Acute traumatic coagulopathy: functional characterisation by rotational thrombolelastometry
Abstract number: PP-TH-685
Davenport1 R.A., Allard2 S., Coates1 A., Thiemermann3 C., Pasi2 J., Pearse3 R., Brohi1 K.
11Trauma Clinical Academic Unit 22Blood Sciences, Royal London Hospital 33William Harvery Research Institute, Barts and the London Medical School, Queen Mary University of London, London, UK
How-to-cite Davenport RA, Allard S, Coates A, Thiemermann C, Pasi J, Pearse R, Brohi K. Acute traumatic coagulopathy: functional characterisation by rotational thrombolelastometry. Journal of Thrombosis and Haemostasis 2009; Volume 7, Supplement 2: Abstract PP-TH-685
Background: Acute Traumatic Coagulopathy (ATC) is present in 25% of severely injured patients on admission. The combination of tissue hypoperfusion and severe tissue trauma appears to be required to produce this endogenous coagulopathy. Patients at risk of ATC have previously been identified as those with a high Injury Severity Score (ISS) and significant shock as measured by base deficit (BD). Our aim was to functionally characterise ATC with rotational thromboelastometry (RoTEM). We hypothesized that patients at risk of ATC could be rapidly diagnosed by RoTEM.
Methods: A prospective study of 143 trauma patients admitted to a single trauma centre. Blood for RoTEM analysis was drawn within 20 min of arrival and analysed within one hour. Patients at risk of ATC were grouped by admission BD and ISS.
Results: RoTEM produced good separation of clot amplitudes (CA) between normal and abnormal coagulation times (abnormal PT, EXTEM: CA5, 36 mm vs 44 mm P < 0.01 and abnormal PTT, INTEM: CA5, 33 mm vs. 45 mm P < 0.01). Patients at risk of ATC had significantly lower alpha angles (65 vs. 72, P < 0.05), clot amplitudes over time (P < 0.001) and maximum clot firmness (MCF: 55 mm vs. 60 mm, P < 0.001). In non-shocked patients, increasing injury severity was associated with higher CA (5–30 min, INTEM only). Increasing degrees of shock in the non-injured subgroup produced a negative effect on clot formation (CA 5–30 min and MCF, EXTEM only). RoTEM was able to classify patients at risk of ATC within five minutes of sample start time (CA5 = 35 mm, P < 0.001).
Conclusions: RoTEM can rapidly identify and functionally characterise ATC. Patients with early traumatic coagulopathy display RoTEM traces with a decreased rate of clot formation, lower clot amplitudes and reduced maximum clot strength. RoTEM can aid the early diagnosis of ATC in the emergency setting.
Disclosure of interest: R Davenport, Pentapharm, Grant/Research Support K Brohi, Pentapharm, Grant/Research Support.