Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy

Joshua J. Sumislawski, S. Ariane Christie, Lucy Z. Kornblith, Gregory R. Stettler, Geoffrey R. Nunns, Hunter B. Moore, Ernest E. Moore, Christopher C. Silliman, Angela Sauaia, Rachael A. Callcut, Mitchell Jay Cohen

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Trauma-induced coagulopathy can present as abnormalities in a conventional or viscoelastic coagulation assay or both. We hypothesized that patients with discordant coagulopathies reflect different clinical phenotypes. Methods: Blood samples were collected prospectively from critically injured patients upon arrival at two urban Level I trauma centers. International normalized ratio (INR), partial thromboplastin time (PTT), thromboelastography (TEG), and coagulation factors were assayed. Results: 278 patients (median ISS 17, mortality 26%)were coagulopathic: 20% with isolated abnormal INR and/or PTT (CONVENTIONAL), 49% with isolated abnormal TEG (VISCOELASTIC), and 31% with abnormal INR/PTT and TEG (BOTH). Compared with VISCOELASTIC, CONVENTIONAL and BOTH had higher ISS, lower GCS, larger base deficit, and decreased factor activities (all p < 0.017). They received more blood products and had more ICU/ventilation days (all p < 0.017). Mortality was higher in CONVENTIONAL (40%)and BOTH (49%)than VISCOELASTIC (6%, p < 0.017). Conclusions: Although TEG-guided resuscitation improves survival after injury, INR and PTT identify coagulopathic patients with highest mortality regardless of TEG and likely represent distinct mechanisms independent of biochemical clot strength.

Original languageEnglish (US)
Pages (from-to)1037-1041
Number of pages5
JournalAmerican Journal of Surgery
Volume217
Issue number6
DOIs
StatePublished - Jun 2019
Externally publishedYes

Keywords

  • Precision medicine
  • Resuscitation
  • Thromboelastography
  • Transfusion
  • Trauma-induced coagulopathy

ASJC Scopus subject areas

  • Surgery

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