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Thromboelastography trauma

Dara L Gottlieb, Jennifer Prittie, Yekaterina Buriko, Kenneth E Lamb
OBJECTIVE: To evaluate the presence of acute traumatic coagulopathy (ATC) in dogs and cats following blunt trauma and to relate coagulation variables with injury severity and admission variables. DESIGN: Prospective, single center, observational study from 2013 to 2014. SETTING: Urban private referral hospital. ANIMALS: Eighteen and 19 client-owned dogs and cats, respectively, sustaining blunt trauma within 8 hours of presentation without prior resuscitation; 17 healthy staff and client-owned control cats METHODS: Blood samples were collected upon presentation for measurement of blood gas, lactate, blood glucose, ionized calcium, PCV, total plasma protein, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, and thromboelastography...
September 30, 2016: Journal of Veterinary Emergency and Critical Care
Samy Figueiredo, Audrey Tantot, Jacques Duranteau
Viscoelastic haemostatic assays (VHAs), mainly thromboelastography (TEG) and the rotational thromboelastometry (ROTEM), provide global information on clot formation and dissolution at patient bedside, allowing fast identification of coagulation disorders. In trauma patients, VHAs are able to predict massive transfusion and mortality. These devices might also be used for applying targeted administration of procoagulant factors (e.g. fibrinogen concentrate) as an alternative to or in addition to using predefined fixed ratios of red blood cells: platelets: fresh frozen plasma/cryoprecipitate...
September 8, 2016: Minerva Anestesiologica
Ashley N Bartels, Cory Johnson, Julie Lewis, James W Clevenger, Stephen L Barnes, Richard D Hammer, Salman Ahmad
BACKGROUND: The mechanism of platelet dysfunction in acute traumatic coagulopathy is unknown. Traumatic brain injury is hypothesized as a cause, while some investigators presume platelets become "exhausted." We hypothesized that platelet hyperstimulation and consumption resulting from trauma leads to decreased platelet function secondary to depletion of platelet granules. METHODS: Twenty-five trauma patients were divided into traumatic brain injury and no traumatic brain injury groups...
October 2016: Surgery
Eric Etchill, Jason Sperry, Brian Zuckerbraun, Louis Alarcon, Joshua Brown, Kevin Schuster, Lewis Kaplan, Greta Piper, Andrew Peitzman, Matthew D Neal
BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively...
October 2016: Transfusion
Abigail J Rao, Amber Laurie, Cole Hilliard, Rochelle Fu, Tori Lennox, Ronald Barbosa, Martin Schreiber, Susan Rowell
INTRODUCTION: Progression of traumatic intracranial hemorrhage (TICH) is associated with increased morbidity and mortality. Half of patients with TICH progression have normal traditional coagulation laboratory studies. We hypothesized that thromboelastography (TEG), which directly measures clot formation and strength, would predict progression of TICH, the need for neurosurgical procedure, and mortality in patients with TICH. METHODS: A prospective observational study in patients with TICH at a level 1 trauma center was undertaken...
August 2016: Neurosurgery
Grigory Levin, Ekaterina Sukhareva
The goal of this research was to study the influence of erythrocyte-derived microvesicles on hemostasis parameters during burn. It was found that the number of microvesicles derived from washed erythrocytes of burn patients after 1 day of storage at 37°C was 4.2 times bigger than the number of microvesicles derived from erythrocytes of healthy donors. Hemocoagulation properties of erythrocyte-derived microvesicles of burn patients also change: according to the results of thromboelastography their procoagulant activity increases significantly, at the same time their antithrombin and fibrinilytic activity decrease...
June 4, 2016: Burns: Journal of the International Society for Burn Injuries
Christiaan N Mamczak, Megan Maloney, Braxton Fritz, Bryan Boyer, Scott Thomas, Ed Evans, Victoria A Ploplis, Francis J Castellino, Jonathon McCollester, Mark Walsh
OBJECTIVES: To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures. DESIGN: Retrospective cohort review. SETTING: Level-2 trauma center. PATIENTS: Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation...
June 2016: Journal of Orthopaedic Trauma
Sandro Rizoli, Arimie Min, Adic Perez Sanchez, Pang Shek, Richard Grodecki, Precilla Veigas, Henry T Peng
BACKGROUND: There is growing interest in viscoelastic hemostatic assays rotational thromboelastometry (ROTEM) and thromboelastography (TEG) for trauma. Despite shared features, it is unknown whether their results are interchangeable and whether one is clinically superior in predicting mortality, blood transfusion, and diagnosing early trauma coagulopathy. METHODS: We conducted a prospective observational study comparing equivalent ROTEM and TEG parameters. Severely injured patients expected to receive massive transfusion were included...
May 2016: Military Medicine
Ian Roberts
Administration of tranexamic acid (TXA) to bleeding trauma patients who are within 3 hours of injury has been shown to safely reduce mortality in bleeding trauma patients. However, some believe that thromboelastography (TEG or ROTEM) can be used to subdivide these patients into those that will benefit from TXA and those that will be harmed by it. If thromboelastography can be used in this way there could be important patient benefits. However, if the approach is misguided, patients could be denied a lifesaving treatment...
April 2016: Transfusion
Mark Walsh, Stephanie Fritz, Daniel Hake, Michael Son, Sarah Greve, Manar Jbara, Swetha Chitta, Braxton Fritz, Adam Miller, Mary K Bader, Jonathon McCollester, Sophia Binz, Alyson Liew-Spilger, Scott Thomas, Anton Crepinsek, Faisal Shariff, Victoria Ploplis, Francis J Castellino
Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation...
2016: Current Drug Targets
Mitchell J Daley, Marc D Trust, Evan J Peterson, Kevin Luftman, Andrew H Miller, Sadia Ali, Adam Clark, Jayson D Aydelotte, Thomas B Coopwood, Carlos V R Brown
Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission...
February 2016: American Surgeon
Donat R Spahn, Gabriela H Spahn, Philipp Stein
Fibrinogen has a central role in coagulation. Following trauma and perioperatively, low fibrinogen levels have been found to be risk factors for exaggerated bleeding, transfusion needs, and adverse outcome. Conversely, treatment with exogenous fibrinogen in critically bleeding patients with low fibrinogen levels has been shown to decrease transfusion needs. Because following trauma and in many perioperative situations fibrinogen is the first coagulation "element" to become critically low, it appears reasonable to target fibrinogen in clinical coagulation algorithms aiming at early specific and goal-directed treatment...
March 2016: Seminars in Thrombosis and Hemostasis
Bo Zhou, Gang Wang, Nanhai Peng, Xiandi He, Xiaoxiang Guan, Yun Liu
BACKGROUND: Extensive preclinical evidence suggests that induced hypothermia can protect tissues from ischemia-reperfusion injury, reduce organ damage, and improve survival in the advanced stages of shock. OBJECTIVES: We assessed the effects of induced hypothermia on the hemodynamic parameters and coagulation capacity during hemorrhagic shock (HS) and fluid resuscitation, in a pig model of HS with multiple intestinal perforations. MATERIAL AND METHODS: Pigs (n=16) were randomized into 2 groups: a hypothermia (HT) group (n=8, 34°C) and a normothermia (NT) group (n=8, 38°C)...
July 2015: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Kareem Abdelfattah, Michael W Cripps
The appropriate resuscitation of patients in hemorrhagic shock is critical to improving survival. Current strategies for massive transfusions utilize fixed ratio protocols to rapidly deliver plasma and platelets to the patient. However, there is some concern that these larger volumes of transfusions can lead to untoward effects. Efforts now exist on methods to provide patient specific transfusion therapy in order to avoid excess transfusions. Viscoelastic testing via thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) are two viscoelastic analyzers capable of providing such therapy...
September 16, 2015: International Journal of Surgery
Daniel J Fletcher, Elizabeth A Rozanski, Benjamin M Brainard, Armelle M de Laforcade, Marjory B Brooks
OBJECTIVE: To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions. DESIGN: Prospective, observational, case-control study. SETTING: Three veterinary teaching hospitals. ANIMALS: Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs. INTERVENTIONS: None...
January 2016: Journal of Veterinary Emergency and Critical Care
Penny Whiting, Maiwenn Al, Marie Westwood, Isaac Corro Ramos, Steve Ryder, Nigel Armstrong, Kate Misso, Janine Ross, Johan Severens, Jos Kleijnen
BACKGROUND: Patients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM® Delta, TEM International GmbH, Munich, Germany;, TEG (TEG® 5000 analyser, Haemonetics Corporation, Niles, IL, USA; and Sonoclot (Sonoclot® coagulation and platelet function analyser, Sienco Inc...
July 2015: Health Technology Assessment: HTA
Sarah Watts, Giles Nordmann, Karim Brohi, Mark Midwinter, Tom Woolley, Robert Gwyther, Callie Wilson, Henrietta Poon, Emrys Kirkman
Acute trauma coagulopathy (ATC) is seen in 30% to 40% of severely injured casualties. Early use of blood products attenuates ATC, but the timing for optimal effect is unknown. Emergent clinical practice has started prehospital deployment of blood products (combined packed red blood cells and fresh frozen plasma [PRBCs:FFP], and alternatively PRBCs alone), but this is associated with significant logistical burden and some clinical risk. It is therefore imperative to establish whether prehospital use of blood products is likely to confer benefit...
August 2015: Shock
Casey J Allen, Clark R Murray, Jonathan P Meizoso, Juliet J Ray, Laura F Teisch, Xiomara D Ruiz, Mena M Hanna, Gerardo A Guarch, Ronald J Manning, Alan S Livingstone, Enrique Ginzburg, Carl I Schulman, Nicholas Namias, Kenneth G Proctor
We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed...
July 2015: American Surgeon
J Kaczynski, M Wilczynska, L Fligelstone, J Hilton
BACKGROUND: The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the diagnosis of trauma-associated coagulopathy and subsequent interventions. METHODS: Review of the literature. RESULTS: The standard laboratory tests, including prothrombin time and activated partial thromboplastin time, are unreliable and describe only an isolated fragment of the complex coagulation pathways...
June 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Miroslav Durila, Pavel Lukáš, Marta Astraverkhava, Tomáš Vymazal
BACKGROUND: Hypothermic coagulopathy is very challenging in bleeding trauma patients. Therefore, we decided to evaluate the efficacy of fibrinogen and prothrombin complex in 30°C hypothermia in vitro to investigate if higher levels of fibrinogen and prothrombin complex concentrate can compensate for the hypothermic effect on coagulation as measured by thromboelastometry/thromboelastography. METHODS: Blood samples were obtained from 12 healthy volunteers (six men and six women) in our study...
September 2015: Scandinavian Journal of Clinical and Laboratory Investigation
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