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Traumatic Coagulopathy

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https://www.readbyqxmd.com/read/29772364/pathophysiology-and-non-surgical-treatment-of-chronic-subdural-hematoma-from-past-to-present-to-future
#1
REVIEW
Dana C Holl, Victor Volovici, Clemens M F Dirven, Wilco C Peul, Fop van Kooten, Korné Jellema, Niels A van der Gaag, Ishita P Miah, Kuan H Kho, Heleen M den Hertog, Hester F Lingsma, Ruben Dammers
BACKGROUND: Chronic subdural hematoma (CSDH) is one of the more frequent pathological entities in daily neurosurgical practice. Historically, CSDH was considered a progressive, recurrent bleeding with a traumatic etiology. However, recent evidence suggests a complex intertwined pathway of inflammation, angiogenesis, local coagulopathy, recurrent microbleeds and exudates. The aim of the present review is to collect existing data on pathophysiology of CSDH in order to direct further research questions aiming to optimize treatment for the individual patient...
May 14, 2018: World Neurosurgery
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
#2
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
#3
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/29675813/computational-model-for-hyperfibrinolytic-onset-of-acute-traumatic-coagulopathy
#4
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/29671294/standard-of-care-controversies-and-innovations-in-the-medical-treatment-of-severe-traumatic-brain-injury-stbi
#5
Alba Scerrati, Silvia De Rosa, Lorenzo Mongardi, Michele A Cavallo, Giorgio Trapella, Pasquale De Bonis
Severe traumatic brain injury (STBI) is characterized by a primary injury which cannot be reversed and a secondary injury that can be prevented or reversed. Management of STBI patients in intensive care mainly aims at preventing the secondary injury. Treatment aims to: reducing ICP pressure (that can result in an ischemic insult); avoiding hypotension, hyperthermia, or hypoxemia; maintaining a normal electrolytes homeostasis; treating the Autonomic dysfunction syndrome, coagulopathies, Acute Kidney Injury and maintaining an adequate nutrition...
April 18, 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29644287/successful-use-of-intrapelvic-quikclot-in-life-threatening-blast-injury
#6
Naveen Virin Goddard, Demetrius Evriviades
Patients that suffer multiple traumatic injuries often present with uncontrollable haemorrhage and rapidly descend into a viscous death triad consisting of hypothermia, coagulopathy and acidosis. Initial surgical intervention does not aim to provide conclusive repair, but instead strives to stop blood loss while priority is given to correct the patient's metabolic state (Duchesne et al., 2010). However in some cases of massive polytrauma, gaining surgical control of bleeding can be incredibly difficult. As a result a number of topical haemostatic agents were developed for use in military and civilian settings...
December 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29628667/early-predictive-factors-of-hypofibrinogenemia-in-acute-trauma-patients
#7
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
#8
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
#9
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/29615381/hyperfibrinolysis-diagnosed-with-rotational-thromboelastometry-and-treated-with-tranexamic-acid-in-a-dog-with-acute-traumatic-coagulopathy
#10
B Muri, P Schmierer, A Schwarz, N Sigrist
A 4-year old male Australian Cattle Dog involved in a road traffic accident was presented with severe polytrauma to the Small Animal Clinic, University of Zurich. He was presented in hemorrhagic shock, with an initial lactate of 10.3mmol/l and ongoing bleeding from multiple injury sites. Acute traumatic coagulopathy diagnosed with ROTEM within one hour after accident showed marked hypocoagulation and hyperfibrinolysis. Treatment with a total dose of 40mg/kg of tranexamic acid intravenously resulted in successful elimination of hyperfibrinolysis in the following, serially measured ROTEM tracings...
April 2018: Schweizer Archiv Für Tierheilkunde
https://www.readbyqxmd.com/read/29589832/acute-traumatic-coagulopathy-the-value-of-histone-in-pediatric-trauma-patients
#11
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/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
#12
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
#13
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
https://www.readbyqxmd.com/read/29554045/adenosine-lidocaine-and-mg2-alm-resuscitation-fluid-protects-against-experimental-traumatic-brain-injury
#14
Hayley L Letson, Geoffrey P Dobson
BACKGROUND: Currently no drug therapy prevents secondary injury progression after TBI. Our aim was to investigate the effects of small-volume intravenous adenosine, lidocaine and Mg (ALM) resuscitation fluid after moderate-TBI in a rat fluid-percussion injury model. METHODS: Anesthetized, mechanically-ventilated male Sprague-Dawley rats (449±5g) were randomly assigned to one of four groups: 1) Sham (craniotomy without TBI), 2) No-Treatment, 3) Saline-controls or 4) ALM therapy (all n=16)...
March 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29538225/interventional-vitamin-c-a-strategy-for-attenuation-of-coagulopathy-and-inflammation-in-a-swine-polytrauma-model
#15
Penny S Reynolds, Bernard J Fisher, Jacquelyn McCarter, Christopher Sweeney, Erika J Martin, Paul Middleton, Matthew Ellenberg, Evan Fowler, Donald F Brophy, Alpha A Fowler, Bruce D Spiess, Ramesh Natarajan
BACKGROUND: Coagulopathy and inflammation induced by hemorrhagic shock and traumatic injury are associated with increased mortality and morbidity. Vitamin C (VitC) is an antioxidant with potential protective effects on the pro-inflammatory and pro-coagulant pathways. We hypothesized that high-dose VitC administered as a supplement to fluid resuscitation would attenuate inflammation, coagulation dysfunction, and end-organ tissue damage in a swine model of polytrauma and hemorrhage. METHODS: Male Sinclair swine (n = 24; mean body weight 27 kg) were anesthetized, intubated, mechanically ventilated, and instrumented for physiological monitoring...
March 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29507078/coagulopathy-induced-by-traumatic-brain-injury-systemic-manifestation-of-a-localized-injury
#16
REVIEW
Jianning Zhang, Fangyi Zhang, Jing-Fei Dong
Traumatic brain injury (TBI)-induced coagulopathy is a common and well-recognized risk for poor clinical outcomes, but its pathogenesis remains poorly understood, and treatment options are limited and ineffective. We discuss the recent progress and knowledge gaps in understanding this lethal complication of TBI. We focus on (1) the disruption of the brain-blood barrier to disseminate brain injury systemically by releasing brain-derived molecules into the circulation and (2) TBI-induced hypercoagulable and hyperfibrinolytic states that result in persistent and delayed intracranial hemorrhage and systemic bleeding...
May 3, 2018: Blood
https://www.readbyqxmd.com/read/29502974/the-effect-of-fibrinogen-concentrate-and-fresh-frozen-plasma-on-the-outcome-of-patients-with-acute-traumatic-coagulopathy-a-quasi-experimental-study
#17
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
https://www.readbyqxmd.com/read/29476389/age-and-mortality-in-pediatric-severe-traumatic-brain-injury-results-from-an-international-study
#18
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
https://www.readbyqxmd.com/read/29452722/traumatic-lingual-hematoma-resulting-in-bilateral-temporal-mandibular-joint-dislocations
#19
Dhara P Amin, Michael N Cooper, Kim I Newton
BACKGROUND: Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction. CASE REPORT: Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously undiagnosed thrombocytopenia...
February 13, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29443859/over-resuscitation-with-plasma-is-associated-with-sustained-fibrinolysis-shutdown-and-death-in-pediatric-traumatic-brain-injury
#20
Christine M Leeper, Matthew D Neal, Timothy R Billiar, Jason L Sperry, Barbara A Gaines
BACKGROUND: Elevated INR is a marker of poor outcome but not necessarily bleeding or clinical coagulopathy in injured children. Conversely, children with traumatic brain injury (TBI) tend to be hypercoagulable based on rapid thromboelastography (rTEG) parameters. Many clinicians continue to utilize INR as a treatment target. METHODS: Prospective observational study of severely-injured children age<18 with rTEG on arrival and daily thereafter for up to 7 days...
February 14, 2018: Journal of Trauma and Acute Care Surgery
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