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Thromboelastometry-based algorithms appear effective in monitoring therapy for trauma-induced coagulopathy
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Rotational thromboelastometry may be useful in monitoring therapy for trauma-induced coagulopathy during ongoing traumatic hemorrhage, according to a study published in Journal of Thrombosis and Hemostasis.
“Trauma-induced coagulopathy develops in up to 25% of severely injured trauma patients, which aggravates massive hemorrhage and is associated with increased mortality,” Nicole P. Juffermans, professor of translational intensive care medicine at Academic Medical Center in the Netherlands, and colleagues wrote. “Current resuscitation practices often include an empirical balanced resuscitation approach with administration of red blood cells, plasma and platelets in a 1:1:1 ratio. While this nonspecific strategy reduces the development of dilutional coagulopathy, it may not correct different pre-existing forms of coagulopathy that are present in individual patients.”
Researchers noted that precision medicine approaches to managing trauma-induced coagulopathy can improve outcomes, but the effects of therapy require monitoring.
Rotational thromboelastometry (ROTEM) is among the viscoelastic haemostatic assays that can detect trauma-induced coagulopathy.
In the prospective, multicenter study, Juffermans and colleagues at six European level-one trauma centers sought to determine the response of ROTEM parameters to treatment among bleeding trauma patients.
They evaluated 309 bleeding patients (median age, 44.8 years; 73% men) who received a minimum of four red blood cell units. Most of the patients had experienced blunt trauma, were in shock and were coagulopathic, as indicated by a prolonged mean international normalized ratio and reduced fibrinogen levels.
Blood draws occurred upon arrival in the ED, after patients received four, eight and 12 red blood cell units, and 24 hours after injury. Personnel performed two ROTEM assays, EXTEM and FIBTEM, after drawing blood.
The researchers assessed ROTEM response to plasma, platelets, tranexamic acid and fibrinogen products among the entire cohort and a subgroup of patients whose ROTEM values showed trauma-induced coagulopathy.
Fibrinogen — administered to 119 patients (39%) at a mean dose of 3.8 g — increased FIBTEMCA5 with 5.2 mm (range, 4.1-6.3), whereas tranexamic acid, administered to 112 patients, reduced lysis by 5.4% (range, 4.3-6.5). Patients who received tranexamic acid had greater improvement in lysis and FIBTEM parameters than patients not treated with tranexamic acid.
Most patients (69%; n = 212) received platelets, which halted any further derangement of clot formation parameters. Platelets also had a more pronounced impact on the EXTEMCA5 values of patients with ROTEM values suggesting trauma-induced coagulopathy.
A majority of patients (91%; n = 280) underwent plasma transfusion, which reduced EXTEM CT by 3.1 seconds (range, –10 to –3.9) in the overall cohort and by 10.6 seconds (range, –45 to 24) in patients with ROTEM values consistent with trauma-induced coagulopathy.
“Viscoelastic hemostatic assays such as ROTEM can be used for monitoring of treatment for trauma-induced coagulopathy during ongoing traumatic hemorrhage,” the researchers wrote. “In patients with ROTEM threshold values known to correspond to coagulopathy, the efficacy of plasma and platelets was possibly clearer than in the whole bleeding population, suggesting that ROTEM-based algorithms can be used to treat and monitor trauma-induced coagulopathy.” – by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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