Towards patient-specific management of trauma hemorrhage: the effect of resuscitation therapy on parameters of thromboelastometry
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Towards patient-specific management of trauma hemorrhage : the effect of resuscitation therapy on parameters of thromboelastometry. / for the TACTIC partners.
In: Journal of Thrombosis and Haemostasis, Vol. 17, No. 3, 2019, p. 441-448.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Towards patient-specific management of trauma hemorrhage
T2 - the effect of resuscitation therapy on parameters of thromboelastometry
AU - Juffermans, Nicole P.
AU - Wirtz, Mathijs R.
AU - Balvers, Kirsten
AU - Baksaas-Aasen, Kjersti
AU - van Dieren, Susan
AU - Gaarder, Christine
AU - Naess, Paul A.
AU - Stanworth, Simon
AU - Johansson, Pär I.
AU - Stensballe, Jakob
AU - Maegele, Marc
AU - Goslings, J. C.
AU - Brohi, Karim
AU - for the TACTIC partners
PY - 2019
Y1 - 2019
N2 - Essentials The response of thromboelastometry (ROTEM) parameters to therapy is unknown. We prospectively recruited hemorrhaging trauma patients in six level-1 trauma centres in Europe. Blood products and pro-coagulants prevent further derangement of ROTEM results. ROTEM algorithms can be used to treat and monitor trauma induced coagulopathy. Summary: Background Rotational thromboelastometry (ROTEM) can detect trauma-induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM to transfusion therapy is unknown. Objectives To determine the response of ROTEM profiles to therapy in bleeding trauma patients. Patients/Methods A prospective multicenter study in bleeding trauma patients (receiving ≥ 4 red blood cell [RBC] units) was performed. Blood was drawn in the emergency department, after administration of 4, 8 and 12 RBC units and 24 h post-injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC. Results Three hundred and nine bleeding and shocked patients were included. A mean dose of 3.8 g of fibrinogen increased FIBTEM CA5 by 5.2 mm (IQR: 4.1–6.3 mm). TXA administration decreased lysis by 5.4% (4.3–6.5%). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEM ca5 values was more pronounced in patients with a ROTEM value indicative of TIC than in the whole cohort. Plasma transfusion decreased EXTEM clotting time by 3.1 s (− 10 s to 3.9 s) in the whole cohort and by 10.6 s (− 45 s to 24 s) in the subgroup of patients with a ROTEM value indicative of TIC. Conclusion The effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values indicative of TIC, the efficacy of PLTs and plasma in correcting deranged ROTEM parameters is possibly more robust.
AB - Essentials The response of thromboelastometry (ROTEM) parameters to therapy is unknown. We prospectively recruited hemorrhaging trauma patients in six level-1 trauma centres in Europe. Blood products and pro-coagulants prevent further derangement of ROTEM results. ROTEM algorithms can be used to treat and monitor trauma induced coagulopathy. Summary: Background Rotational thromboelastometry (ROTEM) can detect trauma-induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM to transfusion therapy is unknown. Objectives To determine the response of ROTEM profiles to therapy in bleeding trauma patients. Patients/Methods A prospective multicenter study in bleeding trauma patients (receiving ≥ 4 red blood cell [RBC] units) was performed. Blood was drawn in the emergency department, after administration of 4, 8 and 12 RBC units and 24 h post-injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC. Results Three hundred and nine bleeding and shocked patients were included. A mean dose of 3.8 g of fibrinogen increased FIBTEM CA5 by 5.2 mm (IQR: 4.1–6.3 mm). TXA administration decreased lysis by 5.4% (4.3–6.5%). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEM ca5 values was more pronounced in patients with a ROTEM value indicative of TIC than in the whole cohort. Plasma transfusion decreased EXTEM clotting time by 3.1 s (− 10 s to 3.9 s) in the whole cohort and by 10.6 s (− 45 s to 24 s) in the subgroup of patients with a ROTEM value indicative of TIC. Conclusion The effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values indicative of TIC, the efficacy of PLTs and plasma in correcting deranged ROTEM parameters is possibly more robust.
KW - hemorrhage
KW - ROTEM
KW - transfusion
KW - trauma
KW - viscoelastic hemostatic assay
U2 - 10.1111/jth.14378
DO - 10.1111/jth.14378
M3 - Journal article
C2 - 30609290
AN - SCOPUS:85061794416
VL - 17
SP - 441
EP - 448
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
SN - 1538-7933
IS - 3
ER -
ID: 241434160