently occurs after severe trauma and is an independent predictive factor for mortality. Therefore, it is very important to grasp the coagulation status of patients with severe trauma quickly and accurately in order to establish the therapeutic strategy. Judging from the description in the European guidelines, the importance of viscoelastic devices in understanding the disease condition of patients with traumatic coagulopathy has been widely recognized in Europe. In the USA, the ACS TQIP Massive Transfusion in Trauma Guidelines proposed by the American College of Surgeons in 2013 presented the test results obtained by the viscoelastic devices, TEG® 5000 and ROTEM®, as the standard for transfusion or injection of blood plasma, cryoprecipitate, platelet concentrate, or anti-fibrinolytic agents in the treatment strategy for traumatic coagulopathy and hemorrhagic shock. However, some studies have reported limitations of these viscoelastic devices. A review in the Cochrane Library published in 2015 pointed out the presence of biases in the abovementioned reports in trauma patients and the absence of a quality study in this field thus far. A quality study on the relationship between traumatic coagulopathy and viscoelastic devices is needed.

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

“…It has been postulated that most signs and symptoms associated with COVID-19 are secondary to a coagulopathy ( 2 , 27 ). Infected patients of all ages can present with arterial and venous thromboses (DVT and pulmonary emboli) and/or microthrombi causing PF and AKI, myocardial infarctions, ischemic and hemorrhagic strokes, or DIC and death ( 2 , 5 , 6 , 27 , 28 ). Coagulopathy is reported to carry an 11.5% mortality rate ( 9 ).…”

Thromboelastometric Analysis of the Correlation Between Burn-Induced Coagulopathy and Severity of Burn Injury

“…Considering that clot firmness in these assays is strongly correlated with BI, a consistent decrease in clot firmness, which is inversely dependent on burn severity, appears to be an essential finding. Since it is generally thought that blood clot firmness reflects platelet and fibrinogen values and their function, it is possible that these changes may reflect the consumption of fibrinogen and platelets with increased thrombogenesis [ 5 ]. For instance, fibrinogen is known to drop to critical levels early in the acute phase of severe trauma, indicating that a similar mechanism may occur during the acute phase of severe burn [ 18 ].…”

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The Use of Total Thrombus Formation Analysis System as a Tool to Assess Platelet Function in Bleeding and Thrombosis Risk—A Systematic Review

“…Therefore, the AR-chip enables assessment of the cooperative capacity of platelets and the coagulation system in thrombus formation. Since the pressure curve reflects the rate of thrombus formation and thrombus firmness, coagulability and platelet function can be assessed by reading the pressure curve [4]. T-TAS, unlike other techniques that usually assess either platelet activity or the clotting system, allows both components to be assessed simultaneously.…”