Hyperfibrinolysis Diagnosed by Rotational Thromboelastometry (ROTEM®) Is Associated with Higher Mortality in Patients with Severe Trauma
- 1 November 2011
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 113 (5), 1003-1012
- https://doi.org/10.1213/ane.0b013e31822e183f
Abstract
BACKGROUND: We investigated whether hyperfibrinolysis and its severity was associated with outcome of traumatized and nontraumatized patients. METHODS: From April 2008 to April 2010, all emergency patients with hyperfibrinolysis were enrolled in this study. Hyperfibrinolysis patients were divided into traumatized (trauma hyperfibrinolysis group) and nontraumatized (nontrauma hyperfibrinolysis group). The trauma hyperfibrinolysis group was matched with 24 polytrauma patients without hyperfibrinolysis (matched trauma group). Data from rotational thromboelastometry measurements, blood gas analysis (metabolic state), laboratory analysis, injury severity score, and 30-day mortality were collected. RESULTS: Thirty-five patients with hyperfibrinolysis were identified (13 traumatized, 22 nontraumatized). Overall mortality for hyperfibrinolysis was 54%. Mortality in the trauma hyperfibrinolysis group (77% ± 12%) was significantly higher than in the nontrauma hyperfibrinolysis group (41% ± 10%; P = 0.001, 95% CI 5%–67%) and the matched trauma group (33% ± 10%; P = 0.009, 95% CI 13%–74%). Hyperfibrinolysis is significantly (P = 0.017) associated with mortality in trauma patients. In the blood gas analysis representing the metabolic state, only pH (P = 0.02) and potassium (P = 0.01) were significantly lower in the trauma hyperfibrinolysis group compared to the nontrauma hyperfibrinolysis group. CONCLUSIONS: Mortality from hyperfibrinolysis is significantly higher in trauma compared with nontrauma patients, and hyperfibrinolysis is an independent factor predicting mortality in trauma patients. Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment.Keywords
This publication has 23 references indexed in Scilit:
- The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trialThe Lancet, 2011
- Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapyCritical Care, 2011
- Primary Fibrinolysis Is Integral in the Pathogenesis of the Acute Coagulopathy of TraumaAnnals of Surgery, 2010
- Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen concentrate and prothrombin complex concentrateCritical Care, 2010
- Rotation thromboelastometry (ROTEM®) stability and reproducibility over time☆European Journal of Cardio-Thoracic Surgery, 2010
- Local Heat Shock Priming Promotes Recanalization of Thromboembolized Microvasculature by Upregulation of Plasminogen ActivatorsArteriosclerosis, Thrombosis, and Vascular Biology, 2006
- Vitronectin Functions as a Cofactor for Rapid Inhibition of Activated Protein C by Plasminogen Activator Inhibitor-1Journal of Biological Chemistry, 2001
- Hyperfibrinolysis.Journal of Clinical Pathology, 1996
- Hyperfibrinolysis during intracranial surgery: effect of high dose aprotinin.Journal of Neurology, Neurosurgery & Psychiatry, 1995
- THE INJURY SEVERITY SCOREJournal Of Trauma-Injury Infection and Critical Care, 1974