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Trauma blood clotting

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https://www.readbyqxmd.com/read/29764673/comparison-between-thromboelastography-and-conventional-coagulation-test-should-we-abandon-conventional-coagulation-tests-in-polytrauma-patients
#1
Jaume Tur Martínez, Patrizio Petrone, Alexander Axelrad, Corrado P Marini
INTRODUCTION: TEG provides an in-vivo assessment of viscoelastic clot strength in whole blood compared with CCT, which may not reflect the influence of platelets. The aim of this study was to compare TEG vs. CCT in trauma patients stratified by mechanism of injury (MOI) and pre-existing coagulation status. METHODS: A retrospective, observational study of 230 polytrauma patients admitted to a University Hospital Level 1 Trauma Center, with TEG and CCT on admission stratified by MOI: multiple trauma (MT), isolated traumatic brain injury (TBI) or MT+TBI...
May 12, 2018: Cirugía Española
https://www.readbyqxmd.com/read/29763772/graphene-kaolin-composite-sponge-for-rapid-and-riskless-hemostasis
#2
Yuping Liang, Congcong Xu, Guofeng Li, Tianchi Liu, Jun F Liang, Xing Wang
Kaolin is an effective and safe hemostatic agent for hemostasis. However, its ontic powder is difficult to use in actual practice. To develop a wieldy and powerful hemostat, composite strategy is usually a good choice. Herein, we developed a graphene-kaolin composite sponge (GKCS), synthesized with graphene oxide sheets, linker molecules and kaolin powders through a facile hydrothermal reaction. SEM observations support that GKCS has a porous structure, and EDS mapping further confirms that kaolin powders are embedded in graphene sheets...
May 8, 2018: Colloids and Surfaces. B, Biointerfaces
https://www.readbyqxmd.com/read/29758989/the-double-hazard-of-bleeding-and-thrombosis-in-hemostasis-from-a-clinical-point-of-view-a-global-assessment-by-rotational-thromboelastometry-rotem
#3
Olga Meltem Akay
Hemostasis is a complex dynamic process involving bleeding and thrombosis as two end-points. Conventional coagulation tests which are measured in plasma examine only isolated portions of the coagulation cascade, thereby giving no information on important interactions essential to the clinical evaluation of hemostatic function. Thromboelastography (TEG), originally described in 1948 has improved over the decades and become a valuable tool of coagulation testing because of the limitations of standard coagulation tests...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29727255/hairpulling-causing-vision-loss-a-case-report
#4
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/29703240/temporal-phenotyping-of-circulating-microparticles-after-trauma-a-prospective-cohort-study
#5
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
#6
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/29664833/effect-of-pre-hospital-red-blood-cell-transfusion-on-mortality-and-time-of-death-in-civilian-trauma-patients
#7
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/29658985/using-rotational-thromboelastometry-clot-firmness-at-5-minutes-rotem-%C3%A2-extem-a5-to-predict-massive-transfusion-and-in-hospital-mortality-in-trauma-a-retrospective-analysis-of-1146-patients
#8
J M Kelly, S Rizoli, P Veigas, S Hollands, A Min
Viscoelastic assays such as TEG® and ROTEM® are increasingly used to guide transfusion of blood products. The EXTEM assay maximum clot firmness (MCF) is a ROTEM measure available after 25-29 min used to guide early decisions. EXTEM A10, the clot firmness at 10 min, is an accepted early surrogate, but investigators differ on whether A5, the clot firmness at 5 min, is acceptable. We re-examined this in a retrospective observational analysis of 1146 trauma patients in one centre who had ROTEM data recorded. A5 and A10 both correlated well with maximum clot firmness, with Pearson coefficients of r = 0...
April 16, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29623230/hepatic-rupture-induced-by-spontaneous-intrahepatic-hematoma
#9
Jin-Bao Zhou, Wei-Bo Chen, Feng Zhu
The etiology of hepatic rupture is usually secondary to trauma, and hepatic rupture induced by spontaneous intrahepatic hematoma is clinically rare. We describe here a 61-year-old female patient who was transferred to our hospital with hepatic rupture induced by spontaneous intrahepatic hematoma. The patient had no history of trauma and had a history of systemic lupus erythematosus for five years, taking a daily dose of 5 mg prednisone for treatment. The patients experienced durative blunt acute right upper abdominal pain one day after satiation, which aggravated in two hours, accompanied by dizziness and sweating...
2018: Case Reports in Surgery
https://www.readbyqxmd.com/read/29621120/absences-of-endothelial-microvesicle-changes-in-the-presence-of-the-endotheliopathy-of-trauma
#10
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/29621007/disseminated-intravascular-coagulation-is-it-fact-or-fancy
#11
Jae C Chang
: 'Disseminated intravascular coagulation (DIC)' occurs commonly in critical illnesses such as sepsis, trauma, cancer, and complications of surgery and pregnancy. Mortality is very high. The pathogenesis has been ascribed to tissue factor-initiated coagulation disorder, resulting in disseminated microblood clots that are made of platelets, plasma factors, fibrins, and blood cells. True DIC depletes coagulation factors and consumes platelets, and activates fibrinolysis. 'DIC' is assumed to orchestrate thrombocytopenia, microangiopathic hemolytic anemia and hypoxic multiorgan dysfunction syndrome, and causes hemorrhagic disorder due to depleted coagulation factors...
April 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29554044/systemic-hyperfibrinolysis-after-trauma-a-pilot-study-of-targeted-proteomic-analysis-of-superposed-mechanisms-in-patient-plasma
#12
Anirban Banerjee, Christopher C Silliman, Ernest E Moore, Monika Dzieciatkowska, Marguerite Kelher, Angela Sauaia, Kenneth Jones, Michael P Chapman, Eduardo Gonzalez, Hunter B Moore, Angelo D'Alessandro, Erik Peltz, Benjamin E Huebner, Peter Einerson, James Chandler, Arsen Ghasabayan, Kirk Hansen
BACKGROUND: Viscoelastic measurements of hemostasis indicate that 20% of seriously injured patients exhibit systemic hyperfibrinolysis, with increased early mortality. These patients have normal clot formation with rapid clot lysis. Targeted proteomics was applied to quantify plasma proteins from hyperfibrinolytic (HF) patients to elucidate potential pathophysiology. METHODS: Blood samples were collected in the field or at emergency department arrival and thrombelastography (TEG) was used to characterize in vitro clot formation under native and tissue plasminogen activator (tPA)-stimulated conditions...
June 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29514336/imaging-of-combat-related-thoracic-trauma-review-of-penetrating-trauma
#13
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29485252/multiscale-systems-biology-of-trauma-induced-coagulopathy
#14
REVIEW
Evan Tsiklidis, Carrie Sims, Talid Sinno, Scott L Diamond
Trauma with hypovolemic shock is an extreme pathological state that challenges the body to maintain blood pressure and oxygenation in the face of hemorrhagic blood loss. In conjunction with surgical actions and transfusion therapy, survival requires the patient's blood to maintain hemostasis to stop bleeding. The physics of the problem are multiscale: (a) the systemic circulation sets the global blood pressure in response to blood loss and resuscitation therapy, (b) local tissue perfusion is altered by localized vasoregulatory mechanisms and bleeding, and (c) altered blood and vessel biology resulting from the trauma as well as local hemodynamics control the assembly of clotting components at the site of injury...
February 27, 2018: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
https://www.readbyqxmd.com/read/29477924/three-stage-management-of-complex-pancreatic-trauma-with-gastroduodenopancreatectomy-a-case-report
#15
Sergio Henrique Bastos Damous, George Felipe Bezerra Darce, Renato Silveira Leal, Adilson Rodrigues Costa, Pedro Henrique Alves Ferreira, Celso de Oliveira Bernini, Edivaldo Massazo Utiyama
INTRODUCTION: Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. PRESENTATION OF CASE: Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head...
2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29394977/bladder-distension-as-a-cause-of-abdominal-compartment-syndrome
#16
Muhammad Yasir, Muhammad Qamarul Hoda, Tauseef Ahmed
Abdominal compartment syndrome (ACS) is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture...
February 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/29394242/pulmonary-arterial-thrombosis-in-a-murine-model-of-blunt-thoracic-trauma
#17
Ian E Brown, Robert R Rigor, Linda M Schutzman, Nasim Khosravi, Karen Chung, James A Becker, Christopher D Pivetti, Gavin T Best, Jessica C Chavez, Joseph M Galante
Pulmonary thromboembolic events cause significant morbidity and mortality after severe trauma. Clinically, these lesions are believed to be emboli arising secondary to deep venous thrombosis (DVT) in the lower extremities. Recently this notion has been challenged by clinical studies showing that pulmonary clots arise after trauma in the absence of DVT. This suggests that pulmonary blood clots arise in situ via de novo thrombosis. In the present study we characterize a murine weight-drop model of lateral blunt thoracic trauma...
February 1, 2018: Shock
https://www.readbyqxmd.com/read/29381955/spontaneous-internal-hemorrhage-of-a-giant-hepatic-hemangioma-a-case-report
#18
Fulong Hao, Xiaoli Yang, Yinsheng Tian, Wenping Wang, Minggang Ge
RATIONALE: Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS: We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma. DIAGNOSES: Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29370058/permissive-hypotension-versus-conventional-resuscitation-strategies-in-adult-trauma-patients-with-hemorrhagic-shock-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#19
Alexandre Tran, Jeffrey Yates, Aaron Lau, Jacinthe Lampron, Maher Matar
BACKGROUND: Aggressive fluid resuscitation in trauma promotes deleterious effects such as clot disruption, dilutional coagulopathy and hypothermia. Animal studies suggest that permissive hypotension maintains appropriate organ perfusion, reduces bleeding and improves mortality. This review assesses the efficacy and safety of permissive hypotension in adult trauma patients with hemorrhagic shock. METHODS: We searched the MEDLINE and EMBASE databases from inception to May 2017 for randomized controlled trials comparing permissive hypotension vs...
May 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29363269/measuring-fibrinolysis-from-research-to-routine-diagnostic-assays
#20
REVIEW
C Longstaff
Development and standardization of fibrinolysis methods have progressed more slowly than coagulation testing and routine high-throughput screening tests for fibrinolysis are still lacking. In laboratory research, a variety of approaches are available and are applied to understand the regulation of fibrinolysis and its contribution to the hemostatic balance. Fibrinolysis in normal blood is slow to develop. For practical purposes plasminogen activators can be added to clotting plasma, or euglobulin prepared to reduce endogenous inhibitors, but results are complicated by these manipulations...
April 2018: Journal of Thrombosis and Haemostasis: JTH
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