Johansson, Pär I

Larsen, Claus F

Ostrowski, Sisse R

Perner, Anders

Sørensen, Anne Marie

Wanscher, Michael

Welling, Karen Lise

English

PubMed

Pär I Johansson

Anne Sørensen

Anders Perner

Karen Welling

Michael Wanscher

Claus F Larsen

Sisse R Ostrowski

Crossref

Critical Care

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study

ABSTRACT: INTRODUCTION: It is debated whether the early trauma induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team activation and had an arterial cannula inserted. Blood was sampled a median of 68 min (IQR 48-88) post-injury. Data on demography, biochemistry, injury severity score (ISS) and mortality were recorded. Plasma/serum was analyzed for biomarkers reflecting tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, Annexin V, thrombomodulin, syndecan-1), coagulation activation/inhibition (prothrombinfragment 1+2, thrombin/antithrombin-complexes, antithrombin, protein C, activated protein C, endothelial protein C receptor, protein S, tissue factor pathway inhibitor, vWF), factor consumption (fibrinogen, FXIII), fibrinolysis (D-dimer, tissue-type plasminogen activator, plasminogen activator inhibitor-1) and inflammation (interleukin (IL)-6, terminal complement complex (sC5b-9)). Comparison of patients stratified according to presence or absence of overt DIC (ISTH criteria) or ACoTS (activated partial thromboplastin time (APTT) and/or international normalized ratio (INR) above normal reference). RESULTS: No patients had overt DIC whereas 15% had ACoTS. ACoTS patients had higher injury severity score (ISS), transfusion requirements and mortality (all 

Johansson, Per Ingemar

Sorensen, Anne Marie

Welling, Karen-Lise

Copenhagen University Research Information System

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

Springer - Publisher Connector

Acute coagulopathy of trauma shock and coagulopathy of trauma: a rebuttal. You are now going down the wrong path.

Allaouchiche B: Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury

and disseminated intravascular coagulation: lessons from the classical literature. Ann Surg

B: The coagulopathy of trauma: a review of mechanisms.

BF: Shedding of the endothelial glycocalyx in patients undergoing major vascular surgery with global and regional ischemia. Circulation

Demetriades D: Early coagulopathy after isolated severe traumatic brain injury: relationship with hypoperfusion challenged.

Differential clot stabilising effects of rFVIIa and rFXIII-A in whole blood from thrombocytopenic patients and healthy volunteers.

Disseminated intravascular coagulation at an early phase of trauma is associated with consumption coagulopathy and excessive fibrinolysis both by plasmin and neutrophil elastase. Surgery

Elalamy I: The influence of fibrin polymerization and platelet-mediated contractile forces on citrated whole blood thromboelastography profile. Thromb Haemost

Kashuk JL: Mechanistic links in trauma-induced coagulopathy: a tale of two cities. Ann Surg

KI: Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res

Krug E: In Injury: A Leading Cause of the Global Burden of Disease,

KT: Extracellular RNA constitutes a natural procoagulant cofactor in blood coagulation. Proc Natl Acad Sci USA

Kurek SJ: Early evaluation of acute traumatic coagulopathy by thrombelastography. Transl Res

Lezotte DC: Early predictors of postinjury multiple organ failure. Arch Surg

Lorand L: Contribution of fibrin stabilization to clot strength. Supplementation of factor XIII-deficient plasma with the purified zymogen.

Opal SM: Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation. J Thromb Haemost

Pathophysiology of early trauma-induced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion.

Pittet JF: Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis.

Pittet JF: Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg

PT: Epidemiology of trauma deaths: a reassessment.

RA: Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care

SR: A high admission syndecan-1 level, a marker of endothelial glycocalyx degradation, is associated with inflammation, protein C depletion, fibrinolysis, and increased mortality in trauma patients. Ann Surg

SR: Acute coagulopathy of trauma: balancing progressive catecholamine induced endothelial activation and damage by fluid phase anticoagulation. Med Hypotheses

SR: High circulating adrenaline levels at admission predict increased mortality after trauma.

The acute coagulopathy of trauma shock: Clinical relevance. Surgeon

Therapeutic strategies targeting the endothelial glycocalyx: acute deficits, but great potential. Cardiovasc Res

Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost

WL: Thrombin generation in trauma patients. Transfusion

https://ccforum.biomedcentral.com/track/pdf/10.1186/cc10553?site=ccforum.biomedcentral.com

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study

Abstract

Similar works

Full text

Available Versions

Crossref

Copenhagen University Research Information System

Springer - Publisher Connector