TY - JOUR
T1 - Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy
AU - Sumislawski, Joshua J.
AU - Christie, S. Ariane
AU - Kornblith, Lucy Z.
AU - Stettler, Gregory R.
AU - Nunns, Geoffrey R.
AU - Moore, Hunter B.
AU - Moore, Ernest E.
AU - Silliman, Christopher C.
AU - Sauaia, Angela
AU - Callcut, Rachael A.
AU - Cohen, Mitchell Jay
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Precision medicine
KW - Resuscitation
KW - Thromboelastography
KW - Transfusion
KW - Trauma-induced coagulopathy
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U2 - 10.1016/j.amjsurg.2019.01.014
DO - 10.1016/j.amjsurg.2019.01.014
M3 - Article
C2 - 31029284
AN - SCOPUS:85064570238
VL - 217
SP - 1037
EP - 1041
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 6
ER -