Thromboelastometry and organ failure in trauma patients: a prospective cohort studyReportar como inadecuado




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Critical Care

, 18:687

First Online: 25 December 2014Received: 23 July 2014Accepted: 25 November 2014

Abstract

IntroductionData on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry ROTEM, is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure MOF and mortality.

MethodsThis was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥11.7 dynes-cm and hypocoagulability as a G value of <5.0 dynes-cm. ROTEM was performed on admission and 24 hours later.

ResultsA total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 interquartile range IQR 26 to 53, 77% were male and median injury severity score was 13 IQR 8 to 25. On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients P <0.001. EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.

ConclusionsThe incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.

AbbreviationsACITActivation of Coagulation and Inflammation in Trauma

ATCacute traumatic coagulopathy

CFTclot formation time

CTcoagulation time

DICdisseminated intravascular coagulation

EDemergency department

FFPfresh frozen plasma

IQRinterquartile range

ISSinjury severity score

MCFmaximum clot firmness

MOFmultiple organ failure

PLTplatelets

RBCred blood cells

ROTEMthromboelastometry

SOFAsequential organ failure assessment

TBItraumatic brain injury

TEGthromboelastography

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0687-6 contains supplementary material, which is available to authorized users.

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Autor: Marcella CA Müller - Kirsten Balvers - Jan M Binnekade - Nicola Curry - Simon Stanworth - Christine Gaarder - Knut M Ko

Fuente: https://link.springer.com/



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