Purpose: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC.
Methods: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards.
Results: A total of 54 patients were included (AC, n=27 [warfarin n=13, dabigatran n=6, aXa inhibitor n=8] vs. no AC, n=27). Baseline characteristics were similar between groups, including age (72±13years vs. 72±15; p=0.85), male gender (70% vs. 74%; p=0.76) and blunt mechanism of injury (100% vs. 100%; p=1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p=0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p<0.01).
Conclusion: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.ajem.2016.12.061 | DOI Listing |
J Crit Care
February 2025
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address:
Purpose: Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.
Materials And Methods: We performed a retrospective single-tertiary hospital cohort study.
Blood Coagul Fibrinolysis
December 2024
Department of Clinical Laboratory, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, China.
Background: Congenital dysfibrinogenemia is characterized by reduced fibrinogen activity, but normal immunoreactive fibrinogen levels. Here, we present a novel case with an elevated risk of thrombosis.
Methods: Coagulation assays, gene analysis, in silico tools, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), fibrin polymerization, thrombin generation assay, and electron microscopy scanning were utilized to elucidate the pathogenic mechanism.
Res Pract Thromb Haemost
October 2024
Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA.
Background: Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated.
Objectives: To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications.
Vet Clin Pathol
September 2024
Servei de Neurologia, Fundació Hospital Clínic Veterinari, Campus Universitat Autònoma de Barcelona, Bellaterra, Spain.
Background: Thromboelastography (TEG) is an effective technique to assess the efficiency of coagulation. Phenobarbital (PB) can induce hematological and coagulation disorders in both animals and humans, but its effects on hemostasis have been little investigated and are poorly understood in dogs.
Objectives: The aim of this article was to assess coagulation using TEG in a population of dogs with idiopathic epilepsy treated with PB.
J Am Vet Med Assoc
January 2025
3Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.
Objective: To determine the effect of tranexamic acid (TXA) on clot hyperfibrinolysis (HF), defined as excessive clot lysis at 30 minutes (LY30%), with rapid thromboelastography (rTEG) or rTEG samples spiked with tissue plasminogen activator (tPA-stressed rTEG), in dogs with hemorrhagic shock.
Methods: Prospective blinded clinical trial at 2 teaching hospitals, March 16, 2018, to May 20, 2022. Twenty-five dogs with hemorrhagic shock and HF were treated with standard care plus either TXA (20 mg/kg; TXA group) or saline (SAL group) over 20 minutes followed by an infusion of the same dose over 8 hours.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!