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Coagulopathy of Trauma

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The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: A propensity matched analysis.
Jehan F, Aziz H, O'Keeffe T, Khan M, Zakaria ER, Hamidi M, Zeeshan M, Kulvatunyou N, Joseph B.
2018 Jul;85(1):18-24.

Rationale for inclusion: Four factor PCC along with FFP was superior to FFP alone for the reversal of the coagulapathy of trauma.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40?138 bleeding patients.
Gayet-Ageron A, Prieto-Merino D, Ker K, Shakur H, Ageron FX, Roberts I; Antifibrinolytic Trials Collaboration.
2018 Jan 13;391(10116):125-132.

Rationale for inclusion: A meta-analysis of 2 randomized trials analyzing transexamic acid for acute severe bleeding.  Survival benefit decreased 10% for every 15 minute TXA administration delay.

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Persistent Fibrinolysis Shutdown Is Associated with Increased Mortality in Severely Injured Trauma Patients.
Meizoso JP, Karcutskie CA, Ray JJ, Namias N, Schulman CI, Proctor KG.
J Am Coll Surg. 2017 Apr;224(4):575-582.

Rationale for inclusion:  TEG was performed upon ICU admission in 181 trauma patients to find that persistent fibrinolsysis shutdown was associated with late mortality.

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Tranexamic acid use in severely injured civilian patients and the effects on outcomes: a prospective cohort study.
Cole E, Davenport R, Willett K, Brohi K.
Ann Surg. 2015 Feb;261(2):390-4.

Rationale for inclusion: Prospective study of TXA, use was associated with reduction in organ failure and all-cause mortality.

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Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage.
Khan S, Brohi K, Chana M, Raza I, Stanworth S, Gaarder C, Davenport R; International Trauma Research Network (INTRN).
J Trauma Acute Care Surg. 2014 Mar;76(3):561-7; discussion 567-8.

Rationale for inclusion: For patients with ongoing bleeding, resuscitation directed by ROTEM did not achieve correction of hypo-perfusion or coagulopathy.

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TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients.
Tapia NM, Chang A, Norman M, Welsh F, Scott B, Wall MJ Jr, Mattox KL, Suliburk J.
J Trauma Acute Care Surg. 2013 Feb;74(2):378-85; discussion 385-6.

Rationale for inclusion: Comparison of standard MTP to TEG-directed resuscitation; TEG resuscitation patients had improved mortality in a subset of patients: patients with penetrating mechanism receiving more than 10U PRBCs.

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The incidence and magnitude of fibrinolytic activation in trauma patients.
Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De'Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K.
J Thromb Haemost. 2013 Feb;11(2):307-14.

Rationale for inclusion: Magnitude of fibronlytic activation correlates with clinical outcome in trauma patients, by thromboelastometry.

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Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients.
Holcomb JB, Minei KM, Scerbo ML, Radwan ZA, Wade CE, Kozar RA, Gill BS, Albarado R, McNutt MK, Khan S, Adams PR, McCarthy JJ, Cotton BA.
Ann Surg. 2012 Sep;256(3):476-86.

Rationale for inclusion: TEG at the time of admission showed better discrimination than conventional coagulation tests when predicting need for massive transfusion.

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Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma.
Wohlauer MV, Moore EE, Thomas S, Sauaia A, Evans E, Harr J, Silliman CC, Ploplis V, Castellino FJ, Walsh M.
J Am Coll Surg. 2012 May;214(5):739-46.

Rationale for inclusion: Shows platelet dysfunction in trauma patients (compared with healthy volunteers) as seen in thromboelastography.

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Functional definition and characterization of acute traumatic coagulopathy.
Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S, Hart D, Pearse R, Pasi KJ, MacCallum P, Stanworth S, Brohi K.
Crit Care Med. 2011 Dec;39(12):2652-8.

Rationale for inclusion: Use of ROTEM for point of care diagnosis of early coagulopathy.

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The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.
CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T.
Lancet. 2011 Mar 26;377(9771):1096-101, 1101.e1-2.

Rationale for inclusion: Further analysis of the CRASH-2 trial data to explain the effect of TXA on bleeding deaths.

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Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma.
Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, Biffl WL, Burlew CC, Johnson JL, Sauaia A.
Ann Surg. 2010 Sep;252(3):434-42; discussion 443-4.

Rationale for inclusion: Identification of primary fibrinolysis by TEG is associated with death.

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Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.
CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S.
Lancet. 2010 Jul 3;376(9734):23-32.

Rationale for inclusion: The CRASH-2 trial.  Randomized use of TXA to placebo, showing decreased risk of death from bleeding in TXA group.

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Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate.
Schöchl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, Kozek-Langenecker S, Solomon C.
Crit Care. 2010;14(2):R55.

Rationale for inclusion: Describes use of thromboelastometry to guide hemostatic therapy.

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Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients.
Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS.
Br J Anaesth. 2008 Jun;100(6):792-7.

Rationale for inclusion: Describes use of ROTEM to detect hyperfibrinolysis.

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Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis.
Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, Pittet JF.
J Trauma. 2008 May;64(5):1211-7; discussion 1217.

Rationale for inclusion: Study examining blood drawn from trauma patients. Acute coagulopathy of trauma is associated with systemic hypoperfusion and is characterized by anticoagulation and hyperfibrinolysis. 

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Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway?
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF.
Ann Surg. 2007 May;245(5):812-8.

Rationale for inclusion: Study of early coagulation labs predicting mortality in trauma.

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Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients.
Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, Simanski C, Neugebauer E, Bouillon B; AG Polytrauma of the German Trauma Society (DGU).
Injury. 2007 Mar;38(3):298-304.

Rationale for inclusion: Early coagulopathy is associated with need for increased fluids, multi-organ failure, and in-hospital mortality.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.
Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A, Allaouchiche B, Negrier C.
J Thromb Haemost. 2007 Feb;5(2):289-95.

Rationale for inclusion: Description of the use of ROTEM for point of care detection of coagulation abnormalities in trauma patients.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Early coagulopathy predicts mortality in trauma.
MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M.
J Trauma. 2003 Jul;55(1):39-44.

Rationale for inclusion: Abnormal coagulation labs are independent predictors of mortality in trauma.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Acute traumatic coagulopathy.
Brohi K, Singh J, Heron M, Coats T.
J Trauma. 2003 Jun;54(6):1127-30.

Rationale for inclusion: Study showing high mortality in patients with coagulopathy.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited.
Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B.
J Trauma. 1997 May;42(5):857-61; discussion 861-2.

Rationale for inclusion:  Prospective analysis of 58 patients who had a massive transfusion. Post-injury life-threatening coagulopathy in the seriously injured requiring massive transfusion is predicted by persistent hypothermia and progressive metabolic acidosis.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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