Pathophysiology of Early Trauma-Induced Coagulopathy: Emerging Evidence for Hemodilution and Coagulation Factor Depletion
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 70 (6), 1401-1407
- https://doi.org/10.1097/ta.0b013e31821266e0
Abstract
Background: Trauma patients present with a coagulopathy, termed early trauma-induced coagulopathy (ETIC), that is associated with increased mortality. This study investigated hemostatic changes responsible for ETIC. Methods: Case-control study of trauma patients with and without ETIC, defined as prolonged prothrombin time (PT), was performed from prospective cohort of consecutive trauma patients who presented to Level I trauma center. Univariate and multivariate analyses were performed. Results: The case-control study group (n = 91) was 80% male, with mean age of 37 years, 17% penetrating trauma and 7% mortality rate. Patients with ETIC demonstrated decreased common and extrinsic pathway factor activities (factors V and VII) and decreased inhibition of the coagulation cascade (antithrombin and protein C activities) when compared with the matched control patients without ETIC. Both cohorts had evidence of increased thrombin and fibrin generation (prothrombin fragment 1.2 levels, thrombin-antithrombin complexes, and soluble fibrin monomer), increased fibrinolysis (d-dimer levels), and increased inhibition of fibrinolysis (plasminogen activator inhibitor-1 activity) above normal reference values. Patients with versus without ETIC had increased mortality and received increased amount of blood products. Conclusion: ETIC following injury is associated with decreased factor activities without significant differences in thrombin and fibrin generation, suggesting that despite these perturbations in the coagulation cascade, patients displayed a balanced hemostatic response to injury. The lower factor activities are likely secondary to increased hemodilution and coagulation factor depletion. Thus, decreasing the amount of crystalloid infused in the early phases following trauma and administration of coagulation factors may prevent the development.Keywords
This publication has 16 references indexed in Scilit:
- Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortalityThrombosis Research, 2009
- The prevalence of abnormal results of conventional coagulation tests on admission to a trauma centerTransfusion, 2008
- The Coagulopathy of Trauma: A Review of MechanismsThe Journal of Trauma and Acute Care Surgery, 2008
- Trauma and coagulopathy: a new paradigm to consider.Archives of Surgery, 2008
- Acute coagulopathy of trauma: mechanism, identification and effectCurrent Opinion in Critical Care, 2007
- Acute Traumatic Coagulopathy: Initiated by HypoperfusionAnnals of Surgery, 2007
- Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patientsInjury, 2007
- HYPOTHERMIA, COAGULOPATHY, AND ACIDOSISSurgical Clinics of North America, 2000
- Epidemiology of Major Trauma and Trauma Deaths in Los Angeles CountyJournal of the American College of Surgeons, 1998
- Injury-control recommendations: bicycle helmets. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.1995