Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients

Blood loss and uncontrollable bleeding are major factors affecting survival in trauma patients. Because treatment with antifibrinolytic drugs may be effective, early detection of hyperfibrinolysis with rotation thrombelastography (ROTEM may be beneficial. Eighty-seven trauma patients were included i...

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Published in:British journal of anaesthesia : BJA Vol. 100; no. 6; p. 792
Main Authors: Levrat, A, Gros, A, Rugeri, L, Inaba, K, Floccard, B, Negrier, C, David, J-S
Format: Journal Article
Language:English
Published: England 01.06.2008
Subjects:
Adult
Blood Coagulation Disorders - diagnosis
Blood Coagulation Disorders - etiology
Blood Coagulation Factors - analysis
Female
Fibrinolysis
Humans
Injury Severity Score
Male
Middle Aged
Prognosis
Prospective Studies
Sensitivity and Specificity
Thrombelastography - methods
Wounds and Injuries - complications
ISSN:1471-6771, 1471-6771
Online Access:Get more information
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Summary:Blood loss and uncontrollable bleeding are major factors affecting survival in trauma patients. Because treatment with antifibrinolytic drugs may be effective, early detection of hyperfibrinolysis with rotation thrombelastography (ROTEM may be beneficial. Eighty-seven trauma patients were included in this prospective observational study. Blood samples were collected at admission. After in vitro activation with tissue factor (EXTEM) and inhibition with aprotinin (APTEM), ROTEM parameters including maximal clot firmness (MCF) and clot lysis index at 30 min (CLI(30)) were determined. Hyperfibrinolysis was defined as a euglobulin lysis time (ELT) <90 min. Threshold for ROTEM parameters were determined with receiver-operating characteristic curves (ROC) analysis according to the ELT results. ELT was determined in a subgroup of 23 patients. In this group of patients, ROC analysis showed that for a threshold of 18 mm (MCF-EXTEM), 71% (CLI(30)) and 7% (increase of MCF-APTEM), sensitivity was, respectively, 100%, 75%, and 80% with a specificity of 100%. With the application of these thresholds to the whole trauma cohort, ROTEM analysis detected hyperfibrinolysis in five patients [6%, 95% confidence interval (CI): 2-13%]. As expected, patients with hyperfibrinolysis were more severely injured (median Injury Severity Score: 75 vs 20, P<0.05), had greater coagulation abnormalities [international normalized ratio (INR): 8.2 vs 1.3, P<0.05; fibrinogen: 0.0 vs 2.2 g litre(-1), P<0.05], and a higher mortality rate (100%, CI: 48-100% vs 11% CI: 5-20%, P<0.05). ROTEM provided rapid and accurate detection of hyperfibrinolysis in severely injured trauma patients.
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ISSN:1471-6771
1471-6771
DOI:10.1093/bja/aen083