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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Hyperfibrinolysis Elicited via Thromboelastography Predicts Mortality in Trauma
Journal of the American College of Surgeons, Volume 215, No. 4, Year 2012
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Description
Background: The acute coagulopathy of trauma has been identified as a critical determinant of outcomes. Antifibrinolytic agents have recently been demonstrated to improve outcomes. This prospective study was designed to assess coagulopathy in trauma patients using thromboelastography. Study Design: Trauma patients meeting our institution's highest tier of trauma team activation criteria were prospectively enrolled during a 5-month period ending April 1, 2011. Thromboelastography was performed at admission, +1 hour, +2 hours, and +6 hours using citrated blood. Hyperfibrinolysis was defined as estimated percent lysis <15%. Patients were followed throughout their hospital course to collect clinical data and outcomes. Results: One hundred and eighteen patients were enrolled (77.1% were male, 51.7% had penetrating trauma, 7.6% had systolic blood pressure <90 mmHg, 47.5% had Injury Severity Score >16, and 23.7% had Glasgow Coma Scale score ≤8). Hyperfibrinolysis was present in 13 patients (11.0%), with a mean time to detection of 13 minutes (range 2 to 60 minutes). By the 6-hour sampling, 8 (61.5%) of the hyperfibrinolytic patients had expired from hemorrhage. Survivors at this point demonstrated correction of coagulopathy, however, 12 patients (92.3%) ultimately expired (75% hemorrhage, 25% head injury). On stepwise logistic regression, hyperfibrinolysis was a strong predictor of early (24 hours) mortality (odds ratio = 25.0; 95% CI, 2.8-221.4; p = 0.004), predicting 53% of early deaths. Compared with patients without hyperfibrinolysis, patients with hyperfibrinolysis had a greater need for massive transfusion (76.9% vs 8.7%; adjusted odds ratio = 19.1; 95% CI, 3.6-101.3; p < 0.001) and had a greater early mortality (69.2% vs 1.9%; adjusted odds ratio = 55.8; 95% CI, 7.2-432.3; p < 0.001) and in-hospital mortality (92.3% vs 9.5%; adjusted odds ratio = 55.5; 95% CI, 4.8-649.7; p = 0.001). Conclusions: In this prospective analysis, hyperfibrinolysis on thromboelastography developed in approximately 10% of patients and was considerably more likely to require massive transfusion. Hyperfibrinolysis was a strong independent predictor of mortality. Additional evaluation of the role of thromboelastography-directed antifibrinolytic therapies is warranted. © 2012 American College of Surgeons.
Authors & Co-Authors
Inaba, Kenji
United States, Los Angeles
Los Angeles County Usc Medical Center
Schöchl, Herbert
Unknown Affiliation
Talving, Peep
United States, Los Angeles
Los Angeles County Usc Medical Center
Demetriades, Demetrios G.
United States, Los Angeles
Los Angeles County Usc Medical Center
Statistics
Citations: 137
Authors: 4
Affiliations: 1
Identifiers
Doi:
10.1016/j.jamcollsurg.2012.06.005
ISSN:
18791190
Research Areas
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Cohort Study
Case-Control Study
Participants Gender
Male