Early evaluation of acute traumatic coagulopathy by thrombelastography

Carroll, Roger C.; Craft, Robert M.; Langdon, Russell J.; Clanton, Colin R.; Snider, Carolyn C.; Wellons, Douglas D.; Dakin, Patrick A.; Lawson, Christy M.; Enderson, Blaine L.; Kurek, Stanley J.

doi:10.1016/j.trsl.2009.04.001

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Volume 154, Issue 1 , Pages 34-39, July 2009

Early evaluation of acute traumatic coagulopathy by thrombelastography

Roger C. Carroll
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
- Reprint requests: Roger C. Carroll, PhD, Department of Anesthesiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN; 37920
Robert M. Craft
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Russell J. Langdon
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Colin R. Clanton
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Carolyn C. Snider
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Douglas D. Wellons
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Patrick A. Dakin
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Christy M. Lawson
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Blaine L. Enderson
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
Stanley J. Kurek
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn

Received 17 November 2008; received in revised form 2 April 2009; accepted 3 April 2009. published online 04 May 2009.

Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, Ill) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t-testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude [MA]), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 ± 17.1 vs MA = 35.7 ± 19.3, P = 0.004) and a correlation of fibrinogen <100 mg/dL with fatalities (P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 ± 11,618 versus 270 ± 393 s (P = < 0.001), and MA was 46.4 ± 22.4 versus 64.7 ± 9.8 mm (P < 0.001). Hyperfibrinolysis (percent fibrinolysis after 60 min [LY60] >15%) was observed in 3 patients in the ED with a 67% fatality rate (P = < 0.001 by chi-square testing). PlateletMapping assays correlated with the need for blood transfusion. The abnormal TEG System parameters correlated with fatality. These coagulopathies were already evident OS. The TEG assays can assess coagulopathy, platelet dysfunction, and hyperfibrinolysis at an early stage posttrauma and suggest more effective interventions.

Abbreviations: ADP, adenosine diphosphate, ED, emergency department, INR, international normalized ratio, K, clot formation time, LY60, percent fibrinolysis at 60 min, MA, maximal amplitude, OS, onsite, PAI-I, plasminogen activator inhibitor type I, PT, prothrombin time, PTT, partial thromboplastin time, R, reaction, TEG, thrombelastograph