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J Thromb Haemost. 2019 Jan 4. doi: 10.1111/jth.14378. [Epub ahead of print]

Towards patient-specific management of trauma hemorrhage: the effect of resuscitation therapy on parameters of thromboelastometry.

Author information

1
Department of Intensive Care Medicine, Academic Medical Center, The Netherlands.
2
Trauma Unit, Department of Surgery, Academic Medical Center, The Netherlands.
3
Department of Traumatology, Oslo University Hospital, Norway.
4
Department of Anaesthesiology, Oslo University Hospital, Norway.
5
NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Radcliffe Department of Medicine, University of Oxford, United Kingdom.
6
Department of Anaesthesiology and Trauma Centre, Center for Head and Orthopaedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
7
Department for Traumatology and Orthopaedic Surgery, Cologne- Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany.
8
Trauma Sciences, Blizard Institute, Barts, London School of Medicine and Dentistry, and the Queen Mary University of London, UK.

Abstract

BACKGROUND:

Rotational Thromboelastometry (ROTEM® ) can detect trauma-induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM® to transfusion therapy is unknown.

OBJECTIVES:

To determine the response of ROTEM profiles to therapy in bleeding trauma patients.

PATIENTS/METHODS:

Prospective multicentre study in bleeding trauma patients (receiving ≥ 4 red blood cell units). Blood was drawn on the emergency department, after administration of 4, 8 and 12 RBCs and 24 hours post injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC.

RESULTS:

309 bleeding and shocked patients were included. A mean dose of 3.8 grams of fibrinogen increased FIBTEMCA5 with 5.2 mm (4.1-6.3). TXA administration decreased lysis by 5.4%(4.3-6.5). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEMCA5 values was more pronounced in patients with a ROTEM value indicative of TIC compared to the whole cohort. Plasma transfusion decreased EXTEM CT with 3.1 sec (-10-3.9) in the whole cohort and with 10.6 sec (-45-24) in the subgroup of patients with a ROTEM value indicative of TIC.

CONCLUSION:

Effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values corresponding to TIC, efficacy of PLT and plasma to correct deranged ROTEM parameters is possibly more robust. This article is protected by copyright. All rights reserved.

KEYWORDS:

ROTEM ; haemorrhage; transfusion; trauma; viscoelastic haemostatic assay

PMID:
30609290
DOI:
10.1111/jth.14378

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