Acute traumatic coagulopathy

Current Opinion in Anaesthesiology

Volumn 25, Issue 2, 2012, Pages 229-234

  Frith, Daniel ^a   Davenport, Ross ^a   Brohi, Karim ^a  

^a QUEEN MARY UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

Coagulopathy; Fibrinolysis; Thromboelastometry; Transfusion; Trauma

Indexed keywords

PROCOAGULANT;

ACUTE TRAUMATIC COAGULOPATHY; ANTICOAGULATION; BLOOD CLOTTING; BLOOD CLOTTING DISORDER; BLOOD CLOTTING TEST; CARDIOVASCULAR SYSTEM; CELL ACTIVATION; ENDOTHELIUM; FIBRINOLYSIS; HEMOSTASIS; HUMAN; MEDICAL LITERATURE; OUTCOME ASSESSMENT; PATHOPHYSIOLOGY; PERFUSION; PRIORITY JOURNAL; RESUSCITATION; REVIEW; SENSITIVITY ANALYSIS; THROMBOCYTE; TISSUE INJURY; VISCOELASTICITY;

ACUTE DISEASE; ANIMALS; BLOOD COAGULATION DISORDERS; BLOOD PLATELETS; ENDOTHELIUM, VASCULAR; HEMOSTASIS; HUMANS; WOUNDS AND INJURIES;

EID: 84859771377     PISSN: 09527907     EISSN: 14736500     Source Type: Journal    
DOI: 10.1097/ACO.0b013e3283509675     Document Type: Review

References (42)

1. Floccard B, Rugeri L, Faure A, et al. Early coagulopathy in trauma patients: An on-scene and hospital admission study. Injury 2010. [Epub ahead of print]. doi:10.1016/j.injury.2010.11.003. The first study to identify coagulopathy in trauma victims at the scene of injury. Important because it confirmed that ATC develops endogenousl
2. Brohi K, Cohen M, Ganter M, et al. Acute coagulopathy of trauma: Hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma 2008; 64:1211-1217; discussion 7. (Pubitemid 351671214)
3. Frith D, Goslings J, Gaarder C, et al. Definition and drivers of acute traumatic coagulopathy: Clinical and experimental investigations. J Thromb Haemost 2010; 8:1919-1925. This study used data from a large trauma cohort (> 5000 patients) to characterize the synergistic relationship between tissue injury and systemic hypoperfusion in the aetiology of ATC.
4. Stansbury L, Dutton R, Stein D, et al. Controversy in trauma resuscitation: Do ratios of plasma to red blood cells matteř Transfus Med Rev 2009; 23:255-265.
5. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet 2010; 376:23-32. A large multinational placebo-controlled trial demonstrating a clinically relevent survivial benefit of tranexamic acid during trauma haemorrhage. This drug should be part of every major haemorrhage protocol.
6. Carroll RC, Craft RM, Langdon RJ, et al. Early evaluation of acute traumatic coagulopathy by thrombelastography. Transl Res 2009; 154:34-39.
7. Simmons JW, White CE, Ritchie JD, et al. Mechanism of injury affects acute coagulopathy of trauma in combat casualties. J Trauma 2011; 71 (1 Suppl): S74-S77. This study found that soldiers injured by explosion (with higher expected tissue injury load) had worse coagulopathies than a similar cohort injured by gun shot.
8. Hess J, Brohi K, Dutton R, et al. The coagulopathy of trauma: A review of mechanisms. J Trauma 2008; 65:748-754.
9. Wafaisade A, Wutzler S, Lefering R, et al. Drivers of acute coagulopathy after severe trauma: A multivariate analysis of 1987 patients. Emerg Med J 2010; 27:934-939. A useful observational study that uses a large retrospective cohort to identify the important variables independently associated with ATC (ISS, shock, hypothermia, high-volume fluids).
10. Hubmann B, Lefering R, Taeger G, et al. Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry. J Emerg Trauma Shock 2011; 4:465-471.
11. Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: Directly addressing the early coagulopathy of trauma. J Trauma 2007; 62:307-310.
12. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003; 54:1127-1130. (Pubitemid 36764882)
13. Plotkin AJ, Wade CE, Jenkins DH, et al. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. J Trauma 2008; 64 (2 Suppl): S64-S68.
14. Maegele M, Lefering R, Yucel N, et al. Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients. Injury 2007; 38:298-304. (Pubitemid 46328919)
15. Brohi K, Cohen M, Ganter M, et al. Acute traumatic coagulopathy: Initiated by hypoperfusion -modulated through the protein C pathway? Ann Surg 2007; 245:812-818. (Pubitemid 46684113)
16. Dunbar NM, Chandler WL. Thrombin generation in trauma patients. Transfusion 2009; 49:2652-2660. Novel study that indicates thrombin generation may actually be maintained acutely after injury. This is important because it would suggest that plasma may not be the optimal initial resuscitation product.
17. Chandler WL. Procoagulant activity in trauma patients. Am J Clin Pathol 2010; 134:90-96.
18. Harrigan C, Lucas CE, Ledgerwood AM. The effect of hemorrhagic shock on the clotting cascade in injured patients. J Trauma 1989; 29:1416-1421; discussion 21-2.
19. Hiippala S. Replacement of massive blood loss. Vox Sang 1998; 74 (Suppl 2): 399-407. (Pubitemid 28379812)
20. White NJ, Martin EJ, Brophy DF, Ward KR. Coagulopathy and traumatic shock: Characterizing hemostatic function during the critical period prior to fluid resuscitation. Resuscitation 2010; 81:111-116. Report of a good quality swine model of ATC that identifies impaired fibrinogen response to trauma and haemorrhagic shock.
21. Martini W, Cortez D, Dubick M, et al. Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs. J Trauma 2008; 65:535-543.
22. Johansson PI, Sorensen AM, Perner A, et al. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study. Crit Care 2011; 15:R272. This study reports novel prospective data showing that diagnostic criteria for disseminated intravascular coagulation (DIC) has poor sensitivity for identifying trauma patients with acute haemostatic impairments.
23. Rossaint R, Bouillon B, Cerny V, et al. Management of bleeding following major trauma: An updated European guideline. Crit Care 2010; 14:R52.
24. Chesebro B, Rahn P, Carles M, et al. Increase in activated protein C mediates acute traumatic coagulopathy in mice. Shock 2009; 32:659-665.
25. Tauber H, Innerhofer P, Breitkopf R, et al. Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: Results of the 'Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study'. Br J Anaesth 2011; 107:378-387. A good size prospective study demonstrating the efficacy of ROTEM in diagnosing and characterizing ATC in trauma patients.
26. Kashuk JL, Moore EE, Sawyer M, et al. Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma. Ann Surg 2010; 252:434-442.
27. Brown LM, Call MS, Margaret Knudson M, et al. A normal platelet count may not be enough: The impact of admission platelet count on mortality and transfusion in severely injured trauma patients. J Trauma 2011; 71 (2 Suppl 3):S337-S342. Interesting study showing that poor outcomes are dose-dependently associated with reductions in admission platelet count, despite often remaining within the normal range. It suggests that we may need a lower transfusion threshold for platelets.
28. Borgman MA, Spinella PC, Holcomb JB, et al. The effect of FFP:RBC ratio on morbidity and mortality in trauma patients based on transfusion prediction score. Vox Sang 2011; 101:44-54.
29. Holcomb JB, Zarzabal LA, Michalek JE, et al. Increased platelet:RBC ratios are associated with improved survival after massive transfusion. J Trauma 2011; 71 (2 Suppl 3):S318-S328. This is a good example of the new retrospective reports suggesting that more and earlier platelet transfusions could improve outcome after injury.
30. Solomon C, Traintinger S, Ziegler B, et al. Platelet function following trauma. A Multiple Electrode Aggregometry study. Thromb Haemost 2011; 106: 322-330. A small but interesting study demonstrating subtle platelet dysfunction after injury. Much more data are needed in this area.
31. Esmon C. The protein C pathway. Chest 2003; 124 (3 Suppl):26S-32S. (Pubitemid 37128433)
32. Johansson PI, Stensballe J, Rasmussen LS, Ostrowski SR. High circulating adrenaline levels at admission predict increased mortality after trauma. J Trauma 2011. [Epub ahead of print]. Highly novel study of possible neurohormonal influences on coagulation after injury.
33. Johansson PI, Stensballe J, Rasmussen LS, Ostrowski SR. A high admission syndecan-1 level, a marker of endothelial glycocalyx degradation, is associated with inflammation, protein C depletion, fibrinolysis, and increased mortality in trauma patients. Ann Surg 2011; 254:194-200. This study is the first to closely examine endothelial perturbations during trauma and haemorrhagic shock.
34. Segal J, Dzik W, Network TMHCT. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: An evidence-based review. Transfusion 2005; 45:1413-1425. (Pubitemid 44194644)
35. Toulon P, Ozier Y, Ankri A, et al. Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study. Thromb Haemost 2009; 101:394-401.
36. Curry N, Stanworth S, Hopewell S, et al. Trauma-induced coagulopathy: A review of the systematic reviews -is there sufficient evidence to guide clinical transfusion practicě Transfus Med Rev 2011; 25:217.e2-231.e2. This report identifies a paucity of good-quality systematic reviews on which to base our resuscitation practices.
37. Davenport R, Manson J, De'Ath H, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med 2011; 39:2652-2658. A prospective study evaluating several different diagnostic modalities for use in trauma resuscitation. It provides good evidence for the superiority of thromboelastometry over routine coagulation tests.
38. Tripodi A, Chantarangkul V, Mannucci PM. Acquired coagulation disorders: Revisited using global coagulation/anticoagulation testing. Br J Haematol 2009; 147:77-82.
39. Doran CM, Woolley T, Midwinter MJ. Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. J Trauma 2010; 69 (Suppl 1):S40-S48.
40. Stainsby D, MacLennan S, Thomas D, et al. Guidelines on the management of massive blood loss. Br J Haematol 2006; 135:634-641. (Pubitemid 44674073)
41. Levrat A, Gros A, Rugeri L, et al. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J Anaesth 2008; 100:792-797. (Pubitemid 351774327)
42. Schöchl H, Frietsch T, Pavelka M, Jámbor C. Hyperfibrinolysis after major trauma: Differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma 2009; 67:125-131. Novel study demonstrating the clinical importance and pathophysiology of fibrinolytic activity after injury.