From the Section for Transfusion Medicine (A.S.P.M., M.A.S.M., M.B.H., S.R.O., P.I.J.), Capital Region Blood Bank, The Trauma Centre (A.M.S.), Centre of Head and Orthopaedics, and Department of Anaesthesia (A.M.S., L.S.R.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgery (A.S.P.M., M.A.S.M., J.H.B., B.A.C., C.E.W., P.I.J.), Center for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Houston, Texas.
J Trauma Acute Care Surg. 2014 Mar;76(3):682-90. doi: 10.1097/TA.0000000000000134.
Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC).
This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational thromboelastometry (ROTEM) parameters were recorded upon arrival. Citrated kaolin (CK), rapid TEG (rTEG), and functional fibrinogen curves were extracted, and early amplitudes A5 and A10 were registered. Patients were stratified according to international normalized ratio of 1.2 or less and international normalized ratio greater than 1.2 (TIC patients) as well as transfusion needs (no red blood cells [RBCs], 1-9 RBCs, and ≥10 RBC in 6 hours). Correlations were analyzed by Spearman's correlation.
TIC patients had lower amplitudes than non-TIC patients in ROTEM/TEG as follows: EXTEM, INTEM, and FIBTEM: A5, A10, and maximum clot firmness (MCF); rTEG: A10; CK: maximum amplitude (MA); and functional fibrinogen: A5, A10, and MA (p < 0.05). Furthermore, A5 and A10 had a strong correlation with MA/MCF (ρ > 0.7 and p < 0.01). The A10 amplitudes were significantly lower in patients transfused with 10 or more units of RBC compared with nontransfused patients (p < 0.02). Fibrinogen concentration and platelet count had moderate correlation with A10 compared with A5 and MA/MCF (0.3 < ρ < 0.7 and p < 0.01). Time (median [interquartile range], in minutes) to obtain a reading was faster for A10 than MA/MCF (p < 0.001) (CK, 16 [15-17] vs. 27 [25-30]; rTEG, 11 [11-11] vs. 18 [17-20]; EXTEM, 11 [11-11] vs. 29 [26-31]; and INTEM 13[12-13] vs. 25 [22-29]).
Early amplitudes were lower in TIC patients, had significant correlations with MA/MCF, and differentiated between nontransfused and patients receiving one to nine RBC units or 10 or more RBC units within 6 hours. A10's superior correlation with platelet count and fibrinogen concentration suggests that A10 reflects a more dynamic part of the hemostatic process rather than MA/MCF. Early amplitudes may translate into earlier goal-directed transfusion therapy and may allow refinement of existing transfusion algorithms.
Prognostic and diagnostic study, level III.
黏弹性止血检测方法可能有助于更早地发现创伤性凝血病（TIC）。
这是一项对 182 名被收入一级创伤中心的创伤患者的前瞻性观察性研究。在到达时记录临床数据、血栓弹力图（TEG）和旋转血栓弹性仪（ROTEM）参数。提取枸橼酸高岭土（CK）、快速 TEG（rTEG）和功能性纤维蛋白原曲线，并记录早期振幅 A5 和 A10。根据国际标准化比值为 1.2 或更低和国际标准化比值大于 1.2（TIC 患者）以及输血需求（无红细胞[RBC]、1-9 RBC 和 6 小时内≥10 RBC）对患者进行分层。通过 Spearman 相关分析进行相关性分析。
TIC 患者的 ROTEM/TEG 中的振幅低于非 TIC 患者，如下所示：EXTEM、INTEM 和 FIBTEM：A5、A10 和最大凝块硬度（MCF）；rTEG：A10；CK：最大振幅（MA）；和功能性纤维蛋白原：A5、A10 和 MA（p<0.05）。此外，A5 和 A10 与 MA/MCF 具有很强的相关性（ρ>0.7，p<0.01）。与未输血患者相比，输注 10 个或更多单位 RBC 的患者的 A10 振幅明显降低（p<0.02）。与 A5 和 MA/MCF 相比，纤维蛋白原浓度和血小板计数与 A10 具有中度相关性（0.3<ρ<0.7，p<0.01）。与 MA/MCF 相比，A10 获得读数的时间（中位数[四分位间距]，分钟）更快（p<0.001）（CK，16[15-17] vs. 27[25-30]；rTEG，11[11-11] vs. 18[17-20]；EXTEM，11[11-11] vs. 29[26-31]；和 INTEM 13[12-13] vs. 25[22-29]）。
TIC 患者的早期振幅较低，与 MA/MCF 具有显著相关性，并可区分非输血患者和在 6 小时内输注 1-9 个 RBC 单位或 10 个或更多 RBC 单位的患者。A10 与血小板计数和纤维蛋白原浓度的相关性较好，表明 A10 反映了止血过程中更动态的部分，而不是 MA/MCF。早期振幅可能转化为更早的目标导向输血治疗，并可能改进现有的输血算法。
预后和诊断研究，III 级。
