Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Jun;217(6):1037-1041.
doi: 10.1016/j.amjsurg.2019.01.014. Epub 2019 Jan 23.

Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy

Joshua J Sumislawski  1 , S Ariane Christie  2 , Lucy Z Kornblith  3 , Gregory R Stettler  4 , Geoffrey R Nunns  5 , Hunter B Moore  6 , Ernest E Moore  7 , Christopher C Silliman  8 , Angela Sauaia  9 , Rachael A Callcut  10 , Mitchell Jay Cohen  11
Affiliations
Observational Study

Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy

Joshua J Sumislawski et al. Am J Surg. 2019 Jun.

Abstract

Background: Trauma-induced coagulopathy can present as abnormalities in a conventional or viscoelastic coagulation assay or both. We hypothesized that patients with discordant coagulopathies reflect different clinical phenotypes.

Methods: Blood samples were collected prospectively from critically injured patients upon arrival at two urban Level I trauma centers. International normalized ratio (INR), partial thromboplastin time (PTT), thromboelastography (TEG), and coagulation factors were assayed.

Results: 278 patients (median ISS 17, mortality 26%) were coagulopathic: 20% with isolated abnormal INR and/or PTT (CONVENTIONAL), 49% with isolated abnormal TEG (VISCOELASTIC), and 31% with abnormal INR/PTT and TEG (BOTH). Compared with VISCOELASTIC, CONVENTIONAL and BOTH had higher ISS, lower GCS, larger base deficit, and decreased factor activities (all p < 0.017). They received more blood products and had more ICU/ventilation days (all p < 0.017). Mortality was higher in CONVENTIONAL (40%) and BOTH (49%) than VISCOELASTIC (6%, p < 0.017).

Conclusions: Although TEG-guided resuscitation improves survival after injury, INR and PTT identify coagulopathic patients with highest mortality regardless of TEG and likely represent distinct mechanisms independent of biochemical clot strength.

Keywords: Precision medicine; Resuscitation; Thromboelastography; Transfusion; Trauma-induced coagulopathy.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Coagulation factor activities by coagulopathic phenotype.
FIGURE 2.
FIGURE 2.
Kaplan-Meier survival analysis by coagulopathic phenotype.
See this image and copyright information in PMC

Comment in

References

    1. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30. - PubMed
    1. MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44. - PubMed
    1. Niles SE, McLaughlin DF, Perkins JG, et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64:1459–63. - PubMed
    1. Shaz BH, Winkler AM, James AB, et al. Pathophysiology of early trauma-induced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion. J Trauma. 2011;70:1401–7. - PMC - PubMed
    1. Kunitake RC, Howard BM, Kornblith LZ, et al. Individual clotting factor contributions to mortality following trauma. J Trauma Acute Care Surg. 2017;82:302–8. - PMC - PubMed

Publication types

MeSH terms