Document Detail


Clotting factor deficiency in early trauma-associated coagulopathy.
MedLine Citation:
PMID:  22071999     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coagulopathic bleeding is a leading cause of in-hospital death after injury. A recently proposed transfusion strategy calls for early and aggressive frozen plasma transfusion to bleeding trauma patients, thus addressing trauma-associated coagulopathy (TAC) by transfusing clotting factors (CFs). This strategy may dramatically improve survival of bleeding trauma patients. However, other studies suggest that early TAC occurs by protein C activation and is independent of CF deficiency. This study investigated whether CF deficiency is associated with early TAC.
METHODS: This is a prospective observational cohort study of severely traumatized patients (Injury Severity Score ≥ 16) admitted shortly after injury, receiving minimal fluids and no prehospital blood. Blood was assayed for CF levels, thromboelastography, and routine coagulation tests. Critical CF deficiency was defined as ≤ 30% activity of any CF.
RESULTS: Of 110 patients, 22 (20%) had critical CF deficiency: critically low factor V level was evident in all these patients. International normalized ratio, activated prothrombin time, and, thromboelastography were abnormal in 32%, 36%, and 35%, respectively, of patients with any critically low CF. Patients with critical CF deficiency suffered more severe injuries, were more acidotic, received more blood transfusions, and showed a trend toward higher mortality (32% vs. 18%, p = 0.23). Computational modeling showed coagulopathic patients had pronounced delays and quantitative deficits in generating thrombin.
CONCLUSIONS: Twenty percent of all severely injured patients had critical CF deficiency on admission, particularly of factor V. The observed factor V deficit aligns with current understanding of the mechanisms underlying early TAC. Critical deficiency of factor V impairs thrombin generation and profoundly affects hemostasis.
Authors:
Sandro B Rizoli; Sandro Scarpelini; Jeannie Callum; Bartolomeu Nascimento; Kenneth G Mann; Ruxandra Pinto; Jan Jansen; Homer C Tien
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  71     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-10     Completed Date:  2012-01-03     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S427-34     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery and Critical Care Medicine, Sunnybrook, Health Sciences Centre, University Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Coagulation / physiology*
Coagulation Protein Disorders / blood*,  complications,  epidemiology
Female
Follow-Up Studies
Hemorrhage / blood,  epidemiology,  etiology*
Humans
Incidence
Injury Severity Score
Male
Middle Aged
Ontario / epidemiology
Prospective Studies
Prothrombin Time*
Thrombelastography
Wounds and Injuries / blood,  complications*,  diagnosis
Young Adult
Grant Support
ID/Acronym/Agency:
HL34575/HL/NHLBI NIH HHS; HL46703/HL/NHLBI NIH HHS; P01 HL046703-09/HL/NHLBI NIH HHS; P01 HL046703-10/HL/NHLBI NIH HHS; P01 HL046703-11/HL/NHLBI NIH HHS; P01 HL046703-12/HL/NHLBI NIH HHS; P01 HL046703-13/HL/NHLBI NIH HHS; P01 HL046703-14/HL/NHLBI NIH HHS; P01 HL046703-15/HL/NHLBI NIH HHS; P01 HL046703-16A1/HL/NHLBI NIH HHS; P01 HL046703-17/HL/NHLBI NIH HHS; P01 HL046703-18/HL/NHLBI NIH HHS; P01 HL046703-19/HL/NHLBI NIH HHS; P01 HL046703-20/HL/NHLBI NIH HHS; R01 HL034575-15/HL/NHLBI NIH HHS; R01 HL034575-16/HL/NHLBI NIH HHS; R01 HL034575-17/HL/NHLBI NIH HHS; R01 HL034575-18/HL/NHLBI NIH HHS; R01 HL034575-19/HL/NHLBI NIH HHS; R01 HL034575-20/HL/NHLBI NIH HHS; R01 HL034575-21/HL/NHLBI NIH HHS; R01 HL034575-22/HL/NHLBI NIH HHS; R01 HL034575-23/HL/NHLBI NIH HHS; R01 HL034575-24/HL/NHLBI NIH HHS; //Canadian Institutes of Health Research
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