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1. Early and individualized goal-directed therapy for trauma-induced coagulopathy

Author

Schöchl Herbert, Maegele Marc, Solomon Cristina, Görlinger Klaus, and Voelckel Wolfgang

Subjects
ROTEM, TEG, trauma, goal-directed coagulation therapy, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Severe trauma-related bleeding is associated with high mortality. Standard coagulation tests provide limited information on the underlying coagulation disorder. Whole-blood viscoelastic tests such as rotational thromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process in trauma. The results are available within minutes and they provide information about the initiation of coagulation, the speed of clot formation, and the quality and stability of the clot. Viscoelastic tests have the potential to guide coagulation therapy according to the actual needs of each patient, reducing the risks of over- or under-transfusion. The concept of early, individualized and goal-directed therapy is explored in this review and the AUVA Trauma Hospital algorithm for managing trauma-induced coagulopathy is presented.

Published
2012
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2. In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

Author

Görlinger Klaus, Flöricke Felix, Schöchl Herbert, Maschler Stephanie, Hanke Alexander A, Zanger Klaus, and Kienbaum Peter

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Hypertonic saline hydroxyethyl starch (HH) has been recommended for first line treatment of hemorrhagic shock. Its effects on coagulation are unclear. We studied in vitro effects of HH dilution on whole blood coagulation and platelet function. Furthermore 7.2% hypertonic saline, 6% hydroxyethylstarch (as ingredients of HH), and 0.9% saline solution (as control) were tested in comparable dilutions to estimate specific component effects of HH on coagulation. Methods The study was designed as experimental non-randomized comparative in vitro study. Following institutional review board approval and informed consent blood samples were taken from 10 healthy volunteers and diluted in vitro with either HH (HyperHaes®, Fresenius Kabi, Germany), hypertonic saline (HT, 7.2% NaCl), hydroxyethylstarch (HS, HAES6%, Fresenius Kabi, Germany) or NaCl 0.9% (ISO) in a proportion of 5%, 10%, 20% and 40%. Coagulation was studied in whole blood by rotation thrombelastometry (ROTEM) after thromboplastin activation without (ExTEM) and with inhibition of thrombocyte function by cytochalasin D (FibTEM), the latter was performed to determine fibrin polymerisation alone. Values are expressed as maximal clot firmness (MCF, [mm]) and clotting time (CT, [s]). Platelet aggregation was determined by impedance aggregrometry (Multiplate) after activation with thrombin receptor-activating peptide 6 (TRAP) and quantified by the area under the aggregation curve (AUC [aggregation units (AU)/min]). Scanning electron microscopy was performed to evaluate HyperHaes induced cell shape changes of thrombocytes. Statistics: 2-way ANOVA for repeated measurements, Bonferroni post hoc test, p < 0.01. Results Dilution impaired whole blood coagulation and thrombocyte aggregation in all dilutions in a dose dependent fashion. In contrast to dilution with ISO and HS, respectively, dilution with HH as well as HT almost abolished coagulation (MCFExTEM from 57.3 ± 4.9 mm (native) to 1.7 ± 2.2 mm (HH 40% dilution; p < 0.0001) and to 6.6 ± 3.4 mm (HT 40% dilution; p < 0.0001) and thrombocyte aggregation (AUC from 1067 ± 234 AU/mm (native) to 14.5 ± 12.5 AU/mm (HH 40% dilution; p < 0.0001) and to 20.4 ± 10.4 AU/min (HT 40% dilution; p < 0.0001) without differences between HH and HT (MCF: p = 0.452; AUC: p = 0.449). Conclusions HH impairs platelet function during in vitro dilution already at 5% dilution. Impairment of whole blood coagulation is significant after 10% dilution or more. This effect can be pinpointed to the platelet function impairing hypertonic saline component and to a lesser extend to fibrin polymerization inhibition by the colloid component or dilution effects. Accordingly, repeated administration and overdosage should be avoided.

Published
2011
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3. Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Author

Bohm, J, Guting, H, Thorn, S, Schafer, N, Rambach, V, Schochl, H, Grottke, O, Rossaint, R, Stanworth, S, Curry, N, Lefering, R, Maegele, M, Akerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Ceyisakar, I, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, B, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Koraropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, M. Castano-Leon, A, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Jagt, M, Steen, G, Naalt, J, Dijck, J, Essen, T, Hecke, W, Heugten, C, Praag, D, Vyvere, T, Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, Zoerle, T, Bohm J. K., Guting H., Thorn S., Schafer N., Rambach V., Schochl H., Grottke O., Rossaint R., Stanworth S., Curry N., Lefering R., Maegele M., Akerlund C., Amrein K., Andelic N., Andreassen L., Anke A., Antoni A., Audibert G., Azouvi P., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Lozano G. C., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Ceyisakar I., Clusmann H., Coburn M., Coles J., Cooper J., Correia M., Covic A., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., Dawes H., Keyser V., Degos V., Corte F. D., Boogert H. d., Depreitere B., Dilvesi B., Dixit A., Donoghue E., Dreier J., Duliere G., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P., Gratz J., Gravesteijn B., Grossi F., Gruen R., Gupta D., Haagsma J., Haitsma I., Helbok R., Helseth E., Horton L., Huijben J., Hutchinson P., Jacobs B., Jankowski S., Jarrett M., Jiang J., Johnson F., Jones K., Karan M., Kolias A., Kompanje E., Kondziella D., Koraropoulos E., Koskinen L., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A., M. Castano-Leon A., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P., Payen J., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Ples H., Polinder S., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roe C., Roise O., Rosand J., Rosenfeld J., Rosenlund C., Rosenthal G., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stevens R., Stewart W., Steyerberg E., Stocchetti N., Sundstrom N., Synnot A., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Tenovuo O., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., Jagt M., Steen G., Naalt J., Dijck J., Essen T., Hecke W. V., Heugten C. v., Praag D. V., Vyvere T. V., Wijk R., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F., Zelinkova V., Ziverte A., Zoerle T., Bohm, J, Guting, H, Thorn, S, Schafer, N, Rambach, V, Schochl, H, Grottke, O, Rossaint, R, Stanworth, S, Curry, N, Lefering, R, Maegele, M, Akerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Ceyisakar, I, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, B, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Koraropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, M. Castano-Leon, A, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Jagt, M, Steen, G, Naalt, J, Dijck, J, Essen, T, Hecke, W, Heugten, C, Praag, D, Vyvere, T, Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, Zoerle, T, Bohm J. K., Guting H., Thorn S., Schafer N., Rambach V., Schochl H., Grottke O., Rossaint R., Stanworth S., Curry N., Lefering R., Maegele M., Akerlund C., Amrein K., Andelic N., Andreassen L., Anke A., Antoni A., Audibert G., Azouvi P., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Lozano G. C., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Ceyisakar I., Clusmann H., Coburn M., Coles J., Cooper J., Correia M., Covic A., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., Dawes H., Keyser V., Degos V., Corte F. D., Boogert H. d., Depreitere B., Dilvesi B., Dixit A., Donoghue E., Dreier J., Duliere G., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P., Gratz J., Gravesteijn B., Grossi F., Gruen R., Gupta D., Haagsma J., Haitsma I., Helbok R., Helseth E., Horton L., Huijben J., Hutchinson P., Jacobs B., Jankowski S., Jarrett M., Jiang J., Johnson F., Jones K., Karan M., Kolias A., Kompanje E., Kondziella D., Koraropoulos E., Koskinen L., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A., M. Castano-Leon A., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P., Payen J., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Ples H., Polinder S., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roe C., Roise O., Rosand J., Rosenfeld J., Rosenlund C., Rosenthal G., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stevens R., Stewart W., Steyerberg E., Stocchetti N., Sundstrom N., Synnot A., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Tenovuo O., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., Jagt M., Steen G., Naalt J., Dijck J., Essen T., Hecke W. V., Heugten C. v., Praag D. V., Vyvere T. V., Wijk R., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F., Zelinkova V., Ziverte A., and Zoerle T.

Abstract

Background: Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods: This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Results: Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to − 6, hypothermia and hypotension increased risk significantly. Conclusion: Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

Published
2021

4. Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Author

Bohm J. K., Guting H., Thorn S., Schafer N., Rambach V., Schochl H., Grottke O., Rossaint R., Stanworth S., Curry N., Lefering R., Maegele M., Akerlund C., Amrein K., Andelic N., Andreassen L., Anke A., Antoni A., Audibert G., Azouvi P., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Lozano G. C., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Ceyisakar I., Clusmann H., Coburn M., Coles J., Cooper J., Correia M., Covic A., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., Dawes H., Keyser V., Degos V., Corte F. D., Boogert H. d., Depreitere B., Dilvesi B., Dixit A., Donoghue E., Dreier J., Duliere G., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P., Gratz J., Gravesteijn B., Grossi F., Gruen R., Gupta D., Haagsma J., Haitsma I., Helbok R., Helseth E., Horton L., Huijben J., Hutchinson P., Jacobs B., Jankowski S., Jarrett M., Jiang J., Johnson F., Jones K., Karan M., Kolias A., Kompanje E., Kondziella D., Koraropoulos E., Koskinen L., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A., M. Castano-Leon A., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P., Payen J., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Ples H., Polinder S., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roe C., Roise O., Rosand J., Rosenfeld J., Rosenlund C., Rosenthal G., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stevens R., Stewart W., Steyerberg E., Stocchetti N., Sundstrom N., Synnot A., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Tenovuo O., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., Jagt M., Steen G., Naalt J., Dijck J., Essen T., Hecke W. V., Heugten C. v., Praag D. V., Vyvere T. V., Wijk R., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F., Zelinkova V., Ziverte A., Zoerle T., Grottke, Oliver [0000-0002-0722-3122], Apollo - University of Cambridge Repository, Böhm, Julia K, Güting, Helge, Thorn, Sophie, Schäfer, Nadine, Rambach, Victoria, Schöchl, Herbert, Grottke, Oliver, Rossaint, Rolf, Stanworth, Simon, Curry, Nicola, Lefering, Rolf, Maegele, Marc (CENTER-TBI Participants and Investigators), Beretta, Luigi, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Centre of Excellence in Complex Disease Genetics, Aarno Palotie / Principal Investigator, Institute for Molecular Medicine Finland, Genomics of Neurological and Neuropsychiatric Disorders, Helsinki Institute for Information Technology, Statistical and population genetics, Department of Mathematics and Statistics, Biostatistics Helsinki, Department of Public Health, Samuli Olli Ripatti / Principal Investigator, Complex Disease Genetics, HUS Neurocenter, Neurokirurgian yksikkö, Clinicum, Helsinki University Hospital Area, Molecular Neuroscience and Ageing Research (MOLAR), Rocka, Saulius, Tamosuitis, Tomas, „Springer Nature' grupė, Bohm, J, Guting, H, Thorn, S, Schafer, N, Rambach, V, Schochl, H, Grottke, O, Rossaint, R, Stanworth, S, Curry, N, Lefering, R, Maegele, M, Akerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Ceyisakar, I, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, B, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Koraropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, M. Castano-Leon, A, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Jagt, M, Steen, G, Naalt, J, Dijck, J, Essen, T, Hecke, W, Heugten, C, Praag, D, Vyvere, T, Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, Zoerle, T, Public Health, Pediatric Surgery, Neurology, Neurosurgery, and Intensive Care

Subjects
Neurologi, INTRACRANIAL HEMORRHAGE, PREINJURY WARFARIN, CENTER-TBI, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Traumatic brain injury, Coagulopathy, Brain Injuries, Traumatic, Prospective Studies, RISK, Anticoagulant, Head injury, Blood Coagulation Disorders, 3. Good health, Neurology, CLOPIDOGREL, Neurosurgery, Blood Coagulation Tests, Original Work, medicine.medical_specialty, medicine.drug_class, Subgroup analysis, 03 medical and health sciences, MORBIDITY, TRANSFUSION, medicine, Humans, VDP::Medisinske Fag: 700, Glasgow Coma Scale, OLDER-ADULTS, coagulopathy, risk factors, traumatic brain injury, HYPOTHERMIA, business.industry, MORTALITY, 3112 Neurosciences, HEAD-INJURY, 030208 emergency & critical care medicine, medicine.disease, VDP::Medical disciplines: 700, Risk factors, Emergency medicine, Base excess, Risk factor, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Results Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to − 6, hypothermia and hypotension increased risk significantly. Conclusion Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

Published
2021
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6. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma.

Author

Ives C, Inaba K, Branco BC, Okoye O, Schochl H, Talving P, Lam L, Shulman I, Nelson J, and Demetriades D

Subjects
Acute Disease, Adult, Female, Humans, Male, Predictive Value of Tests, Prospective Studies, Blood Coagulation Disorders complications, Blood Coagulation Disorders diagnosis, Fibrinolysis, Thrombelastography, Wounds and Injuries complications, Wounds and Injuries mortality
Abstract

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., (Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2012
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