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rotem, trauma

Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
M Maegele
Based upon the results of CRASH-2, early administration of antifibrinolytic tranexamic acid (TXA) is recommended in bleeding trauma patients or trauma patients presumed to bleed. Many trauma centers and emergency medical services have adopted this practice into their routine algorithms. The pitfalls of CRASH-2 have been discussed in the literature, but the positive effects could sometimes not be reproduced in follow-up studies. The mechanism of action of TXA in trauma is still not clear and major knowledge gaps with TXA in the context of trauma have been identified...
September 14, 2016: Der Unfallchirurg
J S David, E Imhoff, S Parat, L Augey, M-O Geay-Baillat, P Incagnoli, K Tazarourte
Viscoelastic technics are used for 10 years and include the ROTEM(®) and the TEG(®). These devices that exploit the viscoelastic properties of the clotting blood, allow a rapid and global analysis of the haemostatic process taking into account all the process interfering with haemostasis such as inflammation. It has been shown that the use of these technics in clinical situations such as trauma, postpartum haemorrhage, gastrointestinal bleeding or cardiac surgery may reduce the need for blood product, the cost and perhaps may improve the outcome of the patients...
September 5, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
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
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
N Schäfer, A Driessen, U Bauerfeind, M Fröhlich, J Ofir, E K Stürmer, M Maegele
OBJECTIVES: To analyse which fibrinogen source may improve coagulation using an in vitro 33% dilutional coagulopathy model. BACKGROUND: Uncritical volume resuscitation in the context of trauma haemorrhage contributes to the iatrogenic arm of the acute trauma-induced coagulopathy through dilution and depletion of coagulation factors, with fibrinogen reaching critical levels first. MATERIALS AND METHODS: By using an experimental model of 33% dilutional coagulopathy, we have analysed which fibrinogen source may exert superior effects on improving haemocoagulative capacities and correcting depleted fibrinogen levels...
August 9, 2016: Transfusion Medicine
Hiroyuki Koami, Yuichiro Sakamoto, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura, Kosuke Chris Yamada, Satoshi Inoue
The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM).This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome...
August 2016: Medicine (Baltimore)
Natasha van Zyl, Elissa M Milford, Sara Diab, Kimble Dunster, Peter McGiffin, Stephen G Rayner, Andrew Staib, Michael C Reade, John F Fraser
INTRODUCTION: Acute traumatic coagulopathy (ATC) is an endogenous coagulopathy that develops following tissue injury and shock. The pathogenesis of ATC remains poorly understood, with platelet dysfunction, activation of the protein C pathway, and endothelial glycocalyx shedding all hypothesized to contribute to onset. The primary aim of this study was to develop an ovine model of traumatic coagulopathy, with a secondary aim of assessing proposed pathophysiological mechanisms within this model...
October 2016: Journal of Trauma and Acute Care Surgery
Cristina Solomon, Lars M Asmis, Donat R Spahn
Recent years have seen increasing worldwide interest in the use of viscoelastic coagulation monitoring tests, performed using devices such as ROTEM and TEG. The use of such tests to guide haemostatic therapy may help reduce transfusion of allogeneic blood products in bleeding patients and is supported in European guidelines for managing trauma and severe perioperative bleeding. In addition, viscoelastic tests form the basis of numerous published treatment algorithms. However, some publications have stated that viscoelastic tests are not validated...
October 2016: Scandinavian Journal of Clinical and Laboratory Investigation
Christian Zentai, Paola E J van der Meijden, Till Braunschweig, Nicolai Hueck, Markus Honickel, Henri M H Spronk, Rolf Rossaint, Oliver Grottke
BACKGROUND: The potential clinical benefits of targeted therapy with coagulation factor concentrates (e.g., fibrinogen) and antifibrinolytic agents (e.g., tranexamic acid [TXA]) for the treatment of trauma-induced coagulopathy are increasingly recognized. We hypothesized that human fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC), administered as combined therapy with TXA, would provide additive effects for reducing blood loss in an animal trauma model. METHODS: Thirty-six pigs were subjected to 2 consecutive blunt liver injuries, resulting in severe hemorrhagic shock and coagulopathy...
July 2016: Anesthesia and Analgesia
Jean-Stéphane David, Maeva Durand, Albrice Levrat, Mathilde Lefevre, Lucia Rugeri, Marie-Odile Geay-Baillat, Kenji Inaba, Pierre Bouzat
BACKGROUND: Thromboelastometry (ROTEM, Pentapharm GmbH, Munich, Germany) is increasingly being used to make a diagnosis of coagulopathy and to guide hemostatic therapy (HT). Although ROTEM parameters and standard laboratory test (SLT) correlated well before administration of HT, it is not known if this correlation persists after hemostatic resuscitation. METHODS: A retrospective analysis of prospectively collected data from a trauma registry (2011-2014) was performed...
August 2016: Journal of Trauma and Acute Care Surgery
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
Wenjun Z Martini, Cassandra M Rodriguez, Rodolfo Deguzman, Jessica B Guerra, Angela K Martin, Anthony E Pusateri, Andrew P Cap, Michael A Dubick
INTRODUCTION: Ibuprofen is commonly used by warfighters in the deployed environment. This study investigated its dose effects on in vitro coagulation in human and pig blood. METHODS: Blood samples were collected from 6 normal volunteers and 6 healthy pigs and processed to make platelet-adjusted samples (100 × 10(3)/μL, common transfusion trigger in trauma). Ibuprofen was added to the samples at concentrations of 0 μg/mL (control), the concentration from the highest recommended oral dose (163 μg/mL, 1×), and 2×, 4×, 8×, 10×, 12×, 16×, and 20×...
May 2016: Military Medicine
Robert D Winfield, Vincent M Mellnick, Jad Chamieh, Eden Nohra, Wen-Hui Tan, Ricardo Ramirez, Constantine Raptis, Isaiah R Turnbull, Kelly Bochicchio, Stacey Reese, Philip C Spinella, Grant V Bochicchio
OBJECTIVES: Obesity is associated with a hypercoagulable state at baseline and following injury. The anatomic location of adipose deposition may influence the type of thrombotic event, with visceral adipose tissue (VAT) associated with arterial thrombosis and subcutaneous adipose tissue (SAT) predisposing to venous thrombosis. We sought to determine whether adipose tissue amount and location correlated with measures of coagulation. METHODS: All adult Level I trauma activations at our institution between January 2013 and August 2014 who underwent admission abdominal computed tomography scan and had admission rotational thromboelastometry measurements were included...
July 2016: Journal of Trauma and Acute Care Surgery
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
Laura E Watkins, Shizhong Han, Ilan Harpaz-Rotem, Natalie P Mota, Steven M Southwick, John H Krystal, Joel Gelernter, Robert H Pietrzak
Polymorphisms in the FK506 Binding Protein 5 (FKBP5) gene may interact with childhood abuse to increase risk of developing posttraumatic stress disorder (PTSD) symptoms. The objective of this study was to examine the relationship of four previously identified FKBP5 putative risk SNPs (rs9296158, rs3800373, rs1360780, rs947008), childhood abuse, and lifetime PTSD symptoms, including contemporary phenotypic models of PTSD symptoms, in two nationally representative samples of European-American (EA) U.S. military veterans...
July 2016: Psychoneuroendocrinology
Natalie Mota, Jack Tsai, Paul D Kirwin, Ilan Harpaz-Rotem, John H Krystal, Steven M Southwick, Robert H Pietrzak
OBJECTIVE: More than 60% of US military veterans are 55 years or older. Although several case studies have suggested that older age is associated with a higher likelihood of reactivated or delayed-onset posttraumatic stress disorder (PTSD) symptoms in veterans, population-based data on the prevalence and determinants of this phenomenon are lacking. METHOD: Using data from the National Health and Resilience in Veterans Study (NHRVS: Wave 1 = October 2011-December 2011; Wave 2 = September 2013), a nationally representative, cohort study of US veterans, we evaluated the prevalence and determinants of exacerbated PTSD symptoms in 1,441 veterans 55 years or older using a DSM-IV-based measure in 2011 and a DSM-5-based measure in 2013...
March 2016: Journal of Clinical Psychiatry
Lital Ruderman, Daniel B Ehrlich, Alicia Roy, Robert H Pietrzak, Ilan Harpaz-Rotem, Ifat Levy
BACKGROUND: Psychiatric symptoms typically cut across traditional diagnostic categories. In order to devise individually tailored treatments, there is a need to identify the basic mechanisms that underlie these symptoms. Behavioral economics provides a framework for studying these mechanisms at the behavioral level. Here, we utilized this framework to examine a widely ignored aspect of trauma-related symptomatology-individual uncertainty attitudes-in combat veterans with and without posttraumatic stress disorder (PTSD)...
July 2016: Depression and Anxiety
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