Thromboelastometry and organ failure in trauma patients: a prospective cohort study

Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whet...

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Vydáno v:	Critical care (London, England) Ročník 18; číslo 6; s. 687
Hlavní autoři:	Müller, Marcella CA, Balvers, Kirsten, Binnekade, Jan M, Curry, Nicola, Stanworth, Simon, Gaarder, Christine, Kolstadbraaten, Knut M, Rourke, Claire, Brohi, Karim, Goslings, J Carel, Juffermans, Nicole P
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 25.12.2014 BioMed Central Ltd
Témata:	Adult Cohort Studies Critical Care Medicine Emergency Medicine Female Humans Intensive Male Medicine Medicine & Public Health Middle Aged Multiple Organ Failure - blood Multiple Organ Failure - diagnosis Multiple Organ Failure - epidemiology Multiple Trauma - blood Multiple Trauma - diagnosis Multiple Trauma - epidemiology Prospective Studies Thrombelastography - methods Multiple Organ Failure Sequential Organ Failure Assessment Score Sequential Organ Failure Assessment Fresh Freeze Plasma Injury Severity Score
ISSN:	1364-8535, 1466-609X, 1364-8535, 1466-609X
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Abstract	Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. Methods This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥11.7 dynes/cm 2 and hypocoagulability as a G value of <5.0 dynes/cm 2 . ROTEM was performed on admission and 24 hours later. Results A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients ( P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. Conclusions The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.
AbstractList	Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. Methods This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥11.7 dynes/cm 2 and hypocoagulability as a G value of <5.0 dynes/cm 2 . ROTEM was performed on admission and 24 hours later. Results A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients ( P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. Conclusions The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants. Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. Methods This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of [greater than or equai to]11.7 dynes/cm.sup.2 and hypocoagulability as a G value of <5.0 dynes/cm.sup.2. ROTEM was performed on admission and 24 hours later. Results A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. Conclusions The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants. Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality.INTRODUCTIONData on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality.This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥ 11.7 dynes/cm(2) and hypocoagulability as a G value of <5.0 dynes/cm(2). ROTEM was performed on admission and 24 hours later.METHODSThis was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥ 11.7 dynes/cm(2) and hypocoagulability as a G value of <5.0 dynes/cm(2). ROTEM was performed on admission and 24 hours later.A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.RESULTSA total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.CONCLUSIONSThe incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants. Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of [greater than or equai to]11.7 dynes/cm.sup.2 and hypocoagulability as a G value of <5.0 dynes/cm.sup.2. ROTEM was performed on admission and 24 hours later. A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants. Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥ 11.7 dynes/cm(2) and hypocoagulability as a G value of <5.0 dynes/cm(2). ROTEM was performed on admission and 24 hours later. A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality. The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.
ArticleNumber	687
Audience	Academic
Author	Gaarder, Christine Juffermans, Nicole P Balvers, Kirsten Binnekade, Jan M Rourke, Claire Stanworth, Simon Müller, Marcella CA Curry, Nicola Kolstadbraaten, Knut M Brohi, Karim Goslings, J Carel
Author_xml	– sequence: 1 givenname: Marcella CA surname: Müller fullname: Müller, Marcella CA email: m.c.muller@amc.uva.nl organization: Department of Intensive Care Medicine, Academic Medical Center – sequence: 2 givenname: Kirsten surname: Balvers fullname: Balvers, Kirsten organization: Department of Intensive Care Medicine, Academic Medical Center, Department of Surgery, Trauma Unit, Academic Medical Center – sequence: 3 givenname: Jan M surname: Binnekade fullname: Binnekade, Jan M organization: Department of Intensive Care Medicine, Academic Medical Center – sequence: 4 givenname: Nicola surname: Curry fullname: Curry, Nicola organization: National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital – sequence: 5 givenname: Simon surname: Stanworth fullname: Stanworth, Simon organization: National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital – sequence: 6 givenname: Christine surname: Gaarder fullname: Gaarder, Christine organization: Department of Traumatology, Oslo University Hospital – sequence: 7 givenname: Knut M surname: Kolstadbraaten fullname: Kolstadbraaten, Knut M organization: Department of Traumatology, Oslo University Hospital – sequence: 8 givenname: Claire surname: Rourke fullname: Rourke, Claire organization: Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University – sequence: 9 givenname: Karim surname: Brohi fullname: Brohi, Karim organization: Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University – sequence: 10 givenname: J Carel surname: Goslings fullname: Goslings, J Carel organization: Department of Surgery, Trauma Unit, Academic Medical Center – sequence: 11 givenname: Nicole P surname: Juffermans fullname: Juffermans, Nicole P organization: Department of Intensive Care Medicine, Academic Medical Center
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Snippet	Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of... Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of... Introduction Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of...
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SubjectTerms	Adult Cohort Studies Critical Care Medicine Emergency Medicine Female Humans Intensive Male Medicine Medicine & Public Health Middle Aged Multiple Organ Failure - blood Multiple Organ Failure - diagnosis Multiple Organ Failure - epidemiology Multiple Trauma - blood Multiple Trauma - diagnosis Multiple Trauma - epidemiology Prospective Studies Thrombelastography - methods
Title	Thromboelastometry and organ failure in trauma patients: a prospective cohort study
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