Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Journal of Trauma and Acute Care Surgery

Volumn 74, Issue 6, 2013, Pages 1587-1598

  Schöchl, Herbert ^a,b   Voelckel, Wolfgang ^a   Grassetto, Alberto ^c   Schlimp, Christoph J ^b  

^a AUVA Trauma Centre   (Austria)

^b LUDWIG BOLTZMANN INSTITUTE FOR EXPERIMENTAL AND CLINICAL TRAUMATOLOGY   (Austria)

^c OSPEDALE DELL'ANGELO   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

ABCIXIMAB; ACETYLSALICYLIC ACID; ADENOSINE DIPHOSPHATE; ANTICOAGULANT AGENT; ANTIVITAMIN K; ARACHIDONIC ACID; BATROXOBIN; BLOOD CLOTTING INHIBITOR; CLOPIDOGREL; CYTOCHALASIN D; ECARIN; FIBRIN; FIBRINOGEN; FIBRINOGEN CONCENTRATE; FRESH FROZEN PLASMA; HEPARIN LYASE; KAOLIN; NONSTEROID ANTIINFLAMMATORY AGENT; RECOMBINANT THROMBOPLASTIN; THROMBIN; TRANEXAMIC ACID;

ANTICOAGULANT THERAPY; BLEEDING; BLOOD CLOT LYSIS; BLOOD CLOTTING DISORDER; BLOOD CLOTTING TEST; BLOOD CLOTTING TIME; BLOOD SAMPLING; BLOOD TRANSFUSION; CLINICAL ASSESSMENT; CLINICAL DECISION MAKING; CLINICAL TRIAL (TOPIC); CRYOPRECIPITATION; DEVICE SAFETY; DIAGNOSTIC EQUIPMENT; DRUG EFFICACY; FIBRIN CLOT; FIBRIN POLYMERIZATION; HEMATOLOGICAL PROCEDURE; HUMAN; IMMUNOASSAY; INJURY; INJURY SCALE; MORTALITY; POINT OF CARE TESTING; PRIORITY JOURNAL; REVIEW; SHEAR STRENGTH; THROMBOCYTE ACTIVATION; THROMBOCYTE TRANSFUSION; THROMBOELASTOGRAPHY; THROMBOELASTOMETRY; TRAUMA INDUCED COAGULOPATHY;

BLOOD COAGULATION DISORDERS; BLOOD COAGULATION TESTS; HUMANS; POINT-OF-CARE SYSTEMS; WOUNDS AND INJURIES;

EID: 84880111010     PISSN: 21630755     EISSN: 21630763     Source Type: Journal    
DOI: 10.1097/TA.0b013e31828c3171     Document Type: Review

References (89)

1. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(suppl 6):S3-S11.
2. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185-193.
3. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127-1130.
4. Maegele M. Frequency, risk stratification and therapeutic management of acute post-traumatic coagulopathy. Vox Sang. 2009;97:39-49.
5. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, Simanski C, Neugebauer E, Bouillon B. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury. 2007;38:298-304.
6. Esposito TJ, Sanddal TL, Reynolds SA, Sanddal ND. Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state. J Trauma. 2003;54:663-669; discussion 9-70.
7. Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg. 2007;245:812-818.
8. Frith D, Goslings JC, Gaarder C, Maegele M, Cohen MJ, Allard S, Johansson PI, Stanworth S, Thiemermann C, Brohi K. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. J Thromb Haemost. 2010;8:1919-1925.
9. Curry NS, Davenport RA, Hunt BJ, Stanworth SJ. Transfusion strategies for traumatic coagulopathy. Blood Rev. 2012;26:223-232.
10. Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, Narayan M, Maier RV. Haemorrhage control in severely injured patients. Lancet. 2012;380: 1099-1108.
11. Dzik WH. Predicting hemorrhage using preoperative coagulation screening assays. Curr Hematol Rep. 2004;3:324-330.
12. Johansson PI. Coagulation monitoring of the bleeding traumatized patient. Curr Opin Anaesthesiol. 2012;25:235-241.
13. Kitchens CS. To bleed or not to bleed? Is that the question for the PTT? J Thromb Haemost. 2005;3:2607-2611.
14. Segal JB, Dzik WH. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion (Paris). 2005;45:1413-1425.
15. Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S, Hart D, Pearse R, Pasi KJ, MacCallum P, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39: 2652-2658.
16. Toulon P, Ozier Y, Ankri A, Fleron MH, Leroux G, Samama CM. Point-ofcare versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study, Thromb Haemost. 2009;101:394Y401.
17. Holcomb JB, Minei KM, Scerbo ML, Radwan ZA, Wade CE, Kozar RA, Gill BS, Albarado R, McNutt MK, Khan S, et al. Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg. 2012;256:476Y486.
18. Schöchl H, Solomon C, Voelckel W. Thromboelastrometry in the perioperative setting. Neth J Crit Care. 2010;14:23-31.
19. Carroll RC, Craft RM, Langdon RJ, Clanton CR, Snider CC, Wellons DD, Dakin PA, Lawson CM, Enderson BL, Kurek SJ. Early evaluation of acute traumatic coagulopathy by thrombelastography. Transl Res. 2009; 154:34-39.
20. Schochl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, Kozek-Langenecker S, Solomon C. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)Yguided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care. 2010;14:R55.
21. Theusinger OM, Felix C, Spahn DR. Strategies to reduce the use of blood products: a European perspective. Curr Opin Anaesthesiol. 2012;25:59-65.
22. Woolley T, Midwinter M, Spencer P, Watts S, Doran C, Kirkman E. Utility of interim ROTEM((R)) values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients. Injury. 2012 April 7. [Epub ahead of print] doi: 10.1016/j.injury.2012.03.018.
23. Ziegler B, Schimke C, Marchet P, Stogermuller B, Schochl H, Solomon C. Severe pediatric blunt traumaV successful ROTEM-guided hemostatic therapy with fibrinogen concentrate and no administration of fresh frozen plasma or platelets. Clin Appl Thromb Hemost. 2012 Sep 10. [Epub ahead of print] doi: 10.1177/1076029612458149.
24. Haemonetics Web site. Available at: http://www.haemonetics.com/en/ Products/Devices/Surgical%20-%20Diagnostic%20Devices/TEG%205000. aspx. Accessed April 30, 2012.
25. Gonzalez E, Pieracci FM, Moore EE, Kashuk JL. Coagulation abnormalities in the trauma patient: the role of point-of-care thromboelastography. Semin Thromb Hemost. 2010;36:723-737.
26. Curry A, Pierce T. Conventional and near-patient tests of coagulation. Crit Care Pain. 2007;7:45-50.
27. Schöchl H, Solomon C, Voelckel W. Thromboelastometry in the perioperative setting. Neth J Crit Care. 2010;14:23-31.
28. Lang T, Von Depka M. Possibilities and limitations of thromboelastometry/thromboelastography. Hämostaseologie. 2007;26(suppl 1):S21-S29.
29. Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106:1366-1375.
30. Kashuk JL, Moore EE, Wohlauer M, Johnson JL, Pezold M, Lawrence J, Biffl WL, Burlew CC, Barnett C, Sawyer M, et al. Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy. Transfusion (Paris). 2012;52:23-33.
31. Johansson PI, Stissing T, Bochsen L, Ostrowski SR. Thrombelastography and tromboelastometry in assessing coagulopathy in trauma. Scand J Trauma Resusc Emerg Med. 2009;17:45.
32. Cotton BA, FazG, Hatch QM, Radwan ZA, Podbielski J, Wade C, Kozar RA, Holcomb JB. Rapid thrombelastography delivers real-timeresults that predict transfusion within 1 hour of admission. J Trauma. 2011;71:407-414; discussion 14-17.
33. Bochsen L, Wiinberg B, Kjelgaard-Hansen M, Steinbruchel DA, Johansson PI. Evaluation of the TEG platelet mapping assay in blood donors. Thromb J. 2007;5:3.
34. Chavez JJ, Foley DE, Snider CC, Howell JC, Cohen E, Muenchen RA, Carroll RC. A novel thrombelastograph tissue factor/kaolin assay of activated clotting times for monitoring heparin anticoagulation during cardiopulmonary bypass. Anesth Analg. 2004;99:1290-1294.
35. Fluger I, Maderova K, Simek M, Simek M, Hajek R, Zapletalova J, Lonsky V. Comparison of functional fibrinogen assessment using thromoelastography with the standard von Clauss method. Biomed Pap Med Fac Univ Palacky Olomouc. 2012;156:1-2.
36. Larsen OH, Fenger-Eriksen C, Christiansen K, Ingerslev J, Sorensen B. Diagnostic performance and therapeutic consequence of thromboelastometry activated by kaolin versus a panel of specific reagents. Anesthesiology. 2011;115:294-302.
37. Korte W. F. XIII in perioperative coagulation management. Best Pract Res Clin Anaesthesiol. 2010;24:85-93.
38. Luddington RJ. Thrombelastography/thromboelastometry. Clin Lab Haematol. 2005;27:81-90.
39. Harr JN, Moore EE, Ghasabyan A, Chin TL, Sauaia A, Banerjee A, Silliman CC. Functional fibrinogen assay indicates that fibrinogen is critical in correcting abnormal clot strength following trauma. Shock. 2013;39:45-49.
40. Solomon C, Sorensen B, Hochleitner G, Kashuk J, Ranucci M, Schochl H. Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry. Anesth Analg. 2012;114:721-730.
41. Lang T, Toller W, Gutl M, Mahla E, Metzler H, Rehak P, Marz W, Halwachs-Baumann G. Different effects of abciximab and cytochalasinDon clot strength in thrombelastography. J Thromb Haemost. 2004;2:147-153.
42. Schochl H, Solomon C, Laux V, Heitmeier S, Bahrami S, Redl H. Similarities in thromboelastometric (ROTEM(R)) findings between humans and baboons. Thromb Res. 2012;130:e107-e112.
43. Grassetto A, De Nardin M, Ganzerla B, GeremiaM, Saggioro D, Serafini E, Zampieri S, Toffoli M, Penzo D, Bossi A, et al. ROTEM(R)-guided coagulation factor concentrate therapy in trauma: 2-year experience in Venice, Italy. Crit Care. 2012;16:428.
44. Rahe-Meyer N, Solomon C, Hanke A, Schmidt DS, Knoerzer D, Hochleitner G, Sorensen B, Hagl C, Pichlmaier M. Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology. 2013;118:40-50.
45. Schochl H, Forster L, Woidke R, Solomon C, Voelckel W. Use of rotation thromboelastometry (ROTEM) to achieve successful treatment of polytrauma with fibrinogen concentrate and prothrombin complex concentrate. Anaesthesia. 2010;65:199-203.
46. Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schochl H, Wade CE, Holcomb JB, Matijevic N. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg. 2012;73:365-370; discussion 70.
47. Ives C, Inaba K, Branco BC, Okoye O, Schochl H, Talving P, Lam L, Shulman I, Nelson J, Demetriades D. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma. J Am Coll Surg. 2012; 215:496-502. (doi: 10.1016/j.jamcollsurg.2012.06.005).
48. Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, Biffl WL, Burlew CC, Johnson JL, Sauaia A. Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma. Ann Surg. 2010;252:434-442; discussion 43-44.
49. Schöchl H, Frietsch T, Pavelka M, Jambor C. Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma. 2009;67:125-131.
50. Schochl H, Voelckel W, Maegele M, Solomon C. Trauma-associated hyperfibrinolysis. Hamostaseologie. 2012;32:22-27.
51. Theusinger OM, Wanner GA, Emmert MY, Billeter A, Eismon J, Seifert B, Simmen HP, Spahn DR, Baulig W. Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma. Anesth Analg. 2011;113:1003-1012.
52. Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De'athH, Allard S, HartD, et al. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost. 2013 Feb;11:307-314. (doi: 10.1111/jth.12078.).
53. Larsen OH, Fenger-Eriksen C, Ingerslev J, Sorensen B. Improved point-ofcare identification of hyperfibrinolysis is needed. Thromb Res. 2012; 130:690-691.
54. Ogawa S, Szlam F, Chen EP, Nishimura T, Kim H, Roback JD, Levy JH, Tanaka KA. A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution-induced coagulation changes after cardiac surgery. Transfusion (Paris). 2012;52:14-22.
55. Hoffman M, Monroe DM 3rd. A cell-based model of hemostasis. Thromb Haemost. 2001;85:958-965.
56. Mann KG, Brummel K, Butenas S. What is all that thrombin for? J Thromb Haemost. 2003;1:1504-1514.
57. Dunbar NM, Chandler WL. Thrombin generation in trauma patients. Transfusion (Paris). 2009;49:2652-2660.
58. Kawasaki J, Katori N, Taketomi T, Terui K, Tanaka KA. The effects of vasoactive agents, platelet agonists and anticoagulation on thrombelastography. Acta Anaesthesiol Scand. 2007;51:1237-1244.
59. Schochl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, Solomon C. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care. 2011;15:R265.
60. Kaufmann CR, Dwyer KM, Crews JD, Dols SJ, Trask AL. Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma. 1997;42:716-720; discussion 20-22.
61. Martini WZ, Cortez DS, Dubick MA, Park MS, Holcomb JB. 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.
62. Tarmey NT, Woolley T, Jansen JO, Doran CM, Easby D, Wood PR, Midwinter MJ. Evolution of coagulopathy monitoring in military damagecontrol resuscitation. J TraumaAcute Care Surg. 2012;73(suppl 5):S417-S422.
63. Plotkin AJ, Wade CE, Jenkins DH, Smith KA, Noe JC, Park MS, Perkins JG, Holcomb JB. 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(suppl 2): S64-S68.
64. Leemann H, Lustenberger T, Talving P, Kobayashi L, Bukur M, Brenni M, Bruesch M, Spahn DR, Keel MJ. The role of rotation thromboelastometry in early prediction of massive transfusion. J Trauma. 2010;69:1403-1408; discussion 8-9.
65. Pezold M, Moore EE, Wohlauer M, Sauaia A, Gonzalez E, Banerjee A, Silliman CC. Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes. Surgery. 2012;151:48-54.
66. Tauber H, Innerhofer P, Breitkopf R, Westermann I, Beer R, El Attal R, Strasak A, Mittermayr M. 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.
67. Nystrup KB, Windelov NA, Thomsen AB, Johansson PI. Reduced clot strength upon admission, evaluated by thrombelastography (TEG), in trauma patients is independently associated with increased 30-day mortality. Scand J Trauma Resusc Emerg Med. 2011;19:52.
68. Kunio NR, Differding JA, Watson KM, Stucke RS, Schreiber MA. Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury. Am J Surg. 2012; 203:584-588.
69. Schochl H, Solomon C, Traintinger S, Nienaber U, Tacacs-Tolnai A, Windhofer C, Bahrami S, Voelckel W. Thromboelastometric (ROTEM) findings in patients suffering from isolated severe traumatic brain injury. J Neurotrauma. 2011;28:2033-2041.
70. Schreiber MA, Differding J, Thorborg P, Mayberry JC, Mullins RJ. Hypercoagulability is most prevalent early after injury and in female patients. J Trauma. 2005;58:475-480; discussion 80-81.
71. Spiezia L, Marchioro P, Radu C, Rossetto V, Tognin G, Monica C, Salmaso L, Simioni P. Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis. Blood Coagul Fibrinolysis. 2008;19:355-360.
72. Kashuk JL, Moore EE, Sabel A, Barnett C, Haenel J, Le T, Pezold M, Lawrence J, Biffl WL, Cothren CC, et al. Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients. Surgery. 2009;146:764-772; discussion 72-74.
73. Cotton BA, Minei KM, Radwan ZA, Matijevic N, Pivalizza E, Podbielski J, Wade CE, Kozar RA, Holcomb JB. Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients. J Trauma Acute Care Surg. 2012;72:1470-1475; discussion 5Y7.
74. Gaarder C, Naess PA, Frischknecht Christensen E, Hakala P, Handolin L, Heier HE, Ivancev K, Johansson P, Leppaniemi A, Lippert F, et al. Scandinavian Guidelines-"The massively bleeding patient". Scand J Surg. 2008;97:15-36.
75. Gorlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA, Schochl H. Reduction of fresh frozen plasma requirements by perioperative point-ofcare coagulation management with early calculated goal-directed therapy. Transfus Med Hemother. 2012;39:104-113.
76. Kashuk JL, Moore EE, Sawyer M, Le T, Johnson J, Biffl WL, Cothren CC, Barnett C, Stahel P, Sillman CC, et al. Postinjury coagulopathy management: goal directed resuscitation via POC thrombelastography. Ann Surg. 2010;251:604-614.
77. Lier H, Vorweg M, Hanke A, Gorlinger K. Thromboelastometry guided therapy of severe bleeding. Essener Runde algorithm. Hamostaseologie. 2013;33:51-61. (doi: 10.5482/HAMO-12-05-0011.).
78. Schochl H, Maegele M, Solomon C, Gorlinger K, Voelckel W. Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med. 2012;20:15.
79. Schochl H, Schlimp C, Voelckel W. Potential value of pharmacological protocols in trauma. Curr Opin Anaesthesiol. 2013;26:221-229. (doi: 10.1097/ACO.0b013e32835cca92).
80. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebocontrolled trial. Lancet. 2010;376:23-32.
81. Schochl H, Nienaber U, Maegele M, Hochleitner G, Primavesi F, Steitz B, Arndt C, Hanke A, Voelckel W, Solomon C. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care. 2011;15:R83.
82. Hagemo JS, Naess PA, Johansson P, Windelov NA, Cohen MJ, Roislien J, Brohi K, Heier HE, Hestnes M, Gaarder C. Evaluation of TEG((R)) and RoTEM((R)) inter-changeability in trauma patients. Injury. 2012 Dec 19. pii: S0020-1383(12)00514-1. doi: 10.1016/j.injury.2012.11.016. [Epub ahead of print].
83. Afshari A, Wikkelso A, Brok J, Moller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev. 2011:CD007871.
84. Weber CF, Gorlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, Cohn LH, Zacharowski K. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012;117:531-547.
85. Spiezia L, Bertini D, Salmaso L, Simioni P. Whole blood rotation thrombelastometry in subjects undergoing vitamin K antagonist treatment: hypo- or hypercoagulable profiles? Thromb Res. 2008;122:568-569.
86. Kaur J, Jones N, Mallett S. Thrombelastography Platelet Mapping is a useful preoperative tool in surgical patients taking antiplatelet medication. Br J Anaesth. 2009;103:304; author reply 304-305.
87. Alstrom U, Granath F, Oldgren J, Stahle E, Tyden H, Siegbahn A. Platelet inhibition assessed with VerifyNow, flow cytometry and PlateletMapping in patients undergoing heart surgery. Thromb Res. 2009;124:572-577.
88. Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anestesiol. 2007;73:401-415.
89. Allen SR, Kashuk JL. Unanswered questions in the use of blood component therapy in trauma. Scand J Trauma Resusc Emerg Med. 2011;19:5.