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Acute coagulopathy of trauma

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
Sunder Balasubramaniam, Ying Xin Teo, Felicia Hz Chua, Jolene Yx Cheng, Li Tserng Teo
No abstract text is available yet for this article.
February 2018: Annals of the Academy of Medicine, Singapore
Ehsan Akbari, Saeed Safari, Hamidreza Hatamabadi
INTRODUCTION: The debate on replacing coagulation factors and its effect on the final outcome of the patients with acute traumatic coagulopathy (ATC) in need of transfusion is still ongoing. Therefore, the present study is designed with the aim of comparing the outcome of patients with acute traumatic coagulopathies receiving fibrinogen and fresh frozen plasma (FFP). METHODS: In this quasi-experimental randomized controlled study, patients with severe blunt trauma (ISS>16) and in need of packed cells transfusion were divided into 3 groups of receiving fibrinogen, receiving FFP, and control, and their final outcome was compared...
February 22, 2018: American Journal of Emergency Medicine
Ajit Sarnaik, Nikki Miller Ferguson, A M Iqbal O'Meara, Shruti Agrawal, Akash Deep, Sandra Buttram, Michael J Bell, Stephen R Wisniewski, James F Luther, Adam L Hartman, Monica S Vavilala
BACKGROUND: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. METHODS: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy)...
February 23, 2018: Neurocritical Care
Ma-Jing Feng, Wei-Bin Ning, Wei Wang, Zhong-Hua Lv, Xin-Bing Liu, Yong Zhu, Wei Gao, Hong-Ze Jin, Shu-Shan Gao
BACKGROUND: S100A12 is related to acute brain injury and inflammation. We investigated the clinical prognostic value of serum S100A12 in patients with severe traumatic brain injury (sTBI). METHODS: Serum S100A12, S100B, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) concentrations were measured in 102 healthy controls and 102 sTBI patients. We recorded 30-day mortality and in-hospital major adverse events (IMAEs) including acute lung injury, acute traumatic coagulopathy, progressive hemorrhagic injury and posttraumatic cerebral infarction...
January 31, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Venencia Albert, Arulselvi Subramanian, Deepak Agrawal, Hara Prasad Pati, Siddhartha Datta Gupta, Asok Kumar Mukhopadhyay
STUDY DESIGN: Prospective observational cohort. OBJECTIVE: To investigate the difference in plasma levels of syndecan-1 (due to glycocalyx degradation) and soluble thrombomodulin (due to endothelial damage) in isolated severe traumatic brain injury (TBI) patients with/without early coagulopathy. A secondary objective was to compare the effects of the degree of TBI endotheliopathy on hospital mortality among patients with TBI-associated coagulopathy (TBI-AC). METHODS: Data was prospectively collected on isolated severe TBI (sTBI) patients with Glasgow Coma Scale (GCS) ≤8 less than 12 h after injury admitted to a level I trauma centre...
January 16, 2018: Medical Sciences: Open Access Journal
Özgür Sezer, Ali Attila Aydin, Sedat Bilge, Fatih Arslan, Hasan Arslan
Lingual hematoma is a severe situation, which is rare and endangers the airway. It can develop due to trauma, vascular abnormalities, and coagulopathy. Due to its sudden development, it can be clinically confused with angioedema. In patients who applied to the doctor with complaints of a swollen tongue, lingual hematoma can be confused with angioedema, in particular, at the beginning if the symptoms occurred after drug use. It should especially be considered that dystonia in the jaw can present as drug-induced hyperkinetic movement disorder...
July 2017: Indian Journal of Pharmacology
Lewis S Gall, Ross A Davenport
PURPOSE OF REVIEW: The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. RECENT FINDINGS: Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage...
April 2018: Current Opinion in Anaesthesiology
Martin Lucien Tonglet, Jean-Louis Poplavsky, Laurence Seidel, Jean Marc Minon, Vincenzo D'Orio, Alexandre Ghuysen
Introduction Evidence supporting the use of Thromboelastography (TEG®) and rotational thromboelastometric (ROTEM®) in the trauma setting remains limited. We present the results of a practical evaluation of the potential interest of ROTEM® in the diagnosis of acute coagulopathy and the need for emergent blood product transfusion in the general trauma population of a non-trauma Belgian emergency department. Methods Extracting a convenience cohort from the initial prospective TICCS study, we performed a retrospective analysis to test the following hypothesis: ROTEM® might be helpful to discriminate trauma patients with or without acute coagulopathy...
January 4, 2018: Acta Clinica Belgica
Michael S Lallemand, Donald M Moe, John M McClellan, Michael Loughren, Shannon Marko, Matthew J Eckert, Matthew J Martin
BACKGROUND: The acute coagulopathy of trauma is often accompanied by hyperfibrinolysis. Tranexamic acid (TXA) can reverse this phenomenon, and, when given early, decreases mortality from bleeding. Establishing intravenous (IV) access can be difficult in trauma and intraosseous (IO) access is often preferred for drug administration. Currently, there are no data on the efficacy of IO administered TXA. Our objectives were to compare serum concentrations of TXA when given IV and IO and to compare the efficacy of IO administered TXA to IV at reversing hyperfibrinolysis...
February 2018: Journal of Trauma and Acute Care Surgery
Xiaowu Wu, Daniel N Darlington, Robbie K Montgomery, Bin Liu, Jeffrey D Keesee, Michael R Scherer, Avi Benov, Jacob Chen, Andrew P Cap
The in vitro haemostatic functions of fresh whole blood (FWB) are well preserved after cold storage. This study aimed to determine whether platelets derived from FWB and stored whole blood (SWB) contribute to clot formation in tissue injury after transfusion into coagulopathic rats with polytrauma/haemorrhage (T/H). The rats were resuscitated 1 h after trauma with FWB or SWB collected from green fluorescence protein (GFP) transgenic rats. After transfusion, a liver incision was made and the tissue was collected 10 min after injury to identify GFP+ platelets by immunohistochemistry...
December 2017: British Journal of Haematology
Junya Tsurukiri, Shoichi Ohta, Akira Hoshiai, Hidefumi Sano, Eitaro Okumura, Nobuhiko Tsubouchi, Hiroyuki Konishi, Tetsuo Yukioka
Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on "speedy stoppage of bleeding" by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy...
April 2017: Acute Medicine & Surgery
Magdalene Brooke, Atul Patel, Federico Castro-Moure, Gregory P Victorino
BACKGROUND: Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. METHODS: We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015...
November 2017: Journal of Surgical Research
Jakob Stensballe, Hanne H Henriksen, Pär I Johansson
PURPOSE OF REVIEW: The aim of this study was to discuss the recent developments in trauma-induced coagulopathy and the evolvement of goal-directed therapy. RECENT FINDINGS: Mortality from major trauma continues to be a worldwide problem, and massive haemorrhage remains a major cause in 40% of potentially preventable trauma deaths. Development of trauma-induced coagulopathy challenges 25-35% of the patients further increasing trauma mortality. The pathophysiology of coagulopathy in trauma reflects at least two distinct mechanisms: Acute traumatic coagulopathy, consisting of endogenous heparinization, activation of the protein C pathway, hyperfibrinolysis and platelet dysfunction, and resuscitation associated coagulopathy...
December 2017: Current Opinion in Critical Care
Tetsuya Yumoto, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Hiromichi Naito, Takaaki Osako, Atsunori Nakao
Worldwide, hemorrhagic shock in major trauma remains a major potentially preventable cause of death. Controlling bleeding and subsequent coagulopathy is a big challenge. Immediate assessment of unidentified bleeding sources is essential in blunt trauma patients with hemorrhagic shock. Chest/pelvic X-ray in conjunction with ultrasonography have been established classically as initial diagnostic imaging modalities to identify the major sources of internal bleeding including intra-thoracic, intra-abdominal, or retroperitoneal hemorrhage related to pelvic fracture...
October 2017: Acta Medica Okayama
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
December 2017: Current Opinion in Critical Care
Edouard Girard, Julio Abba, Bastien Boussat, Bertrand Trilling, Adrian Mancini, Pierre Bouzat, Christian Létoublon, Mircea Chirica, Catherine Arvieux
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7...
April 2018: World Journal of Surgery
Hojjat Derakhshanfar, Ali Vafaei, Ali Tabatabaey, Shamila Noori
INTRODUCTION: Acute traumatic coagulopathy (ATC) is defined as having evidence of coagulopathy in patients with severe trauma. The aim of this preliminary study was to assess the prevalence and associated factors of ATC in severely traumatic patients presenting to emergency department (ED). METHODS: In this retrospective cross sectional study, all patients with severe traumatic injury and available coagulation profile, presenting to the EDs of two major trauma centers in Tehran, Iran, during one year, were studied...
2017: Emergency (Tehran, Iran)
Benjamin R Childs, Daniel R Verhotz, Timothy A Moore, Heather A Vallier
OBJECTIVES: To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality. DESIGN: Prospective, observational. SETTING: Level 1 trauma center. PATIENTS: Three hundred seventy-six skeletally mature patients with an Injury Severity Score greater than 16, who were surgically treated for high-energy fractures of the femur, pelvic ring, acetabulum, and/or spine...
December 2017: Journal of Orthopaedic Trauma
Ashley M Eckel, John R Hess
Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood-derived platelets to packed red blood cells is now the most common strategy and the stated goal of directors of >80% of the level I trauma centers in the United States...
August 2017: Southern Medical Journal
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