PMID- 19590321
OWN - NLM
STAT- MEDLINE
DCOM- 20090728
LR  - 20240103
IS  - 1529-8809 (Electronic)
IS  - 0022-5282 (Linking)
VI  - 67
IP  - 1
DP  - 2009 Jul
TI  - Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns 
      and prognostic value of thrombelastometry.
PG  - 125-31
LID - 10.1097/TA.0b013e31818b2483 [doi]
AB  - BACKGROUND: The aim of this study was to diagnose hyperfibrinolysis (HF) and its 
      pattern using thrombelastometry and to correlate the diagnosis with mortality. 
      Furthermore, routine laboratory based and the rotational thrombelastometry 
      analyzer (ROTEM)-derived variables were also correlated with survival. METHODS: 
      Severe trauma patients showing HF in ROTEM were consecutively enrolled in the 
      study. Three different HF patterns were compared: fulminant breakdown within 30 
      minutes, intermediate HF of 30 to 60 minutes, and late HF after 60 minutes. 
      Injury severity score (ISS), hemodynamics, hemoglobin, hematocrit, platelet count 
      (PC), fibrinogen, and ROTEM variables at admission were analyzed. The observed 
      mortality was compared with the predicted trauma and injury severity score 
      mortality. RESULTS: Thirty-three patients were diagnosed with HF. The mean ISS 
      was 47 +/- 14. Fulminant, intermediate, or late HF (n = 11 each group) resulted 
      in 100%, 91%, or 73% mortality, respectively, with the best prognosis for late HF 
      (p = 0.0031). The actual overall mortality of HF (88%) exceeded the predicted 
      trauma and injury severity score mortality (70%) (p = 0.039). Lower PC (123 +/- 
      53 vs. 193 +/- 91; p = 0.034), ROTEM prolonged clot formation time [CFT, 359 
      (140/632) vs. 82 (14/190); p = 0.042], and lower platelet contribution to maximum 
      clot firmness [MCF(EXTEM) - MCF(FIBTEM), 34 (20/40) vs. 46 (40/53); p = 0.026] 
      were associated with increased mortality. CONCLUSION: ROTEM-based diagnosis of HF 
      predicted outcome. Further independent predictors of death were combination of HF 
      with hemorrhagic shock, low PC, and prolonged CFT in ROTEM. ROTEM-based point of 
      care testing in the emergency room is thus able to identify prognostic factors 
      such as prolonged CFT and low platelet contribution to clot firmness (MCF(EX) - 
      MCF(FIB)) earlier than standard laboratory-based monitoring.
FAU - Schochl, Herbert
AU  - Schochl H
AD  - Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, 
      Austria.
FAU - Frietsch, Thomas
AU  - Frietsch T
FAU - Pavelka, Michaela
AU  - Pavelka M
FAU - Jambor, Csilla
AU  - Jambor C
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Trauma
JT  - The Journal of trauma
JID - 0376373
RN  - 0 (Blood Coagulation Factors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Coagulation Disorders/blood/*diagnosis/etiology
MH  - Blood Coagulation Factors/analysis
MH  - Diagnosis, Differential
MH  - Female
MH  - Fibrinolysis/*physiology
MH  - Follow-Up Studies
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Thrombelastography/*methods
MH  - Wounds, Nonpenetrating/blood/*complications
MH  - Young Adult
EDAT- 2009/07/11 09:00
MHDA- 2009/07/29 09:00
CRDT- 2009/07/11 09:00
PHST- 2009/07/11 09:00 [entrez]
PHST- 2009/07/11 09:00 [pubmed]
PHST- 2009/07/29 09:00 [medline]
AID - 00005373-200907000-00022 [pii]
AID - 10.1097/TA.0b013e31818b2483 [doi]
PST - ppublish
SO  - J Trauma. 2009 Jul;67(1):125-31. doi: 10.1097/TA.0b013e31818b2483.