Contributions
Abstract: EP568
Type: E-Poster Presentation
Session title: Bleeding disorders (congenital and acquired)
Background
Coagulopathic hemorrhage is one of the major modifiable causes of death in trauma. Despite its clinical significance, there is a lack of adequate tests to rapidly diagnose the various aspects of trauma-induced coagulopathy (TIC). Routine coagulation tests, such as PT, aPTT, fibrinogen, platelet count, D-dimer and FDP have a limitation in diagnosis of TIC. Thromboelastography (TEG) is the viscoelastic coagulation monitoring device that measures the entire clotting cascades from fibrin polymerization to fibrinolysis.
Aims
This study aimed to investigate factors related to mortality and blood transfusion requirements based on coagulation profile with fibrinolytic status using thromboelastrography in trauma patients.
Methods
We included 452 trauma patients who visited the trauma center of Uijeongbu St. Mary’s Hospital. Citrated blood samples were analyzed using the TEG 5000 Thrombelastography Hemostasis Analyzer (Haemonetics, Niles, IL). The following indices were obtained from the TEG: R-time, K-time, α-angle, maximum amplitude (MA), and lysis 30 minutes after MA (LY30). Patients were stratified based on LY30% results into fibrinolysis shutdown (SD) (LY30% <0.8%), physiologic fibrinolysis (0.8-3.0%), and hyperfibrinolysis groups (LY30% >3.0%) Also, we investigate transfusion requirement and mortality during hospitalization period.
Results
The mean age was 52.3 years and the mortality rate was 39/452 (8.6%). Lower GCS, longer TEG K-time, and lower TEG MA were independent factors associated with mortality. The lower MA group demonstrated the highest probability of survival (odds ratio 0.207), followed by prolonged R-time (odds ratio 0.220). The patient numbers in fibrinolysis shutdown (SD), physiologic fibrinolysis and hyperfibrinolysis groups were 219 (52.3%), 131 (31.4%), and 68 (16.3%), respectively. The mortality rates of fibrinolysis SD group (11.9%) and hyperfibrinolysis (8.8%) were higher than the physiologic fibrinolysis groups (3.8%). The cutoff obtained from ROC analysis was found to be suitable for predicting survival. R-time, MA, and LY30 were effective to predict survival or death when applying the cutoff value from the ROC analysis (Table 3A). About probability (comparison of prediction power) of survival, the lower MA group (under the cutoff level) showed the highest probability of survival (odds ratio 0.207), followed by prolonged R-time (odds ratio 0.220).The transfusion requirements were significantly higher in the fibrinolysis SD group than in the other two groups.
Conclusion
TEG based markers were shown to be more useful to make a diagnosis coagulopathies including dysfibrinolysis and predict the survival than routine coagulation tests. Dysfunctional fibrinolysis showed higher mortality than physiologic group. If multiple integration of each TEG markers are used, it would be helpful for prompt diagnosis and management of coagulopathies and to decrease a preventable death in trauma.
Keyword(s): Coagulopathy, Fibrinolysis, Thromboembolic events, Trauma
Abstract: EP568
Type: E-Poster Presentation
Session title: Bleeding disorders (congenital and acquired)
Background
Coagulopathic hemorrhage is one of the major modifiable causes of death in trauma. Despite its clinical significance, there is a lack of adequate tests to rapidly diagnose the various aspects of trauma-induced coagulopathy (TIC). Routine coagulation tests, such as PT, aPTT, fibrinogen, platelet count, D-dimer and FDP have a limitation in diagnosis of TIC. Thromboelastography (TEG) is the viscoelastic coagulation monitoring device that measures the entire clotting cascades from fibrin polymerization to fibrinolysis.
Aims
This study aimed to investigate factors related to mortality and blood transfusion requirements based on coagulation profile with fibrinolytic status using thromboelastrography in trauma patients.
Methods
We included 452 trauma patients who visited the trauma center of Uijeongbu St. Mary’s Hospital. Citrated blood samples were analyzed using the TEG 5000 Thrombelastography Hemostasis Analyzer (Haemonetics, Niles, IL). The following indices were obtained from the TEG: R-time, K-time, α-angle, maximum amplitude (MA), and lysis 30 minutes after MA (LY30). Patients were stratified based on LY30% results into fibrinolysis shutdown (SD) (LY30% <0.8%), physiologic fibrinolysis (0.8-3.0%), and hyperfibrinolysis groups (LY30% >3.0%) Also, we investigate transfusion requirement and mortality during hospitalization period.
Results
The mean age was 52.3 years and the mortality rate was 39/452 (8.6%). Lower GCS, longer TEG K-time, and lower TEG MA were independent factors associated with mortality. The lower MA group demonstrated the highest probability of survival (odds ratio 0.207), followed by prolonged R-time (odds ratio 0.220). The patient numbers in fibrinolysis shutdown (SD), physiologic fibrinolysis and hyperfibrinolysis groups were 219 (52.3%), 131 (31.4%), and 68 (16.3%), respectively. The mortality rates of fibrinolysis SD group (11.9%) and hyperfibrinolysis (8.8%) were higher than the physiologic fibrinolysis groups (3.8%). The cutoff obtained from ROC analysis was found to be suitable for predicting survival. R-time, MA, and LY30 were effective to predict survival or death when applying the cutoff value from the ROC analysis (Table 3A). About probability (comparison of prediction power) of survival, the lower MA group (under the cutoff level) showed the highest probability of survival (odds ratio 0.207), followed by prolonged R-time (odds ratio 0.220).The transfusion requirements were significantly higher in the fibrinolysis SD group than in the other two groups.
Conclusion
TEG based markers were shown to be more useful to make a diagnosis coagulopathies including dysfibrinolysis and predict the survival than routine coagulation tests. Dysfunctional fibrinolysis showed higher mortality than physiologic group. If multiple integration of each TEG markers are used, it would be helpful for prompt diagnosis and management of coagulopathies and to decrease a preventable death in trauma.
Keyword(s): Coagulopathy, Fibrinolysis, Thromboembolic events, Trauma