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coagulopathy of trauma

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https://www.readbyqxmd.com/read/29776837/evaluation-of-massive-transfusion-protocol-practices-by-type-of-trauma-at-a-level-i-trauma-center
#1
Roshan Givergis, Swapna Munnangi, Katayoun Fayaz M Fomani, Anthony Boutin, Luis Carlos Zapata, Ld George Angus
PURPOSE: To evaluate massive transfusion protocol practices by trauma type at a level I trauma center. METHODS: A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained. RESULTS: Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients...
April 18, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29745298/impact-of-a-prehospital-discrimination-between-trauma-patients-with-or-without-early-acute-coagulopathy-of-trauma-and-the-need-for-damage-control-resuscitation-rationale-and-design-of-a-multicenter-randomized-phase-ii-trial
#2
Martin Tonglet, Frédéric Swerts, Vincenzo D'Orio, Didier Moens, François-Xavier Lens, Jérémy Alves, Maximilien Thoma, Bernard Kreps, Pierre Youata Towo, Romain Betz, Gerard Decoster B, Michèle Guillaume, Eddy Husson, Anne Françoise Donneau, Jean Louis Poplavsky, Jean Marc Minon, Alexandre Guysen
BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be evaluated. The primary objective of this study is to evaluate the impact on mortality of a prehospital discrimination between trauma patients with or without a potential need for damage control resuscitation. METHODS: The trial will be designed as randomized phase II clinical trial with comparison of the experimental protocol against the standard of care...
May 10, 2018: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/29727255/hairpulling-causing-vision-loss-a-case-report
#3
Sidharth Puri, Sarah Madison Duff, Brett Mueller, Mark Prendes, Jeremy Clark
Subperiosteal extension of a subgaleal hematoma (SGH) to the orbit is a reported, but rare complication of trauma. This report details a 13-year-old African-American male who originally presented to the emergency department after trauma with headache and was found on CT imaging to have a contained subgaleal hemorrhage. He presented 2 days later with increased pain and proptosis of the left eye with findings of decreased visual acuity, elevated intraocular pressure, proptosis, and complete external ophthalmoplegia...
May 4, 2018: Orbit
https://www.readbyqxmd.com/read/29709368/empiric-transfusion-strategies-during-life-threatening-hemorrhage
#4
Geoffrey R Nunns, Ernest E Moore, Gregory R Stettler, Hunter B Moore, Arsen Ghasabyan, Mitchell Cohen, Benjamin R Huebner, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Resuscitation guided by thrombelastography improves survival after injury. If bleeding is rapid, however, or if no thrombelastography data are available, the optimal strategy remains controversial. Our current practice gives fresh frozen plasma and red blood cells (1:2) empirically in patients with life-threatening hemorrhage, with subsequent administration based on rapid thrombelastography. We identified patients at risk of massive transfusion at 1 hour, examined their initial rapid thrombelastography, and used this value to provide empiric recommendations about transfusions...
April 27, 2018: Surgery
https://www.readbyqxmd.com/read/29707780/diagnostic-performance-of-prothrombin-time-point-of-care-to-detect-acute-traumatic-coagulopathy-on-admission-experience-of-522-cases-in-trauma-center
#5
Pauline Deras, Jibril Nouri, Orianne Martinez, Emmanuelle Aubry, Xavier Capdevila, Jonathan Charbit
BACKGROUND: Early identification of acute traumatic coagulopathy is a key challenge during initial management to determine whether to initiate early hemostatic support. We assessed the performance of prothrombin time (PT) at point-of-care in trauma patients to detect moderate and severe coagulopathy on admission. STUDY DESIGN AND METHODS: All admitted consecutive trauma patients were analyzed retrospectively between April 2014 and July 2015. PT was measured on admission with both a PT point-of-care device (PTr-CGK) and a standard coagulation test (PTr-STD)...
April 29, 2018: Transfusion
https://www.readbyqxmd.com/read/29703240/temporal-phenotyping-of-circulating-microparticles-after-trauma-a-prospective-cohort-study
#6
Matthias Fröhlich, Nadine Schäfer, Michael Caspers, Julia K Böhm, Ewa K Stürmer, Bertil Bouillon, Marc Maegele
BACKGROUND: After severe polytrauma the dynamic process of coagulation may deteriorate towards a trauma-induced coagulopathy (TIC) promoting a dramatic increase in morbidity and mortality. Recent evidence suggests that microparticles (MPs) play a pivotal role at the interface between cellular and plasmatic coagulation systems. However, the impact of MPs on functional coagulation has not been clarified yet in the setting of traumatic injuries. We assessed the temporal patterns of circulating MP concentrations including their cellular origin in the context of clinical presentation and global coagulation assays...
April 27, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29683829/harmful-or-physiologic-diagnosing-fibrinolysis-shutdown-in-a-trauma-cohort-with-rotational-thromboelastometry
#7
J Carolina Gomez-Builes, Sergio A Acuna, Bartolomeu Nascimento, Fabiana Madotto, Sandro B Rizoli
BACKGROUND: Despite its central role in early trauma coagulopathy, abnormal fibrinolysis continues to be poorly understood. Excessive fibrinolysis is a known contributor to mortality. Recent studies with thromboelastography (TEG) suggest decreased fibrinolysis (or shutdown) may be just as harmful. Considering the broad use of 2 different viscoelastic assays, which are not interchangeable, we proposed for the first time to define and characterize fibrinolysis shutdown using rotational thromboelastometry (ROTEM)...
April 19, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29675813/computational-model-for-hyperfibrinolytic-onset-of-acute-traumatic-coagulopathy
#8
Tie Bo Wu, Sheng Wu, Matthew Buoni, Thomas Orfeo, Kathleen Brummel-Ziedins, Mitchell Cohen, Linda Petzold
The onset of acute traumatic coagulopathy in trauma patients exacerbates hemorrhaging and dramatically increases mortality. The disease is characterized by increased localized bleeding, and the mechanism for its onset is not yet known. We propose that the fibrinolytic response, specifically the release of tissue-plasminogen activator (t-PA), within vessels of different sizes leads to a variable susceptibility to local coagulopathy through hyperfibrinolysis which can explain many of the clinical observations in the early stages from severely injured coagulopathic patients...
April 19, 2018: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/29664892/the-role-of-4-factor-prothrombin-complex-concentrate-4-pcc-in-coagulopathy-of-trauma-a-propensity-matched-analysis
#9
Faisal Jehan, Hassan Aziz, Terence O'Keeffe, Muhammad Khan, El Rasheid Zakaria, Mohammad Hamidi, Muhammad Zeeshan, Narong Kulvatunyou, Bellal Joseph
INTRODUCTION: Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor Prothrombin Complex Concentrate (4-PCC) as an adjunct to FFP in reversal of coagulopathy of trauma has not been studied. The aim of our study is to compare 4-PCC+FFP vs. FPP alone for the treatment of COT. METHODS: We reviewed all trauma patients >18y who received PCC+FFP or FFP alone at our Level I trauma center from 2015-16. We excluded patients on preinjury oral anticoagulants...
April 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29664836/teg-lysis-shutdown-represents-coagulopathy-in-bleeding-trauma-patients-analysis-of-the-proppr-cohort
#10
Jessica C Cardenas, Charles E Wade, Bryan A Cotton, Mitchell J George, John B Holcomb, Martin A Schreiber, Nathan J White
BACKGROUND: Thrombelastography (TEG) fibrinolysis shutdown after trauma is associated with increased mortality due to hypercoagulability-associated organ failure. However, a lack of mechanistic data has precluded the development of novel interventions to treat shutdown. OBJECTIVES: To define the pathophysiology of TEG shutdown in severely injured, bleeding patients through secondary analysis of the PROPPR trial. METHODS: Fibrinolysis was characterized in PROPPR subjects using admission TEG lysis at 30 minutes (LY30) or plasmin-antiplasmin (PAP) levels...
April 16, 2018: Shock
https://www.readbyqxmd.com/read/29664833/effect-of-pre-hospital-red-blood-cell-transfusion-on-mortality-and-time-of-death-in-civilian-trauma-patients
#11
Marius Rehn, Anne Weaver, Karim Brohi, Sarah Eshelby, Laura Green, Jo Røislien, David J Lockey
BACKGROUND: Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. METHODS: Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients...
April 16, 2018: Shock
https://www.readbyqxmd.com/read/29664514/-damage-control-resuscitation-in-pediatric-severe-trauma
#12
Adriana Wegner Araya
INTRODUCTION: Trauma is an important cause of morbidity and mortality in the pediatric population. It has the first place in mortality in our country without considering perinatal pathologies and congenital malformations. An important percentage of early and late deaths secondary to this cau se, as well as its sequelae, could be prevented with optimal and timely resuscitation. OBJECTIVE: To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma, with emphasis on medical management...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29649339/pathogenic-factors-associated-with-development-of-disseminated-intravascular-coagulopathy-dic-in-a-tertiary-academic-hospital-in-south-africa
#13
Elizabeth S Mayne, Anthony L H Mayne, Susan J Louw
INTRODUCTION: Disseminated intravascular coagulopathy (DIC) is a thrombotic microangiopathy arising from consumption of both coagulation factors and platelets. DIC is triggered by a number of clinical conditions including severe infection, trauma and obstetric complications. Early diagnosis and treatment of the underlying condition is paramount. A high clinical index of suspicion is needed to ensure that patients at risk of developing DIC are appropriately investigated. METHODS: In order to establish the clinical conditions most frequently associated with DIC, we reviewed all DIC screens received at a tertiary hospital in Johannesburg, South Africa over a 1 year period...
2018: PloS One
https://www.readbyqxmd.com/read/29628667/early-predictive-factors-of-hypofibrinogenemia-in-acute-trauma-patients
#14
Shahram Paydar, Behnam Dalfardi, Zahra Shayan, Leila Shayan, Jalal Saem, Shahram Bolandparvaz
Background: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. Aims: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients...
January 2018: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29621120/absences-of-endothelial-microvesicle-changes-in-the-presence-of-the-endotheliopathy-of-trauma
#15
Charles E Wade, Nena Matijevic, Yao-Wei W Wang, Erika Gonzalez Rodriguez, Ernesto Lopez, Sisse R Ostrowski, Jessica C Cardenas, Lisa A Baer, Tzu-An Chen, Jeffrey S Tomasek, Hanne H Henriksen, Jakob Stensballe, Bryan A Cotton, John B Holcomb, Pär I Johansson
INTRODUCTION: Severe trauma is accompanied by endothelial glycocalyx disruption, which drives coagulopathy, increasing transfusion requirements and death. This syndrome has been termed traumatic endotheliopathy (EOT). Some have suggested EOT results from endothelial cellular damage and apoptosis. Endothelial microvesicles (EMVs) represent cellular damage. We hypothesized that EOT is associated with endothelial damage and apoptosis resulting in an increase in circulating EMVs. METHODS: Prospective, observational study enrolling severely injured patients...
April 4, 2018: Shock
https://www.readbyqxmd.com/read/29618154/low-plasma-adamts13-activity-is-associated-with-coagulopathy-endothelial-cell-damage-and-mortality-after-severe-paediatric-trauma
#16
Robert T Russell, Jenny K McDaniel, Wenjing Cao, Michelle Shroyer, Brant M Wagener, X Long Zheng, Jean-François Pittet
Decrease of plasma activity of ADAMTS13, a metalloenzyme that cleaves von Willebrand factor (VWF) and prevents adhesion and aggregation of platelets, has been reported early after onset of systemic inflammation resulting from infections and after severe trauma. Here, we determined whether trauma-induced systemic (sterile) inflammation would be associated with a reduction of plasma ADAMTS13 activity in paediatric patients and its association with disease severity and outcome. Paediatric patients ( n  = 106) with severe trauma at a level 1 paediatric trauma centre between 2014 and 2016 were prospectively enrolled...
April 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29589832/acute-traumatic-coagulopathy-the-value-of-histone-in-pediatric-trauma-patients
#17
Emel Ulusoy, Murat Duman, Aykut Çağlar, Tuncay Küme, Anıl Er, Fatma Akgül, Hale Çitlenbik, Durgül Yılmaz, Hale Ören
OBJECTIVE: Acute traumatic coagulopathy occurs after trauma with impairment of hemostasis and activation of fibrinolysis. Some endogenous substances may play role in this failure of the coagulation system. Extracellular histone is one such molecule that has recently attracted attention. This study investigated the association between plasma histone- complexed DNA (hcDNA) fragments and coagulation abnormalities in pediatric trauma patients. MATERIALS AND METHODS: This prospective case- control study was conducted in pediatric patients with trauma...
March 28, 2018: Turkish Journal of Haematology: Official Journal of Turkish Society of Haematology
https://www.readbyqxmd.com/read/29573326/platelets-loaded-with-thrombin-encapsulated-liposomes-have-increased-coagulability
#18
Vivienne Chan, Morteza Sarkari, Rachel Sunderland, Alexander E St John, Nathan J White, Christian J Kastrup
BACKGROUND: Platelets are integral to clot formation, and are often transfused to stop or prevent bleeding. However, transfusions of platelets are not always effective, particularly in the most severe cases of hemorrhage. Nanoparticle systems have been developed to mimic platelets but inherently lack important aspects of platelet function which limits their potential effectiveness. OBJECTIVES: Increasing the natural coagulability of transfusable platelets could increase their efficacy during treatment of severe hemorrhage...
March 24, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29564685/an-increased-tendency-in-fibrinogen-activity-and-its-association-with-a-hypo-fibrinolytic-state-in-early-stages-after-injury-in-patients-without-acute-traumatic-coagulopathy-atc
#19
S He, M Blombäck, F Boström, H Wallen, J Svensson, A Östlund
Acute traumatic coagulopathy (ATC) diagnosed by prolongation of APTT and/or PT/INR involves alterations in platelet activity, coagulation and fibrinolysis. However, data showing the haemostatic situation in injured patients without ATC are scarce. To assess whether haemostatic impairment is also present in injured patients without ATC, ten injured patients without ATC and ten normal individuals were examined. The patients were sampled on arrival at the emergency department 0, 2, 12 h after surgical or other intervention...
March 21, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29557885/the-s100a10-pathway-mediates-an-occult-hyperfibrinolytic-subtype-in-trauma-patients
#20
Lewis S Gall, Paul Vulliamy, Scarlett Gillespie, Timothy F Jones, Rochelle S J Pierre, Sabine E Breukers, Christine Gaarder, Nicole P Juffermans, Marc Maegele, Jakob Stensballe, Pär I Johansson, Ross A Davenport, Karim Brohi
OBJECTIVE: To determine the characteristics of trauma patients with low levels of fibrinolysis as detected by viscoelastic hemostatic assay (VHA) and explore the underlying mechanisms of this subtype. BACKGROUND: Hyperfibrinolysis is a central component of acute traumatic coagulopathy but a group of patients present with low levels of VHA-detected fibrinolysis. There is concern that these patients may be at risk of thrombosis if empirically administered an antifibrinolytic agent...
March 19, 2018: Annals of Surgery
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