Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients: Results from a multicenter study
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Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients : Results from a multicenter study. / Laursen, Thomas H; Meyer, Martin A S; Meyer, Anna Sina P; Gaarder, Tina; Naess, Paal A; Stensballe, Jakob; Ostrowski, Sisse R; Johansson, Pär I.
I: The Journal of Trauma and Acute Care Surgery, Bind 84, Nr. 2, 2018, s. 334-341.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients
T2 - Results from a multicenter study
AU - Laursen, Thomas H
AU - Meyer, Martin A S
AU - Meyer, Anna Sina P
AU - Gaarder, Tina
AU - Naess, Paal A
AU - Stensballe, Jakob
AU - Ostrowski, Sisse R
AU - Johansson, Pär I
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays, thrombelastography (TEG) and rotation thromboelastometry (ROTEM), provide fast results, which is critical in the resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European Level I Trauma Centers.METHODS: Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway. Biochemistry and clinical data including outcome and TEG parameters were recorded upon arrival. Kaolin TEG, Rapid TEG, and TEG functional fibrinogen curves were extracted, and early amplitudes A5 and A10 (amplitude at 5 and 10 minutes) were registered. Patients were stratified according to international normalized ratio of 1.2 or less or greater than 1.2, as well as transfusion requirements (nontransfused, 1-9 red blood cell units and ≥10 red blood cell units in 12 hours).RESULTS: In total, 404 patients were included, median Injury Severity Score was 13. There were strong positive correlations between A5/A10 and maximum amplitude in all investigated assays. All TEG values except rTEG maximum amplitude and kTEG maximum amplitude correlated significantly with mortality in transfused patients. Time from initiation of assay to A5 and A10 were lowest for rapid TEG and TEG functional fibrinogen compared with kaolin TEG. Rapid TEG A5 reduced time to result with greater than 50% compared with rapid TEG maximum amplitude.CONCLUSION: We found strong associations between TEG early amplitudes A5/A10 and maximum amplitude in rapid TEG, kaolin TEG, and TEG functional fibrinogen across trauma patients with coagulopathy and massive transfusion requirements. Introducing the use of early amplitudes can reduce time to diagnosis of coagulopathy and may be used in TEG monitoring of trauma patient. Further randomized controlled trials evaluating the role of TEG in guiding hemostatic resuscitation are warranted.LEVEL OF EVIDENCE: Prognostic study, level III.
AB - BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays, thrombelastography (TEG) and rotation thromboelastometry (ROTEM), provide fast results, which is critical in the resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European Level I Trauma Centers.METHODS: Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway. Biochemistry and clinical data including outcome and TEG parameters were recorded upon arrival. Kaolin TEG, Rapid TEG, and TEG functional fibrinogen curves were extracted, and early amplitudes A5 and A10 (amplitude at 5 and 10 minutes) were registered. Patients were stratified according to international normalized ratio of 1.2 or less or greater than 1.2, as well as transfusion requirements (nontransfused, 1-9 red blood cell units and ≥10 red blood cell units in 12 hours).RESULTS: In total, 404 patients were included, median Injury Severity Score was 13. There were strong positive correlations between A5/A10 and maximum amplitude in all investigated assays. All TEG values except rTEG maximum amplitude and kTEG maximum amplitude correlated significantly with mortality in transfused patients. Time from initiation of assay to A5 and A10 were lowest for rapid TEG and TEG functional fibrinogen compared with kaolin TEG. Rapid TEG A5 reduced time to result with greater than 50% compared with rapid TEG maximum amplitude.CONCLUSION: We found strong associations between TEG early amplitudes A5/A10 and maximum amplitude in rapid TEG, kaolin TEG, and TEG functional fibrinogen across trauma patients with coagulopathy and massive transfusion requirements. Introducing the use of early amplitudes can reduce time to diagnosis of coagulopathy and may be used in TEG monitoring of trauma patient. Further randomized controlled trials evaluating the role of TEG in guiding hemostatic resuscitation are warranted.LEVEL OF EVIDENCE: Prognostic study, level III.
KW - Adult
KW - Blood Coagulation Disorders/blood
KW - Blood Coagulation Tests
KW - Denmark/epidemiology
KW - Early Diagnosis
KW - Female
KW - Hemorrhage/diagnosis
KW - Humans
KW - Incidence
KW - Injury Severity Score
KW - Male
KW - Middle Aged
KW - Norway/epidemiology
KW - Prognosis
KW - Prospective Studies
KW - Survival Rate/trends
KW - Thrombelastography/methods
KW - Trauma Centers
KW - Wounds and Injuries/complications
U2 - 10.1097/TA.0000000000001735
DO - 10.1097/TA.0000000000001735
M3 - Journal article
C2 - 29112094
VL - 84
SP - 334
EP - 341
JO - Journal of Trauma
JF - Journal of Trauma
SN - 2163-0755
IS - 2
ER -
ID: 215786027