| Clotting factor deficiency in early trauma-associated coagulopathy. | |
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MedLine Citation:
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PMID: 22071999 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of trauma Volume: 71 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-10 Completed Date: 2012-01-03 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: S427-34 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery and Critical Care Medicine, Sunnybrook, Health Sciences Centre, University Toronto, Toronto, Ontario, Canada. |
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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 |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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