*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.
Shock. 2014 Mar;41(3):200-7. doi: 10.1097/SHK.0000000000000109.
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.
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.
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).
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.
创伤后出现低凝状态与不良预后相关。本研究旨在确定创伤后高凝状态对输血量和死亡率的影响。
符合我院 I 级创伤中心最高激活标准的创伤患者，入院时、入院后 1 小时、2 小时和 6 小时使用枸橼酸盐血液进行血栓弹力图（TEG）检查。高凝状态定义为 TEG 任何参数处于高凝范围，低凝状态定义为 TEG 任何参数处于低凝范围。患者在整个住院期间进行前瞻性随访。
共纳入 118 例患者：26.3%（n=31）为高凝状态，55.9%（n=66）为 TEG 正常，17.8%（n=21）为低凝状态。调整人口统计学和临床数据差异后，高凝状态患者较少需要未交叉配血的血液（高凝状态为 11.1%，TEG 正常为 20.4%，低凝状态为 45.7%，调整 P=0.004）。高凝状态患者需要的血液制品总量较少，尤其是在 6 小时时的血浆（高凝状态为 0.1[SD，0.4]U，TEG 正常为 0.7[SD，1.9]U，低凝状态为 4.3[SD，6.3]U，调整 P<0.001）和 24 小时时（高凝状态为 0.2[SD，0.6]U，TEG 正常为 1.1[SD，2.9]U，低凝状态为 8.2[SD，19.3]U，调整 P<0.001）。高凝状态患者的 24 小时死亡率（0.0% vs. 5.5% vs. 27.8%，调整 P<0.001）和 7 天死亡率（0.0% vs. 5.5% vs. 36.1%，调整 P<0.001）较低。高凝组出血相关死亡率较低（0.0% vs. 1.8% vs. 25.0%，调整 P<0.001）。
约四分之一的创伤患者处于高凝状态。高凝状态患者需要的血液制品较少，尤其是血浆。他们的 24 小时和 7 天死亡率较低，出血相关死亡率较低。进一步评估导致高凝状态的机制及其对预后的影响是必要的。
