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Trauma coagulopathy

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https://www.readbyqxmd.com/read/28079258/combined-effect-of-therapeutic-strategies-for-bleeding-injury-on-early-survival-transfusion-needs-and-correction-of-coagulopathy
#1
K Balvers, S van Dieren, K Baksaas-Aasen, C Gaarder, K Brohi, S Eaglestone, S Stanworth, P I Johansson, S R Ostrowski, J Stensballe, M Maegele, J C Goslings, N P Juffermans
BACKGROUND: The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleeding. METHODS: A prospective multicentre observational study was performed in six level 1 trauma centres. Injured patients who received at least 4 units of red blood cells (RBCs) were analysed and divided into groups receiving a low (less than 1 : 1) or high (1 or more : 1) ratio of plasma or platelets to RBCs, and in receipt or not of tranexamic acid or fibrinogen products (fibrinogen concentrates or cryoprecipitate)...
January 12, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28067012/venous-thromboembolism-in-pediatric-trauma-patients-ten-year-experience-and-long-term-follow-up-in-a-tertiary-care-center
#2
Christine M Leeper, Madhav Vissa, James D Cooper, Lynn M Malec, Barbara A Gaines
BACKGROUND: Pediatric trauma patients are at high risk for development of venous thromboembolism (VTE). Our objective is to describe incidence, risk factors, and timing of development of VTE, anticoagulation complications, and long-term VTE outcomes in a critically injured pediatric population. PROCEDURE: We did a retrospective review of pediatric (0-17 years) trauma admissions to intensive care unit from 2005 to 2014. Our center employs VTE screening and prevention protocols for high-risk patients based on hypercoagulable history, age, injuries, and medical interventions...
January 9, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28062209/thromboelastogram-does-not-detect-pre-injury-anticoagulation-in-acute-trauma-patients
#3
Jawad T Ali, Mitchell J Daley, Nina Vadiei, Zachary Enright, Joseph Nguyen, Sadia Ali, Jayson D Aydelotte, Pedro G Teixeira, Thomas B Coopwood, Carlos Vr Brown
PURPOSE: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC. METHODS: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24h...
December 26, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28058475/strategies-for-intravenous-fluid-resuscitation-in-trauma-patients
#4
Robert Wise, Michael Faurie, Manu L N G Malbrain, Eric Hodgson
Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.
January 5, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28053156/targeted-clinical-control-of-trauma-patient-coagulation-through-a-thrombin-dynamics-model
#5
Amor A Menezes, Ryan F Vilardi, Adam P Arkin, Mitchell J Cohen
We present a methodology for personalizing the clinical treatment of severely injured patients with acute traumatic coagulopathy (ATC), an endogenous biological response of impaired coagulation that occurs early after trauma and shock and that is associated with increased bleeding, morbidity, and mortality. Despite biological characterization of ATC, it is not easily or rapidly diagnosed, not always captured by slow laboratory testing, and not accurately represented by coagulation models. This lack of knowledge, combined with the inherent time pressures of trauma treatment, forces surgeons to treat ATC patients according to empirical resuscitation protocols...
January 4, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28041551/-haemostatic-resuscitation-in-bleeding-trauma-patients
#6
Jakob Stensballe, Pär I Johansson, Jacob Steinmetz
Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions or pro-haemostatics...
December 26, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28033136/permissive-hypotension-and-trauma-can-fluid-restriction-reduce-the-incidence-of-ards
#7
Melissa Kolarik, Eric Roberts
Emergency care, including the resuscitation of patients involved in traumatic events, has evolved over the years. A prior practice of utilizing large volumes of crystalloids has been found to contribute to complications such as coagulopathy, fluid overload, and adult respiratory distress syndrome (ARDS). In contrast, permissive hypotension is a method of fluid restriction that allows for low blood pressure and mean arterial pressure during the resuscitation period. When permissive hypotension occurs and fluids are restricted in trauma patients, the incidence of ARDS can be reduced significantly with improvement in patient outcomes...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28033135/omega-3-fatty-acid-supplementation-and-warfarin-a-lethal-combination-in-traumatic-brain-injury
#8
Brian W Gross, Maria Gillio, Cole D Rinehart, Caitlin A Lynch, Frederick B Rogers
Polyunsaturated fatty acids such as omega-3 eicosapentaenoic acid and omega-6 docosahexaenoic acid, found in over-the-counter fish oil supplements, are often consumed for their beneficial, prophylactic, anti-inflammatory effects. Although the mechanisms of action are not fully known, a diet rich in polyunsaturated fats may reduce the risk of hyperlipidemia, atherosclerosis, high low-density lipoprotein cholesterol levels, hypertension, and inflammatory diseases. Masked by its many benefits, the risks of omega-3 fatty acid supplementation are often underappreciated, particularly its ability to inhibit platelet aggregation and promote bleeding in patients taking anticoagulant medications...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28030486/non-human-primate-model-of-poly-traumatic-hemorrhagic-shock-recapitulates-early-platelet-dysfunction-observed-following-severe-injury-in-humans
#9
Leasha J Schaub, Hunter B Moore, Andrew P Cap, Jacob J Glaser, Ernest E Moore, Forest R Sheppard
BACKGROUND: Platelet dysfunction has been described as an early component of trauma induced coagulopathy (TIC). The platelet component of TIC remains to be fully elucidated and translatable animal models are required to facilitate mechanistic investigations. We sought to determine if the early platelet dysfunction described in trauma patients could be recapitulated in an non-human primate (NHP) model of poly-traumatic hemorrhagic shock. METHODS: Twenty-four male Rhesus Macaques weighting 7-14 kilograms were subjected to 60 minutes (min) severe pressure-targeted controlled hemorrhagic shock (HS) with and without other injuries...
December 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27994260/a-case-of-successful-thromboelastographic-guided-resuscitation-after-postpartum-hemorrhage-and-cardiac-arrest
#10
M Hurwich, D Zimmer, E Guerra, E Evans, T Shire, M Abernathy, J T Shreve, G R Kolettis, M T McCurdy, F J Castellino, M Walsh
Amniotic fluid embolism (AFE) is an unusual cause of life threatening peri partum hemorrhage (PPH). AFE resuscitation is often associated with renal and respiratory insufficiency, and a coagulopathy similar to disseminated intravascular coagulation (DIC). Resuscitation requires immediate recognition and limited use of crystalloid. We present a case of PPH caused by AFE with resultant cardiac arrest, renal and respiratory failure, and DIC-like coagulopathy, whose successful resuscitation was guided by perfusionist-directed serial thromboelastography (TEG)...
December 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27984401/who-orders-a-head-ct-perceptions-of-the-cirrhotic-bleeding-risk-in-an-international-multispecialty-survey-study
#11
Laura M Mazer, Marie Méan, Elliot B Tapper
OBJECTIVE: Traditional coagulopathic indices, including elevated international normalized ratio, do not correlate with bleeding risk in patients with cirrhosis. For this reason, head computed tomography (CT) has a low yield in cirrhotic patients with altered mental status and no trauma history. The initial diagnostic evaluation, however, is often made by nongastroenterologists influenced by the so-called "coagulopathy of cirrhosis." We sought to examine the prevalence, impact, and malleability of this perception in an international, multispecialty cohort...
December 14, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27941590/traumatic-hemothorax-blood-contains-elevated-levels-of-microparticles-that-are-prothrombotic-but-inhibit-platelet-aggregation
#12
Thomas A Mitchell, Maryanne C Herzig, Chriselda G Fedyk, Marc A Salhanick, Aaron T Henderson, Bijaya K Parida, Nicolas J Prat, Daniel L Dent, Martin G Schwacha, Andrew P Cap
OBJECTIVES: Autotransfusion of shed blood from traumatic hemothorax is an attractive option for resuscitation of trauma patients in austere environments. However, previous analyses revealed that shed hemothorax (HX) blood is defibrinated, thrombocytopenic, and contains elevated levels of D-dimer. Mixing studies with normal pooled plasma demonstrated hypercoagulability, evoking concern for potentiation of acute traumatic coagulopathy. We hypothesized that induction of coagulopathic changes by shed HX blood may be due to increases in cellular microparticles (MP) and that these may also affect recipient platelet function...
December 9, 2016: Shock
https://www.readbyqxmd.com/read/27940454/acute-traumatic-coagulopathy-pathophysiology-and-resuscitation
#13
J W Simmons, M F Powell
Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27939017/regional-analgesia-in-postsurgical-critically-ill-patients
#14
S Moliner Velázquez, R Rubio Haro, C De Andrés Serrano, J De Andrés Ibáñez
Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed...
December 7, 2016: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27914759/fluid-management-in-patients-with-trauma-restrictive-versus-liberal-approach
#15
REVIEW
Lee Palmer
Massive hemorrhage remains a major cause of traumatic deaths. The ideal fluid resuscitative strategy is much debated. Research has provided inconsistent results regarding which fluid strategy is ideal; the optimum fluid type, timing, and volume remains elusive. Aggressive large-volume resuscitation has been the mainstay based on controlled hemorrhage animal models. For uncontrolled hemorrhagic shock, liberal fluid resuscitative strategies exacerbate the lethal triad, invoke resuscitative injury, and increase mortality while more restrictive fluid strategies tend to ameliorate trauma-induced coagulopathy and favor a greater chance of survival...
December 1, 2016: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/27913815/-volume-therapy-in-the-severely-injured-patient-recommendations-and-current-guidelines
#16
Sigune Kaske, Marc Maegele
BACKGROUND: Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. METHOD: Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature...
December 2, 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27906868/individual-clotting-factor-contributions-to-mortality-following-trauma
#17
Ryan C Kunitake, Benjamin M Howard, Lucy Z Kornblith, Sabrinah A Christie, Amanda S Conroy, Mitchell J Cohen, Rachael A Callcut
BACKGROUND: Acute traumatic coagulopathy (ATC) afflicts 20-30% of trauma patients, but the extensive collinearity of the coagulation cascade complicates attempts to clarify global clotting factor dysfunction. This study aims to characterize phenotypes of clotting factor dysfunction and their contributions to mortality after major trauma. METHODS: This prospective cohort study examines all adult trauma patients of the highest activation level presenting to San Francisco General Hospital between 2/2005 and 2/2015...
November 30, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27898431/improving-outcome-of-trauma-patients-by-implementing-patient-blood-management
#18
Christoph Füllenbach, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. RECENT FINDINGS: Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy...
November 24, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27895932/coagulation-complications-following-trauma
#19
REVIEW
Wenjun Z Martini
Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage from coagulation dysfunction as one of the main potentially preventable causes of the mortality. Hypothermia, acidosis, and resuscitative hemodilution have been considered as the significant contributors to coagulation manifestations following trauma, known as the lethal triad. Over the past decade, clinical observations showed that coagulopathy may be present as early as hospital admission in some severely injured trauma patients...
2016: Military Medical Research
https://www.readbyqxmd.com/read/27894493/optimal-reversal-of-novel-anticoagulants-in-trauma
#20
REVIEW
Jason Weinberger, Mark Cipolle
The incidence of patients with trauma on novel oral anticoagulants (NOACs) for the treatment of thromboembolic disorders is increasing. In severe bleeding or hemorrhage into critical spaces, urgent reversal of this underlying pharmacologic coagulopathy becomes paramount. Optimal reversal strategy for commonly used NOACs is still evolving. Basic tenets of evaluation of patients with trauma and resuscitation remain the same. Clinical outcomes data in bleeding human patients with trauma are lacking, but are needed to establish efficacy and safety in these treatments...
January 2017: Critical Care Clinics
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