Early evaluation of acute traumatic coagulopathy by thrombelastography

Roger C. Carroll, Robert Craft, James Langdon, Colin R. Clanton, Carolyn C. Snider, Douglas D. Wellons, Patrick A. Dakin, Christy Lawson, Blaine Enderson, Stanley J. Kurek

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, Ill) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t-testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude [MA]), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 ± 17.1 vs MA = 35.7 ± 19.3, P = 0.004) and a correlation of fibrinogen <100 mg/dL with fatalities (P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 ± 11,618 versus 270 ± 393 s (P = < 0.001), and MA was 46.4 ± 22.4 versus 64.7 ± 9.8 mm (P < 0.001). Hyperfibrinolysis (percent fibrinolysis after 60 min [LY60] >15%) was observed in 3 patients in the ED with a 67% fatality rate (P = < 0.001 by chi-square testing). PlateletMapping assays correlated with the need for blood transfusion. The abnormal TEG System parameters correlated with fatality. These coagulopathies were already evident OS. The TEG assays can assess coagulopathy, platelet dysfunction, and hyperfibrinolysis at an early stage posttrauma and suggest more effective interventions.

Original languageEnglish (US)
Pages (from-to)34-39
Number of pages6
JournalTranslational Research
Volume154
Issue number1
DOIs
StatePublished - Jan 1 2009

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Thrombelastography
Assays
Platelets
Hospital Emergency Service
Testing
Blood
Blood Platelets
Citric Acid
Adenosine Diphosphate
Fibrinogen
Research Ethics Committees
Blood Transfusion
Prospective Studies
Morbidity
Industry
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Biochemistry, medical
  • Physiology (medical)

Cite this

Carroll, R. C., Craft, R., Langdon, J., Clanton, C. R., Snider, C. C., Wellons, D. D., ... Kurek, S. J. (2009). Early evaluation of acute traumatic coagulopathy by thrombelastography. Translational Research, 154(1), 34-39. https://doi.org/10.1016/j.trsl.2009.04.001

Early evaluation of acute traumatic coagulopathy by thrombelastography. / Carroll, Roger C.; Craft, Robert; Langdon, James; Clanton, Colin R.; Snider, Carolyn C.; Wellons, Douglas D.; Dakin, Patrick A.; Lawson, Christy; Enderson, Blaine; Kurek, Stanley J.

In: Translational Research, Vol. 154, No. 1, 01.01.2009, p. 34-39.

Research output: Contribution to journalArticle

Carroll, RC, Craft, R, Langdon, J, Clanton, CR, Snider, CC, Wellons, DD, Dakin, PA, Lawson, C, Enderson, B & Kurek, SJ 2009, 'Early evaluation of acute traumatic coagulopathy by thrombelastography', Translational Research, vol. 154, no. 1, pp. 34-39. https://doi.org/10.1016/j.trsl.2009.04.001
Carroll, Roger C. ; Craft, Robert ; Langdon, James ; Clanton, Colin R. ; Snider, Carolyn C. ; Wellons, Douglas D. ; Dakin, Patrick A. ; Lawson, Christy ; Enderson, Blaine ; Kurek, Stanley J. / Early evaluation of acute traumatic coagulopathy by thrombelastography. In: Translational Research. 2009 ; Vol. 154, No. 1. pp. 34-39.
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