Viscoelastic hemostasis assay guided diagnosis and treatment of trauma-induced coagulopathy

doi:10.16139/j.1007-9610.2023.05.06

Abstract

Abstract:

The diagnosis and treatment of trauma-induced coagulopathy is an important part of the treatment of severe trauma patients. Trauma-induced coagulopathy has two phenotypes: hypercoagulability and hypocoagulability. The phenotype of coagulopathy in the early stage of trauma patients is variable. Viscoelastic hemostatic assay can reflect the full picture of coagulation in trauma patients. It can guide clinicians to quickly identify different phenotypes of trauma-induced coagulopathy, and fine manage different phenotypes of coagulopathy. This paper introduced the detection methods and principles of common viscoelastic hemostasis assays, and summarized the diagnosis and treatment methods based on viscoelastic hemostasis assay in different phenotypes of trauma-induced coagulopathy from literature, aimed to provide elicitation of diagnosis and treatment for clinicians.

Key words: Viscoelastic hemostasis assay, Trauma-induced coagulopathy, Trauma, Thromboelastography, Hypercoagulability

CLC Number:

SHEN Tuo, ZHU Feng. Viscoelastic hemostasis assay guided diagnosis and treatment of trauma-induced coagulopathy[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 425-431.

Figures/Tables 3

References 40

[1]	TISHERMAN S A, SCHMICKER R H, BRASEL K J, et al. Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium[J]. Ann Surg, 2015, 261(3):586-590. doi: 10.1097/SLA.0000000000000837 pmid: 25072443
[2]	MOORE H B, MOORE E E, GONZALEZ E, et al. Hyperfibrinolysis,physiologic fibrinolysis,and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and rele-vance to antifibrinolytic therapy[J]. J Trauma Acute Care Surg, 2014, 77(6):811-817. doi: 10.1097/TA.0000000000000341 URL
[3]	HOLCOMB J B, TILLEY B C, BARANIUK S, et al. Transfusion of plasma, platelets, and red blood cells in a 1∶1∶ 1 vs. a 1∶1∶2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial[J]. JAMA, 2015, 313(5):471-482. doi: 10.1001/jama.2015.12 URL
[4]	INNERHOFER P, FRIES D, MITTERMAYR M, et al. Reversal of traumainduced coagulopathy using frst-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group,openlabel,randomised trial[J]. Lancet Haematol, 2017, 4(6):e258-e271. doi: 10.1016/S2352-3026(17)30077-7 URL
[5]	SCHÖCHL H, NIENABER U, MAEGELE M, et al. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy[J]. Crit Care, 2011, 15(2):R83. doi: 10.1186/cc10078 URL
[6]	STEIN P, KASERER A, SPRENGEL K, et al. Change of transfusion and treatment paradigm in major trauma patients[J]. Anaesthesia, 2017, 72(11):1317-1326. doi: 10.1111/anae.13920 pmid: 28542848
[7]	GONZALEZ E, MOORE E E, MOORE H B, et al. Goal-directed haemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomised clinical trial comparing a viscoelastic assay to conventional coagulation assays[J]. Ann Surg, 2016, 263(6):1051-1059. doi: 10.1097/SLA.0000000000001608 URL
[8]	COCHRANE C, CHINNA S, UM J Y, et al. Site-of-care viscoelastic assay in major trauma improves outcomes and is cost neutral compared with standard coagulation tests[J]. Diagnostics (Basel), 2020, 10(7):486.
[9]	LAMMERS D T, MARENCO C W, MORTE K R, et al. Viscoelastic testing in combat resuscitation: is it time for a new standard?[J]. J Trauma Acute Care Surg, 2020, 89(1):145-152. doi: 10.1097/TA.0000000000002634 pmid: 32118819
[10]	CANNON J W. Hemorrhagic shock[J]. N Engl J Med, 2018, 378(19):1852-1853.
[11]	MOORE H B, GANDOS, IBA T, et al. Defining trauma-induced coagulopathy with respect to future implications for patient management: communication from the SSC of the ISTH[J]. J Thromb Haemost, 2020, 18(3):740-747. doi: 10.1111/jth.14690 pmid: 32112533
[12]	MEIZOSO J P, BARRETT C D, MOORE E E, et al. Advances in the management of coagulopathy in trauma: the role of viscoelastic hemostatic assays across all phases of trauma care[J]. Semin Thromb Hemost, 2022, 48(7):796-807. doi: 10.1055/s-0042-1756305 pmid: 36113505
[13]	FORT A C, DUDARYK R. Evolving science of trauma-induced coagulopathy[J]. Int Anesthesiol Clin, 2021, 59:25-30. doi: 10.1097/AIA.0000000000000318 pmid: 33625062
[14]	SPAHN D R, BOUILLON B, CERNY V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition[J]. Crit Care, 2019, 23(1):98. doi: 10.1186/s13054-019-2347-3
[15]	宋景春. 创伤性凝血病的概念变迁与展望[J]. 医学研究生学报, 2022, 35(1):5.
	SONG J C. Conceptual changes and perspectives of traumatic coagulopathy[J]. J Med Postgra, 2022, 35(1):5.
[16]	曾庆波, 宋景春, 林青伟, 等. 创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究[J]. 东南国防医药, 2018, 20(5):471-475.
	ZENG Q B, SONG J C, LIN Q W, et al. Clinical study on the diagnostic value of maximum amplitude for the heatstroke with DIC[J]. Mil Med J Southeast China, 2018, 20(5):471-475.
[17]	SPASIANO A, BARBARINO C, MARANGONE A, et al. Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care[J]. Eur J Trauma Emerg Surg, 2022, 48(1):431-439. doi: 10.1007/s00068-020-01493-z
[18]	中国输血协会临床输血学专业委员会. 创伤性出血患者血液管理专家共识(2022年版)[J]. 中国临床新医学, 2022, 15(6):469-476.
	Working Party on Clinical Transfusion,Chinese Society of Blood Transfusion. Expert consensus on patient blood management for traumatic hemorrhage(2022 edition)[J]. Chin J New Clin Med, 2022, 15(6):469-476.
[19]	SIMMONS J W, POWELL M F. Acute traumatic coagulopathy: pathophysiology and resuscitation[J]. Br J Anaesth, 2016, 117(suppl 3):iii31-iii43. doi: 10.1093/bja/aew328 pmid: 27940454
[20]	EINERSEN P M, MOORE E E, CHAPMAN M P, et al. Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion[J]. J Trauma Acute Care Surg, 2017, 82(1):114-119. doi: 10.1097/TA.0000000000001270 pmid: 27805995
[21]	ROSSAINT R, AFSHARI A, BOUILLON B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition[J]. Crit Care, 2023, 27(1):80. doi: 10.1186/s13054-023-04327-7
[22]	CRASH-2 TRIAL COLLABORATORS, SHAKUR H, ROBERTS I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial[J]. Lancet, 2010, 376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5 pmid: 20554319
[23]	MORRISON J J, DUBOSE J J, RASMUSSEN T E, et al. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study[J]. Arch Surg, 2012, 147(2):113-119. doi: 10.1001/archsurg.2011.287 pmid: 22006852
[24]	DIXON A L, MCCULLY B H, RICK E A, et al. Tranexamic acid administration in the feld does not afect admission thromboelastography after traumatic brain injury[J]. J Trauma Acute Care Surg, 2020, 89(5):900-907. doi: 10.1097/TA.0000000000002932 URL
[25]	GRATZ J, GÜTING H, THORN S, et al. Protocolised thromboelastometric-guided haemostatic management in patients with traumatic brain injury: a pilot study[J]. Anaesthesia, 2019, 74(7):883-890. doi: 10.1111/anae.14670 pmid: 31032890
[26]	SCHÖCHL H, MAEGELE M, SOLOMON C, et al. Early and individualized goal-directed therapy for trauma-induced coagulopathy[J]. Scand J Trauma Resusc Emerg Med, 2012, 20:15. doi: 10.1186/1757-7241-20-15 URL
[27]	SCHREIBER M A, DIFFERDING J, THORBORG P, et al. Hypercoagulability is most prevalent early after injury and in female patients[J]. J Trauma, 2005, 58(3):475-480. doi: 10.1097/01.TA.0000153938.77777.26 URL
[28]	SUMISLAWSKI J J, KORNBLITH L Z, CONROY A S, et al. Dynamic coagulability after injury: is delaying venous thromboembolism chemoprophylaxis worth the wait?[J]. J Trauma Acute Care Surg, 2018, 85(5):907-914. doi: 10.1097/TA.0000000000002048 pmid: 30124623
[29]	VAN HAREN R M, VALLE E J, THORSON C M, et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism[J]. J Trauma Acute Care Surg, 2014, 76(2):443-449. doi: 10.1097/TA.0b013e3182a9d11d pmid: 24398771
[30]	SONG J C, YANG L K, ZHAO W, et al. Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy[J]. Mil Med Res, 2021, 8(1):15.
[31]	KAKKOS S, KIRKILESIS G, CAPRINI J A, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism[J]. Cochrane Database Syst Rev, 2022, 1(1):CD005258.
[32]	STETTLER G R, MOORE E E, MOORE H B, et al. Redefining post injury fibrinolysis phenotypes using two viscoelastic assays[J]. J Trauma Acute Care Surg, 2019, 86(4):679-685. doi: 10.1097/TA.0000000000002165 URL
[33]	MEIZOSO J P, DUDARYK R, MULDER M B, et al. Increased risk of ﬁbrinolysis shutdown among severely injured trauma patients receiving tranexamic acid[J]. J Trauma Acute Care Surg, 2018, 84(3):426-432. doi: 10.1097/TA.0000000000001792 URL
[34]	COLEMAN J R, MOORE E E, MOORE H B, et al. Tranexamic acid disturbs the dynamics of postinjury ﬁbrinolysis[J]. ANZ J Surg, 2020, 90(4):420-422. doi: 10.1111/ans.v90.4 URL
[35]	MOORE H B, MOORE E E, LIRAS I N, et al. Acute ﬁbrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients[J]. J Am Coll Surg, 2016, 222(4):347-355. doi: 10.1016/j.jamcollsurg.2016.01.006 URL
[36]	HAYES H V, DROEGE M E, FURNISH C J, et al. Admission thrombelastography does not guide dose adjustment of enoxaparin in trauma patients[J]. Surg Open Sci, 2020, 2(4):41-44. doi: 10.1016/j.sopen.2020.03.003 URL
[37]	COLEMAN J R, KAY A B, MOORE E E, et al. It’s sooner than you think:blunt solid organ injury patients are already hypercoagulable upon hospital admission-results of a bi-institutional, prospective study[J]. Am J Surg, 2019, 218(6):1065-1073. doi: 10.1016/j.amjsurg.2019.08.024 URL
[38]	LOUIS S G, VAN P Y, RIHA G M, et al. Thromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial[J]. J Trauma Acute Care Surg, 2014, 76(4):937-942. doi: 10.1097/TA.0000000000000165 URL
[39]	BRILL J B, CALVO R Y, WALLACE J D, et al. Aspirin as added prophylaxis for deep vein thrombosis in trauma: a retrospective case-control study[J]. J Trauma Acute Care Surg, 2016, 80(4):625-630. doi: 10.1097/TA.0000000000000977 pmid: 26808030
[40]	LEY E J, BROWN C V R, MOORE E E, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: a western trauma association critical decisions algorithm[J]. J Trauma Acute Care Surg, 2020, 89(5):971-981. doi: 10.1097/TA.0000000000002830 URL