Thromboelastogram Evaluation of the Impact of Hypercoagulability in Trauma Patients

Branco, Bernardino C.*; Inaba, Kenji; Ives, Crystal; Okoye, Obi; Shulman, Ira; David, Jean-Stephane§; Schöchl, Herbert; Rhee, Peter; Demetriades, Demetrios

Shock:
doi: 10.1097/SHK.0000000000000109
Clinical Aspects
Abstract

ABSTRACT: Introduction: Admission hypocoagulability has been associated with negative outcomes after trauma. The purpose of this study was to determine the impact of hypercoagulability after trauma on the need for blood product transfusion and mortality. Methods: Injured patients meeting our level I trauma center’s highest activation criteria had a thromboelastography (TEG) performed at admission, +1 h, +2 h, and +6 h using citrated blood. Hypercoagulability was defined as any TEG parameter in the hypercoagulable range, and hypocoagulability as any parameter in the hypocoagulable range. Patients were followed up prospectively throughout their hospital course. Results: A total of 118 patients were enrolled: 26.3% (n = 31) were hypercoagulable, 55.9% (n = 66) had a normal TEG profile, and 17.8% (n = 21) were hypocoagulable. After adjusting for differences in demographics and clinical data, hypercoagulable patients were less likely to require un–cross-matched blood (11.1% for hypercoagulable vs. 20.4% for normal vs. 45.7% for hypocoagulable, adjusted P = 0.004). Hypercoagulable patients required less total blood products, in particular, plasma at 6 h (0.1 [SD, 0.4] U for hypercoagulable vs. 0.7 [SD, 1.9] U for normal vs. 4.3 [SD, 6.3] U for hypocoagulable, adjusted P < 0.001) and 24 h (0.2 [SD, 0.6] U for hypercoagulable vs. 1.1 [SD, 2.9] U for normal vs. 8.2 [SD, 19.3] U for hypocoagulable, adjusted P < 0.001). Hypercoagulable patients had lower 24-h mortality (0.0% vs. 5.5% vs. 27.8%, adjusted P < 0.001) and 7-day mortality (0.0% vs. 5.5% vs. 36.1%, adjusted P < 0.001). Bleeding-related deaths were less likely in the hypercoagulable group (0.0% vs. 1.8% vs. 25.0%, adjusted P < 0.001). Conclusions: Approximately a quarter of trauma patients presented in a hypercoagulable state. Hypercoagulable patients required less blood products, in particular plasma. They also had a lower 24-h and 7-day mortality and lower rates of bleeding-related deaths. Further evaluation of the mechanism responsible for the hypercoagulable state and its implications on outcome is warranted.

Author Information

*Department of Surgery, University of Arizona, Tucson, Arizona; †Division of Trauma and Surgical Critical Care and ‡Department of Pathology, University of Southern California, Los Angeles, California; §Department of Anesthesiology & Critical Care, Lyon-Sud Hospital, Hospital Civils de Lyon (HCL) and Claude Bernard University, Lyon, France; ∥Ludwig Boltzmann Institute of Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria; and ¶Division of Trauma, Critical Care and Emergency Surgery, University of Arizona, Tucson, Arizona

Received 19 Oct 2013; first review completed 07 Nov 2013; accepted in final form 03 Dec 2013

Address reprint requests to Kenji Inaba, MD, FRCSC, FACS, Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo St, Room C5L100, Los Angeles, CA 90033. E-mail: kinaba@surgery.usc.edu.

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