Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients

Bernardino C. Branco, Kenji Inaba, Crystal Ives, Obi Okoye, Ira Shulman, Jean Stephane David, Herbert Schöchl, Peter M Rhee, Demetrios Demetriades

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Introduction: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. Methods: Injured patients meeting our level I trauma center's highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. Results: A total of 118 patients were enrolled: 26.3% (n = 31) were hypercoagulable, 55.9% (n = 66) had a normal TEG profile, and 17.8% (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un-cross-matched blood (11.1% for hypercoagulable vs. 20.4% for normal vs. 45.7% for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0% vs. 5.5% vs. 27.8%, adjusted P < 0.001) and 7-day mortality (0.0% vs. 5.5% vs. 36.1%, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0% vs. 1.8% vs. 25.0%, adjusted P < 0.001). Conclusions: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted.

Original languageEnglish (US)
Pages (from-to)200-207
Number of pages8
JournalShock (Augusta, Ga.)
Volume41
Issue number3
DOIs
StatePublished - Mar 2014

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Thrombophilia
Wounds and Injuries
Thrombelastography
Mortality
Hemorrhage
Trauma Centers
Blood Transfusion
Demography

Keywords

  • Hypercoagulability
  • outcomes
  • thromboelastography
  • transfusion requirements
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Branco, B. C., Inaba, K., Ives, C., Okoye, O., Shulman, I., David, J. S., ... Demetriades, D. (2014). Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients. Shock (Augusta, Ga.), 41(3), 200-207. https://doi.org/10.1097/SHK.0000000000000109

Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients. / Branco, Bernardino C.; Inaba, Kenji; Ives, Crystal; Okoye, Obi; Shulman, Ira; David, Jean Stephane; Schöchl, Herbert; Rhee, Peter M; Demetriades, Demetrios.

In: Shock (Augusta, Ga.), Vol. 41, No. 3, 03.2014, p. 200-207.

Research output: Contribution to journalArticle

Branco, BC, Inaba, K, Ives, C, Okoye, O, Shulman, I, David, JS, Schöchl, H, Rhee, PM & Demetriades, D 2014, 'Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients', Shock (Augusta, Ga.), vol. 41, no. 3, pp. 200-207. https://doi.org/10.1097/SHK.0000000000000109
Branco, Bernardino C. ; Inaba, Kenji ; Ives, Crystal ; Okoye, Obi ; Shulman, Ira ; David, Jean Stephane ; Schöchl, Herbert ; Rhee, Peter M ; Demetriades, Demetrios. / Thromboelastogram evaluation of the impact of hypercoagulability in trauma patients. In: Shock (Augusta, Ga.). 2014 ; Vol. 41, No. 3. pp. 200-207.
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abstract = "Introduction: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. Methods: Injured patients meeting our level I trauma center's highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. Results: A total of 118 patients were enrolled: 26.3{\%} (n = 31) were hypercoagulable, 55.9{\%} (n = 66) had a normal TEG profile, and 17.8{\%} (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un-cross-matched blood (11.1{\%} for hypercoagulable vs. 20.4{\%} for normal vs. 45.7{\%} for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0{\%} vs. 5.5{\%} vs. 27.8{\%}, adjusted P < 0.001) and 7-day mortality (0.0{\%} vs. 5.5{\%} vs. 36.1{\%}, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0{\%} vs. 1.8{\%} vs. 25.0{\%}, adjusted P < 0.001). Conclusions: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted.",
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AU - Branco, Bernardino C.

AU - Inaba, Kenji

AU - Ives, Crystal

AU - Okoye, Obi

AU - Shulman, Ira

AU - David, Jean Stephane

AU - Schöchl, Herbert

AU - Rhee, Peter M

AU - Demetriades, Demetrios

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N2 - Introduction: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. Methods: Injured patients meeting our level I trauma center's highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. Results: A total of 118 patients were enrolled: 26.3% (n = 31) were hypercoagulable, 55.9% (n = 66) had a normal TEG profile, and 17.8% (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un-cross-matched blood (11.1% for hypercoagulable vs. 20.4% for normal vs. 45.7% for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0% vs. 5.5% vs. 27.8%, adjusted P < 0.001) and 7-day mortality (0.0% vs. 5.5% vs. 36.1%, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0% vs. 1.8% vs. 25.0%, adjusted P < 0.001). Conclusions: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted.

AB - Introduction: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. Methods: Injured patients meeting our level I trauma center's highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. Results: A total of 118 patients were enrolled: 26.3% (n = 31) were hypercoagulable, 55.9% (n = 66) had a normal TEG profile, and 17.8% (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un-cross-matched blood (11.1% for hypercoagulable vs. 20.4% for normal vs. 45.7% for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0% vs. 5.5% vs. 27.8%, adjusted P < 0.001) and 7-day mortality (0.0% vs. 5.5% vs. 36.1%, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0% vs. 1.8% vs. 25.0%, adjusted P < 0.001). Conclusions: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted.

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KW - outcomes

KW - thromboelastography

KW - transfusion requirements

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