Brill Jason B, Badiee Jayraan, Zander Ashley L, Wallace James D, Lewis Paul R, Sise Michael J, Bansal Vishal, Shackford Steven R
From the Trauma Service (J.B.B., J.B., A.L.Z., J.D.W., P.R.L., M.J.S., V.B., S.R.S.), Scripps Mercy Hospital, San Diego, California.
J Trauma Acute Care Surg. 2017 Sep;83(3):413-419. doi: 10.1097/TA.0000000000001618.
Venous thromboembolism (VTE) in trauma can occur in patients at low risk. Conventional coagulation tests do not predict VTE. Studies investigating thromboelastography (TEG) for VTE risk are conflicting and have not included routine surveillance to detect deep vein thrombosis (DVT). We undertook a prospective study of TEG to evaluate its utility in predicting VTE.
We conducted a prospective cohort study on all adult trauma patients admitted to our Level I trauma center from 2013 to 2015. TEG was performed immediately on arrival to the trauma bay. Hypercoagulable TEG was defined as reaction time (R) below, angle (α) above, or maximum amplitude (MA) above reference ranges. All patients received mechanical and/or pharmacologic prophylaxis and were followed up for DVT with our ultrasound surveillance protocol. The primary outcome was lower-extremity DVT. After bivariate analysis of variables related to DVT, those with p values of 0.100 or less were included for multivariate logistic regression.
A total of 983 patients were evaluated with TEG on admission; of these, 684 (69.6%) received at least one surveillance ultrasound during the index admission. Lower-extremity DVT was diagnosed in 99 (14.5%) patients. Hypercoagulability based on admission TEG occurred in 582 (85.1%) patients. The lower-extremity DVT rate was higher in patients with hypercoagulable TEG than in those without hypercoagulable TEG (15.6% vs. 8%; p = 0.039). Multivariate analysis showed hypercoagulable TEG remained associated with DVT after adjustment for relevant covariates available at admission, with an odds ratio of 2.41 (95% confidence interval, 1.11-5.24; p = 0.026).
Most trauma patients were hypercoagulable at admission and remained at risk of developing DVT. The rate of DVT doubled in patients with hypercoagulable TEG indices despite prophylaxis. Beyond its current clinical roles, TEG is useful for assessing DVT risk, particularly in patients otherwise perceived to be at low risk.
Prognostic study, level II.
创伤患者中静脉血栓栓塞症（VTE）可发生于低风险患者。传统凝血试验无法预测VTE。关于血栓弹力图（TEG）评估VTE风险的研究结果相互矛盾，且未纳入检测深静脉血栓形成（DVT）的常规监测。我们开展了一项关于TEG的前瞻性研究，以评估其在预测VTE方面的效用。
我们对2013年至2015年入住我院一级创伤中心的所有成年创伤患者进行了一项前瞻性队列研究。患者抵达创伤室后立即进行TEG检测。高凝TEG定义为反应时间（R）低于、角度（α）高于或最大振幅（MA）高于参考范围。所有患者均接受机械和/或药物预防，并按照我们的超声监测方案进行DVT随访。主要结局为下肢DVT。在对与DVT相关的变量进行二元分析后，将p值小于或等于0.100的变量纳入多因素逻辑回归分析。
共有983例患者入院时接受了TEG检测；其中，684例（69.6%）在本次住院期间至少接受了一次超声监测。99例（14.5%）患者被诊断为下肢DVT。入院时基于TEG检测结果显示高凝的患者有582例（85.1%）。高凝TEG患者的下肢DVT发生率高于非高凝TEG患者（15.6%对8%；p = 0.039）。多因素分析显示，在对入院时可用的相关协变量进行校正后，高凝TEG仍与DVT相关，比值比为2.41（95%置信区间，1.11 - 5.24；p = 0.026）。
大多数创伤患者入院时处于高凝状态，仍有发生DVT的风险。尽管进行了预防，高凝TEG指标患者的DVT发生率仍增加了一倍。除了目前的临床作用外，TEG有助于评估DVT风险，尤其是在其他方面被认为是低风险的患者中。
预后研究，二级。
